Minnesota Legislature
SF 2360
2nd Engrossment - 92nd Legislature (2021 - 2022) Posted on 10/27/2021 04:01pm
3.38 3.39
3.40 3.41 3.42 3.43 3.44 3.45 3.46 3.47 4.1 4.2 4.3 4.4
4.5 4.6 4.7
4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15 4.16 4.17 4.18 4.19 4.20 4.21 4.22
4.23 4.24 4.25
4.26 4.27 4.28 4.29 4.30 4.31 4.32 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 5.10 5.11 5.12 5.13 5.14 5.15 5.16 5.17 5.18 5.19 5.20 5.21 5.22 5.23 5.24
5.25 5.26 5.27
5.28 5.29 5.30 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 6.10 6.11 6.12 6.13 6.14 6.15 6.16 6.17 6.18 6.19 6.20 6.21 6.22 6.23 6.24
6.25 6.26 6.27
6.28 6.29 6.30 6.31 6.32 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8 7.9 7.10 7.11 7.12 7.13 7.14 7.15 7.16 7.17 7.18 7.19 7.20 7.21 7.22 7.23 7.24 7.25 7.26 7.27 7.28 7.29 7.30 7.31 7.32
8.1 8.2 8.3
8.4 8.5 8.6 8.7 8.8 8.9 8.10 8.11 8.12 8.13 8.14 8.15 8.16 8.17 8.18 8.19 8.20 8.21 8.22 8.23 8.24 8.25 8.26 8.27 8.28 8.29 8.30 8.31 8.32 9.1 9.2
9.3 9.4 9.5
9.6 9.7 9.8 9.9 9.10 9.11 9.12 9.13 9.14 9.15 9.16 9.17 9.18 9.19 9.20 9.21 9.22 9.23 9.24 9.25 9.26 9.27 9.28 9.29 9.30 9.31 10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 10.9 10.10 10.11 10.12 10.13 10.14 10.15 10.16 10.17 10.18 10.19 10.20 10.21 10.22 10.23 10.24 10.25 10.26 10.27 10.28 10.29 10.30 10.31 11.1 11.2 11.3 11.4 11.5 11.6 11.7 11.8 11.9 11.10 11.11 11.12 11.13 11.14 11.15 11.16 11.17 11.18 11.19 11.20 11.21 11.22 11.23 11.24 11.25 11.26 11.27 11.28 11.29 11.30 11.31 11.32 12.1 12.2 12.3 12.4 12.5 12.6 12.7 12.8 12.9 12.10 12.11 12.12 12.13
12.14 12.15 12.16
12.17 12.18 12.19 12.20 12.21 12.22 12.23 12.24 12.25 12.26 12.27 12.28 12.29 12.30
13.1 13.2 13.3 13.4 13.5 13.6 13.7 13.8 13.9 13.10 13.11 13.12 13.13 13.14 13.15 13.16 13.17 13.18 13.19
13.20
13.21 13.22 13.23 13.24 13.25 13.26 13.27 13.28 13.29 13.30 13.31 13.32 13.33 14.1 14.2 14.3 14.4
14.5 14.6 14.7 14.8 14.9 14.10 14.11 14.12 14.13 14.14 14.15 14.16 14.17 14.18 14.19 14.20 14.21 14.22 14.23 14.24
14.25
14.26 14.27 14.28 14.29 14.30 14.31 14.32 14.33 15.1 15.2
15.3
15.4 15.5 15.6 15.7 15.8 15.9 15.10 15.11 15.12 15.13 15.14 15.15 15.16 15.17 15.18 15.19 15.20 15.21 15.22 15.23
15.24 15.25 15.26 15.27 15.28 15.29 15.30 15.31 15.32 15.33 16.1 16.2 16.3 16.4 16.5 16.6 16.7 16.8 16.9 16.10 16.11 16.12 16.13 16.14 16.15 16.16 16.17 16.18 16.19 16.20 16.21 16.22 16.23 16.24 16.25 16.26 16.27 16.28 16.29 16.30 16.31 16.32 16.33 16.34 17.1 17.2 17.3 17.4 17.5 17.6 17.7 17.8 17.9 17.10 17.11 17.12 17.13 17.14 17.15 17.16 17.17 17.18 17.19 17.20 17.21 17.22 17.23 17.24 17.25 17.26 17.27 17.28 17.29
17.30 17.31 17.32 17.33 17.34 18.1 18.2 18.3
18.4 18.5 18.6
18.7 18.8 18.9 18.10 18.11 18.12 18.13 18.14 18.15 18.16 18.17 18.18 18.19 18.20 18.21 18.22 18.23 18.24 18.25 18.26 18.27 18.28 18.29 18.30 18.31 18.32 18.33 19.1 19.2 19.3
19.4 19.5 19.6
19.7 19.8 19.9 19.10 19.11 19.12 19.13 19.14 19.15 19.16 19.17 19.18 19.19 19.20 19.21 19.22 19.23 19.24 19.25 19.26 19.27 19.28
19.29
19.30 19.31 19.32 20.1 20.2 20.3 20.4 20.5 20.6 20.7 20.8 20.9 20.10 20.11 20.12 20.13 20.14 20.15 20.16 20.17 20.18 20.19 20.20 20.21 20.22 20.23 20.24 20.25 20.26 20.27 20.28 20.29 20.30 20.31 20.32 21.1 21.2 21.3 21.4 21.5 21.6 21.7 21.8 21.9 21.10 21.11 21.12 21.13 21.14 21.15 21.16 21.17 21.18 21.19 21.20 21.21 21.22 21.23 21.24 21.25 21.26 21.27 21.28 21.29 21.30 21.31 21.32 22.1 22.2 22.3 22.4 22.5 22.6 22.7 22.8 22.9 22.10 22.11 22.12 22.13 22.14 22.15 22.16 22.17 22.18 22.19 22.20 22.21 22.22 22.23 22.24 22.25 22.26 22.27 22.28 23.1 23.2 23.3 23.4 23.5 23.6 23.7 23.8 23.9 23.10 23.11 23.12 23.13 23.14 23.15 23.16 23.17 23.18 23.19 23.20 23.21 23.22 23.23 23.24 23.25 23.26 23.27 23.28 23.29 23.30 23.31 23.32 23.33 23.34 24.1 24.2 24.3 24.4 24.5
24.6 24.7 24.8
24.9 24.10 24.11 24.12 24.13 24.14 24.15 24.16 24.17 24.18 24.19 24.20 24.21 24.22 24.23 24.24 24.25 24.26 24.27 24.28 24.29 24.30 24.31 24.32 24.33 24.34 25.1 25.2 25.3 25.4 25.5 25.6 25.7 25.8 25.9 25.10 25.11 25.12 25.13 25.14 25.15 25.16 25.17 25.18 25.19 25.20 25.21 25.22 25.23 25.24 25.25 25.26 25.27 25.28 25.29 25.30
25.31 25.32 25.33 26.1 26.2 26.3 26.4 26.5 26.6 26.7 26.8 26.9 26.10 26.11 26.12 26.13 26.14 26.15 26.16 26.17 26.18 26.19
26.20 26.21 26.22 26.23 26.24 26.25 26.26 26.27 26.28
26.29 26.30 27.1 27.2 27.3 27.4 27.5 27.6 27.7 27.8 27.9 27.10 27.11 27.12 27.13 27.14 27.15 27.16 27.17 27.18 27.19 27.20 27.21 27.22 27.23 27.24 27.25 27.26 27.27 27.28 28.1 28.2 28.3 28.4 28.5 28.6 28.7 28.8 28.9 28.10 28.11 28.12 28.13 28.14 28.15 28.16 28.17 28.18 28.19 28.20 28.21
28.22 28.23 28.24 28.25 28.26 28.27 28.28 28.29 28.30 28.31 29.1 29.2 29.3 29.4 29.5 29.6 29.7 29.8 29.9 29.10
29.11 29.12 29.13 29.14 29.15 29.16 29.17 29.18 29.19 29.20 29.21 29.22 29.23 29.24 29.25 29.26 29.27 29.28 29.29
29.30 29.31 29.32 30.1 30.2 30.3 30.4 30.5 30.6 30.7 30.8 30.9 30.10 30.11 30.12 30.13 30.14 30.15 30.16 30.17 30.18 30.19 30.20 30.21 30.22 30.23 30.24 30.25 30.26 30.27 30.28 30.29 30.30 30.31 30.32 30.33 30.34 31.1 31.2 31.3 31.4 31.5 31.6 31.7 31.8 31.9 31.10 31.11 31.12 31.13 31.14 31.15 31.16 31.17 31.18 31.19 31.20 31.21 31.22 31.23 31.24
31.25 31.26 31.27 31.28 31.29 31.30 31.31 31.32 31.33 31.34 32.1 32.2 32.3 32.4 32.5 32.6 32.7 32.8 32.9 32.10 32.11
32.12 32.13 32.14 32.15 32.16 32.17 32.18 32.19 32.20 32.21 32.22 32.23 32.24 32.25 32.26 32.27 32.28 32.29 32.30 32.31 32.32 32.33 32.34 32.35 33.1 33.2 33.3 33.4 33.5 33.6 33.7 33.8 33.9 33.10 33.11 33.12 33.13 33.14 33.15 33.16 33.17 33.18 33.19 33.20 33.21 33.22 33.23 33.24 33.25 33.26 33.27 33.28 33.29 33.30 33.31 33.32 33.33 33.34 33.35 34.1 34.2 34.3 34.4 34.5 34.6 34.7 34.8 34.9 34.10 34.11 34.12 34.13 34.14 34.15 34.16 34.17 34.18 34.19 34.20 34.21 34.22 34.23 34.24 34.25 34.26 34.27 34.28 34.29 34.30 34.31 34.32 34.33 34.34 34.35 35.1 35.2 35.3 35.4 35.5 35.6 35.7 35.8 35.9 35.10 35.11 35.12 35.13 35.14 35.15 35.16 35.17 35.18 35.19
35.20 35.21 35.22 35.23 35.24 35.25 35.26 35.27 35.28 35.29 35.30 35.31 35.32 35.33 35.34 36.1 36.2 36.3 36.4 36.5 36.6 36.7 36.8 36.9 36.10 36.11 36.12 36.13 36.14 36.15 36.16 36.17
36.18
36.19 36.20 36.21 36.22 36.23 36.24 36.25 36.26 36.27 36.28 36.29 36.30 37.1 37.2 37.3 37.4 37.5 37.6 37.7 37.8 37.9 37.10 37.11 37.12 37.13 37.14
37.15 37.16 37.17 37.18 37.19
37.20 37.21 37.22
37.23 37.24 37.25 37.26 37.27 37.28 37.29 37.30 38.1 38.2 38.3 38.4 38.5 38.6 38.7 38.8 38.9 38.10 38.11 38.12 38.13 38.14 38.15 38.16 38.17 38.18 38.19 38.20 38.21 38.22 38.23 38.24 38.25 38.26 38.27 38.28 38.29 38.30
39.1 39.2 39.3 39.4 39.5 39.6 39.7 39.8 39.9 39.10 39.11 39.12 39.13 39.14 39.15 39.16 39.17 39.18 39.19 39.20 39.21 39.22 39.23 39.24 39.25 39.26 39.27 39.28 39.29 39.30 39.31 39.32 39.33
40.1 40.2 40.3 40.4 40.5 40.6 40.7 40.8 40.9 40.10 40.11 40.12 40.13 40.14
40.15 40.16 40.17 40.18 40.19 40.20 40.21 40.22 40.23 40.24 40.25 40.26 40.27 40.28 40.29 40.30 40.31 41.1 41.2 41.3 41.4 41.5 41.6 41.7 41.8 41.9 41.10 41.11 41.12 41.13 41.14 41.15 41.16 41.17 41.18 41.19 41.20 41.21 41.22 41.23 41.24 41.25 41.26 41.27
41.28 41.29 41.30 41.31 41.32 41.33 41.34 42.1 42.2 42.3 42.4 42.5 42.6 42.7 42.8 42.9 42.10 42.11 42.12 42.13 42.14 42.15 42.16 42.17 42.18 42.19 42.20 42.21 42.22 42.23 42.24 42.25 42.26 42.27 42.28 42.29 42.30 42.31 42.32 42.33 42.34 42.35 43.1 43.2 43.3 43.4 43.5 43.6 43.7 43.8 43.9 43.10 43.11 43.12 43.13 43.14 43.15 43.16 43.17 43.18 43.19 43.20 43.21 43.22 43.23 43.24 43.25 43.26 43.27 43.28 43.29 43.30 43.31 43.32 43.33 43.34 43.35 43.36 44.1 44.2 44.3 44.4 44.5 44.6 44.7 44.8 44.9 44.10 44.11 44.12 44.13 44.14 44.15 44.16 44.17 44.18 44.19 44.20 44.21 44.22 44.23 44.24 44.25 44.26 44.27
44.28 44.29 44.30
44.31 44.32 44.33 45.1 45.2 45.3 45.4 45.5 45.6 45.7 45.8 45.9 45.10 45.11 45.12 45.13 45.14 45.15 45.16 45.17 45.18 45.19 45.20 45.21 45.22 45.23 45.24 45.25 45.26 45.27 45.28 45.29 45.30 45.31 45.32 45.33 46.1 46.2 46.3 46.4 46.5 46.6 46.7 46.8 46.9 46.10 46.11 46.12 46.13 46.14 46.15 46.16 46.17 46.18 46.19 46.20 46.21 46.22 46.23 46.24
46.25 46.26 46.27 46.28
46.29 46.30 46.31 46.32 46.33 46.34 47.1 47.2 47.3 47.4 47.5 47.6 47.7 47.8 47.9
47.10 47.11 47.12 47.13 47.14 47.15 47.16 47.17 47.18 47.19
47.20 47.21 47.22 47.23 47.24 47.25 47.26 47.27 47.28 47.29 47.30 47.31 48.1 48.2 48.3 48.4 48.5 48.6 48.7 48.8 48.9 48.10 48.11 48.12 48.13 48.14 48.15 48.16 48.17 48.18 48.19 48.20 48.21 48.22 48.23 48.24 48.25 48.26 48.27
48.28 48.29 48.30 48.31 49.1 49.2 49.3 49.4 49.5 49.6 49.7 49.8 49.9 49.10 49.11 49.12 49.13 49.14 49.15 49.16 49.17 49.18 49.19 49.20 49.21 49.22 49.23 49.24 49.25 49.26 49.27 49.28 49.29 49.30 49.31 49.32 49.33 49.34 49.35 50.1 50.2 50.3 50.4 50.5 50.6 50.7 50.8 50.9 50.10 50.11 50.12 50.13 50.14 50.15 50.16
50.17 50.18 50.19 50.20 50.21 50.22 50.23 50.24 50.25 50.26 50.27 50.28 50.29 50.30 50.31 50.32 51.1 51.2 51.3 51.4 51.5 51.6 51.7 51.8 51.9 51.10
51.11 51.12 51.13 51.14 51.15
51.16
51.17 51.18 51.19 51.20
51.21
51.22 51.23 51.24 51.25 51.26 51.27 51.28 51.29 51.30 51.31 52.1 52.2
52.3
52.4 52.5 52.6 52.7 52.8 52.9 52.10 52.11 52.12 52.13 52.14 52.15 52.16 52.17 52.18 52.19 52.20 52.21 52.22 52.23 52.24 52.25 52.26 52.27 52.28 52.29 52.30 52.31 52.32 52.33 52.34 53.1 53.2 53.3 53.4 53.5
53.6 53.7
53.8 53.9 53.10 53.11 53.12 53.13 53.14 53.15 53.16 53.17 53.18 53.19 53.20 53.21 53.22 53.23 53.24 53.25 53.26 53.27 53.28 53.29 53.30 53.31 53.32 54.1 54.2 54.3
54.4 54.5 54.6
54.7 54.8 54.9 54.10 54.11 54.12 54.13 54.14 54.15 54.16 54.17 54.18 54.19 54.20 54.21 54.22 54.23 54.24 54.25 54.26 54.27 54.28 54.29 54.30 54.31 55.1 55.2 55.3 55.4 55.5 55.6 55.7 55.8 55.9 55.10 55.11 55.12 55.13 55.14 55.15 55.16 55.17 55.18 55.19 55.20 55.21 55.22 55.23 55.24 55.25 55.26 55.27 55.28 55.29 55.30 55.31 55.32
56.1 56.2
56.3 56.4 56.5 56.6 56.7 56.8 56.9 56.10 56.11
56.12 56.13 56.14 56.15 56.16 56.17 56.18 56.19 56.20 56.21 56.22 56.23 56.24 56.25 56.26 56.27 56.28 56.29 56.30 56.31 57.1 57.2 57.3 57.4 57.5 57.6 57.7 57.8 57.9 57.10 57.11 57.12 57.13 57.14 57.15 57.16 57.17 57.18 57.19 57.20 57.21
57.22
57.23 57.24 57.25 57.26
57.27
58.1 58.2 58.3 58.4 58.5 58.6 58.7 58.8 58.9 58.10 58.11 58.12 58.13 58.14 58.15 58.16 58.17
58.18 58.19 58.20 58.21 58.22 58.23 58.24 58.25 58.26 58.27 58.28
58.29 58.30 58.31 58.32 59.1 59.2 59.3 59.4 59.5
59.6 59.7 59.8 59.9 59.10 59.11
59.12
59.13 59.14 59.15 59.16 59.17 59.18 59.19 59.20 59.21 59.22 59.23 59.24 59.25 59.26 59.27 59.28
59.29 59.30 59.31 59.32 60.1 60.2 60.3 60.4
60.5 60.6 60.7 60.8 60.9
60.10 60.11 60.12
60.13 60.14
60.15 60.16 60.17 60.18 60.19 60.20 60.21 60.22 60.23 60.24
60.25 60.26 60.27 60.28 60.29 60.30 61.1 61.2 61.3 61.4 61.5 61.6 61.7 61.8 61.9 61.10 61.11 61.12 61.13 61.14 61.15 61.16 61.17 61.18 61.19 61.20 61.21 61.22 61.23 61.24
61.25 61.26 61.27 61.28 61.29 61.30 61.31 61.32 61.33 62.1 62.2 62.3 62.4 62.5 62.6 62.7 62.8 62.9 62.10 62.11 62.12 62.13
62.14 62.15 62.16 62.17 62.18 62.19 62.20 62.21 62.22 62.23 62.24 62.25 62.26 62.27 62.28 62.29 62.30 62.31 62.32 62.33 63.1 63.2 63.3 63.4 63.5 63.6 63.7 63.8 63.9 63.10 63.11 63.12 63.13 63.14 63.15 63.16 63.17 63.18 63.19 63.20 63.21 63.22 63.23 63.24 63.25 63.26 63.27 63.28 63.29 63.30 63.31 63.32 63.33 63.34 64.1 64.2 64.3 64.4 64.5 64.6 64.7 64.8 64.9 64.10 64.11 64.12 64.13 64.14 64.15 64.16 64.17 64.18
64.19 64.20 64.21 64.22 64.23 64.24 64.25 64.26 64.27 64.28 64.29 64.30 64.31 64.32 65.1 65.2 65.3 65.4 65.5 65.6 65.7 65.8 65.9 65.10 65.11 65.12 65.13 65.14 65.15 65.16 65.17 65.18 65.19 65.20 65.21 65.22 65.23 65.24 65.25 65.26 65.27 65.28 65.29 65.30 65.31 65.32 66.1 66.2 66.3 66.4 66.5 66.6 66.7 66.8 66.9 66.10 66.11 66.12 66.13 66.14 66.15 66.16 66.17 66.18 66.19 66.20 66.21 66.22 66.23 66.24 66.25 66.26 66.27 66.28 66.29 66.30 66.31 67.1 67.2 67.3 67.4 67.5 67.6 67.7 67.8 67.9 67.10 67.11 67.12 67.13 67.14 67.15 67.16 67.17 67.18 67.19 67.20 67.21 67.22 67.23 67.24 67.25 67.26 67.27 67.28 67.29 67.30 67.31 68.1 68.2 68.3 68.4 68.5 68.6 68.7 68.8 68.9 68.10 68.11 68.12 68.13 68.14 68.15
68.16 68.17 68.18 68.19 68.20 68.21 68.22 68.23 68.24 68.25 68.26 68.27 68.28 68.29 68.30 68.31 68.32 69.1 69.2 69.3 69.4 69.5 69.6 69.7 69.8 69.9 69.10 69.11 69.12 69.13 69.14 69.15 69.16 69.17 69.18 69.19 69.20 69.21 69.22 69.23 69.24 69.25 69.26 69.27 69.28 69.29 69.30 69.31 70.1 70.2 70.3 70.4 70.5 70.6 70.7 70.8 70.9 70.10 70.11 70.12 70.13 70.14 70.15 70.16 70.17 70.18 70.19 70.20 70.21 70.22 70.23 70.24 70.25 70.26 70.27 70.28 70.29 70.30 70.31 71.1 71.2 71.3 71.4 71.5 71.6 71.7 71.8 71.9 71.10 71.11 71.12 71.13 71.14 71.15 71.16 71.17 71.18 71.19 71.20 71.21 71.22 71.23 71.24 71.25 71.26 71.27 71.28 71.29 71.30 71.31 71.32 72.1 72.2 72.3 72.4 72.5 72.6 72.7 72.8 72.9 72.10 72.11 72.12 72.13 72.14 72.15 72.16 72.17 72.18 72.19 72.20 72.21 72.22 72.23 72.24 72.25 72.26 72.27 72.28 72.29 72.30 72.31 72.32 72.33 73.1 73.2 73.3 73.4 73.5 73.6 73.7 73.8 73.9 73.10 73.11 73.12 73.13 73.14 73.15 73.16 73.17 73.18 73.19 73.20 73.21 73.22
73.23 73.24 73.25 73.26 73.27 73.28 73.29 73.30 73.31 74.1 74.2 74.3 74.4 74.5 74.6 74.7 74.8 74.9 74.10 74.11 74.12 74.13 74.14 74.15 74.16 74.17 74.18 74.19 74.20 74.21 74.22 74.23 74.24 74.25 74.26 74.27 74.28 74.29 74.30 74.31 74.32 75.1 75.2 75.3 75.4 75.5 75.6 75.7 75.8 75.9 75.10 75.11 75.12 75.13 75.14 75.15 75.16 75.17 75.18 75.19 75.20 75.21 75.22 75.23 75.24 75.25 75.26 75.27 75.28 75.29 75.30 75.31 75.32 75.33 76.1 76.2 76.3 76.4 76.5 76.6 76.7 76.8 76.9 76.10 76.11 76.12 76.13 76.14 76.15 76.16 76.17 76.18 76.19 76.20 76.21 76.22 76.23 76.24 76.25 76.26 76.27 76.28 76.29 76.30 76.31 76.32 76.33 76.34 77.1 77.2 77.3 77.4 77.5 77.6 77.7 77.8 77.9 77.10 77.11 77.12 77.13 77.14 77.15 77.16 77.17 77.18 77.19 77.20 77.21 77.22 77.23 77.24 77.25 77.26 77.27 77.28 77.29 77.30 77.31 78.1 78.2 78.3 78.4 78.5
78.6 78.7 78.8 78.9 78.10 78.11 78.12 78.13 78.14 78.15 78.16 78.17 78.18 78.19 78.20 78.21 78.22 78.23 78.24 78.25 78.26 78.27 78.28 78.29 78.30 78.31 78.32 79.1 79.2 79.3 79.4 79.5 79.6
79.7 79.8 79.9 79.10 79.11 79.12 79.13 79.14 79.15 79.16 79.17 79.18 79.19 79.20 79.21 79.22 79.23 79.24 79.25
79.26
79.27 79.28 79.29 79.30 79.31 79.32 80.1 80.2 80.3 80.4 80.5 80.6 80.7 80.8 80.9 80.10 80.11 80.12 80.13 80.14 80.15 80.16 80.17 80.18 80.19 80.20 80.21 80.22 80.23 80.24 80.25 80.26 80.27 80.28 80.29
81.1 81.2 81.3 81.4 81.5 81.7 81.6 81.9 81.8 81.10 81.11 81.12 81.13 81.15 81.14 81.16 81.17 81.18 81.19 81.20 81.21 81.22 81.23 81.24 81.25 81.26 81.27 81.28 81.29 81.30 81.31 81.32 81.33 81.34 81.35 81.37 81.36 81.39 81.38 81.40 82.1 82.3 82.2 82.4 82.5 82.6 82.7 82.8 82.9 82.10 82.11 82.12 82.13 82.14 82.15 82.16 82.17 82.18 82.19 82.20 82.21 82.22 82.23 82.24 82.25 82.26 82.27 82.28 82.29 82.30 82.31 82.32 82.33 82.34 82.35 82.36 82.37 82.38 82.39 82.40 82.41 82.43 82.42 83.1 83.2 83.3 83.4 83.5 83.6 83.8 83.7 83.9 83.10 83.12 83.11 83.13 83.14 83.15 83.16 83.17 83.18 83.20 83.19 83.21 83.22 83.23 83.24 83.25 83.26 83.27 83.28 83.29 83.30 83.31 83.32 83.33 83.34 83.35 83.36 83.37
84.1 84.2 84.3 84.4 84.6 84.5 84.7 84.8 84.9 84.10 84.11 84.12 84.13 84.14 84.15 84.16 84.17 84.18 84.19 84.20 84.21 84.22 84.23 84.24 84.25 84.26 84.27 84.28 84.29 84.30 84.31 84.32 84.33 84.34 84.35 84.36 84.37 84.38 84.39 85.1 85.2 85.3 85.4 85.5 85.7 85.6 85.8 85.9 85.10 85.11 85.12 85.13 85.14 85.15 85.16 85.17 85.18 85.19 85.20 85.21 85.22 85.23 85.24 85.25 85.26 85.27 85.28 85.29 85.30 85.31 85.32 85.33 85.34 85.35 85.36
86.1 86.2 86.3 86.4 86.5 86.6
86.7 86.8 86.9 86.10 86.11 86.12 86.13
86.14 86.15 86.16 86.17 86.18
86.19 86.20 86.21 86.22 86.23 86.24 86.25 86.26 86.27 86.28 86.29 86.30 86.31 87.1 87.2 87.3 87.4 87.5
87.6 87.7 87.8 87.9 87.10 87.11 87.12 87.13 87.14 87.15 87.16 87.17 87.18 87.19 87.20
87.21 87.22 87.23 87.24 87.25 87.26 87.27 87.28 87.29 87.30 87.31 87.32 88.1 88.2 88.3 88.4
88.5 88.6 88.7 88.8 88.9 88.10 88.11 88.12 88.13 88.14 88.15 88.16 88.17 88.18 88.19 88.20 88.21 88.22 88.23 88.24 88.25 88.26 88.27 88.28 88.29 88.30 88.31 89.1 89.2 89.3
89.4 89.5 89.6 89.7 89.8 89.9 89.10
89.11
89.12 89.13 89.14 89.15 89.16 89.17 89.18 89.19 89.20 89.21 89.22
89.23
89.24 89.25 89.26 89.27 89.28 89.29 89.30 89.31
90.1
90.2 90.3 90.4 90.5 90.6 90.7 90.8 90.9 90.10 90.11 90.12 90.13 90.14 90.15 90.16 90.17 90.18 90.19 90.20 90.21 90.22 90.23 90.24 90.25 90.26 90.27 90.28 90.29 90.30 91.1 91.2 91.3 91.4 91.5 91.6 91.7 91.8 91.9 91.10 91.11
91.12 91.13 91.14 91.15 91.16 91.17 91.18 91.19 91.20 91.21 91.22 91.23 91.24 91.25 91.26 91.27 91.28 91.29 91.30 91.31 92.1 92.2 92.3 92.4 92.5
92.6
92.7 92.8 92.9 92.10 92.11 92.12 92.13 92.14 92.15 92.16 92.17 92.18 92.19 92.20 92.21 92.22 92.23 92.24 92.25 92.26 92.27 92.28 92.29 92.30 93.1 93.2 93.3 93.4 93.5 93.6 93.7 93.8 93.9 93.10 93.11 93.12 93.13 93.14 93.15 93.16 93.17 93.18 93.19 93.20 93.21 93.22 93.23 93.24 93.25 93.26 93.27 93.28 93.29 93.30 93.31 93.32 93.33 94.1 94.2 94.3 94.4 94.5 94.6 94.7 94.8 94.9 94.10 94.11 94.12 94.13 94.14 94.15 94.16 94.17 94.18 94.19 94.20 94.21 94.22 94.23 94.24 94.25 94.26 94.27 94.28 94.29 94.30 94.31 94.32 95.1 95.2 95.3 95.4 95.5 95.6 95.7 95.8 95.9 95.10 95.11 95.12 95.13 95.14 95.15 95.16 95.17 95.18 95.19 95.20 95.21 95.22 95.23 95.24 95.25 95.26 95.27 95.28 95.29 96.1 96.2 96.3 96.4 96.5 96.6 96.7 96.8 96.9 96.10 96.11 96.12 96.13 96.14 96.15 96.16 96.17 96.18 96.19 96.20 96.21 96.22 96.23 96.24 96.25 96.26 96.27 96.28 96.29 96.30 96.31 96.32 96.33 96.34 97.1 97.2 97.3 97.4 97.5
97.6 97.7 97.8 97.9 97.10 97.11 97.12 97.13 97.14 97.15 97.16 97.17 97.18 97.19 97.20 97.21 97.22 97.23 97.24 97.25 97.26
97.27
97.28 97.29 97.30 97.31 97.32 98.1 98.2 98.3 98.4 98.5 98.6 98.7 98.8 98.9 98.10 98.11 98.12 98.13 98.14 98.15 98.16 98.17 98.18 98.19 98.20 98.21 98.22 98.23 98.24 98.25 98.26 98.27 98.28 98.29 98.30 98.31 98.32 98.33 99.1 99.2 99.3 99.4 99.5 99.6 99.7 99.8 99.9 99.10 99.11 99.12 99.13 99.14 99.15 99.16 99.17 99.18 99.19 99.20 99.21 99.22 99.23 99.24 99.25 99.26 99.27 99.28 99.29 99.30 99.31 100.1 100.2 100.3 100.4 100.5 100.6 100.7 100.8 100.9
100.10 100.11 100.12 100.13 100.14 100.15 100.16 100.17 100.18 100.19 100.20 100.21 100.22 100.23 100.24 100.25 100.26 100.27 100.28 100.29 100.30 100.31 101.1 101.2 101.3 101.4 101.5 101.6 101.7 101.8 101.9 101.10 101.11 101.12 101.13 101.14 101.15 101.16 101.17 101.18 101.19 101.20 101.21 101.22 101.23 101.24 101.25 101.26 101.27 101.28 101.29 101.30 101.31 102.1 102.2 102.3 102.4 102.5 102.6 102.7 102.8 102.9 102.10 102.11 102.12 102.13 102.14 102.15 102.16
102.17 102.18 102.19 102.20 102.21 102.22 102.23 102.24 102.25 102.26 102.27 102.28 102.29 102.30 102.31 102.32 102.33 103.1 103.2 103.3 103.4 103.5 103.6 103.7 103.8 103.9 103.10 103.11 103.12 103.13 103.14 103.15 103.16 103.17 103.18 103.19 103.20 103.21 103.22 103.23 103.24 103.25 103.26 103.27 103.28 103.29 103.30 103.31 103.32 103.33
103.34
104.1 104.2 104.3 104.4 104.5 104.6 104.7 104.8 104.9 104.10 104.11 104.12 104.13 104.14 104.15
104.16 104.17 104.18 104.19 104.20 104.21 104.22 104.23 104.24 104.25 104.26 104.27 104.28 104.29 104.30 104.31 104.32 104.33 104.34 105.1 105.2
105.3 105.4 105.5 105.6
105.7 105.8 105.9 105.10 105.11 105.12 105.13 105.14
105.15 105.16 105.17 105.18 105.19 105.20 105.21 105.22
105.23 105.24
105.25 105.26 105.27 105.28 105.29 105.30 106.1 106.2
106.3 106.4 106.5 106.6 106.7 106.8 106.9 106.10 106.11 106.12 106.13 106.14 106.15 106.16 106.17 106.18 106.19 106.20 106.21 106.22 106.23 106.24 106.25 106.26 106.27 106.28 106.29 107.1 107.2 107.3 107.4 107.5 107.6 107.7 107.8 107.9 107.10 107.11 107.12 107.13 107.14 107.15 107.16 107.17 107.18 107.19 107.20 107.21 107.22 107.23 107.24 107.25 107.26 107.27 107.28 107.29 107.30 107.31 108.1 108.2 108.3 108.4 108.5 108.6 108.7 108.8 108.9 108.10 108.11 108.12 108.13 108.14 108.15 108.16 108.17 108.18 108.19 108.20 108.21 108.22 108.23 108.24 108.25 108.26 108.27 108.28 108.29 108.30 109.1 109.2 109.3 109.4 109.5 109.6 109.7 109.8 109.9 109.10 109.11 109.12 109.13 109.14 109.15 109.16 109.17 109.18 109.19 109.20 109.21 109.22 109.23 109.24 109.25 109.26 109.27 109.28 109.29 109.30 109.31 109.32 110.1 110.2 110.3 110.4 110.5 110.6 110.7 110.8 110.9 110.10 110.11 110.12
110.13 110.14 110.15 110.16 110.17 110.18 110.19 110.20 110.21
110.22 110.23 110.24 110.25 110.26 110.27 110.28
110.29 110.30 110.31 111.1 111.2 111.3 111.4 111.5 111.6 111.7 111.8 111.9 111.10 111.11 111.12 111.13 111.14 111.15 111.16 111.17 111.18 111.19 111.20 111.21 111.22 111.23 111.24 111.25 111.26 111.27 111.28 111.29 111.30 111.31 111.32 111.33 111.34 112.1 112.2 112.3 112.4 112.5 112.6 112.7 112.8 112.9 112.10 112.11 112.12 112.13 112.14 112.15 112.16 112.17 112.18 112.19 112.20 112.21 112.22
112.23 112.24 112.25 112.26 112.27 112.28 112.29 112.30 112.31
113.1 113.2 113.3 113.4 113.5 113.6 113.7 113.8 113.9 113.10 113.11 113.12 113.13 113.14 113.15 113.16 113.17 113.18 113.19 113.20 113.21 113.22 113.23 113.24 113.25 113.26 113.27 113.28 113.29 113.30 114.1 114.2 114.3 114.4 114.5 114.6 114.7 114.8 114.9 114.10 114.11 114.12 114.13 114.14 114.15 114.16 114.17 114.18
114.19 114.20 114.21 114.22 114.23 114.24 114.25 114.26 114.27 114.28 114.29 115.1 115.2 115.3 115.4 115.5 115.6 115.7 115.8 115.9 115.10 115.11 115.12 115.13 115.14 115.15 115.16 115.17 115.18 115.19 115.20 115.21 115.22 115.23 115.24 115.25
115.26 115.27 115.28 115.29 115.30 115.31 115.32
116.1 116.2 116.3 116.4 116.5 116.6 116.7 116.8 116.9 116.10 116.11 116.12 116.13 116.14 116.15 116.16
116.17 116.18 116.19 116.20 116.21 116.22 116.23 116.24 116.25 116.26 116.27 116.28 116.29 116.30 116.31 116.32 117.1 117.2 117.3 117.4 117.5 117.6 117.7 117.8 117.9 117.10 117.11 117.12 117.13 117.14 117.15
117.16 117.17 117.18 117.19 117.20 117.21 117.22 117.23 117.24 117.25 117.26 117.27 117.28
118.1 118.2 118.3 118.4 118.5 118.6 118.7 118.8
118.9 118.10 118.11 118.12 118.13 118.14 118.15 118.16 118.17
118.18 118.19 118.20 118.21 118.22 118.23
118.24 118.25 118.26 118.27 118.28 118.29 118.30 119.1 119.2 119.3 119.4 119.5 119.6
119.7 119.8 119.9 119.10 119.11 119.12 119.13 119.14 119.15 119.16 119.17 119.18 119.19 119.20 119.21 119.22 119.23 119.24 119.25 119.26 119.27 119.28 119.29 119.30 119.31 119.32
120.1 120.2 120.3 120.4 120.5 120.6 120.7 120.8 120.9
120.10 120.11 120.12 120.13 120.14 120.15 120.16 120.17 120.18 120.19
120.20 120.21 120.22 120.23 120.24
120.25 120.26 120.27 120.28 120.29
121.1 121.2 121.3 121.4 121.5 121.6 121.7 121.8 121.9 121.10 121.11 121.12 121.13 121.14 121.15 121.16 121.17 121.18 121.19 121.20 121.21 121.22 121.23 121.24 121.25 121.26 121.27 121.28 121.29 121.30 121.31 121.32 122.1 122.2 122.3 122.4 122.5 122.6 122.7 122.8 122.9 122.10 122.11 122.12 122.13 122.14 122.15 122.16 122.17 122.18 122.19 122.20 122.21 122.22 122.23 122.24 122.25 122.26 122.27 122.28 122.29 122.30 122.31 122.32 122.33 123.1 123.2 123.3 123.4 123.5 123.6 123.7 123.8 123.9 123.10 123.11 123.12 123.13 123.14 123.15 123.16 123.17 123.18 123.19 123.20 123.21 123.22 123.23 123.24 123.25 123.26 123.27 123.28 123.29 123.30 123.31 123.32 123.33 124.1 124.2
124.3 124.4 124.5 124.6 124.7
124.8 124.9 124.10
124.11 124.12
124.13 124.14 124.15 124.16 124.17 124.18 124.19 124.20 124.21 124.22 124.23 124.24 124.25 124.26 124.27 124.28 124.29 124.30 125.1 125.2 125.3 125.4 125.5 125.6 125.7 125.8 125.9 125.10 125.11 125.12 125.13 125.14 125.15 125.16 125.17 125.18 125.19 125.20 125.21 125.22 125.23 125.24 125.25 125.26 125.27 125.28 125.29 125.30 125.31 125.32 125.33 125.34 126.1 126.2
126.3
126.4 126.5 126.6 126.7 126.8 126.9 126.10 126.11 126.12 126.13 126.14 126.15 126.16 126.17 126.18 126.19 126.20 126.21 126.22 126.23 126.24 126.25 126.26 126.27 126.28 126.29 126.30 126.31 126.32 127.1 127.2 127.3 127.4 127.5 127.6 127.7 127.8 127.9 127.10 127.11 127.12 127.13 127.14 127.15 127.16 127.17 127.18 127.19 127.20
127.21 127.22 127.23 127.24 127.25 127.26 127.27 127.28 127.29 127.30 127.31 127.32 128.1 128.2 128.3 128.4 128.5 128.6 128.7 128.8 128.9 128.10 128.11 128.12 128.13 128.14 128.15 128.16 128.17 128.18
128.19 128.20 128.21 128.22 128.23 128.24 128.25 128.26 128.27 128.28 128.29 128.30 128.31 129.1 129.2 129.3 129.4 129.5 129.6 129.7 129.8 129.9 129.10 129.11 129.12
129.13
129.14 129.15 129.16 129.17 129.18 129.19 129.20 129.21 129.22 129.23 129.24 129.25 129.26 129.27 129.28 130.1 130.2 130.3 130.4 130.5 130.6 130.7 130.8
130.9
130.10 130.11 130.12 130.13 130.14 130.15 130.16 130.17 130.18 130.19 130.20
130.21 130.22 130.23 130.24 130.25 130.26 130.27 130.28 130.29 130.30 131.1 131.2 131.3 131.4 131.5 131.6 131.7 131.8 131.9 131.10 131.11 131.12 131.13 131.14 131.15 131.16 131.17 131.18 131.19 131.20 131.21 131.22 131.23 131.24
131.25
131.26 131.27 131.28 131.29 131.30 131.31 131.32 132.1 132.2 132.3 132.4 132.5 132.6 132.7 132.8 132.9 132.10 132.11 132.12 132.13 132.14 132.15 132.16 132.17 132.18 132.19 132.20 132.21 132.22 132.23 132.24 132.25 132.26 132.27 132.28 132.29 132.30 132.31 133.1 133.2 133.3 133.4 133.5 133.6 133.7
133.8
133.9 133.10 133.11 133.12 133.13 133.14 133.15 133.16 133.17 133.18 133.19 133.20 133.21 133.22 133.23 133.24 133.25 133.26 133.27 133.28 133.29 133.30 133.31 133.32 133.33 134.1 134.2 134.3 134.4 134.5 134.6 134.7 134.8 134.9 134.10 134.11 134.12 134.13 134.14 134.15 134.16 134.17
134.18
134.19 134.20 134.21 134.22 134.23 134.24 134.25 134.26 134.27 134.28 134.29 134.30 135.1 135.2 135.3 135.4 135.5 135.6 135.7
135.8
135.9 135.10 135.11 135.12 135.13 135.14 135.15 135.16 135.17
135.18
135.19 135.20 135.21 135.22 135.23 135.24 135.25 135.26 135.27 135.28 135.29 135.30 135.31 136.1 136.2 136.3 136.4 136.5 136.6 136.7 136.8 136.9 136.10 136.11 136.12 136.13 136.14 136.15
136.16
136.17 136.18 136.19 136.20 136.21 136.22 136.23 136.24 136.25 136.26 136.27 136.28 136.29 136.30 136.31 136.32 136.33
137.1
137.2 137.3
137.4 137.5 137.6 137.7 137.8 137.9 137.10 137.11 137.12 137.13 137.14 137.15 137.16 137.17 137.18 137.19 137.20 137.21
137.22 137.23 137.24 137.25 137.26 137.27 137.28 137.29 137.30 138.1 138.2 138.3
138.4 138.5 138.6 138.7 138.8 138.9 138.10 138.11 138.12 138.13 138.14 138.15 138.16 138.17 138.18 138.19 138.20 138.21 138.22 138.23 138.24 138.25 138.26 138.27 138.28 138.29 138.30 138.31 138.32 138.33 139.1 139.2 139.3
139.4 139.5 139.6 139.7 139.8 139.9 139.10 139.11 139.12 139.13 139.14 139.15 139.16 139.17 139.18
139.19 139.20 139.21 139.22 139.23 139.24 139.25 139.26 139.27 139.28 139.29 139.30 139.31 139.32 140.1 140.2 140.3 140.4 140.5 140.6 140.7 140.8 140.9 140.10 140.11 140.12 140.13 140.14
140.15 140.16 140.17 140.18 140.19 140.20 140.21 140.22 140.23 140.24 140.25 140.26 140.27 140.28 140.29 140.30 140.31 141.1 141.2 141.3 141.4 141.5 141.6 141.7 141.8 141.9 141.10 141.11
141.12 141.13
141.14 141.15 141.16 141.17 141.18 141.19
141.20 141.21
141.22 141.23
141.24 141.25 141.26 141.27 141.28 141.29 141.30 142.1 142.2 142.3 142.4 142.5 142.6 142.7 142.8 142.9 142.10 142.11 142.12
142.13 142.14 142.15 142.16 142.17 142.18 142.19 142.20 142.21 142.22 142.23 142.24 142.25 142.26 142.27 142.28 142.29 142.30 142.31 142.32 143.1 143.2 143.3 143.4 143.5 143.6 143.7 143.8 143.9 143.10 143.11 143.12 143.13 143.14 143.15 143.16 143.17 143.18 143.19 143.20 143.21 143.22 143.23 143.24 143.25 143.26 143.27 143.28 143.29 143.30 143.31 143.32 143.33 143.34 144.1 144.2 144.3 144.4 144.5 144.6 144.7 144.8 144.9 144.10 144.11 144.12 144.13 144.14
144.15 144.16 144.17 144.18 144.19 144.20 144.21 144.22 144.23 144.24 144.25 144.26 144.27 144.28 144.29 144.30 144.31 144.32 145.1 145.2 145.3 145.4
145.5 145.6 145.7 145.8 145.9 145.10 145.11 145.12 145.13 145.14 145.15 145.16 145.17 145.18 145.19 145.20 145.21 145.22 145.23 145.24 145.25 145.26 145.27 145.28 145.29 145.30 145.31 145.32 145.33 146.1 146.2 146.3 146.4 146.5 146.6 146.7 146.8 146.9 146.10
146.11
146.12 146.13 146.14 146.15 146.16 146.17
146.18 146.19 146.20 146.21 146.22
146.23 146.24 146.25 146.26 146.27 146.28
147.1 147.2 147.3 147.4 147.5 147.6 147.7 147.8 147.9 147.10 147.11 147.12 147.13 147.14 147.15 147.16 147.17 147.18 147.19 147.20 147.21 147.22 147.23 147.24 147.25 147.26 147.27 147.28 147.29 147.30
147.31 147.32 147.33 148.1 148.2 148.3 148.4 148.5 148.6 148.7 148.8 148.9 148.10 148.11 148.12 148.13 148.14 148.15 148.16 148.17 148.18 148.19 148.20 148.21 148.22 148.23 148.24 148.25 148.26 148.27 148.28 148.29 148.30 148.31 148.32 148.33 148.34 149.1 149.2 149.3 149.4 149.5 149.6 149.7 149.8 149.9 149.10 149.11 149.12
149.13 149.14 149.15 149.16 149.17 149.18 149.19 149.20 149.21 149.22 149.23 149.24 149.25 149.26 149.27 149.28 149.29 149.30 149.31 150.1 150.2 150.3 150.4 150.5 150.6 150.7 150.8 150.9 150.10 150.11 150.12 150.13 150.14 150.15 150.16 150.17 150.18 150.19 150.20
150.21
150.22 150.23 150.24 150.25 150.26 150.27 150.28 150.29 150.30 150.31 150.32 150.33 151.1 151.2 151.3 151.4 151.5 151.6 151.7 151.8 151.9 151.10 151.11 151.12 151.13 151.14 151.15 151.16 151.17 151.18 151.19
151.20
151.21 151.22 151.23 151.24 151.25 151.26 151.27 151.28 151.29 151.30 151.31 151.32 151.33 152.1 152.2 152.3 152.4 152.5 152.6 152.7 152.8 152.9
152.10 152.11 152.12 152.13 152.14 152.15 152.16 152.17 152.18 152.19 152.20 152.21
152.22 152.23 152.24 152.25 152.26 152.27
152.28 152.29 152.30 152.31 152.32 153.1 153.2 153.3 153.4 153.5 153.6 153.7 153.8 153.9 153.10 153.11 153.12 153.13 153.14 153.15 153.16 153.17 153.18 153.19 153.20 153.21 153.22 153.23 153.24 153.25 153.26 153.27 153.28 153.29 153.30 153.31 153.32 154.1 154.2 154.3 154.4 154.5 154.6 154.7 154.8 154.9 154.10 154.11 154.12 154.13 154.14 154.15 154.16 154.17 154.18 154.19 154.20 154.21 154.22 154.23 154.24 154.25 154.26 154.27 154.28 154.29 154.30 154.31 154.32
155.1 155.2 155.3 155.4 155.5 155.6 155.7 155.8 155.9 155.10 155.11 155.12 155.13 155.14 155.15 155.16 155.17 155.18 155.19 155.20 155.21 155.22 155.23 155.24 155.25 155.26 155.27 155.28 155.29 155.30 155.31 155.32 156.1 156.2 156.3 156.4 156.5 156.6 156.7 156.8 156.9 156.10 156.11 156.12 156.13 156.14 156.15 156.16 156.17 156.18 156.19 156.20 156.21 156.22 156.23 156.24 156.25 156.26 156.27 156.28 156.29 156.30 156.31 156.32 157.1 157.2 157.3 157.4 157.5 157.6 157.7
157.8 157.9 157.10 157.11 157.12 157.13 157.14 157.15 157.16 157.17 157.18 157.19 157.20 157.21 157.22 157.23 157.24 157.25 157.26 157.27 157.28 157.29 157.30 157.31 157.32 158.1 158.2 158.3 158.4 158.5 158.6 158.7 158.8 158.9 158.10 158.11 158.12 158.13 158.14 158.15 158.16 158.17 158.18 158.19 158.20 158.21 158.22 158.23 158.24 158.25 158.26 158.27 158.28 158.29 158.30 158.31 159.1 159.2 159.3 159.4 159.5 159.6 159.7 159.8 159.9 159.10 159.11 159.12 159.13 159.14
159.15 159.16 159.17 159.18 159.19 159.20 159.21 159.22 159.23 159.24 159.25 159.26 159.27 159.28 159.29 159.30 160.1 160.2 160.3 160.4 160.5 160.6 160.7 160.8 160.9 160.10 160.11 160.12 160.13 160.14 160.15 160.16 160.17 160.18 160.19 160.20 160.21 160.22 160.23 160.24 160.25 160.26 160.27 160.28 160.29 160.30 160.31 161.1 161.2 161.3 161.4 161.5 161.6 161.7 161.8 161.9 161.10 161.11
161.12
161.13 161.14 161.15 161.16 161.17 161.18 161.19 161.20 161.21 161.22 161.23 161.24 161.25 161.26
161.27 161.28 161.29 161.30 161.31 162.1 162.2 162.3 162.4 162.5 162.6 162.7 162.8 162.9 162.10 162.11 162.12 162.13 162.14 162.15 162.16 162.17 162.18 162.19 162.20 162.21 162.22 162.23 162.24 162.25 162.26 162.27
162.28 162.29 162.30 162.31 162.32
163.1 163.2 163.3 163.4 163.5 163.6 163.7 163.8 163.9 163.10 163.11
163.12 163.13 163.14 163.15 163.16 163.17 163.18 163.19 163.20 163.21
163.22 163.23 163.24 163.25 163.26 163.27 163.28 163.29 163.30 163.31 163.32 164.1 164.2 164.3 164.4 164.5 164.6 164.7 164.8 164.9
164.10 164.11 164.12 164.13 164.14 164.15
164.16
164.17 164.18 164.19 164.20 164.21 164.22 164.23 164.24 164.25 164.26 164.27 164.28 164.29 164.30 164.31 165.1 165.2 165.3 165.4 165.5 165.6 165.7 165.8 165.9 165.10 165.11 165.12 165.13 165.14 165.15 165.16 165.17 165.18 165.19 165.20 165.21 165.22 165.23 165.24 165.25 165.26 165.27 165.28 165.29 165.30 165.31
166.1 166.2 166.3 166.4 166.5 166.6 166.7
166.8 166.9 166.10 166.11 166.12 166.13 166.14 166.15 166.16 166.17 166.18 166.19 166.20 166.21 166.22 166.23 166.24 166.25 166.26 166.27 166.28 166.29
166.30
167.1 167.2 167.3 167.4 167.5 167.6 167.7 167.8 167.9 167.10 167.11 167.12 167.13 167.14 167.15 167.16 167.17 167.18 167.19 167.20 167.21 167.22 167.23 167.24 167.25 167.26 167.27 167.28 167.29 167.30 167.31
168.1 168.2 168.3 168.4 168.5 168.6 168.7 168.8 168.9 168.10 168.11 168.12 168.13 168.14 168.15 168.16 168.17 168.18 168.19 168.20 168.21 168.22 168.23 168.24 168.25 168.26 168.27 168.28 168.29 168.30 168.31 168.32 168.33 169.1 169.2 169.3 169.4 169.5 169.6 169.7 169.8 169.9 169.10 169.11 169.12 169.13 169.14 169.15 169.16 169.17 169.18 169.19 169.20 169.21 169.22 169.23 169.24 169.25
169.26 169.27 169.28 169.29 169.30 169.31 169.32 170.1 170.2 170.3 170.4 170.5 170.6 170.7 170.8 170.9 170.10 170.11 170.12 170.13 170.14 170.15 170.16 170.17 170.18 170.19 170.20 170.21 170.22 170.23
170.24
170.25 170.26 170.27 170.28 170.29 170.30 171.1 171.2
171.3
171.4 171.5 171.6 171.7 171.8 171.9 171.10 171.11 171.12
171.13 171.14 171.15 171.16 171.17 171.18 171.19
171.20 171.21 171.22 171.23 171.24 171.25
171.26 171.27 171.28 171.29 171.30 171.31 172.1 172.2 172.3 172.4 172.5 172.6 172.7 172.8 172.9 172.10 172.11 172.12 172.13 172.14 172.15 172.16 172.17 172.18 172.19 172.20 172.21 172.22 172.23 172.24 172.25
172.26
172.27 172.28 172.29 172.30 172.31 172.32 173.1 173.2 173.3 173.4 173.5 173.6 173.7 173.8 173.9 173.10 173.11 173.12 173.13 173.14 173.15 173.16 173.17 173.18 173.19 173.20 173.21 173.22 173.23 173.24 173.25 173.26 173.27 173.28 173.29 173.30 173.31 173.32 173.33 173.34 173.35 174.1 174.2 174.3 174.4 174.5 174.6 174.7 174.8 174.9 174.10 174.11 174.12 174.13 174.14 174.15 174.16 174.17 174.18 174.19 174.20 174.21 174.22 174.23 174.24 174.25 174.26 174.27 174.28 174.29 174.30 174.31 174.32 174.33 174.34 174.35 175.1 175.2 175.3 175.4 175.5 175.6 175.7 175.8 175.9 175.10 175.11 175.12 175.13 175.14 175.15 175.16 175.17 175.18 175.19 175.20 175.21 175.22 175.23 175.24 175.25 175.26 175.27 175.28 175.29 175.30 175.31 176.1 176.2 176.3 176.4 176.5 176.6 176.7 176.8 176.9 176.10 176.11 176.12 176.13 176.14 176.15 176.16 176.17
176.18
176.19 176.20 176.21 176.22 176.23 176.24 176.25 176.26 176.27 176.28 176.29 176.30 176.31 176.32 177.1 177.2 177.3 177.4 177.5 177.6 177.7 177.8 177.9 177.10 177.11 177.12 177.13 177.14 177.15 177.16 177.17 177.18 177.19 177.20 177.21 177.22 177.23 177.24 177.25
177.26
177.27 177.28 177.29 177.30 177.31 177.32 177.33 177.34 178.1 178.2 178.3 178.4 178.5 178.6 178.7 178.8 178.9 178.10 178.11 178.12 178.13 178.14 178.15 178.16 178.17 178.18 178.19 178.20 178.21 178.22 178.23 178.24 178.25 178.26 178.27 178.28 178.29 178.30 178.31 178.32 178.33 178.34 179.1 179.2 179.3 179.4
179.5
179.6 179.7 179.8 179.9 179.10 179.11 179.12 179.13 179.14 179.15 179.16 179.17 179.18 179.19
179.20
179.21 179.22 179.23 179.24 179.25 179.26 179.27 179.28 179.29 179.30
179.31
180.1 180.2 180.3 180.4 180.5 180.6 180.7 180.8 180.9 180.10 180.11 180.12 180.13 180.14 180.15 180.16 180.17 180.18
180.19 180.20 180.21 180.22 180.23 180.24 180.25 180.26 180.27 180.28 180.29 180.30
181.1 181.2 181.3 181.4 181.5 181.6 181.7 181.8 181.9 181.10 181.11 181.12 181.13 181.14 181.15 181.16 181.17
181.18 181.19 181.20 181.21 181.22 181.23 181.24 181.25 181.26 181.27 181.28 181.29 181.30 181.31 181.32 182.1 182.2 182.3 182.4 182.5 182.6 182.7 182.8 182.9 182.10 182.11 182.12 182.13 182.14 182.15 182.16 182.17 182.18 182.19 182.20 182.21 182.22 182.23 182.24 182.25 182.26 182.27 182.28 182.29 182.30 182.31 182.32 182.33 183.1 183.2 183.3 183.4 183.5 183.6 183.7 183.8 183.9 183.10 183.11 183.12 183.13 183.14 183.15 183.16 183.17 183.18 183.19 183.20 183.21
183.22
183.23 183.24 183.25 183.26 183.27 183.28
183.29
183.30 183.31 184.1 184.2 184.3 184.4 184.5 184.6 184.7 184.8 184.9 184.10 184.11 184.12 184.13 184.14 184.15 184.16 184.17 184.18 184.19 184.20 184.21 184.22 184.23 184.24 184.25 184.26 184.27 184.28 184.29 184.30 184.31 184.32 185.1 185.2 185.3 185.4 185.5 185.6 185.7
185.8
185.9 185.10 185.11 185.12 185.13 185.14 185.15 185.16 185.17 185.18 185.19 185.20 185.21 185.22 185.23
185.24 185.25 185.26 185.27 185.28 185.29 185.30 185.31
185.32
186.1 186.2 186.3 186.4 186.5 186.6 186.7 186.8 186.9
186.10
186.11 186.12 186.13 186.14 186.15 186.16 186.17 186.18 186.19 186.20 186.21 186.22 186.23 186.24 186.25 186.26 186.27 186.28 186.29 186.30 186.31 187.1 187.2 187.3 187.4 187.5 187.6 187.7 187.8 187.9 187.10 187.11 187.12 187.13 187.14 187.15 187.16 187.17 187.18 187.19 187.20 187.21 187.22 187.23 187.24 187.25 187.26 187.27 187.28 187.29 187.30 187.31 187.32 187.33 188.1 188.2 188.3 188.4
188.5 188.6 188.7 188.8 188.9 188.10 188.11 188.12 188.13 188.14 188.15 188.16 188.17 188.18 188.19 188.20 188.21 188.22 188.23 188.24 188.25 188.26 188.27 188.28 188.29 188.30 188.31 189.1 189.2 189.3 189.4 189.5 189.6 189.7 189.8 189.9 189.10 189.11 189.12 189.13 189.14 189.15 189.16 189.17 189.18 189.19 189.20 189.21 189.22 189.23 189.24 189.25 189.26 189.27 189.28 189.29 189.30 189.31 189.32 190.1 190.2 190.3 190.4 190.5 190.6 190.7 190.8 190.9 190.10 190.11 190.12
190.13 190.14
190.15 190.16 190.17 190.18 190.19 190.20 190.21 190.22 190.23 190.24
190.25 190.26 190.27 190.28 190.29 190.30
191.1 191.2 191.3 191.4 191.5
191.6 191.7 191.8 191.9 191.10 191.11 191.12 191.13 191.14 191.15 191.16 191.17 191.18 191.19 191.20 191.21 191.22 191.23 191.24 191.25 191.26 191.27 191.28 191.29 191.30 191.31 191.32 192.1 192.2
192.3 192.4 192.5 192.6 192.7 192.8 192.9 192.10 192.11 192.12 192.13 192.14 192.15
192.16 192.17 192.18 192.19 192.20 192.21 192.22
192.23 192.24 192.25 192.26 192.27 192.28 192.29 192.30 192.31 192.32 192.33 193.1 193.2 193.3 193.4
193.5
193.6 193.7 193.8 193.9 193.10 193.11 193.12
193.13 193.14 193.15 193.16 193.17 193.18
193.19 193.20 193.21 193.22 193.23 193.24
193.25 193.26 193.27 193.28 193.29 193.30 193.31
194.1 194.2
194.3 194.4
194.5 194.6 194.7 194.8 194.9 194.10 194.11 194.12 194.13 194.14 194.15 194.16 194.17 194.18 194.19 194.20 194.21 194.22 194.23 194.24 194.25 194.26 194.27 194.28 194.29 194.30 194.31 194.32 195.1 195.2 195.3
195.4 195.5 195.6 195.7 195.8 195.9 195.10 195.11 195.12 195.13 195.14 195.15 195.16 195.17 195.18 195.19 195.20 195.21 195.22 195.23 195.24 195.25 195.26 195.27 195.28 195.29 195.30 196.1 196.2 196.3 196.4 196.5 196.6 196.7 196.8 196.9 196.10 196.11 196.12 196.13 196.14 196.15 196.16 196.17 196.18 196.19 196.20 196.21 196.22 196.23 196.24
196.25 196.26 196.27 196.28
197.1 197.2 197.3 197.4 197.5 197.6 197.7 197.8 197.9 197.10 197.11 197.12 197.13 197.14 197.15 197.16 197.17 197.18 197.19 197.20 197.21 197.22 197.23 197.24 197.25 197.26 197.27 197.28
197.29 197.30 197.31 197.32 197.33 198.1 198.2 198.3 198.4 198.5 198.6 198.7 198.8 198.9 198.10 198.11 198.12 198.13 198.14 198.15 198.16
198.17 198.18 198.19 198.20 198.21 198.22 198.23 198.24 198.25 198.26 198.27 198.28 198.29 198.30 198.31 198.32 198.33 198.34 199.1 199.2 199.3 199.4 199.5 199.6 199.7 199.8 199.9 199.10 199.11 199.12 199.13 199.14 199.15 199.16 199.17 199.18 199.19 199.20 199.21 199.22 199.23 199.24 199.25 199.26 199.27 199.28 199.29 199.30 199.31 199.32 199.33 199.34 199.35 200.1 200.2 200.3 200.4 200.5 200.6 200.7 200.8 200.9 200.10 200.11 200.12 200.13 200.14 200.15 200.16 200.17 200.18 200.19 200.20 200.21 200.22 200.23 200.24 200.25 200.26 200.27 200.28 200.29 200.30 200.31 200.32 200.33 200.34 201.1 201.2 201.3 201.4 201.5 201.6 201.7 201.8 201.9 201.10 201.11 201.12 201.13 201.14
201.15 201.16 201.17 201.18 201.19 201.20 201.21
201.22 201.23 201.24 201.25 201.26 201.27 201.28
201.29 201.30 201.31 201.32 202.1 202.2 202.3 202.4 202.5 202.6 202.7 202.8 202.9 202.10 202.11 202.12 202.13 202.14 202.15 202.16 202.17 202.18
202.19 202.20 202.21 202.22 202.23 202.24 202.25
202.26 202.27 202.28 202.29 202.30 202.31 202.32 202.33 203.1 203.2 203.3 203.4 203.5 203.6 203.7 203.8 203.9 203.10 203.11 203.12 203.13 203.14 203.15 203.16 203.17
203.18 203.19 203.20 203.21 203.22
203.23 203.24 203.25 203.26 203.27 203.28 203.29 203.30
203.31 203.32 203.33 204.1 204.2 204.3 204.4 204.5 204.6
204.7 204.8 204.9 204.10 204.11 204.12
204.13 204.14 204.15 204.16 204.17 204.18
204.19 204.20 204.21 204.22 204.23 204.24
204.25 204.26 204.27 204.28 204.29 204.30 204.31 205.1 205.2 205.3 205.4 205.5 205.6 205.7 205.8 205.9 205.10 205.11 205.12 205.13 205.14 205.15 205.16 205.17 205.18 205.19 205.20 205.21 205.22 205.23
205.24 205.25 205.26 205.27 205.28 205.29 205.30 205.31 205.32 206.1 206.2 206.3 206.4 206.5 206.6 206.7 206.8 206.9 206.10 206.11 206.12 206.13
206.14 206.15 206.16 206.17 206.18 206.19 206.20 206.21 206.22 206.23 206.24 206.25 206.26
206.27 206.28 206.29 206.30 206.31 206.32
207.1 207.2 207.3 207.4 207.5 207.6 207.7 207.8 207.9 207.10 207.11 207.12 207.13 207.14 207.15 207.16 207.17 207.18 207.19 207.20 207.21 207.22 207.23 207.24 207.25 207.26 207.27 207.28 207.29 207.30 207.31 207.32 207.33 207.34 208.1 208.2 208.3 208.4 208.5 208.6 208.7 208.8 208.9 208.10 208.11 208.12 208.13
208.14 208.15 208.16 208.17 208.18 208.19 208.20 208.21 208.22 208.23 208.24 208.25 208.26 208.27 208.28 208.29 208.30 208.31 208.32 208.33
209.1 209.2 209.3 209.4 209.5 209.6 209.7 209.8 209.9 209.10
209.11 209.12 209.13 209.14 209.15 209.16
209.17 209.18 209.19 209.20 209.21
209.22 209.23 209.24 209.25 209.26 209.27
209.28 209.29 209.30 210.1 210.2 210.3 210.4 210.5
210.6 210.7
210.8 210.9
210.10 210.11 210.12 210.13 210.14 210.15 210.16 210.17 210.18 210.19 210.20 210.21 210.22 210.23 210.24 210.25 210.26 210.27 210.28 210.29 210.30 210.31 211.1 211.2 211.3 211.4 211.5 211.6 211.7 211.8 211.9 211.10 211.11 211.12 211.13 211.14 211.15 211.16 211.17 211.18 211.19 211.20 211.21 211.22 211.23 211.24 211.25 211.26 211.27 211.28 211.29 211.30 211.31 211.32 211.33 211.34 212.1 212.2 212.3 212.4 212.5 212.6 212.7 212.8 212.9 212.10 212.11 212.12 212.13 212.14 212.15 212.16 212.17 212.18 212.19 212.20 212.21 212.22 212.23 212.24 212.25 212.26 212.27 212.28 212.29 212.30 212.31 213.1 213.2 213.3 213.4 213.5 213.6 213.7 213.8 213.9 213.10 213.11 213.12 213.13 213.14 213.15 213.16 213.17 213.18 213.19 213.20 213.21 213.22 213.23 213.24 213.25 213.26 213.27 213.28 213.29 213.30 213.31 213.32 214.1 214.2 214.3 214.4 214.5 214.6 214.7
214.8 214.9 214.10 214.11 214.12 214.13 214.14 214.15 214.16 214.17 214.18 214.19 214.20 214.21 214.22 214.23 214.24 214.25 214.26
214.27 214.28 214.29 214.30 214.31 214.32 215.1 215.2 215.3 215.4 215.5 215.6 215.7 215.8 215.9 215.10 215.11 215.12 215.13 215.14 215.15 215.16 215.17 215.18 215.19 215.20 215.21 215.22 215.23 215.24 215.25 215.26 215.27 215.28 215.29 215.30 215.31 215.32 215.33 215.34 215.35 216.1 216.2 216.3 216.4 216.5 216.6 216.7 216.8 216.9 216.10 216.11 216.12 216.13 216.14 216.15 216.16 216.17 216.18 216.19 216.20 216.21 216.22 216.23 216.24 216.25 216.26 216.27 216.28 216.29 216.30 216.31 217.1 217.2 217.3 217.4 217.5 217.6 217.7 217.8 217.9 217.10 217.11 217.12 217.13 217.14 217.15 217.16 217.17 217.18 217.19 217.20 217.21 217.22 217.23 217.24 217.25 217.26 217.27 217.28
217.29
217.30 217.31 217.32 217.33
218.1 218.2 218.3 218.4 218.5 218.6
218.7 218.8 218.9 218.10 218.11 218.12 218.13 218.14 218.15 218.16 218.17 218.18 218.19 218.20 218.21 218.22 218.23 218.24 218.25 218.26
218.27 218.28 218.29 218.30
218.31 218.32 218.33
219.1 219.2 219.3 219.4 219.5 219.6 219.7 219.8 219.9 219.10 219.11 219.12 219.13 219.14 219.15 219.16 219.17 219.18 219.19 219.20 219.21 219.22 219.23 219.24 219.25 219.26 219.27 219.28 219.29 219.30 219.31 220.1 220.2 220.3 220.4 220.5 220.6 220.7 220.8 220.9 220.10 220.11 220.12 220.13 220.14 220.15 220.16 220.17 220.18 220.19 220.20 220.21 220.22 220.23 220.24 220.25 220.26 220.27 220.28 220.29 220.30 220.31 221.1 221.2 221.3 221.4 221.5 221.6 221.7 221.8 221.9 221.10 221.11 221.12 221.13 221.14 221.15 221.16 221.17 221.18 221.19 221.20 221.21 221.22 221.23 221.24 221.25 221.26 221.27 221.28 221.29 221.30 221.31 221.32 221.33 222.1 222.2 222.3 222.4 222.5 222.6
222.7 222.8 222.9 222.10 222.11 222.12 222.13 222.14 222.15 222.16 222.17 222.18 222.19
222.20 222.21 222.22 222.23 222.24 222.25 222.26 222.27 222.28 222.29 222.30 222.31 223.1 223.2 223.3 223.4 223.5 223.6 223.7 223.8 223.9 223.10 223.11 223.12 223.13 223.14 223.15 223.16 223.17 223.18 223.19 223.20 223.21 223.22 223.23 223.24 223.25 223.26 223.27 223.28 223.29 223.30 223.31 223.32 223.33 224.1 224.2 224.3 224.4 224.5 224.6 224.7 224.8 224.9 224.10 224.11 224.12 224.13 224.14 224.15 224.16 224.17 224.18 224.19 224.20 224.21 224.22 224.23 224.24 224.25 224.26 224.27 224.28 224.29 224.30 224.31 224.32 224.33 225.1 225.2 225.3 225.4 225.5 225.6 225.7 225.8 225.9 225.10 225.11 225.12 225.13 225.14 225.15 225.16 225.17 225.18 225.19 225.20 225.21 225.22 225.23 225.24 225.25 225.26 225.27 225.28 225.29 225.30 225.31 225.32 225.33 226.1 226.2 226.3 226.4 226.5 226.6 226.7 226.8 226.9 226.10 226.11 226.12 226.13 226.14 226.15 226.16 226.17 226.18 226.19 226.20
226.21 226.22 226.23 226.24 226.25 226.26 226.27 226.28 226.29 226.30 226.31 226.32 226.33 227.1 227.2 227.3 227.4 227.5 227.6 227.7 227.8 227.9 227.10 227.11 227.12 227.13 227.14 227.15 227.16 227.17 227.18 227.19 227.20 227.21 227.22 227.23 227.24 227.25 227.26 227.27 227.28 227.29 227.30 227.31 228.1 228.2 228.3 228.4 228.5 228.6 228.7 228.8 228.9 228.10 228.11 228.12 228.13 228.14 228.15 228.16 228.17 228.18 228.19 228.20 228.21 228.22 228.23 228.24 228.25 228.26 228.27 228.28 228.29 228.30 228.31 228.32 228.33 228.34 228.35 229.1 229.2 229.3 229.4 229.5 229.6 229.7 229.8 229.9 229.10 229.11 229.12
229.13 229.14 229.15 229.16 229.17 229.18 229.19 229.20 229.21 229.22 229.23 229.24 229.25 229.26 229.27 229.28 229.29 229.30 229.31 230.1 230.2
230.3 230.4 230.5 230.6 230.7 230.8 230.9 230.10 230.11 230.12 230.13 230.14 230.15 230.16 230.17 230.18 230.19 230.20 230.21 230.22 230.23 230.24 230.25 230.26 230.27 230.28 230.29 230.30 230.31 231.1 231.2 231.3 231.4 231.5 231.6 231.7 231.8 231.9 231.10 231.11 231.12 231.13 231.14 231.15 231.16 231.17 231.18 231.19 231.20 231.21 231.22 231.23 231.24 231.25 231.26 231.27 231.28 231.29 231.30 231.31 231.32 231.33
232.1 232.2 232.3 232.4 232.5 232.6 232.7 232.8 232.9 232.10 232.11 232.12 232.13 232.14 232.15 232.16 232.17 232.18 232.19 232.20 232.21 232.22 232.23 232.24 232.25 232.26 232.27 232.28 232.29 232.30 232.31 232.32 233.1 233.2 233.3 233.4 233.5 233.6 233.7 233.8 233.9 233.10 233.11 233.12 233.13 233.14 233.15 233.16 233.17 233.18 233.19 233.20 233.21 233.22 233.23 233.24 233.25 233.26 233.27 233.28 233.29 233.30 233.31 233.32 233.33 233.34 234.1 234.2 234.3 234.4 234.5 234.6 234.7 234.8 234.9 234.10 234.11 234.12 234.13 234.14 234.15 234.16 234.17 234.18 234.19 234.20 234.21
234.22 234.23 234.24 234.25 234.26 234.27 234.28 234.29 234.30 234.31 235.1 235.2 235.3 235.4 235.5 235.6 235.7 235.8 235.9 235.10 235.11 235.12 235.13 235.14 235.15 235.16 235.17 235.18 235.19 235.20 235.21 235.22 235.23 235.24 235.25 235.26 235.27 235.28 235.29 235.30 235.31 235.32 236.1 236.2 236.3 236.4 236.5 236.6 236.7 236.8 236.9 236.10 236.11 236.12 236.13 236.14 236.15
236.16 236.17 236.18 236.19 236.20 236.21 236.22 236.23 236.24
236.25 236.26 236.27 236.28 236.29 236.30 236.31 237.1 237.2 237.3 237.4 237.5 237.6 237.7 237.8 237.9 237.10 237.11 237.12 237.13 237.14 237.15 237.16 237.17 237.18 237.19 237.20 237.21 237.22 237.23 237.24 237.25 237.26 237.27 237.28 237.29 237.30 237.31 237.32 237.33 238.1 238.2 238.3 238.4 238.5 238.6 238.7 238.8 238.9 238.10 238.11 238.12 238.13 238.14 238.15 238.16 238.17 238.18 238.19 238.20
238.21 238.22 238.23 238.24 238.25 238.26 238.27 238.28 238.29 238.30 238.31 239.1 239.2 239.3 239.4 239.5 239.6 239.7 239.8 239.9 239.10 239.11 239.12 239.13 239.14 239.15 239.16 239.17 239.18 239.19 239.20 239.21 239.22 239.23 239.24 239.25 239.26 239.27 239.28 239.29 239.30 239.31 239.32 239.33 239.34 240.1 240.2 240.3 240.4 240.5 240.6
240.7 240.8 240.9 240.10 240.11 240.12 240.13 240.14 240.15 240.16 240.17 240.18 240.19 240.20 240.21 240.22 240.23 240.24 240.25 240.26 240.27 240.28 240.29 240.30 240.31 240.32 241.1 241.2 241.3 241.4 241.5 241.6 241.7 241.8 241.9 241.10 241.11 241.12 241.13 241.14 241.15 241.16 241.17 241.18 241.19 241.20 241.21 241.22 241.23 241.24 241.25 241.26 241.27 241.28 241.29 241.30 241.31 241.32 241.33 242.1 242.2 242.3 242.4 242.5 242.6 242.7 242.8 242.9 242.10 242.11 242.12 242.13 242.14 242.15 242.16 242.17 242.18 242.19 242.20 242.21 242.22 242.23 242.24 242.25 242.26 242.27 242.28 242.29 242.30 242.31 242.32 242.33 242.34 243.1 243.2 243.3 243.4 243.5 243.6 243.7 243.8 243.9 243.10 243.11 243.12 243.13 243.14 243.15 243.16 243.17 243.18 243.19 243.20 243.21 243.22 243.23 243.24 243.25 243.26
243.27 243.28 243.29 243.30 243.31 243.32 244.1 244.2 244.3 244.4 244.5 244.6 244.7 244.8 244.9 244.10 244.11 244.12 244.13 244.14 244.15 244.16 244.17 244.18 244.19 244.20 244.21 244.22 244.23 244.24 244.25 244.26 244.27 244.28 244.29 244.30 244.31 245.1 245.2 245.3 245.4 245.5 245.6 245.7 245.8 245.9 245.10 245.11 245.12 245.13 245.14 245.15 245.16 245.17 245.18 245.19 245.20 245.21 245.22 245.23 245.24 245.25 245.26 245.27 245.28 245.29 245.30
245.31 245.32 245.33 246.1 246.2 246.3 246.4 246.5 246.6 246.7 246.8 246.9 246.10 246.11 246.12 246.13 246.14 246.15 246.16 246.17 246.18 246.19 246.20 246.21 246.22 246.23 246.24 246.25 246.26 246.27 246.28 246.29 246.30 246.31 246.32 247.1 247.2 247.3 247.4 247.5 247.6 247.7 247.8 247.9 247.10 247.11 247.12 247.13 247.14 247.15 247.16 247.17 247.18 247.19 247.20 247.21 247.22 247.23 247.24 247.25 247.26 247.27 247.28 247.29 247.30 247.31 247.32 247.33 248.1 248.2 248.3 248.4 248.5 248.6
248.7 248.8 248.9 248.10 248.11 248.12 248.13 248.14 248.15 248.16 248.17 248.18 248.19 248.20 248.21 248.22 248.23 248.24 248.25 248.26
248.27 248.28 248.29 248.30 248.31 248.32 249.1 249.2 249.3 249.4
249.5 249.6 249.7 249.8 249.9 249.10 249.11 249.12 249.13 249.14 249.15 249.16 249.17 249.18 249.19 249.20 249.21 249.22 249.23
249.24 249.25 249.26 249.27 249.28 249.29 249.30 249.31 250.1 250.2 250.3 250.4 250.5 250.6 250.7 250.8 250.9 250.10 250.11 250.12 250.13 250.14 250.15 250.16 250.17 250.18 250.19 250.20 250.21 250.22 250.23 250.24 250.25 250.26 250.27 250.28 250.29 250.30 251.1 251.2 251.3 251.4 251.5 251.6 251.7 251.8 251.9 251.10 251.11 251.12 251.13 251.14 251.15 251.16 251.17 251.18 251.19 251.20 251.21 251.22 251.23 251.24 251.25 251.26 251.27 251.28 251.29 251.30 252.1 252.2 252.3 252.4 252.5 252.6 252.7 252.8 252.9 252.10 252.11 252.12 252.13 252.14
252.15 252.16 252.17 252.18 252.19
252.20 252.21 252.22
252.23 252.24
252.25 252.26 252.27 252.28 252.29 252.30 252.31 253.1 253.2 253.3 253.4
253.5
253.6 253.7 253.8 253.9 253.10 253.11 253.12 253.13 253.14 253.15 253.16 253.17 253.18 253.19 253.20 253.21 253.22 253.23 253.24 253.25 253.26 253.27 253.28 253.29 253.30 253.31 253.32 253.33 254.1 254.2 254.3 254.4 254.5 254.6 254.7 254.8 254.9 254.10 254.11 254.12 254.13 254.14 254.15 254.16 254.17 254.18 254.19 254.20 254.21 254.22 254.23 254.24 254.25 254.26 254.27 254.28 254.29 254.30 254.31 254.32 254.33 254.34 255.1 255.2 255.3 255.4 255.5 255.6 255.7 255.8 255.9 255.10 255.11 255.12 255.13 255.14 255.15 255.16 255.17 255.18 255.19 255.20 255.21 255.22 255.23 255.24 255.25 255.26 255.27 255.28 255.29 255.30 255.31 255.32 255.33 256.1 256.2
256.3 256.4 256.5 256.6 256.7 256.8 256.9 256.10 256.11 256.12 256.13 256.14 256.15 256.16 256.17 256.18 256.19 256.20 256.21 256.22 256.23 256.24 256.25 256.26 256.27
256.28 256.29 256.30 256.31 256.32 256.33 257.1 257.2 257.3 257.4 257.5 257.6 257.7
257.8
257.9 257.10 257.11 257.12 257.13 257.14 257.15
257.16
257.17 257.18 257.19 257.20 257.21 257.22 257.23 257.24 257.25 257.26 257.27 257.28 257.29 257.30 257.31 258.1 258.2 258.3 258.4
258.5
258.6 258.7 258.8 258.9 258.10
258.11
258.12 258.13 258.14 258.15 258.16 258.17 258.18 258.19 258.20 258.21 258.22 258.23 258.24 258.25 258.26 258.27 258.28 258.29 258.30 258.31
259.1
259.2 259.3 259.4 259.5 259.6 259.7 259.8 259.9 259.10 259.11 259.12 259.13 259.14 259.15 259.16 259.17 259.18 259.19 259.20
259.21
259.22 259.23 259.24 259.25 259.26 259.27 259.28 259.29 259.30 260.1 260.2 260.3 260.4 260.5 260.6 260.7 260.8 260.9
260.10
260.11 260.12 260.13 260.14
260.15 260.16 260.17 260.18 260.19 260.20 260.21 260.22 260.23 260.24 260.25 260.26 260.27 260.28 260.29 260.30 260.31 261.1 261.2 261.3 261.4 261.5 261.6 261.7 261.8 261.9 261.10 261.11 261.12 261.13 261.14 261.15 261.16 261.17 261.18 261.19 261.20 261.21 261.22 261.23 261.24 261.25 261.26 261.27 261.28 261.29 261.30 261.31 261.32 262.1 262.2
262.3 262.4 262.5 262.6 262.7 262.8 262.9 262.10 262.11 262.12 262.13 262.14 262.15 262.16 262.17 262.18 262.19 262.20 262.21 262.22 262.23 262.24 262.25 262.26 262.27 262.28 262.29 262.30 262.31 262.32
263.1
263.2 263.3 263.4 263.5 263.6 263.7 263.8 263.9 263.10 263.11 263.12 263.13 263.14 263.15 263.16 263.17 263.18 263.19 263.20
263.21
263.22 263.23 263.24 263.25 263.26 263.27 263.28 263.29 263.30 264.1 264.2 264.3
264.4 264.5 264.6 264.7 264.8 264.9 264.10 264.11 264.12 264.13 264.14
264.15
264.16 264.17 264.18 264.19 264.20 264.21 264.22 264.23 264.24 264.25 264.26 264.27 264.28 264.29 264.30 264.31 264.32
265.1 265.2 265.3 265.4 265.5 265.6 265.7 265.8 265.9 265.10 265.11 265.12 265.13
265.14 265.15 265.16 265.17 265.18 265.19 265.20 265.21
265.22 265.23 265.24 265.25 265.26 265.27 265.28 265.29 265.30 265.31 265.32 265.33 266.1 266.2 266.3 266.4 266.5 266.6 266.7 266.8 266.9 266.10 266.11 266.12 266.13 266.14 266.15 266.16 266.17 266.18 266.19 266.20 266.21 266.22 266.23 266.24 266.25 266.26 266.27 266.28 266.29 266.30 266.31 266.32 267.1 267.2 267.3 267.4 267.5 267.6
267.7 267.8 267.9 267.10 267.11 267.12 267.13 267.14 267.15 267.16 267.17 267.18 267.19 267.20 267.21 267.22 267.23 267.24 267.25 267.26 267.27 267.28 267.29 267.30 267.31 268.1 268.2 268.3 268.4 268.5 268.6 268.7 268.8 268.9 268.10 268.11 268.12 268.13 268.14 268.15 268.16 268.17 268.18 268.19 268.20 268.21 268.22 268.23 268.24 268.25 268.26 268.27 268.28 268.29 268.30 268.31 269.1 269.2 269.3 269.4 269.5 269.6 269.7 269.8 269.9 269.10 269.11 269.12 269.13 269.14 269.15 269.16
269.17 269.18 269.19 269.20 269.21 269.22 269.23 269.24 269.25 269.26 269.27 269.28 269.29 269.30 269.31 270.1 270.2 270.3 270.4 270.5 270.6
270.7 270.8 270.9 270.10 270.11 270.12 270.13 270.14 270.15 270.16 270.17 270.18 270.19 270.20 270.21
270.22 270.23 270.24 270.25 270.26 270.27 270.28 270.29 270.30 271.1 271.2 271.3 271.4 271.5 271.6 271.7 271.8 271.9 271.10 271.11 271.12
271.13 271.14 271.15 271.16 271.17 271.18 271.19 271.20 271.21 271.22 271.23 271.24 271.25 271.26 271.27 271.28 271.29
271.30 271.31 271.32 272.1 272.2 272.3 272.4 272.5 272.6 272.7 272.8 272.9 272.10 272.11
272.12 272.13 272.14 272.15 272.16 272.17
272.18 272.19 272.20 272.21 272.22 272.23 272.24 272.25 272.26 272.27 272.28 272.29 272.30 272.31 272.32 273.1 273.2 273.3 273.4 273.5 273.6 273.7 273.8 273.9 273.10 273.11 273.12 273.13 273.14 273.15 273.16 273.17 273.18 273.19 273.20 273.21 273.22 273.23
273.24 273.25 273.26 273.27 273.28 273.29 273.30 273.31 273.32 274.1 274.2 274.3 274.4 274.5 274.6 274.7 274.8 274.9 274.10 274.11 274.12 274.13 274.14 274.15 274.16 274.17 274.18 274.19 274.20 274.21 274.22 274.23 274.24 274.25 274.26 274.27 274.28 274.29 274.30 274.31 274.32 274.33 274.34 275.1 275.2 275.3 275.4
275.5 275.6 275.7 275.8 275.9
275.10
275.11 275.12 275.13 275.14 275.15 275.16 275.17 275.18 275.19
275.20
275.21 275.22 275.23 275.24 275.25 275.26 275.27 275.28 276.1 276.2 276.3 276.4 276.5 276.6 276.7 276.8 276.9 276.10 276.11 276.12 276.13 276.14
276.15
276.16 276.17 276.18 276.19 276.20 276.21 276.22 276.23 276.24 276.25 276.26 276.27 276.28 276.29 276.30 277.1 277.2 277.3 277.4 277.5 277.6 277.7 277.8 277.9 277.10 277.11 277.12 277.13
277.14
277.15 277.16 277.17 277.18 277.19 277.20 277.21 277.22 277.23 277.24 277.25 277.26 277.27 277.28 277.29 277.30 278.1 278.2 278.3 278.4 278.5 278.6 278.7 278.8 278.9 278.10 278.11 278.12 278.13 278.14 278.15 278.16 278.17
278.18
278.19 278.20 278.21 278.22 278.23 278.24 278.25 278.26 278.27 278.28 278.29 278.30 279.1 279.2 279.3 279.4 279.5 279.6
279.7 279.8 279.9 279.10 279.11 279.12 279.13 279.14 279.15 279.16 279.17 279.18 279.19 279.20 279.21 279.22 279.23 279.24
279.25 279.26 279.27 279.28 279.29 279.30 279.31 280.1 280.2 280.3 280.4 280.5 280.6 280.7 280.8 280.9
280.10 280.11 280.12 280.13
280.14 280.15 280.16 280.17
280.18 280.19 280.20 280.21 280.22 280.23
280.24 280.25 280.26 280.27 280.28 280.29 280.30 280.31 281.1 281.2 281.3 281.4
281.5 281.6 281.7 281.8
281.9 281.10 281.11 281.12 281.13 281.14 281.15 281.16 281.17 281.18 281.19 281.20
281.21 281.22 281.23 281.24 281.25 281.26 281.27 281.28 281.29 281.30 281.31 281.32 282.1 282.2 282.3 282.4 282.5
282.6 282.7 282.8 282.9 282.10 282.11 282.12 282.13 282.14 282.15 282.16 282.17
282.18 282.19 282.20 282.21 282.22 282.23 282.24
282.25 282.26 282.27 282.28 282.29 282.30 282.31 283.1 283.2 283.3 283.4 283.5 283.6
283.7 283.8 283.9 283.10 283.11 283.12 283.13 283.14 283.15 283.16 283.17 283.18
283.19 283.20 283.21 283.22 283.23 283.24 283.25 283.26 283.27 283.28 283.29 283.30 283.31 283.32 283.33 284.1 284.2 284.3 284.4 284.5 284.6 284.7 284.8 284.9 284.10 284.11 284.12 284.13 284.14 284.15 284.16 284.17 284.18 284.19 284.20 284.21 284.22 284.23 284.24 284.25 284.26 284.27 284.28 284.29 284.30 284.31 284.32 284.33 285.1 285.2 285.3 285.4 285.5 285.6 285.7 285.8 285.9 285.10 285.11 285.12 285.13 285.14 285.15 285.16 285.17 285.18 285.19 285.20 285.21 285.22 285.23 285.24 285.25 285.26 285.27 285.28 285.29 285.30 285.31 285.32 285.33 286.1 286.2 286.3 286.4 286.5 286.6 286.7 286.8 286.9 286.10 286.11 286.12 286.13 286.14 286.15 286.16 286.17 286.18 286.19 286.20 286.21 286.22 286.23 286.24 286.25 286.26 286.27 286.28 286.29 286.30 286.31 287.1 287.2 287.3 287.4 287.5 287.6 287.7 287.8 287.9 287.10 287.11 287.12 287.13 287.14 287.15 287.16 287.17 287.18 287.19 287.20 287.21 287.22 287.23 287.24 287.25 287.26 287.27 287.28 287.29 287.30 287.31 288.1 288.2 288.3 288.4 288.5 288.6 288.7 288.8 288.9 288.10 288.11 288.12 288.13 288.14 288.15 288.16 288.17 288.18 288.19 288.20 288.21 288.22 288.23 288.24 288.25
288.26 288.27 288.28 288.29 288.30 288.31 288.32 288.33 289.1 289.2 289.3 289.4 289.5 289.6 289.7 289.8 289.9 289.10 289.11 289.12 289.13 289.14 289.15 289.16 289.17 289.18 289.19 289.20 289.21 289.22 289.23 289.24 289.25 289.26 289.27 289.28 289.29 289.30 289.31 290.1 290.2 290.3 290.4 290.5 290.6 290.7 290.8 290.9 290.10 290.11 290.12 290.13 290.14 290.15
290.16 290.17 290.18 290.19 290.20 290.21 290.22 290.23 290.24 290.25 290.26 290.27 290.28 290.29 290.30 290.31 290.32 290.33 290.34 291.1 291.2 291.3
291.4 291.5 291.6 291.7 291.8 291.9
291.10 291.11 291.12 291.13 291.14 291.15 291.16 291.17 291.18 291.19 291.20 291.21 291.22 291.23 291.24 291.25 291.26 291.27 291.28 291.29 291.30 292.1 292.2 292.3 292.4 292.5 292.6 292.7 292.8 292.9 292.10 292.11 292.12 292.13 292.14 292.15 292.16 292.17 292.18
292.19 292.20 292.21 292.22 292.23 292.24 292.25 292.26 292.27 292.28 292.29 292.30 292.31 292.32 293.1 293.2 293.3 293.4 293.5 293.6 293.7 293.8 293.9 293.10 293.11 293.12 293.13 293.14 293.15 293.16 293.17 293.18 293.19 293.20 293.21 293.22 293.23 293.24 293.25
293.26 293.27 293.28 293.29 293.30 293.31 293.32 294.1 294.2 294.3 294.4 294.5 294.6 294.7 294.8 294.9 294.10 294.11 294.12 294.13 294.14 294.15 294.16 294.17 294.18 294.19 294.20 294.21 294.22 294.23 294.24 294.25 294.26 294.27 294.28 294.29 294.30 295.1 295.2 295.3 295.4 295.5 295.6 295.7 295.8 295.9 295.10 295.11 295.12 295.13 295.14 295.15 295.16 295.17 295.18 295.19 295.20 295.21 295.22 295.23 295.24 295.25 295.26 295.27
295.28 295.29 295.30 295.31 296.1 296.2 296.3 296.4 296.5 296.6 296.7 296.8 296.9 296.10 296.11 296.12 296.13 296.14 296.15 296.16 296.17 296.18 296.19 296.20 296.21 296.22 296.23 296.24 296.25 296.26 296.27 296.28 296.29 296.30 296.31 296.32 296.33 297.1 297.2 297.3 297.4 297.5 297.6 297.7 297.8 297.9 297.10 297.11 297.12
297.13 297.14 297.15 297.16 297.17 297.18 297.19 297.20 297.21 297.22 297.23 297.24 297.25 297.26 297.27 297.28 297.29 297.30 297.31 297.32 297.33 298.1 298.2 298.3 298.4
298.5 298.6 298.7 298.8 298.9 298.10 298.11 298.12 298.13 298.14 298.15 298.16 298.17 298.18 298.19 298.20 298.21 298.22 298.23 298.24 298.25 298.26 298.27
298.28 298.29 298.30 298.31 299.1 299.2 299.3 299.4 299.5 299.6 299.7 299.8 299.9 299.10
299.11 299.12 299.13 299.14 299.15 299.16 299.17 299.18 299.19 299.20 299.21 299.22 299.23 299.24
299.25 299.26 299.27 299.28 299.29 299.30 299.31 299.32 299.33 300.1 300.2 300.3 300.4 300.5 300.6 300.7 300.8 300.9
300.10 300.11 300.12 300.13 300.14 300.15
300.16 300.17 300.18
300.19 300.20
300.21 300.22
300.23 300.24 300.25 300.26 300.27 300.28 300.29 301.1 301.2 301.3 301.4 301.5 301.6 301.7 301.8 301.9 301.10 301.11 301.12 301.13 301.14 301.15 301.16 301.17 301.18 301.19 301.20 301.21 301.22 301.23 301.24 301.25 301.26 301.27 301.28 301.29 301.30 301.31 301.32 301.33 301.34 301.35 302.1 302.2 302.3 302.4 302.5 302.6 302.7 302.8 302.9 302.10
302.11
302.12 302.13 302.14 302.15 302.16 302.17 302.18 302.19 302.20 302.21 302.22 302.23 302.24 302.25 302.26 302.27 302.28 302.29 302.30 302.31 302.32 302.33 303.1 303.2 303.3 303.4 303.5 303.6 303.7 303.8 303.9 303.10 303.11 303.12 303.13 303.14 303.15 303.16 303.17 303.18 303.19
303.20
303.21 303.22 303.23 303.24 303.25 303.26 303.27 303.28 303.29 303.30 303.31 303.32 304.1 304.2 304.3 304.4 304.5 304.6 304.7 304.8 304.9 304.10 304.11 304.12 304.13 304.14 304.15 304.16 304.17 304.18 304.19 304.20 304.21 304.22 304.23 304.24 304.25 304.26 304.27 304.28 304.29 304.30 304.31 305.1 305.2 305.3 305.4 305.5 305.6 305.7 305.8 305.9 305.10 305.11 305.12 305.13 305.14
305.15 305.16
305.17 305.18 305.19 305.20 305.21 305.22 305.23 305.24 305.25 305.26 305.27 305.28 305.29 305.30 305.31 305.32
306.1
306.2 306.3 306.4 306.5 306.6 306.7 306.8
306.9 306.10
306.11 306.12 306.13 306.14 306.15 306.16 306.17 306.18 306.19 306.20 306.21 306.22 306.23 306.24 306.25 306.26 306.27 306.28 306.29 306.30 306.31
306.32
307.1 307.2 307.3 307.4 307.5 307.6 307.7 307.8 307.9 307.10 307.11 307.12 307.13 307.14
307.15
307.16 307.17 307.18 307.19 307.20 307.21 307.22 307.23 307.24 307.25 307.26 307.27 307.28 307.29 307.30 307.31 307.32 307.33 308.1 308.2 308.3 308.4 308.5 308.6 308.7 308.8 308.9 308.10 308.11 308.12 308.13 308.14 308.15 308.16 308.17 308.18 308.19 308.20 308.21 308.22 308.23 308.24 308.25 308.26 308.27 308.28 308.29 308.30 308.31 308.32 308.33 308.34 309.1 309.2 309.3 309.4 309.5 309.6 309.7 309.8 309.9 309.10 309.11 309.12 309.13 309.14 309.15 309.16 309.17 309.18 309.19 309.20
309.21
309.22 309.23 309.24 309.25 309.26 309.27
309.28
310.1 310.2 310.3 310.4 310.5
310.6
310.7 310.8 310.9 310.10 310.11
310.12
310.13 310.14 310.15 310.16 310.17
310.18
310.19 310.20 310.21 310.22 310.23 310.24 310.25 310.26 310.27
310.28
311.1 311.2 311.3 311.4 311.5
311.6
311.7 311.8 311.9 311.10 311.11
311.12
311.13 311.14 311.15 311.16 311.17 311.18 311.19 311.20 311.21 311.22
311.23
311.24 311.25 311.26 311.27 311.28 311.29 312.1 312.2 312.3 312.4 312.5 312.6 312.7 312.8 312.9 312.10 312.11 312.12 312.13 312.14 312.15 312.16 312.17 312.18 312.19 312.20 312.21 312.22 312.23 312.24 312.25 312.26 312.27 312.28 312.29 312.30 312.31 312.32 313.1 313.2 313.3 313.4 313.5 313.6 313.7 313.8 313.9 313.10 313.11 313.12 313.13 313.14 313.15 313.16 313.17 313.18 313.19 313.20 313.21 313.22 313.23 313.24 313.25 313.26 313.27 313.28 313.29 313.30 313.31 314.1 314.2 314.3 314.4 314.5 314.6 314.7 314.8 314.9 314.10 314.11 314.12 314.13 314.14 314.15 314.16 314.17 314.18 314.19 314.20 314.21 314.22 314.23 314.24 314.25 314.26 314.27 314.28 314.29 314.30 315.1 315.2 315.3 315.4 315.5 315.6 315.7 315.8 315.9 315.10 315.11 315.12 315.13 315.14 315.15 315.16 315.17 315.18 315.19 315.20 315.21 315.22 315.23 315.24 315.25 315.26 315.27 315.28 315.29 315.30 315.31 315.32 316.1 316.2 316.3 316.4 316.5 316.6 316.7 316.8 316.9 316.10 316.11 316.12 316.13 316.14 316.15 316.16 316.17 316.18 316.19 316.20 316.21 316.22 316.23 316.24 316.25 316.26 316.27 316.28 316.29 316.30 316.31 316.32 317.1 317.2 317.3 317.4 317.5 317.6 317.7 317.8 317.9 317.10 317.11 317.12 317.13 317.14 317.15 317.16 317.17 317.18 317.19 317.20 317.21 317.22 317.23 317.24 317.25 317.26 317.27 317.28 317.29 317.30 317.31 317.32 318.1 318.2 318.3 318.4 318.5 318.6 318.7 318.8 318.9 318.10 318.11 318.12 318.13 318.14 318.15 318.16 318.17 318.18 318.19 318.20 318.21 318.22 318.23 318.24 318.25 318.26 318.27 318.28 318.29 318.30 318.31 319.1 319.2 319.3 319.4 319.5 319.6 319.7 319.8 319.9 319.10 319.11 319.12 319.13 319.14 319.15 319.16 319.17 319.18 319.19 319.20 319.21 319.22 319.23 319.24 319.25 319.26 319.27 319.28 319.29 319.30 319.31 319.32 319.33 320.1 320.2 320.3 320.4 320.5 320.6 320.7 320.8 320.9 320.10 320.11 320.12 320.13 320.14 320.15 320.16 320.17 320.18 320.19 320.20 320.21 320.22 320.23 320.24 320.25 320.26 320.27 320.28 320.29 320.30 320.31 320.32 320.33 321.1 321.2 321.3 321.4 321.5 321.6 321.7 321.8 321.9 321.10 321.11 321.12 321.13 321.14 321.15 321.16 321.17 321.18 321.19 321.20 321.21 321.22 321.23 321.24 321.25 321.26 321.27 321.28 321.29
321.30
322.1 322.2 322.3 322.4 322.5 322.6 322.7 322.8 322.9 322.10 322.11 322.12 322.13 322.14 322.15 322.16 322.17 322.18 322.19 322.20 322.21 322.22 322.23 322.24 322.25 322.26 322.27 322.28 322.29 322.30 322.31 322.32 322.33 323.1 323.2 323.3 323.4 323.5 323.6 323.7 323.8 323.9 323.10 323.11 323.12 323.13 323.14 323.15 323.16 323.17 323.18 323.19 323.20 323.21 323.22 323.23 323.24 323.25 323.26 323.27 323.28 323.29 324.1 324.2 324.3 324.4 324.5 324.6 324.7 324.8 324.9 324.10 324.11 324.12 324.13 324.14 324.15 324.16 324.17 324.18 324.19 324.20 324.21 324.22 324.23
324.24
324.25 324.26 324.27 324.28 324.29 324.30 324.31 324.32 324.33 325.1 325.2 325.3 325.4 325.5 325.6 325.7 325.8 325.9 325.10 325.11 325.12 325.13 325.14 325.15 325.16 325.17 325.18 325.19 325.20 325.21 325.22 325.23 325.24 325.25 325.26 325.27 325.28 325.29 325.30 325.31 325.32
325.33
326.1 326.2 326.3 326.4 326.5 326.6 326.7 326.8 326.9 326.10 326.11 326.12 326.13 326.14 326.15 326.16 326.17
326.18 326.19 326.20 326.21 326.22 326.23 326.24 326.25 326.26 326.27 326.28 326.29 326.30
326.31
327.1 327.2 327.3 327.4 327.5 327.6 327.7 327.8 327.9 327.10 327.11 327.12 327.13 327.14 327.15 327.16 327.17 327.18 327.19 327.20 327.21 327.22 327.23 327.24 327.25 327.26 327.27 327.28 327.29 327.30 327.31 327.32 327.33 327.34 327.35 328.1 328.2 328.3 328.4 328.5 328.6 328.7 328.8 328.9 328.10 328.11 328.12 328.13 328.14 328.15 328.16 328.17 328.18 328.19 328.20 328.21 328.22 328.23 328.24 328.25 328.26 328.27 328.28 328.29 328.30 328.31 328.32 328.33 329.1 329.2 329.3 329.4 329.5 329.6 329.7 329.8 329.9 329.10 329.11 329.12 329.13
329.14
329.15 329.16 329.17 329.18 329.19 329.20 329.21 329.22 329.23 329.24 329.25 329.26 329.27 329.28 329.29 329.30 329.31 329.32 329.33 330.1 330.2 330.3 330.4 330.5 330.6 330.7 330.8 330.9 330.10 330.11 330.12 330.13 330.14 330.15 330.16 330.17 330.18 330.19 330.20 330.21 330.22 330.23 330.24 330.25 330.26 330.27 330.28 330.29 330.30 330.31 330.32 330.33 330.34 331.1 331.2 331.3 331.4 331.5 331.6 331.7 331.8
331.9
331.10 331.11 331.12 331.13 331.14 331.15 331.16 331.17 331.18 331.19 331.20 331.21 331.22 331.23 331.24 331.25 331.26 331.27 331.28 331.29 331.30 331.31 331.32 331.33 332.1 332.2 332.3 332.4 332.5
332.6
332.7 332.8 332.9 332.10 332.11 332.12 332.13 332.14 332.15 332.16 332.17 332.18 332.19 332.20 332.21 332.22 332.23 332.24 332.25 332.26 332.27 332.28 332.29 332.30 332.31 332.32
333.1
333.2 333.3 333.4 333.5 333.6 333.7 333.8 333.9 333.10 333.11 333.12 333.13 333.14 333.15 333.16 333.17 333.18 333.19 333.20 333.21 333.22 333.23 333.24 333.25 333.26 333.27 333.28 333.29 333.30 333.31 333.32
334.1 334.2 334.3 334.4 334.5 334.6 334.7 334.8 334.9 334.10 334.11 334.12 334.13 334.14 334.15 334.16 334.17 334.18 334.19 334.20 334.21 334.22 334.23 334.24 334.25 334.26 334.27 334.28 334.29 334.30 335.1 335.2 335.3 335.4 335.5 335.6 335.7 335.8 335.9 335.10 335.11 335.12 335.13 335.14 335.15 335.16 335.17 335.18 335.19 335.20 335.21 335.22 335.23 335.24 335.25 335.26 335.27 335.28 335.29 335.30 335.31 335.32 335.33 335.34 336.1 336.2 336.3 336.4 336.5 336.6 336.7 336.8 336.9 336.10 336.11 336.12 336.13 336.14 336.15 336.16 336.17 336.18 336.19 336.20 336.21 336.22 336.23 336.24 336.25 336.26 336.27 336.28 336.29 336.30 336.31 337.1 337.2 337.3 337.4 337.5 337.6 337.7 337.8 337.9 337.10 337.11 337.12 337.13 337.14
337.15
337.16 337.17 337.18 337.19 337.20 337.21 337.22 337.23 337.24 337.25 337.26 337.27 337.28 337.29 337.30 337.31 337.32 338.1 338.2 338.3 338.4 338.5 338.6 338.7 338.8 338.9 338.10 338.11 338.12 338.13 338.14 338.15 338.16 338.17 338.18 338.19 338.20 338.21 338.22 338.23 338.24 338.25 338.26 338.27 338.28 338.29 338.30 338.31 338.32 338.33 338.34 339.1 339.2 339.3 339.4 339.5 339.6 339.7 339.8 339.9 339.10 339.11 339.12 339.13 339.14 339.15 339.16 339.17 339.18 339.19 339.20 339.21 339.22 339.23 339.24
339.25
339.26 339.27 339.28 339.29 339.30 339.31 339.32 340.1 340.2 340.3 340.4 340.5 340.6 340.7 340.8 340.9 340.10 340.11 340.12 340.13 340.14 340.15 340.16 340.17 340.18 340.19 340.20 340.21 340.22 340.23 340.24 340.25 340.26 340.27 340.28 340.29 340.30 340.31 340.32 341.1 341.2 341.3 341.4 341.5 341.6 341.7 341.8 341.9 341.10 341.11 341.12 341.13 341.14 341.15 341.16 341.17 341.18 341.19 341.20 341.21 341.22
341.23
341.24 341.25 341.26 341.27 341.28 341.29 341.30 342.1 342.2 342.3 342.4 342.5 342.6 342.7 342.8 342.9 342.10 342.11 342.12 342.13 342.14 342.15 342.16 342.17 342.18 342.19 342.20 342.21 342.22 342.23 342.24 342.25 342.26 342.27 342.28 342.29 342.30 342.31 342.32 342.33 343.1 343.2 343.3 343.4 343.5 343.6 343.7 343.8 343.9 343.10
343.11
343.12 343.13 343.14 343.15 343.16 343.17 343.18 343.19 343.20 343.21 343.22 343.23 343.24 343.25 343.26 343.27 343.28 343.29 343.30 343.31 344.1 344.2 344.3 344.4 344.5 344.6 344.7 344.8 344.9 344.10 344.11 344.12 344.13 344.14 344.15 344.16 344.17 344.18 344.19 344.20 344.21 344.22 344.23 344.24 344.25 344.26 344.27 344.28 344.29 344.30 344.31 345.1 345.2 345.3 345.4 345.5 345.6 345.7 345.8 345.9 345.10 345.11 345.12 345.13 345.14 345.15 345.16 345.17 345.18 345.19 345.20 345.21 345.22 345.23 345.24 345.25 345.26 345.27 345.28 345.29 345.30
345.31
346.1 346.2 346.3 346.4 346.5 346.6 346.7 346.8 346.9 346.10 346.11 346.12 346.13 346.14 346.15 346.16 346.17 346.18 346.19 346.20 346.21 346.22 346.23 346.24 346.25 346.26
346.27
347.1 347.2 347.3 347.4 347.5 347.6 347.7 347.8 347.9 347.10 347.11 347.12 347.13 347.14 347.15 347.16
347.17
347.18 347.19 347.20 347.21 347.22 347.23 347.24 347.25 347.26 347.27 347.28 347.29 347.30 347.31 348.1 348.2 348.3 348.4 348.5 348.6 348.7 348.8 348.9 348.10 348.11 348.12 348.13 348.14 348.15 348.16 348.17 348.18 348.19 348.20 348.21 348.22 348.23 348.24 348.25 348.26 348.27 348.28 348.29 348.30 348.31 348.32 349.1 349.2 349.3 349.4 349.5 349.6 349.7 349.8 349.9 349.10 349.11 349.12 349.13 349.14 349.15 349.16 349.17 349.18 349.19 349.20 349.21 349.22 349.23 349.24 349.25 349.26 349.27 349.28 349.29 349.30 349.31 349.32 349.33 349.34 350.1 350.2 350.3 350.4 350.5 350.6 350.7 350.8 350.9 350.10 350.11 350.12
350.13
350.14 350.15 350.16 350.17 350.18 350.19 350.20 350.21 350.22
350.23
350.24 350.25 350.26 350.27 350.28 350.29 350.30 351.1 351.2 351.3 351.4 351.5 351.6 351.7 351.8 351.9 351.10 351.11 351.12 351.13 351.14 351.15 351.16 351.17 351.18 351.19 351.20 351.21 351.22 351.23 351.24 351.25 351.26 351.27 351.28 351.29 351.30 351.31 352.1 352.2 352.3 352.4 352.5 352.6 352.7 352.8 352.9 352.10 352.11 352.12 352.13 352.14 352.15 352.16 352.17 352.18 352.19 352.20 352.21 352.22 352.23 352.24 352.25 352.26 352.27 352.28 352.29 352.30 352.31 353.1 353.2 353.3 353.4 353.5 353.6 353.7 353.8 353.9
353.10
353.11 353.12 353.13 353.14 353.15 353.16 353.17 353.18 353.19 353.20 353.21 353.22 353.23 353.24 353.25 353.26 353.27 353.28 353.29 353.30 353.31 353.32 354.1 354.2 354.3 354.4 354.5 354.6 354.7 354.8 354.9 354.10 354.11 354.12 354.13 354.14 354.15 354.16 354.17 354.18 354.19 354.20 354.21 354.22 354.23 354.24 354.25 354.26 354.27 354.28 354.29 354.30 354.31 354.32 355.1 355.2 355.3 355.4 355.5 355.6 355.7 355.8 355.9 355.10 355.11 355.12 355.13 355.14 355.15 355.16 355.17 355.18 355.19 355.20 355.21 355.22 355.23 355.24 355.25 355.26 355.27 355.28 355.29 355.30 355.31 356.1 356.2 356.3 356.4 356.5 356.6 356.7
356.8
356.9 356.10 356.11 356.12 356.13 356.14 356.15 356.16 356.17 356.18 356.19 356.20 356.21 356.22 356.23 356.24 356.25 356.26 356.27 356.28 356.29 356.30 357.1 357.2 357.3 357.4 357.5
357.6
357.7 357.8 357.9 357.10 357.11 357.12 357.13 357.14 357.15 357.16 357.17 357.18 357.19 357.20 357.21 357.22 357.23 357.24
357.25
357.26 357.27 357.28 357.29 357.30 357.31 358.1 358.2
358.3
358.4 358.5 358.6 358.7 358.8 358.9 358.10 358.11 358.12 358.13 358.14 358.15 358.16 358.17 358.18
358.19 358.20 358.21 358.22 358.23 358.24 358.25 358.26 358.27 358.28 358.29 358.30 358.31 358.32
359.1 359.2 359.3 359.4 359.5 359.6 359.7 359.8 359.9 359.10 359.11 359.12 359.13 359.14 359.15 359.16 359.17
359.18 359.19 359.20 359.21 359.22 359.23 359.24 359.25 359.26 359.27 359.28 359.29
359.30 359.31
359.32
360.1 360.2
360.3 360.4 360.5 360.6 360.7 360.8 360.9 360.10 360.11 360.12
360.13 360.14 360.15 360.16 360.17 360.18 360.19 360.20 360.21
360.22 360.23 360.24 360.25 360.26 360.27 360.28 360.29 360.30 360.31 360.32 361.1 361.2 361.3 361.4 361.5 361.6 361.7 361.8 361.9 361.10 361.11 361.12 361.13 361.14
361.15 361.16 361.17 361.18 361.19 361.20 361.21 361.22 361.23 361.24 361.25 361.26 361.27
361.28 361.29 361.30 361.31 361.32 361.33 362.1 362.2 362.3 362.4 362.5 362.6 362.7 362.8 362.9 362.10 362.11 362.12 362.13 362.14 362.15 362.16 362.17 362.18 362.19 362.20
362.21 362.22 362.23 362.24 362.25 362.26 362.27 362.28 362.29 362.30 362.31 362.32 363.1 363.2 363.3 363.4 363.5 363.6 363.7 363.8 363.9 363.10 363.11 363.12 363.13 363.14 363.15 363.16 363.17 363.18 363.19 363.20 363.21 363.22 363.23 363.24 363.25 363.26 363.27 363.28 363.29 363.30 363.31 364.1 364.2 364.3 364.4 364.5 364.6 364.7 364.8 364.9 364.10 364.11 364.12 364.13 364.14 364.15 364.16 364.17 364.18 364.19 364.20 364.21 364.22 364.23 364.24 364.25 364.26 364.27 364.28 364.29 364.30 364.31 364.32 365.1 365.2 365.3 365.4 365.5 365.6 365.7 365.8 365.9 365.10 365.11 365.12 365.13 365.14 365.15 365.16 365.17 365.18 365.19 365.20 365.21 365.22 365.23 365.24 365.25 365.26 365.27 365.28 365.29 365.30 365.31 365.32 365.33 366.1 366.2 366.3 366.4 366.5 366.6 366.7 366.8 366.9 366.10 366.11 366.12 366.13 366.14 366.15 366.16 366.17 366.18 366.19 366.20 366.21 366.22 366.23
366.24
366.25 366.26 366.27 366.28 366.29 366.30 366.31 366.32 367.1 367.2 367.3 367.4 367.5 367.6 367.7 367.8 367.9 367.10 367.11 367.12 367.13 367.14 367.15 367.16 367.17 367.18 367.19 367.20 367.21 367.22 367.23 367.24 367.25 367.26 367.27 367.28 367.29 367.30 367.31 367.32 368.1 368.2 368.3 368.4
368.5
368.6 368.7 368.8 368.9 368.10 368.11 368.12 368.13 368.14 368.15 368.16 368.17 368.18 368.19 368.20 368.21 368.22 368.23 368.24 368.25 368.26 368.27 368.28
368.29
369.1 369.2 369.3 369.4 369.5 369.6 369.7 369.8 369.9 369.10 369.11 369.12 369.13 369.14 369.15 369.16 369.17 369.18 369.19 369.20 369.21 369.22 369.23 369.24 369.25
369.26
369.27 369.28 369.29 369.30 369.31 369.32 370.1 370.2 370.3 370.4 370.5 370.6 370.7 370.8 370.9 370.10 370.11 370.12 370.14 370.13 370.16 370.15 370.18 370.17 370.20 370.19 370.22 370.21 370.24 370.23 370.26 370.25 370.28 370.27 370.30 370.29 370.32 370.31 370.34 370.33 370.36 370.35 370.38 370.37 370.40 370.39 370.42 370.41 370.44 370.43 371.2 371.1 371.4 371.3 371.6 371.5 371.8 371.7 371.10 371.9 371.12 371.11 371.14 371.13 371.16 371.15 371.18 371.17 371.20 371.19 371.22 371.21 371.24 371.23 371.26 371.25 371.28 371.27 371.30 371.29 371.32 371.31 371.34 371.33 371.36 371.35 371.38 371.37 371.40 371.39 371.42 371.41 371.44 371.43 371.46 371.45 372.2 372.1 372.4 372.3 372.6 372.5 372.8 372.7 372.10 372.9 372.12 372.11 372.14 372.13 372.16 372.15 372.18 372.17 372.20 372.19 372.22 372.21 372.24 372.23 372.26 372.25 372.28 372.27 372.30 372.29 372.32 372.31 372.34 372.33 372.36 372.35 372.38 372.37 372.40 372.39 372.42 372.41 372.44 372.43 372.46 372.45 373.2 373.1 373.4 373.3 373.6 373.5 373.8 373.7 373.10 373.9 373.12 373.11 373.14 373.13 373.16 373.15 373.18 373.17 373.20 373.19 373.22 373.21 373.24 373.23 373.26 373.25 373.28 373.27 373.30 373.29 373.32 373.31 373.34 373.33 373.36 373.35 373.38 373.37 373.40 373.39 373.42 373.41 373.44 373.43 373.46 373.45 374.2 374.1 374.4 374.3 374.6 374.5 374.8 374.7 374.10 374.9 374.12 374.11 374.14 374.13 374.16 374.15 374.18 374.17 374.20 374.19 374.22 374.21 374.24 374.23 374.26 374.25 374.28 374.27 374.30 374.29 374.32 374.31 374.34 374.33 374.36 374.35 374.38 374.37 374.40 374.39 374.42 374.41 374.44 374.43 374.46 374.45 375.2 375.1 375.4 375.3 375.6 375.5 375.8 375.7 375.10 375.9 375.12 375.11 375.14 375.13 375.16 375.15 375.18 375.17 375.20 375.19 375.22 375.21 375.24 375.23 375.26 375.25 375.28 375.27 375.30 375.29 375.32 375.31 375.34 375.33 375.36 375.35 375.38 375.37 375.40 375.39 375.42 375.41 375.44 375.43 375.46 375.45 376.2 376.1 376.4 376.3 376.6 376.5 376.8 376.7 376.10 376.9 376.11 376.12 376.13 376.14 376.15 376.16 376.17 376.18 376.19 376.20 376.21 376.22 376.23 376.24 376.25 376.26 376.27 376.28 376.29 376.30 376.31 376.32 376.33 376.34 376.35 376.36 376.37 376.38 376.39 376.40 376.41 377.1 377.2 377.3 377.4 377.5 377.6 377.7 377.8 377.9 377.10 377.11 377.12 377.13 377.14 377.15 377.16 377.17 377.18 377.19 377.20 377.21 377.22 377.23 377.24 377.25 377.26
377.27
377.28 377.29 377.30 377.31 377.32 377.33 377.34
378.1 378.2 378.3 378.4 378.5 378.6 378.7 378.8 378.9 378.10 378.11 378.12 378.13 378.14 378.15 378.16 378.17 378.18 378.19
378.20 378.21 378.22 378.23 378.24 378.25 378.26 378.27 378.28 378.29 378.30 378.31 378.32 379.1 379.2 379.3 379.4 379.5 379.6 379.7 379.8 379.9 379.10 379.11 379.12 379.13 379.14 379.15 379.16 379.17
379.18 379.19 379.20 379.21 379.22 379.23 379.24 379.25 379.26 379.27 379.28 379.29 379.30 379.31 379.32 379.33 380.1 380.2 380.3 380.4 380.5 380.6 380.7 380.8 380.9 380.10 380.11 380.12 380.13 380.14 380.15 380.16 380.17 380.18 380.19 380.20 380.21 380.22 380.23 380.24 380.25 380.26 380.27 380.28
380.29
381.1 381.2 381.3 381.4 381.5 381.6 381.7 381.8 381.9
381.10
381.11 381.12 381.13 381.14 381.15 381.16 381.17 381.18 381.19 381.20 381.21 381.22 381.23 381.24 381.25 381.26 381.27 381.28 381.29 381.30 382.1 382.2 382.3 382.4 382.5
382.6
382.7 382.8 382.9 382.10 382.11 382.12 382.13 382.14 382.15 382.16 382.17 382.18 382.19 382.20 382.21 382.22 382.23 382.24 382.25 382.26 382.27 382.28 382.29 382.30 382.31 383.1 383.2 383.3 383.4 383.5 383.6 383.7 383.8 383.9 383.10 383.11 383.12 383.13 383.14 383.15 383.16 383.17 383.18 383.19 383.20 383.21 383.22 383.23 383.24 383.25 383.26 383.27 383.28 383.29 383.30 383.31 383.32 384.1 384.2 384.3 384.4 384.5 384.6 384.7 384.8 384.9 384.10 384.11 384.12 384.13 384.14 384.15 384.16 384.17 384.18 384.19 384.20 384.21 384.22 384.23 384.24 384.25 384.26 384.27 384.28 384.29 384.30 384.31 385.1 385.2
385.3
385.4 385.5 385.6 385.7 385.8 385.9 385.10 385.11 385.12 385.13 385.14 385.15 385.16 385.17 385.18 385.19 385.20 385.21 385.22 385.23 385.24 385.25 385.26 385.27 385.28 385.29 385.30 385.31 385.32 386.1 386.2 386.3 386.4 386.5 386.6 386.7 386.8 386.9 386.10 386.11 386.12 386.13 386.14 386.15 386.16 386.17 386.18 386.19 386.20 386.21 386.22 386.23 386.24 386.25 386.26 386.27 386.28 386.29 386.30 386.31 386.32 387.1 387.2 387.3 387.4 387.5 387.6 387.7 387.8
387.9
387.10 387.11 387.12 387.13 387.14 387.15 387.16 387.17 387.18 387.19 387.20 387.21 387.22 387.23 387.24 387.25 387.26 387.27 387.28 387.29 387.30 387.31 387.32 387.33 388.1 388.2
388.3
388.4 388.5 388.6 388.7 388.8 388.9 388.10 388.11 388.12 388.13
388.14
388.15 388.16 388.17 388.18 388.19 388.20 388.21 388.22 388.23 388.24
388.25
388.26 388.27 388.28 388.29 388.30
388.31
389.1 389.2 389.3 389.4 389.5 389.6 389.7 389.8 389.9 389.10 389.11 389.12 389.13 389.14 389.15 389.16 389.17 389.18 389.19 389.20 389.21 389.22 389.23 389.24 389.25 389.26 389.27 389.28 389.29 389.30 389.31 389.32 389.33 390.1 390.2 390.3 390.4 390.5 390.6 390.7 390.8 390.9 390.10 390.11 390.12 390.13 390.14 390.15 390.16 390.17 390.18 390.19 390.20 390.21 390.22 390.23 390.24 390.25 390.26 390.27 390.28 390.29 390.30 390.31 390.32 390.33 390.34 391.1 391.2 391.3 391.4 391.5 391.6 391.7 391.8 391.9 391.10 391.11 391.12
391.13
391.14 391.15
391.16 391.17 391.18 391.19 391.20 391.21 391.22 391.23 391.24 391.25 391.26 391.27 391.28 391.29 391.30 392.1 392.2 392.3 392.4 392.5 392.6 392.7 392.8 392.9 392.10 392.11 392.12 392.13 392.14 392.15 392.16 392.17 392.18 392.19 392.20 392.21 392.22 392.23 392.24 392.25 392.26 392.27 392.28 392.29 392.30 393.1 393.2
393.3 393.4 393.5 393.6 393.7 393.8 393.9 393.10 393.11 393.12 393.13 393.14 393.15 393.16 393.17 393.18 393.19 393.20 393.21 393.22 393.23 393.24 393.25 393.26 393.27 393.28 393.29 393.30 393.31 393.32 393.33 394.1 394.2 394.3 394.4 394.5 394.6 394.7 394.8 394.9 394.10 394.11 394.12 394.13 394.14 394.15 394.16 394.17 394.18 394.19 394.20 394.21 394.22 394.23 394.24 394.25 394.26 394.27 394.28 394.29 394.30 394.31 394.32 395.1 395.2 395.3 395.4 395.5 395.6 395.7 395.8 395.9 395.10 395.11 395.12 395.13 395.14 395.15 395.16 395.17 395.18 395.19 395.20 395.21 395.22 395.23 395.24 395.25 395.26 395.27 395.28 395.29 395.30 395.31 395.32 395.33 395.34 396.1 396.2 396.3 396.4 396.5 396.6 396.7 396.8 396.9 396.10 396.11 396.12 396.13 396.14 396.15
396.16 396.17 396.18 396.19
396.20 396.21 396.22 396.23 396.24 396.25 396.26 396.27 396.28 396.29
397.1 397.2 397.3 397.4 397.5 397.6 397.7 397.8
397.9 397.10 397.11 397.12 397.13 397.14 397.15 397.16 397.17 397.18 397.19 397.20 397.21 397.22 397.23 397.24 397.25 397.26 397.27 397.28 397.29 398.1 398.2 398.3 398.4 398.5 398.6 398.7 398.8 398.9 398.10 398.11 398.12 398.13 398.14 398.15 398.16 398.17 398.18
398.19 398.20 398.21 398.22 398.23 398.24 398.25 398.26 398.27 398.28 398.29 398.30 398.31 398.32 399.1 399.2 399.3 399.4 399.5 399.6 399.7 399.8 399.9 399.10 399.11 399.12 399.13 399.14 399.15 399.16 399.17 399.18 399.19 399.20 399.21 399.22 399.23
399.24 399.25 399.26
399.27 399.28 399.29 399.30 399.31 399.32 399.33 399.34 400.1 400.2 400.3 400.4 400.5 400.6 400.7 400.8 400.9 400.10 400.11 400.12 400.13 400.14 400.15 400.16 400.17 400.18 400.19 400.20 400.21 400.22 400.23 400.24 400.25 400.26 400.27 400.28 400.29 400.30 400.31 400.32 400.33 400.34 401.1 401.2 401.3 401.4 401.5 401.6 401.7 401.8 401.9 401.10 401.11 401.12 401.13 401.14 401.15 401.16 401.17 401.18 401.19 401.20 401.21 401.22 401.23 401.24 401.25 401.26 401.27 401.28 401.29 401.30 401.31 401.32 401.33 402.1 402.2 402.3 402.4 402.5 402.6 402.7 402.8 402.9 402.10 402.11 402.12 402.13 402.14 402.15 402.16 402.17 402.18 402.19 402.20 402.21 402.22 402.23 402.24 402.25 402.26 402.27 402.28 402.29 402.30 402.31 402.32 403.1 403.2 403.3 403.4 403.5 403.6 403.7 403.8 403.9 403.10
403.11 403.12 403.13 403.14 403.15 403.16 403.17 403.18 403.19 403.20 403.21 403.22 403.23 403.24 403.25 403.26 403.27 403.28 403.29 403.30 403.31 403.32 404.1 404.2 404.3 404.4 404.5 404.6 404.7 404.8 404.9 404.10 404.11 404.12 404.13 404.14 404.15 404.16 404.17 404.18 404.19 404.20 404.21
404.22 404.23 404.24 404.25
404.26 404.27 404.28 404.29 404.30 404.31 404.32 404.33 405.1 405.2 405.3 405.4 405.5 405.6 405.7 405.8 405.9 405.10 405.11 405.12 405.13 405.14 405.15 405.16 405.17 405.18 405.19 405.20 405.21 405.22 405.23 405.24 405.25 405.26 405.27 405.28 405.29 405.30 405.31
405.32 405.33 406.1 406.2
406.3 406.4 406.5 406.6 406.7 406.8
406.9
406.10 406.11 406.12 406.13 406.14 406.15
406.16
406.17 406.18 406.19 406.20 406.21
406.22
406.23 406.24 406.25 406.26 406.27 406.28 406.29 406.30 407.1 407.2
407.3
407.4 407.5 407.6 407.7 407.8 407.9 407.10 407.11 407.12 407.13 407.14 407.15 407.16 407.17 407.18 407.19 407.20 407.21 407.22 407.23 407.24 407.25 407.26 407.27 407.28 407.29 407.30 407.31 407.32 407.33 408.1 408.2 408.3 408.4 408.5 408.6 408.7 408.8 408.9 408.10 408.11 408.12 408.13 408.14 408.15 408.16 408.17 408.18 408.19 408.20 408.21 408.22 408.23 408.24 408.25 408.26 408.27 408.28 408.29 408.30 409.1 409.2 409.3 409.4 409.5 409.6 409.7 409.8 409.9 409.10 409.11 409.12 409.13 409.14 409.15 409.16 409.17 409.18 409.19 409.20 409.21 409.22
409.23 409.24 409.25 409.26 409.27 409.28 410.1 410.2 410.3 410.4 410.5 410.6 410.7 410.8 410.9 410.10 410.11
410.12 410.13 410.14 410.15 410.16 410.17 410.18 410.19 410.20 410.21 410.22 410.23 410.24 410.25 410.26 410.27 410.28 410.29 410.30 410.31 411.1 411.2 411.3 411.4 411.5 411.6 411.7 411.8 411.9 411.10 411.11 411.12 411.13 411.14 411.15 411.16 411.17 411.18 411.19 411.20 411.21 411.22 411.23 411.24 411.25 411.26 411.27 411.28 411.29 411.30 412.1 412.2 412.3 412.4 412.5 412.6 412.7 412.8 412.9 412.10 412.11 412.12 412.13 412.14 412.15 412.16 412.17 412.18 412.19 412.20 412.21
412.22 412.23 412.24 412.25 412.26 412.27 412.28 412.29 412.30 413.1 413.2 413.3 413.4 413.5 413.6 413.7 413.8 413.9 413.10 413.11 413.12 413.13 413.14 413.15 413.16 413.17 413.18 413.19 413.20 413.21 413.22 413.23 413.24 413.25 413.26 413.27 413.28 413.29 413.30 413.31 413.32 414.1 414.2 414.3 414.4 414.5 414.6 414.7 414.8 414.9 414.10 414.11 414.12 414.13 414.14 414.15 414.16 414.17 414.18 414.19 414.20 414.21 414.22 414.23 414.24
414.25 414.26 414.27 414.28 414.29 414.30 414.31 414.32 414.33 415.1 415.2 415.3 415.4 415.5 415.6 415.7 415.8 415.9 415.10 415.11 415.12 415.13 415.14 415.15 415.16 415.17 415.18 415.19 415.20 415.21 415.22 415.23 415.24 415.25
415.26 415.27 415.28 415.29 415.30 415.31 415.32 415.33 415.34 416.1 416.2 416.3 416.4 416.5 416.6 416.7 416.8 416.9 416.10 416.11 416.12 416.13 416.14
416.15 416.16 416.17 416.18 416.19 416.20 416.21 416.22 416.23 416.24 416.25 416.26 416.27 416.28 416.29 416.30 416.31 416.32 416.33
417.1 417.2 417.3 417.4 417.5 417.6 417.7 417.8 417.9 417.10 417.11 417.12 417.13 417.14 417.15 417.16 417.17
417.18 417.19 417.20 417.21 417.22 417.23 417.24 417.25 417.26 417.27
417.28
417.29 417.30 417.31 417.32 418.1 418.2 418.3 418.4 418.5 418.6 418.7 418.8 418.9 418.10 418.11 418.12 418.13 418.14 418.15 418.16 418.17 418.18 418.19 418.20 418.21 418.22 418.23 418.24 418.25 418.26 418.27 418.28
418.29 418.30 418.31 418.32 418.33 419.1 419.2 419.3 419.4 419.5 419.6 419.7 419.8 419.9 419.10 419.11 419.12 419.13 419.14 419.15
419.16 419.17 419.18 419.19 419.20 419.21 419.22 419.23 419.24 419.25 419.26 419.27
419.28 419.29 419.30 419.31 419.32 420.1 420.2 420.3 420.4 420.5 420.6
420.7 420.8 420.9 420.10 420.11 420.12 420.13 420.14 420.15 420.16 420.17 420.18 420.19 420.20 420.21
420.22 420.23 420.24 420.25 420.26 420.27 420.28 420.29 420.30 420.31 420.32 420.33 421.1 421.2
421.3 421.4 421.5 421.6 421.7 421.8 421.9 421.10 421.11
421.12 421.13 421.14 421.15 421.16 421.17 421.18 421.19 421.20 421.21 421.22 421.23 421.24 421.25 421.26 421.27 421.28 421.29 421.30 421.31 421.32 422.1 422.2 422.3 422.4 422.5 422.6
422.7 422.8 422.9 422.10 422.11 422.12 422.13 422.14 422.15 422.16 422.17
422.18 422.19 422.20 422.21 422.22 422.23 422.24 422.25 422.26 422.27 422.28 422.29
423.1 423.2 423.3 423.4 423.5 423.6 423.7 423.8 423.9 423.10 423.11 423.12 423.13
423.14 423.15 423.16 423.17 423.18 423.19 423.20 423.21 423.22 423.23 423.24 423.25 423.26 423.27 423.28 423.29 423.30
424.1 424.2 424.3 424.4 424.5 424.6 424.7 424.8 424.9 424.10 424.11 424.12 424.13 424.14 424.15 424.16
424.17 424.18 424.19 424.20 424.21 424.22 424.23 424.24 424.25 424.26 424.27 424.28 424.29 424.30 424.31 424.32 424.33
425.1 425.2 425.3 425.4 425.5
425.6 425.7
425.8
425.9 425.10
425.11 425.12 425.13 425.14 425.15 425.16 425.17 425.18 425.19 425.20 425.21 425.22 425.23 425.24 425.25 425.26 425.27 425.28 425.29 425.30 425.31 426.1 426.2 426.3 426.4 426.5 426.6 426.7 426.8 426.9 426.10 426.11 426.12 426.13 426.14 426.15 426.16 426.17 426.18 426.19
426.20 426.21
426.22 426.23 426.24 426.25 426.26 426.27 426.28 426.29 426.30 426.31 426.32 427.1 427.2 427.3 427.4 427.5 427.6 427.7 427.8 427.9 427.10 427.11 427.12 427.13 427.14 427.15 427.16 427.17 427.18 427.19 427.20 427.21 427.22 427.23 427.24 427.25 427.26 427.27 427.28 427.29 427.30 427.31 428.1 428.2
428.3 428.4 428.5 428.6 428.7 428.8 428.9 428.10 428.11
428.12 428.13 428.14 428.15 428.16 428.17 428.18 428.19 428.20 428.21 428.22 428.23 428.24 428.25 428.26 428.27 428.28 428.29 428.30 428.31 429.1 429.2 429.3 429.4 429.5 429.6 429.7 429.8 429.9 429.10 429.11 429.12 429.13 429.14 429.15 429.16 429.17 429.18 429.19 429.20 429.21 429.22 429.23 429.24 429.25 429.26 429.27 429.28 429.29 429.30 429.31 429.32 429.33 429.34 430.1 430.2 430.3 430.4 430.5 430.6 430.7 430.8 430.9 430.10 430.11 430.12 430.13 430.14 430.15 430.16 430.17 430.18 430.19 430.20 430.21 430.22 430.23 430.24 430.25 430.26 430.27 430.28 430.29 430.30 430.31 430.32 430.33 430.34 431.1 431.2 431.3 431.4 431.5 431.6 431.7 431.8 431.9 431.10 431.11 431.12 431.13 431.14 431.15 431.16 431.17 431.18 431.19 431.20 431.21 431.22 431.23 431.24 431.25 431.26 431.27 431.28 431.29 431.30 431.31 431.32 431.33 431.34 432.1 432.2 432.3 432.4 432.5 432.6 432.7 432.8 432.9
432.10
432.11 432.12 432.13 432.14 432.15 432.16 432.17 432.18 432.19 432.20 432.21 432.22 432.23 432.24 432.25 432.26 432.27 432.28 432.29 432.30 432.31 433.1 433.2 433.3 433.4 433.5 433.6 433.7 433.8 433.9 433.10 433.11 433.12 433.13 433.14 433.15 433.16 433.17 433.18 433.19 433.20 433.21 433.22 433.23 433.24 433.25 433.26 433.27 433.28
433.29 433.30 433.31 433.32 434.1 434.2 434.3 434.4 434.5 434.6 434.7 434.8 434.9 434.10 434.11 434.12 434.13 434.14 434.15 434.16 434.17 434.18 434.19 434.20 434.21 434.22 434.23 434.24 434.25 434.26 434.27 434.28 434.29 434.30 434.31 434.32 434.33 435.1 435.2 435.3 435.4 435.5 435.6 435.7 435.8 435.9 435.10 435.11 435.12 435.13 435.14 435.15 435.16 435.17 435.18
435.19 435.20 435.21 435.22 435.23 435.24 435.25 435.26 435.27 435.28 435.29 435.30 436.1 436.2 436.3 436.4 436.5 436.6 436.7 436.8
436.9 436.10 436.11 436.12 436.13 436.14 436.15
436.16 436.17 436.18
436.19 436.20 436.21 436.22 436.23 436.24 436.25
436.26 436.27 436.28
436.29 436.30 436.31 437.1 437.2 437.3 437.4 437.5 437.6 437.7 437.8 437.9 437.10 437.11 437.12 437.13 437.14 437.15 437.16 437.17 437.18 437.19 437.20 437.21 437.22 437.23 437.24 437.25 437.26 437.27 437.28 437.29 437.30 437.31 437.32 438.1 438.2 438.3 438.4 438.5 438.6 438.7 438.8 438.9 438.10 438.11 438.12 438.13 438.14 438.15 438.16 438.17 438.18 438.19 438.20 438.21
438.22 438.23 438.24
438.25 438.26 438.27 438.28 438.29 438.30 438.31 438.32 439.1 439.2 439.3 439.4
439.5 439.6 439.7
439.8 439.9 439.10 439.11 439.12 439.13 439.14 439.15 439.16 439.17 439.18 439.19 439.20 439.21 439.22 439.23 439.24 439.25 439.26 439.27 439.28 439.29 439.30 439.31 439.32 439.33 439.34 440.1 440.2 440.3 440.4 440.5 440.6 440.7 440.8 440.9 440.10 440.11 440.12 440.13 440.14 440.15 440.16 440.17 440.18 440.19 440.20 440.21 440.22 440.23 440.24 440.25 440.26 440.27 440.28 440.29 440.30 440.31 440.32 441.1 441.2 441.3 441.4 441.5 441.6 441.7 441.8 441.9 441.10 441.11 441.12 441.13 441.14 441.15 441.16 441.17 441.18 441.19 441.20 441.21 441.22 441.23 441.24 441.25 441.26 441.27 441.28 441.29 441.30 441.31 442.1 442.2 442.3 442.4 442.5 442.6 442.7 442.8 442.9 442.10 442.11 442.12 442.13 442.14 442.15 442.16 442.17 442.18 442.19 442.20 442.21 442.22 442.23 442.24 442.25 442.26 442.27 442.28 442.29 442.30 442.31 442.32 443.1 443.2 443.3 443.4 443.5 443.6 443.7 443.8 443.9 443.10 443.11 443.12 443.13 443.14 443.15 443.16 443.17 443.18 443.19 443.20 443.21 443.22 443.23 443.24 443.25 443.26 443.27 443.28 443.29 443.30 443.31 443.32 443.33 443.34 443.35 444.1 444.2 444.3 444.4 444.5
444.6 444.7
444.8 444.9 444.10 444.11 444.12 444.13 444.14 444.15 444.16 444.17 444.18 444.19 444.20 444.21 444.22 444.23 444.24 444.25 444.26 444.27 444.28 444.29 444.30 444.31 444.32 444.33 445.1 445.2 445.3 445.4 445.5 445.6 445.7 445.8 445.9 445.10 445.11 445.12 445.13 445.14 445.15 445.16 445.17 445.18 445.19 445.20 445.21 445.22 445.23 445.24 445.25
445.26 445.27 445.28 445.29 445.30 445.31 445.32 446.1 446.2 446.3 446.4 446.5 446.6 446.7 446.8 446.9 446.10 446.11 446.12
446.13 446.14 446.15 446.16 446.17 446.18 446.19 446.20 446.21 446.22 446.23 446.24 446.25 446.26 446.27 446.28 446.29 446.30 446.31 446.32 447.1 447.2 447.3 447.4 447.5 447.6 447.7 447.8 447.9 447.10 447.11 447.12 447.13 447.14 447.15 447.16 447.17 447.18 447.19 447.20 447.21 447.22
447.23 447.24 447.25 447.26 447.27 447.28 447.29 447.30 447.31 448.1
448.2 448.3 448.4 448.5 448.6 448.7 448.8 448.9 448.10 448.11 448.12 448.13 448.14 448.15 448.16
448.17 448.18 448.19 448.20 448.21 448.22 448.23 448.24 448.25 448.26 448.27 449.1 449.2 449.3 449.4 449.5 449.6 449.7 449.8 449.9 449.10 449.11 449.12 449.13 449.14 449.15 449.16 449.17 449.18 449.19 449.20 449.21 449.22 449.23 449.24 449.25 449.26 449.27 449.28 449.29 449.30 449.31 450.1 450.2 450.3 450.4
450.5 450.6 450.7 450.8 450.9 450.10 450.11 450.12
450.13 450.14 450.15 450.16 450.17 450.18 450.19 450.20 450.21 450.22 450.23 450.24 450.25 450.26 450.27 450.28 450.29 450.30 451.1 451.2 451.3 451.4 451.5 451.6 451.7 451.8 451.9 451.10 451.11 451.12 451.13 451.14 451.15 451.16 451.17 451.18 451.19 451.20 451.21 451.22 451.23 451.24 451.25 451.26 451.27 451.28
451.29 451.30 451.31
451.32 451.33 451.34 452.1 452.2 452.3 452.4 452.5 452.6 452.7 452.8 452.9 452.10 452.11 452.12 452.13 452.14 452.15 452.16 452.17 452.18 452.19 452.20 452.21 452.22 452.23 452.24 452.25 452.26 452.27 452.28 452.29 452.30 452.31 453.1 453.2 453.3 453.4 453.5 453.6 453.7 453.8 453.9 453.10 453.11 453.12 453.13 453.14 453.15 453.16 453.17 453.18 453.19 453.20 453.21 453.22 453.23 453.24 453.25 453.26
453.27 453.28 453.29 453.30 453.31 453.32 454.1 454.2 454.3 454.4 454.5 454.6 454.7 454.8 454.9 454.10 454.11 454.12 454.13
454.14 454.15 454.16
454.17 454.18 454.19 454.20 454.21 454.22 454.23 454.24 454.25 454.26 454.27 454.28 454.29
455.1 455.2 455.3 455.4 455.5 455.6 455.7 455.8
455.9 455.10 455.11 455.12 455.13 455.14 455.15 455.16 455.17 455.18 455.19 455.20 455.21 455.22 455.23 455.24 455.25 455.26 455.27 455.28 455.29 455.30 455.31 456.1 456.2 456.3 456.4 456.5 456.6 456.7 456.8 456.9 456.10 456.11 456.12 456.13 456.14 456.15 456.16 456.17 456.18 456.19 456.20 456.21 456.22 456.23 456.24 456.25 456.26 456.27 456.28 456.29 456.30 456.31 457.1 457.2 457.3 457.4 457.5 457.6 457.7 457.8 457.9 457.10 457.11 457.12 457.13
457.14 457.15 457.16 457.17 457.18 457.19 457.20 457.21 457.22 457.23
457.24 457.25 457.26 457.27 457.28 457.29 457.30 457.31 458.1 458.2 458.3 458.4 458.5 458.6
458.7 458.8 458.9 458.10 458.11 458.12 458.13 458.14
458.15 458.16 458.17 458.18 458.19 458.20 458.21 458.22 458.23 458.24 458.25 458.26 458.27 458.28 458.29 458.30
459.1 459.2 459.3 459.4 459.5 459.6 459.7 459.8
459.9 459.10 459.11 459.12 459.13 459.14 459.15 459.16 459.17 459.18 459.19 459.20 459.21 459.22 459.23 459.24 459.25 459.26 459.27 459.28 459.29 459.30 459.31 459.32 460.1 460.2
460.3 460.4 460.5 460.6 460.7 460.8 460.9 460.10
460.11 460.12 460.13 460.14 460.15 460.16 460.17 460.18 460.19 460.20 460.21 460.22 460.23 460.24 460.25 460.26 460.27 460.28 460.29 460.30 461.1 461.2 461.3 461.4 461.5 461.6 461.7
461.8 461.9 461.10 461.11 461.12 461.13 461.14 461.15 461.16 461.17 461.18 461.19 461.20 461.21 461.22 461.23 461.24 461.25 461.26 461.27 461.28 461.29 461.30 461.31 462.1 462.2 462.3 462.4 462.5 462.6 462.7 462.8 462.9 462.10 462.11 462.12 462.13 462.14 462.15 462.16 462.17 462.18 462.19 462.20 462.21 462.22 462.23 462.24 462.25 462.26 462.27 462.28 462.29 462.30 462.31 463.1 463.2 463.3 463.4 463.5 463.6 463.7 463.8 463.9 463.10 463.11 463.12 463.13 463.14 463.15 463.16 463.17 463.18 463.19 463.20 463.21 463.22 463.23 463.24 463.25
463.26 463.27 463.28
464.1 464.2 464.3 464.4 464.5 464.6 464.7 464.8 464.9 464.10 464.11 464.12 464.13 464.14 464.15 464.16 464.17 464.18 464.19 464.20 464.21 464.22 464.23 464.24 464.25 464.26 464.27 464.28 464.29 464.30 464.31 464.32 465.1 465.2 465.3 465.4 465.5 465.6 465.7 465.8 465.9 465.10 465.11 465.12 465.13 465.14 465.15 465.16 465.17 465.18 465.19 465.20 465.21 465.22 465.23 465.24 465.25 465.26 465.27 465.28 465.29 465.30 465.31 466.1 466.2 466.3 466.4 466.5 466.6 466.7 466.8 466.9 466.10 466.11 466.12 466.13 466.14 466.15 466.16 466.17 466.18 466.19 466.20 466.21 466.22 466.23 466.24 466.25 466.26 466.27 466.28 466.29 466.30 466.31 466.32 467.1 467.2 467.3 467.4 467.5 467.6 467.7 467.8 467.9 467.10 467.11 467.12 467.13 467.14 467.15 467.16 467.17 467.18 467.19 467.20 467.21 467.22 467.23 467.24 467.25 467.26 467.27 467.28 468.1 468.2 468.3 468.4 468.5 468.6 468.7 468.8 468.9 468.10 468.11 468.12 468.13 468.14 468.15 468.16 468.17 468.18 468.19 468.20 468.21 468.22 468.23 468.24 468.25 468.26 469.1 469.2 469.3 469.4 469.5 469.6 469.7 469.8 469.9 469.10 469.11 469.12 469.13 469.14 469.15 469.16 469.17 469.18 469.19 469.20 469.21 469.22 469.23 469.24 469.25 469.26 469.27 469.28 470.1 470.2 470.3 470.4 470.5 470.6 470.7 470.8 470.9 470.10 470.11 470.12 470.13 470.14 470.15 470.16 470.17 470.18 470.19 470.20 470.21 470.22 470.23 470.24 470.25 470.26 470.27 470.28 470.29 470.30 471.1 471.2 471.3 471.4 471.5 471.6 471.7 471.8 471.9 471.10 471.11 471.12 471.13 471.14 471.15 471.16 471.17 471.18 471.19 471.20
471.21 471.22 471.23 471.24
471.25 471.26 471.27 471.28 471.29 471.30 471.31 471.32 472.1 472.2 472.3 472.4 472.5 472.6 472.7 472.8 472.9 472.10 472.11 472.12 472.13 472.14 472.15 472.16 472.17 472.18 472.19 472.20 472.21 472.22 472.23 472.24 472.25 472.26 472.27 472.28 472.29 472.30 472.31 473.1 473.2 473.3 473.4 473.5 473.6 473.7 473.8 473.9 473.10 473.11 473.12 473.13 473.14 473.15 473.16 473.17 473.18 473.19 473.20 473.21 473.22 473.23 473.24 473.25 473.26 473.27 473.28 473.29 473.30 473.31 474.1 474.2 474.3 474.4 474.5 474.6 474.7 474.8 474.9 474.10 474.11 474.12 474.13 474.14 474.15 474.16 474.17 474.18 474.19 474.20 474.21 474.22 474.23 474.24 474.25
474.26 474.27 474.28 474.29
475.1 475.2 475.3 475.4 475.5 475.6 475.7 475.8 475.9 475.10 475.11 475.12 475.13 475.14 475.15 475.16 475.17 475.18 475.19 475.20 475.21 475.22 475.23 475.24 475.25 475.26 475.27 475.28 475.29 475.30 475.31 475.32 476.1 476.2 476.3 476.4 476.5 476.6 476.7 476.8 476.9 476.10 476.11 476.12 476.13 476.14 476.15 476.16 476.17 476.18 476.19 476.20 476.21 476.22 476.23 476.24 476.25 476.26 476.27 476.28 476.29 476.30 476.31 476.32 477.1 477.2 477.3 477.4 477.5 477.6 477.7 477.8
477.9 477.10 477.11 477.12
477.13 477.14 477.15 477.16 477.17 477.18 477.19 477.20 477.21 477.22 477.23 477.24 477.25 477.26 477.27 477.28 477.29 477.30 477.31 477.32 478.1 478.2 478.3 478.4 478.5 478.6 478.7 478.8 478.9 478.10 478.11 478.12 478.13 478.14 478.15 478.16 478.17 478.18 478.19 478.20 478.21 478.22 478.23 478.24 478.25 478.26 478.27 478.28 478.29 478.30 478.31 478.32 479.1 479.2
479.3 479.4 479.5 479.6 479.7 479.8 479.9 479.10
479.11 479.12 479.13 479.14 479.15 479.16 479.17 479.18 479.19 479.20 479.21 479.22 479.23 479.24 479.25 479.26 479.27 479.28 479.29 479.30 479.31 480.1 480.2 480.3 480.4 480.5 480.6 480.7 480.8 480.9 480.10 480.11 480.12 480.13 480.14 480.15 480.16 480.17 480.18 480.19 480.20 480.21 480.22 480.23 480.24 480.25 480.26 480.27 480.28 480.29 480.30 480.31 481.1 481.2 481.3 481.4 481.5 481.6 481.7 481.8 481.9 481.10 481.11 481.12 481.13 481.14 481.15 481.16
481.17 481.18 481.19 481.20
481.21 481.22 481.23 481.24 481.25 481.26 481.27 481.28 481.29 481.30 481.31
482.1 482.2 482.3
482.4 482.5 482.6 482.7 482.8 482.9 482.10 482.11 482.12 482.13 482.14 482.15 482.16 482.17 482.18 482.19 482.20 482.21 482.22 482.23 482.24 482.25 482.26 482.27 482.28 482.29 482.30 482.31 482.32 483.1 483.2 483.3 483.4 483.5 483.6 483.7 483.8 483.9 483.10 483.11 483.12 483.13 483.14 483.15 483.16 483.17 483.18 483.19 483.20 483.21 483.22 483.23
483.24 483.25 483.26
483.27 483.28 483.29 483.30 484.1 484.2 484.3 484.4
484.5 484.6 484.7
484.8 484.9 484.10 484.11 484.12 484.13 484.14 484.15 484.16 484.17 484.18 484.19 484.20 484.21 484.22 484.23 484.24 484.25 484.26 484.27 484.28 484.29 484.30
485.1 485.2 485.3
485.4 485.5 485.6 485.7 485.8 485.9 485.10 485.11 485.12 485.13
485.14 485.15 485.16
485.17 485.18 485.19 485.20 485.21 485.22 485.23 485.24 485.25 485.26 485.27 485.28 485.29 485.30 485.31 486.1 486.2 486.3 486.4 486.5 486.6 486.7 486.8 486.9 486.10 486.11 486.12 486.13 486.14 486.15 486.16 486.17 486.18 486.19 486.20 486.21 486.22 486.23 486.24 486.25 486.26 486.27 486.28 486.29 486.30 486.31 486.32 487.1 487.2 487.3 487.4 487.5 487.6
487.7 487.8 487.9
487.10 487.11 487.12 487.13 487.14 487.15 487.16 487.17 487.18 487.19 487.20 487.21 487.22 487.23 487.24 487.25 487.26 487.27 487.28 487.29 487.30 488.1 488.2 488.3 488.4 488.5 488.6 488.7 488.8 488.9 488.10 488.11 488.12 488.13 488.14 488.15 488.16 488.17 488.18 488.19 488.20 488.21
488.22 488.23 488.24 488.25 488.26 488.27 488.28 488.29 488.30 488.31 489.1 489.2
489.3
489.4 489.5 489.6 489.7 489.8 489.9 489.10 489.11 489.12 489.13 489.14 489.15 489.16 489.17 489.18 489.19 489.20 489.21 489.22 489.23 489.24 489.25 489.26 489.27 489.28 489.29 489.30 489.31 489.32 489.33 489.34 490.1 490.2 490.3 490.4 490.5 490.6 490.7 490.8 490.9 490.10 490.11 490.12 490.13 490.14 490.15 490.16 490.17 490.18 490.19 490.20 490.21 490.22 490.23 490.24 490.25 490.26 490.27 490.28 490.29 490.30 490.31 490.32 490.33 490.34 491.1 491.2 491.3 491.4 491.5 491.6 491.7 491.8
491.9
491.10 491.11 491.12 491.13 491.14 491.15 491.16 491.17 491.18 491.19 491.20 491.21 491.22 491.23 491.24 491.25 491.26 491.27 491.28 491.29 491.30 491.31 491.32 491.33 491.34 492.1 492.2 492.3 492.4 492.5 492.6 492.7 492.8 492.9 492.10
492.11
492.12 492.13 492.14 492.15 492.16 492.17 492.18 492.19 492.20 492.21 492.22 492.23 492.24 492.25 492.26 492.27 492.28 492.29 492.30 492.31 492.32 492.33 493.1 493.2 493.3 493.4 493.5 493.6 493.7 493.8 493.9 493.10 493.11 493.12 493.13 493.14 493.15 493.16 493.17
493.18 493.19
493.20 493.21 493.22 493.23 493.24 493.25 493.26 493.27 493.28 493.29 493.30 493.31 493.32 493.33 493.34
494.1 494.2 494.3 494.4 494.5 494.6 494.7 494.8 494.9
494.10 494.11 494.12 494.13 494.14 494.15 494.16 494.17 494.18
494.19 494.20 494.21 494.22 494.23 494.24 494.25 494.26 494.27 494.28
494.29 494.30 494.31 494.32 495.1 495.2 495.3 495.4 495.5
495.6 495.7 495.8 495.9 495.10 495.11 495.12 495.13 495.14 495.15 495.16 495.17 495.18 495.19 495.20 495.21
495.22
495.23 495.24 495.25 495.26 495.27 495.28 495.29 495.30 495.31 495.32 495.33 496.1 496.2 496.3 496.4 496.5 496.6 496.7 496.8
496.9
496.10 496.11 496.12 496.13 496.14 496.15 496.16 496.17 496.18 496.19 496.20 496.21 496.22 496.23 496.24 496.25
496.26
496.27 496.28 496.29 496.30 496.31 497.1 497.2 497.3 497.4 497.5 497.6
497.7 497.8 497.9 497.10 497.11 497.12 497.13 497.14 497.15 497.16 497.17 497.18 497.19 497.20 497.21 497.22 497.23 497.24 497.25 497.26 497.27 497.28 497.29 497.30 497.31 497.32 498.1 498.2 498.3 498.4 498.5 498.6 498.7 498.8 498.9 498.10 498.11
498.12 498.13 498.14 498.15
498.16 498.17 498.18 498.19 498.20 498.21 498.22 498.23 498.24 498.25 498.26 498.27 498.28
498.29 498.30 498.31 498.32 499.1 499.2 499.3 499.4 499.5 499.6 499.7 499.8 499.9 499.10 499.11 499.12 499.13 499.14 499.15 499.16 499.17 499.18 499.19 499.20 499.21 499.22 499.23 499.24 499.25 499.26 499.27 499.28 499.29 499.30 499.31 499.32 500.1 500.2 500.3 500.4 500.5 500.6 500.7 500.8 500.9 500.10 500.11 500.12 500.13 500.14 500.15 500.16 500.17 500.18 500.19 500.20 500.21 500.22 500.23 500.24 500.25 500.26 500.27 500.28 500.29 500.30 500.31 500.32 501.1 501.2 501.3 501.4
501.5 501.6 501.7 501.8 501.9 501.10 501.11 501.12 501.13 501.14 501.15 501.16 501.17 501.18
501.19 501.20 501.21 501.22 501.23 501.24 501.25 501.26 501.27 501.28
502.1 502.2 502.3 502.4 502.5 502.6 502.7 502.8 502.9
502.10 502.11 502.12 502.13 502.14 502.15 502.16 502.17 502.18 502.19 502.20 502.21 502.22 502.23 502.24 502.25 502.26 502.27 502.28 502.29 502.30 502.31 502.32 503.1 503.2
503.3 503.4 503.5 503.6 503.7 503.8 503.9 503.10 503.11 503.12
503.13 503.14 503.15 503.16 503.17 503.18 503.19 503.20
503.21 503.22 503.23 503.24 503.25 503.26
503.27 503.28 503.29 503.30 503.31 504.1 504.2 504.3 504.4
504.5 504.6 504.7
504.8 504.9 504.10 504.11 504.12 504.13 504.14 504.15 504.16 504.17 504.18 504.19 504.20 504.21 504.22 504.23 504.24 504.25 504.26 504.27 504.28 504.29 504.30 504.31
505.1 505.2 505.3 505.4 505.5 505.6 505.7 505.8 505.9 505.10 505.11 505.12 505.13 505.14 505.15 505.16 505.17 505.18 505.19 505.20 505.21 505.22 505.23 505.24 505.25 505.26 505.27 505.28 505.29 505.30 505.31 505.32 505.33 506.1 506.2 506.3 506.4 506.5 506.6 506.7 506.8 506.9 506.10 506.11 506.12 506.13 506.14 506.15 506.16 506.17 506.18 506.19 506.20 506.21 506.22 506.23 506.24 506.25 506.26 506.27 506.28 506.29 506.30 507.1 507.2 507.3 507.4 507.5 507.6 507.7 507.8 507.9 507.10 507.11 507.12 507.13 507.14 507.15 507.16 507.17 507.18 507.19 507.20 507.21 507.22 507.23 507.24 507.25 507.26 507.27 507.28 507.29 507.30 507.31 508.1 508.2 508.3 508.4 508.5 508.6 508.7 508.8 508.9 508.10 508.11 508.12 508.13 508.14 508.15 508.16 508.17 508.18 508.19 508.20 508.21 508.22 508.23 508.24 508.25 508.26 508.27 508.28 508.29 508.30 508.31 508.32 509.1 509.2 509.3 509.4 509.5 509.6 509.7 509.8 509.9 509.10 509.11 509.12 509.13 509.14 509.15 509.16 509.17 509.18 509.19 509.20 509.21 509.22 509.23 509.24 509.25 509.26
509.27 509.28 509.29 509.30 509.31 509.32 509.33 510.1 510.2 510.3 510.4 510.5 510.6
510.7
510.8 510.9 510.10 510.11 510.12 510.13 510.14
510.15
510.16 510.17 510.18 510.19 510.20 510.21 510.22 510.23 510.24
510.25 510.26 510.27 510.28 510.29 510.30 510.31 510.32 511.1 511.2 511.3 511.4 511.5 511.6 511.7 511.8
511.9 511.10 511.11 511.12 511.13 511.14
511.15 511.16
511.17 511.18 511.19 511.20 511.21 511.22 511.23 511.24 511.25 511.26 511.27 511.28 511.29 512.1 512.2 512.3 512.4 512.5 512.6 512.7 512.8 512.9 512.10 512.11 512.12 512.13 512.14 512.15 512.16 512.17 512.18 512.19 512.20 512.21 512.22 512.23 512.24 512.25 512.26 512.27 512.28 512.29 512.30 512.31 513.1 513.2 513.3 513.4 513.5 513.6 513.7 513.8 513.9 513.10 513.11 513.12 513.13 513.14 513.15 513.16 513.17 513.18 513.19 513.20 513.21 513.22 513.23 513.24 513.25 513.26 513.27 513.28 513.29 513.30 513.31 513.32 514.1 514.2 514.3 514.4 514.5
514.6 514.7 514.8 514.9 514.10 514.11 514.12 514.13 514.14 514.15 514.16 514.17 514.18 514.19 514.20 514.21 514.22 514.23 514.24 514.25 514.26 514.27 514.28 514.29 514.30 515.1 515.2 515.3 515.4 515.5 515.6 515.7 515.8 515.9
515.10 515.11 515.12 515.13 515.14 515.15 515.16 515.17 515.18 515.19 515.20 515.21 515.22 515.23 515.24 515.25 515.26
515.27
515.28 515.29 515.30 516.1 516.2 516.3 516.4 516.5 516.6 516.7 516.8 516.9 516.10 516.11 516.12 516.13 516.14
516.15 516.16 516.17 516.18 516.19 516.20 516.21 516.22 516.23 516.24
516.25 516.26 516.27 516.28
516.29 516.30 516.31 517.1 517.2 517.3 517.4 517.5 517.6 517.7 517.8 517.9 517.10 517.11 517.12 517.13 517.14 517.15
517.16 517.17 517.18 517.19 517.20 517.21 517.22 517.23 517.24 517.25 517.26 517.27 517.28 517.29 517.30 518.1 518.2 518.3 518.4 518.5 518.6 518.7 518.8 518.9
518.10 518.11 518.12 518.13 518.14
518.15 518.16 518.17 518.18
518.19 518.20 518.21 518.22 518.23 518.24 518.25
518.26 518.27 518.28 518.29 518.30 518.31 519.1 519.2 519.3 519.4 519.5 519.6
519.7 519.8 519.9 519.10 519.11 519.12 519.13 519.14 519.15 519.16 519.17 519.18 519.19 519.20 519.21
519.22 519.23 519.24 519.25 519.26
519.27 519.28 519.29 519.30 519.31 520.1 520.2 520.3 520.4 520.5 520.6 520.7
520.8 520.9 520.10 520.11 520.12
520.13 520.14 520.15 520.16 520.17 520.18 520.19 520.20
520.21 520.22 520.23 520.24 520.25 520.26 520.27
520.28 520.29 521.1 521.2 521.3 521.4 521.5 521.6 521.7 521.8 521.9 521.10 521.11 521.12 521.13 521.14 521.15 521.16 521.17 521.18
521.19 521.20 521.21 521.22 521.23 521.24 521.25 521.26 521.27 521.28
521.29 521.30 521.31 522.1 522.2
522.3 522.4 522.5 522.6 522.7 522.8 522.9 522.10 522.11 522.12
522.13 522.14 522.15 522.16 522.17 522.18 522.19 522.20
522.21 522.22 522.23 522.24
522.25 522.26 522.27 522.28 522.29 522.30
523.1 523.2 523.3 523.4
523.5 523.6 523.7 523.8 523.9 523.10
523.11 523.12 523.13 523.14
523.15 523.16 523.17 523.18 523.19
523.20 523.21 523.22 523.23 523.24 523.25 523.26 523.27 523.28 523.29 524.1 524.2 524.3 524.4 524.5 524.6 524.7
524.8 524.9 524.10 524.11 524.12 524.13
524.14 524.15 524.16 524.17 524.18 524.19 524.20 524.21 524.22 524.23
524.24 524.25 524.26 524.27 524.28 524.29 524.30
525.1 525.2 525.3 525.4 525.5 525.6 525.7 525.8 525.9
525.10 525.11 525.12 525.13 525.14 525.15 525.16 525.17 525.18
525.19 525.20 525.21 525.22 525.23 525.24 525.25 525.26 525.27 525.28 525.29 525.30 526.1 526.2
526.3 526.4 526.5 526.6 526.7 526.8 526.9 526.10 526.11
526.12 526.13 526.14 526.15 526.16 526.17 526.18 526.19 526.20 526.21 526.22 526.23 526.24 526.25 526.26 526.27 526.28 526.29
527.1 527.2 527.3 527.4 527.5 527.6 527.7
527.8 527.9 527.10 527.11 527.12 527.13 527.14 527.15 527.16 527.17 527.18 527.19 527.20
527.21 527.22 527.23 527.24
527.25 527.26 527.27 527.28 527.29
528.1 528.2 528.3 528.4 528.5
528.6 528.7 528.8 528.9 528.10 528.11
528.12 528.13 528.14 528.15 528.16 528.17 528.18 528.19 528.20 528.21 528.22 528.23 528.24 528.25 528.26 528.27 528.28 528.29 528.30 528.31 528.32 528.33 529.1 529.2 529.3 529.4
529.5 529.6 529.7 529.8 529.9 529.10 529.11 529.12 529.13
529.14 529.15 529.16 529.17
529.18 529.19 529.20 529.21 529.22 529.23 529.24 529.25 529.26 529.27 529.28 529.29 529.30 529.31 529.32 529.33 530.1 530.2 530.3 530.4 530.5 530.6 530.7 530.8 530.9 530.10 530.11 530.12 530.13 530.14 530.15 530.16 530.17 530.18 530.19 530.20 530.21 530.22 530.23 530.24 530.25 530.26 530.27
530.28 530.29 530.30 530.31 530.32 530.33
531.1 531.2 531.3 531.4 531.5 531.6 531.7 531.8 531.9 531.10 531.11 531.12 531.13 531.14 531.15 531.16 531.17
531.18 531.19 531.20 531.21 531.22 531.23 531.24 531.25 531.26 531.27 531.28 532.1 532.2 532.3 532.4 532.5 532.6 532.7 532.8 532.9 532.10 532.11 532.12 532.13 532.14 532.15 532.16 532.17
532.18 532.19 532.20 532.21 532.22 532.23 532.24 532.25 532.26 532.27 532.28 532.29
533.1 533.2 533.3 533.4 533.5 533.6
533.7 533.8 533.9 533.10 533.11 533.12 533.13 533.14 533.15 533.16 533.17 533.18 533.19 533.20 533.21 533.22 533.23
533.24 533.25 533.26 533.27 533.28 533.29 534.1 534.2 534.3 534.4 534.5 534.6 534.7 534.8 534.9 534.10 534.11 534.12 534.13 534.14 534.15 534.16 534.17 534.18 534.19 534.20 534.21 534.22 534.23 534.24 534.25 534.26 534.27 534.28 534.29 534.30 534.31 534.32 535.1 535.2 535.3 535.4 535.5 535.6 535.7 535.8 535.9 535.10 535.11 535.12 535.13 535.14 535.15 535.16 535.17 535.18 535.19 535.20 535.21 535.22 535.23 535.24 535.25 535.26 535.27
535.28 535.29 535.30 535.31 535.32 536.1 536.2 536.3 536.4 536.5 536.6 536.7 536.8 536.9 536.10 536.11
536.12 536.13 536.14 536.15 536.16 536.17 536.18 536.19 536.20 536.21 536.22 536.23 536.24 536.25 536.26 536.27 536.28 536.29 536.30 536.31 536.32 536.33 536.34 537.1 537.2 537.3 537.4 537.5 537.6 537.7 537.8 537.9 537.10 537.11 537.12 537.13 537.14 537.15 537.16 537.17 537.18 537.19 537.20 537.21 537.22 537.23 537.24 537.25 537.26 537.27 537.28 537.29 537.30 537.31 537.32 537.33 537.34 538.1 538.2 538.3 538.4 538.5 538.6 538.7 538.8 538.9 538.10 538.11 538.12 538.13 538.14 538.15 538.16 538.17 538.18 538.19 538.20 538.21 538.22 538.23 538.24 538.25 538.26 538.27 538.28 538.29 538.30 538.31 538.32 538.33 538.34 538.35 539.1 539.2 539.3 539.4 539.5 539.6 539.7 539.8 539.9 539.10 539.11 539.12 539.13 539.14 539.15 539.16 539.17 539.18 539.19 539.20 539.21 539.22 539.23 539.24 539.25 539.26 539.27 539.28 539.29 539.30 539.31 539.32 539.33 540.1 540.2 540.3 540.4 540.5 540.6 540.7 540.8 540.9 540.10 540.11 540.12 540.13 540.14 540.15 540.16
540.17 540.18 540.19 540.20 540.21 540.22 540.23 540.24 540.25 540.26 540.27 540.28 540.29 540.30 540.31 540.32 540.33 540.34 541.1 541.2 541.3 541.4
541.5 541.6 541.7 541.8 541.9 541.10 541.11 541.12 541.13 541.14 541.15 541.16 541.17 541.18 541.19 541.20 541.21 541.22 541.23 541.24 541.25 541.26 541.27 541.28 541.29 541.30 542.1 542.2 542.3 542.4 542.5 542.6 542.7 542.8 542.9 542.10 542.11 542.12 542.13 542.14 542.15 542.16 542.17 542.18 542.19 542.20 542.21 542.22 542.23 542.24 542.25 542.26 542.27 542.28 542.29 543.1 543.2 543.3 543.4 543.5 543.6 543.7 543.8 543.9 543.10 543.11 543.12 543.13 543.14 543.15 543.16 543.17 543.18 543.19 543.20 543.21 543.22 543.23 543.24 543.25 543.26 543.27 543.28 543.29 543.30 543.31 544.1 544.2 544.3 544.4 544.5 544.6 544.7 544.8 544.9 544.10 544.11 544.12 544.13 544.14 544.15 544.16 544.17 544.18 544.19 544.20 544.21 544.22 544.23 544.24 544.25 544.26 544.27 544.28 544.29 544.30 544.31 544.32 544.33 545.1 545.2 545.3 545.4 545.5 545.6 545.7 545.8 545.9 545.10 545.11 545.12 545.13 545.14 545.15 545.16 545.17 545.18 545.19 545.20 545.21 545.22 545.23 545.24 545.25 545.26 545.27 545.28 545.29 545.30 545.31 545.32 545.33 546.1 546.2 546.3 546.4 546.5 546.6 546.7 546.8 546.9 546.10 546.11 546.12 546.13 546.14 546.15 546.16 546.17 546.18 546.19 546.20 546.21 546.22 546.23 546.24 546.25 546.26 546.27
546.28 546.29 546.30 546.31 547.1 547.2 547.3 547.4 547.5 547.6 547.7 547.8 547.9 547.10 547.11 547.12 547.13 547.14 547.15 547.16
547.17 547.18 547.19 547.20
547.21 547.22 547.23 547.24 547.25 547.26 547.27 547.28 547.29 548.1 548.2 548.3 548.4 548.5 548.6 548.7 548.8 548.9 548.10 548.11 548.12 548.13 548.14 548.15 548.16 548.17
548.18 548.19 548.20 548.21 548.22 548.23 548.24 548.25 548.26 548.27 548.28 548.29 548.30 548.31 548.32 548.33 548.34 549.1 549.2 549.3 549.4 549.5 549.6 549.7 549.8 549.9 549.10 549.11 549.12 549.13 549.14 549.15 549.16 549.17 549.18 549.19 549.20 549.21 549.22 549.23 549.24 549.25 549.26 549.27 549.28 549.29 549.30 550.1 550.2 550.3 550.4 550.5 550.6 550.7 550.8 550.9 550.10 550.11
550.12 550.13 550.14 550.15 550.16 550.17 550.18 550.19 550.20 550.21 550.22 550.23 550.24 550.25 550.26 550.27 550.28 550.29 550.30 551.1 551.2 551.3 551.4 551.5 551.6 551.7 551.8 551.9 551.10 551.11 551.12 551.13 551.14 551.15
551.16 551.17 551.18 551.19 551.20 551.21 551.22 551.23 551.24 551.25 551.26 551.27 551.28 551.29 551.30 552.1 552.2 552.3 552.4 552.5 552.6 552.7 552.8 552.9 552.10 552.11 552.12 552.13 552.14 552.15 552.16 552.17 552.18 552.19 552.20 552.21 552.22 552.23 552.24 552.25 552.26 552.27 552.28 552.29 552.30 552.31 553.1 553.2 553.3 553.4 553.5 553.6 553.7 553.8 553.9 553.10 553.11 553.12 553.13
553.14 553.15 553.16 553.17 553.18 553.19 553.20 553.21 553.22 553.23 553.24 553.25 553.26 553.27 553.28 553.29 553.30 554.1 554.2 554.3 554.4 554.5 554.6 554.7 554.8 554.9 554.10 554.11 554.12 554.13 554.14 554.15 554.16 554.17
554.18 554.19 554.20 554.21 554.22 554.23 554.24 554.25 554.26 554.27 554.28 554.29 554.30 554.31 555.1 555.2 555.3 555.4 555.5 555.6 555.7 555.8 555.9 555.10 555.11 555.12 555.13 555.14 555.15 555.16 555.17 555.18 555.19 555.20 555.21 555.22 555.23 555.24 555.25 555.26 555.27 555.28 555.29 555.30 555.31 556.1 556.2 556.3 556.4 556.5 556.6 556.7 556.8 556.9 556.10 556.11 556.12 556.13 556.14 556.15 556.16 556.17 556.18 556.19 556.20 556.21 556.22 556.23 556.24 556.25 556.26 556.27 556.28 556.29 557.1 557.2 557.3 557.4 557.5 557.6 557.7 557.8 557.9 557.10
557.11 557.12 557.13 557.14 557.15 557.16 557.17 557.18 557.19 557.20 557.21 557.22 557.23 557.24 557.25 557.26 557.27 557.28 557.29 557.30 557.31 558.1 558.2 558.3 558.4 558.5 558.6 558.7 558.8 558.9 558.10 558.11 558.12 558.13 558.14 558.15 558.16 558.17 558.18 558.19 558.20 558.21 558.22 558.23
558.24 558.25 558.26 558.27 558.28 558.29 558.30 559.1 559.2 559.3 559.4 559.5 559.6 559.7 559.8 559.9 559.10 559.11 559.12 559.13 559.14 559.15 559.16 559.17 559.18 559.19 559.20 559.21 559.22 559.23 559.24 559.25 559.26
559.27 559.28 559.29 559.30 559.31 559.32 560.1 560.2 560.3 560.4 560.5 560.6 560.7 560.8 560.9 560.10 560.11 560.12 560.13 560.14 560.15 560.16 560.17 560.18 560.19 560.20 560.21 560.22 560.23 560.24 560.25 560.26
560.27 560.28 560.29 560.30 560.31 561.1 561.2 561.3 561.4 561.5 561.6 561.7 561.8 561.9 561.10 561.11 561.12 561.13 561.14 561.15 561.16 561.17 561.18 561.19 561.20 561.21 561.22 561.23 561.24 561.25 561.26 561.27 561.28 561.29 561.30 561.31 561.32 562.1 562.2 562.3 562.4 562.5 562.6 562.7 562.8 562.9 562.10 562.11 562.12 562.13 562.14 562.15 562.16 562.17 562.18 562.19 562.20 562.21 562.22 562.23 562.24 562.25 562.26 562.27 562.28 562.29 562.30 562.31 563.1 563.2 563.3 563.4 563.5 563.6
563.7 563.8 563.9 563.10 563.11 563.12 563.13 563.14 563.15 563.16 563.17 563.18 563.19 563.20 563.21 563.22 563.23 563.24 563.25 563.26
563.27 563.28 563.29 563.30 563.31 563.32 564.1 564.2 564.3 564.4 564.5 564.6 564.7 564.8 564.9 564.10 564.11 564.12 564.13 564.14 564.15 564.16 564.17 564.18 564.19 564.20 564.21 564.22 564.23 564.24
564.25 564.26 564.27 564.28 564.29 564.30 564.31 564.32 565.1 565.2 565.3 565.4 565.5 565.6 565.7 565.8 565.9 565.10 565.11 565.12 565.13 565.14 565.15 565.16 565.17 565.18 565.19 565.20 565.21 565.22 565.23 565.24 565.25 565.26 565.27 565.28 565.29 565.30 565.31 565.32 566.1 566.2 566.3 566.4 566.5 566.6 566.7 566.8 566.9 566.10 566.11 566.12 566.13 566.14 566.15 566.16 566.17 566.18 566.19 566.20 566.21 566.22
566.23 566.24 566.25 566.26 566.27 566.28 566.29 566.30 566.31 567.1 567.2 567.3 567.4 567.5 567.6 567.7 567.8 567.9 567.10 567.11 567.12 567.13 567.14 567.15 567.16 567.17 567.18 567.19 567.20 567.21 567.22 567.23 567.24 567.25 567.26 567.27 567.28 568.1 568.2 568.3 568.4 568.5 568.6 568.7 568.8 568.9 568.10 568.11 568.12 568.13 568.14 568.15 568.16 568.17 568.18 568.19 568.20 568.21 568.22 568.23 568.24 568.25 568.26 568.27 568.28 568.29 568.30 568.31 569.1 569.2
569.3 569.4 569.5 569.6 569.7 569.8 569.9 569.10 569.11 569.12 569.13 569.14 569.15 569.16 569.17 569.18 569.19 569.20 569.21 569.22 569.23 569.24 569.25 569.26 569.27 569.28 569.29 569.30 570.1 570.2 570.3 570.4 570.5 570.6 570.7 570.8 570.9
570.10 570.11 570.12 570.13 570.14 570.15 570.16 570.17 570.18 570.19 570.20 570.21 570.22 570.23 570.24 570.25 570.26 570.27 570.28 570.29 570.30 570.31 571.1 571.2 571.3 571.4 571.5 571.6 571.7 571.8 571.9 571.10 571.11 571.12
571.13 571.14 571.15 571.16 571.17 571.18 571.19 571.20 571.21 571.22 571.23 571.24 571.25 571.26 571.27 571.28 571.29 572.1 572.2 572.3 572.4 572.5 572.6 572.7 572.8 572.9 572.10 572.11 572.12 572.13 572.14 572.15 572.16 572.17 572.18 572.19 572.20 572.21 572.22 572.23 572.24
572.25 572.26 572.27 572.28 572.29 572.30 572.31 573.1 573.2 573.3 573.4 573.5 573.6 573.7 573.8 573.9 573.10 573.11 573.12 573.13 573.14 573.15 573.16 573.17 573.18
573.19 573.20 573.21 573.22 573.23 573.24 573.25 573.26 573.27 573.28 573.29 573.30 573.31 573.32 574.1 574.2 574.3 574.4 574.5 574.6 574.7 574.8 574.9 574.10
574.11 574.12 574.13 574.14 574.15 574.16 574.17 574.18 574.19 574.20 574.21 574.22 574.23 574.24 574.25 574.26 574.27 574.28 574.29 574.30 574.31 574.32 574.33 575.1 575.2 575.3 575.4 575.5 575.6 575.7 575.8 575.9 575.10 575.11 575.12 575.13 575.14 575.15 575.16
575.17 575.18 575.19 575.20 575.21 575.22 575.23 575.24 575.25 575.26 575.27 575.28 575.29 575.30 575.31 575.32
576.1 576.2 576.3 576.4 576.5 576.6 576.7 576.8 576.9 576.10 576.11 576.12 576.13 576.14 576.15 576.16
576.17 576.18 576.19 576.20
576.21 576.22
576.23 576.24
576.25 576.26 576.27 576.28 576.29 576.30 576.31 577.1 577.2
577.3 577.4 577.5 577.6 577.7 577.8 577.9 577.10 577.11 577.12 577.13 577.14 577.15 577.16 577.17 577.18 577.19 577.20 577.21 577.22 577.23 577.24 577.25 577.26 577.27 577.28 577.29 577.30 578.1 578.2 578.3 578.4 578.5 578.6 578.7 578.8 578.9 578.10 578.11 578.12 578.13 578.14 578.15 578.16 578.17 578.18 578.19 578.20 578.21 578.22 578.23 578.24 578.25 578.26 578.27 578.28 578.29
579.1 579.2 579.3 579.4 579.5 579.6 579.7 579.8 579.9 579.10 579.11 579.12 579.13 579.14 579.15 579.16 579.17 579.18 579.19 579.20 579.21 579.22 579.23 579.24 579.25 579.26 579.27 579.28 579.29 579.30 579.31 579.32 580.1 580.2 580.3 580.4 580.5 580.6 580.7 580.8 580.9 580.10 580.11 580.12 580.13 580.14 580.15 580.16 580.17 580.18 580.19 580.20 580.21 580.22 580.23 580.24 580.25 580.26 580.27 580.28 580.29 580.30 580.31 580.32 580.33 580.34 581.1 581.2 581.3 581.4 581.5 581.6 581.7 581.8 581.9 581.10 581.11 581.12 581.13 581.14 581.15 581.16 581.17 581.18 581.19 581.20 581.21 581.22 581.23 581.24 581.25 581.26 581.27 581.28 581.29 581.30 581.31 581.32 582.1 582.2 582.3 582.4 582.5 582.6 582.7 582.8 582.9 582.10 582.11 582.12 582.13 582.14 582.15 582.16 582.17 582.18 582.19 582.20 582.21 582.22 582.23 582.24 582.25 582.26 582.27 582.28 582.29 582.30 582.31 582.32 583.1 583.2 583.3 583.4 583.5 583.6 583.7 583.8 583.9 583.10 583.11 583.12
583.13 583.14 583.15 583.16 583.17 583.18 583.19 583.20 583.21 583.22 583.23 583.24 583.25 583.26 583.27 583.28 583.29 583.30 583.31 583.32 583.33 584.1 584.2 584.3 584.4 584.5 584.6 584.7 584.8 584.9 584.10 584.11 584.12 584.13 584.14 584.15 584.16 584.17 584.18 584.19 584.20 584.21 584.22 584.23 584.24 584.25 584.26 584.27 584.28 584.29 584.30 584.31 584.32 585.1 585.2 585.3 585.4 585.5 585.6 585.7 585.8 585.9 585.10 585.11 585.12 585.13 585.14 585.15 585.16 585.17 585.18 585.19 585.20 585.21 585.22 585.23 585.24 585.25 585.26 585.27 585.28 585.29 585.30
586.1 586.2 586.3 586.4 586.5 586.6 586.7 586.8 586.9 586.10 586.11 586.12 586.13 586.14 586.15 586.16 586.17 586.18 586.19 586.20 586.21 586.22 586.23 586.24 586.25 586.26 586.27 586.28 586.29 586.30 586.31 587.1 587.2 587.3 587.4 587.5 587.6 587.7 587.8 587.9 587.10 587.11 587.12 587.13 587.14 587.15 587.16 587.17 587.18 587.19 587.20 587.21 587.22 587.23 587.24 587.25 587.26 587.27 587.28 587.29 587.30 587.31 588.1 588.2 588.3 588.4 588.5 588.6 588.7 588.8 588.9 588.10 588.11 588.12 588.13 588.14 588.15 588.16 588.17 588.18 588.19 588.20 588.21 588.22 588.23 588.24 588.25 588.26 588.27 588.28 588.29 588.30 588.31 588.32 588.33 589.1 589.2 589.3 589.4 589.5 589.6 589.7 589.8 589.9 589.10 589.11 589.12 589.13 589.14 589.15 589.16 589.17 589.18 589.19 589.20 589.21 589.22 589.23 589.24 589.25 589.26 589.27 589.28 589.29 589.30 590.1 590.2 590.3 590.4 590.5 590.6 590.7 590.8 590.9 590.10 590.11 590.12 590.13 590.14 590.15 590.16 590.17 590.18 590.19 590.20 590.21 590.22 590.23 590.24 590.25 590.26 590.27 590.28 590.29 590.30 591.1 591.2 591.3 591.4 591.5 591.6 591.7 591.8 591.9 591.10 591.11 591.12 591.13 591.14 591.15 591.16 591.17 591.18 591.19 591.20 591.21 591.22 591.23
591.24 591.25 591.26 591.27 591.28 591.29 591.30 591.31 591.32 592.1 592.2 592.3 592.4 592.5 592.6 592.7 592.8 592.9 592.10 592.11 592.12 592.13 592.14 592.15 592.16 592.17 592.18 592.19 592.20 592.21 592.22 592.23 592.24 592.25 592.26 592.27 592.28 592.29 592.30 593.1 593.2 593.3 593.4 593.5 593.6 593.7 593.8 593.9 593.10 593.11 593.12 593.13 593.14 593.15 593.16 593.17 593.18 593.19 593.20 593.21 593.22 593.23 593.24 593.25 593.26 593.27 593.28 593.29 593.30 594.1 594.2 594.3 594.4 594.5 594.6 594.7 594.8 594.9 594.10 594.11 594.12 594.13 594.14 594.15 594.16 594.17 594.18 594.19 594.20 594.21 594.22 594.23 594.24 594.25 594.26 594.27 594.28 594.29 594.30
595.1 595.2 595.3 595.4 595.5 595.6 595.7 595.8 595.9 595.10 595.11 595.12 595.13 595.14 595.15 595.16 595.17 595.18 595.19 595.20 595.21 595.22 595.23 595.24 595.25 595.26 595.27 595.28 595.29 595.30 595.31 596.1 596.2 596.3 596.4 596.5 596.6 596.7 596.8 596.9 596.10 596.11 596.12 596.13 596.14 596.15 596.16 596.17 596.18 596.19 596.20 596.21 596.22 596.23 596.24
596.25 596.26 596.27 596.28 596.29 596.30 596.31 597.1 597.2 597.3 597.4 597.5 597.6 597.7 597.8 597.9 597.10 597.11 597.12 597.13 597.14
597.15 597.16 597.17 597.18 597.19 597.20 597.21 597.22 597.23 597.24 597.25 597.26 597.27 597.28 597.29 597.30 597.31 598.1 598.2 598.3 598.4 598.5 598.6 598.7 598.8 598.9 598.10 598.11 598.12 598.13 598.14 598.15 598.16 598.17 598.18 598.19 598.20 598.21 598.22 598.23 598.24 598.25 598.26 598.27 598.28 598.29 598.30 598.31 599.1 599.2
599.3 599.4 599.5 599.6 599.7 599.8 599.9 599.10 599.11 599.12 599.13 599.14 599.15 599.16 599.17 599.18 599.19 599.20 599.21 599.22 599.23 599.24 599.25 599.26 599.27 599.28 599.29 599.30 599.31 599.32 600.1 600.2 600.3 600.4 600.5 600.6 600.7 600.8 600.9
600.10 600.11 600.12 600.13 600.14 600.15 600.16 600.17 600.18 600.19 600.20 600.21 600.22 600.23 600.24 600.25 600.26 600.27 600.28 600.29 600.30 600.31 601.1 601.2 601.3 601.4 601.5 601.6 601.7 601.8 601.9 601.10 601.11 601.12 601.13 601.14 601.15 601.16 601.17 601.18 601.19 601.20 601.21 601.22 601.23 601.24 601.25 601.26 601.27 601.28 601.29 601.30 601.31 602.1 602.2 602.3 602.4 602.5 602.6 602.7 602.8 602.9 602.10 602.11 602.12 602.13 602.14 602.15 602.16 602.17 602.18 602.19 602.20 602.21 602.22 602.23 602.24 602.25 602.26 602.27 602.28 602.29 602.30 602.31 602.32 602.33 603.1 603.2 603.3 603.4 603.5 603.6 603.7 603.8 603.9 603.10 603.11 603.12 603.13 603.14 603.15 603.16 603.17 603.18 603.19 603.20 603.21 603.22 603.23 603.24 603.25 603.26 603.27 603.28 603.29 603.30 604.1 604.2 604.3 604.4 604.5 604.6 604.7 604.8 604.9 604.10 604.11 604.12 604.13 604.14 604.15 604.16 604.17 604.18 604.19 604.20 604.21 604.22 604.23 604.24 604.25 604.26 604.27 604.28 604.29 604.30 604.31 604.32 605.1 605.2 605.3 605.4 605.5 605.6 605.7 605.8 605.9 605.10 605.11 605.12 605.13 605.14 605.15 605.16 605.17 605.18 605.19 605.20 605.21 605.22 605.23 605.24 605.25 605.26 605.27 605.28 605.29 605.30 605.31 606.1 606.2 606.3 606.4 606.5 606.6 606.7 606.8 606.9 606.10 606.11 606.12 606.13 606.14 606.15 606.16 606.17 606.18 606.19 606.20 606.21 606.22 606.23 606.24 606.25 606.26 606.27 606.28 606.29 606.30 606.31 606.32 606.33 607.1 607.2 607.3 607.4 607.5 607.6 607.7 607.8 607.9 607.10 607.11 607.12 607.13 607.14 607.15 607.16 607.17 607.18 607.19 607.20 607.21 607.22 607.23 607.24 607.25
607.26 607.27 607.28 607.29 607.30 608.1 608.2 608.3 608.4 608.5 608.6 608.7 608.8 608.9 608.10 608.11 608.12 608.13 608.14 608.15 608.16 608.17 608.18 608.19 608.20 608.21 608.22 608.23 608.24 608.25 608.26 608.27 608.28 608.29 608.30 608.31 609.1 609.2 609.3 609.4 609.5 609.6 609.7 609.8 609.9 609.10 609.11 609.12 609.13 609.14 609.15 609.16 609.17 609.18 609.19 609.20 609.21 609.22 609.23 609.24 609.25 609.26 609.27 609.28 609.29 609.30 609.31 609.32 610.1 610.2 610.3 610.4 610.5 610.6 610.7
610.8 610.9 610.10 610.11 610.12 610.13 610.14 610.15 610.16 610.17 610.18 610.19 610.20 610.21 610.22 610.23 610.24 610.25 610.26 610.27 610.28 610.29 610.30 610.31 610.32 611.1 611.2 611.3 611.4 611.5 611.6 611.7 611.8 611.9 611.10 611.11 611.12 611.13 611.14 611.15 611.16 611.17 611.18 611.19 611.20 611.21 611.22 611.23 611.24 611.25 611.26 611.27 611.28 611.29 611.30 611.31 611.32 612.1 612.2 612.3 612.4 612.5 612.6 612.7
612.8 612.9 612.10 612.11 612.12 612.13
612.14 612.15 612.16 612.17 612.18 612.19 612.20 612.21 612.22 612.23 612.24 612.25 612.26 612.27 612.28 612.29 612.30 612.31 613.1 613.2 613.3 613.4 613.5 613.6 613.7 613.8 613.9 613.10 613.11 613.12 613.13 613.14 613.15 613.16 613.17 613.18 613.19 613.20 613.21 613.22 613.23 613.24 613.25 613.26 613.27 613.28 613.29 613.30 613.31 613.32 614.1 614.2 614.3 614.4 614.5 614.6 614.7 614.8 614.9 614.10 614.11 614.12 614.13 614.14 614.15 614.16 614.17 614.18 614.19 614.20 614.21 614.22 614.23 614.24 614.25 614.26 614.27 614.28 614.29 614.30 614.31 614.32 614.33 615.1 615.2 615.3 615.4 615.5 615.6 615.7 615.8 615.9 615.10 615.11 615.12 615.13 615.14 615.15 615.16 615.17 615.18 615.19 615.20 615.21 615.22 615.23 615.24 615.25 615.26 615.27 615.28 615.29 615.30 615.31 615.32 616.1 616.2 616.3 616.4 616.5 616.6 616.7 616.8 616.9 616.10 616.11 616.12 616.13 616.14 616.15 616.16 616.17 616.18 616.19 616.20 616.21 616.22 616.23 616.24 616.25 616.26 616.27 616.28 616.29 616.30 616.31 616.32 616.33 616.34 617.1 617.2 617.3 617.4 617.5 617.6 617.7 617.8 617.9 617.10 617.11 617.12 617.13 617.14 617.15 617.16 617.17 617.18 617.19 617.20 617.21 617.22 617.23 617.24 617.25 617.26 617.27 617.28 617.29 617.30 617.31 618.1 618.2 618.3 618.4 618.5 618.6 618.7 618.8 618.9 618.10 618.11 618.12 618.13 618.14 618.15 618.16 618.17 618.18 618.19 618.20 618.21 618.22 618.23 618.24 618.25 618.26 618.27 618.28 618.29 618.30 618.31 618.32 619.1 619.2 619.3 619.4 619.5 619.6 619.7 619.8 619.9 619.10 619.11 619.12 619.13 619.14 619.15 619.16 619.17 619.18 619.19 619.20 619.21 619.22 619.23 619.24 619.25 619.26 619.27 619.28 619.29 619.30 619.31 619.32 619.33
620.1 620.2 620.3 620.4 620.5 620.6 620.7 620.8 620.9 620.10 620.11 620.12 620.13 620.14 620.15 620.16 620.17 620.18 620.19 620.20 620.21 620.22 620.23 620.24 620.25 620.26 620.27 620.28 620.29 620.30 620.31 620.32 621.1 621.2 621.3 621.4 621.5 621.6 621.7 621.8 621.9 621.10 621.11 621.12 621.13 621.14 621.15 621.16 621.17 621.18 621.19 621.20 621.21 621.22 621.23 621.24 621.25 621.26 621.27 621.28 621.29 621.30 622.1 622.2 622.3 622.4 622.5 622.6 622.7 622.8 622.9 622.10 622.11 622.12 622.13 622.14 622.15 622.16 622.17 622.18 622.19 622.20 622.21 622.22 622.23 622.24 622.25 622.26 622.27 622.28 622.29 622.30 623.1 623.2 623.3 623.4 623.5 623.6 623.7 623.8 623.9 623.10 623.11 623.12 623.13 623.14 623.15 623.16 623.17 623.18 623.19 623.20 623.21 623.22 623.23 623.24 623.25 623.26 623.27 623.28 623.29 623.30 623.31 623.32 623.33 623.34 623.35 624.1 624.2 624.3 624.4 624.5 624.6 624.7 624.8 624.9 624.10 624.11 624.12 624.13 624.14 624.15 624.16 624.17 624.18 624.19 624.20 624.21 624.22 624.23 624.24 624.25 624.26 624.27 624.28 624.29 624.30 624.31 624.32 625.1 625.2 625.3 625.4 625.5 625.6 625.7 625.8 625.9 625.10 625.11 625.12 625.13 625.14 625.15 625.16 625.17 625.18 625.19 625.20 625.21 625.22 625.23 625.24 625.25 625.26 625.27 625.28 625.29 625.30 625.31 626.1 626.2 626.3 626.4 626.5 626.6 626.7 626.8 626.9 626.10 626.11 626.12 626.13 626.14 626.15 626.16 626.17 626.18 626.19 626.20 626.21 626.22 626.23 626.24 626.25 626.26 626.27 626.28 626.29 626.30 626.31 626.32 626.33 627.1 627.2 627.3 627.4 627.5 627.6 627.7 627.8 627.9 627.10 627.11 627.12 627.13 627.14 627.15 627.16 627.17 627.18 627.19 627.20 627.21 627.22 627.23 627.24 627.25 627.26 627.27 627.28 627.29 627.30 627.31 628.1 628.2 628.3 628.4 628.5 628.6 628.7 628.8 628.9 628.10 628.11 628.12 628.13 628.14 628.15 628.16 628.17 628.18 628.19 628.20 628.21 628.22 628.23 628.24 628.25 628.26 628.27 628.28 628.29 628.30 628.31 629.1 629.2 629.3 629.4 629.5 629.6 629.7 629.8 629.9 629.10 629.11 629.12 629.13 629.14 629.15 629.16 629.17 629.18 629.19 629.20 629.21 629.22 629.23 629.24 629.25 629.26 629.27 629.28 629.29 629.30 629.31 630.1 630.2 630.3 630.4 630.5 630.6 630.7 630.8 630.9 630.10 630.11 630.12 630.13 630.14 630.15 630.16 630.17 630.18 630.19 630.20 630.21 630.22 630.23 630.24 630.25 630.26 630.27 630.28 630.29 630.30 630.31 631.1 631.2 631.3 631.4 631.5 631.6 631.7 631.8 631.9 631.10 631.11 631.12 631.13 631.14 631.15 631.16 631.17 631.18 631.19 631.20 631.21 631.22 631.23 631.24 631.25 631.26 631.27 631.28 631.29 631.30 631.31 631.32 631.33 632.1 632.2 632.3 632.4 632.5 632.6 632.7 632.8 632.9 632.10 632.11 632.12 632.13 632.14 632.15 632.16
632.17 632.18 632.19 632.20 632.21 632.22 632.23 632.24 632.25 632.26 632.27 632.28 632.29 632.30 632.31 633.1 633.2 633.3 633.4 633.5 633.6 633.7 633.8 633.9 633.10 633.11 633.12 633.13 633.14 633.15 633.16 633.17 633.18 633.19 633.20 633.21 633.22 633.23 633.24 633.25 633.26 633.27 633.28 633.29 633.30 633.31 633.32 634.1 634.2 634.3 634.4 634.5 634.6 634.7 634.8 634.9 634.10 634.11 634.12 634.13 634.14 634.15 634.16 634.17 634.18 634.19 634.20 634.21 634.22 634.23 634.24 634.25 634.26 634.27 634.28 634.29 634.30 634.31 635.1 635.2 635.3 635.4 635.5 635.6 635.7 635.8 635.9 635.10 635.11 635.12 635.13 635.14 635.15 635.16 635.17 635.18 635.19 635.20 635.21 635.22 635.23 635.24 635.25 635.26 635.27 635.28 635.29 635.30 635.31 635.32 636.1 636.2 636.3 636.4 636.5 636.6 636.7 636.8 636.9 636.10 636.11 636.12 636.13 636.14 636.15 636.16 636.17 636.18 636.19 636.20 636.21 636.22 636.23 636.24 636.25 636.26 636.27 636.28 636.29 636.30 636.31 636.32 637.1 637.2 637.3 637.4 637.5 637.6 637.7 637.8 637.9 637.10 637.11 637.12 637.13 637.14 637.15 637.16 637.17 637.18 637.19 637.20 637.21 637.22 637.23 637.24 637.25 637.26 637.27 637.28 637.29 637.30 637.31 638.1 638.2 638.3 638.4 638.5 638.6 638.7 638.8 638.9 638.10 638.11 638.12 638.13 638.14 638.15 638.16 638.17 638.18 638.19 638.20 638.21 638.22 638.23 638.24 638.25 638.26 638.27 638.28 638.29 638.30 638.31 638.32 638.33 639.1 639.2 639.3 639.4 639.5 639.6 639.7 639.8 639.9 639.10 639.11 639.12 639.13 639.14 639.15 639.16 639.17 639.18 639.19 639.20 639.21 639.22 639.23 639.24 639.25 639.26 639.27 639.28 639.29 639.30 639.31 640.1 640.2 640.3 640.4 640.5 640.6 640.7 640.8 640.9 640.10 640.11 640.12 640.13 640.14 640.15 640.16 640.17 640.18 640.19 640.20 640.21 640.22 640.23 640.24 640.25 640.26 640.27 640.28 640.29 640.30 641.1 641.2 641.3 641.4 641.5 641.6 641.7 641.8 641.9 641.10 641.11 641.12 641.13 641.14 641.15 641.16 641.17 641.18 641.19 641.20 641.21 641.22 641.23 641.24 641.25 641.26 641.27 641.28 641.29 641.30 642.1 642.2 642.3 642.4 642.5 642.6 642.7 642.8 642.9 642.10 642.11 642.12 642.13 642.14 642.15 642.16 642.17 642.18 642.19 642.20 642.21 642.22 642.23 642.24 642.25 642.26 642.27 642.28 642.29 642.30 642.31 642.32 642.33 642.34 643.1 643.2 643.3 643.4 643.5 643.6 643.7 643.8 643.9 643.10 643.11 643.12 643.13 643.14 643.15 643.16 643.17 643.18 643.19 643.20 643.21 643.22 643.23 643.24 643.25 643.26 643.27 643.28 643.29 643.30 643.31 643.32 643.33 643.34 644.1 644.2 644.3
644.4 644.5 644.6 644.7 644.8 644.9 644.10 644.11 644.12 644.13
644.14 644.15 644.16
644.17 644.18
644.19 644.20 644.21 644.22 644.23 644.24 644.25 644.26 644.27 644.28 644.29 644.30 644.31 645.1 645.2 645.3 645.4 645.5 645.6 645.7 645.8 645.9 645.10
645.11 645.12 645.13 645.14 645.15 645.16 645.17 645.18 645.19 645.20 645.21 645.22 645.23 645.24 645.25 645.26 645.27 645.28 645.29 645.30 646.1 646.2 646.3 646.4 646.5 646.6 646.7 646.8 646.9 646.10 646.11 646.12 646.13 646.14 646.15 646.16 646.17 646.18
646.19 646.20 646.21 646.22 646.23 646.24 646.25 646.26 646.27 646.28 646.29 646.30 646.31 646.32 647.1 647.2 647.3 647.4 647.5 647.6
647.7 647.8 647.9 647.10 647.11 647.12 647.13 647.14 647.15 647.16 647.17 647.18 647.19 647.20 647.21 647.22 647.23 647.24 647.25 647.26 647.27 647.28 647.29 647.30 648.1 648.2 648.3 648.4 648.5 648.6 648.7 648.8 648.9 648.10 648.11 648.12 648.13 648.14 648.15 648.16 648.17 648.18 648.19 648.20 648.21 648.22 648.23 648.24 648.25 648.26 648.27 648.28 648.29 648.30 648.31 648.32 649.1 649.2 649.3 649.4 649.5 649.6 649.7 649.8 649.9 649.10 649.11 649.12 649.13 649.14 649.15 649.16 649.17 649.18 649.19 649.20 649.21 649.22 649.23 649.24 649.25 649.26 649.27 649.28 649.29 649.30 649.31 649.32 650.1 650.2 650.3 650.4 650.5 650.6 650.7 650.8 650.9 650.10 650.11 650.12 650.13 650.14 650.15 650.16 650.17 650.18 650.19 650.20 650.21 650.22 650.23 650.24 650.25 650.26 650.27 650.28 650.29 650.30 650.31 651.1 651.2 651.3 651.4 651.5 651.6 651.7 651.8 651.9 651.10 651.11 651.12 651.13 651.14 651.15 651.16 651.17 651.18 651.19 651.20 651.21 651.22 651.23 651.24 651.25 651.26 651.27 651.28 651.29 651.30 651.31 652.1 652.2 652.3 652.4 652.5 652.6 652.7 652.8 652.9 652.10 652.11 652.12 652.13 652.14 652.15 652.16 652.17 652.18 652.19 652.20 652.21 652.22 652.23 652.24 652.25 652.26 652.27 652.28 652.29 652.30 652.31 653.1 653.2 653.3 653.4 653.5 653.6 653.7 653.8 653.9 653.10 653.11 653.12 653.13 653.14 653.15 653.16 653.17 653.18 653.19 653.20 653.21 653.22 653.23 653.24 653.25 653.26 653.27 653.28 653.29 653.30 653.31 653.32 653.33 654.1 654.2 654.3 654.4 654.5 654.6 654.7 654.8 654.9 654.10 654.11 654.12 654.13 654.14 654.15 654.16 654.17 654.18 654.19 654.20 654.21 654.22 654.23 654.24 654.25 654.26 654.27 654.28 654.29 654.30 654.31 655.1 655.2 655.3 655.4 655.5 655.6 655.7 655.8 655.9 655.10 655.11 655.12 655.13 655.14 655.15 655.16 655.17 655.18 655.19 655.20 655.21 655.22 655.23 655.24 655.25 655.26 655.27 655.28 655.29 655.30 655.31 655.32 655.33 655.34 656.1 656.2 656.3 656.4 656.5 656.6 656.7 656.8 656.9 656.10 656.11 656.12 656.13 656.14 656.15 656.16 656.17 656.18 656.19 656.20 656.21 656.22 656.23 656.24 656.25 656.26 656.27 656.28 656.29 656.30 656.31 656.32 656.33 657.1 657.2 657.3 657.4 657.5 657.6 657.7 657.8 657.9 657.10 657.11 657.12 657.13 657.14 657.15 657.16 657.17 657.18 657.19 657.20 657.21 657.22 657.23 657.24 657.25 657.26 657.27 657.28 657.29 657.30 657.31 657.32 657.33 658.1 658.2 658.3 658.4 658.5 658.6 658.7 658.8 658.9 658.10 658.11 658.12 658.13 658.14 658.15 658.16 658.17 658.18 658.19 658.20 658.21 658.22 658.23 658.24 658.25 658.26 658.27 658.28 658.29 658.30 658.31 658.32 659.1 659.2 659.3 659.4 659.5 659.6 659.7 659.8 659.9 659.10 659.11 659.12 659.13 659.14 659.15 659.16 659.17 659.18 659.19 659.20 659.21 659.22 659.23 659.24 659.25 659.26 659.27 659.28 659.29 659.30 660.1 660.2 660.3 660.4 660.5 660.6 660.7 660.8 660.9 660.10 660.11 660.12 660.13 660.14 660.15 660.16 660.17 660.18 660.19 660.20 660.21 660.22 660.23 660.24 660.25 660.26 660.27 660.28 660.29 660.30 660.31 661.1 661.2 661.3 661.4 661.5 661.6 661.7 661.8 661.9 661.10 661.11 661.12 661.13 661.14 661.15 661.16 661.17 661.18 661.19 661.20 661.21 661.22 661.23 661.24 661.25 661.26 661.27 661.28 661.29 661.30 661.31
662.1 662.2 662.3
662.4 662.5
662.6 662.7 662.8 662.9 662.10 662.11 662.12 662.13 662.14 662.15 662.16
662.17 662.18 662.19 662.20 662.21 662.22 662.23 662.24 662.25 662.26 662.27 662.28 662.29 662.30 662.31
663.1 663.2 663.3 663.4 663.5 663.6 663.7 663.8 663.9 663.10 663.11 663.12 663.13 663.14
663.15 663.16 663.17 663.18 663.19 663.20 663.21 663.22 663.23 663.24 663.25 663.26 663.27 663.28 663.29 663.30 663.31 663.32 663.33
664.1 664.2 664.3 664.4 664.5 664.6 664.7 664.8 664.9 664.10 664.11 664.12 664.13 664.14 664.15 664.16 664.17 664.18 664.19 664.20 664.21 664.22 664.23 664.24 664.25 664.26 664.27 664.28 664.29 664.30 664.31 665.1
665.2 665.3 665.4 665.5 665.6 665.7 665.8 665.9 665.10 665.11 665.12 665.13 665.14 665.15 665.16 665.17 665.18 665.19 665.20 665.21 665.22 665.23 665.24 665.25 665.26 665.27 665.28 665.29 665.30 665.31 665.32 666.1 666.2 666.3 666.4 666.5 666.6 666.7 666.8 666.9 666.10
666.11 666.12 666.13 666.14 666.15 666.16 666.17 666.18 666.19 666.20 666.21 666.22 666.23 666.24 666.25 666.26 666.27 666.28 666.29 666.30 666.31 667.1 667.2 667.3 667.4
667.5 667.6 667.7 667.8 667.9 667.10 667.11 667.12 667.13 667.14 667.15 667.16 667.17 667.18 667.19 667.20 667.21 667.22 667.23 667.24 667.25 667.26 667.27 667.28 667.29 667.30 667.31 667.32 668.1 668.2 668.3 668.4 668.5 668.6 668.7
668.8 668.9 668.10 668.11 668.12 668.13 668.14 668.15 668.16 668.17 668.18 668.19 668.20 668.21 668.22 668.23 668.24 668.25 668.26 668.27 668.28 668.29 668.30 668.31 668.32 668.33 669.1 669.2
669.3 669.4 669.5
669.6 669.7 669.8 669.9 669.10 669.11 669.12 669.13 669.14 669.15 669.16 669.17 669.18 669.19 669.20 669.21
669.22 669.23 669.24 669.25 669.26 669.27 669.28 669.29 669.30 670.1 670.2 670.3 670.4 670.5 670.6 670.7 670.8 670.9 670.10 670.11
670.12 670.13 670.14 670.15 670.16 670.17 670.18 670.19 670.20 670.21 670.22 670.23 670.24 670.25 670.26 670.27 670.28 670.29 670.30 671.1 671.2 671.3 671.4 671.5 671.6 671.7 671.8 671.9 671.10 671.11 671.12 671.13 671.14
671.15 671.16 671.17 671.18 671.19 671.20 671.21 671.22 671.23
671.24 671.25 671.26 671.27 671.28
671.29 671.30 671.31 671.32 672.1 672.2 672.3 672.4 672.5 672.6 672.7 672.8 672.9 672.10 672.11 672.12 672.13 672.14 672.15 672.16 672.17 672.18 672.19 672.20 672.21 672.22 672.23 672.24 672.25 672.26 672.27 672.28 672.29 672.30 672.31 672.32 673.1 673.2 673.3 673.4 673.5 673.6 673.7 673.8 673.9 673.10 673.11 673.12 673.13 673.14 673.15 673.16 673.17 673.18 673.19 673.20 673.21 673.22 673.23 673.24 673.25 673.26 673.27 673.28 673.29 673.30 673.31 673.32 674.1 674.2 674.3 674.4 674.5 674.6 674.7 674.8
674.9 674.10 674.11 674.12 674.13 674.14 674.15 674.16 674.17 674.18 674.19 674.20 674.21 674.22 674.23 674.24 674.25 674.26 674.27 674.28 674.29 674.30 674.31 675.1 675.2 675.3 675.4 675.5 675.6 675.7 675.8 675.9 675.10 675.11
675.12 675.13 675.14 675.15 675.16 675.17 675.18
675.19 675.20 675.21 675.22 675.23 675.24 675.25
675.26 675.27 675.28 675.29
676.1 676.2 676.3 676.4 676.5 676.6 676.7 676.8 676.9 676.10 676.11 676.12 676.13 676.14 676.15
676.16 676.17 676.18 676.19 676.20 676.21 676.22 676.23 676.24 676.25 676.26 676.27
676.28 676.29 676.30 676.31 677.1 677.2 677.3 677.4 677.5 677.6 677.7 677.8 677.9 677.10 677.11
677.12 677.13 677.14 677.15 677.16 677.17 677.18 677.19 677.20 677.21 677.22 677.23 677.24 677.25 677.26 677.27 677.28 677.29 677.30
677.31 677.32 677.33 677.34 678.1 678.2 678.3 678.4 678.5 678.6 678.7 678.8 678.9 678.10 678.11 678.12 678.13 678.14 678.15 678.16 678.17 678.18 678.19 678.20
678.21 678.22 678.23 678.24 678.25 678.26 678.27 678.28 678.29 678.30 678.31 679.1 679.2 679.3 679.4 679.5 679.6 679.7 679.8 679.9 679.10 679.11 679.12 679.13 679.14 679.15 679.16 679.17 679.18
679.19 679.20 679.21 679.22 679.23 679.24 679.25 679.26 679.27
679.28 679.29 679.30 679.31 680.1 680.2 680.3 680.4 680.5 680.6 680.7 680.8 680.9 680.10 680.11 680.12 680.13 680.14 680.15 680.16 680.17 680.18 680.19 680.20 680.21 680.22 680.23 680.24 680.25
680.26 680.27 680.28 680.29 680.30 680.31 680.32 680.33 681.1 681.2 681.3 681.4 681.5 681.6 681.7 681.8 681.9 681.10
681.11 681.12 681.13 681.14 681.15 681.16 681.17 681.18 681.19 681.20 681.21 681.22 681.23 681.24 681.25 681.26 681.27 681.28 681.29 681.30 681.31 681.32 681.33 682.1 682.2 682.3
682.4 682.5 682.6 682.7 682.8 682.9 682.10 682.11 682.12 682.13 682.14 682.15 682.16 682.17 682.18 682.19 682.20 682.21 682.22 682.23 682.24 682.25 682.26 682.27 682.28 682.29 682.30 682.31 683.1 683.2
683.3 683.4 683.5 683.6 683.7 683.8 683.9 683.10 683.11 683.12 683.13 683.14 683.15 683.16 683.17 683.18 683.19 683.20 683.21 683.22
683.23 683.24 683.25 683.26 683.27 683.28 683.29 683.30 684.1 684.2 684.3
684.4 684.5 684.6 684.7
684.8 684.9 684.10 684.11 684.12 684.13 684.14 684.15 684.16 684.17 684.18 684.19 684.20 684.21 684.22 684.23 684.24 684.25 684.26 684.27 684.28 684.29 684.30 684.31 684.32 685.1 685.2 685.3 685.4 685.5 685.6 685.7 685.8 685.9 685.10 685.11 685.12 685.13 685.14
685.15 685.16 685.17 685.18 685.19 685.20 685.21
685.22 685.23 685.24 685.25 685.26 685.27 685.28 685.29 685.30 685.31 685.32 685.33 686.1 686.2 686.3 686.4
686.5 686.6 686.7 686.8 686.9 686.10 686.11
686.12 686.13 686.14 686.15 686.16 686.17 686.18
686.19 686.20 686.21 686.22
686.23 686.24 686.25 686.26 686.27 686.28 686.29 686.30 686.31 687.1 687.2 687.3 687.4 687.5 687.6
687.7 687.8 687.9 687.10 687.11 687.12 687.13 687.14 687.15 687.16 687.17 687.18 687.19 687.20 687.21 687.22 687.23 687.24 687.25 687.26 687.27 687.28 687.29
687.30 687.31 687.32 687.33 687.34 688.1 688.2 688.3 688.4 688.5 688.6 688.7 688.8 688.9 688.10 688.11 688.12 688.13 688.14 688.15 688.16 688.17 688.18 688.19 688.20
688.21 688.22 688.23 688.24 688.25 688.26 688.27 688.28 688.29 688.30 689.1 689.2 689.3 689.4 689.5
689.6 689.7 689.8 689.9
689.10 689.11 689.12 689.13 689.14 689.15 689.16 689.17 689.18 689.19 689.20 689.21 689.22 689.23 689.24 689.25 689.26 689.27 689.28 689.29 689.30 689.31 689.32 690.1 690.2 690.3 690.4 690.5 690.6 690.7 690.8 690.9 690.10 690.11 690.12 690.13 690.14 690.15 690.16 690.17 690.18 690.19 690.20 690.21 690.22 690.23 690.24 690.25 690.26 690.27 690.28 690.29 690.30 690.31 690.32 691.1 691.2 691.3 691.4 691.5 691.6 691.7 691.8 691.9 691.10 691.11 691.12 691.13 691.14 691.15 691.16 691.17 691.18 691.19 691.20 691.21 691.22 691.23 691.24 691.25 691.26 691.27 691.28 691.29 691.30 691.31 691.32 691.33 691.34 692.1 692.2 692.3 692.4 692.5 692.6 692.7
692.8 692.9 692.10 692.11 692.12 692.13 692.14 692.15 692.16 692.17 692.18 692.19 692.20 692.21 692.22 692.23 692.24 692.25 692.26 692.27 692.28 692.29 692.30 692.31 692.32
693.1 693.2 693.3 693.5 693.4 693.6 693.7 693.8 693.9 693.10 693.11 693.12 693.13 693.14 693.15 693.16 693.17 693.18 693.19 693.20 693.21 693.22 693.23 693.24 693.25 693.26 693.27 693.28 693.29 693.30 693.31 693.32 693.33 693.34 693.35 693.36 693.37 693.38 693.39 694.1 694.2 694.3 694.4 694.5 694.6 694.7 694.8 694.9 694.10 694.11 694.12 694.13 694.14 694.15 694.16 694.17 694.18 694.19 694.20 694.21 694.22 694.23 694.24 694.25 694.26 694.27 694.28 694.29 694.30 694.31 694.32 694.33 694.34 694.35 694.36 694.37 694.38 694.39 694.40 694.41 694.42 694.43 694.44 694.45 695.1 695.2 695.3 695.4 695.5 695.6 695.7 695.8 695.9 695.10 695.11 695.12 695.13 695.14 695.15 695.16 695.17 695.18 695.19 695.20 695.21 695.22 695.23 695.24 695.25 695.26 695.27 695.28 695.29 695.30 695.31 695.32 695.33 696.1 696.2 696.3 696.4 696.5 696.6 696.7 696.8 696.9 696.10 696.11 696.12 696.13 696.14 696.15 696.16 696.17 696.18 696.19 696.20 696.21 696.22 696.23 696.24 696.25 696.26 696.27 696.28 696.29 696.30 696.31 696.32 696.33 696.34 697.1 697.2 697.3 697.4 697.5 697.6 697.7 697.8 697.9
697.10 697.11 697.12 697.13 697.14 697.15 697.16 697.17 697.18 697.19 697.20 697.21 697.22 697.23 697.24 697.25 697.26 697.27 697.28 697.29 697.30 697.31 697.32 697.33 698.1 698.2 698.3 698.4 698.5 698.6 698.7 698.8 698.9 698.10 698.11 698.12 698.13 698.14 698.15 698.16 698.17 698.18 698.19 698.20 698.21 698.22 698.23 698.24 698.25 698.26 698.27 698.28 698.29 698.30 698.31 698.32 698.33
699.1 699.2 699.3 699.4 699.5
699.6 699.7 699.8 699.9 699.10 699.11 699.12 699.13 699.14 699.15 699.16 699.17 699.18 699.19 699.20 699.21 699.22 699.23 699.24 699.25 699.26 699.27 699.28 699.29 699.30 699.31 700.1 700.2 700.3 700.4 700.5 700.6 700.7 700.8 700.9 700.10 700.11 700.12 700.13 700.14 700.15 700.16 700.17 700.18 700.19 700.20 700.21 700.22 700.23 700.24 700.25 700.26 700.27 700.28 700.29 700.30 701.1 701.2 701.3 701.4 701.5 701.6 701.7 701.8 701.9 701.10 701.11 701.12 701.13 701.14 701.15 701.16 701.17 701.18 701.19 701.20 701.21 701.22 701.23 701.24 701.25 701.26 701.27 701.28 701.29 701.30 701.31 701.32 702.1 702.2 702.3 702.4 702.5 702.6 702.7 702.8 702.9 702.10 702.11 702.12 702.13
702.14 702.15 702.16 702.17 702.18 702.19
702.20 702.21 702.22 702.23 702.24 702.25 702.26 702.27 702.28 702.29
702.30 702.31 702.32 703.1 703.2 703.3 703.4 703.5
703.6 703.7 703.8 703.9
703.10 703.11 703.12 703.13 703.14 703.15 703.16 703.17 703.18 703.19 703.20
703.21 703.22 703.23 703.24 703.25 703.26 703.27 703.28 703.29 703.30 703.31
704.1 704.2 704.3 704.4 704.5 704.6 704.7 704.8 704.9 704.10 704.11 704.12 704.13 704.14 704.15 704.16 704.17 704.18 704.19 704.20 704.21 704.22 704.23 704.24 704.25 704.26 704.27 704.28 704.29 704.30 704.31 704.32 704.33 705.1 705.2 705.3 705.4 705.5 705.6 705.7 705.8 705.9 705.10 705.11 705.12 705.13 705.14 705.15 705.16 705.17 705.18 705.19 705.20 705.21 705.22 705.23 705.24 705.25 705.26 705.27 705.28 705.29 705.30 705.31 705.32 705.33 705.34 705.35 706.1 706.2 706.3 706.4 706.5 706.6 706.7 706.8 706.9 706.10 706.11 706.12 706.13 706.14 706.15 706.16 706.17 706.18 706.19 706.20 706.21 706.22 706.23 706.24 706.25 706.26 706.27 706.28 706.29 706.30 706.31 707.1 707.2 707.3 707.4 707.5 707.6 707.7 707.8 707.9 707.10 707.11 707.12 707.13 707.14 707.15 707.16 707.17 707.18 707.19 707.20 707.21 707.22 707.23 707.24
707.25 707.26 707.27 707.28 707.29 707.30 707.31 707.32 708.1 708.2 708.3 708.4 708.5 708.6 708.7 708.8 708.9 708.10 708.11 708.12 708.13 708.14 708.15 708.16 708.17 708.18 708.19 708.20 708.21 708.22 708.23 708.24 708.25 708.26 708.27 708.28
709.1 709.2 709.3 709.4 709.5 709.6 709.7 709.8 709.9 709.10 709.11 709.12 709.13 709.14 709.15 709.16 709.17 709.18 709.19 709.20 709.21 709.22
709.23 709.24 709.25 709.26 709.27 709.28 709.29 709.30 709.31 709.32 710.1 710.2 710.3 710.4 710.5 710.6 710.7 710.8 710.9 710.10 710.11 710.12 710.13 710.14 710.15 710.16 710.17 710.18 710.19 710.20 710.21 710.22 710.23 710.24 710.25 710.26 710.27 710.28 710.29 710.30 710.31 710.32 710.33 711.1 711.2 711.3 711.4 711.5 711.6 711.7 711.8 711.9 711.10 711.11 711.12 711.13 711.14 711.15 711.16 711.17 711.18 711.19 711.20 711.21 711.22 711.23 711.24 711.25 711.26 711.27 711.28
711.29 711.30 711.31 711.32 712.1 712.2 712.3 712.4 712.5 712.6 712.7 712.8 712.9 712.10 712.11 712.12 712.13 712.14 712.15 712.16 712.17 712.18 712.19 712.20 712.21 712.22 712.23 712.24 712.25 712.26 712.27 712.28 712.29 712.30 712.31 712.32 712.33 713.1 713.2 713.3 713.4 713.5 713.6 713.7 713.8 713.9 713.10 713.11 713.12 713.13 713.14 713.15 713.16 713.17 713.18 713.19 713.20 713.21 713.22 713.23 713.24 713.25 713.26 713.27 713.28 713.29 713.30 713.31 713.32 713.33 714.1 714.2 714.3 714.4 714.5 714.6 714.7 714.8 714.9 714.10 714.11 714.12 714.13 714.14 714.15 714.16 714.17 714.18 714.19 714.20 714.21 714.22 714.23 714.24 714.25 714.26 714.27 714.28 714.29 714.30 714.31 714.32 715.1 715.2 715.3 715.4 715.5 715.6 715.7 715.8 715.9 715.10 715.11 715.12 715.13 715.14 715.15 715.16 715.17 715.18 715.19 715.20 715.21 715.22 715.23 715.24 715.25 715.26 715.27 715.28
715.29 715.30 715.31 715.32 716.1 716.2 716.3 716.4 716.5 716.6 716.7 716.8 716.9 716.10 716.11 716.12 716.13 716.14 716.15 716.16 716.17 716.18 716.19 716.20 716.21 716.22 716.23 716.24 716.25 716.26 716.27 716.28 716.29 716.30 716.31 716.32 716.33 717.1 717.2 717.3 717.4 717.5 717.6 717.7 717.8 717.9 717.10 717.11 717.12 717.13 717.14 717.15 717.16 717.17 717.18 717.19 717.20 717.21 717.22 717.23 717.24 717.25 717.26 717.27 717.28 717.29 717.30 717.31 717.32 718.1 718.2 718.3 718.4 718.5 718.6 718.7 718.8 718.9 718.10 718.11 718.12 718.13 718.14 718.15 718.16 718.17 718.18 718.19
718.20 718.21 718.22 718.23 718.24 718.25 718.26 718.27 718.28 718.29 718.30 719.1 719.2 719.3 719.4 719.5 719.6 719.7 719.8 719.9 719.10 719.11 719.12 719.13 719.14 719.15 719.16 719.17 719.18 719.19 719.20 719.21 719.22 719.23 719.24 719.25 719.26 719.27 719.28 719.29 719.30 719.31 719.32 719.33 720.1 720.2 720.3 720.4 720.5 720.6 720.7 720.8 720.9 720.10 720.11 720.12 720.13 720.14 720.15 720.16 720.17 720.18 720.19 720.20 720.21 720.22 720.23 720.24 720.25 720.26 720.27 720.28
720.29 720.30 720.31 720.32 720.33 721.1 721.2 721.3 721.4 721.5 721.6
721.7 721.8 721.9 721.10 721.11 721.12 721.13 721.14 721.15 721.16 721.17 721.18 721.19 721.20 721.21 721.22 721.23 721.24 721.25 721.26 721.27 721.28 721.29 721.30 721.31 721.32 722.1 722.2 722.3 722.4 722.5
722.6 722.7 722.8 722.9 722.10 722.11 722.12 722.13 722.14 722.15 722.16 722.17
722.18 722.19 722.20 722.21 722.22 722.23 722.24 722.25 722.26 722.27 722.28 722.29 722.30 722.31 723.1 723.2 723.3 723.4 723.5 723.6 723.7 723.8 723.9 723.10 723.11 723.12 723.13 723.14 723.15 723.16 723.17 723.18 723.19 723.20 723.21 723.22 723.23 723.24 723.25 723.26 723.27 723.28 723.29 723.30 723.31 724.1 724.2 724.3 724.4 724.5 724.6 724.7 724.8 724.9 724.10
724.11 724.12 724.13 724.14 724.15 724.16 724.17 724.18 724.19 724.20 724.21 724.22 724.23 724.24 724.25 724.26 724.27 724.28 724.29 724.30 724.31 725.1 725.2 725.3 725.4 725.5 725.6 725.7 725.8 725.9 725.10 725.11 725.12 725.13 725.14 725.15 725.16 725.17 725.18 725.19 725.20 725.21 725.22 725.23 725.24 725.25 725.26 725.27 725.28 725.29 725.30 726.1 726.2 726.3 726.4 726.5 726.6 726.7 726.8 726.9 726.10 726.11 726.12 726.13 726.14 726.15 726.16 726.17 726.18 726.19
726.20 726.21 726.22 726.23 726.24 726.25 726.26 726.27 726.28 726.29 726.30 726.31 726.32 727.1 727.2 727.3 727.4 727.5 727.6 727.7 727.8 727.9 727.10 727.11 727.12 727.13 727.14 727.15 727.16 727.17 727.18 727.19 727.20 727.21 727.22 727.23 727.24 727.25 727.26 727.27 727.28 727.29 727.30 727.31 727.32 727.33 728.1 728.2 728.3 728.4 728.5 728.6 728.7 728.8 728.9 728.10 728.11 728.12 728.13 728.14 728.15 728.16 728.17 728.18 728.19 728.20 728.21 728.22 728.23 728.24 728.25
728.26 728.27 728.28 728.29 728.30 728.31 728.32 729.1 729.2 729.3 729.4 729.5 729.6 729.7
729.8 729.9 729.10 729.11 729.12 729.13 729.14 729.15 729.16 729.17 729.18 729.19 729.20 729.21 729.22 729.23 729.24 729.25 729.26 729.27 729.28 729.29 729.30 729.31 729.32 729.33 730.1 730.2 730.3 730.4 730.5 730.6 730.7
730.8 730.9 730.10 730.11 730.12 730.13 730.14 730.15 730.16 730.17 730.18 730.19 730.20 730.21 730.22 730.23 730.24 730.25 730.26 730.27 730.28 730.29 730.30 730.31 730.32 731.1 731.2 731.3 731.4 731.5 731.6 731.7 731.8 731.9 731.10 731.11 731.12 731.13 731.14 731.15 731.16 731.17 731.18 731.19 731.20 731.21 731.22 731.23 731.24 731.25 731.26 731.27 731.28 731.29 731.30 731.31 731.32 731.33 732.1 732.2 732.3
732.4 732.5 732.6 732.7 732.8 732.9 732.10 732.11 732.12 732.13 732.14 732.15 732.16 732.17 732.18 732.19 732.20 732.21 732.22 732.23 732.24 732.25 732.26 732.27 732.28 732.29 732.30 732.31 733.1 733.2 733.3 733.4 733.5 733.6 733.7 733.8 733.9 733.10 733.11 733.12 733.13 733.14 733.15 733.16 733.17 733.18 733.19 733.20 733.21 733.22 733.23 733.24 733.25 733.26 733.27
733.28 733.29
733.30 733.31 733.32 733.33 734.1 734.2 734.3 734.4 734.5 734.6 734.7 734.8
734.9 734.10 734.11 734.12 734.13 734.14 734.15 734.16 734.17 734.18 734.19 734.20 734.21 734.22
734.23 734.24 734.25 734.26 734.27 734.28
734.29 734.30 734.31 734.32 735.1 735.2 735.3 735.4 735.5 735.6 735.7 735.8 735.9
735.10 735.11 735.12 735.13 735.14 735.15 735.16 735.17 735.18 735.19 735.20 735.21 735.22 735.23 735.24 735.25 735.26 735.27 735.28 735.29 735.30
736.1 736.2 736.3 736.4 736.5 736.6 736.7 736.8 736.9 736.10 736.11 736.12 736.13 736.14 736.15 736.16 736.17 736.18 736.19 736.20 736.21 736.22 736.23 736.24 736.25 736.26 736.27 736.28 736.29 736.30 737.1 737.2 737.3 737.4 737.5 737.6 737.7 737.8 737.9 737.10 737.11 737.12 737.13 737.14 737.15 737.16 737.17 737.18 737.19 737.20
737.21 737.22 737.23 737.24 737.25 737.26 737.27 737.28 737.29 737.30 737.31 738.1 738.2 738.3 738.4 738.5 738.6 738.7 738.8 738.9 738.10 738.11 738.12 738.13 738.14 738.15 738.16 738.17 738.18
738.19 738.20 738.21 738.22 738.23 738.24 738.25 738.26 738.27 738.28 738.29 738.30 738.31 739.1 739.2 739.3 739.4 739.5 739.6 739.7 739.8 739.9 739.10 739.11 739.12 739.13 739.14 739.15 739.16 739.17 739.18
739.19 739.20 739.21 739.22 739.23 739.24 739.25 739.26 739.27 739.28 739.29 739.30 739.31 739.32 740.1 740.2 740.3 740.4 740.5 740.6 740.7 740.8 740.9 740.10 740.11 740.12 740.13 740.14 740.15 740.16 740.17 740.18 740.19 740.20 740.21 740.22 740.23 740.24 740.25 740.26 740.27 740.28 740.29 740.30 740.31 740.32 740.33 741.1 741.2 741.3 741.4 741.5 741.6 741.7 741.8 741.9 741.10 741.11 741.12 741.13 741.14 741.15 741.16 741.17 741.18 741.19 741.20 741.21 741.22 741.23 741.24 741.25 741.26 741.27 741.28 741.29 741.30 741.31 741.32 741.33 741.34 742.1 742.2 742.3 742.4 742.5 742.6 742.7 742.8 742.9 742.10 742.11 742.12 742.13 742.14 742.15 742.16 742.17 742.18 742.19 742.20 742.21 742.22 742.23 742.24 742.25 742.26 742.27 742.28 742.29 742.30 742.31 742.32 742.33 742.34 743.1 743.2 743.3 743.4 743.5 743.6 743.7 743.8 743.9 743.10 743.11 743.12 743.13 743.14 743.15
743.16 743.17 743.18 743.19 743.20 743.21 743.22 743.23 743.24 743.25 743.26 743.27 743.28 743.29 743.30 743.31 743.32 744.1
744.2 744.3 744.4 744.5 744.6 744.7 744.8 744.9 744.10 744.11 744.12 744.13 744.14 744.15 744.16 744.17 744.18 744.19 744.20 744.21 744.22 744.23 744.24 744.25 744.26 744.27 744.28 744.29
744.30 744.31 744.32 745.1 745.2 745.3 745.4 745.5 745.6 745.7 745.8 745.9 745.10 745.11 745.12 745.13 745.14 745.15
745.16 745.17 745.18 745.19 745.20 745.21 745.22 745.23 745.24 745.25 745.26 745.27 745.28 745.29 745.30 745.31 745.32 745.33 746.1 746.2 746.3 746.4 746.5 746.6 746.7 746.8 746.9 746.10 746.11 746.12 746.13 746.14 746.15 746.16 746.17 746.18 746.19 746.20 746.21 746.22 746.23 746.24
746.25 746.26 746.27 746.28 746.29
747.1 747.2 747.3 747.4 747.5 747.6 747.7 747.8 747.9 747.10 747.11 747.12 747.13 747.14 747.15 747.16 747.17 747.18 747.19 747.20 747.21 747.22 747.23 747.24 747.25 747.26 747.27 747.28 747.29 747.30 747.31 747.32 747.33 748.1 748.2 748.3 748.4 748.5 748.6 748.7 748.8 748.9 748.10 748.11 748.12 748.13 748.14 748.15 748.16 748.17 748.18 748.19 748.20 748.21 748.22 748.23 748.24 748.25 748.26 748.27 748.28 748.29 748.30 748.31 748.32 748.33 749.1 749.2 749.3 749.4 749.5 749.6 749.7 749.8 749.9 749.10 749.11 749.12 749.13 749.14 749.15 749.16 749.17 749.18 749.19 749.20 749.21 749.22 749.23 749.24 749.25 749.26 749.27 749.28 749.29 749.30 749.31 749.32 749.33 749.34 750.1 750.2 750.3 750.4 750.5 750.6 750.7 750.8 750.9 750.10 750.11 750.12 750.13 750.14 750.15 750.16 750.17 750.18 750.19 750.20 750.21 750.22 750.23 750.24 750.25 750.26 750.27 750.28 750.29 750.30 750.31 750.32 750.33
751.1 751.2 751.3 751.4 751.5 751.6 751.7 751.8 751.9 751.10 751.11 751.12 751.13 751.14 751.15 751.16 751.17 751.18 751.19 751.20 751.21 751.22 751.23 751.24 751.25 751.26 751.27 751.28 751.29
752.1 752.2 752.3 752.4 752.5 752.6 752.7 752.8 752.9 752.10 752.11 752.12 752.13 752.14 752.15 752.16 752.17 752.18 752.19 752.20 752.21 752.22 752.23 752.24 752.25 752.26 752.27 752.28 752.29 752.30 752.31 752.32 752.33 752.34 753.1 753.2 753.3 753.4 753.5 753.6 753.7 753.8 753.9 753.10 753.11 753.12 753.13 753.14 753.15 753.16 753.17 753.18 753.19 753.20 753.21 753.22 753.23 753.24 753.25 753.26 753.27 753.28 753.29 753.30 753.31 753.32 753.33 754.1 754.2 754.3 754.4 754.5 754.6 754.7 754.8 754.9 754.10 754.11 754.12 754.13 754.14 754.15 754.16 754.17 754.18 754.19 754.20 754.21 754.22 754.23 754.24 754.25 754.26 754.27 754.28 754.29 754.30 754.31 754.32 754.33 754.34 755.1 755.2 755.3 755.4 755.5 755.6 755.7 755.8 755.9 755.10 755.11 755.12 755.13 755.14 755.15 755.16 755.17 755.18 755.19 755.20 755.21 755.22 755.23 755.24 755.25 755.26 755.27 755.28 755.29 755.30 755.31 755.32 755.33 756.1 756.2 756.3 756.4 756.5 756.6
756.7 756.8 756.9 756.10 756.11 756.12 756.13 756.14 756.15 756.16 756.17 756.18 756.19 756.20 756.21 756.22 756.23 756.24 756.25 756.26 756.27 756.28
756.29 756.30 756.31 757.1 757.2 757.3 757.4 757.5 757.6 757.7 757.8 757.9 757.10 757.11 757.12 757.13 757.14 757.15 757.16 757.17 757.18 757.19 757.20
757.21 757.22 757.23 757.24 757.25 757.26 757.27 757.28 757.29 757.30 757.31 757.32 758.1 758.2 758.3 758.4 758.5 758.6 758.7 758.8 758.9 758.10 758.11 758.12 758.13 758.14 758.15 758.16 758.17 758.18 758.19 758.20 758.21 758.22 758.23 758.24 758.25 758.26 758.27 758.28 758.29 758.30 758.31 758.32 759.1 759.2 759.3 759.4 759.5 759.6 759.7 759.8 759.9 759.10 759.11 759.12 759.13 759.14 759.15 759.16 759.17 759.18 759.19 759.20 759.21 759.22 759.23 759.24 759.25 759.26 759.27
759.28 759.29 759.30 759.31 759.32 760.1 760.2 760.3 760.4 760.5 760.6 760.7 760.8 760.9 760.10 760.11 760.12 760.13 760.14 760.15 760.16 760.17 760.18 760.19 760.20 760.21 760.22 760.23 760.24 760.25 760.26 760.27
760.28 760.29 760.30 760.31 760.32 760.33 761.1 761.2 761.3 761.4 761.5 761.6 761.7 761.8 761.9 761.10
761.11 761.12 761.13 761.14 761.15 761.16 761.17 761.18 761.19 761.20 761.21 761.22 761.23 761.24 761.25 761.26 761.27 761.28 761.29 761.30 762.1 762.2 762.3 762.4 762.5 762.6 762.7 762.8 762.9 762.10 762.11 762.12 762.13 762.14 762.15 762.16 762.17 762.18 762.19 762.20 762.21 762.22 762.23 762.24 762.25 762.26 762.27 762.28 762.29 762.30
763.1 763.2 763.3 763.4 763.5 763.6 763.7 763.8 763.9 763.10 763.11 763.12 763.13 763.14 763.15 763.16 763.17 763.18 763.19 763.20 763.21 763.22
763.23 763.24 763.25 763.26 763.27 763.28 763.29
764.1 764.2 764.3 764.4 764.5 764.6 764.7 764.8 764.9 764.10 764.11 764.12 764.13 764.14 764.15 764.16 764.17 764.18 764.19 764.20 764.21 764.22 764.23 764.24 764.25 764.26 764.27 764.28 764.29 764.30 764.31 764.32 764.33 765.1 765.2 765.3 765.4 765.5 765.6 765.7 765.8 765.9 765.10 765.11 765.12 765.13 765.14 765.15 765.16 765.17 765.18 765.19 765.20 765.21 765.22 765.23 765.24 765.25 765.26 765.27 765.28 765.29 765.30 766.1 766.2 766.3 766.4 766.5 766.6 766.7 766.8 766.9 766.10 766.11 766.12 766.13 766.14 766.15 766.16 766.17 766.18 766.19 766.20 766.21 766.22 766.23 766.24
766.25 766.26 766.27 766.28 766.29 766.30 767.1 767.2 767.3 767.4 767.5 767.6 767.7 767.8 767.9 767.10 767.11 767.12 767.13
767.14 767.15 767.16 767.17 767.18 767.19 767.20 767.21 767.22 767.23 767.24 767.25 767.26 767.27 767.28 767.29 767.30 767.31 767.32 768.1 768.2 768.3 768.4 768.5 768.6 768.7 768.8 768.9 768.10 768.11 768.12 768.13 768.14 768.15 768.16 768.17 768.18 768.19 768.20 768.21 768.22 768.23 768.24 768.25 768.26 768.27 768.28 768.29 768.30
769.1 769.2 769.3 769.4 769.5 769.6 769.7 769.8 769.9 769.10 769.11 769.12 769.13 769.14 769.15 769.16 769.17 769.18 769.19 769.20 769.21 769.22 769.23 769.24 769.25 769.26 769.27 769.28 769.29 769.30 769.31 769.32 770.1 770.2 770.3 770.4 770.5 770.6 770.7 770.8 770.9 770.10 770.11 770.12 770.13 770.14 770.15 770.16 770.17 770.18 770.19 770.20 770.21 770.22 770.23 770.24 770.25 770.26 770.27 770.28 770.29 770.30 770.31 770.32 771.1 771.2 771.3 771.4 771.5 771.6 771.7 771.8 771.9 771.10 771.11 771.12
771.13 771.14 771.15 771.16 771.17 771.18 771.19 771.20 771.21 771.22 771.23 771.24 771.25 771.26 771.27 771.28 771.29 771.30 771.31 772.1 772.2 772.3 772.4 772.5 772.6 772.7 772.8 772.9 772.10 772.11 772.12 772.13 772.14 772.15 772.16 772.17 772.18 772.19 772.20 772.21 772.22 772.23 772.24 772.25 772.26 772.27 772.28 772.29 772.30 772.31 773.1 773.2 773.3 773.4 773.5 773.6 773.7 773.8 773.9 773.10 773.11 773.12 773.13 773.14 773.15 773.16 773.17 773.18 773.19 773.20 773.21
773.22 773.23 773.24 773.25 773.26 773.27 773.28 773.29 773.30 773.31 773.32 773.33 773.34 774.1 774.2 774.3 774.4 774.5 774.6 774.7 774.8
774.9 774.10 774.11 774.12 774.13 774.14 774.15 774.16 774.17 774.18 774.19 774.20 774.21 774.22 774.23 774.24 774.25 774.26 774.27 774.28 774.29 774.30 774.31 775.1 775.2 775.3 775.4 775.5 775.6 775.7 775.8 775.9 775.10 775.11 775.12 775.13 775.14 775.15 775.16 775.17 775.18 775.19 775.20 775.21 775.22 775.23 775.24 775.25 775.26 775.27 775.28 775.29 775.30 775.31 776.1 776.2 776.3 776.4 776.5 776.6 776.7 776.8 776.9 776.10 776.11 776.12 776.13 776.14 776.15 776.16
776.17 776.18 776.19 776.20 776.21 776.22 776.23 776.24 776.25 776.26 776.27 776.28 776.29
777.1 777.2 777.3 777.4 777.5 777.6 777.7 777.8 777.9 777.10 777.11 777.12 777.13 777.14
777.15 777.16 777.17 777.18 777.19 777.20 777.21 777.22 777.23 777.24 777.25 777.26
777.27 777.28 777.29 777.30 777.31 778.1 778.2 778.3 778.4 778.5 778.6 778.7 778.8 778.9 778.10 778.11 778.12 778.13 778.14 778.15 778.16 778.17 778.18 778.19 778.20 778.21 778.22 778.23 778.24 778.25
778.26 778.27 778.28 778.29 778.30 778.31 779.1 779.2 779.3 779.4 779.5 779.6 779.7 779.8 779.9 779.10 779.11 779.12 779.13 779.14 779.15 779.16 779.17 779.18 779.19 779.20 779.21 779.22 779.23 779.24 779.25 779.26 779.27 779.28 779.29 779.30 779.31 779.32 779.33 780.1 780.2 780.3 780.4 780.5 780.6
780.7 780.8 780.9 780.10 780.11 780.12 780.13 780.14 780.15 780.16 780.17 780.18 780.19 780.20 780.21 780.22
780.23 780.24 780.25 780.26 780.27 780.28 780.29 780.30 781.1 781.2 781.3 781.4 781.5 781.6 781.7 781.8 781.9 781.10 781.11 781.12 781.13 781.14 781.15 781.16 781.17 781.18 781.19 781.20 781.21 781.22 781.23 781.24 781.25 781.26 781.27 781.28 781.29 781.30 781.31 782.1 782.2 782.3 782.4 782.5 782.6 782.7 782.8 782.9
782.10 782.11 782.12 782.13 782.14 782.15 782.16 782.17 782.18 782.19 782.20 782.21 782.22 782.23 782.24 782.25 782.26 782.27 782.28 782.29 782.30 782.31 782.32 783.1 783.2 783.3 783.4 783.5 783.6 783.7 783.8 783.9 783.10 783.11 783.12 783.13 783.14 783.15 783.16 783.17 783.18 783.19 783.20 783.21 783.22 783.23 783.24 783.25 783.26 783.27 783.28 783.29 783.30 783.31
784.1 784.2 784.3 784.4 784.5 784.6 784.7 784.8 784.9 784.10 784.11 784.12
784.13 784.14 784.15 784.16
784.17 784.18
784.19 784.20 784.21 784.22 784.23 784.24 784.25 784.26 784.27 784.28 784.29 784.30 784.31 785.1 785.2 785.3 785.4 785.5 785.6 785.7 785.8 785.9 785.10 785.11 785.12 785.13 785.14 785.15 785.16 785.17 785.18
785.19 785.20 785.21 785.22 785.23 785.24 785.25 785.26 785.27 785.28 785.29 785.30 785.31 785.32 786.1 786.2 786.3 786.4 786.5 786.6 786.7 786.8 786.9 786.10 786.11 786.12 786.13 786.14 786.15
786.16 786.17 786.18 786.19 786.20 786.21 786.22 786.23 786.24 786.25 786.26 786.27 786.28 786.29 786.30 786.31 786.32 787.1 787.2 787.3 787.4 787.5 787.6 787.7 787.8 787.9 787.10 787.11
787.12 787.13 787.14 787.15 787.16 787.17 787.18 787.19 787.20 787.21 787.22 787.23 787.24 787.25 787.26 787.27 787.28 787.29 787.30 787.31 788.1 788.2 788.3 788.4 788.5 788.6 788.7 788.8 788.9 788.10 788.11 788.12 788.13 788.14 788.15 788.16 788.17 788.18 788.19 788.20 788.21 788.22 788.23 788.24 788.25 788.26 788.27 788.28 788.29 788.30 788.31 788.32 789.1 789.2 789.3 789.4 789.5 789.6 789.7 789.8 789.9 789.10 789.11 789.12 789.13 789.14 789.15 789.16 789.17 789.18 789.19 789.20 789.21 789.22 789.23 789.24 789.25
789.26 789.27 789.28 789.29 789.30 789.31 789.32 790.1 790.2 790.3 790.4 790.5 790.6 790.7 790.8 790.9 790.10 790.11 790.12 790.13 790.14 790.15 790.16 790.17 790.18 790.19 790.20 790.21 790.22 790.23 790.24 790.25 790.26 790.27 790.28 790.29 790.30 790.31 790.32 791.1 791.2 791.3 791.4 791.5 791.6 791.7 791.8 791.9 791.10 791.11 791.12 791.13
791.14 791.15 791.16 791.17 791.18 791.19 791.20 791.21 791.22 791.23 791.24 791.25 791.26 791.27 791.28 791.29 791.30 791.31 792.1 792.2 792.3 792.4 792.5 792.6 792.7 792.8 792.9 792.10 792.11 792.12 792.13 792.14 792.15 792.16 792.17 792.18 792.19 792.20 792.21 792.22 792.23 792.24 792.25 792.26 792.27 792.28 792.29 792.30 792.31 792.32 793.1 793.2 793.3 793.4 793.5 793.6 793.7 793.8 793.9 793.10 793.11 793.12 793.13 793.14 793.15 793.16 793.17 793.18 793.19 793.20 793.21 793.22
793.23 793.24 793.25 793.26 793.27 793.28 793.29 793.30 793.31
794.1 794.2 794.3 794.4 794.5 794.6 794.7 794.8 794.9 794.10 794.11 794.12 794.13 794.14 794.15 794.16 794.17 794.18 794.19 794.20 794.21 794.22 794.23 794.24 794.25 794.26 794.27 794.28 794.29 794.30 794.31 795.1 795.2 795.3 795.4 795.5 795.6 795.7 795.8 795.9 795.10 795.11 795.12 795.13 795.14 795.15 795.16 795.17 795.18 795.19 795.20 795.21 795.22 795.23 795.24 795.25 795.26 795.27 795.28 795.29 795.30 796.1 796.2 796.3 796.4 796.5 796.6 796.7 796.8 796.9 796.10 796.11 796.12 796.13 796.14 796.15
796.16 796.17 796.18 796.19 796.20 796.21 796.22 796.23 796.24 796.25 796.26 796.27 796.28 796.29 796.30 796.31 797.1 797.2 797.3 797.4 797.5 797.6 797.7 797.8 797.9 797.10 797.11 797.12 797.13 797.14 797.15 797.16 797.17 797.18 797.19
797.20 797.21 797.22 797.23 797.24 797.25 797.26 797.27 797.28 797.29 797.30 797.31 797.32 798.1 798.2 798.3 798.4 798.5 798.6 798.7 798.8 798.9 798.10 798.11 798.12 798.13 798.14 798.15 798.16 798.17 798.18 798.19 798.20 798.21 798.22 798.23 798.24 798.25 798.26 798.27 798.28 798.29 798.30 798.31 798.32
799.1 799.2 799.3 799.4 799.5 799.6 799.7 799.8
799.9 799.10 799.11 799.12 799.13 799.14 799.15 799.16 799.17 799.18 799.19
799.20 799.21 799.22 799.23 799.24 799.25 799.26 799.27 799.28 799.29 799.30 799.31 799.32 799.33 800.1 800.2 800.3 800.4 800.5 800.6 800.7
800.8 800.9 800.10 800.11 800.12 800.13 800.14
800.15 800.16 800.17 800.18 800.19 800.20 800.21 800.22 800.23 800.24 800.25 800.26 800.27 800.28 800.29 800.30 800.31 800.32 801.1 801.2
801.3 801.4 801.5 801.6 801.7 801.8 801.9 801.10 801.11 801.12 801.13 801.14 801.15 801.16
801.17 801.18 801.19 801.20 801.21 801.22 801.23 801.24 801.25 801.26 801.27 801.28 801.29 801.30 801.31 801.32 801.33 802.1 802.2
802.3 802.4 802.5 802.6 802.7 802.8 802.9
802.10 802.11
802.12 802.13 802.14 802.15 802.16 802.17 802.18 802.19 802.20 802.21 802.22
802.23 802.24 802.25 802.26 802.27 802.28 802.29 802.30 802.31 802.32 802.33 803.1 803.2 803.3 803.4 803.5 803.6 803.7 803.8 803.9 803.10 803.11 803.12 803.13 803.14 803.15 803.16 803.17 803.18 803.19 803.20 803.21 803.22 803.23 803.24 803.25
803.26 803.27
803.28 803.29
803.30 804.1 804.2 804.3 804.4 804.5 804.6 804.7 804.8 804.9 804.10 804.11
804.12 804.13 804.14 804.15 804.16 804.17 804.18 804.19 804.20 804.21 804.22 804.23 804.24 804.25 804.26 804.27 804.28 804.29 804.30 804.31 804.32 804.33 804.34 805.1 805.2 805.3 805.4 805.5 805.6 805.7 805.8 805.9 805.10 805.11 805.12 805.13 805.14 805.15 805.16 805.17 805.18 805.19 805.20 805.21 805.22 805.23 805.24 805.25 805.26 805.27 805.28 805.29 805.30 805.31 805.32 806.1 806.2 806.3 806.4 806.5 806.6 806.7 806.8 806.9 806.10 806.11 806.12 806.13 806.14 806.15 806.16 806.17 806.18 806.19 806.20 806.21 806.22 806.23 806.24 806.25 806.26 806.27 806.28 806.29 806.30 806.31 806.32 806.33 806.34 807.1 807.2 807.3 807.4 807.5 807.6 807.7 807.8 807.9 807.10 807.11 807.12 807.13 807.14 807.15 807.16 807.17 807.18 807.19 807.20 807.21 807.22 807.23 807.24 807.25 807.26 807.27 807.28 807.29 807.30 807.31 807.32 807.33 807.34 807.35 808.1 808.2 808.3 808.4 808.5 808.6 808.7 808.8 808.9 808.10 808.11 808.12 808.13 808.14 808.15 808.16 808.17 808.18 808.19 808.20 808.21 808.22 808.23 808.24 808.25 808.26 808.27 808.28 808.29 808.30 808.31 808.32 808.33 808.34 809.1 809.2 809.3 809.4 809.5 809.6 809.7 809.8 809.9 809.10 809.11 809.12 809.13 809.14 809.15 809.16 809.17 809.18 809.19 809.20 809.21 809.22 809.23 809.24 809.25 809.26 809.27 809.28 809.29 809.30 809.31 809.32 809.33 809.34 810.1 810.2 810.3 810.4 810.5 810.6 810.7 810.8 810.9 810.10 810.11 810.12 810.13 810.14 810.15 810.16 810.17 810.18 810.19 810.20 810.21 810.22 810.23 810.24 810.25 810.26 810.27 810.28 810.29 810.30 810.31 810.32 811.1 811.2 811.3 811.4 811.5 811.6 811.7 811.8 811.9 811.10 811.11 811.12 811.13 811.14 811.15 811.16 811.17 811.18 811.19 811.20 811.21 811.22 811.23 811.24 811.25 811.26 811.27 811.28 811.29 811.30 811.31 811.32 811.33 811.34 811.35 812.1 812.2 812.3 812.4 812.5 812.6 812.7 812.8 812.9 812.10 812.11 812.12 812.13 812.14 812.15 812.16 812.17 812.18 812.19 812.20 812.21 812.22 812.23 812.24 812.25 812.26 812.27 812.28 812.29 812.30 812.31 812.32 812.33 812.34 813.1 813.2 813.3 813.4 813.5 813.6 813.7 813.8 813.9 813.10 813.11 813.12 813.13 813.14 813.15 813.16 813.17 813.18 813.19 813.20 813.21 813.22 813.23 813.24 813.25 813.26 813.27 813.28 813.29 813.30 813.31 813.32 813.33 813.34 814.1 814.2 814.3 814.4 814.5 814.6 814.7 814.8 814.9 814.10 814.11 814.12 814.13 814.14 814.15 814.16 814.17 814.18 814.19 814.20 814.21 814.22 814.23 814.24 814.25 814.26 814.27 814.28 814.29 814.30 814.31 814.32 814.33 814.34 814.35 815.1 815.2 815.3 815.4 815.5 815.6 815.7 815.8 815.9 815.10 815.11 815.12 815.13 815.14 815.15 815.16 815.17 815.18 815.19 815.20 815.21 815.22 815.23 815.24 815.25 815.26 815.27 815.28 815.29 815.30 815.31 815.32 815.33 815.34 816.1 816.2 816.3 816.4 816.5 816.6 816.7 816.8 816.9 816.10 816.11 816.12 816.13 816.14 816.15 816.16 816.17 816.18 816.19 816.20 816.21 816.22 816.23 816.24 816.25 816.26 816.27 816.28 816.29 816.30 816.31 816.32 816.33 816.34 816.35 817.1 817.2 817.3 817.4 817.5 817.6 817.7 817.8 817.9 817.10 817.11 817.12 817.13 817.14 817.15 817.16 817.17 817.18 817.19 817.20 817.21 817.22 817.23 817.24 817.25 817.26 817.27 817.28 817.29 817.30 817.31 817.32 817.33 817.34 817.35 818.1 818.2 818.3 818.4 818.5 818.6 818.7 818.8 818.9 818.10 818.11 818.12 818.13 818.14 818.15 818.16 818.17 818.18 818.19 818.20 818.21 818.22 818.23 818.24 818.25 818.26 818.27 818.28 818.29 818.30 818.31 818.32 818.33 818.34 819.1 819.2 819.3 819.4 819.5 819.6 819.7 819.8 819.9 819.10 819.11 819.12 819.13 819.14 819.15 819.16 819.17 819.18 819.19 819.20 819.21 819.22 819.23 819.24 819.25 819.26 819.27 819.28 819.29 819.30 819.31 819.32 819.33 819.34 819.35 820.1 820.2 820.3 820.4 820.5 820.6 820.7 820.8 820.9 820.10 820.11 820.12 820.13 820.14 820.15 820.16 820.17 820.18 820.19 820.20 820.21 820.22 820.23 820.24 820.25 820.26 820.27 820.28 820.29 820.30 820.31 820.32 820.33 820.34 820.35 820.36 821.1 821.2 821.3 821.4 821.5 821.6 821.7 821.8 821.9 821.10 821.11 821.12 821.13 821.14 821.15 821.16 821.17 821.18 821.19 821.20 821.21 821.22 821.23 821.24 821.25 821.26 821.27 821.28 821.29 821.30 821.31 821.32 821.33 821.34 822.1 822.2 822.3 822.4 822.5 822.6 822.7 822.8 822.9 822.10 822.11 822.12 822.13 822.14 822.15 822.16 822.17 822.18 822.19 822.20 822.21 822.22 822.23 822.24 822.25 822.26 822.27 822.28 822.29 822.30 822.31 822.32 822.33 823.1 823.2 823.3
823.4 823.5 823.6 823.7 823.8 823.9 823.10 823.11 823.12 823.13 823.14 823.15 823.16 823.17 823.18 823.19 823.20 823.21 823.22 823.23 823.24 823.25 823.26 823.27 823.28 823.29 823.30 823.31 823.32 823.33 823.34 823.35 824.1 824.2 824.3 824.4 824.5 824.6 824.7 824.8 824.9 824.10 824.11 824.12 824.13 824.14 824.15 824.16 824.17 824.18 824.19 824.20 824.21 824.22 824.23 824.24 824.25 824.26 824.27 824.28 824.29 824.30 824.31 824.32 824.33 824.34 825.1 825.2 825.3 825.4 825.5 825.6 825.7 825.8 825.9 825.10 825.11 825.12 825.13 825.14 825.15 825.16 825.17 825.18 825.19 825.20 825.21 825.22 825.23 825.24 825.25 825.26 825.27 825.28 825.29 825.30 825.31 825.32 825.33 825.34 825.35 826.1 826.2 826.3 826.4 826.5 826.6 826.7 826.8 826.9 826.10 826.11 826.12 826.13 826.14 826.15 826.16 826.17 826.18 826.19 826.20 826.21 826.22 826.23 826.24 826.25 826.26 826.27 826.28 826.29 826.30 826.31 826.32 826.33 826.34 827.1 827.2 827.3 827.4 827.5 827.6 827.7 827.8 827.9 827.10 827.11 827.12 827.13 827.14 827.15 827.16 827.17 827.18 827.19 827.20 827.21 827.22 827.23 827.24 827.25 827.26 827.27 827.28 827.29
827.30 827.31 827.32 827.33 828.1 828.2 828.3 828.4 828.5 828.6 828.7 828.8 828.9 828.10 828.11 828.12 828.13 828.14 828.15 828.16 828.17 828.18 828.19 828.20 828.21 828.22 828.23 828.24 828.25 828.26 828.27 828.28 828.29 828.30 828.31 828.32 828.33 828.34 828.35 829.1 829.2 829.3 829.4 829.5 829.6 829.7 829.8 829.9 829.10 829.11 829.12 829.13 829.14 829.15 829.16 829.17 829.18 829.19 829.20 829.21 829.22 829.23 829.24 829.25 829.26 829.27 829.28 829.29 829.30 829.31 829.32 829.33 829.34 829.35 830.1 830.2 830.3 830.4 830.5 830.6 830.7 830.8 830.9 830.10 830.11 830.12 830.13 830.14 830.15 830.16 830.17 830.18 830.19 830.20 830.21
830.22 830.23 830.24 830.25 830.26 830.27 830.28 830.29
830.30
830.31 830.32 830.33 831.1 831.2 831.3 831.4 831.5
831.6
831.7 831.8 831.9 831.10 831.11 831.12 831.13 831.14 831.15 831.16 831.17 831.18 831.19 831.20
831.21
831.22 831.23 831.24 831.25 831.26 831.27 831.28 831.29
832.1 832.2 832.3 832.4 832.5 832.6 832.7 832.8 832.9 832.10 832.11 832.12 832.13 832.14 832.15 832.16 832.17
832.18
832.19 832.20 832.21 832.23 832.22 832.24 832.25 832.26 832.27 832.28 832.29 832.30 833.1 833.2 833.3 833.4 833.5 833.6 833.7 833.8 833.9 833.10 833.11 833.12 833.13 833.14 833.15 833.16 833.17 833.18 833.19 833.20 833.21 833.22 833.23 833.24 833.25 833.26 833.27 833.28 833.29 833.30 833.31 833.32 833.33 833.34 833.35 834.1 834.2 834.3 834.4 834.5 834.6 834.7 834.8 834.9 834.10 834.11 834.12 834.13 834.14 834.15 834.16 834.17 834.18 834.19 834.20 834.21 834.22 834.23 834.24 834.25 834.26 834.27 834.28 834.29 834.30 834.31 834.32 834.33 835.1 835.2 835.3 835.4 835.5 835.6 835.7 835.8 835.9 835.10 835.11 835.12 835.13 835.14 835.15 835.16 835.17 835.18 835.19 835.20 835.21 835.22 835.23 835.24 835.25 835.26 835.27 835.28 835.29 835.30 835.31 835.32 835.33 835.34 836.1 836.2 836.3 836.4 836.5 836.6 836.7 836.8 836.9 836.10 836.11 836.12 836.13 836.14 836.15 836.16 836.17 836.18 836.19 836.20 836.21 836.22 836.23 836.24 836.25 836.26 836.27 836.28 836.29 836.30 836.31 836.32 836.33 836.34 837.1 837.2 837.3 837.4 837.5 837.6 837.7 837.8 837.9 837.10 837.11 837.12 837.13 837.14 837.15 837.16 837.17 837.18 837.19 837.20 837.21 837.22 837.23 837.24 837.25 837.26 837.27 837.28 837.29 837.30 837.31
837.32 837.33
838.1 838.2 838.3 838.4 838.5 838.6 838.7 838.8 838.9 838.10 838.11
838.12
838.13 838.14 838.15 838.16 838.17 838.18 838.19 838.20 838.21 838.22
838.23
838.24 838.25 838.26 838.27 838.28 838.29 838.30
838.31
839.1 839.2 839.3
839.4
839.5 839.6 839.7 839.8 839.9
839.10
839.11 839.12 839.13 839.14 839.15 839.16
839.17
839.18 839.19 839.20 839.21 839.22 839.23 839.24 839.25 839.26 839.27 839.28
840.1 840.2 840.3 840.4 840.5
840.6 840.7 840.8 840.9 840.10 840.11 840.12 840.13 840.14 840.15 840.16 840.17 840.18 840.19 840.20 840.21 840.22 840.23
840.24 840.25 840.26
840.27 840.28 840.29
841.1 841.2 841.3
841.4 841.5
A bill for an act
relating to state government; modifying provisions governing health, health care,
human services, human services licensing and background studies, the Minnesota
Higher Education Facilities Authority, health-related licensing boards, prescription
drugs, health insurance, telehealth, children and family services, behavioral health,
direct care and treatment, disability services and continuing care for older adults,
community supports, and chemical and mental health services; implementing
mental health uniform services standards; establishing a budget for health and
human services; making forecast adjustments; making technical and conforming
changes; requiring reports; making appointments; transferring money; appropriating
money; amending Minnesota Statutes 2020, sections 3.732, subdivision 1; 10A.01,
subdivision 35; 16A.151, subdivision 2; 62A.152, subdivision 3; 62A.3094,
subdivision 1; 62J.495, subdivisions 1, 2, 3, 4; 62J.498; 62J.4981; 62J.4982;
62J.701; 62J.72, subdivision 3; 62J.81, subdivisions 1, 1a; 62J.84, subdivision 6;
62Q.096; 62V.05, by adding a subdivision; 62W.11; 119B.09, subdivision 4;
119B.11, subdivision 2a; 119B.13, subdivisions 1, 6; 122A.18, subdivision 8;
136A.25; 136A.26; 136A.27; 136A.28; 136A.29, subdivisions 1, 3, 6, 9, 10, 14,
19, 20, 21, 22, by adding a subdivision; 136A.32, subdivision 4; 136A.33; 136A.34,
subdivisions 3, 4; 136A.36; 136A.38; 136A.41; 136A.42; 136F.67, subdivision
1; 144.05, by adding a subdivision; 144.057, subdivision 1; 144.0724, subdivision
4; 144.1205, subdivisions 2, 4, 8, 9, by adding a subdivision; 144.125, subdivisions
1, 2; 144.1481, subdivision 1; 144.216, by adding subdivisions; 144.218, by adding
a subdivision; 144.225, subdivision 7; 144.226, subdivision 1; 144.551, subdivision
1; 144.651, subdivision 2; 144A.073, subdivision 2, by adding a subdivision;
144D.01, subdivision 4; 144E.001, by adding a subdivision; 144E.27; 144E.28,
subdivisions 1, 3, 7, 8; 144E.283; 144E.285, subdivisions 1, 2, 4, by adding
subdivisions; 144G.08, subdivision 7, as amended; 145.32, subdivision 1; 145.902;
147.033; 148.995, subdivision 2; 148.996, subdivisions 2, 4, by adding a
subdivision; 148B.5301, subdivision 2; 148E.120, subdivision 2; 148F.11,
subdivision 1; 151.01, subdivision 29, by adding subdivisions; 151.065,
subdivisions 1, 3, 7; 151.066, subdivision 3; 151.37, subdivision 2; 151.555,
subdivisions 1, 7, 11, by adding a subdivision; 245.462, subdivisions 1, 6, 8, 9,
14, 16, 17, 18, 21, 23, by adding a subdivision; 245.4661, subdivision 5; 245.4662,
subdivision 1; 245.467, subdivisions 2, 3; 245.469, subdivisions 1, 2; 245.470,
subdivision 1; 245.4712, subdivision 2; 245.472, subdivision 2; 245.4863;
245.4871, subdivisions 9a, 10, 11a, 17, 21, 26, 27, 29, 31, 32, 34, by adding a
subdivision; 245.4874, subdivision 1; 245.4876, subdivisions 2, 3; 245.4879,
subdivision 1; 245.488, subdivision 1; 245.4882, subdivision 1; 245.4885,
subdivision 1; 245.4889, subdivision 1; 245.4901, subdivision 2; 245.62,
subdivision 2; 245.697, subdivision 1; 245.735, subdivisions 3, 5, by adding a
subdivision; 245A.02, by adding subdivisions; 245A.03, subdivision 7, by adding
a subdivision; 245A.04, subdivision 5; 245A.041, by adding a subdivision;
245A.043, subdivision 3; 245A.05; 245A.07, subdivision 1; 245A.08, subdivisions
4, 5; 245A.10, subdivision 4; 245A.14, subdivisions 1, 4; 245A.16, subdivision
1, by adding a subdivision; 245A.50, subdivisions 1a, 7; 245A.65, subdivision 2;
245C.02, subdivision 4a; 245C.03, by adding subdivisions; 245C.05, subdivisions
2c, 2d, 4, 5; 245C.08, subdivisions 1, 3; 245C.10, by adding subdivisions; 245C.14,
subdivision 1; 245C.15, by adding a subdivision; 245C.24, subdivisions 2, 3, 4,
by adding a subdivision; 245C.32, subdivision 1a; 245D.02, subdivision 20;
245E.07, subdivision 1; 245F.03; 245F.04, subdivision 2; 245G.01, subdivisions
13, 26; 245G.02, subdivision 2; 245G.03, subdivision 2; 245G.06, subdivisions
1, 3; 245G.11, subdivision 7; 246.54, subdivision 1b; 252.27, subdivision 2a;
252.43; 252A.01, subdivision 1; 252A.02, subdivisions 2, 9, 11, 12, by adding
subdivisions; 252A.03, subdivisions 3, 4; 252A.04, subdivisions 1, 2, 4; 252A.05;
252A.06, subdivisions 1, 2; 252A.07, subdivisions 1, 2, 3; 252A.081, subdivisions
2, 3, 5; 252A.09, subdivisions 1, 2; 252A.101, subdivisions 2, 3, 5, 6, 7, 8;
252A.111, subdivisions 2, 4, 6; 252A.12; 252A.16; 252A.17; 252A.19, subdivisions
2, 4, 5, 7, 8; 252A.20; 252A.21, subdivisions 2, 4; 254A.19, subdivision 5; 254B.03,
subdivision 2; 254B.05, subdivisions 1, 5, by adding a subdivision; 256.01,
subdivisions 14b, 28, by adding a subdivision; 256.0112, subdivision 6; 256.042,
subdivision 4; 256.043, subdivisions 3, 4; 256.477; 256.741, by adding
subdivisions; 256.969, by adding a subdivision; 256.9695, subdivision 1; 256.983;
256B.051, subdivisions 1, 3, 5, 6, 7, by adding a subdivision; 256B.055, subdivision
6; 256B.056, subdivision 10; 256B.057, subdivision 3; 256B.06, subdivision 4;
256B.0615, subdivisions 1, 5; 256B.0616, subdivisions 1, 3, 5; 256B.0621,
subdivision 10; 256B.0622, subdivisions 1, 2, 3a, 4, 7, 7a, 7b, 7d; 256B.0623,
subdivisions 1, 2, 3, 4, 5, 6, 9, 12; 256B.0624; 256B.0625, subdivisions 3b, 3c,
3d, 3e, 5, 5m, 9, 13, 13c, 13e, 13g, 13h, 19c, 20, 20b, 28a, 42, 46, 48, 49, 56a, by
adding subdivisions; 256B.0638, subdivisions 3, 5, 6; 256B.0653, by adding a
subdivision; 256B.0654, by adding a subdivision; 256B.0659, subdivisions 11,
13, 17a; 256B.0757, subdivision 4c; 256B.0759, subdivisions 2, 4, by adding
subdivisions; 256B.0911, subdivisions 3a, 6, by adding a subdivision; 256B.092,
subdivision 1b; 256B.0924, subdivision 6; 256B.094, subdivision 6; 256B.0941,
subdivision 1; 256B.0943, subdivisions 1, 2, 3, 4, 5, 5a, 6, 7, 9, 11; 256B.0946,
subdivisions 1, 1a, 2, 3, 4, 6; 256B.0947, subdivisions 1, 2, 3, 3a, 5, 6, 7;
256B.0949, subdivisions 2, 4, 5a, 13, by adding a subdivision; 256B.097, by adding
subdivisions; 256B.14, subdivision 2; 256B.19, subdivision 1; 256B.196,
subdivision 2; 256B.25, subdivision 3; 256B.49, subdivision 23, by adding a
subdivision; 256B.4905, by adding subdivisions; 256B.4912, subdivision 13;
256B.4914, subdivisions 2, 5, 6, 7, 8, 9; 256B.5012, by adding a subdivision;
256B.5013, subdivisions 1, 6; 256B.5015, subdivision 2; 256B.69, subdivisions
5a, 6d, by adding a subdivision; 256B.6928, subdivision 5; 256B.75; 256B.761;
256B.763; 256B.85, subdivisions 1, 2, 3, 4, 5, 6, 7, 7a, 8, 9, 10, 11, 11b, 12, 12b,
13, 13a, 15, 16, 17a, 18a, 20b, 23, 23a, by adding subdivisions; 256D.051, by
adding subdivisions; 256E.30, subdivision 2; 256E.34, subdivision 1; 256I.04,
subdivision 3; 256I.05, subdivisions 1a, 1c, 1q, 11, by adding subdivisions; 256I.06,
subdivision 8; 256J.08, subdivision 21; 256J.09, subdivision 3; 256J.30, subdivision
8; 256J.35; 256J.45, subdivision 1; 256J.626, subdivision 1; 256J.95, subdivision
5; 256L.01, subdivision 5; 256L.03, subdivision 1; 256L.04, subdivision 7b;
256L.05, subdivision 3a; 256L.15, subdivision 2, by adding a subdivision; 256N.02,
subdivisions 16, 17; 256N.22, subdivision 1; 256N.23, subdivisions 2, 6; 256N.24,
subdivisions 1, 8, 11, 12, 14; 256N.25, subdivision 1, by adding a subdivision;
256P.01, subdivision 6a; 256P.02, subdivisions 1a, 2; 256P.04, subdivision 4;
256P.05; 256P.06, subdivision 3; 256S.203; 259.22, subdivision 4; 259.241; 259.35,
subdivision 1; 259.53, subdivision 4; 259.73; 259.75, subdivisions 5, 6, 9; 259.83,
subdivision 1a; 259A.75, subdivisions 1, 2, 3, 4; 260C.007, subdivisions 22a, 26c,
31; 260C.157, subdivision 3; 260C.163, subdivision 3; 260C.212, subdivisions 1,
1a, 2, 13, by adding a subdivision; 260C.215, subdivision 4; 260C.219, subdivision
5; 260C.4412; 260C.452; 260C.503, subdivision 2; 260C.515, subdivision 3;
260C.605, subdivision 1; 260C.607, subdivision 6; 260C.609; 260C.615; 260C.704;
260C.706; 260C.708; 260C.71; 260C.712; 260C.714; 260D.01; 260D.05; 260D.06,
subdivision 2; 260D.07; 260D.08; 260D.14; 260E.20, subdivision 2; 260E.31,
subdivision 1; 260E.36, by adding a subdivision; 295.50, subdivision 9b; 295.53,
subdivision 1; 297E.02, subdivision 3; 325F.721, subdivision 1; 326.71, subdivision
4; 326.75, subdivisions 1, 2, 3; 354B.20, subdivision 7; 466.03, subdivision 6d;
518.157, subdivisions 1, 3; 518.68, subdivision 2; 518A.29; 518A.33; 518A.35,
subdivisions 1, 2; 518A.39, subdivision 7; 518A.40, subdivision 4, by adding a
subdivision; 518A.42; 518A.43, by adding a subdivision; 518A.685; 548.091,
subdivisions 1a, 2a, 3b, 9, 10; 549.09, subdivision 1; Laws 2008, chapter 364,
section 17; Laws 2019, First Special Session chapter 9, article 5, section 86,
subdivision 1, as amended; article 14, section 3, as amended; Laws 2020, First
Special Session chapter 7, section 1, as amended; proposing coding for new law
in Minnesota Statutes, chapters 62A; 62J; 62Q; 119B; 144; 145; 145A; 148; 151;
245A; 245G; 254B; 256; 256B; 256S; 363A; 518A; proposing coding for new law
as Minnesota Statutes, chapter 245I; repealing Minnesota Statutes 2020, sections
16A.724, subdivision 2; 62A.67; 62A.671; 62A.672; 136A.29, subdivision 4;
144E.27, subdivisions 1, 1a; 151.19, subdivision 3; 245.462, subdivision 4a;
245.4871, subdivision 32a; 245.4879, subdivision 2; 245.62, subdivisions 3, 4;
245.69, subdivision 2; 245.735, subdivisions 1, 2, 4; 252.28, subdivisions 1, 5;
252A.02, subdivisions 8, 10; 252A.21, subdivision 3; 256B.0615, subdivision 2;
256B.0616, subdivision 2; 256B.0622, subdivisions 3, 5a; 256B.0623, subdivisions
7, 8, 10, 11; 256B.0625, subdivisions 5l, 35a, 35b, 61, 62, 65; 256B.0943,
subdivisions 8, 10; 256B.0944; 256B.0946, subdivision 5; 256B.097, subdivisions
1, 2, 3, 4, 5, 6; 256B.4905, subdivisions 1, 2, 3, 4, 5, 6; 256D.051, subdivisions
1, 1a, 2, 2a, 3, 3a, 3b, 6b, 6c, 7, 8, 9, 18; 256D.052, subdivision 3; 259A.70; Laws
2019, First Special Session chapter 9, article 5, section 90; Minnesota Rules, parts
9505.0370; 9505.0371; 9505.0372; 9520.0010; 9520.0020; 9520.0030; 9520.0040;
9520.0050; 9520.0060; 9520.0070; 9520.0080; 9520.0090; 9520.0100; 9520.0110;
9520.0120; 9520.0130; 9520.0140; 9520.0150; 9520.0160; 9520.0170; 9520.0180;
9520.0190; 9520.0200; 9520.0210; 9520.0230; 9520.0750; 9520.0760; 9520.0770;
9520.0780; 9520.0790; 9520.0800; 9520.0810; 9520.0820; 9520.0830; 9520.0840;
9520.0850; 9520.0860; 9520.0870; 9530.6800; 9530.6810.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
ARTICLE 1
HEALTH CARE; DEPARTMENT OF HUMAN SERVICES
Section 1.
Minnesota Statutes 2020, section 245F.03, is amended to read:
245F.03 APPLICATION.
(a) This chapter establishes minimum standards for withdrawal management programs
licensed by the commissioner that serve one or more unrelated persons.
(b) This chapter does not apply to a withdrawal management program licensed as a
hospital under sections 144.50 to 144.581. A withdrawal management program located in
a hospital licensed under sections 144.50 to 144.581 that chooses to be licensed under this
chapter is deemed to be in compliance with section 245F.13.new text begin This chapter does not apply
when a license holder is providing pre-treatment coordination services under section 254B.05,
subdivision 4a.
new text end
(c) Minnesota Rules, parts 9530.6600 to 9530.6655, do not apply to withdrawal
management programs licensed under this chapter.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained or denied.
new text end
Sec. 2.
Minnesota Statutes 2020, section 245G.02, subdivision 2, is amended to read:
Subd. 2.
Exemption from license requirement.
This chapter does not apply to a county
or recovery community organization that is providing a service for which the county or
recovery community organization is an eligible vendor under section 254B.05. This chapter
does not apply to an organization whose primary functions are information, referral,
diagnosis, case management, and assessment for the purposes of client placement, education,
support group services, or self-help programs. This chapter does not apply to the activities
of a licensed professional in private practice. A license holder providing the initial set of
substance use disorder services allowable under section 254A.03, subdivision 3, paragraph
(c), to an individual referred to a licensed nonresidential substance use disorder treatment
program after a positive screen for alcohol or substance misuse is exempt from sections
245G.05; 245G.06, subdivisions 1, 2, and 4; 245G.07, subdivisions 1, paragraph (a), clauses
(2) to (4), and 2, clauses (1) to (7); and 245G.17.new text begin This chapter does not apply when a license
holder is providing pretreatment coordination services under section 254B.05, subdivision
4a.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained or denied.
new text end
Sec. 3.
Minnesota Statutes 2020, section 245G.06, subdivision 3, is amended to read:
Subd. 3.
Documentation of treatment servicesnew text begin and pretreatment servicesnew text end ; treatment
plan review.
(a) A review of all treatment services must be documented weekly and include
a review of:
(1) deleted text begin caredeleted text end new text begin treatmentnew text end coordination activitiesnew text begin , including any pretreatment coordination
servicesnew text end ;
(2) medical and other appointments the client attended;
(3) issues related to medications that are not documented in the medication administration
record; and
(4) issues related to attendance for treatment services, including the reason for any client
absence from a treatment service.
(b) A note must be entered immediately following any significant event. A significant
event is an event that impacts the client's relationship with other clients, staff, the client's
family, or the client's treatment plan.
(c) A treatment plan review must be entered in a client's file weekly or after each treatment
service, whichever is less frequent, by the staff member providing the service. The review
must indicate the span of time covered by the review and each of the six dimensions listed
in section 245G.05, subdivision 2, paragraph (c). The review must:
(1) indicate the date, type, and amount of each treatment service provided and the client's
response to each service;
(2) address each goal in the treatment plan and whether the methods to address the goals
are effective;
(3) include monitoring of any physical and mental health problems;
(4) document the participation of others;
(5) document staff recommendations for changes in the methods identified in the treatment
plan and whether the client agrees with the change; and
(6) include a review and evaluation of the individual abuse prevention plan according
to section 245A.65.
(d) Each entry in a client's record must be accurate, legible, signed, and dated. A late
entry must be clearly labeled "late entry." A correction to an entry must be made in a way
in which the original entry can still be read.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained or denied.
new text end
Sec. 4.
Minnesota Statutes 2020, section 245G.11, subdivision 7, is amended to read:
Subd. 7.
Treatment coordination provider qualifications.
(a) Treatment coordination
must be provided by qualified staff. An individual is qualified to provide treatment
coordination if the individual meets the qualifications of an alcohol and drug counselor
under subdivision 5 or if the individual:
(1) is skilled in the process of identifying and assessing a wide range of client needs;
(2) is knowledgeable about local community resources and how to use those resources
for the benefit of the client;
(3) has successfully completed 30 hours of classroom instruction on treatment
coordination for an individual with substance use disorder;
(4) has either:
(i) a bachelor's degree in one of the behavioral sciences or related fields; or
(ii) current certification as an alcohol and drug counselor, level I, by the Upper Midwest
Indian Council on Addictive Disorders; and
(5) has at least 2,000 hours of supervised experience working with individuals with
substance use disorder.
(b) A treatment coordinator must receive at least one hour of supervision regarding
individual service delivery from an alcohol and drug counselor, or a mental health
professional who has substance use treatment and assessments within the scope of their
practice, on a monthly basis.
new text begin
(c) County staff who conduct chemical use assessments under Minnesota Rules, part
9530.6615, and are employed as of January 1, 2022, are qualified to provide treatment
coordination under section 245G.07, subdivision 1, paragraph (a), clause (5). County staff
who conduct chemical use assessments under Minnesota Rules, part 9530.6615, and are
employed after January 1, 2021, are qualified to provide treatment coordination under section
245G.07, subdivision 1, paragraph (a), clause (5), if the county staff person completes the
classroom instruction in paragraph (a), clause (3).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained or denied.
new text end
Sec. 5.
Minnesota Statutes 2020, section 254B.05, subdivision 1, is amended to read:
Subdivision 1.
Licensure required.
(a) Programs licensed by the commissioner are
eligible vendors. Hospitals may apply for and receive licenses to be eligible vendors,
notwithstanding the provisions of section 245A.03. American Indian programs that provide
substance use disorder treatment, extended care, transitional residence, deleted text begin ordeleted text end outpatient treatment
services, and are licensed by tribal government are eligible vendors.new text begin American Indian
programs are eligible vendors of peer support services according to section 245G.07,
subdivision 2, clause (8). An alcohol and drug counselor as defined in section 245G.11,
subdivision 5, must be available to recovery peers for ongoing consultation, as needed.
new text end
(b) A licensed professional in private practice as defined in section 245G.01, subdivision
17, who meets the requirements of section 245G.11, subdivisions 1 and 4, is an eligible
vendor of a comprehensive assessment and assessment summary provided according to
section 245G.05, and treatment services provided according to sections 245G.06 and
245G.07, subdivision 1, paragraphs (a), clauses (1) to (5), and (b); and subdivision 2, clauses
(1) to (6).
(c) A county is an eligible vendor for a comprehensive assessment and assessment
summary when provided by an individual who meets the staffing credentials of section
245G.11, subdivisions 1 and 5, and completed according to the requirements of section
245G.05. A county is an eligible vendor of deleted text begin caredeleted text end new text begin treatmentnew text end coordination services when
provided by an individual who meets the staffing credentials of section 245G.11, subdivisions
1 and 7, and provided according to the requirements of section 245G.07, subdivision 1,
paragraph (a), clause (5).new text begin A county is an eligible vendor of peer recovery support services
according to section 245G.07, subdivision 2, clause (8). An alcohol and drug counselor as
defined in section 245G.11, subdivision 5, must be available to recovery peers for ongoing
consultation, as needed.
new text end
(d) new text begin Nonresidential programs licensed under chapter 245G, withdrawal management
programs licensed under chapter 245F, American Indian programs described in paragraph
(a), and counties are eligible vendors of pretreatment coordination services as defined under
section 254B.05, subdivision 4a, when the individual providing the services meets the
staffing credentials in section 245G.11, subdivisions 1 and 7.
new text end
new text begin (e) new text end A recovery community organization that meets certification requirements identified
by the commissioner is an eligible vendor of peer support services.
deleted text begin (e)deleted text end new text begin (f)new text end Detoxification programs licensed under Minnesota Rules, parts 9530.6510 to
9530.6590, are not eligible vendors. Programs that are not licensed as a residential or
nonresidential substance use disorder treatment or withdrawal management program by the
commissioner or by tribal government or do not meet the requirements of subdivisions 1a
and 1b are not eligible vendors.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained or denied.
new text end
Sec. 6.
Minnesota Statutes 2020, section 254B.05, is amended by adding a subdivision to
read:
new text begin Subd. 4a. new text end
new text begin Pretreatment coordination services. new text end
new text begin
(a) An enrolled provider may provide
pretreatment coordination services to an individual prior to the individual's comprehensive
assessment under section 245G.05, to facilitate an individual's access to a comprehensive
assessment. The total pretreatment coordination services must not exceed 36 units per
eligibility determination.
new text end
new text begin
(b) An individual providing pretreatment coordination services must meet the staff
qualifications in section 245G.11, subdivision 7. Section 245G.05 and Minnesota Rules,
parts 9530.6600 to 9530.6655, do not apply to pretreatment coordination services.
new text end
new text begin
(c) To be eligible for pretreatment coordination services, an individual must screen
positive for alcohol or substance misuse using a screening tool approved by the commissioner.
The provider may bill the screening as a pretreatment coordination service.
new text end
new text begin
(d) Pretreatment coordination services include:
new text end
new text begin
(1) assisting with connecting an individual with a qualified comprehensive assessment
provider;
new text end
new text begin
(2) identifying barriers that might inhibit an individual's ability to participate in a
comprehensive assessment; and
new text end
new text begin
(3) assisting with connecting an individual with resources to mitigate an individual's
immediate safety risks.
new text end
new text begin
(e) A license holder is authorized to provide up to 36 units of pretreatment coordination
services, excluding travel time, and must document the following information in the client's
case file:
new text end
new text begin
(1) the dates, number of units, and description of pretreatment coordination services
provided;
new text end
new text begin
(2) identifying an individual's safety concerns and developing a plan to address those
concerns;
new text end
new text begin
(3) assisting an individual with scheduling an appointment for a comprehensive
assessment and confirming that the individual and provider keep the appointment; and
new text end
new text begin
(4) assisting an individual with accessing resources for obtaining a comprehensive
assessment authorizing substance use disorder treatment services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained or denied.
new text end
Sec. 7.
Minnesota Statutes 2020, section 254B.05, subdivision 5, is amended to read:
Subd. 5.
Rate requirements.
(a) The commissioner shall establish rates for substance
use disorder services and service enhancements funded under this chapter.
(b) Eligible substance use disorder treatment services include:
(1) outpatient treatment services that are licensed according to sections 245G.01 to
245G.17, or applicable tribal license;
(2) comprehensive assessments provided according to sections 245.4863, paragraph (a),
and 245G.05;
(3) deleted text begin caredeleted text end new text begin treatmentnew text end coordination services provided according to section 245G.07,
subdivision 1, paragraph (a), clause (5);
(4) peer recovery support services provided according to section 245G.07, subdivision
2, clause (8);
(5) on July 1, 2019, or upon federal approval, whichever is later, withdrawal management
services provided according to chapter 245F;
(6) medication-assisted therapy services that are licensed according to sections 245G.01
to 245G.17 and 245G.22, or applicable tribal license;
(7) medication-assisted therapy plus enhanced treatment services that meet the
requirements of clause (6) and provide nine hours of clinical services each week;
(8) high, medium, and low intensity residential treatment services that are licensed
according to sections 245G.01 to 245G.17 and 245G.21 or applicable tribal license which
provide, respectively, 30, 15, and five hours of clinical services each week;
(9) hospital-based treatment services that are licensed according to sections 245G.01 to
245G.17 or applicable tribal license and licensed as a hospital under sections 144.50 to
144.56;
(10) adolescent treatment programs that are licensed as outpatient treatment programs
according to sections 245G.01 to 245G.18 or as residential treatment programs according
to Minnesota Rules, parts 2960.0010 to 2960.0220, and 2960.0430 to 2960.0490, or
applicable tribal license;
(11) high-intensity residential treatment services that are licensed according to sections
245G.01 to 245G.17 and 245G.21 or applicable tribal license, which provide 30 hours of
clinical services each week provided by a state-operated vendor or to clients who have been
civilly committed to the commissioner, present the most complex and difficult care needs,
and are a potential threat to the community; deleted text begin and
deleted text end
(12) room and board facilities that meet the requirements of subdivision 1anew text begin ; and
new text end
new text begin (13) pretreatment coordination services provided according to subdivision 4anew text end .
(c) The commissioner shall establish higher rates for programs that meet the requirements
of paragraph (b) and one of the following additional requirements:
(1) programs that serve parents with their children if the program:
(i) provides on-site child care during the hours of treatment activity that:
(A) is licensed under chapter 245A as a child care center under Minnesota Rules, chapter
9503; or
(B) meets the licensure exclusion criteria of section 245A.03, subdivision 2, paragraph
(a), clause (6), and meets the requirements under section 245G.19, subdivision 4; or
(ii) arranges for off-site child care during hours of treatment activity at a facility that is
licensed under chapter 245A as:
(A) a child care center under Minnesota Rules, chapter 9503; or
(B) a family child care home under Minnesota Rules, chapter 9502;
(2) culturally specific programs as defined in section 254B.01, subdivision 4a, or
programs or subprograms serving special populations, if the program or subprogram meets
the following requirements:
(i) is designed to address the unique needs of individuals who share a common language,
racial, ethnic, or social background;
(ii) is governed with significant input from individuals of that specific background; and
(iii) employs individuals to provide individual or group therapy, at least 50 percent of
whom are of that specific background, except when the common social background of the
individuals served is a traumatic brain injury or cognitive disability and the program employs
treatment staff who have the necessary professional training, as approved by the
commissioner, to serve clients with the specific disabilities that the program is designed to
serve;
(3) programs that offer medical services delivered by appropriately credentialed health
care staff in an amount equal to two hours per client per week if the medical needs of the
client and the nature and provision of any medical services provided are documented in the
client file; and
(4) programs that offer services to individuals with co-occurring mental health and
chemical dependency problems if:
(i) the program meets the co-occurring requirements in section 245G.20;
(ii) 25 percent of the counseling staff are licensed mental health professionals, as defined
in section 245.462, subdivision 18, clauses (1) to (6), or are students or licensing candidates
under the supervision of a licensed alcohol and drug counselor supervisor and licensed
mental health professional, except that no more than 50 percent of the mental health staff
may be students or licensing candidates with time documented to be directly related to
provisions of co-occurring services;
(iii) clients scoring positive on a standardized mental health screen receive a mental
health diagnostic assessment within ten days of admission;
(iv) the program has standards for multidisciplinary case review that include a monthly
review for each client that, at a minimum, includes a licensed mental health professional
and licensed alcohol and drug counselor, and their involvement in the review is documented;
(v) family education is offered that addresses mental health and substance abuse disorders
and the interaction between the two; and
(vi) co-occurring counseling staff shall receive eight hours of co-occurring disorder
training annually.
(d) In order to be eligible for a higher rate under paragraph (c), clause (1), a program
that provides arrangements for off-site child care must maintain current documentation at
the chemical dependency facility of the child care provider's current licensure to provide
child care services. Programs that provide child care according to paragraph (c), clause (1),
must be deemed in compliance with the licensing requirements in section 245G.19.
(e) Adolescent residential programs that meet the requirements of Minnesota Rules,
parts 2960.0430 to 2960.0490 and 2960.0580 to 2960.0690, are exempt from the requirements
in paragraph (c), clause (4), items (i) to (iv).
(f) Subject to federal approval, chemical dependency services that are otherwise covered
as direct face-to-face services may be provided via two-way interactive video. The use of
two-way interactive video must be medically appropriate to the condition and needs of the
person being served. Reimbursement shall be at the same rates and under the same conditions
that would otherwise apply to direct face-to-face services. The interactive video equipment
and connection must comply with Medicare standards in effect at the time the service is
provided.
(g) For the purpose of reimbursement under this section, substance use disorder treatment
services provided in a group setting without a group participant maximum or maximum
client to staff ratio under chapter 245G shall not exceed a client to staff ratio of 48 to one.
At least one of the attending staff must meet the qualifications as established under this
chapter for the type of treatment service provided. A recovery peer may not be included as
part of the staff ratio.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained or denied.
new text end
Sec. 8.
Minnesota Statutes 2020, section 256.01, subdivision 28, is amended to read:
Subd. 28.
Statewide health information exchange.
(a) The commissioner has the
authority to join and participate as a member in a legal entity developing and operating a
statewide health information exchange new text begin or to develop and operate an encounter alerting
service new text end that shall meet the following criteria:
(1) the legal entity must meet all constitutional and statutory requirements to allow the
commissioner to participate; and
(2) the commissioner or the commissioner's designated representative must have the
right to participate in the governance of the legal entity under the same terms and conditions
and subject to the same requirements as any other member in the legal entity and in that
role shall act to advance state interests and lessen the burdens of government.
(b) Notwithstanding chapter 16C, the commissioner may pay the state's prorated share
of development-related expenses of the legal entity retroactively from October 29, 2007,
regardless of the date the commissioner joins the legal entity as a member.
Sec. 9.
Minnesota Statutes 2020, section 256.01, is amended by adding a subdivision to
read:
new text begin Subd. 42. new text end
new text begin Expiration of report mandates. new text end
new text begin
(a) If the submission of a report by the
commissioner of human services to the legislature is mandated by statute and the enabling
legislation does not include a date for the submission of a final report, the mandate to submit
the report shall expire in accordance with this section.
new text end
new text begin
(b) If the mandate requires the submission of an annual report and the mandate was
enacted before January 1, 2021, the mandate shall expire on January 1,2023. If the mandate
requires the submission of a biennial or less frequent report and the mandate was enacted
before January 1, 2021, the mandate shall expire on January 1, 2024.
new text end
new text begin
(c) Any reporting mandate enacted on or after January 1, 2021 shall expire three years
after the date of enactment if the mandate requires the submission of an annual report and
shall expire five years after the date of enactment if the mandate requires the submission
of a biennial or less frequent report unless the enacting legislation provides for a different
expiration date.
new text end
new text begin
(d) The commissioner shall submit a list to the chairs and ranking minority members of
the legislative committee with jurisdiction over human services by February 15 of each
year, beginning February 15, 2022, of all reports set to expire during the following calendar
year in accordance with this section.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 10.
Minnesota Statutes 2020, section 256.042, subdivision 4, is amended to read:
Subd. 4.
Grants.
(a) The commissioner of human services shall submit a report deleted text begin of the
grants proposed by the advisory council to be awarded for the upcoming fiscal yeardeleted text end to the
chairs and ranking minority members of the legislative committees with jurisdiction over
health and human services policy and finance, by March 1 of each year, beginning March
1, 2020new text begin , describing the priorities and specific activities the advisory council intends to
address for the upcoming fiscal year based on the projected funds available for grant
distributionnew text end .
(b) deleted text begin The commissioner of human services shall award grants from the opiate epidemic
response fund under section 256.043.deleted text end The grants shall be awarded to proposals selected by
the advisory council that address the priorities in subdivision 1, paragraph (a), clauses (1)
to (4), unless otherwise appropriated by the legislature. new text begin The advisory council shall determine
grant awards and funding amounts based on the funds appropriated to the commissioner
under section 256.043, subdivision 3, paragraph (e). The commissioner shall award the
grants from the opiate epidemic response fund and administer the grants in compliance with
section 16B.97. new text end No more than three percent of the grant amount may be used by a grantee
for administration.
Sec. 11.
Minnesota Statutes 2020, section 256.043, subdivision 4, is amended to read:
Subd. 4.
Settlement; sunset.
(a) If the state receives a total sum of $250,000,000 either
as a result of a settlement agreement or an assurance of discontinuance entered into by the
attorney general of the state, or resulting from a court order in litigation brought by the
attorney general of the state on behalf of the state or a state agency, against one or more
opioid manufacturers or opioid wholesale drug distributors new text begin or consulting firms working for
an opioid manufacturer or opioid wholesale drug distributor new text end related to alleged violations of
consumer fraud laws in the marketing, sale, or distribution of opioids in this state, or other
alleged illegal actions that contributed to the excessive use of opioids, or from the fees
collected under sections 151.065, subdivisions 1 and 3, and 151.066, that are deposited into
the opiate epidemic response fund established in this section, or from a combination of both,
the fees specified in section 151.065, subdivisions 1, clause (16), and 3, clause (14), shall
be reduced to $5,260, and the opiate registration fee in section 151.066, subdivision 3, shall
be repealed.
(b) The commissioner of management and budget shall inform the Board of Pharmacy,
the governor, and the legislature when the amount specified in paragraph (a) has been
reached. The board shall apply the reduced license fee for the next licensure period.
(c) Notwithstanding paragraph (a), the reduction of the license fee in section 151.065,
subdivisions 1 and 3, and the repeal of the registration fee in section 151.066 shall not occur
before July 1, 2024.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 12.
Minnesota Statutes 2020, section 256.969, is amended by adding a subdivision
to read:
new text begin Subd. 2f. new text end
new text begin Alternate inpatient payment rate. new text end
new text begin
Effective January 1, 2022, for a hospital
eligible to receive disproportionate share hospital payments under subdivision 9, paragraph
(d), clause (6), the commissioner shall reduce the amount calculated under subdivision 9,
paragraph (d), clause (6), by 99 percent and compute an alternate inpatient payment rate.
The alternate payment rate shall be structured to target a total aggregate reimbursement
amount equal to what the hospital would have received for providing fee-for-service inpatient
services under this section to patients enrolled in medical assistance had the hospital received
the entire amount calculated under subdivision 9, paragraph (d), clause (6).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022.
new text end
Sec. 13.
Minnesota Statutes 2020, section 256.9695, subdivision 1, is amended to read:
Subdivision 1.
Appeals.
A hospital may appeal a decision arising from the application
of standards or methods under section 256.9685, 256.9686, or 256.969, if an appeal would
result in a change to the hospital's payment rate or payments. Both overpayments and
underpayments that result from the submission of appeals shall be implemented. Regardless
of any appeal outcome, relative values, Medicare wage indexes, Medicare cost-to-charge
ratios, and policy adjusters shall not be changed. The appeal shall be heard by an
administrative law judge according to sections 14.57 to 14.62, or upon agreement by both
parties, according to a modified appeals procedure established by the commissioner and the
Office of Administrative Hearings. In any proceeding under this section, the appealing party
must demonstrate by a preponderance of the evidence that the commissioner's determination
is incorrect or not according to law.
To appeal a payment rate or payment determination or a determination made from base
year information, the hospital shall file a written appeal request to the commissioner within
60 days of the date the preliminary payment rate determination was mailed. The appeal
request shall specify: (i) the disputed items; (ii) the authority in federal or state statute or
rule upon which the hospital relies for each disputed item; and (iii) the name and address
of the person to contact regarding the appeal. Facts to be considered in any appeal of base
year information are limited to those in existence deleted text begin 12deleted text end new text begin 18new text end months after the last day of the
calendar year that is the base year for the payment rates in dispute.
Sec. 14.
Minnesota Statutes 2020, section 256.983, is amended to read:
256.983 FRAUD PREVENTION INVESTIGATIONS.
Subdivision 1.
Programs established.
Within the limits of available appropriations, the
commissioner of human services shall require the maintenance of budget neutral fraud
prevention investigation programs in the counties new text begin or tribal agencies new text end participating in the
fraud prevention investigation project established under this section. If funds are sufficient,
the commissioner may also extend fraud prevention investigation programs to other counties
new text begin or tribal agencies new text end provided the expansion is budget neutral to the state. Under any expansion,
the commissioner has the final authority in decisions regarding the creation and realignment
of individual countynew text begin , tribal agency,new text end or regional operations.
Subd. 2.
County new text begin and tribal agency new text end proposals.
Each participating county new text begin and tribal
new text end agency shall develop and submit an annual staffing and funding proposal to the commissioner
no later than April 30 of each year. Each proposal shall include, but not be limited to, the
staffing and funding of the fraud prevention investigation program, a job description for
investigators involved in the fraud prevention investigation program, and the organizational
structure of the county new text begin or tribal new text end agency unit, training programs for case workers, and the
operational requirements which may be directed by the commissioner. The proposal shall
be approved, to include any changes directed or negotiated by the commissioner, no later
than June 30 of each year.
Subd. 3.
Department responsibilities.
The commissioner shall establish training
programs which shall be attended by all investigative and supervisory staff of the involved
county new text begin and tribal new text end agencies. The commissioner shall also develop the necessary operational
guidelines, forms, and reporting mechanisms, which shall be used by the involved countynew text begin
or tribalnew text end agencies. An individual's application or redetermination form for public assistance
benefits, including child care assistance programs and medical care programs, must include
an authorization for release by the individual to obtain documentation for any information
on that form which is involved in a fraud prevention investigation. The authorization for
release is effective for six months after public assistance benefits have ceased.
Subd. 4.
Funding.
(a) County new text begin and tribal new text end agency reimbursement shall be made through
the settlement provisions applicable to the Supplemental Nutrition Assistance Program
(SNAP), MFIP, child care assistance programs, the medical assistance program, and other
federal and state-funded programs.
(b) The commissioner will maintain program compliance if for any three consecutive
month period, a county new text begin or tribal new text end agency fails to comply with fraud prevention investigation
program guidelines, or fails to meet the cost-effectiveness standards developed by the
commissioner. This result is contingent on the commissioner providing written notice,
including an offer of technical assistance, within 30 days of the end of the third or subsequent
month of noncompliance. The county new text begin or tribal new text end agency shall be required to submit a corrective
action plan to the commissioner within 30 days of receipt of a notice of noncompliance.
Failure to submit a corrective action plan or, continued deviation from standards of more
than ten percent after submission of a corrective action plan, will result in denial of funding
for each subsequent month, or billing the county new text begin or tribal new text end agency for fraud prevention
investigation (FPI) service provided by the commissioner, or reallocation of program grant
funds, or investigative resources, or both, to other countiesnew text begin or tribal agenciesnew text end . The denial of
funding shall apply to the general settlement received by the county new text begin or tribal new text end agency on a
quarterly basis and shall not reduce the grant amount applicable to the FPI project.
Subd. 5.
Child care providers; financial misconduct.
(a) A county or tribal agency
may conduct investigations of financial misconduct by child care providers as described in
chapter 245E. Prior to opening an investigation, a county or tribal agency must contact the
commissioner to determine whether an investigation under this chapter may compromise
an ongoing investigation.
(b) If, upon investigation, a preponderance of evidence shows a provider committed an
intentional program violation, intentionally gave the county or tribe materially false
information on the provider's billing forms, provided false attendance records to a county,
tribe, or the commissioner, or committed financial misconduct as described in section
245E.01, subdivision 8, the county or tribal agency may suspend a provider's payment
pursuant to chapter 245E, or deny or revoke a provider's authorization pursuant to section
119B.13, subdivision 6, paragraph (d), clause (2), prior to pursuing other available remedies.
The countynew text begin or tribenew text end must send notice in accordance with the requirements of section
119B.161, subdivision 2. If a provider's payment is suspended under this section, the payment
suspension shall remain in effect until: (1) the commissioner, county,new text begin tribe,new text end or a law
enforcement authority determines that there is insufficient evidence warranting the action
and a county, tribe, or the commissioner does not pursue an additional administrative remedy
under chapter 119B or 245E, or section 256.046 or 256.98; or (2) all criminal, civil, and
administrative proceedings related to the provider's alleged misconduct conclude and any
appeal rights are exhausted.
(c) For the purposes of this section, an intentional program violation includes intentionally
making false or misleading statements; intentionally misrepresenting, concealing, or
withholding facts; and repeatedly and intentionally violating program regulations under
chapters 119B and 245E.
(d) A provider has the right to administrative review under section 119B.161 if: (1)
payment is suspended under chapter 245E; or (2) the provider's authorization was denied
or revoked under section 119B.13, subdivision 6, paragraph (d), clause (2).
Sec. 15.
Minnesota Statutes 2020, section 256B.055, subdivision 6, is amended to read:
Subd. 6.
Pregnant women; needy unborn child.
Medical assistance may be paid for
a pregnant woman who meets the other eligibility criteria of this section and whose unborn
child would be eligible as a needy child under subdivision 10 if born and living with the
woman. In accordance with Code of Federal Regulations, title 42, section 435.956, the
commissioner must accept self-attestation of pregnancy unless the agency has information
that is not reasonably compatible with such attestation. For purposes of this subdivision, a
woman is considered pregnant for deleted text begin 60 daysdeleted text end new text begin six monthsnew text end postpartum.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner shall notify the revisor of statutes when federal
approval has been obtained.
new text end
Sec. 16.
Minnesota Statutes 2020, section 256B.056, subdivision 10, is amended to read:
Subd. 10.
Eligibility verification.
(a) The commissioner shall require women who are
applying for the continuation of medical assistance coverage following the end of the deleted text begin 60-daydeleted text end new text begin
six monthsnew text end postpartum period to update their income and asset information and to submit
any required income or asset verification.
(b) The commissioner shall determine the eligibility of private-sector health care coverage
for infants less than one year of age eligible under section 256B.055, subdivision 10, or
256B.057, subdivision 1, paragraph (c), and shall pay for private-sector coverage if this is
determined to be cost-effective.
(c) The commissioner shall verify assets and income for all applicants, and for all
recipients upon renewal.
(d) The commissioner shall utilize information obtained through the electronic service
established by the secretary of the United States Department of Health and Human Services
and other available electronic data sources in Code of Federal Regulations, title 42, sections
435.940 to 435.956, to verify eligibility requirements. The commissioner shall establish
standards to define when information obtained electronically is reasonably compatible with
information provided by applicants and enrollees, including use of self-attestation, to
accomplish real-time eligibility determinations and maintain program integrity.
(e) Each person applying for or receiving medical assistance under section 256B.055,
subdivision 7, and any other person whose resources are required by law to be disclosed to
determine the applicant's or recipient's eligibility must authorize the commissioner to obtain
information from financial institutions to identify unreported accounts as required in section
256.01, subdivision 18f. If a person refuses or revokes the authorization, the commissioner
may determine that the applicant or recipient is ineligible for medical assistance. For purposes
of this paragraph, an authorization to identify unreported accounts meets the requirements
of the Right to Financial Privacy Act, United States Code, title 12, chapter 35, and need not
be furnished to the financial institution.
(f) County and tribal agencies shall comply with the standards established by the
commissioner for appropriate use of the asset verification system specified in section 256.01,
subdivision 18f.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner shall notify the revisor of statutes when federal
approval has been obtained.
new text end
Sec. 17.
Minnesota Statutes 2020, section 256B.057, subdivision 3, is amended to read:
Subd. 3.
Qualified Medicare beneficiaries.
new text begin (a) new text end A person deleted text begin who is entitled to Part A
Medicare benefits, whose income is equal to or less than 100 percent of the federal poverty
guidelines, and whose assets are no more than $10,000 for a single individual and $18,000
for a married couple or family of two or more,deleted text end is eligible for medical assistance
reimbursement of new text begin Medicare new text end Part A and Part B premiums, Part A and Part B coinsurance
and deductibles, and cost-effective premiums for enrollment with a health maintenance
organization or a competitive medical plan under section 1876 of the Social Security Actdeleted text begin .deleted text end new text begin
if:
new text end
new text begin
(1) the person is entitled to Medicare Part A benefits;
new text end
new text begin
(2) the person's income is equal to or less than 100 percent of the federal poverty
guidelines; and
new text end
new text begin
(3) the person's assets are no more than (i) $10,000 for a single individual, or (ii) $18,000
for a married couple or family of two or more; or, when the resource limits for eligibility
for the Medicare Part D extra help low income subsidy (LIS) exceed either amount in item
(i) or (ii), the person's assets are no more than the LIS resource limit in United States Code,
title 42, section 1396d, subsection (p).
new text end
new text begin (b)new text end Reimbursement of the Medicare coinsurance and deductibles, when added to the
amount paid by Medicare, must not exceed the total rate the provider would have received
for the same service or services if the person were a medical assistance recipient with
Medicare coverage. Increases in benefits under Title II of the Social Security Act shall not
be counted as income for purposes of this subdivision until July 1 of each year.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 18.
Minnesota Statutes 2020, section 256B.06, subdivision 4, is amended to read:
Subd. 4.
Citizenship requirements.
(a) Eligibility for medical assistance is limited to
citizens of the United States, qualified noncitizens as defined in this subdivision, and other
persons residing lawfully in the United States. Citizens or nationals of the United States
must cooperate in obtaining satisfactory documentary evidence of citizenship or nationality
according to the requirements of the federal Deficit Reduction Act of 2005, Public Law
109-171.
(b) "Qualified noncitizen" means a person who meets one of the following immigration
criteria:
(1) admitted for lawful permanent residence according to United States Code, title 8;
(2) admitted to the United States as a refugee according to United States Code, title 8,
section 1157;
(3) granted asylum according to United States Code, title 8, section 1158;
(4) granted withholding of deportation according to United States Code, title 8, section
1253(h);
(5) paroled for a period of at least one year according to United States Code, title 8,
section 1182(d)(5);
(6) granted conditional entrant status according to United States Code, title 8, section
1153(a)(7);
(7) determined to be a battered noncitizen by the United States Attorney General
according to the Illegal Immigration Reform and Immigrant Responsibility Act of 1996,
title V of the Omnibus Consolidated Appropriations Bill, Public Law 104-200;
(8) is a child of a noncitizen determined to be a battered noncitizen by the United States
Attorney General according to the Illegal Immigration Reform and Immigrant Responsibility
Act of 1996, title V, of the Omnibus Consolidated Appropriations Bill, Public Law 104-200;
or
(9) determined to be a Cuban or Haitian entrant as defined in section 501(e) of Public
Law 96-422, the Refugee Education Assistance Act of 1980.
(c) All qualified noncitizens who were residing in the United States before August 22,
1996, who otherwise meet the eligibility requirements of this chapter, are eligible for medical
assistance with federal financial participation.
(d) Beginning December 1, 1996, qualified noncitizens who entered the United States
on or after August 22, 1996, and who otherwise meet the eligibility requirements of this
chapter are eligible for medical assistance with federal participation for five years if they
meet one of the following criteria:
(1) refugees admitted to the United States according to United States Code, title 8, section
1157;
(2) persons granted asylum according to United States Code, title 8, section 1158;
(3) persons granted withholding of deportation according to United States Code, title 8,
section 1253(h);
(4) veterans of the United States armed forces with an honorable discharge for a reason
other than noncitizen status, their spouses and unmarried minor dependent children; or
(5) persons on active duty in the United States armed forces, other than for training,
their spouses and unmarried minor dependent children.
Beginning July 1, 2010, children and pregnant women who are noncitizens described
in paragraph (b) or who are lawfully present in the United States as defined in Code of
Federal Regulations, title 8, section 103.12, and who otherwise meet eligibility requirements
of this chapter, are eligible for medical assistance with federal financial participation as
provided by the federal Children's Health Insurance Program Reauthorization Act of 2009,
Public Law 111-3.
(e) Nonimmigrants who otherwise meet the eligibility requirements of this chapter are
eligible for the benefits as provided in paragraphs (f) to (h). For purposes of this subdivision,
a "nonimmigrant" is a person in one of the classes listed in United States Code, title 8,
section 1101(a)(15).
(f) Payment shall also be made for care and services that are furnished to noncitizens,
regardless of immigration status, who otherwise meet the eligibility requirements of this
chapter, if such care and services are necessary for the treatment of an emergency medical
condition.
(g) For purposes of this subdivision, the term "emergency medical condition" means a
medical condition that meets the requirements of United States Code, title 42, section
1396b(v).
(h)(1) Notwithstanding paragraph (g), services that are necessary for the treatment of
an emergency medical condition are limited to the following:
(i) services delivered in an emergency room or by an ambulance service licensed under
chapter 144E that are directly related to the treatment of an emergency medical condition;
(ii) services delivered in an inpatient hospital setting following admission from an
emergency room or clinic for an acute emergency condition; and
(iii) follow-up services that are directly related to the original service provided to treat
the emergency medical condition and are covered by the global payment made to the
provider.
(2) Services for the treatment of emergency medical conditions do not include:
(i) services delivered in an emergency room or inpatient setting to treat a nonemergency
condition;
(ii) organ transplants, stem cell transplants, and related care;
(iii) services for routine prenatal care;
(iv) continuing care, including long-term care, nursing facility services, home health
care, adult day care, day training, or supportive living services;
(v) elective surgery;
(vi) outpatient prescription drugs, unless the drugs are administered or dispensed as part
of an emergency room visit;
(vii) preventative health care and family planning services;
(viii) rehabilitation services;
(ix) physical, occupational, or speech therapy;
(x) transportation services;
(xi) case management;
(xii) prosthetics, orthotics, durable medical equipment, or medical supplies;
(xiii) dental services;
(xiv) hospice care;
(xv) audiology services and hearing aids;
(xvi) podiatry services;
(xvii) chiropractic services;
(xviii) immunizations;
(xix) vision services and eyeglasses;
(xx) waiver services;
(xxi) individualized education programs; or
(xxii) chemical dependency treatment.
(i) Pregnant noncitizens who are ineligible for federally funded medical assistance
because of immigration status, are not covered by a group health plan or health insurance
coverage according to Code of Federal Regulations, title 42, section 457.310, and who
otherwise meet the eligibility requirements of this chapter, are eligible for medical assistance
through the period of pregnancy, including labor and delivery, and deleted text begin 60 daysdeleted text end new text begin six monthsnew text end
postpartumdeleted text begin , to the extent federal funds are available under title XXI of the Social Security
Act, and the state children's health insurance programdeleted text end .
(j) Beginning October 1, 2003, persons who are receiving care and rehabilitation services
from a nonprofit center established to serve victims of torture and are otherwise ineligible
for medical assistance under this chapter are eligible for medical assistance without federal
financial participation. These individuals are eligible only for the period during which they
are receiving services from the center. Individuals eligible under this paragraph shall not
be required to participate in prepaid medical assistance. The nonprofit center referenced
under this paragraph may establish itself as a provider of mental health targeted case
management services through a county contract under section 256.0112, subdivision 6. If
the nonprofit center is unable to secure a contract with a lead county in its service area, then,
notwithstanding the requirements of section 256B.0625, subdivision 20, the commissioner
may negotiate a contract with the nonprofit center for provision of mental health targeted
case management services. When serving clients who are not the financial responsibility
of their contracted lead county, the nonprofit center must gain the concurrence of the county
of financial responsibility prior to providing mental health targeted case management services
for those clients.
(k) Notwithstanding paragraph (h), clause (2), the following services are covered as
emergency medical conditions under paragraph (f) except where coverage is prohibited
under federal law for services under clauses (1) and (2):
(1) dialysis services provided in a hospital or freestanding dialysis facility;
(2) surgery and the administration of chemotherapy, radiation, and related services
necessary to treat cancer if the recipient has a cancer diagnosis that is not in remission and
requires surgery, chemotherapy, or radiation treatment; and
(3) kidney transplant if the person has been diagnosed with end stage renal disease, is
currently receiving dialysis services, and is a potential candidate for a kidney transplant.
(l) Effective July 1, 2013, recipients of emergency medical assistance under this
subdivision are eligible for coverage of the elderly waiver services provided under chapter
256S, and coverage of rehabilitative services provided in a nursing facility. The age limit
for elderly waiver services does not apply. In order to qualify for coverage, a recipient of
emergency medical assistance is subject to the assessment and reassessment requirements
of section 256B.0911. Initial and continued enrollment under this paragraph is subject to
the limits of available funding.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner shall notify the revisor of statutes when federal
approval has been obtained.
new text end
Sec. 19.
Minnesota Statutes 2020, section 256B.0625, subdivision 3c, is amended to read:
Subd. 3c.
Health Services deleted text begin Policy Committeedeleted text end new text begin Advisory Councilnew text end .
(a) The commissioner,
after receiving recommendations from professional physician associations, professional
associations representing licensed nonphysician health care professionals, and consumer
groups, shall establish a deleted text begin 13-memberdeleted text end new text begin 14-membernew text end Health Services deleted text begin Policy Committeedeleted text end new text begin Advisory
Councilnew text end , which consists of deleted text begin 12deleted text end new text begin 13new text end voting members and one nonvoting member. The Health
Services deleted text begin Policy Committeedeleted text end new text begin Advisory Councilnew text end shall advise the commissioner regardingnew text begin (1)new text end
health services pertaining to the administration of health care benefits covered under deleted text begin the
medical assistance and MinnesotaCare programsdeleted text end new text begin Minnesota health care programs (MHCP);
and (2) evidence-based decision-making and health care benefit and coverage policies for
MHCP. The Health Services Advisory Council shall consider available evidence regarding
quality, safety, and cost-effectiveness when advising the commissionernew text end . The Health Services
deleted text begin Policy Committeedeleted text end new text begin Advisory Councilnew text end shall meet at least quarterly. The Health Services deleted text begin Policy
Committeedeleted text end new text begin Advisory Councilnew text end shall annually deleted text begin electdeleted text end new text begin selectnew text end a deleted text begin physiciandeleted text end chair from among its
membersdeleted text begin ,deleted text end who shall work directly with the commissioner's medical directordeleted text begin ,deleted text end to establish
the agenda for each meeting. The Health Services deleted text begin Policy Committee shall alsodeleted text end new text begin Advisory
Council maynew text end recommend criteria for verifying centers of excellence for specific aspects of
medical care where a specific set of combined services, a volume of patients necessary to
maintain a high level of competency, or a specific level of technical capacity is associated
with improved health outcomes.
(b) The commissioner shall establish a dental deleted text begin subcommitteedeleted text end new text begin subcouncilnew text end to operate under
the Health Services deleted text begin Policy Committeedeleted text end new text begin Advisory Councilnew text end . The dental deleted text begin subcommitteedeleted text end new text begin
subcouncilnew text end consists of general dentists, dental specialists, safety net providers, dental
hygienists, health plan company and county and public health representatives, health
researchers, consumers, and a designee of the commissioner of health. The dental
deleted text begin subcommitteedeleted text end new text begin subcouncilnew text end shall advise the commissioner regarding:
(1) the critical access dental program under section 256B.76, subdivision 4, including
but not limited to criteria for designating and terminating critical access dental providers;
(2) any changes to the critical access dental provider program necessary to comply with
program expenditure limits;
(3) dental coverage policy based on evidence, quality, continuity of care, and best
practices;
(4) the development of dental delivery models; and
(5) dental services to be added or eliminated from subdivision 9, paragraph (b).
deleted text begin
(c) The Health Services Policy Committee shall study approaches to making provider
reimbursement under the medical assistance and MinnesotaCare programs contingent on
patient participation in a patient-centered decision-making process, and shall evaluate the
impact of these approaches on health care quality, patient satisfaction, and health care costs.
The committee shall present findings and recommendations to the commissioner and the
legislative committees with jurisdiction over health care by January 15, 2010.
deleted text end
deleted text begin (d)deleted text end new text begin (c)new text end The Health Services deleted text begin Policy Committee shalldeleted text end new text begin Advisory Council maynew text end monitor and
track the practice patterns of deleted text begin physicians providing services to medical assistance and
MinnesotaCare enrolleesdeleted text end new text begin health care providers who serve MHCP recipientsnew text end under
fee-for-service, managed care, and county-based purchasing. The deleted text begin committeedeleted text end new text begin monitoring
and trackingnew text end shall focus on services or specialties for which there is a high variation in
utilization new text begin or quality new text end across deleted text begin physiciansdeleted text end new text begin providersnew text end , or which are associated with high medical
costs. The commissioner, based upon the findings of the deleted text begin committeedeleted text end new text begin Health Services Advisory
Councilnew text end , deleted text begin shall regularlydeleted text end new text begin maynew text end notify deleted text begin physiciansdeleted text end new text begin providersnew text end whose practice patterns indicate
new text begin below average quality or new text end higher than average utilization or costs. Managed care and
county-based purchasing plans shall provide the commissioner with utilization and cost
data necessary to implement this paragraph, and the commissioner shall make deleted text begin thisdeleted text end new text begin thesenew text end
data available to the deleted text begin committeedeleted text end new text begin Health Services Advisory Councilnew text end .
deleted text begin
(e) The Health Services Policy Committee shall review caesarean section rates for the
fee-for-service medical assistance population. The committee may develop best practices
policies related to the minimization of caesarean sections, including but not limited to
standards and guidelines for health care providers and health care facilities.
deleted text end
Sec. 20.
Minnesota Statutes 2020, section 256B.0625, subdivision 3d, is amended to read:
Subd. 3d.
Health Services deleted text begin Policy Committeedeleted text end new text begin Advisory Councilnew text end members.
(a) The
Health Services deleted text begin Policy Committeedeleted text end new text begin Advisory Councilnew text end consists of:
(1) deleted text begin sevendeleted text end new text begin sixnew text end voting members who are licensed physicians actively engaged in the practice
of medicine in Minnesota, deleted text begin one of whom must be actively engaged in the treatment of persons
with mental illness, anddeleted text end three of whom must represent health plans currently under contract
to serve deleted text begin medical assistancedeleted text end new text begin MHCPnew text end recipients;
(2) two voting members who are new text begin licensed new text end physician specialists actively practicing their
specialty in Minnesota;
(3) two voting members who are nonphysician health care professionals licensed or
registered in their profession and actively engaged in their practice of their profession in
Minnesota;
new text begin
(4) one voting member who is a health care or mental health professional licensed or
registered in the member's profession, actively engaged in the practice of the member's
profession in Minnesota, and actively engaged in the treatment of persons with mental
illness;
new text end
deleted text begin (4) one consumerdeleted text end new text begin (5) two consumersnew text end who shall serve as deleted text begin adeleted text end voting deleted text begin memberdeleted text end new text begin membersnew text end ; and
deleted text begin (5)deleted text end new text begin (6)new text end the commissioner's medical director who shall serve as a nonvoting member.
(b) Members of the Health Services deleted text begin Policy Committeedeleted text end new text begin Advisory Councilnew text end shall not be
employed by the deleted text begin Department of Human Servicesdeleted text end new text begin state of Minnesotanew text end , except for the medical
director.new text begin A quorum shall comprise a simple majority of the voting members. Vacant seats
shall not count toward a quorum.
new text end
Sec. 21.
Minnesota Statutes 2020, section 256B.0625, subdivision 3e, is amended to read:
Subd. 3e.
Health Services deleted text begin Policy Committeedeleted text end new text begin Advisory Councilnew text end terms and
compensation.
deleted text begin Committeedeleted text end Members shall serve staggered three-year terms, with one-third
of the voting members' terms expiring annually. Members may be reappointed by the
commissioner. The commissioner may require more frequent Health Services deleted text begin Policy
Committeedeleted text end new text begin Advisory Councilnew text end meetings as needed. An honorarium of $200 per meeting and
reimbursement for mileage and parking shall be paid to each deleted text begin committeedeleted text end new text begin councilnew text end member
in attendance except the medical director. The Health Services deleted text begin Policy Committeedeleted text end new text begin Advisory
Councilnew text end does not expire as provided in section 15.059, subdivision 6.
Sec. 22.
Minnesota Statutes 2020, section 256B.0625, subdivision 9, is amended to read:
Subd. 9.
Dental services.
(a) Medical assistance covers dental services.
(b) Medical assistance dental coverage for nonpregnant adults is limited to the following
services:
(1) comprehensive exams, limited to once every five years;
(2) periodic exams, limited to one per year;
(3) limited exams;
(4) bitewing x-rays, limited to one per year;
(5) periapical x-rays;
(6) panoramic x-rays, limited to one every five years except (1) when medically necessary
for the diagnosis and follow-up of oral and maxillofacial pathology and trauma or (2) once
every two years for patients who cannot cooperate for intraoral film due to a developmental
disability or medical condition that does not allow for intraoral film placement;
(7) prophylaxis, limited to one per year;
(8) application of fluoride varnish, limited to one per year;
(9) posterior fillings, all at the amalgam rate;
(10) anterior fillings;
(11) endodontics, limited to root canals on the anterior and premolars only;
(12) removable prostheses, each dental arch limited to one every six years;
(13) oral surgery, limited to extractions, biopsies, and incision and drainage of abscesses;
(14) palliative treatment and sedative fillings for relief of pain; deleted text begin and
deleted text end
(15) full-mouth debridement, limited to one every five yearsdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(16) nonsurgical treatment for periodontal disease, including scaling and root planing
once every two years for each quadrant, and routine periodontal maintenance procedures.
new text end
(c) In addition to the services specified in paragraph (b), medical assistance covers the
following services for adults, if provided in an outpatient hospital setting or freestanding
ambulatory surgical center as part of outpatient dental surgery:
(1) periodontics, limited to periodontal scaling and root planing once every two years;
(2) general anesthesia; and
(3) full-mouth survey once every five years.
(d) Medical assistance covers medically necessary dental services for children and
pregnant women. The following guidelines apply:
(1) posterior fillings are paid at the amalgam rate;
(2) application of sealants are covered once every five years per permanent molar for
children only;
(3) application of fluoride varnish is covered once every six months; and
(4) orthodontia is eligible for coverage for children only.
(e) In addition to the services specified in paragraphs (b) and (c), medical assistance
covers the following services for adults:
(1) house calls or extended care facility calls for on-site delivery of covered services;
(2) behavioral management when additional staff time is required to accommodate
behavioral challenges and sedation is not used;
(3) oral or IV sedation, if the covered dental service cannot be performed safely without
it or would otherwise require the service to be performed under general anesthesia in a
hospital or surgical center; and
(4) prophylaxis, in accordance with an appropriate individualized treatment plan, but
no more than four times per year.
(f) The commissioner shall not require prior authorization for the services included in
paragraph (e), clauses (1) to (3), and shall prohibit managed care and county-based purchasing
plans from requiring prior authorization for the services included in paragraph (e), clauses
(1) to (3), when provided under sections 256B.69, 256B.692, and 256L.12.
Sec. 23.
Minnesota Statutes 2020, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 9c. new text end
new text begin Uniform prior authorization for dental services. new text end
new text begin
(a) For purposes of this
subdivision, "dental benefits administrator" means an organization licensed under chapter
62C or 62D that contracts with a managed care plan or county-based purchasing plan to
provide covered dental care services to enrollees of the plan.
new text end
new text begin
(b) By January 1, 2022, the commissioner, in consultation with interested stakeholders,
shall develop uniform prior authorization criteria for all dental services requiring prior
authorization. The commissioner shall publish a list of the dental services requiring prior
authorization and the process for obtaining prior authorization on the department's website.
Dental services on the list and the process for obtaining prior authorization approval must
be consistent. The commissioner shall require that dental providers, managed care plans,
county-based purchasing plans, and dental benefit administrators use the dental services on
the list regardless of whether the services are provided through a fee-for-service system or
through a prepaid medical assistance program.
new text end
new text begin
(c) Managed care plans and county-based purchasing plans may require prior
authorization for additional dental services not on the list described in paragraph (b) if a
uniform process for obtaining prior approvals is applied, including a process for
reconsideration when a prior approval request is denied that can be utilized by both the
patient and the patient's dental provider.
new text end
Sec. 24.
Minnesota Statutes 2020, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 9d. new text end
new text begin Uniform credentialing process. new text end
new text begin
(a) For purposes of this subdivision, "dental
benefits administrator" has the meaning given in subdivision 9c.
new text end
new text begin
(b) By January 1, 2022, the commissioner, in consultation with interested stakeholders,
shall develop a uniform credentialing process for dental providers. Upon federal approval,
the credentialing process must be accepted by all managed care plans, county-based
purchasing plans, and dental benefits administrators that contract with the commissioner or
subcontract with plans to provide dental services to medical assistance or MinnesotaCare
enrollees.
new text end
new text begin
(c) The process developed in this subdivision must include a uniform credentialing
application that must be available in electronic format and accessible on the department's
website. The process developed under this subdivision must include an option to submit a
completed application electronically. The uniform credentialing application must be available
to providers for free.
new text end
new text begin
(d) If applicable, a managed care plan, county-based purchasing plan, dental benefits
administrator, contractor, or vendor that reviews and approves a credentialing application
must notify a provider regarding a deficiency on a submitted credentialing application form
no later than 30 business days after receiving the application form from the provider.
new text end
Sec. 25.
Minnesota Statutes 2020, section 256B.0625, subdivision 13, is amended to read:
Subd. 13.
Drugs.
(a) Medical assistance covers drugs, except for fertility drugs when
specifically used to enhance fertility, if prescribed by a licensed practitioner and dispensed
by a licensed pharmacist, by a physician enrolled in the medical assistance program as a
dispensing physician, or by a physician, a physician assistant, or an advanced practice
registered nurse employed by or under contract with a community health board as defined
in section 145A.02, subdivision 5, for the purposes of communicable disease control.
(b) The dispensed quantity of a prescription drug must not exceed a 34-day supply,
unless authorized by the commissionerdeleted text begin .deleted text end new text begin or the drug appears on the 90-day supply list
published by the commissioner. The 90-day supply list shall be published by the
commissioner on the department's website. The commissioner may add to, delete from, and
otherwise modify the 90-day supply list after providing public notice and the opportunity
for a 15-day public comment period. The 90-day supply list may include cost-effective
generic drugs and shall not include controlled substances.
new text end
(c) For the purpose of this subdivision and subdivision 13d, an "active pharmaceutical
ingredient" is defined as a substance that is represented for use in a drug and when used in
the manufacturing, processing, or packaging of a drug becomes an active ingredient of the
drug product. An "excipient" is defined as an inert substance used as a diluent or vehicle
for a drug. The commissioner shall establish a list of active pharmaceutical ingredients and
excipients which are included in the medical assistance formulary. Medical assistance covers
selected active pharmaceutical ingredients and excipients used in compounded prescriptions
when the compounded combination is specifically approved by the commissioner or when
a commercially available product:
(1) is not a therapeutic option for the patient;
(2) does not exist in the same combination of active ingredients in the same strengths
as the compounded prescription; and
(3) cannot be used in place of the active pharmaceutical ingredient in the compounded
prescription.
(d) Medical assistance covers the following over-the-counter drugs when prescribed by
a licensed practitioner or by a licensed pharmacist who meets standards established by the
commissioner, in consultation with the board of pharmacy: antacids, acetaminophen, family
planning products, aspirin, insulin, products for the treatment of lice, vitamins for adults
with documented vitamin deficiencies, vitamins for children under the age of seven and
pregnant or nursing women, and any other over-the-counter drug identified by the
commissioner, in consultation with the Formulary Committee, as necessary, appropriate,
and cost-effective for the treatment of certain specified chronic diseases, conditions, or
disorders, and this determination shall not be subject to the requirements of chapter 14. A
pharmacist may prescribe over-the-counter medications as provided under this paragraph
for purposes of receiving reimbursement under Medicaid. When prescribing over-the-counter
drugs under this paragraph, licensed pharmacists must consult with the recipient to determine
necessity, provide drug counseling, review drug therapy for potential adverse interactions,
and make referrals as needed to other health care professionals.
(e) Effective January 1, 2006, medical assistance shall not cover drugs that are coverable
under Medicare Part D as defined in the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003, Public Law 108-173, section 1860D-2(e), for individuals eligible
for drug coverage as defined in the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003, Public Law 108-173, section 1860D-1(a)(3)(A). For these
individuals, medical assistance may cover drugs from the drug classes listed in United States
Code, title 42, section 1396r-8(d)(2), subject to this subdivision and subdivisions 13a to
13g, except that drugs listed in United States Code, title 42, section 1396r-8(d)(2)(E), shall
not be covered.
(f) Medical assistance covers drugs acquired through the federal 340B Drug Pricing
Program and dispensed by 340B covered entities and ambulatory pharmacies under common
ownership of the 340B covered entity. Medical assistance does not cover drugs acquired
through the federal 340B Drug Pricing Program and dispensed by 340B contract pharmacies.
(g) Notwithstanding paragraph (a), medical assistance covers self-administered hormonal
contraceptives prescribed and dispensed by a licensed pharmacist in accordance with section
151.37, subdivision 14; nicotine replacement medications prescribed and dispensed by a
licensed pharmacist in accordance with section 151.37, subdivision 15; and opiate antagonists
used for the treatment of an acute opiate overdose prescribed and dispensed by a licensed
pharmacist in accordance with section 151.37, subdivision 16.
Sec. 26.
Minnesota Statutes 2020, section 256B.0625, subdivision 13c, is amended to
read:
Subd. 13c.
Formulary Committee.
The commissioner, after receiving recommendations
from professional medical associations and professional pharmacy associations, and consumer
groups shall designate a Formulary Committee to carry out duties as described in subdivisions
13 to 13g. The Formulary Committee shall be comprised of four licensed physicians actively
engaged in the practice of medicine in Minnesotanew text begin ,new text end one of whom must be actively engaged
in the treatment of persons with mental illness; at least three licensed pharmacists actively
engaged in the practice of pharmacy in Minnesota; and one consumer representative; the
remainder to be made up of health care professionals who are licensed in their field and
have recognized knowledge in the clinically appropriate prescribing, dispensing, and
monitoring of covered outpatient drugs. Members of the Formulary Committee shall not
be employed by the Department of Human Services, but the committee shall be staffed by
an employee of the department who shall serve as an ex officio, nonvoting member of the
committee. The department's medical director shall also serve as an ex officio, nonvoting
member for the committee. Committee members shall serve three-year terms and may be
reappointed by the commissioner. The Formulary Committee shall meet at least twice per
year. The commissioner may require more frequent Formulary Committee meetings as
needed. An honorarium of $100 per meeting and reimbursement for mileage shall be paid
to each committee member in attendance. The Formulary Committee deleted text begin expires June 30, 2022deleted text end
new text begin does not expire as provided in section 15.059, subdivision 6new text end .
Sec. 27.
Minnesota Statutes 2020, 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 ingredient costs of the drugs plus the professional dispensing fee; or the
usual and customary price charged to the public. The usual and customary price means the
lowest price charged by the provider to a patient who pays for the prescription by cash,
check, or charge account and includes prices the pharmacy charges to a patient enrolled in
a prescription savings club or prescription discount club administered by the pharmacy or
pharmacy chain. The amount of payment basis must be reduced to reflect all discount
amounts applied to the charge by any third-party 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 professional dispensing fee shall be
deleted text begin $10.48deleted text end new text begin $10.77new text end for prescriptions filled with legend drugs meeting the definition of "covered
outpatient drugs" according to United States Code, title 42, section 1396r-8(k)(2). The
dispensing fee for intravenous solutions that must be compounded by the pharmacist shall
be deleted text begin $10.48deleted text end new text begin $10.77new text end per deleted text begin bagdeleted text end new text begin claimnew text end . The professional dispensing fee for prescriptions filled
with over-the-counter drugs meeting the definition of covered outpatient drugs shall be
deleted text begin $10.48deleted text end new text begin $10.77new text end for dispensed quantities equal to or greater than the number of units contained
in the manufacturer's original package. The professional dispensing fee shall be prorated
based on the percentage of the package dispensed when the pharmacy dispenses a quantity
less than the number of units contained in the manufacturer's original package. The pharmacy
dispensing fee for prescribed over-the-counter drugs not meeting the definition of covered
outpatient drugs shall be $3.65 for quantities equal to or greater than the number of units
contained in the manufacturer's original package and shall be prorated based on the
percentage of the package dispensed when the pharmacy dispenses a quantity less than the
number of units contained in the manufacturer's original package. The National Average
Drug Acquisition Cost (NADAC) shall be used to determine the ingredient cost of a drug.
For drugs for which a NADAC is not reported, the commissioner shall estimate the ingredient
cost at the wholesale acquisition cost minus two percent. The ingredient cost of a drug for
a provider participating in the federal 340B Drug Pricing Program shall be either the 340B
Drug Pricing Program ceiling price established by the Health Resources and Services
Administration or NADAC, whichever is lower. Wholesale acquisition cost is defined as
the manufacturer's list price for a drug or biological to wholesalers or direct purchasers in
the United States, not including prompt pay or other discounts, rebates, or reductions in
price, for the most recent month for which information is available, as reported in wholesale
price guides or other publications of drug or biological pricing data. The maximum allowable
cost of a multisource drug may be set by the commissioner and it shall be comparable to
the actual acquisition cost of the drug product and no higher than the NADAC of the generic
product. Establishment of the amount of payment for drugs shall not be subject to the
requirements of the Administrative Procedure Act.
(b) Pharmacies dispensing prescriptions to residents of long-term care facilities using
an automated drug distribution system meeting the requirements of section 151.58, or a
packaging system meeting the packaging standards set forth in Minnesota Rules, part
6800.2700, that govern the return of unused drugs to the pharmacy for reuse, may employ
retrospective billing for prescription drugs dispensed to long-term care facility residents. A
retrospectively billing pharmacy must submit a claim only for the quantity of medication
used by the enrolled recipient during the defined billing period. A retrospectively billing
pharmacy must use a billing period not less than one calendar month or 30 days.
(c) A pharmacy provider using packaging that meets the standards set forth in Minnesota
Rules, part 6800.2700, is required to credit the department for the actual acquisition cost
of all unused drugs that are eligible for reuse, unless the pharmacy is using retrospective
billing. The commissioner may permit the drug clozapine to be dispensed in a quantity that
is less than a 30-day supply.
(d) If a pharmacy dispenses a multisource drug, the ingredient cost shall be the NADAC
of the generic product or the maximum allowable cost established by the commissioner
unless prior authorization for the brand name product has been granted according to the
criteria established by the Drug Formulary Committee as required by subdivision 13f,
paragraph (a), and the prescriber has indicated "dispense as written" on the prescription in
a manner consistent with section 151.21, subdivision 2.
(e) The basis for determining the amount of payment for drugs administered in an
outpatient setting shall be the lower of the usual and customary cost submitted by the
provider, 106 percent of the average sales price as determined by the United States
Department of Health and Human Services pursuant to title XVIII, section 1847a of the
federal Social Security Act, the specialty pharmacy rate, or the maximum allowable cost
set by the commissioner. If average sales price is unavailable, the amount of payment must
be lower of the usual and customary cost submitted by the provider, the wholesale acquisition
cost, the specialty pharmacy rate, or the maximum allowable cost set by the commissioner.
The commissioner shall discount the payment rate for drugs obtained through the federal
340B Drug Pricing Program by 28.6 percent. The payment for drugs administered in an
outpatient setting shall be made to the administering facility or practitioner. A retail or
specialty pharmacy dispensing a drug for administration in an outpatient setting is not
eligible for direct reimbursement.
(f) The commissioner may establish maximum allowable cost rates for specialty pharmacy
products that are lower than the ingredient cost formulas specified in paragraph (a). The
commissioner may require individuals enrolled in the health care programs administered
by the department to obtain specialty pharmacy products from providers with whom the
commissioner has negotiated lower reimbursement rates. Specialty pharmacy products are
defined as those used by a small number of recipients or recipients with complex and chronic
diseases that require expensive and challenging drug regimens. Examples of these conditions
include, but are not limited to: multiple sclerosis, HIV/AIDS, transplantation, hepatitis C,
growth hormone deficiency, Crohn's Disease, rheumatoid arthritis, and certain forms of
cancer. Specialty pharmaceutical products include injectable and infusion therapies,
biotechnology drugs, antihemophilic factor products, high-cost therapies, and therapies that
require complex care. The commissioner shall consult with the Formulary Committee to
develop a list of specialty pharmacy products subject to maximum allowable cost
reimbursement. In consulting with the Formulary Committee in developing this list, the
commissioner shall take into consideration the population served by specialty pharmacy
products, the current delivery system and standard of care in the state, and access to care
issues. The commissioner shall have the discretion to adjust the maximum allowable cost
to prevent access to care issues.
(g) Home infusion therapy services provided by home infusion therapy pharmacies must
be paid at rates according to subdivision 8d.
(h) The commissioner shall contract with a vendor to conduct a cost of dispensing survey
for all pharmacies that are physically located in the state of Minnesota that dispense outpatient
drugs under medical assistance. The commissioner shall ensure that the vendor has prior
experience in conducting cost of dispensing surveys. Each pharmacy enrolled with the
department to dispense outpatient prescription drugs to fee-for-service members must
respond to the cost of dispensing survey. The commissioner may sanction a pharmacy under
section 256B.064 for failure to respond. The commissioner shall require the vendor to
measure a single statewide cost of dispensing for new text begin specialty prescription drugs and a single
statewide cost of dispensing for nonspecialty prescription drugs for new text end all responding pharmacies
to measure the mean, mean weighted by total prescription volume, mean weighted by
medical assistance prescription volume, median, median weighted by total prescription
volume, and median weighted by total medical assistance prescription volume. The
commissioner shall post a copy of the final cost of dispensing survey report on the
department's website. The initial survey must be completed no later than January 1, 2021,
and repeated every three years. The commissioner shall provide a summary of the results
of each cost of dispensing survey and provide recommendations for any changes to the
dispensing fee to the chairs and ranking members of the legislative committees with
jurisdiction over medical assistance pharmacy reimbursement.
(i) The commissioner shall increase the ingredient cost reimbursement calculated in
paragraphs (a) and (f) by 1.8 percent for prescription and nonprescription drugs subject to
the wholesale drug distributor tax under section 295.52.
Sec. 28.
Minnesota Statutes 2020, section 256B.0625, subdivision 13g, is amended to
read:
Subd. 13g.
Preferred drug list.
(a) The commissioner shall adopt and implement a
preferred drug list by January 1, 2004. The commissioner may enter into a contract with a
vendor for the purpose of participating in a preferred drug list and supplemental rebate
program. The commissioner shall ensure that any contract meets all federal requirements
and maximizes federal financial participation. The commissioner shall publish the preferred
drug list annually in the State Register and shall maintain an accurate and up-to-date list on
the agency website.
(b) The commissioner may add to, delete from, and otherwise modify the preferred drug
list, after consulting with the Formulary Committee and appropriate medical specialists and
providing public notice and the opportunity for public comment.
(c) The commissioner shall adopt and administer the preferred drug list as part of the
administration of the supplemental drug rebate program. Reimbursement for prescription
drugs not on the preferred drug list may be subject to prior authorization.
(d) For purposes of this subdivision, "preferred drug list" means a list of prescription
drugs within designated therapeutic classes selected by the commissioner, for which prior
authorization based on the identity of the drug or class is not required.
(e) The commissioner shall seek any federal waivers or approvals necessary to implement
this subdivision.
new text begin
(f) Notwithstanding paragraph (b), before the commissioner may delete a drug from the
preferred drug list or modify the inclusion of a drug on the preferred drug list, the
commissioner, in consultation with the commissioner of health, shall consider any
implications the deletion or modification may have on state public health policies or
initiatives and any impact the deletion or modification may have on increasing health
disparities in the state. Prior to deleting a drug or modifying the inclusion of a drug, the
commissioner shall also conduct a public hearing. The commissioner shall provide adequate
notice to the public prior to the hearing that specifies the drug the commissioner is proposing
to delete or modify, any medical or clinical analysis that the commissioner has relied on in
proposing the deletion or modification, and evidence that the commissioner has consulted
with the commissioner of health and has evaluated the impact of the proposed deletion or
modification on public health and health disparities.
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. 29.
Minnesota Statutes 2020, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 13k. new text end
new text begin Eligible providers. new text end
new text begin
(a) To be eligible to dispense prescription drugs under
this section as an enrolled dispensing provider, the dispensing provider must be a:
new text end
new text begin
(1) pharmacy located within the state that is licensed by the Board of Pharmacy under
chapter 151;
new text end
new text begin
(2) physician located in a service area where there is no medical assistance enrolled
pharmacy; or
new text end
new text begin
(3) physician or advanced practice registered nurse employed by or under contract with
a community health board for communicable disease control.
new text end
new text begin
(b) A licensed out-of-state pharmacy may be enrolled as a dispensing provider under
paragraph (a) if the pharmacy is:
new text end
new text begin
(1) a retail pharmacy located within 50 miles of the Minnesota border that serves walk-in
medical assistance enrollees and whose walk-in customers represent at least 75 percent of
the pharmacy's prescription volume;
new text end
new text begin
(2) a retail pharmacy serving foster children enrolled in medical assistance and living
outside of Minnesota;
new text end
new text begin
(3) serving enrollees receiving preapproved organ transplants who require medication
during after-care while residing outside of Minnesota; or
new text end
new text begin
(4) providing products with limited or exclusive distribution channels for which there
is no potential dispensing provider located within the state.
new text end
new text begin
(c) A dispensing provider must attest that they meet the requirements in paragraphs (a)
and (b) before enrolling as a dispensing provider in the medical assistance program. If a
provider is found to be out of compliance with the requirements in paragraphs (a) and (b),
any funds paid to that provider during the time they were out of compliance shall be recovered
under section 256B.064.
new text end
Sec. 30.
Minnesota Statutes 2020, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 67. new text end
new text begin Pretreatment coordination services. new text end
new text begin
Effective January 1, 2022, or upon
federal approval, whichever is later, medical assistance covers pretreatment coordination
services provided according to section 254B.05, subdivision 4a.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022. The commissioner of
human services shall notify the revisor of statutes when federal approval is obtained or
denied.
new text end
Sec. 31.
Minnesota Statutes 2020, section 256B.0638, subdivision 3, is amended to read:
Subd. 3.
Opioid prescribing work group.
(a) The commissioner of human services, in
consultation with the commissioner of health, shall appoint the following voting members
to an opioid prescribing work group:
(1) two consumer members who have been impacted by an opioid abuse disorder or
opioid dependence disorder, either personally or with family members;
(2) one member who is a licensed physician actively practicing in Minnesota and
registered as a practitioner with the DEA;
(3) one member who is a licensed pharmacist actively practicing in Minnesota and
registered as a practitioner with the DEA;
(4) one member who is a licensed nurse practitioner actively practicing in Minnesota
and registered as a practitioner with the DEA;
(5) one member who is a licensed dentist actively practicing in Minnesota and registered
as a practitioner with the DEA;
(6) two members who are nonphysician licensed health care professionals actively
engaged in the practice of their profession in Minnesota, and their practice includes treating
pain;
(7) one member who is a mental health professional who is licensed or registered in a
mental health profession, who is actively engaged in the practice of that profession in
Minnesota, and whose practice includes treating patients with chemical dependency or
substance abuse;
(8) one member who is a medical examiner for a Minnesota county;
(9) one member of the Health Services Policy Committee established under section
256B.0625, subdivisions 3c to 3e;
(10) one member who is a medical director of a health plan company doing business in
Minnesota;
(11) one member who is a pharmacy director of a health plan company doing business
in Minnesota; deleted text begin and
deleted text end
(12) one member representing Minnesota law enforcementdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(13) two consumer members who are Minnesota residents and who have used or are
using opioids to manage chronic pain.
new text end
(b) In addition, the work group shall include the following nonvoting members:
(1) the medical director for the medical assistance program;
(2) a member representing the Department of Human Services pharmacy unit; deleted text begin and
deleted text end
(3) the medical director for the Department of Labor and Industrydeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(4) a member representing the Department of Health.
new text end
(c) An honorarium of $200 per meeting and reimbursement for mileage and parking
shall be paid to each voting member in attendance.
Sec. 32.
Minnesota Statutes 2020, section 256B.0638, subdivision 5, is amended to read:
Subd. 5.
Program implementation.
(a) The commissioner shall implement the programs
within the Minnesota health care program to improve the health of and quality of care
provided to Minnesota health care program enrollees. The commissioner shall annually
collect and report tonew text begin provider groups the sentinel measures of data showing individualnew text end opioid
deleted text begin prescribers data showing the sentinel measures of theirdeleted text end new text begin prescribers'new text end opioid prescribing
patterns compared to their anonymized peers.new text begin Provider groups shall distribute data to their
affiliated, contracted, or employed opioid prescribers.
new text end
(b) The commissioner shall notify an opioid prescriber and all provider groups with
which the opioid prescriber is employed or affiliated when the opioid prescriber's prescribing
pattern exceeds the opioid quality improvement standard thresholds. An opioid prescriber
and any provider group that receives a notice under this paragraph shall submit to the
commissioner a quality improvement plan for review and approval by the commissioner
with the goal of bringing the opioid prescriber's prescribing practices into alignment with
community standards. A quality improvement plan must include:
(1) components of the program described in subdivision 4, paragraph (a);
(2) internal practice-based measures to review the prescribing practice of the opioid
prescriber and, where appropriate, any other opioid prescribers employed by or affiliated
with any of the provider groups with which the opioid prescriber is employed or affiliated;
and
(3) appropriate use of the prescription monitoring program under section 152.126.
(c) If, after a year from the commissioner's notice under paragraph (b), the opioid
prescriber's prescribing practices do not improve so that they are consistent with community
standards, the commissioner shall take one or more of the following steps:
(1) monitor prescribing practices more frequently than annually;
(2) monitor more aspects of the opioid prescriber's prescribing practices than the sentinel
measures; or
(3) require the opioid prescriber to participate in additional quality improvement efforts,
including but not limited to mandatory use of the prescription monitoring program established
under section 152.126.
(d) The commissioner shall terminate from Minnesota health care programs all opioid
prescribers and provider groups whose prescribing practices fall within the applicable opioid
disenrollment standards.
Sec. 33.
Minnesota Statutes 2020, section 256B.0638, subdivision 6, is amended to read:
Subd. 6.
Data practices.
(a) Reports and data identifying an opioid prescriber are private
data on individuals as defined under section 13.02, subdivision 12, until an opioid prescriber
is subject to termination as a medical assistance provider under this section. Notwithstanding
this data classification, the commissioner shall share with all of the provider groups with
which an opioid prescriber is employednew text begin , contracted,new text end or affiliated, deleted text begin a report identifying an
opioid prescriber who is subject to quality improvement activitiesdeleted text end new text begin the datanew text end under subdivision
5, paragraphnew text begin (a),new text end (b)new text begin ,new text end or (c).
(b) Reports and data identifying a provider group are nonpublic data as defined under
section 13.02, subdivision 9, until the provider group is subject to termination as a medical
assistance provider under this section.
(c) Upon termination under this section, reports and data identifying an opioid prescriber
or provider group are public, except that any identifying information of Minnesota health
care program enrollees must be redacted by the commissioner.
Sec. 34.
Minnesota Statutes 2020, section 256B.0659, subdivision 13, is amended to read:
Subd. 13.
Qualified professional; qualifications.
(a) The qualified professional must
work for a personal care assistance provider agency, meet the definition of qualified
professional under section 256B.0625, subdivision 19c, deleted text begin and enroll with the department as
a qualified professional after clearingdeleted text end new text begin clearnew text end a background studynew text begin , and meet provider training
requirementsnew text end . Before a qualified professional provides services, the personal care assistance
provider agency must initiate a background study on the qualified professional under chapter
245C, and the personal care assistance provider agency must have received a notice from
the commissioner that the qualified professional:
(1) is not disqualified under section 245C.14; or
(2) is disqualified, but the qualified professional has received a set aside of the
disqualification under section 245C.22.
(b) The qualified professional shall perform the duties of training, supervision, and
evaluation of the personal care assistance staff and evaluation of the effectiveness of personal
care assistance services. The qualified professional shall:
(1) develop and monitor with the recipient a personal care assistance care plan based on
the service plan and individualized needs of the recipient;
(2) develop and monitor with the recipient a monthly plan for the use of personal care
assistance services;
(3) review documentation of personal care assistance services provided;
(4) provide training and ensure competency for the personal care assistant in the individual
needs of the recipient; and
(5) document all training, communication, evaluations, and needed actions to improve
performance of the personal care assistants.
(c) deleted text begin Effective July 1, 2011,deleted text end The qualified professional shall complete the provider training
with basic information about the personal care assistance program approved by the
commissioner. Newly hired qualified professionals must complete the training within six
months of the date hired by a personal care assistance provider agency. Qualified
professionals who have completed the required training as a worker from a personal care
assistance provider agency do not need to repeat the required training if they are hired by
another agency, if they have completed the training within the last three years. The required
training must be available with meaningful access according to title VI of the Civil Rights
Act and federal regulations adopted under that law or any guidance from the United States
Health and Human Services Department. The required training must be available online or
by electronic remote connection. The required training must provide for competency testing
to demonstrate an understanding of the content without attending in-person training. A
qualified professional is allowed to be employed and is not subject to the training requirement
until the training is offered online or through remote electronic connection. A qualified
professional employed by a personal care assistance provider agency certified for
participation in Medicare as a home health agency is exempt from the training required in
this subdivision. When available, the qualified professional working for a Medicare-certified
home health agency must successfully complete the competency test. The commissioner
shall ensure there is a mechanism in place to verify the identity of persons completing the
competency testing electronically.
Sec. 35.
Minnesota Statutes 2020, section 256B.196, subdivision 2, is amended to read:
Subd. 2.
Commissioner's duties.
(a) For the purposes of this subdivision and subdivision
3, the commissioner shall determine the fee-for-service outpatient hospital services upper
payment limit for nonstate government hospitals. The commissioner shall then determine
the amount of a supplemental payment to Hennepin County Medical Center and Regions
Hospital for these services that would increase medical assistance spending in this category
to the aggregate upper payment limit for all nonstate government hospitals in Minnesota.
In making this determination, the commissioner shall allot the available increases between
Hennepin County Medical Center and Regions Hospital based on the ratio of medical
assistance fee-for-service outpatient hospital payments to the two facilities. The commissioner
shall adjust this allotment as necessary based on federal approvals, the amount of
intergovernmental transfers received from Hennepin and Ramsey Counties, and other factors,
in order to maximize the additional total payments. The commissioner shall inform Hennepin
County and Ramsey County of the periodic intergovernmental transfers necessary to match
federal Medicaid payments available under this subdivision in order to make supplementary
medical assistance payments to Hennepin County Medical Center and Regions Hospital
equal to an amount that when combined with existing medical assistance payments to
nonstate governmental hospitals would increase total payments to hospitals in this category
for outpatient services to the aggregate upper payment limit for all hospitals in this category
in Minnesota. Upon receipt of these periodic transfers, the commissioner shall make
supplementary payments to Hennepin County Medical Center and Regions Hospital.
(b) For the purposes of this subdivision and subdivision 3, the commissioner shall
determine an upper payment limit for physicians and other billing professionals affiliated
with Hennepin County Medical Center and with Regions Hospital. The upper payment limit
shall be based on the average commercial rate or be determined using another method
acceptable to the Centers for Medicare and Medicaid Services. The commissioner shall
inform Hennepin County and Ramsey County of the periodic intergovernmental transfers
necessary to match the federal Medicaid payments available under this subdivision in order
to make supplementary payments to physicians and other billing professionals affiliated
with Hennepin County Medical Center and to make supplementary payments to physicians
and other billing professionals affiliated with Regions Hospital through HealthPartners
Medical Group equal to the difference between the established medical assistance payment
for physician and other billing professional services and the upper payment limit. Upon
receipt of these periodic transfers, the commissioner shall make supplementary payments
to physicians and other billing professionals affiliated with Hennepin County Medical Center
and shall make supplementary payments to physicians and other billing professionals
affiliated with Regions Hospital through HealthPartners Medical Group.
(c) Beginning January 1, 2010, deleted text begin Hennepin County anddeleted text end Ramsey County may make monthly
voluntary intergovernmental transfers to the commissioner in amounts not to exceed
deleted text begin $12,000,000 per year from Hennepin County anddeleted text end $6,000,000 per year deleted text begin from Ramsey Countydeleted text end .
The commissioner shall increase the medical assistance capitation payments to any licensed
health plan under contract with the medical assistance program that agrees to make enhanced
payments to deleted text begin Hennepin County Medical Center ordeleted text end Regions Hospital. The increase shall be
in an amount equal to the annual value of the monthly transfers plus federal financial
participation, with each health plan receiving its pro rata share of the increase based on the
pro rata share of medical assistance admissions to deleted text begin Hennepin County Medical Center anddeleted text end
Regions Hospital by those plans. For the purposes of this paragraph, "the base amount"
means the total annual value of increased medical assistance capitation payments, including
the voluntary intergovernmental transfers, under this paragraph in calendar year 2017. For
managed care contracts beginning on or after January 1, 2018, the commissioner shall reduce
the total annual value of increased medical assistance capitation payments under this
paragraph by an amount equal to ten percent of the base amount, and by an additional ten
percent of the base amount for each subsequent contract year until December 31, 2025.
Upon the request of the commissioner, health plans shall submit individual-level cost data
for verification purposes. The commissioner may ratably reduce these payments on a pro
rata basis in order to satisfy federal requirements for actuarial soundness. If payments are
reduced, transfers shall be reduced accordingly. Any licensed health plan that receives
increased medical assistance capitation payments under the intergovernmental transfer
described in this paragraph shall increase its medical assistance payments to deleted text begin Hennepin
County Medical Center anddeleted text end Regions Hospital by the same amount as the increased payments
received in the capitation payment described in this paragraph. This paragraph expires
January 1, 2026.
(d) For the purposes of this subdivision and subdivision 3, the commissioner shall
determine an upper payment limit for ambulance services affiliated with Hennepin County
Medical Center and the city of St. Paul, and ambulance services owned and operated by
another governmental entity that chooses to participate by requesting the commissioner to
determine an upper payment limit. The upper payment limit shall be based on the average
commercial rate or be determined using another method acceptable to the Centers for
Medicare and Medicaid Services. The commissioner shall inform Hennepin County, the
city of St. Paul, and other participating governmental entities of the periodic
intergovernmental transfers necessary to match the federal Medicaid payments available
under this subdivision in order to make supplementary payments to Hennepin County
Medical Center, the city of St. Paul, and other participating governmental entities equal to
the difference between the established medical assistance payment for ambulance services
and the upper payment limit. Upon receipt of these periodic transfers, the commissioner
shall make supplementary payments to Hennepin County Medical Center, the city of St.
Paul, and other participating governmental entities. A tribal government that owns and
operates an ambulance service is not eligible to participate under this subdivision.
(e) For the purposes of this subdivision and subdivision 3, the commissioner shall
determine an upper payment limit for physicians, dentists, and other billing professionals
affiliated with the University of Minnesota and University of Minnesota Physicians. The
upper payment limit shall be based on the average commercial rate or be determined using
another method acceptable to the Centers for Medicare and Medicaid Services. The
commissioner shall inform the University of Minnesota Medical School and University of
Minnesota School of Dentistry of the periodic intergovernmental transfers necessary to
match the federal Medicaid payments available under this subdivision in order to make
supplementary payments to physicians, dentists, and other billing professionals affiliated
with the University of Minnesota and the University of Minnesota Physicians equal to the
difference between the established medical assistance payment for physician, dentist, and
other billing professional services and the upper payment limit. Upon receipt of these periodic
transfers, the commissioner shall make supplementary payments to physicians, dentists,
and other billing professionals affiliated with the University of Minnesota and the University
of Minnesota Physicians.
(f) The commissioner shall inform the transferring governmental entities on an ongoing
basis of the need for any changes needed in the intergovernmental transfers in order to
continue the payments under paragraphs (a) to (e), at their maximum level, including
increases in upper payment limits, changes in the federal Medicaid match, and other factors.
(g) The payments in paragraphs (a) to (e) shall be implemented independently of each
other, subject to federal approval and to the receipt of transfers under subdivision 3.
(h) All of the data and funding transactions related to the payments in paragraphs (a) to
(e) shall be between the commissioner and the governmental entities.
(i) For purposes of this subdivision, billing professionals are limited to physicians, nurse
practitioners, nurse midwives, clinical nurse specialists, physician assistants,
anesthesiologists, certified registered nurse anesthetists, dentists, dental hygienists, and
dental therapists.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective December 31, 2021, or upon federal
approval, whichever is later. The commissioner of human services shall inform the revisor
of statutes when federal approval is obtained.
new text end
Sec. 36.
new text begin
[256B.1973] DIRECTED PAYMENT ARRANGEMENTS.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For the purposes of this section, the following terms have
the meanings given them.
new text end
new text begin
(b) "Billing professionals" means physicians, nurse practitioners, nurse midwives, clinical
nurse specialists, physician assistants, anesthesiologists, and certified registered anesthetists,
and may include dentists, individually enrolled dental hygienists, and dental therapists.
new text end
new text begin
(c) "Health plan" means a managed care or county-based purchasing plan that is under
contract with the commissioner to deliver services to medical assistance enrollees under
section 256B.69.
new text end
new text begin
(d) "High medical assistance utilization" means a medical assistance utilization rate
equal to the standard established in section 256.969, subdivision 9, paragraph (d), clause
(6).
new text end
new text begin Subd. 2. new text end
new text begin Federal approval required. new text end
new text begin
Each directed payment arrangement under this
section is contingent on federal approval and must conform with the requirements for
permissible directed managed care organization expenditures under section 256B.6928,
subdivision 5.
new text end
new text begin Subd. 3. new text end
new text begin Eligible providers. new text end
new text begin
Eligible providers under this section are nonstate government
teaching hospitals with high medical assistance utilization and a level 1 trauma center and
the hospital's affiliated billing professionals, ambulance services, and clinics.
new text end
new text begin Subd. 4. new text end
new text begin Voluntary intergovernmental transfers. new text end
new text begin
A nonstate governmental entity that
is eligible to perform intergovernmental transfers may make voluntary intergovernmental
transfers to the commissioner. The commissioner shall inform the nonstate governmental
entity of the intergovernmental transfers necessary to maximize the allowable directed
payments.
new text end
new text begin Subd. 5. new text end
new text begin Commissioner's duties; state-directed fee schedule requirement. new text end
new text begin
(a) For
each federally approved directed payment arrangement that is a state-directed fee schedule
requirement, the commissioner shall determine a uniform adjustment factor to be applied
to each claim submitted by an eligible provider to a health plan. The commissioner shall
ensure that the application of the uniform adjustment factor maximizes the allowable directed
payments and does not result in payments exceeding federal limits, and may use a settle-up
process no less than annually to adjust health plan payments to comply with this requirement.
The commissioner shall apply the uniform adjustment to each submitted claim.
new text end
new text begin
(b) For each federally approved directed payment arrangement that is a state-directed
fee schedule requirement, the commissioner must ensure that the total annual amount of
payments equals at least the sum of the annual value of the voluntary intergovernmental
transfers to the commissioner under subdivision 4 and federal financial participation.
new text end
new text begin
(c) For each federally approved directed payment arrangement that is a state-directed
fee schedule requirement, the commissioner shall develop a plan for the initial
implementation of the state-directed fee schedule requirement to ensure that the eligible
provider receives the entire permissible value of the federally approved directed payment
arrangement. If federal approval of a directed payment arrangement under this subdivision
is retroactive, the commissioner shall make a onetime pro rata increase to the uniform
adjustment factor and the initial payments in order to include claims submitted between the
retroactive federal approval date and the period captured by the initial payments.
new text end
new text begin Subd. 6. new text end
new text begin Health plan duties; submission of claims. new text end
new text begin
In accordance with its contract,
each health plan shall submit to the commissioner payment information for each claim paid
to an eligible provider for services provided to a medical assistance enrollee.
new text end
new text begin Subd. 7. new text end
new text begin Health plan duties; directed payments. new text end
new text begin
In accordance with its contract, each
health plan shall make directed payments to the eligible provider in an amount equal to the
payment amounts the plan received from the commissioner.
new text end
new text begin Subd. 8. new text end
new text begin State quality goals. new text end
new text begin
The directed payment arrangement and state-directed fee
schedule requirement must align the state quality goals to Hennepin Healthcare medical
assistance patients, including unstably housed individuals, those with higher levels of social
and clinical risk, limited English proficiency patients, adults with serious chronic conditions,
or individuals of color. The directed payment arrangement will maintain quality and access
to a full range of health care delivery mechanisms for these patients, such as behavioral
health, emergent care, preventive care, hospitalization, transportation, interpretation, and
pharmaceutical. In partnership with the Department of Human Services, the Centers for
Medicare and Medicaid Services, and Hennepin Healthcare, mutually agreed upon measures
to demonstrate access to care must be identified and measured.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later, unless the federal approval provides for an effective date after July 1,
2021, but before the date of federal approval, in which case the federally approved effective
date applies.
new text end
Sec. 37.
Minnesota Statutes 2020, section 256B.69, subdivision 6d, is amended to read:
Subd. 6d.
Prescription drugs.
new text begin (a)new text end The commissioner may exclude or modify coverage
for prescription drugs from the prepaid managed care contracts entered into under this
section in order to increase savings to the state by collecting additional prescription drug
rebates. The contracts must maintain incentives for the managed care plan to manage drug
costs and utilization and may require that the managed care plans maintain an open drug
formulary. In order to manage drug costs and utilization, the contracts may authorize the
managed care plans to use preferred drug lists and prior authorization. This subdivision is
contingent on federal approval of the managed care contract changes and the collection of
additional prescription drug rebates.
new text begin
(b) Managed care plans and county-based purchasing plans or the plan's subcontractor
if the plan subcontracts with a third party to administer pharmacy services, including a
pharmacy benefit manager, must comply with section 256B.0625, subdivision 13k, for
purposes of contracting with dispensing providers to provide pharmacy services to medical
assistance and MinnesotaCare enrollees.
new text end
Sec. 38.
Minnesota Statutes 2020, section 256B.69, is amended by adding a subdivision
to read:
new text begin Subd. 6f. new text end
new text begin Dental fee schedules. new text end
new text begin
(a) A managed care plan, county-based purchasing plan,
or dental benefits administrator as defined under section 256B.0625, subdivision 9c,
paragraph (a), must provide individual dental providers, upon request, the applicable fee
schedules for covered dental services provided under the contract between the dental provider
and the managed care plan, county-based purchasing plan, or dental benefits administrator.
new text end
new text begin
(b) A managed care plan, county-based purchasing plan, or dental benefits administrator
may fulfill this requirement by making the applicable fee schedules available through a
secure web portal for the contracted dental provider to access.
new text end
Sec. 39.
Minnesota Statutes 2020, section 256B.6928, subdivision 5, is amended to read:
Subd. 5.
Direction of managed care organization expenditures.
(a) The commissioner
shall not direct managed care organizations expenditures under the managed care contract,
except deleted text begin indeleted text end new text begin as permitted under Code of Federal Regulations, part 42, section 438.6(c). The
exception under this paragraph includesnew text end the following situations:
(1) implementation of a value-based purchasing model for provider reimbursement,
including pay-for-performance arrangements, bundled payments, or other service payments
intended to recognize value or outcomes over volume of services;
(2) participation in a multipayer or medical assistance-specific delivery system reform
or performance improvement initiative; or
(3) implementation of a minimum or maximum fee schedule, or a uniform dollar or
percentage increase for network providers that provide a particular service. The maximum
fee schedule must allow the managed care organization the ability to reasonably manage
risk and provide discretion in accomplishing the goals of the contract.
(b) Any managed care contract that directs managed care organization expenditures as
permitted under paragraph (a), clauses (1) to (3), must be developed in accordance with
Code of Federal Regulations, part 42, sections 438.4 and 438.5; comply with actuarial
soundness and generally accepted actuarial principles and practices; and have written
approval from the Centers for Medicare and Medicaid Services before implementation. To
obtain approval, the commissioner shall demonstrate in writing that the contract arrangement:
(1) is based on the utilization and delivery of services;
(2) directs expenditures equally, using the same terms of performance for a class of
providers providing service under the contract;
(3) is intended to advance at least one of the goals and objectives in the commissioner's
quality strategy;
(4) has an evaluation plan that measures the degree to which the arrangement advances
at least one of the goals in the commissioner's quality strategy;
(5) does not condition network provider participation on the network provider entering
into or adhering to an intergovernmental transfer agreement; and
(6) is not renewed automatically.
(c) For contract arrangements identified in paragraph (a), clauses (1) and (2), the
commissioner shall:
(1) make participation in the value-based purchasing model, special delivery system
reform, or performance improvement initiative available, using the same terms of
performance, to a class of providers providing services under the contract related to the
model, reform, or initiative; and
(2) use a common set of performance measures across all payers and providers.
(d) The commissioner shall not set the amount or frequency of the expenditures or recoup
from the managed care organization any unspent funds allocated for these arrangements.
Sec. 40.
Minnesota Statutes 2020, section 256B.75, is amended to read:
256B.75 HOSPITAL OUTPATIENT REIMBURSEMENT.
(a) For outpatient hospital facility fee payments for services rendered on or after October
1, 1992, the commissioner of human services shall pay the lower of (1) submitted charge,
or (2) 32 percent above the rate in effect on June 30, 1992, except for those services for
which there is a federal maximum allowable payment. Effective for services rendered on
or after January 1, 2000, payment rates for nonsurgical outpatient hospital facility fees and
emergency room facility fees shall be increased by eight percent over the rates in effect on
December 31, 1999, except for those services for which there is a federal maximum allowable
payment. Services for which there is a federal maximum allowable payment shall be paid
at the lower of (1) submitted charge, or (2) the federal maximum allowable payment. Total
aggregate payment for outpatient hospital facility fee services shall not exceed the Medicare
upper limit. If it is determined that a provision of this section conflicts with existing or
future requirements of the United States government with respect to federal financial
participation in medical assistance, the federal requirements prevail. The commissioner
may, in the aggregate, prospectively reduce payment rates to avoid reduced federal financial
participation resulting from rates that are in excess of the Medicare upper limitations.
(b) Notwithstanding paragraph (a), payment for outpatient, emergency, and ambulatory
surgery hospital facility fee services for critical access hospitals designated under section
144.1483, clause (9), shall be paid on a cost-based payment system that is based on the
cost-finding methods and allowable costs of the Medicare program. Effective for services
provided on or after July 1, 2015, rates established for critical access hospitals under this
paragraph for the applicable payment year shall be the final payment and shall not be settled
to actual costs. Effective for services delivered on or after the first day of the hospital's fiscal
year ending in 2017, the rate for outpatient hospital services shall be computed using
information from each hospital's Medicare cost report as filed with Medicare for the year
that is two years before the year that the rate is being computed. Rates shall be computed
using information from Worksheet C series until the department finalizes the medical
assistance cost reporting process for critical access hospitals. After the cost reporting process
is finalized, rates shall be computed using information from Title XIX Worksheet D series.
The outpatient rate shall be equal to ancillary cost plus outpatient cost, excluding costs
related to rural health clinics and federally qualified health clinics, divided by ancillary
charges plus outpatient charges, excluding charges related to rural health clinics and federally
qualified health clinics.
(c) Effective for services provided on or after July 1, 2003, rates that are based on the
Medicare outpatient prospective payment system shall be replaced by a budget neutral
prospective payment system that is derived using medical assistance data. The commissioner
shall provide a proposal to the 2003 legislature to define and implement this provision.new text begin
When implementing prospective payment methodologies, the commissioner shall use general
methods and rate calculation parameters similar to the applicable Medicare prospective
payment systems for services delivered in outpatient hospital and ambulatory surgical center
settings unless other payment methodologies for these services are specified in this chapter.
new text end
(d) For fee-for-service services provided on or after July 1, 2002, the total payment,
before third-party liability and spenddown, made to hospitals for outpatient hospital facility
services is reduced by .5 percent from the current statutory rate.
(e) In addition to the reduction in paragraph (d), the total payment for fee-for-service
services provided on or after July 1, 2003, made to hospitals for outpatient hospital facility
services before third-party liability and spenddown, is reduced five percent from the current
statutory rates. Facilities defined under section 256.969, subdivision 16, are excluded from
this paragraph.
(f) In addition to the reductions in paragraphs (d) and (e), the total payment for
fee-for-service services provided on or after July 1, 2008, made to hospitals for outpatient
hospital facility services before third-party liability and spenddown, is reduced three percent
from the current statutory rates. Mental health services and facilities defined under section
256.969, subdivision 16, are excluded from this paragraph.
Sec. 41.
new text begin
[256B.795] MATERNAL AND INFANT HEALTH REPORT.
new text end
new text begin
(a) The commissioner of human services, in consultation with the commissioner of
health, shall submit a biennial report beginning April 15, 2022, to the chairs and ranking
minority members of the legislative committees with jurisdiction over health policy and
finance on the effectiveness of state maternal and infant health policies and programs
addressing health disparities in prenatal and postpartum health outcomes. For each reporting
period, the commissioner shall determine the number of women enrolled in the medical
assistance program who are pregnant or are in the six months postpartum period of eligibility
and the percentage of women in that group who, during each reporting period:
new text end
new text begin
(1) received prenatal services;
new text end
new text begin
(2) received doula services;
new text end
new text begin
(3) gave birth by primary cesarean section;
new text end
new text begin
(4) gave birth to an infant who received care in the neonatal intensive care unit;
new text end
new text begin
(5) gave birth to an infant who was premature or who had a low birth weight;
new text end
new text begin
(6) experienced excessive blood loss of more than 500 cc of blood;
new text end
new text begin
(7) received postpartum care within six weeks of giving birth; and
new text end
new text begin
(8) received a prenatal and postpartum follow-up home visit from a public health nurse.
new text end
new text begin
(b) These measurements must be determined through an analysis of the utilization data
from claims submitted during each reporting period and by any other appropriate means,
including the use of utilization data under section 62U.04. The measurements for each metric
must be determined in the aggregate and separately for white women, women of color, and
indigenous women.
new text end
new text begin
(c) The commissioner shall establish a baseline for the metrics described in paragraph
(a) using calendar year 2017. The initial report due April 15, 2022 must contain the baseline
metrics and the metrics data for calendar years 2019 and 2021. The following reports due
biennially thereafter must contain the metrics for the preceding two calendar years.
new text end
Sec. 42.
Minnesota Statutes 2020, section 256L.01, subdivision 5, is amended to read:
Subd. 5.
Income.
"Income" has the meaning given for modified adjusted gross income,
as defined in Code of Federal Regulations, title 26, section 1.36B-1, and means a household's
deleted text begin current income, or if income fluctuates month to month, the income for the 12-month
eligibility perioddeleted text end new text begin projected annual income for the applicable tax yearnew 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. 43.
Minnesota Statutes 2020, section 256L.04, subdivision 7b, is amended to read:
Subd. 7b.
Annual income limits adjustment.
The commissioner shall adjust the income
limits under this section annually deleted text begin each July 1deleted text end new text begin on January 1new text end as deleted text begin described in section 256B.056,
subdivision 1cdeleted text end new text begin provided in Code of Federal Regulations, title 26, section 1.36B-1(h)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. 44.
Minnesota Statutes 2020, section 256L.05, subdivision 3a, is amended to read:
Subd. 3a.
Redetermination of eligibility.
(a) An enrollee's eligibility must be
redetermined on an annual basisdeleted text begin , in accordance with Code of Federal Regulations, title 42,
section 435.916 (a). The 12-month eligibility period begins the month of application.
Beginning July 1, 2017, the commissioner shall adjust the eligibility period for enrollees to
implement renewals throughout the year according to guidance from the Centers for Medicare
and Medicaid Servicesdeleted text end .new text begin The period of eligibility is the entire calendar year following the
year in which eligibility is redetermined. Eligibility redeterminations shall occur during the
open enrollment period for qualified health plans as specified in Code of Federal Regulations,
title 45, section 155.410(e)(3).
new text end
(b) Each new period of eligibility must take into account any changes in circumstances
that impact eligibility and premium amount. Coverage begins as provided in section 256L.06.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 45.
Minnesota Statutes 2020, section 256L.15, subdivision 2, is amended to read:
Subd. 2.
Sliding fee scale; monthly individual or family income.
(a) The commissioner
shall establish a sliding fee scale to determine the percentage of monthly 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 monthly
individual or family income.
(b) Beginning January 1, 2014, MinnesotaCare enrollees shall pay premiums according
to the premium scale specified in paragraph (d).
(c) Paragraph (b) does not apply to:
(1) children 20 years of age or younger; and
(2) individuals with household incomes below 35 percent of the federal poverty
guidelines.
(d) The following premium scale is established for each individual in the household who
is 21 years of age or older and enrolled in MinnesotaCare:
|
Federal Poverty Guideline Greater than or Equal to |
Less than |
Individual Premium Amount |
| 35% |
55% |
$4 |
| 55% |
80% |
$6 |
| 80% |
90% |
$8 |
| 90% |
100% |
$10 |
| 100% |
110% |
$12 |
| 110% |
120% |
$14 |
| 120% |
130% |
$15 |
| 130% |
140% |
$16 |
| 140% |
150% |
$25 |
| 150% |
160% |
$37 |
| 160% |
170% |
$44 |
| 170% |
180% |
$52 |
| 180% |
190% |
$61 |
| 190% |
200% |
$71 |
| 200% |
$80 |
new text begin
(e) Beginning January 1, 2021, the commissioner shall adjust the premium scale
established under paragraph (d) to ensure that premiums do not exceed the amount that an
individual would have been required to pay if the individual was enrolled in an applicable
benchmark plan in accordance with the Code of Federal Regulations, title 42, section
600.505(a)(1).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective retroactively from January 1, 2021 and
applies to premiums due on or after that date.
new text end
Sec. 46.
Minnesota Statutes 2020, section 256L.15, is amended by adding a subdivision
to read:
new text begin Subd. 5. new text end
new text begin Tobacco use premium surcharge. new text end
new text begin
(a) An enrollee who uses tobacco products
as defined in paragraph (e) and is not actively participating in a tobacco cessation program
must pay a tobacco premium surcharge in an amount that is equal to ten percent of the
enrollee's monthly premium. The tobacco use premium surcharge must be calculated on a
monthly basis and paid in accordance with section 256L.06, rounded up to the nearest dollar
amount. Nonpayment of the surcharge may result in disenrollment.
new text end
new text begin
(b) Enrollees who initially apply or renew enrollment in the MinnesotaCare program on
or after July 1, 2021, must attest as part of the application or renewal process whether the
enrollee is using tobacco products and if so, whether the enrollee is actively participating
in a tobacco cessation program. Upon request of the commissioner, the enrollee must provide
documentation verifying that the enrollee is actively participating in tobacco cessation.
new text end
new text begin
(c) If an enrollee indicates on the initial application or at renewal that the enrollee does
not use tobacco or is using tobacco products but is actively participating in a tobacco
cessation program, and it is determined that the enrollee was using tobacco products and
was not actively participating in a tobacco cessation program during the period of enrollment,
the enrollee must pay the total amount of the tobacco use premium surcharge that the enrollee
would have been required to pay as a tobacco user during that enrollment period. If the
enrollee fails to pay the surcharge amount due, the enrollee may be disenrolled and the
unpaid amount may be subject to recovery by the commissioner.
new text end
new text begin
(d) Nonpayment of the surcharge amount owed by the enrollee under paragraph (a) or
(c) shall result in disenrollment effective for the calendar month following the month for
which the surcharge was due. Disenrollment for nonpayment of the surcharge must meet
the requirements in section 256L.06, subdivision 3, paragraphs (d) and (e).
new text end
new text begin
(e) For purposes of this subdivision, the use of tobacco products means the use of a
tobacco product four or more times per week within the past six months. Tobacco products
include the use of cigarettes, cigars, pipe tobacco, chewing tobacco, or snuff.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 47.
Minnesota Statutes 2020, section 295.53, subdivision 1, is amended to read:
Subdivision 1.
Exclusions and exemptions.
(a) The following payments are excluded
from the gross revenues subject to the hospital, surgical center, or health care provider taxes
under sections 295.50 to 295.59:
(1) payments received by a health care provider or the wholly owned subsidiary of a
health care provider for care provided outside Minnesota;
(2) government payments received by the commissioner of human services for
state-operated services;
(3) payments received by a health care provider for hearing aids and related equipment
or prescription eyewear delivered outside of Minnesota; and
(4) payments received by an educational institution from student tuition, student activity
fees, health care service fees, government appropriations, donations, or grants, and for
services identified in and provided under an individualized education program as defined
in section 256B.0625 or Code of Federal Regulations, chapter 34, section 300.340(a). Fee
for service payments and payments for extended coverage are taxable.
(b) The following payments are exempted from the gross revenues subject to hospital,
surgical center, or health care provider taxes under sections 295.50 to 295.59:
(1) payments received for services provided under the Medicare program, including
payments received from the government and organizations governed by sections 1833,
1853, and 1876 of title XVIII of the federal Social Security Act, United States Code, title
42, section 1395; and enrollee deductibles, co-insurance, and co-payments, whether paid
by the Medicare enrollee, by Medicare supplemental coverage as described in section
62A.011, subdivision 3, clause (10), or by Medicaid payments under title XIX of the federal
Social Security Act. Payments for services not covered by Medicare are taxable;
(2) payments received for home health care services;
(3) payments received from hospitals or surgical centers for goods and services on which
liability for tax is imposed under section 295.52 or the source of funds for the payment is
exempt under clause (1), (6), (9), (10), or (11);
(4) payments received from the health care providers for goods and services on which
liability for tax is imposed under this chapter or the source of funds for the payment is
exempt under clause (1), (6), (9), (10), or (11);
(5) amounts paid for legend drugs to a wholesale drug distributor who is subject to tax
under section 295.52, subdivision 3, reduced by reimbursement received for legend drugs
otherwise exempt under this chapter;
(6) payments received from the chemical dependency fund under chapter 254B;
(7) payments received in the nature of charitable donations that are not designated for
providing patient services to a specific individual or group;
(8) payments received for providing patient services incurred through a formal program
of health care research conducted in conformity with federal regulations governing research
on human subjects. Payments received from patients or from other persons paying on behalf
of the patients are subject to tax;
(9) payments received from any governmental agency for services benefiting the public,
not including payments made by the government in its capacity as an employer or insurer
or payments made by the government for services provided under the MinnesotaCare
program or the medical assistance program governed by title XIX of the federal Social
Security Act, United States Code, title 42, sections 1396 to 1396v;
(10) payments received under the federal Employees Health Benefits Act, United States
Code, title 5, section 8909(f), as amended by the Omnibus Reconciliation Act of 1990.
Enrollee deductibles, co-insurance, and co-payments are subject to tax;
(11) payments received under the federal Tricare program, Code of Federal Regulations,
title 32, section 199.17(a)(7). Enrollee deductibles, co-insurance, and co-payments are
subject to tax; and
(12) supplemental deleted text begin ordeleted text end new text begin ,new text end enhancednew text begin , or directednew text end payments authorized under section 256B.196
deleted text begin ordeleted text end new text begin ,new text end 256B.197new text begin , or 256B.1973new text end .
(c) Payments received by wholesale drug distributors for legend drugs sold directly to
veterinarians or veterinary bulk purchasing organizations are excluded from the gross
revenues subject to the wholesale drug distributor tax under sections 295.50 to 295.59.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective for taxable years beginning after December
31, 2020.
new text end
Sec. 48. new text begin CAPITATION PAYMENT DELAY.
new text end
new text begin
(a) The commissioner of human services shall delay $93,742,000 of the medical assistance
capitation payment to managed care plans and county-based purchasing plans due in May
2023 until July 1, 2023. The payment shall be made no earlier than July 1, 2023, and no
later than July 31, 2023.
new text end
new text begin
(b) The commissioner of human services shall delay $114,103,000 of the medical
assistance capitation payment to managed care plans and county-based purchasing plans
due in May 2025 until July 1, 2025. The payment shall be made no earlier than July 1, 2025,
and no later than July 31, 2025
new text end
Sec. 49. new text begin DENTAL HOME DEMONSTRATION PROJECT PLAN.
new text end
new text begin
(a) The commissioner of human services shall develop a plan to implement a dental
home demonstration project. The demonstration project must create dental homes to provide
incentives to dental providers for the provision of patient-centered, high quality,
comprehensive, and coordinated dental care to medical assistance and MinnesotaCare
enrollees. The demonstration project must be designed to establish and evaluate alternative
models of delivery systems and payment methods that:
new text end
new text begin
(1) emphasize, enhance, and encourage access to primary dental care by using dental
teams that include dentists, dental hygienists, dental therapists, advanced dental therapists,
and dental assistants;
new text end
new text begin
(2) ensure enrollees with a consistent and ongoing contact with a dental provider or
dental team and coordination with the enrollee's medical care;
new text end
new text begin
(3) decrease administrative burdens and create greater transparency and accountability;
new text end
new text begin
(4) incorporate outcome measures on access, quality, cost of care and patient experience;
and
new text end
new text begin
(5) establish value-based incentives to:
new text end
new text begin
(i) provide flexibility in enrollment criteria in order to increase the number of dental
providers currently serving medical assistance and MinnesotaCare enrollees;
new text end
new text begin
(ii) reduce disparities in access to dental services for high risk and medically and socially
complex patients; and
new text end
new text begin
(iii) increase overall access to quality dental services.
new text end
new text begin
(b) The commissioner shall develop outcome measures for the demonstration projects
that include measurements for access to preventive care, follow-up care after an oral health
evaluation, patient satisfaction, and administrative costs for delivering dental services.
new text end
new text begin
(c) In developing the dental home demonstration project, the commissioner shall consult
with interested stakeholders including but not limited to representatives of:
new text end
new text begin
(1) private practice dental clinics for which medical assistance and MinnesotaCare
enrollees comprise more than 25 percent of the clinic's patient load;
new text end
new text begin
(2) nonprofit dental clinics with a primary focus on serving Indigenous communities
and other communities of color;
new text end
new text begin
(3) nonprofit dental clinics with a primary focus on providing eldercare;
new text end
new text begin
(4) nonprofit dental clinics with a primary focus on serving children;
new text end
new text begin
(5) nonprofit dental clinics providing services in the seven-county metropolitan area;
new text end
new text begin
(6) nonprofit dental clinics providing services outside of the seven-county metropolitan
area;
new text end
new text begin
(7) multispecialty hospital-based dental clinics; and
new text end
new text begin
(8) educational institutions operating dental programs.
new text end
new text begin
(d) The commissioner of human services shall submit recommendations for the
establishment of a dental home demonstration project to the chairs and ranking minority
members of the legislative committees with jurisdiction over health and human services
policy and finance by February 1, 2022.
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. 50. new text begin FEDERAL APPROVAL; EXTENSION OF POSTPARTUM COVERAGE.
new text end
new text begin
The commissioner of human services shall seek all necessary federal waivers and
approvals necessary to extend medical assistance postpartum coverage, as provided in
Minnesota Statutes, section 256B.055, subdivision 6.
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. 51. new text begin OVERPAYMENTS FOR DURABLE MEDICAL EQUIPMENT,
PROSTHETICS, ORTHOTICS, OR SUPPLIES.
new text end
new text begin
(a) Notwithstanding any other law to the contrary, providers who received payment for
durable medical equipment, prosthetics, orthotics, or supplies between January 1, 2018, and
June 30, 2019, that were subject to the upper payment limits under United States Code, title
42, section 1396b(i)(27), shall not be required to repay any amount received in excess of
the allowable amount to either the state or the Centers for Medicare and Medicaid Services.
new text end
new text begin
(b) The state shall repay with state funds any amount owed to the Centers for Medicare
and Medicaid Services for the federal financial participation amount received by the state
for payments identified in paragraph (a) in excess of the amount allowed effective January
1, 2018, and the state shall hold harmless the providers who received these payments from
recovery of both the state and federal share of the amount determined to have exceeded the
Medicare upper payment limit.
new text end
new text begin
(c) Nothing in this section shall be construed to prohibit the commissioner from recouping
past overpayments due to false claims or for reasons other than exceeding the Medicare
upper payment limits or from recouping future overpayments including the recoupment of
payments that exceed the upper Medicare payment limits.
new text end
Sec. 52. new text begin PROPOSED FORMULARY COMMITTEE.
new text end
new text begin
By March 1, 2022, the commissioner of human services, in consultation with relevant
professional associations and consumer groups, shall submit to the chairs and ranking
minority members of the legislative committees with jurisdiction over health and human
services a proposed reorganization of the Formulary Committee under Minnesota Statutes,
section 256B.0625, subdivision 13c, that includes:
new text end
new text begin
(1) the proposed membership of the committee, including adequate representation of
consumers and health care professionals with expertise in clinical prescribing; and
new text end
new text begin
(2) proposed policies and procedures for the operation of the committee that ensures
public input, including providing public notice and gathering public comments on the
committee's recommendations and proposed actions.
new text end
Sec. 53. new text begin OPIATE EPIDEMIC RESPONSE ADVISORY COUNCIL; INITIAL
MEMBERSHIP TERMS.
new text end
new text begin
Notwithstanding Minnesota Statutes, section 256.042, subdivision 2, paragraph (c), the
initial term for members of the Opiate Epidemic Response Advisory Council established
under Minnesota Statutes, section 256.042, identified in Minnesota Statutes, section 256.042,
subdivision 2, paragraph (a), clauses (1), (3), (5), (7), (9), (11), (13), (15), and (17), ends
September 30, 2022. The initial term for members identified under Minnesota Statutes,
section 256.042, subdivision 2, paragraph (a), clauses (2), (4), (6), (8), (10), (12), (14), and
(16), ends September 30, 2023.
new text end
Sec. 54. new text begin DIRECTION TO COMMISSIONER; DIRECTED PAYMENT
APPLICATION.
new text end
new text begin
The commissioner of human services, in consultation with Hennepin Healthcare System,
shall submit Section 438.6(c) Preprint to the Centers for Medicare and Medicaid Services
no later than July 31, 2021. The commissioner shall request from the Centers for Medicare
and Medicaid Services an effective date of January 1, 2022.
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. 55. new text begin DIRECTIONS TO COMMISSIONER; SCREENING TOOL; SUBSTANCE
USE DISORDER REFORM EVALUATION; SUBSTANCE USE DISORDER
REFORM EDUCATION.
new text end
new text begin
(a) By July 1, 2022, the commissioner of human services shall develop or authorize a
tool for screening individuals for pretreatment coordination services and a template to
document an individual's screening result.
new text end
new text begin
(b) By July 1, 2022, the commissioner of human services shall, in consultation with
counties and substance use disorder treatment providers, develop a tool to evaluate the
effects of substance use disorder treatment reform proposals enacted during the 2019 and
2021 legislative sessions, including access to services, appropriateness of services, and
accuracy of billing service units.
new text end
new text begin
(c) By July 1, 2022, the commissioner of human services shall, in consultation with
counties and substance use disorder treatment providers, develop educational materials for
county staff, providers, and the general public regarding the content and timing of changes
for implementation pursuant to substance use disorder treatment reform proposals enacted
during the 2019 and 2021 legislative sessions.
new text end
Sec. 56. new text begin FUNDING RECOMMENDATIONS FOR PRETREATMENT
COORDINATION SERVICES.
new text end
new text begin
If federal approval is not obtained for pretreatment coordination services under Minnesota
Statutes, section 256B.0625, subdivision 67, the commissioner of human services, in
consultation with the counties, shall submit recommendations on a funding mechanism for
pretreatment coordination services to the chairs and ranking minority members of the
legislative committees with jurisdiction over health hand human services policy and finance
by March 15, 2022.
new text end
Sec. 57. new text begin REVISOR INSTRUCTION.
new text end
new text begin
The revisor of statutes must change the term "Health Services Policy Committee" to
"Health Services Advisory Council" wherever the term appears in Minnesota Statutes and
may make any necessary changes to grammar or sentence structure to preserve the meaning
of the text.
new text end
Sec. 58. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2020, section 16A.724, subdivision 2,
new text end
new text begin
is repealed effective July 1,
2024.
new text end
ARTICLE 2
HEALTH DEPARTMENT
Section 1.
Minnesota Statutes 2020, section 62J.495, subdivision 1, is amended to read:
Subdivision 1.
Implementation.
The commissioner of health, in consultation with the
e-Health Advisory Committee, shall develop uniform standards to be used for the
interoperable electronic health records system for sharing and synchronizing patient data
across systems. The standards must be compatible with federal efforts. The uniform standards
must be developed by January 1, 2009, and updated on an ongoing basis. deleted text begin The commissioner
shall include an update on standards development as part of an annual report to the legislature.deleted text end
Individual health care providers in private practice with no other providers and health care
providers that do not accept reimbursement from a group purchaser, as defined in section
62J.03, subdivision 6, are excluded from the requirements of this section.
Sec. 2.
Minnesota Statutes 2020, section 62J.495, subdivision 2, is amended to read:
Subd. 2.
E-Health Advisory Committee.
(a) The commissioner shall establish an
e-Health Advisory Committee governed by section 15.059 to advise the commissioner on
the following matters:
(1) assessment of the adoption and effective use of health information technology by
the state, licensed health care providers and facilities, and local public health agencies;
(2) recommendations for implementing a statewide interoperable health information
infrastructure, to include estimates of necessary resources, and for determining standards
for clinical data exchange, clinical support programs, patient privacy requirements, and
maintenance of the security and confidentiality of individual patient data;
(3) recommendations for encouraging use of innovative health care applications using
information technology and systems to improve patient care and reduce the cost of care,
including applications relating to disease management and personal health management
that enable remote monitoring of patients' conditions, especially those with chronic
conditions; and
(4) other related issues as requested by the commissioner.
(b) The members of the e-Health Advisory Committee shall include the commissioners,
or commissioners' designees, of health, human services, administration, 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, private purchasers, 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 commissioner to fulfill the
requirements of section 3013, paragraph (g), of the HITECH Act.
(c) deleted 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 action on policy and necessary resources to continue the
promotion of adoption and effective use of health information technology.
deleted text end
deleted text begin (d)deleted text end This subdivision expires June 30, 2021.
Sec. 3.
Minnesota Statutes 2020, section 62J.495, subdivision 3, is amended to read:
Subd. 3.
Interoperable electronic health record requirements.
(a) Hospitals and health
care providers must meet the following criteria when implementing an interoperable
electronic health records system within their hospital system or clinical practice setting.
(b) The electronic health record must be a qualified electronic health record.
(c) The electronic health record must be certified by the Office of the National
Coordinator pursuant to the HITECH Act. This criterion only applies to hospitals and health
care providers if a certified electronic health record product for the provider's particular
practice setting is available. This criterion shall be considered met if a hospital or health
care provider is using an electronic health records system that has been certified within the
last three years, even if a more current version of the system has been certified within the
three-year period.
(d) The electronic health record must meet the standards established according to section
3004 of the HITECH Act as applicable.
(e) The electronic health record must have the ability to generate information on clinical
quality measures and other measures reported under sections 4101, 4102, and 4201 of the
HITECH Act.
(f) The electronic health record system must be connected to a state-certified health
information organization either directly or through a connection facilitated by a deleted text begin state-certifieddeleted text end
health data intermediary as defined in section 62J.498.
(g) A health care provider who is a prescriber or dispenser of legend drugs must have
an electronic health record system that meets the requirements of section 62J.497.
Sec. 4.
Minnesota Statutes 2020, section 62J.495, subdivision 4, is amended to read:
Subd. 4.
Coordination with national HIT activities.
(a) The commissioner, in
consultation with the e-Health Advisory Committee, shall update the statewide
implementation plan required under subdivision 2 and released June 2008, to be consistent
with the updated federal deleted text begin HIT Strategic Plan released by the Office of the National Coordinator
in accordance with section 3001 of the HITECH Act. The statewide plan shall meet the
requirements for a plan required under section 3013 of the HITECH Actdeleted text end new text begin plansnew text end .
(b) The commissioner, in consultation with the e-Health Advisory Committee, shall
work to ensure coordination between state, regional, and national efforts to support and
accelerate efforts to effectively use health information technology to improve the quality
and coordination of health care and the continuity of patient care among health care providers,
to reduce medical errors, to improve population health, to reduce health disparities, and to
reduce chronic disease. The commissioner's coordination efforts shall include but not be
limited to:
deleted text begin
(1) assisting in the development and support of health information technology regional
extension centers established under section 3012(c) of the HITECH Act to provide technical
assistance and disseminate best practices;
deleted text end
deleted text begin
(2) providing supplemental information to the best practices gathered by regional centers
to ensure that the information is relayed in a meaningful way to the Minnesota health care
community;
deleted text end
deleted text begin (3)deleted text end new text begin (1)new text end providing financial and technical support to Minnesota health care providers to
encourage implementation of admission, discharge and transfer alerts, and care summary
document exchange transactions and to evaluate the impact of health information technology
on cost and quality of care. Communications about available financial and technical support
shall include clear information about the interoperable health record requirements in
subdivision 1, including a separate statement in bold-face type clarifying the exceptions to
those requirements;
deleted text begin (4)deleted text end new text begin (2)new text end providing educational resources and technical assistance to health care providers
and patients related to state and national privacy, security, and consent laws governing
clinical health information, including the requirements in sections 144.291 to 144.298. In
carrying out these activities, the commissioner's technical assistance does not constitute
legal advice;
deleted text begin (5)deleted text end new text begin (3)new text end assessing Minnesota's legal, financial, and regulatory framework for health
information exchange, including the requirements in sections 144.291 to 144.298, and
making recommendations for modifications that would strengthen the ability of Minnesota
health care providers to securely exchange data in compliance with patient preferences and
in a way that is efficient and financially sustainable; and
deleted text begin (6)deleted text end new text begin (4)new text end seeking public input on both patient impact and costs associated with requirements
related to patient consent for release of health records for the purposes of treatment, payment,
and health care operations, as required in section 144.293, subdivision 2. The commissioner
shall provide a report to the legislature on the findings of this public input process no later
than February 1, 2017.
(c) The commissioner, in consultation with the e-Health Advisory Committee, shall
monitor national activity related to health information technology and shall coordinate
statewide input on policy development. The commissioner shall coordinate statewide
responses to proposed federal health information technology regulations in order to ensure
that the needs of the Minnesota health care community are adequately and efficiently
addressed in the proposed regulations. The commissioner's responses may include, but are
not limited to:
(1) reviewing and evaluating any standard, implementation specification, or certification
criteria proposed by the national HIT standards deleted text begin committeedeleted text end new text begin committeesnew text end ;
(2) reviewing and evaluating policy proposed by deleted text begin thedeleted text end national HIT policy deleted text begin committeedeleted text end new text begin
committeesnew text end relating to the implementation of a nationwide health information technology
infrastructure;new text begin and
new text end
(3) deleted text begin monitoring and responding to activity related to the development of quality measures
and other measures as required by section 4101 of the HITECH Act. Any response related
to quality measures shall consider and address the quality efforts required under chapter
62U; and
deleted text end
deleted text begin (4)deleted text end monitoring and responding to national activity related to privacy, security, and data
stewardship of electronic health information and individually identifiable health information.
(d) To the extent that the state is either required or allowed to apply, or designate an
entity to apply for or carry out activities and programs deleted text begin under section 3013 of the HITECH
Actdeleted text end , the commissioner of health, in consultation with the e-Health Advisory Committee
and the commissioner of human services, shall be the lead applicant or sole designating
authority. The commissioner shall make such designations consistent with the goals and
objectives of sections 62J.495 to 62J.497 and 62J.50 to 62J.61.
(e) The commissioner of human services shall apply for funding necessary to administer
the incentive payments to providers authorized under title IV of the American Recovery
and Reinvestment Act.
deleted text begin
(f) The commissioner shall include in the report to the legislature information on the
activities of this subdivision and provide recommendations on any relevant policy changes
that should be considered in Minnesota.
deleted text end
Sec. 5.
Minnesota Statutes 2020, section 62J.498, is amended to read:
62J.498 HEALTH INFORMATION EXCHANGE.
Subdivision 1.
Definitions.
(a) The following definitions apply to sections 62J.498 to
62J.4982:
(b) "Clinical data repository" means a real time database that consolidates data from a
variety of clinical sources to present a unified view of a single patient and is used by a
deleted text begin state-certifieddeleted text end health information exchange service provider to enable health information
exchange among health care providers that are not related health care entities as defined in
section 144.291, subdivision 2, paragraph (k). This does not include clinical data that are
submitted to the commissioner for public health purposes required or permitted by law,
including any rules adopted by the commissioner.
(c) "Clinical transaction" means any meaningful use transaction or other health
information exchange transaction that is not covered by section 62J.536.
(d) "Commissioner" means the commissioner of health.
(e) "Health care provider" or "provider" means a health care provider or provider as
defined in section 62J.03, subdivision 8.
(f) "Health data intermediary" means an entity that provides the technical capabilities
or related products and services to enable health information exchange among health care
providers that are not related health care entities as defined in section 144.291, subdivision
2, paragraph (k). This includes but is not limited to health information service providers
(HISP), electronic health record vendors, and pharmaceutical electronic data intermediaries
as defined in section 62J.495.
(g) "Health information exchange" means the electronic transmission of health-related
information between organizations according to nationally recognized standards.
(h) "Health information exchange service provider" means a health data intermediary
or health information organization.
(i) "Health information organization" means an organization that oversees, governs, and
facilitates health information exchange among health care providers that are not related
health care entities as defined in section 144.291, subdivision 2, paragraph (k), to improve
coordination of patient care and the efficiency of health care delivery.
deleted text begin
(j) "HITECH Act" means the Health Information Technology for Economic and Clinical
Health Act as defined in section 62J.495.
deleted text end
deleted text begin (k)deleted text end new text begin (j)new text end "Major participating entity" means:
(1) a participating entity that receives compensation for services that is greater than 30
percent of the health information organization's gross annual revenues from the health
information exchange service provider;
(2) a participating entity providing administrative, financial, or management services to
the health information organization, if the total payment for all services provided by the
participating entity exceeds three percent of the gross revenue of the health information
organization; and
(3) a participating entity that nominates or appoints 30 percent or more of the board of
directors or equivalent governing body of the health information organization.
deleted text begin (l)deleted text end new text begin (k)new text end "Master patient index" means an electronic database that holds unique identifiers
of patients registered at a care facility and is used by a deleted text begin state-certifieddeleted text end health information
exchange service provider to enable health information exchange among health care providers
that are not related health care entities as defined in section 144.291, subdivision 2, paragraph
(k). This does not include data that are submitted to the commissioner for public health
purposes required or permitted by law, including any rules adopted by the commissioner.
deleted text begin
(m) "Meaningful use" means use of certified electronic health record technology to
improve quality, safety, and efficiency and reduce health disparities; engage patients and
families; improve care coordination and population and public health; and maintain privacy
and security of patient health information as established by the Centers for Medicare and
Medicaid Services and the Minnesota Department of Human Services pursuant to sections
4101, 4102, and 4201 of the HITECH Act.
deleted text end
deleted text begin
(n) "Meaningful use transaction" means an electronic transaction that a health care
provider must exchange to receive Medicare or Medicaid incentives or avoid Medicare
penalties pursuant to sections 4101, 4102, and 4201 of the HITECH Act.
deleted text end
deleted text begin (o)deleted text end new text begin (l)new text end "Participating entity" means any of the following persons, health care providers,
companies, or other organizations with which a health information organization deleted text begin or health
data intermediarydeleted text end has contracts or other agreements for the provision of health information
exchange services:
(1) a health care facility licensed under sections 144.50 to 144.56, a nursing home
licensed under sections 144A.02 to 144A.10, and any other health care facility otherwise
licensed under the laws of this state or registered with the commissioner;
(2) a health care provider, and any other health care professional otherwise licensed
under the laws of this state or registered with the commissioner;
(3) a group, professional corporation, or other organization that provides the services of
individuals or entities identified in clause (2), including but not limited to a medical clinic,
a medical group, a home health care agency, an urgent care center, and an emergent care
center;
(4) a health plan as defined in section 62A.011, subdivision 3; and
(5) a state agency as defined in section 13.02, subdivision 17.
deleted text begin (p)deleted text end new text begin (m)new text end "Reciprocal agreement" means an arrangement in which two or more health
information exchange service providers agree to share in-kind services and resources to
allow for the pass-through of clinical transactions.
deleted text begin
(q) "State-certified health data intermediary" means a health data intermediary that has
been issued a certificate of authority to operate in Minnesota.
deleted text end
deleted text begin (r)deleted text end new text begin (n)new text end "State-certified health information organization" means a health information
organization that has been issued a certificate of authority to operate in Minnesota.
Subd. 2.
Health information exchange oversight.
(a) The commissioner shall protect
the public interest on matters pertaining to health information exchange. The commissioner
shall:
(1) review and act on applications from deleted text begin health data intermediaries anddeleted text end health information
organizations for certificates of authority to operate in Minnesota;
new text begin
(2) require information to be provided as needed from health information exchange
service providers in order to meet requirements established under sections 62J.498 to
62J.4982;
new text end
deleted text begin (2)deleted text end new text begin (3)new text end provide ongoing monitoring to ensure compliance with criteria established under
sections 62J.498 to 62J.4982;
deleted text begin (3)deleted text end new text begin (4)new text end respond to public complaints related to health information exchange services;
deleted text begin (4)deleted text end new text begin (5)new text end take enforcement actions as necessary, including the imposition of fines,
suspension, or revocation of certificates of authority as outlined in section 62J.4982;
deleted text begin (5)deleted text end new text begin (6)new text end provide a biennial report on the status of health information exchange services
that includes but is not limited to:
(i) recommendations on actions necessary to ensure that health information exchange
services are adequate to meet the needs of Minnesota citizens and providers statewide;
(ii) recommendations on enforcement actions to ensure that health information exchange
service providers act in the public interest without causing disruption in health information
exchange services;
(iii) recommendations on updates to criteria for obtaining certificates of authority under
this section; and
(iv) recommendations on standard operating procedures for health information exchange,
including but not limited to the management of consumer preferences; and
deleted text begin (6)deleted text end new text begin (7)new text end other duties necessary to protect the public interest.
(b) As part of the application review process for certification under paragraph (a), prior
to issuing a certificate of authority, the commissioner shall:
(1) make all portions of the application classified as public data available to the public
for at least ten days while an application is under consideration. At the request of the
commissioner, the applicant shall participate in a public hearing by presenting an overview
of their application and responding to questions from interested parties; and
(2) consult with hospitals, physicians, and other providers prior to issuing a certificate
of authority.
(c) When the commissioner is actively considering a suspension or revocation of a
certificate of authority as described in section 62J.4982, subdivision 3, all investigatory data
that are collected, created, or maintained related to the suspension or revocation are classified
as confidential data on individuals and as protected nonpublic data in the case of data not
on individuals.
(d) The commissioner may disclose data classified as protected nonpublic or confidential
under paragraph (c) if disclosing the data will protect the health or safety of patients.
(e) After the commissioner makes a final determination regarding a suspension or
revocation of a certificate of authority, all minutes, orders for hearing, findings of fact,
conclusions of law, and the specification of the final disciplinary action, are classified as
public data.
Sec. 6.
Minnesota Statutes 2020, section 62J.4981, is amended to read:
62J.4981 CERTIFICATE OF AUTHORITY TO PROVIDE HEALTH
INFORMATION EXCHANGE SERVICES.
Subdivision 1.
Authority to require organizations to apply.
The commissioner shall
require deleted text begin a health data intermediary ordeleted text end a health information organization to apply for a
certificate of authority under this section. An applicant may continue to operate until the
commissioner acts on the application. If the application is denied, the applicant is considered
a health information exchange service provider whose certificate of authority has been
revoked under section 62J.4982, subdivision 2, paragraph (d).
deleted text begin Subd. 2. deleted text end
deleted text begin Certificate of authority for health data intermediaries. deleted text end
deleted text begin
(a) A health data
intermediary must be certified by the state and comply with requirements established in this
section.
deleted text end
deleted text begin
(b) Notwithstanding any law to the contrary, any corporation organized to do so may
apply to the commissioner for a certificate of authority to establish and operate as a health
data intermediary in compliance with this section. No person shall establish or operate a
health data intermediary in this state, nor sell or offer to sell, or solicit offers to purchase
or receive advance or periodic consideration in conjunction with a health data intermediary
contract unless the organization has a certificate of authority or has an application under
active consideration under this section.
deleted text end
deleted text begin
(c) In issuing the certificate of authority, the commissioner shall determine whether the
applicant for the certificate of authority has demonstrated that the applicant meets the
following minimum criteria:
deleted text end
deleted text begin
(1) hold reciprocal agreements with at least one state-certified health information
organization to access patient data, and for the transmission and receipt of clinical
transactions. Reciprocal agreements must meet the requirements established in subdivision
5; and
deleted text end
deleted text begin
(2) participate in statewide shared health information exchange services as defined by
the commissioner to support interoperability between state-certified health information
organizations and state-certified health data intermediaries.
deleted text end
Subd. 3.
Certificate of authority for health information organizations.
(a) A health
information organization must obtain a certificate of authority from the commissioner and
demonstrate compliance with the criteria in paragraph (c).
(b) Notwithstanding any law to the contrary, an organization may apply for a certificate
of authority to establish and operate a health information organization under this section.
No person shall establish or operate a health information organization in this state, nor sell
or offer to sell, or solicit offers to purchase or receive advance or periodic consideration in
conjunction with a health information organization or health information contract unless
the organization has a certificate of authority under this section.
(c) In issuing the certificate of authority, the commissioner shall determine whether the
applicant for the certificate of authority has demonstrated that the applicant meets the
following minimum criteria:
(1) the entity is a legally established organization;
(2) appropriate insurance, including liability insurance, for the operation of the health
information organization is in place and sufficient to protect the interest of the public and
participating entities;
(3) strategic and operational plans address governance, technical infrastructure, legal
and policy issues, finance, and business operations in regard to how the organization will
expand to support providers in achieving health information exchange goals over time;
(4) the entity addresses the parameters to be used with participating entities and other
health information exchange service providers for clinical transactions, compliance with
Minnesota law, and interstate health information exchange trust agreements;
(5) the entity's board of directors or equivalent governing body is composed of members
that broadly represent the health information organization's participating entities and
consumers;
(6) the entity maintains a professional staff responsible to the board of directors or
equivalent governing body with the capacity to ensure accountability to the organization's
mission;
(7) the organization is compliant with national certification and accreditation programs
designated by the commissioner;
(8) the entity maintains the capability to query for patient information based on national
standards. The query capability may utilize a master patient index, clinical data repository,
or record locator service as defined in section 144.291, subdivision 2, paragraph (j). The
entity must be compliant with the requirements of section 144.293, subdivision 8, when
conducting clinical transactions;
(9) the organization demonstrates interoperability with all other state-certified health
information organizations using nationally recognized standards;
(10) the organization demonstrates compliance with all privacy and security requirements
required by state and federal law; and
(11) the organization uses financial policies and procedures consistent with generally
accepted accounting principles and has an independent audit of the organization's financials
on an annual basis.
(d) Health information organizations that have obtained a certificate of authority must:
(1) meet the requirements established for connecting to the National eHealth Exchange;
(2) annually submit strategic and operational plans for review by the commissioner that
address:
(i) progress in achieving objectives included in previously submitted strategic and
operational plans across the following domains: business and technical operations, technical
infrastructure, legal and policy issues, finance, and organizational governance;
(ii) plans for ensuring the necessary capacity to support clinical transactions;
(iii) approach for attaining financial sustainability, including public and private financing
strategies, and rate structures;
(iv) rates of adoption, utilization, and transaction volume, and mechanisms to support
health information exchange; and
(v) an explanation of methods employed to address the needs of community clinics,
critical access hospitals, and free clinics in accessing health information exchange services;
(3) enter into reciprocal agreements with all other state-certified health information
organizations deleted text begin and state-certified health data intermediariesdeleted text end to enable access to patient data,
and for the transmission and receipt of clinical transactions. Reciprocal agreements must
meet the requirements in subdivision 5;
(4) participate in statewide shared health information exchange services as defined by
the commissioner to support interoperability deleted text begin between state-certified health information
organizations and state-certified health data intermediariesdeleted text end ; and
(5) comply with additional requirements for the certification or recertification of health
information organizations that may be established by the commissioner.
Subd. 4.
Application for certificate of authority for health information deleted text begin exchange
service providersdeleted text end new text begin organizationsnew text end .
(a) Each application for a certificate of authority shall
be in a form prescribed by the commissioner and verified by an officer or authorized
representative of the applicant. Each application shall include the following in addition to
information described in the criteria in deleted text begin subdivisions 2 anddeleted text end new text begin subdivisionnew text end 3:
(1) deleted text begin for health information organizations only,deleted text end a copy of the basic organizational document,
if any, of the applicant and of each major participating entity, such as the articles of
incorporation, or other applicable documents, and all amendments to it;
(2) deleted text begin for health information organizations only,deleted text end a list of the names, addresses, and official
positions of the following:
(i) all members of the board of directors or equivalent governing body, and the principal
officers and, if applicable, shareholders of the applicant organization; and
(ii) all members of the board of directors or equivalent governing body, and the principal
officers of each major participating entity and, if applicable, each shareholder beneficially
owning more than ten percent of any voting stock of the major participating entity;
(3) deleted text begin for health information organizations only,deleted text end the name and address of each participating
entity and the agreed-upon duration of each contract or agreement if applicable;
(4) a copy of each standard agreement or contract intended to bind the participating
entities and the health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end . Contractual
provisions shall be consistent with the purposes of this section, in regard to the services to
be performed under the standard agreement or contract, the manner in which payment for
services is determined, the nature and extent of responsibilities to be retained by the health
information organization, and contractual termination provisions;
(5) a statement generally describing the health information deleted text begin exchange service providerdeleted text end new text begin
organizationnew text end , its health information exchange contracts, facilities, and personnel, including
a statement describing the manner in which the applicant proposes to provide participants
with comprehensive health information exchange services;
(6) a statement reasonably describing the geographic area or areas to be served and the
type or types of participants to be served;
(7) a description of the complaint procedures to be used as required under this section;
(8) a description of the mechanism by which participating entities will have an opportunity
to participate in matters of policy and operation;
(9) a copy of any pertinent agreements between the health information organization and
insurers, including liability insurers, demonstrating coverage is in place;
(10) a copy of the conflict of interest policy that applies to all members of the board of
directors or equivalent governing body and the principal officers of the health information
organization; and
(11) other information as the commissioner may reasonably require to be provided.
(b) Within 45 days after the receipt of the application for a certificate of authority, the
commissioner shall determine whether or not the application submitted meets the
requirements for completion in paragraph (a), and notify the applicant of any further
information required for the application to be processed.
(c) Within 90 days after the receipt of a complete application for a certificate of authority,
the commissioner shall issue a certificate of authority to the applicant if the commissioner
determines that the applicant meets the minimum criteria requirements of subdivision 2 deleted text begin for
health data intermediaries or subdivision 3 for health information organizationsdeleted text end . If the
commissioner determines that the applicant is not qualified, the commissioner shall notify
the applicant and specify the reasons for disqualification.
(d) Upon being granted a certificate of authority to operate as a state-certified health
information organization deleted text begin or state-certified health data intermediarydeleted text end , the organization must
operate in compliance with the provisions of this section. Noncompliance may result in the
imposition of a fine or the suspension or revocation of the certificate of authority according
to section 62J.4982.
Subd. 5.
Reciprocal agreements between health information deleted text begin exchange entitiesdeleted text end new text begin
organizationsnew text end .
(a) Reciprocal agreements between two health information organizations
deleted text begin or between a health information organization and a health data intermediarydeleted text end must include
a fair and equitable model for charges between the entities that:
(1) does not impede the secure transmission of clinical transactions;
(2) does not charge a fee for the exchange of deleted text begin meaningful usedeleted text end transactions transmitted
according to nationally recognized standards where no additional value-added service is
rendered to the sending or receiving health information organization deleted text begin or health data
intermediarydeleted text end either directly or on behalf of the client;
(3) is consistent with fair market value and proportionately reflects the value-added
services accessed as a result of the agreement; and
(4) prevents health care stakeholders from being charged multiple times for the same
service.
(b) Reciprocal agreements must include comparable quality of service standards that
ensure equitable levels of services.
(c) Reciprocal agreements are subject to review and approval by the commissioner.
(d) Nothing in this section precludes a state-certified health information organization deleted text begin or
state-certified health data intermediarydeleted text end from entering into contractual agreements for the
provision of value-added services deleted text begin beyond meaningful use transactionsdeleted text end .
Sec. 7.
Minnesota Statutes 2020, section 62J.4982, is amended to read:
62J.4982 ENFORCEMENT AUTHORITY; COMPLIANCE.
Subdivision 1.
Penalties and enforcement.
(a) The commissioner may, for any violation
of statute or rule applicable to a health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end ,
levy an administrative penalty in an amount up to $25,000 for each violation. In determining
the level of an administrative penalty, the commissioner shall consider the following factors:
(1) the number of participating entities affected by the violation;
(2) the effect of the violation on participating entities' access to health information
exchange services;
(3) if only one participating entity is affected, the effect of the violation on the patients
of that entity;
(4) whether the violation is an isolated incident or part of a pattern of violations;
(5) the economic benefits derived by the health information organization deleted text begin or a health data
intermediarydeleted text end by virtue of the violation;
(6) whether the violation hindered or facilitated an individual's ability to obtain health
care;
(7) whether the violation was intentional;
(8) whether the violation was beyond the direct control of the health information deleted text begin exchange
service providerdeleted text end new text begin organizationnew text end ;
(9) any history of prior compliance with the provisions of this section, including
violations;
(10) whether and to what extent the health information deleted text begin exchange service providerdeleted text end new text begin
organizationnew text end attempted to correct previous violations;
(11) how the health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end responded to
technical assistance from the commissioner provided in the context of a compliance effort;
and
(12) the financial condition of the health information deleted text begin exchange service providerdeleted text end new text begin
organizationnew text end includingdeleted text begin ,deleted text end but not limited todeleted text begin ,deleted text end whether the health information deleted text begin exchange service
providerdeleted text end new text begin organizationnew text end had financial difficulties that affected its ability to comply or whether
the imposition of an administrative monetary penalty would jeopardize the ability of the
health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end to continue to deliver health
information exchange services.
The commissioner shall give reasonable notice in writing to the health information
deleted text begin exchange service providerdeleted text end new text begin organizationnew text end of the intent to levy the penalty and the reasons for
it. A health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end may have 15 days within
which to contest whether the facts found constitute a violation of sections 62J.4981 and
62J.4982, according to the contested case and judicial review provisions of sections 14.57
to 14.69.
(b) If the commissioner has reason to believe that a violation of section 62J.4981 or
62J.4982 has occurred or is likely, the commissioner may confer with the persons involved
before commencing action under subdivision 2. The commissioner may notify the health
information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end and the representatives, or other persons
who appear to be involved in the suspected violation, to arrange a voluntary conference
with the alleged violators or their authorized representatives. The purpose of the conference
is to attempt to learn the facts about the suspected violation and, if it appears that a violation
has occurred or is threatened, to find a way to correct or prevent it. The conference is not
governed by any formal procedural requirements, and may be conducted as the commissioner
considers appropriate.
(c) The commissioner may issue an order directing a health information deleted text begin exchange service
providerdeleted text end new text begin organizationnew text end or a representative of a health information deleted text begin exchange service providerdeleted text end new text begin
organizationnew text end to cease and desist from engaging in any act or practice in violation of sections
62J.4981 and 62J.4982.
(d) Within 20 days after service of the order to cease and desist, a health information
deleted text begin exchange service providerdeleted text end new text begin organizationnew text end may contest whether the facts found constitute a
violation of sections 62J.4981 and 62J.4982 according to the contested case and judicial
review provisions of sections 14.57 to 14.69.
(e) In the event of noncompliance with a cease and desist order issued under this
subdivision, the commissioner may institute a proceeding to obtain injunctive relief or other
appropriate relief in Ramsey County District Court.
Subd. 2.
Suspension or revocation of certificates of authority.
(a) The commissioner
may suspend or revoke a certificate of authority issued to a deleted text begin health data intermediary ordeleted text end
health information organization under section 62J.4981 if the commissioner finds that:
(1) the health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end is operating
significantly in contravention of its basic organizational document, or in a manner contrary
to that described in and reasonably inferred from any other information submitted under
section 62J.4981, unless amendments to the submissions have been filed with and approved
by the commissioner;
(2) the health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end is unable to fulfill its
obligations to furnish comprehensive health information exchange services as required
under its health information exchange contract;
(3) the health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end is no longer financially
solvent or may not reasonably be expected to meet its obligations to participating entities;
(4) the health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end has failed to implement
the complaint system in a manner designed to reasonably resolve valid complaints;
(5) the health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end , or any person acting
with its sanction, has advertised or merchandised its services in an untrue, misleading,
deceptive, or unfair manner;
(6) the continued operation of the health information deleted text begin exchange service providerdeleted text end new text begin
organizationnew text end would be hazardous to its participating entities or the patients served by the
participating entities; or
(7) the health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end has otherwise failed
to substantially comply with section 62J.4981 or with any other statute or administrative
rule applicable to health information exchange service providers, or has submitted false
information in any report required under sections 62J.498 to 62J.4982.
(b) A certificate of authority shall be suspended or revoked only after meeting the
requirements of subdivision 3.
(c) If the certificate of authority of a health information deleted text begin exchange service providerdeleted text end new text begin
organizationnew text end is suspended, the health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end
shall not, during the period of suspension, enroll any additional participating entities, and
shall not engage in any advertising or solicitation.
(d) If the certificate of authority of a health information deleted text begin exchange service providerdeleted text end new text begin
organizationnew text end is revoked, the organization shall proceed, immediately following the effective
date of the order of revocation, to wind up its affairs, and shall conduct no further business
except as necessary to the orderly conclusion of the affairs of the organization. The
organization shall engage in no further advertising or solicitation. The commissioner may,
by written order, permit further operation of the organization as the commissioner finds to
be in the best interest of participating entities, to the end that participating entities will be
given the greatest practical opportunity to access continuing health information exchange
services.
Subd. 3.
Denial, suspension, and revocation; administrative procedures.
(a) When
the commissioner has cause to believe that grounds for the denial, suspension, or revocation
of a certificate of authority exist, the commissioner shall notify the health information
deleted text begin exchange service providerdeleted text end new text begin organizationnew text end in writing stating the grounds for denial, suspension,
or revocation and setting a time within 20 days for a hearing on the matter.
(b) After a hearing before the commissioner at which the health information deleted text begin exchange
service providerdeleted text end new text begin organizationnew text end may respond to the grounds for denial, suspension, or
revocation, or upon the failure of the health information deleted text begin exchange service providerdeleted text end new text begin
organizationnew text end to appear at the hearing, the commissioner shall take action as deemed necessary
and shall issue written findings and mail them to the health information deleted text begin exchange service
providerdeleted text end new text begin organizationnew text end .
(c) If suspension, revocation, or administrative penalty is proposed according to this
section, the commissioner must deliver, or send by certified mail with return receipt
requested, to the health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end written notice
of the commissioner's intent to impose a penalty. This notice of proposed determination
must include:
(1) a reference to the statutory basis for the penalty;
(2) a description of the findings of fact regarding the violations with respect to which
the penalty is proposed;
(3) the nature and amount of the proposed penalty;
(4) any circumstances described in subdivision 1, paragraph (a), that were considered
in determining the amount of the proposed penalty;
(5) instructions for responding to the notice, including a statement of the health
information deleted text begin exchange service provider'sdeleted text end new text begin organization'snew text end right to a contested case proceeding
and a statement that failure to request a contested case proceeding within 30 calendar days
permits the imposition of the proposed penalty; and
(6) the address to which the contested case proceeding request must be sent.
Subd. 4.
Coordination.
The commissioner shall, to the extent possible, seek the advice
of the Minnesota e-Health Advisory Committee, in the review and update of criteria for the
certification and recertification of health information deleted text begin exchange service providersdeleted text end new text begin
organizationsnew text end when implementing sections 62J.498 to 62J.4982.
Subd. 5.
Fees and monetary penalties.
(a) The commissioner shall assess fees on every
health information deleted text begin exchange service providerdeleted text end new text begin organizationnew text end subject to sections 62J.4981 and
62J.4982 as follows:
(1) filing an application for certificate of authority to operate as a health information
organization, $7,000;new text begin and
new text end
(2) deleted text begin filing an application for certificate of authority to operate as a health data intermediary,
$7,000;
deleted text end
deleted text begin (3)deleted text end annual health information organization certificate fee, $7,000deleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(4) annual health data intermediary certificate fee, $7,000.
deleted text end
(b) Fees collected under this section shall be deposited in the state treasury and credited
to the state government special revenue fund.
(c) Administrative monetary penalties imposed under this subdivision shall be credited
to an account in the special revenue fund and are appropriated to the commissioner for the
purposes of sections 62J.498 to 62J.4982.
Sec. 8.
Minnesota Statutes 2020, section 62J.84, subdivision 6, is amended to read:
Subd. 6.
Public posting of prescription drug price information.
(a) The commissioner
shall post on the department's website, or may contract with a private entity or consortium
that satisfies the standards of section 62U.04, subdivision 6, to meet this requirement, the
following information:
(1) a list of the prescription drugs reported under subdivisions 3, 4, and 5, and the
manufacturers of those prescription drugs; and
(2) information reported to the commissioner under subdivisions 3, 4, and 5.
(b) The information must be published in an easy-to-read format and in a manner that
identifies the information that is disclosed on a per-drug basis and must not be aggregated
in a manner that prevents the identification of the prescription drug.
(c) The commissioner shall not post to the department's website or a private entity
contracting with the commissioner shall not post any information described in this section
if the information is not public data under section 13.02, subdivision 8a; or is trade secret
information under section 13.37, subdivision 1, paragraph (b); or is trade secret information
pursuant to the Defend Trade Secrets Act of 2016, United States Code, title 18, section
1836, as amended. If a manufacturer believes information should be withheld from public
disclosure pursuant to this paragraph, the manufacturer must clearly and specifically identify
that information and describe the legal basis in writing when the manufacturer submits the
information under this section. If the commissioner disagrees with the manufacturer's request
to withhold information from public disclosure, the commissioner shall provide the
manufacturer written notice that the information will be publicly posted 30 days after the
date of the notice.
(d) If the commissioner withholds any information from public disclosure pursuant to
this subdivision, the commissioner shall post to the department's website a report describing
the nature of the information and the commissioner's basis for withholding the information
from disclosure.
new text begin
(e) To the extent the information required to be posted under this subdivision is collected
and made available to the public by another state, by the University of Minnesota, or through
an online drug pricing reference and analytical tool, the commissioner may reference the
availability of this drug price data from another source including, within existing
appropriations, creating the ability of the public to access the data from the source for
purposes of meeting the reporting requirements of this subdivision.
new text end
Sec. 9.
Minnesota Statutes 2020, section 144.05, is amended by adding a subdivision to
read:
new text begin Subd. 7. new text end
new text begin Expiration of report mandates. new text end
new text begin
(a) If the submission of a report by the
commissioner of health to the legislature is mandated by statute and the enabling legislation
does not include a date for the submission of a final report, the mandate to submit the report
shall expire in accordance with this section.
new text end
new text begin
(b) If the mandate requires the submission of an annual report and the mandate was
enacted before January 1, 2021, the mandate shall expire on January 1,2023. If the mandate
requires the submission of a biennial or less frequent report and the mandate was enacted
before January 1, 2021, the mandate shall expire on January 1, 2024.
new text end
new text begin
(c) Any reporting mandate enacted on or after January 1, 2021 shall expire three years
after the date of enactment if the mandate requires the submission of an annual report and
shall expire five years after the date of enactment if the mandate requires the submission
of a biennial or less frequent report, unless the enacting legislation provides for a difference
expiration date.
new text end
new text begin
(d) The commissioner shall submit a list to the chairs and ranking minority members of
the legislative committee with jurisdiction over health by February 15 of each year, beginning
February 15, 2022, of all reports set to expire during the following calendar year in
accordance with this section.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 10.
new text begin
[144.064] THE VIVIAN ACT.
new text end
new text begin Subdivision 1. new text end
new text begin Short title. new text end
new text begin
This section shall be known and may be cited as the "Vivian
Act."
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
(1) "commissioner" means the commissioner of health;
new text end
new text begin
(2) "health care practitioner" means a medical professional that provides prenatal or
postnatal care;
new text end
new text begin
(3) "CMV" means the human herpesvirus cytomegalovirus, also called HCMV, human
herpesvirus 5, and HHV-5; and
new text end
new text begin
(4) "congenital CMV" means the transmission of a CMV infection from a pregnant
mother to her fetus.
new text end
new text begin Subd. 3. new text end
new text begin Commissioner duties. new text end
new text begin
(a) The commissioner shall make available to health
care practitioners, women who may become pregnant, expectant parents, and parents of
infants up-to-date and evidence-based information about congenital CMV that has been
reviewed by experts with knowledge of the disease. The information shall include the
following:
new text end
new text begin
(1) the recommendation to consider testing for congenital CMV if the parent or legal
guardian of the infant elected not to have newborn screening performed under section
144.125, and the infant failed a newborn hearing screening or pregnancy history suggests
increased risk for congenital CMV infection;
new text end
new text begin
(2) the incidence of CMV;
new text end
new text begin
(3) the transmission of CMV to pregnant women and women who may become pregnant;
new text end
new text begin
(4) birth defects caused by congenital CMV;
new text end
new text begin
(5) available preventative measures to avoid the infection of women who are pregnant
or may become pregnant; and
new text end
new text begin
(6) resources available for families of children born with congenital CMV.
new text end
new text begin
(b) The commissioner shall follow existing department practice, inclusive of community
engagement, to ensure that the information in paragraph (a) is culturally and linguistically
appropriate for all recipients.
new text end
new text begin
(c) The department shall establish an outreach program to:
new text end
new text begin
(1) educate women who may become pregnant, expectant parents, and parents of infants
about CMV; and
new text end
new text begin
(2) raise awareness for CMV among health care providers who provide care to expectant
mothers or infants.
new text end
Sec. 11.
Minnesota Statutes 2020, section 144.1205, subdivision 2, is amended to read:
Subd. 2.
new text begin Initial and new text end annual fee.
new text begin
(a) A licensee must pay an initial fee that is equivalent
to the annual fee upon issuance of the initial license.
new text end
new text begin (b) new text end A licensee must pay an annual fee at least 60 days before the anniversary date of the
issuance of the license. The annual fee is as follows:
| TYPE |
deleted text begin ANNUALdeleted text end new text begin LICENSEnew text end FEE |
||
| Academic broad scope - type Anew text begin , B, or C new text end |
deleted text begin
$19,920
deleted text end
new text begin
$25,896 new text end |
||
|
deleted text begin
Academic broad scope - type B deleted text end |
deleted text begin
19,920 deleted text end |
||
|
deleted text begin
Academic broad scope - type C deleted text end |
deleted text begin
19,920 deleted text end |
||
|
new text begin
Academic broad scope - type A, B, or C (4-8 locations) new text end |
new text begin
$31,075 new text end |
||
|
new text begin
Academic broad scope - type A, B, or C (9 or more locations) new text end |
new text begin
$36,254 new text end |
||
| Medical broad scope - type A |
deleted text begin
19,920
deleted text end
new text begin
$25,896 new text end |
||
|
new text begin
Medical broad scope- type A (4-8 locations) new text end |
new text begin
$31,075 new text end |
||
|
new text begin
Medical broad scope- type A (9 or more locations) new text end |
new text begin
$36,254 new text end |
||
|
deleted text begin
Medical institution - diagnostic and therapeutic deleted text end |
deleted text begin
3,680 deleted text end |
||
|
new text begin
Medical - diagnostic, diagnostic and therapeutic, mobile nuclear medicine, eye applicators, high dose rate afterloaders, and medical therapy emerging technologies new text end |
new text begin
$4,784 new text end |
||
|
new text begin
Medical - diagnostic, diagnostic and therapeutic, mobile nuclear medicine, eye applicators, high dose rate afterloaders, and medical therapy emerging technologies (4-8 locations) new text end |
new text begin
$5,740 new text end |
||
|
new text begin
Medical - diagnostic, diagnostic and therapeutic, mobile nuclear medicine, eye applicators, high dose rate afterloaders, and medical therapy emerging technologies (9 or more locations) new text end |
new text begin
$6,697 new text end |
||
|
deleted text begin
Medical institution - diagnostic (no written directives) deleted text end |
deleted text begin
3,680 deleted text end |
||
|
deleted text begin
Medical private practice - diagnostic and therapeutic deleted text end |
deleted text begin
3,680 deleted text end |
||
|
deleted text begin
Medical private practice - diagnostic (no written directives) deleted text end |
deleted text begin
3,680 deleted text end |
||
|
deleted text begin
Eye applicators deleted text end |
deleted text begin
3,680 deleted text end |
||
|
deleted text begin
Nuclear medical vans deleted text end |
deleted text begin
3,680 deleted text end |
||
|
deleted text begin
High dose rate afterloader deleted text end |
deleted text begin
3,680 deleted text end |
||
|
deleted text begin
Mobile high dose rate afterloader deleted text end |
deleted text begin
3,680 deleted text end |
||
|
deleted text begin
Medical therapy - other emerging technology deleted text end |
deleted text begin
3,680 deleted text end |
||
| Teletherapy |
deleted text begin
8,960
deleted text end
new text begin
$11,648 new text end |
||
| Gamma knife |
deleted text begin
8,960
deleted text end
new text begin
$11,648 new text end |
||
| Veterinary medicine |
deleted text begin
2,000
deleted text end
new text begin
$2,600 new text end |
||
| In vitro testing lab |
deleted text begin
2,000
deleted text end
new text begin
$2,600 new text end |
||
| Nuclear pharmacy |
deleted text begin
8,800
deleted text end
new text begin
$11,440 new text end |
||
|
new text begin
Nuclear pharmacy (5 or more locations) new text end |
new text begin
$13,728 new text end |
||
| Radiopharmaceutical distribution (10 CFR 32.72) |
deleted text begin
3,840
deleted text end
new text begin
$4,992 new text end |
||
| Radiopharmaceutical processing and distribution (10 CFR 32.72) |
deleted text begin
8,800
deleted text end
new text begin
$11,440 new text end |
||
|
new text begin
Radiopharmaceutical processing and distribution (10 CFR 32.72) (5 or more locations) new text end |
new text begin
$13,728 new text end |
||
| Medical sealed sources - distribution (10 CFR 32.74) |
deleted text begin
3,840
deleted text end
new text begin
$4,992 new text end |
||
| Medical sealed sources - processing and distribution (10 CFR 32.74) |
deleted text begin
8,800
deleted text end
new text begin
$11,440 new text end |
||
|
new text begin
Medical sealed sources - processing and distribution (10 CFR 32.74) (5 or more locations) new text end |
new text begin
$13,728 new text end |
||
| Well logging - sealed sources |
deleted text begin
3,760
deleted text end
new text begin
$4,888 new text end |
||
| Measuring systems - new text begin (new text end fixed gaugenew text begin , portable gauge, gas chromatograph, other) new text end |
deleted text begin
2,000
deleted text end
new text begin
$2,600 new text end |
||
|
deleted text begin
Measuring systems - portable gauge deleted text end |
deleted text begin
2,000 deleted text end |
||
|
new text begin
Measuring systems - (fixed gauge, portable gauge, gas chromatograph, other) (4-8 locations) new text end |
new text begin
$3,120 new text end |
||
|
new text begin
Measuring systems - (fixed gauge, portable gauge, gas chromatograph, other) (9 or more locations) new text end |
new text begin
$3,640 new text end |
||
| X-ray fluorescent analyzer |
deleted text begin
1,520
deleted text end
new text begin
$1,976 new text end |
||
|
deleted text begin
Measuring systems - gas chromatograph deleted text end |
deleted text begin
2,000 deleted text end |
||
|
deleted text begin
Measuring systems - other deleted text end |
deleted text begin
2,000 deleted text end |
||
| deleted text begin Broad scopedeleted text end Manufacturing and distribution - type Anew text begin broad scope new text end |
deleted text begin
19,920
deleted text end
new text begin
$25,896 new text end |
||
|
new text begin
Manufacturing and distribution - type A broad scope (4-8 locations) new text end |
new text begin
$31,075 new text end |
||
|
new text begin
Manufacturing and distribution - type A broad scope (9 or more locations) new text end |
new text begin
$36,254 new text end |
||
| deleted text begin Broad scopedeleted text end Manufacturing and distribution - type Bnew text begin or C broad scope new text end |
deleted text begin
17,600
deleted text end
new text begin
$22,880 new text end |
||
|
deleted text begin
Broad scope Manufacturing and distribution - type C deleted text end |
deleted text begin
17,600 deleted text end |
||
|
new text begin
Manufacturing and distribution - type B or C broad scope (4-8 locations) new text end |
new text begin
$27,456 new text end |
||
|
new text begin
Manufacturing and distribution - type B or C broad scope (9 or more locations) new text end |
new text begin
$32,032 new text end |
||
| Manufacturing and distribution - other |
deleted text begin
5,280
deleted text end
new text begin
$6,864 new text end |
||
|
new text begin
Manufacturing and distribution - other (4-8 locations) new text end |
new text begin
$8,236 new text end |
||
|
new text begin
Manufacturing and distribution - other (9 or more locations) new text end |
new text begin
$9,609 new text end |
||
| Nuclear laundry |
deleted text begin
18,640
deleted text end
new text begin
$24,232 new text end |
||
| Decontamination services |
deleted text begin
4,960
deleted text end
new text begin
$6,448 new text end |
||
| Leak test services only |
deleted text begin
2,000
deleted text end
new text begin
$2,600 new text end |
||
| Instrument calibration service onlydeleted text begin , less than 100 curies deleted text end |
deleted text begin
2,000
deleted text end
new text begin
$2,600 new text end |
||
|
deleted text begin
Instrument calibration service only, 100 curies or more deleted text end |
deleted text begin
2,000 deleted text end |
||
| Service, maintenance, installation, source changes, etc. |
deleted text begin
4,960
deleted text end
new text begin
$6,448 new text end |
||
| Waste disposal service, prepackaged only |
deleted text begin
6,000
deleted text end
new text begin
$7,800 new text end |
||
| Waste disposal |
deleted text begin
8,320
deleted text end
new text begin
$10,816 new text end |
||
| Distribution - general licensed devices (sealed sources) |
deleted text begin
1,760
deleted text end
new text begin
$2,288 new text end |
||
| Distribution - general licensed material (unsealed sources) |
deleted text begin
1,120
deleted text end
new text begin
$1,456 new text end |
||
| Industrial radiography - fixednew text begin or temporarynew text end location |
deleted text begin
9,840
deleted text end
new text begin
$12,792 new text end |
||
|
deleted text begin
Industrial radiography - temporary job sites deleted text end |
deleted text begin
9,840 deleted text end |
||
|
new text begin
Industrial radiography - fixed or temporary location (5 or more locations) new text end |
new text begin
$16,629 new text end |
||
| Irradiators, self-shieldingdeleted text begin , less than 10,000 curies deleted text end |
deleted text begin
2,880
deleted text end
new text begin
$3,744 new text end |
||
| Irradiators, other, less than 10,000 curies |
deleted text begin
5,360
deleted text end
new text begin
$6,968 new text end |
||
|
deleted text begin
Irradiators, self-shielding, 10,000 curies or more deleted text end |
deleted text begin
2,880 deleted text end |
||
| Research and development - type Anew text begin , B, or Cnew text end broad scope |
deleted text begin
9,520
deleted text end
new text begin
$12,376 new text end |
||
|
deleted text begin
Research and development - type B broad scope deleted text end |
deleted text begin
9,520 deleted text end |
||
|
deleted text begin
Research and development - type C broad scope deleted text end |
deleted text begin
9,520 deleted text end |
||
|
new text begin
Research and development - type A, B, or C broad scope (4-8 locations) new text end |
new text begin
$14,851 new text end |
||
|
new text begin
Research and development - type A, B, or C broad scope (9 or more locations) new text end |
new text begin
$17,326 new text end |
||
| Research and development - other |
deleted text begin
4,480
deleted text end
new text begin
$5,824 new text end |
||
| Storage - no operations |
deleted text begin
2,000
deleted text end
new text begin
$2,600 new text end |
||
| Source material - shielding |
deleted text begin
584
deleted text end
new text begin
$759 new text end |
||
| Special nuclear material plutonium - neutron source in device |
deleted text begin
3,680
deleted text end
new text begin
$4,784 new text end |
||
| Pacemaker by-product and/or special nuclear material - medical (institution) |
deleted text begin
3,680
deleted text end
new text begin
$4,784 new text end |
||
| Pacemaker by-product and/or special nuclear material - manufacturing and distribution |
deleted text begin
5,280
deleted text end
new text begin
$6,864 new text end |
||
| Accelerator-produced radioactive material |
deleted text begin
3,840
deleted text end
new text begin
$4,992 new text end |
||
| Nonprofit educational institutions |
deleted text begin
300
deleted text end
new text begin
$500 new text end |
||
|
deleted text begin
General license registration deleted text end |
deleted text begin
150 deleted text end |
||
Sec. 12.
Minnesota Statutes 2020, section 144.1205, subdivision 4, is amended to read:
Subd. 4.
new text begin Initial and renewal new text end application fee.
A licensee must pay an new text begin initial and a
renewal new text end application fee deleted text begin as follows:deleted text end new text begin according to this subdivision.
new text end
| TYPE |
APPLICATION FEE |
||
| Academic broad scope - type Anew text begin , B, or C new text end |
deleted text begin
$ 5,920
deleted text end
new text begin
$6,808 new text end |
||
|
deleted text begin
Academic broad scope - type B deleted text end |
deleted text begin
5,920 deleted text end |
||
|
deleted text begin
Academic broad scope - type C deleted text end |
deleted text begin
5,920 deleted text end |
||
| Medical broad scope - type A |
deleted text begin
3,920
deleted text end
new text begin
$4,508 new text end |
||
|
new text begin
Medical - diagnostic, diagnostic and therapeutic, mobile nuclear medicine, eye applicators, high dose rate afterloaders, and medical therapy emerging technologies new text end |
new text begin
$1,748 new text end |
||
|
deleted text begin
Medical institution - diagnostic and therapeutic deleted text end |
deleted text begin
1,520 deleted text end |
||
|
deleted text begin
Medical institution - diagnostic (no written directives) deleted text end |
deleted text begin
1,520 deleted text end |
||
|
deleted text begin
Medical private practice - diagnostic and therapeutic deleted text end |
deleted text begin
1,520 deleted text end |
||
|
deleted text begin
Medical private practice - diagnostic (no written directives) deleted text end |
deleted text begin
1,520 deleted text end |
||
|
deleted text begin
Eye applicators deleted text end |
deleted text begin
1,520 deleted text end |
||
|
deleted text begin
Nuclear medical vans deleted text end |
deleted text begin
1,520 deleted text end |
||
|
deleted text begin
High dose rate afterloader deleted text end |
deleted text begin
1,520 deleted text end |
||
|
deleted text begin
Mobile high dose rate afterloader deleted text end |
deleted text begin
1,520 deleted text end |
||
|
deleted text begin
Medical therapy - other emerging technology deleted text end |
deleted text begin
1,520 deleted text end |
||
| Teletherapy |
deleted text begin
5,520
deleted text end
new text begin
$6,348 new text end |
||
| Gamma knife |
deleted text begin
5,520
deleted text end
new text begin
$6,348 new text end |
||
| Veterinary medicine |
deleted text begin
960
deleted text end
new text begin
$1,104 new text end |
||
| In vitro testing lab |
deleted text begin
960
deleted text end
new text begin
$1,104 new text end |
||
| Nuclear pharmacy |
deleted text begin
4,880
deleted text end
new text begin
$5,612 new text end |
||
| Radiopharmaceutical distribution (10 CFR 32.72) |
deleted text begin
2,160
deleted text end
new text begin
$2,484 new text end |
||
| Radiopharmaceutical processing and distribution (10 CFR 32.72) |
deleted text begin
4,880
deleted text end
new text begin
$5,612 new text end |
||
| Medical sealed sources - distribution (10 CFR 32.74) |
deleted text begin
2,160
deleted text end
new text begin
$2,484 new text end |
||
| Medical sealed sources - processing and distribution (10 CFR 32.74) |
deleted text begin
4,880
deleted text end
new text begin
$5,612 new text end |
||
| Well logging - sealed sources |
deleted text begin
1,600
deleted text end
new text begin
$1,840 new text end |
||
| Measuring systems - new text begin (new text end fixed gaugenew text begin , portable gauge, gas chromatograph, other) new text end |
deleted text begin
960
deleted text end
new text begin
$1,104 new text end |
||
|
deleted text begin
Measuring systems - portable gauge deleted text end |
deleted text begin
960 deleted text end |
||
| X-ray fluorescent analyzer |
deleted text begin
584
deleted text end
new text begin
$671 new text end |
||
|
deleted text begin
Measuring systems - gas chromatograph deleted text end |
deleted text begin
960 deleted text end |
||
|
deleted text begin
Measuring systems - other deleted text end |
deleted text begin
960 deleted text end |
||
| deleted text begin Broad scopedeleted text end Manufacturing and distribution - type Anew text begin , B, and C broad scope new text end |
deleted text begin
5,920
deleted text end
new text begin
$6,854 new text end |
||
|
deleted text begin
Broad scope manufacturing and distribution - type B deleted text end |
deleted text begin
5,920 deleted text end |
||
|
deleted text begin
Broad scope manufacturing and distribution - type C deleted text end |
deleted text begin
5,920 deleted text end |
||
| Manufacturing and distribution - other |
deleted text begin
2,320
deleted text end
new text begin
$2,668 new text end |
||
| Nuclear laundry |
deleted text begin
10,080
deleted text end
new text begin
$11,592 new text end |
||
| Decontamination services |
deleted text begin
2,640
deleted text end
new text begin
$3,036 new text end |
||
| Leak test services only |
deleted text begin
960
deleted text end
new text begin
$1,104 new text end |
||
| Instrument calibration service onlydeleted text begin , less than 100 curies deleted text end |
deleted text begin
960
deleted text end
new text begin
$1,104 new text end |
||
|
deleted text begin
Instrument calibration service only, 100 curies or more deleted text end |
deleted text begin
960 deleted text end |
||
| Service, maintenance, installation, source changes, etc. |
deleted text begin
2,640
deleted text end
new text begin
$3,036 new text end |
||
| Waste disposal service, prepackaged only |
deleted text begin
2,240
deleted text end
new text begin
$2,576 new text end |
||
| Waste disposal |
deleted text begin
1,520
deleted text end
new text begin
$1,748 new text end |
||
| Distribution - general licensed devices (sealed sources) |
deleted text begin
880
deleted text end
new text begin
$1,012 new text end |
||
| Distribution - general licensed material (unsealed sources) |
deleted text begin
520
deleted text end
new text begin
$598 new text end |
||
| Industrial radiography - fixed new text begin or temporary new text end location |
deleted text begin
2,640
deleted text end
new text begin
$3,036 new text end |
||
|
deleted text begin
Industrial radiography - temporary job sites deleted text end |
deleted text begin
2,640 deleted text end |
||
| Irradiators, self-shieldingdeleted text begin , less than 10,000 curies deleted text end |
deleted text begin
1,440
deleted text end
new text begin
$1,656 new text end |
||
| Irradiators, other, less than 10,000 curies |
deleted text begin
2,960
deleted text end
new text begin
$3,404 new text end |
||
|
deleted text begin
Irradiators, self-shielding, 10,000 curies or more deleted text end |
deleted text begin
1,440 deleted text end |
||
| Research and development - type Anew text begin , B, or Cnew text end broad scope |
deleted text begin
4,960
deleted text end
new text begin
$5,704 new text end |
||
|
deleted text begin
Research and development - type B broad scope deleted text end |
deleted text begin
4,960 deleted text end |
||
|
deleted text begin
Research and development - type C broad scope deleted text end |
deleted text begin
4,960 deleted text end |
||
| Research and development - other |
deleted text begin
2,400
deleted text end
new text begin
$2,760 new text end |
||
| Storage - no operations |
deleted text begin
960
deleted text end
new text begin
$1,104 new text end |
||
| Source material - shielding |
deleted text begin
136
deleted text end
new text begin
$156 new text end |
||
| Special nuclear material plutonium - neutron source in device |
deleted text begin
1,200
deleted text end
new text begin
$1,380 new text end |
||
| Pacemaker by-product and/or special nuclear material - medical (institution) |
deleted text begin
1,200
deleted text end
new text begin
$1,380 new text end |
||
| Pacemaker by-product and/or special nuclear material - manufacturing and distribution |
deleted text begin
2,320
deleted text end
new text begin
$2,668 new text end |
||
| Accelerator-produced radioactive material |
deleted text begin
4,100
deleted text end
new text begin
$4,715 new text end |
||
| Nonprofit educational institutions |
deleted text begin
300
deleted text end
new text begin
$345 new text end |
||
|
deleted text begin
General license registration deleted text end |
deleted text begin
0 deleted text end |
||
|
deleted text begin
Industrial radiographer certification deleted text end |
deleted text begin
150 deleted text end |
||
Sec. 13.
Minnesota Statutes 2020, section 144.1205, subdivision 8, is amended to read:
Subd. 8.
Reciprocity fee.
A licensee submitting an application for reciprocal recognition
of a materials license issued by another agreement state or the United States Nuclear
Regulatory Commission for a period of 180 days or less during a calendar year must pay
deleted text begin $1,200deleted text end new text begin $2,400new text end . For a period of 181 days or more, the licensee must obtain a license under
subdivision 4.
Sec. 14.
Minnesota Statutes 2020, section 144.1205, subdivision 9, is amended to read:
Subd. 9.
Fees for license amendments.
A licensee must pay a fee of deleted text begin $300deleted text end new text begin $600new text end to
amend a license as follows:
(1) to amend a license requiring review including, but not limited to, addition of isotopes,
procedure changes, new authorized users, or a new radiation safety officer; and
(2) to amend a license requiring review and a site visit including, but not limited to,
facility move or addition of processes.
Sec. 15.
Minnesota Statutes 2020, section 144.1205, is amended by adding a subdivision
to read:
new text begin Subd. 10. new text end
new text begin Fees for general license registrations. new text end
new text begin
A person required to register generally
licensed devices according to Minnesota Rules, part 4731.3215, must pay an annual
registration fee of $450.
new text end
Sec. 16.
Minnesota Statutes 2020, section 144.125, subdivision 1, is amended to read:
Subdivision 1.
Duty to perform testing.
(a) It is the duty of (1) the administrative officer
or other person in charge of each institution caring for infants 28 days or less of age, (2) the
person required in pursuance of the provisions of section 144.215, to register the birth of a
child, or (3) the nurse midwife or midwife in attendance at the birth, to arrange to have
administered to every infant or child in its care tests for heritable and congenital disorders
according to subdivision 2 and rules prescribed by the state commissioner of health.
(b) Testing, recording of test results, reporting of test results, and follow-up of infants
with heritable congenital disorders, including hearing loss detected through the early hearing
detection and intervention program in section 144.966, shall be performed at the times and
in the manner prescribed by the commissioner of health.
(c) The fee to support the newborn screening program, including tests administered
under this section and section 144.966, shall be deleted text begin $135deleted text end new text begin $177new text end per specimen. This fee amount
shall be deposited in the state treasury and credited to the state government special revenue
fund.
(d) The fee to offset the cost of the support services provided under section 144.966,
subdivision 3a, shall be $15 per specimen. This fee shall be deposited in the state treasury
and credited to the general fund.
Sec. 17.
Minnesota Statutes 2020, section 144.125, subdivision 2, is amended to read:
Subd. 2.
Determination of tests to be administered.
new text begin (a) new text end The commissioner shall
periodically revise the list of tests to be administered for determining the presence of a
heritable or congenital disorder. Revisions to the list shall reflect advances in medical
science, new and improved testing methods, or other factors that will improve the public
health. In determining whether a test must be administered, the commissioner shall take
into consideration the adequacy of analytical methods to detect the heritable or congenital
disorder, the ability to treat or prevent medical conditions caused by the heritable or
congenital disorder, and the severity of the medical conditions caused by the heritable or
congenital disorder. The list of tests to be performed may be revised if the changes are
recommended by the advisory committee established under section 144.1255, approved by
the commissioner, and published in the State Register. The revision is exempt from the
rulemaking requirements in chapter 14, and sections 14.385 and 14.386 do not apply.
new text begin
(b) Notwithstanding paragraph (a), a test to detect congenital human herpesvirus
cytomegalovirus shall be added to the list of tests to be administered under this section.
new text end
Sec. 18.
new text begin
[144.1461] PREGNANCY AND CHILDBIRTH; MIDWIFE AND DOULA
CARE.
new text end
new text begin
In order to improve maternal and infant health as well as improving birth outcomes in
groups with the most significant disparities that include Black, Indigenous, and other
communities of color; rural communities; and people with low incomes, the commissioner
of health in partnership with patient groups and culturally based community organizations
shall, within existing appropriations:
new text end
new text begin
(1) develop procedures and services designed for making midwife and doula services
available to groups with the most maternal and infant mortality and morbidity disparities;
new text end
new text begin
(2) promote racial, ethnic, and language diversity in the midwife and doula workforce
that better aligns with the childbearing population in groups with the most significant
maternal and infant mortality and morbidity disparities; and
new text end
new text begin
(3) ensure that midwife and doula training and education is tailored to the specific needs
of groups with the most significant maternal and infant mortality and morbidity disparities,
including trauma-informed care, maternal mood disorders, intimate partner violence, and
systemic racism.
new text end
Sec. 19.
Minnesota Statutes 2020, section 144.1481, subdivision 1, is amended to read:
Subdivision 1.
Establishment; membership.
The commissioner of health shall establish
a deleted text begin 15-memberdeleted text end new text begin 16-membernew text end Rural Health Advisory Committee. The committee shall consist
of the following members, all of whom must reside outside the seven-county metropolitan
area, as defined in section 473.121, subdivision 2:
(1) two members from the house of representatives of the state of Minnesota, one from
the majority party and one from the minority party;
(2) two members from the senate of the state of Minnesota, one from the majority party
and one from the minority party;
(3) a volunteer member of an ambulance service based outside the seven-county
metropolitan area;
(4) a representative of a hospital located outside the seven-county metropolitan area;
(5) a representative of a nursing home located outside the seven-county metropolitan
area;
(6) a medical doctor or doctor of osteopathic medicine licensed under chapter 147;
(7) new text begin a dentist licensed under chapter 150A;
new text end
new text begin (8) new text end a midlevel practitioner;
deleted text begin (8)deleted text end new text begin (9)new text end a registered nurse or licensed practical nurse;
deleted text begin (9)deleted text end new text begin (10)new text end a licensed health care professional from an occupation not otherwise represented
on the committee;
deleted text begin (10)deleted text end new text begin (11)new text end a representative of an institution of higher education located outside the
seven-county metropolitan area that provides training for rural health care providers; and
deleted text begin (11)deleted text end new text begin (12)new text end three consumers, at least one of whom must be an advocate for persons who
are mentally ill or developmentally disabled.
The commissioner will make recommendations for committee membership. Committee
members will be appointed by the governor. In making appointments, the governor shall
ensure that appointments provide geographic balance among those areas of the state outside
the seven-county metropolitan area. The chair of the committee shall be elected by the
members. The advisory committee is governed by section 15.059, except that the members
do not receive per diem compensation.
Sec. 20.
Minnesota Statutes 2020, section 144.216, is amended by adding a subdivision
to read:
new text begin Subd. 3. new text end
new text begin Reporting safe place newborn births. new text end
new text begin
A hospital that receives a safe place
newborn under section 145.902 shall report the birth of the newborn to the Office of Vital
Records within five days after receiving the newborn. The state registrar must register
information about the safe place newborn according to Minnesota Rules, part 4601.0600,
subpart 4, item C.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 21.
Minnesota Statutes 2020, section 144.216, is amended by adding a subdivision
to read:
new text begin Subd. 4. new text end
new text begin Status of safe place birth registrations. new text end
new text begin
(a) Information about the safe place
newborn registered under subdivision 3 shall constitute the record of birth for the child. The
birth record for the child is confidential data on individuals as defined in section 13.02,
subdivision 3. Information about the child's birth record or a child's birth certificate issued
from the child's birth record shall be disclosed only to the responsible social services agency
as defined in section 260C.007, subdivision 27a, or pursuant to court order.
new text end
new text begin
(b) Pursuant to section 144.218, subdivision 6, if the safe place newborn was born in a
hospital and it is known that the child's record of birth was registered, the Office of Vital
Records shall replace the original birth record registered under section 144.215.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 22.
Minnesota Statutes 2020, section 144.218, is amended by adding a subdivision
to read:
new text begin Subd. 6. new text end
new text begin Safe place newborns. new text end
new text begin
If a hospital receives a safe place newborn under section
145.902 and it is known that the child's record of birth was registered, the hospital shall
report the newborn to the Office of Vital Records and identify the child's birth record. The
state registrar shall issue a replacement birth record for the child that is free of information
that identifies a parent. The prior vital record is confidential data on individuals as defined
in section 13.02, subdivision 3, and shall not be disclosed except pursuant to court order.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 23.
Minnesota Statutes 2020, section 144.225, subdivision 7, is amended to read:
Subd. 7.
Certified birth or death record.
(a) The state registrar or local issuance office
shall issue a certified birth or death record or a statement of no vital record found to an
individual upon the individual's proper completion of an attestation provided by the
commissioner and payment of the required fee:
(1) to a person who deleted text begin has a tangible interest in the requested vital record. A person who
has a tangible interestdeleted text end is:
(i) the subject of the vital record;
(ii) a child of the subject;
(iii) the spouse of the subject;
(iv) a parent of the subject;
(v) the grandparent or grandchild of the subject;
(vi) if the requested record is a death record, a sibling of the subject;
deleted text begin
(vii) the party responsible for filing the vital record;
deleted text end
deleted text begin (viii)deleted text end new text begin (vii)new text end the legal custodian, guardian or conservator, or health care agent of the subject;
deleted text begin (ix)deleted text end new text begin (viii)new text end a personal representative, by sworn affidavit of the fact that the certified copy
is required for administration of the estate;
deleted text begin (x)deleted text end new text begin (ix)new text end a successor of the subject, as defined in section 524.1-201, if the subject is
deceased, by sworn affidavit of the fact that the certified copy is required for administration
of the estate;
deleted text begin (xi)deleted text end new text begin (x)new text end if the requested record is a death record, a trustee of a trust by sworn affidavit
of the fact that the certified copy is needed for the proper administration of the trust;
deleted text begin (xii)deleted text end new text begin (xi)new text end a person or entity who demonstrates that a certified vital record is necessary
for the determination or protection of a personal or property right, pursuant to rules adopted
by the commissioner; or
deleted text begin (xiii)deleted text end new text begin (xii)new text end an adoption agency in order to complete confidential postadoption searches
as required by section 259.83;
(2) to any local, state, tribal, or federal governmental agency upon request if the certified
vital record is necessary for the governmental agency to perform its authorized duties;
(3) to an attorney new text begin representing the subject of the vital record or another person listed in
clause (1), new text end upon evidence of the attorney's license;
(4) pursuant to a court order issued by a court of competent jurisdiction. For purposes
of this section, a subpoena does not constitute a court order; or
(5) to a representative authorized by a person under clauses (1) to (4).
(b) The state registrar or local issuance office shall also issue a certified death record to
an individual described in paragraph (a), clause (1), items (ii) to deleted text begin (viii)deleted text end new text begin (xi)new text end , if, on behalf of
the individual, a licensed mortician furnishes the registrar with a properly completed
attestation in the form provided by the commissioner within 180 days of the time of death
of the subject of the death record. This paragraph is not subject to the requirements specified
in Minnesota Rules, part 4601.2600, subpart 5, item B.
Sec. 24.
Minnesota Statutes 2020, section 144.226, subdivision 1, is amended to read:
Subdivision 1.
Which services are for fee.
(a) The fees for the following services shall
be the following or an amount prescribed by rule of the commissioner:
(b) The fee for the administrative review and processing of a request for a certified vital
record or a certification that the vital record cannot be found is $9. The fee is payable at the
time of application and is nonrefundable.
(c) The fee for processing a request for the replacement of a birth record for all events,
except new text begin for safe place newborns pursuant to section 144.218, subdivision 6, and new text end when filing
a recognition of parentage pursuant to section 257.73, subdivision 1, is $40. The fee is
payable at the time of application and is nonrefundable.
(d) The fee for administrative review and processing of a request for the filing of a
delayed registration of birth, stillbirth, or death is $40. The fee is payable at the time of
application and is nonrefundable.
(e) The fee for administrative review and processing of a request for the amendment of
any vital record is $40. The fee is payable at the time of application and is nonrefundable.
(f) The fee for administrative review and processing of a request for the verification of
information from vital records is $9 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 subject of the record. Fees charged shall approximate
the costs incurred in searching and copying the vital records. The fee is payable at the time
of application and is nonrefundable.
(g) The fee for administrative review and processing of a request for the issuance of a
copy of any document on file pertaining to a vital record or statement that a related document
cannot be found is $9. The fee is payable at the time of application and is nonrefundable.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 25.
Minnesota Statutes 2020, 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 operated by a hospital 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, notwithstanding section 144.552, 27
beds, of which 12 serve mental health needs, may be transferred from Hennepin County
Medical Center to Regions Hospital under this clause;
(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 in an existing
hospital in Carver County serving the southwest suburban metropolitan area;
(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;
(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;
(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;
(20) notwithstanding section 144.552, a project for the construction of a new hospital
in the city of Maple Grove with a licensed capacity of up to 300 beds provided that:
(i) the project, including each hospital or health system that will own or control the entity
that will hold the new hospital license, is approved by a resolution of the Maple Grove City
Council as of March 1, 2006;
(ii) the entity that will hold the new hospital license will be owned or controlled by one
or more not-for-profit hospitals or health systems that have previously submitted a plan or
plans for a project in Maple Grove as required under section 144.552, and the plan or plans
have been found to be in the public interest by the commissioner of health as of April 1,
2005;
(iii) the new hospital's initial inpatient services must include, but are not limited to,
medical and surgical services, obstetrical and gynecological services, intensive care services,
orthopedic services, pediatric services, noninvasive cardiac diagnostics, behavioral health
services, and emergency room services;
(iv) the new hospital:
(A) will have the ability to provide and staff sufficient new beds to meet the growing
needs of the Maple Grove service area and the surrounding communities currently being
served by the hospital or health system that will own or control the entity that will hold the
new hospital license;
(B) will provide uncompensated care;
(C) will provide mental health services, including inpatient beds;
(D) will be a site for workforce development for a broad spectrum of health-care-related
occupations and have a commitment to providing clinical training programs for physicians
and other health care providers;
(E) will demonstrate a commitment to quality care and patient safety;
(F) will have an electronic medical records system, including physician order entry;
(G) will provide a broad range of senior services;
(H) will provide emergency medical services that will coordinate care with regional
providers of trauma services and licensed emergency ambulance services in order to enhance
the continuity of care for emergency medical patients; and
(I) will be completed by December 31, 2009, unless delayed by circumstances beyond
the control of the entity holding the new hospital license; and
(v) as of 30 days following submission of a written plan, the commissioner of health
has not determined that the hospitals or health systems that will own or control the entity
that will hold the new hospital license are unable to meet the criteria of this clause;
(21) a project approved under section 144.553;
(22) a project for the construction of a hospital with up to 25 beds in Cass County within
a 20-mile radius of the state Ah-Gwah-Ching facility, provided the hospital's license holder
is approved by the Cass County Board;
(23) a project for an acute care hospital in Fergus Falls that will increase the bed capacity
from 108 to 110 beds by increasing the rehabilitation bed capacity from 14 to 16 and closing
a separately licensed 13-bed skilled nursing facility;
(24) notwithstanding section 144.552, a project for the construction and expansion of a
specialty psychiatric hospital in Hennepin County for up to 50 beds, exclusively for patients
who are under 21 years of age on the date of admission. The commissioner conducted a
public interest review of the mental health needs of Minnesota and the Twin Cities
metropolitan area in 2008. No further public interest review shall be conducted for the
construction or expansion project under this clause;
(25) a project for a 16-bed psychiatric hospital in the city of Thief River Falls, if the
commissioner finds the project is in the public interest after the public interest review
conducted under section 144.552 is complete;
(26)(i) a project for a 20-bed psychiatric hospital, within an existing facility in the city
of Maple Grove, exclusively for patients who are under 21 years of age on the date of
admission, if the commissioner finds the project is in the public interest after the public
interest review conducted under section 144.552 is complete;
(ii) this project shall serve patients in the continuing care benefit program under section
256.9693. The project may also serve patients not in the continuing care benefit program;
and
(iii) if the project ceases to participate in the continuing care benefit program, the
commissioner must complete a subsequent public interest review under section 144.552. If
the project is found not to be in the public interest, the license must be terminated six months
from the date of that finding. If the commissioner of human services terminates the contract
without cause or reduces per diem payment rates for patients under the continuing care
benefit program below the rates in effect for services provided on December 31, 2015, the
project may cease to participate in the continuing care benefit program and continue to
operate without a subsequent public interest review;
(27) a project involving the addition of 21 new beds in an existing psychiatric hospital
in Hennepin County that is exclusively for patients who are under 21 years of age on the
date of admission; deleted text begin or
deleted text end
(28) a project to add 55 licensed beds in an existing safety net, level I trauma center
hospital in Ramsey County as designated under section 383A.91, subdivision 5, of which
15 beds are to be used for inpatient mental health and 40 are to be used for other services.
In addition, five unlicensed observation mental health beds shall be addeddeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(29) notwithstanding section 144.552, a project to add 45 licensed beds in an existing
safety net, level I trauma center hospital in Ramsey County as designated under section
383A.91, subdivision 5. The commissioner conducted a public interest review of the
construction and expansion of this hospital in 2018. No further public interest review shall
be conducted for the project under this clause.
new text end
Sec. 26.
Minnesota Statutes 2020, section 145.32, subdivision 1, is amended to read:
Subdivision 1.
Hospital records.
The superintendent or other chief administrative officer
of any public or private hospital, by and with the consent and approval of the board of
directors or other governing body of the hospital, may divest the files and records of that
hospital of any individual case records and, with that consent and approval, may destroy
the records. The records shall first have been transferred and recorded as authorized in
section 145.30.
Portions of individual hospital medical records that comprise an individual permanent
medical record, as defined by the commissioner of health, shall be retained as authorized
in section 145.30. Other portions of the individual medical record, including any
miscellaneous documents, papers, and correspondence in connection with them, may be
divested and destroyed after seven years without transfer to photographic film, electronic
image, or other state-of-the-art electronic preservation technology.
All portions of individual hospital medical records of minors shall be maintained for
seven years deleted text begin following the age of majoritydeleted text end new text begin or until the patient reaches the age of majority,
whichever occurs last, at which time the patient may request that the patient's hospital
records be deletednew text end .
Nothing in this section shall be construed to prohibit the retention of hospital medical
records beyond the periods described in this section. Nor shall anything in this section be
construed to prohibit patient access to hospital medical records as provided in sections
144.291 to 144.298.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 27.
new text begin
[145.4161] LICENSURE OF ABORTION FACILITIES.
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) "Abortion facility" means a clinic, health center, or other facility in which the
pregnancies of ten or more women known to be pregnant are willfully terminated or aborted
each month. A facility licensed as a hospital or as an outpatient surgical center pursuant to
sections 144.50 to 144.56 shall not be considered an abortion facility.
new text end
new text begin
(c) "Accrediting or membership organization" means a national organization that
establishes evidence-based clinical standards for abortion care and accredits abortion facilities
or accepts as members abortion facilities following an application and inspection process.
new text end
new text begin
(d) "Commissioner" means the commissioner of health.
new text end
new text begin Subd. 2. new text end
new text begin License required. new text end
new text begin
(a) Beginning July 1, 2022, no abortion facility shall be
established, operated, or maintained in the state without first obtaining a license from the
commissioner according to this section.
new text end
new text begin
(b) A license issued under this section is not transferable or assignable and is subject to
suspension or revocation at any time for failure to comply with this section.
new text end
new text begin
(c) If a single entity maintains abortion facilities on different premises, each facility
must obtain a separate license.
new text end
new text begin
(d) To be eligible for licensure under this section, an abortion facility must be accredited
or a member of an accrediting or membership organization or must obtain accreditation or
membership within six months of the date of the application for licensure. If the abortion
facility loses its accreditation or membership, the abortion facility must immediately notify
the commissioner.
new text end
new text begin
(e) The commissioner, the attorney general, an appropriate county attorney, or a woman
upon whom an abortion has been performed or attempted to be performed at an unlicensed
facility may seek an injunction in district court against the continued operation of the facility.
Proceedings for securing an injunction may be brought by the attorney general or by the
appropriate county attorney.
new text end
new text begin
(f) Sanctions provided in this subdivision do not restrict other available sanctions.
new text end
new text begin Subd. 3. new text end
new text begin Temporary license. new text end
new text begin
For new abortion facilities planning to begin operations
on or after July 1, 2022, the commissioner may issue a temporary license to the abortion
facility that is valid for a period of six months from the date of issuance. The abortion facility
must submit to the commissioner an application and applicable fee for licensure as required
by subdivisions 4 and 7. The application must include the information required under
subdivision 4, clauses (1), (2), and (4), and provide documentation that the abortion facility
has submitted the application for accreditation or membership from an accrediting or
membership organization. Upon receipt of accreditation or membership verification, the
abortion facility must submit to the commissioner the information required in subdivision
4, clause (3), and the applicable fee under subdivision 7. The commissioner shall then issue
a new license.
new text end
new text begin Subd. 4. new text end
new text begin Application. new text end
new text begin
An application for a license to operate an abortion facility and
the applicable fee under subdivision 7 must be submitted to the commissioner on a form
provided by the commissioner and must contain:
new text end
new text begin
(1) the name of the applicant;
new text end
new text begin
(2) the site location of the abortion facility;
new text end
new text begin
(3) documentation that the abortion facility is accredited or an approved member of an
accrediting or membership organization, including the effective date and the expiration date
of the accreditation or membership, and the date of the last site visit by the accrediting or
membership organization; and
new text end
new text begin
(4) any other information that the commissioner deems necessary.
new text end
new text begin Subd. 5. new text end
new text begin Inspections. new text end
new text begin
Prior to initial licensure and at least once every two years thereafter,
the commissioner shall perform a routine and comprehensive inspection of each abortion
facility. Facilities shall be open at all reasonable times to an inspection authorized in writing
by the commissioner. No notice need be given to any person prior to an inspection authorized
by the commissioner.
new text end
new text begin Subd. 6. new text end
new text begin Suspension, revocation, and refusal to renew. new text end
new text begin
The commissioner may refuse
to grant or renew, or may suspend or revoke, a license on any of the grounds described in
section 144.55, subdivision 6, paragraph (a), clause (2), (3), or (4), or upon the loss of
accreditation or membership described in subdivision 4, clause (3). The applicant or licensee
is entitled to notice and a hearing as described under section 144.55, subdivision 7, and a
new license may be issued after the proper inspection of an abortion facility has been
conducted.
new text end
new text begin Subd. 7. new text end
new text begin Fees. new text end
new text begin
(a) The biennial license fee for abortion facilities is $365.
new text end
new text begin
(b) The temporary license fee is $365.
new text end
new text begin
(c) Fees shall be collected and deposited according to section 144.122.
new text end
new text begin Subd. 8. new text end
new text begin Renewal. new text end
new text begin
(a) A license issued under this section expires two years from the
date of issuance.
new text end
new text begin
(b) A temporary license issued under this section expires six months from the date of
issuance and may be renewed for one additional six-month period.
new text end
new text begin Subd. 9. new text end
new text begin Records. new text end
new text begin
All health records maintained on each client by an abortion facility
are subject to sections 144.292 to 144.298.
new text end
new text begin Subd. 10. new text end
new text begin Severability. new text end
new text begin
If any one or more provision, section, subdivision, sentence,
clause, phrase, or word of this section or the application of it to any person or circumstance
is found to be unconstitutional, it is declared to be severable and the balance of this section
shall remain effective notwithstanding such unconstitutionality. The legislature intends that
it would have passed this section, and each provision, section, subdivision, sentence, clause,
phrase, or word, regardless of the fact that any one provision, section, subdivision, sentence,
clause, phrase, or word is declared unconstitutional.
new text end
Sec. 28.
new text begin
[145.87] HOME VISITING FOR PREGNANT WOMEN AND FAMILIES
WITH YOUNG CHILDREN.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) The terms defined in this subdivision apply to this section
and have the meanings given them.
new text end
new text begin
(b) "Evidence-based home visiting program" means a program that:
new text end
new text begin
(1) is based on a clear, consistent program or model that is research-based and grounded
in relevant, empirically based knowledge;
new text end
new text begin
(2) is linked to program-determined outcomes and is associated with a national
organization, institution of higher education, or national or state public health institute;
new text end
new text begin
(3) has comprehensive home visitation standards that ensure high-quality service delivery
and continuous quality improvement;
new text end
new text begin
(4) has demonstrated significant, sustained positive outcomes; and
new text end
new text begin
(5) either:
new text end
new text begin
(i) has been evaluated using rigorous randomized controlled research designs and the
evaluation results have been published in a peer-reviewed journal; or
new text end
new text begin
(ii) is based on quasi-experimental research using two or more separate, comparable
client samples.
new text end
new text begin
(c) "Evidence-informed home visiting program" means a program that:
new text end
new text begin
(1) has data or evidence demonstrating effectiveness at achieving positive outcomes for
pregnant women and young children; and
new text end
new text begin
(2) either:
new text end
new text begin
(i) has an active evaluation of the program; or
new text end
new text begin
(ii) has a plan and timeline for an active evaluation of the program to be conducted.
new text end
new text begin
(d) "Health equity" means every individual has a fair opportunity to attain the individual's
full health potential and no individual is disadvantaged from achieving this potential.
new text end
new text begin
(e) "Promising practice home visiting program" means a program that has shown
improvement toward achieving positive outcomes for pregnant women or young children.
new text end
new text begin Subd. 2. new text end
new text begin Grants for home visiting programs. new text end
new text begin
(a) The commissioner of health shall
award grants to community health boards, nonprofit organizations, and Tribal nations to
start up or expand voluntary home visiting programs serving pregnant women and families
with young children. Home visiting programs supported under this section shall provide
voluntary home visits by early childhood professionals or health professionals, including
but not limited to nurses, social workers, early childhood educators, and trained
paraprofessionals. Grant money shall be used to:
new text end
new text begin
(1) establish or expand evidence-based, evidence-informed, or promising practice home
visiting programs that address health equity and utilize community-driven health strategies;
new text end
new text begin
(2) serve families with young children or pregnant women who have high needs or are
high-risk, including but not limited to a family with low income, a parent or pregnant woman
with a mental illness or a substance use disorder, or a parent or pregnant woman experiencing
housing instability or domestic abuse; and
new text end
new text begin
(3) improve program outcomes in two or more of the following areas:
new text end
new text begin
(i) maternal and newborn health;
new text end
new text begin
(ii) school readiness and achievement;
new text end
new text begin
(iii) family economic self-sufficiency;
new text end
new text begin
(iv) coordination and referral for other community resources and supports;
new text end
new text begin
(v) reduction in child injuries, abuse, or neglect; or
new text end
new text begin
(vi) reduction in crime or domestic violence.
new text end
new text begin
(b) Grants awarded to evidence-informed and promising practice home visiting programs
must include money to evaluate program outcomes for up to four of the areas listed in
paragraph (a), clause (3).
new text end
new text begin Subd. 3. new text end
new text begin Grant prioritization. new text end
new text begin
(a) In awarding grants, the commissioner shall give
priority to community health boards, nonprofit organizations, and Tribal nations seeking to
expand home visiting services with community or regional partnerships.
new text end
new text begin
(b) The commissioner shall allocate at least 75 percent of the grant money awarded each
grant cycle to evidence-based home visiting programs that address health equity and up to
25 percent of the grant money awarded each grant cycle to evidence-informed or promising
practice home visiting programs that address health equity and utilize community-driven
health strategies.
new text end
new text begin Subd. 4. new text end
new text begin Administrative costs. new text end
new text begin
The commissioner may use up to seven percent of the
annual appropriation under this section to provide training and technical assistance and to
administer and evaluate the program. The commissioner may contract for training,
capacity-building support for grantees or potential grantees, technical assistance, and
evaluation support.
new text end
new text begin Subd. 5. new text end
new text begin Use of state general fund appropriations. new text end
new text begin
Appropriations dedicated to
establishing or expanding evidence-based home visiting programs shall, for grants awarded
on or after July 1, 2021, be awarded according to this section. This section shall not govern
grant awards of federal funds for home visiting programs and shall not govern grant awards
using state general fund appropriations dedicated to establishing or expanding nurse-family
partnership home visiting programs.
new text end
Sec. 29.
Minnesota Statutes 2020, section 145.902, is amended to read:
145.902 GIVE LIFE A CHANCE; SAFE PLACE FOR NEWBORNS DUTIES;
IMMUNITY.
Subdivision 1.
General.
(a) For purposes of this section, a "safe place" means a hospital
licensed under sections 144.50 to 144.56,new text begin including the hospital where the newborn was
born,new text end a health care provider who provides urgent care medical services, or an ambulance
service licensed under chapter 144E dispatched in response to a 911 call from a mother or
a person with the mother's permission to relinquish a newborn infant.
(b) A safe place shall receive a newborn left with an employee on the premises of the
safe place during its hours of operation, provided that:
(1) the newborn was born within seven days of being left at the safe place, as determined
within a reasonable degree of medical certainty; and
(2) the newborn is left in an unharmed condition.
(c) The safe place must not inquire as to the identity of the mother or the person leaving
the newborn or call the police, provided the newborn is unharmed when presented to the
hospital. The safe place may ask the mother or the person leaving the newborn about the
medical history of the mother or newborn new text begin and if the newborn may have lineage to an Indian
Tribe and, if known, the name of the Tribe new text end but the mother or the person leaving the newborn
is not required to provide any information. The safe place may provide the mother or the
person leaving the newborn with information about how to contact relevant social service
agencies.
(d) A safe place that is a health care provider who provides urgent care medical services
shall dial 911, advise the dispatcher that the call is being made from a safe place for
newborns, and ask the dispatcher to send an ambulance or take other appropriate action to
transport the newborn to a hospital. An ambulance with whom a newborn is left shall
transport the newborn to a hospital for care. Hospitals must receive a newborn left with a
safe place and make the report as required in subdivision 2.
Subd. 2.
Reporting.
new text begin (a) new text end Within 24 hours of receiving a newborn under this section, the
hospital must inform the responsible social service agency that a newborn has been left at
the hospital, but must not do so in the presence of the mother or the person leaving the
newborn. The hospital must provide necessary care to the newborn pending assumption of
legal responsibility by the responsible social service agency pursuant to section 260C.139,
subdivision 5.
new text begin
(b) Within five days of receiving a newborn under this section, a hospital shall report
the newborn to the Office of Vital Records pursuant to section 144.216, subdivision 3. If a
hospital receives a safe place newborn under section 145.902 and it is known that the child's
record of birth was registered because the newborn was born at that hospital, the hospital
shall report the newborn to the Office of Vital Records and identify the child's birth record.
The state registrar shall issue a replacement birth record for the child pursuant to section
144.218, subdivision 6.
new text end
Subd. 3.
Immunity.
(a) A safe place with responsibility for performing duties under
this section, and any employee, doctor, ambulance personnel, or other medical professional
working at the safe place, are immune from any criminal liability that otherwise might result
from their actions, if they are acting in good faith in receiving a newborn, and are immune
from any civil liability that otherwise might result from merely receiving a newborn.
(b) A safe place performing duties under this section, or an employee, doctor, ambulance
personnel, or other medical professional working at the safe place who is a mandated reporter
under chapter 260E, is immune from any criminal or civil liability that otherwise might
result from the failure to make a report under that section if the person is acting in good
faith in complying with this section.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 30.
new text begin
[145A.145] NURSE-FAMILY PARTNERSHIP PROGRAMS.
new text end
new text begin
(a) The commissioner of health shall award expansion grants to community health boards
and tribal nations to expand existing nurse-family partnership programs. Grant funds must
be used to start up, expand, or sustain nurse-family partnership programs in the county,
reservation, or region to serve families in accordance with the Nurse-Family Partnership
Service Office nurse-family partnership model. The commissioner shall award grants to
community health boards, nonprofit organizations, or tribal nations in metropolitan and
rural areas of the state.
new text end
new text begin
(b) Priority for all grants shall be given to nurse-family partnership programs that provide
services through a Minnesota health care program-enrolled provider that accepts medical
assistance. Priority for grants to rural areas shall be given to community health boards,
nonprofit organizations, and tribal nations that start up, expand, or sustain services within
regional partnerships that provide the nurse-family partnership program.
new text end
new text begin
(c) Funding available under this section may only be used to supplement, not to replace,
funds being used for nurse-family partnership home visiting services as of June 30, 2015.
new text end
Sec. 31.
Minnesota Statutes 2020, section 326.71, subdivision 4, is amended to read:
Subd. 4.
Asbestos-related work.
"Asbestos-related work" means the enclosure, removal,
or encapsulation of asbestos-containing material in a quantity that meets or exceeds 260
linear feet of friable asbestos-containing material on pipes, 160 square feet of friable
asbestos-containing material on other facility components, or, if linear feet or square feet
cannot be measured, a total of 35 cubic feet of friable asbestos-containing material on or
off all facility components in one facility. In the case of single or multifamily residences,
"asbestos-related work" also means the enclosure, removal, or encapsulation of greater than
ten but less than 260 linear feet of friable asbestos-containing material on pipes, greater
than six but less than 160 square feet of friable asbestos-containing material on other facility
components, or, if linear feet or square feet cannot be measured, greater than one cubic foot
but less than 35 cubic feet of friable asbestos-containing material on or off all facility
components in one facility. deleted text begin This provision excludes asbestos-containing floor tiles and
sheeting, roofing materials, siding, and all ceilings with asbestos-containing material in
single family residences and buildings with no more than four dwelling units.deleted text end
Asbestos-related work includes asbestos abatement area preparation; enclosure, removal,
or encapsulation operations; and an air quality monitoring specified in rule to assure that
the abatement and adjacent areas are not contaminated with asbestos fibers during the project
and after completion.
For purposes of this subdivision, the quantity of deleted text begin asbestos containingdeleted text end material applies
separately for every project.
Sec. 32.
Minnesota Statutes 2020, section 326.75, subdivision 1, is amended to read:
Subdivision 1.
Licensing fee.
A person required to be licensed under section 326.72
shall, before receipt of the license and before causing asbestos-related work to be performed,
pay the commissioner an annual license fee of deleted text begin $100deleted text end new text begin $105new text end .
Sec. 33.
Minnesota Statutes 2020, section 326.75, subdivision 2, is amended to read:
Subd. 2.
Certification fee.
An individual required to be certified new text begin as an asbestos worker
or asbestos site supervisor new text end under section 326.73, subdivision 1, shall pay the commissioner
a certification fee of deleted text begin $50deleted text end new text begin $52.50new text end before the issuance of the certificate. deleted text begin The commissioner
may establish by rule fees required before the issuance ofdeleted text end new text begin An individual required to be
certified as annew text end asbestos inspector, asbestos management planner, deleted text begin anddeleted text end new text begin ornew text end asbestos project
designer deleted text begin certificates requireddeleted text end under section 326.73, subdivisions 2, 3, and 4new text begin , shall pay the
commissioner a certification fee of $105 before the issuance of the certificatenew text end .
Sec. 34.
Minnesota Statutes 2020, section 326.75, subdivision 3, is amended to read:
Subd. 3.
Permit fee.
Five calendar days before beginning asbestos-related work, a person
shall pay a project permit fee to the commissioner equal to deleted text begin onedeleted text end new text begin twonew text end percent of the total costs
of the asbestos-related work. For asbestos-related work performed in single or multifamily
residences, of greater than ten but less than 260 linear feet of asbestos-containing material
on pipes, or greater than six but less than 160 square feet of asbestos-containing material
on other facility components, a person shall pay a project permit fee of $35 to the
commissioner.
ARTICLE 3
HEALTH OCCUPATION AND HEALTH RELATED LICENSING BOARDS
Section 1.
Minnesota Statutes 2020, section 144E.001, is amended by adding a subdivision
to read:
new text begin Subd. 16. new text end
new text begin Education program primary instructor or primary instructor. new text end
new text begin
"Education
program primary instructor" or "primary instructor" means an individual, as approved by
the board, who serves as the lead instructor of an emergency medical care initial certification
course and who is responsible for planning or conducting the course according to the most
current version of the National EMS Education Standards by the NHTSA, United States
Department of Transportation.
new text end
Sec. 2.
Minnesota Statutes 2020, section 144E.27, is amended to read:
144E.27 deleted text begin EDUCATION PROGRAMS; BOARD APPROVALdeleted text end new text begin REGISTRATION
OF EMRnew text end .
Subdivision 1.
Education program instructor.
An education program instructor must
be an emergency medical responder, EMT, AEMT, paramedic, physician, physician assistant,
or registered nurse.
Subd. 1a.
Approval required.
(a) All education programs for an emergency medical
responder must be approved by the board.
(b) To be approved by the board, an education program must:
(1) submit an application prescribed by the board that includes:
(i) type and length of course to be offered;
(ii) names, addresses, and qualifications of the program medical director, program
education coordinator, and instructors;
(iii) admission criteria for students; and
(iv) materials and equipment to be used;
(2) for each course, implement the most current version of the United States Department
of Transportation EMS Education Standards, or its equivalent as determined by the board
applicable to Emergency Medical Responder registration education;
(3) have a program medical director and a program coordinator;
(4) have at least one instructor for every ten students at the practical skill stations;
(5) retain documentation of program approval by the board, course outline, and student
information; and
(6) submit the appropriate fee as required under section 144E.29.
(c) The National EMS Education Standards by the NHTSA, United States Department
of Transportation contains the minimal entry level of knowledge and skills for emergency
medical responders. Medical directors of emergency medical responder groups may expand
the knowledge and skill set.
Subd. 2.
Registrationnew text begin requirementsnew text end .
To be eligible for registration with the board as
an emergency medical responder, an individual shalldeleted text begin complete a board-approved application
deleted text end deleted text begin form anddeleted text end :
(1) successfully completedeleted text begin a board-approved initial emergency medical responder
deleted text end deleted text begin education program. Registration under this clause is valid for two years and expires on
deleted text end deleted text begin October 31deleted text end new text begin the United States Department of Transportation course or its equivalent as
approved by the board, specific to the emergency medical responder classificationnew text end ; deleted text begin or
deleted text end
(2) be credentialed as an emergency medical responder by the National Registry of
Emergency Medical Techniciansdeleted text begin . Registration under this clause expires the same day as
deleted text end deleted text begin the National Registry credential.deleted text end new text begin ; and
new text end
new text begin
(3) complete a board-approved application form.
new text end
Subd. 2a.
Registration new text begin expiration new text end dates.
new text begin Emergency medical responder new text end registration
expiration dates are as follows:
(1) for initial registration granted between January 1 and June 30 of an even-numbered
year, the expiration date is October 31 of the next even-numbered year;
(2) for initial registration granted between July 1 and December 31 of an even-numbered
year, the expiration date is October 31 of the second odd-numbered year;
(3) for initial registration granted between January 1 and June 30 of an odd-numbered
year, the expiration date is October 31 of the next odd-numbered year; and
(4) for initial registration granted between July 1 and December 31 of an odd-numbered
year, the expiration date is October 31 of the second even-numbered year.
Subd. 3.
Renewal.
(a) The board may renew the registration of an emergency medical
responder who:
(1) successfully completes a board-approved refresher course; deleted text begin and
deleted text end
(2) new text begin successfully completes a course in cardiopulmonary resuscitation approved by the
board or the licensee's medical director; and
new text end
new text begin (3) new text end submits a completed renewal application to the board before the registration expiration
date.
(b) The board may renew the lapsed registration of an emergency medical responder
who:
(1) successfully completes a board-approved refresher course; deleted text begin and
deleted text end
(2)new text begin successfully completes a course in cardiopulmonary resuscitation approved by the
board or the licensee's medical director; and
new text end
new text begin (3)new text end submits a completed renewal application to the board within 12 months after the
registration expiration date.
Subd. 5.
Denial, suspension, revocation.
(a) The board may deny, suspend, revoke,
place conditions on, or refuse to renew the registration new text begin as an emergency medical responder
new text end of an individual who the board determines:
(1) violates sections 144E.001 to 144E.33 or the rules adopted under those sections, an
agreement for corrective action, or an order that the board issued or is otherwise empowered
to enforce;
(2) misrepresents or falsifies information on an application form for registration;
(3) is convicted or pleads guilty or nolo contendere to any felony; any gross misdemeanor
relating to assault, sexual misconduct, theft, or the illegal use of drugs or alcohol; or any
misdemeanor relating to assault, sexual misconduct, theft, or the illegal use of drugs or
alcohol;
(4) is actually or potentially unable to provide emergency medical services with
reasonable skill and safety to patients by reason of illness, use of alcohol, drugs, chemicals,
or any other material, or as a result of any mental or physical condition;
(5) engages in unethical conduct, including, but not limited to, conduct likely to deceive,
defraud, or harm the public, or demonstrating a willful or careless disregard for the health,
welfare, or safety of the public;
(6) maltreats or abandons a patient;
(7) violates any state or federal controlled substance law;
(8) engages in unprofessional conduct or any other conduct which has the potential for
causing harm to the public, including any departure from or failure to conform to the
minimum standards of acceptable and prevailing practice without actual injury having to
be established;
(9) provides emergency medical services under lapsed or nonrenewed credentials;
(10) is subject to a denial, corrective, disciplinary, or other similar action in another
jurisdiction or by another regulatory authority;
(11) engages in conduct with a patient that is sexual or may reasonably be interpreted
by the patient as sexual, or in any verbal behavior that is seductive or sexually demeaning
to a patient; or
(12) makes a false statement or knowingly provides false information to the board, or
fails to cooperate with an investigation of the board as required by section 144E.30.
(b) Before taking action under paragraph (a), the board shall give notice to an individual
of the right to a contested case hearing under chapter 14. If an individual requests a contested
case hearing within 30 days after receiving notice, the board shall initiate a contested case
hearing according to chapter 14.
(c) The administrative law judge shall issue a report and recommendation within 30
days after closing the contested case hearing record. The board shall issue a final order
within 30 days after receipt of the administrative law judge's report.
(d) After six months from the board's decision to deny, revoke, place conditions on, or
refuse renewal of an individual's registration for disciplinary action, the individual shall
have the opportunity to apply to the board for reinstatement.
Subd. 6.
Temporary suspension.
(a) In addition to any other remedy provided by law,
the board may temporarily suspend the registration of an individual new text begin as an emergency
responder new text end after conducting a preliminary inquiry to determine whether the board believes
that the individual has violated a statute or rule that the board is empowered to enforce and
determining that the continued provision of service by the individual would create an
imminent risk to public health or harm to others.
(b) A temporary suspension order prohibiting an individual from providing emergency
medical care shall give notice of the right to a preliminary hearing according to paragraph
(d) and shall state the reasons for the entry of the temporary suspension order.
(c) Service of a temporary suspension order is effective when the order is served on the
individual personally or by certified mail, which is complete upon receipt, refusal, or return
for nondelivery to the most recent address provided to the board for the individual.
(d) At the time the board issues a temporary suspension order, the board shall schedule
a hearing, to be held before a group of its members designated by the board, that shall begin
within 60 days after issuance of the temporary suspension order or within 15 working days
of the date of the board's receipt of a request for a hearing from the individual, whichever
is sooner. The hearing shall be on the sole issue of whether there is a reasonable basis to
continue, modify, or lift the temporary suspension. A hearing under this paragraph is not
subject to chapter 14.
(e) Evidence presented by the board or the individual may be in the form of an affidavit.
The individual or the individual's designee may appear for oral argument.
(f) Within five working days of the hearing, the board shall issue its order and, if the
suspension is continued, notify the individual of the right to a contested case hearing under
chapter 14.
(g) If an individual requests a contested case hearing within 30 days after receiving
notice under paragraph (f), the board shall initiate a contested case hearing according to
chapter 14. The administrative law judge shall issue a report and recommendation within
30 days after the closing of the contested case hearing record. The board shall issue a final
order within 30 days after receipt of the administrative law judge's report.
Sec. 3.
Minnesota Statutes 2020, section 144E.28, subdivision 1, is amended to read:
Subdivision 1.
Requirements.
To be eligible for certification by the board as an EMT,
AEMT, or paramedic, an individual shall:
(1) successfully complete the United States Department of Transportation course, or its
equivalent as approved by the board, specific to the EMT, AEMT, or paramedic classification;
(2) deleted text begin pass the written and practical examinations approved by the board and administered
by the board or its designee,deleted text end new text begin obtain National Registry of Emergency Medical Technicians
certificationnew text end specific to the EMT, AEMT, or paramedic classification; and
(3) complete a board-approved application form.
Sec. 4.
Minnesota Statutes 2020, section 144E.28, subdivision 3, is amended to read:
Subd. 3.
Reciprocity.
The board may certify an individual who possesses a current
National Registry of Emergency Medical Technicians deleted text begin registrationdeleted text end new text begin certificationnew text end from another
jurisdiction if the individual submits a board-approved application form. The board
certification classification shall be the same as the National Registry's classification.
Certification shall be for the duration of the applicant's deleted text begin registrationdeleted text end new text begin certificationnew text end period in
another jurisdiction, not to exceed two years.
Sec. 5.
Minnesota Statutes 2020, section 144E.28, subdivision 7, is amended to read:
Subd. 7.
Renewal.
(a) Before the expiration date of certification, an applicant for renewal
of certification as an EMT shall:
(1) successfully complete a course in cardiopulmonary resuscitation that is approved by
the board or the licensee's medical director;
(2) deleted text begin take the United States Department of Transportation EMT refresher course and
successfully pass the practical skills test portion of the course, or successfully complete 48
hours of continuing education in EMT programs that are consistent with the United States
Department of Transportation National EMS Education Standards or its equivalent as
approved by the board or as approved by the licensee's medical director and pass a practical
skills test approved by the board and administered by an education program approved by
the board. The cardiopulmonary resuscitation course and practical skills test may be included
as part of the refresher course or continuing education renewal requirements; anddeleted text end new text begin satisfy
one of the following requirements:
new text end
new text begin
(i) maintain National Registry of Emergency Medical Technicians certification following
the requirements of the National Continued Competency Program, or its equivalent as
approved by the board. The cardiopulmonary resuscitation course required under clause (1)
shall count toward the continuing education requirements for renewal; or
new text end
new text begin
(ii) for an individual who only holds Minnesota EMT certification and held the
certification prior to April 1, 2021, maintain Minnesota certification by completing the
required hours of continuing education as determined in the National Continued Competency
Program of the National Registry of Emergency Medical Technicians, or its equivalent as
approved by the board. The cardiopulmonary resuscitation course required under clause (1)
shall count toward the continuing education requirements for renewal. This item expires
April 1, 2036; and
new text end
(3) complete a board-approved application form.
(b) Before the expiration date of certification, an applicant for renewal of certification
as an AEMT or paramedic shall:
(1) for an AEMT, successfully complete a course in cardiopulmonary resuscitation that
is approved by the board or the licensee's medical directornew text begin ,new text end and for a paramedic, successfully
complete a course in advanced cardiac life support that is approved by the board or the
licensee's medical director;
(2) deleted text begin successfully complete 48 hours of continuing education in emergency medical training
programs, appropriate to the level of the applicant's AEMT or paramedic certification, that
are consistent with the United States Department of Transportation National EMS Education
Standards or its equivalent as approved by the board or as approved by the licensee's medical
director. An applicant may take the United States Department of Transportation Emergency
Medical Technician refresher course or its equivalent without the written or practical test
as approved by the board, and as appropriate to the applicant's level of certification, as part
of the 48 hours of continuing education. Each hour of the refresher course, the
cardiopulmonary resuscitation course, and the advanced cardiac life-support course counts
toward the 48-hour continuing education requirement; anddeleted text end new text begin satisfy one of the following
requirements:
new text end
new text begin
(i) maintain National Registry of Emergency Medical Technicians certification following
the requirements of the National Continued Competency Program, or its equivalent as
approved by the board. The cardiopulmonary resuscitation course or advanced cardiac life
support course required under clause (1) shall count toward the continuing education
requirements for renewal; or
new text end
new text begin
(ii) for an individual who only holds Minnesota AEMT or paramedic certification and
held the certification prior to April 1, 2021, maintain Minnesota certification by completing
the required hours of continuing education as determined in the National Continued
Competency Program of the National Registry of Emergency Medical Technicians, or its
equivalent as approved by the board. The cardiopulmonary resuscitation course or advanced
cardiac life support course required under clause (1) shall count toward the continuing
education requirements for renewal. This item expires April 1, 2036; and
new text end
(3) complete a board-approved application form.
(c) Certification shall be renewed every two years.
(d) If the applicant does not meet the renewal requirements under this subdivision, the
applicant's certification expires.
Sec. 6.
Minnesota Statutes 2020, section 144E.28, subdivision 8, is amended to read:
Subd. 8.
Reinstatement.
(a) Within deleted text begin fourdeleted text end new text begin twonew text end years of a certification expiration date, a
person whose certification has expired under subdivision 7, paragraph (d), may have the
certification reinstated upon submission of:
(1) evidence to the board of training equivalent to the continuing education requirements
of subdivision 7; and
(2) a board-approved application form.
(b) If more than deleted text begin fourdeleted text end new text begin twonew text end years have passed since a certificate expiration date, an applicant
must complete the initial certification process required under subdivision 1.
Sec. 7.
Minnesota Statutes 2020, section 144E.283, is amended to read:
144E.283 new text begin PRIMARY new text end INSTRUCTOR QUALIFICATIONS.
deleted text begin (a)deleted text end An deleted text begin emergency medical techniciandeleted text end new text begin education program primarynew text end instructor must:
(1) possess deleted text begin validdeleted text end new text begin current Minnesotanew text end certification, registration, or licensure asnew text begin one of the
following, at a level that is equivalent to or higher than the level of certification or registration
being taught:
new text end
new text begin (i)new text end an new text begin EMR, new text end EMT, AEMT, new text begin or new text end paramedicdeleted text begin ,deleted text end new text begin ;
new text end
new text begin (ii) anew text end physiciandeleted text begin ,deleted text end new text begin with certification in adult or pediatric emergency medicine from the
American Board of Emergency Medicine or the American Board of Osteopathic Emergency
Medicine, with certification in an emergency medical services subspecialty, or serving as
a medical director of a licensed ambulance service;
new text end
new text begin (iii) anew text end physician assistantdeleted text begin ,deleted text end new text begin with experience in emergency medicine;new text end or
new text begin (iv) anew text end registered nursenew text begin with certification in adult or pediatric prehospital nursing from
(A) the Board of Certification for Emergency Nursing, including certified flight registered
nurse or certified transport registered nurse, or (B) the National Certification Corporation,
including certified in neonatal pediatric transportnew text end ;
(2) deleted text begin have two years of active emergency medical practical experiencedeleted text end new text begin if required under
this chapter for Minnesota certification or registration, possess National Registry of
Emergency Medical Technicians certification or registration as an EMR, EMT, AEMT, or
paramedic, at a level that is equivalent to or higher than the level of certification or
registration being taughtnew text end ;
new text begin
(3) satisfy one of the following requirements:
new text end
new text begin
(i) hold at least an associate's degree and have been certified for at least three years at a
level that is equivalent to or higher than the level of certification or registration being taught;
or
new text end
new text begin
(ii) have been certified for at least five years at a level that is equivalent to or higher
than the level of certification or registration being taught;
new text end
deleted text begin (3)deleted text end new text begin (4)new text end be recommended by a medical director of a licensed hospital, ambulance service,
or education program approved by the board;
deleted text begin (4)deleted text end new text begin (5) satisfy one of the following requirements:
new text end
new text begin (i) new text end successfully complete the United States Department of Transportation Emergency
Medical Services Instructor deleted text begin Education Program or its equivalent as approved by the boarddeleted text end new text begin
coursenew text end ; deleted text begin and
deleted text end
new text begin
(ii) successfully complete the National Association of EMS Educators Instructor level
1 course;
new text end
new text begin
(iii) successfully complete the Fire Instructor I course;
new text end
new text begin
(iv) hold at least a bachelor's degree in education;
new text end
new text begin
(v) hold at least a master's degree in a related field of study;
new text end
new text begin
(vi) have been vetted through the Minnesota State faculty credentialing process; or
new text end
new text begin
(vii) successfully complete an equivalent course or hold an equivalent degree as approved
by the board;
new text end
deleted text begin (5)deleted text end new text begin (6)new text end complete eight hours of continuing education in educational topics every two
years, with documentation filed with the education program coordinatordeleted text begin .deleted text end new text begin ;
new text end
new text begin
(7) complete a board-approved application form; and
new text end
new text begin
(8) receive board approval as a primary instructor.
new text end
deleted text begin
(b) An emergency medical responder instructor must possess valid registration,
certification, or licensure as an EMR, EMT, AEMT, paramedic, physician, physician
assistant, or registered nurse.
deleted text end
Sec. 8.
Minnesota Statutes 2020, section 144E.285, subdivision 1, is amended to read:
Subdivision 1.
Approval required.
(a) All education programs for annew text begin EMR,new text end EMT,
AEMT, or paramedic must be approved by the board.
(b) To be approved by the board, an education program must:
(1) submit an application prescribed by the board that includes:
(i) type deleted text begin and lengthdeleted text end of course to be offered;
(ii) names, addresses, and qualifications of the program medical director, program
education coordinator, and instructors;
deleted text begin
(iii) names and addresses of clinical sites, including a contact person and telephone
number;
deleted text end
deleted text begin (iv)deleted text end new text begin (iii)new text end admission criteria for students; and
deleted text begin (v)deleted text end new text begin (iv)new text end materials and equipment to be used;
(2) for each course, implement the most current version of the United States Department
of Transportation EMS Education Standards, or its equivalent as determined by the board
applicable to new text begin EMR, new text end EMT, AEMT, or paramedic education;
(3) have a program medical director and a program coordinator;
(4) utilize new text begin primary new text end instructors who meet the requirements of section 144E.283 for teaching
at least 50 percent of the course content. The remaining 50 percent of the course may be
taught by guest lecturers approved by the education program coordinator or medical director;
deleted text begin
(5) have at least one instructor for every ten students at the practical skill stations;
deleted text end
deleted text begin
(6) maintain a written agreement with a licensed hospital or licensed ambulance service
designating a clinical training site;
deleted text end
deleted text begin (7)deleted text end new text begin (5)new text end retain documentation of program approval by the board, course outline, and
student information;
deleted text begin (8)deleted text end new text begin (6)new text end notify the board of the starting date of a course prior to the beginning of a course;new text begin
and
new text end
deleted text begin (9)deleted text end new text begin (7)new text end submit the appropriate fee as required under section 144E.29deleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(10) maintain a minimum average yearly pass rate as set by the board on an annual basis.
The pass rate will be determined by the percent of candidates who pass the exam on the
first attempt. An education program not meeting this yearly standard shall be placed on
probation and shall be on a performance improvement plan approved by the board until
meeting the pass rate standard. While on probation, the education program may continue
providing classes if meeting the terms of the performance improvement plan as determined
by the board. If an education program having probation status fails to meet the pass rate
standard after two years in which an EMT initial course has been taught, the board may
take disciplinary action under subdivision 5.
deleted text end
Sec. 9.
Minnesota Statutes 2020, section 144E.285, is amended by adding a subdivision
to read:
new text begin Subd. 1a. new text end
new text begin EMR requirements. new text end
new text begin
The National EMS Education Standards established by
the NHTSA, United States Department of Transportation, specifies the minimum
requirements for knowledge and skills for emergency medical responders. A medical director
of an emergency medical responder education group may establish additional knowledge
and skill requirements for EMRs.
new text end
Sec. 10.
Minnesota Statutes 2020, section 144E.285, is amended by adding a subdivision
to read:
new text begin Subd. 1b. new text end
new text begin EMT requirements. new text end
new text begin
In addition to the requirements under subdivision 1,
paragraph (b), an education program applying for approval to teach EMTs must:
new text end
new text begin
(1) in the application prescribed by the board, include names and addresses of clinical
sites, including a contact person and telephone number;
new text end
new text begin
(2) maintain a written agreement with a licensed hospital or licensed ambulance service
designating a clinical training site; and
new text end
new text begin
(3) maintain a minimum average yearly pass rate as set by the board. An education
program not meeting the standard in this subdivision shall be placed on probation and must
comply with a performance improvement plan approved by the board until the program
meets the pass-rate standard. While on probation, the education program may continue to
provide classes if the program meets the terms of the performance improvement plan, as
determined by the board. If an education program that is on probation status fails to meet
the pass-rate standard after two years in which an EMT initial course has been taught, the
board may take disciplinary action under subdivision 5.
new text end
Sec. 11.
Minnesota Statutes 2020, section 144E.285, subdivision 2, is amended to read:
Subd. 2.
AEMT and paramedic requirements.
(a) In addition to the requirements
under subdivision 1, paragraph (b), an education program applying for approval to teach
AEMTs and paramedics mustnew text begin :
new text end
new text begin (1)new text end be administered by an educational institution accredited by the Commission of
Accreditation of Allied Health Education Programs (CAAHEP)deleted text begin .deleted text end new text begin ;
new text end
new text begin
(2) in the application prescribed by the board, include names and addresses of clinical
sites, including a contact person and telephone number; and
new text end
new text begin
(3) maintain a written agreement with a licensed hospital or licensed ambulance service
designating a clinical training site.
new text end
(b) An AEMT and paramedic education program that is administered by an educational
institution not accredited by CAAHEP, but that is in the process of completing the
accreditation process, may be granted provisional approval by the board upon verification
of submission of its self-study report and the appropriate review fee to CAAHEP.
(c) An educational institution that discontinues its participation in the accreditation
process must notify the board immediately and provisional approval shall be withdrawn.
deleted text begin
(d) This subdivision does not apply to a paramedic education program when the program
is operated by an advanced life-support ambulance service licensed by the Emergency
Medical Services Regulatory Board under this chapter, and the ambulance service meets
the following criteria:
deleted text end
deleted text begin
(1) covers a rural primary service area that does not contain a hospital within the primary
service area or contains a hospital within the primary service area that has been designated
as a critical access hospital under section 144.1483, clause (9);
deleted text end
deleted text begin
(2) has tax-exempt status in accordance with the Internal Revenue Code, section
501(c)(3);
deleted text end
deleted text begin
(3) received approval before 1991 from the commissioner of health to operate a paramedic
education program;
deleted text end
deleted text begin
(4) operates an AEMT and paramedic education program exclusively to train paramedics
for the local ambulance service; and
deleted text end
deleted text begin
(5) limits enrollment in the AEMT and paramedic program to five candidates per
biennium.
deleted text end
Sec. 12.
Minnesota Statutes 2020, section 144E.285, subdivision 4, is amended to read:
Subd. 4.
Reapproval.
An education program shall apply to the board for reapproval at
least three months prior to the expiration date of its approval and must:
(1) submit an application prescribed by the board specifying any changes from the
information provided for prior approval and any other information requested by the board
to clarify incomplete or ambiguous information presented in the application; deleted text begin and
deleted text end
(2) comply with the requirements under subdivision 1, paragraph (b), clauses (2) to deleted text begin (10).deleted text end new text begin
(7);
new text end
new text begin
(3) be subject to a site visit;
new text end
new text begin
(4) for education programs that teach EMTs, comply with the requirements in subdivision
1b; and
new text end
new text begin
(5) for education programs that teach AEMTs and paramedics, comply with the
requirements in subdivision 2 and maintain accreditation with the CAAHEP.
new text end
Sec. 13.
Minnesota Statutes 2020, section 148.995, subdivision 2, is amended to read:
Subd. 2.
Certified doula.
"Certified doula" means an individual who has received a
certification to perform doula services from the International Childbirth Education
Association, the Doulas of North America (DONA), the Association of Labor Assistants
and Childbirth Educators (ALACE), Birthworks, the Childbirth and Postpartum Professional
Association (CAPPA), Childbirth International, the International Center for Traditional
Childbearing, deleted text begin ordeleted text end Commonsense Childbirth, Incnew text begin ., Modern Doula Education (MDE), or an
organization designated by the commissioner under section 148.9965new text end .
Sec. 14.
Minnesota Statutes 2020, section 148.996, subdivision 2, is amended to read:
Subd. 2.
Qualifications.
The commissioner shall include on the registry any individual
who:
(1) submits an application on a form provided by the commissioner. The form must
include the applicant's name, address, and contact information;
(2) deleted text begin maintainsdeleted text end new text begin submits evidence of maintainingnew text end a current certification from one of the
organizations listed in section 148.995, subdivision 2new text begin , or from an organization designated
by the commissioner under section 148.9965new text end ; and
(3) pays the fees required under section 148.997.
Sec. 15.
Minnesota Statutes 2020, section 148.996, subdivision 4, is amended to read:
Subd. 4.
Renewal.
Inclusion on the registry maintained by the commissioner is valid
for three yearsnew text begin , provided the doula meets the requirement in subdivision 2, clause (2), during
the entire periodnew text end . At the end of the three-year period, the certified doula may submit a new
application to remain on the doula registry by meeting the requirements described in
subdivision 2.
Sec. 16.
Minnesota Statutes 2020, section 148.996, is amended by adding a subdivision
to read:
new text begin Subd. 6. new text end
new text begin Removal from registry. new text end
new text begin
(a) If the commissioner determines that a doula
included on the registry does not meet the requirement in subdivision 2, clause (2), the
commissioner shall notify the affected doula that the doula no longer meets the requirement
in subdivision 2, clause (2), specify steps the doula must take to maintain inclusion on the
registry, and specify the effect of failing to take such steps. The commissioner must provide
this notice by first class mail to the address on file with the commissioner for the affected
doula.
new text end
new text begin
(b) Following the provision of notice under paragraph (a), the commissioner shall remove
from the registry any doula who no longer meets the requirement in subdivision 2, clause
(2), and who does not take the steps specified by the commissioner to maintain inclusion
on the registry.
new text end
Sec. 17.
new text begin
[148.9965] DESIGNATION OF DOULA CERTIFICATION
ORGANIZATIONS BY COMMISSIONER.
new text end
new text begin Subdivision 1. new text end
new text begin Review and designation by commissioner. new text end
new text begin
The commissioner shall
periodically review the doula certification organizations listed in section 148.995, subdivision
2, or designated by the commissioner under this section. The commissioner may: (1)
designate additional organizations from which individuals, if maintaining current doula
certification from such an organization, are eligible for inclusion on the registry of certified
doulas; and (2) remove the designation of a doula certification organization previously
designated by the commissioner.
new text end
new text begin Subd. 2. new text end
new text begin Designation. new text end
new text begin
A doula certification organization seeking designation under this
section shall provide the commissioner with evidence that the organization satisfies
designation criteria established by the commissioner. If the commissioner designates a doula
certification organization under this section, the commissioner shall provide notice of the
designation by publication in the State Register and on the Department of Health website
for the registry of certified doulas and shall specify the date after which a certification by
the organization authorizes a doula certified by the organization to be included on the
registry.
new text end
new text begin Subd. 3. new text end
new text begin Removal of designation. new text end
new text begin
(a) The commissioner may remove the designation
of a doula certification organization previously designated by the commissioner under this
section upon a determination by the commissioner that the organization does not meet the
commissioner's criteria for designation. If the commissioner removes a designation, the
commissioner shall provide notice of the removal by publication in the State Register and
shall specify the date after which a certification by the organization no longer authorizes a
doula certified by the organization to be included on the registry.
new text end
new text begin
(b) Following removal of a designation, the Department of Health website for the registry
of certified doulas shall be modified to reflect the removal.
new text end
Sec. 18.
Minnesota Statutes 2020, section 151.01, subdivision 29, is amended to read:
Subd. 29.
deleted text begin Legenddeleted text end Medical gas.
"deleted text begin Legenddeleted text end Medical gas" means deleted text begin a liquid or gaseous
substance used for medical purposes and that is required by federal law to be dispensed
only pursuant to the prescription of a licensed practitionerdeleted text end new text begin any gas or liquid manufactured
or stored in a liquefied, nonliquefied, or cryogenic state that:
new text end
new text begin
(1) has a chemical or physical action in or on the human body or animals or is used in
conjunction with medical gas equipment; and
new text end
new text begin (2) is intended to be used for the diagnosis, cure, mitigation, treatment, or prevention of
diseasenew text end .
Sec. 19.
Minnesota Statutes 2020, section 151.01, is amended by adding a subdivision to
read:
new text begin Subd. 29a. new text end
new text begin Medical gas manufacturer. new text end
new text begin
"Medical gas manufacturer" means any person:
new text end
new text begin
(1) originally manufacturing a medical gas by chemical reaction, physical separation,
compression of atmospheric air, purification, or other means;
new text end
new text begin
(2) filling a medical gas into a dispensing container via gas to gas, liquid to gas, or liquid
to liquid processes;
new text end
new text begin
(3) combining two or more medical gases into a container to form a medically appropriate
mixture; or
new text end
new text begin
(4) filling a medical gas via liquid to liquid into a final use container at the point of use.
new text end
Sec. 20.
Minnesota Statutes 2020, section 151.01, is amended by adding a subdivision to
read:
new text begin Subd. 29b. new text end
new text begin Medical gas wholesaler. new text end
new text begin
"Medical gas wholesaler" means any person who
sells a medical gas to another business or entity for the purpose of reselling or providing
that medical gas to the ultimate consumer or patient.
new text end
Sec. 21.
Minnesota Statutes 2020, section 151.01, is amended by adding a subdivision to
read:
new text begin Subd. 29c. new text end
new text begin Medical gas dispenser. new text end
new text begin
"Medical gas dispenser" means any person, other
than a licensed practitioner or pharmacy, who sells or provides a medical gas directly to the
ultimate consumer or patient via a valid prescription.
new text end
Sec. 22.
new text begin
[151.191] LICENSING MEDICAL GAS FACILITIES; FEES;
PROHIBITIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Medical gas manufacturers; requirements. new text end
new text begin
(a) No person shall act as
a medical gas manufacturer without first obtaining a license from the board and paying any
applicable fee specified in section 151.065.
new text end
new text begin
(b) Application for a medical gas manufacturer license under this section must be made
in a manner specified by the board.
new text end
new text begin
(c) A license must not be issued or renewed for a medical gas manufacturer unless the
applicant agrees to operate in a manner prescribed by federal and state law and according
to Minnesota Rules.
new text end
new text begin
(d) A license must not be issued or renewed for a medical gas manufacturer that is
required to be licensed or registered by the state in which it is physically located unless the
applicant supplies the board with proof of licensure or registration. The board may establish
standards for the licensure of a medical gas manufacturer that is not required to be licensed
or registered by the state in which it is physically located.
new text end
new text begin
(e) The board must require a separate license for each facility located within the state at
which medical gas manufacturing occurs and for each facility located outside of the state
at which medical gases that are shipped into the state are manufactured.
new text end
new text begin
(f) Prior to the issuance of an initial or renewed license for a medical gas manufacturing
facility, the board may require the facility to pass an inspection conducted by an authorized
representative of the board. In the case of a medical gas manufacturing facility located
outside of the state, the board may require the applicant to pay the cost of the inspection,
in addition to the license fee in section 151.065, unless the applicant furnishes the board
with a report, issued by the appropriate regulatory agency of the state in which the facility
is located, of an inspection that has occurred within the 24 months immediately preceding
receipt of the license application by the board. The board may deny licensure unless the
applicant submits documentation satisfactory to the board that any deficiencies noted in an
inspection report have been corrected.
new text end
new text begin
(g) A duly licensed medical gas manufacturing facility may also wholesale or dispense
any medical gas that is manufactured by the licensed facility, or manufactured or wholesaled
by another properly licensed medical gas facility, without also obtaining a medical gas
wholesaler license or medical gas dispenser registration.
new text end
new text begin
(h) The filling of a medical gas into a final use container, at the point of use and by liquid
to liquid transfer, is permitted as long as the facility used as the base of operations is duly
licensed as a medical gas manufacturer.
new text end
new text begin Subd. 2. new text end
new text begin Medical gas wholesalers; requirements. new text end
new text begin
(a) No person shall act as a medical
gas wholesaler without first obtaining a license from the board and paying any applicable
fee specified in section 151.065.
new text end
new text begin
(b) Application for a medical gas wholesaler license under this section must be made in
a manner specified by the board.
new text end
new text begin
(c) A license must not be issued or renewed for a medical gas wholesaler unless the
applicant agrees to operate in a manner prescribed by federal and state law and according
to Minnesota Rules.
new text end
new text begin
(d) A license must not be issued or renewed for a medical gas wholesaler that is required
to be licensed or registered by the state in which it is physically located unless the applicant
supplies the board with proof of licensure or registration. The board may establish standards
for the licensure of a medical gas wholesaler that is not required to be licensed or registered
by the state in which it is physically located.
new text end
new text begin
(e) The board must require a separate license for each facility located within the state at
which medical gas wholesaling occurs and for each facility located outside of the state from
which medical gases that are shipped into the state are wholesaled.
new text end
new text begin
(f) Prior to the issuance of an initial or renewed license for a medical gas wholesaling
facility, the board may require the facility to pass an inspection conducted by an authorized
representative of the board. In the case of a medical gas wholesaling facility located outside
of the state, the board may require the applicant to pay the cost of the inspection, in addition
to the license fee in section 151.065, unless the applicant furnishes the board with a report,
issued by the appropriate regulatory agency of the state in which the facility is located, of
an inspection that has occurred within the 24 months immediately preceding receipt of the
license application by the board. The board may deny licensure unless the applicant submits
documentation satisfactory to the board that any deficiencies noted in an inspection report
have been corrected.
new text end
new text begin
(g) A duly licensed medical gas wholesaling facility may also dispense any medical gas
that is manufactured or wholesaled by another properly licensed medical gas facility.
new text end
new text begin Subd. 3. new text end
new text begin Medical gas dispensers; requirements. new text end
new text begin
(a) A person or establishment not
licensed as a pharmacy, practitioner, medical gas manufacturer, or medical gas dispenser
must not engage in the dispensing of medical gases without first obtaining a registration
from the board and paying the applicable fee specified in section 151.065. The registration
must be displayed in a conspicuous place in the business for which it is issued and expires
on the date set by the board.
new text end
new text begin
(b) Application for a medical gas dispenser registration under this section must be made
in a manner specified by the board.
new text end
new text begin
(c) A registration must not be issued or renewed for a medical gas dispenser located
within the state unless the applicant agrees to operate in a manner prescribed by federal and
state law and according to the rules adopted by the board. A license must not be issued for
a medical gas dispenser located outside of the state unless the applicant agrees to operate
in a manner prescribed by federal law and, when dispensing medical gases for residents of
this state, the laws of this state and Minnesota Rules.
new text end
new text begin
(d) A registration must not be issued or renewed for a medical gas dispenser that is
required to be licensed or registered by the state in which it is physically located unless the
applicant supplies the board with proof of the licensure or registration. The board may
establish standards for the registration of a medical gas dispenser that is not required to be
licensed or registered by the state in which it is physically located.
new text end
new text begin
(e) The board must require a separate registration for each medical gas dispenser located
within the state and for each facility located outside of the state from which medical gases
are dispensed to residents of this state.
new text end
new text begin
(f) Prior to the issuance of an initial or renewed registration for a medical gas dispenser,
the board may require the medical gas dispenser to pass an inspection conducted by an
authorized representative of the board. In the case of a medical gas dispenser located outside
of the state, the board may require the applicant to pay the cost of the inspection, in addition
to the license fee in section 151.065, unless the applicant furnishes the board with a report,
issued by the appropriate regulatory agency of the state in which the facility is located, of
an inspection that has occurred within the 24 months immediately preceding receipt of the
license application by the board. The board may deny licensure unless the applicant submits
documentation satisfactory to the board that any deficiencies noted in an inspection report
have been corrected.
new text end
new text begin
(g) A facility holding a medical gas dispenser registration must not engage in the
manufacturing or wholesaling of medical gases, except that a medical gas dispenser may
transfer medical gases from one of its duly registered facilities to other duly registered
medical gas manufacturing, wholesaling, or dispensing facilities owned or operated by that
same company, without requiring a medical gas wholesaler license.
new text end
Sec. 23. new text begin REVISOR INSTRUCTION.
new text end
new text begin
In Minnesota Statutes, the revisor of statutes shall recode as Minnesota Statutes, section
144E.28, subdivision 8a, the community emergency medical technician certification
requirements that are currently coded as Minnesota Statutes, section 144E.275, subdivision
7, and shall revise any necessary cross-references consistent with that recoding.
new text end
Sec. 24. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2020, sections 144E.27, subdivisions 1 and 1a; and 151.19,
subdivision 3,
new text end
new text begin
are repealed.
new text end
ARTICLE 4
PRESCRIPTION DRUGS AND OPIATES
Section 1.
Minnesota Statutes 2020, section 16A.151, subdivision 2, is amended to read:
Subd. 2.
Exceptions.
(a) If a state official litigates or settles a matter on behalf of specific
injured persons or entities, this section does not prohibit distribution of money to the specific
injured persons or entities on whose behalf the litigation or settlement efforts were initiated.
If money recovered on behalf of injured persons or entities cannot reasonably be distributed
to those persons or entities because they cannot readily be located or identified or because
the cost of distributing the money would outweigh the benefit to the persons or entities, the
money must be paid into the general fund.
(b) Money recovered on behalf of a fund in the state treasury other than the general fund
may be deposited in that fund.
(c) This section does not prohibit a state official from distributing money to a person or
entity other than the state in litigation or potential litigation in which the state is a defendant
or potential defendant.
(d) State agencies may accept funds as directed by a federal court for any restitution or
monetary penalty under United States Code, title 18, section 3663(a)(3), or United States
Code, title 18, section 3663A(a)(3). Funds received must be deposited in a special revenue
account and are appropriated to the commissioner of the agency for the purpose as directed
by the federal court.
(e) Tobacco settlement revenues as defined in section 16A.98, subdivision 1, paragraph
(t), may be deposited as provided in section 16A.98, subdivision 12.
(f) Any money received by the state resulting from a settlement agreement or an assurance
of discontinuance entered into by the attorney general of the state, or a court order in litigation
brought by the attorney general of the state, on behalf of the state or a state agency, against
one or more opioid manufacturers or opioid wholesale drug distributors new text begin or consulting firms
working for an opioid manufacturer or opioid wholesale drug distributor new text end related to alleged
violations of consumer fraud laws in the marketing, sale, or distribution of opioids in this
state or other alleged illegal actions that contributed to the excessive use of opioids, must
be deposited in a separate account in the state treasury and the commissioner shall notify
the chairs and ranking minority members of the Finance Committee in the senate and the
Ways and Means Committee in the house of representatives that an account has been created.
new text begin Notwithstanding section 11A.20, all investment income and all investment losses attributable
to the investment of this account shall be credited to the account. new text end This paragraph does not
apply to attorney fees and costs awarded to the state or the Attorney General's Office, to
contract attorneys hired by the state or Attorney General's Office, or to other state agency
attorneys. If the licensing fees under section 151.065, subdivision 1, clause (16), and
subdivision 3, clause (14), are reduced and the registration fee under section 151.066,
subdivision 3, is repealed in accordance with section 256.043, subdivision 4, then the
commissioner shall transfer from the separate account created in this paragraph to the opiate
epidemic response fund under section 256.043 an amount that ensures that $20,940,000
each fiscal year is available for distribution in accordance with section 256.043, deleted text begin subdivisions
2 anddeleted text end new text begin subdivisionnew text end 3.
new text begin
(g) Notwithstanding paragraph (f), if money is received from a settlement agreement or
an assurance of discontinuance entered into by the attorney general of the state or a court
order in litigation brought by the attorney general of the state on behalf of the state or a state
agency against a consulting firm working for an opioid manufacturer or opioid wholesale
drug distributor and deposited into the separate account created under paragraph (f), the
commissioner shall annually transfer from the separate account to the opiate epidemic
response fund under section 256.043 an amount equal to the estimated amount submitted
to the commissioner by the Board of Pharmacy in accordance with section 151.066,
subdivision 3, paragraph (b). The amount transferred shall be included in the amount available
for distribution in accordance with section 256.043, subdivision 3. This transfer shall occur
each year until the registration fee under section 151.066, subdivision 3, is repealed in
accordance with section 256.043, subdivision 4, or the money deposited in the account in
accordance with this paragraph has been transferred, whichever occurs first.
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. 2.
new text begin
[62J.85] PRESCRIPTION DRUG MANUFACTURER IMPORTATION
PATHWAY PLAN.
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 terms have
the meanings given.
new text end
new text begin
(b) "Drug product" or "drug" means a prescription drug or biological product that is
intended for human use and regulated as a drug except where specific reference is made to
a drug approved under section 505 of the federal Food, Drug, and Cosmetic Act, United
States Code, title 21, section 355, or biological product approved under section 351 of the
federal Public Health Act, United States Code, title 42, section 262. Drug product or drug
does not include biological products that are intended for transfusions, including blood or
blood products; or allogeneic-, cellular-, or tissue-based products.
new text end
new text begin
(c) "FD&C Act" means the federal Food, Drug, and Cosmetic Act, United States Code,
title 21, section 301, et seq.
new text end
new text begin
(d) "Importation guidance" means the draft guidance released by the federal Food and
Drug Administration (FDA) titled "Importation of Certain FDA-Approved Human
Prescription Drugs, Including Biological Products, Under Section 801(d)(1)(B) of the Federal
Food, Drug, and Cosmetic Act; Draft Guidance for the Industry," which if finalized allows
for the importation of MMA products.
new text end
new text begin
(e) "Manufacturer" means the entity that is the holder of the New Drug Application or
Biologics License Application for the drug product.
new text end
new text begin
(f) "Multimarket-approved product" or "MMA product" means a FDA-approved drug
product that:
new text end
new text begin
(1) was manufactured outside the United States and authorized for marketing by another
country's regulatory authority;
new text end
new text begin
(2) is subject to a new drug application or biologics license application;
new text end
new text begin
(3) is imported into the United States and is authorized by the manufacturer to be
marketed in the United States; and
new text end
new text begin
(4) continues to meet the quality standards for marketing in its originally intended foreign
market.
new text end
new text begin Subd. 2. new text end
new text begin Application. new text end
new text begin
This section applies to any MMA product in which the
manufacturer of the product has obtained a new National Drug Code (NDC) for the MMA
product and has imported the MMA product in compliance with the FD&C Act and any
importation guidance finalized by the FDA.
new text end
new text begin Subd. 3. new text end
new text begin Incentives. new text end
new text begin
(a) In order to facilitate importation of drugs pursuant to importation
guidance finalized by the FDA, any MMA product offered for sale in Minnesota at a cost
that is at least 23 percent lower than the wholesale acquisition cost for the FDA-approved
product manufactured in the United States shall be:
new text end
new text begin
(1) included on the uniform preferred drug list and covered under the medical assistance
and MinnesotaCare programs; and
new text end
new text begin
(2) a covered drug under the state employee group insurance program pursuant to chapter
43A.
new text end
new text begin
(b) A health plan company must provide coverage for each MMA product that meets
the requirements in paragraph (a) if the manufacturer's FDA-approved drug product
manufactured in the United States is covered by the health plan company and the health
plan company must not impose any enrollee cost-sharing requirements for the covered
MMA product.
new text end
new text begin
(c) This subdivision shall not become effective for MMA products that are offered for
sale in Minnesota in accordance with paragraph (a) unless affirmative action is taken by
the legislature.
new text end
Sec. 3.
Minnesota Statutes 2020, section 62W.11, is amended to read:
62W.11 GAG CLAUSE PROHIBITION.
(a) No contract between a pharmacy benefit manager or health carrier and a pharmacy
or pharmacist shall prohibit, restrict, or penalize a pharmacy or pharmacist from disclosing
to an enrollee any health care information that the pharmacy or pharmacist deems appropriate
regarding the nature of treatment; the risks or alternatives; the availability of alternative
therapies, consultations, or tests; the decision of utilization reviewers or similar persons to
authorize or deny services; the process that is used to authorize or deny health care services
or benefits; or information on financial incentives and structures used by the health carrier
or pharmacy benefit manager.
(b) A pharmacy or pharmacist must provide to an enrollee information regarding the
enrollee's total cost for each prescription drug dispensed where part or all of the cost of the
prescription is being paid or reimbursed by the employer-sponsored plan or by a health
carrier or pharmacy benefit manager, in accordance with section 151.214, subdivision 1.
(c) A pharmacy benefit manager or health carrier must not prohibit a pharmacist or
pharmacy from discussing information regarding the total cost for pharmacy services for a
prescription drug, including the patient's co-payment amount deleted text begin anddeleted text end new text begin ,new text end the pharmacy's own usual
and customary price deleted text begin ofdeleted text end new text begin fornew text end the prescriptionnew text begin drug, the pharmacy's acquisition cost for the
prescription drug, and the amount the pharmacy is being reimbursed by the pharmacy benefit
manager or health carrier for the prescription drugnew text end .
new text begin
(d) A pharmacy benefit manager must not prohibit a pharmacist or pharmacy from
discussing with a health carrier the amount the pharmacy is being paid or reimbursed for a
prescription drug by the pharmacy benefit manager or the pharmacy's acquisition cost for
a prescription drug.
new text end
deleted text begin (d)deleted text end new text begin (e)new text end A pharmacy benefit manager or health carrier must not prohibit a pharmacist or
pharmacy from discussing the availability of any therapeutically equivalent alternative
prescription drugs or alternative methods for purchasing the prescription drug, including
but not limited to paying out-of-pocket the pharmacy's usual and customary price when that
amount is less expensive to the enrollee than the amount the enrollee is required to pay for
the prescription drug under the enrollee's health plan.
Sec. 4.
Minnesota Statutes 2020, section 151.065, subdivision 1, is amended to read:
Subdivision 1.
Application fees.
Application fees for licensure and registration are as
follows:
(1) pharmacist licensed by examination, $175;
(2) pharmacist licensed by reciprocity, $275;
(3) pharmacy intern, $50;
(4) pharmacy technician, $50;
(5) pharmacy, $260;
(6) drug wholesaler, legend drugs only, $5,260;
(7) drug wholesaler, legend and nonlegend drugs, $5,260;
(8) drug wholesaler, nonlegend drugs, veterinary legend drugs, or both, $5,260;
(9) drug wholesaler, medical gases, deleted text begin $5,260 for the first facility anddeleted text end $260 deleted text begin for each
additional facilitydeleted text end ;
(10) third-party logistics provider, $260;
(11) drug manufacturer, nonopiate legend drugs only, $5,260;
(12) drug manufacturer, nonopiate legend and nonlegend drugs, $5,260;
(13) drug manufacturer, nonlegend or veterinary legend drugs, $5,260;
(14) drug manufacturer, medical gases, deleted text begin $5,260 for the first facility anddeleted text end $260 deleted text begin for each
additional facilitydeleted text end ;
(15) drug manufacturer, also licensed as a pharmacy in Minnesota, $5,260;
(16) drug manufacturer of opiate-containing controlled substances listed in section
152.02, subdivisions 3 to 5, $55,260;
(17) medical gas dispenser, $260;
(18) controlled substance researcher, $75; and
(19) pharmacy professional corporation, $150.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 5.
Minnesota Statutes 2020, section 151.065, subdivision 3, is amended to read:
Subd. 3.
Annual renewal fees.
Annual licensure and registration renewal fees are as
follows:
(1) pharmacist, $175;
(2) pharmacy technician, $50;
(3) pharmacy, $260;
(4) drug wholesaler, legend drugs only, $5,260;
(5) drug wholesaler, legend and nonlegend drugs, $5,260;
(6) drug wholesaler, nonlegend drugs, veterinary legend drugs, or both, $5,260;
(7) drug wholesaler, medical gases, deleted text begin $5,260 for the first facility anddeleted text end $260 deleted text begin for each
additional facilitydeleted text end ;
(8) third-party logistics provider, $260;
(9) drug manufacturer, nonopiate legend drugs only, $5,260;
(10) drug manufacturer, nonopiate legend and nonlegend drugs, $5,260;
(11) drug manufacturer, nonlegend, veterinary legend drugs, or both, $5,260;
(12) drug manufacturer, medical gases, deleted text begin $5,260 for the first facility anddeleted text end $260 deleted text begin for each
additional facilitydeleted text end ;
(13) drug manufacturer, also licensed as a pharmacy in Minnesota, $5,260;
(14) drug manufacturer of opiate-containing controlled substances listed in section
152.02, subdivisions 3 to 5, $55,260;
(15) medical gas dispenser, $260;
(16) controlled substance researcher, $75; and
(17) pharmacy professional corporation, $100.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 6.
Minnesota Statutes 2020, section 151.065, subdivision 7, is amended to read:
Subd. 7.
Deposit of fees.
(a) The license fees collected under this section, with the
exception of the fees identified in paragraphs (b) and (c), shall be deposited in the state
government special revenue fund.
(b) $5,000 of each fee collected under subdivision 1, clauses (6) to deleted text begin (9)deleted text end new text begin (8)new text end , deleted text begin anddeleted text end (11) to
new text begin (13), and new text end (15), and subdivision 3, clauses (4) to deleted text begin (7)deleted text end new text begin (6)new text end , deleted text begin anddeleted text end (9) to new text begin (11), and new text end (13), and $55,000
of each fee collected under subdivision 1, clause (16), and subdivision 3, clause (14), shall
be deposited in the opiate epidemic response fund established in section 256.043.
(c) If the fees collected under subdivision 1, clause (16), or subdivision 3, clause (14),
are reduced under section 256.043, $5,000 of the reduced fee shall be deposited in the opiate
epidemic response fund in section 256.043.
Sec. 7.
Minnesota Statutes 2020, section 151.066, subdivision 3, is amended to read:
Subd. 3.
Determination of an opiate product registration fee.
(a) The board shall
annually assess an opiate product registration fee on any manufacturer of an opiate that
annually sells, delivers, or distributes an opiate within or into the state 2,000,000 or more
units as reported to the board under subdivision 2.
(b) new text begin For purposes of assessing the annual registration fee under this section and
determining the number of opiate units a manufacturer sold, delivered, or distributed within
or into the state, the board shall not consider any opiate that is used for medication-assisted
therapy for substance use disorders. If there is money deposited into the separate account
as described in section 16A.151, subdivision 2, paragraph (g), the board shall submit to the
commissioner of management and budget an estimate of the difference in the annual fee
revenue collected under this section due to this exception.
new text end
new text begin (c) new text end The annual registration fee for each manufacturer meeting the requirement under
paragraph (a) is $250,000.
deleted text begin (c)deleted text end new text begin (d)new text end In conjunction with the data reported under this section, and notwithstanding
section 152.126, subdivision 6, the board may use the data reported under section 152.126,
subdivision 4, to determine which manufacturers meet the requirement under paragraph (a)
and are required to pay the registration fees under this subdivision.
deleted text begin (d)deleted text end new text begin (e)new text end By April 1 of each year, beginning April 1, 2020, the board shall notify a
manufacturer that the manufacturer meets the requirement in paragraph (a) and is required
to pay the annual registration fee in accordance with section 151.252, subdivision 1,
paragraph (b).
deleted text begin (e)deleted text end new text begin (f)new text end A manufacturer may dispute the board's determination that the manufacturer must
pay the registration fee no later than 30 days after the date of notification. However, the
manufacturer must still remit the fee as required by section 151.252, subdivision 1, paragraph
(b). The dispute must be filed with the board in the manner and using the forms specified
by the board. A manufacturer must submit, with the required forms, data satisfactory to the
board that demonstrates that the assessment of the registration fee was incorrect. The board
must make a decision concerning a dispute no later than 60 days after receiving the required
dispute forms. If the board determines that the manufacturer has satisfactorily demonstrated
that the fee was incorrectly assessed, the board must refund the amount paid in error.
deleted text begin (f)deleted text end new text begin (g)new text end For purposes of this subdivision, a unit means the individual dosage form of the
particular drug product that is prescribed to the patient. One unit equals one tablet, capsule,
patch, syringe, milliliter, or gram.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 8.
Minnesota Statutes 2020, section 151.555, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
(a) For the purposes of this section, the terms defined in this
subdivision have the meanings given.
(b) "Central repository" means a wholesale distributor that meets the requirements under
subdivision 3 and enters into a contract with the Board of Pharmacy in accordance with this
section.
(c) "Distribute" means to deliver, other than by administering or dispensing.
(d) "Donor" means:
(1) a health care facility as defined in this subdivision;
(2) a skilled nursing facility licensed under chapter 144A;
(3) an assisted living facility registered under chapter 144D where there is centralized
storage of drugs and 24-hour on-site licensed nursing coverage provided seven days a week;
(4) a pharmacy licensed under section 151.19, and located either in the state or outside
the state;
(5) a drug wholesaler licensed under section 151.47;
(6) a drug manufacturer licensed under section 151.252; or
(7) an individual at least 18 years of age, provided that the drug or medical supply that
is donated was obtained legally and meets the requirements of this section for donation.
(e) "Drug" means any prescription drug that has been approved for medical use in the
United States, is listed in the United States Pharmacopoeia or National Formulary, and
meets the criteria established under this section for donationnew text begin ; or any over-the-counter
medication that meets the criteria established under this section for donationnew text end . This definition
includes cancer drugs and antirejection drugs, but does not include controlled substances,
as defined in section 152.01, subdivision 4, or a prescription drug that can only be dispensed
to a patient registered with the drug's manufacturer in accordance with federal Food and
Drug Administration requirements.
(f) "Health care facility" means:
(1) a physician's office or health care clinic where licensed practitioners provide health
care to patients;
(2) a hospital licensed under section 144.50;
(3) a pharmacy licensed under section 151.19 and located in Minnesota; or
(4) a nonprofit community clinic, including a federally qualified health center; a rural
health clinic; public health clinic; or other community clinic that provides health care utilizing
a sliding fee scale to patients who are low-income, uninsured, or underinsured.
(g) "Local repository" means a health care facility that elects to accept donated drugs
and medical supplies and meets the requirements of subdivision 4.
(h) "Medical supplies" or "supplies" means any prescription and nonprescription medical
supplies needed to administer a prescription drug.
(i) "Original, sealed, unopened, tamper-evident packaging" means packaging that is
sealed, unopened, and tamper-evident, including a manufacturer's original unit dose or
unit-of-use container, a repackager's original unit dose or unit-of-use container, or unit-dose
packaging prepared by a licensed pharmacy according to the standards of Minnesota Rules,
part 6800.3750.
(j) "Practitioner" has the meaning given in section 151.01, subdivision 23, except that
it does not include a veterinarian.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 9.
Minnesota Statutes 2020, section 151.555, subdivision 7, is amended to read:
Subd. 7.
Standards and procedures for inspecting and storing donated prescription
drugs and supplies.
(a) A pharmacist or authorized practitioner who is employed by or
under contract with the central repository or a local repository shall inspect all donated
prescription drugs and supplies before the drug or supply is dispensed to determine, to the
extent reasonably possible in the professional judgment of the pharmacist or practitioner,
that the drug or supply is not adulterated or misbranded, has not been tampered with, is safe
and suitable for dispensing, has not been subject to a recall, and meets the requirements for
donation. The pharmacist or practitioner who inspects the drugs or supplies shall sign an
inspection record stating that the requirements for donation have been met. If a local
repository receives drugs and supplies from the central repository, the local repository does
not need to reinspect the drugs and supplies.
(b) The central repository and local repositories shall store donated drugs and supplies
in a secure storage area under environmental conditions appropriate for the drug or supply
being stored. Donated drugs and supplies may not be stored with nondonated inventory. deleted text begin If
donated drugs or supplies are not inspected immediately upon receipt, a repository must
quarantine the donated drugs or supplies separately from all dispensing stock until the
donated drugs or supplies have been inspected and (1) approved for dispensing under the
program; (2) disposed of pursuant to paragraph (c); or (3) returned to the donor pursuant to
paragraph (d).
deleted text end
(c) The central repository and local repositories shall dispose of all prescription drugs
and medical supplies that are not suitable for donation in compliance with applicable federal
and state statutes, regulations, and rules concerning hazardous waste.
(d) In the event that controlled substances or prescription drugs that can only be dispensed
to a patient registered with the drug's manufacturer are shipped or delivered to a central or
local repository for donation, the shipment delivery must be documented by the repository
and returned immediately to the donor or the donor's representative that provided the drugs.
(e) Each repository must develop drug and medical supply recall policies and procedures.
If a repository receives a recall notification, the repository shall destroy all of the drug or
medical supply in its inventory that is the subject of the recall and complete a record of
destruction form in accordance with paragraph (f). If a drug or medical supply that is the
subject of a Class I or Class II recall has been dispensed, the repository shall immediately
notify the recipient of the recalled drug or medical supply. A drug that potentially is subject
to a recall need not be destroyed if its packaging bears a lot number and that lot of the drug
is not subject to the recall. If no lot number is on the drug's packaging, it must be destroyed.
(f) A record of destruction of donated drugs and supplies that are not dispensed under
subdivision 8, are subject to a recall under paragraph (e), or are not suitable for donation
shall be maintained by the repository for at least deleted text begin fivedeleted text end new text begin twonew text end years. For each drug or supply
destroyed, the record shall include the following information:
(1) the date of destruction;
(2) the name, strength, and quantity of the drug destroyed; and
(3) the name of the person or firm that destroyed the drug.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 10.
Minnesota Statutes 2020, section 151.555, subdivision 11, is amended to read:
Subd. 11.
Forms and record-keeping requirements.
(a) The following forms developed
for the administration of this program shall be utilized by the participants of the program
and shall be available on the board's website:
(1) intake application form described under subdivision 5;
(2) local repository participation form described under subdivision 4;
(3) local repository withdrawal form described under subdivision 4;
(4) drug repository donor form described under subdivision 6;
(5) record of destruction form described under subdivision 7; and
(6) drug repository recipient form described under subdivision 8.
(b) All records, including drug inventory, inspection, and disposal of donated prescription
drugs and medical supplies, must be maintained by a repository for a minimum of deleted text begin fivedeleted text end new text begin twonew text end
years. Records required as part of this program must be maintained pursuant to all applicable
practice acts.
(c) Data collected by the drug repository program from all local repositories shall be
submitted quarterly or upon request to the central repository. Data collected may consist of
the information, records, and forms required to be collected under this section.
(d) The central repository shall submit reports to the board as required by the contract
or upon request of the board.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 11.
Minnesota Statutes 2020, section 151.555, is amended by adding a subdivision
to read:
new text begin Subd. 14. new text end
new text begin Cooperation. new text end
new text begin
The central repository, as approved by the Board of Pharmacy,
may enter into an agreement with another state that has an established drug repository or
drug donation program if the other state's program includes regulations to ensure the purity,
integrity, and safety of the drugs and supplies donated, to permit the central repository to
offer to another state program inventory that is not needed by a Minnesota resident and to
accept inventory from another state program to be distributed to local repositories and
dispensed to Minnesota residents in accordance with this 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. 12.
Minnesota Statutes 2020, section 256.043, subdivision 3, is amended to read:
Subd. 3.
Appropriations from fund.
(a) After the appropriations in Laws 2019, chapter
63, article 3, section 1, paragraphs (e)deleted text begin ,deleted text end new text begin andnew text end (f), deleted text begin (g), and (h)deleted text end are made, $249,000 is appropriated
to the commissioner of human services for the provision of administrative services to the
Opiate Epidemic Response Advisory Council and for the administration of the grants awarded
under paragraph (e).
(b) $126,000 is appropriated to the Board of Pharmacy for the collection of the registration
fees under section 151.066.
(c) $672,000 is appropriated to the commissioner of public safety for the Bureau of
Criminal Apprehension. Of this amount, $384,000 is for drug scientists and lab supplies
and $288,000 is for special agent positions focused on drug interdiction and drug trafficking.
(d) After the appropriations in paragraphs (a) to (c) are made, 50 percent of the remaining
amount is appropriated to the commissioner of human services for distribution to county
social service and tribal social service agencies to provide child protection services to
children and families who are affected by addiction. The commissioner shall distribute this
money proportionally to counties and tribal social service agencies based on out-of-home
placement episodes where parental drug abuse is the primary reason for the out-of-home
placement using data from the previous calendar year. County and tribal social service
agencies receiving funds from the opiate epidemic response fund must annually report to
the commissioner on how the funds were used to provide child protection services, including
measurable outcomes, as determined by the commissioner. County social service agencies
and tribal social service agencies must not use funds received under this paragraph to supplant
current state or local funding received for child protection services for children and families
who are affected by addiction.
(e) After making the appropriations in paragraphs (a) to (d), the remaining amount in
the fund is appropriated to the commissioner to award grants as specified by the Opiate
Epidemic Response Advisory Council in accordance with section 256.042, unless otherwise
appropriated by the legislature.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2024.
new text end
Sec. 13. new text begin OPIATE REGISTRATION FEE REDUCTION.
new text end
new text begin
(a) For purposes of assessing the opiate registration fee under Minnesota Statutes, section
151.066, subdivision 3, that is required to be paid on June 1, 2021, in accordance with
Minnesota Statutes, section 151.252, subdivision 1, paragraph (b), the Board of Pharmacy
shall not consider any injectable opiate product distributed to a hospital or hospital pharmacy.
If there is money deposited into the separate account as described in Minnesota Statutes,
section 16A.151, subdivision 2, paragraph (g), the board shall submit to the commissioner
of management and budget an estimate of the difference in the annual opiate registration
fee revenue collected under Minnesota Statutes, section 151.066, due to the exception
described in this paragraph.
new text end
new text begin
(b) Any estimated loss to the opiate registration fee revenue attributable to paragraph
(a) must be included in any transfer that occurs under Minnesota Statutes, section 16A.151,
subdivision 2, paragraph (g), in calendar year 2021.
new text end
new text begin
(c) If a manufacturer has already paid the opiate registration fee due on June 1, 2021,
the Board of Pharmacy shall return the amount of the fee to the manufacturer if the
manufacturer would not have been required to pay the fee after the calculations described
in paragraph (a) were made.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
ARTICLE 5
HEALTH COVERAGE AND TRANSPARENCY
Section 1.
Minnesota Statutes 2020, section 62J.701, is amended to read:
62J.701 GOVERNMENTAL PROGRAMS.
deleted text begin
(a) Beginning January 1, 1999, the provisions in paragraphs (b) to (e) apply.
deleted text end
deleted text begin (b)deleted text end new text begin (a)new text end For purposes of sections 62J.695 to 62J.80, the requirements and other provisions
that apply to health plan companies also apply to governmental programs.
deleted text begin (c)deleted text end new text begin (b)new text end For purposes of this section, "governmental programs" means the medical
assistance program, the MinnesotaCare program, the state employee group insurance
program, the public employees insurance program under section 43A.316, and coverage
provided by political subdivisions under section 471.617.
deleted text begin (d)deleted text end new text begin (c)new text end Notwithstanding paragraph deleted text begin (b)deleted text end new text begin (a)new text end , section 62J.72 does not apply to the
fee-for-service programs under medical assistance and MinnesotaCarenew text begin and section 62J.72,
subdivision 3, paragraph (b), does not apply to the prepaid medical assistance program or
MinnesotaCarenew text end .
deleted text begin (e)deleted text end new text begin (d)new text end If a state commissioner or local unit of government contracts with a health plan
company or a third-party administrator, the contract may assign any obligations under
paragraph deleted text begin (b)deleted text end new text begin (a)new text end to the health plan company or third-party administrator. Nothing in this
paragraph shall be construed to remove or diminish any enforcement responsibilities of the
commissioners of health or commerce provided in sections 62J.695 to 62J.80.
Sec. 2.
Minnesota Statutes 2020, section 62J.72, subdivision 3, is amended to read:
Subd. 3.
Information on patients' medical bills.
new text begin (a) new text end A health plan company and health
care provider shall provide patients and enrollees with a copy of an explicit and intelligible
bill deleted text begin whenever the patient or enrollee is sent a bill and is responsible for paying any portion
of that billdeleted text end . The deleted text begin billsdeleted text end new text begin billnew text end must contain descriptive language sufficient to be understood by
the average patient or enrollee. This subdivision does not apply to a flat co-pay paid by the
patient or enrollee at the time the service is required.
new text begin
(b) In addition to the requirements in paragraph (a), when a health care provider transmits
a bill to a patient, the bill must specify the following for the health care services provided:
new text end
new text begin
(1) the Medicare-allowable fee-for-service payment rate if the service is covered by
Medicare; and
new text end
new text begin
(2) the provider's Medicare percent, as defined in section 62J.825, subdivision 1.
new text end
Sec. 3.
Minnesota Statutes 2020, section 62J.81, subdivision 1, is amended to read:
Subdivision 1.
Required disclosure by provider.
(a) A health care provider, as defined
in section 62J.03, subdivision 8, or the provider's designee as agreed to by that designee,
shall, at the request of a consumer, and at no cost to the consumer or the consumer's
employer, provide that consumer with a good faith estimate of the allowable payment the
provider has agreed to accept from the consumer's health plan company for the services
specified by the consumer, specifying the amount of the allowable payment due from the
health plan company. If a consumer has no applicable public or private coverage, the health
care provider must give the consumer, and at no cost to the consumer, a good faith estimate
of the average allowable reimbursement the provider accepts as payment from private
third-party payers for the services specified by the consumer and the estimated amount the
noncovered consumer will be required to pay.
(b) In addition to the information required to be disclosed under paragraph (a), a provider
must also provide the consumer with information regarding other types of fees or charges
that the consumer may be required to pay in conjunction with a visit to the provider, including
but not limited to any applicable facility fees.
(c) new text begin For a consumer with health plan coverage, new text end the information required under this
subdivision must be provided to deleted text begin adeleted text end new text begin thenew text end consumer within deleted text begin tendeleted text end new text begin fivenew text end business days from the day
new text begin that new text end a complete request was received by the health care provider. deleted text begin For purposes of this section,
"complete request" includes all the patient and service information the health care provider
requires to provide a good faith estimate, including a completed good faith estimate form
if required by the health care provider.deleted text end new text begin For a consumer with no applicable public or private
coverage, the information required by this subdivision must be provided to the consumer
within three business days from the day that a complete request was received by the health
care provider.
new text end
(d) Payment information provided by a provider, or by the provider's designee as agreed
to by that designee, to a patient pursuant to this subdivision does not constitute a legally
binding estimate of the allowable charge for or cost to the consumer of services.
(e) No contract between a health plan company and a provider shall prohibit a provider
from disclosing the pricing information required under this subdivision.
new text begin
(f) For purposes of this subdivision, "complete request" includes all of the patient and
service information that the health care provider requires to provide a good faith estimate,
including a completed good faith estimate form, if required by the health care provider.
new text end
Sec. 4.
Minnesota Statutes 2020, section 62J.81, subdivision 1a, is amended to read:
Subd. 1a.
Required disclosure by health plan company.
(a) A health plan company,
as defined in section 62J.03, subdivision 10, shall, at the request of an enrollee intending
to receive specific health care services or the enrollee's designee, provide that enrollee with
a good faith estimate of the allowable amount the health plan company has contracted for
with a specified provider within the network as total payment for a health care service
specified by the enrollee and the portion of the allowable amount due from the enrollee and
the enrollee's out-of-pocket costs. An estimate provided to an enrollee under this paragraph
is not a legally binding estimate of the allowable amount or enrollee's out-of-pocket cost.
(b) The information required under this subdivision must be provided by the health plan
company to an enrollee within deleted text begin tendeleted text end new text begin fivenew text end business days from the day a complete request was
received by the health plan company.
new text begin (c) new text end For purposes of this deleted text begin sectiondeleted text end new text begin subdivisionnew text end , "complete request" includes all the patient
and service information the health plan company requires to provide a good faith estimate,
including a completed good faith estimate form if required by the health plan company.
Sec. 5.
new text begin
[62J.825] HEALTH CARE PRICE TRANSPARENCY; NOTICE AND
DISCLOSURE OF MEDICARE PERCENT.
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 in this subdivision
have the meanings given.
new text end
new text begin
(b) "Health plan" has the meaning given in section 62A.011, subdivision 3, and does
not include coverage provided under medical assistance, MinnesotaCare, or Medicare Part
A, Part B, or Part C.
new text end
new text begin
(c) "Medicare percent" means the percentage of the Medicare allowable payment rate
that a health care provider accepts as payment in full for health care services provided by
the provider that are covered by Medicare, and for services not covered by Medicare, a
dollar amount the provider is willing to accept as payment in full.
new text end
new text begin Subd. 2. new text end
new text begin Required notice. new text end
new text begin
(a) A health care provider must establish a Medicare percent
that the provider will accept as payment in full for health care services provided by that
provider for services that are not covered by a patient's health plan or for patients who are
not insured. A provider must provide notice to patients and the public of the provider's
Medicare percent by:
new text end
new text begin
(1) posting information describing the Medicare percent and specifying the provider's
Medicare percent in a prominent, clearly visible location at or near the provider's reception
desk, registration desk, or patient check-in area;
new text end
new text begin
(2) posting information describing the Medicare percent and specifying the provider's
Medicare percent on the provider's public website; and
new text end
new text begin
(3) including information describing the Medicare percent and specifying the provider's
Medicare percent on any document related to provider payments that the provider requires
a patient or patient's representative to sign.
new text end
new text begin
(b) The notices required in paragraph (a) must include the following statement: "The
Medicare percent means the reimbursement that this provider will accept as payment in full
for services provided to patients. The Medicare percent can be used by a patient to compare
the cost of care between providers."
new text end
Sec. 6.
new text begin
[62Q.097] REQUIREMENTS FOR TIMELY PROVIDER CREDENTIALING.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) The definitions in this subdivision apply to this section.
new text end
new text begin
(b) "Clean application for provider credentialing" or "clean application" means an
application for provider credentialing submitted by a health care provider to a health plan
company that is complete, is in the format required by the health plan company, and includes
all information and substantiation required by the health plan company and does not require
evaluation of any identified potential quality or safety concern.
new text end
new text begin
(c) "Provider credentialing" means the process undertaken by a health plan company to
evaluate and approve a health care provider's education, training, residency, licenses,
certifications, and history of significant quality or safety concerns in order to approve the
health care provider to provide health care services to patients at a clinic or facility.
new text end
new text begin Subd. 2. new text end
new text begin Time limit for credentialing determination. new text end
new text begin
A health plan company that
receives an application for provider credentialing must:
new text end
new text begin
(1) if the application is determined to be a clean application for provider credentialing
and if the health care provider submitting the application or the clinic or facility at which
the health care provider provides services requests the information, affirm that the health
care provider's application is a clean application and notify the health care provider or clinic
or facility of the date by which the health plan company will make a determination on the
health care provider's application;
new text end
new text begin
(2) if the application is determined not to be a clean application, inform the health care
provider of the application's deficiencies or missing information or substantiation within
three business days after the health plan company determines the application is not a clean
application; and
new text end
new text begin
(3) make a determination on the health care provider's clean application within 45 days
after receiving the clean application unless the health plan company identifies a substantive
quality or safety concern in the course of provider credentialing that requires further
investigation. Upon notice to the health care provider, clinic, or facility, the health plan
company is allowed 30 additional days to investigate any quality or safety concerns.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section applies to applications for provider credentialing
submitted to a health plan company on or after January 1, 2022.
new text end
Sec. 7.
new text begin
[62Q.524] DISCLOSURE OF APPLICATION OF FUNDS FROM A PATIENT
ASSISTANCE PROGRAM TO A DEDUCTIBLE.
new text end
new text begin
A health plan company must include in the summary of benefits and coverage a statement
indicating whether funds from a patient assistance program, as defined in section 62J.84,
subdivision 2, paragraph (h), are applied by the health plan company to an enrollee's
deductible.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, and applies to health
plans offered, issued, or renewed on or after that date.
new text end
ARTICLE 6
DHS LICENSING AND BACKGROUND STUDIES
Section 1.
Minnesota Statutes 2020, section 62V.05, is amended by adding a subdivision
to read:
new text begin Subd. 4a. new text end
new text begin Background study required. new text end
new text begin
(a) The board must initiate background studies
under section 245C.03 of:
new text end
new text begin
(1) each navigator;
new text end
new text begin
(2) each in-person assister; and
new text end
new text begin
(3) each certified application counselor.
new text end
new text begin
(b) The board may initiate the background studies required by paragraph (a) using the
online NETStudy 2.0 system operated by the commissioner of human services.
new text end
new text begin
(c) The board shall not permit any individual to provide any service or function listed
in paragraph (a) until the board has received notification from the commissioner of human
services indicating that the individual:
new text end
new text begin
(1) is not disqualified under chapter 245C; or
new text end
new text begin
(2) is disqualified, but has received a set aside from the board of that disqualification
according to sections 245C.22 and 245C.23.
new text end
new text begin
(d) The board or its delegate shall review a reconsideration request of an individual in
paragraph (a), including granting a set aside, according to the procedures and criteria in
chapter 245C. The board shall notify the individual and the Department of Human Services
of the board's decision.
new text end
Sec. 2.
new text begin
[119B.27] OMBUDSPERSON FOR CHILD CARE PROVIDERS.
new text end
new text begin Subdivision 1. new text end
new text begin Appointment. new text end
new text begin
The commissioner of human services shall appoint two
ombudspersons in the classified service to assist child care providers, including family child
care providers and legal nonlicensed child care providers, with licensing, compliance, and
other issues facing child care providers. Each ombudsperson must be selected without regard
to the person's political affiliation, and at least one ombudsperson must have been a licensed
family child care provider for at least three years. Each ombudsperson shall serve a term of
four years and may be removed prior to the end of the term for just cause.
new text end
new text begin Subd. 2. new text end
new text begin Duties. new text end
new text begin
(a) Each ombudsperson's duties shall include:
new text end
new text begin
(1) advocating on behalf of a child care provider to address all areas of concern related
to the provision of child care services, including licensing actions, correction orders, penalty
assessments, complaint investigations, and other interactions with state and county staff;
new text end
new text begin
(2) providing recommendations to the commissioner or providers for child care program
improvement or child care provider education;
new text end
new text begin
(3) operating a telephone line to answer questions, receive complaints, and discuss
agency actions when a child care provider believes that the provider's rights or program
may have been adversely affected; and
new text end
new text begin
(4) assisting child care license applicants with the license application process.
new text end
new text begin
(b) The ombudspersons must report annually by December 31 to the commissioner and
the chairs and ranking minority members of the legislative committees with jurisdiction
over child care on the services provided by each ombudsperson to child care providers,
including the number, types, and locations of child care providers served, and the activities
of each ombudsperson to carry out the duties under this section. The commissioner shall
determine the form of the report.
new text end
new text begin Subd. 3. new text end
new text begin Staff. new text end
new text begin
The ombudspersons may appoint and compensate from available funds
a deputy, confidential secretary, and other employees in the unclassified service as authorized
by law. Each ombudsperson and the full-time staff are members of the Minnesota State
Retirement Association. The ombudspersons may delegate to members of the staff any
authority or duties of the office except the duty to provide reports to the governor,
commissioner, or legislature.
new text end
new text begin Subd. 4. new text end
new text begin Access to records. new text end
new text begin
(a) Each ombudsperson or designee, excluding volunteers,
must have access to data of a state agency necessary for the discharge of the ombudsperson's
duties, including records classified as confidential data on individuals or private data on
individuals under chapter 13, or any other law. An ombudsperson's data request must relate
to a specific case. If the data concerns an individual, the ombudsperson or designee shall
first obtain the individual's consent. If the individual cannot consent and has no parent or
legal guardian, then the ombudsperson's access to the data is authorized by this section.
new text end
new text begin
(b) Each ombudsperson and all designees must adhere to the Minnesota Government
Data Practices Act and may not disseminate any private or confidential data on individuals
unless specifically authorized by state, local, or federal law or pursuant to a court order.
new text end
new text begin
(c) The commissioner of human services and county agencies must provide
ombudspersons with copies of all correction orders, fix-it tickets, and licensing actions
issued to child care providers.
new text end
new text begin Subd. 5. new text end
new text begin Independence of action. new text end
new text begin
When carrying out duties under this section,
ombudspersons must act independently of the department to provide testimony to the
legislature, make periodic reports to the legislature, and address areas of concern to child
care providers.
new text end
new text begin Subd. 6. new text end
new text begin Civil actions. new text end
new text begin
Each ombudsperson and designee is not civilly liable for any
action taken under this section if the action was taken in good faith, was within the scope
of the ombudsperson's authority, and did not constitute willful or reckless misconduct.
new text end
new text begin Subd. 7. new text end
new text begin Qualifications. new text end
new text begin
Each ombudsperson must be a person who has knowledge and
experience concerning the provision of child care. Each ombudsperson must be experienced
in dealing with governmental entities, interpretation of laws and regulations, investigations,
record keeping, report writing, public speaking, and management. A person is not eligible
to serve as an ombudsperson while running for or holding public office, or while holding
an active child care license.
new text end
new text begin Subd. 8. new text end
new text begin Office support. new text end
new text begin
The commissioner shall provide ombudspersons with the
necessary office space, supplies, equipment, and clerical support to effectively perform
duties under this section.
new text end
new text begin Subd. 9. new text end
new text begin Posting. new text end
new text begin
(a) The commissioner shall post on the department's website the
mailing address, e-mail address, and telephone number for the office of the ombudsperson.
The commissioner shall provide all licensed child care providers and legal nonlicensed child
care providers with the mailing address, e-mail address, and telephone number of the office
on the department's child care licensing website or upon request from a child care license
applicant or provider. Counties must provide child care license applicants and providers
with the name, mailing address, e-mail address, and telephone number of the office.
new text end
new text begin
(b) Ombudspersons must approve of all posting and notice required by the department
and counties under this subdivision.
new text end
Sec. 3.
Minnesota Statutes 2020, section 122A.18, subdivision 8, is amended to read:
Subd. 8.
Background deleted text begin checksdeleted text end new text begin studiesnew text end .
(a) The Professional Educator Licensing and
Standards Board and the Board of School Administrators must deleted text begin obtain adeleted text end new text begin initiatenew text end criminal
history background deleted text begin check ondeleted text end new text begin studies ofnew text end all first-time deleted text begin teachingdeleted text end applicants for new text begin educator new text end licenses
under their jurisdiction. Applicants must include with their licensure applications:
(1) an executed criminal history consent form, including fingerprints; and
(2) payment to conduct the background deleted text begin checkdeleted text end new text begin studynew text end . The Professional Educator Licensing
and Standards Board must deposit payments received under this subdivision in an account
in the special revenue fund. Amounts in the account are annually appropriated to the
Professional Educator Licensing and Standards Board to pay for the costs of background
deleted text begin checksdeleted text end new text begin studiesnew text end on applicants for licensure.
(b) The background deleted text begin checkdeleted text end new text begin studynew text end for all first-time teaching applicants for licenses must
include a review of information from the Bureau of Criminal Apprehension, including
criminal history data as defined in section 13.87, and must also include a review of the
national criminal records repository. The superintendent of the Bureau of Criminal
Apprehension is authorized to exchange fingerprints with the Federal Bureau of Investigation
for purposes of the criminal history check. deleted text begin The superintendent shall recover the cost to the
bureau of a deleted text end deleted text begin background check through the fee charged to the applicant under paragraph (a).
deleted text end
(c) The Professional Educator Licensing and Standards Board deleted text begin must contract withdeleted text end new text begin may
initiate criminal history background studies throughnew text end the commissioner of human services
new text begin according to section 245C.03 new text end to deleted text begin conduct background checks anddeleted text end obtain background deleted text begin checkdeleted text end
new text begin studynew text end data required under this chapter.
Sec. 4.
Minnesota Statutes 2020, section 144.057, subdivision 1, is amended to read:
Subdivision 1.
Background studies required.
new text begin (a) Except as specified in paragraph (b),
new text end the commissioner of health shall contract with the commissioner of human services to
conduct background studies of:
(1) individuals providing services that have direct contact, as defined under section
245C.02, subdivision 11, with patients and residents in hospitals, boarding care homes,
outpatient surgical centers licensed under sections 144.50 to 144.58; nursing homes and
home care agencies licensed under chapter 144A; assisted living facilities and assisted living
facilities with dementia care licensed under chapter 144G; and board and lodging
establishments that are registered to provide supportive or health supervision services under
section 157.17;
(2) individuals specified in section 245C.03, subdivision 1, who perform direct contact
services in a nursing home or a home care agency licensed under chapter 144A; an assisted
living facility or assisted living facility with dementia care licensed under chapter 144G;
or a boarding care home licensed under sections 144.50 to 144.58. If the individual under
study resides outside Minnesota, the study must include a check for substantiated findings
of maltreatment of adults and children in the individual's state of residence when the
information is made available by that state, and must include a check of the National Crime
Information Center database;
(3) all other employees in assisted living facilities or assisted living facilities with
dementia care licensed under chapter 144G, nursing homes licensed under chapter 144A,
and boarding care homes licensed under sections 144.50 to 144.58. A disqualification of
an individual in this section shall disqualify the individual from positions allowing direct
contact or access to patients or residents receiving services. "Access" means physical access
to a client or the client's personal property without continuous, direct supervision as defined
in section 245C.02, subdivision 8, when the employee's employment responsibilities do not
include providing direct contact services;
(4) individuals employed by a supplemental nursing services agency, as defined under
section 144A.70, who are providing services in health care facilities; and
(5) controlling persons of a supplemental nursing services agency, as defined under
section 144A.70.
new text begin
(b) The commissioner of human services is not required to conduct a background study
on any individual identified in paragraph (a) if the individual has a valid license issued by
a health-related licensing board as defined in section 214.01, subdivision 2, and has completed
the criminal background check as required in section 214.075.
new text end
new text begin (c) new text end If a facility or program is licensed by the Department of Human Services and subject
to the background study provisions of chapter 245C and is also licensed by the Department
of Health, the Department of Human Services is solely responsible for the background
studies of individuals in the jointly licensed programs.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 5.
Minnesota Statutes 2020, section 245A.02, is amended by adding a subdivision to
read:
new text begin Subd. 23. new text end
new text begin Family or group family child care program. new text end
new text begin
"Family or group family child
care program" means a licensed child care program operated in the residence in which the
license holder lives. The license holder is the primary provider of care and may only hold
one family child care license.
new text end
Sec. 6.
Minnesota Statutes 2020, section 245A.02, is amended by adding a subdivision to
read:
new text begin Subd. 24. new text end
new text begin Special family child care program. new text end
new text begin
"Special family child care program"
means a licensed child care program operated in a residence in which the license holder
does not live. The license holder is the primary provider of care.
new text end
Sec. 7.
Minnesota Statutes 2020, section 245A.02, is amended by adding a subdivision to
read:
new text begin Subd. 25. new text end
new text begin Nonresidential family child care program. new text end
new text begin
"Nonresidential family child
care program" means a licensed child care program operated in a location other than the
license holder's own residence, excluding licensed child care centers. The license holder is
one of the individuals or entities listed in section 245A.141, subdivision 1, paragraph (a).
new text end
Sec. 8.
Minnesota Statutes 2020, section 245A.03, is amended by adding a subdivision to
read:
new text begin Subd. 10. new text end
new text begin
Group family day care licensed capacity; child-to-adult capacity ratios;
age distribution restrictions.
new text end
new text begin
(a) Notwithstanding Minnesota Rules, parts 9502.0365,
subpart 1, and 9502.0367, item C, the commissioner shall issue licenses for group family
day care according to the capacity limits, child-to-adult ratios, and age distribution restrictions
in this subdivision.
new text end
new text begin
(b) For purposes of this subdivision, "group family day care" means day care for no
more than 16 children at any one time. The licensed capacity of a group family day care
must include all children of any caregiver when the children are present in the residence,
except notwithstanding Minnesota Rules, part 9502.0365, subpart 1, item A, the licensed
capacity does not include the license holder's biological or adopted children who are nine
years old or older.
new text end
new text begin
(c) Notwithstanding Minnesota Rules, part 9502.0367, item C, subitem (1), for a group
family day care program with a licensed capacity of ten children, one adult caregiver shall
serve no more than ten children younger than 11 years of age. Of those ten, no more than
seven may be younger than four years of age. Of those seven, no more than three may be
younger than 18 months of age. Of those three, no more than two may be infants.
new text end
new text begin
(d) Notwithstanding Minnesota Rules, part 9502.0367, item C, subitem (2), for a group
family day care program with a licensed capacity of 12 children, one adult caregiver shall
serve no more than 12 children younger than 11 years of age. Of those 12, no more than
nine may be younger than four years of age. Of those nine, no more than two may be younger
than 18 months of age.
new text end
new text begin
(e) Notwithstanding Minnesota Rules, part 9502.0367, item C, subitem (3), for a group
family day care program with a licensed capacity of 16 children, two adult caregivers shall
serve no more than 16 children younger than 11 years of age. Of those 16, no more than 11
may be younger than four years of age. Of those 11, no more than four may be younger
than 18 months of age. Of those four, no more than three may be infants. A helper may be
used in place of a second adult caregiver when there is no more than one child younger than
18 months of age present.
new text end
Sec. 9.
Minnesota Statutes 2020, section 245A.043, subdivision 3, is amended to read:
Subd. 3.
Change of ownership process.
(a) When a change in ownership is proposed
and the party intends to assume operation without an interruption in service longer than 60
days after acquiring the program or service, the license holder must provide the commissioner
with written notice of the proposed change on a form provided by the commissioner at least
60 days before the anticipated date of the change in ownership. For purposes of this
subdivision and subdivision 4, "party" means the party that intends to operate the service
or program.
(b) The party must submit a license application under this chapter on the form and in
the manner prescribed by the commissioner at least 30 days before the change in ownership
is complete, and must include documentation to support the upcoming change. The party
must comply with background study requirements under chapter 245C and shall pay the
application fee required under section 245A.10. deleted text begin A party that intends to assume operation
without an interruption in service longer than 60 days after acquiring the program or service
is exempt from the requirements of Minnesota Rules, part 9530.6800.
deleted text end
(c) The commissioner may streamline application procedures when the party is an existing
license holder under this chapter and is acquiring a program licensed under this chapter or
service in the same service class as one or more licensed programs or services the party
operates and those licenses are in substantial compliance. For purposes of this subdivision,
"substantial compliance" means within the previous 12 months the commissioner did not
(1) issue a sanction under section 245A.07 against a license held by the party, or (2) make
a license held by the party conditional according to section 245A.06.
(d) Except when a temporary change in ownership license is issued pursuant to
subdivision 4, the existing license holder is solely responsible for operating the program
according to applicable laws and rules until a license under this chapter is issued to the
party.
(e) If a licensing inspection of the program or service was conducted within the previous
12 months and the existing license holder's license record demonstrates substantial
compliance with the applicable licensing requirements, the commissioner may waive the
party's inspection required by section 245A.04, subdivision 4. The party must submit to the
commissioner (1) proof that the premises was inspected by a fire marshal or that the fire
marshal deemed that an inspection was not warranted, and (2) proof that the premises was
inspected for compliance with the building code or that no inspection was deemed warranted.
(f) If the party is seeking a license for a program or service that has an outstanding action
under section 245A.06 or 245A.07, the party must submit a letter as part of the application
process identifying how the party has or will come into full compliance with the licensing
requirements.
(g) The commissioner shall evaluate the party's application according to section 245A.04,
subdivision 6. If the commissioner determines that the party has remedied or demonstrates
the ability to remedy the outstanding actions under section 245A.06 or 245A.07 and has
determined that the program otherwise complies with all applicable laws and rules, the
commissioner shall issue a license or conditional license under this chapter. The conditional
license remains in effect until the commissioner determines that the grounds for the action
are corrected or no longer exist.
(h) The commissioner may deny an application as provided in section 245A.05. An
applicant whose application was denied by the commissioner may appeal the denial according
to section 245A.05.
(i) This subdivision does not apply to a licensed program or service located in a home
where the license holder resides.
Sec. 10.
Minnesota Statutes 2020, section 245A.05, is amended to read:
245A.05 DENIAL OF APPLICATION.
(a) The commissioner may deny a license if an applicant or controlling individual:
(1) fails to submit a substantially complete application after receiving notice from the
commissioner under section 245A.04, subdivision 1;
(2) fails to comply with applicable laws or rules;
(3) knowingly withholds relevant information from or gives false or misleading
information to the commissioner in connection with an application for a license or during
an investigation;
(4) has a disqualification that has not been set aside under section 245C.22 and no
variance has been granted;
(5) has an individual living in the household who received a background study under
section 245C.03, subdivision 1, paragraph (a), clause (2), who has a disqualification that
has not been set aside under section 245C.22, and no variance has been granted;
(6) is associated with an individual who received a background study under section
245C.03, subdivision 1, paragraph (a), clause (6), who may have unsupervised access to
children or vulnerable adults, and who has a disqualification that has not been set aside
under section 245C.22, and no variance has been granted;
(7) fails to comply with section 245A.04, subdivision 1, paragraph (f) or (g);
(8) fails to demonstrate competent knowledge as required by section 245A.04, subdivision
6;
(9) has a history of noncompliance as a license holder or controlling individual with
applicable laws or rules, including but not limited to this chapter and chapters 119B and
245C; deleted text begin or
deleted text end
(10) is prohibited from holding a license according to section 245.095deleted text begin .deleted text end new text begin ; or
new text end
new text begin
(11) for a family foster setting, has nondisqualifying background study information, as
described in section 245C.05, subdivision 4, that reflects on the individual's ability to safely
provide care to foster children.
new text end
(b) An applicant whose application has been denied by the commissioner must be given
notice of the denial, which must state the reasons for the denial in plain language. Notice
must be given by certified mail or personal service. The notice must state the reasons the
application was denied and must inform the applicant of the right to a contested case hearing
under chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. The applicant may
appeal the denial by notifying the commissioner in writing by certified mail or personal
service. If mailed, the appeal must be postmarked and sent to the commissioner within 20
calendar days after the applicant received the notice of denial. If an appeal request is made
by personal service, it must be received by the commissioner within 20 calendar days after
the applicant received the notice of denial. Section 245A.08 applies to hearings held to
appeal the commissioner's denial of an application.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 11.
Minnesota Statutes 2020, section 245A.07, subdivision 1, is amended to read:
Subdivision 1.
Sanctions; appeals; license.
(a) In addition to making a license conditional
under section 245A.06, the commissioner may suspend or revoke the license, impose a fine,
or secure an injunction against the continuing operation of the program of a license holder
who does not comply with applicable law or rulenew text begin , or who has nondisqualifying background
study information, as described in section 245C.05, subdivision 4, that reflects on the license
holder's ability to safely provide care to foster childrennew text end . When applying sanctions authorized
under this section, the commissioner shall consider the nature, chronicity, or severity of the
violation of law or rule and the effect of the violation on the health, safety, or rights of
persons served by the program.
(b) If a license holder appeals the suspension or revocation of a license and the license
holder continues to operate the program pending a final order on the appeal, the commissioner
shall issue the license holder a temporary provisional license. Unless otherwise specified
by the commissioner, variances in effect on the date of the license sanction under appeal
continue under the temporary provisional license. If a license holder fails to comply with
applicable law or rule while operating under a temporary provisional license, the
commissioner may impose additional sanctions under this section and section 245A.06, and
may terminate any prior variance. If a temporary provisional license is set to expire, a new
temporary provisional license shall be issued to the license holder upon payment of any fee
required under section 245A.10. The temporary provisional license shall expire on the date
the final order is issued. If the license holder prevails on the appeal, a new nonprovisional
license shall be issued for the remainder of the current license period.
(c) If a license holder is under investigation and the license issued under this chapter is
due to expire before completion of the investigation, the program shall be issued a new
license upon completion of the reapplication requirements and payment of any applicable
license fee. Upon completion of the investigation, a licensing sanction may be imposed
against the new license under this section, section 245A.06, or 245A.08.
(d) Failure to reapply or closure of a license issued under this chapter by the license
holder prior to the completion of any investigation shall not preclude the commissioner
from issuing a licensing sanction under this section or section 245A.06 at the conclusion
of the investigation.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 12.
Minnesota Statutes 2020, section 245A.08, subdivision 4, is amended to read:
Subd. 4.
Recommendation new text begin or decision new text end of administrative law judge.
new text begin (a) Except as
provided in paragraph (b), new text end the administrative law judge shall recommend whether or not
the commissioner's order should be affirmed. The recommendations must be consistent with
this chapter and the rules of the commissioner. The recommendations must be in writing
and accompanied by findings of fact and conclusions and must be mailed to the parties by
certified mail to their last known addresses as shown on the license or application.
new text begin
(b) Following a hearing relating to the license of a family child care provider or group
family child care provider, the administrative law judge shall decide whether the
commissioner's order should be affirmed. The decision of the administrative law judge is
binding on both parties to the proceeding and is the final decision of the commissioner. The
decision of the administrative law judge must be:
new text end
new text begin
(1) consistent with this chapter and the applicable licensing rules;
new text end
new text begin
(2) in writing and accompanied by findings of fact and conclusions of law;
new text end
new text begin
(3) mailed to the family child care provider or group family child care provider by
certified mail to the last known address shown on the license or application, or, if service
by certified mail is waived by the provider, served in accordance with Minnesota Rules,
part 1400.8610; and
new text end
new text begin
(4) served in accordance with Minnesota Rules, part 1400.8610, on the Department of
Human Services and any other party.
new text end
new text begin
Any person aggrieved by a final decision under this paragraph is entitled to seek judicial
review of the decision under the provisions of sections 14.63 to 14.68.
new text end
Sec. 13.
Minnesota Statutes 2020, section 245A.08, subdivision 5, is amended to read:
Subd. 5.
Notice of commissioner's final order.
After considering the findings of fact,
conclusions, and recommendations of the administrative law judge, the commissioner shall
issue a final order. The commissioner shall consider, but shall not be bound by, the
recommendations of the administrative law judge. The appellant must be notified of the
commissioner's final order as required by chapter 14 and Minnesota Rules, parts 1400.8505
to 1400.8612. The notice must also contain information about the appellant's rights under
chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. The institution of
proceedings for judicial review of the commissioner's final order shall not stay the
enforcement of the final order except as provided in section 14.65.new text begin This subdivision does
not apply to hearings relating to the license of a family child care provider or group family
child care provider.
new text end
Sec. 14.
Minnesota Statutes 2020, section 245A.14, subdivision 1, is amended to read:
Subdivision 1.
Permitted single-family residential use.
A licensed nonresidential
program with a licensed capacity of 12 or fewer persons and a group family day care facility
licensed under Minnesota Rules, parts 9502.0315 to 9502.0445, to serve deleted text begin 14deleted text end new text begin 16new text end or fewer
children shall be considered a permitted single-family residential use of property for the
purposes of zoning and other land use regulations.
Sec. 15.
Minnesota Statutes 2020, section 245A.14, subdivision 4, is amended to read:
Subd. 4.
Special family deleted text begin daydeleted text end new text begin childnew text end care homes.
new text begin (a) new text end deleted text begin Nonresidential childdeleted text end new text begin Childnew text end care
programs serving deleted text begin 14deleted text end new text begin 16new text end or fewer children that are conducted at a location other than the
license holder's own residence shall be licensed under this section and the rules governing
family day care or group family day care ifdeleted text begin :
deleted text end
deleted text begin (a)deleted text end the license holder is the primary provider of care and the nonresidential child care
program is conducted in a dwellingnew text begin other than the license holder's own residencenew text end that is
located on a residential lotdeleted text begin ;deleted text end new text begin .
new text end
deleted text begin
(b) the license holder is an employer who may or may not be the primary provider of
care, and the purpose for the child care program is to provide child care services to children
of the license holder's employees;
deleted text end
deleted text begin
(c) the license holder is a church or religious organization;
deleted text end
deleted text begin
(d) the license holder is a community collaborative child care provider. For purposes of
this subdivision, a community collaborative child care provider is a provider participating
in a cooperative agreement with a community action agency as defined in section 256E.31;
deleted text end
deleted text begin
(e) the license holder is a not-for-profit agency that provides child care in a dwelling
located on a residential lot and the license holder maintains two or more contracts with
community employers or other community organizations to provide child care services.
The county licensing agency may grant a capacity variance to a license holder licensed
under this paragraph to exceed the licensed capacity of 14 children by no more than five
children during transition periods related to the work schedules of parents, if the license
holder meets the following requirements:
deleted text end
deleted text begin
(1) the program does not exceed a capacity of 14 children more than a cumulative total
of four hours per day;
deleted text end
deleted text begin
(2) the program meets a one to seven staff-to-child ratio during the variance period;
deleted text end
deleted text begin
(3) all employees receive at least an extra four hours of training per year than required
in the rules governing family child care each year;
deleted text end
deleted text begin
(4) the facility has square footage required per child under Minnesota Rules, part
9502.0425;
deleted text end
deleted text begin
(5) the program is in compliance with local zoning regulations;
deleted text end
deleted text begin
(6) the program is in compliance with the applicable fire code as follows:
deleted text end
deleted text begin
(i) if the program serves more than five children older than 2-1/2 years of age, but no
more than five children 2-1/2 years of age or less, the applicable fire code is educational
occupancy, as provided in Group E Occupancy under the Minnesota State Fire Code 2015,
Section 202; or
deleted text end
deleted text begin
(ii) if the program serves more than five children 2-1/2 years of age or less, the applicable
fire code is Group I-4 Occupancies, as provided in the Minnesota State Fire Code 2015,
Section 202, unless the rooms in which the children are cared for are located on a level of
exit discharge and each of these child care rooms has an exit door directly to the exterior,
then the applicable fire code is Group E occupancies, as provided in the Minnesota State
Fire Code 2015, Section 202; and
deleted text end
deleted text begin
(7) any age and capacity limitations required by the fire code inspection and square
footage determinations shall be printed on the license; or
deleted text end
deleted text begin
(f) the license holder is the primary provider of care and has located the licensed child
care program in a commercial space, if the license holder meets the following requirements:
deleted text end
deleted text begin
(1) the program is in compliance with local zoning regulations;
deleted text end
deleted text begin
(2) the program is in compliance with the applicable fire code as follows:
deleted text end
deleted text begin
(i) if the program serves more than five children older than 2-1/2 years of age, but no
more than five children 2-1/2 years of age or less, the applicable fire code is educational
occupancy, as provided in Group E Occupancy under the Minnesota State Fire Code 2015,
Section 202; or
deleted text end
deleted text begin
(ii) if the program serves more than five children 2-1/2 years of age or less, the applicable
fire code is Group I-4 Occupancies, as provided under the Minnesota State Fire Code 2015,
Section 202;
deleted text end
deleted text begin
(3) any age and capacity limitations required by the fire code inspection and square
footage determinations are printed on the license; and
deleted text end
deleted text begin
(4) the license holder prominently displays the license issued by the commissioner which
contains the statement "This special family child care provider is not licensed as a child
care center."
deleted text end
deleted text begin
(g) The commissioner may approve two or more licenses under paragraphs (a) to (f) to
be issued at the same location or under one contiguous roof, if each license holder is able
to demonstrate compliance with all applicable rules and laws. Each license holder must
operate the license holder's respective licensed program as a distinct program and within
the capacity, age, and ratio distributions of each license.
deleted text end
deleted text begin (h)deleted text end new text begin (b)new text end The commissioner may grant variances to this section to allow a primary provider
of caredeleted text begin , a not-for-profit organization, a church or religious organization, an employer, or a
community collaborativedeleted text end to be licensed to provide child care under deleted text begin paragraphs (e) and (f)deleted text end
new text begin section 245A.141, subdivision 1, paragraph (a), clauses (4) and (5), new text end if the license holder
meets the other requirements of the statute.
Sec. 16.
new text begin
[245A.141] NONRESIDENTIAL FAMILY CHILD CARE PROGRAM
LICENSING.
new text end
new text begin Subdivision 1. new text end
new text begin Nonresidential family child care programs. new text end
new text begin
(a) The following child
care programs serving 16 or fewer children that are conducted at a location other than the
license holder's own residence shall be licensed under this section:
new text end
new text begin
(1) the license holder is an employer who may or may not be the primary provider of
care, and the purpose for the child care program is to provide child care services to children
of the license holder's employees;
new text end
new text begin
(2) the license holder is a church or religious organization;
new text end
new text begin
(3) the license holder is a community collaborative child care provider. For purposes of
this subdivision, a community collaborative child care provider is a provider participating
in a cooperative agreement with a community action agency as defined in section 256E.31;
new text end
new text begin
(4) the license holder is a not-for-profit agency that provides child care in a dwelling
located on a residential lot and the license holder maintains two or more contracts with
community employers or other community organizations to provide child care services.
The county licensing agency may grant a capacity variance to a license holder licensed
under this paragraph to exceed the licensed capacity of 16 children by no more than five
children during transition periods related to the work schedules of parents, if the license
holder meets the following requirements:
new text end
new text begin
(i) the program does not exceed a capacity of 16 children more than a cumulative total
of four hours per day;
new text end
new text begin
(ii) the program meets a one-to-eight staff-to-child ratio during the variance period;
new text end
new text begin
(iii) all employees receive at least an extra four hours of training per year than are required
in the rules governing family child care each year;
new text end
new text begin
(iv) the facility has square footage required per child under Minnesota Rules, part
9502.0425;
new text end
new text begin
(v) the program is in compliance with local zoning regulations;
new text end
new text begin
(vi) the program is in compliance with the applicable fire code as follows:
new text end
new text begin
(A) if the program serves more than five children older than 2-1/2 years of age, but no
more than five children 2-1/2 years of age or younger, the applicable fire code is educational
occupancy, as provided in Group E Occupancy under the Minnesota State Fire Code 2015,
Section 202; or
new text end
new text begin
(B) if the program serves more than five children 2-1/2 years of age or younger, the
applicable fire code is Group I-4 Occupancies, as provided in the Minnesota State Fire Code
2015, Section 202, unless the rooms in which the children are cared for are located on a
level of exit discharge and each of these child care rooms has an exit door directly to the
exterior, then the applicable fire code is Group E Occupancies, as provided in the Minnesota
State Fire Code 2015, Section 202; and
new text end
new text begin
(vii) any age and capacity limitations required by the fire code inspection and square
footage determinations shall be printed on the license; or
new text end
new text begin
(5) the license holder is the primary provider of care and has located the licensed child
care program in a commercial space, if the license holder meets the following requirements:
new text end
new text begin
(i) the program is in compliance with local zoning regulations;
new text end
new text begin
(ii) the program is in compliance with the applicable fire code as follows:
new text end
new text begin
(A) if the program serves more than five children older than 2-1/2 years of age, but no
more than five children 2-1/2 years of age or younger, the applicable fire code is educational
occupancy, as provided in Group E Occupancy under the Minnesota State Fire Code 2015,
Section 202; or
new text end
new text begin
(B) if the program serves more than five children 2-1/2 years of age or younger, the
applicable fire code is Group I-4 Occupancies, as provided under the Minnesota State Fire
Code 2015, Section 202;
new text end
new text begin
(iii) any age and capacity limitations required by the fire code inspection and square
footage determinations are printed on the license; and
new text end
new text begin
(iv) the license holder prominently displays the license issued by the commissioner that
contains the statement "This special family child care provider is not licensed as a child
care center."
new text end
new text begin
(b) Programs licensed under this section shall be subject to the rules governing family
day care or group family day care.
new text end
new text begin
(c) Programs licensed under this section shall be monitored by county licensing agencies
under section 245A.16.
new text end
new text begin Subd. 2. new text end
new text begin Multiple license approval. new text end
new text begin
The commissioner may approve up to four licenses
under subdivision 1, paragraph (a), clause (1) or (2), to be issued at the same location or
under one contiguous roof, if each license holder is able to demonstrate compliance with
all applicable rules and laws. Each license holder must operate the license holder's respective
licensed program as a distinct program and within the capacity, age, and ratio distributions
of each license.
new text end
new text begin Subd. 3. new text end
new text begin Variances. new text end
new text begin
The commissioner may grant variances to this section to allow a
primary provider of care, a not-for-profit organization, a church or religious organization,
an employer, or a community collaborative to be licensed to provide child care under
subdivision 1, paragraph (a), clauses (4) and (5), if the license holder meets the other
requirements of the statute.
new text end
Sec. 17.
Minnesota Statutes 2020, section 245A.16, subdivision 1, is amended to read:
Subdivision 1.
Delegation of authority to agencies.
(a) County agencies and private
agencies that have been designated or licensed by the commissioner to perform licensing
functions and activities under section 245A.04 and background studies for family child care
under chapter 245C; to recommend denial of applicants under section 245A.05; to issue
correction orders, to issue variances, and recommend a conditional license under section
245A.06; or to recommend suspending or revoking a license or issuing a fine under section
245A.07, shall comply with rules and directives of the commissioner governing those
functions and with this section. The following variances are excluded from the delegation
of variance authority and may be issued only by the commissioner:
(1) dual licensure of family child care and child foster care, dual licensure of child and
adult foster care, and adult foster care and family child care;
(2) adult foster care maximum capacity;
(3) adult foster care minimum age requirement;
(4) child foster care maximum age requirement;
(5) variances regarding disqualified individuals except that, before the implementation
of NETStudy 2.0, county agencies may issue variances under section 245C.30 regarding
disqualified individuals when the county is responsible for conducting a consolidated
reconsideration according to sections 245C.25 and 245C.27, subdivision 2, clauses (a) and
(b), of a county maltreatment determination and a disqualification based on serious or
recurring maltreatment;
(6) the required presence of a caregiver in the adult foster care residence during normal
sleeping hours;
(7) variances to requirements relating to chemical use problems of a license holder or a
household member of a license holder; and
(8) variances to section 245A.53 for a time-limited period. If the commissioner grants
a variance under this clause, the license holder must provide notice of the variance to all
parents and guardians of the children in care.
Except as provided in section deleted text begin 245A.14, subdivision 4, paragraph (e)deleted text end new text begin 245A.141, subdivision
1, paragraph (a), clause (4)new text end , a county agency must not grant a license holder a variance to
exceed the maximum allowable family child care license capacity of deleted text begin 14deleted text end new text begin 16new text end children.
(b) A county agency that has been designated by the commissioner to issue family child
care variances must:
(1) publish the county agency's policies and criteria for issuing variances on the county's
public website and update the policies as necessary; and
(2) annually distribute the county agency's policies and criteria for issuing variances to
all family child care license holders in the county.
(c) Before the implementation of NETStudy 2.0, county agencies must report information
about disqualification reconsiderations under sections 245C.25 and 245C.27, subdivision
2, paragraphs (a) and (b), and variances granted under paragraph (a), clause (5), to the
commissioner at least monthly in a format prescribed by the commissioner.
(d) For family child care programs, the commissioner shall require a county agency to
conduct one unannounced licensing review at least annually.
(e) For family adult day services programs, the commissioner may authorize licensing
reviews every two years after a licensee has had at least one annual review.
(f) A license issued under this section may be issued for up to two years.
(g) During implementation of chapter 245D, the commissioner shall consider:
(1) the role of counties in quality assurance;
(2) the duties of county licensing staff; and
(3) the possible use of joint powers agreements, according to section 471.59, with counties
through which some licensing duties under chapter 245D may be delegated by the
commissioner to the counties.
Any consideration related to this paragraph must meet all of the requirements of the corrective
action plan ordered by the federal Centers for Medicare and Medicaid Services.
(h) Licensing authority specific to section 245D.06, subdivisions 5, 6, 7, and 8, or
successor provisions; and section 245D.061 or successor provisions, for family child foster
care programs providing out-of-home respite, as identified in section 245D.03, subdivision
1, paragraph (b), clause (1), is excluded from the delegation of authority to county and
private agencies.
(i) A county agency shall report to the commissioner, in a manner prescribed by the
commissioner, the following information for a licensed family child care program:
(1) the results of each licensing review completed, including the date of the review, and
any licensing correction order issued;
(2) any death, serious injury, or determination of substantiated maltreatment; and
(3) any fires that require the service of a fire department within 48 hours of the fire. The
information under this clause must also be reported to the state fire marshal within two
business days of receiving notice from a licensed family child care provider.
new text begin
(j) A county agency must forward all communications from the Department of Human
Services about family child care to family child care providers in the county. Additional
comments by the county agency may be included if labeled as county agency comments.
new text end
Sec. 18.
Minnesota Statutes 2020, section 245A.16, is amended by adding a subdivision
to read:
new text begin Subd. 9. new text end
new text begin Licensed family foster settings. new text end
new text begin
(a) Before recommending to grant a license,
deny a license under section 245A.05, or revoke a license under section 245A.07 for
nondisqualifying background study information received under section 245C.05, subdivision
4, paragraph (a), clause (3), for a licensed family foster setting, a county agency or private
agency that has been designated or licensed by the commissioner must review the following:
new text end
new text begin
(1) the type of offenses;
new text end
new text begin
(2) the number of offenses;
new text end
new text begin
(3) the nature of the offenses;
new text end
new text begin
(4) the age of the individual at the time of the offenses;
new text end
new text begin
(5) the length of time that has elapsed since the last offense;
new text end
new text begin
(6) the relationship of the offenses and the capacity to care for a child;
new text end
new text begin
(7) evidence of rehabilitation;
new text end
new text begin
(8) information or knowledge from community members regarding the individual's
capacity to provide foster care;
new text end
new text begin
(9) any available information regarding child maltreatment reports or child in need of
protection or services petitions, or related cases, in which the individual has been involved
or implicated, and documentation that the individual has remedied issues or conditions
identified in child protection or court records that are relevant to safely caring for a child;
new text end
new text begin
(10) a statement from the study subject;
new text end
new text begin
(11) a statement from the license holder; and
new text end
new text begin
(12) other aggravating and mitigating factors.
new text end
new text begin
(b) For purposes of this section, "evidence of rehabilitation" includes but is not limited
to the following:
new text end
new text begin
(1) maintaining a safe and stable residence;
new text end
new text begin
(2) continuous, regular, or stable employment;
new text end
new text begin
(3) successful participation in an education or job training program;
new text end
new text begin
(4) positive involvement with the community or extended family;
new text end
new text begin
(5) compliance with the terms and conditions of probation or parole following the
individual's most recent conviction;
new text end
new text begin
(6) if the individual has had a substance use disorder, successful completion of a substance
use disorder assessment, substance use disorder treatment, and recommended continuing
care, if applicable, demonstrated abstinence from controlled substances, as defined in section
152.01, subdivision 4, or the establishment of a sober network;
new text end
new text begin
(7) if the individual has had a mental illness or documented mental health issues,
demonstrated completion of a mental health evaluation, participation in therapy or other
recommended mental health treatment, or appropriate medication management, if applicable;
new text end
new text begin
(8) if the individual's offense or conduct involved domestic violence, demonstrated
completion of a domestic violence or anger management program, and the absence of any
orders for protection or harassment restraining orders against the individual since the previous
offense or conduct;
new text end
new text begin
(9) written letters of support from individuals of good repute, including but not limited
to employers, members of the clergy, probation or parole officers, volunteer supervisors,
or social services workers;
new text end
new text begin
(10) demonstrated remorse for convictions or conduct, or demonstrated positive behavior
changes; and
new text end
new text begin
(11) absence of convictions or arrests since the previous offense or conduct, including
any convictions that were expunged or pardoned.
new text end
new text begin
(c) An applicant for a family foster setting license must sign all releases of information
requested by the county or private licensing agency.
new text end
new text begin
(d) When licensing a relative for a family foster setting, the commissioner shall also
consider the importance of maintaining the child's relationship with relatives as an additional
significant factor in determining whether an application will be denied.
new text end
new text begin
(e) When recommending that the commissioner deny or revoke a license, the county or
private licensing agency must send a summary of the review completed according to
paragraph (a), on a form developed by the commissioner, to the commissioner and include
any recommendation for licensing action.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 19.
Minnesota Statutes 2020, section 245A.50, subdivision 1a, is amended to read:
Subd. 1a.
Definitions and general provisions.
For the purposes of this section, the
following terms have the meanings given:
(1) "second adult caregiver" means an adult who cares for children in the licensed
program along with the license holder for a cumulative total of more than 500 hours annually;
(2) "helper" means a minor, ages 13 to 17, who assists in caring for children; deleted text begin and
deleted text end
(3) "substitute" means an adult who assumes responsibility for a license holder for a
cumulative total of not more than 500 hours annuallynew text begin ; and
new text end
new text begin (4) "adult assistant" means an adult who assists in caring for children exclusively under
the direct supervision of the license holder. An adult assistant may not serve as a second
adult caregiver and has the same training requirements as helpersnew text end .
An adultnew text begin , except for an adult assistant,new text end who cares for children in the licensed program along
with the license holder for a cumulative total of not more than 500 hours annually has the
same training requirements as a substitute.
Sec. 20.
Minnesota Statutes 2020, section 245A.50, subdivision 7, is amended to read:
Subd. 7.
Training requirements for family and group family child care.
new text begin (a) new text end For
purposes of family and group family child care, the license holder and each second adult
caregiver must complete 16 hours of ongoing training each year. Repeat of topical training
requirements in subdivisions 2 to 8 shall count toward the annual 16-hour training
requirement. Additional ongoing training subjects to meet the annual 16-hour training
requirement must be selected from the following areas:
(1) child development and learning training in understanding how a child develops
physically, cognitively, emotionally, and socially, and how a child learns as part of the
child's family, culture, and community;
(2) developmentally appropriate learning experiences, including training in creating
positive learning experiences, promoting cognitive development, promoting social and
emotional development, promoting physical development, promoting creative development;
and behavior guidance;
(3) relationships with families, including training in building a positive, respectful
relationship with the child's family;
(4) assessment, evaluation, and individualization, including training in observing,
recording, and assessing development; assessing and using information to plan; and assessing
and using information to enhance and maintain program quality;
(5) historical and contemporary development of early childhood education, including
training in past and current practices in early childhood education and how current events
and issues affect children, families, and programs;
(6) professionalism, including training in knowledge, skills, and abilities that promote
ongoing professional development; and
(7) health, safety, and nutrition, including training in establishing healthy practices;
ensuring safety; and providing healthy nutrition.
new text begin
(b) A provider who is approved as a trainer through the Develop data system may count
up to two hours of training instruction toward the annual 16-hour training requirement in
paragraph (a). The provider may only count training instruction hours for the first instance
in which they deliver a particular content-specific training during each licensing year. Hours
counted as training instruction must be approved through the Develop data system with
attendance verified on the trainer's individual learning record.
new text end
Sec. 21.
Minnesota Statutes 2020, section 245C.02, subdivision 4a, is amended to read:
Subd. 4a.
Authorized fingerprint collection vendor.
"Authorized fingerprint collection
vendor" means deleted text begin adeleted text end new text begin one of up to three new text end qualified deleted text begin organizationdeleted text end new text begin organizationsnew text end under deleted text begin adeleted text end written
contract with the commissioner to provide services in accordance with section 245C.05,
subdivision 5, paragraph (b).
Sec. 22.
Minnesota Statutes 2020, section 245C.03, is amended by adding a subdivision
to read:
new text begin Subd. 14. new text end
new text begin
First-time applicants for educator licenses with the Professional Educator
Licensing and Standards Board.
new text end
new text begin
The Professional Educator Licensing and Standards
Board shall make all eligibility determinations for background studies conducted under this
section for the Professional Educator Licensing and Standards Board. The commissioner
may conduct a background study of all first-time applicants for educator licenses pursuant
to section 122A.18, subdivision 8. The background study of all first-time applicants for
educator licenses must include a review of information from the Bureau of Criminal
Apprehension, including criminal history data as defined in section 13.87, and must also
include a review of the national criminal records repository.
new text end
Sec. 23.
Minnesota Statutes 2020, section 245C.03, is amended by adding a subdivision
to read:
new text begin Subd. 15. new text end
new text begin
First-time applicants for administrator licenses with the Board of School
Administrators.
new text end
new text begin
The Board of School Administrators shall make all eligibility determinations
for background studies conducted under this section for the Board of School Administrators.
The commissioner may conduct a background study of all first-time applicants for
administrator licenses pursuant to section 122A.18, subdivision 8. The background study
of all first-time applicants for administrator licenses must include a review of information
from the Bureau of Criminal Apprehension, including criminal history data as defined in
section 13.87, and must also include a review of the national criminal records repository.
new text end
Sec. 24.
Minnesota Statutes 2020, section 245C.03, is amended by adding a subdivision
to read:
new text begin Subd. 16. new text end
new text begin Occupations regulated by MNsure. new text end
new text begin
(a) The commissioner shall conduct a
background study of any individual required under section 62V.05 to have a background
study completed under this chapter. The commissioner shall conduct a background study
only based on Minnesota criminal records of:
new text end
new text begin
(1) each navigator;
new text end
new text begin
(2) each in-person assister; and
new text end
new text begin
(3) each certified application counselor.
new text end
new text begin
(b) The MNsure board of directors may initiate background studies required by paragraph
(a) using the online NETStudy 2.0 system operated by the commissioner.
new text end
new text begin
(c) The commissioner shall review information that the commissioner receives to
determine if the study subject has potentially disqualifying offenses. The commissioner
shall send a letter to the subject indicating any of the subject's potential disqualifications as
well as any relevant records. The commissioner shall send a copy of the letter indicating
any of the subject's potential disqualifications to the MNsure board.
new text end
new text begin
(d) The MNsure board or the board's delegate shall review a reconsideration request of
an individual in paragraph (a), including granting a set-aside, according to the procedures
and criteria in chapter 245C. The board shall notify the individual and the Department of
Human Services of the board's decision.
new text end
Sec. 25.
Minnesota Statutes 2020, section 245C.03, is amended by adding a subdivision
to read:
new text begin Subd. 17. new text end
new text begin Early intensive developmental and behavioral intervention providers. new text end
new text begin
The
commissioner shall conduct background studies according to this chapter when initiated by
an early intensive developmental and behavioral intervention provider under section
256B.0949.
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. 26.
Minnesota Statutes 2020, section 245C.05, subdivision 2c, is amended to read:
Subd. 2c.
Privacy notice to background study subject.
(a) Prior to initiating each
background study, the entity initiating the study must provide the commissioner's privacy
notice to the background study subject required under section 13.04, subdivision 2. The
notice must be available through the commissioner's electronic NETStudy and NETStudy
2.0 systems and shall include the information in paragraphs (b) and (c).
(b) The background study subject shall be informed that any previous background studies
that received a set-aside will be reviewed, and without further contact with the background
study subject, the commissioner may notify the agency that initiated the subsequent
background study:
(1) that the individual has a disqualification that has been set aside for the program or
agency that initiated the study;
(2) the reason for the disqualification; and
(3) that information about the decision to set aside the disqualification will be available
to the license holder upon request without the consent of the background study subject.
(c) The background study subject must also be informed that:
(1) the subject's fingerprints collected for purposes of completing the background study
under this chapter must not be retained by the Department of Public Safety, Bureau of
Criminal Apprehension, or by the commissioner. The Federal Bureau of Investigation will
deleted text begin only retain fingerprints of subjects with a criminal historydeleted text end new text begin not retain background study
subjects' fingerprintsnew text end ;
(2) effective upon implementation of NETStudy 2.0, the subject's photographic image
will be retained by the commissioner, and if the subject has provided the subject's Social
Security number for purposes of the background study, the photographic image will be
available to prospective employers and agencies initiating background studies under this
chapter to verify the identity of the subject of the background study;
(3) deleted text begin the commissioner'sdeleted text end new text begin annew text end authorized fingerprint collection vendor shall, for purposes
of verifying the identity of the background study subject, be able to view the identifying
information entered into NETStudy 2.0 by the entity that initiated the background study,
but shall not retain the subject's fingerprints, photograph, or information from NETStudy
2.0. deleted text begin Thedeleted text end new text begin Annew text end authorized fingerprint collection vendor shall retain no more than the subject's
name and the date and time the subject's fingerprints were recorded and sent, only as
necessary for auditing and billing activities;
(4) the commissioner shall provide the subject notice, as required in section 245C.17,
subdivision 1, paragraph (a), when an entity initiates a background study on the individual;
(5) the subject may request in writing a report listing the entities that initiated a
background study on the individual as provided in section 245C.17, subdivision 1, paragraph
(b);
(6) the subject may request in writing that information used to complete the individual's
background study in NETStudy 2.0 be destroyed if the requirements of section 245C.051,
paragraph (a), are met; and
(7) notwithstanding clause (6), the commissioner shall destroy:
(i) the subject's photograph after a period of two years when the requirements of section
245C.051, paragraph (c), are met; and
(ii) any data collected on a subject under this chapter after a period of two years following
the individual's death as provided in section 245C.051, paragraph (d).
Sec. 27.
Minnesota Statutes 2020, section 245C.05, subdivision 2d, is amended to read:
Subd. 2d.
Fingerprint data notification.
The commissioner of human services shall
notify all background study subjects under this chapter that the Department of Human
Services, Department of Public Safety, and the Bureau of Criminal Apprehension do not
retain fingerprint data after a background study is completed, and that the Federal Bureau
of Investigation deleted text begin only retains the fingerprints of subjects who have a criminal historydeleted text end new text begin does
not retain background study subjects' fingerprintsnew text end .
Sec. 28.
Minnesota Statutes 2020, section 245C.05, subdivision 4, is amended to read:
Subd. 4.
Electronic transmission.
(a) For background studies conducted by the
Department of Human Services, the commissioner shall implement a secure system for the
electronic transmission of:
(1) background study information to the commissioner;
(2) background study results to the license holder;
(3) background study results to counties for background studies conducted by the
commissioner for child foster carenew text begin , including a summary of nondisqualifying results, except
as prohibited by lawnew text end ; and
(4) background study results to county agencies for background studies conducted by
the commissioner for adult foster care and family adult day services and, upon
implementation of NETStudy 2.0, family child care and legal nonlicensed child care
authorized under chapter 119B.
(b) Unless the commissioner has granted a hardship variance under paragraph (c), a
license holder or an applicant must use the electronic transmission system known as
NETStudy or NETStudy 2.0 to submit all requests for background studies to the
commissioner as required by this chapter.
(c) A license holder or applicant whose program is located in an area in which high-speed
Internet is inaccessible may request the commissioner to grant a variance to the electronic
transmission requirement.
(d) Section 245C.08, subdivision 3, paragraph (c), applies to results transmitted under
this subdivision.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 29.
Minnesota Statutes 2020, section 245C.05, subdivision 5, is amended to read:
Subd. 5.
Fingerprints and photograph.
(a) Notwithstanding paragraph (b), for
background studies conducted by the commissioner for child foster care, children's residential
facilities, adoptions, or a transfer of permanent legal and physical custody of a child, the
subject of the background study, who is 18 years of age or older, shall provide the
commissioner with a set of classifiable fingerprints obtained from an authorized agency for
a national criminal history record check.
(b) For background studies initiated on or after the implementation of NETStudy 2.0,
except as provided under subdivision 5a, every subject of a background study must provide
the commissioner with a set of the background study subject's classifiable fingerprints and
photograph. The photograph and fingerprints must be recorded at the same time by deleted text begin the
commissioner'sdeleted text end new text begin annew text end authorized fingerprint collection vendor and sent to the commissioner
through the commissioner's secure data system described in section 245C.32, subdivision
1a, paragraph (b).
(c) The fingerprints shall be submitted by the commissioner to the Bureau of Criminal
Apprehension and, when specifically required by law, submitted to the Federal Bureau of
Investigation for a national criminal history record check.
(d) The fingerprints must not be retained by the Department of Public Safety, Bureau
of Criminal Apprehension, or the commissioner. The Federal Bureau of Investigation will
not retain background study subjects' fingerprints.
(e) deleted text begin The commissioner'sdeleted text end new text begin Annew text end authorized fingerprint collection vendor shall, for purposes
of verifying the identity of the background study subject, be able to view the identifying
information entered into NETStudy 2.0 by the entity that initiated the background study,
but shall not retain the subject's fingerprints, photograph, or information from NETStudy
2.0. deleted text begin Thedeleted text end new text begin Annew text end authorized fingerprint collection vendor shall retain no more than the name
and date and time the subject's fingerprints were recorded and sent, only as necessary for
auditing and billing activities.
(f) For any background study conducted under this chapter, the subject shall provide the
commissioner with a set of classifiable fingerprints when the commissioner has reasonable
cause to require a national criminal history record check as defined in section 245C.02,
subdivision 15a.
Sec. 30.
Minnesota Statutes 2020, section 245C.08, subdivision 1, is amended to read:
Subdivision 1.
Background studies conducted by Department of Human Services.
(a)
For a background study conducted by the Department of Human Services, the commissioner
shall review:
(1) information related to names of substantiated perpetrators of maltreatment of
vulnerable adults that has been received by the commissioner as required under section
626.557, subdivision 9c, paragraph (j);
(2) the commissioner's records relating to the maltreatment of minors in licensed
programs, and from findings of maltreatment of minors as indicated through the social
service information system;
(3) information from juvenile courts as required in subdivision 4 for individuals listed
in section 245C.03, subdivision 1, paragraph (a), when there is reasonable cause;
(4) information from the Bureau of Criminal Apprehension, including information
regarding a background study subject's registration in Minnesota as a predatory offender
under section 243.166;
(5) except as provided in clause (6), information received as a result of submission of
fingerprints for a national criminal history record check, as defined in section 245C.02,
subdivision 13c, when the commissioner has reasonable cause for a national criminal history
record check as defined under section 245C.02, subdivision 15a, or as required under section
144.057, subdivision 1, new text begin paragraph (a), new text end clause (2);
(6) for a background study related to a child foster family setting application for licensure,
foster residence settings, children's residential facilities, a transfer of permanent legal and
physical custody of a child under sections 260C.503 to 260C.515, or adoptions, and for a
background study required for family child care, certified license-exempt child care, child
care centers, and legal nonlicensed child care authorized under chapter 119B, the
commissioner shall also review:
(i) information from the child abuse and neglect registry for any state in which the
background study subject has resided for the past five years;
(ii) when the background study subject is 18 years of age or older, or a minor under
section 245C.05, subdivision 5a, paragraph (c), information received following submission
of fingerprints for a national criminal history record check; and
(iii) when the background study subject is 18 years of age or older or a minor under
section 245C.05, subdivision 5a, paragraph (d), for licensed family child care, certified
license-exempt child care, licensed child care centers, and legal nonlicensed child care
authorized under chapter 119B, information obtained using non-fingerprint-based data
including information from the criminal and sex offender registries for any state in which
the background study subject resided for the past five years and information from the national
crime information database and the national sex offender registry; and
(7) for a background study required for family child care, certified license-exempt child
care centers, licensed child care centers, and legal nonlicensed child care authorized under
chapter 119B, the background study shall also include, to the extent practicable, a name
and date-of-birth search of the National Sex Offender Public website.
(b) Notwithstanding expungement by a court, the commissioner may consider information
obtained under paragraph (a), clauses (3) and (4), unless the commissioner received notice
of the petition for expungement and the court order for expungement is directed specifically
to the commissioner.
(c) The commissioner shall also review criminal case information received according
to section 245C.04, subdivision 4a, from the Minnesota court information system that relates
to individuals who have already been studied under this chapter and who remain affiliated
with the agency that initiated the background study.
(d) When the commissioner has reasonable cause to believe that the identity of a
background study subject is uncertain, the commissioner may require the subject to provide
a set of classifiable fingerprints for purposes of completing a fingerprint-based record check
with the Bureau of Criminal Apprehension. Fingerprints collected under this paragraph
shall not be saved by the commissioner after they have been used to verify the identity of
the background study subject against the particular criminal record in question.
(e) The commissioner may inform the entity that initiated a background study under
NETStudy 2.0 of the status of processing of the subject's fingerprints.
Sec. 31.
Minnesota Statutes 2020, section 245C.08, subdivision 3, is amended to read:
Subd. 3.
Arrest and investigative information.
(a) For any background study completed
under this section, if the commissioner has reasonable cause to believe the information is
pertinent to the disqualification of an individual, the commissioner also may review arrest
and investigative information from:
(1) the Bureau of Criminal Apprehension;
(2) the commissioners of health and human services;
(3) a county attorney;
(4) a county sheriff;
(5) a county agency;
(6) a local chief of police;
(7) other states;
(8) the courts;
(9) the Federal Bureau of Investigation;
(10) the National Criminal Records Repository; and
(11) criminal records from other states.
(b) Except when specifically required by law, the commissioner is not required to conduct
more than one review of a subject's records from the Federal Bureau of Investigation if a
review of the subject's criminal history with the Federal Bureau of Investigation has already
been completed by the commissioner and there has been no break in the subject's affiliation
with the entity that initiated the background study.
(c) If the commissioner conducts a national criminal history record check when required
by law and uses the information from the national criminal history record check to make a
disqualification determination, the data obtained is private data and cannot be shared with
deleted text begin county agencies,deleted text end private agenciesdeleted text begin ,deleted text end or prospective employers of the background study subject.
(d) If the commissioner conducts a national criminal history record check when required
by law and uses the information from the national criminal history record check to make a
disqualification determination, the license holder or entity that submitted the study is not
required to obtain a copy of the background study subject's disqualification letter under
section 245C.17, subdivision 3.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 32.
Minnesota Statutes 2020, section 245C.10, is amended by adding a subdivision
to read:
new text begin Subd. 17. new text end
new text begin Early intensive developmental and behavioral intervention providers. new text end
new text begin
The
commissioner shall recover the cost of background studies required under section 245C.03,
subdivision 15, for the purposes of early intensive developmental and behavioral intervention
under section 256B.0949, through a fee of no more than $20 per study charged to the enrolled
agency. The fees collected under this subdivision are appropriated to the commissioner for
the purpose of conducting background studies.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 33.
Minnesota Statutes 2020, section 245C.10, is amended by adding a subdivision
to read:
new text begin Subd. 18. new text end
new text begin Occupations regulated by MNsure. new text end
new text begin
The commissioner shall set fees to
recover the cost of background studies and criminal background checks initiated by MNsure
under sections 62V.05 and 245C.03. The fee amount shall be established through interagency
agreement between the commissioner and the board of MNsure or its designee. The fees
collected under this subdivision shall be deposited in the special revenue fund and are
appropriated to the commissioner for the purpose of conducting background studies and
criminal background checks.
new text end
Sec. 34.
Minnesota Statutes 2020, section 245C.10, is amended by adding a subdivision
to read:
new text begin Subd. 19. new text end
new text begin Professional Educators Licensing Standards Board. new text end
new text begin
The commissioner
shall recover the cost of background studies initiated by the Professional Educators Licensing
Standards Board through a fee of no more than $51 per study. Fees collected under this
subdivision are appropriated to the commissioner for purposes of conducting background
studies.
new text end
Sec. 35.
Minnesota Statutes 2020, section 245C.10, is amended by adding a subdivision
to read:
new text begin Subd. 20. new text end
new text begin Board of School Administrators. new text end
new text begin
The commissioner shall recover the cost
of background studies initiated by the Board of School Administrators through a fee of no
more than $51 per study. Fees collected under this subdivision are appropriated to the
commissioner for purposes of conducting background studies.
new text end
Sec. 36.
Minnesota Statutes 2020, section 245C.14, subdivision 1, is amended to read:
Subdivision 1.
Disqualification from direct contact.
(a) The commissioner shall
disqualify an individual who is the subject of a background study from any position allowing
direct contact with persons receiving services from the license holder or entity identified in
section 245C.03, upon receipt of information showing, or when a background study
completed under this chapter shows any of the following:
(1) a conviction of, admission to, or Alford plea to one or more crimes listed in section
245C.15, regardless of whether the conviction or admission is a felony, gross misdemeanor,
or misdemeanor level crime;
(2) a preponderance of the evidence indicates the individual has committed an act or
acts that meet the definition of any of the crimes listed in section 245C.15, regardless of
whether the preponderance of the evidence is for a felony, gross misdemeanor, or
misdemeanor level crime; or
(3) an investigation results in an administrative determination listed under section
245C.15, subdivision 4, paragraph (b).
(b) No individual who is disqualified following a background study under section
245C.03, subdivisions 1 and 2, may be retained in a position involving direct contact with
persons served by a program or entity identified in section 245C.03, unless the commissioner
has provided written notice under section 245C.17 stating that:
(1) the individual may remain in direct contact during the period in which the individual
may request reconsideration as provided in section 245C.21, subdivision 2;
(2) the commissioner has set aside the individual's disqualification for that program or
entity identified in section 245C.03, as provided in section 245C.22, subdivision 4; or
(3) the license holder has been granted a variance for the disqualified individual under
section 245C.30.
new text begin
(c) Notwithstanding paragraph (a), for the purposes of a background study affiliated
with a licensed family foster setting, the commissioner shall disqualify an individual who
is the subject of a background study from any position allowing direct contact with persons
receiving services from the license holder or entity identified in section 245C.03, upon
receipt of information showing or when a background study completed under this chapter
shows reason for disqualification under section 245C.15, subdivision 4a.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 37.
Minnesota Statutes 2020, section 245C.15, is amended by adding a subdivision
to read:
new text begin Subd. 4a. new text end
new text begin Licensed family foster setting disqualifications. new text end
new text begin
(a) Notwithstanding
subdivisions 1 to 4, for a background study affiliated with a licensed family foster setting,
regardless of how much time has passed, an individual is disqualified under section 245C.14
if the individual committed an act that resulted in a felony-level conviction for sections:
609.185 (murder in the first degree); 609.19 (murder in the second degree); 609.195 (murder
in the third degree); 609.20 (manslaughter in the first degree); 609.205 (manslaughter in
the second degree); 609.2112 (criminal vehicular homicide); 609.221 (assault in the first
degree); 609.223, subdivision 2 (assault in the third degree, past pattern of child abuse);
609.223, subdivision 3 (assault in the third degree, victim under four); a felony offense
under sections 609.2242 and 609.2243 (domestic assault, spousal abuse, child abuse or
neglect, or a crime against children); 609.2247 (domestic assault by strangulation); 609.2325
(criminal abuse of a vulnerable adult resulting in the death of a vulnerable adult); 609.245
(aggravated robbery); 609.25 (kidnapping); 609.255 (false imprisonment); 609.2661 (murder
of an unborn child in the first degree); 609.2662 (murder of an unborn child in the second
degree); 609.2663 (murder of an unborn child in the third degree); 609.2664 (manslaughter
of an unborn child in the first degree); 609.2665 (manslaughter of an unborn child in the
second degree); 609.267 (assault of an unborn child in the first degree); 609.2671 (assault
of an unborn child in the second degree); 609.268 (injury or death of an unborn child in the
commission of a crime); 609.322, subdivision 1 (solicitation, inducement, and promotion
of prostitution; sex trafficking in the first degree); 609.324, subdivision 1 (other prohibited
acts; engaging in, hiring, or agreeing to hire minor to engage in prostitution); 609.342
(criminal sexual conduct in the first degree); 609.343 (criminal sexual conduct in the second
degree); 609.344 (criminal sexual conduct in the third degree); 609.345 (criminal sexual
conduct in the fourth degree); 609.3451 (criminal sexual conduct in the fifth degree);
609.3453 (criminal sexual predatory conduct); 609.352 (solicitation of children to engage
in sexual conduct); 609.377 (malicious punishment of a child); 609.378 (neglect or
endangerment of a child); 609.561 (arson in the first degree); 609.582, subdivision 1 (burglary
in the first degree); 609.746 (interference with privacy); 617.23 (indecent exposure); 617.246
(use of minors in sexual performance prohibited); or 617.247 (possession of pictorial
representations of minors).
new text end
new text begin
(b) Notwithstanding subdivisions 1 to 4, for the purposes of a background study affiliated
with a licensed family foster setting, an individual is disqualified under section 245C.14,
regardless of how much time has passed, if the individual:
new text end
new text begin
(1) committed an action under paragraph (d) that resulted in death or involved sexual
abuse, as defined in section 260E.03, subdivision 20;
new text end
new text begin
(2) committed an act that resulted in a gross misdemeanor-level conviction for section
609.3451 (criminal sexual conduct in the fifth degree);
new text end
new text begin
(3) committed an act against or involving a minor that resulted in a felony-level conviction
for: section 609.222 (assault in the second degree); 609.223, subdivision 1 (assault in the
third degree); 609.2231 (assault in the fourth degree); or 609.224 (assault in the fifth degree);
or
new text end
new text begin
(4) committed an act that resulted in a misdemeanor or gross misdemeanor-level
conviction for section 617.293 (dissemination and display of harmful materials to minors).
new text end
new text begin
(c) Notwithstanding subdivisions 1 to 4, for a background study affiliated with a licensed
family foster setting, an individual is disqualified under section 245C.14 if less than 20
years have passed since the termination of the individual's parental rights under section
260C.301, subdivision 1, paragraph (b), or if the individual consented to a termination of
parental rights under section 260C.301, subdivision 1, paragraph (a), to settle a petition to
involuntarily terminate parental rights. An individual is disqualified under section 245C.14
if less than 20 years have passed since the termination of the individual's parental rights in
any other state or country, where the conditions for the individual's termination of parental
rights are substantially similar to the conditions in section 260C.301, subdivision 1, paragraph
(b).
new text end
new text begin
(d) Notwithstanding subdivisions 1 to 4, for a background study affiliated with a licensed
family foster setting, an individual is disqualified under section 245C.14 if less than five
years have passed since a felony-level violation for sections: 152.021 (controlled substance
crime in the first degree); 152.022 (controlled substance crime in the second degree); 152.023
(controlled substance crime in the third degree); 152.024 (controlled substance crime in the
fourth degree); 152.025 (controlled substance crime in the fifth degree); 152.0261 (importing
controlled substances across state borders); 152.0262, subdivision 1, paragraph (b)
(possession of substance with intent to manufacture methamphetamine); 152.027, subdivision
6, paragraph (c) (sale or possession of synthetic cannabinoids); 152.096 (conspiracies
prohibited); 152.097 (simulated controlled substances); 152.136 (anhydrous ammonia;
prohibited conduct; criminal penalties; civil liabilities); 152.137 (methamphetamine-related
crimes involving children or vulnerable adults); 169A.24 (felony first-degree driving while
impaired); 243.166 (violation of predatory offender registration requirements); 609.2113
(criminal vehicular operation; bodily harm); 609.2114 (criminal vehicular operation; unborn
child); 609.228 (great bodily harm caused by distribution of drugs); 609.2325 (criminal
abuse of a vulnerable adult not resulting in the death of a vulnerable adult); 609.233 (criminal
neglect); 609.235 (use of drugs to injure or facilitate a crime); 609.24 (simple robbery);
609.322, subdivision 1a (solicitation, inducement, and promotion of prostitution; sex
trafficking in the second degree); 609.498, subdivision 1 (tampering with a witness in the
first degree); 609.498, subdivision 1b (aggravated first-degree witness tampering); 609.562
(arson in the second degree); 609.563 (arson in the third degree); 609.582, subdivision 2
(burglary in the second degree); 609.66 (felony dangerous weapons); 609.687 (adulteration);
609.713 (terroristic threats); 609.749, subdivision 3, 4, or 5 (felony-level harassment or
stalking); 609.855, subdivision 5 (shooting at or in a public transit vehicle or facility); or
624.713 (certain people not to possess firearms).
new text end
new text begin
(e) Notwithstanding subdivisions 1 to 4, except as provided in paragraph (a), for a
background study affiliated with a licensed family child foster care license, an individual
is disqualified under section 245C.14 if less than five years have passed since:
new text end
new text begin
(1) a felony-level violation for an act not against or involving a minor that constitutes:
section 609.222 (assault in the second degree); 609.223, subdivision 1 (assault in the third
degree); 609.2231 (assault in the fourth degree); or 609.224, subdivision 4 (assault in the
fifth degree);
new text end
new text begin
(2) a violation of an order for protection under section 518B.01, subdivision 14;
new text end
new text begin
(3) a determination or disposition of the individual's failure to make required reports
under section 260E.06 or 626.557, subdivision 3, for incidents in which the final disposition
under chapter 260E or section 626.557 was substantiated maltreatment and the maltreatment
was recurring or serious;
new text end
new text begin
(4) a determination or disposition of the individual's substantiated serious or recurring
maltreatment of a minor under chapter 260E, a vulnerable adult under section 626.557, or
serious or recurring maltreatment in any other state, the elements of which are substantially
similar to the elements of maltreatment under chapter 260E or section 626.557 and meet
the definition of serious maltreatment or recurring maltreatment;
new text end
new text begin
(5) a gross misdemeanor-level violation for sections: 609.224, subdivision 2 (assault in
the fifth degree); 609.2242 and 609.2243 (domestic assault); 609.233 (criminal neglect);
609.377 (malicious punishment of a child); 609.378 (neglect or endangerment of a child);
609.746 (interference with privacy); 609.749 (stalking); or 617.23 (indecent exposure); or
new text end
new text begin
(6) committing an act against or involving a minor that resulted in a misdemeanor-level
violation of section 609.224, subdivision 1 (assault in the fifth degree).
new text end
new text begin
(f) For purposes of this subdivision, the disqualification begins from:
new text end
new text begin
(1) the date of the alleged violation, if the individual was not convicted;
new text end
new text begin
(2) the date of conviction, if the individual was convicted of the violation but not
committed to the custody of the commissioner of corrections; or
new text end
new text begin
(3) the date of release from prison, if the individual was convicted of the violation and
committed to the custody of the commissioner of corrections.
new text end
new text begin
Notwithstanding clause (3), if the individual is subsequently reincarcerated for a violation
of the individual's supervised release, the disqualification begins from the date of release
from the subsequent incarceration.
new text end
new text begin
(g) An individual's aiding and abetting, attempt, or conspiracy to commit any of the
offenses listed in paragraphs (a) and (b), as each of these offenses is defined in Minnesota
Statutes, permanently disqualifies the individual under section 245C.14. An individual is
disqualified under section 245C.14 if less than five years have passed since the individual's
aiding and abetting, attempt, or conspiracy to commit any of the offenses listed in paragraphs
(d) and (e).
new text end
new text begin
(h) An individual's offense in any other state or country, where the elements of the
offense are substantially similar to any of the offenses listed in paragraphs (a) and (b),
permanently disqualifies the individual under section 245C.14. An individual is disqualified
under section 245C.14 if less than five years have passed since an offense in any other state
or country, the elements of which are substantially similar to the elements of any offense
listed in paragraphs (d) and (e).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 38.
Minnesota Statutes 2020, section 245C.24, subdivision 2, is amended to read:
Subd. 2.
Permanent bar to set aside a disqualification.
(a) Except as provided in
paragraphs (b) to deleted text begin (e)deleted text end new text begin (f)new text end , the commissioner may not set aside the disqualification of any
individual disqualified pursuant to this chapter, regardless of how much time has passed,
if the individual was disqualified for a crime or conduct listed in section 245C.15, subdivision
1.
(b) For an individual in the chemical dependency or corrections field who was disqualified
for a crime or conduct listed under section 245C.15, subdivision 1, and whose disqualification
was set aside prior to July 1, 2005, the commissioner must consider granting a variance
pursuant to section 245C.30 for the license holder for a program dealing primarily with
adults. A request for reconsideration evaluated under this paragraph must include a letter
of recommendation from the license holder that was subject to the prior set-aside decision
addressing the individual's quality of care to children or vulnerable adults and the
circumstances of the individual's departure from that service.
(c) If an individual who requires a background study for nonemergency medical
transportation services under section 245C.03, subdivision 12, was disqualified for a crime
or conduct listed under section 245C.15, subdivision 1, and if more than 40 years have
passed since the discharge of the sentence imposed, the commissioner may consider granting
a set-aside pursuant to section 245C.22. A request for reconsideration evaluated under this
paragraph must include a letter of recommendation from the employer. This paragraph does
not apply to a person disqualified based on a violation of sections 243.166; 609.185 to
609.205; 609.25; 609.342 to 609.3453; 609.352; 617.23, subdivision 2, clause (1), or 3,
clause (1); 617.246; or 617.247.
(d) When a licensed foster care provider adopts an individual who had received foster
care services from the provider for over six months, and the adopted individual is required
to receive a background study under section 245C.03, subdivision 1, paragraph (a), clause
(2) or (6), the commissioner may grant a variance to the license holder under section 245C.30
to permit the adopted individual with a permanent disqualification to remain affiliated with
the license holder under the conditions of the variance when the variance is recommended
by the county of responsibility for each of the remaining individuals in placement in the
home and the licensing agency for the home.
new text begin
(e) For an individual 18 years of age or older affiliated with a licensed family foster
setting, the commissioner must not set aside or grant a variance for the disqualification of
any individual disqualified pursuant to this chapter, regardless of how much time has passed,
if the individual was disqualified for a crime or conduct listed in section 245C.15, subdivision
4a, paragraphs (a) and (b).
new text end
new text begin
(f) In connection with a family foster setting license, the commissioner may grant a
variance to the disqualification for an individual who is under 18 years of age at the time
the background study is submitted.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 39.
Minnesota Statutes 2020, section 245C.24, subdivision 3, is amended to read:
Subd. 3.
Ten-year bar to set aside disqualification.
(a) The commissioner may not set
aside the disqualification of an individual in connection with a license to provide family
child care for childrendeleted text begin , foster care for children in the provider's home,deleted text end or foster care or day
care services for adults in the provider's home if: (1) less than ten years has passed since
the discharge of the sentence imposed, if any, for the offense; or (2) when disqualified based
on a preponderance of evidence determination under section 245C.14, subdivision 1,
paragraph (a), clause (2), or an admission under section 245C.14, subdivision 1, paragraph
(a), clause (1), and less than ten years has passed since the individual committed the act or
admitted to committing the act, whichever is later; and (3) the individual has committed a
violation of any of the following offenses: sections 609.165 (felon ineligible to possess
firearm); criminal vehicular homicide or criminal vehicular operation causing death under
609.2112, 609.2113, or 609.2114 (criminal vehicular homicide or injury); 609.215 (aiding
suicide or aiding attempted suicide); felony violations under 609.223 or 609.2231 (assault
in the third or fourth degree); 609.229 (crimes committed for benefit of a gang); 609.713
(terroristic threats); 609.235 (use of drugs to injure or to facilitate crime); 609.24 (simple
robbery); 609.255 (false imprisonment); 609.562 (arson in the second degree); 609.71 (riot);
609.498, subdivision 1 or 1b (aggravated first-degree or first-degree tampering with a
witness); burglary in the first or second degree under 609.582 (burglary); 609.66 (dangerous
weapon); 609.665 (spring guns); 609.67 (machine guns and short-barreled shotguns);
609.749, subdivision 2 (gross misdemeanor harassment); 152.021 or 152.022 (controlled
substance crime in the first or second degree); 152.023, subdivision 1, clause (3) or (4) or
subdivision 2, clause (4) (controlled substance crime in the third degree); 152.024,
subdivision 1, clause (2), (3), or (4) (controlled substance crime in the fourth degree);
609.224, subdivision 2, paragraph (c) (fifth-degree assault by a caregiver against a vulnerable
adult); 609.23 (mistreatment of persons confined); 609.231 (mistreatment of residents or
patients); 609.2325 (criminal abuse of a vulnerable adult); 609.233 (criminal neglect of a
vulnerable adult); 609.2335 (financial exploitation of a vulnerable adult); 609.234 (failure
to report); 609.265 (abduction); 609.2664 to 609.2665 (manslaughter of an unborn child in
the first or second degree); 609.267 to 609.2672 (assault of an unborn child in the first,
second, or third degree); 609.268 (injury or death of an unborn child in the commission of
a crime); repeat offenses under 617.23 (indecent exposure); 617.293 (disseminating or
displaying harmful material to minors); a felony-level conviction involving alcohol or drug
use, a gross misdemeanor offense under 609.324, subdivision 1 (other prohibited acts); a
gross misdemeanor offense under 609.378 (neglect or endangerment of a child); a gross
misdemeanor offense under 609.377 (malicious punishment of a child); 609.72, subdivision
3 (disorderly conduct against a vulnerable adult); or 624.713 (certain persons not to possess
firearms); or Minnesota Statutes 2012, section 609.21.
(b) The commissioner may not set aside the disqualification of an individual if less than
ten years have passed since the individual's aiding and abetting, attempt, or conspiracy to
commit any of the offenses listed in paragraph (a) as each of these offenses is defined in
Minnesota Statutes.
(c) The commissioner may not set aside the disqualification of an individual if less than
ten years have passed since the discharge of the sentence imposed for an offense in any
other state or country, the elements of which are substantially similar to the elements of any
of the offenses listed in paragraph (a).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 40.
Minnesota Statutes 2020, section 245C.24, subdivision 4, is amended to read:
Subd. 4.
Seven-year bar to set aside disqualification.
The commissioner may not set
aside the disqualification of an individual in connection with a license to provide family
child care for childrendeleted text begin , foster care for children in the provider's home,deleted text end or foster care or day
care services for adults in the provider's home if within seven years preceding the study:
(1) the individual committed an act that constitutes maltreatment of a child under sections
260E.24, subdivisions 1, 2, and 3, and 260E.30, subdivisions 1, 2, and 4, and the maltreatment
resulted in substantial bodily harm as defined in section 609.02, subdivision 7a, or substantial
mental or emotional harm as supported by competent psychological or psychiatric evidence;
or
(2) the individual was determined under section 626.557 to be the perpetrator of a
substantiated incident of maltreatment of a vulnerable adult that resulted in substantial
bodily harm as defined in section 609.02, subdivision 7a, or substantial mental or emotional
harm as supported by competent psychological or psychiatric evidence.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 41.
Minnesota Statutes 2020, section 245C.24, is amended by adding a subdivision
to read:
new text begin Subd. 6. new text end
new text begin Five-year bar to set aside disqualification; family foster setting. new text end
new text begin
(a) The
commissioner shall not set aside or grant a variance for the disqualification of an individual
18 years of age or older in connection with a foster family setting license if within five years
preceding the study the individual is convicted of a felony in section 245C.15, subdivision
4a, paragraph (d).
new text end
new text begin
(b) In connection with a foster family setting license, the commissioner may set aside
or grant a variance to the disqualification for an individual who is under 18 years of age at
the time the background study is submitted.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 42.
Minnesota Statutes 2020, section 245C.32, subdivision 1a, is amended to read:
Subd. 1a.
NETStudy 2.0 system.
(a) The commissioner shall design, develop, and test
the NETStudy 2.0 system and implement it no later than September 1, 2015.
(b) The NETStudy 2.0 system developed and implemented by the commissioner shall
incorporate and meet all applicable data security standards and policies required by the
Federal Bureau of Investigation (FBI), Department of Public Safety, Bureau of Criminal
Apprehension, and the Office of MN.IT Services. The system shall meet all required
standards for encryption of data at the database level as well as encryption of data that
travels electronically among agencies initiating background studies, deleted text begin the commissioner'sdeleted text end
authorized fingerprint collection deleted text begin vendordeleted text end new text begin vendorsnew text end , the commissioner, the Bureau of Criminal
Apprehension, and in cases involving national criminal record checks, the FBI.
(c) The data system developed and implemented by the commissioner shall incorporate
a system of data security that allows the commissioner to control access to the data field
level by the commissioner's employees. The commissioner shall establish that employees
have access to the minimum amount of private data on any individual as is necessary to
perform their duties under this chapter.
(d) The commissioner shall oversee regular quality and compliance audits of deleted text begin thedeleted text end
authorized fingerprint collection deleted text begin vendordeleted text end new text begin vendorsnew text end .
Sec. 43.
Minnesota Statutes 2020, section 245F.04, subdivision 2, is amended to read:
Subd. 2.
Contents of application.
Prior to the issuance of a license, an applicant must
submit, on forms provided by the commissioner, documentation demonstrating the following:
(1) compliance with this section;
(2) compliance with applicable building, fire, and safety codes; health rules; zoning
ordinances; and other applicable rules and regulations or documentation that a waiver has
been granted. The granting of a waiver does not constitute modification of any requirement
of this section;new text begin and
new text end
(3) deleted text begin completion of an assessment of need for a new or expanded program as required by
Minnesota Rules, part 9530.6800; and
deleted text end
deleted text begin (4)deleted text end insurance coverage, including bonding, sufficient to cover all patient funds, property,
and interests.
Sec. 44.
Minnesota Statutes 2020, section 245G.03, subdivision 2, is amended to read:
Subd. 2.
Application.
new text begin (a) new text end Before the commissioner issues a license, an applicant must
submit, on forms provided by the commissioner, any documents the commissioner requires.
new text begin
(b) At least 60 days prior to submitting an application for licensure under this chapter,
the applicant must notify the county human services director in writing of the applicant's
intent to open a new treatment program. The written notification must include, at a minimum:
new text end
new text begin
(1) a description of the proposed treatment program;
new text end
new text begin
(2) a description of the target population served by the treatment program; and
new text end
new text begin
(3) a copy of the program's abuse prevention plan, required by section 245A.65,
subdivision 2.
new text end
new text begin
(c) The county human services director may submit a written statement to the
commissioner regarding the county's support of or opposition to opening the new treatment
program. The written statement must include documentation of the rationale for the county's
determination. The commissioner shall consider the county's written statement when
determining whether to issue a license for the treatment program. If the county does not
submit a written statement, the commissioner shall confirm with the county that the county
received the notification required by paragraph (b).
new text end
Sec. 45.
new text begin
[245G.031] ALTERNATIVE LICENSING INSPECTIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Eligibility for an alternative licensing inspection. new text end
new text begin
(a) A license holder
providing services licensed under this chapter, with a qualifying accreditation and meeting
the eligibility criteria in paragraphs (b) and (c), may request approval for an alternative
licensing inspection when all services provided under the license holder's license are
accredited. A license holder with a qualifying accreditation and meeting the eligibility
criteria in paragraphs (b) and (c) may request approval for an alternative licensing inspection
for individual community residential settings or day services facilities licensed under this
chapter.
new text end
new text begin
(b) In order to be eligible for an alternative licensing inspection, the program must have
had at least one inspection by the commissioner following issuance of the initial license.
new text end
new text begin
(c) In order to be eligible for an alternative licensing inspection, the program must have
been in substantial and consistent compliance at the time of the last licensing inspection
and during the current licensing period. For purposes of this section, "substantial and
consistent compliance" means:
new text end
new text begin
(1) the license holder's license was not made conditional, suspended, or revoked;
new text end
new text begin
(2) there have been no substantiated allegations of maltreatment against the license
holder within the past ten years; and
new text end
new text begin
(3) the license holder maintained substantial compliance with the other requirements of
chapters 245A and 245C and other applicable laws and rules.
new text end
new text begin
(d) For the purposes of this section, the license holder's license includes services licensed
under this chapter that were previously licensed under chapter 245A or Minnesota Rules,
chapter 9530, until January 1, 2018.
new text end
new text begin Subd. 2. new text end
new text begin Qualifying accreditation. new text end
new text begin
The commissioner must accept an accreditation
from the joint commission as a qualifying accreditation.
new text end
new text begin Subd. 3. new text end
new text begin Request for approval of an alternative inspection status. new text end
new text begin
(a) A request for
an alternative inspection must be made on the forms and in the manner prescribed by the
commissioner. When submitting the request, the license holder must submit all documentation
issued by the accrediting body verifying that the license holder has obtained and maintained
the qualifying accreditation and has complied with recommendations or requirements from
the accrediting body during the period of accreditation. Based on the request and the
additional required materials, the commissioner may approve an alternative inspection
status.
new text end
new text begin
(b) The commissioner must notify the license holder in writing that the request for an
alternative inspection status has been approved. Approval must be granted until the end of
the qualifying accreditation period.
new text end
new text begin
(c) The license holder must submit a written request for approval of an alternative
inspection status to be renewed one month before the end of the current approval period
according to the requirements in paragraph (a). If the license holder does not submit a request
to renew approval of an alternative inspection status as required, the commissioner must
conduct a licensing inspection.
new text end
new text begin Subd. 4. new text end
new text begin
Programs approved for alternative licensing inspection; deemed compliance
licensing requirements.
new text end
new text begin
(a) A license holder approved for alternative licensing inspection
under this section is required to maintain compliance with all licensing standards according
to this chapter.
new text end
new text begin
(b) A license holder approved for alternative licensing inspection under this section is
deemed to be in compliance with all the requirements of this chapter, and the commissioner
must not perform routine licensing inspections.
new text end
new text begin
(c) Upon receipt of a complaint regarding the services of a license holder approved for
alternative licensing inspection under this section, the commissioner must investigate the
complaint and may take any action as provided under section 245A.06 or 245A.07.
new text end
new text begin Subd. 5. new text end
new text begin Investigations of alleged or suspected maltreatment. new text end
new text begin
Nothing in this section
changes the commissioner's responsibilities to investigate alleged or suspected maltreatment
of a minor under chapter 260E or a vulnerable adult under section 626.557.
new text end
new text begin Subd. 6. new text end
new text begin Termination or denial of subsequent approval. new text end
new text begin
Following approval of an
alternative licensing inspection, the commissioner may terminate or deny subsequent approval
of an alternative licensing inspection if the commissioner determines that:
new text end
new text begin
(1) the license holder has not maintained the qualifying accreditation;
new text end
new text begin
(2) the commissioner has substantiated maltreatment for which the license holder or
facility is determined to be responsible during the qualifying accreditation period; or
new text end
new text begin
(3) during the qualifying accreditation period, the license holder has been issued an order
for conditional license, fine, suspension, or license revocation that has not been reversed
upon appeal.
new text end
new text begin Subd. 7. new text end
new text begin Appeals. new text end
new text begin
The commissioner's decision that the conditions for approval for an
alternative licensing inspection have not been met is subject to appeal under the provisions
of chapter 14.
new text end
new text begin Subd. 8. new text end
new text begin Commissioner's programs. new text end
new text begin
Substance use disorder treatment services licensed
under this chapter for which the commissioner is the license holder with a qualifying
accreditation are excluded from being approved for an alternative licensing inspection.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 1, 2021.
new text end
Sec. 46.
Minnesota Statutes 2020, section 256B.0949, is amended by adding a subdivision
to read:
new text begin Subd. 16a. new text end
new text begin Background studies. new text end
new text begin
An early intensive developmental and behavioral
intervention services agency must fulfill any background studies requirements under this
section by initiating a background study through the commissioner's NETStudy system as
provided under sections 245C.03, subdivision 15, and 245C.10, subdivision 17.
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. 47.
Minnesota Statutes 2020, section 260C.215, subdivision 4, is amended to read:
Subd. 4.
Duties of commissioner.
The commissioner of human services shall:
(1) provide practice guidance to responsible social services agencies and licensed
child-placing agencies that reflect federal and state laws and policy direction on placement
of children;
(2) develop criteria for determining whether a prospective adoptive or foster family has
the ability to understand and validate the child's cultural background;
(3) provide a standardized training curriculum for adoption and foster care workers and
administrators who work with children. Training must address the following objectives:
(i) developing and maintaining sensitivity to all cultures;
(ii) assessing values and their cultural implications;
(iii) making individualized placement decisions that advance the best interests of a
particular child under section 260C.212, subdivision 2; and
(iv) issues related to cross-cultural placement;
(4) provide a training curriculum for all prospective adoptive and foster families that
prepares them to care for the needs of adoptive and foster children taking into consideration
the needs of children outlined in section 260C.212, subdivision 2, paragraph (b), and, as
necessary, preparation is continued after placement of the child and includes the knowledge
and skills related to reasonable and prudent parenting standards for the participation of the
child in age or developmentally appropriate activities, according to section 260C.212,
subdivision 14;
(5) develop and provide to responsible social services agencies and licensed child-placing
agencies a home study format to assess the capacities and needs of prospective adoptive
and foster families. The format must address problem-solving skills; parenting skills; evaluate
the degree to which the prospective family has the ability to understand and validate the
child's cultural background, and other issues needed to provide sufficient information for
agencies to make an individualized placement decision consistent with section 260C.212,
subdivision 2. For a study of a prospective foster parent, the format must also address the
capacity of the prospective foster parent to provide a safe, healthy, smoke-free home
environment. If a prospective adoptive parent has also been a foster parent, any update
necessary to a home study for the purpose of adoption may be completed by the licensing
authority responsible for the foster parent's license. If a prospective adoptive parent with
an approved adoptive home study also applies for a foster care license, the license application
may be made with the same agency which provided the adoptive home study; deleted text begin and
deleted text end
(6) consult with representatives reflecting diverse populations from the councils
established under sections 3.922 and 15.0145, and other state, local, and community
organizationsdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(7) establish family foster setting licensing guidelines for county agencies and private
agencies designated or licensed by the commissioner to perform licensing functions and
activities under section 245A.04. Guidelines that the commissioner establishes under this
paragraph shall be considered directives of the commissioner under section 245A.16.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2023.
new text end
Sec. 48.
Minnesota Statutes 2020, section 466.03, subdivision 6d, is amended to read:
Subd. 6d.
Licensing of providers.
new text begin (a) new text end A claim against a municipality based on the failure
of a provider to meet the standards needed for a license to operate a day care facility under
chapter 245A for children, unless the municipality had actual knowledge of a failure to meet
licensing standards that resulted in a dangerous condition that foreseeably threatened the
plaintiff. A municipality shall be immune from liability for a claim arising out of a provider's
use of a swimming pool located at a family day care or group family day care home under
section 245A.14, subdivision deleted text begin 10deleted text end new text begin 11new text end , unless the municipality had actual knowledge of a
provider's failure to meet the licensing standards under section 245A.14, subdivision deleted text begin 10deleted text end new text begin 11new text end ,
paragraph (a), clauses (1) to (3), that resulted in a dangerous condition that foreseeably
threatened the plaintiff.
new text begin
(b) For purposes of paragraph (a), the fact that a licensing variance had been granted for
a day care facility for children under chapter 245A shall not constitute actual knowledge
by the municipality that granted the variance of a failure to meet licensing standards that
resulted in a dangerous condition that foreseeably threatened the plaintiff.
new text end
Sec. 49.
Laws 2020, First Special Session chapter 7, section 1, as amended by Laws 2020,
Third Special Session chapter 1, section 3, is amended by adding a subdivision to read:
new text begin Subd. 5. new text end
new text begin Waiver extension; 180-day transition period. new text end
new text begin
When the peacetime emergency
declared by the governor in response to the COVID-19 outbreak expires, is terminated, or
is rescinded by the proper authority, the modification in CV23: modifying certain background
study requirements, issued by the commissioner of human services pursuant to Executive
Orders 20-11 and 20-12, and including any amendments to the modification issued before
the peacetime emergency expires, shall remain in effect for no more than 180 days.
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. 50.
Laws 2020, First Special Session chapter 7, section 1, subdivision 3, is amended
to read:
Subd. 3.
Waivers and modifications; 60-day transition period.
When the peacetime
emergency declared by the governor in response to the COVID-19 outbreak expires, is
terminated, or is rescinded by the proper authority, all waivers or modifications issued by
the commissioner of human services in response to the COVID-19 outbreak that have not
been extended as provided in subdivisions 1, 2, deleted text begin anddeleted text end 4new text begin , and 5new text end of this section may remain in
effect for no more than 60 days, only for purposes of transitioning affected programs back
to operating without the waivers or modifications in place.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 51. new text begin FAMILY CHILD CARE TRAINING ADVISORY COMMITTEE.
new text end
new text begin Subdivision 1. new text end
new text begin Formation; duties. new text end
new text begin
(a) The Family Child Care Training Advisory
Committee shall advise the commissioner of human services on the training requirements
for licensed family and group family child care providers. Beginning January 1, 2022, the
advisory committee shall meet at least twice per year. The advisory committee shall annually
elect a chair from among its members who shall establish the agenda for each meeting. The
commissioner or commissioner's designee shall attend all advisory committee meetings.
new text end
new text begin
(b) The Family Child Care Training Advisory Committee shall advise and make
recommendations to the commissioner of human services on:
new text end
new text begin
(1) updates to the rules and statutes governing family child care training, including
technical updates to facilitate providers' understanding of training requirements;
new text end
new text begin
(2) modernization of family child care training requirements, including substantive
changes to the training subject areas;
new text end
new text begin
(3) difficulties facing family child care providers in completing training requirements,
including proposed solutions to provider difficulties; and
new text end
new text begin
(4) any other aspect of family child care training, as requested by:
new text end
new text begin
(i) a committee member, who may request an item to be placed on the agenda for a future
meeting. The request may be considered by the committee and voted upon. If the motion
carries, the meeting agenda item may be developed for presentation to the committee;
new text end
new text begin
(ii) a member of the public, who may approach the committee by letter or e-mail
requesting that an item be placed on a future meeting agenda. The request may be considered
by the committee and voted upon. If the motion carries, the agenda item may be developed
for presentation to the committee; or
new text end
new text begin
(iii) the commissioner of human services or the commissioner's designee.
new text end
new text begin
(c) The Family Child Care Training Advisory Committee shall expire December 1, 2025.
new text end
new text begin Subd. 2. new text end
new text begin Advisory committee members. new text end
new text begin
(a) The Family Child Care Training Advisory
Committee consists of:
new text end
new text begin
(1) four members who are family child care providers from greater Minnesota, including
one member appointed by the speaker of the house, one member appointed by the senate
majority leader, one member appointed by the Minnesota Association of Child Care
Professionals, and one member appointed by the Minnesota Child Care Provider Network;
new text end
new text begin
(2) four members who are family child care providers from the metropolitan area as
defined in Minnesota Statutes, section 473.121, subdivision 2, including one member
appointed by the speaker of the house, one member appointed by the senate majority leader,
one member appointed by the Minnesota Association of Child Care Professionals, and one
member appointed by the Minnesota Child Care Provider Network; and
new text end
new text begin
(3) up to seven members who have expertise in child development, instructional design,
or training delivery, including up to two members appointed by the speaker of the house,
up to two members appointed by the senate majority leader, one member appointed by the
Minnesota Association of Child Care Professionals, one member appointed by the Minnesota
Child Care Provider Network, and one member appointed by the Greater Minnesota
Partnership.
new text end
new text begin
(b) Advisory committee members shall not be employed by the Department of Human
Services. Advisory committee members shall receive no compensation, except that public
members of the advisory committee may be compensated as provided by Minnesota Statutes,
section 15.059, subdivision 3.
new text end
new text begin
(c) Advisory committee members must include representatives of diverse cultural
communities.
new text end
new text begin
(d) Advisory committee members shall serve two-year terms. Initial appointments to
the advisory committee must be made by December 1, 2021. Subsequent appointments to
the advisory committee must be made by December 1 of the year in which the member's
term expires.
new text end
new text begin
(e) The commissioner of human services must convene the first meeting of the advisory
committee by March 1, 2022.
new text end
new text begin Subd. 3. new text end
new text begin Commissioner report. new text end
new text begin
The commissioner of human services shall report to
the chairs and ranking minority members of the legislative committees with jurisdiction
over child care on any recommendations from the Family Child Care Training Advisory
Committee, including any draft legislation necessary to implement the recommendations.
new text end
Sec. 52. new text begin LEGISLATIVE TASK FORCE; HUMAN SERVICES BACKGROUND
STUDY ELIGIBILITY.
new text end
new text begin Subdivision 1. new text end
new text begin Creation; duties. new text end
new text begin
A legislative task force is created to review the statutes
relating to human services background study eligibility and disqualifications, including but
not limited to Minnesota Statutes, sections 245C.14 and 245C.15, in order to:
new text end
new text begin
(1) evaluate the existing statutes' effectiveness in achieving their intended purposes,
including by gathering and reviewing available background study disqualification data;
new text end
new text begin
(2) identify the existing statutes' weaknesses, inefficiencies, unintended consequences,
or other areas for improvement or modernization; and
new text end
new text begin
(3) develop legislative proposals that improve or modernize the human services
background study eligibility statutes, or otherwise address the issues identified in clauses
(1) and (2).
new text end
new text begin Subd. 2. new text end
new text begin Membership. new text end
new text begin
(a) The task force shall consist of 26 members, appointed as
follows:
new text end
new text begin
(1) two members representing licensing boards whose licensed providers are subject to
the provisions in Minnesota Statutes, section 245C.03, one appointed by the speaker of the
house of representatives, and one appointed by the senate majority leader;
new text end
new text begin
(2) the commissioner of human services or a designee;
new text end
new text begin
(3) the commissioner of health or a designee;
new text end
new text begin
(4) two members representing county attorneys and law enforcement, one appointed by
the speaker of the house of representatives, and one appointed by the senate majority leader;
new text end
new text begin
(5) two members representing licensed service providers who are subject to the provisions
in Minnesota Statutes, section 245C.15, one appointed by the speaker of the house of
representatives, and one appointed by the senate majority leader;
new text end
new text begin
(6) four members of the public, including two who have been subject to disqualification
based on the provisions of Minnesota Statutes, section 245C.15, and two who have been
subject to a set-aside based on the provisions of Minnesota Statutes, section 245C.15, with
one from each category appointed by the speaker of the house of representatives, and one
from each category appointed by the senate majority leader;
new text end
new text begin
(7) one member appointed by the governor's Workforce Development Board;
new text end
new text begin
(8) one member appointed by the One Minnesota Council on Diversity, Inclusion, and
Equity;
new text end
new text begin
(9) two members representing the Minnesota courts, one appointed by the speaker of
the house of representatives, and one appointed by the senate majority leader;
new text end
new text begin
(10) one member appointed jointly by Mid-Minnesota Legal Aid, Southern Minnesota
Legal Services, and the Legal Rights Center;
new text end
new text begin
(11) one member representing Tribal organizations, appointed by the Minnesota Indian
Affairs Council;
new text end
new text begin
(12) two members from the house of representatives, including one appointed by the
speaker of the house of representatives and one appointed by the minority leader in the
house of representatives;
new text end
new text begin
(13) two members from the senate, including one appointed by the senate majority leader
and one appointed by the senate minority leader;
new text end
new text begin
(14) two members representing county human services agencies appointed by the
Minnesota Association of County Social Service Administrators, including one appointed
to represent the metropolitan area as defined in Minnesota Statutes, section 473.121,
subdivision 2, and one appointed to represent the area outside of the metropolitan area; and
new text end
new text begin
(15) two attorneys who have represented individuals that appealed a background study
disqualification determination based on Minnesota Statutes, sections 245C.14 and 245C.15,
one appointed by the speaker of the house of representatives, and one appointed by the
senate majority leader.
new text end
new text begin
(b) Appointments to the task force must be made by August 18, 2021.
new text end
new text begin Subd. 3. new text end
new text begin Compensation. new text end
new text begin
Public members of the task force may be compensated as
provided by Minnesota Statutes, section 15.059, subdivision 3.
new text end
new text begin Subd. 4. new text end
new text begin Officers; meetings. new text end
new text begin
(a) The first meeting of the task force shall be cochaired
by the task force member from the majority party of the house of representatives and the
task force member from the majority party of the senate. The task force shall elect a chair
and vice chair at the first meeting who shall preside at the remainder of the task force
meetings. The task force may elect other officers as necessary.
new text end
new text begin
(b) The task force shall meet at least monthly. The Legislative Coordinating Commission
shall convene the first meeting by September 1, 2021.
new text end
new text begin
(c) Meetings of the task force are subject to the Minnesota Open Meeting Law under
Minnesota Statutes, chapter 13D.
new text end
new text begin Subd. 5. new text end
new text begin Reports required. new text end
new text begin
The task force shall submit an interim written report by
March 11, 2022, and a final report by December 16, 2022, to the chairs and ranking minority
members of the committees in the house of representatives and the senate with jurisdiction
over human services licensing. The reports shall explain the task force's findings and
recommendations relating to each of the duties under subdivision 1, and include any draft
legislation necessary to implement the recommendations.
new text end
new text begin Subd. 6. new text end
new text begin Expiration. new text end
new text begin
The task force expires upon submission of the final report in
subdivision 5 or December 20, 2022, whichever is later.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment and
expires December 31, 2022.
new text end
Sec. 53. new text begin DIRECTION TO THE COMMISSIONER OF HUMAN SERVICES; CHILD
FOSTER CARE LICENSING GUIDELINES.
new text end
new text begin
By July 1, 2023, the commissioner of human services shall, in consultation with
stakeholders with expertise in child protection and children's behavioral health, develop
family foster setting licensing guidelines for county agencies and private agencies that
perform licensing functions. Stakeholders include but are not limited to child advocates,
representatives from community organizations, representatives of the state ethnic councils,
the ombudsperson for families, family foster setting providers, youth who have experienced
family foster setting placements, county child protection staff, and representatives of county
and private licensing agencies.
new text end
Sec. 54. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; DHS
FAMILY CHILD CARE FREQUENTLY ASKED QUESTIONS WEBSITE
MODIFICATIONS.
new text end
new text begin
By January 1, 2022, the commissioner of human services shall expand the "frequently
asked questions" website for family child care providers to include more answers to submitted
questions and a function to search for answers to specific question topics.
new text end
Sec. 55. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; FAMILY
CHILD CARE TASK FORCE RECOMMENDATIONS IMPLEMENTATION PLAN.
new text end
new text begin
The commissioner of human services shall include individuals representing family child
care providers in any group that develops a plan for implementing the recommendations of
the Family Child Care Task Force.
new text end
Sec. 56. new text begin DIRECTION TO THE COMMISSIONER OF HUMAN SERVICES;
FAMILY CHILD CARE REGULATION MODERNIZATION.
new text end
new text begin
(a) The commissioner of human services shall contract with an experienced and
independent organization or individual consultant to conduct the work outlined in this
section. If practicable, the commissioner must contract with the National Association for
Regulatory Administration.
new text end
new text begin
(b) The consultant shall develop a proposal for a risk-based model for monitoring
compliance with family child care licensing standards, grounded in national regulatory best
practices. Violations in the new model must be weighted to reflect the potential risk they
pose to children's health and safety, and licensing sanctions must be tied to the potential
risk. The proposed new model must protect the health and safety of children in family child
care programs and be child-centered, family-friendly, and fair to providers. The proposal
shall also include updates to family child care licensing standards.
new text end
new text begin
(c) The consultant shall develop and implement a stakeholder engagement process that
solicits input from parents, licensed family child care providers, county licensors, staff of
the Department of Human Services, and experts in child development about licensing
standards, tiers for violations of the standards based on the potential risk of harm that each
violation poses, and licensing sanctions for each tier.
new text end
new text begin
(d) The consultant shall solicit input from parents, licensed family child care providers,
county licensors, and staff of the Department of Human Services about which family child
care providers should be eligible for abbreviated inspections that predict compliance with
other licensing standards for licensed family child care providers using key indicators
previously identified by an empirically based statistical methodology developed by the
National Association for Regulatory Administration and the Research Institute for Key
Indicators.
new text end
new text begin
(e) No later than February 1, 2024, the commissioner shall submit a report and proposed
legislation required to implement the new licensing model and updated licensing standards
to the chairs and ranking minority members of the legislative committees with jurisdiction
over child care regulation.
new text end
Sec. 57. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; FAMILY
CHILD CARE ONE-STOP ASSISTANCE NETWORK.
new text end
new text begin
By January 1, 2022, the commissioner of human services shall, in consultation with
county agencies, providers, and other relevant stakeholders, develop a proposal to create,
advertise, and implement a one-stop regional assistance network comprised of individuals
who have experience starting a licensed family or group family day care or technical expertise
regarding the applicable licensing statutes and procedures, in order to assist individuals with
matters relating to starting or sustaining a licensed family or group family day care program.
The proposal shall include an estimated timeline for implementation of the assistance
network, an estimated budget of the cost of the assistance network, and any necessary
legislative proposals to implement the assistance network. The proposal shall also include
a plan to raise awareness and distribute contact information for the assistance network to
all licensed family or group family day care providers.
new text end
Sec. 58. new text begin DIRECTION TO THE COMMISSIONER OF HUMAN SERVICES;
FAMILY CHILD CARE LICENSE APPLICANT ORIENTATION TRAINING.
new text end
new text begin
By July 1, 2022, working with licensed family child care providers and county agencies,
the commissioner of human services shall develop and implement orientation training for
family child care license applicants to ensure that all family child care license applicants
have the same critical baseline information about Minnesota Statutes, chapters 245A and
245C, and Minnesota Rules, chapter 9502.
new text end
Sec. 59. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; ON-SITE
BACKGROUND STUDY FINGERPRINTING.
new text end
new text begin
(a) The commissioner of human services shall contract with a qualified contractor to
conduct on-site fingerprinting beginning August 1, 2021, at locations of employers with 50
or more staff with outstanding background studies, including studies that have been delayed
pursuant to the commissioner's modifications to background study requirements issued in
response to the COVID-19 outbreak. The commissioner shall develop a list of employers
with 50 or more staff who need fingerprints taken in order to complete a background study.
The commissioner and the contractor shall coordinate to develop a plan to identify which
employer locations the contractor shall serve and inform those employers and staff of the
timing and nature of the contractor's services.
new text end
new text begin
(b) The commissioner may contract with the qualified contractor to provide services
under paragraph (a) up to the date of the expiration of the modification in CV23: modifying
certain background study requirements, issued by the commissioner of human services
pursuant to Executive Orders 20-11 and 20-12.
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. 60. new text begin CHILD CARE AND DEVELOPMENT BLOCK GRANT ALLOCATION;
FAMILY CHILD CARE REGULATION MODERNIZATION PROJECT.
new text end
new text begin
The commissioner of human services shall allocate $1,170,000 in fiscal year 2022 from
the amount that Minnesota received under the American Rescue Plan Act, Public Law 117-2,
section 2201, for the child care and development block grant for the family child care
regulation modernization project. This is a onetime allocation and remains available until
June 30, 2024.
new text end
Sec. 61. new text begin CHILD CARE AND DEVELOPMENT BLOCK GRANT ALLOCATION;
FAMILY CHILD CARE ONE-STOP ASSISTANCE NETWORK.
new text end
new text begin
The commissioner of human services shall allocate $4,000,000 in fiscal year 2023 and
$4,000,000 in fiscal year 2024 from the amount that Minnesota received under the American
Rescue Plan Act, Public Law 117-2, section 2201, for the family child care one-stop
assistance network. This is a onetime allocation.
new text end
Sec. 62. new text begin CHILD CARE AND DEVELOPMENT BLOCK GRANT ALLOCATION;
FAMILY CHILD CARE LICENSE APPLICANT ORIENTATION TRAINING.
new text end
new text begin
The commissioner of human services shall allocate $1,000,000 in fiscal year 2023 and
$1,000,000 in fiscal year 2024 from the amount that Minnesota received under the American
Rescue Plan Act, Public Law 117-2, section 2201, for family child care license applicant
orientation training. This is a onetime allocation.
new text end
Sec. 63. new text begin CHILD CARE AND DEVELOPMENT BLOCK GRANT ALLOCATION;
DHS FAMILY CHILD CARE FREQUENTLY ASKED QUESTIONS WEBSITE
MODIFICATIONS.
new text end
new text begin
The commissioner of human services shall allocate $50,000 in fiscal year 2022 from
the amount that Minnesota received under the American Rescue Plan Act, Public Law 117-2,
section 2201, for the modifications to the family child care provider "frequently asked
questions" website. This is a onetime allocation.
new text end
Sec. 64. new text begin REPEALER.
new text end
new text begin
Minnesota Rules, parts 9530.6800; and 9530.6810,
new text end
new text begin
are repealed.
new text end
ARTICLE 7
MINNESOTA HEALTH AND EDUCATION FACILITIES AUTHORITY
Section 1.
Minnesota Statutes 2020, section 3.732, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
As used in this section and section 3.736 the terms defined
in this section have the meanings given them.
(1) "State" includes each of the departments, boards, agencies, commissions, courts, and
officers in the executive, legislative, and judicial branches of the state of Minnesota and
includes but is not limited to the Housing Finance Agency, the Minnesota Office of Higher
Education, the deleted text begin Higherdeleted text end new text begin Health andnew text end Education Facilities Authority, the Health Technology
Advisory Committee, the Armory Building Commission, the Zoological Board, the
Department of Iron Range Resources and Rehabilitation, the Minnesota Historical Society,
the State Agricultural Society, the University of Minnesota, the Minnesota State Colleges
and Universities, state hospitals, and state penal institutions. It does not include a city, town,
county, school district, or other local governmental body corporate and politic.
(2) "Employee of the state" means all present or former officers, members, directors, or
employees of the state, members of the Minnesota National Guard, members of a bomb
disposal unit approved by the commissioner of public safety and employed by a municipality
defined in section 466.01 when engaged in the disposal or neutralization of bombs or other
similar hazardous explosives, as defined in section 299C.063, outside the jurisdiction of the
municipality but within the state, or persons acting on behalf of the state in an official
capacity, temporarily or permanently, with or without compensation. It does not include
either an independent contractor except, for purposes of this section and section 3.736 only,
a guardian ad litem acting under court appointment, or members of the Minnesota National
Guard while engaged in training or duty under United States Code, title 10, or title 32,
section 316, 502, 503, 504, or 505, as amended through December 31, 1983. Notwithstanding
sections 43A.02 and 611.263, for purposes of this section and section 3.736 only, "employee
of the state" includes a district public defender or assistant district public defender in the
Second or Fourth Judicial District, a member of the Health Technology Advisory Committee,
and any officer, agent, or employee of the state of Wisconsin performing work for the state
of Minnesota pursuant to a joint state initiative.
(3) "Scope of office or employment" means that the employee was acting on behalf of
the state in the performance of duties or tasks lawfully assigned by competent authority.
(4) "Judicial branch" has the meaning given in section 43A.02, subdivision 25.
Sec. 2.
Minnesota Statutes 2020, section 10A.01, subdivision 35, is amended to read:
Subd. 35.
Public official.
"Public official" means any:
(1) member of the legislature;
(2) individual employed by the legislature as secretary of the senate, legislative auditor,
director of the Legislative Budget Office, chief clerk of the house of representatives, revisor
of statutes, or researcher, legislative analyst, fiscal analyst, or attorney in the Office of
Senate Counsel, Research and Fiscal Analysis, House Research, or the House Fiscal Analysis
Department;
(3) constitutional officer in the executive branch and the officer's chief administrative
deputy;
(4) solicitor general or deputy, assistant, or special assistant attorney general;
(5) commissioner, deputy commissioner, or assistant commissioner of any state
department or agency as listed in section 15.01 or 15.06, or the state chief information
officer;
(6) member, chief administrative officer, or deputy chief administrative officer of a state
board or commission that has either the power to adopt, amend, or repeal rules under chapter
14, or the power to adjudicate contested cases or appeals under chapter 14;
(7) individual employed in the executive branch who is authorized to adopt, amend, or
repeal rules under chapter 14 or adjudicate contested cases under chapter 14;
(8) executive director of the State Board of Investment;
(9) deputy of any official listed in clauses (7) and (8);
(10) judge of the Workers' Compensation Court of Appeals;
(11) administrative law judge or compensation judge in the State Office of Administrative
Hearings or unemployment law judge in the Department of Employment and Economic
Development;
(12) member, regional administrator, division director, general counsel, or operations
manager of the Metropolitan Council;
(13) member or chief administrator of a metropolitan agency;
(14) director of the Division of Alcohol and Gambling Enforcement in the Department
of Public Safety;
(15) member or executive director of the deleted text begin Higherdeleted text end new text begin Health and new text end Education Facilities
Authority;
(16) member of the board of directors or president of Enterprise Minnesota, Inc.;
(17) member of the board of directors or executive director of the Minnesota State High
School League;
(18) member of the Minnesota Ballpark Authority established in section 473.755;
(19) citizen member of the Legislative-Citizen Commission on Minnesota Resources;
(20) manager of a watershed district, or member of a watershed management organization
as defined under section 103B.205, subdivision 13;
(21) supervisor of a soil and water conservation district;
(22) director of Explore Minnesota Tourism;
(23) citizen member of the Lessard-Sams Outdoor Heritage Council established in section
97A.056;
(24) citizen member of the Clean Water Council established in section 114D.30;
(25) member or chief executive of the Minnesota Sports Facilities Authority established
in section 473J.07;
(26) district court judge, appeals court judge, or supreme court justice;
(27) county commissioner;
(28) member of the Greater Minnesota Regional Parks and Trails Commission; or
(29) member of the Destination Medical Center Corporation established in section
469.41.
Sec. 3.
Minnesota Statutes 2020, section 136A.25, is amended to read:
136A.25 CREATION.
A state agency known as the Minnesota deleted text begin Higherdeleted text end new text begin Health and new text end Education Facilities Authority
is hereby created.
Sec. 4.
Minnesota Statutes 2020, section 136A.26, is amended to read:
136A.26 MEMBERSHIPS; OFFICERS; COMPENSATION; REMOVAL.
Subdivision 1.
Membership.
The Minnesota deleted text begin Higherdeleted text end new text begin Health and new text end Education Facilities
Authority shall consist of deleted text begin eightdeleted text end new text begin ninenew text end members appointed by the governor with the advice
and consent of the senate, and a representative of the deleted text begin officedeleted text end new text begin Office of Higher Educationnew text end .
All members to be appointed by the governor shall be residents of the state. At least two
members must reside outside the metropolitan area as defined in section 473.121, subdivision
2. At least one of the members shall be a person having a favorable reputation for skill,
knowledge, and experience in the field of state and municipal finance; deleted text begin anddeleted text end at least one shall
be a person having a favorable reputation for skill, knowledge, and experience in the building
construction field; deleted text begin anddeleted text end at least one of the members shall be a trustee, director, officer, or
employee of an institution of higher educationnew text begin ; and at least one of the members shall be a
trustee, director, officer, or employee of a health care organizationnew text end .
Subd. 1a.
Private College Council member.
The president of the Minnesota Private
College Council, or the president's designee, shall serve without compensation as an advisory,
nonvoting member of the authority.
new text begin Subd. 1b. new text end
new text begin Nonprofit health care association member. new text end
new text begin
The chief executive officer of
a Minnesota nonprofit membership association whose members are primarily nonprofit
health care organizations, or the chief executive officer's designee, shall serve without
compensation as an advisory, nonvoting member of the authority. The identity of the
Minnesota nonprofit membership association shall be determined and may be changed from
time to time by the members of the authority in accordance with and as shall be provided
in the bylaws of the authority.
new text end
Subd. 2.
Term; compensation; removal.
The membership terms, compensation, removal
of members, and filling of vacancies for authority members other than the representative
of the office, deleted text begin anddeleted text end the president of the Private College Council,new text begin or the chief executive officer
of the Minnesota nonprofit membership association described in subdivision 1bnew text end shall be as
provided in section 15.0575.
Sec. 5.
Minnesota Statutes 2020, section 136A.27, is amended to read:
136A.27 POLICY.
It is hereby declared that for the benefit of the people of the state, the increase of their
commerce, welfare and prosperity and the improvement of their health and living conditions
it is essential that new text begin health care organizations within the state be provided with appropriate
additional means to establish, acquire, construct, improve, and expand health care facilities
in furtherance of their purposes; that new text end this and future generations of youth be given the fullest
opportunity to learn and to develop their intellectual and mental capacities; deleted text begin that it is essentialdeleted text end
that institutions of higher education within the state be provided with appropriate additional
means to assist such youth in achieving the required levels of learning and development of
their intellectual and mental capacitiesnew text begin ;new text end andnew text begin that health care organizations and institutions
of higher educationnew text end be enabled to refinance outstanding indebtedness incurred to provide
existing facilities used for such purposes in order to preserve and enhance the utilization of
facilities for purposes of new text begin health care and new text end higher education, to extend or adjust maturities in
relation to the resources available for their payment, and to save interest costs and thereby
reduce new text begin health care costs or higher education new text end tuition, feesnew text begin ,new text end and chargesdeleted text begin ; anddeleted text end new text begin . It is hereby
further declarednew text end that it is the purpose of sections 136A.25 to 136A.42 to provide a measure
of assistance and an alternative method to enable new text begin health care organizations and new text end institutions
of higher education in the state to provide the facilities and structures which are sorely
needed to accomplish the purposes of sections 136A.25 to 136A.42, all to the public benefit
and good, to the extent and manner provided herein.
Sec. 6.
Minnesota Statutes 2020, section 136A.28, is amended to read:
136A.28 DEFINITIONS.
Subdivision 1.
Scope.
In sections 136A.25 to 136A.42, the following words and terms
shall, unless the context otherwise requires, have the meanings ascribed to them.
new text begin Subd. 1a. new text end
new text begin Affiliate. new text end
new text begin
"Affiliate" means an entity that directly or indirectly controls, is
controlled by, or is under common control with, another entity. For the purposes of this
subdivision, "control" means either the power to elect a majority of the members of the
governing body of an entity or the power, whether by contract or otherwise, to direct the
management and policies of the entity. Affiliate also means an entity whose business or
substantially all of whose property is operated under a lease, management agreement, or
operating agreement by another entity, or an entity who operates the business or substantially
all of the property of another entity under a lease, management agreement, or operating
agreement.
new text end
Subd. 2.
Authority.
"Authority" means the deleted text begin Higherdeleted text end new text begin Health and new text end Education Facilities
Authority created by sections 136A.25 to 136A.42.
Subd. 3.
Project.
"Project" means deleted text begin a structure or structures available for use as a dormitory
or other student housing facility, a dining hall, student union, administration building,
academic building, library, laboratory, research facility, classroom, athletic facility, health
care facility, child care facility, and maintenance, storage, or utility facility and other
structures or facilities related thereto or required or useful for the instruction of students or
the conducting of research or the operation of an institution of higher education, whether
proposed, under construction, or completed, including parking and other facilities or
structures essential or convenient for the orderly conduct of such institution for higher
education, and shall also include landscaping, site preparation, furniture, equipment and
machinery, and other similar items necessary or convenient for the operation of a particular
facility or structure in the manner for which its use is intended but shall not include such
items as books, fuel, supplies, or other items the costs of which are customarily deemed to
result in a current operating charge, and shalldeleted text end new text begin a health care facility or an education facility
whether proposed, under construction, or completed, and includes land or interests in land,
appurtenances, site preparation, landscaping, buildings and structures, systems, fixtures,
furniture, machinery, equipment, and parking. Project also includes other structures, facilities,
improvements, machinery, equipment, and means of transport of a capital nature that are
necessary or convenient for the operation of the facility. Project does new text end not includenew text begin : (1)new text end any
facility used or to be used for sectarian instruction or as a place of religious worship deleted text begin nordeleted text end new text begin ;
(2)new text end any facility which is used or to be used primarily in connection with any part of the
program of a school or department of divinity for any religious denominationnew text begin ; nor (3) any
books, supplies, medicine, medical supplies, fuel, or other items, the cost of which are
customarily deemed to result in a current operating chargenew text end .
Subd. 4.
Cost.
"Cost," as applied to a project or any portion thereof financed under the
provisions of sections 136A.25 to 136A.42, means all or any part of the cost of construction,
acquisition, alteration, enlargement, reconstruction and remodeling of a project including
all lands, structures, real or personal property, rights, rights-of-way, franchises, easements
and interests acquired or used for or in connection with a project, the cost of demolishing
or removing any buildings or structures on land so acquired, including the cost of acquiring
any lands to which deleted text begin suchdeleted text end buildings or structures may be moved, the cost of all machinery
and equipment, financing charges, interest prior to, during and for a period after completion
of such construction and acquisition, provisions for reserves for principal and interest and
for extensions, enlargements, additions and improvements, the cost of architectural,
engineering, financial and legal services, plans, specifications, studies, surveys, estimates
of cost and of revenues, administrative expenses, expenses necessary or incident to
determining the feasibility or practicability of constructing the project and such other
expenses as may be necessary or incident to the construction and acquisition of the project,
the financing of such construction and acquisition and the placing of the project in operation.
Subd. 5.
Bonds.
"Bonds," or "revenue bonds" means revenue bonds of the authority
issued under the provisions of sections 136A.25 to 136A.42, including revenue refunding
bonds, notwithstanding that the same may be secured by mortgage or the full faith and credit
of a participating institution deleted text begin for higher educationdeleted text end or any other lawfully pledged security of
a participating institution deleted text begin for higher educationdeleted text end .
Subd. 6.
Institution of higher education.
"Institution of higher education" means a
nonprofit educational institution within the state authorized to provide a program of education
beyond the high school level.
new text begin Subd. 6a. new text end
new text begin Health care organization. new text end
new text begin
(a) "Health care organization" means a nonprofit
organization located within the state and authorized by law to operate a nonprofit health
care facility in the state. Health care organization also means a nonprofit affiliate of a health
care organization as defined under this paragraph, provided the affiliate is located within
the state or within a state that is geographically contiguous to Minnesota.
new text end
new text begin
(b) Health care organization also means a nonprofit organization located within another
state that is geographically contiguous to Minnesota and authorized by law to operate a
nonprofit health care facility in that state, provided that the nonprofit organization located
within the contiguous state is an affiliate of a health care organization located within the
state.
new text end
new text begin Subd. 6b. new text end
new text begin Education facility. new text end
new text begin
"Education facility" means a structure or structures
available for use as a dormitory or other student housing facility, dining hall, student union,
administration building, academic building, library, laboratory, research facility, classroom,
athletic facility, student health care facility, or child care facility, and includes other facilities
or structures related thereto essential or convenient for the orderly conduct of an institution
of higher education.
new text end
new text begin Subd. 6c. new text end
new text begin Health care facility. new text end
new text begin
(a) "Health care facility" means a structure or structures
available for use within this state as a hospital, clinic, psychiatric residential treatment
facility, birth center, outpatient surgical center, comprehensive outpatient rehabilitation
facility, outpatient physical therapy or speech pathology facility, end-stage renal dialysis
facility, medical laboratory, pharmacy, radiation therapy facility, diagnostic imaging facility,
medical office building, residence for nurses or interns, nursing home, boarding care home,
assisted living facility, residential hospice, intermediate care facility for persons with
developmental disabilities, supervised living facility, housing with services establishment,
board and lodging establishment with special services, adult day care center, day services
facility, prescribed pediatric extended care facility, community residential setting, adult
foster home, or other facility related to medical or health care research, or the delivery or
administration of health care services, and includes other structures or facilities related
thereto essential or convenient for the orderly conduct of a health care organization.
new text end
new text begin
(b) Health care facility also means a facility in a state that is geographically contiguous
to Minnesota operated by a health care organization that corresponds by purpose, function,
or use with a facility listed in paragraph (a).
new text end
Subd. 7.
Participating institution deleted text begin of higher educationdeleted text end .
"Participating institution deleted text begin of
higher educationdeleted text end " meansnew text begin a health care organization ornew text end an institution of higher education
that, under the provisions of sections 136A.25 to 136A.42, undertakes the financing and
construction or acquisition of a project or undertakes the refunding or refinancing of
obligations or of a mortgage or of advances as provided in sections 136A.25 to 136A.42.
Community colleges and technical colleges may be considered participating institutions deleted text begin of
higher educationdeleted text end for the purpose of financing and constructing child care facilities and
parking facilities.
Sec. 7.
Minnesota Statutes 2020, section 136A.29, subdivision 1, is amended to read:
Subdivision 1.
Purpose.
The purpose of the authority shall be to assist new text begin health care
organizations and new text end institutions of higher education in the construction, financing, and
refinancing of projects. The exercise by the authority of the powers conferred by sections
136A.25 to 136A.42, shall be deemed and held to be the performance of an essential public
function. For the purpose of sections 136A.25 to 136A.42, the authority shall have the
powers and duties set forth in subdivisions 2 to 23.
Sec. 8.
Minnesota Statutes 2020, section 136A.29, subdivision 3, is amended to read:
Subd. 3.
Employees.
The authority is authorized and empowered to appoint and employ
employees as it may deem necessary to carry out its duties, determine the title of the
employees so employed, and fix the salary of deleted text begin saiddeleted text end new text begin itsnew text end employees. Employees of the authority
shall participate in retirement and other benefits in the same manner that employees in the
deleted text begin unclassified service of the officedeleted text end new text begin managerial plan under section 43A.18, subdivision 3,new text end
participate.
Sec. 9.
Minnesota Statutes 2020, section 136A.29, subdivision 6, is amended to read:
Subd. 6.
Projects; generally.
new text begin (a) new text end The authority is authorized and empowered to determine
the location and character of any project to be financed under the provisions of sections
136A.25 to 136A.42, and to construct, reconstruct, remodel, maintain, manage, enlarge,
alter, add to, repair, operate, lease, as lessee or lessor, and regulate the same, to enter into
contracts for any or all of such purposes, to enter into contracts for the management and
operation of a project, and to designate a participating institution deleted text begin of higher educationdeleted text end as its
agent to determine the location and character of a project undertaken by such participating
institution deleted text begin of higher educationdeleted text end under the provisions of sections 136A.25 to 136A.42 and as
the agent of the authority, to construct, reconstruct, remodel, maintain, manage, enlarge,
alter, add to, repair, operate, lease, as lessee or lessor, and regulate the same, and as the
agent of the authority, to enter into contracts for any or all of such purposes, including
contracts for the management and operation of such project.
new text begin
(b) Notwithstanding paragraph (a), a project involving a health care facility within the
state financed under sections 136A.25 to 136A.42, must comply with all applicable
requirements in state law related to authorizing construction of or modifications to a health
care facility, including the requirements of sections 144.5509, 144.551, 144A.071, and
252.291.
new text end
new text begin (c) new text end Contracts of the authority or of a participating institution deleted text begin of higher educationdeleted text end to
acquire or to construct, reconstruct, remodel, maintain, enlarge, alter, add to, or repair
projects shall not be subject to the provisions of chapter 16C or section 574.26, or any other
public contract or competitive bid law.
Sec. 10.
Minnesota Statutes 2020, section 136A.29, subdivision 9, is amended to read:
Subd. 9.
Revenue bonds; limit.
The authority is authorized and empowered to issue
revenue bonds whose aggregate principal amount at any time shall not exceed deleted text begin $1,300,000,000deleted text end new text begin
$4,000,000,000new text end and to issue notes, bond anticipation notes, and revenue refunding bonds
of the authority under the provisions of sections 136A.25 to 136A.42, to provide funds for
acquiring, constructing, reconstructing, enlarging, remodeling, renovating, improving,
furnishing, or equipping one or more projects or parts thereof.
Sec. 11.
Minnesota Statutes 2020, section 136A.29, subdivision 10, is amended to read:
Subd. 10.
Revenue bonds; issuance, purpose, conditions.
The authority is authorized
and empowered to issue revenue bonds to acquire projects from or to make loans to
participating institutions deleted text begin of higher educationdeleted text end and thereby refinance outstanding indebtedness
incurred by participating institutions deleted text begin of higher educationdeleted text end to provide funds for the acquisition,
construction or improvement of a facility before or after the enactment of sections 136A.25
to 136A.42, but otherwise eligible to be and being a project thereunder, whenever the
authority finds that such refinancing will enhance or preserve such participating institutions
and such facilities or utilization thereof for new text begin health care or new text end educational purposes or extend
or adjust maturities to correspond to the resources available for their payment, or reduce
new text begin charges or fees imposed on patients or occupants, or new text end the tuition, chargesnew text begin ,new text end or fees imposed
on students for the use new text begin or occupancy new text end of the facilities of such participating institutions deleted text begin of
higher educationdeleted text end or costs met by federal or state public funds, or enhance or preserve new text begin health
care or new text end educational programs and research or the acquisition or improvement of other
facilities eligible to be a project or part thereof by the participating institution deleted text begin of higher
educationdeleted text end . The amount of revenue bonds to be issued to refinance outstanding indebtedness
of a participating institution deleted text begin of higher educationdeleted text end shall not exceed the lesser of (a) the fair
value of the project to be acquired by the authority from the institution or mortgaged to the
authority by the institution or (b) the amount of the outstanding indebtedness including any
premium thereon and any interest accrued or to accrue to the date of redemption and any
legal, fiscal and related costs in connection with such refinancing and reasonable reserves,
as determined by the authority. The provisions of this subdivision do not prohibit the authority
from issuing revenue bonds within and charged against the limitations provided in subdivision
9 to provide funds for improvements, alteration, renovation, or extension of the project
refinanced.
Sec. 12.
Minnesota Statutes 2020, section 136A.29, subdivision 14, is amended to read:
Subd. 14.
Rules for use of projects.
The authority is authorized and empowered to
establish rules for the use of a project or any portion thereof and to designate a participating
institution deleted text begin of higher educationdeleted text end as its agent to establish rules for the use of a project undertaken
for such participating institution deleted text begin of higher educationdeleted text end .
Sec. 13.
Minnesota Statutes 2020, section 136A.29, subdivision 19, is amended to read:
Subd. 19.
Surety.
Before the issuance of any revenue bonds under the provisions of
sections 136A.25 to 136A.42, any member or officer of the authority authorized by resolution
of the authority to handle funds or sign checks of the authority shall be covered under a
surety or fidelity bond in an amount to be determined by the authority. Each such bond shall
be conditioned upon the faithful performance of the duties of the office of the member or
officer, new text begin and new text end shall be executed by a surety company authorized to transact business in the
state of Minnesota as surety. The cost of each such bond shall be paid by the authority.
Sec. 14.
Minnesota Statutes 2020, section 136A.29, subdivision 20, is amended to read:
Subd. 20.
Sale, lease, and disposal of property.
The authority is authorized and
empowered to sell, lease, releasenew text begin ,new text end or otherwise dispose of real and personal property or
interests therein, or a combination thereof, acquired by the authority under authority of
sections 136A.25 to 136A.42 and no longer needed for the purposes of deleted text begin suchdeleted text end new text begin thisnew text end chapter or
of the authority, and grant such easements and other rights in, over, under, or across a project
as will not interfere with its use of deleted text begin suchdeleted text end new text begin thenew text end property. deleted text begin Suchdeleted text end new text begin Thenew text end sale, lease, release,
disposition, or grant may be made without competitive bidding and in deleted text begin suchdeleted text end new text begin thenew text end mannernew text begin andnew text end
for such consideration as the authority in its judgment deems appropriate.
Sec. 15.
Minnesota Statutes 2020, section 136A.29, subdivision 21, is amended to read:
Subd. 21.
Loans.
The authority is authorized and empowered to make loans to any
participating institution deleted text begin of higher educationdeleted text end for the cost of a project in accordance with an
agreement between the authority and the participating institution deleted text begin of higher educationdeleted text end ;
provided that no deleted text begin suchdeleted text end loan shall exceed the total cost of the project as determined by the
participating institution deleted text begin of higher educationdeleted text end and approved by the authority.
Sec. 16.
Minnesota Statutes 2020, section 136A.29, subdivision 22, is amended to read:
Subd. 22.
Costs, expenses, and other charges.
The authority is authorized and
empowered to charge to and apportion among participating institutions deleted text begin of higher educationdeleted text end
its administrative costs and expenses incurred in the exercise of the powers and duties
conferred by sections 136A.25 to 136A.42new text begin in the manner as the authority in its judgment
deems appropriatenew text end .
Sec. 17.
Minnesota Statutes 2020, section 136A.29, is amended by adding a subdivision
to read:
new text begin Subd. 24. new text end
new text begin Determination of affiliate status. new text end
new text begin
The authority is authorized and empowered
to determine whether an entity is an affiliate as defined in section 136A.28, subdivision 1a.
A determination by the authority of affiliate status shall be deemed conclusive for the
purposes of sections 136A.25 to 136A.42.
new text end
Sec. 18.
Minnesota Statutes 2020, section 136A.32, subdivision 4, is amended to read:
Subd. 4.
Provisions of resolution authorizing bonds.
Any resolution or resolutions
authorizing any revenue bonds or any issue of revenue bonds may contain provisions, which
shall be a part of the contract with the holders of the revenue bonds to be authorized, as to:
(1) pledging all or any part of the revenues of a project or projects, any revenue producing
contract or contracts made by the authority with deleted text begin any individual partnership, corporation or
association or other bodydeleted text end new text begin one or more partnerships, corporations or associations, or other
bodiesnew text end , public or private, to secure the payment of the revenue bonds or of any particular
issue of revenue bonds, subject to such agreements with bondholders as may then exist;
(2) the rentals, fees and other charges to be charged, and the amounts to be raised in
each year thereby, and the use and disposition of the revenues;
(3) the setting aside of reserves or sinking funds, and the regulation and disposition
thereof;
(4) limitations on the right of the authority or its agent to restrict and regulate the use of
the project;
(5) limitations on the purpose to which the proceeds of sale of any issue of revenue
bonds then or thereafter to be issued may be applied and pledging such proceeds to secure
the payment of the revenue bonds or any issue of the revenue bonds;
(6) limitations on the issuance of additional bonds, the terms upon which additional
bonds may be issued and secured and the refunding of outstanding bonds;
(7) the procedure, if any, by which the terms of any contract with bondholders may be
amended or abrogated, the amount of bonds the holders of which must consent thereto, and
the manner in which such consent may be given;
(8) limitations on the amount of moneys derived from the project to be expended for
operating, administrative or other expenses of the authority;
(9) defining the acts or omissions to act which shall constitute a default in the duties of
the authority to holders of its obligations and providing the rights and remedies of such
holders in the event of a default;new text begin or
new text end
(10) the mortgaging of a project and the site thereof for the purpose of securing the
bondholders.
Sec. 19.
Minnesota Statutes 2020, section 136A.33, is amended to read:
136A.33 TRUST AGREEMENT.
In the discretion of the authority any revenue bonds issued under the provisions of
sections 136A.25 to 136A.42, may be secured by a trust agreement by and between the
authority and a corporate trustee or trustees, which may be any trust company or bank having
the powers of a trust company within the state. deleted text begin Suchdeleted text end new text begin Thenew text end trust agreement or the resolution
providing for the issuance of deleted text begin suchdeleted text end revenue bonds may pledge or assign the revenues to be
received or proceeds of any contract or contracts pledged and may convey or mortgage the
project or any portion thereof. deleted text begin Suchdeleted text end new text begin Thenew text end trust agreement or resolution providing for the
issuance of deleted text begin suchdeleted text end revenue bonds may contain such provisions for protecting and enforcing
the rights and remedies of the bondholders as may be reasonable and proper and not in
violation of laws, including particularly such provisions as have hereinabove been specifically
authorized to be included in any resolution or resolutions of the authority authorizing revenue
bonds thereof. Any bank or trust company incorporated under the laws of the state deleted text begin whichdeleted text end new text begin
thatnew text end may act as depository of the proceeds of bonds or of revenues or other moneys may
furnish deleted text begin suchdeleted text end indemnifying bonds or deleted text begin pledges suchdeleted text end new text begin pledge new text end securities as may be required by
the authority. Any deleted text begin suchdeleted text end trust agreement may set forth the rights and remedies of the
bondholders and of the trustee or trustees and may restrict the individual right of action by
bondholders. In addition to the foregoing, any deleted text begin suchdeleted text end trust agreement or resolution may contain
deleted text begin suchdeleted text end other provisions as the authority may deem reasonable and proper for the security of
the bondholders. All expenses incurred in carrying out the provisions of deleted text begin suchdeleted text end new text begin thenew text end trust
agreement or resolution may be treated as a part of the cost of the operation of a project.
Sec. 20.
Minnesota Statutes 2020, section 136A.34, subdivision 3, is amended to read:
Subd. 3.
Investment.
Any deleted text begin suchdeleted text end escrowed proceeds, pending such use, may be invested
and reinvested in direct obligations of the United States of America, or in certificates of
deposit or time deposits secured by direct obligations of the United States of America, new text begin or
in shares or units in any money market mutual fund whose investment portfolio consists
solely of direct obligations of the United States of America, new text end maturing at such time or times
as shall be appropriate to assure the prompt payment, as to principal, interest and redemption
premium, if any, of the outstanding revenue bonds to be so refunded. The interest, income
and profits, if any, earned or realized on any such investment may also be applied to the
payment of the outstanding revenue bonds to be so refunded. After the terms of the escrow
have been fully satisfied and carried out, any balance of such proceeds and interest, income
and profits, if any, earned or realized on the investments thereof may be returned to the
authority for use by it in any lawful manner.
Sec. 21.
Minnesota Statutes 2020, section 136A.34, subdivision 4, is amended to read:
Subd. 4.
Additional purpose; improvements.
The portion of the proceeds of any deleted text begin suchdeleted text end
revenue bonds issued for the additional purpose of paying all or any part of the cost of
constructing and acquiring additions, improvements, extensions or enlargements of a project
may be invested or deposited deleted text begin in time depositsdeleted text end as provided in section 136A.32, subdivision
7.
Sec. 22.
Minnesota Statutes 2020, section 136A.36, is amended to read:
136A.36 REVENUES.
The authority may fix, revise, charge and collect rates, rents, fees and charges for the
use of and for the services furnished or to be furnished by each project and deleted text begin todeleted text end new text begin maynew text end contract
with any person, partnership, association or corporation, or other body, public or private,
in respect thereof. deleted text begin Suchdeleted text end new text begin Thenew text end rates, rents, feesnew text begin ,new text end and charges new text begin may vary between projects
involving an education facility and projects involving a health care facility and new text end shall be
fixed and adjusted in respect of the aggregate of rates, rents, feesnew text begin ,new text end and charges from deleted text begin suchdeleted text end new text begin
thenew text end project so as to provide funds sufficient with other revenues, if any:
(1) to pay the cost of maintaining, repairing and operating the project and each and every
portion thereof, to the extent that the payment of such cost has not otherwise been adequately
provided for;
(2) to pay the principal of and the interest on outstanding revenue bonds of the authority
issued in respect of such project as the same shall become due and payable; and
(3) to create and maintain reserves required or provided for in any resolution authorizing,
or trust agreement securing, deleted text begin suchdeleted text end revenue bonds of the authority. deleted text begin Suchdeleted text end new text begin Thenew text end rates, rents, fees
and charges shall not be subject to supervision or regulation by any department, commission,
board, body, bureau or agency of this state other than the authority. A sufficient amount of
the revenues derived in respect of a project, except deleted text begin suchdeleted text end part of deleted text begin suchdeleted text end new text begin thenew text end revenues as may
be necessary to pay the cost of maintenance, repair and operation and to provide reserves
and for renewals, replacements, extensions, enlargements and improvements as may be
provided for in the resolution authorizing the issuance of any revenue bonds of the authority
or in the trust agreement securing the same, shall be set aside at such regular intervals as
may be provided in deleted text begin suchdeleted text end new text begin thenew text end resolution or trust agreement in a sinking or other similar fund
deleted text begin whichdeleted text end new text begin thatnew text end is hereby pledged to, and charged with, the payment of the principal of and the
interest on deleted text begin suchdeleted text end revenue bonds as the same shall become due, and the redemption price or
the purchase price of bonds retired by call or purchase as therein provided. deleted text begin Suchdeleted text end new text begin Thenew text end pledge
shall be valid and binding from the time when the pledge is made; the rates, rents, fees and
charges and other revenues or other moneys so pledged and thereafter received by the
authority shall immediately be subject to the lien of deleted text begin suchdeleted text end new text begin thenew text end pledge without physical delivery
thereof or further act, and the lien of any such pledge shall be valid and binding as against
all parties having claims of any kind against the authority, irrespective of whether such
parties have notice thereof. Neither the resolution nor any trust agreement by which a pledge
is created need be filed or recorded except in the records of the authority. The use and
disposition of moneys to the credit of such sinking or other similar fund shall be subject to
the provisions of the resolution authorizing the issuance of such bonds or of such trust
agreement. Except as may otherwise be provided in deleted text begin suchdeleted text end new text begin thenew text end resolution or deleted text begin suchdeleted text end trust
agreement, deleted text begin suchdeleted text end new text begin thenew text end sinking or other similar fund shall be a fund for all deleted text begin suchdeleted text end revenue bonds
issued to finance a project or projects at one or more participating institutions deleted text begin of higher
educationdeleted text end without distinction or priority of one over another; provided the authority in any
such resolution or trust agreement may provide that such sinking or other similar fund shall
be the fund for a particular project at deleted text begin andeleted text end new text begin a participatingnew text end institution deleted text begin of higher educationdeleted text end and
for the revenue bonds issued to finance a particular project and may, additionally, permit
and provide for the issuance of revenue bonds having a subordinate lien in respect of the
security herein authorized to other revenue bonds of the authority and, in such case, the
authority may create separate or other similar funds in respect of deleted text begin suchdeleted text end new text begin thenew text end subordinate lien
bonds.
Sec. 23.
Minnesota Statutes 2020, section 136A.38, is amended to read:
136A.38 BONDS ELIGIBLE FOR INVESTMENT.
Bonds issued bynew text begin thenew text end authority under the provisions of sections 136A.25 to 136A.42, are
hereby made securities in which all public officers and public bodies of the state and its
political subdivisions, all insurance companies, trust companies, banking associations,
investment companies, executors, administrators, trustees and other fiduciaries may properly
and legally invest funds, including capital in their control or belonging to them; it being the
purpose of this section to authorize the investment in such bonds of all sinking, insurance,
retirement, compensation, pension and trust funds, whether owned or controlled by private
or public persons or officers; provided, however, that nothing contained in this section may
be construed as relieving any person, firm, or corporation from any duty of exercising due
care in selecting securities for purchase or investment; and provide further, that in no event
shall assets of pension funds of public employees of the state of Minnesota or any of its
agencies, boards or subdivisions, whether publicly or privately administered, be invested
in bonds issued under the provisions of sections 136A.25 to 136A.42. Such bonds are hereby
constituted "authorized securities" within the meaning and for the purposes of Minnesota
Statutes 1969, section 50.14. deleted text begin Suchdeleted text end new text begin Thenew text end bonds are hereby made securities deleted text begin whichdeleted text end new text begin thatnew text end may
properly and legally be deposited with and received by any state or municipal officer or any
agency or political subdivision of the state for any purpose for which the deposit of bonds
or obligations of the state now or may hereafter be authorized by law.
Sec. 24.
Minnesota Statutes 2020, section 136A.41, is amended to read:
136A.41 CONFLICT OF INTEREST.
Notwithstanding any other law to the contrary it shall not be or constitute a conflict of
interest for a trustee, director, officer or employee of any participating institution deleted text begin of higher
educationdeleted text end , financial institution, investment banking firm, brokerage firm, commercial bank
or trust company, architecture firm, insurance company, construction company, or any other
firm, person or corporation to serve as a member of the authority, provided such trustee,
director, officer or employee shall abstain from deliberation, action and vote by the authority
in each instance where the business affiliation of any such trustee, director, officer or
employee is involved.
Sec. 25.
Minnesota Statutes 2020, section 136A.42, is amended to read:
136A.42 ANNUAL REPORT.
The authority shall keep an accurate account of all of its activities and all of its receipts
and expenditures deleted text begin and shall annually report to the officedeleted text end .new text begin Each year, the authority shall submit
to the Minnesota Historical Society and the Legislative Reference Library a report of the
authority's activities in the previous year, including all financial activities.
new text end
Sec. 26.
Minnesota Statutes 2020, section 136F.67, subdivision 1, is amended to read:
Subdivision 1.
Authorization.
A technical college or a community college must not
seek financing for child care facilities or parking facilities through the deleted text begin Higherdeleted text end new text begin Health andnew text end
Education Facilities Authority, as provided in section 136A.28, subdivision 7, without the
explicit authorization of the board.
Sec. 27.
Minnesota Statutes 2020, section 354B.20, subdivision 7, is amended to read:
Subd. 7.
Employing unit.
"Employing unit," if the agency employs any persons covered
by the individual retirement account plan under section 354B.211, means:
(1) the board;
(2) the Minnesota Office of Higher Education; and
(3) the deleted text begin Higherdeleted text end new text begin Health andnew text end Education Facilities Authority.
Sec. 28. new text begin REVISOR INSTRUCTION.
new text end
new text begin
The revisor of statutes shall renumber the law establishing and governing the Minnesota
Higher Education Facilities Authority, renamed the Minnesota Health and Education
Facilities Authority in this act, as Minnesota Statutes, chapter 16F, coded in Minnesota
Statutes 2020, sections 136A.25 to 136A.42, as amended or repealed in this act. The revisor
of statutes shall also duplicate any required definitions from Minnesota Statutes, chapter
136A, revise any statutory cross-references consistent with the recoding, and report the
history in Minnesota Statutes, chapter 16F.
new text end
Sec. 29. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2020, section 136A.29, subdivision 4,
new text end
new text begin
is repealed.
new text end
ARTICLE 8
TELEHEALTH
Section 1.
new text begin
[62A.673] COVERAGE OF SERVICES PROVIDED THROUGH
TELEHEALTH.
new text end
new text begin Subdivision 1. new text end
new text begin Citation. new text end
new text begin
This section may be cited as the "Minnesota Telehealth Act."
new text end
new text begin Subd. 2. 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.
new text end
new text begin
(b) "Distant site" means a site at which a health care provider is located while providing
health care services or consultations by means of telehealth.
new text end
new text begin
(c) "Health care provider" means a health care professional who is licensed or registered
by the state to perform health care services within the provider's scope of practice and in
accordance with state law. A health care provider includes a mental health professional as
defined under section 245.462, subdivision 18, or 245.4871, subdivision 27; a mental health
practitioner as defined under section 245.462, subdivision 17, or 245.4871, subdivision 26;
a treatment coordinator under section 245G.11, subdivision 7; an alcohol and drug counselor
under section 245G.11, subdivision 5; and a recovery peer under section 245G.11, subdivision
8.
new text end
new text begin
(d) "Health carrier" has the meaning given in section 62A.011, subdivision 2.
new text end
new text begin
(e) "Health plan" has the meaning given in section 62A.011, subdivision 3. Health plan
includes dental plans as defined in section 62Q.76, subdivision 3, but does not include dental
plans that provide indemnity-based benefits, regardless of expenses incurred, and are designed
to pay benefits directly to the policy holder.
new text end
new text begin
(f) "Originating site" means a site at which a patient is located at the time health care
services are provided to the patient by means of telehealth. For purposes of store-and-forward
transfer, the originating site also means the location at which a health care provider transfers
or transmits information to the distant site.
new text end
new text begin
(g) "Store-and-forward transfer" means the asynchronous electronic transfer of a patient's
medical information or data from an originating site to a distant site for the purposes of
diagnostic and therapeutic assistance in the care of a patient.
new text end
new text begin
(h) "Telehealth" means the delivery of health care services or consultations through the
use of real time two-way interactive audio and visual or audio-only communications to
provide or support health care delivery and facilitate the assessment, diagnosis, consultation,
treatment, education, and care management of a patient's health care. Telehealth includes
the application of secure video conferencing, store-and-forward transfers, and synchronous
interactions between a patient located at an originating site and a health care provider located
at a distant site. Telehealth includes audio-only communication between a health care
provider and a patient if the communication is a scheduled appointment and the standard
of care for the service can be met through the use of audio-only communication. Telehealth
does not include communication between health care providers or between a health care
provider and a patient that consists solely of an e-mail or facsimile transmission. Telehealth
does not include communication between health care providers that consists solely of a
telephone conversation. Telehealth does not include telemonitoring services as defined in
paragraph (i).
new text end
new text begin
(i) "Telemonitoring services" means the remote monitoring of clinical data related to
the enrollee's vital signs or biometric data by a monitoring device or equipment that transmits
the data electronically to a health care provider for analysis. Telemonitoring is intended to
collect an enrollee's health-related data for the purpose of assisting a health care provider
in assessing and monitoring the enrollee's medical condition or status.
new text end
new text begin Subd. 3. new text end
new text begin Coverage of telehealth. new text end
new text begin
(a) A health plan sold, issued, or renewed by a health
carrier in Minnesota must (1) cover benefits delivered through telehealth in the same manner
as any other benefits covered under the health plan, and (2) comply with this section.
new text end
new text begin
(b) Coverage for services delivered through telehealth must not be limited on the basis
of geography, location, or distance for travel subject to the health care provider network
available to the enrollee through the enrollee's health plan.
new text end
new text begin
(c) A health carrier must not create a separate provider network to deliver services
through telehealth that does not include network providers who provide in-person care to
patients for the same service or require an enrollee to use a specific provider within the
network to receive services through telehealth.
new text end
new text begin
(d) A health carrier may require a deductible, co-payment, or coinsurance payment for
a health care service provided through telehealth, provided that the deductible, co-payment,
or coinsurance payment is not in addition to, and does not exceed, the deductible, co-payment,
or coinsurance applicable for the same service provided through in-person contact.
new text end
new text begin
(e) Nothing in this section:
new text end
new text begin
(1) requires a health carrier to provide coverage for services that are not medically
necessary or are not covered under the enrollee's health plan; or
new text end
new text begin
(2) prohibits a health carrier from:
new text end
new text begin
(i) establishing criteria that a health care provider must meet to demonstrate the safety
or efficacy of delivering a particular service through telehealth for which the health carrier
does not already reimburse other health care providers for delivering the service through
telehealth; or
new text end
new text begin
(ii) establishing reasonable medical management techniques, provided the criteria or
techniques are not unduly burdensome or unreasonable for the particular service; or
new text end
new text begin
(iii) requiring documentation or billing practices designed to protect the health carrier
or patient from fraudulent claims, provided the practices are not unduly burdensome or
unreasonable for the particular service.
new text end
new text begin
(f) Nothing in this section requires the use of telehealth when a health care provider
determines that the delivery of a health care service through telehealth is not appropriate or
when an enrollee chooses not to receive a health care service through telehealth.
new text end
new text begin Subd. 4. new text end
new text begin Parity between telehealth and in-person services. new text end
new text begin
(a) A health carrier must
not restrict or deny coverage of a health care service that is covered under a health plan
solely:
new text end
new text begin
(1) because the health care service provided by the health care provider through telehealth
is not provided through in-person contact; or
new text end
new text begin
(2) based on the communication technology or application used to deliver the health
care service through telehealth, provided the technology or application complies with this
section and is appropriate for the particular service.
new text end
new text begin
(b) Prior authorization may be required for health care services delivered through
telehealth only if prior authorization is required before the delivery of the same service
through in-person contact.
new text end
new text begin
(c) A health carrier may require a utilization review for services delivered through
telehealth, provided the utilization review is conducted in the same manner and uses the
same clinical review criteria as a utilization review for the same services delivered through
in-person contact.
new text end
new text begin
(d) A health carrier or health care provider shall not require an enrollee to pay a fee to
download a specific communication technology or application.
new text end
new text begin Subd. 5. new text end
new text begin Reimbursement for services delivered through telehealth. new text end
new text begin
(a) A health carrier
must reimburse the health care provider for services delivered through telehealth on the
same basis and at the same rate as the health carrier would apply to those services if the
services had been delivered by the health care provider through in-person contact.
new text end
new text begin
(b) A health carrier must not deny or limit reimbursement based solely on a health care
provider delivering the service or consultation through telehealth instead of through in-person
contact.
new text end
new text begin
(c) A health carrier must not deny or limit reimbursement based solely on the technology
and equipment used by the health care provider to deliver the health care service or
consultation through telehealth, provided the technology and equipment used by the provider
meets the requirements of this section and is appropriate for the particular service.
new text end
new text begin Subd. 6. new text end
new text begin Telehealth equipment. new text end
new text begin
(a) A health carrier must not require a health care
provider to use specific telecommunications technology and equipment as a condition of
coverage under this section, provided the health care provider uses telecommunications
technology and equipment that complies with current industry interoperable standards and
complies with standards required under the federal Health Insurance Portability and
Accountability Act of 1996, Public Law 104-191, and regulations promulgated under that
Act, unless authorized under this section.
new text end
new text begin
(b) A health carrier must provide coverage for health care services delivered through
telehealth by means of the use of audio-only telephone communication if the communication
is a scheduled appointment and the standard of care for that particular service can be met
through the use of audio-only communication.
new text end
new text begin Subd. 7. new text end
new text begin Telemonitoring services. new text end
new text begin
A health carrier must provide coverage for
telemonitoring services if:
new text end
new text begin
(1) the telemonitoring service is medically appropriate based on the enrollee's medical
condition or status;
new text end
new text begin
(2) the enrollee is cognitively and physically capable of operating the monitoring device
or equipment, or the enrollee has a caregiver who is willing and able to assist with the
monitoring device or equipment; and
new text end
new text begin
(3) the enrollee resides in a setting that is suitable for telemonitoring and not in a setting
that has health care staff on site.
new text end
new text begin Subd. 8. new text end
new text begin Exception. new text end
new text begin
This section does not apply to coverage provided to state public
health care program enrollees under chapter 256B or 256L.
new text end
Sec. 2.
Minnesota Statutes 2020, section 147.033, is amended to read:
147.033 PRACTICE OF deleted text begin TELEMEDICINEdeleted text end new text begin TELEHEALTHnew text end .
Subdivision 1.
Definition.
For the purposes of this section, deleted text begin "telemedicine" means the
delivery of health care services or consultations while the patient is at an originating site
and the licensed health care provider is at a distant site. A communication between licensed
health care providers that consists solely of a telephone conversation, e-mail, or facsimile
transmission does not constitute telemedicine consultations or services. A communication
between a licensed health care provider and a patient that consists solely of an e-mail or
facsimile transmission does not constitute telemedicine consultations or services.
Telemedicine may be provided by means of real-time two-way interactive audio, and visual
communications, including the application of secure video conferencing or store-and-forward
technology to provide or support health care delivery, that facilitate the assessment, diagnosis,
consultation, treatment, education, and care management of a patient's health care.deleted text end new text begin
"telehealth" has the meaning given in section 62A.673, subdivision 2, paragraph (h).
new text end
Subd. 2.
Physician-patient relationship.
A physician-patient relationship may be
established through deleted text begin telemedicinedeleted text end new text begin telehealthnew text end .
Subd. 3.
Standards of practice and conduct.
A physician providing health care services
by deleted text begin telemedicinedeleted text end new text begin telehealthnew text end in this state shall be held to the same standards of practice and
conduct as provided in this chapter for in-person health care services.
Sec. 3.
Minnesota Statutes 2020, section 151.37, subdivision 2, is amended to read:
Subd. 2.
Prescribing and filing.
(a) A licensed practitioner in the course of professional
practice only, may prescribe, administer, and dispense a legend drug, and may cause the
same to be administered by a nurse, a physician assistant, or medical student or resident
under the practitioner's direction and supervision, and may cause a person who is an
appropriately certified, registered, or licensed health care professional to prescribe, dispense,
and administer the same within the expressed legal scope of the person's practice as defined
in Minnesota Statutes. A licensed practitioner may prescribe a legend drug, without reference
to a specific patient, by directing a licensed dietitian or licensed nutritionist, pursuant to
section 148.634; a nurse, pursuant to section 148.235, subdivisions 8 and 9; physician
assistant; medical student or resident; or pharmacist according to section 151.01, subdivision
27, to adhere to a particular practice guideline or protocol when treating patients whose
condition falls within such guideline or protocol, and when such guideline or protocol
specifies the circumstances under which the legend drug is to be prescribed and administered.
An individual who verbally, electronically, or otherwise transmits a written, oral, or electronic
order, as an agent of a prescriber, shall not be deemed to have prescribed the legend drug.
This paragraph applies to a physician assistant only if the physician assistant meets the
requirements of deleted text begin section 147A.18deleted text end new text begin sections 147A.02 and 147A.09new text end .
(b) The commissioner of health, if a licensed practitioner, or a person designated by the
commissioner who is a licensed practitioner, may prescribe a legend drug to an individual
or by protocol for mass dispensing purposes where the commissioner finds that the conditions
triggering section 144.4197 or 144.4198, subdivision 2, paragraph (b), exist. The
commissioner, if a licensed practitioner, or a designated licensed practitioner, may prescribe,
dispense, or administer a legend drug or other substance listed in subdivision 10 to control
tuberculosis and other communicable diseases. The commissioner may modify state drug
labeling requirements, and medical screening criteria and documentation, where time is
critical and limited labeling and screening are most likely to ensure legend drugs reach the
maximum number of persons in a timely fashion so as to reduce morbidity and mortality.
(c) A licensed practitioner that dispenses for profit a legend drug that is to be administered
orally, is ordinarily dispensed by a pharmacist, and is not a vaccine, must file with the
practitioner's licensing board a statement indicating that the practitioner dispenses legend
drugs for profit, the general circumstances under which the practitioner dispenses for profit,
and the types of legend drugs generally dispensed. It is unlawful to dispense legend drugs
for profit after July 31, 1990, unless the statement has been filed with the appropriate
licensing board. For purposes of this paragraph, "profit" means (1) any amount received by
the practitioner in excess of the acquisition cost of a legend drug for legend drugs that are
purchased in prepackaged form, or (2) any amount received by the practitioner in excess
of the acquisition cost of a legend drug plus the cost of making the drug available if the
legend drug requires compounding, packaging, or other treatment. The statement filed under
this paragraph is public data under section 13.03. This paragraph does not apply to a licensed
doctor of veterinary medicine or a registered pharmacist. Any person other than a licensed
practitioner with the authority to prescribe, dispense, and administer a legend drug under
paragraph (a) shall not dispense for profit. To dispense for profit does not include dispensing
by a community health clinic when the profit from dispensing is used to meet operating
expenses.
(d) A prescription drug order for the following drugs is not valid, unless it can be
established that the prescription drug order was based on a documented patient evaluation,
including an examination, adequate to establish a diagnosis and identify underlying conditions
and contraindications to treatment:
(1) controlled substance drugs listed in section 152.02, subdivisions 3 to 5;
(2) drugs defined by the Board of Pharmacy as controlled substances under section
152.02, subdivisions 7, 8, and 12;
(3) muscle relaxants;
(4) centrally acting analgesics with opioid activity;
(5) drugs containing butalbital; or
(6) phosphodiesterase type 5 inhibitors when used to treat erectile dysfunction.
deleted text begin
For purposes of prescribing drugs listed in clause (6), the requirement for a documented
patient evaluation, including an examination, may be met through the use of telemedicine,
as defined in section 147.033, subdivision 1.
deleted text end
(e) For the purposes of paragraph (d), the requirement for an examination shall be met
ifnew text begin :
new text end
new text begin (1)new text end an in-person examination has been completed in any of the following circumstances:
deleted text begin (1)deleted text end new text begin (i)new text end the prescribing practitioner examines the patient at the time the prescription or
drug order is issued;
deleted text begin (2)deleted text end new text begin (ii)new text end the prescribing practitioner has performed a prior examination of the patient;
deleted text begin (3)deleted text end new text begin (iii)new text end another prescribing practitioner practicing within the same group or clinic as
the prescribing practitioner has examined the patient;
deleted text begin (4)deleted text end new text begin (iv)new text end a consulting practitioner to whom the prescribing practitioner has referred the
patient has examined the patient; or
deleted text begin (5)deleted text end new text begin (v)new text end the referring practitioner has performed an examination in the case of a consultant
practitioner issuing a prescription or drug order when providing services by means of
telemedicinedeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(2) the prescription order is for a drug listed in paragraph (d), clause (6), or for medication
assisted therapy for a substance use disorder, and the prescribing practitioner has completed
an examination of the patient via telehealth as defined in section 62A.673, subdivision 2,
paragraph (h).
new text end
(f) Nothing in paragraph (d) or (e) prohibits a licensed practitioner from prescribing a
drug through the use of a guideline or protocol pursuant to paragraph (a).
(g) Nothing in this chapter prohibits a licensed practitioner from issuing a prescription
or dispensing a legend drug in accordance with the Expedited Partner Therapy in the
Management of Sexually Transmitted Diseases guidance document issued by the United
States Centers for Disease Control.
(h) Nothing in paragraph (d) or (e) limits prescription, administration, or dispensing of
legend drugs through a public health clinic or other distribution mechanism approved by
the commissioner of health or a community health board in order to prevent, mitigate, or
treat a pandemic illness, infectious disease outbreak, or intentional or accidental release of
a biological, chemical, or radiological agent.
(i) No pharmacist employed by, under contract to, or working for a pharmacy located
within the state and licensed under section 151.19, subdivision 1, may dispense a legend
drug based on a prescription that the pharmacist knows, or would reasonably be expected
to know, is not valid under paragraph (d).
(j) No pharmacist employed by, under contract to, or working for a pharmacy located
outside the state and licensed under section 151.19, subdivision 1, may dispense a legend
drug to a resident of this state based on a prescription that the pharmacist knows, or would
reasonably be expected to know, is not valid under paragraph (d).
(k) Nothing in this chapter prohibits the commissioner of health, if a licensed practitioner,
or, if not a licensed practitioner, a designee of the commissioner who is a licensed
practitioner, from prescribing legend drugs for field-delivered therapy in the treatment of
a communicable disease according to the Centers For Disease Control and Prevention Partner
Services Guidelines.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 4.
Minnesota Statutes 2020, section 245G.01, subdivision 13, is amended to read:
Subd. 13.
Face-to-face.
"Face-to-face" means two-way, real-time, interactive deleted text begin and visualdeleted text end
communication between a client and a treatment service provider and includes services
delivered in person or via deleted text begin telemedicinedeleted text end new text begin telehealthnew text end .
Sec. 5.
Minnesota Statutes 2020, section 245G.01, subdivision 26, is amended to read:
Subd. 26.
deleted text begin Telemedicinedeleted text end new text begin Telehealthnew text end .
deleted text begin "Telemedicine"deleted text end new text begin "Telehealth"new text end means the delivery
of a substance use disorder treatment service while the client is at an originating site and
the deleted text begin licenseddeleted text end health care provider is at a distant sitenew text begin via telehealth as defined in section
256B.0625, subdivision 3b, andnew text end as specified in section 254B.05, subdivision 5, paragraph
(f).
Sec. 6.
Minnesota Statutes 2020, section 245G.06, subdivision 1, is amended to read:
Subdivision 1.
General.
Each client must have a person-centered individual treatment
plan developed by an alcohol and drug counselor within ten days from the day of service
initiation for a residential program and within five calendar days on which a treatment
session has been provided from the day of service initiation for a client in a nonresidential
program. Opioid treatment programs must complete the individual treatment plan within
21 days from the day of service initiation. The individual treatment plan must be signed by
the client and the alcohol and drug counselor and document the client's involvement in the
development of the plan. The individual treatment plan is developed upon the qualified staff
member's dated signature. Treatment planning must include ongoing assessment of client
needs. An individual treatment plan must be updated based on new information gathered
about the client's condition, the client's level of participation, and on whether methods
identified have the intended effect. A change to the plan must be signed by the client and
the alcohol and drug counselor. If the client chooses to have family or others involved in
treatment services, the client's individual treatment plan must include how the family or
others will be involved in the client's treatment.new text begin If a client is receiving treatment services
or an assessment via telehealth and the alcohol and drug counselor documents the reason
the client's signature cannot be obtained, the alcohol and drug counselor may document the
client's verbal approval of the treatment plan or change to the treatment plan in lieu of the
client's signature.
new text end
Sec. 7.
Minnesota Statutes 2020, section 254A.19, subdivision 5, is amended to read:
Subd. 5.
Assessment via deleted text begin telemedicinedeleted text end new text begin telehealthnew text end .
Notwithstanding Minnesota Rules,
part 9530.6615, subpart 3, item A, a chemical use assessment may be conducted via
deleted text begin telemedicinedeleted text end new text begin telehealth as defined in section 256B.0625, subdivision 3bnew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 8.
Minnesota Statutes 2020, section 254B.05, subdivision 5, is amended to read:
Subd. 5.
Rate requirements.
(a) The commissioner shall establish rates for substance
use disorder services and service enhancements funded under this chapter.
(b) Eligible substance use disorder treatment services include:
(1) outpatient treatment services that are licensed according to sections 245G.01 to
245G.17, or applicable tribal license;
(2) comprehensive assessments provided according to sections 245.4863, paragraph (a),
and 245G.05;
(3) care coordination services provided according to section 245G.07, subdivision 1,
paragraph (a), clause (5);
(4) peer recovery support services provided according to section 245G.07, subdivision
2, clause (8);
(5) on July 1, 2019, or upon federal approval, whichever is later, withdrawal management
services provided according to chapter 245F;
(6) medication-assisted therapy services that are licensed according to sections 245G.01
to 245G.17 and 245G.22, or applicable tribal license;
(7) medication-assisted therapy plus enhanced treatment services that meet the
requirements of clause (6) and provide nine hours of clinical services each week;
(8) high, medium, and low intensity residential treatment services that are licensed
according to sections 245G.01 to 245G.17 and 245G.21 or applicable tribal license which
provide, respectively, 30, 15, and five hours of clinical services each week;
(9) hospital-based treatment services that are licensed according to sections 245G.01 to
245G.17 or applicable tribal license and licensed as a hospital under sections 144.50 to
144.56;
(10) adolescent treatment programs that are licensed as outpatient treatment programs
according to sections 245G.01 to 245G.18 or as residential treatment programs according
to Minnesota Rules, parts 2960.0010 to 2960.0220, and 2960.0430 to 2960.0490, or
applicable tribal license;
(11) high-intensity residential treatment services that are licensed according to sections
245G.01 to 245G.17 and 245G.21 or applicable tribal license, which provide 30 hours of
clinical services each week provided by a state-operated vendor or to clients who have been
civilly committed to the commissioner, present the most complex and difficult care needs,
and are a potential threat to the community; and
(12) room and board facilities that meet the requirements of subdivision 1a.
(c) The commissioner shall establish higher rates for programs that meet the requirements
of paragraph (b) and one of the following additional requirements:
(1) programs that serve parents with their children if the program:
(i) provides on-site child care during the hours of treatment activity that:
(A) is licensed under chapter 245A as a child care center under Minnesota Rules, chapter
9503; or
(B) meets the licensure exclusion criteria of section 245A.03, subdivision 2, paragraph
(a), clause (6), and meets the requirements under section 245G.19, subdivision 4; or
(ii) arranges for off-site child care during hours of treatment activity at a facility that is
licensed under chapter 245A as:
(A) a child care center under Minnesota Rules, chapter 9503; or
(B) a family child care home under Minnesota Rules, chapter 9502;
(2) culturally specific programs as defined in section 254B.01, subdivision 4a, or
programs or subprograms serving special populations, if the program or subprogram meets
the following requirements:
(i) is designed to address the unique needs of individuals who share a common language,
racial, ethnic, or social background;
(ii) is governed with significant input from individuals of that specific background; and
(iii) employs individuals to provide individual or group therapy, at least 50 percent of
whom are of that specific background, except when the common social background of the
individuals served is a traumatic brain injury or cognitive disability and the program employs
treatment staff who have the necessary professional training, as approved by the
commissioner, to serve clients with the specific disabilities that the program is designed to
serve;
(3) programs that offer medical services delivered by appropriately credentialed health
care staff in an amount equal to two hours per client per week if the medical needs of the
client and the nature and provision of any medical services provided are documented in the
client file; and
(4) programs that offer services to individuals with co-occurring mental health and
chemical dependency problems if:
(i) the program meets the co-occurring requirements in section 245G.20;
(ii) 25 percent of the counseling staff are licensed mental health professionals, as defined
in section 245.462, subdivision 18, clauses (1) to (6), or are students or licensing candidates
under the supervision of a licensed alcohol and drug counselor supervisor and licensed
mental health professional, except that no more than 50 percent of the mental health staff
may be students or licensing candidates with time documented to be directly related to
provisions of co-occurring services;
(iii) clients scoring positive on a standardized mental health screen receive a mental
health diagnostic assessment within ten days of admission;
(iv) the program has standards for multidisciplinary case review that include a monthly
review for each client that, at a minimum, includes a licensed mental health professional
and licensed alcohol and drug counselor, and their involvement in the review is documented;
(v) family education is offered that addresses mental health and substance abuse disorders
and the interaction between the two; and
(vi) co-occurring counseling staff shall receive eight hours of co-occurring disorder
training annually.
(d) In order to be eligible for a higher rate under paragraph (c), clause (1), a program
that provides arrangements for off-site child care must maintain current documentation at
the chemical dependency facility of the child care provider's current licensure to provide
child care services. Programs that provide child care according to paragraph (c), clause (1),
must be deemed in compliance with the licensing requirements in section 245G.19.
(e) Adolescent residential programs that meet the requirements of Minnesota Rules,
parts 2960.0430 to 2960.0490 and 2960.0580 to 2960.0690, are exempt from the requirements
in paragraph (c), clause (4), items (i) to (iv).
(f) Subject to federal approval, chemical dependency services that are otherwise covered
as direct face-to-face services may be provided via deleted text begin two-way interactive videodeleted text end new text begin telehealth as
defined in section 256B.0625, subdivision 3bnew text end . The use of deleted text begin two-way interactive videodeleted text end new text begin telehealth
to deliver servicesnew text end must be medically appropriate to the condition and needs of the person
being served. Reimbursement shall be at the same rates and under the same conditions that
would otherwise apply to direct face-to-face services. deleted text begin The interactive video equipment and
connection must comply with Medicare standards in effect at the time the service is provided.
deleted text end
(g) For the purpose of reimbursement under this section, substance use disorder treatment
services provided in a group setting without a group participant maximum or maximum
client to staff ratio under chapter 245G shall not exceed a client to staff ratio of 48 to one.
At least one of the attending staff must meet the qualifications as established under this
chapter for the type of treatment service provided. A recovery peer may not be included as
part of the staff ratio.
Sec. 9.
Minnesota Statutes 2020, section 256B.0621, subdivision 10, is amended to read:
Subd. 10.
Payment rates.
The commissioner shall set payment rates for targeted case
management under this subdivision. Case managers may bill according to the following
criteria:
(1) for relocation targeted case management, case managers may bill for direct case
management activities, including face-to-face contact, telephone contact, and interactive
video contact deleted text begin according to section 256B.0924, subdivision 4a,deleted text end in the lesser of:
(i) 180 days preceding an eligible recipient's discharge from an institution; or
(ii) the limits and conditions which apply to federal Medicaid funding for this service;
(2) for home care targeted case management, case managers may bill for direct case
management activities, including face-to-face and telephone contacts; and
(3) billings for targeted case management services under this subdivision shall not
duplicate payments made under other program authorities for the same purpose.
Sec. 10.
Minnesota Statutes 2020, section 256B.0622, subdivision 7a, is amended to read:
Subd. 7a.
Assertive community treatment team staff requirements and roles.
(a)
The required treatment staff qualifications and roles for an ACT team are:
(1) the team leader:
(i) shall be a licensed mental health professional who is qualified under Minnesota Rules,
part 9505.0371, subpart 5, item A. Individuals who are not licensed but who are eligible
for licensure and are otherwise qualified may also fulfill this role but must obtain full
licensure within 24 months of assuming the role of team leader;
(ii) must be an active member of the ACT team and provide some direct services to
clients;
(iii) must be a single full-time staff member, dedicated to the ACT team, who is
responsible for overseeing the administrative operations of the team, providing clinical
oversight of services in conjunction with the psychiatrist or psychiatric care provider, and
supervising team members to ensure delivery of best and ethical practices; and
(iv) must be available to provide overall clinical oversight to the ACT team after regular
business hours and on weekends and holidays. The team leader may delegate this duty to
another qualified member of the ACT team;
(2) the psychiatric care provider:
(i) must be a licensed psychiatrist certified by the American Board of Psychiatry and
Neurology or eligible for board certification or certified by the American Osteopathic Board
of Neurology and Psychiatry or eligible for board certification, or a psychiatric nurse who
is qualified under Minnesota Rules, part 9505.0371, subpart 5, item A. The psychiatric care
provider must have demonstrated clinical experience working with individuals with serious
and persistent mental illness;
(ii) shall collaborate with the team leader in sharing overall clinical responsibility for
screening and admitting clients; monitoring clients' treatment and team member service
delivery; educating staff on psychiatric and nonpsychiatric medications, their side effects,
and health-related conditions; actively collaborating with nurses; and helping provide clinical
supervision to the team;
(iii) shall fulfill the following functions for assertive community treatment clients:
provide assessment and treatment of clients' symptoms and response to medications, including
side effects; provide brief therapy to clients; provide diagnostic and medication education
to clients, with medication decisions based on shared decision making; monitor clients'
nonpsychiatric medical conditions and nonpsychiatric medications; and conduct home and
community visits;
(iv) shall serve as the point of contact for psychiatric treatment if a client is hospitalized
for mental health treatment and shall communicate directly with the client's inpatient
psychiatric care providers to ensure continuity of care;
(v) shall have a minimum full-time equivalency that is prorated at a rate of 16 hours per
50 clients. Part-time psychiatric care providers shall have designated hours to work on the
team, with sufficient blocks of time on consistent days to carry out the provider's clinical,
supervisory, and administrative responsibilities. No more than two psychiatric care providers
may share this role;
(vi) may deleted text begin notdeleted text end provide deleted text begin specific roles and responsibilities by telemedicine unless approved
by the commissionerdeleted text end new text begin services through telehealth as defined under section 256B.0625,
subdivision 3b, when necessary to ensure the continuation of psychiatric and medication
services availability for clients and to maintain statutory requirements for psychiatric care
provider staffing levelsnew text end ; and
(vii) shall provide psychiatric backup to the program after regular business hours and
on weekends and holidays. The psychiatric care provider may delegate this duty to another
qualified psychiatric provider;
(3) the nursing staff:
(i) shall consist of one to three registered nurses or advanced practice registered nurses,
of whom at least one has a minimum of one-year experience working with adults with
serious mental illness and a working knowledge of psychiatric medications. No more than
two individuals can share a full-time equivalent position;
(ii) are responsible for managing medication, administering and documenting medication
treatment, and managing a secure medication room; and
(iii) shall develop strategies, in collaboration with clients, to maximize taking medications
as prescribed; screen and monitor clients' mental and physical health conditions and
medication side effects; engage in health promotion, prevention, and education activities;
communicate and coordinate services with other medical providers; facilitate the development
of the individual treatment plan for clients assigned; and educate the ACT team in monitoring
psychiatric and physical health symptoms and medication side effects;
(4) the co-occurring disorder specialist:
(i) shall be a full-time equivalent co-occurring disorder specialist who has received
specific training on co-occurring disorders that is consistent with national evidence-based
practices. The training must include practical knowledge of common substances and how
they affect mental illnesses, the ability to assess substance use disorders and the client's
stage of treatment, motivational interviewing, and skills necessary to provide counseling to
clients at all different stages of change and treatment. The co-occurring disorder specialist
may also be an individual who is a licensed alcohol and drug counselor as described in
section 148F.01, subdivision 5, or a counselor who otherwise meets the training, experience,
and other requirements in section 245G.11, subdivision 5. No more than two co-occurring
disorder specialists may occupy this role; and
(ii) shall provide or facilitate the provision of co-occurring disorder treatment to clients.
The co-occurring disorder specialist shall serve as a consultant and educator to fellow ACT
team members on co-occurring disorders;
(5) the vocational specialist:
(i) shall be a full-time vocational specialist who has at least one-year experience providing
employment services or advanced education that involved field training in vocational services
to individuals with mental illness. An individual who does not meet these qualifications
may also serve as the vocational specialist upon completing a training plan approved by the
commissioner;
(ii) shall provide or facilitate the provision of vocational services to clients. The vocational
specialist serves as a consultant and educator to fellow ACT team members on these services;
and
(iii) should not refer individuals to receive any type of vocational services or linkage by
providers outside of the ACT team;
(6) the mental health certified peer specialist:
(i) shall be a full-time equivalent mental health certified peer specialist as defined in
section 256B.0615. No more than two individuals can share this position. The mental health
certified peer specialist is a fully integrated team member who provides highly individualized
services in the community and promotes the self-determination and shared decision-making
abilities of clients. This requirement may be waived due to workforce shortages upon
approval of the commissioner;
(ii) must provide coaching, mentoring, and consultation to the clients to promote recovery,
self-advocacy, and self-direction, promote wellness management strategies, and assist clients
in developing advance directives; and
(iii) must model recovery values, attitudes, beliefs, and personal action to encourage
wellness and resilience, provide consultation to team members, promote a culture where
the clients' points of view and preferences are recognized, understood, respected, and
integrated into treatment, and serve in a manner equivalent to other team members;
(7) the program administrative assistant shall be a full-time office-based program
administrative assistant position assigned to solely work with the ACT team, providing a
range of supports to the team, clients, and families; and
(8) additional staff:
(i) shall be based on team size. Additional treatment team staff may include licensed
mental health professionals as defined in Minnesota Rules, part 9505.0371, subpart 5, item
A; mental health practitioners as defined in section 245.462, subdivision 17; a mental health
practitioner working as a clinical trainee according to Minnesota Rules, part 9505.0371,
subpart 5, item C; or mental health rehabilitation workers as defined in section 256B.0623,
subdivision 5, paragraph (a), clause (4). These individuals shall have the knowledge, skills,
and abilities required by the population served to carry out rehabilitation and support
functions; and
(ii) shall be selected based on specific program needs or the population served.
(b) Each ACT team must clearly document schedules for all ACT team members.
(c) Each ACT team member must serve as a primary team member for clients assigned
by the team leader and are responsible for facilitating the individual treatment plan process
for those clients. The primary team member for a client is the responsible team member
knowledgeable about the client's life and circumstances and writes the individual treatment
plan. The primary team member provides individual supportive therapy or counseling, and
provides primary support and education to the client's family and support system.
(d) Members of the ACT team must have strong clinical skills, professional qualifications,
experience, and competency to provide a full breadth of rehabilitation services. Each staff
member shall be proficient in their respective discipline and be able to work collaboratively
as a member of a multidisciplinary team to deliver the majority of the treatment,
rehabilitation, and support services clients require to fully benefit from receiving assertive
community treatment.
(e) Each ACT team member must fulfill training requirements established by the
commissioner.
Sec. 11.
Minnesota Statutes 2020, section 256B.0625, subdivision 3b, is amended to read:
Subd. 3b.
deleted text begin Telemedicinedeleted text end new text begin Telehealthnew text end services.
(a) Medical assistance covers medically
necessary services and consultations delivered by a deleted text begin licenseddeleted text end health care provider deleted text begin via
telemedicinedeleted text end new text begin through telehealthnew text end in the same manner as if the service or consultation was
delivered deleted text begin in persondeleted text end new text begin through in-person contactnew text end . deleted text begin Coverage is limited to three telemedicine
services per enrollee per calendar week, except as provided in paragraph (f). Telemedicinedeleted text end
Services new text begin or consultations delivered through telehealth new text end shall be paid at the full allowable
rate.
(b) The commissioner deleted text begin shalldeleted text end new text begin maynew text end establish criteria that a health care provider must attest
to in order to demonstrate the safety or efficacy of delivering a particular service deleted text begin via
telemedicinedeleted text end new text begin through telehealthnew text end . The attestation may include that the health care provider:
(1) has identified the categories or types of services the health care provider will provide
deleted text begin via telemedicinedeleted text end new text begin through telehealthnew text end ;
(2) has written policies and procedures specific to deleted text begin telemedicinedeleted text end servicesnew text begin delivered through
telehealthnew text end that are regularly reviewed and updated;
(3) has policies and procedures that adequately address patient safety before, during,
and after the deleted text begin telemedicinedeleted text end service is deleted text begin rendereddeleted text end new text begin delivered through telehealthnew text end ;
(4) has established protocols addressing how and when to discontinue telemedicine
services; and
(5) has an established quality assurance process related to deleted text begin telemedicinedeleted text end new text begin deliveringnew text end servicesnew text begin
through telehealthnew text end .
(c) As a condition of payment, a licensed health care provider must document each
occurrence of a health service deleted text begin provided by telemedicinedeleted text end new text begin delivered through telehealthnew text end to a
medical assistance enrollee. Health care service records for services deleted text begin provided by telemedicinedeleted text end new text begin
delivered through telehealthnew text end must meet the requirements set forth in Minnesota Rules, part
9505.2175, subparts 1 and 2, and must document:
(1) the type of service deleted text begin provided by telemedicinedeleted text end new text begin delivered through telehealthnew text end ;
(2) the time the service began and the time the service ended, including an a.m. and p.m.
designation;
(3) the deleted text begin licenseddeleted text end health care provider's basis for determining that deleted text begin telemedicinedeleted text end new text begin telehealthnew text end
is an appropriate and effective means for delivering the service to the enrollee;
(4) the mode of transmission deleted text begin ofdeleted text end new text begin used to delivernew text end the deleted text begin telemedicinedeleted text end service new text begin through telehealth
new text end and records evidencing that a particular mode of transmission was utilized;
(5) the location of the originating site and the distant site;
(6) if the claim for payment is based on a physician's deleted text begin telemedicinedeleted text end consultation with
another physiciannew text begin through telehealthnew text end , the written opinion from the consulting physician
providing the deleted text begin telemedicinedeleted text end new text begin telehealthnew text end consultation; and
(7) compliance with the criteria attested to by the health care provider in accordance
with paragraph (b).
new text begin
(d) Telehealth visits, as described in this subdivision provided through audio and visual
communication, may be used to satisfy the face-to-face requirement for reimbursement
under the payment methods that apply to a federally qualified health center, rural health
clinic, Indian health service, 638 tribal clinic, and certified community behavioral health
clinic, if the service would have otherwise qualified for payment if performed in person.
new text end
new text begin
(e) For mental health services or assessments delivered through telehealth that are based
on an individual treatment plan, the provider may document the client's verbal approval of
the treatment plan or change in the treatment plan in lieu of the client's signature in
accordance with Minnesota Rules, part 9505.0371.
new text end
deleted text begin (d)deleted text end new text begin (f)new text end For purposes of this subdivision, unless otherwise covered under this chapterdeleted text begin ,
"telemedicine" is defined as the delivery of health care services or consultations while the
patient is at an originating site and the licensed health care provider is at a distant site. A
communication between licensed health care providers, or a licensed health care provider
and a patient that consists solely of a telephone conversation, e-mail, or facsimile transmission
does not constitute telemedicine consultations or services. Telemedicine may be provided
by means of real-time two-way, interactive audio and visual communications, including the
application of secure video conferencing or store-and-forward technology to provide or
support health care delivery, which facilitate the assessment, diagnosis, consultation,
treatment, education, and care management of a patient's health care.deleted text end new text begin :
new text end
new text begin
(1) "telehealth" means the delivery of health care services or consultations through the
use of real time two-way interactive audio and visual communication to provide or support
health care delivery and facilitate the assessment, diagnosis, consultation, treatment,
education, and care management of a patient's health care. Telehealth includes the application
of secure video conferencing, store-and-forward transfers, and synchronous interactions
between a patient located at an originating site and a health care provider located at a distant
site.Telehealth does not include communication between health care providers or between
a health care provider and a patient that consists solely of a audio-only communication , an
e-mail, or facsimile transmission unless authorized by the commissioner or specified by
law;
new text end
deleted text begin (e) For purposes of this section, "licenseddeleted text end new text begin (2) "new text end health care provider" means a deleted text begin licenseddeleted text end
health care provider deleted text begin under section 62A.671, subdivision 6deleted text end new text begin as defined under section 62A.673new text end ,
a community paramedic as defined under section 144E.001, subdivision 5f, deleted text begin or a mental
health practitioner defined under section 245.462, subdivision 17, or 245.4871, subdivision
26, working under the general supervision of a mental health professional, anddeleted text end a community
health worker who meets the criteria under subdivision 49, paragraph (a)deleted text begin ; "health care
provider" is defined under section 62A.671, subdivision 3;deleted text end new text begin , a mental health certified peer
specialist under section 256B.0615, subdivision 5, a mental health certified family peer
specialist under section 256B.0616, subdivision 5, a mental health rehabilitation worker
under section 256B.0623, subdivision 5, paragraph (a), clause (4), and paragraph (b), a
mental health behavioral aide under section 256B.0943, subdivision 7, paragraph (b), clause
(3), a treatment coordinator under section 245G.11, subdivision 7, an alcohol and drug
counselor under section 245G.11, subdivision 5, a recovery peer under section 245G.11,
subdivision 8;new text end and
new text begin (3) new text end "originating site" deleted text begin is defined under section 62A.671, subdivision 7deleted text end new text begin , "distant site," and
"store-and-forward transfer" have the meanings given in section 62A.673, subdivision 2new text end .
deleted text begin
(f) The limit on coverage of three telemedicine services per enrollee per calendar week
does not apply if:
deleted text end
deleted text begin
(1) the telemedicine services provided by the licensed health care provider are for the
treatment and control of tuberculosis; and
deleted text end
deleted text begin
(2) the services are provided in a manner consistent with the recommendations and best
practices specified by the Centers for Disease Control and Prevention and the commissioner
of health.
deleted text end
Sec. 12.
Minnesota Statutes 2020, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 3h. new text end
new text begin Telemonitoring services. new text end
new text begin
(a) Medical assistance covers telemonitoring services
if:
new text end
new text begin
(1) the telemonitoring service is medically appropriate based on the recipient's medical
condition or status;
new text end
new text begin
(2) the recipient's health care provider has identified that telemonitoring services would
likely prevent the recipient's admission or readmission to a hospital, emergency room, or
nursing facility;
new text end
new text begin
(3) the recipient is cognitively and physically capable of operating the monitoring device
or equipment, or the recipient has a caregiver who is willing and able to assist with the
monitoring device or equipment; and
new text end
new text begin
(4) the recipient resides in a setting that is suitable for telemonitoring and not in a setting
that has health care staff on site.
new text end
new text begin
(b) For purposes of this subdivision, "telemonitoring services" means the remote
monitoring of data related to a recipient's vital signs or biometric data by a monitoring
device or equipment that transmits the data electronically to a provider for analysis. The
assessment and monitoring of the health data transmitted by telemonitoring must be
performed by one of the following licensed health care professionals: physician, podiatrist,
registered nurse, advanced practice registered nurse, physician assistant, respiratory therapist,
or licensed professional working under the supervision of a medical director.
new text end
Sec. 13.
Minnesota Statutes 2020, section 256B.0625, subdivision 13h, is amended to
read:
Subd. 13h.
Medication therapy management services.
(a) Medical assistance covers
medication therapy management services for a recipient taking prescriptions to treat or
prevent one or more chronic medical conditions. 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:
(1) performing or obtaining necessary assessments of the patient's health status;
(2) formulating a medication treatment plan, which may include prescribing medications
or products in accordance with section 151.37, subdivision 14, 15, or 16;
(3) monitoring and evaluating the patient's response to therapy, including safety and
effectiveness;
(4) performing a comprehensive medication review to identify, resolve, and prevent
medication-related problems, including adverse drug events;
(5) documenting the care delivered and communicating essential information to the
patient's other primary care providers;
(6) providing verbal education and training designed to enhance patient understanding
and appropriate use of the patient's medications;
(7) providing information, support services, and resources designed to enhance patient
adherence with the patient's therapeutic regimens; and
(8) coordinating and integrating medication therapy management services within the
broader health care management services being provided to the patient.
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.
(b) To be eligible for reimbursement for services under this subdivision, a pharmacist
must meet the following requirements:
(1) have a valid license issued by the Board of Pharmacy of the state in which the
medication therapy management service is being performed;
(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 begin and
new text end
deleted 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,
or in home settings, including long-term care settings, group homes, and facilities providing
assisted living services, but excluding skilled nursing facilities; and
deleted text end
deleted text begin (4)deleted text end new text begin (3)new text end make use of an electronic patient record system that meets state standards.
(c) For purposes of reimbursement for medication therapy management services, the
commissioner may enroll individual pharmacists as medical assistance providers. The
commissioner may also establish deleted text begin contact requirements between the pharmacist and recipient,
including limitingdeleted text end new text begin limits on new text end the number of reimbursable consultations per recipient.
(d) deleted text begin If there are no pharmacists who meet the requirements of paragraph (b) practicing
within a reasonable geographic distance of the patient, a pharmacist who meets the
requirements may provide Thedeleted text end new text begin Medication therapy managementnew text end services new text begin may be provided
new text end via deleted text begin two-way interactive videodeleted text end new text begin telehealth as defined in subdivision 3b and may be delivered
into a patient's residencenew text end . Reimbursement shall be at the same rates and under the same
conditions that would otherwise apply to the services provided. To qualify for reimbursement
under this paragraph, the pharmacist providing the services must meet the requirements of
paragraph (b)deleted text begin , and must be located within an ambulatory care setting that meets the
requirements of paragraph (b), clause (3). The patient must also be located within an
ambulatory care setting that meets the requirements of paragraph (b), clause (3). Services
provided under this paragraph may not be transmitted into the patient's residencedeleted text end .
deleted text begin
(e) Medication therapy management services may be delivered into a patient's residence
via secure interactive video if the medication therapy management services are performed
electronically during a covered home care visit by an enrolled provider. Reimbursement
shall be at the same rates and under the same conditions that would otherwise apply to the
services provided. To qualify for reimbursement under this paragraph, the pharmacist
providing the services must meet the requirements of paragraph (b) and must be located
within an ambulatory care setting that meets the requirements of paragraph (b), clause (3).
deleted text end
Sec. 14.
Minnesota Statutes 2020, section 256B.0625, subdivision 20, is amended to read:
Subd. 20.
Mental health case management.
(a) To the extent authorized by rule of the
state agency, medical assistance covers case management services to persons with serious
and persistent mental illness and children with severe emotional disturbance. Services
provided under this section must meet the relevant standards in sections 245.461 to 245.4887,
the Comprehensive Adult and Children's Mental Health Acts, Minnesota Rules, parts
9520.0900 to 9520.0926, and 9505.0322, excluding subpart 10.
(b) Entities meeting program standards set out in rules governing family community
support services as defined in section 245.4871, subdivision 17, are eligible for medical
assistance reimbursement for case management services for children with severe emotional
disturbance when these services meet the program standards in Minnesota Rules, parts
9520.0900 to 9520.0926 and 9505.0322, excluding subparts 6 and 10.
(c) Medical assistance and MinnesotaCare payment for mental health case management
shall be made on a monthly basis. In order to receive payment for an eligible child, the
provider must document at least a face-to-face contact new text begin either in person or by interactive
video that meets the requirements of subdivision 20bnew text end with the child, the child's parents, or
the child's legal representative. To receive payment for an eligible adult, the provider must
document:
(1) at least a face-to-face contact with the adult or the adult's legal representative deleted text begin ordeleted text end deleted text begin adeleted text end
deleted text begin contact bydeleted text end deleted text begin interactive videodeleted text end new text begin either in person or by interactive videonew text end that meets the
requirements of subdivision 20b; or
(2) at least a telephone contact with the adult or the adult's legal representative and
document a face-to-face contact deleted text begin or a contact bydeleted text end deleted text begin interactive videodeleted text end new text begin either in person or by
interactive videonew text end that meets the requirements of subdivision 20b with the adult or the adult's
legal representative within the preceding two months.
(d) Payment for mental health case management provided by county or state staff shall
be based on the monthly rate methodology under section 256B.094, subdivision 6, paragraph
(b), with separate rates calculated for child welfare and mental health, and within mental
health, separate rates for children and adults.
(e) Payment for mental health case management provided by Indian health services or
by agencies operated by Indian tribes may be made according to this section or other relevant
federally approved rate setting methodology.
(f) Payment for mental health case management provided by vendors who contract with
a county or Indian tribe shall be based on a monthly rate negotiated by the host county or
tribe. The negotiated rate must not exceed the rate charged by the vendor for the same
service to other payers. If the service is provided by a team of contracted vendors, the county
or tribe may negotiate a team rate with a vendor who is a member of the team. The team
shall determine how to distribute the rate among its members. No reimbursement received
by contracted vendors shall be returned to the county or tribe, except to reimburse the county
or tribe for advance funding provided by the county or tribe to the vendor.
(g) If the service is provided by a team which includes contracted vendors, tribal staff,
and county or state staff, the costs for county or state staff participation in the team shall be
included in the rate for county-provided services. In this case, the contracted vendor, the
tribal agency, and the county may each receive separate payment for services provided by
each entity in the same month. In order to prevent duplication of services, each entity must
document, in the recipient's file, the need for team case management and a description of
the roles of the team members.
(h) Notwithstanding section 256B.19, subdivision 1, the nonfederal share of costs for
mental health case management shall be provided by the recipient's county of responsibility,
as defined in sections 256G.01 to 256G.12, from sources other than federal funds or funds
used to match other federal funds. If the service is provided by a tribal agency, the nonfederal
share, if any, shall be provided by the recipient's tribe. When this service is paid by the state
without a federal share through fee-for-service, 50 percent of the cost shall be provided by
the recipient's county of responsibility.
(i) Notwithstanding any administrative rule to the contrary, prepaid medical assistance
and MinnesotaCare include mental health case management. When the service is provided
through prepaid capitation, the nonfederal share is paid by the state and the county pays no
share.
(j) The commissioner may suspend, reduce, or terminate the reimbursement to a provider
that does not meet the reporting or other requirements of this section. The county of
responsibility, as defined in sections 256G.01 to 256G.12, or, if applicable, the tribal agency,
is responsible for any federal disallowances. The county or tribe may share this responsibility
with its contracted vendors.
(k) The commissioner shall set aside a portion of the federal funds earned for county
expenditures under this section to repay the special revenue maximization account under
section 256.01, subdivision 2, paragraph (o). The repayment is limited to:
(1) the costs of developing and implementing this section; and
(2) programming the information systems.
(l) Payments to counties and tribal agencies for case management expenditures under
this section shall only be made from federal earnings from services provided under this
section. When this service is paid by the state without a federal share through fee-for-service,
50 percent of the cost shall be provided by the state. Payments to county-contracted vendors
shall include the federal earnings, the state share, and the county share.
(m) Case management services under this subdivision do not include therapy, treatment,
legal, or outreach services.
(n) If the recipient is a resident of a nursing facility, intermediate care facility, or hospital,
and the recipient's institutional care is paid by medical assistance, payment for case
management services under this subdivision is limited to the lesser of:
(1) the last 180 days of the recipient's residency in that facility and may not exceed more
than six months in a calendar year; or
(2) the limits and conditions which apply to federal Medicaid funding for this service.
(o) Payment for case management services under this subdivision shall not duplicate
payments made under other program authorities for the same purpose.
(p) If the recipient is receiving care in a hospital, nursing facility, or residential setting
licensed under chapter 245A or 245D that is staffed 24 hours a day, seven days a week,
mental health targeted case management services must actively support identification of
community alternatives for the recipient and discharge planning.
Sec. 15.
Minnesota Statutes 2020, section 256B.0625, subdivision 20b, is amended to
read:
Subd. 20b.
deleted text begin Mental healthdeleted text end Targeted case management deleted text begin throughdeleted text end new text begin by new text end interactive
video.
(a) deleted text begin Subject to federal approval, contact made for targeted case management by
interactive video shall be eligible for payment if:deleted text end new text begin Minimum required face-to-face contacts
for targeted case management may be provided by interactive video if interactive video is
in the best interests of the person and is deemed appropriate by the person receiving targeted
case management or the person's legal guardian and the case management provider.
new text end
deleted text begin
(1) the person receiving targeted case management services is residing in:
deleted text end
deleted text begin
(i) a hospital;
deleted text end
deleted text begin
(ii) a nursing facility; or
deleted text end
deleted text begin
(iii) a residential setting licensed under chapter 245A or 245D or a boarding and lodging
establishment or lodging establishment that provides supportive services or health supervision
services according to section 157.17 that is staffed 24 hours a day, seven days a week;
deleted text end
deleted text begin
(2) interactive video is in the best interests of the person and is deemed appropriate by
the person receiving targeted case management or the person's legal guardian, the case
management provider, and the provider operating the setting where the person is residing;
deleted text end
deleted text begin
(3) the use of interactive video is approved as part of the person's written personal service
or case plan, taking into consideration the person's vulnerability and active personal
relationships; and
deleted text end
deleted text begin
(4) interactive video is used for up to, but not more than, 50 percent of the minimum
required face-to-face contact.
deleted text end
(b) The person receiving targeted case management or the person's legal guardian has
the right to choose and consent to the use of interactive video under this subdivision and
has the right to refuse the use of interactive video at any time.
(c) The commissionerdeleted text begin shalldeleted text end new text begin may new text end establish criteria that a targeted case management
provider must attest to in order to demonstrate the safety or efficacy ofdeleted text begin delivering the service
via interactive video. The attestation may include that the case management provider has:deleted text end new text begin
meeting the minimum face-to-face contact requirements for targeted case management by
interactive video.
new text end
deleted text begin
(1) written policies and procedures specific to interactive video services that are regularly
reviewed and updated;
deleted text end
deleted text begin
(2) policies and procedures that adequately address client safety before, during, and after
the interactive video services are rendered;
deleted text end
deleted text begin
(3) established protocols addressing how and when to discontinue interactive video
services; and
deleted text end
deleted text begin
(4) established a quality assurance process related to interactive video services.
deleted text end
(d) As a condition of payment, the targeted case management provider must document
the following for each occurrence of targeted case management provided by interactive
videonew text begin for the purposes of face-to-face contactnew text end :
(1) the time thedeleted text begin servicedeleted text end new text begin contact new text end began and the time the service ended, including an a.m.
and p.m. designationdeleted text begin ;
deleted text end
(2) the basis for determining that interactive video is an appropriate and effective means
fordeleted text begin delivering the service todeleted text end new text begin contactingnew text end the person receiving new text begin targeted new text end case management
services;
(3) the mode of transmission of thedeleted text begin interactive videodeleted text end servicesnew text begin delivered by interactive
videonew text end and recordsdeleted text begin evidencingdeleted text end new text begin stating new text end that a particular mode of transmission was utilized;new text begin
and
new text end
(4) the location of the originating site and the distant sitedeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(5) compliance with the criteria attested to by the targeted case management provider
as provided in paragraph (c).
deleted text end
new text begin
(e) Interactive video must not be used to meet minimum face-to-face contact requirements
for children receiving case management services for child protection reasons or who are in
out-of-home placement.
new text end
new text begin
(f) For purposes of this section, "interactive video" means the delivery of targeted case
management services in real time through the use of two-way interactive audio and visual
communication.
new text end
Sec. 16.
Minnesota Statutes 2020, section 256B.0625, subdivision 46, is amended to read:
Subd. 46.
Mental health deleted text begin telemedicinedeleted text end new text begin telehealthnew text end .
deleted text begin Effective January 1, 2006, anddeleted text end Subject
to federal approval, mental health services that are otherwise covered by medical assistance
as direct face-to-face services may be provided via deleted text begin two-way interactive videodeleted text end new text begin telehealth as
defined in subdivision 3bnew text end . Use of deleted text begin two-way interactive videodeleted text end new text begin telehealth to deliver servicesnew text end
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. deleted text begin The interactive video equipment and connection must comply with
Medicare standards in effect at the time the service is provided.
deleted text end
Sec. 17.
Minnesota Statutes 2020, section 256B.0924, subdivision 6, is amended to read:
Subd. 6.
Payment for targeted case management.
(a) Medical assistance and
MinnesotaCare payment for targeted case management shall be made on a monthly basis.
In order to receive payment for an eligible adult, the provider must document at least one
contact per month and not more than two consecutive months without a face-to-face contact
new text begin either in person or by interactive video that meets the requirements in section 256B.0625,
subdivision 20bnew text end with the adult or the adult's legal representative, family, primary caregiver,
or other relevant persons identified as necessary to the development or implementation of
the goals of the personal service plan.
(b) Payment for targeted case management provided by county staff under this subdivision
shall be based on the monthly rate methodology under section 256B.094, subdivision 6,
paragraph (b), calculated as one combined average rate together with adult mental health
case management under section 256B.0625, subdivision 20, except for calendar year 2002.
In calendar year 2002, the rate for case management under this section shall be the same as
the rate for adult mental health case management in effect as of December 31, 2001. Billing
and payment must identify the recipient's primary population group to allow tracking of
revenues.
(c) Payment for targeted case management provided by county-contracted vendors shall
be based on a monthly rate negotiated by the host county. The negotiated rate must not
exceed the rate charged by the vendor for the same service to other payers. If the service is
provided by a team of contracted vendors, the county may negotiate a team rate with a
vendor who is a member of the team. The team shall determine how to distribute the rate
among its members. No reimbursement received by contracted vendors shall be returned
to the county, except to reimburse the county for advance funding provided by the county
to the vendor.
(d) If the service is provided by a team that includes contracted vendors and county staff,
the costs for county staff participation on the team shall be included in the rate for
county-provided services. In this case, the contracted vendor and the county may each
receive separate payment for services provided by each entity in the same month. In order
to prevent duplication of services, the county must document, in the recipient's file, the need
for team targeted case management and a description of the different roles of the team
members.
(e) Notwithstanding section 256B.19, subdivision 1, the nonfederal share of costs for
targeted case management shall be provided by the recipient's county of responsibility, as
defined in sections 256G.01 to 256G.12, from sources other than federal funds or funds
used to match other federal funds.
(f) The commissioner may suspend, reduce, or terminate reimbursement to a provider
that does not meet the reporting or other requirements of this section. The county of
responsibility, as defined in sections 256G.01 to 256G.12, is responsible for any federal
disallowances. The county may share this responsibility with its contracted vendors.
(g) The commissioner shall set aside five percent of the federal funds received under
this section for use in reimbursing the state for costs of developing and implementing this
section.
(h) Payments to counties for targeted case management expenditures under this section
shall only be made from federal earnings from services provided under this section. Payments
to contracted vendors shall include both the federal earnings and the county share.
(i) Notwithstanding section 256B.041, county payments for the cost of case management
services provided by county staff shall not be made to the commissioner of management
and budget. For the purposes of targeted case management services provided by county
staff under this section, the centralized disbursement of payments to counties under section
256B.041 consists only of federal earnings from services provided under this section.
(j) If the recipient is a resident of a nursing facility, intermediate care facility, or hospital,
and the recipient's institutional care is paid by medical assistance, payment for targeted case
management services under this subdivision is limited to the lesser of:
(1) the last 180 days of the recipient's residency in that facility; or
(2) the limits and conditions which apply to federal Medicaid funding for this service.
(k) Payment for targeted case management services under this subdivision shall not
duplicate payments made under other program authorities for the same purpose.
(l) Any growth in targeted case management services and cost increases under this
section shall be the responsibility of the counties.
Sec. 18.
Minnesota Statutes 2020, section 256B.094, subdivision 6, is amended to read:
Subd. 6.
Medical assistance reimbursement of case management services.
(a) Medical
assistance reimbursement for services under this section shall be made on a monthly basis.
Payment is based on face-to-face or telephone contacts between the case manager and the
client, client's family, primary caregiver, legal representative, or other relevant person
identified as necessary to the development or implementation of the goals of the individual
service plan regarding the status of the client, the individual service plan, or the goals for
the client. These contacts must meet the deleted text begin minimum standardsdeleted text end new text begin requirementsnew text end in clauses (1)
deleted text begin and (2)deleted text end new text begin to (3)new text end :
(1) there must be a face-to-face contact at least once a month except as provided in deleted text begin clausedeleted text end
new text begin clausesnew text end (2) new text begin and (3)new text end ; deleted text begin and
deleted text end
(2) for a client placed outside of the county of financial responsibility, or a client served
by tribal social services placed outside the reservation, in an excluded time facility under
section 256G.02, subdivision 6, or through the Interstate Compact for the Placement of
Children, section 260.93, and the placement in either case is more than 60 miles beyond
the county or reservation boundaries, there must be at least one contact per month and not
more than two consecutive months without a face-to-face deleted text begin contact.deleted text end new text begin in-person contact; and
new text end
new text begin
(3) for a child receiving case management services for child protection reasons or who
is in out-of-home placement, face-to-face contact must be through in-person contact.
new text end
(b) Except as provided under paragraph (c), the payment rate is established using time
study data on activities of provider service staff and reports required under sections 245.482
and 256.01, subdivision 2, paragraph (p).
(c) Payments for tribes may be made according to section 256B.0625 or other relevant
federally approved rate setting methodology for child welfare targeted case management
provided by Indian health services and facilities operated by a tribe or tribal organization.
(d) Payment for case management provided by county or tribal social services contracted
vendors shall be based on a monthly rate negotiated by the host county or tribal social
services. The negotiated rate must not exceed the rate charged by the vendor for the same
service to other payers. If the service is provided by a team of contracted vendors, the county
or tribal social services may negotiate a team rate with a vendor who is a member of the
team. The team shall determine how to distribute the rate among its members. No
reimbursement received by contracted vendors shall be returned to the county or tribal social
services, except to reimburse the county or tribal social services for advance funding provided
by the county or tribal social services to the vendor.
(e) If the service is provided by a team that includes contracted vendors and county or
tribal social services staff, the costs for county or tribal social services staff participation in
the team shall be included in the rate for county or tribal social services provided services.
In this case, the contracted vendor and the county or tribal social services may each receive
separate payment for services provided by each entity in the same month. To prevent
duplication of services, each entity must document, in the recipient's file, the need for team
case management and a description of the roles and services of the team members.
Separate payment rates may be established for different groups of providers to maximize
reimbursement as determined by the commissioner. The payment rate will be reviewed
annually and revised periodically to be consistent with the most recent time study and other
data. Payment for services will be made upon submission of a valid claim and verification
of proper documentation described in subdivision 7. Federal administrative revenue earned
through the time study, or under paragraph (c), shall be distributed according to earnings,
to counties, reservations, or groups of counties or reservations which have the same payment
rate under this subdivision, and to the group of counties or reservations which are not
certified providers under section 256F.10. The commissioner shall modify the requirements
set out in Minnesota Rules, parts 9550.0300 to 9550.0370, as necessary to accomplish this.
Sec. 19.
Minnesota Statutes 2020, section 256B.0943, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
For purposes of this section, the following terms have the
meanings given them.
(a) "Children's therapeutic services and supports" means the flexible package of mental
health services for children who require varying therapeutic and rehabilitative levels of
intervention to treat a diagnosed emotional disturbance, as defined in section 245.4871,
subdivision 15, or a diagnosed mental illness, as defined in section 245.462, subdivision
20. The services are time-limited interventions that are delivered using various treatment
modalities and combinations of services designed to reach treatment outcomes identified
in the individual treatment plan.
(b) "Clinical supervision" means the overall responsibility of the mental health
professional for the control and direction of individualized treatment planning, service
delivery, and treatment review for each client. A mental health professional who is an
enrolled Minnesota health care program provider accepts full professional responsibility
for a supervisee's actions and decisions, instructs the supervisee in the supervisee's work,
and oversees or directs the supervisee's work.
(c) "Clinical trainee" means a mental health practitioner who meets the qualifications
specified in Minnesota Rules, part 9505.0371, subpart 5, item C.
(d) "Crisis assistance" has the meaning given in section 245.4871, subdivision 9a. Crisis
assistance entails the development of a written plan to assist a child's family to contend with
a potential crisis and is distinct from the immediate provision of crisis intervention services.
(e) "Culturally competent provider" means a provider who understands and can utilize
to a client's benefit the client's culture when providing services to the client. A provider
may be culturally competent because the provider is of the same cultural or ethnic group
as the client or the provider has developed the knowledge and skills through training and
experience to provide services to culturally diverse clients.
(f) "Day treatment program" for children means a site-based structured mental health
program consisting of psychotherapy for three or more individuals and individual or group
skills training provided by a multidisciplinary team, under the clinical supervision of a
mental health professional.
(g) "Diagnostic assessment" has the meaning given in Minnesota Rules, part 9505.0372,
subpart 1.
(h) "Direct service time" means the time that a mental health professional, clinical trainee,
mental health practitioner, or mental health behavioral aide spends face-to-face with a client
and the client's family or providing covered deleted text begin telemedicinedeleted text end servicesnew text begin through tehehealth as
defined under section 256B.0625, subdivision 3bnew text end . Direct service time includes time in which
the provider obtains a client's history, develops a client's treatment plan, records individual
treatment outcomes, or provides service components of children's therapeutic services and
supports. Direct service time does not include time doing work before and after providing
direct services, including scheduling or maintaining clinical records.
(i) "Direction of mental health behavioral aide" means the activities of a mental health
professional or mental health practitioner in guiding the mental health behavioral aide in
providing services to a client. The direction of a mental health behavioral aide must be based
on the client's individualized treatment plan and meet the requirements in subdivision 6,
paragraph (b), clause (5).
(j) "Emotional disturbance" has the meaning given in section 245.4871, subdivision 15.
(k) "Individual behavioral plan" means a plan of intervention, treatment, and services
for a child written by a mental health professional or mental health practitioner, under the
clinical supervision of a mental health professional, to guide the work of the mental health
behavioral aide. The individual behavioral plan may be incorporated into the child's individual
treatment plan so long as the behavioral plan is separately communicable to the mental
health behavioral aide.
(l) "Individual treatment plan" has the meaning given in Minnesota Rules, part 9505.0371,
subpart 7.
(m) "Mental health behavioral aide services" means medically necessary one-on-one
activities performed by a trained paraprofessional qualified as provided in subdivision 7,
paragraph (b), clause (3), to assist a child retain or generalize psychosocial skills as previously
trained by a mental health professional or mental health practitioner and as described in the
child's individual treatment plan and individual behavior plan. Activities involve working
directly with the child or child's family as provided in subdivision 9, paragraph (b), clause
(4).
(n) "Mental health practitioner" has the meaning given in section 245.462, subdivision
17, except that a practitioner working in a day treatment setting may qualify as a mental
health practitioner if the practitioner holds a bachelor's degree in one of the behavioral
sciences or related fields from an accredited college or university, and: (1) has at least 2,000
hours of clinically supervised experience in the delivery of mental health services to clients
with mental illness; (2) is fluent in the language, other than English, of the cultural group
that makes up at least 50 percent of the practitioner's clients, completes 40 hours of training
on the delivery of services to clients with mental illness, and receives clinical supervision
from a mental health professional at least once per week until meeting the required 2,000
hours of supervised experience; or (3) receives 40 hours of training on the delivery of
services to clients with mental illness within six months of employment, and clinical
supervision from a mental health professional at least once per week until meeting the
required 2,000 hours of supervised experience.
(o) "Mental health professional" means an individual as defined in Minnesota Rules,
part 9505.0370, subpart 18.
(p) "Mental health service plan development" includes:
(1) the development, review, and revision of a child's individual treatment plan, as
provided in Minnesota Rules, part 9505.0371, subpart 7, including involvement of the client
or client's parents, primary caregiver, or other person authorized to consent to mental health
services for the client, and including arrangement of treatment and support activities specified
in the individual treatment plan; and
(2) administering standardized outcome measurement instruments, determined and
updated by the commissioner, as periodically needed to evaluate the effectiveness of
treatment for children receiving clinical services and reporting outcome measures, as required
by the commissioner.
(q) "Mental illness," for persons at least age 18 but under age 21, has the meaning given
in section 245.462, subdivision 20, paragraph (a).
(r) "Psychotherapy" means the treatment of mental or emotional disorders or
maladjustment by psychological means. Psychotherapy may be provided in many modalities
in accordance with Minnesota Rules, part 9505.0372, subpart 6, including patient and/or
family psychotherapy; family psychotherapy; psychotherapy for crisis; group psychotherapy;
or multiple-family psychotherapy. Beginning with the American Medical Association's
Current Procedural Terminology, standard edition, 2014, the procedure "individual
psychotherapy" is replaced with "patient and/or family psychotherapy," a substantive change
that permits the therapist to work with the client's family without the client present to obtain
information about the client or to explain the client's treatment plan to the family.
Psychotherapy is appropriate for crisis response when a child has become dysregulated or
experienced new trauma since the diagnostic assessment was completed and needs
psychotherapy to address issues not currently included in the child's individual treatment
plan.
(s) "Rehabilitative services" or "psychiatric rehabilitation services" means a series or
multidisciplinary combination of psychiatric and psychosocial interventions to: (1) restore
a child or adolescent to an age-appropriate developmental trajectory that had been disrupted
by a psychiatric illness; or (2) enable the child to self-monitor, compensate for, cope with,
counteract, or replace psychosocial skills deficits or maladaptive skills acquired over the
course of a psychiatric illness. Psychiatric rehabilitation services for children combine
psychotherapy to address internal psychological, emotional, and intellectual processing
deficits, and skills training to restore personal and social functioning. Psychiatric
rehabilitation services establish a progressive series of goals with each achievement building
upon a prior achievement. Continuing progress toward goals is expected, and rehabilitative
potential ceases when successive improvement is not observable over a period of time.
(t) "Skills training" means individual, family, or group training, delivered by or under
the supervision of a mental health professional, designed to facilitate the acquisition of
psychosocial skills that are medically necessary to rehabilitate the child to an age-appropriate
developmental trajectory heretofore disrupted by a psychiatric illness or to enable the child
to self-monitor, compensate for, cope with, counteract, or replace skills deficits or
maladaptive skills acquired over the course of a psychiatric illness. Skills training is subject
to the service delivery requirements under subdivision 9, paragraph (b), clause (2).
Sec. 20.
Minnesota Statutes 2020, section 256B.0947, subdivision 6, is amended to read:
Subd. 6.
Service standards.
The standards in this subdivision apply to intensive
nonresidential rehabilitative mental health services.
(a) The treatment team must use team treatment, not an individual treatment model.
(b) Services must be available at times that meet client needs.
(c) Services must be age-appropriate and meet the specific needs of the client.
(d) The initial functional assessment must be completed within ten days of intake and
updated at least every six months or prior to discharge from the service, whichever comes
first.
(e) An individual treatment plan must:
(1) be based on the information in the client's diagnostic assessment and baselines;
(2) identify goals and objectives of treatment, a treatment strategy, a schedule for
accomplishing treatment goals and objectives, and the individuals responsible for providing
treatment services and supports;
(3) be developed after completion of the client's diagnostic assessment by a mental health
professional or clinical trainee and before the provision of children's therapeutic services
and supports;
(4) be developed through a child-centered, family-driven, culturally appropriate planning
process, including allowing parents and guardians to observe or participate in individual
and family treatment services, assessments, and treatment planning;
(5) be reviewed at least once every six months and revised to document treatment progress
on each treatment objective and next goals or, if progress is not documented, to document
changes in treatment;
(6) be signed by the clinical supervisor and by the client or by the client's parent or other
person authorized by statute to consent to mental health services for the client. A client's
parent may approve the client's individual treatment plan by secure electronic signature or
by documented oral approval that is later verified by written signature;
(7) be completed in consultation with the client's current therapist and key providers and
provide for ongoing consultation with the client's current therapist to ensure therapeutic
continuity and to facilitate the client's return to the community. For clients under the age of
18, the treatment team must consult with parents and guardians in developing the treatment
plan;
(8) if a need for substance use disorder treatment is indicated by validated assessment:
(i) identify goals, objectives, and strategies of substance use disorder treatment; develop
a schedule for accomplishing treatment goals and objectives; and identify the individuals
responsible for providing treatment services and supports;
(ii) be reviewed at least once every 90 days and revised, if necessary;
(9) be signed by the clinical supervisor and by the client and, if the client is a minor, by
the client's parent or other person authorized by statute to consent to mental health treatment
and substance use disorder treatment for the client; and
(10) provide for the client's transition out of intensive nonresidential rehabilitative mental
health services by defining the team's actions to assist the client and subsequent providers
in the transition to less intensive or "stepped down" services.
(f) The treatment team shall actively and assertively engage the client's family members
and significant others by establishing communication and collaboration with the family and
significant others and educating the family and significant others about the client's mental
illness, symptom management, and the family's role in treatment, unless the team knows or
has reason to suspect that the client has suffered or faces a threat of suffering any physical
or mental injury, abuse, or neglect from a family member or significant other.
(g) For a client age 18 or older, the treatment team may disclose to a family member,
other relative, or a close personal friend of the client, or other person identified by the client,
the protected health information directly relevant to such person's involvement with the
client's care, as provided in Code of Federal Regulations, title 45, part 164.502(b). If the
client is present, the treatment team shall obtain the client's agreement, provide the client
with an opportunity to object, or reasonably infer from the circumstances, based on the
exercise of professional judgment, that the client does not object. If the client is not present
or is unable, by incapacity or emergency circumstances, to agree or object, the treatment
team may, in the exercise of professional judgment, determine whether the disclosure is in
the best interests of the client and, if so, disclose only the protected health information that
is directly relevant to the family member's, relative's, friend's, or client-identified person's
involvement with the client's health care. The client may orally agree or object to the
disclosure and may prohibit or restrict disclosure to specific individuals.
(h) The treatment team shall provide interventions to promote positive interpersonal
relationships.
new text begin
(i) The services and responsibilities of the psychiatric provider may be provided through
telehealth as defined under section 256B.0625, subdivision 3b, when necessary to prevent
disruption in client services or to maintain the required psychiatric staffing level.
new text end
Sec. 21.
Minnesota Statutes 2020, section 256B.0949, subdivision 13, is amended to read:
Subd. 13.
Covered services.
(a) The services described in paragraphs (b) to (l) are
eligible for reimbursement by medical assistance under this section. Services must be
provided by a qualified EIDBI provider and supervised by a QSP. An EIDBI service must
address the person's medically necessary treatment goals and must be targeted to develop,
enhance, or maintain the individual developmental skills of a person with ASD or a related
condition to improve functional communication, including nonverbal or social
communication, social or interpersonal interaction, restrictive or repetitive behaviors,
hyperreactivity or hyporeactivity to sensory input, behavioral challenges and self-regulation,
cognition, learning and play, self-care, and safety.
(b) EIDBI treatment must be delivered consistent with the standards of an approved
modality, as published by the commissioner. EIDBI modalities include:
(1) applied behavior analysis (ABA);
(2) developmental individual-difference relationship-based model (DIR/Floortime);
(3) early start Denver model (ESDM);
(4) PLAY project;
(5) relationship development intervention (RDI); or
(6) additional modalities not listed in clauses (1) to (5) upon approval by the
commissioner.
(c) An EIDBI provider may use one or more of the EIDBI modalities in paragraph (b),
clauses (1) to (5), as the primary modality for treatment as a covered service, or several
EIDBI modalities in combination as the primary modality of treatment, as approved by the
commissioner. An EIDBI provider that identifies and provides assurance of qualifications
for a single specific treatment modality must document the required qualifications to meet
fidelity to the specific model.
(d) Each qualified EIDBI provider must identify and provide assurance of qualifications
for professional licensure certification, or training in evidence-based treatment methods,
and must document the required qualifications outlined in subdivision 15 in a manner
determined by the commissioner.
(e) CMDE is a comprehensive evaluation of the person's developmental status to
determine medical necessity for EIDBI services and meets the requirements of subdivision
5. The services must be provided by a qualified CMDE provider.
(f) EIDBI intervention observation and direction is the clinical direction and oversight
of EIDBI services by the QSP, level I treatment provider, or level II treatment provider,
including developmental and behavioral techniques, progress measurement, data collection,
function of behaviors, and generalization of acquired skills for the direct benefit of a person.
EIDBI intervention observation and direction informs any modification of the current
treatment protocol to support the outcomes outlined in the ITP.
(g) Intervention is medically necessary direct treatment provided to a person with ASD
or a related condition as outlined in their ITP. All intervention services must be provided
under the direction of a QSP. Intervention may take place across multiple settings. The
frequency and intensity of intervention services are provided based on the number of
treatment goals, person and family or caregiver preferences, and other factors. Intervention
services may be provided individually or in a group. Intervention with a higher provider
ratio may occur when deemed medically necessary through the person's ITP.
(1) Individual intervention is treatment by protocol administered by a single qualified
EIDBI provider delivered deleted text begin face-to-facedeleted text end to one person.
(2) Group intervention is treatment by protocol provided by one or more qualified EIDBI
providers, delivered to at least two people who receive EIDBI services.
(h) ITP development and ITP progress monitoring is development of the initial, annual,
and progress monitoring of an ITP. ITP development and ITP progress monitoring documents
provide oversight and ongoing evaluation of a person's treatment and progress on targeted
goals and objectives and integrate and coordinate the person's and the person's legal
representative's information from the CMDE and ITP progress monitoring. This service
must be reviewed and completed by the QSP, and may include input from a level I provider
or a level II provider.
(i) Family caregiver training and counseling is specialized training and education for a
family or primary caregiver to understand the person's developmental status and help with
the person's needs and development. This service must be provided by the QSP, level I
provider, or level II provider.
(j) A coordinated care conference is a voluntary deleted text begin face-to-facedeleted text end meeting with the person
and the person's family to review the CMDE or ITP progress monitoring and to integrate
and coordinate services across providers and service-delivery systems to develop the ITP.
This service must be provided by the QSP and may include the CMDE provider or a level
I provider or a level II provider.
(k) Travel time is allowable billing for traveling to and from the person's home, school,
a community setting, or place of service outside of an EIDBI center, clinic, or office from
a specified location to provide deleted text begin face-to-facedeleted text end new text begin in-personnew text end EIDBI intervention, observation and
direction, or family caregiver training and counseling. The person's ITP must specify the
reasons the provider must travel to the person.
(l) Medical assistance covers medically necessary EIDBI services and consultations
delivered by a licensed health care provider via deleted text begin telemedicinedeleted text end new text begin telehealthnew text end , as defined under
section 256B.0625, subdivision 3b, in the same manner as if the service or consultation was
delivered in person.
Sec. 22. new text begin COMMISSIONER OF HUMAN SERVICES; EXTENSION OF COVID-19
HUMAN SERVICES PROGRAM MODIFICATIONS.
new text end
new text begin
Notwithstanding Laws 2020, First Special Session chapter 7, section 1, subdivision 2,
as amended by Laws 2020, First Special Session chapter 1, section 3, when the peacetime
emergency declared by the governor in response to the COVID-19 outbreak expires, is
terminated, or is rescinded by the proper authority, the following modifications issued by
the commissioner of human services pursuant to Executive Orders 20-11 and 20-12, and
including any amendments to the modification issued before the peacetime emergency
expires, shall remain in effect until June 30, 2023:
new text end
new text begin
(1) CV16: expanding access to telemedicine services for Children's Health Insurance
Program, Medical Assistance, and MinnesotaCare enrollees;
new text end
new text begin
(2) CV21: allowing telemedicine alternative for school-linked mental health services
and intermediate school district mental health services;
new text end
new text begin
(3) CV24: allowing phone or video use for targeted case management visits;
new text end
new text begin
(4) CV30: expanding telemedicine in health care, mental health, and substance use
disorder settings; and
new text end
new text begin
(5) CV45: permitting comprehensive assessments to be completed by telephone or video
communication and permitting a counselor, recovery peer, or treatment coordinator to
provide treatment services from their home by telephone or video communication to a client
in their home.
new text end
Sec. 23. new text begin EXPANDING TELEHEALTH DELIVERY OPTIONS STUDY.
new text end
new text begin
The commissioner of human services, in consultation with providers, shall study the
viability of the use of audio-only communication as a permitted option for delivering services
through telehealth within the public health care programs. The study shall examine the use
of audio-only communication in supporting equitable access to health care services, including
behavioral health services for the elderly, rural communities, and communities of color,
and eliminating barriers for vulnerable and underserved populations. The commissioner
shall submit recommendations to the chairs and ranking minority members of the legislative
committees with jurisdiction over health and human services policy and finances, by
December 15, 2022.
new text end
Sec. 24. new text begin STUDY OF TELEHEALTH.
new text end
new text begin
(a) The commissioner of health, in consultation with the commissioner of human services,
shall study the impact of telehealth payment methodologies and expansion under this act
on the coverage and provision of telehealth services under public health care programs and
private health insurance. The study shall review:
new text end
new text begin
(1) the impacts of telehealth payment methodologies and expansion on access to health
care services, quality of care, and value-based payments and innovation in care delivery;
new text end
new text begin
(2) the short-term and long-term impacts of telehealth payment methodologies and
expansion in reducing health care disparities and providing equitable access for underserved
communities; and
new text end
new text begin
(3) and make recommendations on interstate licensing options for health care
professionals by reviewing advances in the delivery of health care through interstate telehealth
while ensuring the safety and health of patients.
new text end
new text begin
(b) In conducting the study, the commissioner shall consult with stakeholders and
communities impacted by telehealth payment and expansion. The commissioner,
notwithstanding Minnesota Statutes, section 62U.04, subdivision 11, may use data available
under that section to conduct the study. The commissioner shall report findings to the chairs
and ranking minority members of the legislative committees with jurisdiction over health
and human services policy and finance and commerce, by February 15, 2024.
new text end
Sec. 25. new text begin TASK FORCE ON A PUBLIC-PRIVATE TELEPRESENCE STRATEGY.
new text end
new text begin Subdivision 1. new text end
new text begin Membership. new text end
new text begin
(a) The task force on person-centered telepresence platform
strategy consists of the following 20 members:
new text end
new text begin
(1) two senators, one appointed by the majority leader of the senate and one appointed
by the minority leader of the senate;
new text end
new text begin
(2) two members of the house of representatives, one appointed by the speaker of the
house of representatives and one appointed by the minority leader of the house of
representatives;
new text end
new text begin
(3) two members appointed by the Association of Minnesota Counties representing
county services in the areas of human services, public health, and corrections or law
enforcement. One of these members must represent counties outside the metropolitan area
defined in Minnesota Statutes, section 473.121, and one of these members must represent
the metropolitan area defined in Minnesota Statutes, section 473.121;
new text end
new text begin
(4) one member appointed by the Minnesota American Indian Mental Health Advisory
Council;
new text end
new text begin
(5) one member appointed by the Minnesota Medical Association who is a primary care
provider practicing in Minnesota;
new text end
new text begin
(6) one member appointed by the NAMI of Minnesota;
new text end
new text begin
(7) one member appointed by the Minnesota School Boards Association;
new text end
new text begin
(8) one member appointed by the Minnesota Hospital Association to represent hospital
emergency departments;
new text end
new text begin
(9) one member appointed by the Minnesota Association of Community Mental Health
Programs to represent rural community mental health centers;
new text end
new text begin
(10) one member appointed by the Council of Health Plans;
new text end
new text begin
(11) one member from a rural nonprofit foundation with expertise in delivering health
and human services via broadband, appointed by the Blandin Foundation;
new text end
new text begin
(12) one member representing child advocacy centers, appointed by the Minnesota Social
Service Association;
new text end
new text begin
(13) one member appointed by the Minnesota Social Service Association;
new text end
new text begin
(14) one member appointed by the Medical Alley Association;
new text end
new text begin
(15) one member appointed by the Minnesota Nurses Association;
new text end
new text begin
(16) one member appointed by the chief justice of the supreme court; and
new text end
new text begin
(17) the state public defender or a designee.
new text end
new text begin
(b) In addition to the members identified in paragraph (a), the task force shall include
the following members as ex officio, nonvoting members:
new text end
new text begin
(1) the commissioner of corrections or a designee;
new text end
new text begin
(2) the commissioner of human services or a designee;
new text end
new text begin
(3) the commissioner of health or a designee; and
new text end
new text begin
(4) the commissioner of education or a designee.
new text end
new text begin Subd. 2. new text end
new text begin Appointment deadline; first meeting; chair. new text end
new text begin
Appointing authorities must
complete appointments by June 15, 2021. The task force shall select a chair from among
their members at their first meeting. The member appointed by the senate majority leader
shall convene the first meeting of the task force by July 15, 2021.
new text end
new text begin Subd. 3. new text end
new text begin Duties. new text end
new text begin
The task force shall:
new text end
new text begin
(1) explore opportunities for improving behavioral health and other health care service
delivery through the use of a common interoperable person-centered telepresence platform
that provides HIPAA compliant connectivity and technical support to potential users;
new text end
new text begin
(2) review and coordinate state and local innovation initiatives and investments designed
to leverage telepresence connectivity and collaboration for Minnesotans;
new text end
new text begin
(3) determine standards for a single interoperable telepresence platform;
new text end
new text begin
(4) determine statewide capabilities for a single interoperable telepresence platform;
new text end
new text begin
(5) identify barriers to providing a telepresence technology, including limited availability
of bandwidth, limitations in providing certain services via telepresence, and broadband
infrastructure needs;
new text end
new text begin
(6) identify and make recommendations for governance that will assure person-centered
responsiveness;
new text end
new text begin
(7) identify how the business model can be innovated to provide an incentive for ongoing
innovation in Minnesota's health care, human services, education, corrections, and related
ecosystems;
new text end
new text begin
(8) identify criteria for suggested deliverables including:
new text end
new text begin
(i) equitable statewide access;
new text end
new text begin
(ii) evaluating bandwidth availability; and
new text end
new text begin
(iii) competitive pricing;
new text end
new text begin
(9) identify sustainable financial support for a single telepresence platform, including
infrastructure costs and startup costs for potential users; and
new text end
new text begin
(10) identify the benefits to partners in the private sector, state, political subdivisions,
tribal governments, and the constituents they serve in using a common person-centered
telepresence platform for delivering behavioral health services.
new text end
new text begin Subd. 4. new text end
new text begin Administrative support. new text end
new text begin
The Legislative Coordinating Commission shall
provide administrative support to the task force. The Legislative Coordinating Commission
may provide meeting space or may use space provided by the Minnesota Social Service
Association for meetings.
new text end
new text begin Subd. 5. new text end
new text begin Per diem; expenses. new text end
new text begin
Public members of the task force may be compensated
and have their expenses reimbursed as provided in Minnesota Statutes, section 15.059,
subdivision 3.
new text end
new text begin Subd. 6. new text end
new text begin Report. new text end
new text begin
The task force shall report to the chairs and ranking minority members
of the committees in the senate and the house of representatives with primary jurisdiction
over health and state information technology by January 15, 2022, with recommendations
related to expanding the state's telepresence platform and any legislation required to
implement the recommendations.
new text end
new text begin Subd. 7. new text end
new text begin Expiration. new text end
new text begin
The task force expires July 31, 2022, or the day after the task force
submits the report required in this section, whichever is earlier.
new text end
Sec. 26. new text begin REVISOR INSTRUCTION.
new text end
new text begin
In Minnesota Statutes and Minnesota Rules, the revisor of statutes shall substitute the
term "telemedicine" with "telehealth" whenever the term appears and substitute Minnesota
Statutes, section 62A.673, whenever references to Minnesota Statutes, sections 62A.67,
62A.671, and 62A.672 appear.
new text end
Sec. 27. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2020; 256.0596; and section 256B.0924, subdivision 4a, sections
62A.67; 62A.671; 62A.672,
new text end
new text begin
are repealed.
new text end
ARTICLE 9
ECONOMIC SUPPORTS
Section 1.
Minnesota Statutes 2020, section 119B.09, subdivision 4, is amended to read:
Subd. 4.
Eligibility; annual income; calculation.
(a) Annual income of the applicant
family is the current monthly income of the family multiplied by 12 or the income for the
12-month period immediately preceding the date of application, or income calculated by
the method which provides the most accurate assessment of income available to the family.
(b) Self-employment income must be calculated based on deleted text begin gross receipts less operating
expensesdeleted text end new text begin section 256P.05, subdivision 2new text end .
(c) Income changes are processed under section 119B.025, subdivision 4. Included lump
sums counted as income under section 256P.06, subdivision 3, must be annualized over 12
months. Income must be verified with documentary evidence. If the applicant does not have
sufficient evidence of income, verification must be obtained from the source of the income.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective May 1, 2022.
new text end
Sec. 2.
Minnesota Statutes 2020, section 252.27, subdivision 2a, is amended to read:
Subd. 2a.
Contribution amount.
(a) The natural or adoptive parents of a minor child,
new text begin not new text end including a child determined eligible for medical assistance without consideration of
parental incomenew text begin under the TEFRA option or for the purposes of accessing home and
community-based waiver servicesnew text end , must contribute to the cost of services used by making
monthly payments on a sliding scale based on income, unless the child is married or has
been married, parental rights have been terminated, or the child's adoption is subsidized
according to chapter 259A or through title IV-E of the Social Security Act. The parental
contribution is a partial or full payment for medical services provided for diagnostic,
therapeutic, curing, treating, mitigating, rehabilitation, maintenance, and personal care
services as defined in United States Code, title 26, section 213, needed by the child with a
chronic illness or disability.
(b) For households with adjusted gross income equal to or greater than 275 percent of
federal poverty guidelines, the parental contribution shall be computed by applying the
following schedule of rates to the adjusted gross income of the natural or adoptive parents:
(1) if the adjusted gross income is equal to or greater than 275 percent of federal poverty
guidelines and less than or equal to 545 percent of federal poverty guidelines, the parental
contribution shall be determined using a sliding fee scale established by the commissioner
of human services which begins at 1.65 percent of adjusted gross income at 275 percent of
federal poverty guidelines and increases to 4.5 percent of adjusted gross income for those
with adjusted gross income up to 545 percent of federal poverty guidelines;
(2) if the adjusted gross income is greater than 545 percent of federal poverty guidelines
and less than 675 percent of federal poverty guidelines, the parental contribution shall be
4.5 percent of adjusted gross income;
(3) if the adjusted gross income is equal to or greater than 675 percent of federal poverty
guidelines and less than 975 percent of federal poverty guidelines, the parental contribution
shall be determined using a sliding fee scale established by the commissioner of human
services which begins at 4.5 percent of adjusted gross income at 675 percent of federal
poverty guidelines and increases to 5.99 percent of adjusted gross income for those with
adjusted gross income up to 975 percent of federal poverty guidelines; and
(4) if the adjusted gross income is equal to or greater than 975 percent of federal poverty
guidelines, the parental contribution shall be 7.49 percent of adjusted gross income.
If the child lives with the parent, the annual adjusted gross income is reduced by $2,400
prior to calculating the parental contribution. If the child resides in an institution specified
in section 256B.35, the parent is responsible for the personal needs allowance specified
under that section in addition to the parental contribution determined under this section.
The parental contribution is reduced by any amount required to be paid directly to the child
pursuant to a court order, but only if actually paid.
(c) The household size to be used in determining the amount of contribution under
paragraph (b) includes natural and adoptive parents and their dependents, including the
child receiving services. Adjustments in the contribution amount due to annual changes in
the federal poverty guidelines shall be implemented on the first day of July following
publication of the changes.
(d) For purposes of paragraph (b), "income" means the adjusted gross income of the
natural or adoptive parents determined according to the previous year's federal tax form,
except, effective retroactive to July 1, 2003, taxable capital gains to the extent the funds
have been used to purchase a home shall not be counted as income.
(e) The contribution shall be explained in writing to the parents at the time eligibility
for services is being determined. The contribution shall be made on a monthly basis effective
with the first month in which the child receives services. Annually upon redetermination
or at termination of eligibility, if the contribution exceeded the cost of services provided,
the local agency or the state shall reimburse that excess amount to the parents, either by
direct reimbursement if the parent is no longer required to pay a contribution, or by a
reduction in or waiver of parental fees until the excess amount is exhausted. All
reimbursements must include a notice that the amount reimbursed may be taxable income
if the parent paid for the parent's fees through an employer's health care flexible spending
account under the Internal Revenue Code, section 125, and that the parent is responsible
for paying the taxes owed on the amount reimbursed.
(f) The monthly contribution amount must be reviewed at least every 12 months; when
there is a change in household size; and when there is a loss of or gain in income from one
month to another in excess of ten percent. The local agency shall mail a written notice 30
days in advance of the effective date of a change in the contribution amount. A decrease in
the contribution amount is effective in the month that the parent verifies a reduction in
income or change in household size.
(g) Parents of a minor child who do not live with each other shall each pay the
contribution required under paragraph (a). An amount equal to the annual court-ordered
child support payment actually paid on behalf of the child receiving services shall be deducted
from the adjusted gross income of the parent making the payment prior to calculating the
parental contribution under paragraph (b).
(h) The contribution under paragraph (b) shall be increased by an additional five percent
if the local agency determines that insurance coverage is available but not obtained for the
child. For purposes of this section, "available" means the insurance is a benefit of employment
for a family member at an annual cost of no more than five percent of the family's annual
income. For purposes of this section, "insurance" means health and accident insurance
coverage, enrollment in a nonprofit health service plan, health maintenance organization,
self-insured plan, or preferred provider organization.
Parents who have more than one child receiving services shall not be required to pay
more than the amount for the child with the highest expenditures. There shall be no resource
contribution from the parents. The parent shall not be required to pay a contribution in
excess of the cost of the services provided to the child, not counting payments made to
school districts for education-related services. Notice of an increase in fee payment must
be given at least 30 days before the increased fee is due.
(i) The contribution under paragraph (b) shall be reduced by $300 per fiscal year if, in
the 12 months prior to July 1:
(1) the parent applied for insurance for the child;
(2) the insurer denied insurance;
(3) the parents submitted a complaint or appeal, in writing to the insurer, submitted a
complaint or appeal, in writing, to the commissioner of health or the commissioner of
commerce, or litigated the complaint or appeal; and
(4) as a result of the dispute, the insurer reversed its decision and granted insurance.
For purposes of this section, "insurance" has the meaning given in paragraph (h).
A parent who has requested a reduction in the contribution amount under this paragraph
shall submit proof in the form and manner prescribed by the commissioner or county agency,
includingdeleted text begin ,deleted text end but not limited todeleted text begin ,deleted text end 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. 3.
Minnesota Statutes 2020, section 256B.14, subdivision 2, is amended to read:
Subd. 2.
Actions to obtain payment.
The state agency shall promulgate rules to
determine the ability of responsible relatives to contribute partial or complete payment or
repayment of medical assistance furnished to recipients for whom they are responsible. All
medical assistance exclusions shall be allowed, and a resource limit of $10,000 for
nonexcluded resources shall be implemented. Above these limits, a contribution of one-third
of the excess resources shall be required. These rules shall not require payment or repayment
when payment would cause undue hardship to the responsible relative or that relative's
immediate family. These rules shall deleted text begin be consistent with the requirements of section 252.27
fordeleted text end new text begin not apply tonew text end parents of children whose eligibility for medical assistance was determined
without deeming of the parents' resources and incomenew text begin under the TEFRA option or for the
purposes of accessing home and community-based waiver servicesnew text end . The county agency
shall give the responsible relative notice of the amount of the payment or repayment. If the
state agency or county agency finds that notice of the payment obligation was given to the
responsible relative, but that the relative failed or refused to pay, a cause of action exists
against the responsible relative for that portion of medical assistance granted after notice
was given to the responsible relative, which the relative was determined to be able to pay.
The action may be brought by the state agency or the county agency in the county where
assistance was granted, for the assistance, together with the costs of disbursements incurred
due to the action.
In addition to granting the county or state agency a money judgment, the court may,
upon a motion or order to show cause, order continuing contributions by a responsible
relative found able to repay the county or state agency. The order shall be effective only
for the period of time during which the recipient receives medical assistance from the county
or state agency.
Sec. 4.
Minnesota Statutes 2020, section 256D.051, is amended by adding a subdivision
to read:
new text begin Subd. 20. new text end
new text begin SNAP employment and training. new text end
new text begin
The commissioner shall implement a
Supplemental Nutrition Assistance Program (SNAP) employment and training program
that meets the SNAP employment and training participation requirements of the United
States Department of Agriculture governed by Code of Federal Regulations, title 7, section
273.7. The commissioner shall operate a SNAP employment and training program in which
SNAP recipients elect to participate. In order to receive SNAP assistance beyond the time
limit, unless residing in an area covered by a time-limit waiver governed by Code of Federal
Regulations, title 7, section 273.24, nonexempt SNAP recipients who do not meet federal
SNAP work requirements must participate in an employment and training program. In
addition to county and Tribal agencies that administer SNAP, the commissioner may contract
with third-party providers for SNAP employment and training services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 5.
Minnesota Statutes 2020, section 256D.051, is amended by adding a subdivision
to read:
new text begin Subd. 21. new text end
new text begin County and Tribal agency duties. new text end
new text begin
County or Tribal agencies that administer
SNAP shall inform adult SNAP recipients about employment and training services and
providers in the recipient's area. County or Tribal agencies that administer SNAP may elect
to subcontract with a public or private entity approved by the commissioner to provide
SNAP employment and training services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 6.
Minnesota Statutes 2020, section 256D.051, is amended by adding a subdivision
to read:
new text begin Subd. 22. new text end
new text begin Duties of commissioner. new text end
new text begin
In addition to any other duties imposed by law, the
commissioner shall:
new text end
new text begin
(1) supervise the administration of SNAP employment and training services to county,
Tribal, and contracted agencies under this section and Code of Federal Regulations, title 7,
section 273.7;
new text end
new text begin
(2) disburse money allocated and reimbursed for SNAP employment and training services
to county, Tribal, and contracted agencies;
new text end
new text begin
(3) accept and supervise the disbursement of any funds that may be provided by the
federal government or other sources for SNAP employment and training services;
new text end
new text begin
(4) cooperate with other agencies, including any federal agency or agency of another
state, in all matters concerning the powers and duties of the commissioner under this section;
new text end
new text begin
(5) coordinate with the commissioner of employment and economic development to
deliver employment and training services statewide;
new text end
new text begin
(6) work in partnership with counties, tribes, and other agencies to enhance the reach
and services of a statewide SNAP employment and training program; and
new text end
new text begin
(7) identify eligible nonfederal funds to earn federal reimbursement for SNAP
employment and training services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 7.
Minnesota Statutes 2020, section 256D.051, is amended by adding a subdivision
to read:
new text begin Subd. 23. new text end
new text begin Participant duties. new text end
new text begin
Unless residing in an area covered by a time-limit waiver,
nonexempt SNAP recipients must meet federal SNAP work requirements to receive SNAP
assistance beyond the time limit.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 8.
Minnesota Statutes 2020, section 256D.051, is amended by adding a subdivision
to read:
new text begin Subd. 24. new text end
new text begin Program funding. new text end
new text begin
(a) The United States Department of Agriculture annually
allocates SNAP employment and training funds to the commissioner of human services for
the operation of the SNAP employment and training program.
new text end
new text begin
(b) The United States Department of Agriculture authorizes the disbursement of SNAP
employment and training reimbursement funds to the commissioner of human services for
the operation of the SNAP employment and training program.
new text end
new text begin
(c) Except for funds allocated for state program development and administrative purposes
or designated by the United States Department of Agriculture for a specific project, the
commissioner of human services shall disburse money allocated for federal SNAP
employment and training to counties and tribes that administer SNAP based on a formula
determined by the commissioner that includes but is not limited to the county's or tribe's
proportion of adult SNAP recipients as compared to the statewide total.
new text end
new text begin
(d) The commissioner of human services shall disburse federal funds that the
commissioner receives as reimbursement for SNAP employment and training costs to the
state agency, county, tribe, or contracted agency that incurred the costs being reimbursed.
new text end
new text begin
(e) The commissioner of human services may reallocate unexpended money disbursed
under this section to county, Tribal, or contracted agencies that demonstrate a need for
additional funds.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 9.
Minnesota Statutes 2020, section 256E.30, subdivision 2, is amended to read:
Subd. 2.
Allocation of money.
(a) State money appropriated and community service
block grant money allotted to the state and all money transferred to the community service
block grant from other block grants shall be allocated annually to community action agencies
and Indian reservation governments under paragraphs (b) and (c), and to migrant and seasonal
farmworker organizations under paragraph (d).
(b) The available annual money will provide base funding to all community action
agencies and the Indian reservations. Base funding amounts per agency are as follows: for
agencies with low income populations up to deleted text begin 1,999, $25,000; 2,000 todeleted text end 23,999, $50,000; and
24,000 or more, $100,000.
(c) All remaining money of the annual money available after the base funding has been
determined must be allocated to each agency and reservation in proportion to the size of
the poverty level population in the agency's service area compared to the size of the poverty
level population in the state.
(d) Allocation of money to migrant and seasonal farmworker organizations must not
exceed three percent of the total annual money available. Base funding allocations must be
made for all community action agencies and Indian reservations that received money under
this subdivision, in fiscal year 1984, and for community action agencies designated under
this section with a service area population of 35,000 or greater.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 10.
Minnesota Statutes 2020, section 256E.34, subdivision 1, is amended to read:
Subdivision 1.
Distribution of appropriation.
The commissioner must distribute funds
appropriated to the commissioner by law for that purpose to Hunger Solutions, a statewide
association of food shelves organized as a nonprofit corporation as defined under section
501(c)(3) of the Internal Revenue Code of 1986, to distribute to qualifying food shelves. A
food shelf qualifies under this section if:
(1) it is a nonprofit corporation, or is affiliated with a nonprofit corporation, as defined
in section 501(c)(3) of the Internal Revenue Code of 1986new text begin or a federally recognized Tribal
nationnew text end ;
(2) it distributes standard food orders without charge to needy individuals. The standard
food order must consist of at least a two-day supply or six pounds per person of nutritionally
balanced food items;
(3) it does not limit food distributions to individuals of a particular religious affiliation,
race, or other criteria unrelated to need or to requirements necessary to administration of a
fair and orderly distribution system;
(4) it does not use the money received or the food distribution program to foster or
advance religious or political views; and
(5) it has a stable address and directly serves individuals.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 11.
Minnesota Statutes 2020, section 256J.08, subdivision 21, is amended to read:
Subd. 21.
Date of application.
"Date of application" means the date on which the county
agency receives an applicant's deleted text begin signeddeleted text end applicationnew text begin as a signed written application, an
application submitted by telephone, or an application submitted through Internet telepresencenew text end .
Sec. 12.
Minnesota Statutes 2020, section 256J.09, subdivision 3, is amended to read:
Subd. 3.
Submitting application form.
(a) A county agency must offer, in person or
by mail, the application forms prescribed by the commissioner as soon as a person makes
a written or oral inquiry. At that time, the county agency must:
(1) inform the person that assistance begins deleted text begin withdeleted text end new text begin onnew text end the datenew text begin thatnew text end the deleted text begin signeddeleted text end application
is received by the county agency new text begin either as a signed written application; an application
submitted by telephone; or an application submitted through Internet telepresence; new text end or new text begin on
new text end the datenew text begin thatnew text end all eligibility criteria are met, whichever is later;
new text begin
(2) inform a person that the person may submit the application by telephone or through
Internet telepresence;
new text end
new text begin
(3) inform a person that when the person submits the application by telephone or through
Internet telepresence, the county agency must receive a signed written application within
30 days of the date that the person submitted the application by telephone or through Internet
telepresence;
new text end
deleted text begin (2)deleted text end new text begin (4)new text end inform the person that any delay in submitting the application will reduce the
amount of assistance paid for the month of application;
deleted text begin (3)deleted text end new text begin (5)new text end inform a person that the person may submit the application before an interview;
deleted text begin (4)deleted text end new text begin (6)new text end explain the information that will be verified during the application process by
the county agency as provided in section 256J.32;
deleted text begin (5)deleted text end new text begin (7)new text end inform a person about the county agency's average application processing time
and explain how the application will be processed under subdivision 5;
deleted text begin (6)deleted text end new text begin (8)new text end explain how to contact the county agency if a person's application information
changes and how to withdraw the application;
deleted text begin (7)deleted text end new text begin (9)new text end inform a person that the next step in the application process is an interview and
what a person must do if the application is approved including, but not limited to, attending
orientation under section 256J.45 and complying with employment and training services
requirements in sections 256J.515 to 256J.57;
deleted text begin (8)deleted text end new text begin (10)new text end inform the person that deleted text begin thedeleted text end new text begin annew text end interview must be conductednew text begin . The interview may
be conductednew text end face-to-face in the county officenew text begin or at a location mutually agreed uponnew text end , through
Internet telepresence, or deleted text begin at a location mutually agreed upondeleted text end new text begin by telephonenew text end ;
deleted text begin
(9) inform a person who has received MFIP or DWP in the past 12 months of the option
to have a face-to-face, Internet telepresence, or telephone interview;
deleted text end
deleted text begin (10)deleted text end new text begin (11)new text end explain the child care and transportation services that are available under
paragraph (c) to enable caregivers to attend the interview, screening, and orientation; and
deleted text begin (11)deleted text end new text begin (12)new text end identify any language barriers and arrange for translation assistance during
appointments, including, but not limited to, screening under subdivision 3a, orientation
under section 256J.45, and assessment under section 256J.521.
(b) Upon receipt of a signed application, the county agency must stamp the date of receipt
on the face of the application. The county agency must process the application within the
time period required under subdivision 5. An applicant may withdraw the application at
any time by giving written or oral notice to the county agency. The county agency must
issue a written notice confirming the withdrawal. The notice must inform the applicant of
the county agency's understanding that the applicant has withdrawn the application and no
longer wants to pursue it. When, within ten days of the date of the agency's notice, an
applicant informs a county agency, in writing, that the applicant does not wish to withdraw
the application, the county agency must reinstate the application and finish processing the
application.
(c) Upon a participant's request, the county agency must arrange for transportation and
child care or reimburse the participant for transportation and child care expenses necessary
to enable participants to attend the screening under subdivision 3a and orientation under
section 256J.45.
Sec. 13.
Minnesota Statutes 2020, section 256J.30, subdivision 8, is amended to read:
Subd. 8.
Late MFIP household report forms.
(a) Paragraphs (b) to (e) apply to the
reporting requirements in subdivision 7.
(b) When the county agency receives an incomplete MFIP household report form, the
county agency must immediately deleted text begin return the incomplete form and clearly state what the
caregiver must do for the form to be completedeleted text end new text begin contact the caregiver by phone or in writing
to acquire the necessary information to complete the formnew text end .
(c) The automated eligibility system must send a notice of proposed termination of
assistance to the assistance unit if a complete MFIP household report form is not received
by a county agency. The automated notice must be mailed to the caregiver by approximately
the 16th of the month. When a caregiver submits an incomplete form on or after the date a
notice of proposed termination has been sent, the termination is valid unless the caregiver
submits a complete form before the end of the month.
(d) An assistance unit required to submit an MFIP household report form is considered
to have continued its application for assistance if a complete MFIP household report form
is received within a calendar month after the month in which the form was due and assistance
shall be paid for the period beginning with the first day of that calendar month.
(e) A county agency must allow good cause exemptions from the reporting requirements
under subdivision 5 when any of the following factors cause a caregiver to fail to provide
the county agency with a completed MFIP household report form before the end of the
month in which the form is due:
(1) an employer delays completion of employment verification;
(2) a county agency does not help a caregiver complete the MFIP household report form
when the caregiver asks for help;
(3) a caregiver does not receive an MFIP household report form due to mistake on the
part of the department or the county agency or due to a reported change in address;
(4) a caregiver is ill, or physically or mentally incapacitated; or
(5) some other circumstance occurs that a caregiver could not avoid with reasonable
care which prevents the caregiver from providing a completed MFIP household report form
before the end of the month in which the form is due.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 1, 2021.
new text end
Sec. 14.
Minnesota Statutes 2020, section 256J.35, is amended to read:
256J.35 AMOUNT OF ASSISTANCE PAYMENT.
Except as provided in paragraphs (a) to (d), the amount of an assistance payment is equal
to the difference between the MFIP standard of need or the Minnesota family wage level
in section 256J.24 and countable income.
(a) Beginning July 1, 2015, MFIP assistance units are eligible for an MFIP housing
assistance grant of deleted text begin $110deleted text end new text begin $150new text end per month, unless:
(1) the housing assistance unit is currently receiving public and assisted rental subsidies
provided through the Department of Housing and Urban Development (HUD) and is subject
to section 256J.37, subdivision 3a; or
(2) the assistance unit is a child-only case under section 256J.88.
(b) When MFIP eligibility exists for the month of application, the amount of the assistance
payment for the month of application must be prorated from the date of application or the
date all other eligibility factors are met for that applicant, whichever is later. This provision
applies when an applicant loses at least one day of MFIP eligibility.
(c) MFIP overpayments to an assistance unit must be recouped according to section
256P.08, subdivision 6.
(d) An initial assistance payment must not be made to an applicant who is not eligible
on the date payment is made.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 15.
Minnesota Statutes 2020, section 256J.45, subdivision 1, is amended to read:
Subdivision 1.
County agency to provide orientation.
A county agency must provide
deleted text begin a face-to-facedeleted text end new text begin annew text end orientation to each MFIP caregiver unless the caregiver is:
(1) a single parent, or one parent in a two-parent family, employed at least 35 hours per
week; or
(2) a second parent in a two-parent family who is employed for 20 or more hours per
week provided the first parent is employed at least 35 hours per week.
The county agency must inform caregivers who are not exempt under clause (1) or (2) that
failure to attend the orientation is considered an occurrence of noncompliance with program
requirements, and will result in the imposition of a sanction under section 256J.46. If the
client complies with the orientation requirement prior to the first day of the month in which
the grant reduction is proposed to occur, the orientation sanction shall be lifted.
Sec. 16.
Minnesota Statutes 2020, 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. Counties new text begin and
tribes that administer MFIP eligibility new text end may use the funds for any allowable expenditures
under subdivision 2, including case management. Tribes new text begin that do not administer MFIP
eligibility new text end may use the funds for any allowable expenditures under subdivision 2, including
case management, except those in subdivision 2, paragraph (a), clauses (1) and (6). new text begin All
payments made through the MFIP consolidated fund to support a caregiver's pursuit of
greater economic stability does not count when determining a family's available income.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 17.
Minnesota Statutes 2020, section 256J.95, subdivision 5, is amended to read:
Subd. 5.
Submitting application form.
The eligibility date for the diversionary work
program begins deleted text begin withdeleted text end new text begin onnew text end the date new text begin that new text end the deleted text begin signeddeleted text end combined application form (CAF) is received
by the county agency new text begin either as a signed written application; an application submitted by
telephone; or an application submitted through Internet telepresence; new text end or new text begin on new text end the date new text begin that
new text end diversionary work program eligibility criteria are met, whichever is later. new text begin The county agency
must inform an applicant that when the applicant submits the application by telephone or
through Internet telepresence, the county agency must receive a signed written application
within 30 days of the date that the applicant submitted the application by telephone or
through Internet telepresence. new text end The county agency must inform the applicant that any delay
in submitting the application will reduce the benefits paid for the month of application. The
county agency must inform a person that an application may be submitted before the person
has an interview appointment. Upon receipt of a signed application, the county agency must
stamp the date of receipt on the face of the application. The applicant may withdraw the
application at any time prior to approval by giving written or oral notice to the county
agency. The county agency must follow the notice requirements in section 256J.09,
subdivision 3, when issuing a notice confirming the withdrawal.
Sec. 18.
Minnesota Statutes 2020, section 256N.02, subdivision 16, is amended to read:
Subd. 16.
Permanent legal and physical custody.
"Permanent legal and physical
custody" meansnew text begin : (1)new text end a new text begin full new text end transfer of permanent legal and physical custody new text begin of a child ordered
by a Minnesota juvenile court under section 260C.515, subdivision 4, new text end to a relative deleted text begin ordered
by a Minnesota juvenile court under section 260C.515, subdivision 4,deleted text end new text begin who is not the child's
parent as defined in section 260C.007, subdivision 25;new text end or new text begin (2) new text end for a child under jurisdiction
of a tribal court, a judicial determination under a similar provision in tribal code which
means that a relative will assume the duty and authority to provide care, control, and
protection of a child who is residing in foster care, and to make decisions regarding the
child's education, health care, and general welfare until adulthood.new text begin To establish eligibility
for Northstar kinship assistance, permanent legal and physical custody does not include
joint legal custody, joint physical custody, or joint legal and joint physical custody of a child
shared by the child's parent and relative custodian.
new text end
Sec. 19.
Minnesota Statutes 2020, section 256N.02, subdivision 17, is amended to read:
Subd. 17.
Reassessment.
"Reassessment" means an update of a previous assessment
through the process under section 256N.24 for a child who has been continuously eligible
for Northstar Care for Children, or when a child identified as an at-risk child (Level A)
under deleted text begin guardianship ordeleted text end adoption assistance has manifested the disability upon which eligibility
for the agreement was based according to section 256N.25, subdivision 3, paragraph (b).
A reassessment may be used to update an initial assessment, a special assessment, or a
previous reassessment.
Sec. 20.
Minnesota Statutes 2020, section 256N.22, subdivision 1, is amended to read:
Subdivision 1.
General eligibility requirements.
(a) To be eligible for Northstar kinship
assistance under this section, there must be a judicial determination under section 260C.515,
subdivision 4, that a transfer of permanent legal and physical custody to a relative new text begin who is
not the child's parent new text end is in the child's best interest. For a child under jurisdiction of a tribal
court, a judicial determination under a similar provision in tribal code indicating that a
relative will assume the duty and authority to provide care, control, and protection of a child
who is residing in foster care, and to make decisions regarding the child's education, health
care, and general welfare until adulthood, and that this is in the child's best interest is
considered equivalent. new text begin A child whose parent shares legal, physical, or legal and physical
custody of the child with a relative custodian is not eligible for Northstar kinship assistance.
new text end Additionally, a child must:
(1) have been removed from the child's home pursuant to a voluntary placement
agreement or court order;
(2)(i) have resided with the prospective relative custodian who has been a licensed child
foster parent for at least six consecutive months; or
(ii) have received from the commissioner an exemption from the requirement in item
(i) that the prospective relative custodian has been a licensed child foster parent for at least
six consecutive months, based on a determination that:
(A) an expedited move to permanency is in the child's best interest;
(B) expedited permanency cannot be completed without provision of Northstar kinship
assistance;
(C) the prospective relative custodian is uniquely qualified to meet the child's needs, as
defined in section 260C.212, subdivision 2, on a permanent basis;
(D) the child and prospective relative custodian meet the eligibility requirements of this
section; and
(E) efforts were made by the legally responsible agency to place the child with the
prospective relative custodian as a licensed child foster parent for six consecutive months
before permanency, or an explanation why these efforts were not in the child's best interests;
(3) meet the agency determinations regarding permanency requirements in subdivision
2;
(4) meet the applicable citizenship and immigration requirements in subdivision 3;
(5) have been consulted regarding the proposed transfer of permanent legal and physical
custody to a relative, if the child is at least 14 years of age or is expected to attain 14 years
of age prior to the transfer of permanent legal and physical custody; and
(6) have a written, binding agreement under section 256N.25 among the caregiver or
caregivers, the financially responsible agency, and the commissioner established prior to
transfer of permanent legal and physical custody.
(b) In addition to the requirements in paragraph (a), the child's prospective relative
custodian or custodians must meet the applicable background study requirements in
subdivision 4.
(c) To be eligible for title IV-E Northstar kinship assistance, a child must also meet any
additional criteria in section 473(d) of the Social Security Act. The sibling of a child who
meets the criteria for title IV-E Northstar kinship assistance in section 473(d) of the Social
Security Act is eligible for title IV-E Northstar kinship assistance if the child and sibling
are placed with the same prospective relative custodian or custodians, and the legally
responsible agency, relatives, and commissioner agree on the appropriateness of the
arrangement for the sibling. A child who meets all eligibility criteria except those specific
to title IV-E Northstar kinship assistance is entitled to Northstar kinship assistance paid
through funds other than title IV-E.
Sec. 21.
Minnesota Statutes 2020, section 256N.23, subdivision 2, is amended to read:
Subd. 2.
Special needs determination.
(a) A child is considered a child with special
needs under this section if the requirements in paragraphs (b) to (g) are met.
(b) There must be a determination that the child must not or should not be returned to
the home of the child's parents as evidenced by:
(1) a court-ordered termination of parental rights;
(2) a petition to terminate parental rights;
(3) consent of new text begin the child's new text end parent to adoption accepted by the court under chapter 260Cnew text begin
or, in the case of a child receiving Northstar kinship assistance payments under section
256N.22, consent of the child's parent to the child's adoption executed under chapter 259new text end ;
(4) in circumstances when tribal law permits the child to be adopted without a termination
of parental rights, a judicial determination by a tribal court indicating the valid reason why
the child cannot or should not return home;
(5) a voluntary relinquishment under section 259.25 deleted text begin or 259.47deleted text end or, if relinquishment
occurred in another state, the applicable laws in that state; or
(6) the death of the legal parent or parents if the child has two legal parents.
(c) There exists a specific factor or condition of which it is reasonable to conclude that
the child cannot be placed with adoptive parents without providing adoption assistance as
evidenced by:
(1) a determination by the Social Security Administration that the child meets all medical
or disability requirements of title XVI of the Social Security Act with respect to eligibility
for Supplemental Security Income benefits;
(2) a documented physical, mental, emotional, or behavioral disability not covered under
clause (1);
(3) a member of a sibling group being adopted at the same time by the same parent;
(4) an adoptive placement in the home of a parent who previously adopted a sibling for
whom they receive adoption assistance; or
(5) documentation that the child is an at-risk child.
(d) A reasonable but unsuccessful effort must have been made to place the child with
adoptive parents without providing adoption assistance as evidenced by:
(1) a documented search for an appropriate adoptive placement; or
(2) a determination by the commissioner that a search under clause (1) is not in the best
interests of the child.
(e) The requirement for a documented search for an appropriate adoptive placement
under paragraph (d), including the registration of the child with the state adoption exchange
and other recruitment methods under paragraph (f), must be waived if:
(1) the child is being adopted by a relative and it is determined by the child-placing
agency that adoption by the relative is in the best interests of the child;
(2) the child is being adopted by a foster parent with whom the child has developed
significant emotional ties while in the foster parent's care as a foster child and it is determined
by the child-placing agency that adoption by the foster parent is in the best interests of the
child; or
(3) the child is being adopted by a parent that previously adopted a sibling of the child,
and it is determined by the child-placing agency that adoption by this parent is in the best
interests of the child.
For an Indian child covered by the Indian Child Welfare Act, a waiver must not be
granted unless the child-placing agency has complied with the placement preferences required
by the Indian Child Welfare Act, United States Code, title 25, section 1915(a).
(f) To meet the requirement of a documented search for an appropriate adoptive placement
under paragraph (d), clause (1), the child-placing agency minimally must:
(1) conduct a relative search as required by section 260C.221 and give consideration to
placement with a relative, as required by section 260C.212, subdivision 2;
(2) comply with the placement preferences required by the Indian Child Welfare Act
when the Indian Child Welfare Act, United States Code, title 25, section 1915(a), applies;
(3) locate prospective adoptive families by registering the child on the state adoption
exchange, as required under section 259.75; and
(4) if registration with the state adoption exchange does not result in the identification
of an appropriate adoptive placement, the agency must employ additional recruitment
methods prescribed by the commissioner.
(g) Once the legally responsible agency has determined that placement with an identified
parent is in the child's best interests and made full written disclosure about the child's social
and medical history, the agency must ask the prospective adoptive parent if the prospective
adoptive parent is willing to adopt the child without receiving adoption assistance under
this section. If the identified parent is either unwilling or unable to adopt the child without
adoption assistance, the legally responsible agency must provide documentation as prescribed
by the commissioner to fulfill the requirement to make a reasonable effort to place the child
without adoption assistance. If the identified parent is willing to adopt the child without
adoption assistance, the parent must provide a written statement to this effect to the legally
responsible agency and the statement must be maintained in the permanent adoption record
of the legally responsible agency. For children under guardianship of the commissioner,
the legally responsible agency shall submit a copy of this statement to the commissioner to
be maintained in the permanent adoption record.
Sec. 22.
Minnesota Statutes 2020, section 256N.23, subdivision 6, is amended to read:
Subd. 6.
Exclusions.
The commissioner must not enter into an adoption assistance
agreement with the following individuals:
(1) a child's biological parent or stepparent;
(2) a child's relative under section 260C.007, subdivision 26b or 27, with whom the
child resided immediately prior to child welfare involvement unless:
(i) the child was in the custody of a Minnesota county or tribal agency pursuant to an
order under chapter 260C or equivalent provisions of tribal code and the agency had
placement and care responsibility for permanency planning for the child; and
(ii) the child is under guardianship of the commissioner of human services according to
the requirements of section 260C.325, subdivision 1 or 3, or is a ward of a Minnesota tribal
court after termination of parental rights, suspension of parental rights, or a finding by the
tribal court that the child cannot safely return to the care of the parent;
(3) an individual adopting a child who is the subject of a direct adoptive placement under
section 259.47 or the equivalent in tribal code;
(4) a child's legal custodian or guardian who is now adopting the childnew text begin , except for a
relative custodian as defined in section 256N.02, subdivision 19, who is currently receiving
Northstar kinship assistance benefits on behalf of the childnew text end ; or
(5) an individual who is adopting a child who is not a citizen or resident of the United
States and was either adopted in another country or brought to the United States for the
purposes of adoption.
Sec. 23.
Minnesota Statutes 2020, section 256N.24, subdivision 1, is amended to read:
Subdivision 1.
Assessment.
(a) Each child eligible under sections 256N.21, 256N.22,
and 256N.23, must be assessed to determine the benefits the child may receive under section
256N.26, in accordance with the assessment tool, process, and requirements specified in
subdivision 2.
(b) If an agency applies the emergency foster care rate for initial placement under section
256N.26, the agency may wait up to 30 days to complete the initial assessment.
(c) Unless otherwise specified in paragraph (d), a child must be assessed at the basic
level, level B, or one of ten supplemental difficulty of care levels, levels C to L.
(d) An assessment must not be completed for:
(1) a child eligible for Northstar deleted text begin kinship assistance under section 256N.22 ordeleted text end adoption
assistance under section 256N.23 who is determined to be an at-risk child. A child under
this clause must be assigned level A under section 256N.26, subdivision 1; and
(2) a child transitioning into Northstar Care for Children under section 256N.28,
subdivision 7, unless the commissioner determines an assessment is appropriate.
Sec. 24.
Minnesota Statutes 2020, section 256N.24, subdivision 8, is amended to read:
Subd. 8.
Completing the special assessment.
(a) The special assessment must be
completed in consultation with the child's caregiver. Face-to-face contact with the caregiver
is not required to complete the special assessment.
(b) If a new special assessment is required prior to the effective date of the Northstar
kinship assistance agreement, it must be completed by the financially responsible agency,
in consultation with the legally responsible agency if different. If the prospective relative
custodian is unable or unwilling to cooperate with the special assessment process, the child
shall be assigned the basic level, level B under section 256N.26, subdivision 3deleted text begin , unless the
child is known to be an at-risk child, in which case, the child shall be assigned level A under
section 256N.26, subdivision 1deleted text end .
(c) If a special assessment is required prior to the effective date of the adoption assistance
agreement, it must be completed by the financially responsible agency, in consultation with
the legally responsible agency if different. If there is no financially responsible agency, the
special assessment must be completed by the agency designated by the commissioner. If
the prospective adoptive parent is unable or unwilling to cooperate with the special
assessment process, the child must be assigned the basic level, level B under section 256N.26,
subdivision 3, unless the child is known to be an at-risk child, in which case, the child shall
be assigned level A under section 256N.26, subdivision 1.
(d) Notice to the prospective relative custodians or prospective adoptive parents must
be provided as specified in subdivision 13.
Sec. 25.
Minnesota Statutes 2020, section 256N.24, subdivision 11, is amended to read:
Subd. 11.
Completion of reassessment.
(a) The reassessment must be completed in
consultation with the child's caregiver. Face-to-face contact with the caregiver is not required
to complete the reassessment.
(b) For foster children eligible under section 256N.21, reassessments must be completed
by the financially responsible agency, in consultation with the legally responsible agency
if different.
(c) If reassessment is required after the effective date of the Northstar kinship assistance
agreement, the reassessment must be completed by the financially responsible agency.
(d) If a reassessment is required after the effective date of the adoption assistance
agreement, it must be completed by the financially responsible agency or, if there is no
financially responsible agency, the agency designated by the commissioner.
(e) If the child's caregiver is unable or unwilling to cooperate with the reassessment, the
child must be assessed at level B under section 256N.26, subdivision 3, unless the child has
deleted text begin andeleted text end new text begin a Northstarnew text end adoption assistance deleted text begin or Northstar kinship assistancedeleted text end agreement deleted text begin in placedeleted text end and
is known to be an at-risk child, in which case the child must be assessed at level A under
section 256N.26, subdivision 1.
Sec. 26.
Minnesota Statutes 2020, section 256N.24, subdivision 12, is amended to read:
Subd. 12.
Approval of initial assessments, special assessments, and reassessments.
(a)
Any agency completing initial assessments, special assessments, or reassessments must
designate one or more supervisors or other staff to examine and approve assessments
completed by others in the agency under subdivision 2. The person approving an assessment
must not be the case manager or staff member completing that assessment.
(b) In cases where a special assessment or reassessment for deleted text begin guardiandeleted text end new text begin Northstar kinshipnew text end
assistance and adoption assistance is required under subdivision 8 or 11, the commissioner
shall review and approve the assessment as part of the eligibility determination process
outlined in section 256N.22, subdivision 7, for Northstar kinship assistance, or section
256N.23, subdivision 7, for adoption assistance. The assessment determines the maximum
deleted text begin fordeleted text end new text begin ofnew text end the negotiated agreement amount under section 256N.25.
(c) The new rate is effective the calendar month that the assessment is approved, or the
effective date of the agreement, whichever is later.
Sec. 27.
Minnesota Statutes 2020, section 256N.24, subdivision 14, is amended to read:
Subd. 14.
Assessment tool determines rate of benefits.
The assessment tool established
by the commissioner in subdivision 2 determines the monthly benefit level for children in
foster care. The monthly payment for deleted text begin guardiandeleted text end new text begin Northstar kinshipnew text end assistance or adoption
assistance may be negotiated up to the monthly benefit level under foster care for those
children eligible for a payment under section 256N.26, subdivision 1.
Sec. 28.
Minnesota Statutes 2020, section 256N.25, subdivision 1, is amended to read:
Subdivision 1.
Agreement; Northstar kinship assistance; adoption assistance.
(a) In
order to receive Northstar kinship assistance or adoption assistance benefits on behalf of
an eligible child, a written, binding agreement between the caregiver or caregivers, the
financially responsible agency, or, if there is no financially responsible agency, the agency
designated by the commissioner, and the commissioner must be established prior to
finalization of the adoption or a transfer of permanent legal and physical custody. The
agreement must be negotiated with the caregiver or caregivers under subdivision 2 and
renegotiated under subdivision 3, if applicable.
(b) The agreement must be on a form approved by the commissioner and must specify
the following:
(1) duration of the agreement;
(2) the nature and amount of any payment, services, and assistance to be provided under
such agreement;
(3) the child's eligibility for Medicaid services;
(4) the terms of the payment, including any child care portion as specified in section
256N.24, subdivision 3;
(5) eligibility for reimbursement of nonrecurring expenses associated with adopting or
obtaining permanent legal and physical custody of the child, to the extent that the total cost
does not exceed $2,000 per childnew text begin pursuant to subdivision 1anew text end ;
(6) that the agreement must remain in effect regardless of the state of which the adoptive
parents or relative custodians are residents at any given time;
(7) provisions for modification of the terms of the agreement, including renegotiation
of the agreement;
(8) the effective date of the agreement; and
(9) the successor relative custodian or custodians for Northstar kinship assistance, when
applicable. The successor relative custodian or custodians may be added or changed by
mutual agreement under subdivision 3.
(c) The caregivers, the commissioner, and the financially responsible agency, or, if there
is no financially responsible agency, the agency designated by the commissioner, must sign
the agreement. A copy of the signed agreement must be given to each party. Once signed
by all parties, the commissioner shall maintain the official record of the agreement.
(d) The effective date of the Northstar kinship assistance agreement must be the date of
the court order that transfers permanent legal and physical custody to the relative. The
effective date of the adoption assistance agreement is the date of the finalized adoption
decree.
(e) Termination or disruption of the preadoptive placement or the foster care placement
prior to assignment of custody makes the agreement with that caregiver void.
Sec. 29.
Minnesota Statutes 2020, section 256N.25, is amended by adding a subdivision
to read:
new text begin Subd. 1a. new text end
new text begin Reimbursement of nonrecurring expenses. new text end
new text begin
(a) The commissioner of human
services must reimburse a relative custodian with a fully executed Northstar kinship assistance
benefit agreement for costs that the relative custodian incurs while seeking permanent legal
and physical custody of a child who is the subject of a Northstar kinship assistance benefit
agreement. The commissioner must reimburse a relative custodian for expenses that are
reasonable and necessary that the relative incurs during the transfer of permanent legal and
physical custody of a child to the relative custodian, subject to a maximum of $2,000. To
be eligible for reimbursement, the expenses must directly relate to the legal transfer of
permanent legal and physical custody of the child to the relative custodian, must not have
been incurred by the relative custodian in violation of state or federal law, and must not
have been reimbursed from other sources or funds. The relative custodian must submit
reimbursement requests to the commissioner within 21 months of the date of the child's
finalized transfer of permanent legal and physical custody, and the relative custodian must
follow all requirements and procedures that the commissioner prescribes.
new text end
new text begin
(b) The commissioner of human services must reimburse an adoptive parent for costs
that the adoptive parent incurs in an adoption of a child with special needs according to
section 256N.23, subdivision 2. The commissioner must reimburse an adoptive parent for
expenses that are reasonable and necessary for the adoption of the child to occur, subject
to a maximum of $2,000. To be eligible for reimbursement, the expenses must directly relate
to the legal adoption of the child, must not have been incurred by the adoptive parent in
violation of state or federal law, and must not have been reimbursed from other sources or
funds.
new text end
new text begin
(1) Children who have special needs but who are not citizens or residents of the United
States and were either adopted in another country or brought to this country for the purposes
of adoption are categorically ineligible for the reimbursement program in this section, except
when the child meets the eligibility criteria in this section after the dissolution of the child's
international adoption.
new text end
new text begin
(2) An adoptive parent, in consultation with the responsible child-placing agency, may
request reimbursement of nonrecurring adoption expenses by submitting a complete
application to the commissioner that follows the commissioner's requirements and procedures
on forms that the commissioner prescribes.
new text end
new text begin
(3) The commissioner must determine a child's eligibility for adoption expense
reimbursement under title IV-E of the Social Security Act, United States Code, title 42,
sections 670 to 679c. If the commissioner determines that a child is eligible, the commissioner
of human services must fully execute the agreement for nonrecurring adoption expense
reimbursement by signing the agreement. For a child to be eligible, the commissioner must
have fully executed the agreement for nonrecurring adoption expense reimbursement prior
to finalizing a child's adoption.
new text end
new text begin
(4) An adoptive parent who has a fully executed Northstar adoption assistance agreement
is not required to submit a separate application for reimbursement of nonrecurring adoption
expenses for the child who is the subject of the Northstar adoption assistance agreement.
new text end
new text begin
(5) If the commissioner has determined the child to be eligible, the adoptive parent must
submit reimbursement requests to the commissioner within 21 months of the date of the
child's adoption decree, and the adoptive parent must follow requirements and procedures
that the commissioner prescribes.
new text end
Sec. 30.
Minnesota Statutes 2020, section 256P.02, subdivision 1a, is amended to read:
Subd. 1a.
Exemption.
Participants who qualify for child care assistance programs under
chapter 119B are exempt from this sectionnew text begin , except that the personal property identified in
subdivision 2 is counted toward the asset limit of the child care assistance program under
chapter 119Bnew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective May 1, 2022.
new text end
Sec. 31.
Minnesota Statutes 2020, section 256P.02, subdivision 2, is amended to read:
Subd. 2.
Personal property limitations.
The equity value of an assistance unit's personal
property listed in clauses (1) to deleted text begin (4)deleted text end new text begin (5)new text end must not exceed $10,000 for applicants and
participants. For purposes of this subdivision, personal property is limited to:
(1) cash;
(2) bank accounts;
(3) liquid stocks and bonds that can be readily accessed without a financial penalty; deleted text begin and
deleted text end
(4) vehicles not excluded under subdivision 3deleted text begin .deleted text end new text begin ; and
new text end
new text begin
(5) the full value of business accounts used to pay expenses not related to the business.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective May 1, 2022.
new text end
Sec. 32.
Minnesota Statutes 2020, section 256P.04, subdivision 4, is amended to read:
Subd. 4.
Factors to be verified.
(a) The agency shall verify the following at application:
(1) identity of adults;
(2) age, if necessary to determine eligibility;
(3) immigration status;
(4) income;
(5) spousal support and child support payments made to persons outside the household;
(6) vehicles;
(7) checking and savings accountsnew text begin , including but not limited to any business accounts
used to pay expenses not related to the businessnew text end ;
(8) inconsistent information, if related to eligibility;
(9) residence;
(10) Social Security number; and
(11) use of nonrecurring income under section 256P.06, subdivision 3, clause (2), item
(ix), for the intended purpose for which it was given and received.
(b) Applicants who are qualified noncitizens and victims of domestic violence as defined
under section 256J.08, subdivision 73, clause (7), are not required to verify the information
in paragraph (a), clause (10). When a Social Security number is not provided to the agency
for verification, this requirement is satisfied when each member of the assistance unit
cooperates with the procedures for verification of Social Security numbers, issuance of
duplicate cards, and issuance of new numbers which have been established jointly between
the Social Security Administration and the commissioner.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective May 1, 2022.
new text end
Sec. 33.
Minnesota Statutes 2020, section 256P.05, is amended to read:
256P.05 SELF-EMPLOYMENT EARNINGS.
Subdivision 1.
Exempted programs.
Participants who qualify for deleted text begin child care assistance
programs under chapter 119B,deleted text end Minnesota supplemental aid under chapter 256Ddeleted text begin ,deleted text end and housing
support under chapter 256I on the basis of eligibility for Supplemental Security Income are
exempt from this section.new text begin Participants who qualify for child care assistance programs under
chapter 119B are exempt from subdivision 3.
new text end
Subd. 2.
Self-employment income determinations.
new text begin Applicants and participants must
choose one of the methods described in this subdivision for determining self-employment
earned income. new text end An agency must determine self-employment income, which is either:
(1) one-half of gross earnings from self-employment; or
(2) taxable income as determined from an Internal Revenue Service tax form that has
been filed with the Internal Revenue Service deleted text begin within the lastdeleted text end new text begin for the most recentnew text end yearnew text begin and
according to guidance provided for the Supplemental Nutrition Assistance Programnew text end . A
12-month average using deleted text begin netdeleted text end taxable income shall be used to budget monthly income.
Subd. 3.
Self-employment budgeting.
(a) The self-employment budget period begins
in the month of application or in the first month of self-employment. deleted text begin Applicants and
participants must choose one of the methods described in subdivision 2 for determining
self-employment earned income.
deleted text end
(b) Applicants and participants who elect to use taxable income as described in
subdivision 2, clause (2), to determine self-employment income must continue to use this
method until recertification, unless there is an unforeseen significant change in gross income
equaling a decline in gross income of the amount equal to or greater than the earned income
disregard as defined in section 256P.03 from the income used to determine the benefit for
the current month.
(c) For applicants and participants who elect to use one-half of gross earnings as described
in subdivision 2, clause (1), to determine self-employment income, earnings must be counted
as income in the month received.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective May 1, 2022.
new text end
Sec. 34.
Minnesota Statutes 2020, section 256P.06, subdivision 3, is amended to read:
Subd. 3.
Income inclusions.
The following must be included in determining the income
of an assistance unit:
(1) earned income; and
(2) unearned income, which includes:
(i) interest and dividends from investments and savings;
(ii) capital gains as defined by the Internal Revenue Service from any sale of real property;
(iii) proceeds from rent and contract for deed payments in excess of the principal and
interest portion owed on property;
(iv) income from trusts, excluding special needs and supplemental needs trusts;
(v) interest income from loans made by the participant or household;
(vi) cash prizes and winnings;
(vii) unemployment insurance incomenew text begin that is received by an adult member of the
assistance unit unless the individual receiving unemployment insurance income is:
new text end
new text begin
(A) 18 years of age and enrolled in a secondary school; or
new text end
new text begin (B) 18 or 19 years of age, a caregiver, and is enrolled in school at least half-timenew text end ;
(viii) retirement, survivors, and disability insurance payments;
(ix) nonrecurring income over $60 per quarter unless earmarked and used for the purpose
for which it is intended. Income and use of this income is subject to verification requirements
under section 256P.04;
(x) retirement benefits;
(xi) cash assistance benefits, as defined by each program in chapters 119B, 256D, 256I,
and 256J;
(xii) tribal per capita payments unless excluded by federal and state law;
(xiii) income and payments from service and rehabilitation programs that meet or exceed
the state's minimum wage rate;
(xiv) income from members of the United States armed forces unless excluded from
income taxes according to federal or state law;
(xv) all child support payments for programs under chapters 119B, 256D, and 256I;
(xvi) the amount of child support received that exceeds $100 for assistance units with
one child and $200 for assistance units with two or more children for programs under chapter
256J; and
(xvii) spousal support.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 35.
Minnesota Statutes 2020, section 259.22, subdivision 4, is amended to read:
Subd. 4.
Time for filing petition.
A petition shall be filed not later than 12 months after
a child is placed in a prospective adoptive home. If a petition is not filed by that time, the
agency that placed the child, or, in a direct adoptive placement, the agency that is supervising
the placement shall file with the district court in the county where the prospective adoptive
parent resides a motion for an order and a report recommending one of the following:
(1) that the time for filing a petition be extended because of the child's special needs as
defined under title IV-E of the Social Security Act, United States Code, title 42, section
673;
(2) that, based on a written plan for completing filing of the petition, including a specific
timeline, to which the prospective adoptive parents have agreed, the time for filing a petition
be extended long enough to complete the plan because such an extension is in the best
interests of the child and additional time is needed for the child to adjust to the adoptive
home; or
(3) that the child be removed from the prospective adoptive home.
The prospective adoptive parent must reimburse an agency for the cost of preparing and
filing the motion and report under this section, unless the costs are reimbursed by the
commissioner under section 259.73 or deleted text begin 259A.70deleted text end new text begin 256N.25, subdivision 1anew text end .
Sec. 36.
Minnesota Statutes 2020, section 259.241, is amended to read:
259.241 ADULT ADOPTION.
(a) Any adult person may be adopted, regardless of the adult person's residence. A
resident of Minnesota may petition the court of record having jurisdiction of adoption
proceedings to adopt an individual who has reached the age of 18 years or older.
(b) The consent of the person to be adopted shall be the only consent necessary, according
to section 259.24. The consent of an adult in the adult person's own adoption is invalid if
the adult is considered to be a vulnerable adult under section 626.5572, subdivision 21, or
if the person consenting to the adoption is determined not competent to give consent.
new text begin
(c) Notwithstanding paragraph (b), a person in extended foster care under section
260C.451 may consent to the person's own adoption as long as the court with jurisdiction
finds the person competent to give consent.
new text end
deleted text begin (c)deleted text end new text begin (d)new text end The decree of adoption establishes a parent-child relationship between the adopting
parent or parents and the person adopted, including the right to inherit, and also terminates
the parental rights deleted text begin and sibling relationshipdeleted text end between the adopted person and the adopted
person's birth parents deleted text begin and siblingsdeleted text end according to section 259.59.
deleted text begin (d)deleted text end new text begin (e)new text end If the adopted person requests a change of name, the adoption decree shall order
the name change.
Sec. 37.
Minnesota Statutes 2020, section 259.35, subdivision 1, is amended to read:
Subdivision 1.
Parental responsibilities.
Prior to commencing an investigation of the
suitability of proposed adoptive parents, a child-placing agency shall give the individuals
the following written notice in all capital letters at least one-eighth inch high:
"Minnesota Statutes, section 259.59, provides that upon legally adopting a child, adoptive
parents assume all the rights and responsibilities of birth parents. The responsibilities include
providing for the child's financial support and caring for health, emotional, and behavioral
problems. Except for subsidized adoptions under Minnesota Statutes, chapter deleted text begin 259Adeleted text end new text begin 256Nnew text end ,
or any other provisions of law that expressly apply to adoptive parents and children, adoptive
parents are not eligible for state or federal financial subsidies besides those that a birth
parent would be eligible to receive for a child. Adoptive parents may not terminate their
parental rights to a legally adopted child for a reason that would not apply to a birth parent
seeking to terminate rights to a child. An individual who takes guardianship of a child for
the purpose of adopting the child shall, upon taking guardianship from the child's country
of origin, assume all the rights and responsibilities of birth and adoptive parents as stated
in this paragraph."
Sec. 38.
Minnesota Statutes 2020, section 259.53, subdivision 4, is amended to read:
Subd. 4.
Preadoption residence.
No petition shall be grantednew text begin under this chapternew text end until
the child deleted text begin shall havedeleted text end new text begin hasnew text end livednew text begin fornew text end three months in the proposed new text begin adoptive new text end home, subject to a
right of visitation by the commissioner or an agency or their authorized representatives.
Sec. 39.
Minnesota Statutes 2020, section 259.73, is amended to read:
259.73 REIMBURSEMENT OF NONRECURRING ADOPTION EXPENSES.
An individual may apply for reimbursement for costs incurred in an adoption of a child
with special needs under section deleted text begin 259A.70deleted text end new text begin 256N.25, subdivision 1anew text end .
Sec. 40.
Minnesota Statutes 2020, section 259.75, subdivision 5, is amended to read:
Subd. 5.
Withdrawal of registration.
A child's registration shall be withdrawn when
the exchange service has been notified in writing by the local social service agency or the
licensed child-placing agency that the child has been placed in an adoptive home deleted text begin ordeleted text end new text begin ,new text end has
diednew text begin , or is no longer under the guardianship of the commissioner and is no longer seeking
an adoptive homenew text end .
Sec. 41.
Minnesota Statutes 2020, section 259.75, subdivision 6, is amended to read:
Subd. 6.
Periodic review of status.
new text begin (a) new text end The deleted text begin exchange servicedeleted text end new text begin commissionernew text end shall
deleted text begin semiannually checkdeleted text end new text begin reviewnew text end thenew text begin state adoption exchangenew text end status of deleted text begin listeddeleted text end children deleted text begin for whom
inquiries have been receiveddeleted text end new text begin identified under subdivision 2, including a child whose
registration was withdrawn pursuant to subdivision 5. The commissioner may determine
that a child who is unregistered, or whose registration has been deferred, must be registered
and require the authorized child-placing agency to register the child with the state adoption
exchange within ten working days of the commissioner's determinationnew text end .
new text begin (b)new text end Periodic deleted text begin checksdeleted text end new text begin reviewsnew text end shall be made by the deleted text begin servicedeleted text end new text begin commissionernew text end to determine the
progress toward adoption of deleted text begin those children and the status ofdeleted text end children registered deleted text begin but never
listeddeleted text end in the deleted text begin exchange book because of placement in an adoptive home prior to or at the
time of registrationdeleted text end new text begin state adoption exchangenew text end .
Sec. 42.
Minnesota Statutes 2020, section 259.75, subdivision 9, is amended to read:
Subd. 9.
Rules; staff.
The commissioner of human services shall make rules as necessary
to administer this section and shall employ necessary staff to carry out the purposes of this
section.new text begin The commissioner may contract for services to carry out the purposes of this section.
new text end
Sec. 43.
Minnesota Statutes 2020, section 259.83, subdivision 1a, is amended to read:
Subd. 1a.
Social and medical history.
(a) If a person aged 19 years and over who was
adopted on or after August 1, 1994, or the adoptive parent requests the detailed nonidentifying
social and medical history of the adopted person's birth family that was provided at the time
of the adoption, agencies must provide the information to the adopted person or adoptive
parent on thenew text begin applicablenew text end form required under deleted text begin sectiondeleted text end new text begin sectionsnew text end 259.43new text begin and 260C.212,
subdivision 15new text end .
(b) If an adopted person aged 19 years and over or the adoptive parent requests the
agency to contact the adopted person's birth parents to request current nonidentifying social
and medical history of the adopted person's birth family, agencies must use thenew text begin applicablenew text end
form required under deleted text begin sectiondeleted text end new text begin sectionsnew text end 259.43new text begin and 260C.212, subdivision 15,new text end when obtaining
the information for the adopted person or adoptive parent.
Sec. 44.
Minnesota Statutes 2020, section 259A.75, subdivision 1, is amended to read:
Subdivision 1.
General information.
(a) Subject to the procedures required by the
commissioner and the provisions of this section, a Minnesota countynew text begin or Tribal agencynew text end shall
receive a reimbursement from the commissioner equal to 100 percent of the reasonable and
appropriate cost for contracted adoption placement services identified for a specific child
that are not reimbursed under other federal or state funding sources.
(b) The commissioner may spend up to $16,000 for each purchase of service contract.
Only one contract per child per adoptive placement is permitted. Funds encumbered and
obligated under the contract for the child remain available until the terms of the contract
are fulfilled or the contract is terminated.
(c) The commissioner shall set aside an amount not to exceed five percent of the total
amount of the fiscal year appropriation from the state for the adoption assistance program
to reimburse a Minnesota county or tribal social services placing agency for child-specific
adoption placement services. When adoption assistance payments for children's needs exceed
95 percent of the total amount of the fiscal year appropriation from the state for the adoption
assistance program, the amount of reimbursement available to placing agencies for adoption
services is reduced correspondingly.
Sec. 45.
Minnesota Statutes 2020, section 259A.75, subdivision 2, is amended to read:
Subd. 2.
Purchase of service contract child eligibility criteria.
deleted text begin (a)deleted text end A child who is the
subject of a purchase of service contract must:
(1) have the goal of adoption, which may include an adoption in accordance with tribal
law;
(2) be under the guardianship of the commissioner of human services or be a ward of
tribal court pursuant to section 260.755, subdivision 20; and
(3) meet all of the special needs criteria according to section deleted text begin 259A.10, subdivision 2deleted text end new text begin
256N.23, subdivision 2new text end .
deleted text begin
(b) A child under the guardianship of the commissioner must have an identified adoptive
parent and a fully executed adoption placement agreement according to section 260C.613,
subdivision 1, paragraph (a).
deleted text end
Sec. 46.
Minnesota Statutes 2020, section 259A.75, subdivision 3, is amended to read:
Subd. 3.
Agency eligibility criteria.
(a) A Minnesota countynew text begin or Tribalnew text end social services
agency shall receive reimbursement for child-specific adoption placement services for an
eligible child that it purchases from a private adoption agency licensed in Minnesota or any
other state or tribal social services agency.
(b) Reimbursement for adoption services is available only for services provided prior
to the date of the adoption decree.
Sec. 47.
Minnesota Statutes 2020, section 259A.75, subdivision 4, is amended to read:
Subd. 4.
Application and eligibility determination.
(a) Anew text begin Minnesotanew text end countynew text begin or Tribalnew text end
social services agency may request reimbursement of costs for adoption placement services
by submitting a complete purchase of service application, according to the requirements
and procedures and on forms prescribed by the commissioner.
(b) The commissioner shall determine eligibility for reimbursement of adoption placement
services. If determined eligible, the commissioner of human services shall sign the purchase
of service agreement, making this a fully executed contract. No reimbursement under this
section shall be made to an agency for services provided prior to the fully executed contract.
(c) Separate purchase of service agreements shall be made, and separate records
maintained, on each child. Only one agreement per child per adoptive placement is permitted.
For siblings who are placed together, services shall be planned and provided to best maximize
efficiency of the contracted hours.
Sec. 48.
Minnesota Statutes 2020, section 260C.007, subdivision 22a, is amended to read:
Subd. 22a.
Licensed residential family-based substance use disorder treatment
program.
"Licensed residential family-based substance use disorder treatment program"
means a residential treatment facility that provides the parent or guardian with parenting
skills training, parent education, or individual and family counseling, under an organizational
structure and treatment framework that involves understanding, recognizing, and responding
to the effects of all types of trauma according to recognized principles of a trauma-informed
approach and trauma-specific interventions to address the consequences of trauma and
facilitate healing. The residential program must be licensed by the Department of Human
Services under deleted text begin chapterdeleted text end new text begin chaptersnew text end 245A and deleted text begin sections 245G.01 to 245G.16, 245G.19, and
245G.21deleted text end new text begin 245G or Tribally licensed or approvednew text end as a residential substance use disorder
treatment program specializing in the treatment of clients with children.
Sec. 49.
Minnesota Statutes 2020, section 260C.212, subdivision 1, is amended to read:
Subdivision 1.
Out-of-home placement; plan.
(a) An out-of-home placement plan shall
be prepared within 30 days after any child is placed in foster care by court order or a
voluntary placement agreement between the responsible social services agency and the
child's parent pursuant to section 260C.227 or chapter 260D.
(b) An out-of-home placement plan means a written document which is prepared by the
responsible social services agency jointly with the parent or parents or guardian of the child
and in consultation with the child's guardian ad litem, the child's tribe, if the child is an
Indian child, the child's foster parent or representative of the foster care facility, and, where
appropriate, the child. When a child is age 14 or older, the child may include two other
individuals on the team preparing the child's out-of-home placement plan. The child may
select one member of the case planning team to be designated as the child's advisor and to
advocate with respect to the application of the reasonable and prudent parenting standards.
The responsible social services agency may reject an individual selected by the child if the
agency has good cause to believe that the individual would not act in the best interest of the
child. For a child in voluntary foster care for treatment under chapter 260D, preparation of
the out-of-home placement plan shall additionally include the child's mental health treatment
provider. For a child 18 years of age or older, the responsible social services agency shall
involve the child and the child's parents as appropriate. As appropriate, the plan shall be:
(1) submitted to the court for approval under section 260C.178, subdivision 7;
(2) ordered by the court, either as presented or modified after hearing, under section
260C.178, subdivision 7, or 260C.201, subdivision 6; and
(3) signed by the parent or parents or guardian of the child, the child's guardian ad litem,
a representative of the child's tribe, the responsible social services agency, and, if possible,
the child.
(c) The out-of-home placement plan shall be explained to all persons involved in its
implementation, including the child who has signed the plan, and shall set forth:
(1) a description of the foster care home or facility selected, including how the
out-of-home placement plan is designed to achieve a safe placement for the child in the
least restrictive, most family-like, setting available which is in close proximity to the home
of the parent or parents or guardian of the child when the case plan goal is reunification,
and how the placement is consistent with the best interests and special needs of the child
according to the factors under subdivision 2, paragraph (b);
(2) the specific reasons for the placement of the child in foster care, and when
reunification is the plan, a description of the problems or conditions in the home of the
parent or parents which necessitated removal of the child from home and the changes the
parent or parents must make for the child to safely return home;
(3) a description of the services offered and provided to prevent removal of the child
from the home and to reunify the family including:
(i) the specific actions to be taken by the parent or parents of the child to eliminate or
correct the problems or conditions identified in clause (2), and the time period during which
the actions are to be taken; and
(ii) the reasonable efforts, or in the case of an Indian child, active efforts to be made to
achieve a safe and stable home for the child including social and other supportive services
to be provided or offered to the parent or parents or guardian of the child, the child, and the
residential facility during the period the child is in the residential facility;
(4) a description of any services or resources that were requested by the child or the
child's parent, guardian, foster parent, or custodian since the date of the child's placement
in the residential facility, and whether those services or resources were provided and if not,
the basis for the denial of the services or resources;
(5) the visitation plan for the parent or parents or guardian, other relatives as defined in
section 260C.007, subdivision 26b or 27, and siblings of the child if the siblings are not
placed together in foster care, and whether visitation is consistent with the best interest of
the child, during the period the child is in foster care;
(6) when a child cannot return to or be in the care of either parent, documentation of
steps to finalize adoption as the permanency plan for the child through reasonable efforts
to place the child for adoption. At a minimum, the documentation must include consideration
of whether adoption is in the best interests of the child, child-specific recruitment efforts
such as relative search and the use of state, regional, and national adoption exchanges to
facilitate orderly and timely placements in and outside of the state. A copy of this
documentation shall be provided to the court in the review required under section 260C.317,
subdivision 3, paragraph (b);
(7) when a child cannot return to or be in the care of either parent, documentation of
steps to finalize the transfer of permanent legal and physical custody to a relative as the
permanency plan for the child. This documentation must support the requirements of the
kinship placement agreement under section 256N.22 and must include the reasonable efforts
used to determine that it is not appropriate for the child to return home or be adopted, and
reasons why permanent placement with a relative through a Northstar kinship assistance
arrangement is in the child's best interest; how the child meets the eligibility requirements
for Northstar kinship assistance payments; agency efforts to discuss adoption with the child's
relative foster parent and reasons why the relative foster parent chose not to pursue adoption,
if applicable; and agency efforts to discuss with the child's parent or parents the permanent
transfer of permanent legal and physical custody or the reasons why these efforts were not
made;
(8) efforts to ensure the child's educational stability while in foster care for a child who
attained the minimum age for compulsory school attendance under state law and is enrolled
full time in elementary or secondary school, or instructed in elementary or secondary
education at home, or instructed in an independent study elementary or secondary program,
or incapable of attending school on a full-time basis due to a medical condition that is
documented and supported by regularly updated information in the child's case plan.
Educational stability efforts include:
(i) efforts to ensure that the child remains in the same school in which the child was
enrolled prior to placement or upon the child's move from one placement to another, including
efforts to work with the local education authorities to ensure the child's educational stability
and attendance; or
(ii) if it is not in the child's best interest to remain in the same school that the child was
enrolled in prior to placement or move from one placement to another, efforts to ensure
immediate and appropriate enrollment for the child in a new school;
(9) the educational records of the child including the most recent information available
regarding:
(i) the names and addresses of the child's educational providers;
(ii) the child's grade level performance;
(iii) the child's school record;
(iv) a statement about how the child's placement in foster care takes into account
proximity to the school in which the child is enrolled at the time of placement; and
(v) any other relevant educational information;
(10) the efforts by the responsible social services agency to ensure the oversight and
continuity of health care services for the foster child, including:
(i) the plan to schedule the child's initial health screens;
(ii) how the child's known medical problems and identified needs from the screens,
including any known communicable diseases, as defined in section 144.4172, subdivision
2, shall be monitored and treated while the child is in foster care;
(iii) how the child's medical information shall be updated and shared, including the
child's immunizations;
(iv) who is responsible to coordinate and respond to the child's health care needs,
including the role of the parent, the agency, and the foster parent;
(v) who is responsible for oversight of the child's prescription medications;
(vi) how physicians or other appropriate medical and nonmedical professionals shall be
consulted and involved in assessing the health and well-being of the child and determine
the appropriate medical treatment for the child; and
(vii) the responsibility to ensure that the child has access to medical care through either
medical insurance or medical assistance;
(11) the health records of the child including information available regarding:
(i) the names and addresses of the child's health care and dental care providers;
(ii) a record of the child's immunizations;
(iii) the child's known medical problems, including any known communicable diseases
as defined in section 144.4172, subdivision 2;
(iv) the child's medications; and
(v) any other relevant health care information such as the child's eligibility for medical
insurance or medical assistance;
(12) an independent living plan for a child 14 years of age or older, developed in
consultation with the child. The child may select one member of the case planning team to
be designated as the child's advisor and to advocate with respect to the application of the
reasonable and prudent parenting standards in subdivision 14. The plan should include, but
not be limited to, the following objectives:
(i) educational, vocational, or employment planning;
(ii) health care planning and medical coverage;
(iii) transportation including, where appropriate, assisting the child in obtaining a driver's
license;
(iv) money management, including the responsibility of the responsible social services
agency to ensure that the child annually receives, at no cost to the child, a consumer report
as defined under section 13C.001 and assistance in interpreting and resolving any inaccuracies
in the report;
(v) planning for housing;
(vi) social and recreational skills;
(vii) establishing and maintaining connections with the child's family and community;
and
(viii) regular opportunities to engage in age-appropriate or developmentally appropriate
activities typical for the child's age group, taking into consideration the capacities of the
individual child;
(13) for a child in voluntary foster care for treatment under chapter 260D, diagnostic
and assessment information, specific services relating to meeting the mental health care
needs of the child, and treatment outcomes;
(14) for a child 14 years of age or older, a signed acknowledgment that describes the
child's rights regarding education, health care, visitation, safety and protection from
exploitation, and court participation; receipt of the documents identified in section 260C.452;
and receipt of an annual credit report. The acknowledgment shall state that the rights were
explained in an age-appropriate manner to the child; and
(15) for a child placed in a qualified residential treatment program, the plan must include
the requirements in section 260C.708.
(d) The parent or parents or guardian and the child each shall have the right to legal
counsel in the preparation of the case plan and shall be informed of the right at the time of
placement of the child. The child shall also have the right to a guardian ad litem. If unable
to employ counsel from their own resources, the court shall appoint counsel upon the request
of the parent or parents or the child or the child's legal guardian. The parent or parents may
also receive assistance from any person or social services agency in preparation of the case
plan.
After the plan has been agreed upon by the parties involved or approved or ordered by
the court, the foster parents shall be fully informed of the provisions of the case plan and
shall be provided a copy of the plan.
Uponnew text begin the child'snew text end discharge from foster care, thenew text begin responsible social services agency must
provide the child'snew text end parent, adoptive parent, or permanent legal and physical custodian, deleted text begin as
appropriate,deleted text end and the child, if deleted text begin appropriate, must be provideddeleted text end new text begin the child is 14 years of age or
older,new text end with a current copy of the child's health and education record.new text begin If a child meets the
conditions in subdivision 15, paragraph (b), the agency must also provide the child with the
child's social and medical history. The responsible social services agency may give a copy
of the child's health and education record and social and medical history to a child who is
younger than 14 years of age, if it is appropriate and if subdivision 15, paragraph (b), applies.
new text end
Sec. 50.
Minnesota Statutes 2020, section 260C.212, subdivision 2, is amended to read:
Subd. 2.
Placement decisions based on best interests of the child.
(a) The policy of
the state of Minnesota is to ensure that the child's best interests are met by requiring an
individualized determination of the needs of the child and of how the selected placement
will serve the needs of the child being placed. The authorized child-placing agency shall
place a child, released by court order or by voluntary release by the parent or parents, in a
family foster home selected by considering placement with relatives and important friends
in the following order:
(1) with an individual who is related to the child by blood, marriage, or adoptionnew text begin ,
including the legal parent, guardian, or custodian of the child's siblingsnew text end ; or
(2) with an individual who is an important friend with whom the child has resided or
had significant contact.
For an Indian child, the agency shall follow the order of placement preferences in the Indian
Child Welfare Act of 1978, United States Code, title 25, section 1915.
(b) Among the factors the agency shall consider in determining the needs of the child
are the following:
(1) the child's current functioning and behaviors;
(2) the medical needs of the child;
(3) the educational needs of the child;
(4) the developmental needs of the child;
(5) the child's history and past experience;
(6) the child's religious and cultural needs;
(7) the child's connection with a community, school, and faith community;
(8) the child's interests and talents;
(9) the child's relationship to current caretakers, parents, siblings, and relatives;
(10) the reasonable preference of the child, if the court, or the child-placing agency in
the case of a voluntary placement, deems the child to be of sufficient age to express
preferences; and
(11) for an Indian child, the best interests of an Indian child as defined in section 260.755,
subdivision 2a.
(c) Placement of a child cannot be delayed or denied based on race, color, or national
origin of the foster parent or the child.
(d) Siblings should be placed together for foster care and adoption at the earliest possible
time unless it is documented that a joint placement would be contrary to the safety or
well-being of any of the siblings or unless it is not possible after reasonable efforts by the
responsible social services agency. In cases where siblings cannot be placed together, the
agency is required to provide frequent visitation or other ongoing interaction between
siblings unless the agency documents that the interaction would be contrary to the safety
or well-being of any of the siblings.
(e) Except for emergency placement as provided for in section 245A.035, the following
requirements must be satisfied before the approval of a foster or adoptive placement in a
related or unrelated home: (1) a completed background study under section 245C.08; and
(2) a completed review of the written home study required under section 260C.215,
subdivision 4, clause (5), or 260C.611, to assess the capacity of the prospective foster or
adoptive parent to ensure the placement will meet the needs of the individual child.
(f) The agency must determine whether colocation with a parent who is receiving services
in a licensed residential family-based substance use disorder treatment program is in the
child's best interests according to paragraph (b) and include that determination in the child's
case plan under subdivision 1. The agency may consider additional factors not identified
in paragraph (b). The agency's determination must be documented in the child's case plan
before the child is colocated with a parent.
(g) The agency must establish a juvenile treatment screening team under section 260C.157
to determine whether it is necessary and appropriate to recommend placing a child in a
qualified residential treatment program, as defined in section 260C.007, subdivision 26d.
Sec. 51.
Minnesota Statutes 2020, section 260C.212, is amended by adding a subdivision
to read:
new text begin Subd. 15. new text end
new text begin Social and medical history. new text end
new text begin
(a) The responsible social services agency must
complete each child's social and medical history using forms developed by the commissioner.
The responsible social services agency must work with each child's birth family, foster
family, medical and treatment providers, and school to ensure that there is a detailed and
up-to-date social and medical history of the child on forms provided by the commissioner.
new text end
new text begin
(b) If the child continues to be in placement out of the home of the parent or guardian
from whom the child was removed, reasonable efforts by the responsible social services
agency to complete the child's social and medical history must begin no later than the child's
permanency progress review hearing required under section 260C.204 or six months after
the child's placement in foster care, whichever occurs earlier.
new text end
new text begin
(c) In a child's social and medical history, the responsible social services agency must
include background information and health history specific to the child, the child's birth
parents, and the child's other birth relatives. Applicable background and health information
about the child includes the child's current health condition, behavior, and demeanor;
placement history; education history; sibling information; and birth, medical, dental, and
immunization information. Redacted copies of pertinent records, assessments, and evaluations
must be attached to the child's social and medical history. Applicable background information
about the child's birth parents and other birth relatives includes general background
information; education and employment history; physical health and mental health history;
and reasons for the child's placement.
new text end
Sec. 52.
Minnesota Statutes 2020, section 260C.219, subdivision 5, is amended to read:
Subd. 5.
Children reaching age of majority; copies of records.
new text begin Regardless of new text end whethernew text begin
a child isnew text end under state guardianship deleted text begin or notdeleted text end , if a child leaves foster care by reason of having
attained the age of majority under state law, the child must be given at no cost a copy of
the child's social and medical history, as deleted text begin defineddeleted text end new text begin describednew text end in section deleted text begin 259.43,deleted text end new text begin 260C.212,
subdivision 15, including the child's healthnew text end and education report.
Sec. 53.
Minnesota Statutes 2020, section 260C.503, subdivision 2, is amended to read:
Subd. 2.
Termination of parental rights.
(a) The responsible social services agency
must ask the county attorney to immediately file a termination of parental rights petition
when:
(1) the child has been subjected to egregious harm as defined in section 260C.007,
subdivision 14;
(2) the child is determined to be the sibling of a child who was subjected to egregious
harm;
(3) the child is an abandoned infant as defined in section 260C.301, subdivision 2,
paragraph (a), clause (2);
(4) the child's parent has lost parental rights to another child through an order involuntarily
terminating the parent's rights;
(5) the parent has committed sexual abuse as defined in section 260E.03, against the
child or another child of the parent;
(6) the parent has committed an offense that requires registration as a predatory offender
under section 243.166, subdivision 1b, paragraph (a) or (b); or
(7) another child of the parent is the subject of an order involuntarily transferring
permanent legal and physical custody of the child to a relative under this chapter or a similar
law of another jurisdiction;
The county attorney shall file a termination of parental rights petition unless the conditions
of paragraph (d) are met.
(b) When the termination of parental rights petition is filed under this subdivision, the
responsible social services agency shall identify, recruit, and approve an adoptive family
for the child. If a termination of parental rights petition has been filed by another party, the
responsible social services agency shall be joined as a party to the petition.
(c) If criminal charges have been filed against a parent arising out of the conduct alleged
to constitute egregious harm, the county attorney shall determine which matter should
proceed to trial first, consistent with the best interests of the child and subject to the
defendant's right to a speedy trial.
(d) The requirement of paragraph (a) does not apply if the responsible social services
agency and the county attorney determine and file with the court:
(1) a petition for transfer of permanent legal and physical custody to a relative under
sections 260C.505 and 260C.515, subdivision deleted text begin 3deleted text end new text begin 4new text end , including a determination that adoption
is not in the child's best interests and that transfer of permanent legal and physical custody
is in the child's best interests; or
(2) a petition under section 260C.141 alleging the child, and where appropriate, the
child's siblings, to be in need of protection or services accompanied by a case plan prepared
by the responsible social services agency documenting a compelling reason why filing a
termination of parental rights petition would not be in the best interests of the child.
Sec. 54.
Minnesota Statutes 2020, section 260C.515, subdivision 3, is amended to read:
Subd. 3.
Guardianship; commissioner.
The court may new text begin issue an new text end order new text begin that the child is
under the new text end guardianship deleted text begin todeleted text end new text begin ofnew text end the commissioner of human services under the following
procedures and conditions:
(1) there is an identified prospective adoptive parent agreed to by the responsible social
services agency deleted text begin havingdeleted text end new text begin that hasnew text end legal custody of the child pursuant to court order under this
chapter and that prospective adoptive parent has agreed to adopt the child;
(2) the court accepts the parent's voluntary consent to adopt in writing on a form
prescribed by the commissioner, executed before two competent witnesses and confirmed
by the consenting parent before the court or executed before the court. The consent shall
contain notice that consent given under this chapter:
(i) is irrevocable upon acceptance by the court unless fraud is established and an order
is issued permitting revocation as stated in clause (9) unless the matter is governed by the
Indian Child Welfare Act, United States Code, title 25, section 1913(c); and
(ii) will result in an order that the child is under the guardianship of the commissioner
of human services;
(3) a consent executed and acknowledged outside of this state, either in accordance with
the law of this state or in accordance with the law of the place where executed, is valid;
(4) the court must review the matter at least every 90 days under section 260C.317;
(5) a consent to adopt under this subdivision vests guardianship of the child with the
commissioner of human services and makes the child a ward of the commissioner of human
services under section 260C.325;
(6) the court must forward to the commissioner a copy of the consent to adopt, together
with a certified copy of the order transferring guardianship to the commissioner;
(7) if an adoption is not finalized by the identified prospective adoptive parent within
six months of the execution of the consent to adopt under this clause, the responsible social
services agency shall pursue adoptive placement in another home unless the court finds in
a hearing under section 260C.317 that the failure to finalize is not due to either an action
or a failure to act by the prospective adoptive parent;
(8) notwithstanding clause (7), the responsible social services agency must pursue
adoptive placement in another home as soon as the agency determines that finalization of
the adoption with the identified prospective adoptive parent is not possible, that the identified
prospective adoptive parent is not willing to adopt the child, or that the identified prospective
adoptive parent is not cooperative in completing the steps necessary to finalize the adoptionnew text begin .
The court may order a termination of parental rights under subdivision 2new text end ; and
(9) unless otherwise required by the Indian Child Welfare Act, United States Code, title
25, section 1913(c), a consent to adopt executed under this section shall be irrevocable upon
acceptance by the court except upon order permitting revocation issued by the same court
after written findings that consent was obtained by fraud.
Sec. 55.
Minnesota Statutes 2020, section 260C.605, subdivision 1, is amended to read:
Subdivision 1.
Requirements.
(a) Reasonable efforts to finalize the adoption of a child
under the guardianship of the commissioner shall be made by the responsible social services
agency responsible for permanency planning for the child.
(b) Reasonable efforts to make a placement in a home according to the placement
considerations under section 260C.212, subdivision 2, with a relative or foster parent who
will commit to being the permanent resource for the child in the event the child cannot be
reunified with a parent are required under section 260.012 and may be made concurrently
with reasonable, or if the child is an Indian child, active efforts to reunify the child with the
parent.
(c) Reasonable efforts under paragraph (b) must begin as soon as possible when the
child is in foster care under this chapter, but not later than the hearing required under section
260C.204.
(d) Reasonable efforts to finalize the adoption of the child include:
(1) using age-appropriate engagement strategies to plan for adoption with the child;
(2) identifying an appropriate prospective adoptive parent for the child by updating the
child's identified needs using the factors in section 260C.212, subdivision 2;
(3) making an adoptive placement that meets the child's needs by:
(i) completing or updating the relative search required under section 260C.221 and giving
notice of the need for an adoptive home for the child to:
(A) relatives who have kept the agency or the court apprised of their whereabouts and
who have indicated an interest in adopting the child; or
(B) relatives of the child who are located in an updated search;
(ii) an updated search is required whenever:
(A) there is no identified prospective adoptive placement for the child notwithstanding
a finding by the court that the agency made diligent efforts under section 260C.221, in a
hearing required under section 260C.202;
(B) the child is removed from the home of an adopting parent; or
(C) the court determines a relative search by the agency is in the best interests of the
child;
(iii) engaging the child's foster parent and the child's relatives identified as an adoptive
resource during the search conducted under section 260C.221, to commit to being the
prospective adoptive parent of the child; or
(iv) when there is no identified prospective adoptive parent:
(A) registering the child on the state adoption exchange as required in section 259.75
unless the agency documents to the court an exception to placing the child on the state
adoption exchange reported to the commissioner;
(B) reviewing all families with approved adoption home studies associated with the
responsible social services agency;
(C) presenting the child to adoption agencies and adoption personnel who may assist
with finding an adoptive home for the child;
(D) using newspapers and other media to promote the particular child;
(E) using a private agency under grant contract with the commissioner to provide adoption
services for intensive child-specific recruitment efforts; and
(F) making any other efforts or using any other resources reasonably calculated to identify
a prospective adoption parent for the child;
(4) updating and completing the social and medical history required under sections
deleted text begin 259.43deleted text end new text begin 260C.212, subdivision 15,new text end and 260C.609;
(5) making, and keeping updated, appropriate referrals required by section 260.851, the
Interstate Compact on the Placement of Children;
(6) giving notice regarding the responsibilities of an adoptive parent to any prospective
adoptive parent as required under section 259.35;
(7) offering the adopting parent the opportunity to apply for or decline adoption assistance
under chapter deleted text begin 259Adeleted text end new text begin 256Nnew text end ;
(8) certifying the child for adoption assistance, assessing the amount of adoption
assistance, and ascertaining the status of the commissioner's decision on the level of payment
if the adopting parent has applied for adoption assistance;
(9) placing the child with siblings. If the child is not placed with siblings, the agency
must document reasonable efforts to place the siblings together, as well as the reason for
separation. The agency may not cease reasonable efforts to place siblings together for final
adoption until the court finds further reasonable efforts would be futile or that placement
together for purposes of adoption is not in the best interests of one of the siblings; and
(10) working with the adopting parent to file a petition to adopt the child and with the
court administrator to obtain a timely hearing to finalize the adoption.
Sec. 56.
Minnesota Statutes 2020, section 260C.607, subdivision 6, is amended to read:
Subd. 6.
Motion and hearing to order adoptive placement.
(a) At any time after the
district court orders the child under the guardianship of the commissioner of human services,
but not later than 30 days after receiving notice required under section 260C.613, subdivision
1, paragraph (c), that the agency has made an adoptive placement, a relative or the child's
foster parent may file a motion for an order for adoptive placement of a child who is under
the guardianship of the commissioner if the relative or the child's foster parent:
(1) has an adoption home study under section 259.41 approving the relative or foster
parent for adoption and has been a resident of Minnesota for at least six months before filing
the motion; the court may waive the residency requirement for the moving party if there is
a reasonable basis to do so; or
(2) is not a resident of Minnesota, but has an approved adoption home study by an agency
licensed or approved to complete an adoption home study in the state of the individual's
residence and the study is filed with the motion for adoptive placement.
(b) The motion shall be filed with the court conducting reviews of the child's progress
toward adoption under this section. The motion and supporting documents must make a
prima facie showing that the agency has been unreasonable in failing to make the requested
adoptive placement. The motion must be served according to the requirements for motions
under the Minnesota Rules of Juvenile Protection Procedure and shall be made on all
individuals and entities listed in subdivision 2.
(c) If the motion and supporting documents do not make a prima facie showing for the
court to determine whether the agency has been unreasonable in failing to make the requested
adoptive placement, the court shall dismiss the motion. If the court determines a prima facie
basis is made, the court shall set the matter for evidentiary hearing.
(d) At the evidentiary hearing, the responsible social services agency shall proceed first
with evidence about the reason for not making the adoptive placement proposed by the
moving party. The moving party then has the burden of proving by a preponderance of the
evidence that the agency has been unreasonable in failing to make the adoptive placement.
(e) At the conclusion of the evidentiary hearing, if the court finds that the agency has
been unreasonable in failing to make the adoptive placement and that the relative or the
child's foster parent is the most suitable adoptive home to meet the child's needs using the
factors in section 260C.212, subdivision 2, paragraph (b), the court may order the responsible
social services agency to make an adoptive placement in the home of the relative or the
child's foster parent.
(f) If, in order to ensure that a timely adoption may occur, the court orders the responsible
social services agency to make an adoptive placement under this subdivision, the agency
shall:
(1) make reasonable efforts to obtain a fully executed adoption placement agreement;
(2) work with the moving party regarding eligibility for adoption assistance as required
under chapter deleted text begin 259Adeleted text end new text begin 256Nnew text end ; and
(3) if the moving party is not a resident of Minnesota, timely refer the matter for approval
of the adoptive placement through the Interstate Compact on the Placement of Children.
(g) Denial or granting of a motion for an order for adoptive placement after an evidentiary
hearing is an order which may be appealed by the responsible social services agency, the
moving party, the child, when age ten or over, the child's guardian ad litem, and any
individual who had a fully executed adoption placement agreement regarding the child at
the time the motion was filed if the court's order has the effect of terminating the adoption
placement agreement. An appeal shall be conducted according to the requirements of the
Rules of Juvenile Protection Procedure.
Sec. 57.
Minnesota Statutes 2020, section 260C.609, is amended to read:
260C.609 SOCIAL AND MEDICAL HISTORY.
deleted text begin
(a) The responsible social services agency shall work with the birth family of the child,
foster family, medical and treatment providers, and the child's school to ensure there is a
detailed, thorough, and currently up-to-date social and medical history of the child as required
under section 259.43 on the forms required by the commissioner.
deleted text end
deleted text begin
(b) When the child continues in foster care, the agency's reasonable efforts to complete
the history shall begin no later than the permanency progress review hearing required under
section 260C.204 or six months after the child's placement in foster care.
deleted text end
deleted text begin (c)deleted text end new text begin (a)new text end Thenew text begin responsible social servicesnew text end agency shall thoroughly discuss the child's history
with the deleted text begin adoptingdeleted text end new text begin prospective adoptivenew text end parent of the child and shall give anew text begin redactednew text end copy
of deleted text begin the report ofdeleted text end the child's social and medical historynew text begin as described in section 260C.212,
subdivision 15, including redacted attachments,new text end to the deleted text begin adoptingdeleted text end new text begin prospective adoptivenew text end parent.new text begin
If the prospective adoptive parent does not pursue adoption of the child, the prospective
adoptive parent must return the child's social and medical history and redacted attachments
to the agency. The responsible social services agency may givenew text end anew text begin redactednew text end copy of the child's
social and medical history deleted text begin may also be givendeleted text end to the childdeleted text begin , as appropriatedeleted text end new text begin according to section
260C.212, subdivision 1new text end .
deleted text begin (d)deleted text end new text begin (b)new text end The report shall not include information that identifies birth relatives. Redacted
copies of allnew text begin ofnew text end the child's relevant evaluations, assessments, and records must be attached
to the social and medical history.
new text begin
(c) The agency must submit the child's social and medical history to the Department of
Human Services at the time that the agency submits the child's adoption placement agreement.
Pursuant to section 260C.623, subdivision 4, the child's social and medical history must be
submitted to the court at the time the adoption petition is filed with the court.
new text end
Sec. 58.
Minnesota Statutes 2020, section 260C.615, is amended to read:
260C.615 DUTIES OF COMMISSIONER.
Subdivision 1.
Duties.
(a) For any child who is under the guardianship of the
commissioner, the commissioner has the exclusive rights to consent to:
(1) the medical care plan for the treatment of a child who is at imminent risk of death
or who has a chronic disease that, in a physician's judgment, will result in the child's death
in the near future including a physician's order not to resuscitate or intubate the child; and
(2) the child donating a part of the child's body to another person while the child is living;
the decision to donate a body part under this clause shall take into consideration the child's
wishes and the child's culture.
(b) In addition to the exclusive rights under paragraph (a), the commissioner has a duty
to:
(1) process any complete and accurate request for home study and placement through
the Interstate Compact on the Placement of Children under section 260.851;
(2) process any complete and accurate application for adoption assistance forwarded by
the responsible social services agency according to chapter deleted text begin 259Adeleted text end new text begin 256Nnew text end ;
(3) deleted text begin complete the execution ofdeleted text end new text begin review and processnew text end an adoption placement agreement
forwarded to the commissioner by the responsible social services agency and return it to
the agency in a timely fashion; and
(4) maintain records as required in chapter 259.
Subd. 2.
Duties not reserved.
All duties, obligations, and consents not specifically
reserved to the commissioner in this section are delegated to the responsible social services
agencynew text begin , subject to supervision by the commissioner under section 393.07new text end .
Sec. 59. new text begin GRANT TO MINNESOTA ASSOCIATION FOR VOLUNTEER
ADMINISTRATION.
new text end
new text begin
The commissioner of human services shall establish a onetime grant to the Minnesota
Association for Volunteer Administration to administer needs-based volunteerism subgrants
for underresourced nonprofit organizations in greater Minnesota to support the organizations'
efforts to address and minimize disparities in access to human services through increased
volunteerism. Successful subgrant applicants must demonstrate that the populations served
by the subgrantee are underserved or suffer from or are at risk of homelessness, hunger,
poverty, lack of access to health care, or deficits in education. The Minnesota Association
for Volunteer Administration shall give priority to organizations that are serving the needs
of vulnerable populations. By December 15, 2023, the Minnesota Association for Volunteer
Administration shall report data on outcomes of the subgrants and make recommendations
for improving and sustaining volunteer efforts statewide to the chairs and ranking minority
members of the legislative committees and divisions with jurisdiction over human services.
new text end
Sec. 60. new text begin CHILD CARE AND DEVELOPMENT BLOCK GRANT ALLOCATION;
TRANSFER FUNDS FOR EARLY LEARNING SCHOLARSHIPS.
new text end
new text begin
The commissioner of human services shall allocate $73,000,000 in fiscal year 2022 and
$73,000,000 in fiscal year 2023 from the amount that Minnesota received under the American
Rescue Plan Act, Public Law 117-2, section 2201, for the child care and development block
grant, to be transferred to the commissioner of education for the early learning scholarship
program under Minnesota Statutes, section 124D.165. For purposes of expending federal
resources, the commissioner of human services shall consult with the commissioner of
education to ensure that the transferred resources are deployed to support prioritized groups
of children, including but not limited to the groups identified in Minnesota Statutes, section
124D.165, while identifying and implementing any other oversight and reporting necessary
to maintain compliance with the federal child care and development block grant
accountability and data collection requirements in United States Code, title 42, section
9858i.
new text end
Sec. 61. new text begin FEDERAL PANDEMIC EMERGENCY ASSISTANCE ALLOCATION;
EMERGENCY ASSISTANCE GRANTS.
new text end
new text begin
(a) From the amount that Minnesota received under section 9201 of the federal American
Rescue Plan Act, Public Law 117-2, for pandemic emergency assistance, the commissioner
of human services shall allocate $10,000,000 in fiscal year 2022 for emergency assistance
grants according to paragraph (b).
new text end
new text begin
(b) The commissioner shall distribute funds to counties to provide emergency assistance
grants to families with children under Minnesota Statutes, section 256J.626. The emergency
assistance grants under this section must be available for:
new text end
new text begin
(1) rent or mortgage, including arrears;
new text end
new text begin
(2) utility bills, including arrears;
new text end
new text begin
(3) food;
new text end
new text begin
(4) clothing needed for work or school;
new text end
new text begin
(5) public transportation and vehicle repairs; and
new text end
new text begin
(6) school-related equipment needs.
new text end
new text begin
(c) Notwithstanding any county policies to the contrary, applicants are eligible for grants,
subject to applicable maximum payments, for a security deposit, or if they are in arrears for
rent, mortgage, or contract for deed payments.
new text end
Sec. 62. new text begin FEDERAL PANDEMIC EMERGENCY ASSISTANCE ALLOCATION;
MFIP CONSOLIDATED FUND.
new text end
new text begin
From the amount that Minnesota received under section 9201 of the federal American
Rescue Plan Act, Public Law 117-2, for pandemic emergency assistance, the commissioner
of human services shall allocate $4,327,000 in fiscal year 2023 to counties according to
Minnesota Statutes, section 256J.626.
new text end
Sec. 63. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2020, sections 256D.051, subdivisions 1, 1a, 2, 2a, 3, 3a, 3b, 6b, 6c,
7, 8, 9, and 18; 256D.052, subdivision 3; and 259A.70
new text end
new text begin
are repealed.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021, except that the repeal
of Minnesota Statutes, section 259A.70 is effective July 1, 2021.
new text end
ARTICLE 10
CHILD CARE ASSISTANCE
Section 1.
Minnesota Statutes 2020, section 119B.11, subdivision 2a, is amended to read:
Subd. 2a.
Recovery of overpayments.
(a) An amount of child care assistance paid to a
recipientnew text begin or providernew text end in excess of the payment due is recoverable by the county agency
under paragraphs (b) and (c), even when the overpayment was caused by deleted text begin agency error ordeleted text end
circumstances outside the responsibility and control of the family or provider.new text begin Overpayments
designated solely as agency error, and not the result of acts or omissions on the part of a
provider or recipient, must not be established or collected.
new text end
(b) An overpayment must be recouped or recovered from the family if the overpayment
benefited the family by causing the family to pay less for child care expenses than the family
otherwise would have been required to pay under child care assistance program requirements.
If the family remains eligible for child care assistance, the overpayment must be recovered
through recoupment as identified in Minnesota Rules, part 3400.0187, except that the
overpayments must be calculated and collected on a service period basis. If the family no
longer remains eligible for child care assistance, the county may choose to initiate efforts
to recover overpayments from the family for overpayment less than $50. If the overpayment
is greater than or equal to $50, the county shall seek voluntary repayment of the overpayment
from the family. If the county is unable to recoup the overpayment through voluntary
repayment, the county shall initiate civil court proceedings to recover the overpayment
unless the county's costs to recover the overpayment will exceed the amount of the
overpayment. A family with an outstanding debt under this subdivision is not eligible for
child care assistance until: (1) the debt is paid in full; or (2) satisfactory arrangements are
made with the county to retire the debt consistent with the requirements of this chapter and
Minnesota Rules, chapter 3400, and the family is in compliance with the arrangements.
(c) The county must recover an overpayment from a provider if the overpayment did
not benefit the family by causing it to receive more child care assistance or to pay less for
child care expenses than the family otherwise would have been eligible to receive or required
to pay under child care assistance program requirements, and benefited the provider by
causing the provider to receive more child care assistance than otherwise would have been
paid on the family's behalf under child care assistance program requirements. If the provider
continues to care for children receiving child care assistance, the overpayment must be
recovered through reductions in child care assistance payments for services as described in
an agreement with the county. The provider may not charge families using that provider
more to cover the cost of recouping the overpayment. If the provider no longer cares for
children receiving child care assistance, the county may choose to initiate efforts to recover
overpayments of less than $50 from the provider. If the overpayment is greater than or equal
to $50, the county shall seek voluntary repayment of the overpayment from the provider.
If the county is unable to recoup the overpayment through voluntary repayment, the county
shall initiate civil court proceedings to recover the overpayment unless the county's costs
to recover the overpayment will exceed the amount of the overpayment. A provider with
an outstanding debt under this subdivision is not eligible to care for children receiving child
care assistance until:
(1) the debt is paid in full; or
(2) satisfactory arrangements are made with the county to retire the debt consistent with
the requirements of this chapter and Minnesota Rules, chapter 3400, and the provider is in
compliance with the arrangements.
(d) When both the family and the provider acted together to intentionally cause the
overpayment, both the family and the provider are jointly liable for the overpayment
regardless of who benefited from the overpayment. The county must recover the overpayment
as provided in paragraphs (b) and (c). When the family or the provider is in compliance
with a repayment agreement, the party in compliance is eligible to receive child care
assistance or to care for children receiving child care assistance despite the other party's
noncompliance with repayment arrangements.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 2.
Minnesota Statutes 2020, section 119B.13, subdivision 1, is amended to read:
Subdivision 1.
Subsidy restrictions.
(a) The maximum rate paid for child care assistance
in any county or county price cluster under the child care fund shall be the greater of the
25th percentile of the deleted text begin 2018deleted text end new text begin 2021new text end child care provider rate survey or the rates in effect at the
time of the update. For a child care provider located within the boundaries of a city located
in two or more of the counties of Benton, Sherburne, and Stearns, the maximum rate paid
for child care assistance shall be equal to the maximum rate paid in the county with the
highest maximum reimbursement rates or the provider's charge, whichever is less. The
commissioner may: (1) assign a county with no reported provider prices to a similar price
cluster; and (2) consider county level access when determining final price clusters.
(b) A rate which includes a special needs rate paid under subdivision 3 may be in excess
of the maximum rate allowed under this subdivision.
(c) The department shall monitor the effect of this paragraph on provider rates. The
county shall pay the provider's full charges for every child in care up to the maximum
established. The commissioner shall determine the maximum rate for each type of care on
an hourly, full-day, and weekly basis, including special needs and disability care.
(d) If a child uses one provider, the maximum payment for one day of care must not
exceed the daily rate. The maximum payment for one week of care must not exceed the
weekly rate.
(e) If a child uses two providers under section 119B.097, the maximum payment must
not exceed:
(1) the daily rate for one day of care;
(2) the weekly rate for one week of care by the child's primary provider; and
(3) two daily rates during two weeks of care by a child's secondary provider.
(f) Child care providers receiving reimbursement under this chapter must not be paid
activity fees or an additional amount above the maximum rates for care provided during
nonstandard hours for families receiving assistance.
(g) If the provider charge is greater than the maximum provider rate allowed, the parent
is responsible for payment of the difference in the rates in addition to any family co-payment
fee.
(h) All maximum provider rates changes shall be implemented on the Monday following
the effective date of the maximum provider rate.
(i) deleted text begin Beginning September 21, 2020,deleted text end The maximum registration fee paid for child care
assistance in any county or county price cluster under the child care fund shall be the greater
of the 25th percentile of the deleted text begin 2018deleted text end new text begin 2021new text end child care provider rate survey or the registration
fee in effect at the time of the update. Maximum registration fees must be set for licensed
family child care and for child care centers. For a child care provider located in the boundaries
of a city located in two or more of the counties of Benton, Sherburne, and Stearns, the
maximum registration fee paid for child care assistance shall be equal to the maximum
registration fee paid in the county with the highest maximum registration fee or the provider's
charge, whichever is less.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 3.
Minnesota Statutes 2020, section 119B.13, subdivision 6, is amended to read:
Subd. 6.
Provider payments.
(a) A provider shall bill only for services documented
according to section 119B.125, subdivision 6. The provider shall bill for services provided
within ten days of the end of the service period. Payments under the child care fund shall
be made within 21 days of receiving a complete bill from the provider. Counties or the state
may establish policies that make payments on a more frequent basis.
(b) If a provider has received an authorization of care and been issued a billing form for
an eligible family, the bill must be submitted within 60 days of the last date of service on
the bill. A bill submitted more than 60 days after the last date of service must be paid if the
county determines that the provider has shown good cause why the bill was not submitted
within 60 days. Good cause must be defined in the county's child care fund plan under
section 119B.08, subdivision 3, and the definition of good cause must include county error.
Any bill submitted more than a year after the last date of service on the bill must not be
paid.
(c) If a provider provided care for a time period without receiving an authorization of
care and a billing form for an eligible family, payment of child care assistance may only be
made retroactively for a maximum of deleted text begin sixdeleted text end new text begin threenew text end months from the date the provider is issued
an authorization of care and billing form.new text begin For a family at application, if a provider provided
child care during a time period without receiving an authorization of care and a billing form,
a county may only make child care assistance payments to the provider retroactively from
the date that child care began, or from the date that the family's eligibility began under
section 119B.09, subdivision 7, or from the date that the family meets authorization
requirements, not to exceed six months from the date that the provider is issued an
authorization of care and billing form, whichever is later.
new text end
(d) A county or the commissioner may refuse to issue a child care authorization to a
licensed or legal nonlicensed provider, revoke an existing child care authorization to a
licensed or legal nonlicensed provider, stop payment issued to a licensed or legal nonlicensed
provider, or refuse to pay a bill submitted by a licensed or legal nonlicensed provider if:
(1) the provider admits to intentionally giving the county materially false information
on the provider's billing forms;
(2) a county or the commissioner finds by a preponderance of the evidence that the
provider intentionally gave the county materially false information on the provider's billing
forms, or provided false attendance records to a county or the commissioner;
(3) the provider is in violation of child care assistance program rules, until the agency
determines those violations have been corrected;
(4) the provider is operating after:
(i) an order of suspension of the provider's license issued by the commissioner;
(ii) an order of revocation of the provider's license; or
(iii) a final order of conditional license issued by the commissioner for as long as the
conditional license is in effect;
(5) the provider submits false attendance reports or refuses to provide documentation
of the child's attendance upon request;
(6) the provider gives false child care price information; or
(7) the provider fails to report decreases in a child's attendance as required under section
119B.125, subdivision 9.
(e) For purposes of paragraph (d), clauses (3), (5), (6), and (7), the county or the
commissioner may withhold the provider's authorization or payment for a period of time
not to exceed three months beyond the time the condition has been corrected.
(f) A county's payment policies must be included in the county's child care plan under
section 119B.08, subdivision 3. If payments are made by the state, in addition to being in
compliance with this subdivision, the payments must be made in compliance with section
16A.124.
new text begin
(g) The commissioner shall not withhold a provider's authorization or payment under
paragraph (d) where the provider's alleged misconduct is the result of the provider relying
upon representations from the commissioner, local agency, or licensor that the provider had
been in compliance with the rules and regulations necessary to maintain the provider's
authorization.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, except that the language
in paragraph (g) is effective retroactively from July 1, 2020.
new text end
Sec. 4.
Minnesota Statutes 2020, section 245E.07, subdivision 1, is amended to read:
Subdivision 1.
Grounds for and methods of monetary recovery.
(a) The department
may obtain monetary recovery from a provider who has been improperly paid by the child
care assistance program, regardless of whether the error was intentional deleted text begin or county errordeleted text end .
new text begin Overpayments designated solely as agency error, and not the result of acts or omissions on
the part of a provider or recipient, must not be established or collected. new text end The department
does not need to establish a pattern as a precondition of monetary recovery of erroneous or
false billing claims, duplicate billing claims, or billing claims based on false statements or
financial misconduct.
(b) The department shall obtain monetary recovery from providers by the following
means:
(1) permitting voluntary repayment of money, either in lump-sum payment or installment
payments;
(2) using any legal collection process;
(3) deducting or withholding program payments; or
(4) utilizing the means set forth in chapter 16D.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 5. new text begin CHILD CARE AND DEVELOPMENT BLOCK GRANT ALLOCATION;
BASIC SLIDING FEE CHILD CARE ASSISTANCE PROGRAM.
new text end
new text begin
The commissioner of human services shall allocate $14,574,000 in fiscal year 2022,
$14,574,000 in fiscal year 2023, and $14,574,000 in fiscal year 2024 from the amount
Minnesota received under the American Rescue Plan Act, Public Law 117-2, section 2201,
for the child care and development block grant, for the basic sliding fee child care assistance
program under Minnesota Statutes, section 119B.03. This is a onetime allocation.
new text end
ARTICLE 11
CHILD PROTECTION
Section 1.
Minnesota Statutes 2020, section 245.4876, subdivision 3, is amended to read:
Subd. 3.
Individual treatment plans.
All providers of outpatient services, day treatment
services, professional home-based family treatment, residential treatment, and acute care
hospital inpatient treatment, and all regional treatment centers that provide mental health
services for children must develop an individual treatment plan for each child client. The
individual treatment plan must be based on a diagnostic assessment. To the extent appropriate,
the child and the child's family shall be involved in all phases of developing and
implementing the individual treatment plan. Providers of residential treatment, professional
home-based family treatment, and acute care hospital inpatient treatment, and regional
treatment centers must develop the individual treatment plan within ten working days of
client intake or admission and must review the individual treatment plan every 90 days after
intakedeleted text begin , except that the administrative review of the treatment plan of a child placed in a
residential facility shall be as specified in sections 260C.203 and 260C.212, subdivision 9deleted text end .
Providers of day treatment services must develop the individual treatment plan before the
completion of five working days in which service is provided or within 30 days after the
diagnostic assessment is completed or obtained, whichever occurs first. Providers of
outpatient services must develop the individual treatment plan within 30 days after the
diagnostic assessment is completed or obtained or by the end of the second session of an
outpatient service, not including the session in which the diagnostic assessment was provided,
whichever occurs first. Providers of outpatient and day treatment services must review the
individual treatment plan every 90 days after intake.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 2.
Minnesota Statutes 2020, section 245.4882, subdivision 1, is amended to read:
Subdivision 1.
Availability of residential treatment services.
County boards must
provide or contract for enough residential treatment services to meet the needs of each child
with severe emotional disturbance residing in the county and needing this level of care.
Length of stay is based on the child's residential treatment need and shall be deleted text begin subject to the
six-month review process established in section 260C.203, and for children in voluntary
placement for treatment, the court review process in section 260D.06deleted text end new text begin reviewed every 90
daysnew text end . Services must be appropriate to the child's age and treatment needs and must be made
available as close to the county as possible. Residential treatment must be designed to:
(1) help the child improve family living and social interaction skills;
(2) help the child gain the necessary skills to return to the community;
(3) stabilize crisis admissions; and
(4) work with families throughout the placement to improve the ability of the families
to care for children with severe emotional disturbance in the home.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 3.
Minnesota Statutes 2020, section 245.4885, subdivision 1, is amended to read:
Subdivision 1.
Admission criteria.
(a) Prior to admission or placement, except in the
case of an emergency, all children referred for treatment of severe emotional disturbance
in a deleted text begin treatment foster care setting,deleted text end residential treatment facilitydeleted text begin ,deleted text end or informally admitted to a
regional treatment center shall undergo an assessment to determine the appropriate level of
care if deleted text begin publicdeleted text end new text begin countynew text end funds are used to pay for the new text begin child's new text end services.
(b) The deleted text begin responsible social services agencydeleted text end new text begin county boardnew text end shall determine the appropriate
level of care for a child when county-controlled funds are used to pay for the child's deleted text begin services
or placementdeleted text end new text begin residential treatment under this chapter, including residential treatment provided
new text end in a qualified residential treatment deleted text begin facility under chapter deleted text end deleted text begin 260Cdeleted text end deleted text begin and licensed by the
commissioner under chapter deleted text end deleted text begin 245Adeleted text end deleted text begin . In accordance with section 260C.157, a juvenile treatment
screening team shall conduct a screening before the team may recommend whether to place
a child in a qualified residential treatmentdeleted text end program as defined in section 260C.007,
subdivision 26d. When a deleted text begin social services agencydeleted text end new text begin county boardnew text end does not have responsibility
for a child's placement and the child is enrolled in a prepaid health program under section
256B.69, the enrolled child's contracted health plan must determine the appropriate level
of carenew text begin for the childnew text end . When Indian Health Services funds or funds of a tribally owned facility
funded under the Indian Self-Determination and Education Assistance Act, Public Law
93-638, are to be usednew text begin for a childnew text end , the Indian Health Services or 638 tribal health facility
must determine the appropriate level of carenew text begin for the childnew text end . When more than one entity bears
responsibility fornew text begin a child'snew text end coverage, the entities shall coordinate level of care determination
activitiesnew text begin for the childnew text end to the extent possible.
(c) The deleted text begin responsible social services agency must make the level of care determination
available to the juvenile treatment screening team, as permitted under chapter deleted text end deleted text begin 13deleted text end deleted text begin . The level
of care determination shall inform the juvenile treatment screening team process and the
assessment in section 260C.704 when considering whether to place the child in a qualified
residential treatment program. When the responsible social services agency is not involved
in determining a child's placement, thedeleted text end child's level of care determination 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
deleted text begin needdeleted text end new text begin needsnew text end .
(d) When a level of care determination is conducted, the deleted text begin responsible social services
agencydeleted text end new text begin county boardnew text end or other entity may not determine that a screening deleted text begin under section
260C.157 ordeleted text end new text begin ,new text end referralnew text begin ,new text end or admission to a treatment foster care setting or residential treatment
facility 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. The level of care determination must be based on a diagnostic
assessment deleted text begin that includes a functional assessmentdeleted text end new text begin of a child new text end which evaluatesnew text begin the child'snew text end
family, school, and community living situations; 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 carenew text begin to the childnew text end . The validated tool must be approved by
the commissioner of human services. If a diagnostic assessment deleted text begin including a functionaldeleted text end
deleted text begin assessmentdeleted text end has been completed by a mental health professional within the past 180 days, a
new diagnostic 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 level of care determination process shall include
specific community services needed by the child and, if appropriate, the child's family, and
shall indicate whether deleted text begin or notdeleted text end these services are available and accessible to the child andnew text begin the
child'snew text end family.new text begin The child and the child's family must be invited to any meeting at which the
level of care determination is discussed and decisions regarding residential treatment are
made. The child and the child's family may invite other relatives, friends, or advocates to
attend these meetings.
new text end
(e) During the level of care determination 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.
(f) deleted text begin When the responsible social services agency has authority, the agency must engage
the child's parents in case planning under sections 260C.212 and 260C.708 unless a court
terminates the parent's rights or court orders restrict the parent from participating in case
planning, visitation, or parental responsibilities.
deleted text end
deleted text begin (g)deleted text end The level of care determination, and placement decision, and recommendations for
mental health services must be documented in the child's record, as required in deleted text begin chapterdeleted text end new text begin
chaptersnew text end 260Cnew text begin and 260Dnew text end .
new text begin
(g) Discharge planning for the child to return to the community must include identification
of and referrals to appropriate home and community supports to meet the needs of the child
and family. Discharge planning must begin within 30 days after the child enters residential
treatment and be updated every 60 days.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 4.
Minnesota Statutes 2020, section 245A.02, is amended by adding a subdivision to
read:
new text begin Subd. 3c. new text end
new text begin
At risk of becoming a victim of sex trafficking or commercial sexual
exploitation.
new text end
new text begin
For the purposes of section 245A.25, a youth who is "at risk of becoming a
victim of sex trafficking or commercial sexual exploitation" means a youth who meets the
criteria established by the commissioner of human services for this purpose.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 5.
Minnesota Statutes 2020, section 245A.02, is amended by adding a subdivision to
read:
new text begin Subd. 4a. new text end
new text begin Children's residential facility. new text end
new text begin
"Children's residential facility" means a
residential program licensed under this chapter or chapter 241 according to the applicable
standards in Minnesota Rules, parts 2960.0010 to 2960.0710.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 6.
Minnesota Statutes 2020, section 245A.02, is amended by adding a subdivision to
read:
new text begin Subd. 6d. new text end
new text begin Foster family setting. new text end
new text begin
"Foster family setting" has the meaning given in
Minnesota Rules, part 2960.3010, subpart 23, and includes settings licensed by the
commissioner of human services or the commissioner of corrections.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 7.
Minnesota Statutes 2020, section 245A.02, is amended by adding a subdivision to
read:
new text begin Subd. 6e. new text end
new text begin Foster residence setting. new text end
new text begin
"Foster residence setting" has the meaning given
in Minnesota Rules, part 2960.3010, subpart 26, and includes settings licensed by the
commissioner of human services or the commissioner of corrections.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 8.
Minnesota Statutes 2020, section 245A.02, is amended by adding a subdivision to
read:
new text begin Subd. 18a. new text end
new text begin Trauma. new text end
new text begin
For the purposes of section 245A.25, "trauma" means an event,
series of events, or set of circumstances experienced by an individual as physically or
emotionally harmful or life-threatening and has lasting adverse effects on the individual's
functioning and mental, physical, social, emotional, or spiritual well-being. Trauma includes
the cumulative emotional or psychological harm of group traumatic experiences transmitted
across generations within a community that are often associated with racial and ethnic
population groups that have suffered major intergenerational losses.
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. 9.
Minnesota Statutes 2020, section 245A.02, is amended by adding a subdivision to
read:
new text begin Subd. 23. new text end
new text begin Victim of sex trafficking or commercial sexual exploitation. new text end
new text begin
For the purposes
of section 245A.25, "victim of sex trafficking or commercial sexual exploitation" means a
person who meets the definitions in section 260C.007, subdivision 31, clauses (4) and (5).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 10.
Minnesota Statutes 2020, section 245A.02, is amended by adding a subdivision
to read:
new text begin Subd. 24. new text end
new text begin Youth. new text end
new text begin
For the purposes of section 245A.25, "youth" means a child as defined
in section 260C.007, subdivision 4, and includes individuals under 21 years of age who are
in foster care pursuant to section 260C.451.
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. 11.
Minnesota Statutes 2020, section 245A.041, is amended by adding a subdivision
to read:
new text begin Subd. 5. new text end
new text begin
First date of working in a facility or setting; documentation
requirements.
new text end
new text begin
Children's residential facility and foster residence setting license holders
must document the first date that a person who is a background study subject begins working
in the license holder's facility or setting. If the license holder does not maintain documentation
of each background study subject's first date of working in the facility or setting in the
license holder's personnel files, the license holder must provide documentation to the
commissioner that contains the first date that each background study subject began working
in the license holder's program upon the commissioner's request.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021.
new text end
Sec. 12.
new text begin
[245A.25] RESIDENTIAL PROGRAM CERTIFICATIONS FOR
COMPLIANCE WITH THE FAMILY FIRST PREVENTION SERVICES ACT.
new text end
new text begin Subdivision 1. new text end
new text begin Certification scope and applicability. new text end
new text begin
(a) This section establishes the
requirements that a children's residential facility or child foster residence setting must meet
to be certified for the purposes of Title IV-E funding requirements as:
new text end
new text begin
(1) a qualified residential treatment program;
new text end
new text begin
(2) a residential setting specializing in providing care and supportive services for youth
who have been or are at risk of becoming victims of sex trafficking or commercial sexual
exploitation;
new text end
new text begin
(3) a residential setting specializing in providing prenatal, postpartum, or parenting
support for youth; or
new text end
new text begin
(4) a supervised independent living setting for youth who are 18 years of age or older.
new text end
new text begin
(b) This section does not apply to a foster family setting in which the license holder
resides in the foster home.
new text end
new text begin
(c) Children's residential facilities licensed as detention settings according to Minnesota
Rules, parts 2960.0230 to 2960.0290, or secure programs according to Minnesota Rules,
parts 2960.0300 to 2960.0420, may not be certified under this section.
new text end
new text begin
(d) For purposes of this section, "license holder" means an individual, organization, or
government entity that was issued a children's residential facility or foster residence setting
license by the commissioner of human services under this chapter or by the commissioner
of corrections under chapter 241.
new text end
new text begin
(e) Certifications issued under this section for foster residence settings may only be
issued by the commissioner of human services and are not delegated to county or private
licensing agencies under section 245A.16.
new text end
new text begin Subd. 2. new text end
new text begin Program certification types and requests for certification. new text end
new text begin
(a) By July 1,
2021, the commissioner of human services must offer certifications to license holders for
the following types of programs:
new text end
new text begin
(1) qualified residential treatment programs;
new text end
new text begin
(2) residential settings specializing in providing care and supportive services for youth
who have been or are at risk of becoming victims of sex trafficking or commercial sexual
exploitation;
new text end
new text begin
(3) residential settings specializing in providing prenatal, postpartum, or parenting
support for youth; and
new text end
new text begin
(4) supervised independent living settings for youth who are 18 years of age or older.
new text end
new text begin
(b) An applicant or license holder must submit a request for certification under this
section on a form and in a manner prescribed by the commissioner of human services. The
decision of the commissioner of human services to grant or deny a certification request is
final and not subject to appeal under chapter 14.
new text end
new text begin Subd. 3. new text end
new text begin Trauma-informed care. new text end
new text begin
(a) Programs certified under subdivision 4 or 5 must
provide services to a person according to a trauma-informed model of care that meets the
requirements of this subdivision, except that programs certified under subdivision 5 are not
required to meet the requirements of paragraph (e).
new text end
new text begin
(b) For the purposes of this section, "trauma-informed care" means care that:
new text end
new text begin
(1) acknowledges the effects of trauma on a person receiving services and on the person's
family;
new text end
new text begin
(2) modifies services to respond to the effects of trauma on the person receiving services;
new text end
new text begin
(3) emphasizes skill and strength-building rather than symptom management; and
new text end
new text begin
(4) focuses on the physical and psychological safety of the person receiving services
and the person's family.
new text end
new text begin
(c) The license holder must have a process for identifying the signs and symptoms of
trauma in a youth and must address the youth's needs related to trauma. This process must
include:
new text end
new text begin
(1) screening for trauma by completing a trauma-specific screening tool with each youth
upon the youth's admission or obtaining the results of a trauma-specific screening tool that
was completed with the youth within 30 days prior to the youth's admission to the program;
and
new text end
new text begin
(2) ensuring that trauma-based interventions targeting specific trauma-related symptoms
are available to each youth when needed to assist the youth in obtaining services. For
qualified residential treatment programs, this must include the provision of services in
paragraph (e).
new text end
new text begin
(d) The license holder must develop and provide services to each youth according to the
principles of trauma-informed care including:
new text end
new text begin
(1) recognizing the impact of trauma on a youth when determining the youth's service
needs and providing services to the youth;
new text end
new text begin
(2) allowing each youth to participate in reviewing and developing the youth's
individualized treatment or service plan;
new text end
new text begin
(3) providing services to each youth that are person-centered and culturally responsive;
and
new text end
new text begin
(4) adjusting services for each youth to address additional needs of the youth.
new text end
new text begin
(e) In addition to the other requirements of this subdivision, qualified residential treatment
programs must use a trauma-based treatment model that includes:
new text end
new text begin
(1) assessing each youth to determine if the youth needs trauma-specific treatment
interventions;
new text end
new text begin
(2) identifying in each youth's treatment plan how the program will provide
trauma-specific treatment interventions to the youth;
new text end
new text begin
(3) providing trauma-specific treatment interventions to a youth that target the youth's
specific trauma-related symptoms; and
new text end
new text begin
(4) training all clinical staff of the program on trauma-specific treatment interventions.
new text end
new text begin
(f) At the license holder's program, the license holder must provide a physical, social,
and emotional environment that:
new text end
new text begin
(1) promotes the physical and psychological safety of each youth;
new text end
new text begin
(2) avoids aspects that may be retraumatizing;
new text end
new text begin
(3) responds to trauma experienced by each youth and the youth's other needs; and
new text end
new text begin
(4) includes designated spaces that are available to each youth for engaging in sensory
and self-soothing activities.
new text end
new text begin
(g) The license holder must base the program's policies and procedures on
trauma-informed principles. In the program's policies and procedures, the license holder
must:
new text end
new text begin
(1) describe how the program provides services according to a trauma-informed model
of care;
new text end
new text begin
(2) describe how the program's environment fulfills the requirements of paragraph (f);
new text end
new text begin
(3) prohibit the use of aversive consequences for a youth's violation of program rules
or any other reason;
new text end
new text begin
(4) describe the process for how the license holder incorporates trauma-informed
principles and practices into the organizational culture of the license holder's program; and
new text end
new text begin
(5) if the program is certified to use restrictive procedures under Minnesota Rules, part
2960.0710, describe how the program uses restrictive procedures only when necessary for
a youth in a manner that addresses the youth's history of trauma and avoids causing the
youth additional trauma.
new text end
new text begin
(h) Prior to allowing a staff person to have direct contact, as defined in section 245C.02,
subdivision 11, with a youth and annually thereafter, the license holder must train each staff
person about:
new text end
new text begin
(1) concepts of trauma-informed care and how to provide services to each youth according
to these concepts; and
new text end
new text begin
(2) impacts of each youth's culture, race, gender, and sexual orientation on the youth's
behavioral health and traumatic experiences.
new text end
new text begin Subd. 4. new text end
new text begin Qualified residential treatment programs; certification requirements. new text end
new text begin
(a)
To be certified as a qualified residential treatment program, a license holder must meet:
new text end
new text begin
(1) the definition of a qualified residential treatment program in section 260C.007,
subdivision 26d;
new text end
new text begin
(2) the requirements for providing trauma-informed care and using a trauma-based
treatment model in subdivision 3; and
new text end
new text begin
(3) the requirements of this subdivision.
new text end
new text begin
(b) For each youth placed in the license holder's program, the license holder must
collaborate with the responsible social services agency and other appropriate parties to
implement the youth's out-of-home placement plan and the youth's short-term and long-term
mental health and behavioral health goals in the assessment required by sections 260C.212,
subdivision 1; 260C.704; and 260C.708.
new text end
new text begin
(c) A qualified residential treatment program must use a trauma-based treatment model
that meets all of the requirements of subdivision 3 that is designed to address the needs,
including clinical needs, of youth with serious emotional or behavioral disorders or
disturbances. The license holder must develop, document, and review a treatment plan for
each youth according to the requirements of Minnesota Rules, parts 2960.0180, subpart 2,
item B; and 2960.0190, subpart 2.
new text end
new text begin
(d) The following types of staff must be on-site according to the program's treatment
model and must be available 24 hours a day and seven days a week to provide care within
the scope of their practice:
new text end
new text begin
(1) a registered nurse or licensed practical nurse licensed by the Minnesota Board of
Nursing to practice professional nursing or practical nursing as defined in section 148.171,
subdivisions 14 and 15; and
new text end
new text begin
(2) other licensed clinical staff to meet each youth's clinical needs.
new text end
new text begin
(e) A qualified residential treatment program must be accredited by one of the following
independent, not-for-profit organizations:
new text end
new text begin
(1) the Commission on Accreditation of Rehabilitation Facilities (CARF);
new text end
new text begin
(2) the Joint Commission;
new text end
new text begin
(3) the Council on Accreditation (COA); or
new text end
new text begin
(4) another independent, not-for-profit accrediting organization approved by the Secretary
of the United States Department of Health and Human Services.
new text end
new text begin
(f) The license holder must facilitate participation of a youth's family members in the
youth's treatment program, consistent with the youth's best interests and according to the
youth's out-of-home placement plan required by sections 260C.212, subdivision 1; and
260C.708.
new text end
new text begin
(g) The license holder must contact and facilitate outreach to each youth's family
members, including the youth's siblings, and must document outreach to the youth's family
members in the youth's file, including the contact method and each family member's contact
information. In the youth's file, the license holder must record and maintain the contact
information for all known biological family members and fictive kin of the youth.
new text end
new text begin
(h) The license holder must document in the youth's file how the program integrates
family members into the treatment process for the youth, including after the youth's discharge
from the program, and how the program maintains the youth's connections to the youth's
siblings.
new text end
new text begin
(i) The program must provide discharge planning and family-based aftercare support to
each youth for at least six months after the youth's discharge from the program. When
providing aftercare to a youth, the program must have monthly contact with the youth and
the youth's caregivers to promote the youth's engagement in aftercare services and to regularly
evaluate the family's needs. The program's monthly contact with the youth may be
face-to-face, by telephone, or virtual.
new text end
new text begin
(j) The license holder must maintain a service delivery plan that describes how the
program provides services according to the requirements in paragraphs (b) to (i).
new text end
new text begin Subd. 5. new text end
new text begin
Residential settings specializing in providing care and supportive services
for youth who have been or are at risk of becoming victims of sex trafficking or
commercial sexual exploitation; certification requirements.
new text end
new text begin
(a) To be certified as a
residential setting specializing in providing care and supportive services for youth who have
been or are at risk of becoming victims of sex trafficking or commercial sexual exploitation,
a license holder must meet the requirements of this subdivision.
new text end
new text begin
(b) Settings certified according to this subdivision are exempt from the requirements of
section 245A.04, subdivision 11, paragraph (b).
new text end
new text begin
(c) The program must use a trauma-informed model of care that meets all of the applicable
requirements of subdivision 3, and that is designed to address the needs, including emotional
and mental health needs, of youth who have been or are at risk of becoming victims of sex
trafficking or commercial sexual exploitation.
new text end
new text begin
(d) The program must provide high-quality care and supportive services for youth who
have been or are at risk of becoming victims of sex trafficking or commercial sexual
exploitation and must:
new text end
new text begin
(1) offer a safe setting to each youth designed to prevent ongoing and future trafficking
of the youth;
new text end
new text begin
(2) provide equitable, culturally responsive, and individualized services to each youth;
new text end
new text begin
(3) assist each youth with accessing medical, mental health, legal, advocacy, and family
services based on the youth's individual needs;
new text end
new text begin
(4) provide each youth with relevant educational, life skills, and employment supports
based on the youth's individual needs;
new text end
new text begin
(5) offer a trafficking prevention education curriculum and provide support for each
youth at risk of future sex trafficking or commercial sexual exploitation; and
new text end
new text begin
(6) engage with the discharge planning process for each youth and the youth's family.
new text end
new text begin
(e) The license holder must maintain a service delivery plan that describes how the
program provides services according to the requirements in paragraphs (c) and (d).
new text end
new text begin
(f) The license holder must ensure that each staff person who has direct contact, as
defined in section 245C.02, subdivision 11, with a youth served by the license holder's
program completes a human trafficking training approved by the Department of Human
Services' Children and Family Services Administration before the staff person has direct
contact with a youth served by the program and annually thereafter. For programs certified
prior to January 1, 2022, the license holder must ensure that each staff person at the license
holder's program completes the initial training by January 1, 2022.
new text end
new text begin Subd. 6. new text end
new text begin
Residential settings specializing in providing prenatal, postpartum, or
parenting supports for youth; certification requirements.
new text end
new text begin
(a) To be certified as a
residential setting specializing in providing prenatal, postpartum, or parenting supports for
youth, a license holder must meet the requirements of this subdivision.
new text end
new text begin
(b) The license holder must collaborate with the responsible social services agency and
other appropriate parties to implement each youth's out-of-home placement plan required
by section 260C.212, subdivision 1.
new text end
new text begin
(c) The license holder must specialize in providing prenatal, postpartum, or parenting
supports for youth and must:
new text end
new text begin
(1) provide equitable, culturally responsive, and individualized services to each youth;
new text end
new text begin
(2) assist each youth with accessing postpartum services during the same period of time
that a woman is considered pregnant for the purposes of medical assistance eligibility under
section 256B.055, subdivision 6, including providing each youth with:
new text end
new text begin
(i) sexual and reproductive health services and education; and
new text end
new text begin
(ii) a postpartum mental health assessment and follow-up services; and
new text end
new text begin
(3) discharge planning that includes the youth and the youth's family.
new text end
new text begin
(d) On or before the date of a child's initial physical presence at the facility, the license
holder must provide education to the child's parent related to safe bathing and reducing the
risk of sudden unexpected infant death and abusive head trauma from shaking infants and
young children. The license holder must use the educational material developed by the
commissioner of human services to comply with this requirement. At a minimum, the
education must address:
new text end
new text begin
(1) instruction that: (i) a child or infant should never be left unattended around water;
(ii) a tub should be filled with only two to four inches of water for infants; and (iii) an infant
should never be put into a tub when the water is running; and
new text end
new text begin
(2) the risk factors related to sudden unexpected infant death and abusive head trauma
from shaking infants and young children and means of reducing the risks, including the
safety precautions identified in section 245A.1435 and the risks of co-sleeping.
new text end
new text begin
The license holder must document the parent's receipt of the education and keep the
documentation in the parent's file. The documentation must indicate whether the parent
agrees to comply with the safeguards described in this paragraph. If the parent refuses to
comply, program staff must provide additional education to the parent as described in the
parental supervision plan. The parental supervision plan must include the intervention,
frequency, and staff responsible for the duration of the parent's participation in the program
or until the parent agrees to comply with the safeguards described in this paragraph.
new text end
new text begin
(e) On or before the date of a child's initial physical presence at the facility, the license
holder must document the parent's capacity to meet the health and safety needs of the child
while on the facility premises considering the following factors:
new text end
new text begin
(1) the parent's physical and mental health;
new text end
new text begin
(2) the parent being under the influence of drugs, alcohol, medications, or other chemicals;
new text end
new text begin
(3) the child's physical and mental health; and
new text end
new text begin
(4) any other information available to the license holder indicating that the parent may
not be able to adequately care for the child.
new text end
new text begin
(f) The license holder must have written procedures specifying the actions that staff shall
take if a parent is or becomes unable to adequately care for the parent's child.
new text end
new text begin
(g) If the parent refuses to comply with the safeguards described in paragraph (d) or is
unable to adequately care for the child, the license holder must develop a parental supervision
plan in conjunction with the parent. The plan must account for any factors in paragraph (e)
that contribute to the parent's inability to adequately care for the child. The plan must be
dated and signed by the staff person who completed the plan.
new text end
new text begin
(h) The license holder must have written procedures addressing whether the program
permits a parent to arrange for supervision of the parent's child by another youth in the
program. If permitted, the facility must have a procedure that requires staff approval of the
supervision arrangement before the supervision by the nonparental youth occurs. The
procedure for approval must include an assessment of the nonparental youth's capacity to
assume the supervisory responsibilities using the criteria in paragraph (e). The license holder
must document the license holder's approval of the supervisory arrangement and the
assessment of the nonparental youth's capacity to supervise the child and must keep this
documentation in the file of the parent whose child is being supervised by the nonparental
youth.
new text end
new text begin
(i) The license holder must maintain a service delivery plan that describes how the
program provides services according to paragraphs (b) to (h).
new text end
new text begin Subd. 7. new text end
new text begin
Supervised independent living settings for youth 18 years of age or older;
certification requirements.
new text end
new text begin
(a) To be certified as a supervised independent living setting
for youth who are 18 years of age or older, a license holder must meet the requirements of
this subdivision.
new text end
new text begin
(b) A license holder must provide training, counseling, instruction, supervision, and
assistance for independent living according to the youth's needs.
new text end
new text begin
(c) A license holder may provide services to assist the youth with locating housing,
money management, meal preparation, shopping, health care, transportation, and any other
support services necessary to meet the youth's needs and improve the youth's ability to
conduct such tasks independently.
new text end
new text begin
(d) The service plan for the youth must contain an objective of independent living skills.
new text end
new text begin
(e) The license holder must maintain a service delivery plan that describes how the
program provides services according to paragraphs (b) to (d).
new text end
new text begin Subd. 8. new text end
new text begin Monitoring and inspections. new text end
new text begin
(a) For a program licensed by the commissioner
of human services, the commissioner of human services may review a program's compliance
with certification requirements by conducting an inspection, a licensing review, or an
investigation of the program. The commissioner may issue a correction order to the license
holder for a program's noncompliance with the certification requirements of this section.
For a program licensed by the commissioner of human services, a license holder must make
a request for reconsideration of a correction order according to section 245A.06, subdivision
2.
new text end
new text begin
(b) For a program licensed by the commissioner of corrections, the commissioner of
human services may review the program's compliance with the requirements for a certification
issued under this section biennially and may issue a correction order identifying the program's
noncompliance with the requirements of this section. The correction order must state the
following:
new text end
new text begin
(1) the conditions that constitute a violation of a law or rule;
new text end
new text begin
(2) the specific law or rule violated; and
new text end
new text begin
(3) the time allowed for the program to correct each violation.
new text end
new text begin
(c) For a program licensed by the commissioner of corrections, if a license holder believes
that there are errors in the correction order of the commissioner of human services, the
license holder may ask the Department of Human Services to reconsider the parts of the
correction order that the license holder alleges are in error. To submit a request for
reconsideration, the license holder must send a written request for reconsideration by United
States mail to the commissioner of human services. The request for reconsideration must
be postmarked within 20 calendar days of the date that the correction order was received
by the license holder and must:
new text end
new text begin
(1) specify the parts of the correction order that are alleged to be in error;
new text end
new text begin
(2) explain why the parts of the correction order are in error; and
new text end
new text begin
(3) include documentation to support the allegation of error.
new text end
new text begin
A request for reconsideration does not stay any provisions or requirements of the correction
order. The commissioner of human services' disposition of a request for reconsideration is
final and not subject to appeal under chapter 14.
new text end
new text begin
(d) Nothing in this subdivision prohibits the commissioner of human services from
decertifying a license holder according to subdivision 9 prior to issuing a correction order.
new text end
new text begin Subd. 9. new text end
new text begin Decertification. new text end
new text begin
(a) The commissioner of human services may rescind a
certification issued under this section if a license holder fails to comply with the certification
requirements in this section.
new text end
new text begin
(b) The license holder may request reconsideration of a decertification by notifying the
commissioner of human services by certified mail or personal service. The license holder
must request reconsideration of a decertification in writing. If the license holder sends the
request for reconsideration of a decertification by certified mail, the license holder must
send the request by United States mail to the commissioner of human services and the
request must be postmarked within 20 calendar days after the license holder received the
notice of decertification. If the license holder requests reconsideration of a decertification
by personal service, the request for reconsideration must be received by the commissioner
of human services within 20 calendar days after the license holder received the notice of
decertification. When submitting a request for reconsideration of a decertification, the license
holder must submit a written argument or evidence in support of the request for
reconsideration.
new text end
new text begin
(c) The commissioner of human services' disposition of a request for reconsideration is
final and not subject to appeal under chapter 14.
new text end
new text begin Subd. 10. new text end
new text begin Variances. new text end
new text begin
The commissioner of human services may grant variances to the
requirements in this section that do not affect a youth's health or safety or compliance with
federal requirements for Title IV-E funding if the conditions in section 245A.04, subdivision
9, are met.
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. 13.
Minnesota Statutes 2020, section 256.01, subdivision 14b, is amended to read:
Subd. 14b.
American Indian child welfare projects.
(a) The commissioner of human
services may authorize projects to initiate tribal delivery of child welfare services to American
Indian children and their parents and custodians living on the reservation. The commissioner
has authority to solicit and determine which tribes may participate in a project. Grants may
be issued to Minnesota Indian tribes to support the projects. The commissioner may waive
existing state rules as needed to accomplish the projects. The commissioner may authorize
projects to use alternative methods of (1) screening, investigating, and assessing reports of
child maltreatment, and (2) administrative reconsideration, administrative appeal, and
judicial appeal of maltreatment determinations, provided the alternative methods used by
the projects comply with the provisions of section 256.045 and chapter 260E that deal with
the rights of individuals who are the subjects of reports or investigations, including notice
and appeal rights and data practices requirements. The commissioner shall only authorize
alternative methods that comply with the public policy under section 260E.01. The
commissioner may seek any federal approval necessary to carry out the projects as well as
seek and use any funds available to the commissioner, including use of federal funds,
foundation funds, existing grant funds, and other funds. The commissioner is authorized to
advance state funds as necessary to operate the projects. Federal reimbursement applicable
to the projects is appropriated to the commissioner for the purposes of the projects. The
projects must be required to address responsibility for safety, permanency, and well-being
of children.
(b) For the purposes of this section, "American Indian child" means a person under 21
years old and who is a tribal member or eligible for membership in one of the tribes chosen
for a project under this subdivision and who is residing on the reservation of that tribe.
(c) In order to qualify for an American Indian child welfare project, a tribe must:
(1) be one of the existing tribes with reservation land in Minnesota;
(2) have a tribal court with jurisdiction over child custody proceedings;
(3) have a substantial number of children for whom determinations of maltreatment have
occurred;
(4)(i) have capacity to respond to reports of abuse and neglect under chapter 260E; or
(ii) have codified the tribe's screening, investigation, and assessment of reports of child
maltreatment procedures, if authorized to use an alternative method by the commissioner
under paragraph (a);
(5) provide a wide range of services to families in need of child welfare services; deleted text begin and
deleted text end
(6) have a tribal-state title IV-E agreement in effectnew text begin ; and
new text end
new text begin (7) enter into host Tribal contracts pursuant to section 256.0112, subdivision 6new text end .
(d) Grants awarded under this section may be used for the nonfederal costs of providing
child welfare services to American Indian children on the tribe's reservation, including costs
associated with:
(1) assessment and prevention of child abuse and neglect;
(2) family preservation;
(3) facilitative, supportive, and reunification services;
(4) out-of-home placement for children removed from the home for child protective
purposes; and
(5) other activities and services approved by the commissioner that further the goals of
providing safety, permanency, and well-being of American Indian children.
(e) When a tribe has initiated a project and has been approved by the commissioner to
assume child welfare responsibilities for American Indian children of that tribe under this
section, the affected county social service agency is relieved of responsibility for responding
to reports of abuse and neglect under chapter 260E for those children during the time within
which the tribal project is in effect and funded. The commissioner shall work with tribes
and affected counties to develop procedures for data collection, evaluation, and clarification
of ongoing role and financial responsibilities of the county and tribe for child welfare services
prior to initiation of the project. Children who have not been identified by the tribe as
participating in the project shall remain the responsibility of the county. Nothing in this
section shall alter responsibilities of the county for law enforcement or court services.
(f) Participating tribes may conduct children's mental health screenings under section
245.4874, subdivision 1, paragraph (a), clause (12), for children who are eligible for the
initiative and living on the reservation and who meet one of the following criteria:
(1) the child must be receiving child protective services;
(2) the child must be in foster care; or
(3) the child's parents must have had parental rights suspended or terminated.
Tribes may access reimbursement from available state funds for conducting the screenings.
Nothing in this section shall alter responsibilities of the county for providing services under
section 245.487.
(g) Participating tribes may establish a local child mortality review panel. In establishing
a local child mortality review panel, the tribe agrees to conduct local child mortality reviews
for child deaths or near-fatalities occurring on the reservation under subdivision 12. Tribes
with established child mortality review panels shall have access to nonpublic data and shall
protect nonpublic data under subdivision 12, paragraphs (c) to (e). The tribe shall provide
written notice to the commissioner and affected counties when a local child mortality review
panel has been established and shall provide data upon request of the commissioner for
purposes of sharing nonpublic data with members of the state child mortality review panel
in connection to an individual case.
(h) The commissioner shall collect information on outcomes relating to child safety,
permanency, and well-being of American Indian children who are served in the projects.
Participating tribes must provide information to the state in a format and completeness
deemed acceptable by the state to meet state and federal reporting requirements.
(i) In consultation with the White Earth Band, the commissioner shall develop and submit
to the chairs and ranking minority members of the legislative committees with jurisdiction
over health and human services a plan to transfer legal responsibility for providing child
protective services to White Earth Band member children residing in Hennepin County to
the White Earth Band. The plan shall include a financing proposal, definitions of key terms,
statutory amendments required, and other provisions required to implement the plan. The
commissioner shall submit the plan by January 15, 2012.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 14.
Minnesota Statutes 2020, section 256.0112, subdivision 6, is amended to read:
Subd. 6.
Contracting within and across county lines; lead county contractsnew text begin ; lead
Tribal contractsnew text end .
Paragraphs (a) to (e) govern contracting within and across county lines
and lead county contracts.new text begin Paragraphs (a) to (e) govern contracting within and across
reservation boundaries and lead Tribal contracts for initiative tribes under section 256.01,
subdivision 14b. For purposes of this subdivision, "local agency" includes a tribe or a county
agency.
new text end
(a) Once a local agency and an approved vendor execute a contract that meets the
requirements of this subdivision, the contract governs all other purchases of service from
the vendor by all other local agencies for the term of the contract. The local agency that
negotiated and entered into the contract becomes the leadnew text begin tribe ornew text end county for the contract.
(b) When the local agency in the countynew text begin or reservationnew text end where a vendor is located wants
to purchase services from that vendor and the vendor has no contract with the local agency
or any othernew text begin tribe ornew text end county, the local agency must negotiate and execute a contract with
the vendor.
(c) When a local agency deleted text begin in one countydeleted text end wants to purchase services from a vendor located
in another countynew text begin or reservationnew text end , it must notify the local agency in the countynew text begin or reservationnew text end
where the vendor is located. Within 30 days of being notified, the local agency in the vendor's
countynew text begin or reservationnew text end must:
(1) if it has a contract with the vendor, send a copy to the inquiring new text begin local new text end agency;
(2) if there is a contract with the vendor for which another local agency is the lead new text begin tribe
or new text end county, identify the lead new text begin tribe or new text end county to the inquiring agency; or
(3) if no local agency has a contract with the vendor, inform the inquiring agency whether
it will negotiate a contract and become the lead new text begin tribe or new text end county. If the agency where the
vendor is located will not negotiate a contract with the vendor because of concerns related
to clients' health and safety, the agency must share those concerns with the inquiringnew text begin localnew text end
agency.
(d) If the local agency in the county where the vendor is located declines to negotiate a
contract with the vendor or fails to respond within 30 days of receiving the notification
under paragraph (c), the inquiring agency is authorized to negotiate a contract and must
notify the local agency that declined or failed to respond.
(e) When the inquiring deleted text begin countydeleted text end new text begin local agencynew text end under paragraph (d) becomes the lead new text begin tribe
or new text end county for a contract and the contract expires and needs to be renegotiated, that new text begin tribe or
new text end county must again follow the requirements under paragraph (c) and notify the local agency
where the vendor is located. The local agency where the vendor is located has the option
of becoming the lead new text begin tribe or new text end county for the new contract. If the local agency does not
exercise the option, paragraph (d) applies.
(f) This subdivision does not affect the requirement to seek county concurrence under
section 256B.092, subdivision 8a, when the services are to be purchased for a person with
a developmental disability or under section 245.4711, subdivision 3, when the services to
be purchased are for an adult with serious and persistent mental illness.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 15.
Minnesota Statutes 2020, section 260C.007, subdivision 26c, is amended to read:
Subd. 26c.
Qualified individual.
new text begin (a) new text end "Qualified individual" means a trained culturally
competent professional or licensed clinician, including a mental health professional under
section 245.4871, subdivision 27, who is deleted text begin notdeleted text end new text begin qualified to conduct the assessment approved
by the commissioner. The qualified individual must not benew text end an employee of the responsible
social services agency deleted text begin and who is notdeleted text end new text begin or an individualnew text end connected to or affiliated with any
placement setting in which a responsible social services agency has placed children.
new text begin
(b) When the Indian Child Welfare Act of 1978, United States Code, title 25, sections
1901 to 1963, applies to a child, the county must contact the child's tribe without delay to
give the tribe the option to designate a qualified individual who is a trained culturally
competent professional or licensed clinician, including a mental health professional under
section 245.4871, subdivision 27, who is not employed by the responsible social services
agency and who is not connected to or affiliated with any placement setting in which a
responsible social services agency has placed children. Only a federal waiver that
demonstrates maintained objectivity may allow a responsible social services agency employee
or Tribal employee affiliated with any placement setting in which the responsible social
services agency has placed children to be designated the qualified individual.
new text end
Sec. 16.
Minnesota Statutes 2020, section 260C.007, subdivision 31, is amended to read:
Subd. 31.
Sexually exploited youth.
"Sexually exploited youth" means an individual
who:
(1) is alleged to have engaged in conduct which would, if committed by an adult, violate
any federal, state, or local law relating to being hired, offering to be hired, or agreeing to
be hired by another individual to engage in sexual penetration or sexual conduct;
(2) is a victim of a crime described in section 609.342, 609.343, 609.344, 609.345,
609.3451, 609.3453, 609.352, 617.246, or 617.247;
(3) is a victim of a crime described in United States Code, title 18, section 2260; 2421;
2422; 2423; 2425; 2425A; or 2256; deleted text begin or
deleted text end
(4) is a sex trafficking victim as defined in section 609.321, subdivision 7bdeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(5) is a victim of commercial sexual exploitation as defined in United States Code, title
22, section 7102(11)(A) and (12).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 17.
Minnesota Statutes 2020, section 260C.157, subdivision 3, is amended to read:
Subd. 3.
Juvenile treatment screening team.
(a) The responsible social services agency
shall establish a juvenile treatment screening team to conduct screenings under this chapternew text begin
and chapter 260D,new text end deleted text begin and section 245.487, subdivision 3,deleted text end for a child to receive treatment for
an emotional disturbance, a developmental disability, or related condition in a residential
treatment facility licensed by the commissioner of human services under chapter 245A, or
licensed or approved by a tribe. A screening team is not required for a child to be in: (1) a
residential facility specializing in prenatal, postpartum, or parenting support; (2) a facility
specializing in high-quality residential care and supportive services to children and youth
who deleted text begin aredeleted text end new text begin have been or are at risk of becoming victims ofnew text end deleted text begin sex-traffickingdeleted text end new text begin sex trafficking
new text end deleted text begin victims or are at risk of becoming sex-trafficking victimsdeleted text end new text begin or commercial sexual exploitationnew text end ;
(3) supervised settings for youthnew text begin who arenew text end 18 years deleted text begin olddeleted text end new text begin of agenew text end or oldernew text begin andnew text end living
independently; or (4) a licensed residential family-based treatment facility for substance
abuse consistent with section 260C.190. Screenings are also not required when a child must
be placed in a facility due to an emotional crisis or other mental health emergency.
(b) The responsible social services agency shall conduct screenings within 15 days of a
request for a screening, unless the screening is for the purpose of residential treatment and
the child is enrolled in a prepaid health program under section 256B.69, in which case the
agency shall conduct the screening within ten working days of a request. The responsible
social services agency shall convene the new text begin juvenile treatment screening new text end team, which may be
constituted under section 245.4885 or 256B.092 or Minnesota Rules, parts 9530.6600 to
9530.6655. The team shall consist of social workers; persons with expertise in the treatment
of juveniles who are emotionally deleted text begin disableddeleted text end new text begin disturbednew text end , chemically dependent, or have a
developmental disability; and the child's parent, guardian, or permanent legal custodian.
The team may include the child's relatives as defined in section 260C.007, subdivisions 26b
and 27, the child's foster care provider, and professionals who are a resource to the child's
family such as teachers, medical or mental health providers, and clergy, as appropriate,
consistent with the family and permanency team as defined in section 260C.007, subdivision
16a. Prior to forming the team, the responsible social services agency must consult with new text begin the
child's parents,new text end the child if the child is age 14 or older, deleted text begin the child's parents,deleted text end and, if applicable,
the child's tribe new text begin to obtain recommendations regarding which individuals to include on the
team andnew text end to ensure that the team is family-centered and will act in the child's best deleted text begin interestdeleted text end
new text begin interestsnew text end . If the child, child's parents, or legal guardians raise concerns about specific relatives
or professionals, the team should not include those individuals. This provision does not
apply to paragraph (c).
(c) If the agency provides notice to tribes under section 260.761, and the child screened
is an Indian child, the responsible social services agency must make a rigorous and concerted
effort to include a designated representative of the Indian child's tribe on the juvenile
treatment screening team, unless the child's tribal authority declines to appoint a
representative. The Indian child's tribe may delegate its authority to represent the child to
any other federally recognized Indian tribe, as defined in section 260.755, subdivision 12.
The provisions of the Indian Child Welfare Act of 1978, United States Code, title 25, sections
1901 to 1963, and the Minnesota Indian Family Preservation Act, sections 260.751 to
260.835, apply to this section.
(d) If the court, prior to, or as part of, a final disposition or other court order, proposes
to place a child with an emotional disturbance or developmental disability or related condition
in residential treatment, the responsible social services agency must conduct a screening.
If the team recommends treating the child in a qualified residential treatment program, the
agency must follow the requirements of sections 260C.70 to 260C.714.
The court shall ascertain whether the child is an Indian child and shall notify the
responsible social services agency and, if the child is an Indian child, shall notify the Indian
child's tribe as paragraph (c) requires.
(e) When the responsible social services agency is responsible for placing and caring
for the child and the screening team recommends placing a child in a qualified residential
treatment program as defined in section 260C.007, subdivision 26d, the agency must: (1)
begin the assessment and processes required in section 260C.704 without delay; and (2)
conduct a relative search according to section 260C.221 to assemble the child's family and
permanency team under section 260C.706. Prior to notifying relatives regarding the family
and permanency team, the responsible social services agency must consult with new text begin the child's
parents andnew text end the child if the child is age 14 or olderdeleted text begin , the child's parentsdeleted text end and, if applicable, the
child's tribe to ensure that the agency is providing notice to individuals who will act in the
child's best deleted text begin interestdeleted text end new text begin interestsnew text end . The child and the child's parents may identify a culturally
competent qualified individual to complete the child's assessment. The agency shall make
efforts to refer the assessment to the identified qualified individual. The assessment may
not be delayed for the purpose of having the assessment completed by a specific qualified
individual.
(f) When a screening team determines that a child does not need treatment in a qualified
residential treatment program, the screening team must:
(1) document the services and supports that will prevent the child's foster care placement
and will support the child remaining at home;
(2) document the services and supports that the agency will arrange to place the child
in a family foster home; or
(3) document the services and supports that the agency has provided in any other setting.
(g) When the Indian child's tribe or tribal health care services provider or Indian Health
Services provider proposes to place a child for the primary purpose of treatment for an
emotional disturbance, a developmental disability, or co-occurring emotional disturbance
and chemical dependency, the Indian child's tribe or the tribe delegated by the child's tribe
shall submit necessary documentation to the county juvenile treatment screening team,
which must invite the Indian child's tribe to designate a representative to the screening team.
(h) The responsible social services agency must conduct and document the screening in
a format approved by the commissioner of human services.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 18.
Minnesota Statutes 2020, section 260C.163, subdivision 3, is amended to read:
Subd. 3.
Appointment of counsel.
(a) The child, parent, guardian or custodian has the
right to effective assistance of counsel in connection with a proceeding in juvenile court as
provided in this subdivision.
(b) Except in proceedings where the sole basis for the petition is habitual truancy, if the
child desires counsel but is unable to employ it, the court shall appoint counsel to represent
the child who is ten years of age or older under section 611.14, clause (4), or other counsel
at public expense.
(c) deleted text begin Except in proceedings where the sole basis for the petition is habitual truancy, if the
parent, guardian, or custodian desires counsel but is unable to employ it, the court shall
appoint counsel to represent the parent, guardian, or custodian in any case in which it feels
that such an appointment is appropriate if the person would be financially unable to obtain
counsel under the guidelines set forth in section 611.17.deleted text end new text begin In all child protection proceedings
where a child risks removal from the care of the child's parent, guardian, or custodian,
including a child in need of protection or services petition, an action pursuing removal of
a child from the child's home, a termination of parental rights petition, or a petition for
permanent out-of-home placement, if the parent, guardian, or custodian desires counsel and
is eligible for counsel under section 611.17, the court shall appoint counsel to represent
each parent, guardian, or custodian prior to the first hearing on the petition and at all stages
of the proceedings.new text end Court appointed counsel shall be at county expense as outlined in
paragraph (h).
(d) In any proceeding where the subject of a petition for a child in need of protection or
services is ten years of age or older, the responsible social services agency shall, within 14
days after filing the petition or at the emergency removal hearing under section 260C.178,
subdivision 1, if the child is present, fully and effectively inform the child of the child's
right to be represented by appointed counsel upon request and shall notify the court as to
whether the child desired counsel. Information provided to the child shall include, at a
minimum, the fact that counsel will be provided without charge to the child, that the child's
communications with counsel are confidential, and that the child has the right to participate
in all proceedings on a petition, including the opportunity to personally attend all hearings.
The responsible social services agency shall also, within 14 days of the child's tenth birthday,
fully and effectively inform the child of the child's right to be represented by counsel if the
child reaches the age of ten years while the child is the subject of a petition for a child in
need of protection or services or is a child under the guardianship of the commissioner.
(e) In any proceeding where the sole basis for the petition is habitual truancy, the child,
parent, guardian, and custodian do not have the right to appointment of a public defender
or other counsel at public expense. However, before any out-of-home placement, including
foster care or inpatient treatment, can be ordered, the court must appoint a public defender
or other counsel at public expense in accordance with this subdivision.
(f) Counsel for the child shall not also act as the child's guardian ad litem.
(g) In any proceeding where the subject of a petition for a child in need of protection or
services is not represented by an attorney, the court shall determine the child's preferences
regarding the proceedings, including informing the child of the right to appointed counsel
and asking whether the child desires counsel, if the child is of suitable age to express a
preference.
(h) Court-appointed counsel for the parent, guardian, or custodian under this subdivision
is at county expense. If the county has contracted with counsel deleted text begin meeting qualifications under
paragraph (i)deleted text end , the court shall appoint the counsel retained by the county, unless a conflict
of interest exists. If a conflict exists, after consulting with the chief judge of the judicial
district or the judge's designee, the county shall contract with competent counsel to provide
the necessary representation. The court may appoint only one counsel at public expense for
the first court hearing to represent the interests of the parents, guardians, and custodians,
unless, at any time during the proceedings upon petition of a party, the court determines
and makes written findings on the record that extraordinary circumstances exist that require
counsel to be appointed to represent a separate interest of other parents, guardians, or
custodians subject to the jurisdiction of the juvenile court.
deleted text begin
(i) Counsel retained by the county under paragraph (h) must meet the qualifications
deleted text end
deleted text begin
established by the Judicial Council in at least one of the following: (1) has a minimum of
deleted text end
deleted text begin
two years' experience handling child protection cases; (2) has training in handling child
deleted text end
deleted text begin
protection cases from a course or courses approved by the Judicial Council; or (3) is
deleted text end
deleted text begin
supervised by an attorney who meets the minimum qualifications under clause (1) or (2).
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 19.
Minnesota Statutes 2020, section 260C.212, subdivision 1a, is amended to read:
Subd. 1a.
Out-of-home placement plan update.
(a) Within 30 days of placing the child
in foster care, the agency must file thenew text begin child'snew text end initial out-of-home placement plan with the
court. After filing thenew text begin child'snew text end initial out-of-home placement plan, the agency shall update
and file thenew text begin child'snew text end out-of-home placement plan with the court as follows:
(1) when the agency moves a child to a different foster care setting, the agency shall
inform the court within 30 days of the new text begin child's new text end placement change or court-ordered trial home
visit. The agency must file the new text begin child's new text end updated out-of-home placement plan with the court
at the next required review hearing;
(2) when the agency places a child in a qualified residential treatment program as defined
in section 260C.007, subdivision 26d, or moves a child from one qualified residential
treatment program to a different qualified residential treatment program, the agency must
update thenew text begin child'snew text end out-of-home placement plan within 60 days. To meet the requirements
of section 260C.708, the agency must file thenew text begin child'snew text end out-of-home placement plan deleted text begin with the
court as part of the 60-day hearing anddeleted text end new text begin along with the agency's report seeking the court's
approval of the child's placement at a qualified residential treatment program under section
260C.71. After the court issues an order, the agencynew text end must update thenew text begin child's out-of-home
placementnew text end plan deleted text begin after the court hearingdeleted text end to document the court's approval or disapproval of
the child's placement in a qualified residential treatment program;
(3) when the agency places a child with the child's parent in a licensed residential
family-based substance use disorder treatment program under section 260C.190, the agency
must identify the treatment programnew text begin where the child will be placednew text end in the child's out-of-home
placement plan prior to the child's placement. The agency must file thenew text begin child'snew text end out-of-home
placement plan with the court at the next required review hearing; and
(4) under sections 260C.227 and 260C.521, the agency must update thenew text begin child'snew text end
out-of-home placement plan and file thenew text begin child's out-of-home placementnew text end plan with the court.
(b) When none of the items in paragraph (a) apply, the agency must update thenew text begin child'snew text end
out-of-home placement plan no later than 180 days after the child's initial placement and
every six months thereafter, consistent with section 260C.203, paragraph (a).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 20.
Minnesota Statutes 2020, section 260C.212, subdivision 13, is amended to read:
Subd. 13.
Protecting missing and runaway children and youth at risk of sex
traffickingnew text begin or commercial sexual exploitationnew text end .
(a) The local social services agency shall
expeditiously locate any child missing from foster care.
(b) The local social services agency shall report immediately, but no later than 24 hours,
after receiving information on a missing or abducted child to the local law enforcement
agency for entry into the National Crime Information Center (NCIC) database of the Federal
Bureau of Investigation, and to the National Center for Missing and Exploited Children.
(c) The local social services agency shall not discharge a child from foster care or close
the social services case until diligent efforts have been exhausted to locate the child and the
court terminates the agency's jurisdiction.
(d) The local social services agency shall determine the primary factors that contributed
to the child's running away or otherwise being absent from care and, to the extent possible
and appropriate, respond to those factors in current and subsequent placements.
(e) The local social services agency shall determine what the child experienced while
absent from care, including screening the child to determine if the child is a possible sex
traffickingnew text begin or commercial sexual exploitationnew text end victim as defined in section deleted text begin 609.321,
subdivision 7bdeleted text end new text begin 260C.007, subdivision 31new text end .
(f) The local social services agency shall report immediately, but no later than 24 hours,
to the local law enforcement agency any reasonable cause to believe a child is, or is at risk
of being, a sex traffickingnew text begin or commercial sexual exploitationnew text end victim.
(g) The local social services agency shall determine appropriate services as described
in section 145.4717 with respect to any child for whom the local social services agency has
responsibility for placement, care, or supervision when the local social services agency has
reasonable cause to believenew text begin thatnew text end the child is, or is at risk of being, a sex traffickingnew text begin or
commercial sexual exploitationnew text end victim.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 21.
Minnesota Statutes 2020, section 260C.4412, is amended to read:
260C.4412 PAYMENT FOR RESIDENTIAL PLACEMENTS.
(a) When a child is placed in a foster care group residential setting under Minnesota
Rules, parts 2960.0020 to 2960.0710, a foster residence licensed under chapter 245A that
meets the standards of Minnesota Rules, parts 2960.3200 to 2960.3230, or a children's
residential facility licensed or approved by a tribe, foster care maintenance payments must
be made on behalf of the child to cover the cost of providing food, clothing, shelter, daily
supervision, school supplies, child's personal incidentals and supports, reasonable travel for
visitation, or other transportation needs associated with the items listed. Daily supervision
in the group residential setting includes routine day-to-day direction and arrangements to
ensure the well-being and safety of the child. It may also include reasonable costs of
administration and operation of the facility.
(b) The commissioner of human services shall specify the title IV-E administrative
procedures under section 256.82 for each of the following residential program settings:
(1) residential programs licensed under chapter 245A or licensed by a tribe, including:
(i) qualified residential treatment programs as defined in section 260C.007, subdivision
26d;
(ii) program settings specializing in providing prenatal, postpartum, or parenting supports
for youth; and
(iii) program settings providing high-quality residential care and supportive services to
children and youth who are, or are at risk of becoming, sex trafficking victims;
(2) licensed residential family-based substance use disorder treatment programs as
defined in section 260C.007, subdivision 22a; and
(3) supervised settings in which a foster child age 18 or older may live independently,
consistent with section 260C.451.
new text begin
(c) A lead contract under section 256.0112, subdivision 6, is not required to establish
the foster care maintenance payment in paragraph (a) for foster residence settings licensed
under chapter 245A that meet the standards of Minnesota Rules, parts 2960.3200 to
2960.3230. The foster care maintenance payment for these settings must be consistent with
section 256N.26, subdivision 3, and subject to the annual revision as specified in section
256N.26, subdivision 9.
new text end
Sec. 22.
Minnesota Statutes 2020, section 260C.452, is amended to read:
260C.452 SUCCESSFUL TRANSITION TO ADULTHOOD.
Subdivision 1.
Scopenew text begin ; purposenew text end .
new text begin
(a) For purposes of this section, "youth" means a person
who is at least 14 years of age and under 23 years of age.
new text end
new text begin (b) new text end This section pertains to a deleted text begin childdeleted text end new text begin youthnew text end whonew text begin :
new text end
new text begin (1)new text end isnew text begin in foster care and is 14 years of age or older, including a youth who isnew text end under the
guardianship of the commissioner of human servicesdeleted text begin , or whodeleted text end new text begin ;
new text end
new text begin (2)new text end has a permanency disposition of permanent custody to the agencydeleted text begin , or whodeleted text end new text begin ;
new text end
new text begin (3)new text end will leave foster care deleted text begin at 18 to 21 years of age.deleted text end new text begin when the youth is 18 years of age or
older and under 21 years of age;
new text end
new text begin
(4) has left foster care and was placed at a permanent adoptive placement when the youth
was 16 years of age or older;
new text end
new text begin
(5) is 16 years of age or older, has left foster care, and was placed with a relative to
whom permanent legal and physical custody of the youth has been transferred; or
new text end
new text begin
(6) was reunified with the youth's primary caretaker when the youth was 14 years of age
or older and under 18 years of age.
new text end
new text begin
(c) The purpose of this section is to provide support to a youth who is transitioning to
adulthood by providing services to the youth concerning:
new text end
new text begin
(1) education;
new text end
new text begin
(2) employment;
new text end
new text begin
(3) daily living skills such as financial literacy training and driving instruction, preventive
health activities including promoting abstinence from substance use and smoking, and
nutrition education and pregnancy prevention;
new text end
new text begin
(4) forming meaningful, permanent connections with caring adults;
new text end
new text begin
(5) engaging in age-appropriate and developmentally appropriate activities under section
260C.212, subdivision 14, and positive youth development;
new text end
new text begin
(6) financial, housing, counseling, and other services to assist a youth over 18 years of
age in achieving self-sufficiency and accepting personal responsibility for the transition
from adolescence to adulthood; and
new text end
new text begin
(7) making vouchers available for education and training.
new text end
new text begin
(d) The responsible social services agency may provide support and case management
services to a youth as defined in paragraph (a) until the youth reaches 23 years of age.
According to section 260C.451, a youth's placement in a foster care setting will end when
the youth reaches 21 years of age.
new text end
new text begin Subd. 1a. new text end
new text begin Case management services. new text end
new text begin
Case management services include the
responsibility for planning, coordinating, authorizing, monitoring, and evaluating services
for a youth and shall be provided to a youth by the responsible social services agency or
the contracted agency. Case management services include the out-of-home placement plan
under section 260C.212, subdivision 1, when the youth is in out-of-home placement.
new text end
Subd. 2.
Independent living plan.
When the deleted text begin childdeleted text end new text begin youthnew text end is 14 years of age or oldernew text begin and
is receiving support from the responsible social services agency under this sectionnew text end , the
responsible social services agency, in consultation with the deleted text begin childdeleted text end new text begin youthnew text end , shall complete thenew text begin
youth'snew text end independent living plan according to section 260C.212, subdivision 1, paragraph
(c), clause (12)new text begin , regardless of the youth's current placement statusnew text end .
deleted text begin Subd. 3. deleted text end
deleted text begin Notification. deleted text end
deleted text begin
Six months before the child is expected to be discharged from
foster care, the responsible social services agency shall provide written notice to the child
regarding the right to continued access to services for certain children in foster care past 18
years of age and of the right to appeal a denial of social services under section 256.045.
deleted text end
Subd. 4.
Administrative or court review of placements.
(a) When the deleted text begin childdeleted text end new text begin youthnew text end is
14 years of age or older, the court, in consultation with the deleted text begin childdeleted text end new text begin youthnew text end , shall review thenew text begin
youth'snew text end independent living plan according to section 260C.203, paragraph (d).
(b) The responsible social services agency shall file a copy of the notification deleted text begin required
in subdivision 3deleted text end new text begin of foster care benefits for a youth who is 18 years of age or older according
to section 260C.451, subdivision 1,new text end with the court. If the responsible social services agency
does not file the notice by the time the deleted text begin childdeleted text end new text begin youthnew text end is 17-1/2 years of age, the court shall
require the responsible social services agency to file the notice.
(c) new text begin When a youth is 18 years of age or older, new text end the court shall ensure that the responsible
social services agency assists the deleted text begin childdeleted text end new text begin youthnew text end in obtaining the following documents before
the deleted text begin childdeleted text end new text begin youthnew text end leaves foster care: a Social Security card; an official or certified copy of the
deleted text begin child'sdeleted text end new text begin youth'snew text end birth certificate; a state identification card or driver's license, tribal enrollment
identification card, green card, or school visa; health insurance information; the deleted text begin child'sdeleted text end new text begin
youth'snew text end school, medical, and dental records; a contact list of the deleted text begin child'sdeleted text end new text begin youth'snew text end medical,
dental, and mental health providers; and contact information for the deleted text begin child'sdeleted text end new text begin youth'snew text end siblings,
if the siblings are in foster care.
(d) For a deleted text begin childdeleted text end new text begin youthnew text end who will be discharged from foster care at 18 years of age or older
new text begin because the youth is not eligible for extended foster care benefits or chooses to leave foster
carenew text end , the responsible social services agency must develop a personalized transition plan as
directed by the deleted text begin childdeleted text end new text begin youthnew text end during the deleted text begin 90-daydeleted text end new text begin 180-daynew text end period immediately prior to the
expected date of discharge. The transition plan must be as detailed as the deleted text begin childdeleted text end new text begin youthnew text end elects
and include specific options, including but not limited to:
(1) affordable housing with necessary supports that does not include a homeless shelter;
(2) health insurance, including eligibility for medical assistance as defined in section
256B.055, subdivision 17;
(3) education, including application to the Education and Training Voucher Program;
(4) local opportunities for mentors and continuing support servicesdeleted text begin , including the Healthy
Transitions and Homeless Prevention program, if availabledeleted text end ;
(5) workforce supports and employment services;
(6) a copy of the deleted text begin child'sdeleted text end new text begin youth'snew text end consumer credit report as defined in section 13C.001
and assistance in interpreting and resolving any inaccuracies in the report, at no cost to the
deleted text begin childdeleted text end new text begin youthnew text end ;
(7) information on executing a health care directive under chapter 145C and on the
importance of designating another individual to make health care decisions on behalf of the
deleted text begin childdeleted text end new text begin youthnew text end if the deleted text begin childdeleted text end new text begin youthnew text end becomes unable to participate in decisions;
(8) appropriate contact information through 21 years of age if the deleted text begin childdeleted text end new text begin youthnew text end needs
information or help dealing with a crisis situation; and
(9) official documentation that the youth was previously in foster care.
Subd. 5.
Notice of termination of deleted text begin foster caredeleted text end new text begin social servicesnew text end .
(a) deleted text begin Whendeleted text end new text begin Beforenew text end a deleted text begin childdeleted text end new text begin
youth who is 18 years of age or oldernew text end leaves foster care deleted text begin at 18 years of age or olderdeleted text end , the
responsible social services agency shall give the deleted text begin childdeleted text end new text begin youthnew text end written notice that foster care
shall terminate 30 days from the datenew text begin thatnew text end the notice is sentnew text begin by the agency according to
section 260C.451, subdivision 8new text end .
deleted text begin
(b) The child or the child's guardian ad litem may file a motion asking the court to review
the responsible social services agency's determination within 15 days of receiving the notice.
The child shall not be discharged from foster care until the motion is heard. The responsible
social services agency shall work with the child to transition out of foster care.
deleted text end
deleted text begin
(c) The written notice of termination of benefits shall be on a form prescribed by the
commissioner and shall give notice of the right to have the responsible social services
agency's determination reviewed by the court under this section or sections 260C.203,
260C.317, and 260C.515, subdivision 5 or 6. A copy of the termination notice shall be sent
to the child and the child's attorney, if any, the foster care provider, the child's guardian ad
litem, and the court. The responsible social services agency is not responsible for paying
foster care benefits for any period of time after the child leaves foster care.
deleted text end
new text begin
(b) Before case management services will end for a youth who is at least 18 years of
age and under 23 years of age, the responsible social services agency shall give the youth:
(1) written notice that case management services for the youth shall terminate; and (2)
written notice that the youth has the right to appeal the termination of case management
services under section 256.045, subdivision 3, by responding in writing within ten days of
the date that the agency mailed the notice. The termination notice must include information
about services for which the youth is eligible and how to access the services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 23.
Minnesota Statutes 2020, section 260C.704, is amended to read:
260C.704 REQUIREMENTS FOR THE QUALIFIED INDIVIDUAL'S
ASSESSMENT OF THE CHILD FOR PLACEMENT IN A QUALIFIED
RESIDENTIAL TREATMENT PROGRAM.
(a) A qualified individual must complete an assessment of the child prior to deleted text begin or withindeleted text end
deleted text begin 30 days ofdeleted text end the child's placement in a qualified residential treatment program in a format
approved by the commissioner of human servicesdeleted text begin , anddeleted text end new text begin unless, due to a crisis, the child must
immediately be placed in a qualified residential treatment program. When a child must
immediately be placed in a qualified residential treatment program without an assessment,
the qualified individual must complete the child's assessment within 30 days of the child's
placement. The qualified individualnew text end must:
(1) assess the child's needs and strengths, using an age-appropriate, evidence-based,
validated, functional assessment approved by the commissioner of human services;
(2) determine whether the child's needs can be met by the child's family members or
through placement in a family foster home; or, if not, determine which residential setting
would provide the child with the most effective and appropriate level of care to the child
in the least restrictive environment;
(3) develop a list of short- and long-term mental and behavioral health goals for the
child; and
(4) work with the child's family and permanency team using culturally competent
practices.
new text begin
If a level of care determination was conducted under section 245.4885, that information
must be shared with the qualified individual and the juvenile treatment screening team.
new text end
(b) The child and the child's parents, when appropriate, may request that a specific
culturally competent qualified individual complete the child's assessment. The agency shall
make efforts to refer the child to the identified qualified individual to complete the
assessment. The assessment must not be delayed for a specific qualified individual to
complete the assessment.
(c) The qualified individual must provide the assessment, when complete, to the
responsible social services agencydeleted text begin , the child's parents or legal guardians, the guardian ad
litem, and the courtdeleted text end new text begin . If the assessment recommends placement of the child in a qualified
residential treatment facility, the agency must distribute the assessment to the child's parent
or legal guardian and file the assessment with the court reportnew text end as required in section 260C.71new text begin ,
subdivision 2. If the assessment does not recommend placement in a qualified residential
treatment facility, the agency must provide a copy of the assessment to the parents or legal
guardians and the guardian ad litem and file the assessment determination with the court at
the next required hearing as required in section 260C.71, subdivision 5new text end . If court rules and
chapter 13 permit disclosure of the results of the child's assessment, the agency may share
the results of the child's assessment with the child's foster care provider, other members of
the child's family, and the family and permanency team. The agency must not share the
child's private medical data with the family and permanency team unless: (1) chapter 13
permits the agency to disclose the child's private medical data to the family and permanency
team; or (2) the child's parent has authorized the agency to disclose the child's private medical
data to the family and permanency team.
(d) For an Indian child, the assessment of the child must follow the order of placement
preferences in the Indian Child Welfare Act of 1978, United States Code, title 25, section
1915.
(e) In the assessment determination, the qualified individual must specify in writing:
(1) the reasons why the child's needs cannot be met by the child's family or in a family
foster home. A shortage of family foster homes is not an acceptable reason for determining
that a family foster home cannot meet a child's needs;
(2) why the recommended placement in a qualified residential treatment program will
provide the child with the most effective and appropriate level of care to meet the child's
needs in the least restrictive environment possible and how placing the child at the treatment
program is consistent with the short-term and long-term goals of the child's permanency
plan; and
(3) if the qualified individual's placement recommendation is not the placement setting
that the parent, family and permanency team, child, or tribe prefer, the qualified individual
must identify the reasons why the qualified individual does not recommend the parent's,
family and permanency team's, child's, or tribe's placement preferences. The out-of-home
placement plan under section 260C.708 must also include reasons why the qualified
individual did not recommend the preferences of the parents, family and permanency team,
child, or tribe.
(f) If the qualified individual determines that the child's family or a family foster home
or other less restrictive placement may meet the child's needs, the agency must move the
child out of the qualified residential treatment program and transition the child to a less
restrictive setting within 30 days of the determination.new text begin If the responsible social services
agency has placement authority of the child, the agency must make a plan for the child's
placement according to section 260C.212, subdivision 2. The agency must file the child's
assessment determination with the court at the next required hearing.
new text end
new text begin
(g) If the qualified individual recommends placing the child in a qualified residential
treatment program and if the responsible social services agency has placement authority of
the child, the agency shall make referrals to appropriate qualified residential treatment
programs and, upon acceptance by an appropriate program, place the child in an approved
or certified qualified residential treatment program.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 24.
Minnesota Statutes 2020, section 260C.706, is amended to read:
260C.706 FAMILY AND PERMANENCY TEAM REQUIREMENTS.
(a) When the responsible social services agency's juvenile treatment screening team, as
defined in section 260C.157, recommends placing the child in a qualified residential treatment
program, the agency must assemble a family and permanency team within ten days.
(1) The team must include all appropriate biological family members, the child's parents,
legal guardians or custodians, foster care providers, and relatives as defined in section
260C.007, subdivisions deleted text begin 26cdeleted text end new text begin 26bnew text end and 27, and professionals, as appropriate, who are a resource
to the child's family, such as teachers, medical or mental health providers, or clergy.
(2) When a child is placed in foster care prior to the qualified residential treatment
program, the agency shall include relatives responding to the relative search notice as
required under section 260C.221 on this team, unless the juvenile court finds that contacting
a specific relative would deleted text begin endangerdeleted text end new text begin present a safety or health risk tonew text end the parent, guardian,
child, sibling, or any other family member.
(3) When a qualified residential treatment program is the child's initial placement setting,
the responsible social services agency must engage with the child and the child's parents to
determine the appropriate family and permanency team members.
(4) When the permanency goal is to reunify the child with the child's parent or legal
guardian, the purpose of the relative search and focus of the family and permanency team
is to preserve family relationships and identify and develop supports for the child and parents.
(5) The responsible agency must make a good faith effort to identify and assemble all
appropriate individuals to be part of the child's family and permanency team and request
input from the parents regarding relative search efforts consistent with section 260C.221.
The out-of-home placement plan in section 260C.708 must include all contact information
for the team members, as well as contact information for family members or relatives who
are not a part of the family and permanency team.
(6) If the child is age 14 or older, the team must include members of the family and
permanency team that the child selects in accordance with section 260C.212, subdivision
1, paragraph (b).
(7) Consistent with section 260C.221, a responsible social services agency may disclose
relevant and appropriate private data about the child to relatives in order for the relatives
to participate in caring and planning for the child's placement.
(8) If the child is an Indian child under section 260.751, the responsible social services
agency must make active efforts to include the child's tribal representative on the family
and permanency team.
(b) The family and permanency team shall meet regarding the assessment required under
section 260C.704 to determine whether it is necessary and appropriate to place the child in
a qualified residential treatment program and to participate in case planning under section
260C.708.
(c) When reunification of the child with the child's parent or legal guardian is the
permanency plan, the family and permanency team shall support the parent-child relationship
by recognizing the parent's legal authority, consulting with the parent regarding ongoing
planning for the child, and assisting the parent with visiting and contacting the child.
(d) When the agency's permanency plan is to transfer the child's permanent legal and
physical custody to a relative or for the child's adoption, the team shall:
(1) coordinate with the proposed guardian to provide the child with educational services,
medical care, and dental care;
(2) coordinate with the proposed guardian, the agency, and the foster care facility to
meet the child's treatment needs after the child is placed in a permanent placement with the
proposed guardian;
(3) plan to meet the child's need for safety, stability, and connection with the child's
family and community after the child is placed in a permanent placement with the proposed
guardian; and
(4) in the case of an Indian child, communicate with the child's tribe to identify necessary
and appropriate services for the child, transition planning for the child, the child's treatment
needs, and how to maintain the child's connections to the child's community, family, and
tribe.
(e) The agency shall invite the family and permanency team to participate in case planning
and the agency shall give the team notice of court reviews under sections 260C.152 and
260C.221 until: (1) the child is reunited with the child's parents; or (2) the child's foster care
placement ends and the child is in a permanent placement.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 25.
Minnesota Statutes 2020, section 260C.708, is amended to read:
260C.708 OUT-OF-HOME PLACEMENT PLAN FOR QUALIFIED
RESIDENTIAL TREATMENT PROGRAM PLACEMENTS.
(a) When the responsible social services agency places a child in a qualified residential
treatment program as defined in section 260C.007, subdivision 26d, the out-of-home
placement plan must include:
(1) the case plan requirements in section deleted text begin 260.212, subdivision 1deleted text end new text begin 260C.212new text end ;
(2) the reasonable and good faith efforts of the responsible social services agency to
identify and include all of the individuals required to be on the child's family and permanency
team under section 260C.007;
(3) all contact information for members of the child's family and permanency team and
for other relatives who are not part of the family and permanency team;
(4) evidence that the agency scheduled meetings of the family and permanency team,
including meetings relating to the assessment required under section 260C.704, at a time
and place convenient for the family;
new text begin
(5) evidence that the family and permanency team is involved in the assessment required
under section 260C.704 to determine the appropriateness of the child's placement in a
qualified residential treatment program;
new text end
new text begin
(6) the family and permanency team's placement preferences for the child in the
assessment required under section 260C.704. When making a decision about the child's
placement preferences, the family and permanency team must recognize:
new text end
new text begin
(i) that the agency should place a child with the child's siblings unless a court finds that
placing a child with the child's siblings is not possible due to a child's specialized placement
needs or is otherwise contrary to the child's best interests; and
new text end
new text begin
(ii) that the agency should place an Indian child according to the requirements of the
Indian Child Welfare Act, the Minnesota Family Preservation Act under sections 260.751
to 260.835, and section 260C.193, subdivision 3, paragraph (g);
new text end
deleted text begin (5)deleted text end new text begin (7)new text end when reunification of the child with the child's parent or legal guardian is the
agency's goal, evidence demonstrating that the parent or legal guardian provided input about
the members of the family and permanency team under section 260C.706;
deleted text begin (6)deleted text end new text begin (8)new text end when the agency's permanency goal is to reunify the child with the child's parent
or legal guardian, the out-of-home placement plan must identify services and supports that
maintain the parent-child relationship and the parent's legal authority, decision-making, and
responsibility for ongoing planning for the child. In addition, the agency must assist the
parent with visiting and contacting the child;
deleted text begin (7)deleted text end new text begin (9)new text end when the agency's permanency goal is to transfer permanent legal and physical
custody of the child to a proposed guardian or to finalize the child's adoption, the case plan
must document the agency's steps to transfer permanent legal and physical custody of the
child or finalize adoption, as required in section 260C.212, subdivision 1, paragraph (c),
clauses (6) and (7); and
deleted text begin (8)deleted text end new text begin (10)new text end the qualified individual's recommendation regarding the child's placement in a
qualified residential treatment program and the court approval or disapproval of the placement
as required in section 260C.71.
(b) If the placement preferences of the family and permanency team, child, and tribe, if
applicable, are not consistent with the placement setting that the qualified individual
recommends, the case plan must include the reasons why the qualified individual did not
recommend following the preferences of the family and permanency team, child, and the
tribe.
(c) The agency must file the out-of-home placement plan with the court as part of the
60-day deleted text begin hearingdeleted text end new text begin court ordernew text end under section 260C.71.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 26.
Minnesota Statutes 2020, section 260C.71, is amended to read:
260C.71 COURT APPROVAL REQUIREMENTS.
new text begin Subdivision 1. new text end
new text begin Judicial review. new text end
new text begin
When the responsible social services agency has legal
authority to place a child at a qualified residential treatment facility under section 260C.007,
subdivision 21a, and the child's assessment under section 260C.704 recommends placing
the child in a qualified residential treatment facility, the agency shall place the child at a
qualified residential facility. Within 60 days of placing the child at a qualified residential
treatment facility, the agency must obtain a court order finding that the child's placement
is appropriate and meets the child's individualized needs.
new text end
new text begin Subd. 2. new text end
new text begin Qualified residential treatment program; agency report to court. new text end
new text begin
(a) The
responsible social services agency shall file a written report with the court after receiving
the qualified individual's assessment as specified in section 260C.704 prior to the child's
placement or within 35 days of the date of the child's placement in a qualified residential
treatment facility. The written report shall contain or have attached:
new text end
new text begin
(1) the child's name, date of birth, race, gender, and current address;
new text end
new text begin
(2) the names, races, dates of birth, residence, and post office address of the child's
parents or legal custodian, or guardian;
new text end
new text begin
(3) the name and address of the qualified residential treatment program, including a
chief administrator of the facility;
new text end
new text begin
(4) a statement of the facts that necessitated the child's foster care placement;
new text end
new text begin
(5) the child's out-of-home placement plan under section 260C.212, subdivision 1,
including the requirements in section 260C.708;
new text end
new text begin
(6) if the child is placed in an out-of-state qualified residential treatment program, the
compelling reasons why the child's needs cannot be met by an in-state placement;
new text end
new text begin
(7) the qualified individual's assessment of the child under section 260C.704, paragraph
(c), in a format approved by the commissioner;
new text end
new text begin
(8) if, at the time required for the report under this subdivision, the child's parent or legal
guardian, a child who is ten years of age or older, the family and permanency team, or a
tribe disagrees with the recommended qualified residential treatment program placement,
information regarding the disagreement and to the extent possible, the basis for the
disagreement in the report; and
new text end
new text begin
(9) any other information that the responsible social services agency, child's parent, legal
custodian or guardian, child, or, in the case of an Indian child, tribe would like the court to
consider.
new text end
new text begin
(b) The agency shall file the written report under paragraph (a) with the court and serve
on the parties a request for a hearing or a court order without a hearing.
new text end
new text begin
(c) The agency must inform the child's parent or legal guardian and a child who is ten
years of age or older of the court review requirements of this section and the child and child's
parent's or legal guardian's right to submit information to the court:
new text end
new text begin
(1) the agency must inform the child's parent or legal guardian and a child who is ten
years of age or older of the reporting date and the date by which the agency must receive
information from the child and child's parent so that the agency is able to submit the report
required by this subdivision to the court;
new text end
new text begin
(2) the agency must inform the child's parent or legal guardian, and a child who is ten
years of age or older that the court will hold a hearing upon the request of the child or the
child's parent; and
new text end
new text begin
(3) the agency must inform the child's parent or legal guardian, and a child who is ten
years of age or older that they have the right to request a hearing and the right to present
information to the court for the court's review under this subdivision.
new text end
new text begin Subd. 3. new text end
new text begin Court hearing. new text end
new text begin
(a) The court shall hold a hearing when a party or a child who
is ten years of age or older requests a hearing.
new text end
new text begin
(b) In all other circumstances, the court has the discretion to hold a hearing or issue an
order without a hearing.
new text end
new text begin Subd. 4. new text end
new text begin Court findings and order. new text end
(a) Within 60 days from the beginning of each
placement in a qualified residential treatment programnew text begin when the qualified individual's
assessment of the child recommends placing the child in a qualified residential treatment
programnew text end , the court mustnew text begin consider the qualified individual's assessment of the child under
section 260C.704 and issue an order tonew text end :
deleted text begin
(1) consider the qualified individual's assessment of whether it is necessary and
appropriate to place the child in a qualified residential treatment program under section
260C.704;
deleted text end
deleted text begin (2)deleted text end new text begin (1)new text end determine whether a family foster home can meet the child's needs, whether it is
necessary and appropriate to place a child in a qualified residential treatment program that
is the least restrictive environment possible, and whether the child's placement is consistent
with the child's short and long term goals as specified in the permanency plan; and
deleted text begin (3)deleted text end new text begin (2)new text end approve or disapprove of the child's placement.
(b) deleted text begin In the out-of-home placement plan, the agency must document the court's approval
or disapproval of the placement, as specified in section 260C.708.deleted text end new text begin If the court disapproves
of the child's placement in a qualified residential treatment program, the responsible social
services agency shall: (1) remove the child from the qualified residential treatment program
within 30 days of the court's order; and (2) make a plan for the child's placement that is
consistent with the child's best interests under section 260C.212, subdivision 2.
new text end
new text begin Subd. 5. new text end
new text begin Court review and approval not required. new text end
new text begin
When the responsible social services
agency has legal authority to place a child under section 260C.007, subdivision 21a, and
the qualified individual's assessment of the child does not recommend placing the child in
a qualified residential treatment program, the court is not required to hold a hearing and the
court is not required to issue an order. Pursuant to section 260C.704, paragraph (f), the
responsible social services agency shall make a plan for the child's placement consistent
with the child's best interests under section 260C.212, subdivision 2. The agency must file
the agency's assessment determination for the child with the court at the next required
hearing.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 27.
Minnesota Statutes 2020, section 260C.712, is amended to read:
260C.712 ONGOING REVIEWS AND PERMANENCY HEARING
REQUIREMENTS.
As long as a child remains placed in a qualified residential treatment program, the
responsible social services agency shall submit evidence at each administrative review under
section 260C.203; each court review under sections 260C.202, 260C.203, deleted text begin anddeleted text end 260C.204new text begin ,
260D.06, 260D.07, and 260D.08new text end ; and each permanency hearing under section 260C.515,
260C.519, deleted text begin ordeleted text end 260C.521,new text begin or 260D.07new text end that:
(1) demonstrates that an ongoing assessment of the strengths and needs of the child
continues to support the determination that the child's needs cannot be met through placement
in a family foster home;
(2) demonstrates that the placement of the child in a qualified residential treatment
program provides the most effective and appropriate level of care for the child in the least
restrictive environment;
(3) demonstrates how the placement is consistent with the short-term and long-term
goals for the child, as specified in the child's permanency plan;
(4) documents how the child's specific treatment or service needs will be met in the
placement;
(5) documents the length of time that the agency expects the child to need treatment or
services; deleted text begin and
deleted text end
(6) documents the responsible social services agency's efforts to prepare the child to
return home or to be placed with a fit and willing relative, legal guardian, adoptive parent,
or foster familydeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(7) if the child is placed in a qualified residential treatment program out-of-state,
documents the compelling reasons for placing the child out-of-state, and the reasons that
the child's needs cannot be met by an in-state placement.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 28.
Minnesota Statutes 2020, section 260C.714, is amended to read:
260C.714 REVIEW OF EXTENDED QUALIFIED RESIDENTIAL TREATMENT
PROGRAM PLACEMENTS.
(a) When a responsible social services agency places a child in a qualified residential
treatment program for more than 12 consecutive months or 18 nonconsecutive months or,
in the case of a child who is under 13 years of age, for more than six consecutive or
nonconsecutive months, the agency must submit: (1) the signed approval by the county
social services director of the responsible social services agency; and (2) the evidence
supporting the child's placement at the most recent court review or permanency hearing
under section 260C.712deleted text begin , paragraph (b)deleted text end .
(b) The commissioner shall specify the procedures and requirements for the agency's
review and approval of a child's extended qualified residential treatment program placement.
The commissioner may consult with counties, tribes, child-placing agencies, mental health
providers, licensed facilities, the child, the child's parents, and the family and permanency
team members to develop case plan requirements and engage in periodic reviews of the
case plan.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 29.
Minnesota Statutes 2020, section 260D.01, is amended to read:
260D.01 CHILD IN VOLUNTARY FOSTER CARE FOR TREATMENT.
(a) Sections 260D.01 to 260D.10, may be cited as the "child in voluntary foster care for
treatment" provisions of the Juvenile Court Act.
(b) The juvenile court has original and exclusive jurisdiction over a child in voluntary
foster care for treatment upon the filing of a report or petition required under this chapter.
All obligations of thenew text begin responsible social servicesnew text end agency to a child and family in foster care
contained in chapter 260C not inconsistent with this chapter are also obligations of the
agency with regard to a child in foster care for treatment under this chapter.
(c) This chapter shall be construed consistently with the mission of the children's mental
health service system as set out in section 245.487, subdivision 3, and the duties of an agency
under sections 256B.092 and 260C.157 and Minnesota Rules, parts 9525.0004 to 9525.0016,
to meet the needs of a child with a developmental disability or related condition. This
chapter:
(1) establishes voluntary foster care through a voluntary foster care agreement as the
means for an agency and a parent to provide needed treatment when the child must be in
foster care to receive necessary treatment for an emotional disturbance or developmental
disability or related condition;
(2) establishes court review requirements for a child in voluntary foster care for treatment
due to emotional disturbance or developmental disability or a related condition;
(3) establishes the ongoing responsibility of the parent as legal custodian to visit the
child, to plan together with the agency for the child's treatment needs, to be available and
accessible to the agency to make treatment decisions, and to obtain necessary medical,
dental, and other care for the child; deleted text begin and
deleted text end
(4) applies to voluntary foster care when the child's parent and the agency agree that the
child's treatment needs require foster care either:
(i) due to a level of care determination by the agency's screening team informed by thenew text begin
child'snew text end diagnostic and functional assessment under section 245.4885; or
(ii) due to a determination regarding the level of services needed bynew text begin the child bynew text end the
responsible social deleted text begin services'deleted text end new text begin services agency'snew text end screening team under section 256B.092, and
Minnesota Rules, parts 9525.0004 to 9525.0016deleted text begin .deleted text end new text begin ; and
new text end
new text begin
(5) includes the requirements for a child's placement in sections 260C.70 to 260C.714,
when the juvenile treatment screening team recommends placing a child in a qualified
residential treatment program except as modified by this chapter.
new text end
(d) This chapter does not apply when there is a current determination under chapter
260E that the child requires child protective services or when the child is in foster care for
any reason other than treatment for the child's emotional disturbance or developmental
disability or related condition. When there is a determination under chapter 260E that the
child requires child protective services based on an assessment that there are safety and risk
issues for the child that have not been mitigated through the parent's engagement in services
or otherwise, or when the child is in foster care for any reason other than the child's emotional
disturbance or developmental disability or related condition, the provisions of chapter 260C
apply.
(e) The paramount consideration in all proceedings concerning a child in voluntary foster
care for treatment is the safety, health, and the best interests of the child. The purpose of
this chapter is:
(1) to ensurenew text begin thatnew text end a child with a disability is provided the services necessary to treat or
ameliorate the symptoms of the child's disability;
(2) to preserve and strengthen the child's family ties whenever possible and in the child's
best interests, approving the child's placement away from the child's parents only when the
child's need for care or treatment requires deleted text begin itdeleted text end new text begin out-of-home placementnew text end and the child cannot
be maintained in the home of the parent; and
(3) to ensurenew text begin thatnew text end the child's parent retains legal custody of the child and associated
decision-making authority unless the child's parent willfully fails or is unable to make
decisions that meet the child's safety, health, and best interests. The court may not find that
the parent willfully fails or is unable to make decisions that meet the child's needs solely
because the parent disagrees with the agency's choice of foster care facility, unless the
agency files a petition under chapter 260C, and establishes by clear and convincing evidence
that the child is in need of protection or services.
(f) The legal parent-child relationship shall be supported under this chapter by maintaining
the parent's legal authority and responsibility for ongoing planning for the child and by the
agency's assisting the parent, deleted text begin wheredeleted text end new text begin whennew text end necessary, to exercise the parent's ongoing right
and obligation to visit or to have reasonable contact with the child. Ongoing planning means:
(1) actively participating in the planning and provision of educational services, medical,
and dental care for the child;
(2) actively planning and participating with the agency and the foster care facility for
the child's treatment needs; deleted text begin and
deleted text end
(3) planning to meet the child's need for safety, stability, and permanency, and the child's
need to stay connected to the child's family and communitydeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(4) engaging with the responsible social services agency to ensure that the family and
permanency team under section 260C.706 consists of appropriate family members. For
purposes of voluntary placement of a child in foster care for treatment under chapter 260D,
prior to forming the child's family and permanency team, the responsible social services
agency must consult with the child's parents and the child if the child is 14 years of age or
older, and if applicable, the child's tribe to obtain recommendations regarding which
individuals to include on the team and to ensure that the team is family-centered and will
act in the child's best interests. If the child or the child's parent or legal guardian raises
concerns about specific relatives or professionals, the team should not include those
individuals on the team unless the individual is a treating professional or an important
connection to the youth as outlined in the case or crisis plan. For voluntary placements under
this chapter in a qualified residential treatment program, as defined in section 260C.007,
subdivision 26d, for purposes of engaging in a relative search as provided in section
260C.221, the county agency must consult with the child's parent or legal guardian, the
child if the child is 14 years of age or older, and, if applicable, the tribe, to obtain
recommendations regarding which adult relatives should be notified. If the child, parent,
or legal guardian raises concerns about specific relatives, the county agency must not notify
them.
new text end
(g) The provisions of section 260.012 to ensure placement prevention, family
reunification, and all active and reasonable effort requirements of that section apply. This
chapter shall be construed consistently with the requirements of the Indian Child Welfare
Act of 1978, United States Code, title 25, section 1901, et al., and the provisions of the
Minnesota Indian Family Preservation Act, sections 260.751 to 260.835.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 30.
Minnesota Statutes 2020, section 260D.05, is amended to read:
260D.05 ADMINISTRATIVE REVIEW OF CHILD IN VOLUNTARY FOSTER
CARE FOR TREATMENT.
The administrative reviews required under section 260C.203 must be conducted for a
child in voluntary foster care for treatment, except that the initial administrative review
must take place prior to the submission of the report to the court required under section
260D.06, subdivision 2.new text begin When a child is placed in a qualified residential treatment program
as defined in section 260C.007, subdivision 26d, the responsible social services agency
must submit evidence to the court as specified in section 260C.712.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 31.
Minnesota Statutes 2020, section 260D.06, subdivision 2, is amended to read:
Subd. 2.
Agency report to court; court review.
The agency shall obtain judicial review
by reporting to the court according to the following procedures:
(a) A written report shall be forwarded to the court within 165 days of the date of the
voluntary placement agreement. The written report shall contain or have attached:
(1) a statement of facts that necessitate the child's foster care placement;
(2) the child's name, date of birth, race, gender, and current address;
(3) the names, race, date of birth, residence, and post office addresses of the child's
parents or legal custodian;
(4) a statement regarding the child's eligibility for membership or enrollment in an Indian
tribe and the agency's compliance with applicable provisions of sections 260.751 to 260.835;
(5) the names and addresses of the foster parents or chief administrator of the facility in
which the child is placed, if the child is not in a family foster home or group home;
(6) a copy of the out-of-home placement plan required under section 260C.212,
subdivision 1;
(7) a written summary of the proceedings of any administrative review required under
section 260C.203; deleted text begin and
deleted text end
(8) new text begin evidence as specified in section 260C.712 when a child is placed in a qualified
residential treatment program as defined in section 260C.007, subdivision 26d; and
new text end
new text begin (9) new text end any other information the agency, parent or legal custodian, the child or the foster
parent, or other residential facility wants the court to consider.
(b) In the case of a child in placement due to emotional disturbance, the written report
shall include as an attachment, the child's individual treatment plan developed by the child's
treatment professional, as provided in section 245.4871, subdivision 21, or the child's
standard written plan, as provided in section 125A.023, subdivision 3, paragraph (e).
(c) In the case of a child in placement due to developmental disability or a related
condition, the written report shall include as an attachment, the child's individual service
plan, as provided in section 256B.092, subdivision 1b; the child's individual program plan,
as provided in Minnesota Rules, part 9525.0004, subpart 11; the child's waiver care plan;
or the child's standard written plan, as provided in section 125A.023, subdivision 3, paragraph
(e).
(d) The agency must inform the child, age 12 or older, the child's parent, and the foster
parent or foster care facility of the reporting and court review requirements of this section
and of their right to submit information to the court:
(1) if the child or the child's parent or the foster care provider wants to send information
to the court, the agency shall advise those persons of the reporting date and the date by
which the agency must receive the information they want forwarded to the court so the
agency is timely able submit it with the agency's report required under this subdivision;
(2) the agency must also inform the child, age 12 or older, the child's parent, and the
foster care facility that they have the right to be heard in person by the court and how to
exercise that right;
(3) the agency must also inform the child, age 12 or older, the child's parent, and the
foster care provider that an in-court hearing will be held if requested by the child, the parent,
or the foster care provider; and
(4) if, at the time required for the report under this section, a child, age 12 or older,
disagrees about the foster care facility or services provided under the out-of-home placement
plan required under section 260C.212, subdivision 1, the agency shall include information
regarding the child's disagreement, and to the extent possible, the basis for the child's
disagreement in the report required under this section.
(e) After receiving the required report, the court has jurisdiction to make the following
determinations and must do so within ten days of receiving the forwarded report, whether
a hearing is requested:
(1) whether the voluntary foster care arrangement is in the child's best interests;
(2) whether the parent and agency are appropriately planning for the child; and
(3) in the case of a child age 12 or older, who disagrees with the foster care facility or
services provided under the out-of-home placement plan, whether it is appropriate to appoint
counsel and a guardian ad litem for the child using standards and procedures under section
260C.163.
(f) Unless requested by a parent, representative of the foster care facility, or the child,
no in-court hearing is required in order for the court to make findings and issue an order as
required in paragraph (e).
(g) If the court finds the voluntary foster care arrangement is in the child's best interests
and that the agency and parent are appropriately planning for the child, the court shall issue
an order containing explicit, individualized findings to support its determination. The
individualized findings shall be based on the agency's written report and other materials
submitted to the court. The court may make this determination notwithstanding the child's
disagreement, if any, reported under paragraph (d).
(h) The court shall send a copy of the order to the county attorney, the agency, parent,
child, age 12 or older, and the foster parent or foster care facility.
(i) The court shall also send the parent, the child, age 12 or older, the foster parent, or
representative of the foster care facility notice of the permanency review hearing required
under section 260D.07, paragraph (e).
(j) If the court finds continuing the voluntary foster care arrangement is not in the child's
best interests or that the agency or the parent are not appropriately planning for the child,
the court shall notify the agency, the parent, the foster parent or foster care facility, the child,
age 12 or older, and the county attorney of the court's determinations and the basis for the
court's determinations. In this case, the court shall set the matter for hearing and appoint a
guardian ad litem for the child under section 260C.163, subdivision 5.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 32.
Minnesota Statutes 2020, section 260D.07, is amended to read:
260D.07 REQUIRED PERMANENCY REVIEW HEARING.
(a) When the court has found that the voluntary arrangement is in the child's best interests
and that the agency and parent are appropriately planning for the child pursuant to the report
submitted under section 260D.06, and the child continues in voluntary foster care as defined
in section 260D.02, subdivision 10, for 13 months from the date of the voluntary foster care
agreement, or has been in placement for 15 of the last 22 months, the agency must:
(1) terminate the voluntary foster care agreement and return the child home; or
(2) determine whether there are compelling reasons to continue the voluntary foster care
arrangement and, if the agency determines there are compelling reasons, seek judicial
approval of its determination; or
(3) file a petition for the termination of parental rights.
(b) When the agency is asking for the court's approval of its determination that there are
compelling reasons to continue the child in the voluntary foster care arrangement, the agency
shall file a "Petition for Permanency Review Regarding a Child in Voluntary Foster Care
for Treatment" and ask the court to proceed under this section.
(c) The "Petition for Permanency Review Regarding a Child in Voluntary Foster Care
for Treatment" shall be drafted or approved by the county attorney and be under oath. The
petition shall include:
(1) the date of the voluntary placement agreement;
(2) whether the petition is due to the child's developmental disability or emotional
disturbance;
(3) the plan for the ongoing care of the child and the parent's participation in the plan;
(4) a description of the parent's visitation and contact with the child;
(5) the date of the court finding that the foster care placement was in the best interests
of the child, if required under section 260D.06, or the date the agency filed the motion under
section 260D.09, paragraph (b);
(6) the agency's reasonable efforts to finalize the permanent plan for the child, including
returning the child to the care of the child's family; deleted text begin and
deleted text end
(7) a citation to this chapter as the basis for the petitiondeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(8) evidence as specified in section 260C.712 when a child is placed in a qualified
residential treatment program as defined in section 260C.007, subdivision 26d.
new text end
(d) An updated copy of the out-of-home placement plan required under section 260C.212,
subdivision 1, shall be filed with the petition.
(e) The court shall set the date for the permanency review hearing no later than 14 months
after the child has been in placement or within 30 days of the petition filing date when the
child has been in placement 15 of the last 22 months. The court shall serve the petition
together with a notice of hearing by United States mail on the parent, the child age 12 or
older, the child's guardian ad litem, if one has been appointed, the agency, the county
attorney, and counsel for any party.
(f) The court shall conduct the permanency review hearing on the petition no later than
14 months after the date of the voluntary placement agreement, within 30 days of the filing
of the petition when the child has been in placement 15 of the last 22 months, or within 15
days of a motion to terminate jurisdiction and to dismiss an order for foster care under
chapter 260C, as provided in section 260D.09, paragraph (b).
(g) At the permanency review hearing, the court shall:
(1) inquire of the parent if the parent has reviewed the "Petition for Permanency Review
Regarding a Child in Voluntary Foster Care for Treatment," whether the petition is accurate,
and whether the parent agrees to the continued voluntary foster care arrangement as being
in the child's best interests;
(2) inquire of the parent if the parent is satisfied with the agency's reasonable efforts to
finalize the permanent plan for the child, including whether there are services available and
accessible to the parent that might allow the child to safely be with the child's family;
(3) inquire of the parent if the parent consents to the court entering an order that:
(i) approves the responsible agency's reasonable efforts to finalize the permanent plan
for the child, which includes ongoing future planning for the safety, health, and best interests
of the child; and
(ii) approves the responsible agency's determination that there are compelling reasons
why the continued voluntary foster care arrangement is in the child's best interests; and
(4) inquire of the child's guardian ad litem and any other party whether the guardian or
the party agrees that:
(i) the court should approve the responsible agency's reasonable efforts to finalize the
permanent plan for the child, which includes ongoing and future planning for the safety,
health, and best interests of the child; and
(ii) the court should approve of the responsible agency's determination that there are
compelling reasons why the continued voluntary foster care arrangement is in the child's
best interests.
(h) At a permanency review hearing under this section, the court may take the following
actions based on the contents of the sworn petition and the consent of the parent:
(1) approve the agency's compelling reasons that the voluntary foster care arrangement
is in the best interests of the child; and
(2) find that the agency has made reasonable efforts to finalize the permanent plan for
the child.
(i) A child, age 12 or older, may object to the agency's request that the court approve its
compelling reasons for the continued voluntary arrangement and may be heard on the reasons
for the objection. Notwithstanding the child's objection, the court may approve the agency's
compelling reasons and the voluntary arrangement.
(j) If the court does not approve the voluntary arrangement after hearing from the child
or the child's guardian ad litem, the court shall dismiss the petition. In this case, either:
(1) the child must be returned to the care of the parent; or
(2) the agency must file a petition under section 260C.141, asking for appropriate relief
under sections 260C.301 or 260C.503 to 260C.521.
(k) When the court approves the agency's compelling reasons for the child to continue
in voluntary foster care for treatment, and finds that the agency has made reasonable efforts
to finalize a permanent plan for the child, the court shall approve the continued voluntary
foster care arrangement, and continue the matter under the court's jurisdiction for the purposes
of reviewing the child's placement every 12 months while the child is in foster care.
(l) A finding that the court approves the continued voluntary placement means the agency
has continued legal authority to place the child while a voluntary placement agreement
remains in effect. The parent or the agency may terminate a voluntary agreement as provided
in section 260D.10. Termination of a voluntary foster care placement of an Indian child is
governed by section 260.765, subdivision 4.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 33.
Minnesota Statutes 2020, section 260D.08, is amended to read:
260D.08 ANNUAL REVIEW.
(a) After the court conducts a permanency review hearing under section 260D.07, the
matter must be returned to the court for further review of the responsible social services
reasonable efforts to finalize the permanent plan for the child and the child's foster care
placement at least every 12 months while the child is in foster care. The court shall give
notice to the parent and child, age 12 or older, and the foster parents of the continued review
requirements under this section at the permanency review hearing.
(b) Every 12 months, the court shall determine whether the agency made reasonable
efforts to finalize the permanency plan for the child, which means the exercise of due
diligence by the agency to:
(1) ensure that the agreement for voluntary foster care is the most appropriate legal
arrangement to meet the child's safety, health, and best interests and to conduct a genuine
examination of whether there is another permanency disposition order under chapter 260C,
including returning the child home, that would better serve the child's need for a stable and
permanent home;
(2) engage and support the parent in continued involvement in planning and decision
making for the needs of the child;
(3) strengthen the child's ties to the parent, relatives, and community;
(4) implement the out-of-home placement plan required under section 260C.212,
subdivision 1, and ensure that the plan requires the provision of appropriate services to
address the physical health, mental health, and educational needs of the child; deleted text begin and
deleted text end
new text begin
(5) submit evidence to the court as specified in section 260C.712 when a child is placed
in a qualified residential treatment program setting as defined in section 260C.007,
subdivision 26d; and
new text end
deleted text begin (5)deleted text end new text begin (6)new text end ensure appropriate planning for the child's safe, permanent, and independent
living arrangement after the child's 18th birthday.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
Sec. 34.
Minnesota Statutes 2020, section 260D.14, is amended to read:
260D.14 SUCCESSFUL TRANSITION TO ADULTHOOD FOR deleted text begin CHILDRENdeleted text end new text begin
YOUTHnew text end IN VOLUNTARY PLACEMENT.
Subdivision 1.
Case planning.
When deleted text begin the childdeleted text end new text begin a youthnew text end is 14 years of age or older, the
responsible social services agency shall ensurenew text begin thatnew text end a deleted text begin childdeleted text end new text begin youthnew text end in foster care under this
chapter is provided with the case plan requirements in section 260C.212, subdivisions 1
and 14.
Subd. 2.
Notification.
The responsible social services agency shall providenew text begin a youth withnew text end
written notice of deleted text begin the right to continued access to services for certain children in foster care
past 18 years of age under section 260C.452, subdivision 3deleted text end new text begin foster care benefits that a youth
who is 18 years of age or older may continue to receive according to section 260C.451,
subdivision 1new text end , and of the right to appeal a denial of social services under section 256.045.
The notice must be provided to the deleted text begin childdeleted text end new text begin youthnew text end six months before the deleted text begin child'sdeleted text end new text begin youth'snew text end 18th
birthday.
Subd. 3.
Administrative or court reviews.
When deleted text begin the childdeleted text end new text begin a youthnew text end is deleted text begin 17deleted text end new text begin 14new text end years of
age or older, the administrative review or court hearing must include a review of the
responsible social services agency's support for the deleted text begin child'sdeleted text end new text begin youth'snew text end successful transition to
adulthood as required in section 260C.452, subdivision 4.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 35.
Minnesota Statutes 2020, section 260E.36, is amended by adding a subdivision
to read:
new text begin Subd. 1a. new text end
new text begin Sex trafficking and sexual exploitation training requirement. new text end
new text begin
As required
by the Child Abuse Prevention and Treatment Act amendments through Public Law 114-22
and to implement Public Law 115-123, all child protection social workers and social services
staff who have responsibility for child protective duties under this chapter or chapter 260C
shall complete training implemented by the commissioner of human services regarding sex
trafficking and sexual exploitation of children and youth.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 36. new text begin DIRECTION TO THE COMMISSIONER; INITIAL IMPLEMENTATION
OF COURT-APPOINTED COUNSEL IN CHILD PROTECTION PROCEEDINGS.
new text end
new text begin
The commissioner of human services shall collect data from counties regarding
court-appointed counsel under Minnesota Statutes, section 260C.163, subdivision 3, including
but not limited to:
new text end
new text begin
(1) data documenting the presence of court-appointed counsel for qualifying parents,
guardians, or custodians at each emergency protective hearing;
new text end
new text begin
(2) total annual court-appointed parent representation expenditures for each county; and
new text end
new text begin
(3) additional demographic information that would assist counties in obtaining title IV-E
reimbursement.
new text end
new text begin
The commissioner must complete and submit a report on the data in this section and efforts
to assist counties with implementation of required court-appointment of counsel under
Minnesota Statutes, section 260C.163, subdivision 3, to the chairs and ranking minority
members of the legislative committees with jurisdiction over human services and judiciary
policy and finance on or before July 1, 2022.
new text end
Sec. 37. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES;
AFTERCARE SUPPORTS.
new text end
new text begin
The commissioner of human services shall consult with stakeholders to develop policies
regarding aftercare supports for the transition of a child from a qualified residential treatment
program as defined in Minnesota Statutes, section 260C.007, subdivision 26d, to reunification
with the child's parent or legal guardian, including potential placement in a less restrictive
setting prior to reunification that aligns with the child's permanency plan and person-centered
support plan, when applicable. The policies must be consistent with Minnesota Rules, part
2960.0190, and Minnesota Statutes, section 245A.25, subdivision 4, paragraph (i), and
address the coordination of the qualified residential treatment program discharge planning
and aftercare supports where needed, the county social services case plan, and services from
community-based providers, to maintain the child's progress with behavioral health goals
as defined in the child's treatment plan. The commissioner must complete development of
the policy guidance by December 31, 2022.
new text end
Sec. 38. new text begin DIRECTION TO THE COMMISSIONER OF HUMAN SERVICES; COSTS
TO STATE, COUNTIES, AND PROVIDERS FOR IMPLEMENTATION OF THE
FAMILY FIRST PRESERVATION SERVICES ACT.
new text end
new text begin
The commissioner of human services shall contract with an appropriate vendor to study
the increased costs incurred by the state, counties, and providers to implement the
requirements of the federal Family First Preservation Services Act in Minnesota. Identified
costs should include, but are not limited to, reductions in Title IV-E payments to lead
agencies; additional staff needs for the state, lead agencies, and providers; implementation
of the federal Qualified Residential Treatment Program placement requirements and new
prevention services by the state, lead agencies, and providers; costs incurred by residential
facility providers to become certified as a qualified residential treatment program and to
maintain certification standards; and other costs that are directly or indirectly related to
implementation of the federal Family First Prevention Services Act. The study should also
include known or estimates of increased federal funding that the state or lead agencies could
receive through expanded Title IV-E reimbursements. The commissioner shall provide a
report on these costs to the chairs and ranking minority members of the legislative committees
with jurisdiction over human services by January 15, 2024.
new text end
Sec. 39. new text begin DIRECTION TO THE COMMISSIONER OF HUMAN SERVICES;
OMBUDSPERSON FOR FAMILIES REORGANIZATION STUDY.
new text end
new text begin
The commissioner of human services shall evaluate different options to reorganize the
Office of Ombudsperson for Families under Minnesota Statutes, section 257.0755, into at
least two separate offices, and develop and recommend a corresponding legislative proposal
for introduction in the 2022 regular legislative session. The proposal shall also include any
recommended reorganization of the community-specific boards under Minnesota Statutes,
section 257.0768. The commissioner shall submit a copy of the legislative proposal and a
letter describing the reasons for recommending the proposal, the analysis that led to the
recommended proposal, other reorganization options that were considered, and any fiscal
impacts or considerations, to the chairs and ranking minority members of the legislative
committees with jurisdiction over the Office of Ombudsperson for Families.
new text end
Sec. 40. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2020, section 245.4871, subdivision 32a,
new text end
new text begin
is repealed.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective September 30, 2021.
new text end
ARTICLE 12
CHILD PROTECTION POLICY
Section 1.
Minnesota Statutes 2020, section 256.741, is amended by adding a subdivision
to read:
new text begin Subd. 12a. new text end
new text begin Appeals of good cause determinations. new text end
new text begin
According to section 256.045, an
individual may appeal the determination or redetermination of good cause under this section.
To initiate an appeal of a good cause determination or redetermination, the individual must
make a request for a state agency hearing in writing within 30 calendar days after the date
that a notice of denial for good cause is mailed or otherwise transmitted to the individual.
Until a human services judge issues a decision under section 256.0451, subdivision 22, the
child support agency shall cease all child support enforcement efforts and shall not report
the individual's noncooperation to public assistance agencies.
new text end
Sec. 2.
Minnesota Statutes 2020, section 256.741, is amended by adding a subdivision to
read:
new text begin Subd. 12b. new text end
new text begin Reporting noncooperation. new text end
new text begin
The public authority may issue a notice of the
individual's noncooperation to each public assistance agency providing public assistance
to the individual if:
new text end
new text begin
(1) 30 calendar days have passed since the later of the initial county denial or the date
of the denial following the state agency hearing; or
new text end
new text begin
(2) the individual has not cooperated with the child support agency as required in
subdivision 5.
new text end
Sec. 3.
Minnesota Statutes 2020, section 260E.20, subdivision 2, is amended to read:
Subd. 2.
Face-to-face contact.
(a) Upon receipt of a screened in report, the local welfare
agency shall deleted text begin conduct adeleted text end new text begin havenew text end face-to-face contact with the child reported to be maltreated
and with the child's primary caregiver sufficient to complete a safety assessment and ensure
the immediate safety of the child.
(b) The face-to-face contact with the child and primary caregiver shall occur immediately
if sexual abuse or substantial child endangerment is alleged and within five calendar days
for all other reports. If the alleged offender was not already interviewed as the primary
caregiver, the local welfare agency shall also conduct a face-to-face interview with the
alleged offender in the early stages of the assessment or investigation.new text begin Face-to-face contact
with the child and primary caregiver in response to a report alleging sexual abuse or
substantial child endangerment may be postponed for no more than five calendar days if
the child is residing in a location that is confirmed to restrict contact with the alleged offender
as established in guidelines issued by the commissioner, or if the local welfare agency is
pursuing a court order for the child's caregiver to produce the child for questioning under
section 260E.22, subdivision 5.
new text end
(c) At the initial contact with the alleged offender, the local welfare agency or the agency
responsible for assessing or investigating the report must inform the alleged offender of the
complaints or allegations made against the individual in a manner consistent with laws
protecting the rights of the person who made the report. The interview with the alleged
offender may be postponed if it would jeopardize an active law enforcement investigation.
(d) The local welfare agency or the agency responsible for assessing or investigating
the report must provide the alleged offender with an opportunity to make a statement. The
alleged offender may submit supporting documentation relevant to the assessment or
investigation.
Sec. 4.
Minnesota Statutes 2020, section 518.157, subdivision 1, is amended to read:
Subdivision 1.
Implementation; administration.
new text begin (a) new text end By January 1, 1998, the chief
judge of each judicial district or a designee shall implement one or more parent education
programs within the judicial district for the purpose of educating parents about the impact
that divorce, the restructuring of families, and judicial proceedings have upon children and
families; methods for preventing parenting time conflicts; and dispute resolution options.
The chief judge of each judicial district or a designee may require that children attend a
separate education program designed to deal with the impact of divorce upon children as
part of the parent education program. Each parent education program must enable persons
to have timely and reasonable access to education sessions.
new text begin
(b) The chief judge of each judicial district shall ensure that the judicial district's website
includes information on the parent education program or programs required under this
section.
new text end
Sec. 5.
Minnesota Statutes 2020, section 518.157, subdivision 3, is amended to read:
Subd. 3.
Attendance.
new text begin (a) new text end In a proceeding under this chapter where new text begin the parties have not
agreed to new text end custody or new text begin a new text end parenting time deleted text begin is contesteddeleted text end new text begin schedulenew text end , new text begin the court shall ordernew text end the parents
of a minor child deleted text begin shall attenddeleted text end new text begin to attend or take onlinenew text end a minimum of eight hours in an
orientation and education program that meets the minimum standards promulgated by the
Minnesota Supreme Court.
new text begin (b)new text end In all other proceedings involving custody, support, or parenting time the court may
order the parents of a minor child to attend a parent education program.
new text begin (c)new text end The program shall provide the court with names of persons who fail to attend the
parent education program as ordered by the court. Persons who are separated or contemplating
involvement in a dissolution, paternity, custody, or parenting time proceeding may attend
a parent education program without a court order.
new text begin (d)new text end Unless otherwise ordered by the court, participation in a parent education program
must begin new text begin before an initial case management conference and new text end within 30 days after the first
filing with the court or as soon as practicable after that time based on the reasonable
availability of classes for the program for the parent. Parent education programs must offer
an opportunity to participate at all phases of a pending or postdecree proceeding.
new text begin (e)new text end Upon request of a party and a showing of good cause, the court may excuse the party
from attending the program. If past or present domestic abuse, as defined in chapter 518B,
is alleged, the court shall not require the parties to attend the same parent education sessions
and shall enter an order setting forth the manner in which the parties may safely participate
in the program.
new text begin
(f) Before an initial case management conference for a proceeding under this chapter
where the parties have not agreed to custody or parenting time, the court shall notify the
parties of their option to resolve disagreements, including the development of a parenting
plan, through the use of private mediation.
new text end
Sec. 6.
Minnesota Statutes 2020, section 518.68, subdivision 2, is amended to read:
Subd. 2.
Contents.
The required notices must be substantially as follows:
IMPORTANT NOTICE
1. PAYMENTS TO PUBLIC AGENCY
According to Minnesota Statutes, section 518A.50, payments ordered for maintenance
and support must be paid to the public agency responsible for child support enforcement
as long as the person entitled to receive the payments is receiving or has applied for
public assistance or has applied for support and maintenance collection services. MAIL
PAYMENTS TO:
2. DEPRIVING ANOTHER OF CUSTODIAL OR PARENTAL RIGHTS -- A FELONY
A person may be charged with a felony who conceals a minor child or takes, obtains,
retains, or fails to return a minor child from or to the child's parent (or person with
custodial or visitation rights), according to Minnesota Statutes, section 609.26. A copy
of that section is available from any district court clerk.
3. NONSUPPORT OF A SPOUSE OR CHILD -- CRIMINAL PENALTIES
A person who fails to pay court-ordered child support or maintenance may be charged
with a crime, which may include misdemeanor, gross misdemeanor, or felony charges,
according to Minnesota Statutes, section 609.375. A copy of that section is available
from any district court clerk.
4. RULES OF SUPPORT, MAINTENANCE, PARENTING TIME
(a) Payment of support or spousal maintenance is to be as ordered, and the giving of
gifts or making purchases of food, clothing, and the like will not fulfill the obligation.
(b) Payment of support must be made as it becomes due, and failure to secure or denial
of parenting time is NOT an excuse for nonpayment, but the aggrieved party must seek
relief through a proper motion filed with the court.
(c) Nonpayment of support is not grounds to deny parenting time. The party entitled to
receive support may apply for support and collection services, file a contempt motion,
or obtain a judgment as provided in Minnesota Statutes, section 548.091.
(d) The payment of support or spousal maintenance takes priority over payment of debts
and other obligations.
(e) A party who accepts additional obligations of support does so with the full knowledge
of the party's prior obligation under this proceeding.
(f) Child support or maintenance is based on annual income, and it is the responsibility
of a person with seasonal employment to budget income so that payments are made
throughout the year as ordered.
(g) Reasonable parenting time guidelines are contained in Appendix B, which is available
from the court administrator.
(h) The nonpayment of support may be enforced through the denial of student grants;
interception of state and federal tax refunds; suspension of driver's, recreational, and
occupational licenses; referral to the department of revenue or private collection agencies;
seizure of assets, including bank accounts and other assets held by financial institutions;
reporting to credit bureaus; deleted text begin interest charging,deleted text end income withholdingdeleted text begin ,deleted text end and contempt
proceedings; and other enforcement methods allowed by law.
(i) The public authority may suspend or resume collection of the amount allocated for
child care expenses if the conditions of Minnesota Statutes, section 518A.40, subdivision
4, are met.
(j) The public authority may remove or resume a medical support offset if the conditions
of Minnesota Statutes, section 518A.41, subdivision 16, are met.
deleted text begin
(k) The public authority may suspend or resume interest charging on child support
judgments if the conditions of Minnesota Statutes, section 548.091, subdivision 1a, are met.
deleted text end
5. MODIFYING CHILD SUPPORT
If either the obligor or obligee is laid off from employment or receives a pay reduction,
child support may be modified, increased, or decreased. Any modification will only take
effect when it is ordered by the court, and will only relate back to the time that a motion
is filed. Either the obligor or obligee may file a motion to modify child support, and may
request the public agency for help. UNTIL A MOTION IS FILED, THE CHILD
SUPPORT OBLIGATION WILL CONTINUE AT THE CURRENT LEVEL. THE
COURT IS NOT PERMITTED TO REDUCE SUPPORT RETROACTIVELY.
6. PARENTAL RIGHTS FROM MINNESOTA STATUTES, SECTION 518.17,
SUBDIVISION 3
Unless otherwise provided by the Court:
(a) Each party has the right of access to, and to receive copies of, school, medical, dental,
religious training, and other important records and information about the minor children.
Each party has the right of access to information regarding health or dental insurance
available to the minor children. Presentation of a copy of this order to the custodian of
a record or other information about the minor children constitutes sufficient authorization
for the release of the record or information to the requesting party.
(b) Each party shall keep the other informed as to the name and address of the school
of attendance of the minor children. Each party has the right to be informed by school
officials about the children's welfare, educational progress and status, and to attend
school and parent teacher conferences. The school is not required to hold a separate
conference for each party.
(c) In case of an accident or serious illness of a minor child, each party shall notify the
other party of the accident or illness, and the name of the health care provider and the
place of treatment.
(d) Each party has the right of reasonable access and telephone contact with the minor
children.
7. WAGE AND INCOME DEDUCTION OF SUPPORT AND MAINTENANCE
Child support and/or spousal maintenance may be withheld from income, with or without
notice to the person obligated to pay, when the conditions of Minnesota Statutes, section
518A.53 have been met. A copy of those sections is available from any district court
clerk.
8. CHANGE OF ADDRESS OR RESIDENCE
Unless otherwise ordered, each party shall notify the other party, the court, and the public
authority responsible for collection, if applicable, of the following information within
ten days of any change: the residential and mailing address, telephone number, driver's
license number, Social Security number, and name, address, and telephone number of
the employer.
9. COST OF LIVING INCREASE OF SUPPORT AND MAINTENANCE
Basic support and/or spousal maintenance may be adjusted every two years based upon
a change in the cost of living (using Department of Labor Consumer Price Index ..........,
unless otherwise specified in this order) when the conditions of Minnesota Statutes,
section 518A.75, are met. Cost of living increases are compounded. A copy of Minnesota
Statutes, section 518A.75, and forms necessary to request or contest a cost of living
increase are available from any district court clerk.
10. JUDGMENTS FOR UNPAID SUPPORT
If a person fails to make a child support payment, the payment owed becomes a judgment
against the person responsible to make the payment by operation of law on or after the
date the payment is due, and the person entitled to receive the payment or the public
agency may obtain entry and docketing of the judgment WITHOUT NOTICE to the
person responsible to make the payment under Minnesota Statutes, section 548.091.
deleted text begin Interest begins to accrue on a payment or installment of child support whenever the
unpaid amount due is greater than the current support due, according to Minnesota
Statutes, section 548.091, subdivision 1a.
deleted text end
11. JUDGMENTS FOR UNPAID MAINTENANCE
new text begin (a) new text end A judgment for unpaid spousal maintenance may be entered when the conditions of
Minnesota Statutes, section 548.091, are met. A copy of that section is available from
any district court clerk.
new text begin
(b) The public authority is not responsible for calculating interest on any judgment for
unpaid spousal maintenance. When providing services in IV-D cases, as defined in
Minnesota Statutes, section 518A.26, subdivision 10, the public authority will only
collect interest on spousal maintenance if spousal maintenance is reduced to a sum
certain judgment.
new text end
12. ATTORNEY FEES AND COLLECTION COSTS FOR ENFORCEMENT OF CHILD
SUPPORT
A judgment for attorney fees and other collection costs incurred in enforcing a child
support order will be entered against the person responsible to pay support when the
conditions of Minnesota Statutes, section 518A.735, are met. A copy of Minnesota
Statutes, sections 518.14 and 518A.735 and forms necessary to request or contest these
attorney fees and collection costs are available from any district court clerk.
13. PARENTING TIME EXPEDITOR PROCESS
On request of either party or on its own motion, the court may appoint a parenting time
expeditor to resolve parenting time disputes under Minnesota Statutes, section 518.1751.
A copy of that section and a description of the expeditor process is available from any
district court clerk.
14. PARENTING TIME REMEDIES AND PENALTIES
Remedies and penalties for the wrongful denial of parenting time are available under
Minnesota Statutes, section 518.175, subdivision 6. These include compensatory parenting
time; civil penalties; bond requirements; contempt; and reversal of custody. A copy of
that subdivision and forms for requesting relief are available from any district court
clerk.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022.
new text end
Sec. 7.
Minnesota Statutes 2020, section 518A.29, is amended to read:
518A.29 CALCULATION OF GROSS INCOME.
(a) Subject to the exclusions and deductions in this section, gross income includes any
form of periodic payment to an individual, including, but not limited to, salaries, wages,
commissions, self-employment income under section 518A.30, workers' compensation,
unemployment benefits, annuity payments, military and naval retirement, pension and
disability payments, spousal maintenance received under a previous order or the current
proceeding, Social Security or veterans benefits provided for a joint child under section
518A.31, and potential income under section 518A.32. Salaries, wages, commissions, or
other compensation paid by third parties shall be based upon gross income before
participation in an employer-sponsored benefit plan that allows an employee to pay for a
benefit or expense using pretax dollars, such as flexible spending plans and health savings
accounts. No deductions shall be allowed for contributions to pensions, 401-K, IRA, or
other retirement benefits.
(b) Gross income does not include compensation received by a party for employment
in excess of a 40-hour work week, provided that:
(1) child support is ordered in an amount at least equal to the guideline amount based
on gross income not excluded under this clause; and
(2) the party demonstrates, and the court finds, that:
(i) the excess employment began after the filing of the petition for dissolution or legal
separation or a petition related to custody, parenting time, or support;
(ii) the excess employment reflects an increase in the work schedule or hours worked
over that of the two years immediately preceding the filing of the petition;
(iii) the excess employment is voluntary and not a condition of employment;
(iv) the excess employment is in the nature of additional, part-time or overtime
employment compensable by the hour or fraction of an hour; and
(v) the party's compensation structure has not been changed for the purpose of affecting
a support or maintenance obligation.
(c) Expense reimbursements or in-kind payments received by a parent in the course of
employment, self-employment, or operation of a business shall be counted as income if
they reduce personal living expenses.
(d) Gross income may be calculated on either an annual or monthly basis. Weekly income
shall be translated to monthly income by multiplying the weekly income by 4.33.
(e) Gross income does not include a child support payment received by a party. It is a
rebuttable presumption that adoption assistance payments, Northstar kinship assistance
payments, and foster care subsidies are not gross income.
(f) Gross income does not include the income of the obligor's spouse and the obligee's
spouse.
(g) deleted text begin Child support ordeleted text end Spousal maintenance payments ordered by a court for a deleted text begin nonjoint
child ordeleted text end former spouse or ordered payable to the other party as part of the current proceeding
are deducted from other periodic payments received by a party for purposes of determining
gross income.
(h) Gross income does not include public assistance benefits received under section
256.741 or other forms of public assistance based on need.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 8.
Minnesota Statutes 2020, section 518A.33, is amended to read:
518A.33 DEDUCTION FROM INCOME FOR NONJOINT CHILDREN.
(a) When either or both parents are legally responsible for a nonjoint child, a deduction
for this obligation shall be calculated under this section deleted text begin if:deleted text end new text begin .
new text end
deleted text begin
(1) the nonjoint child primarily resides in the parent's household; and
deleted text end
deleted text begin
(2) the parent is not obligated to pay basic child support for the nonjoint child to the
other parent or a legal custodian of the child under an existing child support order.
deleted text end
(b) deleted text begin The court shall use the guidelines under section 518A.35 to determine the basic child
support obligation for the nonjoint child or children by using the gross income of the parent
for whom the deduction is being calculated and the number of nonjoint children primarily
residing in the parent's household. If the number of nonjoint children to be used for the
determination is greater than two, the determination must be made using the number two
instead of the greater number.deleted text end new text begin Court-ordered child support for a nonjoint child shall be
deducted from the payor's gross income.
new text end
(c) deleted text begin The deduction for nonjoint children is 50 percent of the guideline amount determined
under paragraph (b).deleted text end new text begin When a parent is legally responsible for a nonjoint child and the parent
is not obligated to pay basic child support for the nonjoint child to the other parent or a legal
custodian under an existing child support order, a deduction shall be calculated. The court
shall use the basic support guideline table under section 518A.35 to determine this deduction
by using the gross income of the parent for whom the deduction is being calculated, minus
any deduction under paragraph (b) and the number of eligible nonjoint children, up to six
children. The deduction for nonjoint children is 75 percent of the guideline amount
determined under this paragraph.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 9.
Minnesota Statutes 2020, section 518A.35, subdivision 1, is amended to read:
Subdivision 1.
Determination of support obligation.
(a) The guideline in this section
is a rebuttable presumption and shall be used in any judicial or administrative proceeding
to establish or modify a support obligation under this chapter.
(b) The basic child support obligation shall be determined by referencing the guideline
for the appropriate number of joint children and the combined parental income for
determining child support of the parents.
(c) If a child is not in the custody of either parent and a support order is sought against
one or both parents, the basic child support obligation shall be determined by referencing
the guideline for the appropriate number of joint children, and the parent's individual parental
income for determining child support, not the combined parental incomes for determining
child support of the parents. Unless a parent has court-ordered parenting time, the parenting
expense adjustment formula under section 518A.34 must not be applied.
(d) If a child is deleted text begin in custody of either parentdeleted text end new text begin not residing with the parent that has
court-ordered or statutory custodynew text end and a support order is sought deleted text begin by the public authoritydeleted text end
under section 256.87new text begin against one or both parentsnew text end , deleted text begin unless the parent against whom the support
order is sought has court-ordered parenting time,deleted text end the new text begin basicnew text end support obligation must be
determined by referencing the guideline for the appropriate number of joint children and
the parent's individual income without application of the parenting expense adjustment
formula under section 518A.34.
(e) For combined parental incomes for determining child support exceeding deleted text begin $15,000deleted text end new text begin
$20,000new text end per month, the presumed basic child support obligations shall be as for parents
with combined parental income for determining child support of deleted text begin $15,000deleted text end new text begin $20,000new text end per month.
A basic child support obligation in excess of this level may be demonstrated for those reasons
set forth in section 518A.43.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 10.
Minnesota Statutes 2020, section 518A.35, subdivision 2, is amended to read:
Subd. 2.
Basic support; guideline.
Unless otherwise agreed to by the parents and
approved by the court, when establishing basic support, the court must order that basic
support be divided between the parents based on their proportionate share of the parents'
combined monthly parental income for determining child support (PICS). Basic support
must be computed using the following guideline:
| Combined Parental |
Number of Children |
|||||
| Income for Determining Child Support |
One |
Two |
Three |
Four |
Five |
Six |
| $0- deleted text begin $799 deleted text end new text begin $1,399 new text end |
$50 |
deleted text begin
$50 deleted text end new text begin $60 new text end |
deleted text begin
$75 deleted text end new text begin $70 new text end |
deleted text begin
$75 deleted text end new text begin $80 new text end |
deleted text begin
$100 deleted text end new text begin $90 new text end |
$100 |
|
deleted text begin
800- 899 deleted text end |
deleted text begin
80 deleted text end |
deleted text begin
129 deleted text end |
deleted text begin
149 deleted text end |
deleted text begin
173 deleted text end |
deleted text begin
201 deleted text end |
deleted text begin
233 deleted text end |
|
deleted text begin
900- 999 deleted text end |
deleted text begin
90 deleted text end |
deleted text begin
145 deleted text end |
deleted text begin
167 deleted text end |
deleted text begin
194 deleted text end |
deleted text begin
226 deleted text end |
deleted text begin
262 deleted text end |
|
deleted text begin
1,000- 1,099 deleted text end |
deleted text begin
116 deleted text end |
deleted text begin
161 deleted text end |
deleted text begin
186 deleted text end |
deleted text begin
216 deleted text end |
deleted text begin
251 deleted text end |
deleted text begin
291 deleted text end |
|
deleted text begin
1,100- 1,199 deleted text end |
deleted text begin
145 deleted text end |
deleted text begin
205 deleted text end |
deleted text begin
237 deleted text end |
deleted text begin
275 deleted text end |
deleted text begin
320 deleted text end |
deleted text begin
370 deleted text end |
|
deleted text begin
1,200- 1,299 deleted text end |
deleted text begin
177 deleted text end |
deleted text begin
254 deleted text end |
deleted text begin
294 deleted text end |
deleted text begin
341 deleted text end |
deleted text begin
396 deleted text end |
deleted text begin
459 deleted text end |
|
deleted text begin
1,300- 1,399 deleted text end |
deleted text begin
212 deleted text end |
deleted text begin
309 deleted text end |
deleted text begin
356 deleted text end |
deleted text begin
414 deleted text end |
deleted text begin
480 deleted text end |
deleted text begin
557 deleted text end |
| 1,400- 1,499 |
deleted text begin
251 deleted text end new text begin 60 new text end |
deleted text begin
368 deleted text end new text begin 75 new text end |
deleted text begin
425 deleted text end new text begin 85 new text end |
deleted text begin
493 deleted text end new text begin 100 new text end |
deleted text begin
573 deleted text end new text begin 110 new text end |
deleted text begin
664 deleted text end new text begin 120 new text end |
| 1,500- 1,599 |
deleted text begin
292 deleted text end new text begin 75 new text end |
deleted text begin
433 deleted text end new text begin 90 new text end |
deleted text begin
500 deleted text end new text begin 105 new text end |
deleted text begin
580 deleted text end new text begin 125 new text end |
deleted text begin
673 deleted text end new text begin 135 new text end |
deleted text begin
780 deleted text end new text begin 145 new text end |
| 1,600- 1,699 |
deleted text begin
337 deleted text end new text begin 90 new text end |
deleted text begin
502 deleted text end new text begin 110 new text end |
deleted text begin
580 deleted text end new text begin 130 new text end |
deleted text begin
673 deleted text end new text begin 150 new text end |
deleted text begin
781 deleted text end new text begin 160 new text end |
deleted text begin
905 deleted text end new text begin 170 new text end |
| 1,700- 1,799 |
deleted text begin
385 deleted text end new text begin 110 new text end |
deleted text begin
577 deleted text end new text begin 130 new text end |
deleted text begin
666 deleted text end new text begin 155 new text end |
deleted text begin
773 deleted text end new text begin 175 new text end |
deleted text begin
897 deleted text end new text begin 185 new text end |
deleted text begin
1,040 deleted text end new text begin 195 new text end |
| 1,800- 1,899 |
deleted text begin
436 deleted text end new text begin 130 new text end |
deleted text begin
657 deleted text end new text begin 150 new text end |
deleted text begin
758 deleted text end new text begin 180 new text end |
deleted text begin
880 deleted text end new text begin 200 new text end |
deleted text begin
1,021 deleted text end new text begin 210 new text end |
deleted text begin
1,183 deleted text end new text begin 220 new text end |
| 1,900- 1,999 |
deleted text begin
490 deleted text end new text begin 150 new text end |
deleted text begin
742 deleted text end new text begin 175 new text end |
deleted text begin
856 deleted text end new text begin 205 new text end |
deleted text begin
994 deleted text end new text begin 235 new text end |
deleted text begin
1,152 deleted text end new text begin 245 new text end |
deleted text begin
1,336 deleted text end new text begin 255 new text end |
| 2,000- 2,099 |
deleted text begin
516 deleted text end new text begin 170 new text end |
deleted text begin
832 deleted text end new text begin 200 new text end |
deleted text begin
960 deleted text end new text begin 235 new text end |
deleted text begin
1,114 deleted text end new text begin 270 new text end |
deleted text begin
1,292 deleted text end new text begin 285 new text end |
deleted text begin
1,498 deleted text end new text begin 295 new text end |
| 2,100- 2,199 |
deleted text begin
528 deleted text end new text begin 190 new text end |
deleted text begin
851 deleted text end new text begin 225 new text end |
deleted text begin
981 deleted text end new text begin 265 new text end |
deleted text begin
1,139 deleted text end new text begin 305 new text end |
deleted text begin
1,320 deleted text end new text begin 325 new text end |
deleted text begin
1,531 deleted text end new text begin 335 new text end |
| 2,200- 2,299 |
deleted text begin
538 deleted text end new text begin 215 new text end |
deleted text begin
867 deleted text end new text begin 255 new text end |
deleted text begin
1,000 deleted text end new text begin 300 new text end |
deleted text begin
1,160 deleted text end new text begin 345 new text end |
deleted text begin
1,346 deleted text end new text begin 367 new text end |
deleted text begin
1,561 deleted text end new text begin 379 new text end |
| 2,300- 2,399 |
deleted text begin
546 deleted text end new text begin 240 new text end |
deleted text begin
881 deleted text end new text begin 285 new text end |
deleted text begin
1,016 deleted text end new text begin 335 new text end |
deleted text begin
1,179 deleted text end new text begin 385 new text end |
deleted text begin
1,367 deleted text end new text begin 409 new text end |
deleted text begin
1,586 deleted text end new text begin 423 new text end |
| 2,400- 2,499 |
deleted text begin
554 deleted text end new text begin 265 new text end |
deleted text begin
893 deleted text end new text begin 315 new text end |
deleted text begin
1,029 deleted text end new text begin 370 new text end |
deleted text begin
1,195 deleted text end new text begin 425 new text end |
deleted text begin
1,385 deleted text end new text begin 451 new text end |
deleted text begin
1,608 deleted text end new text begin 467 new text end |
| 2,500- 2,599 |
deleted text begin
560 deleted text end new text begin 290 new text end |
deleted text begin
903 deleted text end new text begin 350 new text end |
deleted text begin
1,040 deleted text end new text begin 408 new text end |
deleted text begin
1,208 deleted text end new text begin 465 new text end |
deleted text begin
1,400 deleted text end new text begin 493 new text end |
deleted text begin
1,625 deleted text end new text begin 511 new text end |
| 2,600- 2,699 |
deleted text begin
570 deleted text end new text begin 315 new text end |
deleted text begin
920 deleted text end new text begin 385 new text end |
deleted text begin
1,060 deleted text end new text begin 446 new text end |
deleted text begin
1,230 deleted text end new text begin 505 new text end |
deleted text begin
1,426 deleted text end new text begin 535 new text end |
deleted text begin
1,655 deleted text end new text begin 555 new text end |
| 2,700- 2,799 |
deleted text begin
580 deleted text end new text begin 340 new text end |
deleted text begin
936 deleted text end new text begin 420 new text end |
deleted text begin
1,078 deleted text end new text begin 484 new text end |
deleted text begin
1,251 deleted text end new text begin 545 new text end |
deleted text begin
1,450 deleted text end new text begin 577 new text end |
deleted text begin
1,683 deleted text end new text begin 599 new text end |
| 2,800- 2,899 |
deleted text begin
589 deleted text end new text begin 365 new text end |
deleted text begin
950 deleted text end new text begin 455 new text end |
deleted text begin
1,094 deleted text end new text begin 522 new text end |
deleted text begin
1,270 deleted text end new text begin 585 new text end |
deleted text begin
1,472 deleted text end new text begin 619 new text end |
deleted text begin
1,707 deleted text end new text begin 643 new text end |
| 2,900- 2,999 |
deleted text begin
596 deleted text end new text begin 390 new text end |
deleted text begin
963 deleted text end new text begin 490 new text end |
deleted text begin
1,109 deleted text end new text begin 560 new text end |
deleted text begin
1,287 deleted text end new text begin 625 new text end |
deleted text begin
1,492 deleted text end new text begin 661 new text end |
deleted text begin
1,730 deleted text end new text begin 687 new text end |
| 3,000- 3,099 |
deleted text begin
603 deleted text end new text begin 415 new text end |
deleted text begin
975 deleted text end new text begin 525 new text end |
deleted text begin
1,122 deleted text end new text begin 598 new text end |
deleted text begin
1,302 deleted text end new text begin 665 new text end |
deleted text begin
1,509 deleted text end new text begin 703 new text end |
deleted text begin
1,749 deleted text end new text begin 731 new text end |
| 3,100- 3,199 |
deleted text begin
613 deleted text end new text begin 440 new text end |
deleted text begin
991 deleted text end new text begin 560 new text end |
deleted text begin
1,141 deleted text end new text begin 636 new text end |
deleted text begin
1,324 deleted text end new text begin 705 new text end |
deleted text begin
1,535 deleted text end new text begin 745 new text end |
deleted text begin
1,779 deleted text end new text begin 775 new text end |
| 3,200- 3,299 |
deleted text begin
623 deleted text end new text begin 465 new text end |
deleted text begin
1,007 deleted text end new text begin 595 new text end |
deleted text begin
1,158 deleted text end new text begin 674 new text end |
deleted text begin
1,344 deleted text end new text begin 745 new text end |
deleted text begin
1,558 deleted text end new text begin 787 new text end |
deleted text begin
1,807 deleted text end new text begin 819 new text end |
| 3,300- 3,399 |
deleted text begin
636 deleted text end new text begin 485 new text end |
deleted text begin
1,021 deleted text end new text begin 630 new text end |
deleted text begin
1,175 deleted text end new text begin 712 new text end |
deleted text begin
1,363 deleted text end new text begin 785 new text end |
deleted text begin
1,581 deleted text end new text begin 829 new text end |
deleted text begin
1,833 deleted text end new text begin 863 new text end |
| 3,400- 3,499 |
deleted text begin
650 deleted text end new text begin 505 new text end |
deleted text begin
1,034 deleted text end new text begin 665 new text end |
deleted text begin
1,190 deleted text end new text begin 750 new text end |
deleted text begin
1,380 deleted text end new text begin 825 new text end |
deleted text begin
1,601 deleted text end new text begin 871 new text end |
deleted text begin
1,857 deleted text end new text begin 907 new text end |
| 3,500- 3,599 |
deleted text begin
664 deleted text end new text begin 525 new text end |
deleted text begin
1,047 deleted text end new text begin 695 new text end |
deleted text begin
1,204 deleted text end new text begin 784 new text end |
deleted text begin
1,397 deleted text end new text begin 861 new text end |
deleted text begin
1,621 deleted text end new text begin 910 new text end |
deleted text begin
1,880 deleted text end new text begin 948 new text end |
| 3,600- 3,699 |
deleted text begin
677 deleted text end new text begin 545 new text end |
deleted text begin
1,062 deleted text end new text begin 725 new text end |
deleted text begin
1,223 deleted text end new text begin 818 new text end |
deleted text begin
1,418 deleted text end new text begin 897 new text end |
deleted text begin
1,646 deleted text end new text begin 949 new text end |
deleted text begin
1,909 deleted text end new text begin 989 new text end |
| 3,700- 3,799 |
deleted text begin
691 deleted text end new text begin 565 new text end |
deleted text begin
1,077 deleted text end new text begin 755 new text end |
deleted text begin
1,240 deleted text end new text begin 852 new text end |
deleted text begin
1,439 deleted text end new text begin 933 new text end |
deleted text begin
1,670 deleted text end new text begin 988 new text end |
deleted text begin
1,937 deleted text end new text begin 1,030 new text end |
| 3,800- 3,899 |
deleted text begin
705 deleted text end new text begin 585 new text end |
deleted text begin
1,081 deleted text end new text begin 785 new text end |
deleted text begin
1,257 deleted text end new text begin 886 new text end |
deleted text begin
1,459 deleted text end new text begin 969 new text end |
deleted text begin
1,693 deleted text end new text begin 1,027 new text end |
deleted text begin
1,963 deleted text end new text begin 1,071 new text end |
| 3,900- 3,999 |
deleted text begin
719 deleted text end new text begin 605 new text end |
deleted text begin
1,104 deleted text end new text begin 815 new text end |
deleted text begin
1,273 deleted text end new text begin 920 new text end |
deleted text begin
1,478 deleted text end new text begin 1,005 new text end |
deleted text begin
1,715 deleted text end new text begin 1,065 new text end |
deleted text begin
1,988 deleted text end new text begin 1,111 new text end |
| 4,000- 4,099 |
deleted text begin
732 deleted text end new text begin 625 new text end |
deleted text begin
1,116 deleted text end new text begin 845 new text end |
deleted text begin
1,288 deleted text end new text begin 954 new text end |
deleted text begin
1,496 deleted text end new text begin 1,041 new text end |
deleted text begin
1,736 deleted text end new text begin 1,103 new text end |
deleted text begin
2,012 deleted text end new text begin 1,151 new text end |
| 4,100- 4,199 |
deleted text begin
746 deleted text end new text begin 645 new text end |
deleted text begin
1,132 deleted text end new text begin 875 new text end |
deleted text begin
1,305 deleted text end new text begin 988 new text end |
deleted text begin
1,516 deleted text end new text begin 1,077 new text end |
deleted text begin
1,759 deleted text end new text begin 1,142 new text end |
deleted text begin
2,039 deleted text end new text begin 1,191 new text end |
| 4,200- 4,299 |
deleted text begin
760 deleted text end new text begin 665 new text end |
deleted text begin
1,147 deleted text end new text begin 905 new text end |
deleted text begin
1,322 deleted text end new text begin 1,022 new text end |
deleted text begin
1,536 deleted text end new text begin 1,113 new text end |
deleted text begin
1,781 deleted text end new text begin 1,180 new text end |
deleted text begin
2,064 deleted text end new text begin 1,230 new text end |
| 4,300- 4,399 |
deleted text begin
774 deleted text end new text begin 685 new text end |
deleted text begin
1,161 deleted text end new text begin 935 new text end |
deleted text begin
1,338 deleted text end new text begin 1,056 new text end |
deleted text begin
1,554 deleted text end new text begin 1,149 new text end |
deleted text begin
1,802 deleted text end new text begin 1,218 new text end |
deleted text begin
2,088 deleted text end new text begin 1,269 new text end |
| 4,400- 4,499 |
deleted text begin
787 deleted text end new text begin 705 new text end |
deleted text begin
1,175 deleted text end new text begin 965 new text end |
deleted text begin
1,353 deleted text end new text begin 1,090 new text end |
deleted text begin
1,572 deleted text end new text begin 1,185 new text end |
deleted text begin
1,822 deleted text end new text begin 1,256 new text end |
deleted text begin
2,111 deleted text end new text begin 1,308 new text end |
| 4,500- 4,599 |
deleted text begin
801 deleted text end new text begin 724 new text end |
deleted text begin
1,184 deleted text end new text begin 993 new text end |
deleted text begin
1,368 deleted text end new text begin 1,122 new text end |
deleted text begin
1,589 deleted text end new text begin 1,219 new text end |
deleted text begin
1,841 deleted text end new text begin 1,292 new text end |
deleted text begin
2,133 deleted text end new text begin 1,345 new text end |
| 4,600- 4,699 |
deleted text begin
808 deleted text end new text begin 743 new text end |
deleted text begin
1,200 deleted text end new text begin 1,021 new text end |
deleted text begin
1,386 deleted text end new text begin 1,154 new text end |
deleted text begin
1,608 deleted text end new text begin 1,253 new text end |
deleted text begin
1,864 deleted text end new text begin 1,328 new text end |
deleted text begin
2,160 deleted text end new text begin 1,382 new text end |
| 4,700- 4,799 |
deleted text begin
814 deleted text end new text begin 762 new text end |
deleted text begin
1,215 deleted text end new text begin 1,049 new text end |
deleted text begin
1,402 deleted text end new text begin 1,186 new text end |
deleted text begin
1,627 deleted text end new text begin 1,287 new text end |
deleted text begin
1,887 deleted text end new text begin 1,364 new text end |
deleted text begin
2,186 deleted text end new text begin 1,419 new text end |
| 4,800- 4,899 |
deleted text begin
820 deleted text end new text begin 781 new text end |
deleted text begin
1,231 deleted text end new text begin 1,077 new text end |
deleted text begin
1,419 deleted text end new text begin 1,218 new text end |
deleted text begin
1,645 deleted text end new text begin 1,321 new text end |
deleted text begin
1,908 deleted text end new text begin 1,400 new text end |
deleted text begin
2,212 deleted text end new text begin 1,456 new text end |
| 4,900- 4,999 |
deleted text begin
825 deleted text end new text begin 800 new text end |
deleted text begin
1,246 deleted text end new text begin 1,105 new text end |
deleted text begin
1,435 deleted text end new text begin 1,250 new text end |
deleted text begin
1,663 deleted text end new text begin 1,354 new text end |
deleted text begin
1,930 deleted text end new text begin 1,435 new text end |
deleted text begin
2,236 deleted text end new text begin 1,493 new text end |
| 5,000- 5,099 |
deleted text begin
831 deleted text end new text begin 818 new text end |
deleted text begin
1,260 deleted text end new text begin 1,132 new text end |
deleted text begin
1,450 deleted text end new text begin 1,281 new text end |
deleted text begin
1,680 deleted text end new text begin 1,387 new text end |
deleted text begin
1,950 deleted text end new text begin 1,470 new text end |
deleted text begin
2,260 deleted text end new text begin 1,529 new text end |
| 5,100- 5,199 |
deleted text begin
837 deleted text end new text begin 835 new text end |
deleted text begin
1,275 deleted text end new text begin 1,159 new text end |
deleted text begin
1,468 deleted text end new text begin 1,312 new text end |
deleted text begin
1,701 deleted text end new text begin 1,420 new text end |
deleted text begin
1,975 deleted text end new text begin 1,505 new text end |
deleted text begin
2,289 deleted text end new text begin 1,565 new text end |
| 5,200- 5,299 |
deleted text begin
843 deleted text end new text begin 852 new text end |
deleted text begin
1,290 deleted text end new text begin 1,186 new text end |
deleted text begin
1,485 deleted text end new text begin 1,343 new text end |
deleted text begin
1,722 deleted text end new text begin 1,453 new text end |
deleted text begin
1,999 deleted text end new text begin 1,540 new text end |
deleted text begin
2,317 deleted text end new text begin 1,601 new text end |
| 5,300- 5,399 |
deleted text begin
849 deleted text end new text begin 869 new text end |
deleted text begin
1,304 deleted text end new text begin 1,213 new text end |
deleted text begin
1,502 deleted text end new text begin 1,374 new text end |
deleted text begin
1,743 deleted text end new text begin 1,486 new text end |
deleted text begin
2,022 deleted text end new text begin 1,575 new text end |
deleted text begin
2,345 deleted text end new text begin 1,638 new text end |
| 5,400- 5,499 |
deleted text begin
854 deleted text end new text begin 886 new text end |
deleted text begin
1,318 deleted text end new text begin 1,240 new text end |
deleted text begin
1,518 deleted text end new text begin 1,405 new text end |
deleted text begin
1,763 deleted text end new text begin 1,519 new text end |
deleted text begin
2,046 deleted text end new text begin 1,610 new text end |
deleted text begin
2,372 deleted text end new text begin 1,674 new text end |
| 5,500- 5,599 |
deleted text begin
860 deleted text end new text begin 903 new text end |
deleted text begin
1,331 deleted text end new text begin 1,264 new text end |
deleted text begin
1,535 deleted text end new text begin 1,434 new text end |
deleted text begin
1,782 deleted text end new text begin 1,550 new text end |
deleted text begin
2,068 deleted text end new text begin 1,643 new text end |
deleted text begin
2,398 deleted text end new text begin 1,708 new text end |
| 5,600- 5,699 |
deleted text begin
866 deleted text end new text begin 920 new text end |
deleted text begin
1,346 deleted text end new text begin 1,288 new text end |
deleted text begin
1,551 deleted text end new text begin 1,463 new text end |
deleted text begin
1,801 deleted text end new text begin 1,581 new text end |
deleted text begin
2,090 deleted text end new text begin 1,676 new text end |
deleted text begin
2,424 deleted text end new text begin 1,743 new text end |
| 5,700- 5,799 |
deleted text begin
873 deleted text end new text begin 937 new text end |
deleted text begin
1,357 deleted text end new text begin 1,312 new text end |
deleted text begin
1,568 deleted text end new text begin 1,492 new text end |
deleted text begin
1,819 deleted text end new text begin 1,612 new text end |
deleted text begin
2,111 deleted text end new text begin 1,709 new text end |
deleted text begin
2,449 deleted text end new text begin 1,777 new text end |
| 5,800- 5,899 |
deleted text begin
881 deleted text end new text begin 954 new text end |
deleted text begin
1,376 deleted text end new text begin 1,336 new text end |
deleted text begin
1,583 deleted text end new text begin 1,521 new text end |
deleted text begin
1,837 deleted text end new text begin 1,643 new text end |
deleted text begin
2,132 deleted text end new text begin 1,742 new text end |
deleted text begin
2,473 deleted text end new text begin 1,811 new text end |
| 5,900- 5,999 |
deleted text begin
888 deleted text end new text begin 971 new text end |
deleted text begin
1,390 deleted text end new text begin 1,360 new text end |
deleted text begin
1,599 deleted text end new text begin 1,550 new text end |
deleted text begin
1,855 deleted text end new text begin 1,674 new text end |
deleted text begin
2,152 deleted text end new text begin 1,775 new text end |
deleted text begin
2,497 deleted text end new text begin 1,846 new text end |
| 6,000- 6,099 |
deleted text begin
895 deleted text end new text begin 988 new text end |
deleted text begin
1,404 deleted text end new text begin 1,383 new text end |
deleted text begin
1,604 deleted text end new text begin 1,577 new text end |
deleted text begin
1,872 deleted text end new text begin 1,703 new text end |
deleted text begin
2,172 deleted text end new text begin 1,805 new text end |
deleted text begin
2,520 deleted text end new text begin 1,877 new text end |
| 6,100- 6,199 |
deleted text begin
902 deleted text end new text begin 993 new text end |
deleted text begin
1,419 deleted text end new text begin 1,391 new text end |
deleted text begin
1,631 deleted text end new text begin 1,586 new text end |
deleted text begin
1,892 deleted text end new text begin 1,713 new text end |
deleted text begin
2,195 deleted text end new text begin 1,815 new text end |
deleted text begin
2,546 deleted text end new text begin 1,887 new text end |
| 6,200- 6,299 |
deleted text begin
909 deleted text end new text begin 999 new text end |
deleted text begin
1,433 deleted text end new text begin 1,399 new text end |
deleted text begin
1,645 deleted text end new text begin 1,594 new text end |
deleted text begin
1,912 deleted text end new text begin 1,722 new text end |
deleted text begin
2,217 deleted text end new text begin 1,825 new text end |
deleted text begin
2,572 deleted text end new text begin 1,898 new text end |
| 6,300- 6,399 |
deleted text begin
916 deleted text end new text begin 1,005 new text end |
deleted text begin
1,448 deleted text end new text begin 1,406 new text end |
deleted text begin
1,664 deleted text end new text begin 1,603 new text end |
deleted text begin
1,932 deleted text end new text begin 1,732 new text end |
deleted text begin
2,239 deleted text end new text begin 1,836 new text end |
deleted text begin
2,597 deleted text end new text begin 1,909 new text end |
| 6,400- 6,499 |
deleted text begin
923 deleted text end new text begin 1,010 new text end |
deleted text begin
1,462 deleted text end new text begin 1,414 new text end |
deleted text begin
1,682 deleted text end new text begin 1,612 new text end |
deleted text begin
1,951 deleted text end new text begin 1,741 new text end |
deleted text begin
2,260 deleted text end new text begin 1,846 new text end |
deleted text begin
2,621 deleted text end new text begin 1,920 new text end |
| 6,500- 6,599 |
deleted text begin
930 deleted text end new text begin 1,016 new text end |
deleted text begin
1,476 deleted text end new text begin 1,422 new text end |
deleted text begin
1,697 deleted text end new text begin 1,621 new text end |
deleted text begin
1,970 deleted text end new text begin 1,751 new text end |
deleted text begin
2,282 deleted text end new text begin 1,856 new text end |
deleted text begin
2,646 deleted text end new text begin 1,931 new text end |
| 6,600- 6,699 |
deleted text begin
936 deleted text end new text begin 1,021 new text end |
deleted text begin
1,490 deleted text end new text begin 1,430 new text end |
deleted text begin
1,713 deleted text end new text begin 1,630 new text end |
deleted text begin
1,989 deleted text end new text begin 1,761 new text end |
deleted text begin
2,305 deleted text end new text begin 1,866 new text end |
deleted text begin
2,673 deleted text end new text begin 1,941 new text end |
| 6,700- 6,799 |
deleted text begin
943 deleted text end new text begin 1,027 new text end |
deleted text begin
1,505 deleted text end new text begin 1,438 new text end |
deleted text begin
1,730 deleted text end new text begin 1,639 new text end |
deleted text begin
2,009 deleted text end new text begin 1,770 new text end |
deleted text begin
2,328 deleted text end new text begin 1,876 new text end |
deleted text begin
2,700 deleted text end new text begin 1,951 new text end |
| 6,800- 6,899 |
deleted text begin
950 deleted text end new text begin 1,032 new text end |
deleted text begin
1,519 deleted text end new text begin 1,445 new text end |
deleted text begin
1,746 deleted text end new text begin 1,648 new text end |
deleted text begin
2,028 deleted text end new text begin 1,780 new text end |
deleted text begin
2,350 deleted text end new text begin 1,887 new text end |
deleted text begin
2,727 deleted text end new text begin 1,962 new text end |
| 6,900- 6,999 |
deleted text begin
957 deleted text end new text begin 1,038 new text end |
deleted text begin
1,533 deleted text end new text begin 1,453 new text end |
deleted text begin
1,762 deleted text end new text begin 1,657 new text end |
deleted text begin
2,047 deleted text end new text begin 1,790 new text end |
deleted text begin
2,379 deleted text end new text begin 1,897 new text end |
deleted text begin
2,747 deleted text end new text begin 1,973 new text end |
| 7,000- 7,099 |
deleted text begin
963 deleted text end new text begin 1,044 new text end |
deleted text begin
1,547 deleted text end new text begin 1,462 new text end |
deleted text begin
1,778 deleted text end new text begin 1,666 new text end |
deleted text begin
2,065 deleted text end new text begin 1,800 new text end |
deleted text begin
2,394 deleted text end new text begin 1,908 new text end |
deleted text begin
2,753 deleted text end new text begin 1,984 new text end |
| 7,100- 7,199 |
deleted text begin
970 deleted text end new text begin 1,050 new text end |
deleted text begin
1,561 deleted text end new text begin 1,470 new text end |
deleted text begin
1,795 deleted text end new text begin 1,676 new text end |
deleted text begin
2,085 deleted text end new text begin 1,810 new text end |
deleted text begin
2,417 deleted text end new text begin 1,918 new text end |
deleted text begin
2,758 deleted text end new text begin 1,995 new text end |
| 7,200- 7,299 |
deleted text begin
974 deleted text end new text begin 1,056 new text end |
deleted text begin
1,574 deleted text end new text begin 1,479 new text end |
deleted text begin
1,812 deleted text end new text begin 1,686 new text end |
deleted text begin
2,104 deleted text end new text begin 1,821 new text end |
deleted text begin
2,439 deleted text end new text begin 1,930 new text end |
deleted text begin
2,764 deleted text end new text begin 2,007 new text end |
| 7,300- 7,399 |
deleted text begin
980 deleted text end new text begin 1,063 new text end |
deleted text begin
1,587 deleted text end new text begin 1,488 new text end |
deleted text begin
1,828 deleted text end new text begin 1,696 new text end |
deleted text begin
2,123 deleted text end new text begin 1,832 new text end |
deleted text begin
2,462 deleted text end new text begin 1,942 new text end |
deleted text begin
2,769 deleted text end new text begin 2,019 new text end |
| 7,400- 7,499 |
deleted text begin
989 deleted text end new text begin 1,069 new text end |
deleted text begin
1,600 deleted text end new text begin 1,496 new text end |
deleted text begin
1,844 deleted text end new text begin 1,706 new text end |
deleted text begin
2,142 deleted text end new text begin 1,843 new text end |
deleted text begin
2,483 deleted text end new text begin 1,953 new text end |
deleted text begin
2,775 deleted text end new text begin 2,032 new text end |
| 7,500- 7,599 |
deleted text begin
998 deleted text end new text begin 1,075 new text end |
deleted text begin
1,613 deleted text end new text begin 1,505 new text end |
deleted text begin
1,860 deleted text end new text begin 1,716 new text end |
deleted text begin
2,160 deleted text end new text begin 1,854 new text end |
deleted text begin
2,505 deleted text end new text begin 1,965 new text end |
deleted text begin
2,781 deleted text end new text begin 2,043 new text end |
| 7,600- 7,699 |
deleted text begin
1,006 deleted text end new text begin 1,081 new text end |
deleted text begin
1,628 deleted text end new text begin 1,514 new text end |
deleted text begin
1,877 deleted text end new text begin 1,725 new text end |
deleted text begin
2,180 deleted text end new text begin 1,863 new text end |
deleted text begin
2,528 deleted text end new text begin 1,975 new text end |
deleted text begin
2,803 deleted text end new text begin 2,054 new text end |
| 7,700- 7,799 |
deleted text begin
1,015 deleted text end new text begin 1,087 new text end |
deleted text begin
1,643 deleted text end new text begin 1,522 new text end |
deleted text begin
1,894 deleted text end new text begin 1,735 new text end |
deleted text begin
2,199 deleted text end new text begin 1,874 new text end |
deleted text begin
2,550 deleted text end new text begin 1,986 new text end |
deleted text begin
2,833 deleted text end new text begin 2,066 new text end |
| 7,800- 7,899 |
deleted text begin
1,023 deleted text end new text begin 1,093 new text end |
deleted text begin
1,658 deleted text end new text begin 1,531 new text end |
deleted text begin
1,911 deleted text end new text begin 1,745 new text end |
deleted text begin
2,218 deleted text end new text begin 1,885 new text end |
deleted text begin
2,572 deleted text end new text begin 1,998 new text end |
deleted text begin
2,864 deleted text end new text begin 2,078 new text end |
| 7,900- 7,999 |
deleted text begin
1,032 deleted text end new text begin 1,099 new text end |
deleted text begin
1,673 deleted text end new text begin 1,540 new text end |
deleted text begin
1,928 deleted text end new text begin 1,755 new text end |
deleted text begin
2,237 deleted text end new text begin 1,896 new text end |
deleted text begin
2,594 deleted text end new text begin 2,009 new text end |
deleted text begin
2,894 deleted text end new text begin 2,090 new text end |
| 8,000- 8,099 |
deleted text begin
1,040 deleted text end new text begin 1,106 new text end |
deleted text begin
1,688 deleted text end new text begin 1,548 new text end |
deleted text begin
1,944 deleted text end new text begin 1,765 new text end |
deleted text begin
2,256 deleted text end new text begin 1,907 new text end |
deleted text begin
2,616 deleted text end new text begin 2,021 new text end |
deleted text begin
2,925 deleted text end new text begin 2,102 new text end |
| 8,100- 8,199 |
deleted text begin
1,048 deleted text end new text begin 1,112 new text end |
deleted text begin
1,703 deleted text end new text begin 1,557 new text end |
deleted text begin
1,960 deleted text end new text begin 1,775 new text end |
deleted text begin
2,274 deleted text end new text begin 1,917 new text end |
deleted text begin
2,637 deleted text end new text begin 2,032 new text end |
deleted text begin
2,955 deleted text end new text begin 2,114 new text end |
| 8,200- 8,299 |
deleted text begin
1,056 deleted text end new text begin 1,118 new text end |
deleted text begin
1,717 deleted text end new text begin 1,566 new text end |
deleted text begin
1,976 deleted text end new text begin 1,785 new text end |
deleted text begin
2,293 deleted text end new text begin 1,928 new text end |
deleted text begin
2,658 deleted text end new text begin 2,044 new text end |
deleted text begin
2,985 deleted text end new text begin 2,126 new text end |
| 8,300 -8,399 |
deleted text begin
1,064 deleted text end new text begin 1,124 new text end |
deleted text begin
1,731 deleted text end new text begin 1,574 new text end |
deleted text begin
1,992 deleted text end new text begin 1,795 new text end |
deleted text begin
2,311 deleted text end new text begin 1,939 new text end |
deleted text begin
2,679 deleted text end new text begin 2,055 new text end |
deleted text begin
3,016 deleted text end new text begin 2,137 new text end |
| 8,400- 8,499 |
deleted text begin
1,072 deleted text end new text begin 1,131 new text end |
deleted text begin
1,746 deleted text end new text begin 1,583 new text end |
deleted text begin
2,008 deleted text end new text begin 1,804 new text end |
deleted text begin
2,328 deleted text end new text begin 1,949 new text end |
deleted text begin
2,700 deleted text end new text begin 2,066 new text end |
deleted text begin
3,046 deleted text end new text begin 2,149 new text end |
| 8,500- 8,599 |
deleted text begin
1,080 deleted text end new text begin 1,137 new text end |
deleted text begin
1,760 deleted text end new text begin 1,592 new text end |
deleted text begin
2,023 deleted text end new text begin 1,814 new text end |
deleted text begin
2,346 deleted text end new text begin 1,960 new text end |
deleted text begin
2,720 deleted text end new text begin 2,078 new text end |
deleted text begin
3,077 deleted text end new text begin 2,161 new text end |
| 8,600- 8,699 |
deleted text begin
1,092 deleted text end new text begin 1,143 new text end |
deleted text begin
1,780 deleted text end new text begin 1,600 new text end |
deleted text begin
2,047 deleted text end new text begin 1,824 new text end |
deleted text begin
2,374 deleted text end new text begin 1,970 new text end |
deleted text begin
2,752 deleted text end new text begin 2,089 new text end |
deleted text begin
3,107 deleted text end new text begin 2,173 new text end |
| 8,700- 8,799 |
deleted text begin
1,105 deleted text end new text begin 1,149 new text end |
deleted text begin
1,801 deleted text end new text begin 1,609 new text end |
deleted text begin
2,071 deleted text end new text begin 1,834 new text end |
deleted text begin
2,401 deleted text end new text begin 1,981 new text end |
deleted text begin
2,784 deleted text end new text begin 2,100 new text end |
deleted text begin
3,138 deleted text end new text begin 2,185 new text end |
| 8,800- 8,899 |
deleted text begin
1,118 deleted text end new text begin 1,155 new text end |
deleted text begin
1,822 deleted text end new text begin 1,618 new text end |
deleted text begin
2,094 deleted text end new text begin 1,844 new text end |
deleted text begin
2,429 deleted text end new text begin 1,992 new text end |
deleted text begin
2,816 deleted text end new text begin 2,112 new text end |
deleted text begin
3,168 deleted text end new text begin 2,197 new text end |
| 8,900- 8,999 |
deleted text begin
1,130 deleted text end new text begin 1,162 new text end |
deleted text begin
1,842 deleted text end new text begin 1,626 new text end |
deleted text begin
2,118 deleted text end new text begin 1,854 new text end |
deleted text begin
2,456 deleted text end new text begin 2,003 new text end |
deleted text begin
2,848 deleted text end new text begin 2,124 new text end |
deleted text begin
3,199 deleted text end new text begin 2,209 new text end |
| 9,000- 9,099 |
deleted text begin
1,143 deleted text end new text begin 1,168 new text end |
deleted text begin
1,863 deleted text end new text begin 1,635 new text end |
deleted text begin
2,142 deleted text end new text begin 1,864 new text end |
deleted text begin
2,484 deleted text end new text begin 2,014 new text end |
deleted text begin
2,880 deleted text end new text begin 2,135 new text end |
deleted text begin
3,223 deleted text end new text begin 2,221 new text end |
| 9,100- 9,199 |
deleted text begin
1,156 deleted text end new text begin 1,174 new text end |
deleted text begin
1,884 deleted text end new text begin 1,644 new text end |
deleted text begin
2,166 deleted text end new text begin 1,874 new text end |
deleted text begin
2,512 deleted text end new text begin 2,024 new text end |
deleted text begin
2,912 deleted text end new text begin 2,146 new text end |
deleted text begin
3,243 deleted text end new text begin 2,232 new text end |
| 9,200- 9,299 |
deleted text begin
1,168 deleted text end new text begin 1,180 new text end |
deleted text begin
1,904 deleted text end new text begin 1,652 new text end |
deleted text begin
2,190 deleted text end new text begin 1,884 new text end |
deleted text begin
2,539 deleted text end new text begin 2,035 new text end |
deleted text begin
2,944 deleted text end new text begin 2,158 new text end |
deleted text begin
3,263 deleted text end new text begin 2,244 new text end |
| 9,300- 9,399 |
deleted text begin
1,181 deleted text end new text begin 1,186 new text end |
deleted text begin
1,925 deleted text end new text begin 1,661 new text end |
deleted text begin
2,213 deleted text end new text begin 1,893 new text end |
deleted text begin
2,567 deleted text end new text begin 2,045 new text end |
deleted text begin
2,976 deleted text end new text begin 2,168 new text end |
deleted text begin
3,284 deleted text end new text begin 2,255 new text end |
| 9,400- 9,499 |
deleted text begin
1,194 deleted text end new text begin 1,193 new text end |
deleted text begin
1,946 deleted text end new text begin 1,670 new text end |
deleted text begin
2,237 deleted text end new text begin 1,903 new text end |
deleted text begin
2,594 deleted text end new text begin 2,056 new text end |
deleted text begin
3,008 deleted text end new text begin 2,179 new text end |
deleted text begin
3,304 deleted text end new text begin 2,267 new text end |
| 9,500- 9,599 |
deleted text begin
1,207 deleted text end new text begin 1,199 new text end |
deleted text begin
1,967 deleted text end new text begin 1,678 new text end |
deleted text begin
2,261 deleted text end new text begin 1,913 new text end |
deleted text begin
2,622 deleted text end new text begin 2,066 new text end |
deleted text begin
3,031 deleted text end new text begin 2,190 new text end |
deleted text begin
3,324 deleted text end new text begin 2,278 new text end |
| 9,600- 9,699 |
deleted text begin
1,219 deleted text end new text begin 1,205 new text end |
deleted text begin
1,987 deleted text end new text begin 1,687 new text end |
deleted text begin
2,285 deleted text end new text begin 1,923 new text end |
deleted text begin
2,650 deleted text end new text begin 2,077 new text end |
deleted text begin
3,050 deleted text end new text begin 2,202 new text end |
deleted text begin
3,345 deleted text end new text begin 2,290 new text end |
| 9,700- 9,799 |
deleted text begin
1,232 deleted text end new text begin 1,211 new text end |
deleted text begin
2,008 deleted text end new text begin 1,696 new text end |
deleted text begin
2,309 deleted text end new text begin 1,933 new text end |
deleted text begin
2,677 deleted text end new text begin 2,088 new text end |
deleted text begin
3,069 deleted text end new text begin 2,214 new text end |
deleted text begin
3,365 deleted text end new text begin 2,302 new text end |
| 9,800- 9,899 |
deleted text begin
1,245 deleted text end new text begin 1,217 new text end |
deleted text begin
2,029 deleted text end new text begin 1,704 new text end |
deleted text begin
2,332 deleted text end new text begin 1,943 new text end |
deleted text begin
2,705 deleted text end new text begin 2,099 new text end |
deleted text begin
3,087 deleted text end new text begin 2,225 new text end |
deleted text begin
3,385 deleted text end new text begin 2,314 new text end |
| 9,900- 9,999 |
deleted text begin
1,257 deleted text end new text begin 1,224 new text end |
deleted text begin
2,049 deleted text end new text begin 1,713 new text end |
deleted text begin
2,356 deleted text end new text begin 1,953 new text end |
deleted text begin
2,732 deleted text end new text begin 2,110 new text end |
deleted text begin
3,106 deleted text end new text begin 2,237 new text end |
deleted text begin
3,406 deleted text end new text begin 2,326 new text end |
| 10,000-10,099 |
deleted text begin
1,270 deleted text end new text begin 1,230 new text end |
deleted text begin
2,070 deleted text end new text begin 1,722 new text end |
deleted text begin
2,380 deleted text end new text begin 1,963 new text end |
deleted text begin
2,760 deleted text end new text begin 2,121 new text end |
deleted text begin
3,125 deleted text end new text begin 2,248 new text end |
deleted text begin
3,426 deleted text end new text begin 2,338 new text end |
| 10,100-10,199 |
deleted text begin
1,283 deleted text end new text begin 1,236 new text end |
deleted text begin
2,091 deleted text end new text begin 1,730 new text end |
deleted text begin
2,404 deleted text end new text begin 1,973 new text end |
deleted text begin
2,788 deleted text end new text begin 2,131 new text end |
deleted text begin
3,144 deleted text end new text begin 2,259 new text end |
deleted text begin
3,446 deleted text end new text begin 2,350 new text end |
| 10,200-10,299 |
deleted text begin
1,295 deleted text end new text begin 1,242 new text end |
deleted text begin
2,111 deleted text end new text begin 1,739 new text end |
deleted text begin
2,428 deleted text end new text begin 1,983 new text end |
deleted text begin
2,815 deleted text end new text begin 2,142 new text end |
deleted text begin
3,162 deleted text end new text begin 2,270 new text end |
deleted text begin
3,467 deleted text end new text begin 2,361 new text end |
| 10,300-10,399 |
deleted text begin
1,308 deleted text end new text begin 1,248 new text end |
deleted text begin
2,132 deleted text end new text begin 1,748 new text end |
deleted text begin
2,451 deleted text end new text begin 1,992 new text end |
deleted text begin
2,843 deleted text end new text begin 2,152 new text end |
deleted text begin
3,181 deleted text end new text begin 2,281 new text end |
deleted text begin
3,487 deleted text end new text begin 2,373 new text end |
| 10,400-10,499 |
deleted text begin
1,321 deleted text end new text begin 1,254 new text end |
deleted text begin
2,153 deleted text end new text begin 1,756 new text end |
deleted text begin
2,475 deleted text end new text begin 2,002 new text end |
deleted text begin
2,870 deleted text end new text begin 2,163 new text end |
deleted text begin
3,200 deleted text end new text begin 2,292 new text end |
deleted text begin
3,507 deleted text end new text begin 2,384 new text end |
| 10,500-10,599 |
deleted text begin
1,334 deleted text end new text begin 1,261 new text end |
deleted text begin
2,174 deleted text end new text begin 1,765 new text end |
deleted text begin
2,499 deleted text end new text begin 2,012 new text end |
deleted text begin
2,898 deleted text end new text begin 2,173 new text end |
deleted text begin
3,218 deleted text end new text begin 2,304 new text end |
deleted text begin
3,528 deleted text end new text begin 2,396 new text end |
| 10,600-10,699 |
deleted text begin
1,346 deleted text end new text begin 1,267 new text end |
deleted text begin
2,194 deleted text end new text begin 1,774 new text end |
deleted text begin
2,523 deleted text end new text begin 2,022 new text end |
deleted text begin
2,921 deleted text end new text begin 2,184 new text end |
deleted text begin
3,237 deleted text end new text begin 2,316 new text end |
deleted text begin
3,548 deleted text end new text begin 2,409 new text end |
| 10,700-10,799 |
deleted text begin
1,359 deleted text end new text begin 1,273 new text end |
deleted text begin
2,215 deleted text end new text begin 1,782 new text end |
deleted text begin
2,547 deleted text end new text begin 2,032 new text end |
deleted text begin
2,938 deleted text end new text begin 2,195 new text end |
deleted text begin
3,256 deleted text end new text begin 2,327 new text end |
deleted text begin
3,568 deleted text end new text begin 2,420 new text end |
| 10,800-10,899 |
deleted text begin
1,372 deleted text end new text begin 1,279 new text end |
deleted text begin
2,236 deleted text end new text begin 1,791 new text end |
deleted text begin
2,570 deleted text end new text begin 2,042 new text end |
deleted text begin
2,955 deleted text end new text begin 2,206 new text end |
deleted text begin
3,274 deleted text end new text begin 2,338 new text end |
deleted text begin
3,589 deleted text end new text begin 2,432 new text end |
| 10,900-10,999 |
deleted text begin
1,384 deleted text end new text begin 1,285 new text end |
deleted text begin
2,256 deleted text end new text begin 1,800 new text end |
deleted text begin
2,594 deleted text end new text begin 2,052 new text end |
deleted text begin
2,972 deleted text end new text begin 2,217 new text end |
deleted text begin
3,293 deleted text end new text begin 2,349 new text end |
deleted text begin
3,609 deleted text end new text begin 2,444 new text end |
| 11,000-11,099 |
deleted text begin
1,397 deleted text end new text begin 1,292 new text end |
deleted text begin
2,277 deleted text end new text begin 1,808 new text end |
deleted text begin
2,618 deleted text end new text begin 2,061 new text end |
deleted text begin
2,989 deleted text end new text begin 2,226 new text end |
deleted text begin
3,312 deleted text end new text begin 2,360 new text end |
deleted text begin
3,629 deleted text end new text begin 2,455 new text end |
| 11,100-11,199 |
deleted text begin
1,410 deleted text end new text begin 1,298 new text end |
deleted text begin
2,294 deleted text end new text begin 1,817 new text end |
deleted text begin
2,642 deleted text end new text begin 2,071 new text end |
deleted text begin
3,006 deleted text end new text begin 2,237 new text end |
deleted text begin
3,331 deleted text end new text begin 2,372 new text end |
deleted text begin
3,649 deleted text end new text begin 2,467 new text end |
| 11,200-11,299 |
deleted text begin
1,422 deleted text end new text begin 1,304 new text end |
deleted text begin
2,306 deleted text end new text begin 1,826 new text end |
deleted text begin
2,666 deleted text end new text begin 2,081 new text end |
deleted text begin
3,023 deleted text end new text begin 2,248 new text end |
deleted text begin
3,349 deleted text end new text begin 2,384 new text end |
deleted text begin
3,667 deleted text end new text begin 2,479 new text end |
| 11,300-11,399 |
deleted text begin
1,435 deleted text end new text begin 1,310 new text end |
deleted text begin
2,319 deleted text end new text begin 1,834 new text end |
deleted text begin
2,689 deleted text end new text begin 2,091 new text end |
deleted text begin
3,040 deleted text end new text begin 2,259 new text end |
deleted text begin
3,366 deleted text end new text begin 2,395 new text end |
deleted text begin
3,686 deleted text end new text begin 2,491 new text end |
| 11,400-11,499 |
deleted text begin
1,448 deleted text end new text begin 1,316 new text end |
deleted text begin
2,331 deleted text end new text begin 1,843 new text end |
deleted text begin
2,713 deleted text end new text begin 2,101 new text end |
deleted text begin
3,055 deleted text end new text begin 2,270 new text end |
deleted text begin
3,383 deleted text end new text begin 2,406 new text end |
deleted text begin
3,705 deleted text end new text begin 2,503 new text end |
| 11,500-11,599 |
deleted text begin
1,461 deleted text end new text begin 1,323 new text end |
deleted text begin
2,344 deleted text end new text begin 1,852 new text end |
deleted text begin
2,735 deleted text end new text begin 2,111 new text end |
deleted text begin
3,071 deleted text end new text begin 2,280 new text end |
deleted text begin
3,400 deleted text end new text begin 2,417 new text end |
deleted text begin
3,723 deleted text end new text begin 2,514 new text end |
| 11,600-11,699 |
deleted text begin
1,473 deleted text end new text begin 1,329 new text end |
deleted text begin
2,356 deleted text end new text begin 1,860 new text end |
deleted text begin
2,748 deleted text end new text begin 2,121 new text end |
deleted text begin
3,087 deleted text end new text begin 2,291 new text end |
deleted text begin
3,417 deleted text end new text begin 2,428 new text end |
deleted text begin
3,742 deleted text end new text begin 2,526 new text end |
| 11,700-11,799 |
deleted text begin
1,486 deleted text end new text begin 1,335 new text end |
deleted text begin
2,367 deleted text end new text begin 1,869 new text end |
deleted text begin
2,762 deleted text end new text begin 2,131 new text end |
deleted text begin
3,102 deleted text end new text begin 2,302 new text end |
deleted text begin
3,435 deleted text end new text begin 2,439 new text end |
deleted text begin
3,761 deleted text end new text begin 2,537 new text end |
| 11,800-11,899 |
deleted text begin
1,499 deleted text end new text begin 1,341 new text end |
deleted text begin
2,378 deleted text end new text begin 1,878 new text end |
deleted text begin
2,775 deleted text end new text begin 2,141 new text end |
deleted text begin
3,116 deleted text end new text begin 2,313 new text end |
deleted text begin
3,452 deleted text end new text begin 2,451 new text end |
deleted text begin
3,780 deleted text end new text begin 2,549 new text end |
| 11,900-11,999 |
deleted text begin
1,511 deleted text end new text begin 1,347 new text end |
deleted text begin
2,389 deleted text end new text begin 1,886 new text end |
deleted text begin
2,788 deleted text end new text begin 2,150 new text end |
deleted text begin
3,131 deleted text end new text begin 2,323 new text end |
deleted text begin
3,469 deleted text end new text begin 2,463 new text end |
deleted text begin
3,798 deleted text end new text begin 2,561 new text end |
| 12,000-12,099 |
deleted text begin
1,524 deleted text end new text begin 1,354 new text end |
deleted text begin
2,401 deleted text end new text begin 1,895 new text end |
deleted text begin
2,801 deleted text end new text begin 2,160 new text end |
deleted text begin
3,146 deleted text end new text begin 2,333 new text end |
deleted text begin
3,485 deleted text end new text begin 2,474 new text end |
deleted text begin
3,817 deleted text end new text begin 2,573 new text end |
| 12,100-12,199 |
deleted text begin
1,537 deleted text end new text begin 1,360 new text end |
deleted text begin
2,412 deleted text end new text begin 1,904 new text end |
deleted text begin
2,814 deleted text end new text begin 2,170 new text end |
deleted text begin
3,160 deleted text end new text begin 2,344 new text end |
deleted text begin
3,501 deleted text end new text begin 2,485 new text end |
deleted text begin
3,836 deleted text end new text begin 2,585 new text end |
| 12,200-12,299 |
deleted text begin
1,549 deleted text end new text begin 1,366 new text end |
deleted text begin
2,423 deleted text end new text begin 1,912 new text end |
deleted text begin
2,828 deleted text end new text begin 2,180 new text end |
deleted text begin
3,175 deleted text end new text begin 2,355 new text end |
deleted text begin
3,517 deleted text end new text begin 2,497 new text end |
deleted text begin
3,854 deleted text end new text begin 2,597 new text end |
| 12,300-12,399 |
deleted text begin
1,562 deleted text end new text begin 1,372 new text end |
deleted text begin
2,434 deleted text end new text begin 1,921 new text end |
deleted text begin
2,841 deleted text end new text begin 2,190 new text end |
deleted text begin
3,190 deleted text end new text begin 2,366 new text end |
deleted text begin
3,534 deleted text end new text begin 2,509 new text end |
deleted text begin
3,871 deleted text end new text begin 2,609 new text end |
| 12,400-12,499 |
deleted text begin
1,575 deleted text end new text begin 1,378 new text end |
deleted text begin
2,445 deleted text end new text begin 1,930 new text end |
deleted text begin
2,854 deleted text end new text begin 2,200 new text end |
deleted text begin
3,205 deleted text end new text begin 2,377 new text end |
deleted text begin
3,550 deleted text end new text begin 2,520 new text end |
deleted text begin
3,889 deleted text end new text begin 2,621 new text end |
| 12,500-12,599 |
deleted text begin
1,588 deleted text end new text begin 1,385 new text end |
deleted text begin
2,456 deleted text end new text begin 1,938 new text end |
deleted text begin
2,867 deleted text end new text begin 2,210 new text end |
deleted text begin
3,219 deleted text end new text begin 2,387 new text end |
deleted text begin
3,566 deleted text end new text begin 2,531 new text end |
deleted text begin
3,907 deleted text end new text begin 2,633 new text end |
| 12,600-12,699 |
deleted text begin
1,600 deleted text end new text begin 1,391 new text end |
deleted text begin
2,467 deleted text end new text begin 1,947 new text end |
deleted text begin
2,880 deleted text end new text begin 2,220 new text end |
deleted text begin
3,234 deleted text end new text begin 2,397 new text end |
deleted text begin
3,582 deleted text end new text begin 2,542 new text end |
deleted text begin
3,924 deleted text end new text begin 2,644 new text end |
| 12,700-12,799 |
deleted text begin
1,613 deleted text end new text begin 1,397 new text end |
deleted text begin
2,478 deleted text end new text begin 1,956 new text end |
deleted text begin
2,894 deleted text end new text begin 2,230 new text end |
deleted text begin
3,249 deleted text end new text begin 2,408 new text end |
deleted text begin
3,598 deleted text end new text begin 2,553 new text end |
deleted text begin
3,942 deleted text end new text begin 2,656 new text end |
| 12,800-12,899 |
deleted text begin
1,626 deleted text end new text begin 1,403 new text end |
deleted text begin
2,489 deleted text end new text begin 1,964 new text end |
deleted text begin
2,907 deleted text end new text begin 2,240 new text end |
deleted text begin
3,264 deleted text end new text begin 2,419 new text end |
deleted text begin
3,615 deleted text end new text begin 2,565 new text end |
deleted text begin
3,960 deleted text end new text begin 2,668 new text end |
| 12,900-12,999 |
deleted text begin
1,638 deleted text end new text begin 1,409 new text end |
deleted text begin
2,500 deleted text end new text begin 1,973 new text end |
deleted text begin
2,920 deleted text end new text begin 2,250 new text end |
deleted text begin
3,278 deleted text end new text begin 2,430 new text end |
deleted text begin
3,631 deleted text end new text begin 2,576 new text end |
deleted text begin
3,977 deleted text end new text begin 2,680 new text end |
| 13,000-13,099 |
deleted text begin
1,651 deleted text end new text begin 1,416 new text end |
deleted text begin
2,512 deleted text end new text begin 1,982 new text end |
deleted text begin
2,933 deleted text end new text begin 2,259 new text end |
deleted text begin
3,293 deleted text end new text begin 2,440 new text end |
deleted text begin
3,647 deleted text end new text begin 2,587 new text end |
deleted text begin
3,995 deleted text end new text begin 2,691 new text end |
| 13,100-13,199 |
deleted text begin
1,664 deleted text end new text begin 1,422 new text end |
deleted text begin
2,523 deleted text end new text begin 1,990 new text end |
deleted text begin
2,946 deleted text end new text begin 2,269 new text end |
deleted text begin
3,308 deleted text end new text begin 2,451 new text end |
deleted text begin
3,663 deleted text end new text begin 2,599 new text end |
deleted text begin
4,012 deleted text end new text begin 2,703 new text end |
| 13,200-13,299 |
deleted text begin
1,676 deleted text end new text begin 1,428 new text end |
deleted text begin
2,534 deleted text end new text begin 1,999 new text end |
deleted text begin
2,960 deleted text end new text begin 2,279 new text end |
deleted text begin
3,322 deleted text end new text begin 2,462 new text end |
deleted text begin
3,679 deleted text end new text begin 2,610 new text end |
deleted text begin
4,030 deleted text end new text begin 2,715 new text end |
| 13,300-13,399 |
deleted text begin
1,689 deleted text end new text begin 1,434 new text end |
deleted text begin
2,545 deleted text end new text begin 2,008 new text end |
deleted text begin
2,973 deleted text end new text begin 2,289 new text end |
deleted text begin
3,337 deleted text end new text begin 2,473 new text end |
deleted text begin
3,696 deleted text end new text begin 2,622 new text end |
deleted text begin
4,048 deleted text end new text begin 2,727 new text end |
| 13,400-13,499 |
deleted text begin
1,702 deleted text end new text begin 1,440 new text end |
deleted text begin
2,556 deleted text end new text begin 2,016 new text end |
deleted text begin
2,986 deleted text end new text begin 2,299 new text end |
deleted text begin
3,352 deleted text end new text begin 2,484 new text end |
deleted text begin
3,712 deleted text end new text begin 2,633 new text end |
deleted text begin
4,065 deleted text end new text begin 2,739 new text end |
| 13,500-13,599 |
deleted text begin
1,715 deleted text end new text begin 1,446 new text end |
deleted text begin
2,567 deleted text end new text begin 2,025 new text end |
deleted text begin
2,999 deleted text end new text begin 2,309 new text end |
deleted text begin
3,367 deleted text end new text begin 2,494 new text end |
deleted text begin
3,728 deleted text end new text begin 2,644 new text end |
deleted text begin
4,083 deleted text end new text begin 2,751 new text end |
| 13,600-13,699 |
deleted text begin
1,727 deleted text end new text begin 1,453 new text end |
deleted text begin
2,578 deleted text end new text begin 2,034 new text end |
deleted text begin
3,012 deleted text end new text begin 2,318 new text end |
deleted text begin
3,381 deleted text end new text begin 2,504 new text end |
deleted text begin
3,744 deleted text end new text begin 2,655 new text end |
deleted text begin
4,100 deleted text end new text begin 2,762 new text end |
| 13,700-13,799 |
deleted text begin
1,740 deleted text end new text begin 1,459 new text end |
deleted text begin
2,589 deleted text end new text begin 2,042 new text end |
deleted text begin
3,026 deleted text end new text begin 2,328 new text end |
deleted text begin
3,396 deleted text end new text begin 2,515 new text end |
deleted text begin
3,760 deleted text end new text begin 2,666 new text end |
deleted text begin
4,118 deleted text end new text begin 2,773 new text end |
| 13,800-13,899 |
deleted text begin
1,753 deleted text end new text begin 1,465 new text end |
deleted text begin
2,600 deleted text end new text begin 2,051 new text end |
deleted text begin
3,039 deleted text end new text begin 2,338 new text end |
deleted text begin
3,411 deleted text end new text begin 2,526 new text end |
deleted text begin
3,777 deleted text end new text begin 2,677 new text end |
deleted text begin
4,136 deleted text end new text begin 2,784 new text end |
| 13,900-13,999 |
deleted text begin
1,765 deleted text end new text begin 1,471 new text end |
deleted text begin
2,611 deleted text end new text begin 2,060 new text end |
deleted text begin
3,052 deleted text end new text begin 2,348 new text end |
deleted text begin
3,425 deleted text end new text begin 2,537 new text end |
deleted text begin
3,793 deleted text end new text begin 2,688 new text end |
deleted text begin
4,153 deleted text end new text begin 2,795 new text end |
| 14,000-14,099 |
deleted text begin
1,778 deleted text end new text begin 1,477 new text end |
deleted text begin
2,623 deleted text end new text begin 2,068 new text end |
deleted text begin
3,065 deleted text end new text begin 2,358 new text end |
deleted text begin
3,440 deleted text end new text begin 2,547 new text end |
deleted text begin
3,809 deleted text end new text begin 2,699 new text end |
deleted text begin
4,171 deleted text end new text begin 2,807 new text end |
| 14,100-14,199 |
deleted text begin
1,791 deleted text end new text begin 1,484 new text end |
deleted text begin
2,634 deleted text end new text begin 2,077 new text end |
deleted text begin
3,078 deleted text end new text begin 2,368 new text end |
deleted text begin
3,455 deleted text end new text begin 2,558 new text end |
deleted text begin
3,825 deleted text end new text begin 2,711 new text end |
deleted text begin
4,189 deleted text end new text begin 2,819 new text end |
| 14,200-14,299 |
deleted text begin
1,803 deleted text end new text begin 1,490 new text end |
deleted text begin
2,645 deleted text end new text begin 2,086 new text end |
deleted text begin
3,092 deleted text end new text begin 2,378 new text end |
deleted text begin
3,470 deleted text end new text begin 2,569 new text end |
deleted text begin
3,841 deleted text end new text begin 2,722 new text end |
deleted text begin
4,206 deleted text end new text begin 2,831 new text end |
| 14,300-14,399 |
deleted text begin
1,816 deleted text end new text begin 1,496 new text end |
deleted text begin
2,656 deleted text end new text begin 2,094 new text end |
deleted text begin
3,105 deleted text end new text begin 2,388 new text end |
deleted text begin
3,484 deleted text end new text begin 2,580 new text end |
deleted text begin
3,858 deleted text end new text begin 2,734 new text end |
deleted text begin
4,224 deleted text end new text begin 2,843 new text end |
| 14,400-14,499 |
deleted text begin
1,829 deleted text end new text begin 1,502 new text end |
deleted text begin
2,667 deleted text end new text begin 2,103 new text end |
deleted text begin
3,118 deleted text end new text begin 2,398 new text end |
deleted text begin
3,499 deleted text end new text begin 2,590 new text end |
deleted text begin
3,874 deleted text end new text begin 2,746 new text end |
deleted text begin
4,239 deleted text end new text begin 2,855 new text end |
| 14,500-14,599 |
deleted text begin
1,842 deleted text end new text begin 1,508 new text end |
deleted text begin
2,678 deleted text end new text begin 2,111 new text end |
deleted text begin
3,131 deleted text end new text begin 2,407 new text end |
deleted text begin
3,514 deleted text end new text begin 2,600 new text end |
deleted text begin
3,889 deleted text end new text begin 2,757 new text end |
deleted text begin
4,253 deleted text end new text begin 2,867 new text end |
| 14,600-14,699 |
deleted text begin
1,854 deleted text end new text begin 1,515 new text end |
deleted text begin
2,689 deleted text end new text begin 2,120 new text end |
deleted text begin
3,144 deleted text end new text begin 2,417 new text end |
deleted text begin
3,529 deleted text end new text begin 2,611 new text end |
deleted text begin
3,902 deleted text end new text begin 2,768 new text end |
deleted text begin
4,268 deleted text end new text begin 2,879 new text end |
| 14,700-14,799 |
deleted text begin
1,864 deleted text end new text begin 1,521 new text end |
deleted text begin
2,700 deleted text end new text begin 2,129 new text end |
deleted text begin
3,158 deleted text end new text begin 2,427 new text end |
deleted text begin
3,541 deleted text end new text begin 2,622 new text end |
deleted text begin
3,916 deleted text end new text begin 2,780 new text end |
deleted text begin
4,282 deleted text end new text begin 2,891 new text end |
| 14,800-14,899 |
deleted text begin
1,872 deleted text end new text begin 1,527 new text end |
deleted text begin
2,711 deleted text end new text begin 2,138 new text end |
deleted text begin
3,170 deleted text end new text begin 2,437 new text end |
deleted text begin
3,553 deleted text end new text begin 2,633 new text end |
deleted text begin
3,929 deleted text end new text begin 2,792 new text end |
deleted text begin
4,297 deleted text end new text begin 2,903 new text end |
| 14,900-14,999 |
deleted text begin
1,879 deleted text end new text begin 1,533 new text end |
deleted text begin
2,722 deleted text end new text begin 2,146 new text end |
deleted text begin
3,181 deleted text end new text begin 2,447 new text end |
deleted text begin
3,565 deleted text end new text begin 2,643 new text end |
deleted text begin
3,942 deleted text end new text begin 2,802 new text end |
deleted text begin
4,311 deleted text end new text begin 2,914 new text end |
| 15,000deleted text begin , or the amount in effect under subd. 4 deleted text end new text begin -15,099 new text end |
deleted text begin
1,883 deleted text end new text begin 1,539 new text end |
deleted text begin
2,727 deleted text end new text begin 2,155 new text end |
deleted text begin
3,186 deleted text end new text begin 2,457 new text end |
deleted text begin
3,571 deleted text end new text begin 2,654 new text end |
deleted text begin
3,949 deleted text end new text begin 2,813 new text end |
deleted text begin
4,319 deleted text end new text begin 2,926 new text end |
|
new text begin
15,100-15,199 new text end |
new text begin
1,545 new text end |
new text begin
2,163 new text end |
new text begin
2,466 new text end |
new text begin
2,664 new text end |
new text begin
2,825 new text end |
new text begin
2,937 new text end |
|
new text begin
15,200-15,299 new text end |
new text begin
1,551 new text end |
new text begin
2,171 new text end |
new text begin
2,476 new text end |
new text begin
2,675 new text end |
new text begin
2,836 new text end |
new text begin
2,949 new text end |
|
new text begin
15,300-15,399 new text end |
new text begin
1,557 new text end |
new text begin
2,180 new text end |
new text begin
2,486 new text end |
new text begin
2,685 new text end |
new text begin
2,847 new text end |
new text begin
2,961 new text end |
|
new text begin
15,400-15,499 new text end |
new text begin
1,563 new text end |
new text begin
2,188 new text end |
new text begin
2,495 new text end |
new text begin
2,695 new text end |
new text begin
2,858 new text end |
new text begin
2,973 new text end |
|
new text begin
15,500-15,599 new text end |
new text begin
1,569 new text end |
new text begin
2,197 new text end |
new text begin
2,505 new text end |
new text begin
2,706 new text end |
new text begin
2,869 new text end |
new text begin
2,985 new text end |
|
new text begin
15,600-15,699 new text end |
new text begin
1,575 new text end |
new text begin
2,205 new text end |
new text begin
2,514 new text end |
new text begin
2,716 new text end |
new text begin
2,880 new text end |
new text begin
2,996 new text end |
|
new text begin
15,700-15,799 new text end |
new text begin
1,581 new text end |
new text begin
2,214 new text end |
new text begin
2,524 new text end |
new text begin
2,727 new text end |
new text begin
2,891 new text end |
new text begin
3,008 new text end |
|
new text begin
15,800-15,899 new text end |
new text begin
1,587 new text end |
new text begin
2,222 new text end |
new text begin
2,534 new text end |
new text begin
2,737 new text end |
new text begin
2,902 new text end |
new text begin
3,019 new text end |
|
new text begin
15,900-15,999 new text end |
new text begin
1,593 new text end |
new text begin
2,230 new text end |
new text begin
2,543 new text end |
new text begin
2,747 new text end |
new text begin
2,913 new text end |
new text begin
3,030 new text end |
|
new text begin
16,000-16,099 new text end |
new text begin
1,599 new text end |
new text begin
2,239 new text end |
new text begin
2,553 new text end |
new text begin
2,758 new text end |
new text begin
2,924 new text end |
new text begin
3,042 new text end |
|
new text begin
16,100-16,199 new text end |
new text begin
1,605 new text end |
new text begin
2,247 new text end |
new text begin
2,562 new text end |
new text begin
2,768 new text end |
new text begin
2,935 new text end |
new text begin
3,053 new text end |
|
new text begin
16,200-16,299 new text end |
new text begin
1,611 new text end |
new text begin
2,256 new text end |
new text begin
2,572 new text end |
new text begin
2,779 new text end |
new text begin
2,946 new text end |
new text begin
3,065 new text end |
|
new text begin
16,300-16,399 new text end |
new text begin
1,617 new text end |
new text begin
2,264 new text end |
new text begin
2,582 new text end |
new text begin
2,789 new text end |
new text begin
2,957 new text end |
new text begin
3,076 new text end |
|
new text begin
16,400-16,499 new text end |
new text begin
1,623 new text end |
new text begin
2,272 new text end |
new text begin
2,591 new text end |
new text begin
2,799 new text end |
new text begin
2,968 new text end |
new text begin
3,088 new text end |
|
new text begin
16,500-16,599 new text end |
new text begin
1,629 new text end |
new text begin
2,281 new text end |
new text begin
2,601 new text end |
new text begin
2,810 new text end |
new text begin
2,979 new text end |
new text begin
3,099 new text end |
|
new text begin
16,600-16,699 new text end |
new text begin
1,635 new text end |
new text begin
2,289 new text end |
new text begin
2,610 new text end |
new text begin
2,820 new text end |
new text begin
2,990 new text end |
new text begin
3,110 new text end |
|
new text begin
16,700-16,799 new text end |
new text begin
1,641 new text end |
new text begin
2,298 new text end |
new text begin
2,620 new text end |
new text begin
2,830 new text end |
new text begin
3,001 new text end |
new text begin
3,121 new text end |
|
new text begin
16,800-16,899 new text end |
new text begin
1,647 new text end |
new text begin
2,306 new text end |
new text begin
2,629 new text end |
new text begin
2,840 new text end |
new text begin
3,011 new text end |
new text begin
3,132 new text end |
|
new text begin
16,900-16,999 new text end |
new text begin
1,653 new text end |
new text begin
2,315 new text end |
new text begin
2,639 new text end |
new text begin
2,851 new text end |
new text begin
3,022 new text end |
new text begin
3,143 new text end |
|
new text begin
17,000-17,099 new text end |
new text begin
1,659 new text end |
new text begin
2,323 new text end |
new text begin
2,649 new text end |
new text begin
2,861 new text end |
new text begin
3,033 new text end |
new text begin
3,155 new text end |
|
new text begin
17,100-17,199 new text end |
new text begin
1,665 new text end |
new text begin
2,331 new text end |
new text begin
2,658 new text end |
new text begin
2,871 new text end |
new text begin
3,044 new text end |
new text begin
3,167 new text end |
|
new text begin
17,200-17,299 new text end |
new text begin
1,671 new text end |
new text begin
2,340 new text end |
new text begin
2,668 new text end |
new text begin
2,882 new text end |
new text begin
3,055 new text end |
new text begin
3,178 new text end |
|
new text begin
17,300-17,399 new text end |
new text begin
1,677 new text end |
new text begin
2,348 new text end |
new text begin
2,677 new text end |
new text begin
2,892 new text end |
new text begin
3,066 new text end |
new text begin
3,189 new text end |
|
new text begin
17,400-17,499 new text end |
new text begin
1,683 new text end |
new text begin
2,357 new text end |
new text begin
2,687 new text end |
new text begin
2,902 new text end |
new text begin
3,077 new text end |
new text begin
3,201 new text end |
|
new text begin
17,500-17,599 new text end |
new text begin
1,689 new text end |
new text begin
2,365 new text end |
new text begin
2,696 new text end |
new text begin
2,912 new text end |
new text begin
3,088 new text end |
new text begin
3,212 new text end |
|
new text begin
17,600-17,699 new text end |
new text begin
1,695 new text end |
new text begin
2,373 new text end |
new text begin
2,705 new text end |
new text begin
2,922 new text end |
new text begin
3,098 new text end |
new text begin
3,223 new text end |
|
new text begin
17,700-17,799 new text end |
new text begin
1,701 new text end |
new text begin
2,382 new text end |
new text begin
2,715 new text end |
new text begin
2,932 new text end |
new text begin
3,109 new text end |
new text begin
3,234 new text end |
|
new text begin
17,800-17,899 new text end |
new text begin
1,707 new text end |
new text begin
2,390 new text end |
new text begin
2,724 new text end |
new text begin
2,942 new text end |
new text begin
3,119 new text end |
new text begin
3,245 new text end |
|
new text begin
17,900-17,999 new text end |
new text begin
1,713 new text end |
new text begin
2,399 new text end |
new text begin
2,734 new text end |
new text begin
2,953 new text end |
new text begin
3,130 new text end |
new text begin
3,256 new text end |
|
new text begin
18,000-18,099 new text end |
new text begin
1,719 new text end |
new text begin
2,407 new text end |
new text begin
2,744 new text end |
new text begin
2,963 new text end |
new text begin
3,141 new text end |
new text begin
3,268 new text end |
|
new text begin
18,100-18,199 new text end |
new text begin
1,725 new text end |
new text begin
2,415 new text end |
new text begin
2,753 new text end |
new text begin
2,973 new text end |
new text begin
3,152 new text end |
new text begin
3,279 new text end |
|
new text begin
18,200-18,299 new text end |
new text begin
1,731 new text end |
new text begin
2,424 new text end |
new text begin
2,763 new text end |
new text begin
2,984 new text end |
new text begin
3,163 new text end |
new text begin
3,290 new text end |
|
new text begin
18,300-18,399 new text end |
new text begin
1,737 new text end |
new text begin
2,432 new text end |
new text begin
2,772 new text end |
new text begin
2,994 new text end |
new text begin
3,174 new text end |
new text begin
3,301 new text end |
|
new text begin
18,400-18,499 new text end |
new text begin
1,743 new text end |
new text begin
2,441 new text end |
new text begin
2,782 new text end |
new text begin
3,004 new text end |
new text begin
3,185 new text end |
new text begin
3,313 new text end |
|
new text begin
18,500-18,599 new text end |
new text begin
1,749 new text end |
new text begin
2,449 new text end |
new text begin
2,791 new text end |
new text begin
3,014 new text end |
new text begin
3,196 new text end |
new text begin
3,324 new text end |
|
new text begin
18,600-18,699 new text end |
new text begin
1,755 new text end |
new text begin
2,457 new text end |
new text begin
2,801 new text end |
new text begin
3,024 new text end |
new text begin
3,206 new text end |
new text begin
3,335 new text end |
|
new text begin
18,700-18,799 new text end |
new text begin
1,761 new text end |
new text begin
2,466 new text end |
new text begin
2,811 new text end |
new text begin
3,035 new text end |
new text begin
3,217 new text end |
new text begin
3,346 new text end |
|
new text begin
18,800-18,899 new text end |
new text begin
1,767 new text end |
new text begin
2,474 new text end |
new text begin
2,820 new text end |
new text begin
3,045 new text end |
new text begin
3,227 new text end |
new text begin
3,357 new text end |
|
new text begin
18,900-18,999 new text end |
new text begin
1,773 new text end |
new text begin
2,483 new text end |
new text begin
2,830 new text end |
new text begin
3,056 new text end |
new text begin
3,238 new text end |
new text begin
3,368 new text end |
|
new text begin
19,000-19,099 new text end |
new text begin
1,779 new text end |
new text begin
2,491 new text end |
new text begin
2,840 new text end |
new text begin
3,066 new text end |
new text begin
3,249 new text end |
new text begin
3,380 new text end |
|
new text begin
19,100-19,199 new text end |
new text begin
1,785 new text end |
new text begin
2,499 new text end |
new text begin
2,849 new text end |
new text begin
3,076 new text end |
new text begin
3,260 new text end |
new text begin
3,392 new text end |
|
new text begin
19,200-19,299 new text end |
new text begin
1,791 new text end |
new text begin
2,508 new text end |
new text begin
2,859 new text end |
new text begin
3,087 new text end |
new text begin
3,271 new text end |
new text begin
3,403 new text end |
|
new text begin
19,300-19,399 new text end |
new text begin
1,797 new text end |
new text begin
2,516 new text end |
new text begin
2,868 new text end |
new text begin
3,097 new text end |
new text begin
3,282 new text end |
new text begin
3,414 new text end |
|
new text begin
19,400-19,499 new text end |
new text begin
1,803 new text end |
new text begin
2,525 new text end |
new text begin
2,878 new text end |
new text begin
3,107 new text end |
new text begin
3,293 new text end |
new text begin
3,426 new text end |
|
new text begin
19,500-19,599 new text end |
new text begin
1,809 new text end |
new text begin
2,533 new text end |
new text begin
2,887 new text end |
new text begin
3,117 new text end |
new text begin
3,304 new text end |
new text begin
3,437 new text end |
|
new text begin
19,600-19,699 new text end |
new text begin
1,815 new text end |
new text begin
2,541 new text end |
new text begin
2,896 new text end |
new text begin
3,127 new text end |
new text begin
3,315 new text end |
new text begin
3,448 new text end |
|
new text begin
19,700-19,799 new text end |
new text begin
1,821 new text end |
new text begin
2,550 new text end |
new text begin
2,906 new text end |
new text begin
3,138 new text end |
new text begin
3,326 new text end |
new text begin
3,459 new text end |
|
new text begin
19,800-19,899 new text end |
new text begin
1,827 new text end |
new text begin
2,558 new text end |
new text begin
2,915 new text end |
new text begin
3,148 new text end |
new text begin
3,337 new text end |
new text begin
3,470 new text end |
|
new text begin
19,900-19,999 new text end |
new text begin
1,833 new text end |
new text begin
2,567 new text end |
new text begin
2,925 new text end |
new text begin
3,159 new text end |
new text begin
3,348 new text end |
new text begin
3,481 new text end |
|
new text begin
20,000 and over or the amount in effect under subdivision 4 new text end |
new text begin
1,839 new text end |
new text begin
2,575 new text end |
new text begin
2,935 new text end |
new text begin
3,170 new text end |
new text begin
3,359 new text end |
new text begin
3,492 new text end |
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 11.
Minnesota Statutes 2020, section 518A.39, subdivision 7, is amended to read:
Subd. 7.
Child care exception.
Child care support must be based on the actual child
care expenses. The court may provide that a decrease in the amount of the child care based
on a decrease in the actual child care expenses is effective as of the date the expense is
decreased.new text begin Under section 518A.40, subdivision 4, paragraph (d), a decrease in the amount
of child care support shall be effective as of the date the expenses terminated unless otherwise
found by the court.
new text end
Sec. 12.
Minnesota Statutes 2020, section 518A.40, is amended by adding a subdivision
to read:
new text begin Subd. 3a. new text end
new text begin Child care cost information. new text end
new text begin
(a) Upon the request of the obligor when child
care support is ordered to be paid, unless there is a protective or restraining order issued by
the court regarding one of the parties or on behalf of a joint child, or the obligee is a
participant in the Safe at Home program:
new text end
new text begin
(1) the obligee must give the child care provider the name and address of the obligor
and must give the obligor the name, address, and telephone number of the child care provider;
new text end
new text begin
(2) by February 1 of each year, the obligee must provide the obligor with verification
from the child care provider that indicates the total child care expenses paid for the previous
year; and
new text end
new text begin
(3) when there is a change in the child care provider, the type of child care provider, or
the age group of the child, the obligee must provide updated information to the obligor
within 30 calendar days. If the obligee fails to provide the annual verification from the
provider or updated information, the obligor may request the verification from the provider.
new text end
new text begin
(b) When the obligee is no longer incurring child care expenses, the obligee must notify
the obligor, and the public authority if it provides child support services, that the child care
expenses ended and on which date. If the public authority is providing services, the public
authority must follow the procedure outlined in subdivision 4.
new text end
Sec. 13.
Minnesota Statutes 2020, section 518A.40, subdivision 4, is amended to read:
Subd. 4.
Change in child care.
(a) When a court order provides for child care expenses,
and child care support is not assigned under section 256.741, the public authority, if the
public authority provides child support enforcement services, may suspend collecting the
amount allocated for child care expenses when either party informs the public authority that
no child care deleted text begin costsdeleted text end new text begin expensesnew text end are being incurred and:
(1) the public authority verifies the accuracy of the information with the obligee; or
(2) the obligee fails to respond within 30 days of the date of a written request from the
public authority for information regarding child care costs. A written or oral response from
the obligee that child care costs are being incurred is sufficient for the public authority to
continue collecting child care expenses.
The suspension is effective as of the first day of the month following the date that the public
authority either verified the information with the obligee or the obligee failed to respond.
The public authority will resume collecting child care expenses when either party provides
information that child care costs are incurred, or when a child care support assignment takes
effect under section 256.741, subdivision 4. The resumption is effective as of the first day
of the month after the date that the public authority received the information.
(b) If the parties provide conflicting information to the public authority regarding whether
child care expenses are being incurred, the public authority will continue or resume collecting
child care expenses. Either party, by motion to the court, may challenge the suspension,
continuation, or resumption of the collection of child care expenses under this subdivision.
If the public authority suspends collection activities for the amount allocated for child care
expenses, all other provisions of the court order remain in effect.
(c) In cases where there is a substantial increase or decrease in child care expenses, the
parties may modify the order under section 518A.39.
new text begin
(d) In cases where child care expenses have terminated, the parties may modify the order
under section 518A.39.
new text end
new text begin
(e) When the public authority is providing child support services, the parties may contact
the public authority about the option of a stipulation to modify or terminate the child care
support amount.
new text end
Sec. 14.
Minnesota Statutes 2020, section 518A.42, is amended to read:
518A.42 ABILITY TO PAY; SELF-SUPPORT ADJUSTMENT.
Subdivision 1.
Ability to pay.
(a) It is a rebuttable presumption that a child support
order should not exceed the obligor's ability to pay. To determine the amount of child support
the obligor has the ability to pay, the court shall follow the procedure set out in this section.
(b) The court shall calculate the obligor's income available for support by subtracting a
monthly self-support reserve equal to 120 percent of the federal poverty guidelines for one
person from the obligor's deleted text begin gross incomedeleted text end new text begin parental income for determining child support (PICS)new text end .
If the obligor's income available for support calculated under this paragraph is equal to or
greater than the obligor's support obligation calculated under section 518A.34, the court
shall order child support under section 518A.34.
(c) If the obligor's income available for support calculated under paragraph (b) is more
than the minimum support amount under subdivision 2, but less than the guideline amount
under section 518A.34, then the court shall apply a reduction to the child support obligation
in the following order, until the support order is equal to the obligor's income available for
support:
(1) medical support obligation;
(2) child care support obligation; and
(3) basic support obligation.
(d) If the obligor's income available for support calculated under paragraph (b) is equal
to or less than the minimum support amount under subdivision 2 or if the obligor's gross
income is less than 120 percent of the federal poverty guidelines for one person, the minimum
support amount under subdivision 2 applies.
Subd. 2.
Minimum basic support amount.
(a) If the basic support amount applies, the
court must order the following amount as the minimum basic support obligation:
(1) for one deleted text begin or two childrendeleted text end new text begin childnew text end , the obligor's basic support obligation is $50 per month;
(2) new text begin for two children, the obligor's basic support obligation is $60 per month;
new text end
new text begin (3) new text end for three deleted text begin or fourdeleted text end children, the obligor's basic support obligation is deleted text begin $75deleted text end new text begin $70new text end per month;
deleted text begin and
deleted text end
new text begin
(4) for four children, the obligor's basic support obligation is $80 per month;
new text end
deleted text begin (3)deleted text end new text begin (5)new text end for five deleted text begin or moredeleted text end children, the obligor's basic support obligation is deleted text begin $100deleted text end new text begin $90new text end per
monthdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(6) for six or more children, the obligor's basic support obligation is $100 per month.
new text end
(b) If the court orders the obligor to pay the minimum basic support amount under this
subdivision, the obligor is presumed unable to pay child care support and medical support.
deleted text begin
If the court finds the obligor receives no income and completely lacks the ability to earn
income, the minimum basic support amount under this subdivision does not apply.
deleted text end
Subd. 3.
Exception.
new text begin (a) new text end This section does not apply to an obligor who is incarcerated.
new text begin
(b) If the court finds the obligor receives no income and completely lacks the ability to
earn income, the minimum basic support amount under this subdivision does not apply.
new text end
new text begin
(c) If the obligor's basic support amount is reduced below the minimum basic support
amount due to the application of the parenting expense adjustment, the minimum basic
support amount under this subdivision does not apply and the lesser amount is the guideline
basic support.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 15.
Minnesota Statutes 2020, section 518A.43, is amended by adding a subdivision
to read:
new text begin Subd. 1b. new text end
new text begin Increase in income of custodial parent. new text end
new text begin
In a modification of support under
section 518A.39, the court may deviate from the presumptive child support obligation under
section 518A.34 when the only change in circumstances is an increase to the custodial
parent's income and:
new text end
new text begin
(1) the basic support increases;
new text end
new text begin
(2) the parties' combined gross income is $6,000 or less; or
new text end
new text begin
(3) the obligor's income is $2,000 or less.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 16.
Minnesota Statutes 2020, section 518A.685, is amended to read:
518A.685 CONSUMER REPORTING AGENCY; REPORTING ARREARS.
(a) If a public authority determines that an obligor has not paid the current monthly
support obligation plus any required arrearage payment for three months, the public authority
deleted text begin mustdeleted text end new text begin maynew text end report this information to a consumer reporting agency.
(b) Before reporting that an obligor is in arrears for court-ordered child support, the
public authority must:
(1) provide written notice to the obligor that the public authority intends to report the
arrears to a consumer reporting agency; and
(2) mail the written notice to the obligor's last known mailing address at least 30 days
before the public authority reports the arrears to a consumer reporting agency.
(c) The obligor may, within 21 days of receipt of the notice, do the following to prevent
the public authority from reporting the arrears to a consumer reporting agency:
(1) pay the arrears in full; deleted text begin or
deleted text end
(2) request an administrative review. An administrative review is limited to issues of
mistaken identity, a pending legal action involving the arrears, or an incorrect arrears
balancedeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(3) enter into a written payment agreement pursuant to section 518A.69 that is approved
by a court, a child support magistrate, or the public authority responsible for child support
enforcement.
new text end
(d) A public authority that reports arrearage information under this section must make
monthly reports to a consumer reporting agency. The monthly report must be consistent
with credit reporting industry standards for child support.
(e) For purposes of this section, "consumer reporting agency" has the meaning given in
section 13C.001, subdivision 4, and United States Code, title 15, section 1681a(f).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2023.
new text end
Sec. 17.
new text begin
[518A.80] MOTION TO TRANSFER TO TRIBAL COURT.
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.
new text end
new text begin
(b) "Case participant" means a person who is a party to the case.
new text end
new text begin
(c) "District court" means a district court of the state of Minnesota.
new text end
new text begin
(d) "Party" means a person or entity named or admitted as a party or seeking to be
admitted as a party in the district court action, including the county IV-D agency, regardless
of whether the person or entity is named in the caption.
new text end
new text begin
(e) "Tribal court" means a tribal court of a federally recognized Indian tribe located in
Minnesota that is receiving funding from the federal government to operate a child support
program under United States Code, title 42, chapter 7, subchapter IV, part D, sections 654
to 669b.
new text end
new text begin
(f) "Tribal IV-D agency" has the meaning given in Code of Federal Regulations, title
45, part 309.05.
new text end
new text begin
(g) "Title IV-D child support case" has the meaning given in section 518A.26, subdivision
10.
new text end
new text begin Subd. 2. new text end
new text begin Actions eligible for transfer. new text end
new text begin
Under this section, a postjudgment child support,
custody, or parenting time action is eligible for transfer to a Tribal court. This section does
not apply to a child protection action or a dissolution action involving a child.
new text end
new text begin Subd. 3. new text end
new text begin Motion to transfer. new text end
new text begin
(a) A party's or Tribal IV-D agency's motion to transfer a
child support, custody, or parenting time action to a Tribal court shall include:
new text end
new text begin
(1) the address of each case participant;
new text end
new text begin
(2) the Tribal affiliation of each case participant, if applicable;
new text end
new text begin
(3) the name, Tribal affiliation if applicable, and date of birth of each living minor or
dependent child of a case participant who is subject to the action; and
new text end
new text begin
(4) the legal and factual basis for the court to find that the district court and a Tribal
court have concurrent jurisdiction in the case.
new text end
new text begin
(b) A party or Tribal IV-D agency bringing a motion to transfer a child support, custody,
or parenting time action to a Tribal court must file the motion with the district court and
serve the required documents on each party and the Tribal IV-D agency, regardless of
whether the Tribal IV-D agency is a party to the action.
new text end
new text begin
(c) A party's or Tribal IV-D agency's motion to transfer a child support, custody, or
parenting time action to a Tribal court must be accompanied by an affidavit setting forth
facts in support of the motion.
new text end
new text begin
(d) When a party other than the Tribal IV-D agency has filed a motion to transfer a child
support, custody, or parenting time action to a Tribal court, an affidavit of the Tribal IV-D
agency stating whether the Tribal IV-D agency provides services to a party must be filed
and served on each party within 15 days from the date of service of the motion to transfer
the action.
new text end
new text begin Subd. 4. new text end
new text begin Order to transfer to Tribal court. new text end
new text begin
(a) Unless a district court holds a hearing
under subdivision 6, upon motion of a party or a Tribal IV-D agency, a district court must
transfer a postjudgment child support, custody, or parenting time action to a Tribal court
when the district court finds that:
new text end
new text begin
(1) the district court and Tribal court have concurrent jurisdiction of the action;
new text end
new text begin
(2) a case participant in the action is receiving services from the Tribal IV-D agency;
and
new text end
new text begin
(3) no party or Tribal IV-D agency files and serves a timely objection to transferring the
action to a Tribal court.
new text end
new text begin
(b) When the district court finds that each requirement of this subdivision is satisfied,
the district court is not required to hold a hearing on the motion to transfer the action to a
Tribal court. The district court's order transferring the action to a Tribal court must include
written findings that describe how each requirement of this subdivision is met.
new text end
new text begin Subd. 5. new text end
new text begin Objection to motion to transfer. new text end
new text begin
(a) To object to a motion to transfer a child
support, custody, or parenting time action to a Tribal court, a party or Tribal IV-D agency
must file with the court and serve on each party and the Tribal IV-D agency a responsive
motion objecting to the motion to transfer within 30 days of the motion to transfer's date of
service.
new text end
new text begin
(b) If a party or Tribal IV-D agency files with the district court and properly serves a
timely objection to the motion to transfer a child support, custody, or parenting time action
to a Tribal court, the district court must hold a hearing on the motion.
new text end
new text begin Subd. 6. new text end
new text begin Hearing. new text end
new text begin
If a district court holds a hearing under this section, the district court
must evaluate and make written findings about all relevant factors, including:
new text end
new text begin
(1) whether an issue requires interpretation of Tribal law, including the Tribal constitution,
statutes, bylaws, ordinances, resolutions, treaties, or case law;
new text end
new text begin
(2) whether the action involves Tribal traditional or cultural matters;
new text end
new text begin
(3) whether the tribe is a party to the action;
new text end
new text begin
(4) whether Tribal sovereignty, jurisdiction, or territory is an issue in the action;
new text end
new text begin
(5) the Tribal membership status of each case participant in the action;
new text end
new text begin
(6) where the claim arises that forms the basis of the action;
new text end
new text begin
(7) the location of the residence of each case participant in the action and each child
who is a subject of the action;
new text end
new text begin
(8) whether the parties have by contract chosen a forum or the law to be applied in the
event of a dispute;
new text end
new text begin
(9) the timing of any motion to transfer the action to a Tribal court, each party's
expenditure of time and resources, the court's expenditure of time and resources, and the
district court's scheduling order;
new text end
new text begin
(10) which court will hear and decide the action more expeditiously;
new text end
new text begin
(11) the burden on each party if the court transfers the action to a Tribal court, including
costs, access to and admissibility of evidence, and matters of procedure; and
new text end
new text begin
(12) any other factor that the court determines to be relevant.
new text end
new text begin Subd. 7. new text end
new text begin Future exercise of jurisdiction. new text end
new text begin
Nothing in this section shall be construed to
limit the district court's exercise of jurisdiction when the Tribal court waives jurisdiction,
transfers the action back to district court, or otherwise declines to exercise jurisdiction over
the action.
new text end
new text begin Subd. 8. new text end
new text begin Transfer to Red Lake Nation Tribal Court. new text end
new text begin
When a party or Tribal IV-D
agency brings a motion to transfer a child support, custody, or parenting time action to the
Red Lake Nation Tribal Court, the court must transfer the action to the Red Lake Nation
Tribal Court if the case participants and child resided within the boundaries of the Red Lake
Reservation for six months preceding the motion to transfer the action to the Red Lake
Nation Tribal Court.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 18.
Minnesota Statutes 2020, section 548.091, subdivision 1a, is amended to read:
Subd. 1a.
Child support judgment by operation of law.
deleted text begin (a)deleted text end Any payment or installment
of support required by a judgment or decree of dissolution or legal separation, determination
of parentage, an order under chapter 518C, an order under section 256.87, or an order under
section 260B.331 or 260C.331, that is not paid or withheld from the obligor's income as
required under section 518A.53, or which is ordered as child support by judgment, decree,
or order by a court in any other state, is a judgment by operation of law on and after the
date it is due, is entitled to full faith and credit in this state and any other state, and shall be
entered and docketed by the court administrator on the filing of affidavits as provided in
subdivision 2a. deleted text begin Except as otherwise provided by paragraphs (b) and (e), interest accrues
from the date the unpaid amount due is greater than the current support due at the annual
rate provided in section 549.09, subdivision 1, not to exceed an annual rate of 18 percent.deleted text end
A payment or installment of support that becomes a judgment by operation of law between
the date on which a party served notice of a motion for modification under section 518A.39,
subdivision 2, and the date of the court's order on modification may be modified under that
subdivision.new text begin Interest does not accrue on a judgment for child support, confinement and
pregnancy expenses, or genetic testing fees.
new text end
deleted text begin
(b) Notwithstanding the provisions of section 549.09, upon motion to the court and upon
proof by the obligor of 12 consecutive months of complete and timely payments of both
current support and court-ordered paybacks of a child support debt or arrearage, the court
may order interest on the remaining debt or arrearage to stop accruing. Timely payments
are those made in the month in which they are due. If, after that time, the obligor fails to
make complete and timely payments of both current support and court-ordered paybacks
of child support debt or arrearage, the public authority or the obligee may move the court
for the reinstatement of interest as of the month in which the obligor ceased making complete
and timely payments.
deleted text end
deleted text begin
The court shall provide copies of all orders issued under this section to the public
authority. The state court administrator shall prepare and make available to the court and
the parties forms to be submitted by the parties in support of a motion under this paragraph.
deleted text end
deleted text begin
(c) Notwithstanding the provisions of section 549.09, upon motion to the court, the court
may order interest on a child support debt or arrearage to stop accruing where the court
finds that the obligor is:
deleted text end
deleted text begin
(1) unable to pay support because of a significant physical or mental disability;
deleted text end
deleted text begin
(2) a recipient of Supplemental Security Income (SSI), Title II Older Americans Survivor's
Disability Insurance (OASDI), other disability benefits, or public assistance based upon
need; or
deleted text end
deleted text begin
(3) institutionalized or incarcerated for at least 30 days for an offense other than
nonsupport of the child or children involved, and is otherwise financially unable to pay
support.
deleted text end
deleted text begin
(d) If the conditions in paragraph (c) no longer exist, upon motion to the court, the court
may order interest accrual to resume retroactively from the date of service of the motion to
resume the accrual of interest.
deleted text end
deleted text begin
(e) Notwithstanding section 549.09, the public authority must suspend the charging of
interest when:
deleted text end
deleted text begin
(1) the obligor makes a request to the public authority that the public authority suspend
the charging of interest;
deleted text end
deleted text begin
(2) the public authority provides full IV-D child support services; and
deleted text end
deleted text begin
(3) the obligor has made, through the public authority, 12 consecutive months of complete
and timely payments of both current support and court-ordered paybacks of a child support
debt or arrearage.
deleted text end
deleted text begin
Timely payments are those made in the month in which they are due.
deleted text end
deleted text begin
Interest charging must be suspended on the first of the month following the date of the
written notice of the public authority's action to suspend the charging of interest. If, after
interest charging has been suspended, the obligor fails to make complete and timely payments
of both current support and court-ordered paybacks of child support debt or arrearage, the
public authority may resume the charging of interest as of the first day of the month in which
the obligor ceased making complete and timely payments.
deleted text end
deleted text begin
The public authority must provide written notice to the parties of the public authority's
action to suspend or resume the charging of interest. The notice must inform the parties of
the right to request a hearing to contest the public authority's action. The notice must be
sent by first class mail to the parties' last known addresses.
deleted text end
deleted text begin
A party may contest the public authority's action to suspend or resume the charging of
interest if the party makes a written request for a hearing within 30 days of the date of written
notice. If a party makes a timely request for a hearing, the public authority must schedule
a hearing and send written notice of the hearing to the parties by mail to the parties' last
known addresses at least 14 days before the hearing. The hearing must be conducted in
district court or in the expedited child support process if section 484.702 applies. The district
court or child support magistrate must determine whether suspending or resuming the interest
charging is appropriate and, if appropriate, the effective date.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022.
new text end
Sec. 19.
Minnesota Statutes 2020, section 548.091, subdivision 2a, is amended to read:
Subd. 2a.
Entry and docketing of child support judgment.
(a) On or after the date an
unpaid amount becomes a judgment by operation of law under subdivision 1a, the obligee
or the public authority may file with the court administrator:
(1) a statement identifying, or a copy of, the judgment or decree of dissolution or legal
separation, determination of parentage, order under chapter 518B or 518C, an order under
section 256.87, an order under section 260B.331 or 260C.331, or judgment, decree, or order
for child support by a court in any other state, which provides for periodic installments of
child support, or a judgment or notice of attorney fees and collection costs under section
518A.735;
(2) an affidavit of default. The affidavit of default must state the full name, occupation,
place of residence, and last known post office address of the obligor, the name of the obligee,
the date or dates payment was due and not received and judgment was obtained by operation
of law, the total amount of the judgments to be entered and docketed; and
(3) an affidavit of service of a notice of intent to enter and docket judgment and to recover
attorney fees and collection costs on the obligor, in person or by first class mail at the
obligor's last known post office address. Service is completed upon mailing in the manner
designated. Where applicable, a notice of interstate lien in the form promulgated under
United States Code, title 42, section 652(a), is sufficient to satisfy the requirements of clauses
(1) and (2).
(b) A judgment entered and docketed under this subdivision has the same effect and is
subject to the same procedures, defenses, and proceedings as any other judgment in district
court, and may be enforced or satisfied in the same manner as judgments under section
548.09, except as otherwise provided.
new text begin
(c) A judgment entered and docketed under this subdivision is not subject to interest
charging or accrual.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022.
new text end
Sec. 20.
Minnesota Statutes 2020, section 548.091, subdivision 3b, is amended to read:
Subd. 3b.
Child support judgment administrative renewals.
Child support judgments
may be renewed by service of notice upon the debtor. Service must be by first class mail at
the last known address of the debtor, with service deemed complete upon mailing in the
manner designated, or in the manner provided for the service of civil process. Upon the
filing of the notice and proof of service, the court administrator shall administratively renew
the judgment for child support without any additional filing fee in the same court file as the
original child support judgment. The judgment must be renewed in an amount equal to the
unpaid principal plus the deleted text begin accrueddeleted text end unpaid interestnew text begin accrued prior to August 1, 2022new text end . Child
support judgments may be renewed multiple times until paid.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022.
new text end
Sec. 21.
Minnesota Statutes 2020, section 548.091, subdivision 9, is amended to read:
Subd. 9.
Payoff statement.
The public authority shall issue to the obligor, attorneys,
lenders, and closers, or their agents, a payoff statement setting forth conclusively the amount
necessary to satisfy the lien. Payoff statements must be issued within three business days
after receipt of a request by mail, personal delivery, telefacsimile, or electronic mail
transmission, and must be delivered to the requester by telefacsimile or electronic mail
transmission if requested and if appropriate technology is available to the public authority.new text begin
If the payoff statement includes amounts for unpaid maintenance, the statement shall specify
that the public authority does not calculate accrued interest and that an interest balance in
addition to the payoff statement may be owed.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022.
new text end
Sec. 22.
Minnesota Statutes 2020, section 548.091, subdivision 10, is amended to read:
Subd. 10.
Release of lien.
Upon payment of the new text begin child support new text end amount due, the public
authority shall execute and deliver a satisfaction of the judgment lien within five business
days.new text begin The public authority is not responsible for satisfaction of judgments for unpaid
maintenance.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022.
new text end
Sec. 23.
Minnesota Statutes 2020, section 549.09, subdivision 1, is amended to read:
Subdivision 1.
When owed; rate.
(a) When a judgment or award is for the recovery of
money, including a judgment for the recovery of taxes, interest from the time of the verdict,
award, or report until judgment is finally entered shall be computed by the court administrator
or arbitrator as provided in paragraph (c) and added to the judgment or award.
(b) Except as otherwise provided by contract or allowed by law, preverdict, preaward,
or prereport interest on pecuniary damages shall be computed as provided in paragraph (c)
from the time of the commencement of the action or a demand for arbitration, or the time
of a written notice of claim, whichever occurs first, except as provided herein. The action
must be commenced within two years of a written notice of claim for interest to begin to
accrue from the time of the notice of claim. If either party serves a written offer of settlement,
the other party may serve a written acceptance or a written counteroffer within 30 days.
After that time, interest on the judgment or award shall be calculated by the judge or arbitrator
in the following manner. The prevailing party shall receive interest on any judgment or
award from the time of commencement of the action or a demand for arbitration, or the time
of a written notice of claim, or as to special damages from the time when special damages
were incurred, if later, until the time of verdict, award, or report only if the amount of its
offer is closer to the judgment or award than the amount of the opposing party's offer. If
the amount of the losing party's offer was closer to the judgment or award than the prevailing
party's offer, the prevailing party shall receive interest only on the amount of the settlement
offer or the judgment or award, whichever is less, and only from the time of commencement
of the action or a demand for arbitration, or the time of a written notice of claim, or as to
special damages from when the special damages were incurred, if later, until the time the
settlement offer was made. Subsequent offers and counteroffers supersede the legal effect
of earlier offers and counteroffers. For the purposes of clause (2), the amount of settlement
offer must be allocated between past and future damages in the same proportion as determined
by the trier of fact. Except as otherwise provided by contract or allowed by law, preverdict,
preaward, or prereport interest shall not be awarded on the following:
(1) judgments, awards, or benefits in workers' compensation cases, but not including
third-party actions;
(2) judgments or awards for future damages;
(3) punitive damages, fines, or other damages that are noncompensatory in nature;
(4) judgments or awards not in excess of the amount specified in section 491A.01; and
(5) that portion of any verdict, award, or report which is founded upon interest, or costs,
disbursements, attorney fees, or other similar items added by the court or arbitrator.
(c)(1)(i) For a judgment or award of $50,000 or less or a judgment or award for or against
the state or a political subdivision of the state, regardless of the amount, or a judgment or
award in a family court action, new text begin except for a child support judgment, new text end regardless of the amount,
the interest shall be computed as simple interest per annum. The rate of interest shall be
based on the secondary market yield of one year United States Treasury bills, calculated on
a bank discount basis as provided in this section.
On or before the 20th day of December of each year the state court administrator shall
determine the rate from the one-year constant maturity treasury yield for the most recent
calendar month, reported on a monthly basis in the latest statistical release of the board of
governors of the Federal Reserve System. This yield, rounded to the nearest one percent,
or four percent, whichever is greater, shall be the annual interest rate during the succeeding
calendar year. The state court administrator shall communicate the interest rates to the court
administrators and sheriffs for use in computing the interest on verdicts and shall make the
interest rates available to arbitrators.
This item applies to any section that references section 549.09 by citation for the purposes
of computing an interest rate on any amount owed to or by the state or a political subdivision
of the state, regardless of the amount.
(ii) The court, in a family court action, may order a lower interest rate or no interest rate
if the parties agree or if the court makes findings explaining why application of a lower
interest rate or no interest rate is necessary to avoid causing an unfair hardship to the debtor.
This item does not apply to child support or spousal maintenance judgments subject to
section 548.091.
(2) For a judgment or award over $50,000, other than a judgment or award for or against
the state or a political subdivision of the state or a judgment or award in a family court
action, the interest rate shall be ten percent per year until paid.
(3) When a judgment creditor, or the judgment creditor's attorney or agent, has received
a payment after entry of judgment, whether the payment is made voluntarily by or on behalf
of the judgment debtor, or is collected by legal process other than execution levy where a
proper return has been filed with the court administrator, the judgment creditor, or the
judgment creditor's attorney, before applying to the court administrator for an execution
shall file with the court administrator an affidavit of partial satisfaction. The affidavit must
state the dates and amounts of payments made upon the judgment after the most recent
affidavit of partial satisfaction filed, if any; the part of each payment that is applied to taxable
disbursements and to accrued interest and to the unpaid principal balance of the judgment;
and the accrued, but the unpaid interest owing, if any, after application of each payment.
new text begin
(4) Interest shall not accrue on child support judgments.
new text end
(d) This section does not apply to arbitrations between employers and employees under
chapter 179 or 179A. An arbitrator is neither required to nor prohibited from awarding
interest under chapter 179 or under section 179A.16 for essential employees.
(e) For purposes of this subdivision:
(1) "state" includes a department, board, agency, commission, court, or other entity in
the executive, legislative, or judicial branch of the state; and
(2) "political subdivision" includes a town, statutory or home rule charter city, county,
school district, or any other political subdivision of the state.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2022.
new text end
ARTICLE 13
BEHAVIORAL HEALTH
Section 1.
Minnesota Statutes 2020, section 245.4889, subdivision 1, is amended to read:
Subdivision 1.
Establishment and authority.
(a) The commissioner is authorized to
make grants from available appropriations to assist:
(1) counties;
(2) Indian tribes;
(3) children's collaboratives under section 124D.23 or 245.493; or
(4) mental health service providers.
(b) The following services are eligible for grants under this section:
(1) services to children with emotional disturbances as defined in section 245.4871,
subdivision 15, and their families;
(2) transition services under section 245.4875, subdivision 8, for young adults under
age 21 and their families;
(3) respite care services for children with emotional disturbances or severe emotional
disturbances who are at risk of out-of-home placement. A child is not required to have case
management services to receive respite care services;
(4) children's mental health crisis services;
(5) mental health services for people from cultural and ethnic minorities;
(6) children's mental health screening and follow-up diagnostic assessment and treatment;
(7) services to promote and develop the capacity of providers to use evidence-based
practices in providing children's mental health services;
(8) school-linked mental health services under section 245.4901;
(9) building evidence-based mental health intervention capacity for children birth to age
five;
(10) suicide prevention and counseling services that use text messaging statewide;
(11) mental health first aid training;
(12) training for parents, collaborative partners, and mental health providers on the
impact of adverse childhood experiences and trauma and development of an interactive
website to share information and strategies to promote resilience and prevent trauma;
(13) transition age services to develop or expand mental health treatment and supports
for adolescents and young adults 26 years of age or younger;
(14) early childhood mental health consultation;
(15) evidence-based interventions for youth at risk of developing or experiencing a first
episode of psychosis, and a public awareness campaign on the signs and symptoms of
psychosis;
(16) psychiatric consultation for primary care practitioners; deleted text begin and
deleted text end
(17) providers to begin operations and meet program requirements when establishing a
new children's mental health program. These may be start-up grantsdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(18) evidence-informed interventions for youth and young adults who are at risk of
developing a mood disorder or are experiencing an emerging mood disorder, including
major depression and bipolar disorders, and a public awareness campaign on the signs and
symptoms of mood disorders in youth and young adults.
new text end
(c) Services under paragraph (b) must be designed to help each child to function and
remain with the child's family in the community and delivered consistent with the child's
treatment plan. Transition services to eligible young adults under this paragraph must be
designed to foster independent living in the community.
(d) As a condition of receiving grant funds, a grantee shall obtain all available third-party
reimbursement sources, if applicable.
Sec. 2.
Minnesota Statutes 2020, section 245.735, subdivision 3, is amended to read:
Subd. 3.
Certified community behavioral health clinics.
(a) The commissioner shall
establish a state certification process for certified community behavioral health clinics
(CCBHCs)new text begin that satisfy all federal requirements necessary for CCBHCs certified under this
section to be eligible for reimbursement under medical assistance, without service area
limits based on geographic area or regionnew text end . new text begin The commissioner shall consult with CCBHC
stakeholders before establishing and implementing changes in the certification process and
requirements.new text end Entities that choose to be CCBHCs must:
deleted text begin
(1) comply with the CCBHC criteria published by the United States Department of
Health and Human Services;
deleted text end
new text begin
(1) comply with state licensing requirements and other requirements issued by the
commissioner;
new text end
(2) employ or contract for clinic staff who have backgrounds in diverse disciplines,
including licensed mental health professionals and licensed alcohol and drug counselors,
and staff who are culturally and linguistically trained to meet the needs of the population
the clinic serves;
(3) ensure that clinic services are available and accessible to individuals and families of
all ages and genders and that crisis management services are available 24 hours per day;
(4) establish fees for clinic services for individuals who are not enrolled in medical
assistance using a sliding fee scale that ensures that services to patients are not denied or
limited due to an individual's inability to pay for services;
(5) comply with quality assurance reporting requirements and other reporting
requirements, including any required reporting of encounter data, clinical outcomes data,
and quality data;
(6) provide crisis mental health and substance use services, withdrawal management
services, emergency crisis intervention services, and stabilization servicesnew text begin , through existing
mobile crisis servicesnew text end ; screening, assessment, and diagnosis services, including risk
assessments and level of care determinations; person- and family-centered treatment planning;
outpatient mental health and substance use services; targeted case management; psychiatric
rehabilitation services; peer support and counselor services and family support services;
and intensive community-based mental health services, including mental health services
for members of the armed forces and veteransdeleted text begin ;deleted text end new text begin . CCBHCs must directly provide the majority
of these services to enrollees, but may coordinate some services with another entity through
a collaboration or agreement, pursuant to paragraph (b);
new text end
(7) provide coordination of care across settings and providers to ensure seamless
transitions for individuals being served across the full spectrum of health services, including
acute, chronic, and behavioral needs. Care coordination may be accomplished through
partnerships or formal contracts with:
(i) counties, health plans, pharmacists, pharmacies, rural health clinics, federally qualified
health centers, inpatient psychiatric facilities, substance use and detoxification facilities, or
community-based mental health providers; and
(ii) other community services, supports, and providers, including schools, child welfare
agencies, juvenile and criminal justice agencies, Indian health services clinics, tribally
licensed health care and mental health facilities, urban Indian health clinics, Department of
Veterans Affairs medical centers, outpatient clinics, drop-in centers, acute care hospitals,
and hospital outpatient clinics;
(8) be certified as mental health clinics under section 245.69, subdivision 2;
(9) comply with standards new text begin established by the commissioner new text end relating to deleted text begin mental health
services in Minnesota Rules, parts 9505.0370 to 9505.0372deleted text end new text begin CCBHC screenings, assessments,
and evaluationsnew text end ;
(10) be licensed to provide substance use disorder treatment under chapter 245G;
(11) be certified to provide children's therapeutic services and supports under section
256B.0943;
(12) be certified to provide adult rehabilitative mental health services under section
256B.0623;
(13) be enrolled to provide mental health crisis response services under deleted text begin sectionsdeleted text end new text begin sectionnew text end
256B.0624 deleted text begin and 256B.0944deleted text end ;
(14) be enrolled to provide mental health targeted case management under section
256B.0625, subdivision 20;
(15) comply with standards relating to mental health case management in Minnesota
Rules, parts 9520.0900 to 9520.0926;
(16) provide services that comply with the evidence-based practices described in
paragraph (e); and
(17) comply with standards relating to peer services under sections 256B.0615,
256B.0616, and 245G.07, subdivision 1, paragraph (a), clause (5), as applicable when peer
services are provided.
(b) If deleted text begin an entitydeleted text end new text begin a certified CCBHCnew text end is unable to provide one or more of the services listed
in paragraph (a), clauses (6) to (17), the deleted text begin commissioner may certify the entity as adeleted text end CCBHCdeleted text begin ,
if the entity has a currentdeleted text end new text begin maynew text end contract with another entity that has the required authority
to provide that service and that meets deleted text begin federal CCBHCdeleted text end new text begin the followingnew text end criteria as a designated
collaborating organizationdeleted text begin , or, to the extent allowed by the federal CCBHC criteria, the
commissioner may approve a referral arrangement. The CCBHC must meet federal
requirements regarding the type and scope of services to be provided directly by the CCBHC.deleted text end new text begin :
new text end
new text begin
(1) the entity has a formal agreement with the CCBHC to furnish one or more of the
services under paragraph (a), clause (6);
new text end
new text begin
(2) the entity provides assurances that it will provide services according to CCBHC
service standards and provider requirements;
new text end
new text begin
(3) the entity agrees that the CCBHC is responsible for coordinating care and has clinical
and financial responsibility for the services that the entity provides under the agreement;
and
new text end
new text begin
(4) the entity meets any additional requirements issued by the commissioner.
new text end
(c) Notwithstanding any other law that requires a county contract or other form of county
approval for certain services listed in paragraph (a), clause (6), a clinic that otherwise meets
CCBHC requirements may receive the prospective payment under section 256B.0625,
subdivision 5m, for those services without a county contract or county approval. As part of
the certification process in paragraph (a), the commissioner shall require a letter of support
from the CCBHC's host county confirming that the CCBHC and the county or counties it
serves have an ongoing relationship to facilitate access and continuity of care, especially
for individuals who are uninsured or who may go on and off medical assistance.
(d) When the standards listed in paragraph (a) or other applicable standards conflict or
address similar issues in duplicative or incompatible ways, the commissioner may grant
variances to state requirements if the variances do not conflict with federal requirementsnew text begin
for services reimbursed under medical assistancenew text end . If standards overlap, the commissioner
may substitute all or a part of a licensure or certification that is substantially the same as
another licensure or certification. The commissioner shall consult with stakeholders, as
described in subdivision 4, before granting variances under this provision. For the CCBHC
that is certified but not approved for prospective payment under section 256B.0625,
subdivision 5m, the commissioner may grant a variance under this paragraph if the variance
does not increase the state share of costs.
(e) The commissioner shall issue a list of required evidence-based practices to be
delivered by CCBHCs, and may also provide a list of recommended evidence-based practices.
The commissioner may update the list to reflect advances in outcomes research and medical
services for persons living with mental illnesses or substance use disorders. The commissioner
shall take into consideration the adequacy of evidence to support the efficacy of the practice,
the quality of workforce available, and the current availability of the practice in the state.
At least 30 days before issuing the initial list and any revisions, the commissioner shall
provide stakeholders with an opportunity to comment.
(f) The commissioner shall recertify CCBHCs at least every three years. The
commissioner shall establish a process for decertification and shall require corrective action,
medical assistance repayment, or decertification of a CCBHC that no longer meets the
requirements in this section or that fails to meet the standards provided by the commissioner
in the application and certification process.
Sec. 3.
Minnesota Statutes 2020, section 245.735, subdivision 5, is amended to read:
Subd. 5.
Information systems support.
The commissioner and the state chief information
officer shall provide information systems support to the projects as necessary to comply
with new text begin state and new text end federal requirements.
Sec. 4.
Minnesota Statutes 2020, section 245.735, is amended by adding a subdivision to
read:
new text begin Subd. 6. new text end
new text begin Demonstration entities. new text end
new text begin
The commissioner may operate the demonstration
program established by section 223 of the Protecting Access to Medicare Act if federal
funding for the demonstration program remains available from the United States Department
of Health and Human Services. To the extent practicable, the commissioner shall align the
requirements of the demonstration program with the requirements under this section for
CCBHCs receiving medical assistance reimbursement. A CCBHC may not apply to
participate as a billing provider in both the CCBHC federal demonstration and the benefit
for CCBHCs under the medical assistance program.
new text end
Sec. 5.
Minnesota Statutes 2020, section 246.54, subdivision 1b, is amended to read:
Subd. 1b.
Community behavioral health hospitals.
A county's payment of the cost of
care provided at state-operated community-based behavioral health hospitalsnew text begin for adults and
childrennew text end shall be according to the following schedule:
(1) 100 percent for each day during the stay, including the day of admission, when the
facility determines that it is clinically appropriate for the client to be discharged; and
(2) the county shall not be entitled to reimbursement from the client, the client's estate,
or from the client's relatives, except as provided in section 246.53.
Sec. 6.
new text begin
[254B.17] SCHOOL-LINKED SUBSTANCE ABUSE GRANTS.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The commissioner of human services shall establish a
school-linked substance abuse grant program to provide early identification of and
intervention for secondary school students with substance use disorder needs, and to build
the capacity of secondary schools to support students with substance use disorder needs in
the classroom.
new text end
new text begin Subd. 2. new text end
new text begin Eligible applicant. new text end
new text begin
(a) An eligible applicant for a school-linked substance
abuse grant is an entity or individual that is:
new text end
new text begin
(1) licensed under chapter 245G and in compliance with the general requirements in
chapters 245A, 245C, and 260E, section 626.557, and Minnesota Rules, chapter 9544; or
new text end
new text begin
(2) an alcohol and drug counselor licensed under chapter 148F and in compliance with
section 245G.11, subdivision 5.
new text end
new text begin Subd. 3. new text end
new text begin Allowable grant activities and related expenses. new text end
new text begin
(a) Allowable grant activities
and related expenses may include but are not limited to:
new text end
new text begin
(1) identifying and diagnosing substance use disorders of students;
new text end
new text begin
(2) delivering substance use disorder treatment and services to students and their families,
including via telemedicine;
new text end
new text begin
(3) supporting families in meeting their child's needs, including navigating health care,
social service, and juvenile justice systems;
new text end
new text begin
(4) providing transportation for students receiving school-linked substance use disorder
treatment services when school is not in session;
new text end
new text begin
(5) building the capacity of schools to meet the needs of students with substance use
disorder concerns, including school staff development activities for licensed and nonlicensed
staff; and
new text end
new text begin
(6) purchasing equipment, connection charges, on-site coordination, setup fees, and site
fees in order to deliver school-linked substance use disorder treatment services via
telemedicine.
new text end
new text begin
(b) Grantees shall obtain all available third-party reimbursement sources as a condition
of receiving a grant. For purposes of the grant program, a third-party reimbursement source
excludes a public school as defined in section 120A.20, subdivision 1. Grantees shall serve
each student regardless of the student's health coverage status or ability to pay.
new text end
new text begin
(c) Prior to issuing a request for proposals for grants under this section, the commissioner
shall award grants to eligible applicants that are currently providing substance use disorder
treatment services in secondary schools or that are currently providing school-linked mental
health services but have the demonstrated capacity to provide allowable substance use
disorder treatment services in secondary schools.
new text end
new text begin Subd. 4. new text end
new text begin Data collection and outcome measurement. new text end
new text begin
Grantees shall provide data to
the commissioner for the purpose of evaluating the effectiveness of the school-linked
substance use disorder treatment grant program.
new text end
Sec. 7.
Minnesota Statutes 2020, section 256B.0624, subdivision 7, is amended to read:
Subd. 7.
Crisis stabilization services.
(a) Crisis stabilization services must be provided
by qualified staff of a crisis stabilization services provider entity and must meet the following
standards:
(1) a crisis stabilization treatment plan must be developed which meets the criteria in
subdivision 11;
(2) staff must be qualified as defined in subdivision 8; and
(3) services must be delivered according to the treatment plan and include face-to-face
contact with the recipient by qualified staff for further assessment, help with referrals,
updating of the crisis stabilization treatment plan, supportive counseling, skills training,
and collaboration with other service providers in the community.
(b) If crisis stabilization services are provided in a supervised, licensed residential setting,
the recipient must be contacted face-to-face daily by a qualified mental health practitioner
or mental health professional. The program must have 24-hour-a-day residential staffing
which may include staff who do not meet the qualifications in subdivision 8. The residential
staff must have 24-hour-a-day immediate direct or telephone access to a qualified mental
health professional or practitioner.
(c) If crisis stabilization services are provided in a supervised, licensed residential setting
that serves no more than four adult residents, and one or more individuals are present at the
setting to receive residential crisis stabilization services, the residential staff must include,
for at least eight hours per day, at least one individual who meets the qualifications in
subdivision 8, paragraph (a), clause (1) or (2).new text begin The commissioner shall establish a statewide
per diem rate for crisis stabilization services provided under this paragraph to medical
assistance enrollees. The rate for a provider shall not exceed the rate charged by that provider
for the same service to other payers. Payment shall not be made to more than one entity for
each individual for services provided under this paragraph on a given day. The commissioner
shall set rates prospectively for the annual rate period. The commissioner shall require
providers to submit annual cost reports on a uniform cost reporting form and shall use
submitted cost reports to inform the rate-setting process. The commissioner shall recalculate
the statewide per diem every year.
new text end
(d) If crisis stabilization services are provided in a supervised, licensed residential setting
that serves more than four adult residents, and one or more are recipients of crisis stabilization
services, the residential staff must include, for 24 hours a day, at least one individual who
meets the qualifications in subdivision 8. During the first 48 hours that a recipient is in the
residential program, the residential program must have at least two staff working 24 hours
a day. Staffing levels may be adjusted thereafter according to the needs of the recipient as
specified in the crisis stabilization treatment plan.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2021, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 8.
Minnesota Statutes 2020, section 256B.0625, subdivision 5m, is amended to read:
Subd. 5m.
Certified community behavioral health clinic services.
(a) Medical
assistance covers certified community behavioral health clinic (CCBHC) services that meet
the requirements of section 245.735, subdivision 3.
(b) The commissioner shall deleted text begin establish standards and methodologies for adeleted text end new text begin reimburse
CCBHCs on a per-visit basis under the new text end prospective payment system for medical assistance
payments deleted text begin for services delivered by a CCBHC, in accordance with guidance issued by the
Centers for Medicare and Medicaid Servicesdeleted text end new text begin as described in paragraph (c)new text end . The commissioner
shall include a quality deleted text begin bonusdeleted text end new text begin incentivenew text end payment in the prospective payment system deleted text begin based
on federal criteriadeleted text end new text begin as described in paragraph (e)new text end . There is no county share for medical
assistance services when reimbursed through the CCBHC prospective payment system.
(c) deleted text begin Unless otherwise indicated in applicable federal requirements, the prospective payment
system must continue to be based on the federal instructions issued for the federal section
223 CCBHC demonstration, except:deleted text end new text begin The commissioner shall ensure that the prospective
payment system for CCBHC payments under medical assistance meets the following
requirements:
new text end
new text begin
(1) the prospective payment rate shall be a provider-specific rate calculated for each
CCBHC, based on the daily cost of providing CCBHC services and the total annual allowable
costs for CCBHCs divided by the total annual number of CCBHC visits. For calculating
the payment rate, total annual visits include visits covered by medical assistance and visits
not covered by medical assistance. Allowable costs include but are not limited to the salaries
and benefits of medical assistance providers; the cost of CCBHC services provided under
section 245.735, subdivision 3, paragraph (a), clauses (6) and (7); and other costs such as
insurance or supplies needed to provide CCBHC services;
new text end
new text begin
(2) payment shall be limited to one payment per day per medical assistance enrollee for
each CCBHC visit eligible for reimbursement. A CCBHC visit is eligible for reimbursement
if at least one of the CCBHC services listed under section 245.735, subdivision 3, paragraph
(a), clause (6), is furnished to a medical assistance enrollee by a health care practitioner or
licensed agency employed by or under contract with a CCBHC;
new text end
new text begin
(3) new payment rates set by the commissioner for newly certified CCBHCs under
section 245.735, subdivision 3, shall be based on rates for established CCBHCs with a
similar scope of services. If no comparable CCBHC exists, the commissioner shall establish
a clinic-specific rate using audited historical cost report data adjusted for the estimated cost
of delivering CCBHC services, including the estimated cost of providing the full scope of
services and the projected change in visits resulting from the change in scope;
new text end
deleted text begin (1)deleted text end new text begin (4)new text end the commissioner shall rebase CCBHC rates deleted text begin at leastdeleted text end new text begin oncenew text end every three yearsnew text begin and
12 months following an initial rate or a rate change due to a change in the scope of services,
whichever is earliernew text end ;
deleted text begin (2)deleted text end new text begin (5)new text end the commissioner shall provide for a 60-day appeals process new text begin after notice of the
results new text end of the rebasing;
deleted text begin
(3) the prohibition against inclusion of new facilities in the demonstration does not apply
after the demonstration ends;
deleted text end
deleted text begin (4)deleted text end new text begin (6)new text end the prospective payment rate under this section does not apply to services rendered
by CCBHCs to individuals who are dually eligible for Medicare and medical assistance
when Medicare is the primary payer for the service. An entity that receives a prospective
payment system rate that overlaps with the CCBHC rate is not eligible for the CCBHC rate;
deleted text begin (5)deleted text end new text begin (7)new text end payments for CCBHC services to individuals enrolled in managed care shall be
coordinated with the state's phase-out of CCBHC wrap paymentsnew text begin . The commissioner shall
complete the phase-out of CCBHC wrap payments within 60 days of the implementation
of the prospective payment system in the Medicaid Management Information System
(MMIS), for CCBHCs reimbursed under this chapter, with a final settlement of payments
due made payable to CCBHCs no later than 18 months thereafternew text end ;
deleted text begin
(6) initial prospective payment rates for CCBHCs certified after July 1, 2019, shall be
based on rates for comparable CCBHCs. If no comparable provider exists, the commissioner
shall compute a CCBHC-specific rate based upon the CCBHC's audited costs adjusted for
changes in the scope of services;
deleted text end
deleted text begin (7)deleted text end new text begin (8)new text end the prospective payment rate for each CCBHC shall be deleted text begin adjusted annuallydeleted text end new text begin updated
new text end bynew text begin trending each provider-specific rate bynew text end the Medicare Economic Index deleted text begin as defined for the
federal section 223 CCBHC demonstrationdeleted text end new text begin for primary care services. This update shall
occur each year in between rebasing periods determined by the commissioner in accordance
with clause (4). CCBHCs must provide data on costs and visits to the state annually using
the CCBHC cost report established by the commissionernew text end ; and
new text begin
(9) a CCBHC may request a rate adjustment for changes in the CCBHC's scope of
services when such changes are expected to result in an adjustment to the CCBHC payment
rate by 2.5 percent or more. The CCBHC must provide the commissioner with information
regarding the changes in the scope of services, including the estimated cost of providing
the new or modified services and any projected increase or decrease in the number of visits
resulting from the change. Rate adjustments for changes in scope shall occur no more than
once per year in between rebasing periods per CCBHC and are effective on the date of the
annual CCBHC rate update.
new text end
deleted text begin
(8) the commissioner shall seek federal approval for a CCBHC rate methodology that
allows for rate modifications based on changes in scope for an individual CCBHC, including
for changes to the type, intensity, or duration of services. Upon federal approval, a CCBHC
may submit a change of scope request to the commissioner if the change in scope would
result in a change of 2.5 percent or more in the prospective payment system rate currently
received by the CCBHC. CCBHC change of scope requests must be according to a format
and timeline to be determined by the commissioner in consultation with CCBHCs.
deleted text end
(d) Managed care plans and county-based purchasing plans shall reimburse CCBHC
providers at the prospective payment rate. The commissioner shall monitor the effect of
this requirement on the rate of access to the services delivered by CCBHC providers. If, for
any contract year, federal approval is not received for this paragraph, the commissioner
must adjust the capitation rates paid to managed care plans and county-based purchasing
plans for that contract year to reflect the removal of this provision. Contracts between
managed care plans and county-based purchasing plans and providers to whom this paragraph
applies must allow recovery of payments from those providers if capitation rates are adjusted
in accordance with this paragraph. Payment recoveries must not exceed the amount equal
to any increase in rates that results from this provision. This paragraph expires if federal
approval is not received for this paragraph at any time.
new text begin
(e) The commissioner shall implement a quality incentive payment program for CCBHCs
that meets the following requirements:
new text end
new text begin
(1) a CCBHC shall receive a quality incentive payment upon meeting specific numeric
thresholds for performance metrics established by the commissioner, in addition to payments
for which the CCBHC is eligible under the prospective payment system described in
paragraph (c);
new text end
new text begin
(2) a CCBHC must be certified and enrolled as a CCBHC for the entire measurement
year to be eligible for incentive payments;
new text end
new text begin
(3) each CCBHC shall receive written notice of the criteria that must be met in order to
receive quality incentive payments at least 90 days prior to the measurement year; and
new text end
new text begin
(4) a CCBHC must provide the commissioner with data needed to determine incentive
payment eligibility within six months following the measurement year. The commissioner
shall notify CCBHC providers of their performance on the required measures and the
incentive payment amount within 12 months following the measurement year.
new text end
new text begin
(f) All claims to managed care plans for CCBHC services as provided under this section
shall be submitted directly to, and paid by, the commissioner on the dates specified no later
than January 1 of the following calendar year, if:
new text end
new text begin
(1) one or more managed care plans does not comply with the federal requirement for
payment of clean claims to CCBHCs, as defined in Code of Federal Regulations, title 42,
section 447.45(b), and the managed care plan does not resolve the payment issue within 30
days of noncompliance; and
new text end
new text begin
(2) the total amount of clean claims not paid in accordance with federal requirements
by one or more managed care plans is 50 percent of, or greater than, the total CCBHC claims
eligible for payment by managed care plans.
new text end
new text begin
If the conditions in this paragraph are met between January 1 and June 30 of a calendar
year, claims shall be submitted to and paid by the commissioner beginning on January 1 of
the following year. If the conditions in this paragraph are met between July 1 and December
31 of a calendar year, claims shall be submitted to and paid by the commissioner beginning
on July 1 of the following year.
new text end
Sec. 9.
Minnesota Statutes 2020, section 256B.0759, subdivision 2, is amended to read:
Subd. 2.
Provider participation.
new text begin (a) Outpatient new text end substance use disorder treatment
providers may elect to participate in the demonstration project and meet the requirements
of subdivision 3. To participate, a provider must notify the commissioner of the provider's
intent to participate in a format required by the commissioner and enroll as a demonstration
project provider.
new text begin
(b) Programs licensed by the Department of Human Services as a residential treatment
program according to section 245G.21 that receive payment under this chapter must enroll
as demonstration project providers and meet the requirements of subdivision 3 by June 30,
2025. Programs that do not meet the requirements of this paragraph are ineligible for payment
for services provided under section 256B.0625.
new text end
new text begin
(c) Programs licensed by the Department of Human Services as a withdrawal management
program according to chapter 245F that receive payment under this chapter must enroll as
demonstration project providers and meet the requirements of subdivision 3 by June 30,
2025. Programs that do not meet the requirements of this paragraph are ineligible for payment
for services provided under section 256B.0625.
new text end
new text begin
(d) Out-of-state residential substance use disorder treatment programs that receive
payment under this chapter must enroll as demonstration project providers and meet the
requirements of subdivision 3 by June 30, 2025. Programs that do not meet the requirements
of this paragraph are ineligible for payment for services provided under section 256B.0625.
new text end
new text begin
(e) Tribally licensed programs may elect to participate in the demonstration project and
meet the requirements of subdivision 3. The Department of Human Services must consult
with Tribal nations to discuss participation in the substance use disorder demonstration
project.
new text end
new text begin
(f) All rate enhancements for services rendered by voluntarily enrolled demonstration
providers enrolled before July 1, 2021, are applicable only to dates of service on or after
the effective date of the provider's enrollment in the demonstration project, except as
authorized under paragraph (g). The commissioner shall recoup any rate enhancements paid
under paragraph (g) to a provider that does not meet the requirements of subdivision 3 by
July 1, 2021.
new text end
new text begin
(g) The commissioner may allow providers enrolled before July 1, 2021, to receive any
applicable rate enhancements authorized under subdivision 4 for services provided on dates
of service no earlier than July 22, 2020, for fee-for-service enrollees and no earlier than
January 1, 2021, to managed care enrollees if the provider meets all of the following
requirements:
new text end
new text begin
(1) the provider attests that during the time period for which the provider is seeking the
rate enhancement, the provider took meaningful steps and had a reasonable plan approved
by the commissioner to meet the demonstration project requirements in subdivision 3;
new text end
new text begin
(2) the provider submits attestation and evidence, including all information requested
by the commissioner, of meeting the requirements of subdivision 3 to the commissioner in
a format required by the commissioner; and
new text end
new text begin
(3) the commissioner received the provider's application for enrollment on or before
June 1, 2021.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, or upon federal approval,
whichever is later, except paragraphs (f) and (g) are effective the day following final
enactment. The commissioner shall notify the revisor of statutes when federal approval is
obtained.
new text end
Sec. 10.
Minnesota Statutes 2020, section 256B.0759, subdivision 4, is amended to read:
Subd. 4.
Provider payment rates.
(a) Payment rates for participating providers must
be increased for services provided to medical assistance enrollees. To receive a rate increase,
participating providers must meet demonstration project requirements and provide evidence
of formal referral arrangements with providers delivering step-up or step-down levels of
care.new text begin Providers that have enrolled in the demonstration project but have not met the provider
standards under subdivision 3 as of July 1, 2022, are not eligible for a rate increase in this
subdivision until the date that the provider meets the provider standards in subdivision 3.
Services provided from July 1, 2022, to the date that the provider meets the provider standards
under subdivision 3 shall be reimbursed at rates according to section 254B.05, subdivision
5, paragraph (b).
new text end
new text begin
(b) The commissioner may temporarily suspend payments to the provider according to
section 256B.04, subdivision 21, paragraph (d), if the provider does not meet the requirements
in paragraph (a). Payments withheld from the provider must be made once the commissioner
determines that the requirements in paragraph (a) are met.
new text end
deleted text begin (b)deleted text end new text begin (c)new text end For substance use disorder services under section 254B.05, subdivision 5,
paragraph (b), clause (8), provided on or after July 1, 2020, payment rates must be increased
by deleted text begin 15deleted text end new text begin 35new text end percent over the rates in effect on December 31, 2019.
deleted text begin (c)deleted text end new text begin (d)new text end For substance use disorder services under section 254B.05, subdivision 5,
paragraph (b), clauses (1), (6), and (7), and adolescent treatment programs that are licensed
as outpatient treatment programs according to sections 245G.01 to 245G.18, provided on
or after January 1, 2021, payment rates must be increased by deleted text begin tendeleted text end new text begin 30new text end percent over the rates
in effect on December 31, 2020.
deleted text begin (d)deleted text end new text begin (e)new text end Effective January 1, 2021, and contingent on annual federal approval, managed
care plans and county-based purchasing plans must reimburse providers of the substance
use disorder services meeting the criteria described in paragraph (a) who are employed by
or under contract with the plan an amount that is at least equal to the fee-for-service base
rate payment for the substance use disorder services described in paragraphs deleted text begin (b)deleted text end new text begin (c)new text end and deleted text begin (c)deleted text end new text begin
(d)new text end . The commissioner must monitor the effect of this requirement on the rate of access to
substance use disorder services and residential substance use disorder rates. Capitation rates
paid to managed care organizations and county-based purchasing plans must reflect the
impact of this requirement. This paragraph expires if federal approval is not received at any
time as required under this paragraph.
deleted text begin (e)deleted text end new text begin (f)new text end Effective July 1, 2021, contracts between managed care plans and county-based
purchasing plans and providers to whom paragraph deleted text begin (d)deleted text end new text begin (e)new text end applies must allow recovery of
payments from those providers if, for any contract year, federal approval for the provisions
of paragraph deleted text begin (d)deleted text end new text begin (e)new text end is not received, and capitation rates are adjusted as a result. Payment
recoveries must not exceed the amount equal to any decrease in rates that results from this
provision.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, or upon federal approval,
whichever occurs later, except paragraphs (c) and (d) are effective January 1, 2022, or upon
federal approval, whichever is later. The commissioner shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 11.
Minnesota Statutes 2020, section 256B.0759, is amended by adding a subdivision
to read:
new text begin Subd. 6. new text end
new text begin Medium intensity residential program participation. new text end
new text begin
Medium intensity
residential programs that qualify to participate in the demonstration project shall use the
specified base payment rate of $132.90 per day, and shall be eligible for the rate increases
specified in subdivision 4.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective retroactively from July 1, 2020.
new text end
Sec. 12.
Minnesota Statutes 2020, section 256B.0759, is amended by adding a subdivision
to read:
new text begin Subd. 7. new text end
new text begin Public access. new text end
new text begin
The state shall post the final documents, for example, monitoring
reports, close out report, approved evaluation design, interim evaluation report, and
summative evaluation report, on the state's Medicaid website within 30 calendar days of
approval by CMS.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 13.
Minnesota Statutes 2020, section 256B.0759, is amended by adding a subdivision
to read:
new text begin Subd. 8. new text end
new text begin Federal approval; demonstration project extension. new text end
new text begin
The commissioner shall
seek all necessary federal authority to extend the demonstration and must submit the request
for extension by the federally required date of June 30, 2023.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 14.
Minnesota Statutes 2020, section 256B.0759, is amended by adding a subdivision
to read:
new text begin Subd. 9. new text end
new text begin Demonstration project evaluation work group. new text end
new text begin
Beginning October 1, 2021,
the commissioner shall assemble a work group of relevant stakeholders, including but not
limited to demonstration project participants and the Minnesota Association of Resources
for Recovery and Chemical Health, that shall meet at least quarterly for the duration of the
demonstration to evaluate the long-term sustainability of any improvements to quality or
access to substance use disorder treatment services caused by participation in the
demonstration project. The work group shall also determine how to implement successful
outcomes of the demonstration project once the project expires.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 15.
Minnesota Statutes 2020, section 256B.0947, 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 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, as adapted for youth, and are directed to recipients
deleted text begin ages 16, 17, 18, 19, or 20deleted text end new text begin who are eight years of age or older and under 26 years of agenew text end with
a serious mental illness or co-occurring mental illness and substance abuse addiction who
require intensive services to prevent admission to an inpatient psychiatric hospital or
placement in a residential treatment facility or who require intensive services to step down
from inpatient or residential care to community-based care.
(b) "Co-occurring mental illness and substance abuse addiction" means a dual diagnosis
of at least one form of mental illness and at least one substance use disorder. Substance use
disorders include alcohol or drug abuse or dependence, excluding nicotine use.
(c) "Diagnostic assessment" has the meaning given to it in Minnesota Rules, part
9505.0370, subpart 11. A diagnostic assessment must be provided according to Minnesota
Rules, part 9505.0372, subpart 1, and for this section must incorporate a determination of
the youth's necessary level of care using a standardized functional assessment instrument
approved and periodically updated by the commissioner.
(d) "Education specialist" means an individual with knowledge and experience working
with youth regarding special education requirements and goals, special education plans,
and coordination of educational activities with health care activities.
(e) "Housing access support" means an ancillary activity to help an individual find,
obtain, retain, and move to safe and adequate housing. Housing access support does not
provide monetary assistance for rent, damage deposits, or application fees.
(f) "Integrated dual disorders treatment" means the integrated treatment of co-occurring
mental illness and substance use disorders by a team of cross-trained clinicians within the
same program, and is characterized by assertive outreach, stage-wise comprehensive
treatment, treatment goal setting, and flexibility to work within each stage of treatment.
(g) "Medication education services" means services provided individually or in groups,
which focus on:
(1) educating the client and client's family or significant nonfamilial supporters about
mental illness and symptoms;
(2) the role and effects of medications in treating symptoms of mental illness; and
(3) the side effects of medications.
Medication education is coordinated with medication management services and does not
duplicate it. Medication education services are provided by physicians, pharmacists, or
registered nurses with certification in psychiatric and mental health care.
(h) "Peer specialist" means an employed team member who is a mental health certified
peer specialist according to section 256B.0615 and also a former children's mental health
consumer who:
(1) provides direct services to clients including social, emotional, and instrumental
support and outreach;
(2) assists younger peers to identify and achieve specific life goals;
(3) works directly with clients to promote the client's self-determination, personal
responsibility, and empowerment;
(4) assists youth with mental illness to regain control over their lives and their
developmental process in order to move effectively into adulthood;
(5) provides training and education to other team members, consumer advocacy
organizations, and clients on resiliency and peer support; and
(6) meets the following criteria:
(i) is at least 22 years of age;
(ii) has had a diagnosis of mental illness, as defined in Minnesota Rules, part 9505.0370,
subpart 20, or co-occurring mental illness and substance abuse addiction;
(iii) is a former consumer of child and adolescent mental health services, or a former or
current consumer of adult mental health services for a period of at least two years;
(iv) has at least a high school diploma or equivalent;
(v) has successfully completed training requirements determined and periodically updated
by the commissioner;
(vi) is willing to disclose the individual's own mental health history to team members
and clients; and
(vii) must be free of substance use problems for at least one year.
(i) "Provider agency" means a for-profit or nonprofit organization established to
administer an assertive community treatment for youth team.
(j) "Substance use disorders" means one or more of the disorders defined in the diagnostic
and statistical manual of mental disorders, current edition.
(k) "Transition services" means:
(1) activities, materials, consultation, and coordination that ensures continuity of the
client's care in advance of and in preparation for the client's move from one stage of care
or life to another by maintaining contact with the client and assisting the client to establish
provider relationships;
(2) providing the client with knowledge and skills needed posttransition;
(3) establishing communication between sending and receiving entities;
(4) supporting a client's request for service authorization and enrollment; and
(5) establishing and enforcing procedures and schedules.
A youth's transition from the children's mental health system and services to the adult
mental health system and services and return to the client's home and entry or re-entry into
community-based mental health services following discharge from an out-of-home placement
or inpatient hospital stay.
(l) "Treatment team" means all staff who provide services to recipients under this section.
(m) "Family peer specialist" means a staff person qualified under section 256B.0616.
Sec. 16.
Minnesota Statutes 2020, section 256B.0947, subdivision 3, is amended to read:
Subd. 3.
Client eligibility.
An eligible recipient is an individual who:
(1) is deleted text begin age 16, 17, 18, 19, or 20deleted text end new text begin eight years of age or older and under 26 years of agenew text end ; deleted text begin and
deleted text end
(2) is diagnosed with a serious mental illness or co-occurring mental illness and substance
abuse addiction, for which intensive nonresidential rehabilitative mental health services are
needed;
(3) has received a level-of-care determination, using an instrument approved by the
commissioner, that indicates a need for intensive integrated intervention without 24-hour
medical monitoring and a need for extensive collaboration among multiple providers;
(4) has a functional impairment and a history of difficulty in functioning safely and
successfully in the community, school, home, or job; or who is likely to need services from
the adult mental health system deleted text begin within the next two yearsdeleted text end new text begin during adulthoodnew text end ; and
(5) has had a recent diagnostic assessment, as provided in Minnesota Rules, part
9505.0372, subpart 1, by a mental health professional who is qualified under Minnesota
Rules, part 9505.0371, subpart 5, item A, that documents that intensive nonresidential
rehabilitative mental health services are medically necessary to ameliorate identified
symptoms and functional impairments and to achieve individual transition goals.
Sec. 17.
Minnesota Statutes 2020, section 256B.0947, subdivision 5, is amended to read:
Subd. 5.
Standards for intensive nonresidential rehabilitative providers.
(a) Services
must be provided by a provider entity as provided in subdivision 4.
new text begin
(b) The treatment team must have specialized training in providing services to the specific
age group of youth that the team serves. An individual treatment team must serve youth
who are: (1) at least eight years of age or older and under 16 years of age, or (2) at least 14
years of age or older and under 26 years of age.
new text end
deleted text begin (b)deleted text end new text begin (c)new text end The treatment team for intensive nonresidential rehabilitative mental health
services comprises both permanently employed core team members and client-specific team
members as follows:
(1) The core treatment team is an entity that operates under the direction of an
independently licensed mental health professional, who is qualified under Minnesota Rules,
part 9505.0371, subpart 5, item A, and that assumes comprehensive clinical responsibility
for clients. Based on professional qualifications and client needs, clinically qualified core
team members are assigned on a rotating basis as the client's lead worker to coordinate a
client's care. The core team must comprise at least four full-time equivalent direct care staff
and must include, but is not limited to:
(i) an independently licensed mental health professional, qualified under Minnesota
Rules, part 9505.0371, subpart 5, item A, who serves as team leader to provide administrative
direction and clinical supervision to the team;
(ii) an advanced-practice registered nurse with certification in psychiatric or mental
health care or a board-certified child and adolescent psychiatrist, either of which must be
credentialed to prescribe medications;
(iii) a licensed alcohol and drug counselor who is also trained in mental health
interventions; and
(iv) a peer specialist as defined in subdivision 2, paragraph (h).
(2) The core team may also include any of the following:
(i) additional mental health professionals;
(ii) a vocational specialist;
(iii) an educational specialist;
(iv) a child and adolescent psychiatrist who may be retained on a consultant basis;
(v) a mental health practitioner, as defined in section 245.4871, subdivision 26;
(vi) a case management service provider, as defined in section 245.4871, subdivision 4;
(vii) a housing access specialist; and
(viii) a family peer specialist as defined in subdivision 2, paragraph (m).
(3) A treatment team may include, in addition to those in clause (1) or (2), ad hoc
members not employed by the team who consult on a specific client and who must accept
overall clinical direction from the treatment team for the duration of the client's placement
with the treatment team and must be paid by the provider agency at the rate for a typical
session by that provider with that client or at a rate negotiated with the client-specific
member. Client-specific treatment team members may include:
(i) the mental health professional treating the client prior to placement with the treatment
team;
(ii) the client's current substance abuse counselor, if applicable;
(iii) a lead member of the client's individualized education program team or school-based
mental health provider, if applicable;
(iv) a representative from the client's health care home or primary care clinic, as needed
to ensure integration of medical and behavioral health care;
(v) the client's probation officer or other juvenile justice representative, if applicable;
and
(vi) the client's current vocational or employment counselor, if applicable.
deleted text begin (c)deleted text end new text begin (d)new text end The clinical supervisor shall be an active member of the treatment team and shall
function as a practicing clinician at least on a part-time basis. The treatment team shall meet
with the clinical supervisor at least weekly to discuss recipients' progress and make rapid
adjustments to meet recipients' needs. The team meeting must include client-specific case
reviews and general treatment discussions among team members. Client-specific case
reviews and planning must be documented in the individual client's treatment record.
deleted text begin (d)deleted text end new text begin (e)new text end The staffing ratio must not exceed ten clients to one full-time equivalent treatment
team position.
deleted text begin (e)deleted text end new text begin (f)new text end The treatment team shall serve no more than 80 clients at any one time. Should
local demand exceed the team's capacity, an additional team must be established rather than
exceed this limit.
deleted text begin (f)deleted text end new text begin (g)new text end Nonclinical staff shall have prompt access in person or by telephone to a mental
health practitioner or mental health professional. The provider shall have the capacity to
promptly and appropriately respond to emergent needs and make any necessary staffing
adjustments to ensure the health and safety of clients.
deleted text begin (g)deleted text end new text begin (h)new text end The intensive nonresidential rehabilitative mental health services provider shall
participate in evaluation of the assertive community treatment for youth (Youth ACT) model
as conducted by the commissioner, including the collection and reporting of data and the
reporting of performance measures as specified by contract with the commissioner.
deleted text begin (h)deleted text end new text begin (i)new text end A regional treatment team may serve multiple counties.
Sec. 18.
Minnesota Statutes 2020, section 256B.0947, subdivision 6, is amended to read:
Subd. 6.
Service standards.
The standards in this subdivision apply to intensive
nonresidential rehabilitative mental health services.
(a) The treatment team must use team treatment, not an individual treatment model.
(b) Services must be available at times that meet client needs.
(c) Services must be age-appropriate and meet the specific needs of the client.
(d) The initial functional assessment must be completed within ten days of intake and
updated at least every six months or prior to discharge from the service, whichever comes
first.
(e)new text begin The treatment team must completenew text end an individual treatment plan new text begin for each client and
the individual treatment plan new text end must:
(1) be based on the information in the client's diagnostic assessment and baselines;
(2) identify goals and objectives of treatment, a treatment strategy, a schedule for
accomplishing treatment goals and objectives, and the individuals responsible for providing
treatment services and supports;
(3) be developed after completion of the client's diagnostic assessment by a mental health
professional or clinical trainee and before the provision of children's therapeutic services
and supports;
(4) be developed through a child-centered, family-driven, culturally appropriate planning
process, including allowing parents and guardians to observe or participate in individual
and family treatment services, assessments, and treatment planning;
(5) be reviewed at least once every six months and revised to document treatment progress
on each treatment objective and next goals or, if progress is not documented, to document
changes in treatment;
(6) be signed by the clinical supervisor and by the client or by the client's parent or other
person authorized by statute to consent to mental health services for the client. A client's
parent may approve the client's individual treatment plan by secure electronic signature or
by documented oral approval that is later verified by written signature;
(7) be completed in consultation with the client's current therapist and key providers and
provide for ongoing consultation with the client's current therapist to ensure therapeutic
continuity and to facilitate the client's return to the community. For clients under the age of
18, the treatment team must consult with parents and guardians in developing the treatment
plan;
(8) if a need for substance use disorder treatment is indicated by validated assessment:
(i) identify goals, objectives, and strategies of substance use disorder treatment; develop
a schedule for accomplishing treatment goals and objectives; and identify the individuals
responsible for providing treatment services and supports;
(ii) be reviewed at least once every 90 days and revised, if necessary;
(9) be signed by the clinical supervisor and by the client and, if the client is a minor, by
the client's parent or other person authorized by statute to consent to mental health treatment
and substance use disorder treatment for the client; and
(10) provide for the client's transition out of intensive nonresidential rehabilitative mental
health services by defining the team's actions to assist the client and subsequent providers
in the transition to less intensive or "stepped down" services.
(f) The treatment team shall actively and assertively engage the client's family members
and significant others by establishing communication and collaboration with the family and
significant others and educating the family and significant others about the client's mental
illness, symptom management, and the family's role in treatment, unless the team knows or
has reason to suspect that the client has suffered or faces a threat of suffering any physical
or mental injury, abuse, or neglect from a family member or significant other.
(g) For a client age 18 or older, the treatment team may disclose to a family member,
other relative, or a close personal friend of the client, or other person identified by the client,
the protected health information directly relevant to such person's involvement with the
client's care, as provided in Code of Federal Regulations, title 45, part 164.502(b). If the
client is present, the treatment team shall obtain the client's agreement, provide the client
with an opportunity to object, or reasonably infer from the circumstances, based on the
exercise of professional judgment, that the client does not object. If the client is not present
or is unable, by incapacity or emergency circumstances, to agree or object, the treatment
team may, in the exercise of professional judgment, determine whether the disclosure is in
the best interests of the client and, if so, disclose only the protected health information that
is directly relevant to the family member's, relative's, friend's, or client-identified person's
involvement with the client's health care. The client may orally agree or object to the
disclosure and may prohibit or restrict disclosure to specific individuals.
(h) The treatment team shall provide interventions to promote positive interpersonal
relationships.
Sec. 19.
Minnesota Statutes 2020, section 297E.02, subdivision 3, is amended to read:
Subd. 3.
Collection; disposition.
(a) Taxes imposed by this section are due and payable
to the commissioner when the gambling tax return is required to be filed. Distributors must
file their monthly sales figures with the commissioner on a form prescribed by the
commissioner. Returns covering the taxes imposed under this section must be filed with
the commissioner on or before the 20th day of the month following the close of the previous
calendar month. The commissioner shall prescribe the content, format, and manner of returns
or other documents pursuant to section 270C.30. The proceeds, along with the revenue
received from all license fees and other fees under sections 349.11 to 349.191, 349.211,
and 349.213, must be paid to the commissioner of management and budget for deposit in
the general fund.
(b) The sales tax imposed by chapter 297A on the sale of pull-tabs and tipboards by the
distributor is imposed on the retail sales price. The retail sale of pull-tabs or tipboards by
the organization is exempt from taxes imposed by chapter 297A and is exempt from all
local taxes and license fees except a fee authorized under section 349.16, subdivision 8.
(c) One-half of one percent of the revenue deposited in the general fund under paragraph
(a), is appropriated to the commissioner of human services for the compulsive gambling
treatment program established under section 245.98. One-half of one percent of the revenue
deposited in the general fund under paragraph (a), is appropriated to the commissioner of
human services for a grant to the state affiliate recognized by the National Council on
Problem Gambling to increase public awareness of problem gambling, education and training
for individuals and organizations providing effective treatment services to problem gamblers
and their families, and research relating to problem gambling. Money appropriated by this
paragraph must supplement and must not replace existing state funding for these programs.
new text begin
(d) The commissioner of human services must provide to the state affiliate recognized
by the National Council on Problem Gambling a monthly statement of the amounts deposited
under paragraph (c). Beginning January 1, 2022, the commissioner of human services must
provide to the chairs and ranking minority members of the legislative committees with
jurisdiction over treatment for problem gambling and to the state affiliate recognized by the
National Council on Problem Gambling an annual reconciliation of the amounts deposited
under paragraph (c). The annual reconciliation under this paragraph must include the amount
allocated to the commissioner of human services for the compulsive gambling treatment
program established under section 245.98, and the amount allocated to the state affiliate
recognized by the National Council on Problem Gambling.
new text end
Sec. 20. new text begin SUBSTANCE USE DISORDER TREATMENT PATHFINDER
COMPANION PILOT PROJECT.
new text end
new text begin
(a) Anoka County and an academic institution acting as a research partner, in consultation
with the North Metro Mental Health Roundtable, shall conduct a one-year pilot project
beginning September 1, 2021, to evaluate the effects on treatment outcomes of the use by
individuals in substance use disorder recovery of the telephone-based Pathfinder Companion
application, which allows individuals in recovery to connect with peers, resources, providers,
and others helping with recovery after an individual is discharged from treatment, and the
use by providers of the computer-based Pathfinder Bridge application, which allows providers
to prioritize care, connect directly with patients, and monitor long-term outcomes and
recovery effectiveness.
new text end
new text begin
(b) Prior to launching the program, Anoka County must secure the participation of an
academic research institution as a research partner and the project must receive approval
from the institution's institutional review board.
new text end
new text begin
(c) The pilot project must monitor and evaluate the effects on treatment outcomes of
using the Pathfinder Companion and Pathfinder Bridge applications in order to determine
whether the addition of digital recovery support services alongside traditional methods of
recovery treatment improves treatment outcomes. The participating research partner shall
design and conduct the program evaluation.
new text end
new text begin
(d) Anoka County and the participating research partner, in consultation with the North
Metro Mental Health Roundtable, shall report to the commissioner of human services and
the chairs and ranking minority members of the legislative committees with jurisdiction
over substance use disorder treatment by January 15, 2023, on the results of the pilot project.
new text end
Sec. 21. new text begin FIRST EPISODE OF PSYCHOSIS GRANT PROGRAM; AUTHORIZED
USES OF GRANT FUNDS.
new text end
new text begin
(a) Grant funds awarded by the commissioner of human services pursuant to Minnesota
Statutes, section 245.4889, subdivision 1, paragraph (b), clause (15), must be used to:
new text end
new text begin
(1) provide intensive treatment and support for adolescents and adults experiencing or
at risk of experiencing a first psychotic episode. Intensive treatment and support includes
medication management, psychoeducation for an individual and an individual's family, case
management, employment support, education support, cognitive behavioral approaches,
social skills training, peer support, crisis planning, and stress management. Projects must
use all available funding streams;
new text end
new text begin
(2) conduct outreach and provide training and guidance to mental health and health care
professionals, including postsecondary health clinics, on early psychosis symptoms, screening
tools, and best practices; and
new text end
new text begin
(3) ensure access for individuals to first psychotic episode services under this section,
including ensuring access to first psychotic episode services for individuals who live in
rural areas.
new text end
new text begin
(b) Grant funds may also be used to pay for housing or travel expenses or to address
other barriers preventing individuals and their families from participating in first psychotic
episode services.
new text end
Sec. 22. new text begin EMERGING MOOD DISORDER GRANT PROGRAM; AUTHORIZED
USES OF GRANT FUNDS.
new text end
new text begin
(a) Grant funds awarded by the commissioner of human services pursuant to Minnesota
Statutes, section 245.4889, subdivision 1, paragraph (b), clause (18), must be used to:
new text end
new text begin
(1) provide intensive treatment and support to adolescents and young adults experiencing
or at risk of experiencing an emerging mood disorder. Intensive treatment and support
includes medication management, psychoeducation for the individual and the individual's
family, case management, employment support, education support, cognitive behavioral
approaches, social skills training, peer support, crisis planning, and stress management.
Grant recipients must use all available funding streams;
new text end
new text begin
(2) conduct outreach and provide training and guidance to mental health and health care
professionals, including postsecondary health clinics, on early symptoms of mood disorders,
screening tools, and best practices; and
new text end
new text begin
(3) ensure access for individuals to emerging mood disorder services under this section,
including ensuring access to services for individuals who live in rural areas.
new text end
new text begin
(b) Grant funds may also be used by the grant recipient to evaluate the efficacy for
providing intensive services and supports to people with emerging mood disorders.
new text end
Sec. 23. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; MENTAL
HEALTH GRANT PROGRAMS STATUTE REVISION.
new text end
new text begin
The commissioner of human services, in coordination with the Office of Senate Counsel,
Research, and Fiscal Analysis, the Office of the House Research Department, and the revisor
of statutes, shall prepare legislation for the 2022 legislative session to enact as statutes the
grant programs authorized and funded under Minnesota Statutes, section 245.4661,
subdivision 9. The draft statutes shall at least include the eligibility criteria, target populations,
authorized uses of grant funds, and outcome measures for each grant. The commissioner
shall provide a courtesy copy of the proposed legislation to the chairs and ranking minority
members of the legislative committees with jurisdiction over mental health grants.
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. 24. new text begin DIRECTION TO THE COMMISSIONER; SUBSTANCE USE DISORDER
TREATMENT PAPERWORK REDUCTION.
new text end
new text begin
(a) The commissioner of human services, in consultation with counties, tribes, managed
care organizations, substance use disorder treatment professional associations, and other
relevant stakeholders, shall develop, assess, and recommend systems improvements to
minimize regulatory paperwork and improve systems for substance use disorder programs
licensed under Minnesota Statutes, chapter 245A, and regulated under Minnesota Statutes,
chapters 245F and 245G, and Minnesota Rules, chapters 2960 and 9530. The commissioner
of human services shall make available any resources needed from other divisions within
the department to implement systems improvements.
new text end
new text begin
(b) The commissioner of health shall make available needed information and resources
from the Division of Health Policy.
new text end
new text begin
(c) The Office of MN.IT Services shall provide advance consultation and implementation
of the changes needed in data systems.
new text end
new text begin
(d) The commissioner of human services shall contract with a vendor that has experience
with developing statewide system changes for multiple states at the payer and provider
levels. If the commissioner, after exercising reasonable diligence, is unable to secure a
vendor with the requisite qualifications, the commissioner may select the best qualified
vendor available. When developing recommendations, the commissioner shall consider
input from all stakeholders. The commissioner's recommendations shall maximize benefits
for clients and utility for providers, regulatory agencies, and payers.
new text end
new text begin
(e) The commissioner of human services and the contracted vendor shall follow the
recommendations from the report issued in response to Laws 2019, First Special Session
chapter 9, article 6, section 76.
new text end
new text begin
(f) By December 15, 2022, the commissioner of human services shall take steps to
implement paperwork reductions and systems improvements within the commissioner's
authority and submit to the chairs and ranking minority members of the legislative committees
with jurisdiction over health and human services a report that includes recommendations
for changes in statutes that would further enhance systems improvements to reduce
paperwork. The report shall include a summary of the approaches developed and assessed
by the commissioner of human services and stakeholders and the results of any assessments
conducted.
new text end
Sec. 25. new text begin DIRECTION TO THE COMMISSIONER; SOBER HOUSING PROGRAM
RECOMMENDATIONS.
new text end
new text begin
(a) The commissioner of human services, in consultation with stakeholders, must develop
recommendations on:
new text end
new text begin
(1) increasing access to sober housing programs;
new text end
new text begin
(2) promoting person-centered practices and cultural responsiveness in sober housing
programs;
new text end
new text begin
(3) potential oversight of sober housing programs; and
new text end
new text begin
(4) providing consumer protections for individuals in sober housing programs with
substance use disorders and individuals with co-occurring mental illnesses.
new text end
new text begin
(b) Stakeholders include but are not limited to the Minnesota Association of Sober
Homes, the Minnesota Association of Resources for Recovery and Chemical Health,
Minnesota Recovery Connection, NAMI Minnesota, and residents and former residents of
sober housing programs based in Minnesota. Stakeholders must equitably represent
geographic areas of the state, and must include individuals in recovery and providers
representing Black, Indigenous, people of color, or immigrant communities.
new text end
new text begin
(c) The commissioner must complete and submit a report on the recommendations in
this section to the chairs and ranking minority members of the legislative committees with
jurisdiction over health and human services policy and finance on or before September 1,
2022.
new text end
Sec. 26. new text begin DIRECTION TO COMMISSIONERS OF HEALTH AND HUMAN
SERVICES; COMPULSIVE GAMBLING PROGRAMMING AND FUNDING.
new text end
new text begin
By September 1, 2022, the commissioner of human services shall consult with the
commissioner of health and report to the chairs and ranking minority members of the
legislative committees with jurisdiction over health and human services with a
recommendation on whether the revenue appropriated to the commissioner of human services
for a grant to the state affiliate recognized by the National Council on Problem Gambling
under Minnesota Statutes, section 297E.02, subdivision 3, paragraph (c), is more properly
appropriated to and managed by an agency other than the Department of Human Services.
The commissioners shall also recommend whether the compulsive gambling treatment
program in Minnesota Statutes, section 245.98, should continue to be managed by the
Department of Human Services or be managed by another agency.
new text end
Sec. 27. new text begin DIRECTION TO THE COMMISSIONER OF HUMAN SERVICES; SUD
DEMONSTRATION PROJECT ENROLLMENT REPORT.
new text end
new text begin
Beginning with the November 2021 budget forecast and for each budget forecast
thereafter, the commissioner of human services shall report to the chairs and ranking minority
members of the legislative committees with jurisdiction over human services on the number
of institutions for mental disease providers enrolled in the demonstration project under
Minnesota Statutes, section 256B.0759, and the amount of the federal financial participation
for institutions for mental disease providers enrolled in the demonstration project and the
amount of the federal financial participation that exceeds the commissioner's projected
enrollment as of the November 2021 forecast. This report shall be provided for the duration
of the demonstration project.
new text end
Sec. 28. new text begin DIRECTION TO THE COMMISSIONER; SUBSTANCE USE DISORDER
TREATMENT RATE RESTRUCTURE.
new text end
new text begin
(a) By January 1, 2022, the commissioner shall issue a request for proposal for
frameworks and modeling of substance use disorder rates. Rates must be predicated on a
uniform methodology that is transparent, culturally responsive, supports staffing needed to
treat a patient's assessed need, and promotes quality service delivery and patient choice.
The commissioner must consult with substance use disorder treatment programs across the
spectrum of services, substance use disorder treatment programs from across each region
of the state, and culturally responsive providers in the development of the request for proposal
process and for the duration of the contract.
new text end
new text begin
(b) By January 15, 2023, the commissioner of human services shall submit a report to
the chairs and ranking minority members of the legislative committees with jurisdiction
over human services policy and finance on the results of the vendor's work. The report must
include legislative language necessary to implement a new substance use disorder treatment
rate methodology and a detailed fiscal analysis.
new text end
Sec. 29. new text begin DIRECTION TO THE COMMISSIONER; SUBSTANCE USE DISORDER
TECHNICAL ASSISTANCE CENTERS.
new text end
new text begin
The commissioner shall establish one or more community-based technical assistance
centers for substance use disorder treatment providers that offer both virtual learning
environments and in-person opportunities. The technical assistance centers must provide
guidance to substance use disorder providers concerning the enrollment process for the
substance use disorder reform demonstration project under Minnesota Statutes, section
256B.0759, and provide advice concerning bringing the provider's treatment practices into
compliance with American Society of Addiction Medicine standards during the one-year
transition period. Technical assistance centers may also promote awareness of new and
evidence-based practices and services for the treatment of substance use disorders, and offer
education, training, resources, and information for the behavioral health care workforce.
The commissioner must award funding to technical assistance centers by March 1, 2022,
to initiate operations.
new text end
Sec. 30. new text begin FEDERAL COMMUNITY MENTAL HEALTH SERVICES BLOCK
GRANT ALLOCATION; CHILDREN'S MENTAL HEALTH GRANTS FOR
EMERGING MOOD DISORDERS PROGRAMS.
new text end
new text begin
From the amount that Minnesota received under title II of the federal Consolidated
Appropriations Act, Public Law 116-260, for the community mental health services block
grant, the commissioner of human services shall allocate $400,000 in fiscal year 2022,
$400,000 in fiscal year 2023, $400,000 in fiscal year 2024, and $400,000 in fiscal year
2025, for children's mental health grants for emerging mood disorder programs under
Minnesota Statutes, section 245.4889, subdivision 1, paragraph (b), clause (18).
new text end
Sec. 31. new text begin FEDERAL COMMUNITY MENTAL HEALTH SERVICES BLOCK
GRANT ALLOCATION; CHILDREN'S MENTAL HEALTH GRANTS FOR FIRST
EPISODE OF PSYCHOSIS PROGRAMS.
new text end
new text begin
(a) From the amount that Minnesota received under title II of the federal Consolidated
Appropriations Act, Public Law 116-260, for the community mental health services block
grant, the commissioner of human services shall allocate $1,600,000 in fiscal year 2022,
$1,500,000 in fiscal year 2023, and $222,000 in fiscal year 2024, for children's mental health
grants for first episode of psychosis programs under Minnesota Statutes, section 245.4889,
subdivision 1, paragraph (b), clause (15).
new text end
new text begin
(b) From the amount that Minnesota received under section 2701 of the federal American
Rescue Plan Act, Public Law 117-2, for the community mental health services block grant,
the commissioner of human services shall allocate $1,278,000 in fiscal year 2024 and
$1,500,000 in fiscal year 2025, for children's mental health grants for first episode of
psychosis programs under Minnesota Statutes, section 245.4889, subdivision 1, paragraph
(b), clause (15).
new text end
new text begin
(c) From the amount that Minnesota received under section 2701 of the federal American
Rescue Plan Act, Public Law 117-2, for the community mental health services block grant,
the commissioner of human services shall allocate $200,000 in fiscal year 2022 and $200,000
in fiscal year 2023, foradditional funding to four existing first episode of psychosis programs
that receive children's mental health grants funding under Minnesota Statutes, section
245.4889, subdivision 1, paragraph (b), clause (15).
new text end
new text begin
(d) From the amount that Minnesota received under title II of the federal Consolidated
Appropriations Act, Public Law 116-260, for the community mental health services block
grant, the commissioner of human services shall allocate $200,000 in fiscal year 2024 and
$200,000 in fiscal year 2025, for additional funding to four existing first episode of psychosis
programs that receive children's mental health grants funding under Minnesota Statutes,
section 245.4889, subdivision 1, paragraph (b), clause (15).
new text end
Sec. 32. new text begin FEDERAL COMMUNITY MENTAL HEALTH SERVICES BLOCK
GRANT ALLOCATION; ADULT MENTAL HEALTH INITIATIVE GRANTS.
new text end
new text begin
(a) From the amount that Minnesota received under title II of the federal Consolidated
Appropriations Act, Public Law 116-260, for the community mental health services block
grant, the commissioner of human services shall allocate $2,350,000 in fiscal year 2022
and $2,350,000 in fiscal year 2023, for adult mental health initiative grants under Minnesota
Statutes, section 245.4661, subdivision 1.
new text end
new text begin
(b) From the amount that Minnesota received under section 2701 of the federal American
Rescue Plan Act, Public Law 117-2, the commissioner of human services shall allocate
$2,350,000 in fiscal year 2024 and $2,350,000 in fiscal year 2025, for the adult mental
health initiative grants under Minnesota Statutes, section 245.4661, subdivision 1.
new text end
Sec. 33. new text begin FEDERAL COMMUNITY MENTAL HEALTH SERVICES BLOCK
GRANT ALLOCATION; SCHOOL-LINKED MENTAL HEALTH GRANTS.
new text end
new text begin
(a) From the amount that Minnesota received under title II of the federal Consolidated
Appropriations Act, Public Law 116-260, for the community mental health services block
grant, the commissioner of human services shall allocate $2,500,000 in fiscal year 2022
and $2,500,000 in fiscal year 2023, for school-linked mental health grants under Minnesota
Statutes, section 245.4901.
new text end
new text begin
(b) From the amount that Minnesota received under section 2701 of the federal American
Rescue Plan Act, Public Law 117-2, for the community mental health services block grant,
the commissioner of human services shall allocate $2,500,000 in fiscal year 2024 and
$2,500,000 in fiscal year 2025, for school-linked mental health grants under Minnesota
Statutes, section 245.4901.
new text end
Sec. 34. new text begin FEDERAL SUBSTANCE ABUSE PREVENTION AND TREATMENT
BLOCK GRANT ALLOCATION; SCHOOL-LINKED SUBSTANCE ABUSE
GRANTS.
new text end
new text begin
(a) From the amount that Minnesota received under title II of the federal Consolidated
Appropriations Act of 2020, Public Law 116-260, for the substance abuse prevention and
treatment block grant, the commissioner of human services shall allocate $1,500,000 in
fiscal year 2022, $1,500,000 in fiscal year 2023, and $1,079,000 in fiscal year 2024, for
school-linked substance abuse grants under Minnesota Statutes, section 245.4901.
new text end
new text begin
(b) From the amount that Minnesota received under section 2702 of the federal American
Rescue Plan Act, Public Law 117-2, for the substance abuse prevention and treatment block
grant, the commissioner shall allocate $421,000 in fiscal year 2024 and $1,500,000 in fiscal
year 2025, for school-linked substance abuse grants under Minnesota Statutes, section
245.4901.
new text end
Sec. 35. new text begin FEDERAL SUBSTANCE ABUSE PREVENTION AND TREATMENT
BLOCK GRANT ALLOCATION; SUBSTANCE USE DISORDER TREATMENT
PATHFINDER COMPANION PILOT PROJECT.
new text end
new text begin
(a) From the amount that Minnesota received under title II of the federal Consolidated
Appropriations Act of 2020, Public Law 116-260, for the substance abuse prevention and
treatment block grant, the commissioner of human services shall allocate $250,000 in fiscal
year 2022 for a grant to Anoka County to conduct a substance use disorder treatment
pathfinder companion pilot project. This is a onetime allocation and is available until January
15, 2023.
new text end
new text begin
(b) Of this allocation, up to $200,000 is for licensed use of the pathfinder companion
application for individuals participating in the pilot project and up to $50,000 is for licensed
use of the pathfinder bridge application for providers participating in the pilot project.
new text end
new text begin
(c) From the amount that Minnesota received under section 2702 of the federal American
Rescue Plan Act, Public Law 117-2, for the substance abuse prevention and treatment block
grant, the commissioner shall allocate $300,000 in fiscal year 2022 for a grant to Anoka
County to conduct the substance use disorder treatment pathfinder companion pilot project.
This is a onetime allocation and is available until January 15, 2023.
new text end
Sec. 36. new text begin FEDERAL SUBSTANCE ABUSE PREVENTION AND TREATMENT
BLOCK GRANT ALLOCATION; OPIOID EPIDEMIC RESPONSE GRANTS.
new text end
new text begin
(a) From the amount that Minnesota received under title II of the federal Consolidated
Appropriations Act of 2020, Public Law 116-260, for the substance abuse prevention and
treatment block grant, the commissioner of human services shall allocate $3,500,000 in
fiscal year 2022 and $3,500,000 in fiscal year 2023, for grants to be awarded according to
recommendations of the Opioid Epidemic Response Advisory Council under Minnesota
Statutes, section 256.042.
new text end
new text begin
(b) From the amount that Minnesota received under Section 2702 of the federal American
Rescue Plan Act, Public Law 117-2, for the substance abuse prevention and treatment block
grant, the commissioner shall allocate $3,500,000 in fiscal year 2024 and $3,500,000 in
fiscal year 2025, for grants to be awarded according to recommendations of the Opioid
Epidemic Response Advisory Council under Minnesota Statutes, section 256.042.
new text end
new text begin
(c) The commissioner shall include information on the grants awarded under this section
in the annual report under Minnesota Statutes, section 256.042, subdivision 5, paragraph
(a).
new text end
Sec. 37. new text begin FEDERAL SUBSTANCE ABUSE PREVENTION AND TREATMENT
BLOCK GRANT ALLOCATION; RECOVERY COMMUNITY ORGANIZATION
INFRASTRUCTURE GRANTS.
new text end
new text begin
(a) From the amount that Minnesota received under title II of the federal Consolidated
Appropriations Act of 2020, Public Law 116-260, for the substance abuse prevention and
treatment block grant, the commissioner of human services shall allocate $2,000,000 in
fiscal year 2022 and $2,000,000 in fiscal year 2023, for grants to recovery community
organizations, as defined in Minnesota Statutes, section 254B.01, subdivision 8, to provide
community-based peer recovery support services that are not otherwise eligible for
reimbursement under Minnesota Statutes, section 254B.05.
new text end
new text begin
(b) From the amount that Minnesota received under Section 2702 of the federal American
Rescue Plan Act, Public Law 117-2, for the substance abuse prevention and treatment block
grant for grants, the commissioner of human services shall allocate $2,000,000 in fiscal
year 2024 and $2,000,000 in fiscal year 2025, to recovery community organizations, as
defined in Minnesota Statutes, section 254B.01, subdivision 8, to provide community-based
peer recovery support services that are not otherwise eligible for reimbursement under
Minnesota Statutes, section 254B.05.
new text end
Sec. 38. new text begin REVISOR INSTRUCTION.
new text end
new text begin
The revisor of statutes shall replace "EXCELLENCE IN MENTAL HEALTH
DEMONSTRATION PROJECT" with "CERTIFIED COMMUNITY BEHAVIORAL
HEALTH CLINIC SERVICES" in the section headnote for Minnesota Statutes, section
245.735.
new text end
Sec. 39. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2020, section 245.735, subdivisions 1, 2, and 4,
new text end
new text begin
are repealed.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
ARTICLE 14
DISABILITY SERVICES AND CONTINUING CARE FOR OLDER ADULTS
Section 1.
Minnesota Statutes 2020, section 144.0724, subdivision 4, is amended to read:
Subd. 4.
Resident assessment schedule.
(a) A facility must conduct and electronically
submit to the commissioner of health MDS assessments that conform with the assessment
schedule defined by Code of Federal Regulations, title 42, section 483.20, and published
by the United States Department of Health and Human Services, Centers for Medicare and
Medicaid Services, in the Long Term Care Assessment Instrument User's Manual, version
3.0, and subsequent updates when issued by the Centers for Medicare and Medicaid Services.
The commissioner of health may substitute successor manuals or question and answer
documents published by the United States Department of Health and Human Services,
Centers for Medicare and Medicaid Services, to replace or supplement the current version
of the manual or document.
(b) The assessments used to determine a case mix classification for reimbursement
include the following:
(1) a new admission assessment;
(2) an annual assessment which must have an assessment reference date (ARD) within
92 days of the previous assessment and the previous comprehensive assessment;
(3) a significant change in status assessment must be completed within 14 days of the
identification of a significant change, whether improvement or decline, and regardless of
the amount of time since the last significant change in status assessment;
(4) all quarterly assessments must have an assessment reference date (ARD) within 92
days of the ARD of the previous assessment;
(5) any significant correction to a prior comprehensive assessment, if the assessment
being corrected is the current one being used for RUG classification; and
(6) any significant correction to a prior quarterly assessment, if the assessment being
corrected is the current one being used for RUG classification.
(c) new text begin In addition to the assessments listed in paragraph (b), a significant change in status
assessment is required when:
new text end
new text begin
(1) all speech, occupational, and physical therapies have ended. The assessment reference
date of this assessment must be set on day eight after all therapy services have ended; and
new text end
new text begin
(2) isolation for an active infectious disease has ended. The assessment reference date
of this assessment must be set on day 15 after isolation has ended.
new text end
new text begin (d) new text end In addition to the assessments listed in deleted text begin paragraphdeleted text end new text begin paragraphsnew text end (b)new text begin and (c)new text end , the
assessments used to determine nursing facility level of care include the following:
(1) preadmission screening completed under section 256.975, subdivisions 7a to 7c, by
the Senior LinkAge Line or other organization under contract with the Minnesota Board on
Aging; and
(2) a nursing facility level of care determination as provided for under section 256B.0911,
subdivision 4e, as part of a face-to-face long-term care consultation assessment completed
under section 256B.0911, by a county, tribe, or managed care organization under contract
with the Department of Human Services.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective for all assessments with an assessment
reference date of July 1, 2021, or later.
new text end
Sec. 2.
Minnesota Statutes 2020, section 144A.073, subdivision 2, is amended to read:
Subd. 2.
Request for proposals.
At the authorization by the legislature of additional
medical assistance expenditures for exceptions to the moratorium on nursing homes, the
commissioner shall publish in the State Register a request for proposals for nursing home
and certified boarding care home projects for conversion, relocation, renovation, replacement,
upgrading, or addition. The public notice of this funding and the request for proposals must
specify how the approval criteria will be prioritized by the commissioner. The notice must
describe the information that must accompany a request and state that proposals must be
submitted to the commissioner within 150 days of the date of publication. The notice must
include the amount of the legislative appropriation available for the additional costs to the
medical assistance program of projects approved under this section. If money is appropriated,
the commissioner shall initiate the application and review process described in this section
at least once each biennium. A second application and review process must occur if remaining
funds are either greater than $300,000 or more than 50 percent of the baseline appropriation
for the biennium. Authorized funds may be awarded in full in the first review process of
the biennium. Appropriated funds not encumbered within a biennium shall carry forwarddeleted text begin
to the following bienniumdeleted text end . To be considered for approval, a proposal must include the
following information:
(1) whether the request is for renovation, replacement, upgrading, conversion, addition,
or relocation;
(2) a description of the problems the project is designed to address;
(3) a description of the proposed project;
(4) an analysis of projected costs of the nursing facility proposed project, including:
(i) initial construction and remodeling costs;
(ii) site preparation costs;
(iii) equipment and technology costs;
(iv) financing costs, the current estimated long-term financing costs of the proposal,
which is to include details of any proposed funding mechanism already arranged or being
considered, including estimates of the amount and sources of money, reserves if required,
annual payments schedule, interest rates, length of term, closing costs and fees, insurance
costs, any completed marketing study or underwriting review; and
(v) estimated operating costs during the first two years after completion of the project;
(5) for proposals involving replacement of all or part of a facility, the proposed location
of the replacement facility and an estimate of the cost of addressing the problem through
renovation;
(6) for proposals involving renovation, an estimate of the cost of addressing the problem
through replacement;
(7) the proposed timetable for commencing construction and completing the project;
(8) a statement of any licensure or certification issues, such as certification survey
deficiencies;
(9) the proposed relocation plan for current residents if beds are to be closed according
to section 144A.161; and
(10) other information required by permanent rule of the commissioner of health in
accordance with subdivisions 4 and 8.
Sec. 3.
Minnesota Statutes 2020, section 144A.073, is amended by adding a subdivision
to read:
new text begin Subd. 17. new text end
new text begin Moratorium exception funding. new text end
new text begin
(a) During the biennium beginning July 1,
2021, and during each biennium thereafter, the commissioner of health may approve
moratorium exception projects under this section for which the full biennial state share of
medical assistance costs does not exceed $10,000,000, plus any carryover of previous
appropriations for this purpose.
new text end
new text begin
(b) For the purposes of this subdivision, "biennium" has the meaning given in section
16A.011, subdivision 6.
new text end
Sec. 4.
Minnesota Statutes 2020, section 245A.03, subdivision 7, is amended to read:
Subd. 7.
Licensing moratorium.
(a) The commissioner shall not issue an initial license
for child foster care licensed under Minnesota Rules, parts 2960.3000 to 2960.3340, or adult
foster care licensed under Minnesota Rules, parts 9555.5105 to 9555.6265, under this chapter
for a physical location that will not be the primary residence of the license holder for the
entire period of licensure. If a license is issued during this moratorium, and the license
holder changes the license holder's primary residence away from the physical location of
the foster care license, the commissioner shall revoke the license according to section
245A.07. The commissioner shall not issue an initial license for a community residential
setting licensed under chapter 245D. When approving an exception under this paragraph,
the commissioner shall consider the resource need determination process in paragraph (h),
the availability of foster care licensed beds in the geographic area in which the licensee
seeks to operate, the results of a person's choices during their annual assessment and service
plan review, and the recommendation of the local county board. The determination by the
commissioner is final and not subject to appeal. Exceptions to the moratorium include:
(1) foster care settings that are required to be registered under chapter 144D;
(2) foster care licenses replacing foster care licenses in existence on May 15, 2009, or
community residential setting licenses replacing adult foster care licenses in existence on
December 31, 2013, and determined to be needed by the commissioner under paragraph
(b);
(3) new foster care licenses or community residential setting licenses determined to be
needed by the commissioner under paragraph (b) for the closure of a nursing facility, ICF/DD,
or regional treatment center; restructuring of state-operated services that limits the capacity
of state-operated facilities; or allowing movement to the community for people who no
longer require the level of care provided in state-operated facilities as provided under section
256B.092, subdivision 13, or 256B.49, subdivision 24;
(4) new foster care licenses or community residential setting licenses determined to be
needed by the commissioner under paragraph (b) for persons requiring hospital level care;
deleted text begin or
deleted text end
(5) new foster care licenses or community residential setting licenses for people receiving
services under chapter 245D and residing in an unlicensed setting before May 1, 2017, and
for which a license is required. This exception does not apply to people living in their own
home. For purposes of this clause, there is a presumption that a foster care or community
residential setting license is required for services provided to three or more people in a
dwelling unit when the setting is controlled by the provider. A license holder subject to this
exception may rebut the presumption that a license is required by seeking a reconsideration
of the commissioner's determination. The commissioner's disposition of a request for
reconsideration is final and not subject to appeal under chapter 14. The exception is available
until June 30, 2018. This exception is available when:
(i) the person's case manager provided the person with information about the choice of
service, service provider, and location of service, including in the person's home, to help
the person make an informed choice; and
(ii) the person's services provided in the licensed foster care or community residential
setting are less than or equal to the cost of the person's services delivered in the unlicensed
setting as determined by the lead agencydeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(6) new foster care licenses or community residential setting licenses for people receiving
customized living or 24-hour customized living services under the brain injury or community
access for disability inclusion waiver plans under section 256B.49 and residing in the
customized living setting before July 1, 2022, for which a license is required. A customized
living service provider subject to this exception may rebut the presumption that a license
is required by seeking a reconsideration of the commissioner's determination. The
commissioner's disposition of a request for reconsideration is final and not subject to appeal
under chapter 14. The exception is available until June 30, 2023. This exception is available
when:
new text end
new text begin
(i) the person's customized living services are provided in a customized living service
setting serving four or fewer people under the brain injury or community access for disability
inclusion waiver plans under section 256B.49 in a single-family home operational on or
before June 30, 2021. Operational is defined in section 256B.49, subdivision 28;
new text end
new text begin
(ii) the person's case manager provided the person with information about the choice of
service, service provider, and location of service, including in the person's home, to help
the person make an informed choice; and
new text end
new text begin
(iii) the person's services provided in the licensed foster care or community residential
setting are less than or equal to the cost of the person's services delivered in the customized
living setting as determined by the lead agency.
new text end
(b) The commissioner shall determine the need for newly licensed foster care homes or
community residential settings as defined under this subdivision. As part of the determination,
the commissioner shall consider the availability of foster care capacity in the area in which
the licensee seeks to operate, and the recommendation of the local county board. The
determination by the commissioner must be final. A determination of need is not required
for a change in ownership at the same address.
(c) When an adult resident served by the program moves out of a foster home that is not
the primary residence of the license holder according to section 256B.49, subdivision 15,
paragraph (f), or the adult community residential setting, the county shall immediately
inform the Department of Human Services Licensing Division. The department may decrease
the statewide licensed capacity for adult foster care settings.
(d) Residential settings that would otherwise be subject to the decreased license capacity
established in paragraph (c) shall be exempt if the license holder's beds are occupied by
residents whose primary diagnosis is mental illness and the license holder is certified under
the requirements in subdivision 6a or section 245D.33.
(e) A resource need determination process, managed at the state level, using the available
reports required by section 144A.351, and other data and information shall be used to
determine where the reduced capacity determined under section 256B.493 will be
implemented. The commissioner shall consult with the stakeholders described in section
144A.351, and employ a variety of methods to improve the state's capacity to meet the
informed decisions of those people who want to move out of corporate foster care or
community residential settings, long-term service needs within budgetary limits, including
seeking proposals from service providers or lead agencies to change service type, capacity,
or location to improve services, increase the independence of residents, and better meet
needs identified by the long-term services and supports reports and statewide data and
information.
(f) At the time of application and reapplication for licensure, the applicant and the license
holder that are subject to the moratorium or an exclusion established in paragraph (a) are
required to inform the commissioner whether the physical location where the foster care
will be provided is or will be the primary residence of the license holder for the entire period
of licensure. If the primary residence of the applicant or license holder changes, the applicant
or license holder must notify the commissioner immediately. The commissioner shall print
on the foster care license certificate whether or not the physical location is the primary
residence of the license holder.
(g) License holders of foster care homes identified under paragraph (f) that are not the
primary residence of the license holder and that also provide services in the foster care home
that are covered by a federally approved home and community-based services waiver, as
authorized under chapter 256S or section 256B.092 or 256B.49, must inform the human
services licensing division that the license holder provides or intends to provide these
waiver-funded services.
(h) The commissioner may adjust capacity to address needs identified in section
144A.351. Under this authority, the commissioner may approve new licensed settings or
delicense existing settings. Delicensing of settings will be accomplished through a process
identified in section 256B.493. Annually, by August 1, the commissioner shall provide
information and data on capacity of licensed long-term services and supports, actions taken
under the subdivision to manage statewide long-term services and supports resources, and
any recommendations for change to the legislative committees with jurisdiction over the
health and human services budget.
(i) The commissioner must notify a license holder when its corporate foster care or
community residential setting licensed beds are reduced under this section. The notice of
reduction of licensed beds must be in writing and delivered to the license holder by certified
mail or personal service. The notice must state why the licensed beds are reduced and must
inform the license holder of its right to request reconsideration by the commissioner. The
license holder's request for reconsideration must be in writing. If mailed, the request for
reconsideration must be postmarked and sent to the commissioner within 20 calendar days
after the license holder's receipt of the notice of reduction of licensed beds. If a request for
reconsideration is made by personal service, it must be received by the commissioner within
20 calendar days after the license holder's receipt of the notice of reduction of licensed beds.
(j) The commissioner shall not issue an initial license for children's residential treatment
services licensed under Minnesota Rules, parts 2960.0580 to 2960.0700, under this chapter
for a program that Centers for Medicare and Medicaid Services would consider an institution
for mental diseases. Facilities that serve only private pay clients are exempt from the
moratorium described in this paragraph. The commissioner has the authority to manage
existing statewide capacity for children's residential treatment services subject to the
moratorium under this paragraph and may issue an initial license for such facilities if the
initial license would not increase the statewide capacity for children's residential treatment
services subject to the moratorium under this paragraph.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022.
new text end
Sec. 5.
Minnesota Statutes 2020, section 256.477, is amended to read:
256.477 SELF-ADVOCACY GRANTS.
new text begin Subdivision 1. new text end
new text begin The Rick Cardenas Statewide Self-Advocacy Network. new text end
(a) The
commissioner shall make available a grant for the purposes of establishing and maintaining
deleted text begin adeleted text end new text begin the Rick Cardenasnew text end Statewide Self-Advocacy Network for persons with intellectual and
developmental disabilities. The new text begin Rick Cardenas Statewide new text end Self-Advocacy Network shall:
(1) ensure that persons with intellectual and developmental disabilities are informed of
their rights in employment, housing, transportation, voting, government policy, and other
issues pertinent to the intellectual and developmental disability community;
(2) provide public education and awareness of the civil and human rights issues persons
with intellectual and developmental disabilities face;
(3) provide funds, technical assistance, and other resources for self-advocacy groups
across the state; deleted text begin and
deleted text end
(4) organize systems of communications to facilitate an exchange of information between
self-advocacy groupsnew text begin ;
new text end
new text begin
(5) train and support the activities of a statewide network of peer-to-peer mentors for
persons with developmental disabilities focused on building awareness among people with
developmental disabilities of service options; assisting people with developmental disabilities
choose service options; and developing the advocacy skills of people with developmental
disabilities necessary for them to move toward full inclusion in community life, including
by developing and delivering a curriculum to support the peer-to-peer network;
new text end
new text begin
(6) provide outreach activities, including statewide conferences and disability networking
opportunities, focused on self-advocacy, informed choice, and community engagement
skills; and
new text end
new text begin (7) provide an annual leadership program for persons with intellectual and developmental
disabilitiesnew text end .
(b) An organization receiving a grant under paragraph (a) must be an organization
governed by people with intellectual and developmental disabilities that administers a
statewide network of disability groups in order to maintain and promote self-advocacy
services and supports for persons with intellectual and developmental disabilities throughout
the state.
new text begin
(c) An organization receiving a grant under this subdivision may use a portion of grant
revenue determined by the commissioner for administration and general operating costs.
new text end
new text begin Subd. 2. new text end
new text begin Subgrants for outreach to persons in institutional settings. new text end
new text begin
The commissioner
shall make available to an organization described under subdivision 1 a grant for subgrants
to organizations in Minnesota to conduct outreach to persons working and living in
institutional settings to provide education and information about community options. Subgrant
funds must be used to deliver peer-led skill training sessions in six regions of the state to
help persons with intellectual and developmental disabilities understand community service
options related to:
new text end
new text begin
(1) housing;
new text end
new text begin
(2) employment;
new text end
new text begin
(3) education;
new text end
new text begin
(4) transportation;
new text end
new text begin
(5) emerging service reform initiatives contained in the state's Olmstead plan; the
Workforce Innovation and Opportunity Act, Public Law 113-128; and federal home and
community-based services regulations; and
new text end
new text begin
(6) connecting with individuals who can help persons with intellectual and developmental
disabilities make an informed choice and plan for a transition in services.
new text end
Sec. 6.
new text begin
[256.4772] MINNESOTA INCLUSION INITIATIVE GRANT.
new text end
new text begin Subdivision 1. new text end
new text begin Grant program established. new text end
new text begin
The commissioner of human services shall
establish the Minnesota inclusion initiative grant program to encourage self-advocacy groups
of persons with intellectual and developmental disabilities to develop and organize projects
that increase the inclusion of persons with intellectual and developmental disabilities in the
community, improve community integration outcomes, educate decision-makers and the
public about persons with intellectual and developmental disabilities, including the systemic
barriers that prevent them from being included in the community, and to advocate for changes
that increase access to formal and informal supports and services necessary for greater
inclusion of persons with intellectual and developmental disabilities in the community.
new text end
new text begin Subd. 2. new text end
new text begin Administration. new text end
new text begin
The commissioner of human services, as authorized by section
256.01, subdivision 2, paragraph (a), clause (6), shall issue a request for proposals to contract
with a public or private entity to (1) serve as a fiscal host for the money appropriated for
the purposes described in this section, and (2) develop guidelines, criteria, and procedures
for awarding grants. The fiscal host shall establish an advisory committee consisting of
self-advocates, nonprofit advocacy organizations, and Department of Human Services staff
to review applications and award grants under this section.
new text end
new text begin Subd. 3. new text end
new text begin Applications. new text end
new text begin
(a) Entities seeking grants under this section shall apply to the
advisory committee of the fiscal host under contract with the commissioner. The grant
applicant must include a description of the project that the applicant is proposing, the amount
of money that the applicant is seeking, and a proposed budget describing how the applicant
will spend the grant money.
new text end
new text begin
(b) The advisory committee may award grants to applicants only for projects that meet
the requirements of subdivision 4.
new text end
new text begin Subd. 4. new text end
new text begin Use of grant money. new text end
new text begin
Projects funded by grant money must have person-centered
goals, call attention to issues that limit inclusion of persons with intellectual and
developmental disabilities, address barriers to inclusion that persons with intellectual and
developmental disabilities face in their communities, or increase the inclusion of persons
with intellectual and developmental disabilities in their communities. Applicants may
propose strategies to increase inclusion of persons with intellectual and developmental
disabilities in their communities by:
new text end
new text begin
(1) decreasing barriers to workforce participation experienced by persons with intellectual
and developmental disabilities;
new text end
new text begin
(2) overcoming barriers to accessible and reliable transportation options for persons with
intellectual and developmental disabilities;
new text end
new text begin
(3) identifying and addressing barriers to voting experienced by persons with intellectual
and developmental disabilities;
new text end
new text begin
(4) advocating for increased accessible housing for persons with intellectual and
developmental disabilities;
new text end
new text begin
(5) working with governmental agencies or businesses on accessibility issues under the
Americans with Disabilities Act;
new text end
new text begin
(6) increasing collaboration between self-advocacy groups and other organizations to
effectively address systemic issues that impact persons with intellectual and developmental
disabilities;
new text end
new text begin
(7) increasing capacity for inclusion in a community; or
new text end
new text begin
(8) providing public education and awareness of the civil and human rights of persons
with intellectual and developmental disabilities.
new text end
new text begin Subd. 5. new text end
new text begin Reports. new text end
new text begin
(a) Grant recipients shall provide the advisory committee with a report
about the activities funded by the grant program in a format and at a time specified by the
advisory committee. The advisory committee shall require grant recipients to include in the
grant recipient's report at least the information necessary for the advisory committee to meet
the advisory committee's obligation under paragraph (b).
new text end
new text begin
(b) The advisory committee shall provide the commissioner with a report that describes
all of the activities and outcomes of projects funded by the grant program in a format and
at a time determined by the commissioner.
new text end
Sec. 7.
new text begin
[256.4776] PARENT-TO-PARENT PEER SUPPORT.
new text end
new text begin
(a) The commissioner shall make a grant to an alliance member of Parent to Parent USA
to support the alliance member's parent-to-parent peer support program for families of
children with any type of disability or special health care needs. An eligible alliance member
must have an established parent-to-parent peer support program that is statewide and
represents diverse cultures and geographic locations, that conducts outreach and provides
individualized support to any parent or guardian of a child with a disability or special health
care need, including newly identified parents of such a child or parents experiencing
transitions or changes in their child's care, and that implements best practices for peer-to-peer
support, including providing support from trained parent staff and volunteer support parents
who have received Parent to Parent USA's specialized parent-to-parent peer support training.
new text end
new text begin
(b) Grant recipients must use grant money for the purposes specified in paragraph (a).
new text end
new text begin
(c) For purposes of this section, "special health care needs" means disabilities, chronic
illnesses or conditions, health-related educational or behavioral problems, or the risk of
developing disabilities, conditions, illnesses, or problems.
new text end
new text begin
(d) Grant recipients must report to the commissioner of human services annually by
January 15 about the services and programs funded by this grant. The report must include
measurable outcomes from the previous year, including the number of families served by
the organization's parent-to-parent programs and the number of volunteer support parents
trained by the organization's parent-to-parent programs.
new text end
Sec. 8.
Minnesota Statutes 2020, section 256B.0653, is amended by adding a subdivision
to read:
new text begin Subd. 8. new text end
new text begin Payment rates for home health agency services. new text end
new text begin
The commissioner shall
annually adjust payments for home health agency services to reflect the change in the federal
Centers for Medicare and Medicaid Services Home Health Agency Market Basket. The
commissioner shall use the indices as forecasted for the midpoint of the prior rate year to
the midpoint of the current rate year.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, or upon federal approval,
whichever occurs later, for services delivered on or after January 1, 2022. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end
Sec. 9.
Minnesota Statutes 2020, section 256B.0654, is amended by adding a subdivision
to read:
new text begin Subd. 5. new text end
new text begin Payment rates for home care nursing services. new text end
new text begin
The commissioner shall
annually adjust payments for home care nursing services to reflect the change in the federal
Centers for Medicare and Medicaid Services Home Health Agency Market Basket. The
commissioner shall use the indices as forecasted for the midpoint of the prior rate year to
the midpoint of the current rate year.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, or upon federal approval,
whichever occurs later, for services delivered on or after January 1, 2022. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end
Sec. 10.
Minnesota Statutes 2020, section 256B.0659, subdivision 11, is amended to read:
Subd. 11.
Personal care assistant; requirements.
(a) A personal care assistant must
meet the following requirements:
(1) be at least 18 years of age with the exception of persons who are 16 or 17 years of
age with these additional requirements:
(i) supervision by a qualified professional every 60 days; and
(ii) employment by only one personal care assistance provider agency responsible for
compliance with current labor laws;
(2) be employed by a personal care assistance provider agency;
(3) enroll with the department as a personal care assistant after clearing a background
study. Except as provided in subdivision 11a, before a personal care assistant provides
services, the personal care assistance provider agency must initiate a background study on
the personal care assistant under chapter 245C, and the personal care assistance provider
agency must have received a notice from the commissioner that the personal care assistant
is:
(i) not disqualified under section 245C.14; or
(ii) disqualified, but the personal care assistant has received a set aside of the
disqualification under section 245C.22;
(4) be able to effectively communicate with the recipient and personal care assistance
provider agency;
(5) be able to provide covered personal care assistance services according to the recipient's
personal care assistance care plan, respond appropriately to recipient needs, and report
changes in the recipient's condition to the supervising qualified professional, physician, or
advanced practice registered nurse;
(6) not be a consumer of personal care assistance services;
(7) maintain daily written records including, but not limited to, time sheets under
subdivision 12;
(8) effective January 1, 2010, complete standardized training as determined by the
commissioner before completing enrollment. The training must be available in languages
other than English and to those who need accommodations due to disabilities. Personal care
assistant training must include successful completion of the following training components:
basic first aid, vulnerable adult, child maltreatment, OSHA universal precautions, basic
roles and responsibilities of personal care assistants including information about assistance
with lifting and transfers for recipients, emergency preparedness, orientation to positive
behavioral practices, fraud issues, and completion of time sheets. Upon completion of the
training components, the personal care assistant must demonstrate the competency to provide
assistance to recipients;
(9) complete training and orientation on the needs of the recipient; and
(10) be limited to providing and being paid for up to 310 hours per month of personal
care assistance services regardless of the number of recipients being served or the number
of personal care assistance provider agencies enrolled with. The number of hours worked
per day shall not be disallowed by the department unless in violation of the law.
(b) A legal guardian may be a personal care assistant if the guardian is not being paid
for the guardian services and meets the criteria for personal care assistants in paragraph (a).
(c) Persons who do not qualify as a personal care assistant include parents, stepparents,
and legal guardians of minors; spouses; paid legal guardians of adults; family foster care
providers, except as otherwise allowed in section 256B.0625, subdivision 19a; and staff of
a residential setting.
(d) Personal care assistance services qualify for the enhanced rate described in subdivision
17a if the personal care assistant providing the services:
(1) provides covered services to a recipient who qualifies for deleted text begin 12deleted text end new text begin tennew text end or more hours per
day of personal care assistance services; and
(2) satisfies the current requirements of Medicare for training and competency or
competency evaluation of home health aides or nursing assistants, as provided in the Code
of Federal Regulations, title 42, section 483.151 or 484.36, or alternative state-approved
training or competency requirements.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, or upon federal approval,
whichever occurs later. The commissioner shall notify the revisor of statutes when federal
approval is obtained.
new text end
Sec. 11.
Minnesota Statutes 2020, section 256B.0659, subdivision 17a, is amended to
read:
Subd. 17a.
Enhanced rate.
An enhanced rate of 107.5 percent of the rate paid for
personal care assistance services shall be paid for services provided to persons who qualify
for deleted text begin 12deleted text end new text begin tennew text end or more hours of personal care assistance services per day when provided by a
personal care assistant who meets the requirements of subdivision 11, paragraph (d). The
enhanced rate for personal care assistance services includes, and is not in addition to, any
rate adjustments implemented by the commissioner on July 1, 2019, to comply with the
terms of a collective bargaining agreement between the state of Minnesota and an exclusive
representative of individual providers under section 179A.54, that provides for wage increases
for individual providers who serve participants assessed to need 12 or more hours of personal
care assistance services per day.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, or upon federal approval,
whichever occurs later. The commissioner shall notify the revisor of statutes when federal
approval is obtained.
new text end
Sec. 12.
Minnesota Statutes 2020, section 256B.0911, subdivision 3a, is amended to read:
Subd. 3a.
Assessment and support planning.
(a) Persons requesting assessment, services
planning, or other assistance intended to support community-based living, including persons
who need assessment in order to determine waiver or alternative care program eligibility,
must be visited by a long-term care consultation team within 20 calendar days after the date
on which an assessment was requested or recommended. Upon statewide implementation
of subdivisions 2b, 2c, and 5, this requirement also applies to an assessment of a person
requesting personal care assistance services. The commissioner shall provide at least a
90-day notice to lead agencies prior to the effective date of this requirement. Face-to-face
assessments must be conducted according to paragraphs (b) to (i).
(b) Upon implementation of subdivisions 2b, 2c, and 5, lead agencies shall use certified
assessors to conduct the assessment. For a person with complex health care needs, a public
health or registered nurse from the team must be consulted.
(c) The MnCHOICES assessment provided by the commissioner to lead agencies must
be used to complete a comprehensive, conversation-based, person-centered assessment.
The assessment must include the health, psychological, functional, environmental, and
social needs of the individual necessary to develop a person-centered community support
plan that meets the individual's needs and preferences.
(d) The assessment must be conducted by a certified assessor in a face-to-face
conversational interview with the person being assessed. The person's legal representative
must provide input during the assessment process and may do so remotely if requested. At
the request of the person, other individuals may participate in the assessment to provide
information on the needs, strengths, and preferences of the person necessary to develop a
community support plan that ensures the person's health and safety. Except for legal
representatives or family members invited by the person, persons participating in the
assessment may not be a provider of service or have any financial interest in the provision
of services. For persons who are to be assessed for elderly waiver customized living or adult
day services under chapter 256S, with the permission of the person being assessed or the
person's designated or legal representative, the client's current or proposed provider of
services may submit a copy of the provider's nursing assessment or written report outlining
its recommendations regarding the client's care needs. The person conducting the assessment
must notify the provider of the date by which this information is to be submitted. This
information shall be provided to the person conducting the assessment prior to the assessment.
For a person who is to be assessed for waiver services under section 256B.092 or 256B.49,
with the permission of the person being assessed or the person's designated legal
representative, the person's current provider of services may submit a written report outlining
recommendations regarding the person's care needs the person completed in consultation
with someone who is known to the person and has interaction with the person on a regular
basis. The provider must submit the report at least 60 days before the end of the person's
current service agreement. The certified assessor must consider the content of the submitted
report prior to finalizing the person's assessment or reassessment.
(e) The certified assessor and the individual responsible for developing the coordinated
service and support plan must complete the community support plan and the coordinated
service and support plan no more than 60 calendar days from the assessment visit. The
person or the person's legal representative must be provided with a written community
support plan within the timelines established by the commissioner, regardless of whether
the person is eligible for Minnesota health care programs.
(f) For a person being assessed for elderly waiver services under chapter 256S, a provider
who submitted information under paragraph (d) shall receive the final written community
support plan when available and the Residential Services Workbook.
(g) The written community support plan must include:
(1) a summary of assessed needs as defined in paragraphs (c) and (d);
(2) the individual's options and choices to meet identified needs, including:
(i) all available options for case management services and providers;
(ii) all available options for employment services, settings, and providers;
(iii) all available options for living arrangements;
(iv) all available options for self-directed services and supports, including self-directed
budget options; and
(v) service provided in a non-disability-specific setting;
(3) identification of health and safety risks and how those risks will be addressed,
including personal risk management strategies;
(4) referral information; and
(5) informal caregiver supports, if applicable.
For a person determined eligible for state plan home care under subdivision 1a, paragraph
(b), clause (1), the person or person's representative must also receive a copy of the home
care service plan developed by the certified assessor.
(h) A person may request assistance in identifying community supports without
participating in a complete assessment. Upon a request for assistance identifying community
support, the person must be transferred or referred to long-term care options counseling
services available under sections 256.975, subdivision 7, and 256.01, subdivision 24, for
telephone assistance and follow up.
(i) The person has the right to make the final decision:
(1) between institutional placement and community placement after the recommendations
have been provided, except as provided in section 256.975, subdivision 7a, paragraph (d);
(2) between community placement in a setting controlled by a provider and living
independently in a setting not controlled by a provider;
(3) between day services and employment services; and
(4) regarding available options for self-directed services and supports, including
self-directed funding options.
(j) The lead agency must give the person receiving long-term care consultation services
or the person's legal representative, materials, and forms supplied by the commissioner
containing the following information:
(1) written recommendations for community-based services and consumer-directed
options;
(2) documentation that the most cost-effective alternatives available were offered to the
individual. For purposes of this clause, "cost-effective" means community services and
living arrangements that cost the same as or less than institutional care. For an individual
found to meet eligibility criteria for home and community-based service programs under
chapter 256S or section 256B.49, "cost-effectiveness" has the meaning found in the federally
approved waiver plan for each program;
(3) the need for and purpose of preadmission screening conducted by long-term care
options counselors according to section 256.975, subdivisions 7a to 7c, if the person selects
nursing facility placement. If the individual selects nursing facility placement, the lead
agency shall forward information needed to complete the level of care determinations and
screening for developmental disability and mental illness collected during the assessment
to the long-term care options counselor using forms provided by the commissioner;
(4) the role of long-term care consultation assessment and support planning in eligibility
determination for waiver and alternative care programs, and state plan home care, case
management, and other services as defined in subdivision 1a, paragraphs (a), clause (6),
and (b);
(5) information about Minnesota health care programs;
(6) the person's freedom to accept or reject the recommendations of the team;
(7) the person's right to confidentiality under the Minnesota Government Data Practices
Act, chapter 13;
(8) the certified assessor's decision regarding the person's need for institutional level of
care as determined under criteria established in subdivision 4e and the certified assessor's
decision regarding eligibility for all services and programs as defined in subdivision 1a,
paragraphs (a), clause (6), and (b);
(9) the person's right to appeal the certified assessor's decision regarding eligibility for
all services and programs as defined in subdivision 1a, paragraphs (a), clauses (6), (7), and
(8), and (b), and incorporating the decision regarding the need for institutional level of care
or the lead agency's final decisions regarding public programs eligibility according to section
256.045, subdivision 3. The certified assessor must verbally communicate this appeal right
to the person and must visually point out where in the document the right to appeal is stated;
and
(10) documentation that available options for employment services, independent living,
and self-directed services and supports were described to the individual.
(k) Face-to-face assessment completed as part of an eligibility determination for multiple
programs for the alternative care, elderly waiver, developmental disabilities, community
access for disability inclusion, community alternative care, and brain injury waiver programs
under chapter 256S and sections 256B.0913, 256B.092, and 256B.49 is valid to establish
service eligibility for no more than 60 calendar days after the date of assessment.
(l) The effective eligibility start date for programs in paragraph (k) can never be prior
to the date of assessment. If an assessment was completed more than 60 days before the
effective waiver or alternative care program eligibility start date, assessment and support
plan information must be updated and documented in the department's Medicaid Management
Information System (MMIS). Notwithstanding retroactive medical assistance coverage of
state plan services, the effective date of eligibility for programs included in paragraph (k)
cannot be prior to the date the most recent updated assessment is completed.
(m) If an eligibility update is completed within 90 days of the previous face-to-face
assessment and documented in the department's Medicaid Management Information System
(MMIS), the effective date of eligibility for programs included in paragraph (k) is the date
of the previous face-to-face assessment when all other eligibility requirements are met.
new text begin
(n) If a person who receives home and community-based waiver services under section
256B.0913, 256B.092, or 256B.49 or chapter 256S temporarily enters for 121 days or fewer
a hospital, institution of mental disease, nursing facility, intensive residential treatment
services program, transitional care unit, or inpatient substance use disorder treatment setting,
the person may return to the community with home and community-based waiver services
under the same waiver, without requiring an assessment or reassessment under this section,
unless the person's annual reassessment is otherwise due. Nothing in this paragraph shall
change annual long-term care consultation reassessment requirements, payment for
institutional or treatment services, medical assistance financial eligibility, or any other law.
new text end
deleted text begin (n)deleted text end new text begin (o)new text end At the time of reassessment, the certified assessor shall assess each person
receiving waiver residential supports and services currently residing in a community
residential setting, licensed adult foster care home that is either not the primary residence
of the license holder or in which the license holder is not the primary caregiver, family adult
foster care residence, customized living setting, or supervised living facility to determine
if that person would prefer to be served in a community-living setting as defined in section
256B.49, subdivision 23, in a setting not controlled by a provider, or to receive integrated
community supports as described in section 245D.03, subdivision 1, paragraph (c), clause
(8). The certified assessor shall offer the person, through a person-centered planning process,
the option to receive alternative housing and service options.
deleted text begin (o)deleted text end new text begin (p)new text end At the time of reassessment, the certified assessor shall assess each person
receiving waiver day services to determine if that person would prefer to receive employment
services as described in section 245D.03, subdivision 1, paragraph (c), clauses (5) to (7).
The certified assessor shall describe to the person through a person-centered planning process
the option to receive employment services.
deleted text begin (p)deleted text end new text begin (q)new text end At the time of reassessment, the certified assessor shall assess each person
receiving non-self-directed waiver services to determine if that person would prefer an
available service and setting option that would permit self-directed services and supports.
The certified assessor shall describe to the person through a person-centered planning process
the option to receive self-directed services and supports.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective upon federal approval. The commissioner
shall notify the revisor of statutes when federal approval is obtained.
new text end
Sec. 13.
Minnesota Statutes 2020, section 256B.0911, subdivision 6, is amended to read:
Subd. 6.
Payment for long-term care consultation services.
deleted text begin
(a) Until September 30,
2013, payment for long-term care consultation face-to-face assessment shall be made as
described in this subdivision.
deleted text end
deleted text begin
(b) The total payment for each county must be paid monthly by Certified nursing facilities
in the county. The monthly amount to be paid by each nursing facility for each fiscal year
must be determined by dividing the county's annual allocation for long-term care consultation
services by 12 to determine the monthly payment and allocating the monthly payment to
each nursing facility based on the number of licensed beds in the nursing facility. Payments
to counties in which there is no certified nursing facility must be made by increasing the
payment rate of the two facilities located nearest to the county seat.
deleted text end
deleted text begin
(c) The commissioner shall include the total annual payment determined under paragraph
(b) for each nursing facility reimbursed under section 256B.431 or 256B.434 or chapter
256R.
deleted text end
deleted text begin
(d) In the event of the layaway, delicensure and decertification, or removal from layaway
of 25 percent or more of the beds in a facility, the commissioner may adjust the per diem
payment amount in paragraph (c) and may adjust the monthly payment amount in paragraph
(b). The effective date of an adjustment made under this paragraph shall be on or after the
first day of the month following the effective date of the layaway, delicensure and
decertification, or removal from layaway.
deleted text end
deleted text begin (e)deleted text end new text begin (a)new text end Payments for long-term care consultation services are available to deleted text begin the county ordeleted text end
counties new text begin and Tribal nations that are lead agencies new text end to cover staff salaries and expenses to
provide the services described in subdivision 1a. The county new text begin or Tribal nation new text end shall employ,
or contract with other agencies to employ, deleted text begin within the limits of available funding,deleted text end sufficient
personnel to provide long-term care consultation services while meeting the state's long-term
care outcomes and objectives as defined in subdivision 1. The county new text begin or Tribal nation new text end shall
be accountable for meeting local objectives as approved by the commissioner in the biennial
home and community-based services quality assurance plan on a form provided by the
commissioner.
deleted text begin
(f) Notwithstanding section 256B.0641, overpayments attributable to payment of the
screening costs under the medical assistance program may not be recovered from a facility.
deleted text end
deleted text begin
(g) The commissioner of human services shall amend the Minnesota medical assistance
plan to include reimbursement for the local consultation teams.
deleted text end
deleted text begin (h) Until the alternative payment methodology in paragraph (i) is implemented, the
county may bill, as case management services, assessments, support planning, and
follow-along provided to persons determined to be eligible for case management under
Minnesota health care programs.
deleted text end
new text begin (b) new text end No individual or family member shall be charged for an initial assessment or initial
support plan development provided under subdivision 3a or 3b.
deleted text begin (i)deleted text end new text begin (c)new text end The commissioner shall develop an alternative payment methodology, effective
on October 1, 2013, for long-term care consultation services that includes the funding
available under this subdivision, and for assessments authorized under sections 256B.092
and 256B.0659. In developing the new payment methodology, the commissioner shall
consider the maximization of other funding sources, including federal administrative
reimbursement through federal financial participation funding, for all long-term care
consultation activity. The alternative payment methodology shall include the use of the
appropriate time studies and the state financing of nonfederal share as part of the state's
medical assistance program. Between July 1, 2017, and June 30, 2019, the state shall pay
84.3 percent of the nonfederal share as reimbursement to the counties. Beginning July 1,
2019, the state shall pay 81.9 percent of the nonfederal share as reimbursement to the
counties.
Sec. 14.
Minnesota Statutes 2020, section 256B.0911, is amended by adding a subdivision
to read:
new text begin Subd. 6b. new text end
new text begin
Payment for long-term care consultation services; transition to tiered
rates.
new text end
new text begin
(a) Notwithstanding subdivision 6, paragraph (c), beginning July 1, 2021, for each
fiscal year through fiscal year 2025, the state shall pay to each county and Tribal nation as
reimbursement for services provided under this section a percentage of the nonfederal share
equal to the value of the county's or the Tribal nation's prorated share of the nonfederal
share paid to counties and Tribal nations as reimbursement for services provided under
subdivision 6, paragraph (c), during fiscal year 2019.
new text end
new text begin
(b) Beginning October 1, 2022, each county or Tribal nation reimbursed under paragraph
(a) must submit to the commissioner by October 1 an annual report documenting the total
number of assessments performed under this section, the number of assessments by type of
assessment, amount of time spent on each assessment, amount of time spent preparing for
each assessment, amount of time spent finalizing a community support plan following each
assessment, and amount of time an assessor spent on other assessment-related activities for
each assessment. In its annual report, each county and Tribal nation must distinguish between
services provided to people who were eligible for medical assistance at the time the services
were provided and services provided to those who were not.
new text end
new text begin
(c) This subdivision expires July 1, 2025.
new text end
Sec. 15.
Minnesota Statutes 2020, section 256B.092, subdivision 1b, is amended to read:
Subd. 1b.
Coordinated service and support plan.
(a) Each recipient of home and
community-based waivered services shall be provided a copy of the written person-centered
coordinated service and support plan that:
(1) is developed with and signed by the recipient within the timelines established by the
commissioner and section 256B.0911, subdivision 3a, paragraph (e);
(2) includes the person's need for service, including identification of service needs that
will be or that are met by the person's relatives, friends, and others, as well as community
services used by the general public;
(3) reasonably ensures the health and welfare of the recipient;
(4) identifies the person's preferences for services as stated by the person, the person's
legal guardian or conservator, or the parent if the person is a minor, including the person's
choices made on self-directed options, services and supports to achieve employment goals,
and living arrangements;
(5) provides for an informed choice, as defined in section 256B.77, subdivision 2,
paragraph (o), of service and support providers, and identifies all available options for case
management services and providers;
(6) identifies long-range and short-range goals for the person;
(7) identifies specific services and the amount and frequency of the services to be provided
to the person based on assessed needs, preferences, and available resources. The
person-centered coordinated service and support plan shall also specify other services the
person needs that are not availablenew text begin and indicate in a clear and accessible manner the total
monetary resources available to meet the assessed needs and preferences of the individualnew text end ;
(8) identifies the need for an individual program plan to be developed by the provider
according to the respective state and federal licensing and certification standards, and
additional assessments to be completed or arranged by the provider after service initiation;
(9) identifies provider responsibilities to implement and make recommendations for
modification to the coordinated service and support plan;
(10) includes notice of the right to request a conciliation conference or a hearing under
section 256.045;
(11) is agreed upon and signed by the person, the person's legal guardian or conservator,
or the parent if the person is a minor, and the authorized county representative;
(12) is reviewed by a health professional if the person has overriding medical needs that
impact the delivery of services; and
(13) includes the authorized annual and monthly amounts for the services.
(b) In developing the person-centered coordinated service and support plan, the case
manager is encouraged to include the use of volunteers, religious organizations, social clubs,
and civic and service organizations to support the individual in the community. The lead
agency must be held harmless for damages or injuries sustained through the use of volunteers
and agencies under this paragraph, including workers' compensation liability.
(c) Approved, written, and signed changes to a consumer's services that meet the criteria
in this subdivision shall be an addendum to that consumer's individual service plan.
Sec. 16.
Minnesota Statutes 2020, section 256B.097, is amended by adding a subdivision
to read:
new text begin Subd. 7. new text end
new text begin Regional quality councils and systems improvement. new text end
new text begin
The commissioner of
human services shall maintain the regional quality councils initially established under
Minnesota Statutes 2020, section 256B.097, subdivision 4. The regional quality councils
shall:
new text end
new text begin
(1) support efforts and initiatives that drive overall systems and social change to promote
inclusion of people who have disabilities in the state of Minnesota;
new text end
new text begin
(2) improve person-centered outcomes in disability services; and
new text end
new text begin
(3) identify or enhance quality of life indicators for people who have disabilities.
new text end
Sec. 17.
Minnesota Statutes 2020, section 256B.097, is amended by adding a subdivision
to read:
new text begin Subd. 8. new text end
new text begin Membership and staff. new text end
new text begin
(a) Regional quality councils shall be comprised of
key stakeholders including, but not limited to:
new text end
new text begin
(1) individuals who have disabilities;
new text end
new text begin
(2) family members of people who have disabilities;
new text end
new text begin
(3) disability service providers;
new text end
new text begin
(4) disability advocacy groups;
new text end
new text begin
(5) lead agency staff; and
new text end
new text begin
(6) staff of state agencies with jurisdiction over special education and disability services.
new text end
new text begin
(b) Membership in a regional quality council must be representative of the communities
in which the council operates, with an emphasis on individuals with lived experience from
diverse racial and cultural backgrounds.
new text end
new text begin
(c) Each regional quality council may hire staff to perform the duties assigned in
subdivision 9.
new text end
Sec. 18.
Minnesota Statutes 2020, section 256B.097, is amended by adding a subdivision
to read:
new text begin Subd. 9. new text end
new text begin Duties. new text end
new text begin
(a) Each regional quality council shall:
new text end
new text begin
(1) identify issues and barriers that impede Minnesotans who have disabilities from
optimizing choice of home and community-based services;
new text end
new text begin
(2) promote informed-decision making, autonomy, and self-direction;
new text end
new text begin
(3) analyze and review quality outcomes and critical incident data, and immediately
report incidents of life safety concerns to the Department of Human Services Licensing
Division;
new text end
new text begin
(4) inform a comprehensive system for effective incident reporting, investigation, analysis,
and follow-up;
new text end
new text begin
(5) collaborate on projects and initiatives to advance priorities shared with state agencies,
lead agencies, educational institutions, advocacy organizations, community partners, and
other entities engaged in disability service improvements;
new text end
new text begin
(6) establish partnerships and working relationships with individuals and groups in the
regions;
new text end
new text begin
(7) identify and implement regional and statewide quality improvement projects;
new text end
new text begin
(8) transform systems and drive social change in alignment with the disability rights and
disability justice movements identified by leaders who have disabilities;
new text end
new text begin
(9) provide information and training programs for persons who have disabilities and
their families and legal representatives on formal and informal support options and quality
expectations;
new text end
new text begin
(10) make recommendations to state agencies and other key decision-makers regarding
disability services and supports;
new text end
new text begin
(11) submit every two years a report to legislative committees with jurisdiction over
disability services on the status, outcomes, improvement priorities, and activities in the
region;
new text end
new text begin
(12) support people by advocating to resolve complaints between the counties, providers,
persons receiving services, and their families and legal representatives; and
new text end
new text begin
(13) recruit, train, and assign duties to regional quality council teams, including council
members, interns, and volunteers, taking into account the skills necessary for the team
members to be successful in this work.
new text end
new text begin
(b) Each regional quality council may engage in quality improvement initiatives related
to, but not limited to:
new text end
new text begin
(1) the home and community-based services waiver programs for persons with
developmental disabilities under section 256B.092, subdivision 4, or section 256B.49,
including brain injuries and services for those persons who qualify for nursing facility level
of care or hospital facility level of care and any other services licensed under chapter 245D;
new text end
new text begin
(2) home care services under section 256B.0651;
new text end
new text begin
(3) family support grants under section 252.32;
new text end
new text begin
(4) consumer support grants under section 256.476;
new text end
new text begin
(5) semi-independent living services under section 252.275; and
new text end
new text begin
(6) services provided through an intermediate care facility for persons with developmental
disabilities.
new text end
new text begin
(c) Each regional quality council's work must be informed and directed by the needs
and desires of persons who have disabilities in the region in which the council operates.
new text end
Sec. 19.
Minnesota Statutes 2020, section 256B.097, is amended by adding a subdivision
to read:
new text begin Subd. 10. new text end
new text begin Compensation. new text end
new text begin
(a) A member of a regional quality council who does not
receive a salary or wages from an employer may be paid a per diem and reimbursed for
expenses related to the member's participation in efforts and initiatives described in
subdivision 9 in the same manner and in an amount not to exceed the amount authorized
by the commissioner's plan adopted under section 43A.18, subdivision 2.
new text end
new text begin
(b) Regional quality councils may charge fees for their services.
new text end
Sec. 20.
Minnesota Statutes 2020, 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, 90 percent state funds and ten percent county funds for the
costs of placements that have exceeded 90 days in intermediate care facilities for persons
with developmental disabilities 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 256Gnew text begin ;
new text end
new text begin
(5) for any individual who has not been continuously receiving services in an intermediate
care facility for persons with developmental disabilities since December 31, 2021, 90 percent
state funds and ten percent county funds for the costs of any placement of an individual 18
years of age or older and under 27 years of age exceeding 90 days in any intermediate care
facility for persons with developmental disabilities. This provision includes pass-through
payments made under section 256B.5015. This provision is not in addition to the division
of costs under clause (3). This provision continues to apply to an individual after the
individual reaches the age of 27 and until the individual transitions to a community setting;
and
new text end
new text begin (6) for any individual who has not been continuously receiving residential support
services since December 31, 2021, 90 percent state funds and ten percent county funds for
the costs of residential support services when authorized for an individual 18 years of age
or older and under 27 years of age. This provision continues to apply to an individual after
the individual reaches the age of 27 and until the individual no longer receives residential
support services. For the purposes of this clause, "residential support services" means the
following residential support services reimbursed under section 256B.4914: community
residential services, customized living services, and 24-hour customized living servicesnew 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.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall inform the revisor of statutes
when federal approval is obtained.
new text end
Sec. 21.
Minnesota Statutes 2020, section 256B.49, subdivision 23, is amended to read:
Subd. 23.
Community-living settings.
(a) For the purposes of this chapter,
"community-living settings" means a single-family home or multifamily dwelling unit where
a service recipient or a service recipient's family owns or rents, and maintains control over
the individual unit as demonstrated by a lease agreement. Community-living settings does
not include a home or dwelling unit that the service provider owns, operates, or leases or
in which the service provider has a direct or indirect financial interest.
(b) To ensure a service recipient or the service recipient's family maintains control over
the home or dwelling unit, community-living settings are subject to the following
requirements:
(1) service recipients must not be required to receive services or share services;
(2) service recipients must not be required to have a disability or specific diagnosis to
live in the community-living setting;
(3) service recipients may hire service providers of their choice;
(4) service recipients may choose whether to share their household and with whom;
(5) the home or multifamily dwelling unit must include living, sleeping, bathing, and
cooking areas;
(6) service recipients must have lockable access and egress;
(7) service recipients must be free to receive visitors and leave the settings at times and
for durations of their own choosing;
(8) leases must comply with chapter 504B;
(9) landlords must not charge different rents to tenants who are receiving home and
community-based services; and
(10) access to the greater community must be easily facilitated based on the service
recipient's needs and preferences.
(c) Nothing in this section prohibits a service recipient from having another person or
entity not affiliated with the service provider cosign a lease. Nothing in this section prohibits
a service recipient, during any period in which a service provider has cosigned the service
recipient's lease, from modifying services with an existing cosigning service provider and,
subject to the approval of the landlord, maintaining a lease cosigned by the service provider.
Nothing in this section prohibits a service recipient, during any period in which a service
provider has cosigned the service recipient's lease, from terminating services with the
cosigning service provider, receiving services from a new service provider, and, subject to
the approval of the landlord, maintaining a lease cosigned by the new service provider.
(d) A lease cosigned by a service provider meets the requirements of paragraph (a) if
the service recipient and service provider develop and implement a transition plan which
must provide that, within two years of cosigning the initial lease, the service provider shall
transfer the lease to the service recipient and other cosigners, if any.
(e) In the event the landlord has not approved the transfer of the lease within two years
of the service provider cosigning the initial lease, the service provider must submit a
time-limited extension request to the commissioner of human services to continue the
cosigned lease arrangement. The extension request must include:
(1) the reason the landlord denied the transfer;
(2) the plan to overcome the denial to transfer the lease;
(3) the length of time needed to successfully transfer the lease, not to exceed an additional
two years;
(4) a description of how the transition plan was followed, what occurred that led to the
landlord denying the transfer, and what changes in circumstances or condition, if any, the
service recipient experienced; and
(5) a revised transition plan to transfer the cosigned lease between the service provider
and the service recipient to the service recipient.
The commissioner must approve an extension within sufficient time to ensure the continued
occupancy by the service recipient.
new text begin
(f) In the event that a landlord has not approved a transfer of the lease within the timelines
of any approved time-limited extension request, a service provider must submit another
time-limited extension request to the commissioner of human services to continue a cosigned
lease arrangement. A time-limited extension request submitted under this paragraph must
include the same information required for an initial time-limited extension request under
paragraph (e). The commissioner must approve of an extension within sufficient time to
ensure continued occupancy by the service recipient.
new text end
Sec. 22.
Minnesota Statutes 2020, section 256B.49, is amended by adding a subdivision
to read:
new text begin Subd. 28. new text end
new text begin
Customized living moratorium for brain injury and community access
for disability inclusion waivers.
new text end
new text begin
(a) Notwithstanding section 245A.03, subdivision 2,
paragraph (a), clause (23), to prevent new development of customized living settings that
otherwise meet the residential program definition under section 245A.02, subdivision 14,
the commissioner shall not enroll new customized living settings serving four or fewer
people in a single-family home to deliver customized living services as defined under the
brain injury or community access for disability inclusion waiver plans under section 256B.49.
new text end
new text begin
(b) The commissioner may approve an exception to paragraph (a) when an existing
customized living setting changes ownership at the same address.
new text end
new text begin
(c) Customized living settings operational on or before June 30, 2021, are considered
existing customized living settings.
new text end
new text begin
(d) For any new customized living settings serving four or fewer people in a single-family
home to deliver customized living services as defined in paragraph (a) and that was not
operational on or before June 30, 2021, the authorizing lead agency is financially responsible
for all home and community-based service payments in the setting.
new text end
new text begin
(e) For purposes of this subdivision, "operational" means customized living services are
authorized and delivered to a person in the customized living setting.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021. This section applies only
to customized living services as defined under the brain injury or community access for
disability inclusion waiver plans under Minnesota Statutes, section 256B.49.
new text end
Sec. 23.
Minnesota Statutes 2020, section 256B.4905, is amended by adding a subdivision
to read:
new text begin Subd. 1a. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have the
meanings given.
new text end
new text begin
(b) "Informed choice" means a choice that adults who have disabilities and, with support
from their families or legal representatives, that children who have disabilities make regarding
services and supports that best meets the adult's or child's needs and preferences. Before
making an informed choice, an individual who has disabilities must be provided, in an
accessible format and manner that meets the individual's needs, the tools, information, and
opportunities the individual requests or requires to understand all of the individual's options.
new text end
new text begin
(c) "HCBS" means home and community-based services covered under this chapter by
the medical assistance state plan, and the home and community-based waiver services
covered under sections 256B.092 and 256B.49.
new text end
Sec. 24.
Minnesota Statutes 2020, section 256B.4905, is amended by adding a subdivision
to read:
new text begin Subd. 2a. new text end
new text begin Informed choice policy. new text end
new text begin
It is the policy of this state that all adults who have
disabilities and, with support from their families or legal representatives, all children who
have disabilities:
new text end
new text begin
(1) can make informed choices to select and utilize disability services and supports; and
new text end
new text begin
(2) will be offered an informed decision-making process sufficient to make informed
choices.
new text end
Sec. 25.
Minnesota Statutes 2020, section 256B.4905, is amended by adding a subdivision
to read:
new text begin Subd. 3a. new text end
new text begin Informed decision making. new text end
new text begin
(a) The commissioner of human services and
lead agencies shall ensure that:
new text end
new text begin
(1) disability services support the presumption that adults who have disabilities and,
with support from their families or legal representatives, children who have disabilities can
make informed choices;
new text end
new text begin
(2) all adults who have disabilities and are accessing HCBS and all families of children
who have disabilities and are accessing HCBS are provided an informed decision-making
process satisfying the requirements of paragraph (b);
new text end
new text begin
(3) all adults who have disabilities and are accessing HCBS and all families of children
who have disabilities and are accessing HCBS are provided the opportunity to revisit or
change any decision or choice at any time of the adult's or family's choosing; and
new text end
new text begin
(4) services or supports necessary to accomplish each step of an informed
decision-making process or to make an informed choice to utilize disability services are
authorized and implemented within a reasonable time frame for individuals accessing HCBS.
new text end
new text begin
(b) The commissioner of human services must develop and ensure compliance with an
informed decision-making standard that provides accessible, correct, and complete
information to help an individual accessing HCBS make an informed choice. This information
must be accessible and understandable to the person so that the person can demonstrate
understanding of the options. Any written information provided in the process must be
accessible and the process must be experiential whenever possible. The process must also
consider and offer to the person, in a person-centered manner, the following:
new text end
new text begin
(1) reasonable accommodations as needed or requested by the person to fully participate
in the informed decision-making process and acquire the information necessary to make an
informed choice;
new text end
new text begin
(2) discussion of the person's own preferences, abilities, goals, and objectives;
new text end
new text begin
(3) identification of the person's cultural needs and access to culturally responsive services
and providers;
new text end
new text begin
(4) information about the benefits of inclusive and individualized services and supports;
new text end
new text begin
(5) presentation and discussion of all options with the person;
new text end
new text begin
(6) documentation, in a manner prescribed by the commissioner, of each option discussed;
new text end
new text begin
(7) exploration and development of new or other options;
new text end
new text begin
(8) facilitation of opportunities to visit alternative locations or to engage in experiences
to understand how any service option might work for the person;
new text end
new text begin
(9) opportunities to meet with other individuals with disabilities who live, work, and
receive services different from the person's own services;
new text end
new text begin
(10) development of a transition plan, when needed or requested by the person, to
facilitate the choice to move from one service type or setting to another, and authorization
of the services and supports necessary to effectuate the plan;
new text end
new text begin
(11) identification of any barriers to assisting or implementing the person's informed
choice and authorization of the services and supports necessary to overcome those barriers;
and
new text end
new text begin
(12) ample time and timely opportunity to consider available options before the individual
makes a final choice or changes a choice.
new text end
new text begin
(c) The commissioner shall ensure that individuals accessing HCBS have access to an
informed decision-making process at least annually by:
new text end
new text begin
(1) updating informed choice protocols for HCBS to reflect the informed choice definition
in subdivision 1a, paragraph (b), and the informed decision-making process outlined in
paragraph (b);
new text end
new text begin
(2) developing a survey designed for individuals accessing HCBS to assess their
experience with informed choice and the informed decision-making process, including how
frequently it is offered and how well it meets the standard in paragraph (b). The survey shall
be administered and results used to determine the quality and frequency of informed choice
and informed decision making consistent with this section. The commissioner shall utilize
survey results to increase the frequency and quality of informed decision making and
informed choice as experienced by individuals accessing HCBS;
new text end
new text begin
(3) creating option for interested persons to file incident reports regarding an access to
and the quality of informed choice and informed decision making experienced by an
individual accessing HCBS, and implementing appropriate processes upon receipt of the
reports;
new text end
new text begin
(4) updating informed choice, informed decision making, and other relevant training
tools for lead agency and provider staff to reflect the informed choice definition in subdivision
1a, paragraph (b), informed decision-making process outlined in paragraph (b), and other
requirements of this section; and
new text end
new text begin
(5) mandating informed choice training for lead agency staff who support individuals
accessing HCBS.
new text end
Sec. 26.
Minnesota Statutes 2020, section 256B.4905, is amended by adding a subdivision
to read:
new text begin Subd. 4a. new text end
new text begin Informed choice in employment policy. new text end
new text begin
It is the policy of this state that
working-age individuals who have disabilities:
new text end
new text begin
(1) can work and achieve competitive integrated employment with appropriate services
and supports, as needed;
new text end
new text begin
(2) make informed choices about their postsecondary education, work, and career goals;
and
new text end
new text begin
(3) will be offered the opportunity to make an informed choice, at least annually, to
pursue postsecondary education or to work and earn a competitive wage.
new text end
Sec. 27.
Minnesota Statutes 2020, section 256B.4905, is amended by adding a subdivision
to read:
new text begin Subd. 5a. new text end
new text begin Informed choice in employment implementation. new text end
new text begin
(a) The commissioner of
human services and lead agencies shall ensure that disability services align with the
employment first policy adopted by the Olmstead subcabinet on September 29, 2014, or
successor policies.
new text end
new text begin
(b) The commissioner and lead agencies shall implement the provisions of subdivision
3a, paragraph (c), and take other appropriate actions to ensure that all working-age individuals
who have disabilities and are accessing HCBS are offered an informed decision-making
process that will help them make an informed choice about postsecondary education offering
meaningful credentials; and about working and earning, with appropriate services and
supports, a competitive wage in work or a career that the individual chooses before being
offered exclusively day services as defined in section 245D.03, subdivision 1, paragraph
(c), clause (4), or successor provisions.
new text end
Sec. 28.
Minnesota Statutes 2020, section 256B.4905, is amended by adding a subdivision
to read:
new text begin Subd. 7. new text end
new text begin Informed choice in community living policy. new text end
new text begin
It is the policy of this state that
all adults who have disabilities:
new text end
new text begin
(1) can live in the communities of the individual's choosing with appropriate services
and supports as needed; and
new text end
new text begin
(2) have the right, at least annually, to make an informed decision-making process that
can help them make an informed choice to live outside of a provider-controlled setting.
new text end
Sec. 29.
Minnesota Statutes 2020, section 256B.4905, is amended by adding a subdivision
to read:
new text begin Subd. 8. new text end
new text begin Informed choice in community living implementation. new text end
new text begin
(a) The commissioner
of human services and lead agencies shall ensure that disability services support the
presumption that all adults who have disabilities can and want to live in the communities
of the individual's choosing with services and supports as needed.
new text end
new text begin
(b) The commissioner and lead agencies shall implement the provisions of subdivision
3a, paragraph (c), and take any appropriate action to ensure that all adults who have
disabilities and are accessing HCBS are offered, after an informed decision-making process
and during a person-centered planning process, the services and supports the individual
needs to live as the individual chooses, including in a non-provider-controlled setting.
Provider-controlled settings include customized living services provided in a single-family
home or residential supports and services as defined in section 245D.03, subdivision 1,
paragraph (c), clause (3), or successor provisions, unless the residential services and supports
are provided in a family adult foster care residence under a shared living option as described
in Laws 2013, chapter 108, article 7, section 62.
new text end
Sec. 30.
Minnesota Statutes 2020, section 256B.4905, is amended by adding a subdivision
to read:
new text begin Subd. 9. new text end
new text begin Informed choice in self-direction policy. new text end
new text begin
It is the policy of this state that adults
who have disabilities and families of children who have disabilities:
new text end
new text begin
(1) can direct the adult's or child's needed services and supports; and
new text end
new text begin
(2) have the right to make an informed choice to self-direct the adult's or child's services
and supports before being offered options that do not allow the adult or family to self-direct
the adult's or child's services and supports.
new text end
Sec. 31.
Minnesota Statutes 2020, section 256B.4905, is amended by adding a subdivision
to read:
new text begin Subd. 10. new text end
new text begin Informed choice in self-direction implementation. new text end
new text begin
(a) The commissioner
of human services and lead agencies shall ensure that disability services support the
presumption that adults who have disabilities and families of children who have disabilities
can direct all of the adult's or child's services and supports, including control over the funding
of the adult's or child's services and supports.
new text end
new text begin
(b) The commissioner and lead agencies shall implement the provisions of subdivision
3a, paragraph (c), and take any other appropriate actions to ensure that at intervals described
in paragraph (c), adults who have disabilities and are accessing HCBS and families of
children who have disabilities and are accessing HCBS are offered, after an informed
decision-making process and during a person-centered planning process, the option to direct
the adult's or child's services and supports, including the option to have control over the
funding of the adult's or child's services and supports.
new text end
new text begin
(c) The commissioner or lead agency shall offer adults who have disabilities and families
of children who have disabilities the options described in paragraph (b) at least annually
during regularly scheduled planning meetings or more frequently when:
new text end
new text begin
(1) the adults who have disabilities or families of children who have disabilities requests
or suggests the options described in paragraph (b) or when the adult or family expresses
dissatisfaction with services and supports that do not allow for self-direction;
new text end
new text begin
(2) the family or a legal representative of the individual with disabilities requests or
suggests the options described in paragraph (b);
new text end
new text begin
(3) any member of the individual's service planning team or expanded service planning
team requests or suggests the options described in paragraph (b); or
new text end
new text begin
(4) self-directed services and supports could enhance the individual's independence or
quality of life.
new text end
Sec. 32.
Minnesota Statutes 2020, section 256B.4905, is amended by adding a subdivision
to read:
new text begin Subd. 11. new text end
new text begin Informed choice in technology policy. new text end
new text begin
It is the policy of this state that all
adults who have disabilities and children who have disabilities:
new text end
new text begin
(1) can use assistive technology, remote supports, or a combination of both to enhance
the adult's or child's independence and quality of life; and
new text end
new text begin
(2) have the right, at least annually, to make an informed choice about the adult's or
child's use of assistive technology and remote supports.
new text end
Sec. 33.
Minnesota Statutes 2020, section 256B.4905, is amended by adding a subdivision
to read:
new text begin Subd. 12. new text end
new text begin Informed choice in technology implementation. new text end
new text begin
(a) The commissioner of
human services and lead agencies shall ensure that disability services support the presumption
that adults who have disabilities and children who have disabilities can use or benefit from
assistive technology, remote supports, or both.
new text end
new text begin
(b) The commissioner and lead agencies shall implement the provisions of subdivision
3a, paragraph (c), and take any other appropriate actions to ensure that at intervals described
in paragraph (c), adults who have disabilities and are accessing HCBS and families of
children who have disabilities and are accessing HCBS are offered, after an informed
decision-making process and during a person-centered planning process, the opportunity
to choose assistive technology, remote support, or both, to ensure equitable access.
new text end
new text begin
(c) The commissioner or lead agency shall offer adults who have disabilities and families
of children who have disabilities the options described in paragraph (b) at least annually
during a regularly scheduled planning meeting or more frequently when:
new text end
new text begin
(1) the adult who has disabilities or the family of a child who has disabilities requests
or suggests the options described in paragraph (b) or when the adult or family expresses
dissatisfaction with in-person services and supports;
new text end
new text begin
(2) the family or a legal representative of the individual with disabilities requests or
suggests the options described in paragraph (b);
new text end
new text begin
(3) any member of the individual's service planning team or expanded service planning
team requests or suggests the options described in paragraph (b); or
new text end
new text begin
(4) assistive technology, remote supports, or both could enhance the individual's
independence or quality of life.
new text end
new text begin
(d) The availability of assistive technology, remote supports, or both, shall not preclude
an individual with disabilities from accessing in-person supports and services, nor shall it
result in a denial of in-person supports and services.
new text end
Sec. 34.
Minnesota Statutes 2020, section 256B.4914, subdivision 2, is amended to read:
Subd. 2.
Definitions.
(a) For purposes of this section, the following terms have the
meanings given them, unless the context clearly indicates otherwise.
(b) "Commissioner" means the commissioner of human services.
(c) "Comparable occupations" means the occupations, excluding direct care staff, as
represented by the Bureau of Labor Statistics standard occupational classification codes
that have the same classification for:
(1) typical education needed for entry;
(2) work experience in a related occupation; and
(3) typical on-the-job training competency as the most predominant classification for
direct care staff.
(d) "Component value" means underlying factors that are part of the cost of providing
services that are built into the waiver rates methodology to calculate service rates.
(e) "Customized living tool" means a methodology for setting service rates that delineates
and documents the amount of each component service included in a recipient's customized
living service plan.
(f) "Direct care staff" means employees providing direct service to people receiving
services under this section. Direct care staff excludes executive, managerial, and
administrative staff.
(g) "Disability waiver rates system" means a statewide system that establishes rates that
are based on uniform processes and captures the individualized nature of waiver services
and recipient needs.
(h) "Individual staffing" means the time spent as a one-to-one interaction specific to an
individual recipient by staff to provide direct support and assistance with activities of daily
living, instrumental activities of daily living, and training to participants, and is based on
the requirements in each individual's coordinated service and support plan under section
245D.02, subdivision 4b; any coordinated service and support plan addendum under section
245D.02, subdivision 4c; and an assessment tool. Provider observation of an individual's
needs must also be considered.
(i) "Lead agency" means a county, partnership of counties, or tribal agency charged with
administering waivered services under sections 256B.092 and 256B.49.
(j) "Median" means the amount that divides distribution into two equal groups, one-half
above the median and one-half below the median.
(k) "Payment or rate" means reimbursement to an eligible provider for services provided
to a qualified individual based on an approved service authorization.
(l) "Rates management system" means a web-based software application that uses a
framework and component values, as determined by the commissioner, to establish service
rates.
(m) "Recipient" means a person receiving home and community-based services funded
under any of the disability waivers.
(n) "Shared staffing" means time spent by employees, not defined under paragraph (f),
providing or available to provide more than one individual with direct support and assistance
with activities of daily living as defined under section 256B.0659, subdivision 1, paragraph
(b); instrumental activities of daily living as defined under section 256B.0659, subdivision
1, paragraph (i); ancillary activities needed to support individual services; and training to
participants, and is based on the requirements in each individual's coordinated service and
support plan under section 245D.02, subdivision 4b; any coordinated service and support
plan addendum under section 245D.02, subdivision 4c; an assessment tool; and provider
observation of an individual's service need. Total shared staffing hours are divided
proportionally by the number of individuals who receive the shared service provisions.
(o) "Staffing ratio" means the number of recipients a service provider employee supports
during a unit of service based on a uniform assessment tool, provider observation, case
history, and the recipient's services of choice, and not based on the staffing ratios under
section 245D.31.
(p) "Unit of service" means the following:
(1) for residential support services under subdivision 6, a unit of service is a day. Any
portion of any calendar day, within allowable Medicaid rules, where an individual spends
time in a residential setting is billable as a day;
(2) for day services under subdivision 7:
(i) for day training and habilitation services, a unit of service is either:
(A) a day unit of service is defined as six or more hours of time spent providing direct
services and transportation; or
(B) a partial day unit of service is defined as fewer than six hours of time spent providing
direct services and transportation; and
(C) for new day service recipients after January 1, 2014, 15 minute units of service must
be used for fewer than six hours of time spent providing direct services and transportation;
(ii) for adult day and structured day services, a unit of service is a day or 15 minutes. A
day unit of service is six or more hours of time spent providing direct services;
(iii) for day support services, a unit of service is 15 minutes; and
(iv) for prevocational services, a unit of service is a day or 15 minutes. A day unit of
service is six or more hours of time spent providing direct service;
(3) for unit-based services with programming under subdivision 8:
(i) for supported living services, a unit of service is a day or 15 minutes. When a day
rate is authorized, any portion of a calendar day where an individual receives services is
billable as a day; deleted text begin and
deleted text end
(ii) new text begin for individualized home supports with training, a unit of service is a day or 15 minutes.
A day unit of service is six or more hours of time spent providing direct service; and
new text end
new text begin (iii) new text end for all other services, a unit of service is 15 minutes; and
(4) for unit-based services without programming under subdivision 9, a unit of service
is 15 minutes.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 35.
Minnesota Statutes 2020, section 256B.4914, subdivision 5, is amended to read:
Subd. 5.
Base wage index and standard component values.
(a) The base wage index
is established to determine staffing costs associated with providing services to individuals
receiving home and community-based services. For purposes of developing and calculating
the proposed base wage, Minnesota-specific wages taken from job descriptions and standard
occupational classification (SOC) codes from the Bureau of Labor Statistics as defined in
the most recent edition of the Occupational Handbook must be used. The base wage index
must be calculated as follows:
(1) for residential direct care staff, the sum of:
(i) 15 percent of the subtotal of 50 percent of the median wage for personal and home
health aide (SOC code 39-9021); 30 percent of the median wage for nursing assistant (SOC
code 31-1014); and 20 percent of the median wage for social and human services aide (SOC
code 21-1093); and
(ii) 85 percent of the subtotal of 20 percent of the median wage for home health aide
(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
(SOC code 39-9021); 20 percent of the median wage for nursing assistant (SOC code
31-1014); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
and 20 percent of the median wage for social and human services aide (SOC code 21-1093);
(2) for adult day services, 70 percent of the median wage for nursing assistant (SOC
code 31-1014); and 30 percent of the median wage for personal care aide (SOC code
39-9021);
(3) for day services, day support services, and prevocational services, 20 percent of the
median wage for nursing assistant (SOC code 31-1014); 20 percent of the median wage for
psychiatric technician (SOC code 29-2053); and 60 percent of the median wage for social
and human services aide (SOC code 21-1093);
(4) for residential asleep-overnight staff, the wage is the minimum wage in Minnesota
for large employers, except in a family foster care setting, the wage is 36 percent of the
minimum wage in Minnesota for large employers;
(5) for positive supports analyst staff, 100 percent of the median wage for mental health
counselors (SOC code 21-1014);
(6) for positive supports professional staff, 100 percent of the median wage for clinical
counseling and school psychologist (SOC code 19-3031);
(7) for positive supports specialist staff, 100 percent of the median wage for psychiatric
technicians (SOC code 29-2053);
(8) for supportive living services staff, 20 percent of the median wage for nursing assistant
(SOC code 31-1014); 20 percent of the median wage for psychiatric technician (SOC code
29-2053); and 60 percent of the median wage for social and human services aide (SOC code
21-1093);
(9) for housing access coordination staff, 100 percent of the median wage for community
and social services specialist (SOC code 21-1099);
(10) for in-home family support and individualized home supports with family training
staff, 20 percent of the median wage for nursing aide (SOC code 31-1012); 30 percent of
the median wage for community social service specialist (SOC code 21-1099); 40 percent
of the median wage for social and human services aide (SOC code 21-1093); and ten percent
of the median wage for psychiatric technician (SOC code 29-2053);
(11) for individualized home supports with training services staff, 40 percent of the
median wage for community social service specialist (SOC code 21-1099); 50 percent of
the median wage for social and human services aide (SOC code 21-1093); and ten percent
of the median wage for psychiatric technician (SOC code 29-2053);
(12) for independent living skills staff, 40 percent of the median wage for community
social service specialist (SOC code 21-1099); 50 percent of the median wage for social and
human services aide (SOC code 21-1093); and ten percent of the median wage for psychiatric
technician (SOC code 29-2053);
(13) for employment support services staff, 50 percent of the median wage for
rehabilitation counselor (SOC code 21-1015); and 50 percent of the median wage for
community and social services specialist (SOC code 21-1099);
(14) for employment exploration services staff, 50 percent of the median wage for
deleted text begin rehabilitation counselor (SOC code 21-1015)deleted text end new text begin education, guidance, school, and vocational
counselors (SOC code 21-1012)new text end ; and 50 percent of the median wage for community and
social services specialist (SOC code 21-1099);
(15) for employment development services staff, 50 percent of the median wage for
education, guidance, school, and vocational counselors (SOC code 21-1012); and 50 percent
of the median wage for community and social services specialist (SOC code 21-1099);
(16) for individualized home support staff, 50 percent of the median wage for personal
and home care aide (SOC code 39-9021); and 50 percent of the median wage for nursing
assistant (SOC code 31-1014);
(17) for adult companion staff, 50 percent of the median wage for personal and home
care aide (SOC code 39-9021); and 50 percent of the median wage for nursing assistant
(SOC code 31-1014);
(18) for night supervision staff, 20 percent of the median wage for home health aide
(SOC code 31-1011); 20 percent of the median wage for personal and home health aide
(SOC code 39-9021); 20 percent of the median wage for nursing assistant (SOC code
31-1014); 20 percent of the median wage for psychiatric technician (SOC code 29-2053);
and 20 percent of the median wage for social and human services aide (SOC code 21-1093);
(19) for respite staff, 50 percent of the median wage for personal and home care aide
(SOC code 39-9021); and 50 percent of the median wage for nursing assistant (SOC code
31-1014);
(20) for personal support staff, 50 percent of the median wage for personal and home
care aide (SOC code 39-9021); and 50 percent of the median wage for nursing assistant
(SOC code 31-1014);
(21) for supervisory staff, 100 percent of the median wage for community and social
services specialist (SOC code 21-1099), with the exception of the supervisor of positive
supports professional, positive supports analyst, and positive supports specialists, which is
100 percent of the median wage for clinical counseling and school psychologist (SOC code
19-3031);
(22) for registered nurse staff, 100 percent of the median wage for registered nurses
(SOC code 29-1141); and
(23) for licensed practical nurse staff, 100 percent of the median wage for licensed
practical nurses (SOC code 29-2061).
(b) Component values for corporate foster care services, corporate supportive living
services daily, community residential services, and integrated community support services
are:
(1) competitive workforce factor: 4.7 percent;
(2) supervisory span of control ratio: 11 percent;
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
(4) employee-related cost ratio: 23.6 percent;
(5) general administrative support ratio: 13.25 percent;
(6) program-related expense ratio: 1.3 percent; and
(7) absence and utilization factor ratio: 3.9 percent.
(c) Component values for family foster care are:
(1) competitive workforce factor: 4.7 percent;
(2) supervisory span of control ratio: 11 percent;
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
(4) employee-related cost ratio: 23.6 percent;
(5) general administrative support ratio: 3.3 percent;
(6) program-related expense ratio: 1.3 percent; and
(7) absence factor: 1.7 percent.
(d) Component values for day training and habilitation, day support services, and
prevocational services are:
(1) competitive workforce factor: 4.7 percent;
(2) supervisory span of control ratio: 11 percent;
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
(4) employee-related cost ratio: 23.6 percent;
(5) program plan support ratio: 5.6 percent;
(6) client programming and support ratio: ten percent;
(7) general administrative support ratio: 13.25 percent;
(8) program-related expense ratio: 1.8 percent; and
(9) absence and utilization factor ratio: 9.4 percent.
(e) new text begin Component values for day support services and prevocational services delivered
remotely are:
new text end
new text begin
(1) competitive workforce factor: 4.7 percent;
new text end
new text begin
(2) supervisory span of control ratio: 11 percent;
new text end
new text begin
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
new text end
new text begin
(4) employee-related cost ratio: 23.6 percent;
new text end
new text begin
(5) program plan support ratio: 5.6 percent;
new text end
new text begin
(6) client programming and support ratio: 10.37 percent;
new text end
new text begin
(7) general administrative support ratio: 13.25 percent;
new text end
new text begin
(8) program-related expense ratio: 1.8 percent; and
new text end
new text begin
(9) absence and utilization factor ratio: 9.4 percent.
new text end
new text begin (f) new text end Component values for adult day services are:
(1) competitive workforce factor: 4.7 percent;
(2) supervisory span of control ratio: 11 percent;
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
(4) employee-related cost ratio: 23.6 percent;
(5) program plan support ratio: 5.6 percent;
(6) client programming and support ratio: 7.4 percent;
(7) general administrative support ratio: 13.25 percent;
(8) program-related expense ratio: 1.8 percent; and
(9) absence and utilization factor ratio: 9.4 percent.
deleted text begin (f)deleted text end new text begin (g)new text end Component values for unit-based services with programming are:
(1) competitive workforce factor: 4.7 percent;
(2) supervisory span of control ratio: 11 percent;
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
(4) employee-related cost ratio: 23.6 percent;
(5) program plan supports ratio: 15.5 percent;
(6) client programming and supports ratio: 4.7 percent;
(7) general administrative support ratio: 13.25 percent;
(8) program-related expense ratio: 6.1 percent; and
(9) absence and utilization factor ratio: 3.9 percent.
deleted text begin (g)deleted text end new text begin (h) Component values for unit-based services with programming delivered remotely
are:
new text end
new text begin
(1) competitive workforce factor: 4.7 percent;
new text end
new text begin
(2) supervisory span of control ratio: 11 percent;
new text end
new text begin
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
new text end
new text begin
(4) employee-related cost ratio: 23.6 percent;
new text end
new text begin
(5) program plan supports ratio: 15.5 percent;
new text end
new text begin
(6) client programming and supports ratio: 4.7 percent;
new text end
new text begin
(7) general administrative support ratio: 13.25 percent;
new text end
new text begin
(8) program-related expense ratio: 6.1 percent; and
new text end
new text begin
(9) absence and utilization factor ratio: 3.9 percent.
new text end
new text begin (i) new text end Component values for unit-based services without programming except respite are:
(1) competitive workforce factor: 4.7 percent;
(2) supervisory span of control ratio: 11 percent;
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
(4) employee-related cost ratio: 23.6 percent;
(5) program plan support ratio: 7.0 percent;
(6) client programming and support ratio: 2.3 percent;
(7) general administrative support ratio: 13.25 percent;
(8) program-related expense ratio: 2.9 percent; and
(9) absence and utilization factor ratio: 3.9 percent.
new text begin
(j) Component values for unit-based services without programming delivered remotely,
except respite, are:
new text end
new text begin
(1) competitive workforce factor: 4.7 percent;
new text end
new text begin
(2) supervisory span of control ratio: 11 percent;
new text end
new text begin
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
new text end
new text begin
(4) employee-related cost ratio: 23.6 percent;
new text end
new text begin
(5) program plan support ratio: 7.0 percent;
new text end
new text begin
(6) client programming and support ratio: 2.3 percent;
new text end
new text begin
(7) general administrative support ratio: 13.25 percent;
new text end
new text begin
(8) program-related expense ratio: 2.9 percent; and
new text end
new text begin
(9) absence and utilization factor ratio: 3.9 percent.
new text end
deleted text begin (h)deleted text end new text begin (k) new text end Component values for unit-based services without programming for respite are:
(1) competitive workforce factor: 4.7 percent;
(2) supervisory span of control ratio: 11 percent;
(3) employee vacation, sick, and training allowance ratio: 8.71 percent;
(4) employee-related cost ratio: 23.6 percent;
(5) general administrative support ratio: 13.25 percent;
(6) program-related expense ratio: 2.9 percent; and
(7) absence and utilization factor ratio: 3.9 percent.
deleted text begin (i)deleted text end new text begin (l)new text end On July 1, 2022, and every two years thereafter, the commissioner shall update
the base wage index in paragraph (a) based on wage data by SOC from the Bureau of Labor
Statistics available 30 months and one day prior to the scheduled update. The commissioner
shall publish these updated values and load them into the rate management system.
deleted text begin (j)deleted text end new text begin (m)new text end Beginning February 1, 2021, and every two years thereafter, the commissioner
shall report to the chairs and ranking minority members of the legislative committees and
divisions with jurisdiction over health and human services policy and finance an analysis
of the competitive workforce factor. The report must include recommendations to update
the competitive workforce factor using:
(1) the most recently available wage data by SOC code for the weighted average wage
for direct care staff for residential services and direct care staff for day services;
(2) the most recently available wage data by SOC code of the weighted average wage
of comparable occupations; and
(3) workforce data as required under subdivision 10a, paragraph (g).
The commissioner shall not recommend an increase or decrease of the competitive workforce
factor from the current value by more than two percentage points. If, after a biennial analysis
for the next report, the competitive workforce factor is less than or equal to zero, the
commissioner shall recommend a competitive workforce factor of zero.
deleted text begin (k)deleted text end new text begin (n)new text end On July 1, 2022, and every two years thereafter, the commissioner shall update
the framework components in paragraph (d), clause (6); paragraph (e), clause (6); paragraph
(f), clause (6); and paragraph (g), clause (6); new text begin paragraph (h), clause (6); paragraph (i), clause
(6); paragraph (j), clause (6); new text end subdivision 6, paragraphs (b), clauses (9) and (10), and (e),
clause (10); and subdivision 7, clauses (11), (17), and (18), for changes in the Consumer
Price Index. The commissioner shall adjust these values higher or lower by the percentage
change in the CPI-U from the date of the previous update to the data available 30 months
and one day prior to the scheduled update. The commissioner shall publish these updated
values and load them into the rate management system.
deleted text begin (l)deleted text end new text begin (o)new text end Upon the implementation of the updates under paragraphs deleted text begin (i) and (k)deleted text end new text begin (l) and (n)new text end ,
rate adjustments authorized under section 256B.439, subdivision 7; Laws 2013, chapter
108, article 7, section 60; and Laws 2014, chapter 312, article 27, section 75, shall be
removed from service rates calculated under this section.
deleted text begin (m)deleted text end new text begin (p)new text end Any rate adjustments applied to the service rates calculated under this section
outside of the cost components and rate methodology specified in this section shall be
removed from rate calculations upon implementation of the updates under paragraphs deleted text begin (i)
and (k)deleted text end new text begin (l) and (n)new text end .
deleted text begin (n)deleted text end new text begin (q)new text end In this subdivision, if Bureau of Labor Statistics occupational codes or Consumer
Price Index items are unavailable in the future, the commissioner shall recommend to the
legislature codes or items to update and replace missing component values.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, six months after the
end of the federal public health emergency, or upon federal approval, whichever is later.
The commissioner of human services shall notify the revisor of statutes when the federal
public health emergency ends and when federal approval is obtained.
new text end
Sec. 36.
Minnesota Statutes 2020, section 256B.4914, subdivision 6, is amended to read:
Subd. 6.
Payments for residential support services.
(a) For purposes of this subdivision,
residential support services includes 24-hour customized living services, community
residential services, customized living services, family residential services, foster care
services, integrated community supports, and supportive living services daily.
(b) Payments for community residential services, corporate foster care services, corporate
supportive living services daily, family residential services, and family foster care services
must be calculated as follows:
(1) determine the number of shared staffing and individual direct staff hours to meet a
recipient's needs provided on site or through monitoring technology;
(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5;
(3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (2) by the product of one plus the competitive workforce factor in subdivision
5, paragraph (b), clause (1);
(4) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (3);
(5) multiply the number of shared and individual direct staff hours provided on site or
through monitoring technology and nursing hours by the appropriate staff wages;
(6) multiply the number of shared and individual direct staff hours provided on site or
through monitoring technology and nursing hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (b), clause (2), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);
(7) combine the results of clauses (5) and (6), excluding any shared and individual direct
staff hours provided through monitoring technology, and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b),
clause (3). This is defined as the direct staffing cost;
(8) for employee-related expenses, multiply the direct staffing cost, excluding any shared
and individual direct staff hours provided through monitoring technology, by one plus the
employee-related cost ratio in subdivision 5, paragraph (b), clause (4);
(9) for client programming and supports, the commissioner shall add $2,179; and
(10) for transportation, if provided, the commissioner shall add $1,680, or $3,000 if
customized for adapted transport, based on the resident with the highest assessed need.
(c) The total rate must be calculated using the following steps:
(1) subtotal paragraph (b), clauses (8) to (10), and the direct staffing cost of any shared
and individual direct staff hours provided through monitoring technology that was excluded
in clause (8);
(2) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization ratio;
(3) divide the result of clause (1) by one minus the result of clause (2). This is the total
payment amount; and
(4) adjust the result of clause (3) by a factor to be determined by the commissioner to
adjust for regional differences in the cost of providing services.
(d) The payment methodology for customized living new text begin andnew text end , 24-hour customized living,
deleted text begin anddeleted text end deleted text begin residential caredeleted text end services must be the customized living tool. deleted text begin Revisions todeleted text end new text begin The
commissioner shall revisenew text end the customized living tool deleted text begin must be madedeleted text end to reflect the services
and activities unique to disability-related recipient needsnew text begin , adjust for regional differences in
the cost of providing services, and the rate adjustments described in section 256S.205.
Customized living and 24-hour customized living rates determined under this section shall
not include more than 24 hours of support in a daily unit. The commissioner shall establish
acuity-based input limits, based on case mix, for customized living and 24-hour customized
living rates determined under this sectionnew text end .
(e) Payments for integrated community support services must be calculated as follows:
(1) the base shared staffing deleted text begin shalldeleted text end new text begin mustnew text end be eight hours divided by the number of people
receiving support in the integrated community support setting;
(2) the individual staffing hours deleted text begin shalldeleted text end new text begin mustnew text end be the average number of direct support hours
provided directly to the service recipient;
(3) the personnel hourly wage rate must be based on the most recent Bureau of Labor
Statistics Minnesota-specific rates or rates derived by the commissioner as provided in
subdivision 5;
(4) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (3) by the product of one plus the competitive workforce factor in subdivision
5, paragraph (b), clause (1);
(5) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (4);
(6) multiply the number of shared and individual direct staff hours in clauses (1) and
(2) by the appropriate staff wages;
(7) multiply the number of shared and individual direct staff hours in clauses (1) and
(2) by the product of the supervisory span of control ratio in subdivision 5, paragraph (b),
clause (2), and the appropriate supervisory wage in subdivision 5, paragraph (a), clause
(21);
(8) combine the results of clauses (6) and (7) and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (b), clause
(3). This is defined as the direct staffing cost;
(9) for employee-related expenses, multiply the direct staffing cost by one plus the
employee-related cost ratio in subdivision 5, paragraph (b), clause (4); and
(10) for client programming and supports, the commissioner shall add $2,260.21 divided
by 365.
(f) The total rate must be calculated as follows:
(1) add the results of paragraph (e), clauses (9) and (10);
(2) add the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;
(3) divide the result of clause (1) by one minus the result of clause (2). This is the total
payment amount; and
(4) adjust the result of clause (3) by a factor to be determined by the commissioner to
adjust for regional differences in the cost of providing services.
deleted text begin
(g) The payment methodology for customized living and 24-hour customized living
deleted text end
deleted text begin
services must be the customized living tool. The commissioner shall revise the customized
deleted text end
deleted text begin
living tool to reflect the services and activities unique to disability-related recipient needs
deleted text end
deleted text begin
and adjust for regional differences in the cost of providing services.
deleted text end
deleted text begin (h)deleted text end new text begin (g)new text end The number of days authorized for all individuals enrolling in residential services
must include every day that services start and end.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, or upon federal approval,
whichever is later, except the fourth sentence of paragraph (d) is effective January 1, 2022.
The commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.
new text end
Sec. 37.
Minnesota Statutes 2020, section 256B.4914, subdivision 7, is amended to read:
Subd. 7.
Payments for day programs.
Payments for services with day programs
including adult day services, day treatment and habilitation, day support services,
prevocational services, and structured day services new text begin provided in person or remotely new text end must be
calculated as follows:
(1) determine the number of units of service and staffing ratio to meet a recipient's needs:
(i) the staffing ratios for the units of service provided to a recipient in a typical week
must be averaged to determine an individual's staffing ratio; and
(ii) the commissioner, in consultation with service providers, shall develop a uniform
staffing ratio worksheet to be used to determine staffing ratios under this subdivision;
(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5;
(3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (2) by the product of one plus the competitive workforce factor in subdivision
5, paragraph (d), clause (1);
(4) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (3);
(5) multiply the number of day program direct staff hours and nursing hours by the
appropriate staff wage;
(6) multiply the number of day direct staff hours by the product of the supervision span
of control ratio in subdivision 5, paragraph (d), clause (2), new text begin for in-person services or
subdivision 5, paragraph (e), clause (2), for remote services, new text end and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);
(7) combine the results of clauses (5) and (6), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph (d), clause
(3)new text begin , for in-person services or subdivision 5, paragraph (e), clause (3), for remote servicesnew text end .
This is defined as the direct staffing rate;
(8) for program plan support, multiply the result of clause (7) by one plus the program
plan support ratio in subdivision 5, paragraph (d), clause (5)new text begin , for in-person services or
subdivision 5, paragraph (e), clause (5), for remote servicesnew text end ;
(9) for employee-related expenses, multiply the result of clause (8) by one plus the
employee-related cost ratio in subdivision 5, paragraph (d), clause (4)new text begin , for in-person services
or subdivision 5, paragraph (e), clause (4), for remote servicesnew text end ;
(10) for client programming and supports, multiply the result of clause (9) by one plus
the client programming and support ratio in subdivision 5, paragraph (d), clause (6)new text begin , for
in-person services or subdivision 5, paragraph (e), clause (6), for remote servicesnew text end ;
(11) for program facility costs, add deleted text begin $19.30deleted text end new text begin $20.02new text end per week with consideration of staffing
ratios to meet individual needs;
(12) for adult day bath services, add $7.01 per 15 minute unit;
(13) this is the subtotal rate;
(14) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;
(15) divide the result of clause (13) by one minus the result of clause (14). This is the
total payment amount;
(16) adjust the result of clause (15) by a factor to be determined by the commissioner
to adjust for regional differences in the cost of providing services;
(17) for transportation provided as part of day training and habilitation for an individual
who does not require a lift, add:
(i) $10.50 for a trip between zero and ten miles for a nonshared ride in a vehicle without
a lift, $8.83 for a shared ride in a vehicle without a lift, and $9.25 for a shared ride in a
vehicle with a lift;
(ii) $15.75 for a trip between 11 and 20 miles for a nonshared ride in a vehicle without
a lift, $10.58 for a shared ride in a vehicle without a lift, and $11.88 for a shared ride in a
vehicle with a lift;
(iii) $25.75 for a trip between 21 and 50 miles for a nonshared ride in a vehicle without
a lift, $13.92 for a shared ride in a vehicle without a lift, and $16.88 for a shared ride in a
vehicle with a lift; or
(iv) $33.50 for a trip of 51 miles or more for a nonshared ride in a vehicle without a lift,
$16.50 for a shared ride in a vehicle without a lift, and $20.75 for a shared ride in a vehicle
with a lift;
(18) for transportation provided as part of day training and habilitation for an individual
who does require a lift, add:
(i) $19.05 for a trip between zero and ten miles for a nonshared ride in a vehicle with a
lift, and $15.05 for a shared ride in a vehicle with a lift;
(ii) $32.16 for a trip between 11 and 20 miles for a nonshared ride in a vehicle with a
lift, and $28.16 for a shared ride in a vehicle with a lift;
(iii) $58.76 for a trip between 21 and 50 miles for a nonshared ride in a vehicle with a
lift, and $58.76 for a shared ride in a vehicle with a lift; or
(iv) $80.93 for a trip of 51 miles or more for a nonshared ride in a vehicle with a lift,
and $80.93 for a shared ride in a vehicle with a lift.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, six months after the
end of the federal public health emergency, or upon federal approval, whichever is later.
The commissioner of human services shall notify the revisor of statutes when the federal
public health emergency ends and when federal approval is obtained.
new text end
Sec. 38.
Minnesota Statutes 2020, section 256B.4914, subdivision 8, is amended to read:
Subd. 8.
Payments for unit-based services with programming.
Payments for unit-based
services with programming, including employment exploration services, employment
development services, housing access coordination, individualized home supports with
family training, individualized home supports with training, in-home family support,
independent living skills training, and hourly supported living services provided to an
individual outside of any day or residential service plannew text begin provided in person or remotelynew text end
must be calculated as follows, unless the services are authorized separately under subdivision
6 or 7:
(1) determine the number of units of service to meet a recipient's needs;
(2) personnel hourly wage rate must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rates or rates derived by the commissioner as provided in subdivision
5;
(3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (2) by the product of one plus the competitive workforce factor in subdivision
5, paragraph deleted text begin (f)deleted text end new text begin (g)new text end , clause (1);
(4) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (3);
(5) multiply the number of direct staff hours by the appropriate staff wage;
(6) multiply the number of direct staff hours by the product of the supervision span of
control ratio in subdivision 5, paragraph deleted text begin (f)deleted text end new text begin (g)new text end , clause (2), new text begin for in-person services or
subdivision 5, paragraph (h), clause (2), for remote services, new text end and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);
(7) combine the results of clauses (5) and (6), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph deleted text begin (f)deleted text end new text begin (g)new text end ,
clause (3)new text begin , for in-person services or subdivision 5, paragraph (h), clause (3), for remote
servicesnew text end . This is defined as the direct staffing rate;
(8) for program plan support, multiply the result of clause (7) by one plus the program
plan supports ratio in subdivision 5, paragraph deleted text begin (f)deleted text end new text begin (g)new text end , clause (5)new text begin , for in-person services or
subdivision 5, paragraph (h), clause (5), for remote servicesnew text end ;
(9) for employee-related expenses, multiply the result of clause (8) by one plus the
employee-related cost ratio in subdivision 5, paragraph deleted text begin (f)deleted text end new text begin (g)new text end , clause (4)new text begin , for in-person
services or subdivision 5, paragraph (h), clause (4), for remote servicesnew text end ;
(10) for client programming and supports, multiply the result of clause (9) by one plus
the client programming and supports ratio in subdivision 5, paragraph deleted text begin (f)deleted text end new text begin (g)new text end , clause (6)new text begin ,
for in-person services or subdivision 5, paragraph (h), clause (6), for remote servicesnew text end ;
(11) this is the subtotal rate;
(12) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;
(13) divide the result of clause (11) by one minus the result of clause (12). This is the
total payment amount;
(14) for employment exploration services provided in a shared manner, divide the total
payment amount in clause (13) by the number of service recipients, not to exceed five. For
employment support services provided in a shared manner, divide the total payment amount
in clause (13) by the number of service recipients, not to exceed six. For independent living
skills trainingdeleted text begin , individualized home supports with training,deleted text end and individualized home supports
with family training provided in a shared manner, divide the total payment amount in clause
(13) by the number of service recipients, not to exceed twonew text begin . For individualized home supports
with training, provided in a shared manner, including for a day unit of individualized home
supports with training provided in a shared manner, divide the total payment amount in
clause (13) by the number of service recipients, not to exceed threenew text end ; and
(15) adjust the result of clause (14) by a factor to be determined by the commissioner
to adjust for regional differences in the cost of providing services.
new text begin EFFECTIVE DATE. new text end
new text begin
(a) Except for the amendment to clause (14), this section is
effective January 1, 2022, six months after the end of the federal public health emergency,
or upon federal approval, whichever is later. The commissioner of human services shall
notify the revisor of statutes when the federal public health emergency ends and when
federal approval is obtained.
new text end
new text begin
(b) The amendment to clause (14) is effective January 1, 2022, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 39.
Minnesota Statutes 2020, section 256B.4914, subdivision 9, is amended to read:
Subd. 9.
Payments for unit-based services without programming.
Payments for
unit-based services without programming, including individualized home supports, night
supervision, personal support, respite, and companion care provided to an individual outside
of any day or residential service plannew text begin provided in person or remotelynew text end must be calculated as
follows unless the services are authorized separately under subdivision 6 or 7:
(1) for all services except respite, determine the number of units of service to meet a
recipient's needs;
(2) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;
(3) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (2) by the product of one plus the competitive workforce factor in subdivision
5, paragraph deleted text begin (g)deleted text end new text begin (i)new text end , clause (1);
(4) for a recipient requiring customization for deaf and hard-of-hearing language
accessibility under subdivision 12, add the customization rate provided in subdivision 12
to the result of clause (3);
(5) multiply the number of direct staff hours by the appropriate staff wage;
(6) multiply the number of direct staff hours by the product of the supervision span of
control ratio in subdivision 5, paragraph deleted text begin (g)deleted text end new text begin (i)new text end , clause (2), new text begin for in-person services or
subdivision 5, paragraph (j), clause (2), for remote services, new text end and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);
(7) combine the results of clauses (5) and (6), and multiply the result by one plus the
employee vacation, sick, and training allowance ratio in subdivision 5, paragraph deleted text begin (g)deleted text end new text begin (i)new text end ,
clause (3)new text begin , for in-person services or subdivision 5, paragraph (j), clause (3), for remote
servicesnew text end . This is defined as the direct staffing rate;
(8) for program plan support, multiply the result of clause (7) by one plus the program
plan support ratio in subdivision 5, paragraph deleted text begin (g)deleted text end new text begin (i)new text end , clause (5)new text begin , for in-person services or
subdivision 5, paragraph (j), clause (5), for remote servicesnew text end ;
(9) for employee-related expenses, multiply the result of clause (8) by one plus the
employee-related cost ratio in subdivision 5, paragraph deleted text begin (g)deleted text end new text begin (i)new text end , clause (4)new text begin , for in-person
services or subdivision 5, paragraph (j), clause (4), for remote servicesnew text end ;
(10) for client programming and supports, multiply the result of clause (9) by one plus
the client programming and support ratio in subdivision 5, paragraph deleted text begin (g)deleted text end new text begin (i)new text end , clause (6)new text begin , for
in-person services or subdivision 5, paragraph (j), clause (6), for remote servicesnew text end ;
(11) this is the subtotal rate;
(12) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;
(13) divide the result of clause (11) by one minus the result of clause (12). This is the
total payment amount;
(14) for respite services, determine the number of day units of service to meet an
individual's needs;
(15) personnel hourly wage rates must be based on the 2009 Bureau of Labor Statistics
Minnesota-specific rate or rates derived by the commissioner as provided in subdivision 5;
(16) except for subdivision 5, paragraph (a), clauses (4) and (21) to (23), multiply the
result of clause (15) by the product of one plus the competitive workforce factor in
subdivision 5, paragraph deleted text begin (h)deleted text end new text begin (k)new text end , clause (1);
(17) for a recipient requiring deaf and hard-of-hearing customization under subdivision
12, add the customization rate provided in subdivision 12 to the result of clause (16);
(18) multiply the number of direct staff hours by the appropriate staff wage;
(19) multiply the number of direct staff hours by the product of the supervisory span of
control ratio in subdivision 5, paragraph deleted text begin (h)deleted text end new text begin (k)new text end , clause (2), and the appropriate supervision
wage in subdivision 5, paragraph (a), clause (21);
(20) combine the results of clauses (18) and (19), and multiply the result by one plus
the employee vacation, sick, and training allowance ratio in subdivision 5, paragraph deleted text begin (h)deleted text end new text begin
(k)new text end , clause (3). This is defined as the direct staffing rate;
(21) for employee-related expenses, multiply the result of clause (20) by one plus the
employee-related cost ratio in subdivision 5, paragraph deleted text begin (h)deleted text end new text begin (k)new text end , clause (4);
(22) this is the subtotal rate;
(23) sum the standard general and administrative rate, the program-related expense ratio,
and the absence and utilization factor ratio;
(24) divide the result of clause (22) by one minus the result of clause (23). This is the
total payment amount;
(25) for individualized home supports provided in a shared manner, divide the total
payment amount in clause (13) by the number of service recipients, not to exceed two;
(26) for respite care services provided in a shared manner, divide the total payment
amount in clause (24) by the number of service recipients, not to exceed three; and
(27) adjust the result of clauses (13), (25), and (26) by a factor to be determined by the
commissioner to adjust for regional differences in the cost of providing services.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2022, six months after the
end of the federal public health emergency, or upon federal approval, whichever is later.
The commissioner of human services shall notify the revisor of statutes when the federal
public health emergency ends and when federal approval is obtained.
new text end
Sec. 40.
Minnesota Statutes 2020, section 256B.5012, is amended by adding a subdivision
to read:
new text begin Subd. 18. new text end
new text begin ICF/DD rate increases effective July 1, 2021. new text end
new text begin
(a) For the rate period beginning
July 1, 2021, the commissioner must increase operating payments for each facility reimbursed
under this section equal to five percent of the operating payment rates in effect on June 30,
2021.
new text end
new text begin
(b) For each facility, the commissioner must apply the rate increase based on occupied
beds, using the percentage specified in this subdivision multiplied by the total payment rate,
including the variable rate but excluding the property-related payment rate in effect on June
30, 2021. The total rate increase must include the adjustment provided in section 256B.501,
subdivision 12.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, or upon federal approval,
whichever is later. The commissioner of human services shall inform the revisor of statutes
when federal approval is obtained.
new text end
Sec. 41.
Minnesota Statutes 2020, section 256B.5013, subdivision 1, is amended to read:
Subdivision 1.
Variable rate adjustments.
(a) deleted text begin For rate years beginning on or after
October 1, 2000,deleted text end When there is a documented increase in the needs of a current ICF/DD
recipient, the county of financial responsibility may recommend a variable rate to enable
the facility to meet the individual's increased needs. Variable rate adjustments made under
this subdivision replace payments for persons with special needs for crisis intervention
services under section 256B.501, subdivision 8a. deleted text begin Effective July 1, 2003, facilities with a
base rate above the 50th percentile of the statewide average reimbursement rate for a Class
A facility or Class B facility, whichever matches the facility licensure, are not eligible for
a variable rate adjustment. Variable rate adjustments may not exceed a 12-month period,
except when approved for purposes established in paragraph (b), clause (1).deleted text end new text begin Once approved,
variable rate adjustments must continue to remain in place unless there is an identified
change in need. A review of needed resources must be done at the time of the individual's
annual support plan meeting. Any change in need identified must result in submission of a
request to adjust the resources for the individual.new text end Variable rate adjustments approved solely
on the basis of changes on a developmental disabilities screening document will end June
30, 2002.
new text begin
(b) The county of financial responsibility must act on a variable rate request within 30
days and notify the initiator of the request of the county's recommendation in writing.
new text end
deleted text begin (b)deleted text end new text begin (c)new text end A variable rate may be recommended by the county of financial responsibility
for increased needs in the following situations:
(1) a need for resources due to an individual's full or partial retirement from participation
in a day training and habilitation service when the individual: (i) has reached the age of 65
or has a change in health condition that makes it difficult for the person to participate in
day training and habilitation services over an extended period of time because it is medically
contraindicated; and (ii) has expressed a desire for change through the developmental
disability screening process under section 256B.092;
(2) a need for additional resources for intensive short-term programming deleted text begin whichdeleted text end new text begin thatnew text end is
necessary prior to an individual's discharge to a less restrictive, more integrated setting;
(3) a demonstrated medical need that significantly impacts the type or amount of services
needed by the individual; deleted text begin or
deleted text end
(4) a demonstrated behavioralnew text begin or cognitivenew text end need that significantly impacts the type or
amount of services needed by the individualdeleted text begin .deleted text end new text begin ; or
new text end
deleted text begin
(c) The county of financial responsibility must justify the purpose, the projected length
of time, and the additional funding needed for the facility to meet the needs of the individual.
deleted text end
deleted text begin
(d) The facility shall provide an annual report to the county case manager on the use of
the variable rate funds and the status of the individual on whose behalf the funds were
approved. The county case manager will forward the facility's report with a recommendation
to the commissioner to approve or disapprove a continuation of the variable rate.
deleted text end
deleted text begin
(e) Funds made available through the variable rate process that are not used by the facility
to meet the needs of the individual for whom they were approved shall be returned to the
state.
deleted text end
new text begin
(5) a demonstrated increased need for staff assistance, changes in the type of staff
credentials needed, or a need for expert consultation based on assessments conducted prior
to the annual support plan meeting.
new text end
new text begin
(d) Variable rate requests must include the following information:
new text end
new text begin
(1) the service needs change;
new text end
new text begin
(2) the variable rate requested and the difference from the current rate;
new text end
new text begin
(3) a basis for the underlying costs used for the variable rate and any accompanying
documentation; and
new text end
new text begin
(4) documentation of the expected outcomes to be achieved and the frequency of progress
monitoring associated with the rate increase.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, or upon federal approval,
whichever is later. The commissioner of human services shall inform the revisor of statutes
when federal approval is obtained.
new text end
Sec. 42.
Minnesota Statutes 2020, section 256B.5013, subdivision 6, is amended to read:
Subd. 6.
Commissioner's responsibilities.
The commissioner shall:
(1) make a determination to approve, deny, or modify a request for a variable rate
adjustment within 30 days of the receipt of the completed application;
(2) notify the ICF/DD facility and county case manager of the deleted text begin duration and conditions
of variable rate adjustment approvalsdeleted text end new text begin determinationnew text end ; and
(3) modify MMIS II service agreements to reimburse ICF/DD facilities for approved
variable rates.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, or upon federal approval,
whichever is later. The commissioner of human services shall inform the revisor of statutes
when federal approval is obtained.
new text end
Sec. 43.
Minnesota Statutes 2020, section 256B.5015, subdivision 2, is amended to read:
Subd. 2.
Services during the day.
new text begin (a) new text end Services during the day, as defined in section
256B.501, but excluding day training and habilitation services, shall be paid as a pass-through
payment deleted text begin no later than January 1, 2004deleted text end . The commissioner shall establish rates for these
services, other than day training and habilitation services, at deleted text begin levels that do not exceed 75deleted text end new text begin
100new text end percent of a recipient's day training and habilitation service costs prior to the service
change.
new text begin
(b) An individual qualifies for services during the day under paragraph (a) if, through
consultation with the individual and the individual's support team or interdisciplinary team:
new text end
new text begin
(1) it has been determined that the individual's needs can best be met through partial or
full retirement from:
new text end
new text begin
(i) participation in a day training and habilitation service; or
new text end
new text begin
(ii) the use of services during the day in the individual's home environment; and
new text end
new text begin
(2) an individualized plan has been developed with designated outcomes that:
new text end
new text begin
(i) address the support needs and desires contained in the person-centered plan or
individual support plan; and
new text end
new text begin
(ii) include goals that focus on community integration as appropriate for the individual.
new text end
new text begin (c) new text end When establishing a rate for these services, the commissioner shall also consider an
individual recipient's needs as identified in the deleted text begin individualized servicedeleted text end new text begin individual supportnew text end
plan and the person's need for active treatment as defined under federal regulations. The
pass-through payments for services during the day shall be paid separately by the
commissioner and shall not be included in the computation of the ICF/DD facility total
payment rate.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, or upon federal approval,
whichever is later. The commissioner of human services shall inform the revisor of statutes
when federal approval is obtained.
new text end
Sec. 44.
Minnesota Statutes 2020, section 256B.85, subdivision 7a, is amended to read:
Subd. 7a.
Enhanced rate.
An enhanced rate of 107.5 percent of the rate paid for CFSS
must be paid for services provided to persons who qualify for deleted text begin 12deleted text end new text begin tennew text end or more hours of CFSS
per day when provided by a support worker who meets the requirements of subdivision 16,
paragraph (e). The enhanced rate for CFSS includes, and is not in addition to, any rate
adjustments implemented by the commissioner on July 1, 2019, to comply with the terms
of a collective bargaining agreement between the state of Minnesota and an exclusive
representative of individual providers under section 179A.54 that provides for wage increases
for individual providers who serve participants assessed to need 12 or more hours of CFSS
per day.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, or upon federal approval,
whichever occurs later. The commissioner shall notify the revisor of statutes when federal
approval is obtained.
new text end
Sec. 45.
Minnesota Statutes 2020, section 256B.85, subdivision 16, is amended to read:
Subd. 16.
Support workers requirements.
(a) Support workers shall:
(1) enroll with the department as a support worker after a background study under chapter
245C has been completed and the support worker has received a notice from the
commissioner that the support worker:
(i) is not disqualified under section 245C.14; or
(ii) is disqualified, but has received a set-aside of the disqualification under section
245C.22;
(2) have the ability to effectively communicate with the participant or the participant's
representative;
(3) have the skills and ability to provide the services and supports according to the
participant's CFSS service delivery plan and respond appropriately to the participant's needs;
(4) complete the basic standardized CFSS training as determined by the commissioner
before completing enrollment. The training must be available in languages other than English
and to those who need accommodations due to disabilities. CFSS support worker training
must include successful completion of the following training components: basic first aid,
vulnerable adult, child maltreatment, OSHA universal precautions, basic roles and
responsibilities of support workers including information about basic body mechanics,
emergency preparedness, orientation to positive behavioral practices, orientation to
responding to a mental health crisis, fraud issues, time cards and documentation, and an
overview of person-centered planning and self-direction. Upon completion of the training
components, the support worker must pass the certification test to provide assistance to
participants;
(5) complete employer-directed training and orientation on the participant's individual
needs;
(6) maintain the privacy and confidentiality of the participant; and
(7) not independently determine the medication dose or time for medications for the
participant.
(b) The commissioner may deny or terminate a support worker's provider enrollment
and provider number if the support worker:
(1) does not meet the requirements in paragraph (a);
(2) fails to provide the authorized services required by the employer;
(3) has been intoxicated by alcohol or drugs while providing authorized services to the
participant or while in the participant's home;
(4) has manufactured or distributed drugs while providing authorized services to the
participant or while in the participant's home; or
(5) has been excluded as a provider by the commissioner of human services, or by the
United States Department of Health and Human Services, Office of Inspector General, from
participation in Medicaid, Medicare, or any other federal health care program.
(c) A support worker may appeal in writing to the commissioner to contest the decision
to terminate the support worker's provider enrollment and provider number.
(d) A support worker must not provide or be paid for more than 310 hours of CFSS per
month, regardless of the number of participants the support worker serves or the number
of agency-providers or participant employers by which the support worker is employed.
The department shall not disallow the number of hours per day a support worker works
unless it violates other law.
(e) CFSS qualify for an enhanced rate if the support worker providing the services:
(1) provides services, within the scope of CFSS described in subdivision 7, to a participant
who qualifies for deleted text begin 12deleted text end new text begin tennew text end or more hours per day of CFSS; and
(2) satisfies the current requirements of Medicare for training and competency or
competency evaluation of home health aides or nursing assistants, as provided in the Code
of Federal Regulations, title 42, section 483.151 or 484.36, or alternative state-approved
training or competency requirements.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021, or upon federal approval,
whichever occurs later. The commissioner shall notify the revisor of statutes when federal
approval is obtained.
new text end
Sec. 46.
Minnesota Statutes 2020, section 256B.85, is amended by adding a subdivision
to read:
new text begin Subd. 27. new text end
new text begin
Personal care assistance and community first services and supports
provider agency; required reporting and analysis of cost data.
new text end
new text begin
(a) The commissioner
must evaluate on an ongoing basis whether the rates paid for personal care assistance and
community first services and supports appropriately address the costs to provide these
services. The commissioner must make recommendations to adjust the rates paid as indicated
by the evaluation. As determined by the commissioner, in consultation with stakeholders,
agencies enrolled to provide personal care assistance and community first services and
supports with rates determined under this section must submit requested cost data to the
commissioner. Requested cost data may include but is not limited to:
new text end
new text begin
(1) worker wage costs;
new text end
new text begin
(2) benefits paid;
new text end
new text begin
(3) supervisor wage costs;
new text end
new text begin
(4) executive wage costs;
new text end
new text begin
(5) vacation, sick, and training time paid;
new text end
new text begin
(6) taxes, workers' compensation, and unemployment insurance costs paid;
new text end
new text begin
(7) administrative costs paid;
new text end
new text begin
(8) program costs paid;
new text end
new text begin
(9) transportation costs paid;
new text end
new text begin
(10) vacancy rates; and
new text end
new text begin
(11) other data relating to costs necessary to provide services requested by the
commissioner.
new text end
new text begin
(b) At least once in any three-year period, a provider must submit cost data for a fiscal
year that ended not more than 18 months prior to the submission date. The commissioner
shall give each provider notice 90 days prior to the submission due date. If a provider fails
to submit the required reporting data, the commissioner shall provide notice to the provider
30 days after the required submission date, and a second notice to a provider who fails to
submit the required data 60 days after the required submission date. The commissioner shall
temporarily suspend payments to a provider if the provider fails to submit cost data within
90 days after the required submission date. The commissioner shall make withheld payments
to the provider once the commissioner receives cost data from the provider.
new text end
new text begin
(c) The commissioner shall conduct a random validation of data submitted under
paragraph (a) to ensure data accuracy.
new text end
new text begin
(d) The commissioner, in consultation with stakeholders, shall develop and implement
a process for providing training and technical assistance necessary to support provider
submission of cost documentation required under paragraph (a). The commissioner shall
provide dedicated support for providers who meet one of the following criteria:
new text end
new text begin
(1) the provider employs fewer than ten staff to provide the services under this section;
new text end
new text begin
(2) the provider's first language is not English; or
new text end
new text begin
(3) the provider serves a population that includes greater than or equal to 50 percent
black people, Indigenous people, or people of color.
new text end
Sec. 47.
Minnesota Statutes 2020, section 256B.85, is amended by adding a subdivision
to read:
new text begin Subd. 28. new text end
new text begin Payment rates evaluation. new text end
new text begin
(a) The commissioner shall assess data collected
under subdivision 27 and shall publish evaluation findings in a report to the legislature on
August 1, 2024, and once every two years thereafter. Evaluation findings shall include:
new text end
new text begin
(1) the costs that providers incur while providing services under this section;
new text end
new text begin
(2) comparisons between those costs and the costs incurred by providers of comparable
services and employers in industries competing in the same labor market;
new text end
new text begin
(3) changes in wages, benefits provided, hours worked, and retention over time; and
new text end
new text begin
(4) recommendations for the rate methodologies paid based on the evaluation findings.
new text end
new text begin
(b) The commissioner shall only release cost data in an aggregate form and shall not
release cost data from individual providers except as permitted by current law.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 48.
Minnesota Statutes 2020, section 256I.04, subdivision 3, is amended to read:
Subd. 3.
Moratorium on development of housing support beds.
(a) Agencies shall
not enter into agreements for new housing support beds with total rates in excess of the
MSA equivalent rate except:
(1) for establishments licensed under chapter 245D provided the facility is needed to
meet the census reduction targets for persons with developmental disabilities at regional
treatment centers;
(2) up to 80 beds in a single, specialized facility located in Hennepin County that will
provide housing for chronic inebriates who are repetitive users of detoxification centers and
are refused placement in emergency shelters because of their state of intoxication, and
planning for the specialized facility must have been initiated before July 1, 1991, in
anticipation of receiving a grant from the Housing Finance Agency under section 462A.05,
subdivision 20a, paragraph (b);
(3) notwithstanding the provisions of subdivision 2a, for up to 226 supportive housing
units in Anoka, Dakota, Hennepin, or Ramsey County for homeless adults with a mental
illness, a history of substance abuse, or human immunodeficiency virus or acquired
immunodeficiency syndrome. For purposes of this section, "homeless adult" means a person
who is living on the street or in a shelter or discharged from a regional treatment center,
community hospital, or residential treatment program and has no appropriate housing
available and lacks the resources and support necessary to access appropriate housing. At
least 70 percent of the supportive housing units must serve homeless adults with mental
illness, substance abuse problems, or human immunodeficiency virus or acquired
immunodeficiency syndrome who are about to be or, within the previous six months, have
been discharged from a regional treatment center, or a state-contracted psychiatric bed in
a community hospital, or a residential mental health or chemical dependency treatment
program. If a person meets the requirements of subdivision 1, paragraph (a), and receives
a federal or state housing subsidy, the housing support rate for that person is limited to the
supplementary rate under section 256I.05, subdivision 1a, and is determined by subtracting
the amount of the person's countable income that exceeds the MSA equivalent rate from
the housing support supplementary service rate. A resident in a demonstration project site
who no longer participates in the demonstration program shall retain eligibility for a housing
support payment in an amount determined under section 256I.06, subdivision 8, using the
MSA equivalent rate. Service funding under section 256I.05, subdivision 1a, will end June
30, 1997, if federal matching funds are available and the services can be provided through
a managed care entity. If federal matching funds are not available, then service funding will
continue under section 256I.05, subdivision 1a;
(4) for an additional two beds, resulting in a total of 32 beds, for a facility located in
Hennepin County providing services for recovering and chemically dependent men that has
had a housing support contract with the county and has been licensed as a board and lodge
facility with special services since 1980;
(5) for a housing support provider located in the city of St. Cloud, or a county contiguous
to the city of St. Cloud, that operates a 40-bed facility, that received financing through the
Minnesota Housing Finance Agency Ending Long-Term Homelessness Initiative and serves
chemically dependent clientele, providing 24-hour-a-day supervision;
(6) for a new 65-bed facility in Crow Wing County that will serve chemically dependent
persons, operated by a housing support provider that currently operates a 304-bed facility
in Minneapolis, and a 44-bed facility in Duluth;
(7) for a housing support provider that operates two ten-bed facilities, one located in
Hennepin County and one located in Ramsey County, that provide community support and
24-hour-a-day supervision to serve the mental health needs of individuals who have
chronically lived unsheltered; deleted text begin and
deleted text end
(8) for a facility authorized for recipients of housing support in Hennepin County with
a capacity of up to 48 beds that has been licensed since 1978 as a board and lodging facility
and that until August 1, 2007, operated as a licensed chemical dependency treatment
programdeleted text begin .deleted text end new text begin ;
new text end
new text begin
(9) for an additional 42 beds, resulting in a total of 54 beds, for a recovery community
organization and housing support provider that currently operates a 38-bed facility in Olmsted
County serving individuals diagnosed with substance use disorder, originally licensed and
registered by the Department of Health under section 157.17 in 2019, and will operate a
new 14-bed facility in Olmsted County serving individuals diagnosed with substance use
disorder; and
new text end
new text begin
(10) for 46 beds for a recovery community organization and housing support provider
that as of March 1, 2021, operates three facilities in Blue Earth County licensed and registered
by the Department of Health under section 157.17, serving individuals diagnosed with
substance use disorder.
new text end
(b) An agency may enter into a housing support agreement for beds with rates in excess
of the MSA equivalent rate in addition to those currently covered under a housing support
agreement if the additional beds are only a replacement of beds with rates in excess of the
MSA equivalent rate which have been made available due to closure of a setting, a change
of licensure or certification which removes the beds from housing support payment, or as
a result of the downsizing of a setting authorized for recipients of housing support. The
transfer of available beds from one agency to another can only occur by the agreement of
both agencies.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 49.
Minnesota Statutes 2020, section 256I.05, subdivision 1a, is amended to read:
Subd. 1a.
Supplementary service rates.
(a) Subject to the provisions of section 256I.04,
subdivision 3, the deleted text begin countydeleted text end agency may negotiate a payment not to exceed $426.37 for other
services necessary to provide room and board if the residence is licensed by or registered
by the Department of Health, or licensed by the Department of Human Services to provide
services in addition to room and board, and if the provider of services is not also concurrently
receiving funding for services for a recipient under a home and community-based waiver
under title XIX of the new text begin federal new text end Social Security Act; or funding from the medical assistance
program under section 256B.0659, for personal care services for residents in the setting; or
residing in a setting which receives funding under section 245.73. If funding is available
for other necessary services through a home and community-based waiver, or personal care
services under section 256B.0659, then the housing support rate is limited to the rate set in
subdivision 1. Unless otherwise provided in law, in no case may the supplementary service
rate exceed $426.37. The registration and licensure requirement does not apply to
establishments which are exempt from state licensure because they are located on Indian
reservations and for which the tribe has prescribed health and safety requirements. Service
payments under this section may be prohibited under rules to prevent the supplanting of
federal funds with state funds. The commissioner shall pursue the feasibility of obtaining
the approval of the Secretary of Health and Human Services to provide home and
community-based waiver services under title XIX of the new text begin federal new text end Social Security Act for
residents who are not eligible for an existing home and community-based waiver due to a
primary diagnosis of mental illness or chemical dependency and shall apply for a waiver if
it is determined to be cost-effective.
(b) The commissioner is authorized to make cost-neutral transfers from the housing
support fund for beds under this section to other funding programs administered by the
department after consultation with the deleted text begin county or countiesdeleted text end new text begin agencynew text end in which the affected beds
are located. The commissioner may also make cost-neutral transfers from the housing support
fund to deleted text begin county human servicedeleted text end agencies for beds permanently removed from the housing
support census under a plan submitted by the deleted text begin countydeleted text end agency and approved by the
commissioner. The commissioner shall report the amount of any transfers under this provision
annually to the legislature.
(c) deleted text begin Countiesdeleted text end new text begin Agenciesnew text end must not negotiate supplementary service rates with providers of
housing support that are licensed as board and lodging with special services and that do not
encourage a policy of sobriety on their premises and make referrals to available community
services for volunteer and employment opportunities for residents.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 50.
Minnesota Statutes 2020, section 256I.05, subdivision 1c, is amended to read:
Subd. 1c.
Rate increases.
An agency may not increase the rates negotiated for housing
support above those in effect on June 30, 1993, except as provided in paragraphs (a) to (f).
(a) An agency may increase the rates for room and board to the MSA equivalent rate
for those settings whose current rate is below the MSA equivalent rate.
(b) An agency may increase the rates for residents in adult foster care whose difficulty
of care has increased. The total housing support rate for these residents must not exceed the
maximum rate specified in subdivisions 1 and 1a. Agencies must not include nor increase
difficulty of care rates for adults in foster care whose difficulty of care is eligible for funding
by home and community-based waiver programs under title XIX of the Social Security Act.
(c) new text begin An agency must increase new text end the room and board rates deleted text begin will be increaseddeleted text end each year when
the MSA equivalent rate is adjusted for SSI cost-of-living increases by the amount of the
annual SSI increase, less the amount of the increase in the medical assistance personal needs
allowance under section 256B.35.
(d) deleted text begin When housing support pays for an individual's room and board, or other costs
necessary to provide room and board, the rate payable to the residence must continue for
up to 18 calendar days per incident that the person is temporarily absent from the residence,
not to exceed 60 days in a calendar year, if the absence or absences are reported in advance
to the county agency's social service staff. Advance reporting is not required for emergency
absences due to crisis, illness, or injury.
deleted text end
deleted text begin (e) Fordeleted text end new text begin An agency may increase the rates for residents innew text end facilities meeting substantial
change criteria within the prior year. Substantial change criteria deleted text begin existsdeleted text end new text begin existnew text end if the
establishment experiences a 25 percent increase or decrease in the total number of its beds,
if the net cost of capital additions or improvements is in excess of 15 percent of the current
market value of the residence, or if the residence physically moves, or changes its licensure,
and incurs a resulting increase in operation and property costs.
deleted text begin (f)deleted text end new text begin (e)new text end Until June 30, 1994, an agency may increase by up to five percent the total rate
paid for recipients of assistance under sections 256D.01 to 256D.21 or 256D.33 to 256D.54
who reside in residences that are licensed by the commissioner of health as a boarding care
home, but are not certified for the purposes of the medical assistance program. However,
an increase under this clause must not exceed an amount equivalent to 65 percent of the
1991 medical assistance reimbursement rate for nursing home resident class A, in the
geographic grouping in which the facility is located, as established under Minnesota Rules,
parts 9549.0051 to 9549.0058.
new text begin
(f) Notwithstanding the provisions of subdivision 1, an agency may increase the monthly
room and board rates by $100 per month for residents in settings under section 256I.04,
subdivision 2a, paragraph (b), clause (2). Participants in the Minnesota supportive housing
demonstration program under section 256I.04, subdivision 3, paragraph (a), clause (3), may
not receive the increase under this paragraph.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2022, except the striking of
paragraph (d) is effective July 1, 2021.
new text end
Sec. 51.
Minnesota Statutes 2020, section 256I.05, subdivision 1q, is amended to read:
Subd. 1q.
Supplemental rate; Olmsted County.
new text begin (a) new text end Notwithstanding the provisions of
subdivisions 1a and 1c, beginning July 1, 2017, a county agency shall negotiate a
supplementary rate in addition to the rate specified in subdivision 1, not to exceed $750 per
month, including any legislatively authorized inflationary adjustments, for a housing support
provider located in Olmsted County that operates long-term residential facilities with a total
of 104 beds that serve chemically dependent men and women and provide 24-hour-a-day
supervision and other support services.
new text begin
(b) Notwithstanding the provisions of subdivisions 1a and 1c, beginning July 1, 2021,
a county agency shall negotiate a supplemental service rate for 54 total beds in addition to
the rate specified in subdivision 1, not to exceed the maximum rate allowed under subdivision
1a, including any legislatively authorized inflationary adjustments, for a recovery community
organization and housing support provider located in Olmsted County serving individuals
diagnosed with substance use disorder, originally licensed and registered by the Department
of Health under section 157.17 in 2019.
new text end
Sec. 52.
Minnesota Statutes 2020, section 256I.05, is amended by adding a subdivision
to read:
new text begin Subd. 1s. new text end
new text begin Supplemental rate; Douglas County. new text end
new text begin
Notwithstanding subdivisions 1a and
1c, beginning July 1, 2021, a county agency shall negotiate a supplemental rate for up to
20 beds in addition to the rate specified in subdivision 1, not to exceed the maximum rate
allowed under subdivision 1a, including any legislatively authorized inflationary adjustments,
for a housing support provider located in Douglas County that operates two facilities and
provides room and board and supplementary services to adult males recovering from
substance use disorder, mental illness, or housing instability.
new text end
Sec. 53.
Minnesota Statutes 2020, section 256I.05, is amended by adding a subdivision
to read:
new text begin Subd. 1t. new text end
new text begin Supplementary services rate; Winona County. new text end
new text begin
Notwithstanding the
provisions of subdivisions 1a and 1c, beginning July 1, 2021, a county agency shall negotiate
a supplementary services rate in addition to the monthly room and board rate specified in
subdivision 1, not to exceed $750 per month, including any legislatively authorized
inflationary adjustments, for a housing support provider located in Winona County that
operates a permanent supportive housing facility with 20 one-bedroom apartments for adults
with long-term homeless and long-term mental health needs.
new text end
Sec. 54.
Minnesota Statutes 2020, section 256I.05, is amended by adding a subdivision
to read:
new text begin Subd. 1u. new text end
new text begin Supplemental rate; Blue Earth County. new text end
new text begin
Notwithstanding the provisions of
subdivisions 1a and 1c, beginning July 1, 2021, a county agency shall negotiate a
supplemental service rate for 46 beds in addition to the rate specified in subdivision 1, not
to exceed the maximum rate allowed under subdivision 1a, including any legislatively
authorized inflationary adjustments, for a recovery community organization and housing
support provider that as of March 1, 2021, operates three facilities in Blue Earth County
licensed and registered by the Department of Health under section 157.17, serving individuals
diagnosed with substance use disorder.
new text end
Sec. 55.
Minnesota Statutes 2020, section 256I.05, is amended by adding a subdivision
to read:
new text begin Subd. 1v. new text end
new text begin Supplementary services rate; Steele County. new text end
new text begin
Notwithstanding the provisions
of subdivisions 1a and 1c, beginning July 1, 2021, a county agency shall negotiate a
supplementary services rate in addition to the monthly room and board rate specified in
subdivision 1, not to exceed $750 per month, including any legislatively authorized
inflationary adjustments, for a housing support provider located in Steele County that
operates a permanent supportive housing facility with 16 units for adults with long-term
homeless and long-term mental health needs.
new text end
Sec. 56.
Minnesota Statutes 2020, section 256I.05, is amended by adding a subdivision
to read:
new text begin Subd. 2a. new text end
new text begin Absent days. new text end
new text begin
(a) When a person receiving housing support is temporarily
absent and the absence is reported in advance to the agency's social service staff, the agency
must continue to pay on behalf of the person the applicable rate for housing support. Advance
reporting is not required for absences due to crisis, illness, or injury. The limit on payments
for absence days under this paragraph is 18 calendar days per incident, not to exceed 60
days in a calendar year.
new text end
new text begin
(b) An agency must continue to pay an additional 74 days per incident, not to exceed a
total of 92 days in a calendar year, for a person who is temporarily absent due to admission
at a residential behavioral health facility, inpatient hospital, or nursing facility.
new text end
new text begin
(c) If a person is temporarily absent due to admission at a residential behavioral health
facility, inpatient hospital, or nursing facility for a period of time exceeding the limits
described in paragraph (b), the agency may request in a format prescribed by the
commissioner an absence day limit exception to continue housing support payments until
the person is discharged.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 57.
Minnesota Statutes 2020, section 256I.05, subdivision 11, is amended to read:
Subd. 11.
Transfer of emergency shelter funds.
(a) The commissioner shall make a
cost-neutral transfer of funding from the housing support fund to deleted text begin county human service
agenciesdeleted text end new text begin the agencynew text end for emergency shelter beds removed from the housing support census
under a biennial plan submitted by the deleted text begin countydeleted text end new text begin agencynew text end and approved by the commissioner.
The plan must describe: (1) anticipated and actual outcomes for persons experiencing
homelessness in emergency shelters; (2) improved efficiencies in administration; (3)
requirements for individual eligibility; and (4) plans for quality assurance monitoring and
quality assurance outcomes. The commissioner shall review the deleted text begin countydeleted text end new text begin agencynew text end plan to
monitor implementation and outcomes at least biennially, and more frequently if the
commissioner deems necessary.
(b) The funding under paragraph (a) may be used for the provision of room and board
or supplemental services according to section 256I.03, subdivisions 2 and 8. Providers must
meet the requirements of section 256I.04, subdivisions 2a to 2f. Funding must be allocated
annually, and the room and board portion of the allocation shall be adjusted according to
the percentage change in the housing support room and board rate. The room and board
portion of the allocation shall be determined at the time of transfer. The commissioner or
deleted text begin countydeleted text end new text begin agencynew text end may return beds to the housing support fund with 180 days' notice, including
financial reconciliation.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 58.
Minnesota Statutes 2020, section 256I.06, subdivision 8, is amended to read:
Subd. 8.
Amount of housing support payment.
(a) The amount of a room and board
payment to be made on behalf of an eligible individual is determined by subtracting the
individual's countable income under section 256I.04, subdivision 1, for a whole calendar
month from the room and board rate for that same month. The housing support payment is
determined by multiplying the housing support rate times the period of time the individual
was a resident or temporarily absent under section 256I.05, subdivision deleted text begin 1cdeleted text end deleted text begin , paragraph (d)deleted text end new text begin
2anew text end .
(b) For an individual with earned income under paragraph (a), prospective budgeting
must be used to determine the amount of the individual's payment for the following six-month
period. An increase in income shall not affect an individual's eligibility or payment amount
until the month following the reporting month. A decrease in income shall be effective the
first day of the month after the month in which the decrease is reported.
(c) For an individual who receives housing support payments under section 256I.04,
subdivision 1, paragraph (c), the amount of the housing support payment is determined by
multiplying the housing support rate times the period of time the individual was a resident.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 59.
Minnesota Statutes 2020, section 256S.203, is amended to read:
256S.203 CUSTOMIZED LIVING SERVICES; MANAGED CARE RATES.
Subdivision 1.
Capitation payments.
The commissioner deleted text begin shalldeleted text end new text begin mustnew text end adjust the elderly
waiver capitation payment rates for managed care organizations paid to reflect the monthly
service rate limits for customized living services and 24-hour customized living services
established under section 256S.202new text begin and the rate adjustments for disproportionate share
facilities under section 256S.205new text end .
Subd. 2.
Reimbursement rates.
Medical assistance rates paid to customized living
providers by managed care organizations under this chapter deleted text begin shalldeleted text end new text begin mustnew text end not exceed the
monthly service rate limits and component rates as determined by the commissioner under
sections 256S.15 and 256S.20 to 256S.202new text begin , plus any rate adjustment under section 256S.205new text end .
Sec. 60.
new text begin
[256S.205] CUSTOMIZED LIVING SERVICES; DISPROPORTIONATE
SHARE RATE ADJUSTMENTS.
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 in this
subdivision have the meanings given.
new text end
new text begin
(b) "Application year" means a year in which a facility submits an application for
designation as a disproportionate share facility.
new text end
new text begin
(c) "Assisted living facility" or "facility" means an assisted living facility licensed under
chapter 144G.
new text end
new text begin
(d) "Disproportionate share facility" means an assisted living facility designated by the
commissioner under subdivision 4.
new text end
new text begin Subd. 2. new text end
new text begin Rate adjustment application. new text end
new text begin
An assisted living facility may apply to the
commissioner for designation as a disproportionate share facility. Applications must be
submitted annually between October 1 and October 31. The applying facility must apply
in a manner determined by the commissioner. The applying facility must document as a
percentage the census of elderly waiver participants residing in the facility on October 1 of
the application year.
new text end
new text begin Subd. 3. new text end
new text begin Rate adjustment eligibility criteria. new text end
new text begin
Only facilities with a census of at least
80 percent elderly waiver participants on October 1 of the application year are eligible for
designation as a disproportionate share facility.
new text end
new text begin Subd. 4. new text end
new text begin Designation as a disproportionate share facility. new text end
new text begin
By November 15 of each
application year, the commissioner must designate as a disproportionate share facility a
facility that complies with the application requirements of subdivision 2 and meets the
eligibility criteria of subdivision 3.
new text end
new text begin Subd. 5. new text end
new text begin Rate adjustment; rate floor. new text end
new text begin
(a) Notwithstanding the 24-hour customized
living monthly service rate limits under section 256S.202, subdivision 2, and the component
service rates established under section 256S.201, subdivision 4, the commissioner must
establish a rate floor equal to $119 per resident per day for 24-hour customized living
services provided in a designated disproportionate share facility for the purpose of ensuring
the minimal level of staffing required to meet the health and safety need of elderly waiver
participants.
new text end
new text begin
(b) The commissioner must adjust the rate floor at least annually in the manner described
under section 256S.18, subdivisions 5 and 6.
new text end
new text begin
(c) The commissioner shall not implement the rate floor under this section if the
customized living rates established under sections 256S.21 to 256S.215 will be implemented
at 100 percent on January 1 of the year following an application year.
new text end
new text begin Subd. 6. new text end
new text begin Budget cap disregard. new text end
new text begin
The value of the rate adjustment under this section
must not be included in an elderly waiver client's monthly case mix budget cap.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective October 1, 2021, or upon federal approval,
whichever is later, and applies to services provided on or after January 1, 2022, or on or
after the date upon which federal approval is obtained, whichever is later. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end
Sec. 61.
Laws 2019, First Special Session chapter 9, article 5, section 86, subdivision 1,
as amended by Laws 2020, First Special Session chapter 2, article 3, section 2, subdivision
1, is amended to read:
Subdivision 1.
Intent.
It is the intent of the legislature to reform the medical assistance
waiver programs for people with disabilities to simplify administration of the programs.
Disability waiver reconfiguration must incentivize inclusive, person-centered, individualized
supports and services; enhance each person's self-determination and personal authority over
the person's service choice; align benefits across waivers; ensure equity across programs
and populations; new text begin assess and address racial and geographical disparities and institutional bias
in services and programs; new text end promote long-term sustainability of waiver services; and maintain
service stability and continuity of care while prioritizing, promoting, and creating incentives
for independent, integrated, and individualized supports and services chosen by each person
through an informed decision-making process and person-centered planning.
Sec. 62. new text begin PARENTING WITH A DISABILITY; PILOT PROJECT.
new text end
new text begin Subdivision 1. new text end
new text begin Purpose. new text end
new text begin
The commissioner of human services shall establish a pilot
project to provide grants to personal care assistance provider agencies to provide assistance
with child rearing tasks to a parent who is eligible for personal care assistance services
under Minnesota Statutes, section 256B.0659, or for services and supports provided through
community first services and supports under Minnesota Statutes, section 256B.85. The
purpose of this pilot project is to study the benefits of supportive parenting while assisting
parents with a disability in child rearing tasks and preventing removal of a child from a
parent because the parent has a disability.
new text end
new text begin Subd. 2. new text end
new text begin Definitions. new text end
new text begin
(a) For the purposes of this section, in addition to the definitions
in Minnesota Statutes, section 256B.0659, subdivision 1, applying to the personal care
assistance program and the definitions in Minnesota Statutes, section 256B.85, subdivision
2, applying to community first services and supports, the following terms have the meanings
given them in this subdivision.
new text end
new text begin
(b) "Adaptive parenting equipment" means a piece of equipment that increases, extends,
or improves the parenting capabilities of a parent with a disability.
new text end
new text begin
(c) "Child" means a person under 12 years of age.
new text end
new text begin
(d) "Child rearing task" means a task that assists a parent with a disability to care for a
child. Child rearing task includes, but is not limited to: lifting and carrying a child, organizing
supplies for a child, preparing meals for a child, washing clothing and bedding for a child,
bathing a child, childproofing the home that the parent and child live in, and assisting with
transporting a child.
new text end
new text begin
(e) "Commissioner" means the commissioner of human services.
new text end
new text begin
(f) "Parent" means a child's biological, foster, or adoptive parent or legal guardian who
is legally obligated to care for and support the child.
new text end
new text begin
(g) "Person with a disability" means an individual who has a physical, mental, or
psychological impairment or dysfunction that limits independent functioning in a family,
community, or employment.
new text end
new text begin
(h) "Personal care assistant" or "PCA" also means support worker.
new text end
new text begin
(i) "Personal care assistance services" also means the services and supports provided by
community first services and supports.
new text end
new text begin
(j) "Supportive parenting assistant" or "SPA" means an individual providing supportive
parenting services who is also a personal care assistant.
new text end
new text begin
(k) "Supportive parenting service" means a state-funded service that (1) helps a parent
with a disability compensate for aspects of the parent's disability that affect the parent's
ability to care for the child, and (2) enables the parent to complete parental responsibilities,
including child rearing tasks. Supportive parenting service does not include disciplining the
parent's child.
new text end
new text begin Subd. 3. new text end
new text begin Grants. new text end
new text begin
(a) The commissioner shall develop a competitive application process
for up to three two-year state-funded grants to personal care assistance provider agencies
to provide supportive parenting services described in subdivision 4 and to purchase adaptive
parenting equipment described in subdivision 5. A grant applicant must be a personal care
assistance provider agency.
new text end
new text begin
(b) Grant applications must describe how the applicant would recruit families to
participate in the pilot project and how the applicant would select families to receive
supportive parenting services while giving preference to families in which both parents are
receiving personal care assistance services.
new text end
new text begin
(c) Grantees must agree to provide supportive parenting to each selected family for at
least one year.
new text end
new text begin Subd. 4. new text end
new text begin Supportive parenting services. new text end
new text begin
(a) If a parent is eligible for and receiving
personal care assistance services, the parent is eligible to receive supportive parenting
services funded by a grant under this section. A parent must use one supportive parenting
assistant at a time, regardless of the parent's number of children. Supportive parenting
services provided under this section are services for the parent and not the child.
new text end
new text begin
(b) An SPA providing supportive parenting services under this section must not perform
personal care assistance services while scheduled to provide supportive parenting services.
A PCA providing personal care assistance services must not perform supportive parenting
services while scheduled to provide personal care assistance services. A PCA providing
personal care assistance services and an SPA providing supportive parenting services may
be scheduled to support the parent at the same time. The same individual may provide
personal care assistance services and supportive parenting assistance to a parent as long as
the requirements of this paragraph are met. Supportive parenting services under this section
do not count toward a PCA's 310 hours per-month limit on providing personal care assistance
services under Minnesota Statutes, section 256B.0659, subdivision 11, paragraph (a), clause
(10).
new text end
new text begin
(c) Supportive parenting services under this section must not replace personal care
assistance services.
new text end
new text begin
(d) A parent's supportive parenting services shall be limited to 40 hours per month.
new text end
new text begin Subd. 5. new text end
new text begin Adaptive parenting equipment. new text end
new text begin
A grantee may purchase adaptive parenting
equipment at the request of a parent receiving supportive parenting services under subdivision
4. A grantee must not purchase adaptive parenting equipment covered by medical assistance.
A grantee must purchase the least costly item to meet the parent's need.
new text end
Sec. 63. new text begin DIRECTION TO THE COMMISSIONER; STUDY OF SUPPORTIVE
PARENTING SERVICES.
new text end
new text begin
The commissioner shall study the feasibility of providing supportive parenting services
to parents with disabilities and disabling conditions as a covered medical assistance service
and submit a report to the chairs and ranking minority members of the legislative committees
with jurisdiction over health and human services by February 15, 2023. The report must
contain at a minimum:
new text end
new text begin
(1) the total number of parents that were provided services through the pilot project;
new text end
new text begin
(2) the total cost of developing and providing the services provided under the pilot
project;
new text end
new text begin
(3) recommendations on expansion or continuation of the pilot project;
new text end
new text begin
(4) recommendations on seeking federal approval of supportive parenting services as a
covered service under medical assistance; and
new text end
new text begin
(5) draft legislative language.
new text end
Sec. 64. new text begin DIRECTION TO THE COMMISSIONER OF HUMAN SERVICES; PLAN
FOR ADDRESSING EFFECTS ON COMMUNITY OF CERTAIN
STATE-OPERATED SERVICES.
new text end
new text begin
The commissioner of human services, in consultation with stakeholders, shall develop
and submit to the chairs and ranking minority members of the house of representatives and
senate committees with jurisdiction over health and human services by January 31, 2022,
a plan to ameliorate the effects of repeated incidents, as defined in Minnesota Statutes,
section 245D.02, subdivision 11, occurring at Minnesota state-operated community services
programs that affect the community in which the program is located and the neighbors of
the service site of the program.
new text end
Sec. 65. new text begin DIRECTION TO THE COMMISSIONER; INITIAL PACE
IMPLEMENTATION FUNDING.
new text end
new text begin
The commissioner of human services must work with stakeholders to develop
recommendations for financing mechanisms to complete the actuarial work and cover the
administrative costs of a program of all-inclusive care for the elderly (PACE). The
commissioner must recommend a financing mechanism that could begin July 1, 2023. The
commissioner shall inform the chairs and ranking minority members of the legislative
committees with jurisdiction over health care funding by December 15, 2022, on the
commissioner's progress toward developing a recommended financing mechanism.
new text end
Sec. 66. new text begin DIRECTION TO COMMISSIONERS; CUSTOMIZED LIVING REPORT.
new text end
new text begin
(a) By January 15, 2022, the commissioner of human services shall submit a report to
the chairs and ranking minority members of the legislative committees with jurisdiction
over human services policy and finance. The report must include the commissioner's:
new text end
new text begin
(1) assessment of the prevalence of customized living services provided under Minnesota
Statutes, section 256B.49, supplanting the provision of residential services and supports
licensed under Minnesota Statutes, chapter 245D, and provided in settings licensed under
Minnesota Statutes, chapter 245A;
new text end
new text begin
(2) recommendations regarding the continuation of the moratorium on home and
community-based services customized living settings under Minnesota Statutes, section
256B.49, subdivision 28;
new text end
new text begin
(3) other policy recommendations to ensure that customized living services are being
provided in a manner consistent with the policy objectives of the foster care licensing
moratorium under Minnesota Statutes, section 245A.03, subdivision 7; and
new text end
new text begin
(4) recommendations for needed statutory changes to implement the transition from
existing four-person or fewer customized living settings to corporate adult foster care or
community residential settings.
new text end
new text begin
(b) The commissioner of health shall provide the commissioner of human services with
the required data to complete the report in paragraph (a) and implement the moratorium on
home and community-based services customized living settings under Minnesota Statutes,
section 256B.49, subdivision 28. The data must include, at a minimum, each registered
housing with services establishment under Minnesota Statutes, chapter 144D, enrolled as
a customized living setting to deliver customized living services as defined under the brain
injury or community access for disability inclusion waiver plans under Minnesota Statutes,
section 256B.49.
new text end
Sec. 67. new text begin DIRECTION TO THE COMMISSIONER OF HUMAN SERVICES;
DIRECT CARE SERVICES DURING SHORT-TERM ACUTE HOSPITAL VISITS.
new text end
new text begin
The commissioner of human services, in consultation with stakeholders, shall develop
a new covered service under Minnesota Statutes, chapter 256B, or develop modifications
to existing covered services, that permits receipt of direct care services in an acute care
hospital in a manner consistent with the requirements of United States Code, title 42, section
1396a(h). By August 31, 2022, the commissioner must provide to the chairs and ranking
minority members of the house of representatives and senate committees and divisions with
jurisdiction over direct care services any draft legislation as may be necessary to implement
the new or modified covered service.
new text end
Sec. 68. new text begin DIRECTION TO THE COMMISSIONER; LONG-TERM CARE
CONSULTATION SERVICE RATES.
new text end
new text begin
By January 15, 2025, the commissioner of human services shall develop a proposal with
legislative language for capitated rates for each type of assessment or activity provided
under Minnesota Statutes, section 256B.0911, as determined by the commissioner. The
commissioner shall provide the proposal and legislative language to the chairs and ranking
minority members of the legislative committees and divisions with jurisdiction over human
services policy and finance by January 15, 2025.
new text end
Sec. 69. new text begin HOUSING SUPPORT SUPPLEMENTAL SERVICE RATE REDUCTION
DELAY.
new text end
new text begin
The rate reduction described in Minnesota Statutes, section 256B.051, subdivision 7,
does not apply until October 1, 2021, for individuals who receive supplemental services
from providers that made a good faith effort to become a Medicaid provider by submitting
an application by June 1, 2021.
new text end
Sec. 70. new text begin PERSONAL CARE ASSISTANCE COMPENSATION FOR SERVICES
PROVIDED BY A PARENT OR SPOUSE.
new text end
new text begin
(a) Notwithstanding Minnesota Statutes, section 256B.0659, subdivisions 3, paragraph
(a), clause (1); 11, paragraph (c); and 19, paragraph (b), clause (3), a parent, stepparent, or
legal guardian of a minor who is a personal care assistance recipient or a spouse of a personal
care assistance recipient may provide and be paid for providing personal care assistance
services.
new text end
new text begin
(b) This section expires upon full implementation and phase-in of the community first
services and supports program under Minnesota Statutes, section 256B.85.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment, or
upon federal approval, whichever is later. The commissioner of human services shall notify
the revisor of statutes when federal approval is obtained.
new text end
Sec. 71. new text begin DIRECTIONS TO THE COMMISSIONER OF HUMAN SERVICES;
WAIVER GROWTH LIMITS.
new text end
new text begin Subdivision 1. new text end
new text begin
Community access for disability inclusion waiver growth
limit.
new text end
new text begin
Between July 1, 2021, and June 30, 2025, the commissioner shall allocate to county
and Tribal agencies money for home and community-based waiver programs under Minnesota
Statutes, section 256B.49, to ensure a reduction in forecasted state spending that is equivalent
to limiting the caseload growth of the community access for disability inclusion waiver to
zero allocations per year. Limits do not apply to conversions from nursing facilities. Counties
and Tribal agencies shall manage the annual allocations made by the commissioner to ensure
that persons for whom services are temporarily discontinued for no more than 90 days are
reenrolled. If a county or Tribal agency fails to meet the authorization and spending
requirements under Minnesota Statutes, section 256B.49, subdivision 27, the commissioner
may determine a corrective action plan is unnecessary if the failure to meet the requirements
is due to managing the annual allocation for the purposes of allowing people to reenroll
after their services are temporarily discontinued.
new text end
new text begin Subd. 2. new text end
new text begin Developmental disabilities waiver growth limit. new text end
new text begin
Between July 1, 2021, and
June 30, 2025, the commissioner shall allocate to county and Tribal agencies money for
home and community-based waiver programs under Minnesota Statutes, section 256B.092,
to ensure a reduction in forecasted state spending that is equivalent to limiting the caseload
growth of the developmental disabilities waiver to zero allocations per year. Limits do not
apply to conversions from intermediate care facilities for persons with developmental
disabilities. Counties and Tribal agencies shall manage the annual allocations made by the
commissioner to ensure that persons for whom services are temporarily discontinued for
no more than 90 days are reenrolled.
new text end
Sec. 72. new text begin RETAINER PAYMENTS FOR HOME AND COMMUNITY-BASED
SERVICE PROVIDERS.
new text end
new text begin Subdivision 1. new text end
new text begin Retainer payments. new text end
new text begin
(a) The commissioner of human services shall make
quarterly retainer payments to eligible recipients by July 1, 2021; September 30, 2021;
December 31, 2021; March 31, 2022; and June 30, 2022. The value of the first quarterly
payment to each eligible recipient shall be equal to a percentage to be determined by the
commissioner under subdivision 9 applied to the eligible recipient's total home and
community-based service revenue from medical assistance as of May 31, 2021. The value
of each subsequent quarterly payment shall be equal to a percentage to be determined by
the commissioner under subdivision 9 applied to the eligible recipient's total home and
community-based service revenue from medical assistance based on new data for service
claims paid as of the first day of the month in which the retainer payment will be made.
new text end
new text begin
(b) The commissioner shall implement retainer payments and the process of making
retainer payments under this subdivision without compliance with time-consuming procedures
and formalities prescribed in law, such as the following statutes and related policies:
Minnesota Statutes, sections 16A.15, subdivision 3; 16B.97; 16B.98, subdivisions 5 and 7;
and 16B.98, subdivision 8, the express audit clause requirement.
new text end
new text begin
(c) The commissioner's determination of the retainer amount determined under this
subdivision is final and is not subject to appeal. This paragraph does not apply to recoupment
by the commissioner under subdivision 8.
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:
new text end
new text begin
(1) "direct care professional" means any individual who while providing an eligible
service has direct contact with the person receiving the eligible service. Direct care
professional excludes executive, managerial, and administrative staff;
new text end
new text begin
(2) "eligible recipient" means an enrolled provider of eligible services, including the
Direct Care and Treatment Division at the Department of Human Services, that meets the
attestation and agreement requirements in subdivisions 5 and 6;
new text end
new text begin
(3) "eligible service" means a home and community-based service as defined in section
9817(a)(2)(B) of the federal American Rescue Plan Act, Public Law 117-2, except:
new text end
new text begin
(i) community first services and supports;
new text end
new text begin
(ii) extended community first services and supports;
new text end
new text begin
(iii) personal care assistance services;
new text end
new text begin
(iv) extended personal care assistance service;
new text end
new text begin
(v) consumer-directed community supports;
new text end
new text begin
(vi) consumer support grants;
new text end
new text begin
(vii) home health agency services; and
new text end
new text begin
(viii) home care nursing services;
new text end
new text begin
(4) "recipient" means an enrolled provider of an eligible service that receives a retainer
payment under this section; and
new text end
new text begin
(5) "total home and community-based service revenue from medical assistance" includes
both fee-for-service revenue and revenue from managed care organizations attributable to
the provision of eligible services from April 1, 2021, to March 31, 2022. The commissioner
shall determine each eligible provider's total home and community-based service revenue
from medical assistance based on data for service claims paid as of the date specified in
subdivision 9.
new text end
new text begin Subd. 3. new text end
new text begin Allowable uses of funds. new text end
new text begin
(a) Recipients must use retainer payments to
implement one or more of the following activities to enhance, expand, or strengthen home
and community-based services:
new text end
new text begin
(1) temporarily increase wages, salaries, and benefits for direct care professionals and
any corresponding increase in the employer's share of FICA taxes, Medicare taxes, state
and federal unemployment taxes, and workers' compensation premiums;
new text end
new text begin
(2) provide hazard pay, overtime pay, and shift differential pay for direct care
professionals;
new text end
new text begin
(3) pay for paid sick leave, paid family leave, and paid medical leave due to COVID-19
for direct care professionals;
new text end
new text begin
(4) pay for training for direct care professionals that is specific to the COVID-19 public
health emergency;
new text end
new text begin
(5) recruit new direct care professionals;
new text end
new text begin
(6) pay for American sign language and other languages interpreters to assist in providing
eligible services or to inform the general public about COVID-19;
new text end
new text begin
(7) purchase emergency supplies and equipment to enhance access to eligible services
and to protect the health and well-being of direct care professionals;
new text end
new text begin
(8) support family care providers of eligible individuals with needed supplies and
equipment, which may include items not typically covered under the Medicaid program,
such as personal protective equipment and pay; and
new text end
new text begin
(9) pay for assistive technologies, staffing, and other costs incurred during the COVID-19
public health emergency period to mitigate isolation and ensure an individual's
person-centered service plan continues to be fully implemented.
new text end
new text begin
(b) Recipients must:
new text end
new text begin
(1) use at least 50 percent of the additional revenue received in the form of retainer
payments for the purposes described in paragraph (a), clauses (1) to (3); and
new text end
new text begin
(2) use any remainder of the additional revenue received in the form of retainer payments
for the purposes described in paragraph (a), clauses (4) to (9).
new text end
new text begin Subd. 4. new text end
new text begin Retainer payment requests. new text end
new text begin
Eligible recipients must request retainer payments
under this section no later than June 1, 2022. The commissioner shall develop an expedited
request process that includes a form allowing providers to meet the requirements of
subdivisions 5 and 6 in as timely a manner as possible. The commissioner shall allow the
use of electronic submission of request forms and accept electronic signatures.
new text end
new text begin Subd. 5. new text end
new text begin Attestation. new text end
new text begin
(a) As a condition of obtaining funds under this section, an eligible
recipient must attest to the following on the retainer payment request form:
new text end
new text begin
(1) the intent to provide eligible services through March 31, 2022; and
new text end
new text begin
(2) that the recipient will use the retainer payments only for purposes permitted under
this section.
new text end
new text begin
(b) By accepting a retainer payment under this section, the recipient attests to the
conditions specified in this subdivision.
new text end
new text begin Subd. 6. new text end
new text begin Agreement. new text end
new text begin
(a) As a condition of receiving retainer payments under this section,
an eligible recipient must agree to the following on the retainer payment request form:
new text end
new text begin
(1) to cooperate with the commissioner of human services to deliver services according
to the program and service waivers and modifications issued under the commissioner's
authority;
new text end
new text begin
(2) to acknowledge that retention grants may be subject to a special recoupment under
this section if a state audit performed under this section determines that the provider used
retainer payments for purposes not authorized under this section; and
new text end
new text begin
(3) to acknowledge that a recipient must comply with the distribution requirements
described in subdivision 7.
new text end
new text begin
(b) By accepting a retainer payment under this section, the recipient agrees to the
conditions specified in this subdivision.
new text end
new text begin Subd. 7. new text end
new text begin Distribution plans. new text end
new text begin
(a) A recipient must prepare and, upon request, submit to
the commissioner, a distribution plan that specifies the anticipated amount and proposed
uses of the additional revenue the recipient will receive under this section.
new text end
new text begin
(b) Within 60 days of receipt of the recipient's first retainer payment, the recipient must
post the distribution plan and leave it posted for a period of at least six weeks in an area of
the recipient's operation to which all direct care professionals have access. The provider
must post with the distribution plan instructions on how to contact the commissioner of
human services if direct care professionals do not believe they have received the wage
increase or benefits required under subdivision 3 specified in the distribution plan. The
instructions must include a mailing address, e-mail address, and telephone number that the
direct care professional may use to contact the commissioner or the commissioner's
representative.
new text end
new text begin Subd. 8. new text end
new text begin Recoupment. new text end
new text begin
(a) The commissioner may perform an audit under this section
up to six years after any retainer payment is made to ensure the funds are utilized solely for
the purposes authorized under this section.
new text end
new text begin
(b) If the commissioner determines that a provider used retainer payments for purposes
not authorized under this section, the commissioner shall treat any amount used for a purpose
not authorized under this section as an overpayment. The commissioner shall recover any
overpayment.
new text end
new text begin Subd. 9. new text end
new text begin Calculation of retainer payments. new text end
new text begin
(a) The commissioner shall determine a
percentage to apply to each recipient's total home and community-based service revenue
from medical assistance to calculate the value of each quarterly retainer payment.
new text end
new text begin
(b) The commissioner shall make an estimate of the total projected expenditures for
eligible services between April 1, 2021, and March 31, 2022, determine a percentage to be
applied to the total projected home and community-based service revenue from medical
assistance for all providers of eligible services sufficient to expend the total appropriation
for retainer payments, and apply this percentage to each recipient's total home and
community-based service revenue from medical assistance on the following schedule:
new text end
new text begin
(1) no earlier than July 1, 2021, make a retainer payment by applying the percentage to
each recipient's total home and community-based service revenue from medical assistance
based on service claims paid as of May 31, 2021;
new text end
new text begin
(2) no later than September 30, 2021, make a retainer payment by applying the percentage
to each recipient's total home and community-based service revenue from medical assistance
based on new service claims paid as of September 1, 2021, that were not included in the
calculation of a prior retainer payment;
new text end
new text begin
(3) no later than December 31, 2021, make a retainer payment by applying the percentage
to each recipient's total home and community-based service revenue from medical assistance
based on new service claims paid as of December 1, 2021, that were not included in the
calculation of a prior retainer payment; and
new text end
new text begin
(4) no later than March 31, 2022, make a retainer payment by applying the percentage
to each recipient's total home and community-based service revenue from medical assistance
based on new service claims paid as of March 1, 2022, that were not included in the
calculation of a prior retainer payment.
new text end
new text begin
(c) The commissioner may redetermine the percentage to be applied to each recipient's
total home and community-based services revenue from medical assistance.
new text end
new text begin
(d) By June 30, 2022, the commissioner shall redetermine a percentage to be applied to
the total home and community-based service revenue from medical assistance based on
new service claims paid as of June 1, 2021, that were not included in the calculation of a
prior retainer payment. The redetermined percentage must be sufficient to expend the total
appropriation for retainer payments. No later than June 30, 2022, the commissioner shall
make a final retainer payment by applying the redetermined percentage to each recipient's
total home and community-based service revenue from medical assistance based on new
service claims paid as of June 1, 2021, that were not included in the calculation of a prior
retainer payment.
new text end
Sec. 73. new text begin DIRECTION TO THE COMMISSIONER; PERSONAL CARE
ASSISTANCE SERVICE RATE INCREASES.
new text end
new text begin
Effective July 1, 2021, The commissioner of human services shall increase the
reimbursement rates, individual budgets, grants, and allocations for community first services
and supports under Minnesota Statutes, section 256B.85; personal care assistance services
under Minnesota Statutes, section 256B.0659; extended personal care assistance service as
defined in Minnesota Statutes, section 256B.0605, subdivision 1, paragraph (g); and extended
community first services and supports as defined in Minnesota Statutes, section 256B.85,
subdivision 2, paragraph (l); and for budgets of individuals utilizing consumer-directed
community supports or participating in the consumer support grant program. The
commissioner shall determine the amount of the rate increase to ensure that the state share
of the increase does not exceed the amount appropriated in each fiscal year for this purpose
in this act.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 74. new text begin DIRECTION TO THE COMMISSIONER; HOME CARE SERVICE RATE
INCREASE.
new text end
new text begin
Effective July 1, 2021, The commissioner of human services shall increase service rates
for home health agency services under Minnesota Statutes, section 256B.0653, and for home
care nursing services under Minnesota Statutes, section 256B.0654. The commissioner shall
determine the amount of the rate increase to ensure that the state share of the increase does
not exceed the amount appropriated in this act in each fiscal year for this purpose.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 75. new text begin DIRECTION TO THE COMMISSIONER; ELDERLY WAIVER RATE
INCREASE.
new text end
new text begin
The commissioner of human services shall modify the ratio of the blended rate described
under Minnesota Statutes, section 256S.2101, to increase statewide service rates and
component service rates. The commissioner shall also adjust service rate limits, monthly
service rate limits, and monthly case mix budget caps to accommodate the increased service
rates and component service rates established under this section. The commissioner shall
modify the blended rates to ensure that the state share of the service rate increase does not
exceed the amount appropriated in each fiscal year for this purpose in this act.
new text end
Sec. 76. new text begin REVISOR INSTRUCTION.
new text end
new text begin
(a) The revisor of statutes, in consultation with the Office of Senate Counsel, Research
and Fiscal Analysis, the Office of the House Research Department, and the commissioner
of human services, shall prepare legislation for the 2022 legislative session to recodify
Minnesota Statutes, sections 256.975, subdivisions 7 to 7d, and 256B.0911.
new text end
new text begin
(b) The revisor of statutes, in consultation with the Office of Senate Counsel, Research
and Fiscal Analysis, the Office of the House Research Department, and the commissioner
of human services, shall to the greatest extent practicable renumber as subdivisions the
paragraphs of Minnesota Statutes, section 256B.4914, prior to the publication of the 2021
Supplement of Minnesota Statutes, and shall without changing the meaning or effect of
these provisions minimize the use of internal cross-references, including by drafting new
technical definitions as substitutes for necessary cross-references or by other means
acceptable to the commissioner of human services.
new text end
new text begin
(c) The revisor of statutes shall change the headnote for Minnesota Statutes, section
256B.097, to read "REGIONAL AND SYSTEMS IMPROVEMENT FOR MINNESOTANS
WHO HAVE DISABILITIES."
new text end
Sec. 77. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2020, section 256B.4905, subdivisions 1, 2, 3, 4, 5, and 6,
new text end
new text begin
are
repealed.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Statutes 2020, section 256B.097, subdivisions 1, 2, 3, 4, 5, and 6,
new text end
new text begin
are
repealed.
new text end
new text begin
(c)
new text end
new text begin
Laws 2019, First Special Session chapter 9, article 5, section 90,
new text end
new text begin
is repealed.
new text end
ARTICLE 15
COMMUNITY SUPPORTS POLICY
Section 1.
Minnesota Statutes 2020, section 245.4874, subdivision 1, is amended to read:
Subdivision 1.
Duties of county board.
(a) The county board must:
(1) develop a system of affordable and locally available children's mental health services
according to sections 245.487 to 245.4889;
(2) consider 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;
(3) assure that parents and providers in the county receive information about how to
gain access to services provided according to sections 245.487 to 245.4889;
(4) 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;
(5) assure that mental health services delivered according to sections 245.487 to 245.4889
are delivered expeditiously and are appropriate to the child's diagnostic assessment and
individual treatment plan;
(6) 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;
(7) 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;
(8) prudently administer grants and purchase-of-service contracts that the county board
determines are necessary to fulfill its responsibilities under sections 245.487 to 245.4889;
(9) 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;
(10) 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;
(11) assure that culturally competent 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
(12) consistent with section 245.486, arrange for or provide a children's mental health
screening for:
(i) a child receiving child protective services;
(ii) a child in out-of-home placement;
(iii) a child for whom parental rights have been terminated;
(iv) a child found to be delinquent; or
(v) a child found to have committed a juvenile petty offense for the third or subsequent
time.
A children's mental health screening is not required when a screening or diagnostic
assessment has been performed within the previous 180 days, or the child is currently under
the care of a mental health professional.
(b) When a child is receiving protective services or is in out-of-home placement, 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.
(c) When a child is found to be delinquent or a child is found to have committed a
juvenile petty offense for the third or subsequent time, the court or county agency must
obtain written informed consent from the parent or legal guardian before a screening is
conducted unless the court, notwithstanding the parent's failure to consent, determines that
the screening is in the child's best interest.
(d) 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. Screenings 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:
(1) training in the administration of the instrument;
(2) the interpretation of its validity given the child's current circumstances;
(3) the state and federal data practices laws and confidentiality standards;
(4) the parental consent requirement; and
(5) 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.
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 deleted text begin shall be considered private datadeleted text end deleted text begin and the
commissioner shall not collect individual screening resultsdeleted text end new text begin are classified as private data on
individuals, as defined by section 13.02, subdivision 12. The county board or Tribal nation
may provide the commissioner with access to the screening results for the purposes of
program evaluation and improvementnew text end .
(e) 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 desired
services components not covered under section 256B.0943 and identify the reimbursement
source for those requested services, the method of payment, and the payment rate to the
provider.
Sec. 2.
Minnesota Statutes 2020, section 245.697, subdivision 1, is amended to read:
Subdivision 1.
Creation.
(a) A State Advisory Council on Mental Health is created. The
council must have members appointed by the governor in accordance with federal
requirements. In making the appointments, the governor shall consider appropriate
representation of communities of color. The council must be composed of:
(1) the assistant commissioner of deleted text begin mental health fordeleted text end the Department of Human Services
new text begin who oversees behavioral health policynew text end ;
(2) a representative of the Department of Human Services responsible for the medical
assistance program;
new text begin
(3) a representative of the Department of Health;
new text end
deleted text begin (3)deleted text end new text begin (4)new text end one member of each of the following professions:
(i) psychiatry;
(ii) psychology;
(iii) social work;
(iv) nursing;
(v) marriage and family therapy; and
(vi) professional clinical counseling;
deleted text begin (4)deleted text end new text begin (5)new text end one representative from each of the following advocacy groups: Mental Health
Association of Minnesota, NAMI-MN, deleted text begin Mental Health Consumer/Survivor Network of
Minnesota, anddeleted text end Minnesota Disability Law Centernew text begin , American Indian Mental Health Advisory
Council, and a consumer-run mental health advocacy groupnew text end ;
deleted text begin (5)deleted text end new text begin (6)new text end providers of mental health services;
deleted text begin (6)deleted text end new text begin (7)new text end consumers of mental health services;
deleted text begin (7)deleted text end new text begin (8)new text end family members of persons with mental illnesses;
deleted text begin (8)deleted text end new text begin (9)new text end legislators;
deleted text begin (9)deleted text end new text begin (10)new text end social service agency directors;
deleted text begin (10)deleted text end new text begin (11)new text end county commissioners; and
deleted text begin (11)deleted text end new text begin (12)new text end other members reflecting a broad range of community interests, including
family physicians, or members as the United States Secretary of Health and Human Services
may prescribe by regulation or as may be selected by the governor.
(b) The council shall select a chair. Terms, compensation, and removal of members and
filling of vacancies are governed by section 15.059. Notwithstanding provisions of section
15.059, the council and its subcommittee on children's mental health do not expire. The
commissioner of human services shall provide staff support and supplies to the council.
Sec. 3.
Minnesota Statutes 2020, section 252.43, is amended to read:
252.43 COMMISSIONER'S DUTIES.
new text begin (a) new text end The commissioner shall supervise lead agencies' provision of day services to adults
with disabilities. The commissioner shall:
(1) determine the need for day deleted text begin servicesdeleted text end new text begin programsnew text end under deleted text begin sectiondeleted text end new text begin sectionsnew text end 256B.4914new text begin and
252.41 to 252.46new text end ;
(2) establish payment rates as provided under section 256B.4914;
(3) adopt rules for the administration and provision of day services under sections
245A.01 to 245A.16deleted text begin ,deleted text end new text begin ;new text end 252.28, subdivision 2deleted text begin ,deleted text end new text begin ;new text end or 252.41 to 252.46deleted text begin ,deleted text end new text begin ;new text end or Minnesota Rules,
parts 9525.1200 to 9525.1330;
(4) enter into interagency agreements necessary to ensure effective coordination and
provision of day services;
(5) monitor and evaluate the costs and effectiveness of day services; and
(6) provide information and technical help to lead agencies and vendors in their
administration and provision of day services.
new text begin
(b) A determination of need in paragraph (a), clause (1), shall not be required for a
change in day service provider name or ownership.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 4.
Minnesota Statutes 2020, section 252A.01, subdivision 1, is amended to read:
Subdivision 1.
Policy.
(a) It is the policy of the state of Minnesota to provide a
coordinated approach to the supervision, protection, and habilitation of its adult citizens
with a developmental disability. In furtherance of this policy, sections 252A.01 to 252A.21
are enacted to authorize the commissioner of human services to:
(1) supervise those adult citizens with a developmental disability who are unable to fully
provide for their own needs and for whom no qualified person is willing and able to seek
guardianship deleted text begin or conservatorshipdeleted text end under sections 524.5-101 to 524.5-502; and
(2) protect adults with a developmental disability from violation of their human and civil
rights by deleted text begin assuringdeleted text end new text begin ensuringnew text end that they receive the full range of needed social, financial,
residential, and habilitative services to which they are lawfully entitled.
(b) Public guardianship deleted text begin or conservatorshipdeleted text end is the most restrictive form of guardianship
deleted text begin or conservatorshipdeleted text end and should be imposed only when deleted text begin no other acceptable alternative is
availabledeleted text end new text begin less restrictive alternatives have been attempted and determined to be insufficient
to meet the person's needs. Less restrictive alternatives include but are not limited to
supported decision making, community or residential services, or appointment of a health
care agentnew text end .
Sec. 5.
Minnesota Statutes 2020, section 252A.02, subdivision 2, is amended to read:
Subd. 2.
Person with a developmental disability.
"Person with a developmental
disability" refers to any person age 18 or older whonew text begin :
new text end
new text begin (1)new text end has been diagnosed as having deleted text begin significantly subaverage intellectual functioning existing
concurrently with demonstrated deficits in adaptive behavior such as to require supervision
and protection for the person's welfare or the public welfare.deleted text end new text begin a developmental disability;
new text end
new text begin
(2) is impaired to the extent of lacking sufficient understanding or capacity to make
personal decisions; and
new text end
new text begin
(3) is unable to meet personal needs for medical care, nutrition, clothing, shelter, or
safety, even with appropriate technological and supported decision-making assistance.
new text end
Sec. 6.
Minnesota Statutes 2020, section 252A.02, subdivision 9, is amended to read:
Subd. 9.
deleted text begin Warddeleted text end new text begin Person subject to public guardianshipnew text end .
deleted text begin "Ward"deleted text end new text begin "Person subject to
public guardianship"new text end means a person with a developmental disability for whom the court
has appointed a public guardian.
Sec. 7.
Minnesota Statutes 2020, section 252A.02, subdivision 11, is amended to read:
Subd. 11.
Interested person.
"Interested person" means an interested responsible adult,
deleted text begin including, but not limited to, a public official, guardian, spouse, parent, adult sibling, legal
counsel, adult child, or next of kin of a person alleged to have a developmental disability.deleted text end new text begin
including but not limited to:
new text end
new text begin
(1) the person subject to guardianship, protected person, or respondent;
new text end
new text begin
(2) a nominated guardian or conservator;
new text end
new text begin
(3) a legal representative;
new text end
new text begin
(4) the spouse; parent, including stepparent; adult children, including adult stepchildren
of a living spouse; and siblings. If no such persons are living or can be located, the next of
kin of the person subject to public guardianship or the respondent is an interested person;
new text end
new text begin
(5) a representative of a state ombudsman's office or a federal protection and advocacy
program that has notified the commissioner or lead agency that it has a matter regarding
the protected person subject to guardianship, person subject to conservatorship, or respondent;
and
new text end
new text begin
(6) a health care agent or proxy appointed pursuant to a health care directive as defined
in section 145C.01, subdivision 5a; a living will under chapter 145B; or other similar
documentation executed in another state and enforceable under the laws of this state.
new text end
Sec. 8.
Minnesota Statutes 2020, section 252A.02, subdivision 12, is amended to read:
Subd. 12.
Comprehensive evaluation.
new text begin (a) new text end "Comprehensive evaluation" deleted text begin shall consistdeleted text end new text begin
consistsnew text end of:
(1) a medical report on the health status and physical condition of the proposed deleted text begin ward,deleted text end new text begin
person subject to public guardianshipnew text end prepared under the direction of a licensed physician
or advanced practice registered nurse;
(2) a report on the deleted text begin proposed ward'sdeleted text end intellectual capacity and functional abilitiesdeleted text begin , specifyingdeleted text end new text begin
of the proposed person subject to public guardianship that specifiesnew text end the tests and other data
used in reaching its conclusionsdeleted text begin ,deleted text end new text begin and isnew text end prepared by a psychologist who is qualified in the
diagnosis of developmental disability; and
(3) a report from the case manager that includes:
(i) the most current assessment of deleted text begin individual servicedeleted text end new text begin coordinated service and supportnew text end
needs as described in rules of the commissioner;
(ii) the most current individual service plan under section 256B.092, subdivision 1b;
and
(iii) a description of contacts with and responses of near relatives of the proposed deleted text begin warddeleted text end new text begin
person subject to public guardianshipnew text end notifying deleted text begin themdeleted text end new text begin the near relativesnew text end that a nomination
for public guardianship has been made and advising deleted text begin themdeleted text end new text begin the near relativesnew text end that they may
seek private guardianship.
new text begin (b) new text end Each report new text begin under paragraph (a), clause (3), new text end shall contain recommendations as to the
amount of assistance and supervision required by the proposed deleted text begin warddeleted text end new text begin person subject to public
guardianshipnew text end to function as independently as possible in society. To be considered part of
the comprehensive evaluation, new text begin the new text end reports must be completed no more than one year before
filing the petition under section 252A.05.
Sec. 9.
Minnesota Statutes 2020, section 252A.02, is amended by adding a subdivision to
read:
new text begin Subd. 16. new text end
new text begin Protected person. new text end
new text begin
"Protected person" means a person for whom a guardian
or conservator has been appointed or other protective order has been sought. A protected
person may be a minor.
new text end
Sec. 10.
Minnesota Statutes 2020, section 252A.02, is amended by adding a subdivision
to read:
new text begin Subd. 17. new text end
new text begin Respondent. new text end
new text begin
"Respondent" means an individual for whom the appointment
of a guardian or conservator or other protective order is sought.
new text end
Sec. 11.
Minnesota Statutes 2020, section 252A.02, is amended by adding a subdivision
to read:
new text begin Subd. 18. new text end
new text begin Supported decision making. new text end
new text begin
"Supported decision making" means assistance
to understand the nature and consequences of personal and financial decisions from one or
more persons of the individual's choosing to enable the individual to make the personal and
financial decisions and, when consistent with the individual's wishes, to communicate a
decision once made.
new text end
Sec. 12.
Minnesota Statutes 2020, section 252A.03, subdivision 3, is amended to read:
Subd. 3.
Standard for acceptance.
The commissioner shall accept the nomination ifnew text begin :new text end
deleted text begin the comprehensive evaluation concludes that:
deleted text end
deleted text begin
(1) the person alleged to have developmental disability is, in fact, developmentally
disabled;
deleted text end
new text begin
(1) the person's assessment confirms that they are a person with a developmental
disability under section 252A.02, subdivision 2;
new text end
(2) the person is in need of the supervision and protection of a deleted text begin conservator ordeleted text end guardian;
deleted text begin and
deleted text end
(3) no qualified person is willing to assume guardianship deleted text begin or conservatorshipdeleted text end under
sections 524.5-101 to 524.5-502deleted text begin .deleted text end new text begin ; and
new text end
new text begin
(4) the person subject to public guardianship was included in the process prior to the
submission of the nomination.
new text end
Sec. 13.
Minnesota Statutes 2020, section 252A.03, subdivision 4, is amended to read:
Subd. 4.
Alternatives.
new text begin (a) new text end Public guardianship deleted text begin or conservatorshipdeleted text end may be imposed only
whennew text begin :
new text end
new text begin
(1) the person subject to guardianship is impaired to the extent of lacking sufficient
understanding or capacity to make personal decisions;
new text end
new text begin
(2) the person subject to guardianship is unable to meet personal needs for medical care,
nutrition, clothing, shelter, or safety, even with appropriate technological and supported
decision-making assistance; and
new text end
new text begin (3)new text end no acceptable, less restrictive form of guardianship deleted text begin or conservatorshipdeleted text end is available.
new text begin (b)new text end The commissioner shall seek parents, near relatives, and other interested persons to
assume guardianship for persons with developmental disabilities who are currently under
public guardianship. If a person seeks to become a guardian deleted text begin or conservatordeleted text end , costs to the
person may be reimbursed under section 524.5-502. The commissioner must provide technical
assistance to parents, near relatives, and interested persons seeking to become guardians deleted text begin or
conservatorsdeleted text end .
Sec. 14.
Minnesota Statutes 2020, section 252A.04, subdivision 1, is amended to read:
Subdivision 1.
Local agency.
Upon receipt of a written nomination, the commissioner
shall promptly order the local agency of the county in which the proposed deleted text begin warddeleted text end new text begin person
subject to public guardianshipnew text end resides to coordinate or arrange for a comprehensive evaluation
of the proposed deleted text begin warddeleted text end new text begin person subject to public guardianshipnew text end .
Sec. 15.
Minnesota Statutes 2020, section 252A.04, subdivision 2, is amended to read:
Subd. 2.
Medication; treatment.
A proposed deleted text begin warddeleted text end new text begin person subject to public guardianshipnew text end
who, at the time the comprehensive evaluation is to be performed, has been under medical
care shall not be so under the influence or so suffer the effects of drugs, medication, or other
treatment as to be hampered in the testing or evaluation process. When in the opinion of
the licensed physician or advanced practice registered nurse attending the proposed deleted text begin warddeleted text end new text begin
person subject to public guardianshipnew text end , the discontinuance of medication or other treatment
is not in the deleted text begin proposed ward'sdeleted text end best interestnew text begin of the proposed person subject to public
guardianshipnew text end , the physician or advanced practice registered nurse shall record a list of all
drugs, medicationnew text begin ,new text end or other treatment deleted text begin whichdeleted text end new text begin thatnew text end the proposed deleted text begin warddeleted text end new text begin person subject to public
guardianshipnew text end received 48 hours immediately prior to any examination, testnew text begin ,new text end or interview
conducted in preparation for the comprehensive evaluation.
Sec. 16.
Minnesota Statutes 2020, section 252A.04, subdivision 4, is amended to read:
Subd. 4.
File.
The comprehensive evaluation shall be kept on file at the Department of
Human Services and shall be open to the inspection of the proposed deleted text begin warddeleted text end new text begin person subject to
public guardianshipnew text end and deleted text begin suchdeleted text end other persons deleted text begin as may be given permissiondeleted text end new text begin permittednew text end by the
commissioner.
Sec. 17.
Minnesota Statutes 2020, section 252A.05, is amended to read:
252A.05 COMMISSIONER'S PETITION FOR APPOINTMENT AS PUBLIC
GUARDIAN deleted text begin OR PUBLIC CONSERVATORdeleted text end .
In every case in which the commissioner agrees to accept a nomination, the local agency,
within 20 working days of receipt of the commissioner's acceptance, shall petition on behalf
of the commissioner in the county or court of the county of residence of the person with a
developmental disability for appointment to act as deleted text begin public conservator ordeleted text end public guardian of
the person with a developmental disability.
Sec. 18.
Minnesota Statutes 2020, section 252A.06, subdivision 1, is amended to read:
Subdivision 1.
Who may file.
deleted text begin The commissioner, the local agency, a person with a
developmental disability or any parent, spouse or relative of a person with a developmental
disability may filedeleted text end A verified petition alleging that the appointment of a deleted text begin public conservator
ordeleted text end public guardian is requirednew text begin may be filed by: the commissioner; the local agency; a person
with a developmental disability; or a parent, stepparent, spouse, or relative of a person with
a developmental disabilitynew text end .
Sec. 19.
Minnesota Statutes 2020, section 252A.06, subdivision 2, is amended to read:
Subd. 2.
Contents.
The petition shall set forth:
(1) the name and address of the petitionerdeleted text begin ,deleted text end and, in the case of a petition brought by a
person other than the commissioner, whether the petitioner is a parent, spouse, or relative
deleted text begin of the proposed warddeleted text end new text begin of the proposed person subject to guardianshipnew text end ;
(2) whether the commissioner has accepted a nomination to act as deleted text begin public conservator
ordeleted text end public guardian;
(3) the name, address, and date of birth of the proposed deleted text begin warddeleted text end new text begin person subject to public
guardianshipnew text end ;
(4) the names and addresses of the nearest relatives and spouse, if any, of the proposed
deleted text begin warddeleted text end new text begin person subject to public guardianshipnew text end ;
(5) the probable value and general character of the deleted text begin proposed ward'sdeleted text end real and personal
propertynew text begin of the proposed person subject to public guardianshipnew text end and the probable amount of
the deleted text begin proposed ward'sdeleted text end debtsnew text begin of the proposed person subject to public guardianshipnew text end ;new text begin and
new text end
(6) the facts supporting the establishment of public deleted text begin conservatorship ordeleted text end guardianship,
including that no family member or other qualified individual is willing to assume
guardianship deleted text begin or conservatorshipdeleted text end responsibilities under sections 524.5-101 to 524.5-502deleted text begin ;
anddeleted text end new text begin .
new text end
deleted text begin
(7) if conservatorship is requested, the powers the petitioner believes are necessary to
protect and supervise the proposed conservatee.
deleted text end
Sec. 20.
Minnesota Statutes 2020, section 252A.07, subdivision 1, is amended to read:
Subdivision 1.
With petition.
When a petition is brought by the commissioner or local
agency, a copy of the comprehensive evaluation shall be filed with the petition. If a petition
is brought by a person other than the commissioner or local agency and a comprehensive
evaluation has been prepared within a year of the filing of the petition, the local agency
shall deleted text begin forwarddeleted text end new text begin sendnew text end a copy of the comprehensive evaluation to the court upon notice of the
filing of the petition. If a comprehensive evaluation has not been prepared within a year of
the filing of the petition, the local agency, upon notice of the filing of the petition, shall
arrange for a comprehensive evaluation to be prepared and deleted text begin forwardeddeleted text end new text begin providednew text end to the court
within 90 days.
Sec. 21.
Minnesota Statutes 2020, section 252A.07, subdivision 2, is amended to read:
Subd. 2.
Copies.
A copy of the comprehensive evaluation shall be made available by
the court to the proposed deleted text begin warddeleted text end new text begin person subject to public guardianshipnew text end , the deleted text begin proposed ward'sdeleted text end
counselnew text begin of the proposed person subject to public guardianshipnew text end , the county attorney, the
attorney generalnew text begin ,new text end and the petitioner.
Sec. 22.
Minnesota Statutes 2020, section 252A.07, subdivision 3, is amended to read:
Subd. 3.
Evaluation required; exception.
new text begin (a) new text end No action for the appointment of a public
guardian may proceed to hearing unless a comprehensive evaluation has been first filed
with the courtdeleted text begin ; provided, however, that an action may proceed and a guardian appointeddeleted text end new text begin .
new text end
new text begin (b) Paragraph (a) does not applynew text end if the director of the local agency responsible for
conducting the comprehensive evaluation has filed an affidavit that the proposed deleted text begin warddeleted text end new text begin
person subject to public guardianshipnew text end refused to participate in the comprehensive evaluation
and the court finds on the basis of clear and convincing evidence that the proposed deleted text begin warddeleted text end new text begin
person subject to public guardianshipnew text end is developmentally disabled and in need of the
supervision and protection of a guardian.
Sec. 23.
Minnesota Statutes 2020, section 252A.081, subdivision 2, is amended to read:
Subd. 2.
Service of notice.
Service of notice on the deleted text begin warddeleted text end new text begin person subject to public
guardianshipnew text end or proposed deleted text begin warddeleted text end new text begin person subject to public guardianshipnew text end must be made by a
nonuniformed personnew text begin or nonuniformed visitornew text end . To the extent possible, the deleted text begin process server or
visitordeleted text end new text begin person or visitor serving the noticenew text end shall explain the document's meaning to the
proposed deleted text begin warddeleted text end new text begin person subject to public guardianshipnew text end . In addition to the persons required to
be served under sections 524.5-113, 524.5-205, and 524.5-304, the mailed notice of the
hearing must be served on the commissioner, the local agency, and the county attorney.
Sec. 24.
Minnesota Statutes 2020, section 252A.081, subdivision 3, is amended to read:
Subd. 3.
Attorney.
In place of the notice of attorney provisions in sections 524.5-205
and 524.5-304, the notice must state that the court will appoint an attorney for the proposed
deleted text begin warddeleted text end new text begin person subject to public guardianshipnew text end unless an attorney is provided by other persons.
Sec. 25.
Minnesota Statutes 2020, section 252A.081, subdivision 5, is amended to read:
Subd. 5.
Defective notice of service.
A defect in the service of notice or process, other
than personal service upon the proposed deleted text begin ward or conservateedeleted text end new text begin person subject to public
guardianshipnew text end or service upon the commissioner and local agency within the time allowed
and the form prescribed in this section and sections 524.5-113, 524.5-205, and 524.5-304,
does not invalidate any public guardianship deleted text begin or conservatorshipdeleted text end proceedings.
Sec. 26.
Minnesota Statutes 2020, section 252A.09, subdivision 1, is amended to read:
Subdivision 1.
Attorney appointment.
Upon the filing of the petition, the court shall
appoint an attorney for the proposed deleted text begin warddeleted text end new text begin person subject to public guardianshipnew text end , unless
such counsel is provided by others.
Sec. 27.
Minnesota Statutes 2020, section 252A.09, subdivision 2, is amended to read:
Subd. 2.
Representation.
Counsel shall visit with and, to the extent possible, consult
with the proposed deleted text begin warddeleted text end new text begin person subject to public guardianshipnew text end prior to the hearing and shall
be given adequate time to prepare deleted text begin therefordeleted text end new text begin for the hearingnew text end . Counsel shall be given the full
right of subpoena and shall be supplied with a copy of all documents filed with or issued
by the court.
Sec. 28.
Minnesota Statutes 2020, section 252A.101, subdivision 2, is amended to read:
Subd. 2.
Waiver of presence.
The proposed deleted text begin warddeleted text end new text begin person subject to public guardianshipnew text end
may waive the right to be present at the hearing only if the proposed deleted text begin warddeleted text end new text begin person subject
to public guardianshipnew text end has met with counsel and specifically waived the right to appear.
Sec. 29.
Minnesota Statutes 2020, section 252A.101, subdivision 3, is amended to read:
Subd. 3.
Medical care.
If, at the time of the hearing, the proposed deleted text begin warddeleted text end new text begin person subject
to public guardianshipnew text end has been under medical care, the deleted text begin warddeleted text end new text begin person subject to public
guardianshipnew text end has the same rights regarding limitation on the use of drugs, medication, or
other treatment before the hearing that are available under section 252A.04, subdivision 2.
Sec. 30.
Minnesota Statutes 2020, section 252A.101, subdivision 5, is amended to read:
Subd. 5.
Findings.
(a) In all cases the court shall make specific written findings of fact,
conclusions of law, and direct entry of an appropriate judgment or order. The court shall
order the appointment of the commissioner as guardian deleted text begin or conservatordeleted text end if it finds that:
(1) the proposed deleted text begin ward or conservateedeleted text end new text begin person subject to public guardianshipnew text end is a person
with a developmental disability as defined in section 252A.02, subdivision 2;
(2) the proposed deleted text begin ward or conservateedeleted text end new text begin person subject to public guardianshipnew text end is incapable
of exercising specific legal rights, which must be enumerated in deleted text begin itsdeleted text end new text begin the court'snew text end findings;
(3) the proposed deleted text begin ward or conservateedeleted text end new text begin person subject to public guardianshipnew text end is in need
of the supervision and protection of a new text begin public new text end guardian deleted text begin or conservatordeleted text end ; and
(4) no appropriate alternatives to public guardianship deleted text begin or public conservatorshipdeleted text end exist
that are less restrictive of the person's civil rights and liberties, such as appointing a new text begin private
new text end guardiannew text begin ,new text end deleted text begin or conservatordeleted text end new text begin supported decision maker, or health care agent; or arranging
residential or community servicesnew text end under sections 524.5-101 to 524.5-502.
(b) The court shall grant the specific powers that are necessary for the commissioner to
act as public guardian deleted text begin or conservatordeleted text end on behalf of the deleted text begin ward or conservateedeleted text end new text begin person subject
to public guardianshipnew text end .
Sec. 31.
Minnesota Statutes 2020, section 252A.101, subdivision 6, is amended to read:
Subd. 6.
Notice of order; appeal.
A copy of the order shall be served by mail upon the
deleted text begin ward or conservateedeleted text end new text begin person subject to public guardianshipnew text end and the deleted text begin ward'sdeleted text end counselnew text begin of the
person subject to public guardianshipnew text end . The order must be accompanied by a notice that
advises the deleted text begin ward or conservateedeleted text end new text begin person subject to public guardianshipnew text end of the right to appeal
the guardianship deleted text begin or conservatorshipdeleted text end appointment within 30 days.
Sec. 32.
Minnesota Statutes 2020, section 252A.101, subdivision 7, is amended to read:
Subd. 7.
Letters of guardianship.
new text begin (a) new text end Letters of guardianship deleted text begin or conservatorshipdeleted text end must
be issued by the court and contain:
(1) the name, address, and telephone number of the deleted text begin ward or conservateedeleted text end new text begin person subject
to public guardianshipnew text end ; and
(2) the powers to be exercised on behalf of the deleted text begin ward or conservateedeleted text end new text begin person subject to
public guardianshipnew text end .
new text begin (b) new text end The lettersnew text begin under paragraph (a)new text end must be served by mail upon the deleted text begin ward or conservateedeleted text end new text begin
person subject to public guardianshipnew text end , the deleted text begin ward'sdeleted text end counselnew text begin of the person subject to public
guardianshipnew text end , the commissioner, and the local agency.
Sec. 33.
Minnesota Statutes 2020, section 252A.101, subdivision 8, is amended to read:
Subd. 8.
Dismissal.
If upon the completion of the hearing and consideration of the record,
the court finds that the proposed deleted text begin warddeleted text end new text begin person subject to public guardianshipnew text end is not
developmentally disabled or is developmentally disabled but not in need of the supervision
and protection of a deleted text begin conservator ordeleted text end new text begin publicnew text end guardian, deleted text begin itdeleted text end new text begin the courtnew text end shall dismiss the application
and shall notify the proposed deleted text begin warddeleted text end new text begin person subject to public guardianshipnew text end , the deleted text begin ward'sdeleted text end counselnew text begin
of the person subject to public guardianshipnew text end , and the petitionernew text begin of the court's findingsnew text end .
Sec. 34.
Minnesota Statutes 2020, section 252A.111, subdivision 2, is amended to read:
Subd. 2.
Additional powers.
In addition to the powers contained in sections 524.5-207
and 524.5-313, the powers of a public guardian that the court may grant include:
(1) the power to permit or withhold permission for the deleted text begin warddeleted text end new text begin person subject to public
guardianshipnew text end to marry;
(2) the power to begin legal action or defend against legal action in the name of the deleted text begin warddeleted text end new text begin
person subject to public guardianshipnew text end ; and
(3) the power to consent to the adoption of the deleted text begin warddeleted text end new text begin person subject to public guardianshipnew text end
as provided in section 259.24.
Sec. 35.
Minnesota Statutes 2020, section 252A.111, subdivision 4, is amended to read:
Subd. 4.
Appointment of conservator.
If the deleted text begin warddeleted text end new text begin person subject to public guardianshipnew text end
has a personal estate beyond that which is necessary for the deleted text begin ward'sdeleted text end personal and immediate
needsnew text begin of the person subject to public guardianshipnew text end , the commissioner shall determine whether
a conservator should be appointed. The commissioner shall consult with the parents, spouse,
or nearest relative of the deleted text begin warddeleted text end new text begin person subject to public guardianshipnew text end . The commissioner
may petition the court for the appointment of a private conservator of the deleted text begin warddeleted text end new text begin person
subject to public guardianshipnew text end . The commissioner cannot act as conservator for public deleted text begin wardsdeleted text end new text begin
persons subject to public guardianshipnew text end or public protected persons.
Sec. 36.
Minnesota Statutes 2020, section 252A.111, subdivision 6, is amended to read:
Subd. 6.
Special duties.
In exercising powers and duties under this chapter, the
commissioner shall:
(1) maintain close contact with the deleted text begin warddeleted text end new text begin person subject to public guardianshipnew text end , visiting
at least twice a year;
(2) protect and exercise the legal rights of the deleted text begin warddeleted text end new text begin person subject to public guardianshipnew text end ;
(3) take actions and make decisions on behalf of the deleted text begin warddeleted text end new text begin person subject to public
guardianshipnew text end that encourage and allow the maximum level of independent functioning in a
manner least restrictive of the deleted text begin ward'sdeleted text end personal freedom new text begin of the person subject to public
guardianship new text end consistent with the need for supervision and protection; and
(4) permit and encourage maximum self-reliance on the part of the deleted text begin warddeleted text end new text begin person subject
to public guardianshipnew text end and permit and encourage input by the nearest relative of the deleted text begin warddeleted text end new text begin
person subject to public guardianshipnew text end in planning and decision making on behalf of the
deleted text begin warddeleted text end new text begin person subject to public guardianshipnew text end .
Sec. 37.
Minnesota Statutes 2020, section 252A.12, is amended to read:
252A.12 APPOINTMENT OF deleted text begin CONSERVATORdeleted text end new text begin PUBLIC GUARDIANnew text end NOT A
FINDING OF INCOMPETENCY.
An appointment of the commissioner as deleted text begin conservatordeleted text end new text begin public guardiannew text end shall not constitute
a judicial finding that the person with a developmental disability is legally incompetent
except for the restrictions deleted text begin whichdeleted text end new text begin thatnew text end the deleted text begin conservatorshipdeleted text end new text begin public guardianshipnew text end places on the
deleted text begin conservateedeleted text end new text begin person subject to public guardianshipnew text end . The appointment of a deleted text begin conservatordeleted text end new text begin public
guardiannew text end shall not deprive the deleted text begin conservateedeleted text end new text begin person subject to public guardianshipnew text end of the right
to vote.
Sec. 38.
Minnesota Statutes 2020, section 252A.16, is amended to read:
252A.16 ANNUAL REVIEW.
Subdivision 1.
Review required.
The commissioner shall require an annual review of
the physical, mental, and social adjustment and progress of every deleted text begin ward and conservateedeleted text end new text begin
person subject to public guardianshipnew text end . A copy of this review shall be kept on file at the
Department of Human Services and may be inspected by the deleted text begin ward or conservateedeleted text end new text begin person
subject to public guardianshipnew text end , the deleted text begin ward's or conservatee'sdeleted text end parents, spouse, or relatives new text begin of
the person subject to public guardianship, new text end and other persons who receive the permission of
the commissioner. The review shall contain information required under Minnesota Rules,
part 9525.3065, subpart 1.
Subd. 2.
Assessment of need for continued guardianship.
The commissioner shall
annually review the legal status of each deleted text begin warddeleted text end new text begin person subject to public guardianshipnew text end in light
of the progress indicated in the annual review. If the commissioner determines the deleted text begin warddeleted text end new text begin
person subject to public guardianshipnew text end is no longer in need of public guardianship deleted text begin or
conservatorshipdeleted text end or is capable of functioning under a less restrictive deleted text begin conservatorshipdeleted text end new text begin
guardianshipnew text end , the commissioner or local agency shall petition the court pursuant to section
252A.19 to restore the deleted text begin warddeleted text end new text begin person subject to public guardianshipnew text end to capacity or for a
modification of the court's previous order.
Sec. 39.
Minnesota Statutes 2020, section 252A.17, is amended to read:
252A.17 EFFECT OF SUCCESSION IN OFFICE.
The appointment by the court of the commissioner deleted text begin of human servicesdeleted text end as public
deleted text begin conservator ordeleted text end guardian shall be by the title of the commissioner's office. The authority of
the commissioner as public deleted text begin conservator ordeleted text end guardian shall cease upon the termination of the
commissioner's term of office and shall vest in a successor or successors in office without
further court proceedings.
Sec. 40.
Minnesota Statutes 2020, section 252A.19, subdivision 2, is amended to read:
Subd. 2.
Petition.
The commissioner, deleted text begin warddeleted text end new text begin person subject to public guardianshipnew text end , or
any interested person may petition the appointing court or the court to which venue has
been transferred deleted text begin for an order todeleted text end new text begin :
new text end
new text begin (1) for an order tonew text end remove the guardianship deleted text begin or todeleted text end new text begin ;
new text end
new text begin (2) for an order tonew text end limit or expand the powers of the guardianship deleted text begin or todeleted text end new text begin ;
new text end
new text begin (3) for an order tonew text end appoint a guardian deleted text begin or conservatordeleted text end under sections 524.5-101 to
524.5-502 deleted text begin or todeleted text end new text begin ;
new text end
new text begin (4) for an order tonew text end restore the deleted text begin warddeleted text end new text begin person subject to public guardianshipnew text end or protected
person to full legal capacity deleted text begin or todeleted text end new text begin ;
new text end
new text begin (5) tonew text end review de novo any decision made by the public guardian deleted text begin or public conservatordeleted text end
for or on behalf of a deleted text begin warddeleted text end new text begin person subject to public guardianshipnew text end or protected personnew text begin ;new text end or
new text begin (6) new text end for any other order as the court may deem just and equitable.
Sec. 41.
Minnesota Statutes 2020, section 252A.19, subdivision 4, is amended to read:
Subd. 4.
Comprehensive evaluation.
The commissioner shall, at the court's request,
arrange for the preparation of a comprehensive evaluation of the deleted text begin warddeleted text end new text begin person subject to
public guardianshipnew text end or protected person.
Sec. 42.
Minnesota Statutes 2020, section 252A.19, subdivision 5, is amended to read:
Subd. 5.
Court order.
Upon proof of the allegations of the petition the court shall enter
an order removing the guardianship or limiting or expanding the powers of the guardianship
or restoring the deleted text begin warddeleted text end new text begin person subject to public guardianshipnew text end or protected person to full legal
capacity or may enter such other order as the court may deem just and equitable.
Sec. 43.
Minnesota Statutes 2020, section 252A.19, subdivision 7, is amended to read:
Subd. 7.
Attorney general's role; commissioner's role.
The attorney general may
appear and represent the commissioner in such proceedings. The commissioner shall support
or oppose the petition if the commissioner deems such action necessary for the protection
and supervision of the deleted text begin warddeleted text end new text begin person subject to public guardianshipnew text end or protected person.
Sec. 44.
Minnesota Statutes 2020, section 252A.19, subdivision 8, is amended to read:
Subd. 8.
deleted text begin Court appointeddeleted text end new text begin Court-appointednew text end counsel.
In all such proceedings, the
protected person or deleted text begin warddeleted text end new text begin person subject to public guardianshipnew text end shall be afforded an
opportunity to be represented by counsel, and if neither the protected person or deleted text begin warddeleted text end new text begin person
subject to public guardianshipnew text end nor others provide counsel the court shall appoint counsel to
represent the protected person or deleted text begin warddeleted text end new text begin person subject to public guardianshipnew text end .
Sec. 45.
Minnesota Statutes 2020, section 252A.20, is amended to read:
252A.20 COSTS OF HEARINGS.
Subdivision 1.
Witness and attorney fees.
In each proceeding under sections 252A.01
to 252A.21, the court shall allow and order paid to each witness subpoenaed the fees and
mileage prescribed by law; to each physician, advanced practice registered nurse,
psychologist, or social worker who assists in the preparation of the comprehensive evaluation
and who is not deleted text begin in the employ ofdeleted text end new text begin employed bynew text end the local agency or the state Department of
Human Services, a reasonable sum for services and for travel; and to the deleted text begin ward'sdeleted text end counselnew text begin of
the person subject to public guardianshipnew text end , when appointed by the court, a reasonable sum
for travel and for each day or portion of a day actually employed in court or actually
consumed in preparing for the hearing. Upon order the county auditor shall issue a warrant
on the county treasurer for payment of the amount allowed.
Subd. 2.
Expenses.
When the settlement of the deleted text begin warddeleted text end new text begin person subject to public guardianshipnew text end
is found to be in another county, the court shall transmit to the county auditor a statement
of the expenses incurred pursuant to subdivision 1. The auditor shall transmit the statement
to the auditor of the county of the deleted text begin ward'sdeleted text end settlement new text begin of the person subject to public
guardianship new text end and this claim shall be paid as other claims against that county. If the auditor
to whom this claim is transmitted denies the claim, the auditor shall transmit it, together
with the objections thereto, to the commissioner, who shall determine the question of
settlement and certify findings to each auditor. If the claim is not paid within 30 days after
such certification, an action may be maintained thereon in the district court of the claimant
county.
Subd. 3.
Change of venue; cost of proceedings.
Whenever venue of a proceeding has
been transferred under sections 252A.01 to 252A.21, the costs of such proceedings shall be
reimbursed to the county of the deleted text begin ward'sdeleted text end settlement new text begin of the person subject to public guardianship
new text end by the state.
Sec. 46.
Minnesota Statutes 2020, section 252A.21, subdivision 2, is amended to read:
Subd. 2.
Rules.
The commissioner shall adopt rules to implement this chapter. The rules
must include standards for performance of guardianship deleted text begin or conservatorshipdeleted text end duties includingdeleted text begin ,deleted text end
but not limited to: twice a year visits with the deleted text begin warddeleted text end new text begin person subject to public guardianshipnew text end ;
a requirement that the duties of guardianship deleted text begin or conservatorshipdeleted text end and case management not
be performed by the same person; specific standards for action on "do not resuscitate" orders
as recommended by a physician, an advanced practice registered nurse, or a physician
assistant; sterilization requests; and the use of psychotropic medication and aversive
procedures.
Sec. 47.
Minnesota Statutes 2020, section 252A.21, subdivision 4, is amended to read:
Sec. 48.
Minnesota Statutes 2020, section 254B.03, subdivision 2, is amended to read:
Subd. 2.
Chemical dependency fund payment.
(a) Payment from the chemical
dependency fund is limited to payments for services other than detoxification licensed under
Minnesota Rules, parts 9530.6510 to 9530.6590, deleted text begin that, if located outside of federally
recognized tribal lands, would be required to be licensed by the commissioner as a chemical
dependency treatment or rehabilitation program under sections 245A.01 to 245A.16,deleted text end new text begin services
identified in section 254B.05,new text end and services other than detoxification provided in another
state that would be required to be licensed as a chemical dependency program if the program
were in the state. Out of state vendors must also provide the commissioner with assurances
that the program complies substantially with state licensing requirements and possesses all
licenses and certifications required by the host state to provide chemical dependency
treatment. Vendors receiving payments from the chemical dependency fund must not require
co-payment from a recipient of benefits for services provided under this subdivision. The
vendor is prohibited from using the client's public benefits to offset the cost of services paid
under this section. The vendor shall not require the client to use public benefits for room
or board costs. This includes but is not limited to cash assistance benefits under chapters
119B, 256D, and 256J, or SNAP benefits. Retention of SNAP benefits is a right of a client
receiving services through the consolidated chemical dependency treatment fund or through
state contracted managed care entities. Payment from the chemical dependency fund shall
be made for necessary room and board costs provided by vendors meeting the criteria under
section 254B.05, subdivision 1a, or in a community hospital licensed by the commissioner
of health according to sections 144.50 to 144.56 to a client who is:
(1) determined to meet the criteria for placement in a residential chemical dependency
treatment program according to rules adopted under section 254A.03, subdivision 3; and
(2) concurrently receiving a chemical dependency treatment service in a program licensed
by the commissioner and reimbursed by the chemical dependency fund.
(b) A county may, from its own resources, provide chemical dependency services for
which state payments are not made. A county may elect to use the same invoice procedures
and obtain the same state payment services as are used for chemical dependency services
for which state payments are made under this section if county payments are made to the
state in advance of state payments to vendors. When a county uses the state system for
payment, the commissioner shall make monthly billings to the county using the most recent
available information to determine the anticipated services for which payments will be made
in the coming month. Adjustment of any overestimate or underestimate based on actual
expenditures shall be made by the state agency by adjusting the estimate for any succeeding
month.
(c) The commissioner shall coordinate chemical dependency services and determine
whether there is a need for any proposed expansion of chemical dependency treatment
services. The commissioner shall deny vendor certification to any provider that has not
received prior approval from the commissioner for the creation of new programs or the
expansion of existing program capacity. The commissioner shall consider the provider's
capacity to obtain clients from outside the state based on plans, agreements, and previous
utilization history, when determining the need for new treatment services.
Sec. 49.
Minnesota Statutes 2020, section 256B.051, subdivision 1, is amended to read:
Subdivision 1.
Purpose.
Housing deleted text begin supportdeleted text end new text begin stabilizationnew text end services are established to provide
housing deleted text begin supportdeleted text end new text begin stabilizationnew text end services to an individual with a disability that limits the
individual's ability to obtain or maintain stable housing. The services support an individual's
transition to housing in the community and increase long-term stability in housing, to avoid
future periods of being at risk of homelessness or institutionalization.
Sec. 50.
Minnesota Statutes 2020, section 256B.051, subdivision 3, is amended to read:
Subd. 3.
Eligibility.
An individual with a disability is eligible for housing deleted text begin supportdeleted text end new text begin
stabilizationnew text end services if the individual:
(1) is 18 years of age or older;
(2) is enrolled in medical assistance;
(3) has an assessment of functional need that determines a need for services due to
limitations caused by the individual's disability;
(4) resides in or plans to transition to a community-based setting as defined in Code of
Federal Regulations, title 42, section 441.301 (c); and
(5) has housing instability evidenced by:
(i) being homeless or at-risk of homelessness;
(ii) being in the process of transitioning from, or having transitioned in the past six
months from, an institution or licensed or registered setting;
(iii) being eligible for waiver services under chapter 256S or section 256B.092 or
256B.49; or
(iv) having been identified by a long-term care consultation under section 256B.0911
as at risk of institutionalization.
Sec. 51.
Minnesota Statutes 2020, section 256B.051, subdivision 5, is amended to read:
Subd. 5.
Housing deleted text begin supportdeleted text end new text begin stabilizationnew text end services.
(a) Housing deleted text begin supportdeleted text end new text begin stabilizationnew text end
services include housing transition services and housing and tenancy sustaining services.
(b) Housing transition services are defined as:
(1) tenant screening and housing assessment;
(2) assistance with the housing search and application process;
(3) identifying resources to cover onetime moving expenses;
(4) ensuring a new living arrangement is safe and ready for move-in;
(5) assisting in arranging for and supporting details of a move; and
(6) developing a housing support crisis plan.
(c) Housing and tenancy sustaining services include:
(1) prevention and early identification of behaviors that may jeopardize continued stable
housing;
(2) education and training on roles, rights, and responsibilities of the tenant and the
property manager;
(3) coaching to develop and maintain key relationships with property managers and
neighbors;
(4) advocacy and referral to community resources to prevent eviction when housing is
at risk;
(5) assistance with housing recertification process;
(6) coordination with the tenant to regularly review, update, and modify the housing
support and crisis plan; and
(7) continuing training on being a good tenant, lease compliance, and household
management.
(d) A housing deleted text begin supportdeleted text end new text begin stabilizationnew text end service may include person-centered planning for
people who are not eligible to receive person-centered planning through any other service,
if the person-centered planning is provided by a consultation service provider that is under
contract with the department and enrolled as a Minnesota health care program.
Sec. 52.
Minnesota Statutes 2020, section 256B.051, subdivision 6, is amended to read:
Subd. 6.
Provider qualifications and duties.
A provider eligible for reimbursement
under this section shall:
(1) enroll as a medical assistance Minnesota health care program provider and meet all
applicable provider standards and requirements;
(2) demonstrate compliance with federal and state laws and policies for housing deleted text begin supportdeleted text end new text begin
stabilizationnew text end services as determined by the commissioner;
(3) comply with background study requirements under chapter 245C and maintain
documentation of background study requests and results; deleted text begin and
deleted text end
(4) directly provide housing deleted text begin supportdeleted text end new text begin stabilizationnew text end services and not use a subcontractor
or reporting agentdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(5) complete annual vulnerable adult training.
new text end
Sec. 53.
Minnesota Statutes 2020, section 256B.051, subdivision 7, is amended to read:
Subd. 7.
Housing support supplemental service rates.
Supplemental service rates for
individuals in settings according to sections 144D.025, 256I.04, subdivision 3, paragraph
(a), clause (3), and 256I.05, subdivision 1g, shall be reduced by one-half over a two-year
period. This reduction only applies to supplemental service rates for individuals eligible for
housing deleted text begin supportdeleted text end new text begin stabilizationnew text end services under this section.
Sec. 54.
Minnesota Statutes 2020, section 256B.051, is amended by adding a subdivision
to read:
new text begin Subd. 8. new text end
new text begin Documentation requirements. new text end
new text begin
(a) Documentation may be collected and
maintained electronically or in paper form by providers and must be produced upon request
by the commissioner.
new text end
new text begin
(b) Documentation of a delivered service must be in English and must be legible according
to the standard of a reasonable person.
new text end
new text begin
(c) If the service is reimbursed at an hourly or specified minute-based rate, each
documentation of the provision of a service, unless otherwise specified, must include:
new text end
new text begin
(1) the date the documentation occurred;
new text end
new text begin
(2) the day, month, and year the service was provided;
new text end
new text begin
(3) the start and stop times with a.m. and p.m. designations, except for person-centered
planning services described under subdivision 5, paragraph (d);
new text end
new text begin
(4) the service name or description of the service provided; and
new text end
new text begin
(5) the name, signature, and title, if any, of the provider of service. If the service is
provided by multiple staff members, the provider may designate a staff member responsible
for verifying services and completing the documentation required by this paragraph.
new text end
Sec. 55.
Minnesota Statutes 2020, section 256B.0947, subdivision 6, is amended to read:
Subd. 6.
Service standards.
The standards in this subdivision apply to intensive
nonresidential rehabilitative mental health services.
(a) The treatment team must use team treatment, not an individual treatment model.
(b) Services must be available at times that meet client needs.
(c) Services must be age-appropriate and meet the specific needs of the client.
(d) The initial functional assessment must be completed within ten days of intake and
updated at least every six months or prior to discharge from the service, whichever comes
first.
(e) new text begin The treatment team must completenew text end an individual treatment plan new text begin for each client and
the individual treatment plannew text end must:
(1) be based on the information in the client's diagnostic assessment and baselines;
(2) identify goals and objectives of treatment, a treatment strategy, a schedule for
accomplishing treatment goals and objectives, and the individuals responsible for providing
treatment services and supports;
(3) be developed after completion of the client's diagnostic assessment by a mental health
professional or clinical trainee and before the provision of children's therapeutic services
and supports;
(4) be developed through a child-centered, family-driven, culturally appropriate planning
process, including allowing parents and guardians to observe or participate in individual
and family treatment services, assessments, and treatment planning;
(5) be reviewed at least once every six months and revised to document treatment progress
on each treatment objective and next goals or, if progress is not documented, to document
changes in treatment;
(6) be signed by the clinical supervisor and by the client or by the client's parent or other
person authorized by statute to consent to mental health services for the client. A client's
parent may approve the client's individual treatment plan by secure electronic signature or
by documented oral approval that is later verified by written signature;
(7) be completed in consultation with the client's current therapist and key providers and
provide for ongoing consultation with the client's current therapist to ensure therapeutic
continuity and to facilitate the client's return to the community. For clients under the age of
18, the treatment team must consult with parents and guardians in developing the treatment
plan;
(8) if a need for substance use disorder treatment is indicated by validated assessment:
(i) identify goals, objectives, and strategies of substance use disorder treatment; develop
a schedule for accomplishing treatment goals and objectives; and identify the individuals
responsible for providing treatment services and supports;
(ii) be reviewed at least once every 90 days and revised, if necessary;
(9) be signed by the clinical supervisor and by the client and, if the client is a minor, by
the client's parent or other person authorized by statute to consent to mental health treatment
and substance use disorder treatment for the client; and
(10) provide for the client's transition out of intensive nonresidential rehabilitative mental
health services by defining the team's actions to assist the client and subsequent providers
in the transition to less intensive or "stepped down" services.
(f) The treatment team shall actively and assertively engage the client's family members
and significant others by establishing communication and collaboration with the family and
significant others and educating the family and significant others about the client's mental
illness, symptom management, and the family's role in treatment, unless the team knows or
has reason to suspect that the client has suffered or faces a threat of suffering any physical
or mental injury, abuse, or neglect from a family member or significant other.
(g) For a client age 18 or older, the treatment team may disclose to a family member,
other relative, or a close personal friend of the client, or other person identified by the client,
the protected health information directly relevant to such person's involvement with the
client's care, as provided in Code of Federal Regulations, title 45, part 164.502(b). If the
client is present, the treatment team shall obtain the client's agreement, provide the client
with an opportunity to object, or reasonably infer from the circumstances, based on the
exercise of professional judgment, that the client does not object. If the client is not present
or is unable, by incapacity or emergency circumstances, to agree or object, the treatment
team may, in the exercise of professional judgment, determine whether the disclosure is in
the best interests of the client and, if so, disclose only the protected health information that
is directly relevant to the family member's, relative's, friend's, or client-identified person's
involvement with the client's health care. The client may orally agree or object to the
disclosure and may prohibit or restrict disclosure to specific individuals.
(h) The treatment team shall provide interventions to promote positive interpersonal
relationships.
Sec. 56.
Minnesota Statutes 2020, section 256B.4912, subdivision 13, is amended to read:
Subd. 13.
Waiver transportation documentation and billing requirements.
(a) A
waiver transportation service must be a waiver transportation service that: (1) is not covered
by medical transportation under the Medicaid state plan; and (2) is not included as a
component of another waiver service.
(b) In addition to the documentation requirements in subdivision 12, a waiver
transportation service provider must maintain:
(1) odometer and other records pursuant to section 256B.0625, subdivision 17b, paragraph
(b), clause (3), sufficient to distinguish an individual trip with a specific vehicle and driver
for a waiver transportation service that is billed directly by the mile. A common carrier as
defined by Minnesota Rules, part 9505.0315, subpart 1, item B, or a publicly operated transit
system provider are exempt from this clause; and
(2) documentation demonstrating that a vehicle and a driver meet the deleted text begin standards determined
by the Department of Human Services on vehicle and driver qualifications in section
256B.0625, subdivision 17, paragraph (c)deleted text end new text begin transportation waiver service provider standards
and qualifications according to the federally approved waiver plannew text end .
Sec. 57.
Minnesota Statutes 2020, section 256B.69, subdivision 5a, is amended to read:
Subd. 5a.
Managed care contracts.
(a) Managed care contracts under this section and
section 256L.12 shall be entered into or renewed on a calendar year basis. The commissioner
may issue separate contracts with requirements specific to services to medical assistance
recipients age 65 and older.
(b) A prepaid health plan providing covered health services for eligible persons pursuant
to chapters 256B and 256L is responsible for complying with the terms of its contract with
the commissioner. Requirements applicable to managed care programs under chapters 256B
and 256L established after the effective date of a contract with the commissioner take effect
when the contract is next issued or renewed.
(c) The commissioner shall withhold five percent of managed care plan payments under
this section and county-based purchasing plan payments under section 256B.692 for the
prepaid medical assistance program pending completion of performance targets. Each
performance target must be quantifiable, objective, measurable, and reasonably attainable,
except in the case of a performance target based on a federal or state law or rule. Criteria
for assessment of each performance target must be outlined in writing prior to the contract
effective date. Clinical or utilization performance targets and their related criteria must
consider evidence-based research and reasonable interventions when available or applicable
to the populations served, and must be developed with input from external clinical experts
and stakeholders, including managed care plans, county-based purchasing plans, and
providers. The managed care or county-based purchasing plan must demonstrate, to the
commissioner's satisfaction, that the data submitted regarding attainment of the performance
target is accurate. The commissioner shall periodically change the administrative measures
used as performance targets in order to improve plan performance across a broader range
of administrative services. The performance targets must include measurement of plan
efforts to contain spending on health care services and administrative activities. The
commissioner may adopt plan-specific performance targets that take into account factors
affecting only one plan, including characteristics of the plan's enrollee population. The
withheld funds must be returned no sooner than July of the following year if performance
targets in the contract are achieved. The commissioner may exclude special demonstration
projects under subdivision 23.
(d) The commissioner shall require that managed care plans use the assessment and
authorization processes, forms, timelines, standards, documentation, and data reporting
requirements, protocols, billing processes, and policies consistent with medical assistance
fee-for-service or the Department of Human Services contract requirements for all personal
care assistance services under section 256B.0659new text begin and community first services and supports
under section 256B.85new text end .
(e) Effective for services rendered on or after January 1, 2012, the commissioner shall
include as part of the performance targets described in paragraph (c) a reduction in the health
plan's emergency department utilization rate for medical assistance and MinnesotaCare
enrollees, as determined by the commissioner. For 2012, the reduction shall be based on
the health plan's utilization in 2009. To earn the return of the withhold each subsequent
year, the managed care plan or county-based purchasing plan must achieve a qualifying
reduction of no less than ten percent of the plan's emergency department utilization rate for
medical assistance and MinnesotaCare enrollees, excluding enrollees in programs described
in subdivisions 23 and 28, compared to the previous measurement year until the final
performance target is reached. When measuring performance, the commissioner must
consider the difference in health risk in a managed care or county-based purchasing plan's
membership in the baseline year compared to the measurement year, and work with the
managed care or county-based purchasing plan to account for differences that they agree
are significant.
The withheld funds must be returned no sooner than July 1 and no later than July 31 of
the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that a reduction in the utilization rate
was achieved. The commissioner shall structure the withhold so that the commissioner
returns a portion of the withheld funds in amounts commensurate with achieved reductions
in utilization less than the targeted amount.
The withhold described in this paragraph shall continue for each consecutive contract
period until the plan's emergency room utilization rate for state health care program enrollees
is reduced by 25 percent of the plan's emergency room utilization rate for medical assistance
and MinnesotaCare enrollees for calendar year 2009. Hospitals shall cooperate with the
health plans in meeting this performance target and shall accept payment withholds that
may be returned to the hospitals if the performance target is achieved.
(f) Effective for services rendered on or after January 1, 2012, the commissioner shall
include as part of the performance targets described in paragraph (c) a reduction in the plan's
hospitalization admission rate for medical assistance and MinnesotaCare enrollees, as
determined by the commissioner. To earn the return of the withhold each year, the managed
care plan or county-based purchasing plan must achieve a qualifying reduction of no less
than five percent of the plan's hospital admission rate for medical assistance and
MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and
28, compared to the previous calendar year until the final performance target is reached.
When measuring performance, the commissioner must consider the difference in health risk
in a managed care or county-based purchasing plan's membership in the baseline year
compared to the measurement year, and work with the managed care or county-based
purchasing plan to account for differences that they agree are significant.
The withheld funds must be returned no sooner than July 1 and no later than July 31 of
the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that this reduction in the hospitalization
rate was achieved. The commissioner shall structure the withhold so that the commissioner
returns a portion of the withheld funds in amounts commensurate with achieved reductions
in utilization less than the targeted amount.
The withhold described in this paragraph shall continue until there is a 25 percent
reduction in the hospital admission rate compared to the hospital admission rates in calendar
year 2011, as determined by the commissioner. The hospital admissions in this performance
target do not include the admissions applicable to the subsequent hospital admission
performance target under paragraph (g). Hospitals shall cooperate with the plans in meeting
this performance target and shall accept payment withholds that may be returned to the
hospitals if the performance target is achieved.
(g) Effective for services rendered on or after January 1, 2012, the commissioner shall
include as part of the performance targets described in paragraph (c) a reduction in the plan's
hospitalization admission rates for subsequent hospitalizations within 30 days of a previous
hospitalization of a patient regardless of the reason, for medical assistance and MinnesotaCare
enrollees, as determined by the commissioner. To earn the return of the withhold each year,
the managed care plan or county-based purchasing plan must achieve a qualifying reduction
of the subsequent hospitalization rate for medical assistance and MinnesotaCare enrollees,
excluding enrollees in programs described in subdivisions 23 and 28, of no less than five
percent compared to the previous calendar year until the final performance target is reached.
The withheld funds must be returned no sooner than July 1 and no later than July 31 of
the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that a qualifying reduction in the
subsequent hospitalization rate was achieved. The commissioner shall structure the withhold
so that the commissioner returns a portion of the withheld funds in amounts commensurate
with achieved reductions in utilization less than the targeted amount.
The withhold described in this paragraph must continue for each consecutive contract
period until the plan's subsequent hospitalization rate for medical assistance and
MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and
28, is reduced by 25 percent of the plan's subsequent hospitalization rate for calendar year
2011. Hospitals shall cooperate with the plans in meeting this performance target and shall
accept payment withholds that must be returned to the hospitals if the performance target
is achieved.
(h) Effective for services rendered on or after January 1, 2013, through December 31,
2013, the commissioner shall withhold 4.5 percent of managed care plan payments under
this section and county-based purchasing plan payments under section 256B.692 for the
prepaid medical assistance program. The withheld funds must be returned no sooner than
July 1 and no later than July 31 of the following year. The commissioner may exclude
special demonstration projects under subdivision 23.
(i) Effective for services rendered on or after January 1, 2014, the commissioner shall
withhold three percent of managed care plan payments under this section and county-based
purchasing plan payments under section 256B.692 for the prepaid medical assistance
program. The withheld funds must be returned no sooner than July 1 and no later than July
31 of the following year. The commissioner may exclude special demonstration projects
under subdivision 23.
(j) A managed care plan or a county-based purchasing plan under section 256B.692 may
include as admitted assets under section 62D.044 any amount withheld under this section
that is reasonably expected to be returned.
(k) Contracts between the commissioner and a prepaid health plan are exempt from the
set-aside and preference provisions of section 16C.16, subdivisions 6, paragraph (a), and
7.
(l) The return of the withhold under paragraphs (h) and (i) is not subject to the
requirements of paragraph (c).
(m) Managed care plans and county-based purchasing plans shall maintain current and
fully executed agreements for all subcontractors, including bargaining groups, for
administrative services that are expensed to the state's public health care programs.
Subcontractor agreements determined to be material, as defined by the commissioner after
taking into account state contracting and relevant statutory requirements, must be in the
form of a written instrument or electronic document containing the elements of offer,
acceptance, consideration, payment terms, scope, duration of the contract, and how the
subcontractor services relate to state public health care programs. Upon request, the
commissioner shall have access to all subcontractor documentation under this paragraph.
Nothing in this paragraph shall allow release of information that is nonpublic data pursuant
to section 13.02.
Sec. 58.
Minnesota Statutes 2020, section 256B.85, subdivision 1, is amended to read:
Subdivision 1.
Basis and scope.
(a) Upon federal approval, the commissioner shall
establish a state plan option for the provision of home and community-based personal
assistance service and supports called "community first services and supports (CFSS)."
(b) CFSS is a participant-controlled method of selecting and providing services and
supports that allows the participant maximum control of the services and supports.
Participants may choose the degree to which they direct and manage their supports by
choosing to have a significant and meaningful role in the management of services and
supports including by directly employing support workers with the necessary supports to
perform that function.
(c) CFSS is available statewide to eligible people to assist with accomplishing activities
of daily living (ADLs), instrumental activities of daily living (IADLs), and health-related
procedures and tasks through hands-on assistance to accomplish the task or constant
supervision and cueing to accomplish the task; and to assist with acquiring, maintaining,
and enhancing the skills necessary to accomplish ADLs, IADLs, and health-related
procedures and tasks. CFSS allows payment for new text begin the participant for new text end certain supports and
goods such as environmental modifications and technology that are intended to replace or
decrease the need for human assistance.
(d) Upon federal approval, CFSS will replace the personal care assistance program under
sections 256.476, 256B.0625, subdivisions 19a and 19c, and 256B.0659.
new text begin
(e) For the purposes of this section, notwithstanding the provisions of section 144A.43,
subdivision 3, supports purchased under CFSS are not considered home care services.
new text end
Sec. 59.
Minnesota Statutes 2020, section 256B.85, subdivision 2, is amended to read:
Subd. 2.
Definitions.
(a) For the purposes of this section, the terms defined in this
subdivision have the meanings given.
(b) "Activities of daily living" or "ADLs" means deleted text begin eating, toileting, grooming, dressing,
bathing, mobility, positioning, and transferring.deleted text end new text begin :
new text end
new text begin
(1) dressing, including assistance with choosing, applying, and changing clothing and
applying special appliances, wraps, or clothing;
new text end
new text begin
(2) grooming, including assistance with basic hair care, oral care, shaving, applying
cosmetics and deodorant, and care of eyeglasses and hearing aids. Grooming includes nail
care, except for recipients who are diabetic or have poor circulation;
new text end
new text begin
(3) bathing, including assistance with basic personal hygiene and skin care;
new text end
new text begin
(4) eating, including assistance with hand washing and applying orthotics required for
eating, transfers, or feeding;
new text end
new text begin
(5) transfers, including assistance with transferring the participant from one seating or
reclining area to another;
new text end
new text begin
(6) mobility, including assistance with ambulation and use of a wheelchair. Mobility
does not include providing transportation for a participant;
new text end
new text begin
(7) positioning, including assistance with positioning or turning a participant for necessary
care and comfort; and
new text end
new text begin
(8) toileting, including assistance with bowel or bladder elimination and care, transfers,
mobility, positioning, feminine hygiene, use of toileting equipment or supplies, cleansing
the perineal area, inspection of the skin, and adjusting clothing.
new text end
(c) "Agency-provider model" means a method of CFSS under which a qualified agency
provides services and supports through the agency's own employees and policies. The agency
must allow the participant to have a significant role in the selection and dismissal of support
workers of their choice for the delivery of their specific services and supports.
(d) "Behavior" means a description of a need for services and supports used to determine
the home care rating and additional service units. The presence of Level I behavior is used
to determine the home care rating.
(e) "Budget model" means a service delivery method of CFSS that allows the use of a
service budget and assistance from a financial management services (FMS) provider for a
participant to directly employ support workers and purchase supports and goods.
(f) "Complex health-related needs" means an intervention listed in clauses (1) to (8) that
has been ordered by a physician, new text begin advanced practice registered nurse, or physician's assistant
new text end and is specified in a community support plan, including:
(1) tube feedings requiring:
(i) a gastrojejunostomy tube; or
(ii) continuous tube feeding lasting longer than 12 hours per day;
(2) wounds described as:
(i) stage III or stage IV;
(ii) multiple wounds;
(iii) requiring sterile or clean dressing changes or a wound vac; or
(iv) open lesions such as burns, fistulas, tube sites, or ostomy sites that require specialized
care;
(3) parenteral therapy described as:
(i) IV therapy more than two times per week lasting longer than four hours for each
treatment; or
(ii) total parenteral nutrition (TPN) daily;
(4) respiratory interventions, including:
(i) oxygen required more than eight hours per day;
(ii) respiratory vest more than one time per day;
(iii) bronchial drainage treatments more than two times per day;
(iv) sterile or clean suctioning more than six times per day;
(v) dependence on another to apply respiratory ventilation augmentation devices such
as BiPAP and CPAP; and
(vi) ventilator dependence under section 256B.0651;
(5) insertion and maintenance of catheter, including:
(i) sterile catheter changes more than one time per month;
(ii) clean intermittent catheterization, and including self-catheterization more than six
times per day; or
(iii) bladder irrigations;
(6) bowel program more than two times per week requiring more than 30 minutes to
perform each time;
(7) neurological intervention, including:
(i) seizures more than two times per week and requiring significant physical assistance
to maintain safety; or
(ii) swallowing disorders diagnosed by a physiciannew text begin , advanced practice registered nurse,
or physician's assistantnew text end and requiring specialized assistance from another on a daily basis;
and
(8) other congenital or acquired diseases creating a need for significantly increased direct
hands-on assistance and interventions in six to eight activities of daily living.
(g) "Community first services and supports" or "CFSS" means the assistance and supports
program under this section needed for accomplishing activities of daily living, instrumental
activities of daily living, and health-related tasks through hands-on assistance to accomplish
the task or constant supervision and cueing to accomplish the task, or the purchase of goods
as defined in subdivision 7, clause (3), that replace the need for human assistance.
(h) "Community first services and supports service delivery plan" or "CFSS service
delivery plan" means a written document detailing the services and supports chosen by the
participant to meet assessed needs that are within the approved CFSS service authorization,
as determined in subdivision 8. Services and supports are based on the coordinated service
and support plan identified in deleted text begin sectiondeleted text end new text begin sections 256B.092, subdivision 1b, andnew text end 256S.10.
(i) "Consultation services" means a Minnesota health care program enrolled provider
organization that provides assistance to the participant in making informed choices about
CFSS services in general and self-directed tasks in particular, and in developing a
person-centered CFSS service delivery plan to achieve quality service outcomes.
(j) "Critical activities of daily living" means transferring, mobility, eating, and toileting.
(k) "Dependency" in activities of daily living means a person requires hands-on assistance
or constant supervision and cueing to accomplish one or more of the activities of daily living
every day or on the days during the week that the activity is performed; however, a child
deleted text begin maydeleted text end new text begin mustnew text end 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 assistance needed is the assistance appropriate for a typical child of the
same age.
(l) "Extended CFSS" means CFSS services and supports provided under CFSS that are
included in the CFSS service delivery plan through one of the home and community-based
services waivers and as approved and authorized under chapter 256S and sections 256B.092,
subdivision 5, and 256B.49, which exceed the amount, duration, and frequency of the state
plan CFSS services for participants.new text begin Extended CFSS excludes the purchase of goods.
new text end
(m) "Financial management services provider" or "FMS provider" means a qualified
organization required for participants using the budget model under subdivision 13 that is
an enrolled provider with the department to provide vendor fiscal/employer agent financial
management services (FMS).
(n) "Health-related procedures and tasks" means procedures and tasks related to the
specific assessed health needs of a participant that can be taught or assigned by a
state-licensed health care or mental health professional and performed by a support worker.
(o) "Instrumental activities of daily living" means activities related to living independently
in the community, including but not limited to: meal planning, preparation, and cooking;
shopping for food, clothing, or other essential items; laundry; housecleaning; assistance
with medications; managing finances; communicating needs and preferences during activities;
arranging supports; and assistance with traveling around and participating in the community.
(p) "Lead agency" has the meaning given in section 256B.0911, subdivision 1a, paragraph
(e).
(q) "Legal representative" means parent of a minor, a court-appointed guardian, or
another representative with legal authority to make decisions about services and supports
for the participant. Other representatives with legal authority to make decisions include but
are not limited to a health care agent or an attorney-in-fact authorized through a health care
directive or power of attorney.
(r) "Level I behavior" means physical aggression new text begin toward new text end deleted text begin towardsdeleted text end self or others or
destruction of property that requires the immediate response of another person.
(s) "Medication assistance" means providing verbal or visual reminders to take regularly
scheduled medication, and includes any of the following supports listed in clauses (1) to
(3) and other types of assistance, except that a support worker deleted text begin maydeleted text end new text begin mustnew text end not determine
medication dose or time for medication or inject medications into veins, muscles, or skin:
(1) under the direction of the participant or the participant's representative, bringing
medications to the participant including medications given through a nebulizer, opening a
container of previously set-up medications, emptying the container into the participant's
hand, opening and giving the medication in the original container to the participant, or
bringing to the participant liquids or food to accompany the medication;
(2) organizing medications as directed by the participant or the participant's representative;
and
(3) providing verbal or visual reminders to perform regularly scheduled medications.
(t) "Participant" means a person who is eligible for CFSS.
(u) "Participant's representative" means a parent, family member, advocate, or other
adult authorized by the participant or participant's legal representative, if any, to serve as a
representative in connection with the provision of CFSS. deleted text begin This authorization must be in
writing or by another method that clearly indicates the participant's free choice and may be
withdrawn at any time. The participant's representative must have no financial interest in
the provision of any services included in the participant's CFSS service delivery plan and
must be capable of providing the support necessary to assist the participant in the use of
CFSS. If through the assessment process described in subdivision 5 a participant is
determined to be in need of a participant's representative, one must be selected.deleted text end If the
participant is unable to assist in the selection of a participant's representative, the legal
representative shall appoint one. deleted text begin Two persons may be designated as a participant's
representative for reasons such as divided households and court-ordered custodies. Duties
of a participant's representatives may include:
deleted text end
deleted text begin
(1) being available while services are provided in a method agreed upon by the participant
or the participant's legal representative and documented in the participant's CFSS service
delivery plan;
deleted text end
deleted text begin
(2) monitoring CFSS services to ensure the participant's CFSS service delivery plan is
being followed; and
deleted text end
deleted text begin
(3) reviewing and signing CFSS time sheets after services are provided to provide
verification of the CFSS services.
deleted text end
(v) "Person-centered planning process" means a process that is directed by the participant
to plan for CFSS services and supports.
(w) "Service budget" means the authorized dollar amount used for the budget model or
for the purchase of goods.
(x) "Shared services" means the provision of CFSS services by the same CFSS support
worker to two or three participants who voluntarily enter into deleted text begin andeleted text end new text begin a writtennew text end agreement to
receive services at the same time deleted text begin anddeleted text end new text begin ,new text end in the same setting deleted text begin bydeleted text end new text begin , and throughnew text end the same deleted text begin employerdeleted text end new text begin
agency-provider or FMS providernew text end .
(y) "Support worker" means a qualified and trained employee of the agency-provider
as required by subdivision 11b or of the participant employer under the budget model as
required by subdivision 14 who has direct contact with the participant and provides services
as specified within the participant's CFSS service delivery plan.
(z) "Unit" means the increment of service based on hours or minutes identified in the
service agreement.
(aa) "Vendor fiscal employer agent" means an agency that provides financial management
services.
(bb) "Wages and benefits" means the hourly wages and salaries, the employer's share
of FICA taxes, Medicare taxes, state and federal unemployment taxes, workers' compensation,
mileage reimbursement, health and dental insurance, life insurance, disability insurance,
long-term care insurance, uniform allowance, contributions to employee retirement accounts,
or other forms of employee compensation and benefits.
(cc) "Worker training and development" means services provided according to subdivision
18a for developing workers' skills as required by the participant's individual CFSS service
delivery plan that are arranged for or provided by the agency-provider or purchased by the
participant employer. These services include training, education, direct observation and
supervision, and evaluation and coaching of job skills and tasks, including supervision of
health-related tasks or behavioral supports.
Sec. 60.
Minnesota Statutes 2020, section 256B.85, subdivision 3, is amended to read:
Subd. 3.
Eligibility.
(a) CFSS is available to a person who deleted text begin meets one of the followingdeleted text end :
deleted text begin
(1) is an enrollee of medical assistance as determined under section 256B.055, 256B.056,
or 256B.057, subdivisions 5 and 9;
deleted text end
new text begin
(1) is determined eligible for medical assistance under this chapter, excluding those
under section 256B.057, subdivisions 3, 3a, 3b, and 4;
new text end
(2) is a participant in the alternative care program under section 256B.0913;
(3) is a waiver participant as defined under chapter 256S or section 256B.092, 256B.093,
or 256B.49; or
(4) has medical services identified in a person's individualized education program and
is eligible for services as determined in section 256B.0625, subdivision 26.
(b) In addition to meeting the eligibility criteria in paragraph (a), a person must also
meet all of the following:
(1) require assistance and be determined dependent in one activity of daily living or
Level I behavior based on assessment under section 256B.0911; and
(2) is not a participant under a family support grant under section 252.32.
(c) A pregnant woman eligible for medical assistance under section 256B.055, subdivision
6, is eligible for CFSS without federal financial participation if the woman: (1) is eligible
for CFSS under paragraphs (a) and (b); and (2) does not meet institutional level of care, as
determined under section 256B.0911.
Sec. 61.
Minnesota Statutes 2020, section 256B.85, subdivision 4, is amended to read:
Subd. 4.
Eligibility for other services.
Selection of CFSS by a participant must not
restrict access to other medically necessary care and services furnished under the state plan
benefit or other services available through new text begin the new text end alternative carenew text begin programnew text end .
Sec. 62.
Minnesota Statutes 2020, section 256B.85, subdivision 5, is amended to read:
Subd. 5.
Assessment requirements.
(a) The assessment of functional need must:
(1) be conducted by a certified assessor according to the criteria established in section
256B.0911, subdivision 3a;
(2) be conducted face-to-face, initially and at least annually thereafter, or when there is
a significant change in the participant's condition or a change in the need for services and
supports, or at the request of the participant when the participant experiences a change in
condition or needs a change in the services or supports; and
(3) be completed using the format established by the commissioner.
(b) The results of the assessment and any recommendations and authorizations for CFSS
must be determined and communicated in writing by the lead agency's deleted text begin certifieddeleted text end assessor as
defined in section 256B.0911 to the participant deleted text begin and the agency-provider or FMS provider
chosen by the participantdeleted text end new text begin or the participant's representative and chosen CFSS providersnew text end
within deleted text begin 40 calendardeleted text end new text begin ten business new text end days and must include the participant's right to appeal new text begin the
assessment new text end under section 256.045, subdivision 3.
(c) The lead agency assessor may authorize a temporary authorization for CFSS services
to be provided under the agency-provider model. new text begin The lead agency assessor may authorize
a temporary authorization for CFSS services to be provided under the agency-provider
model without using the assessment process described in this subdivision. new text end Authorization
for a temporary level of CFSS services under the agency-provider model is limited to the
time specified by the commissioner, but shall not exceed 45 days. The level of services
authorized under this paragraph shall have no bearing on a future authorization. deleted text begin Participants
approved for a temporary authorization shall access the consultation servicedeleted text end new text begin For CFSS
services needed beyond the 45-day temporary authorization, the lead agency must conduct
an assessment as described in this subdivision and participants must use consultation servicesnew text end
to complete their orientation and selection of a service model.
Sec. 63.
Minnesota Statutes 2020, section 256B.85, subdivision 6, is amended to read:
Subd. 6.
Community first services and supports service delivery plan.
(a) The CFSS
service delivery plan must be developed and evaluated through a person-centered planning
process by the participant, or the participant's representative or legal representative who
may be assisted by a consultation services provider. The CFSS service delivery plan must
reflect the services and supports that are important to the participant and for the participant
to meet the needs assessed by the certified assessor and identified in the coordinated service
and support plan identified in deleted text begin sectiondeleted text end new text begin sections 256B.092, subdivision 1b, andnew text end 256S.10. The
CFSS service delivery plan must be reviewed by the participant, the consultation services
provider, and the agency-provider or FMS provider prior to starting services and at least
annually upon reassessment, or when there is a significant change in the participant's
condition, or a change in the need for services and supports.
(b) The commissioner shall establish the format and criteria for the CFSS service delivery
plan.
(c) The CFSS service delivery plan must be person-centered and:
(1) specify the consultation services provider, agency-provider, or FMS provider selected
by the participant;
(2) reflect the setting in which the participant resides that is chosen by the participant;
(3) reflect the participant's strengths and preferences;
(4) include the methods and supports used to address the needs as identified through an
assessment of functional needs;
(5) include the participant's identified goals and desired outcomes;
(6) reflect the services and supports, paid and unpaid, that will assist the participant to
achieve identified goals, including the costs of the services and supports, and the providers
of those services and supports, including natural supports;
(7) identify the amount and frequency of face-to-face supports and amount and frequency
of remote supports and technology that will be used;
(8) identify risk factors and measures in place to minimize them, including individualized
backup plans;
(9) be understandable to the participant and the individuals providing support;
(10) identify the individual or entity responsible for monitoring the plan;
(11) be finalized and agreed to in writing by the participant and signed by deleted text begin alldeleted text end individuals
and providers responsible for its implementation;
(12) be distributed to the participant and other people involved in the plan;
(13) prevent the provision of unnecessary or inappropriate care;
(14) include a detailed budget for expenditures for budget model participants or
participants under the agency-provider model if purchasing goods; and
(15) include a plan for worker training and development provided according to
subdivision 18a detailing what service components will be used, when the service components
will be used, how they will be provided, and how these service components relate to the
participant's individual needs and CFSS support worker services.
(d) new text begin The CFSS service delivery plan must describe the units or dollar amount available
to the participant. new text end The total units of agency-provider services or the service budget amount
for the budget model include both annual totals and a monthly average amount that cover
the number of months of the service agreement. The amount used each month may vary,
but additional funds must not be provided above the annual service authorization amount,
determined according to subdivision 8, unless a change in condition is assessed and
authorized by the certified assessor and documented in the coordinated service and support
plan and CFSS service delivery plan.
(e) In assisting with the development or modification of the CFSS service delivery plan
during the authorization time period, the consultation services provider shall:
(1) consult with the FMS provider on the spending budget when applicable; and
(2) consult with the participant or participant's representative, agency-provider, and case
managerdeleted text begin /deleted text end new text begin or new text end care coordinator.
(f) The CFSS service delivery plan must be approved by the consultation services provider
for participants without a case manager or care coordinator who is responsible for authorizing
services. A case manager or care coordinator must approve the plan for a waiver or alternative
care program participant.
Sec. 64.
Minnesota Statutes 2020, section 256B.85, subdivision 7, is amended to read:
Subd. 7.
Community first services and supports; covered services.
Services and
supports covered under CFSS include:
(1) assistance to accomplish activities of daily living (ADLs), instrumental activities of
daily living (IADLs), and health-related procedures and tasks through hands-on assistance
to accomplish the task or constant supervision and cueing to accomplish the task;
(2) assistance to acquire, maintain, or enhance the skills necessary for the participant to
accomplish activities of daily living, instrumental activities of daily living, or health-related
tasks;
(3) expenditures for items, services, supports, environmental modifications, or goods,
including assistive technology. These expenditures must:
(i) relate to a need identified in a participant's CFSS service delivery plan; and
(ii) increase independence or substitute for human assistancenew text begin ,new text end to the extent that
expenditures would otherwise be made for human assistance for the participant's assessed
needs;
(4) observation and redirection for behavior or symptoms where there is a need for
assistance;
(5) back-up systems or mechanisms, such as the use of pagers or other electronic devices,
to ensure continuity of the participant's services and supports;
(6) services provided by a consultation services provider as defined under subdivision
17, that is under contract with the department and enrolled as a Minnesota health care
program provider;
(7) services provided by an FMS provider as defined under subdivision 13a, that is an
enrolled provider with the department;
(8) CFSS services provided by a support worker who is a parent, stepparent, or legal
guardian of a participant under age 18, or who is the participant's spouse. These support
workers shall notnew text begin :
new text end
new text begin (i)new text end provide any medical assistance home and community-based services in excess of 40
hours per seven-day period regardless of the number of parents providing services,
combination of parents and spouses providing services, or number of children who receive
medical assistance services; and
new text begin
(ii) have a wage that exceeds the current rate for a CFSS support worker including the
wage, benefits, and payroll taxes; and
new text end
(9) worker training and development services as described in subdivision 18a.
Sec. 65.
Minnesota Statutes 2020, section 256B.85, subdivision 8, is amended to read:
Subd. 8.
Determination of CFSS service authorization amount.
(a) All community
first services and supports must be authorized by the commissioner or the commissioner's
designee before services begin. The authorization for CFSS must be completed as soon as
possible following an assessment but no later than 40 calendar days from the date of the
assessment.
(b) The amount of CFSS authorized must be based on the participant's home care rating
described in paragraphs (d) and (e) and any additional service units for which the participant
qualifies as described in paragraph (f).
(c) The home care rating shall be determined by the commissioner or the commissioner's
designee based on information submitted to the commissioner identifying the following for
a participant:
(1) the total number of dependencies of activities of daily living;
(2) the presence of complex health-related needs; and
(3) the presence of Level I behavior.
(d) The methodology to determine the total service units for CFSS for each home care
rating is based on the median paid units per day for each home care rating from fiscal year
2007 data for the PCA program.
(e) Each home care rating is designated by the letters P through Z and EN and has the
following base number of service units assigned:
(1) P home care rating requires Level I behavior or one to three dependencies in ADLs
and qualifies the person for five service units;
(2) Q home care rating requires Level I behavior and one to three dependencies in ADLs
and qualifies the person for six service units;
(3) R home care rating requires a complex health-related need and one to three
dependencies in ADLs and qualifies the person for seven service units;
(4) S home care rating requires four to six dependencies in ADLs and qualifies the person
for ten service units;
(5) T home care rating requires four to six dependencies in ADLs and Level I behavior
and qualifies the person for 11 service units;
(6) U home care rating requires four to six dependencies in ADLs and a complex
health-related need and qualifies the person for 14 service units;
(7) V home care rating requires seven to eight dependencies in ADLs and qualifies the
person for 17 service units;
(8) W home care rating requires seven to eight dependencies in ADLs and Level I
behavior and qualifies the person for 20 service units;
(9) Z home care rating requires seven to eight dependencies in ADLs and a complex
health-related need and qualifies the person for 30 service units; and
(10) EN home care rating includes ventilator dependency as defined in section 256B.0651,
subdivision 1, paragraph (g). A person who meets the definition of ventilator-dependent
and the EN home care rating and utilize a combination of CFSS and home care nursing
services is limited to a total of 96 service units per day for those services in combination.
Additional units may be authorized when a person's assessment indicates a need for two
staff to perform activities. Additional time is limited to 16 service units per day.
(f) Additional service units are provided through the assessment and identification of
the following:
(1) 30 additional minutes per day for a dependency in each critical activity of daily
living;
(2) 30 additional minutes per day for each complex health-related need; and
(3) 30 additional minutes per day deleted text begin when thedeleted text end new text begin for eachnew text end behavior new text begin under this clause that
new text end requires assistance at least four times per week deleted text begin for one or more of the following behaviorsdeleted text end :
(i) level I behaviornew text begin that requires the immediate response of another personnew text end ;
(ii) increased vulnerability due to cognitive deficits or socially inappropriate behavior;
or
(iii) increased need for assistance for participants who are verbally aggressive or resistive
to care so that the time needed to perform activities of daily living is increased.
(g) The service budget for budget model participants shall be based on:
(1) assessed units as determined by the home care rating; and
(2) an adjustment needed for administrative expenses.
Sec. 66.
Minnesota Statutes 2020, section 256B.85, is amended by adding a subdivision
to read:
new text begin Subd. 8a. new text end
new text begin Authorization; exceptions. new text end
new text begin
All CFSS services must be authorized by the
commissioner or the commissioner's designee as described in subdivision 8 except when:
new text end
new text begin
(1) the lead agency temporarily authorizes services in the agency-provider model as
described in subdivision 5, paragraph (c);
new text end
new text begin
(2) CFSS services in the agency-provider model were required to treat an emergency
medical condition that if not immediately treated could cause a participant serious physical
or mental disability, continuation of severe pain, or death. The CFSS agency provider must
request retroactive authorization from the lead agency no later than five working days after
providing the initial emergency service. The CFSS agency provider must be able to
substantiate the emergency through documentation such as reports, notes, and admission
or discharge histories. A lead agency must follow the authorization process in subdivision
5 after the lead agency receives the request for authorization from the agency provider;
new text end
new text begin
(3) the lead agency authorizes a temporary increase to the amount of services authorized
in the agency or budget model to accommodate the participant's temporary higher need for
services. Authorization for a temporary level of CFSS services is limited to the time specified
by the commissioner, but shall not exceed 45 days. The level of services authorized under
this clause shall have no bearing on a future authorization;
new text end
new text begin
(4) a participant's medical assistance eligibility has lapsed, is then retroactively reinstated,
and an authorization for CFSS services is completed based on the date of a current
assessment, eligibility, and request for authorization;
new text end
new text begin
(5) a third-party payer for CFSS 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;
new text end
new text begin
(6) the commissioner has determined that a lead agency or state human services agency
has made an error; or
new text end
new text begin
(7) a participant enrolled in managed care experiences a temporary disenrollment from
a health plan, in which case the commissioner shall accept the current health plan
authorization for CFSS services for up to 60 days. The request must be received within the
first 30 days of the disenrollment. If the recipient's reenrollment in managed care is after
the 60 days and before 90 days, the provider shall request an additional 30-day extension
of the current health plan authorization, for a total limit of 90 days from the time of
disenrollment.
new text end
Sec. 67.
Minnesota Statutes 2020, section 256B.85, subdivision 9, is amended to read:
Subd. 9.
Noncovered services.
(a) Services or supports that are not eligible for payment
under this section include those that:
(1) are not authorized by the certified assessor or included in the CFSS service delivery
plan;
(2) are provided prior to the authorization of services and the approval of the CFSS
service delivery plan;
(3) are duplicative of other paid services in the CFSS service delivery plan;
(4) supplant natural unpaid supports that appropriately meet a need in the CFSS service
delivery plan, are provided voluntarily to the participant, and are selected by the participant
in lieu of other services and supports;
(5) are not effective means to meet the participant's needs; and
(6) are available through other funding sources, includingdeleted text begin ,deleted text end but not limited todeleted text begin ,deleted text end funding
through title IV-E of the Social Security Act.
(b) Additional services, goods, or supports that are not covered include:
(1) those that are not for the direct benefit of the participant, except that services for
caregivers such as training to improve the ability to provide CFSS are considered to directly
benefit the participant if chosen by the participant and approved in the support plan;
(2) any fees incurred by the participant, such as Minnesota health care programs fees
and co-pays, legal fees, or costs related to advocate agencies;
(3) insurance, except for insurance costs related to employee coverage;
(4) room and board costs for the participant;
(5) services, supports, or goods that are not related to the assessed needs;
(6) special education and related services provided under the Individuals with Disabilities
Education Act and vocational rehabilitation services provided under the Rehabilitation Act
of 1973;
(7) assistive technology devices and assistive technology services other than those for
back-up systems or mechanisms to ensure continuity of service and supports listed in
subdivision 7;
(8) medical supplies and equipment covered under medical assistance;
(9) environmental modifications, except as specified in subdivision 7;
(10) expenses for travel, lodging, or meals related to training the participant or the
participant's representative or legal representative;
(11) experimental treatments;
(12) any service or good covered by other state plan services, including prescription and
over-the-counter medications, compounds, and solutions and related fees, including premiums
and co-payments;
(13) membership dues or costs, except when the service is necessary and appropriate to
treat a health condition or to improve or maintain the new text begin adult new text end participant's health condition.
The condition must be identified in the participant's CFSS service delivery plan and
monitored by a Minnesota health care program enrolled physiciannew text begin , advanced practice
registered nurse, or physician's assistantnew text end ;
(14) vacation expenses other than the cost of direct services;
(15) vehicle maintenance or modifications not related to the disability, health condition,
or physical need;
(16) tickets and related costs to attend sporting or other recreational or entertainment
events;
(17) services provided and billed by a provider who is not an enrolled CFSS provider;
(18) CFSS provided by a participant's representative or paid legal guardian;
(19) services that are used solely as a child care or babysitting service;
(20) services that are the responsibility or in the daily rate of a residential or program
license holder under the terms of a service agreement and administrative rules;
(21) sterile procedures;
(22) giving of injections into veins, muscles, or skin;
(23) homemaker services that are not an integral part of the assessed CFSS service;
(24) home maintenance or chore services;
(25) home care services, including hospice services if elected by the participant, covered
by Medicare or any other insurance held by the participant;
(26) services to other members of the participant's household;
(27) services not specified as covered under medical assistance as CFSS;
(28) application of restraints or implementation of deprivation procedures;
(29) assessments by CFSS provider organizations or by independently enrolled registered
nurses;
(30) services provided in lieu of legally required staffing in a residential or child care
setting; deleted text begin and
deleted text end
(31) services provided by deleted text begin the residential or programdeleted text end new text begin a foster carenew text end license holder deleted text begin in a
residence for more than four participants.deleted text end new text begin except when the home of the person receiving
services is the licensed foster care provider's primary residence;
new text end
new text begin
(32) services that are the responsibility of the foster care provider under the terms of the
foster care placement agreement, assessment under sections 256N.24 and 260C.4411, and
administrative rules under sections 256N.24 and 260C.4411;
new text end
new text begin
(33) services in a setting that has a licensed capacity greater than six, unless all conditions
for a variance under section 245A.04, subdivision 9a, are satisfied for a sibling, as defined
in section 260C.007, subdivision 32;
new text end
new text begin
(34) services from a provider who owns or otherwise controls the living arrangement,
except when the provider of services is related by blood, marriage, or adoption or when the
provider is a licensed foster care provider who is not prohibited from providing services
under clauses (31) to (33);
new text end
new text begin
(35) instrumental activities of daily living for children younger than 18 years of age,
except when immediate attention is needed for health or hygiene reasons integral to an
assessed need for assistance with activities of daily living, health-related procedures, and
tasks or behaviors; or
new text end
new text begin
(36) services provided to a resident of a nursing facility, hospital, intermediate care
facility, or health care facility licensed by the commissioner of health.
new text end
Sec. 68.
Minnesota Statutes 2020, section 256B.85, subdivision 10, is amended to read:
Subd. 10.
Agency-provider and FMS provider qualifications and duties.
(a)
Agency-providers identified in subdivision 11 and FMS providers identified in subdivision
13a shall:
(1) enroll as a medical assistance Minnesota health care programs provider and meet all
applicable provider standards and requirementsnew text begin including completion of required provider
training as determined by the commissionernew text end ;
(2) demonstrate compliance with federal and state laws and policies for CFSS as
determined by the commissioner;
(3) comply with background study requirements under chapter 245C and maintain
documentation of background study requests and results;
(4) verify and maintain records of all services and expenditures by the participant,
including hours worked by support workers;
(5) not engage in any agency-initiated direct contact or marketing in person, by telephone,
or other electronic means to potential participants, guardians, family members, or participants'
representatives;
(6) directly provide services and not use a subcontractor or reporting agent;
(7) meet the financial requirements established by the commissioner for financial
solvency;
(8) have never had a lead agency contract or provider agreement discontinued due to
fraud, or have never had an owner, board member, or manager fail a state or FBI-based
criminal background check while enrolled or seeking enrollment as a Minnesota health care
programs provider; and
(9) have an office located in Minnesota.
(b) In conducting general duties, agency-providers and FMS providers shall:
(1) pay support workers based upon actual hours of services provided;
(2) pay for worker training and development services based upon actual hours of services
provided or the unit cost of the training session purchased;
(3) withhold and pay all applicable federal and state payroll taxes;
(4) make arrangements and pay unemployment insurance, taxes, workers' compensation,
liability insurance, and other benefits, if any;
(5) enter into a written agreement with the participant, participant's representative, or
legal representative that assigns roles and responsibilities to be performed before services,
supports, or goods are providednew text begin and that meets the requirements of subdivisions 20a, 20b,
and 20c for agency-providersnew text end ;
(6) report maltreatment as required under section 626.557 and chapter 260E;
(7) comply with the labor market reporting requirements described in section 256B.4912,
subdivision 1a;
(8) comply with any data requests from the department consistent with the Minnesota
Government Data Practices Act under chapter 13; deleted text begin and
deleted text end
(9) maintain documentation for the requirements under subdivision 16, paragraph (e),
clause (2), to qualify for an enhanced rate under this sectiondeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(10) request reassessments 60 days before the end of the current authorization for CFSS
on forms provided by the commissioner.
new text end
Sec. 69.
Minnesota Statutes 2020, section 256B.85, subdivision 11, is amended to read:
Subd. 11.
Agency-provider model.
(a) The agency-provider model includes services
provided by support workers and staff providing worker training and development services
who are employed by an agency-provider that meets the criteria established by the
commissioner, including required training.
(b) The agency-provider shall allow the participant to have a significant role in the
selection and dismissal of the support workers for the delivery of the services and supports
specified in the participant's CFSS service delivery plan.new text begin The agency must make a reasonable
effort to fulfill the participant's request for the participant's preferred support worker.
new text end
(c) A participant may use authorized units of CFSS services as needed within a service
agreement that is not greater than 12 months. Using authorized units in a flexible manner
in either the agency-provider model or the budget model does not increase the total amount
of services and supports authorized for a participant or included in the participant's CFSS
service delivery plan.
(d) A participant may share CFSS services. Two or three CFSS participants may share
services at the same time provided by the same support worker.
(e) The agency-provider must use a minimum of 72.5 percent of the revenue generated
by the medical assistance payment for CFSS for support worker wages and benefits, except
all of the revenue generated by a medical assistance rate increase due to a collective
bargaining agreement under section 179A.54 must be used for support worker wages and
benefits. The agency-provider must document how this requirement is being met. The
revenue generated by the worker training and development services and the reasonable costs
associated with the worker training and development services must not be used in making
this calculation.
(f) The agency-provider model must be used by deleted text begin individualsdeleted text end new text begin participantsnew text end who are restricted
by the Minnesota restricted recipient program under Minnesota Rules, parts 9505.2160 to
9505.2245.
(g) Participants purchasing goods under this model, along with support worker services,
must:
(1) specify the goods in the CFSS service delivery plan and detailed budget for
expenditures that must be approved by the consultation services provider, case manager, or
care coordinator; and
(2) use the FMS provider for the billing and payment of such goods.
Sec. 70.
Minnesota Statutes 2020, section 256B.85, subdivision 11b, is amended to read:
Subd. 11b.
Agency-provider model; support worker competency.
(a) The
agency-provider must ensure that support workers are competent to meet the participant's
assessed needs, goals, and additional requirements as written in the CFSS service delivery
plan. deleted text begin Within 30 days of any support worker beginning to provide services for a participant,deleted text end
The agency-provider must evaluate the competency of the new text begin supportnew text end worker through direct
observation of the support worker's performance of the job functions in a setting where the
participant is using CFSSdeleted text begin .deleted text end new text begin within 30 days of:
new text end
new text begin
(1) any support worker beginning to provide services for a participant; or
new text end
new text begin
(2) any support worker beginning to provide shared services.
new text end
(b) The agency-provider must verify and maintain evidence of support worker
competency, including documentation of the support worker's:
(1) education and experience relevant to the job responsibilities assigned to the support
worker and the needs of the participant;
(2) relevant training received from sources other than the agency-provider;
(3) orientation and instruction to implement services and supports to participant needs
and preferences as identified in the CFSS service delivery plan; deleted text begin and
deleted text end
new text begin
(4) orientation and instruction delivered by an individual competent to perform, teach,
or assign the health-related tasks for tracheostomy suctioning and services to participants
on ventilator support, including equipment operation and maintenance; and
new text end
deleted text begin (4)deleted text end new text begin (5)new text end periodic performance reviews completed by the agency-provider at least annually,
including any evaluations required under subdivision 11a, paragraph (a). If a support worker
is a minor, all evaluations of worker competency must be completed in person and in a
setting where the participant is using CFSS.
(c) The agency-provider must develop a worker training and development plan with the
participant to ensure support worker competency. The worker training and development
plan must be updated when:
(1) the support worker begins providing services;
new text begin
(2) the support worker begins providing shared services;
new text end
deleted text begin (2)deleted text end new text begin (3)new text end there is any change in condition or a modification to the CFSS service delivery
plan; or
deleted text begin (3)deleted text end new text begin (4)new text end a performance review indicates that additional training is needed.
Sec. 71.
Minnesota Statutes 2020, section 256B.85, subdivision 12, is amended to read:
Subd. 12.
Requirements for enrollment of CFSS agency-providers.
(a) All CFSS
agency-providers must provide, at the time of enrollment, reenrollment, and revalidation
as a CFSS agency-provider in a format determined by the commissioner, information and
documentation that includesdeleted text begin ,deleted text end but is not limited todeleted text begin ,deleted text end the following:
(1) the CFSS agency-provider's current contact information including address, telephone
number, and e-mail address;
(2) proof of surety bond coverage. Upon new enrollment, or if the agency-provider's
Medicaid revenue in the previous calendar year is less than or equal to $300,000, the
agency-provider must purchase a surety bond of $50,000. If the agency-provider's Medicaid
revenue in the previous calendar year is greater than $300,000, the agency-provider must
purchase a surety bond of $100,000. The surety bond must be in a form approved by the
commissioner, must be renewed annually, and must allow for recovery of costs and fees in
pursuing a claim on the bond;
(3) proof of fidelity bond coverage in the amount of $20,000new text begin per provider locationnew text end ;
(4) proof of workers' compensation insurance coverage;
(5) proof of liability insurance;
(6) a deleted text begin descriptiondeleted text end new text begin copynew text end of the CFSS agency-provider's deleted text begin organizationdeleted text end new text begin organizational chartnew text end
identifying the names new text begin and roles new text end of all owners, managing employees, staff, board of directors,
and deleted text begin thedeleted text end new text begin additional documentation reporting anynew text end affiliations of the directors and owners to
other service providers;
(7) deleted text begin a copy ofdeleted text end new text begin proof thatnew text end the CFSS deleted text begin agency-provider'sdeleted text end new text begin agency-provider hasnew text end written policies
and procedures including: hiring of employees; training requirements; service delivery; and
employee and consumer safety, including the process for notification and resolution of
participant grievances, incident response, identification and prevention of communicable
diseases, and employee misconduct;
(8) deleted text begin copies of all other formsdeleted text end new text begin proof thatnew text end the CFSS agency-provider deleted text begin uses in the course of
daily business including, but not limited todeleted text end new text begin has all of the following forms and documentsnew text end :
(i) a copy of the CFSS agency-provider's time sheet; and
(ii) a copy of the participant's individual CFSS service delivery plan;
(9) a list of all training and classes that the CFSS agency-provider requires of its staff
providing CFSS services;
(10) documentation that the CFSS agency-provider and staff have successfully completed
all the training required by this section;
(11) documentation of the agency-provider's marketing practices;
(12) disclosure of ownership, leasing, or management of all residential properties that
are used or could be used for providing home care services;
(13) documentation that the agency-provider will use at least the following percentages
of revenue generated from the medical assistance rate paid for CFSS services for CFSS
support worker wages and benefits: 72.5 percent of revenue from CFSS providers, except
100 percent of the revenue generated by a medical assistance rate increase due to a collective
bargaining agreement under section 179A.54 must be used for support worker wages and
benefits. The revenue generated by the worker training and development services and the
reasonable costs associated with the worker training and development services shall not be
used in making this calculation; and
(14) documentation that the agency-provider does not burden participants' free exercise
of their right to choose service providers by requiring CFSS support workers to sign an
agreement not to work with any particular CFSS participant or for another CFSS
agency-provider after leaving the agency and that the agency is not taking action on any
such agreements or requirements regardless of the date signed.
(b) CFSS agency-providers shall provide to the commissioner the information specified
in paragraph (a).
(c) All CFSS agency-providers shall require all employees in management and
supervisory positions and owners of the agency who are active in the day-to-day management
and operations of the agency to complete mandatory training as determined by the
commissioner. Employees in management and supervisory positions and owners who are
active in the day-to-day operations of an agency who have completed the required training
as an employee with a CFSS agency-provider do not need to repeat the required training if
they are hired by another agencydeleted text begin , ifdeleted text end new text begin andnew text end they have completed the training within the past
three years. CFSS agency-provider billing staff shall complete training about CFSS program
financial management. Any new owners or employees in management and supervisory
positions involved in the day-to-day operations are required to complete mandatory training
as a requisite of working for the agency.
deleted text begin
(d) The commissioner shall send annual review notifications to agency-providers 30
days prior to renewal. The notification must:
deleted text end
deleted text begin
(1) list the materials and information the agency-provider is required to submit;
deleted text end
deleted text begin
(2) provide instructions on submitting information to the commissioner; and
deleted text end
deleted text begin
(3) provide a due date by which the commissioner must receive the requested information.
deleted text end
deleted text begin
Agency-providers shall submit all required documentation for annual review within 30 days
of notification from the commissioner. If an agency-provider fails to submit all the required
documentation, the commissioner may take action under subdivision 23a.
deleted text end
new text begin
(d) Agency-providers shall submit all required documentation in this section within 30
days of notification from the commissioner. If an agency-provider fails to submit all the
required documentation, the commissioner may take action under subdivision 23a.
new text end
Sec. 72.
Minnesota Statutes 2020, section 256B.85, subdivision 12b, is amended to read:
Subd. 12b.
CFSS agency-provider requirements; notice regarding termination of
services.
(a) An agency-provider must provide written notice when it intends to terminate
services with a participant at least deleted text begin tendeleted text end new text begin 30new text end calendar days before the proposed service
termination is to become effective, except in cases where:
(1) the participant engages in conduct that significantly alters the terms of the CFSS
service delivery plan with the agency-provider;
(2) the participant or other persons at the setting where services are being provided
engage in conduct that creates an imminent risk of harm to the support worker or other
agency-provider staff; or
(3) an emergency or a significant change in the participant's condition occurs within a
24-hour period that results in the participant's service needs exceeding the participant's
identified needs in the current CFSS service delivery plan so that the agency-provider cannot
safely meet the participant's needs.
(b) When a participant initiates a request to terminate CFSS services with the
agency-provider, the agency-provider must give the participant a written deleted text begin acknowledgementdeleted text end new text begin
acknowledgmentnew text end of the participant's service termination request that includes the date the
request was received by the agency-provider and the requested date of termination.
(c) The agency-provider must participate in a coordinated transfer of the participant to
a new agency-provider to ensure continuity of care.
Sec. 73.
Minnesota Statutes 2020, section 256B.85, subdivision 13, is amended to read:
Subd. 13.
Budget model.
(a) Under the budget model participants exercise responsibility
and control over the services and supports described and budgeted within the CFSS service
delivery plan. Participants must use services specified in subdivision 13a provided by an
FMS provider. Under this model, participants may use their approved service budget
allocation to:
(1) directly employ support workers, and pay wages, federal and state payroll taxes, and
premiums for workers' compensation, liability, and health insurance coverage; and
(2) obtain supports and goods as defined in subdivision 7.
(b) Participants who are unable to fulfill any of the functions listed in paragraph (a) may
authorize a legal representative or participant's representative to do so on their behalf.
new text begin
(c) If two or more participants using the budget model live in the same household and
have the same support worker, the participants must use the same FMS provider.
new text end
new text begin
(d) If the FMS provider advises that there is a joint employer in the budget model, all
participants associated with that joint employer must use the same FMS provider.
new text end
deleted text begin (c)deleted text end new text begin (e)new text end The commissioner shall disenroll or exclude participants from the budget model
and transfer them to the agency-provider model under, but not limited to, the following
circumstances:
(1) when a participant has been restricted by the Minnesota restricted recipient program,
in which case the participant may be excluded for a specified time period under Minnesota
Rules, parts 9505.2160 to 9505.2245;
(2) when a participant exits the budget model during the participant's service plan year.
Upon transfer, the participant shall not access the budget model for the remainder of that
service plan year; or
(3) when the department determines that the participant or participant's representative
or legal representative is unable to fulfill the responsibilities under the budget model, as
specified in subdivision 14.
deleted text begin (d)deleted text end new text begin (f)new text end A participant may appeal in writing to the department under section 256.045,
subdivision 3, to contest the department's decision under paragraph deleted text begin (c)deleted text end new text begin (e)new text end , clause (3), to
disenroll or exclude the participant from the budget model.
Sec. 74.
Minnesota Statutes 2020, section 256B.85, subdivision 13a, is amended to read:
Subd. 13a.
Financial management services.
(a) Services provided by an FMS provider
include but are not limited to: filing and payment of federal and state payroll taxes on behalf
of the participant; initiating and complying with background study requirements under
chapter 245C and maintaining documentation of background study requests and results;
billing for approved CFSS services with authorized funds; monitoring expenditures;
accounting for and disbursing CFSS funds; providing assistance in obtaining and filing for
liability, workers' compensation, and unemployment coverage; and providing participant
instruction and technical assistance to the participant in fulfilling employer-related
requirements in accordance with section 3504 of the Internal Revenue Code and related
regulations and interpretations, including Code of Federal Regulations, title 26, section
31.3504-1.
(b) Agency-provider services shall not be provided by the FMS provider.
(c) The FMS provider shall provide service functions as determined by the commissioner
for budget model participants that include but are not limited to:
(1) assistance with the development of the detailed budget for expenditures portion of
the CFSS service delivery plan as requested by the consultation services provider or
participant;
(2) data recording and reporting of participant spending;
(3) other duties established by the department, including with respect to providing
assistance to the participant, participant's representative, or legal representative in performing
employer responsibilities regarding support workers. The support worker shall not be
considered the employee of the FMS provider; and
(4) billing, payment, and accounting of approved expenditures for goods.
(d) The FMS provider shall obtain an assurance statement from the participant employer
agreeing to follow state and federal regulations and CFSS policies regarding employment
of support workers.
(e) The FMS provider shall:
(1) not limit or restrict the participant's choice of service or support providers or service
delivery models consistent with any applicable state and federal requirements;
(2) provide the participant, consultation services provider, and case manager or care
coordinator, if applicable, with a monthly written summary of the spending for services and
supports that were billed against the spending budget;
(3) be knowledgeable of state and federal employment regulations, including those under
the Fair Labor Standards Act of 1938, and comply with the requirements under section 3504
of the Internal Revenue Code and related regulations and interpretations, including Code
of Federal Regulations, title 26, section 31.3504-1, regarding agency employer tax liability
for vendor fiscal/employer agent, and any requirements necessary to process employer and
employee deductions, provide appropriate and timely submission of employer tax liabilities,
and maintain documentation to support medical assistance claims;
(4) have current and adequate liability insurance and bonding and sufficient cash flow
as determined by the commissioner and have on staff or under contract a certified public
accountant or an individual with a baccalaureate degree in accounting;
(5) assume fiscal accountability for state funds designated for the program and be held
liable for any overpayments or violations of applicable statutes or rules, including but not
limited to the Minnesota False Claims Act, chapter 15C; deleted text begin and
deleted text end
(6) maintain documentation of receipts, invoices, and bills to track all services and
supports expenditures for any goods purchased and maintain time records of support workers.
The documentation and time records must be maintained for a minimum of five years from
the claim date and be available for audit or review upon request by the commissioner. Claims
submitted by the FMS provider to the commissioner for payment must correspond with
services, amounts, and time periods as authorized in the participant's service budget and
service plan and must contain specific identifying information as determined by the
commissionerdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(7) provide written notice to the participant or the participant's representative at least 30
calendar days before a proposed service termination becomes effective.
new text end
(f) The commissioner deleted text begin of human servicesdeleted text end shall:
(1) establish rates and payment methodology for the FMS provider;
(2) identify a process to ensure quality and performance standards for the FMS provider
and ensure statewide access to FMS providers; and
(3) establish a uniform protocol for delivering and administering CFSS services to be
used by eligible FMS providers.
Sec. 75.
Minnesota Statutes 2020, section 256B.85, is amended by adding a subdivision
to read:
new text begin Subd. 14a. new text end
new text begin Participant's representative responsibilities. new text end
new text begin
(a) If a participant is unable
to direct the participant's own care, the participant must use a participant's representative
to receive CFSS services. A participant's representative is required if:
new text end
new text begin
(1) the person is under 18 years of age;
new text end
new text begin
(2) the person has a court-appointed guardian; or
new text end
new text begin
(3) an assessment according to section 256B.0659, subdivision 3a, determines that the
participant is in need of a participant's representative.
new text end
new text begin
(b) A participant's representative must:
new text end
new text begin
(1) be at least 18 years of age;
new text end
new text begin
(2) actively participate in planning and directing CFSS services;
new text end
new text begin
(3) have sufficient knowledge of the participant's circumstances to use CFSS services
consistent with the participant's health and safety needs identified in the participant's service
delivery plan;
new text end
new text begin
(4) not have a financial interest in the provision of any services included in the
participant's CFSS service delivery plan; and
new text end
new text begin
(5) be capable of providing the support necessary to assist the participant in the use of
CFSS services.
new text end
new text begin
(c) A participant's representative must not be the:
new text end
new text begin
(1) support worker;
new text end
new text begin
(2) worker training and development service provider;
new text end
new text begin
(3) agency-provider staff, unless related to the participant by blood, marriage, or adoption;
new text end
new text begin
(4) consultation service provider, unless related to the participant by blood, marriage,
or adoption;
new text end
new text begin
(5) FMS staff, unless related to the participant by blood, marriage, or adoption;
new text end
new text begin
(6) FMS owner or manager; or
new text end
new text begin
(7) lead agency staff acting as part of employment.
new text end
new text begin
(d) A licensed family foster parent who lives with the participant may be the participant's
representative if the family foster parent meets the other participant's representative
requirements.
new text end
new text begin
(e) There may be two persons designated as the participant's representative, including
instances of divided households and court-ordered custodies. Each person named as the
participant's representative must meet the program criteria and responsibilities.
new text end
new text begin
(f) The participant or the participant's legal representative shall appoint a participant's
representative. The participant's representative must be identified at the time of assessment
and listed on the participant's service agreement and CFSS service delivery plan.
new text end
new text begin
(g) A participant's representative must enter into a written agreement with an
agency-provider or FMS on a form determined by the commissioner and maintained in the
participant's file, to:
new text end
new text begin
(1) be available while care is provided using a method agreed upon by the participant
or the participant's legal representative and documented in the participant's service delivery
plan;
new text end
new text begin
(2) monitor CFSS services to ensure the participant's service delivery plan is followed;
new text end
new text begin
(3) review and sign support worker time sheets after services are provided to verify the
provision of services;
new text end
new text begin
(4) review and sign vendor paperwork to verify receipt of goods; and
new text end
new text begin
(5) in the budget model, review and sign documentation to verify worker training and
development expenditures.
new text end
new text begin
(h) A participant's representative may delegate responsibility to another adult who is not
the support worker during a temporary absence of at least 24 hours but not more than six
months. To delegate responsibility, the participant's representative must:
new text end
new text begin
(1) ensure that the delegate serving as the participant's representative satisfies the
requirements of the participant's representative;
new text end
new text begin
(2) ensure that the delegate performs the functions of the participant's representative;
new text end
new text begin
(3) communicate to the CFSS agency-provider or FMS provider about the need for a
delegate by updating the written agreement to include the name of the delegate and the
delegate's contact information; and
new text end
new text begin
(4) ensure that the delegate protects the participant's privacy according to federal and
state data privacy laws.
new text end
new text begin
(i) The designation of a participant's representative remains in place until:
new text end
new text begin
(1) the participant revokes the designation;
new text end
new text begin
(2) the participant's representative withdraws the designation or becomes unable to fulfill
the duties;
new text end
new text begin
(3) the legal authority to act as a participant's representative changes; or
new text end
new text begin
(4) the participant's representative is disqualified.
new text end
new text begin
(j) A lead agency may disqualify a participant's representative who engages in conduct
that creates an imminent risk of harm to the participant, the support workers, or other staff.
A participant's representative who fails to provide support required by the participant must
be referred to the common entry point.
new text end
Sec. 76.
Minnesota Statutes 2020, section 256B.85, subdivision 15, is amended to read:
Subd. 15.
Documentation of support services provided; time sheets.
(a) CFSS services
provided to a participant by a support worker employed by either an agency-provider or the
participant employer must be documented daily by each support worker, on a time sheet.
Time sheets may be created, submitted, and maintained electronically. Time sheets must
be submitted by the support worker new text begin at least once per month new text end to the:
(1) agency-provider when the participant is using the agency-provider model. The
agency-provider must maintain a record of the time sheet and provide a copy of the time
sheet to the participant; or
(2) participant and the participant's FMS provider when the participant is using the
budget model. The participant and the FMS provider must maintain a record of the time
sheet.
(b) The documentation on the time sheet must correspond to the participant's assessed
needs within the scope of CFSS covered services. The accuracy of the time sheets must be
verified by the:
(1) agency-provider when the participant is using the agency-provider model; or
(2) participant employer and the participant's FMS provider when the participant is using
the budget model.
(c) The time sheet must document the time the support worker provides services to the
participant. The following elements must be included in the time sheet:
(1) the support worker's full name and individual provider number;
(2) the agency-provider's name and telephone numbers, when responsible for the CFSS
service delivery plan;
(3) the participant's full name;
(4) the dates within the pay period established by the agency-provider or FMS provider,
including month, day, and year, and arrival and departure times with a.m. or p.m. notations
for days worked within the established pay period;
(5) the covered services provided to the participant on each date of service;
(6) deleted text begin adeleted text end new text begin thenew text end signature deleted text begin line fordeleted text end new text begin ofnew text end the participant or the participant's representative and a
statement that the participant's or participant's representative's signature is verification of
the time sheet's accuracy;
(7) the deleted text begin personaldeleted text end signature of the support worker;
(8) any shared care provided, if applicable;
(9) a statement that it is a federal crime to provide false information on CFSS billings
for medical assistance payments; and
(10) dates and location of participant stays in a hospital, care facility, or incarceration
occurring within the established pay period.
Sec. 77.
Minnesota Statutes 2020, section 256B.85, subdivision 17a, is amended to read:
Subd. 17a.
Consultation services provider qualifications and
requirements.
Consultation services providers must meet the following qualifications and
requirements:
(1) meet the requirements under subdivision 10, paragraph (a), excluding clauses (4)
and (5);
(2) are under contract with the department;
(3) are not the FMS provider, the lead agency, or the CFSS or home and community-based
services waiver vendor or agency-provider to the participant;
(4) meet the service standards as established by the commissioner;
new text begin
(5) have proof of surety bond coverage. Upon new enrollment, or if the consultation
service provider's Medicaid revenue in the previous calendar year is less than or equal to
$300,000, the consultation service provider must purchase a surety bond of $50,000. If the
agency-provider's Medicaid revenue in the previous calendar year is greater than $300,000,
the consultation service provider must purchase a surety bond of $100,000. The surety bond
must be in a form approved by the commissioner, must be renewed annually, and must
allow for recovery of costs and fees in pursuing a claim on the bond;
new text end
deleted text begin (5)deleted text end new text begin (6)new text end employ lead professional staff with a minimum of deleted text begin threedeleted text end new text begin twonew text end years of experience
in providing services such as support planning, support broker, case management or care
coordination, or consultation services and consumer education to participants using a
self-directed program using FMS under medical assistance;
new text begin
(7) report maltreatment as required under chapter 260E and section 626.557;
new text end
deleted text begin (6)deleted text end new text begin (8)new text end comply with medical assistance provider requirements;
deleted text begin (7)deleted text end new text begin (9)new text end understand the CFSS program and its policies;
deleted text begin (8)deleted text end new text begin (10)new text end are knowledgeable about self-directed principles and the application of the
person-centered planning process;
deleted text begin (9)deleted text end new text begin (11)new text end have general knowledge of the FMS provider duties and the vendor
fiscal/employer agent model, including all applicable federal, state, and local laws and
regulations regarding tax, labor, employment, and liability and workers' compensation
coverage for household workers; and
deleted text begin (10)deleted text end new text begin (12)new text end have all employees, including lead professional staff, staff in management and
supervisory positions, and owners of the agency who are active in the day-to-day management
and operations of the agency, complete training as specified in the contract with the
department.
Sec. 78.
Minnesota Statutes 2020, section 256B.85, subdivision 18a, is amended to read:
Subd. 18a.
Worker training and development services.
(a) The commissioner shall
develop the scope of tasks and functions, service standards, and service limits for worker
training and development services.
(b) Worker training and development costs are in addition to the participant's assessed
service units or service budget. Services provided according to this subdivision must:
(1) help support workers obtain and expand the skills and knowledge necessary to ensure
competency in providing quality services as needed and defined in the participant's CFSS
service delivery plan and as required under subdivisions 11b and 14;
(2) be provided or arranged for by the agency-provider under subdivision 11, or purchased
by the participant employer under the budget model as identified in subdivision 13; deleted text begin and
deleted text end
new text begin
(3) be delivered by an individual competent to perform, teach, or assign the tasks,
including health-related tasks, identified in the plan through education, training, and work
experience relevant to the person's assessed needs; and
new text end
deleted text begin (3)deleted text end new text begin (4)new text end be described in the participant's CFSS service delivery plan and documented in
the participant's file.
(c) Services covered under worker training and development shall include:
(1) support worker training on the participant's individual assessed needs and condition,
provided individually or in a group setting by a skilled and knowledgeable trainer beyond
any training the participant or participant's representative provides;
(2) tuition for professional classes and workshops for the participant's support workers
that relate to the participant's assessed needs and condition;
(3) direct observation, monitoring, coaching, and documentation of support worker job
skills and tasks, beyond any training the participant or participant's representative provides,
including supervision of health-related tasks or behavioral supports that is conducted by an
appropriate professional based on the participant's assessed needs. These services must be
provided at the start of services or the start of a new support worker except as provided in
paragraph (d) and must be specified in the participant's CFSS service delivery plan; and
(4) the activities to evaluate CFSS services and ensure support worker competency
described in subdivisions 11a and 11b.
(d) The services in paragraph (c), clause (3), are not required to be provided for a new
support worker providing services for a participant due to staffing failures, unless the support
worker is expected to provide ongoing backup staffing coverage.
(e) Worker training and development services shall not include:
(1) general agency training, worker orientation, or training on CFSS self-directed models;
(2) payment for preparation or development time for the trainer or presenter;
(3) payment of the support worker's salary or compensation during the training;
(4) training or supervision provided by the participant, the participant's support worker,
or the participant's informal supports, including the participant's representative; or
(5) services in excess of deleted text begin 96 unitsdeleted text end new text begin the limit set by the commissionernew text end per annual service
agreement, unless approved by the department.
Sec. 79.
Minnesota Statutes 2020, section 256B.85, subdivision 20b, is amended to read:
Subd. 20b.
Service-related rights under an agency-provider.
A participant receiving
CFSS from an agency-provider has service-related rights to:
(1) participate in and approve the initial development and ongoing modification and
evaluation of CFSS services provided to the participant;
(2) refuse or terminate services and be informed of the consequences of refusing or
terminating services;
(3) before services are initiated, be told the limits to the services available from the
agency-provider, including the agency-provider's knowledge, skill, and ability to meet the
participant's needs identified in the CFSS service delivery plan;
(4) a coordinated transfer of services when there will be a change in the agency-provider;
(5) before services are initiated, be told what the agency-provider charges for the services;
(6) before services are initiated, be told to what extent payment may be expected from
health insurance, public programs, or other sources, if known; and what charges the
participant may be responsible for paying;
(7) receive services from an individual who is competent and trained, who has
professional certification or licensure, as required, and who meets additional qualifications
identified in the participant's CFSS service delivery plan;
(8) have the participant's preferences for support workers identified and documented,
and have those preferences met when possible; and
(9) before services are initiated, be told the choices that are available from the
agency-provider for meeting the participant's assessed needs identified in the CFSS service
delivery plan, including but not limited to which support worker staff will be providing
services deleted text begin anddeleted text end new text begin ,new text end the proposed frequency and schedule of visitsnew text begin , and any agreements for shared
servicesnew text end .
Sec. 80.
Minnesota Statutes 2020, section 256B.85, subdivision 23, is amended to read:
Subd. 23.
Commissioner's access.
(a) When the commissioner is investigating a possible
overpayment of Medicaid funds, the commissioner must be given immediate access without
prior notice to the agency-provider, consultation services provider, or FMS provider's office
during regular business hours and to documentation and records related to services provided
and submission of claims for services provided. deleted text begin Denying the commissioner access to records
is cause for immediate suspension of payment and terminatingdeleted text end new text begin Ifnew text end the deleted text begin agency-provider's
enrollment ordeleted text end new text begin agency-provider,new text end FMS deleted text begin provider's enrollmentdeleted text end new text begin provider, or consultation services
provider denies the commissioner access to records, the provider's payment may be
immediately suspended or the provider's enrollment may be terminatednew text end according to section
256B.064 deleted text begin or terminating the consultation services provider contractdeleted text end .
(b) The commissioner has the authority to request proof of compliance with laws, rules,
and policies from agency-providers, consultation services providers, FMS providers, and
participants.
(c) When relevant to an investigation conducted by the commissioner, the commissioner
must be given access to the business office, documents, and records of the agency-provider,
consultation services provider, or FMS provider, including records maintained in electronic
format; participants served by the program; and staff during regular business hours. The
commissioner must be given access without prior notice and as often as the commissioner
considers necessary if the commissioner is investigating an alleged violation of applicable
laws or rules. The commissioner may request and shall receive assistance from lead agencies
and other state, county, and municipal agencies and departments. The commissioner's access
includes being allowed to photocopy, photograph, and make audio and video recordings at
the commissioner's expense.
Sec. 81.
Minnesota Statutes 2020, section 256B.85, subdivision 23a, is amended to read:
Subd. 23a.
Sanctions; information for participants upon termination of services.
(a)
The commissioner may withhold payment from the provider or suspend or terminate the
provider enrollment number if the provider fails to comply fully with applicable laws or
rules. The provider has the right to appeal the decision of the commissioner under section
256B.064.
(b) Notwithstanding subdivision 13, paragraph (c), if a participant employer fails to
comply fully with applicable laws or rules, the commissioner may disenroll the participant
from the budget model. A participant may appeal in writing to the department under section
256.045, subdivision 3, to contest the department's decision to disenroll the participant from
the budget model.
(c) Agency-providers of CFSS services or FMS providers must provide each participant
with a copy of participant protections in subdivision 20c at least 30 days prior to terminating
services to a participant, if the termination results from sanctions under this subdivision or
section 256B.064, such as a payment withhold or a suspension or termination of the provider
enrollment number. If a CFSS agency-provider deleted text begin ordeleted text end new text begin ,new text end FMS providernew text begin , or consultation services
providernew text end determines it is unable to continue providing services to a participant because of
an action under this subdivision or section 256B.064, the agency-provider deleted text begin ordeleted text end new text begin ,new text end FMS providernew text begin ,
or consultation services providernew text end must notify the participant, the participant's representative,
and the commissioner 30 days prior to terminating services to the participant, and must
assist the commissioner and lead agency in supporting the participant in transitioning to
another CFSS agency-provider deleted text begin ordeleted text end new text begin ,new text end FMS providernew text begin , or consultation services providernew text end of the
participant's choice.
(d) In the event the commissioner withholds payment from a CFSS agency-provider deleted text begin ordeleted text end new text begin ,new text end
FMS providernew text begin , or consultation services providernew text end , or suspends or terminates a provider
enrollment number of a CFSS agency-provider deleted text begin ordeleted text end new text begin ,new text end FMS providernew text begin , or consultation services
providernew text end under this subdivision or section 256B.064, the commissioner may inform the
Office of Ombudsman for Long-Term Care and the lead agencies for all participants with
active service agreements with the agency-provider deleted text begin ordeleted text end new text begin ,new text end FMS providernew text begin , or consultation
services providernew text end . At the commissioner's request, the lead agencies must contact participants
to ensure that the participants are continuing to receive needed care, and that the participants
have been given free choice of agency-provider deleted text begin ordeleted text end new text begin ,new text end FMS providernew text begin , or consultation services
providernew text end if they transfer to another CFSS agency-provider deleted text begin ordeleted text end new text begin ,new text end FMS providernew text begin , or consultation
services providernew text end . In addition, the commissioner or the commissioner's delegate may directly
notify participants who receive care from the agency-provider deleted text begin ordeleted text end new text begin ,new text end FMS providernew text begin , or
consultation services providernew text end that payments have been new text begin or will be new text end withheld or that the
provider's participation in medical assistance has been new text begin or will be new text end suspended or terminated,
if the commissioner determines that the notification is necessary to protect the welfare of
the participants.
Sec. 82.
Minnesota Statutes 2020, section 256L.03, subdivision 1, is amended to read:
Subdivision 1.
Covered health services.
(a) "Covered health services" means the health
services reimbursed under chapter 256B, with the exception of special education services,
home care nursing services, adult dental care services other than services covered under
section 256B.0625, subdivision 9, orthodontic services, nonemergency medical transportation
services, personal care assistance and case management services, new text begin community first services
and supports under Minnesota Statutes, section 256B.85,new text end behavioral health home services
under section 256B.0757, new text begin housing stabilization services under section 256B.051, new text end and nursing
home or intermediate care facilities services.
(b) 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.
(c) Covered health services shall be expanded as provided in this section.
(d) For the purposes of covered health services under this section, "child" means an
individual younger than 19 years of age.
Sec. 83. new text begin REVISOR INSTRUCTION.
new text end
new text begin
(a) In Minnesota Statutes, sections 245A.191, paragraph (a); 245G.02, subdivision 3;
246.18, subdivision 2; 246.23, subdivision 2; 246.64, subdivision 3; 254A.03, subdivision
3; 254A.19, subdivision 4; 254B.03, subdivision 2; 254B.04, subdivision 1; 254B.05,
subdivisions 1a and 4; 254B.051; 254B.06, subdivision 1; 254B.12, subdivisions 1 and 2;
254B.13, subdivisions 2a and 5; 254B.14, subdivision 5; 256L.03, subdivision 2; and 295.53,
subdivision 1, the revisor of statutes must change the term "consolidated chemical
dependency treatment fund" or similar terms to "behavioral health fund." The revisor may
make grammatical changes related to the term change.
new text end
new text begin
(b) In Minnesota Statutes, sections 245C.03, subdivision 13, and 256B.051, the revisor
of statutes must change the term "housing support services" or similar terms to "housing
stabilization services." The revisor may make grammatical changes related to the term
change.
new text end
new text begin
(c) In Minnesota Statutes, section 245C.03, subdivision 10, the revisor of statutes must
change the term "group residential housing" to "housing support." The revisor may make
grammatical changes related to the term change.
new text end
Sec. 84. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2020, section 252.28, subdivisions 1 and 5,
new text end
new text begin
are repealed.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Statutes 2020, sections 252A.02, subdivisions 8 and 10; and 252A.21,
subdivision 3,
new text end
new text begin
are repealed.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
Paragraph (a) is effective the day following final enactment.
Paragraph (b) is effective August 1, 2021.
new text end
ARTICLE 16
MENTAL HEALTH UNIFORM SERVICE STANDARDS
Section 1.
new text begin
[245I.01] PURPOSE AND CITATION.
new text end
new text begin Subdivision 1. new text end
new text begin Citation. new text end
new text begin
This chapter may be cited as the "Mental Health Uniform
Service Standards Act."
new text end
new text begin Subd. 2. new text end
new text begin Purpose. new text end
new text begin
In accordance with sections 245.461 and 245.487, the purpose of this
chapter is to create a system of mental health care that is unified, accountable, and
comprehensive, and to promote the recovery and resiliency of Minnesotans who have mental
illnesses. The state's public policy is to support Minnesotans' access to quality outpatient
and residential mental health services. Further, the state's public policy is to protect the
health and safety, rights, and well-being of Minnesotans receiving mental health services.
new text end
Sec. 2.
new text begin
[245I.011] APPLICABILITY.
new text end
new text begin Subdivision 1. new text end
new text begin License requirements. new text end
new text begin
A license holder under this chapter must comply
with the requirements in chapters 245A, 245C, and 260E; section 626.557; and Minnesota
Rules, chapter 9544.
new text end
new text begin Subd. 2. new text end
new text begin Variances. new text end
new text begin
(a) The commissioner may grant a variance to an applicant, license
holder, or certification holder as long as the variance does not affect the staff qualifications
or the health or safety of any person in a licensed or certified program and the applicant,
license holder, or certification holder meets the following conditions:
new text end
new text begin
(1) an applicant, license holder, or certification holder must request the variance on a
form approved by the commissioner and in a manner prescribed by the commissioner;
new text end
new text begin
(2) the request for a variance must include the:
new text end
new text begin
(i) reasons that the applicant, license holder, or certification holder cannot comply with
a requirement as stated in the law; and
new text end
new text begin
(ii) alternative equivalent measures that the applicant, license holder, or certification
holder will follow to comply with the intent of the law; and
new text end
new text begin
(3) the request for a variance must state the period of time when the variance is requested.
new text end
new text begin
(b) The commissioner may grant a permanent variance when the conditions under which
the applicant, license holder, or certification holder requested the variance do not affect the
health or safety of any person whom the licensed or certified program serves, and when the
conditions of the variance do not compromise the qualifications of staff who provide services
to clients. A permanent variance expires when the conditions that warranted the variance
change in any way. Any applicant, license holder, or certification holder must inform the
commissioner of any changes to the conditions that warranted the permanent variance. If
an applicant, license holder, or certification holder fails to advise the commissioner of
changes to the conditions that warranted the variance, the commissioner must revoke the
permanent variance and may impose other sanctions under sections 245A.06 and 245A.07.
new text end
new text begin
(c) The commissioner's decision to grant or deny a variance request is final and not
subject to appeal under the provisions of chapter 14.
new text end
new text begin Subd. 3. new text end
new text begin Certification required. new text end
new text begin
(a) An individual, organization, or government entity
that is exempt from licensure under section 245A.03, subdivision 2, paragraph (a), clause
(19), and chooses to be identified as a certified mental health clinic must:
new text end
new text begin
(1) be a mental health clinic that is certified under section 245I.20;
new text end
new text begin
(2) comply with all of the responsibilities assigned to a license holder by this chapter
except subdivision 1; and
new text end
new text begin
(3) comply with all of the responsibilities assigned to a certification holder by chapter
245A.
new text end
new text begin
(b) An individual, organization, or government entity described by this subdivision must
obtain a criminal background study of each staff person or volunteer who provides direct
contact services to clients.
new text end
new text begin Subd. 4. new text end
new text begin License required. new text end
new text begin
An individual, organization, or government entity providing
intensive residential treatment services or residential crisis stabilization to adults must be
licensed under section 245I.23. An entity with an adult foster care license providing
residential crisis stabilization is exempt from licensure under section 245I.23.
new text end
new text begin Subd. 5. new text end
new text begin Programs certified under chapter 256B. new text end
new text begin
(a) An individual, organization, or
government entity certified under the following sections must comply with all of the
responsibilities assigned to a license holder under this chapter except subdivision 1:
new text end
new text begin
(1) an assertive community treatment provider under section 256B.0622, subdivision
3a;
new text end
new text begin
(2) an adult rehabilitative mental health services provider under section 256B.0623;
new text end
new text begin
(3) a mobile crisis team under section 256B.0624;
new text end
new text begin
(4) a children's therapeutic services and supports provider under section 256B.0943;
new text end
new text begin
(5) an intensive treatment in foster care provider under section 256B.0946; and
new text end
new text begin
(6) an intensive nonresidential rehabilitative mental health services provider under section
256B.0947.
new text end
new text begin
(b) An individual, organization, or government entity certified under the sections listed
in paragraph (a), clauses (1) to (6), must obtain a criminal background study of each staff
person and volunteer providing direct contact services to a client.
new text end
Sec. 3.
new text begin
[245I.02] DEFINITIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Scope. new text end
new text begin
For purposes of this chapter, the terms in this section have the
meanings given.
new text end
new text begin Subd. 2. new text end
new text begin Approval. new text end
new text begin
"Approval" means the documented review of, opportunity to request
changes to, and agreement with a treatment document. An individual may demonstrate
approval with a written signature, secure electronic signature, or documented oral approval.
new text end
new text begin Subd. 3. new text end
new text begin Behavioral sciences or related fields. new text end
new text begin
"Behavioral sciences or related fields"
means an education from an accredited college or university in social work, psychology,
sociology, community counseling, family social science, child development, child
psychology, community mental health, addiction counseling, counseling and guidance,
special education, nursing, and other similar fields approved by the commissioner.
new text end
new text begin Subd. 4. new text end
new text begin Business day. new text end
new text begin
"Business day" means a weekday on which government offices
are open for business. Business day does not include state or federal holidays, Saturdays,
or Sundays.
new text end
new text begin Subd. 5. new text end
new text begin Case manager. new text end
new text begin
"Case manager" means a client's case manager according to
section 256B.0596; 256B.0621; 256B.0625, subdivision 20; 256B.092, subdivision 1a;
256B.0924; 256B.093, subdivision 3a; 256B.094; or 256B.49.
new text end
new text begin Subd. 6. new text end
new text begin Certified rehabilitation specialist. new text end
new text begin
"Certified rehabilitation specialist" means
a staff person who meets the qualifications of section 245I.04, subdivision 8.
new text end
new text begin Subd. 7. new text end
new text begin Child. new text end
new text begin
"Child" means a client under the age of 18.
new text end
new text begin Subd. 8. new text end
new text begin Client. new text end
new text begin
"Client" means a person who is seeking or receiving services regulated
by this chapter. For the purpose of a client's consent to services, client includes a parent,
guardian, or other individual legally authorized to consent on behalf of a client to services.
new text end
new text begin Subd. 9. new text end
new text begin Clinical trainee. new text end
new text begin
"Clinical trainee" means a staff person who is qualified
according to section 245I.04, subdivision 6.
new text end
new text begin Subd. 10. new text end
new text begin Commissioner. new text end
new text begin
"Commissioner" means the commissioner of human services
or the commissioner's designee.
new text end
new text begin Subd. 11. new text end
new text begin Co-occurring substance use disorder treatment. new text end
new text begin
"Co-occurring substance
use disorder treatment" means the treatment of a person who has a co-occurring mental
illness and substance use disorder. Co-occurring substance use disorder treatment is
characterized by stage-wise comprehensive treatment, treatment goal setting, and flexibility
for clients at each stage of treatment. Co-occurring substance use disorder treatment includes
assessing and tracking each client's stage of change readiness and treatment using a treatment
approach based on a client's stage of change, such as motivational interviewing when working
with a client at an earlier stage of change readiness and a cognitive behavioral approach
and relapse prevention to work with a client at a later stage of change; and facilitating a
client's access to community supports.
new text end
new text begin Subd. 12. new text end
new text begin Crisis plan. new text end
new text begin
"Crisis plan" means a plan to prevent and de-escalate a client's
future crisis situation, with the goal of preventing future crises for the client and the client's
family and other natural supports. Crisis plan includes a crisis plan developed according to
section 245.4871, subdivision 9a.
new text end
new text begin Subd. 13. new text end
new text begin Critical incident. new text end
new text begin
"Critical incident" means an occurrence involving a client
that requires a license holder to respond in a manner that is not part of the license holder's
ordinary daily routine. Critical incident includes a client's suicide, attempted suicide, or
homicide; a client's death; an injury to a client or other person that is life-threatening or
requires medical treatment; a fire that requires a fire department's response; alleged
maltreatment of a client; an assault of a client; an assault by a client; or other situation that
requires a response by law enforcement, the fire department, an ambulance, or another
emergency response provider.
new text end
new text begin Subd. 14. new text end
new text begin Diagnostic assessment. new text end
new text begin
"Diagnostic assessment" means the evaluation and
report of a client's potential diagnoses that a mental health professional or clinical trainee
completes under section 245I.10, subdivisions 4 to 6.
new text end
new text begin Subd. 15. new text end
new text begin Direct contact. new text end
new text begin
"Direct contact" has the meaning given in section 245C.02,
subdivision 11.
new text end
new text begin Subd. 16. new text end
new text begin Family and other natural supports. new text end
new text begin
"Family and other natural supports"
means the people whom a client identifies as having a high degree of importance to the
client. Family and other natural supports also means people that the client identifies as being
important to the client's mental health treatment, regardless of whether the person is related
to the client or lives in the same household as the client.
new text end
new text begin Subd. 17. new text end
new text begin Functional assessment. new text end
new text begin
"Functional assessment" means the assessment of a
client's current level of functioning relative to functioning that is appropriate for someone
the client's age. For a client five years of age or younger, a functional assessment is the
Early Childhood Service Intensity Instrument (ESCII). For a client six to 17 years of age,
a functional assessment is the Child and Adolescent Service Intensity Instrument (CASII).
For a client 18 years of age or older, a functional assessment is the functional assessment
described in section 245I.10, subdivision 9.
new text end
new text begin Subd. 18. new text end
new text begin Individual abuse prevention plan. new text end
new text begin
"Individual abuse prevention plan" means
a plan according to section 245A.65, subdivision 2, paragraph (b), and section 626.557,
subdivision 14.
new text end
new text begin Subd. 19. new text end
new text begin Level of care assessment. new text end
new text begin
"Level of care assessment" means the level of care
decision support tool appropriate to the client's age. For a client five years of age or younger,
a level of care assessment is the Early Childhood Service Intensity Instrument (ESCII). For
a client six to 17 years of age, a level of care assessment is the Child and Adolescent Service
Intensity Instrument (CASII). For a client 18 years of age or older, a level of care assessment
is the Level of Care Utilization System for Psychiatric and Addiction Services (LOCUS).
new text end
new text begin Subd. 20. new text end
new text begin License. new text end
new text begin
"License" has the meaning given in section 245A.02, subdivision 8.
new text end
new text begin Subd. 21. new text end
new text begin License holder. new text end
new text begin
"License holder" has the meaning given in section 245A.02,
subdivision 9.
new text end
new text begin Subd. 22. new text end
new text begin Licensed prescriber. new text end
new text begin
"Licensed prescriber" means an individual who is
authorized to prescribe legend drugs under section 151.37.
new text end
new text begin Subd. 23. new text end
new text begin Mental health behavioral aide. new text end
new text begin
"Mental health behavioral aide" means a
staff person who is qualified under section 245I.04, subdivision 16.
new text end
new text begin Subd. 24. new text end
new text begin Mental health certified family peer specialist. new text end
new text begin
"Mental health certified
family peer specialist" means a staff person who is qualified under section 245I.04,
subdivision 12.
new text end
new text begin Subd. 25. new text end
new text begin Mental health certified peer specialist. new text end
new text begin
"Mental health certified peer
specialist" means a staff person who is qualified under section 245I.04, subdivision 10.
new text end
new text begin Subd. 26. new text end
new text begin Mental health practitioner. new text end
new text begin
"Mental health practitioner" means a staff person
who is qualified under section 245I.04, subdivision 4.
new text end
new text begin Subd. 27. new text end
new text begin Mental health professional. new text end
new text begin
"Mental health professional" means a staff person
who is qualified under section 245I.04, subdivision 2.
new text end
new text begin Subd. 28. new text end
new text begin Mental health rehabilitation worker. new text end
new text begin
"Mental health rehabilitation worker"
means a staff person who is qualified under section 245I.04, subdivision 14.
new text end
new text begin Subd. 29. new text end
new text begin Mental illness. new text end
new text begin
"Mental illness" means any of the conditions included in the
most recent editions of the DC: 0-5 Diagnostic Classification of Mental Health and
Development Disorders of Infancy and Early Childhood published by Zero to Three or the
Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric
Association.
new text end
new text begin Subd. 30. new text end
new text begin Organization. new text end
new text begin
"Organization" has the meaning given in section 245A.02,
subdivision 10c.
new text end
new text begin Subd. 31. new text end
new text begin Personnel file. new text end
new text begin
"Personnel file" means a set of records under section 245I.07,
paragraph (a). Personnel files excludes information related to a person's employment that
is not included in section 245I.07.
new text end
new text begin Subd. 32. new text end
new text begin Registered nurse. new text end
new text begin
"Registered nurse" means a staff person who is qualified
under section 148.171, subdivision 20.
new text end
new text begin Subd. 33. new text end
new text begin Rehabilitative mental health services. new text end
new text begin
"Rehabilitative mental health services"
means mental health services provided to an adult client that enable the client to develop
and achieve psychiatric stability, social competencies, personal and emotional adjustment,
independent living skills, family roles, and community skills when symptoms of mental
illness has impaired any of the client's abilities in these areas.
new text end
new text begin Subd. 34. new text end
new text begin Residential program. new text end
new text begin
"Residential program" has the meaning given in section
245A.02, subdivision 14.
new text end
new text begin Subd. 35. new text end
new text begin Signature. new text end
new text begin
"Signature" means a written signature or an electronic signature
defined in section 325L.02, paragraph (h).
new text end
new text begin Subd. 36. new text end
new text begin Staff person. new text end
new text begin
"Staff person" means an individual who works under a license
holder's direction or under a contract with a license holder. Staff person includes an intern,
consultant, contractor, individual who works part-time, and an individual who does not
provide direct contact services to clients. Staff person includes a volunteer who provides
treatment services to a client or a volunteer whom the license holder regards as a staff person
for the purpose of meeting staffing or service delivery requirements. A staff person must
be 18 years of age or older.
new text end
new text begin Subd. 37. new text end
new text begin Strengths. new text end
new text begin
"Strengths" means a person's inner characteristics, virtues, external
relationships, activities, and connections to resources that contribute to a client's resilience
and core competencies. A person can build on strengths to support recovery.
new text end
new text begin Subd. 38. new text end
new text begin Trauma. new text end
new text begin
"Trauma" means an event, series of events, or set of circumstances
that is experienced by an individual as physically or emotionally harmful or life-threatening
that has lasting adverse effects on the individual's functioning and mental, physical, social,
emotional, or spiritual well-being. Trauma includes group traumatic experiences. Group
traumatic experiences are emotional or psychological harm that a group experiences. Group
traumatic experiences can be transmitted across generations within a community and are
often associated with racial and ethnic population groups who suffer major intergenerational
losses.
new text end
new text begin Subd. 39. new text end
new text begin Treatment plan. new text end
new text begin
"Treatment plan" means services that a license holder
formulates to respond to a client's needs and goals. A treatment plan includes individual
treatment plans under section 245I.10, subdivisions 7 and 8; initial treatment plans under
section 245I.23, subdivision 7; and crisis treatment plans under sections 245I.23, subdivision
8, and 256B.0624, subdivision 11.
new text end
new text begin Subd. 40. new text end
new text begin Treatment supervision. new text end
new text begin
"Treatment supervision" means a mental health
professional's or certified rehabilitation specialist's oversight, direction, and evaluation of
a staff person providing services to a client according to section 245I.06.
new text end
new text begin Subd. 41. new text end
new text begin Volunteer. new text end
new text begin
"Volunteer" means an individual who, under the direction of the
license holder, provides services to or facilitates an activity for a client without compensation.
new text end
Sec. 4.
new text begin
[245I.03] REQUIRED POLICIES AND PROCEDURES.
new text end
new text begin Subdivision 1. new text end
new text begin Generally. new text end
new text begin
A license holder must establish, enforce, and maintain policies
and procedures to comply with the requirements of this chapter and chapters 245A, 245C,
and 260E; sections 626.557 and 626.5572; and Minnesota Rules, chapter 9544. The license
holder must make all policies and procedures available in writing to each staff person. The
license holder must complete and document a review of policies and procedures every two
years and update policies and procedures as necessary. Each policy and procedure must
identify the date that it was initiated and the dates of all revisions. The license holder must
clearly communicate any policy and procedural change to each staff person and provide
necessary training to each staff person to implement any policy and procedural change.
new text end
new text begin Subd. 2. new text end
new text begin Health and safety. new text end
new text begin
A license holder must have policies and procedures to
ensure the health and safety of each staff person and client during the provision of services,
including policies and procedures for services based in community settings.
new text end
new text begin Subd. 3. new text end
new text begin Client rights. new text end
new text begin
A license holder must have policies and procedures to ensure
that each staff person complies with the client rights and protections requirements in section
245I.12.
new text end
new text begin Subd. 4. new text end
new text begin Behavioral emergencies. new text end
new text begin
(a) A license holder must have procedures that each
staff person follows when responding to a client who exhibits behavior that threatens the
immediate safety of the client or others. A license holder's behavioral emergency procedures
must incorporate person-centered planning and trauma-informed care.
new text end
new text begin
(b) A license holder's behavioral emergency procedures must include:
new text end
new text begin
(1) a plan designed to prevent the client from inflicting self-harm and harming others;
new text end
new text begin
(2) contact information for emergency resources that a staff person must use when the
license holder's behavioral emergency procedures are unsuccessful in controlling a client's
behavior;
new text end
new text begin
(3) the types of behavioral emergency procedures that a staff person may use;
new text end
new text begin
(4) the specific circumstances under which the program may use behavioral emergency
procedures; and
new text end
new text begin
(5) the staff persons whom the license holder authorizes to implement behavioral
emergency procedures.
new text end
new text begin
(c) The license holder's behavioral emergency procedures must not include secluding
or restraining a client except as allowed under section 245.8261.
new text end
new text begin
(d) Staff persons must not use behavioral emergency procedures to enforce program
rules or for the convenience of staff persons. Behavioral emergency procedures must not
be part of any client's treatment plan. A staff person may not use behavioral emergency
procedures except in response to a client's current behavior that threatens the immediate
safety of the client or others.
new text end
new text begin Subd. 5. new text end
new text begin Health services and medications. new text end
new text begin
If a license holder is licensed as a residential
program, stores or administers client medications, or observes clients self-administer
medications, the license holder must ensure that a staff person who is a registered nurse or
licensed prescriber reviews and approves of the license holder's policies and procedures to
comply with the health services and medications requirements in section 245I.11, the training
requirements in section 245I.05, subdivision 6, and the documentation requirements in
section 245I.08, subdivision 5.
new text end
new text begin Subd. 6. new text end
new text begin Reporting maltreatment. new text end
new text begin
A license holder must have policies and procedures
for reporting a staff person's suspected maltreatment, abuse, or neglect of a client according
to chapter 260E and section 626.557.
new text end
new text begin Subd. 7. new text end
new text begin Critical incidents. new text end
new text begin
If a license holder is licensed as a residential program, the
license holder must have policies and procedures for reporting and maintaining records of
critical incidents according to section 245I.13.
new text end
new text begin Subd. 8. new text end
new text begin Personnel. new text end
new text begin
A license holder must have personnel policies and procedures that:
new text end
new text begin
(1) include a chart or description of the organizational structure of the program that
indicates positions and lines of authority;
new text end
new text begin
(2) ensure that it will not adversely affect a staff person's retention, promotion, job
assignment, or pay when a staff person communicates in good faith with the Department
of Human Services, the Office of Ombudsman for Mental Health and Developmental
Disabilities, the Department of Health, a health-related licensing board, a law enforcement
agency, or a local agency investigating a complaint regarding a client's rights, health, or
safety;
new text end
new text begin
(3) prohibit a staff person from having sexual contact with a client in violation of chapter
604, sections 609.344 or 609.345;
new text end
new text begin
(4) prohibit a staff person from neglecting, abusing, or maltreating a client as described
in chapter 260E and sections 626.557 and 626.5572;
new text end
new text begin
(5) include the drug and alcohol policy described in section 245A.04, subdivision 1,
paragraph (c);
new text end
new text begin
(6) describe the process for disciplinary action, suspension, or dismissal of a staff person
for violating a policy provision described in clauses (3) to (5);
new text end
new text begin
(7) describe the license holder's response to a staff person who violates other program
policies or who has a behavioral problem that interferes with providing treatment services
to clients; and
new text end
new text begin
(8) describe each staff person's position that includes the staff person's responsibilities,
authority to execute the responsibilities, and qualifications for the position.
new text end
new text begin Subd. 9. new text end
new text begin Volunteers. new text end
new text begin
A license holder must have policies and procedures for using
volunteers, including when a license holder must submit a background study of a volunteer,
and the specific tasks that a volunteer may perform.
new text end
new text begin Subd. 10. new text end
new text begin Data privacy. new text end
new text begin
(a) A license holder must have policies and procedures that
comply with all applicable state and federal law. A license holder's use of electronic record
keeping or electronic signatures does not alter a license holder's obligations to comply with
applicable state and federal law.
new text end
new text begin
(b) A license holder must have policies and procedures for a staff person to promptly
document a client's revocation of consent to disclose the client's health record. The license
holder must verify that the license holder has permission to disclose a client's health record
before releasing any client data.
new text end
Sec. 5.
new text begin
[245I.04] PROVIDER QUALIFICATIONS AND SCOPE OF PRACTICE.
new text end
new text begin Subdivision 1. new text end
new text begin Tribal providers. new text end
new text begin
For purposes of this section, a Tribal entity may
credential an individual according to section 256B.02, subdivision 7, paragraphs (b) and
(c).
new text end
new text begin Subd. 2. new text end
new text begin Mental health professional qualifications. new text end
new text begin
The following individuals may
provide services to a client as a mental health professional:
new text end
new text begin
(1) a registered nurse who is licensed under sections 148.171 to 148.285 and is certified
as a: (i) clinical nurse specialist in child or adolescent, family, or adult psychiatric and
mental health nursing by a national certification organization; or (ii) nurse practitioner in
adult or family psychiatric and mental health nursing by a national nurse certification
organization;
new text end
new text begin
(2) a licensed independent clinical social worker as defined in section 148E.050,
subdivision 5;
new text end
new text begin
(3) a psychologist licensed by the Board of Psychology under sections 148.88 to 148.98;
new text end
new text begin
(4) a physician licensed under chapter 147 if the physician is: (i) certified by the American
Board of Psychiatry and Neurology; (ii) certified by the American Osteopathic Board of
Neurology and Psychiatry; or (iii) eligible for board certification in psychiatry;
new text end
new text begin
(5) a marriage and family therapist licensed under sections 148B.29 to 148B.392; or
new text end
new text begin
(6) a licensed professional clinical counselor licensed under section 148B.5301.
new text end
new text begin Subd. 3. new text end
new text begin Mental health professional scope of practice. new text end
new text begin
A mental health professional
must maintain a valid license with the mental health professional's governing health-related
licensing board and must only provide services to a client within the scope of practice
determined by the applicable health-related licensing board.
new text end
new text begin Subd. 4. new text end
new text begin Mental health practitioner qualifications. new text end
new text begin
(a) An individual who is qualified
in at least one of the ways described in paragraph (b) to (d) may serve as a mental health
practitioner.
new text end
new text begin
(b) An individual is qualified as a mental health practitioner through relevant coursework
if the individual completes at least 30 semester hours or 45 quarter hours in behavioral
sciences or related fields and:
new text end
new text begin
(1) has at least 2,000 hours of experience providing services to individuals with:
new text end
new text begin
(i) a mental illness or a substance use disorder; or
new text end
new text begin
(ii) a traumatic brain injury or a developmental disability, and completes the additional
training described in section 245I.05, subdivision 3, paragraph (c), before providing direct
contact services to a client;
new text end
new text begin
(2) is fluent in the non-English language of the ethnic group to which at least 50 percent
of the individual's clients belong, and completes the additional training described in section
245I.05, subdivision 3, paragraph (c), before providing direct contact services to a client;
new text end
new text begin
(3) is working in a day treatment program under section 256B.0671, subdivision 3, or
256B.0943; or
new text end
new text begin
(4) has completed a practicum or internship that (i) required direct interaction with adult
clients or child clients, and (ii) was focused on behavioral sciences or related fields.
new text end
new text begin
(c) An individual is qualified as a mental health practitioner through work experience
if the individual:
new text end
new text begin
(1) has at least 4,000 hours of experience in the delivery of services to individuals with:
new text end
new text begin
(i) a mental illness or a substance use disorder; or
new text end
new text begin
(ii) a traumatic brain injury or a developmental disability, and completes the additional
training described in section 245I.05, subdivision 3, paragraph (c), before providing direct
contact services to clients; or
new text end
new text begin
(2) receives treatment supervision at least once per week until meeting the requirement
in clause (1) of 4,000 hours of experience and has at least 2,000 hours of experience providing
services to individuals with:
new text end
new text begin
(i) a mental illness or a substance use disorder; or
new text end
new text begin
(ii) a traumatic brain injury or a developmental disability, and completes the additional
training described in section 245I.05, subdivision 3, paragraph (c), before providing direct
contact services to clients.
new text end
new text begin
(d) An individual is qualified as a mental health practitioner if the individual has a
master's or other graduate degree in behavioral sciences or related fields.
new text end
new text begin Subd. 5. new text end
new text begin Mental health practitioner scope of practice. new text end
new text begin
(a) A mental health practitioner
under the treatment supervision of a mental health professional or certified rehabilitation
specialist may provide an adult client with client education, rehabilitative mental health
services, functional assessments, level of care assessments, and treatment plans. A mental
health practitioner under the treatment supervision of a mental health professional may
provide skill-building services to a child client and complete treatment plans for a child
client.
new text end
new text begin
(b) A mental health practitioner must not provide treatment supervision to other staff
persons. A mental health practitioner may provide direction to mental health rehabilitation
workers and mental health behavioral aides.
new text end
new text begin
(c) A mental health practitioner who provides services to clients according to section
256B.0624 or 256B.0944 may perform crisis assessments and interventions for a client.
new text end
new text begin Subd. 6. new text end
new text begin Clinical trainee qualifications. new text end
new text begin
(a) A clinical trainee is a staff person who: (1)
is enrolled in an accredited graduate program of study to prepare the staff person for
independent licensure as a mental health professional and who is participating in a practicum
or internship with the license holder through the individual's graduate program; or (2) has
completed an accredited graduate program of study to prepare the staff person for independent
licensure as a mental health professional and who is in compliance with the requirements
of the applicable health-related licensing board, including requirements for supervised
practice.
new text end
new text begin
(b) A clinical trainee is responsible for notifying and applying to a health-related licensing
board to ensure that the trainee meets the requirements of the health-related licensing board.
As permitted by a health-related licensing board, treatment supervision under this chapter
may be integrated into a plan to meet the supervisory requirements of the health-related
licensing board but does not supersede those requirements.
new text end
new text begin Subd. 7. new text end
new text begin Clinical trainee scope of practice. new text end
new text begin
(a) A clinical trainee under the treatment
supervision of a mental health professional may provide a client with psychotherapy, client
education, rehabilitative mental health services, diagnostic assessments, functional
assessments, level of care assessments, and treatment plans.
new text end
new text begin
(b) A clinical trainee must not provide treatment supervision to other staff persons. A
clinical trainee may provide direction to mental health behavioral aides and mental health
rehabilitation workers.
new text end
new text begin
(c) A psychological clinical trainee under the treatment supervision of a psychologist
may perform psychological testing of clients.
new text end
new text begin
(d) A clinical trainee must not provide services to clients that violate any practice act of
a health-related licensing board, including failure to obtain licensure if licensure is required.
new text end
new text begin Subd. 8. new text end
new text begin Certified rehabilitation specialist qualifications. new text end
new text begin
A certified rehabilitation
specialist must have:
new text end
new text begin
(1) a master's degree from an accredited college or university in behavioral sciences or
related fields;
new text end
new text begin
(2) at least 4,000 hours of post-master's supervised experience providing mental health
services to clients; and
new text end
new text begin
(3) a valid national certification as a certified rehabilitation counselor or certified
psychosocial rehabilitation practitioner.
new text end
new text begin Subd. 9. new text end
new text begin Certified rehabilitation specialist scope of practice. new text end
new text begin
(a) A certified
rehabilitation specialist may provide an adult client with client education, rehabilitative
mental health services, functional assessments, level of care assessments, and treatment
plans.
new text end
new text begin
(b) A certified rehabilitation specialist may provide treatment supervision to a mental
health certified peer specialist, mental health practitioner, and mental health rehabilitation
worker.
new text end
new text begin Subd. 10. new text end
new text begin Mental health certified peer specialist qualifications. new text end
new text begin
A mental health
certified peer specialist must:
new text end
new text begin
(1) have been diagnosed with a mental illness;
new text end
new text begin
(2) be a current or former mental health services client; and
new text end
new text begin
(3) have a valid certification as a mental health certified peer specialist under section
256B.0615.
new text end
new text begin Subd. 11. new text end
new text begin Mental health certified peer specialist scope of practice. new text end
new text begin
A mental health
certified peer specialist under the treatment supervision of a mental health professional or
certified rehabilitation specialist must:
new text end
new text begin
(1) provide individualized peer support to each client;
new text end
new text begin
(2) promote a client's recovery goals, self-sufficiency, self-advocacy, and development
of natural supports; and
new text end
new text begin
(3) support a client's maintenance of skills that the client has learned from other services.
new text end
new text begin Subd. 12. new text end
new text begin Mental health certified family peer specialist qualifications. new text end
new text begin
A mental
health certified family peer specialist must:
new text end
new text begin
(1) have raised or be currently raising a child with a mental illness;
new text end
new text begin
(2) have experience navigating the children's mental health system; and
new text end
new text begin
(3) have a valid certification as a mental health certified family peer specialist under
section 256B.0616.
new text end
new text begin Subd. 13. new text end
new text begin Mental health certified family peer specialist scope of practice. new text end
new text begin
A mental
health certified family peer specialist under the treatment supervision of a mental health
professional must provide services to increase the child's ability to function in the child's
home, school, and community. The mental health certified family peer specialist must:
new text end
new text begin
(1) provide family peer support to build on a client's family's strengths and help the
family achieve desired outcomes;
new text end
new text begin
(2) provide nonadversarial advocacy to a child client and the child's family that
encourages partnership and promotes the child's positive change and growth;
new text end
new text begin
(3) support families in advocating for culturally appropriate services for a child in each
treatment setting;
new text end
new text begin
(4) promote resiliency, self-advocacy, and development of natural supports;
new text end
new text begin
(5) support maintenance of skills learned from other services;
new text end
new text begin
(6) establish and lead parent support groups;
new text end
new text begin
(7) assist parents in developing coping and problem-solving skills; and
new text end
new text begin
(8) educate parents about mental illnesses and community resources, including resources
that connect parents with similar experiences to one another.
new text end
new text begin Subd. 14. new text end
new text begin Mental health rehabilitation worker qualifications. new text end
new text begin
(a) A mental health
rehabilitation worker must:
new text end
new text begin
(1) have a high school diploma or equivalent; and
new text end
new text begin
(2) meet one of the following qualification requirements:
new text end
new text begin
(i) be fluent in the non-English language or competent in the culture of the ethnic group
to which at least 20 percent of the mental health rehabilitation worker's clients belong;
new text end
new text begin
(ii) have an associate of arts degree;
new text end
new text begin
(iii) have two years of full-time postsecondary education or a total of 15 semester hours
or 23 quarter hours in behavioral sciences or related fields;
new text end
new text begin
(iv) be a registered nurse;
new text end
new text begin
(v) have, within the previous ten years, three years of personal life experience with
mental illness;
new text end
new text begin
(vi) have, within the previous ten years, three years of life experience as a primary
caregiver to an adult with a mental illness, traumatic brain injury, substance use disorder,
or developmental disability; or
new text end
new text begin
(vii) have, within the previous ten years, 2,000 hours of work experience providing
health and human services to individuals.
new text end
new text begin
(b) A mental health rehabilitation worker who is scheduled as an overnight staff person
and works alone is exempt from the additional qualification requirements in paragraph (a),
clause (2).
new text end
new text begin Subd. 15. new text end
new text begin Mental health rehabilitation worker scope of practice. new text end
new text begin
A mental health
rehabilitation worker under the treatment supervision of a mental health professional or
certified rehabilitation specialist may provide rehabilitative mental health services to an
adult client according to the client's treatment plan.
new text end
new text begin Subd. 16. new text end
new text begin Mental health behavioral aide qualifications. new text end
new text begin
(a) A level 1 mental health
behavioral aide must have: (1) a high school diploma or equivalent; or (2) two years of
experience as a primary caregiver to a child with mental illness within the previous ten
years.
new text end
new text begin
(b) A level 2 mental health behavioral aide must: (1) have an associate or bachelor's
degree; or (2) be certified by a program under section 256B.0943, subdivision 8a.
new text end
new text begin Subd. 17. new text end
new text begin Mental health behavioral aide scope of practice. new text end
new text begin
While under the treatment
supervision of a mental health professional, a mental health behavioral aide may practice
psychosocial skills with a child client according to the child's treatment plan and individual
behavior plan that a mental health professional, clinical trainee, or mental health practitioner
has previously taught to the child.
new text end
Sec. 6.
new text begin
[245I.05] TRAINING REQUIRED.
new text end
new text begin Subdivision 1. new text end
new text begin Training plan. new text end
new text begin
A license holder must develop a training plan to ensure
that staff persons receive ongoing training according to this section. The training plan must
include:
new text end
new text begin
(1) a formal process to evaluate the training needs of each staff person. An annual
performance evaluation of a staff person satisfies this requirement;
new text end
new text begin
(2) a description of how the license holder conducts ongoing training of each staff person,
including whether ongoing training is based on a staff person's hire date or a specified annual
cycle determined by the program;
new text end
new text begin
(3) a description of how the license holder verifies and documents each staff person's
previous training experience. A license holder may consider a staff person to have met a
training requirement in subdivision 3, paragraph (d) or (e), if the staff person has received
equivalent postsecondary education in the previous four years or training experience in the
previous two years; and
new text end
new text begin
(4) a description of how the license holder determines when a staff person needs
additional training, including when the license holder will provide additional training.
new text end
new text begin Subd. 2. new text end
new text begin Documentation of training. new text end
new text begin
(a) The license holder must provide training to
each staff person according to the training plan and must document that the license holder
provided the training to each staff person. The license holder must document the following
information for each staff person's training:
new text end
new text begin
(1) the topics of the training;
new text end
new text begin
(2) the name of the trainee;
new text end
new text begin
(3) the name and credentials of the trainer;
new text end
new text begin
(4) the license holder's method of evaluating the trainee's competency upon completion
of training;
new text end
new text begin
(5) the date of the training; and
new text end
new text begin
(6) the length of training in hours and minutes.
new text end
new text begin
(b) Documentation of a staff person's continuing education credit accepted by the
governing health-related licensing board is sufficient to document training for purposes of
this subdivision.
new text end
new text begin Subd. 3. new text end
new text begin Initial training. new text end
new text begin
(a) A staff person must receive training about:
new text end
new text begin
(1) vulnerable adult maltreatment under section 245A.65, subdivision 3; and
new text end
new text begin
(2) the maltreatment of minor reporting requirements and definitions in chapter 260E
within 72 hours of first providing direct contact services to a client.
new text end
new text begin
(b) Before providing direct contact services to a client, a staff person must receive training
about:
new text end
new text begin
(1) client rights and protections under section 245I.12;
new text end
new text begin
(2) the Minnesota Health Records Act, including client confidentiality, family engagement
under section 144.294, and client privacy;
new text end
new text begin
(3) emergency procedures that the staff person must follow when responding to a fire,
inclement weather, a report of a missing person, and a behavioral or medical emergency;
new text end
new text begin
(4) specific activities and job functions for which the staff person is responsible, including
the license holder's program policies and procedures applicable to the staff person's position;
new text end
new text begin
(5) professional boundaries that the staff person must maintain; and
new text end
new text begin
(6) specific needs of each client to whom the staff person will be providing direct contact
services, including each client's developmental status, cognitive functioning, physical and
mental abilities.
new text end
new text begin
(c) Before providing direct contact services to a client, a mental health rehabilitation
worker, mental health behavioral aide, or mental health practitioner qualified under section
245I.04, subdivision 4, must receive 30 hours of training about:
new text end
new text begin
(1) mental illnesses;
new text end
new text begin
(2) client recovery and resiliency;
new text end
new text begin
(3) mental health de-escalation techniques;
new text end
new text begin
(4) co-occurring mental illness and substance use disorders; and
new text end
new text begin
(5) psychotropic medications and medication side effects.
new text end
new text begin
(d) Within 90 days of first providing direct contact services to an adult client, a clinical
trainee, mental health practitioner, mental health certified peer specialist, or mental health
rehabilitation worker must receive training about:
new text end
new text begin
(1) trauma-informed care and secondary trauma;
new text end
new text begin
(2) person-centered individual treatment plans, including seeking partnerships with
family and other natural supports;
new text end
new text begin
(3) co-occurring substance use disorders; and
new text end
new text begin
(4) culturally responsive treatment practices.
new text end
new text begin
(e) Within 90 days of first providing direct contact services to a child client, a clinical
trainee, mental health practitioner, mental health certified family peer specialist, mental
health certified peer specialist, or mental health behavioral aide must receive training about
the topics in clauses (1) to (5). This training must address the developmental characteristics
of each child served by the license holder and address the needs of each child in the context
of the child's family, support system, and culture. Training topics must include:
new text end
new text begin
(1) trauma-informed care and secondary trauma, including adverse childhood experiences
(ACEs);
new text end
new text begin
(2) family-centered treatment plan development, including seeking partnership with a
child client's family and other natural supports;
new text end
new text begin
(3) mental illness and co-occurring substance use disorders in family systems;
new text end
new text begin
(4) culturally responsive treatment practices; and
new text end
new text begin
(5) child development, including cognitive functioning, and physical and mental abilities.
new text end
new text begin
(f) For a mental health behavioral aide, the training under paragraph (e) must include
parent team training using a curriculum approved by the commissioner.
new text end
new text begin Subd. 4. new text end
new text begin Ongoing training. new text end
new text begin
(a) A license holder must ensure that staff persons who
provide direct contact services to clients receive annual training about the topics in
subdivision 3, paragraphs (a) and (b), clauses (1) to (3).
new text end
new text begin
(b) A license holder must ensure that each staff person who is qualified under section
245I.04 who is not a mental health professional receives 30 hours of training every two
years. The training topics must be based on the program's needs and the staff person's areas
of competency.
new text end
new text begin Subd. 5. new text end
new text begin Additional training for medication administration. new text end
new text begin
(a) Prior to administering
medications to a client under delegated authority or observing a client self-administer
medications, a staff person who is not a licensed prescriber, registered nurse, or licensed
practical nurse qualified under section 148.171, subdivision 8, must receive training about
psychotropic medications, side effects, and medication management.
new text end
new text begin
(b) Prior to administering medications to a client under delegated authority, a staff person
must successfully complete a:
new text end
new text begin
(1) medication administration training program for unlicensed personnel through an
accredited Minnesota postsecondary educational institution with completion of the course
documented in writing and placed in the staff person's personnel file; or
new text end
new text begin
(2) formalized training program taught by a registered nurse or licensed prescriber that
is offered by the license holder. A staff person's successful completion of the formalized
training program must include direct observation of the staff person to determine the staff
person's areas of competency.
new text end
Sec. 7.
new text begin
[245I.06] TREATMENT SUPERVISION.
new text end
new text begin Subdivision 1. new text end
new text begin Generally. new text end
new text begin
(a) A license holder must ensure that a mental health
professional or certified rehabilitation specialist provides treatment supervision to each staff
person who provides services to a client and who is not a mental health professional or
certified rehabilitation specialist. When providing treatment supervision, a treatment
supervisor must follow a staff person's written treatment supervision plan.
new text end
new text begin
(b) Treatment supervision must focus on each client's treatment needs and the ability of
the staff person under treatment supervision to provide services to each client, including
the following topics related to the staff person's current caseload:
new text end
new text begin
(1) a review and evaluation of the interventions that the staff person delivers to each
client;
new text end
new text begin
(2) instruction on alternative strategies if a client is not achieving treatment goals;
new text end
new text begin
(3) a review and evaluation of each client's assessments, treatment plans, and progress
notes for accuracy and appropriateness;
new text end
new text begin
(4) instruction on the cultural norms or values of the clients and communities that the
license holder serves and the impact that a client's culture has on providing treatment;
new text end
new text begin
(5) evaluation of and feedback regarding a direct service staff person's areas of
competency; and
new text end
new text begin
(6) coaching, teaching, and practicing skills with a staff person.
new text end
new text begin
(c) A treatment supervisor must provide treatment supervision to a staff person using
methods that allow for immediate feedback, including in-person, telephone, and interactive
video supervision.
new text end
new text begin
(d) A treatment supervisor's responsibility for a staff person receiving treatment
supervision is limited to the services provided by the associated license holder. If a staff
person receiving treatment supervision is employed by multiple license holders, each license
holder is responsible for providing treatment supervision related to the treatment of the
license holder's clients.
new text end
new text begin Subd. 2. new text end
new text begin Treatment supervision planning. new text end
new text begin
(a) A treatment supervisor and the staff
person supervised by the treatment supervisor must develop a written treatment supervision
plan. The license holder must ensure that a new staff person's treatment supervision plan is
completed and implemented by a treatment supervisor and the new staff person within 30
days of the new staff person's first day of employment. The license holder must review and
update each staff person's treatment supervision plan annually.
new text end
new text begin
(b) Each staff person's treatment supervision plan must include:
new text end
new text begin
(1) the name and qualifications of the staff person receiving treatment supervision;
new text end
new text begin
(2) the names and licensures of the treatment supervisors who are supervising the staff
person;
new text end
new text begin
(3) how frequently the treatment supervisors must provide treatment supervision to the
staff person; and
new text end
new text begin
(4) the staff person's authorized scope of practice, including a description of the client
population that the staff person serves, and a description of the treatment methods and
modalities that the staff person may use to provide services to clients.
new text end
new text begin Subd. 3. new text end
new text begin
Treatment supervision and direct observation of mental health
rehabilitation workers and mental health behavioral aides.
new text end
new text begin
(a) A mental health behavioral
aide or a mental health rehabilitation worker must receive direct observation from a mental
health professional, clinical trainee, certified rehabilitation specialist, or mental health
practitioner while the mental health behavioral aide or mental health rehabilitation worker
provides treatment services to clients, no less than twice per month for the first six months
of employment and once per month thereafter. The staff person performing the direct
observation must approve of the progress note for the observed treatment service.
new text end
new text begin
(b) For a mental health rehabilitation worker qualified under section 245I.04, subdivision
14, paragraph (a), clause (2), item (i), treatment supervision in the first 2,000 hours of work
must at a minimum consist of:
new text end
new text begin
(1) monthly individual supervision; and
new text end
new text begin
(2) direct observation twice per month.
new text end
Sec. 8.
new text begin
[245I.07] PERSONNEL FILES.
new text end
new text begin
(a) For each staff person, a license holder must maintain a personnel file that includes:
new text end
new text begin
(1) verification of the staff person's qualifications required for the position including
training, education, practicum or internship agreement, licensure, and any other required
qualifications;
new text end
new text begin
(2) documentation related to the staff person's background study;
new text end
new text begin
(3) the hiring date of the staff person;
new text end
new text begin
(4) a description of the staff person's job responsibilities with the license holder;
new text end
new text begin
(5) the date that the staff person's specific duties and responsibilities became effective,
including the date that the staff person began having direct contact with clients;
new text end
new text begin
(6) documentation of the staff person's training as required by section 245I.05, subdivision
2;
new text end
new text begin
(7) a verification copy of license renewals that the staff person completed during the
staff person's employment;
new text end
new text begin
(8) annual job performance evaluations; and
new text end
new text begin
(9) if applicable, the staff person's alleged and substantiated violations of the license
holder's policies under section 245I.03, subdivision 8, clauses (3) to (7), and the license
holder's response.
new text end
new text begin
(b) The license holder must ensure that all personnel files are readily accessible for the
commissioner's review. The license holder is not required to keep personnel files in a single
location.
new text end
Sec. 9.
new text begin
[245I.08] DOCUMENTATION STANDARDS.
new text end
new text begin Subdivision 1. new text end
new text begin Generally. new text end
new text begin
A license holder must ensure that all documentation required
by this chapter complies with this section.
new text end
new text begin Subd. 2. new text end
new text begin Documentation standards. new text end
new text begin
A license holder must ensure that all documentation
required by this chapter:
new text end
new text begin
(1) is legible;
new text end
new text begin
(2) identifies the applicable client and staff person on each page; and
new text end
new text begin
(3) is signed and dated by the staff persons who provided services to the client or
completed the documentation, including the staff persons' credentials.
new text end
new text begin Subd. 3. new text end
new text begin Documenting approval. new text end
new text begin
A license holder must ensure that all diagnostic
assessments, functional assessments, level of care assessments, and treatment plans completed
by a clinical trainee or mental health practitioner contain documentation of approval by a
treatment supervisor within five business days of initial completion by the staff person under
treatment supervision.
new text end
new text begin Subd. 4. new text end
new text begin Progress notes. new text end
new text begin
A license holder must use a progress note to document each
occurrence of a mental health service that a staff person provides to a client. A progress
note must include the following:
new text end
new text begin
(1) the type of service;
new text end
new text begin
(2) the date of service;
new text end
new text begin
(3) the start and stop time of the service unless the license holder is licensed as a
residential program;
new text end
new text begin
(4) the location of the service;
new text end
new text begin
(5) the scope of the service, including: (i) the targeted goal and objective; (ii) the
intervention that the staff person provided to the client and the methods that the staff person
used; (iii) the client's response to the intervention; (iv) the staff person's plan to take future
actions, including changes in treatment that the staff person will implement if the intervention
was ineffective; and (v) the service modality;
new text end
new text begin
(6) the signature, printed name, and credentials of the staff person who provided the
service to the client;
new text end
new text begin
(7) the mental health provider travel documentation required by section 256B.0625, if
applicable; and
new text end
new text begin
(8) significant observations by the staff person, if applicable, including: (i) the client's
current risk factors; (ii) emergency interventions by staff persons; (iii) consultations with
or referrals to other professionals, family, or significant others; and (iv) changes in the
client's mental or physical symptoms.
new text end
new text begin Subd. 5. new text end
new text begin Medication administration record. new text end
new text begin
If a license holder administers or observes
a client self-administer medications, the license holder must maintain a medication
administration record for each client that contains the following, as applicable:
new text end
new text begin
(1) the client's date of birth;
new text end
new text begin
(2) the client's allergies;
new text end
new text begin
(3) all medication orders for the client, including client-specific orders for
over-the-counter medications and approved condition-specific protocols;
new text end
new text begin
(4) the name of each ordered medication, date of each medication's expiration, each
medication's dosage frequency, method of administration, and time;
new text end
new text begin
(5) the licensed prescriber's name and telephone number;
new text end
new text begin
(6) the date of initiation;
new text end
new text begin
(7) the signature, printed name, and credentials of the staff person who administered the
medication or observed the client self-administer the medication; and
new text end
new text begin
(8) the reason that the license holder did not administer the client's prescribed medication
or observe the client self-administer the client's prescribed medication.
new text end
Sec. 10.
new text begin
[245I.09] CLIENT FILES.
new text end
new text begin Subdivision 1. new text end
new text begin Generally. new text end
new text begin
(a) A license holder must maintain a file for each client that
contains the client's current and accurate records. The license holder must store each client
file on the premises where the license holder provides or coordinates services for the client.
The license holder must ensure that all client files are readily accessible for the
commissioner's review. The license holder is not required to keep client files in a single
location.
new text end
new text begin
(b) The license holder must protect client records against loss, tampering, or unauthorized
disclosure of confidential client data according to the Minnesota Government Data Practices
Act, chapter 13; the privacy provisions of the Minnesota health care programs provider
agreement; the Health Insurance Portability and Accountability Act of 1996 (HIPAA),
Public Law 104-191; and the Minnesota Health Records Act, sections 144.291 to 144.298.
new text end
new text begin Subd. 2. new text end
new text begin Record retention. new text end
new text begin
A license holder must retain client records of a discharged
client for a minimum of five years from the date of the client's discharge. A license holder
who ceases to provide treatment services to a client must retain the client's records for a
minimum of five years from the date that the license holder stopped providing services to
the client and must notify the commissioner of the location of the client records and the
name of the individual responsible for storing and maintaining the client records.
new text end
new text begin Subd. 3. new text end
new text begin Contents. new text end
new text begin
A license holder must retain a clear and complete record of the
information that the license holder receives regarding a client, and of the services that the
license holder provides to the client. If applicable, each client's file must include the following
information:
new text end
new text begin
(1) the client's screenings, assessments, and testing;
new text end
new text begin
(2) the client's treatment plans and reviews of the client's treatment plan;
new text end
new text begin
(3) the client's individual abuse prevention plans;
new text end
new text begin
(4) the client's health care directive under section 145C.01, subdivision 5a, and the
client's emergency contacts;
new text end
new text begin
(5) the client's crisis plans;
new text end
new text begin
(6) the client's consents for releases of information and documentation of the client's
releases of information;
new text end
new text begin
(7) the client's significant medical and health-related information;
new text end
new text begin
(8) a record of each communication that a staff person has with the client's other mental
health providers and persons interested in the client, including the client's case manager,
family members, primary caregiver, legal representatives, court representatives,
representatives from the correctional system, or school administration;
new text end
new text begin
(9) written information by the client that the client requests to include in the client's file;
and
new text end
new text begin
(10) the date of the client's discharge from the license holder's program, the reason that
the license holder discontinued services for the client, and the client's discharge summaries.
new text end
Sec. 11.
new text begin
[245I.10] ASSESSMENT AND TREATMENT PLANNING.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) "Diagnostic formulation" means a written analysis and
explanation of a client's clinical assessment to develop a hypothesis about the cause and
nature of a client's presenting problems and to identify the most suitable approach for treating
the client.
new text end
new text begin
(b) "Responsivity factors" means the factors other than the diagnostic formulation that
may modify a client's treatment needs. This includes a client's learning style, abilities,
cognitive functioning, cultural background, and personal circumstances. When documenting
a client's responsivity factors a mental health professional or clinical trainee must include
an analysis of how a client's strengths are reflected in the license holder's plan to deliver
services to the client.
new text end
new text begin Subd. 2. new text end
new text begin Generally. new text end
new text begin
(a) A license holder must use a client's diagnostic assessment or
crisis assessment to determine a client's eligibility for mental health services, except as
provided in this section.
new text end
new text begin
(b) Prior to completing a client's initial diagnostic assessment, a license holder may
provide a client with the following services:
new text end
new text begin
(1) an explanation of findings;
new text end
new text begin
(2) neuropsychological testing, neuropsychological assessment, and psychological
testing;
new text end
new text begin
(3) any combination of psychotherapy sessions, family psychotherapy sessions, and
family psychoeducation sessions not to exceed three sessions;
new text end
new text begin
(4) crisis assessment services according to section 256B.0624; and
new text end
new text begin
(5) ten days of intensive residential treatment services according to the assessment and
treatment planning standards in section 245.23, subdivision 7.
new text end
new text begin
(c) Based on the client's needs that a crisis assessment identifies under section 256B.0624,
a license holder may provide a client with the following services:
new text end
new text begin
(1) crisis intervention and stabilization services under section 245I.23 or 256B.0624;
and
new text end
new text begin
(2) any combination of psychotherapy sessions, group psychotherapy sessions, family
psychotherapy sessions, and family psychoeducation sessions not to exceed ten sessions
within a 12-month period without prior authorization.
new text end
new text begin
(d) Based on the client's needs in the client's brief diagnostic assessment, a license holder
may provide a client with any combination of psychotherapy sessions, group psychotherapy
sessions, family psychotherapy sessions, and family psychoeducation sessions not to exceed
ten sessions within a 12-month period without prior authorization for any new client or for
an existing client who the license holder projects will need fewer than ten sessions during
the next 12 months.
new text end
new text begin
(e) Based on the client's needs that a hospital's medical history and presentation
examination identifies, a license holder may provide a client with:
new text end
new text begin
(1) any combination of psychotherapy sessions, group psychotherapy sessions, family
psychotherapy sessions, and family psychoeducation sessions not to exceed ten sessions
within a 12-month period without prior authorization for any new client or for an existing
client who the license holder projects will need fewer than ten sessions during the next 12
months; and
new text end
new text begin
(2) up to five days of day treatment services or partial hospitalization.
new text end
new text begin
(f) A license holder must complete a new standard diagnostic assessment of a client:
new text end
new text begin
(1) when the client requires services of a greater number or intensity than the services
that paragraphs (b) to (e) describe;
new text end
new text begin
(2) at least annually following the client's initial diagnostic assessment if the client needs
additional mental health services and the client does not meet the criteria for a brief
assessment;
new text end
new text begin
(3) when the client's mental health condition has changed markedly since the client's
most recent diagnostic assessment; or
new text end
new text begin
(4) when the client's current mental health condition does not meet the criteria of the
client's current diagnosis.
new text end
new text begin
(g) For an existing client, the license holder must ensure that a new standard diagnostic
assessment includes a written update containing all significant new or changed information
about the client, and an update regarding what information has not significantly changed,
including a discussion with the client about changes in the client's life situation, functioning,
presenting problems, and progress with achieving treatment goals since the client's last
diagnostic assessment was completed.
new text end
new text begin Subd. 3. new text end
new text begin Continuity of services. new text end
new text begin
(a) For any client with a diagnostic assessment
completed under Minnesota Rules, parts 9505.0370 to 9505.0372, before the effective date
of this section, the diagnostic assessment is valid for authorizing the client's treatment and
billing for one calendar year after the date that the assessment was completed.
new text end
new text begin
(b) For any client with an individual treatment plan completed under section 256B.0622,
256B.0623, 256B.0943, 256B.0946, or 256B.0947 or Minnesota Rules, parts 9505.0370 to
9505.0372, the client's treatment plan is valid for authorizing treatment and billing until the
treatment plan's expiration date.
new text end
new text begin
(c) This subdivision expires July 1, 2023.
new text end
new text begin Subd. 4. new text end
new text begin Diagnostic assessment. new text end
new text begin
A client's diagnostic assessment must: (1) identify at
least one mental health diagnosis for which the client meets the diagnostic criteria and
recommend mental health services to develop the client's mental health services and treatment
plan; or (2) include a finding that the client does not meet the criteria for a mental health
disorder.
new text end
new text begin Subd. 5. new text end
new text begin Brief diagnostic assessment; required elements. new text end
new text begin
(a) Only a mental health
professional or clinical trainee may complete a brief diagnostic assessment of a client. A
license holder may only use a brief diagnostic assessment for a client who is six years of
age or older.
new text end
new text begin
(b) When conducting a brief diagnostic assessment of a client, the assessor must complete
a face-to-face interview with the client and a written evaluation of the client. The assessor
must gather and document initial components of the client's standard diagnostic assessment,
including the client's:
new text end
new text begin
(1) age;
new text end
new text begin
(2) description of symptoms, including the reason for the client's referral;
new text end
new text begin
(3) history of mental health treatment;
new text end
new text begin
(4) cultural influences on the client; and
new text end
new text begin
(5) mental status examination.
new text end
new text begin
(c) Based on the initial components of the assessment, the assessor must develop a
provisional diagnostic formulation about the client. The assessor may use the client's
provisional diagnostic formulation to address the client's immediate needs and presenting
problems.
new text end
new text begin
(d) A mental health professional or clinical trainee may use treatment sessions with the
client authorized by a brief diagnostic assessment to gather additional information about
the client to complete the client's standard diagnostic assessment if the number of sessions
will exceed the coverage limits in subdivision 2.
new text end
new text begin Subd. 6. new text end
new text begin Standard diagnostic assessment; required elements. new text end
new text begin
(a) Only a mental health
professional or a clinical trainee may complete a standard diagnostic assessment of a client.
A standard diagnostic assessment of a client must include a face-to-face interview with a
client and a written evaluation of the client. The assessor must complete a client's standard
diagnostic assessment within the client's cultural context.
new text end
new text begin
(b) When completing a standard diagnostic assessment of a client, the assessor must
gather and document information about the client's current life situation, including the
following information:
new text end
new text begin
(1) the client's age;
new text end
new text begin
(2) the client's current living situation, including the client's housing status and household
members;
new text end
new text begin
(3) the status of the client's basic needs;
new text end
new text begin
(4) the client's education level and employment status;
new text end
new text begin
(5) the client's current medications;
new text end
new text begin
(6) any immediate risks to the client's health and safety;
new text end
new text begin
(7) the client's perceptions of the client's condition;
new text end
new text begin
(8) the client's description of the client's symptoms, including the reason for the client's
referral;
new text end
new text begin
(9) the client's history of mental health treatment; and
new text end
new text begin
(10) cultural influences on the client.
new text end
new text begin
(c) If the assessor cannot obtain the information that this subdivision requires without
retraumatizing the client or harming the client's willingness to engage in treatment, the
assessor must identify which topics will require further assessment during the course of the
client's treatment. The assessor must gather and document information related to the following
topics:
new text end
new text begin
(1) the client's relationship with the client's family and other significant personal
relationships, including the client's evaluation of the quality of each relationship;
new text end
new text begin
(2) the client's strengths and resources, including the extent and quality of the client's
social networks;
new text end
new text begin
(3) important developmental incidents in the client's life;
new text end
new text begin
(4) maltreatment, trauma, potential brain injuries, and abuse that the client has suffered;
new text end
new text begin
(5) the client's history of or exposure to alcohol and drug usage and treatment; and
new text end
new text begin
(6) the client's health history and the client's family health history, including the client's
physical, chemical, and mental health history.
new text end
new text begin
(d) When completing a standard diagnostic assessment of a client, an assessor must use
a recognized diagnostic framework.
new text end
new text begin
(1) When completing a standard diagnostic assessment of a client who is five years of
age or younger, the assessor must use the current edition of the DC: 0-5 Diagnostic
Classification of Mental Health and Development Disorders of Infancy and Early Childhood
published by Zero to Three.
new text end
new text begin
(2) When completing a standard diagnostic assessment of a client who is six years of
age or older, the assessor must use the current edition of the Diagnostic and Statistical
Manual of Mental Disorders published by the American Psychiatric Association.
new text end
new text begin
(3) When completing a standard diagnostic assessment of a client who is five years of
age or younger, an assessor must administer the Early Childhood Service Intensity Instrument
(ECSII) to the client and include the results in the client's assessment.
new text end
new text begin
(4) When completing a standard diagnostic assessment of a client who is six to 17 years
of age, an assessor must administer the Child and Adolescent Service Intensity Instrument
(CASII) to the client and include the results in the client's assessment.
new text end
new text begin
(5) When completing a standard diagnostic assessment of a client who is 18 years of
age or older, an assessor must use either (i) the CAGE-AID Questionnaire or (ii) the criteria
in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders
published by the American Psychiatric Association to screen and assess the client for a
substance use disorder.
new text end
new text begin
(e) When completing a standard diagnostic assessment of a client, the assessor must
include and document the following components of the assessment:
new text end
new text begin
(1) the client's mental status examination;
new text end
new text begin
(2) the client's baseline measurements; symptoms; behavior; skills; abilities; resources;
vulnerabilities; safety needs, including client information that supports the assessor's findings
after applying a recognized diagnostic framework from paragraph (d); and any differential
diagnosis of the client;
new text end
new text begin
(3) an explanation of: (i) how the assessor diagnosed the client using the information
from the client's interview, assessment, psychological testing, and collateral information
about the client; (ii) the client's needs; (iii) the client's risk factors; (iv) the client's strengths;
and (v) the client's responsivity factors.
new text end
new text begin
(f) When completing a standard diagnostic assessment of a client, the assessor must
consult the client and the client's family about which services that the client and the family
prefer to treat the client. The assessor must make referrals for the client as to services required
by law.
new text end
new text begin Subd. 7. new text end
new text begin Individual treatment plan. new text end
new text begin
A license holder must follow each client's written
individual treatment plan when providing services to the client with the following exceptions:
new text end
new text begin
(1) services that do not require that a license holder completes a standard diagnostic
assessment of a client before providing services to the client;
new text end
new text begin
(2) when developing a service plan; and
new text end
new text begin
(3) when a client re-engages in services under subdivision 8, paragraph (b).
new text end
new text begin Subd. 8. new text end
new text begin Individual treatment plan; required elements. new text end
new text begin
(a) After completing a client's
diagnostic assessment and before providing services to the client, the license holder must
complete the client's individual treatment plan. The license holder must:
new text end
new text begin
(1) base the client's individual treatment plan on the client's diagnostic assessment and
baseline measurements;
new text end
new text begin
(2) for a child client, use a child-centered, family-driven, and culturally appropriate
planning process that allows the child's parents and guardians to observe and participate in
the child's individual and family treatment services, assessments, and treatment planning;
new text end
new text begin
(3) for an adult client, use a person-centered, culturally appropriate planning process
that allows the client's family and other natural supports to observe and participate in the
client's treatment services, assessments, and treatment planning;
new text end
new text begin
(4) identify the client's treatment goals, measureable treatment objectives, a schedule
for accomplishing the client's treatment goals and objectives, a treatment strategy, and the
individuals responsible for providing treatment services and supports to the client. The
license holder must have a treatment strategy to engage the client in treatment if the client:
new text end
new text begin
(i) has a history of not engaging in treatment; and
new text end
new text begin
(ii) is ordered by a court to participate in treatment services or to take neuroleptic
medications;
new text end
new text begin
(5) identify the participants involved in the client's treatment planning. The client must
be a participant in the client's treatment planning. If applicable, the license holder must
document the reasons that the license holder did not involve the client's family or other
natural supports in the client's treatment planning;
new text end
new text begin
(6) review the client's individual treatment plan every 180 days and update the client's
individual treatment plan with the client's treatment progress, new treatment objectives and
goals or, if the client has not made treatment progress, changes in the license holder's
approach to treatment; and
new text end
new text begin
(7) ensure that the client approves of the client's individual treatment plan unless a court
orders the client's treatment plan under chapter 253B.
new text end
new text begin
(b) If the client disagrees with the client's treatment plan, the license holder must
document in the client file the reasons why the client does not agree with the treatment plan.
If the license holder cannot obtain the client's approval of the treatment plan, a mental health
professional must make efforts to obtain approval from a person who is authorized to consent
on the client's behalf within 30 days after the client's previous individual treatment plan
expired. A license holder may not deny a client service during this time period solely because
the license holder could not obtain the client's approval of the client's individual treatment
plan. A license holder may continue to bill for the client's otherwise eligible services when
the client re-engages in services.
new text end
new text begin Subd. 9. new text end
new text begin Functional assessment; required elements. new text end
new text begin
When a license holder is
completing a functional assessment for an adult client, the license holder must:
new text end
new text begin
(1) complete a functional assessment of the client after completing the client's diagnostic
assessment;
new text end
new text begin
(2) use a collaborative process that allows the client and the client's family and other
natural supports, the client's referral sources, and the client's providers to provide information
about how the client's symptoms of mental illness impact the client's functioning;
new text end
new text begin
(3) if applicable, document the reasons that the license holder did not contact the client's
family and other natural supports;
new text end
new text begin
(4) assess and document how the client's symptoms of mental illness impact the client's
functioning in the following areas:
new text end
new text begin
(i) the client's mental health symptoms;
new text end
new text begin
(ii) the client's mental health service needs;
new text end
new text begin
(iii) the client's substance use;
new text end
new text begin
(iv) the client's vocational and educational functioning;
new text end
new text begin
(v) the client's social functioning, including the use of leisure time;
new text end
new text begin
(vi) the client's interpersonal functioning, including relationships with the client's family
and other natural supports;
new text end
new text begin
(vii) the client's ability to provide self-care and live independently;
new text end
new text begin
(viii) the client's medical and dental health;
new text end
new text begin
(ix) the client's financial assistance needs; and
new text end
new text begin
(x) the client's housing and transportation needs;
new text end
new text begin
(5) include a narrative summarizing the client's strengths, resources, and all areas of
functional impairment;
new text end
new text begin
(6) complete the client's functional assessment before the client's initial individual
treatment plan unless a service specifies otherwise; and
new text end
new text begin
(7) update the client's functional assessment with the client's current functioning whenever
there is a significant change in the client's functioning or at least every 180 days, unless a
service specifies otherwise.
new text end
Sec. 12.
new text begin
[245I.11] HEALTH SERVICES AND MEDICATIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Generally. new text end
new text begin
If a license holder is licensed as a residential program, stores
or administers client medications, or observes clients self-administer medications, the license
holder must ensure that a staff person who is a registered nurse or licensed prescriber is
responsible for overseeing storage and administration of client medications and observing
as a client self-administers medications, including training according to section 245I.05,
subdivision 6, and documenting the occurrence according to section 245I.08, subdivision
5.
new text end
new text begin Subd. 2. new text end
new text begin Health services. new text end
new text begin
If a license holder is licensed as a residential program, the
license holder must:
new text end
new text begin
(1) ensure that a client is screened for health issues within 72 hours of the client's
admission;
new text end
new text begin
(2) monitor the physical health needs of each client on an ongoing basis;
new text end
new text begin
(3) offer referrals to clients and coordinate each client's care with psychiatric and medical
services;
new text end
new text begin
(4) identify circumstances in which a staff person must notify a registered nurse or
licensed prescriber of any of a client's health concerns and the process for providing
notification of client health concerns; and
new text end
new text begin
(5) identify the circumstances in which the license holder must obtain medical care for
a client and the process for obtaining medical care for a client.
new text end
new text begin Subd. 3. new text end
new text begin Storing and accounting for medications. new text end
new text begin
(a) If a license holder stores client
medications, the license holder must:
new text end
new text begin
(1) store client medications in original containers in a locked location;
new text end
new text begin
(2) store refrigerated client medications in special trays or containers that are separate
from food;
new text end
new text begin
(3) store client medications marked "for external use only" in a compartment that is
separate from other client medications;
new text end
new text begin
(4) store Schedule II to IV drugs listed in section 152.02, subdivisions 3 to 5, in a
compartment that is locked separately from other medications;
new text end
new text begin
(5) ensure that only authorized staff persons have access to stored client medications;
new text end
new text begin
(6) follow a documentation procedure on each shift to account for all scheduled drugs;
and
new text end
new text begin
(7) record each incident when a staff person accepts a supply of client medications and
destroy discontinued, outdated, or deteriorated client medications.
new text end
new text begin
(b) If a license holder is licensed as a residential program, the license holder must allow
clients who self-administer medications to keep a private medication supply. The license
holder must ensure that the client stores all private medication in a locked container in the
client's private living area, unless the private medication supply poses a health and safety
risk to any clients. A client must not maintain a private medication supply of a prescription
medication without a written medication order from a licensed prescriber and a prescription
label that includes the client's name.
new text end
new text begin Subd. 4. new text end
new text begin Medication orders. new text end
new text begin
(a) If a license holder stores, prescribes, or administers
medications or observes a client self-administer medications, the license holder must:
new text end
new text begin
(1) ensure that a licensed prescriber writes all orders to accept, administer, or discontinue
client medications;
new text end
new text begin
(2) accept nonwritten orders to administer client medications in emergency circumstances
only;
new text end
new text begin
(3) establish a timeline and process for obtaining a written order with the licensed
prescriber's signature when the license holder accepts a nonwritten order to administer client
medications;
new text end
new text begin
(4) obtain prescription medication renewals from a licensed prescriber for each client
every 90 days for psychotropic medications and annually for all other medications; and
new text end
new text begin
(5) maintain the client's right to privacy and dignity.
new text end
new text begin
(b) If a license holder employs a licensed prescriber, the license holder must inform the
client about potential medication effects and side effects and obtain and document the client's
informed consent before the licensed prescriber prescribes a medication.
new text end
new text begin Subd. 5. new text end
new text begin Medication administration. new text end
new text begin
If a license holder is licensed as a residential
program, the license holder must:
new text end
new text begin
(1) assess and document each client's ability to self-administer medication. In the
assessment, the license holder must evaluate the client's ability to: (i) comply with prescribed
medication regimens; and (ii) store the client's medications safely and in a manner that
protects other individuals in the facility. Through the assessment process, the license holder
must assist the client in developing the skills necessary to safely self-administer medication;
new text end
new text begin
(2) monitor the effectiveness of medications, side effects of medications, and adverse
reactions to medications for each client. The license holder must address and document any
concerns about a client's medications;
new text end
new text begin
(3) ensure that no staff person or client gives a legend drug supply for one client to
another client;
new text end
new text begin
(4) have policies and procedures for: (i) keeping a record of each client's medication
orders; (ii) keeping a record of any incident of deferring a client's medications; (iii)
documenting any incident when a client's medication is omitted; and (iv) documenting when
a client refuses to take medications as prescribed; and
new text end
new text begin
(5) document and track medication errors, document whether the license holder notified
anyone about the medication error, determine if the license holder must take any follow-up
actions, and identify the staff persons who are responsible for taking follow-up actions.
new text end
Sec. 13.
new text begin
[245I.12] CLIENT RIGHTS AND PROTECTIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Client rights. new text end
new text begin
A license holder must ensure that all clients have the
following rights:
new text end
new text begin
(1) the rights listed in the health care bill of rights in section 144.651;
new text end
new text begin
(2) the right to be free from discrimination based on age, race, color, creed, religion,
national origin, gender, marital status, disability, sexual orientation, and status with regard
to public assistance. The license holder must follow all applicable state and federal laws
including the Minnesota Human Rights Act, chapter 363A; and
new text end
new text begin
(3) the right to be informed prior to a photograph or audio or video recording being made
of the client. The client has the right to refuse to allow any recording or photograph of the
client that is not for the purposes of identification or supervision by the license holder.
new text end
new text begin Subd. 2. new text end
new text begin Restrictions to client rights. new text end
new text begin
If the license holder restricts a client's right, the
license holder must document in the client file a mental health professional's approval of
the restriction and the reasons for the restriction.
new text end
new text begin Subd. 3. new text end
new text begin Notice of rights. new text end
new text begin
The license holder must give a copy of the client's rights
according to this section to each client on the day of the client's admission. The license
holder must document that the license holder gave a copy of the client's rights to each client
on the day of the client's admission according to this section. The license holder must post
a copy of the client rights in an area visible or accessible to all clients. The license holder
must include the client rights in Minnesota Rules, chapter 9544, for applicable clients.
new text end
new text begin Subd. 4. new text end
new text begin Client property. new text end
new text begin
(a) The license holder must meet the requirements of section
245A.04, subdivision 13.
new text end
new text begin
(b) If the license holder is unable to obtain a client's signature acknowledging the receipt
or disbursement of the client's funds or property required by section 245A.04, subdivision
13, paragraph (c), clause (1), two staff persons must sign documentation acknowledging
that the staff persons witnessed the client's receipt or disbursement of the client's funds or
property.
new text end
new text begin
(c) The license holder must return all of the client's funds and other property to the client
except for the following items:
new text end
new text begin
(1) illicit drugs, drug paraphernalia, and drug containers that are subject to forfeiture
under section 609.5316. The license holder must give illicit drugs, drug paraphernalia, and
drug containers to a local law enforcement agency or destroy the items; and
new text end
new text begin
(2) weapons, explosives, and other property that may cause serious harm to the client
or others. The license holder may give a client's weapons and explosives to a local law
enforcement agency. The license holder must notify the client that a local law enforcement
agency has the client's property and that the client has the right to reclaim the property if
the client has a legal right to possess the item.
new text end
new text begin
(d) If a client leaves the license holder's program but abandons the client's funds or
property, the license holder must retain and store the client's funds or property, including
medications, for a minimum of 30 days after the client's discharge from the program.
new text end
new text begin Subd. 5. new text end
new text begin Client grievances. new text end
new text begin
(a) The license holder must have a grievance procedure
that:
new text end
new text begin
(1) describes to clients how the license holder will meet the requirements in this
subdivision; and
new text end
new text begin
(2) contains the current public contact information of the Department of Human Services,
Licensing Division; the Office of Ombudsman for Mental Health and Developmental
Disabilities; the Department of Health, Office of Health Facilities Complaints; and all
applicable health-related licensing boards.
new text end
new text begin
(b) On the day of each client's admission, the license holder must explain the grievance
procedure to the client.
new text end
new text begin
(c) The license holder must:
new text end
new text begin
(1) post the grievance procedure in a place visible to clients and provide a copy of the
grievance procedure upon request;
new text end
new text begin
(2) allow clients, former clients, and their authorized representatives to submit a grievance
to the license holder;
new text end
new text begin
(3) within three business days of receiving a client's grievance, acknowledge in writing
that the license holder received the client's grievance. If applicable, the license holder must
include a notice of the client's separate appeal rights for a managed care organization's
reduction, termination, or denial of a covered service;
new text end
new text begin
(4) within 15 business days of receiving a client's grievance, provide a written final
response to the client's grievance containing the license holder's official response to the
grievance; and
new text end
new text begin
(5) allow the client to bring a grievance to the person with the highest level of authority
in the program.
new text end
Sec. 14.
new text begin
[245I.13] CRITICAL INCIDENTS.
new text end
new text begin
If a license holder is licensed as a residential program, the license holder must report all
critical incidents to the commissioner within ten days of learning of the incident on a form
approved by the commissioner. The license holder must keep a record of critical incidents
in a central location that is readily accessible to the commissioner for review upon the
commissioner's request for a minimum of two licensing periods.
new text end
Sec. 15.
new text begin
[245I.20] MENTAL HEALTH CLINIC.
new text end
new text begin Subdivision 1. new text end
new text begin Purpose. new text end
new text begin
Certified mental health clinics provide clinical services for the
treatment of mental illnesses with a treatment team that reflects multiple disciplines and
areas of expertise.
new text end
new text begin Subd. 2. new text end
new text begin Definitions. new text end
new text begin
(a) "Clinical services" means services provided to a client to
diagnose, describe, predict, and explain the client's status relative to a condition or problem
as described in the: (1) current edition of the Diagnostic and Statistical Manual of Mental
Disorders published by the American Psychiatric Association; or (2) current edition of the
DC: 0-5 Diagnostic Classification of Mental Health and Development Disorders of Infancy
and Early Childhood published by Zero to Three. Where necessary, clinical services includes
services to treat a client to reduce the client's impairment due to the client's condition.
Clinical services also includes individual treatment planning, case review, record-keeping
required for a client's treatment, and treatment supervision. For the purposes of this section,
clinical services excludes services delivered to a client under a separate license and services
listed under section 245I.011, subdivision 5.
new text end
new text begin
(b) "Competent" means having professional education, training, continuing education,
consultation, supervision, experience, or a combination thereof necessary to demonstrate
sufficient knowledge of and proficiency in a specific clinical service.
new text end
new text begin
(c) "Discipline" means a branch of professional knowledge or skill acquired through a
specific course of study, training, and supervised practice. Discipline is usually documented
by a specific educational degree, licensure, or certification of proficiency. Examples of the
mental health disciplines include but are not limited to psychiatry, psychology, clinical
social work, marriage and family therapy, clinical counseling, and psychiatric nursing.
new text end
new text begin
(d) "Treatment team" means the mental health professionals, mental health practitioners,
and clinical trainees who provide clinical services to clients.
new text end
new text begin Subd. 3. new text end
new text begin Organizational structure. new text end
new text begin
(a) A mental health clinic location must be an entire
facility or a clearly identified unit within a facility that is administratively and clinically
separate from the rest of the facility. The mental health clinic location may provide services
other than clinical services to clients, including medical services, substance use disorder
services, social services, training, and education.
new text end
new text begin
(b) The certification holder must notify the commissioner of all mental health clinic
locations. If there is more than one mental health clinic location, the certification holder
must designate one location as the main location and all of the other locations as satellite
locations. The main location as a unit and the clinic as a whole must comply with the
minimum staffing standards in subdivision 4.
new text end
new text begin
(c) The certification holder must ensure that each satellite location:
new text end
new text begin
(1) adheres to the same policies and procedures as the main location;
new text end
new text begin
(2) provides treatment team members with face-to-face or telephone access to a mental
health professional for the purposes of supervision whenever the satellite location is open.
The certification holder must maintain a schedule of the mental health professionals who
will be available and the contact information for each available mental health professional.
The schedule must be current and readily available to treatment team members; and
new text end
new text begin
(3) enables clients to access all of the mental health clinic's clinical services and treatment
team members, as needed.
new text end
new text begin Subd. 4. new text end
new text begin Minimum staffing standards. new text end
new text begin
(a) A certification holder's treatment team must
consist of at least four mental health professionals. At least two of the mental health
professionals must be employed by or under contract with the mental health clinic for a
minimum of 35 hours per week each. Each of the two mental health professionals must
specialize in a different mental health discipline.
new text end
new text begin
(b) The treatment team must include:
new text end
new text begin
(1) a physician qualified as a mental health professional according to section 245I.04,
subdivision 2, clause (4), or a nurse qualified as a mental health professional according to
section 245I.04, subdivision 2, clause (1); and
new text end
new text begin
(2) a psychologist qualified as a mental health professional according to section 245I.04,
subdivision 2, clause (3).
new text end
new text begin
(c) The staff persons fulfilling the requirement in paragraph (b) must provide clinical
services at least:
new text end
new text begin
(1) eight hours every two weeks if the mental health clinic has over 25.0 full-time
equivalent treatment team members;
new text end
new text begin
(2) eight hours each month if the mental health clinic has 15.1 to 25.0 full-time equivalent
treatment team members;
new text end
new text begin
(3) four hours each month if the mental health clinic has 5.1 to 15.0 full-time equivalent
treatment team members; or
new text end
new text begin
(4) two hours each month if the mental health clinic has 2.0 to 5.0 full-time equivalent
treatment team members or only provides in-home services to clients.
new text end
new text begin
(d) The certification holder must maintain a record that demonstrates compliance with
this subdivision.
new text end
new text begin Subd. 5. new text end
new text begin Treatment supervision specified. new text end
new text begin
(a) A mental health professional must remain
responsible for each client's case. The certification holder must document the name of the
mental health professional responsible for each case and the dates that the mental health
professional is responsible for the client's case from beginning date to end date. The
certification holder must assign each client's case for assessment, diagnosis, and treatment
services to a treatment team member who is competent in the assigned clinical service, the
recommended treatment strategy, and in treating the client's characteristics.
new text end
new text begin
(b) Treatment supervision of mental health practitioners and clinical trainees required
by section 245I.06 must include case reviews as described in this paragraph. Every two
months, a mental health professional must complete a case review of each client assigned
to the mental health professional when the client is receiving clinical services from a mental
health practitioner or clinical trainee. The case review must include a consultation process
that thoroughly examines the client's condition and treatment, including: (1) a review of the
client's reason for seeking treatment, diagnoses and assessments, and the individual treatment
plan; (2) a review of the appropriateness, duration, and outcome of treatment provided to
the client; and (3) treatment recommendations.
new text end
new text begin Subd. 6. new text end
new text begin Additional policy and procedure requirements. new text end
new text begin
(a) In addition to the policies
and procedures required by section 245I.03, the certification holder must establish, enforce,
and maintain the policies and procedures required by this subdivision.
new text end
new text begin
(b) The certification holder must have a clinical evaluation procedure to identify and
document each treatment team member's areas of competence.
new text end
new text begin
(c) The certification holder must have policies and procedures for client intake and case
assignment that:
new text end
new text begin
(1) outline the client intake process;
new text end
new text begin
(2) describe how the mental health clinic determines the appropriateness of accepting a
client into treatment by reviewing the client's condition and need for treatment, the clinical
services that the mental health clinic offers to clients, and other available resources; and
new text end
new text begin
(3) contain a process for assigning a client's case to a mental health professional who is
responsible for the client's case and other treatment team members.
new text end
new text begin Subd. 7. new text end
new text begin Referrals. new text end
new text begin
If necessary treatment for a client or treatment desired by a client
is not available at the mental health clinic, the certification holder must facilitate appropriate
referrals for the client. When making a referral for a client, the treatment team member must
document a discussion with the client that includes: (1) the reason for the client's referral;
(2) potential treatment resources for the client; and (3) the client's response to receiving a
referral.
new text end
new text begin Subd. 8. new text end
new text begin Emergency service. new text end
new text begin
For the certification holder's telephone numbers that clients
regularly access, the certification holder must include the contact information for the area's
mental health crisis services as part of the certification holder's message when a live operator
is not available to answer clients' calls.
new text end
new text begin Subd. 9. new text end
new text begin Quality assurance and improvement plan. new text end
new text begin
(a) At a minimum, a certification
holder must develop a written quality assurance and improvement plan that includes a plan
for:
new text end
new text begin
(1) encouraging ongoing consultation among members of the treatment team;
new text end
new text begin
(2) obtaining and evaluating feedback about services from clients, family and other
natural supports, referral sources, and staff persons;
new text end
new text begin
(3) measuring and evaluating client outcomes;
new text end
new text begin
(4) reviewing client suicide deaths and suicide attempts;
new text end
new text begin
(5) examining the quality of clinical service delivery to clients; and
new text end
new text begin
(6) self-monitoring of compliance with this chapter.
new text end
new text begin
(b) At least annually, the certification holder must review, evaluate, and update the
quality assurance and improvement plan. The review must: (1) include documentation of
the actions that the certification holder will take as a result of information obtained from
monitoring activities in the plan; and (2) establish goals for improved service delivery to
clients for the next year.
new text end
new text begin Subd. 10. new text end
new text begin Application procedures. new text end
new text begin
(a) The applicant for certification must submit any
documents that the commissioner requires on forms approved by the commissioner.
new text end
new text begin
(b) Upon submitting an application for certification, an applicant must pay the application
fee required by section 245A.10, subdivision 3.
new text end
new text begin
(c) The commissioner must act on an application within 90 working days of receiving
a completed application.
new text end
new text begin
(d) When the commissioner receives an application for initial certification that is
incomplete because the applicant failed to submit required documents or is deficient because
the submitted documents do not meet certification requirements, the commissioner must
provide the applicant with written notice that the application is incomplete or deficient. In
the notice, the commissioner must identify the particular documents that are missing or
deficient and give the applicant 45 days to submit a second application that is complete. An
applicant's failure to submit a complete application within 45 days after receiving notice
from the commissioner is a basis for certification denial.
new text end
new text begin
(e) The commissioner must give notice of a denial to an applicant when the commissioner
has made the decision to deny the certification application. In the notice of denial, the
commissioner must state the reasons for the denial in plain language. The commissioner
must send or deliver the notice of denial to an applicant by certified mail or personal service.
In the notice of denial, the commissioner must state the reasons that the commissioner denied
the application and must inform the applicant of the applicant's right to request a contested
case hearing under chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. The
applicant may appeal the denial by notifying the commissioner in writing by certified mail
or personal service. If mailed, the appeal must be postmarked and sent to the commissioner
within 20 calendar days after the applicant received the notice of denial. If an applicant
delivers an appeal by personal service, the commissioner must receive the appeal within 20
calendar days after the applicant received the notice of denial.
new text end
new text begin Subd. 11. new text end
new text begin Commissioner's right of access. new text end
new text begin
(a) When the commissioner is exercising
the powers conferred to the commissioner by this chapter, if the mental health clinic is in
operation and the information is relevant to the commissioner's inspection or investigation,
the certification holder must provide the commissioner access to:
new text end
new text begin
(1) the physical facility and grounds where the program is located;
new text end
new text begin
(2) documentation and records, including electronically maintained records;
new text end
new text begin
(3) clients served by the mental health clinic;
new text end
new text begin
(4) staff persons of the mental health clinic; and
new text end
new text begin
(5) personnel records of current and former staff of the mental health clinic.
new text end
new text begin
(b) The certification holder must provide the commissioner with access to the facility
and grounds, documentation and records, clients, and staff without prior notice and as often
as the commissioner considers necessary if the commissioner is investigating alleged
maltreatment or a violation of a law or rule, or conducting an inspection. When conducting
an inspection, the commissioner may request and must receive assistance from other state,
county, and municipal governmental agencies and departments. The applicant or certification
holder must allow the commissioner, at the commissioner's expense, to photocopy,
photograph, and make audio and video recordings during an inspection.
new text end
new text begin Subd. 12. new text end
new text begin Monitoring and inspections. new text end
new text begin
(a) The commissioner may conduct a certification
review of the certified mental health clinic every two years to determine the certification
holder's compliance with applicable rules and statutes.
new text end
new text begin
(b) The commissioner must offer the certification holder a choice of dates for an
announced certification review. A certification review must occur during the clinic's normal
working hours.
new text end
new text begin
(c) The commissioner must make the results of certification reviews and investigations
publicly available on the department's website.
new text end
new text begin Subd. 13. new text end
new text begin Correction orders. new text end
new text begin
(a) If the applicant or certification holder fails to comply
with a law or rule, the commissioner may issue a correction order. The correction order
must state:
new text end
new text begin
(1) the condition that constitutes a violation of the law or rule;
new text end
new text begin
(2) the specific law or rule that the applicant or certification holder has violated; and
new text end
new text begin
(3) the time that the applicant or certification holder is allowed to correct each violation.
new text end
new text begin
(b) If the applicant or certification holder believes that the commissioner's correction
order is erroneous, the applicant or certification holder may ask the commissioner to
reconsider the part of the correction order that is allegedly erroneous. An applicant or
certification holder must make a request for reconsideration in writing. The request must
be postmarked and sent to the commissioner within 20 calendar days after the applicant or
certification holder received the correction order; and the request must:
new text end
new text begin
(1) specify the part of the correction order that is allegedly erroneous;
new text end
new text begin
(2) explain why the specified part is erroneous; and
new text end
new text begin
(3) include documentation to support the allegation of error.
new text end
new text begin
(c) A request for reconsideration does not stay any provision or requirement of the
correction order. The commissioner's disposition of a request for reconsideration is final
and not subject to appeal.
new text end
new text begin
(d) If the commissioner finds that the applicant or certification holder failed to correct
the violation specified in the correction order, the commissioner may decertify the certified
mental health clinic according to subdivision 14.
new text end
new text begin
(e) Nothing in this subdivision prohibits the commissioner from decertifying a mental
health clinic according to subdivision 14.
new text end
new text begin Subd. 14. new text end
new text begin Decertification. new text end
new text begin
(a) The commissioner may decertify a mental health clinic
if a certification holder:
new text end
new text begin
(1) failed to comply with an applicable law or rule; or
new text end
new text begin
(2) knowingly withheld relevant information from or gave false or misleading information
to the commissioner in connection with an application for certification, during an
investigation, or regarding compliance with applicable laws or rules.
new text end
new text begin
(b) When considering decertification of a mental health clinic, the commissioner must
consider the nature, chronicity, or severity of the violation of law or rule and the effect of
the violation on the health, safety, or rights of clients.
new text end
new text begin
(c) If the commissioner decertifies a mental health clinic, the order of decertification
must inform the certification holder of the right to have a contested case hearing under
chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. The certification holder
may appeal the decertification. The certification holder must appeal a decertification in
writing and send or deliver the appeal to the commissioner by certified mail or personal
service. If the certification holder mails the appeal, the appeal must be postmarked and sent
to the commissioner within ten calendar days after the certification holder receives the order
of decertification. If the certification holder delivers an appeal by personal service, the
commissioner must receive the appeal within ten calendar days after the certification holder
received the order. If a certification holder submits a timely appeal of an order of
decertification, the certification holder may continue to operate the program until the
commissioner issues a final order on the decertification.
new text end
new text begin
(d) If the commissioner decertifies a mental health clinic pursuant to paragraph (a),
clause (1), based on a determination that the mental health clinic was responsible for
maltreatment, and if the certification holder appeals the decertification according to paragraph
(c), and appeals the maltreatment determination under section 260E.33, the final
decertification determination is stayed until the commissioner issues a final decision regarding
the maltreatment appeal.
new text end
new text begin Subd. 15. new text end
new text begin Transfer prohibited. new text end
new text begin
A certification issued under this section is only valid
for the premises and the individual, organization, or government entity identified by the
commissioner on the certification. A certification is not transferable or assignable.
new text end
new text begin Subd. 16. new text end
new text begin Notifications required and noncompliance. new text end
new text begin
(a) A certification holder must
notify the commissioner, in a manner prescribed by the commissioner, and obtain the
commissioner's approval before making any change to the name of the certification holder
or the location of the mental health clinic.
new text end
new text begin
(b) Changes in mental health clinic organization, staffing, treatment, or quality assurance
procedures that affect the ability of the certification holder to comply with the minimum
standards of this section must be reported in writing by the certification holder to the
commissioner within 15 days of the occurrence. Review of the change must be conducted
by the commissioner. A certification holder with changes resulting in noncompliance in
minimum standards must receive written notice and may have up to 180 days to correct the
areas of noncompliance before being decertified. Interim procedures to resolve the
noncompliance on a temporary basis must be developed and submitted in writing to the
commissioner for approval within 30 days of the commissioner's determination of the
noncompliance. Not reporting an occurrence of a change that results in noncompliance
within 15 days, failure to develop an approved interim procedure within 30 days of the
determination of the noncompliance, or nonresolution of the noncompliance within 180
days will result in immediate decertification.
new text end
new text begin
(c) The mental health clinic may be required to submit written information to the
department to document that the mental health clinic has maintained compliance with this
section and mental health clinic procedures.
new text end
Sec. 16.
new text begin
[245I.23] INTENSIVE RESIDENTIAL TREATMENT SERVICES AND
RESIDENTIAL CRISIS STABILIZATION.
new text end
new text begin Subdivision 1. new text end
new text begin Purpose. new text end
new text begin
(a) Intensive residential treatment services is a community-based
medically monitored level of care for an adult client that uses established rehabilitative
principles to promote a client's recovery and to develop and achieve psychiatric stability,
personal and emotional adjustment, self-sufficiency, and other skills that help a client
transition to a more independent setting.
new text end
new text begin
(b) Residential crisis stabilization provides structure and support to an adult client in a
community living environment when a client has experienced a mental health crisis and
needs short-term services to ensure that the client can safely return to the client's home or
precrisis living environment with additional services and supports identified in the client's
crisis assessment.
new text end
new text begin Subd. 2. new text end
new text begin Definitions. new text end
new text begin
(a) "Program location" means a set of rooms that are each physically
self-contained and have defining walls extending from floor to ceiling. Program location
includes bedrooms, living rooms or lounge areas, bathrooms, and connecting areas.
new text end
new text begin
(b) "Treatment team" means a group of staff persons who provide intensive residential
treatment services or residential crisis stabilization to clients. The treatment team includes
mental health professionals, mental health practitioners, clinical trainees, certified
rehabilitation specialists, mental health rehabilitation workers, and mental health certified
peer specialists.
new text end
new text begin Subd. 3. new text end
new text begin Treatment services description. new text end
new text begin
The license holder must describe in writing
all treatment services that the license holder provides. The license holder must have the
description readily available for the commissioner upon the commissioner's request.
new text end
new text begin Subd. 4. new text end
new text begin Required intensive residential treatment services. new text end
new text begin
(a) On a daily basis, the
license holder must follow a client's treatment plan to provide intensive residential treatment
services to the client to improve the client's functioning.
new text end
new text begin
(b) The license holder must offer and have the capacity to directly provide the following
treatment services to each client:
new text end
new text begin
(1) rehabilitative mental health services;
new text end
new text begin
(2) crisis prevention planning to assist a client with:
new text end
new text begin
(i) identifying and addressing patterns in the client's history and experience of the client's
mental illness; and
new text end
new text begin
(ii) developing crisis prevention strategies that include de-escalation strategies that have
been effective for the client in the past;
new text end
new text begin
(3) health services and administering medication;
new text end
new text begin
(4) co-occurring substance use disorder treatment;
new text end
new text begin
(5) engaging the client's family and other natural supports in the client's treatment and
educating the client's family and other natural supports to strengthen the client's social and
family relationships; and
new text end
new text begin
(6) making referrals for the client to other service providers in the community and
supporting the client's transition from intensive residential treatment services to another
setting.
new text end
new text begin
(c) The license holder must include Illness Management and Recovery (IMR), Enhanced
Illness Management and Recovery (E-IMR), or other similar interventions in the license
holder's programming as approved by the commissioner.
new text end
new text begin Subd. 5. new text end
new text begin Required residential crisis stabilization services. new text end
new text begin
(a) On a daily basis, the
license holder must follow a client's individual crisis treatment plan to provide services to
the client in residential crisis stabilization to improve the client's functioning.
new text end
new text begin
(b) The license holder must offer and have the capacity to directly provide the following
treatment services to the client:
new text end
new text begin
(1) crisis stabilization services as described in section 256B.0624, subdivision 7;
new text end
new text begin
(2) rehabilitative mental health services;
new text end
new text begin
(3) health services and administering the client's medications; and
new text end
new text begin
(4) making referrals for the client to other service providers in the community and
supporting the client's transition from residential crisis stabilization to another setting.
new text end
new text begin Subd. 6. new text end
new text begin Optional treatment services. new text end
new text begin
(a) If the license holder offers additional treatment
services to a client, the treatment service must be:
new text end
new text begin
(1) approved by the commissioner; and
new text end
new text begin
(2)(i) a mental health evidence-based practice that the federal Department of Health and
Human Services Substance Abuse and Mental Health Service Administration has adopted;
new text end
new text begin
(ii) a nationally recognized mental health service that substantial research has validated
as effective in helping individuals with serious mental illness achieve treatment goals; or
new text end
new text begin
(iii) developed under state-sponsored research of publicly funded mental health programs
and validated to be effective for individuals, families, and communities.
new text end
new text begin
(b) Before providing an optional treatment service to a client, the license holder must
provide adequate training to a staff person about providing the optional treatment service
to a client.
new text end
new text begin Subd. 7. new text end
new text begin
Intensive residential treatment services assessment and treatment
planning.
new text end
new text begin
(a) Within 12 hours of a client's admission, the license holder must evaluate and
document the client's immediate needs, including the client's:
new text end
new text begin
(1) health and safety, including the client's need for crisis assistance;
new text end
new text begin
(2) responsibilities for children, family and other natural supports, and employers; and
new text end
new text begin
(3) housing and legal issues.
new text end
new text begin
(b) Within 24 hours of the client's admission, the license holder must complete an initial
treatment plan for the client. The license holder must:
new text end
new text begin
(1) base the client's initial treatment plan on the client's referral information and an
assessment of the client's immediate needs;
new text end
new text begin
(2) consider crisis assistance strategies that have been effective for the client in the past;
new text end
new text begin
(3) identify the client's initial treatment goals, measurable treatment objectives, and
specific interventions that the license holder will use to help the client engage in treatment;
new text end
new text begin
(4) identify the participants involved in the client's treatment planning. The client must
be a participant; and
new text end
new text begin
(5) ensure that a treatment supervisor approves of the client's initial treatment plan if a
mental health practitioner or clinical trainee completes the client's treatment plan,
notwithstanding section 245I.08, subdivision 3.
new text end
new text begin
(c) According to section 245A.65, subdivision 2, paragraph (b), the license holder must
complete an individual abuse prevention plan as part of a client's initial treatment plan.
new text end
new text begin
(d) Within five days of the client's admission and again within 60 days after the client's
admission, the license holder must complete a level of care assessment of the client. If the
license holder determines that a client does not need a medically monitored level of service,
a treatment supervisor must document how the client's admission to and continued services
in intensive residential treatment services are medically necessary for the client.
new text end
new text begin
(e) Within ten days of a client's admission, the license holder must complete or review
and update the client's standard diagnostic assessment.
new text end
new text begin
(f) Within ten days of a client's admission, the license holder must complete the client's
individual treatment plan, notwithstanding section 245I.10, subdivision 8. Within 40 days
after the client's admission and again within 70 days after the client's admission, the license
holder must update the client's individual treatment plan. The license holder must focus the
client's treatment planning on preparing the client for a successful transition from intensive
residential treatment services to another setting. In addition to the required elements of an
individual treatment plan under section 245I.10, subdivision 8, the license holder must
identify the following information in the client's individual treatment plan: (1) the client's
referrals and resources for the client's health and safety; and (2) the staff persons who are
responsible for following up with the client's referrals and resources. If the client does not
receive a referral or resource that the client needs, the license holder must document the
reason that the license holder did not make the referral or did not connect the client to a
particular resource. The license holder is responsible for determining whether additional
follow-up is required on behalf of the client.
new text end
new text begin
(g) Within 30 days of the client's admission, the license holder must complete a functional
assessment of the client. Within 60 days after the client's admission, the license holder must
update the client's functional assessment to include any changes in the client's functioning
and symptoms.
new text end
new text begin
(h) For a client with a current substance use disorder diagnosis and for a client whose
substance use disorder screening in the client's standard diagnostic assessment indicates the
possibility that the client has a substance use disorder, the license holder must complete a
written assessment of the client's substance use within 30 days of the client's admission. In
the substance use assessment, the license holder must: (1) evaluate the client's history of
substance use, relapses, and hospitalizations related to substance use; (2) assess the effects
of the client's substance use on the client's relationships including with family member and
others; (3) identify financial problems, health issues, housing instability, and unemployment;
(4) assess the client's legal problems, past and pending incarceration, violence, and
victimization; and (5) evaluate the client's suicide attempts, noncompliance with taking
prescribed medications, and noncompliance with psychosocial treatment.
new text end
new text begin
(i) On a weekly basis, a mental health professional or certified rehabilitation specialist
must review each client's treatment plan and individual abuse prevention plan. The license
holder must document in the client's file each weekly review of the client's treatment plan
and individual abuse prevention plan.
new text end
new text begin Subd. 8. new text end
new text begin Residential crisis stabilization assessment and treatment planning. new text end
new text begin
(a)
Within 12 hours of a client's admission, the license holder must evaluate the client and
document the client's immediate needs, including the client's:
new text end
new text begin
(1) health and safety, including the client's need for crisis assistance;
new text end
new text begin
(2) responsibilities for children, family and other natural supports, and employers; and
new text end
new text begin
(3) housing and legal issues.
new text end
new text begin
(b) Within 24 hours of a client's admission, the license holder must complete a crisis
treatment plan for the client under section 256B.0624, subdivision 11. The license holder
must base the client's crisis treatment plan on the client's referral information and an
assessment of the client's immediate needs.
new text end
new text begin
(c) Section 245A.65, subdivision 2, paragraph (b), requires the license holder to complete
an individual abuse prevention plan for a client as part of the client's crisis treatment plan.
new text end
new text begin Subd. 9. new text end
new text begin Key staff positions. new text end
new text begin
(a) The license holder must have a staff person assigned
to each of the following key staff positions at all times:
new text end
new text begin
(1) a program director who qualifies as a mental health practitioner. The license holder
must designate the program director as responsible for all aspects of the operation of the
program and the program's compliance with all applicable requirements. The program
director must know and understand the implications of this chapter; chapters 245A, 245C,
and 260E; sections 626.557 and 626.5572; Minnesota Rules, chapter 9544; and all other
applicable requirements. The license holder must document in the program director's
personnel file how the program director demonstrates knowledge of these requirements.
The program director may also serve as the treatment director of the program, if qualified;
new text end
new text begin
(2) a treatment director who qualifies as a mental health professional. The treatment
director must be responsible for overseeing treatment services for clients and the treatment
supervision of all staff persons; and
new text end
new text begin
(3) a registered nurse who qualifies as a mental health practitioner. The registered nurse
must:
new text end
new text begin
(i) work at the program location a minimum of eight hours per week;
new text end
new text begin
(ii) provide monitoring and supervision of staff persons as defined in section 148.171,
subdivisions 8a and 23;
new text end
new text begin
(iii) be responsible for the review and approval of health service and medication policies
and procedures under section 245I.03, subdivision 5; and
new text end
new text begin
(iv) oversee the license holder's provision of health services to clients, medication storage,
and medication administration to clients.
new text end
new text begin
(b) Within five business days of a change in a key staff position, the license holder must
notify the commissioner of the staffing change. The license holder must notify the
commissioner of the staffing change on a form approved by the commissioner and include
the name of the staff person now assigned to the key staff position and the staff person's
qualifications.
new text end
new text begin Subd. 10. new text end
new text begin Minimum treatment team staffing levels and ratios. new text end
new text begin
(a) The license holder
must maintain a treatment team staffing level sufficient to:
new text end
new text begin
(1) provide continuous daily coverage of all shifts;
new text end
new text begin
(2) follow each client's treatment plan and meet each client's needs as identified in the
client's treatment plan;
new text end
new text begin
(3) implement program requirements; and
new text end
new text begin
(4) safely monitor and guide the activities of each client, taking into account the client's
level of behavioral and psychiatric stability, cultural needs, and vulnerabilities.
new text end
new text begin
(b) The license holder must ensure that treatment team members:
new text end
new text begin
(1) remain awake during all work hours; and
new text end
new text begin
(2) are available to monitor and guide the activities of each client whenever clients are
present in the program.
new text end
new text begin
(c) On each shift, the license holder must maintain a treatment team staffing ratio of at
least one treatment team member to nine clients. If the license holder is serving nine or
fewer clients, at least one treatment team member on the day shift must be a mental health
professional, clinical trainee, certified rehabilitation specialist, or mental health practitioner.
If the license holder is serving more than nine clients, at least one of the treatment team
members working during both the day and evening shifts must be a mental health
professional, clinical trainee, certified rehabilitation specialist, or mental health practitioner.
new text end
new text begin
(d) If the license holder provides residential crisis stabilization to clients and is serving
at least one client in residential crisis stabilization and more than four clients in residential
crisis stabilization and intensive residential treatment services, the license holder must
maintain a treatment team staffing ratio on each shift of at least two treatment team members
during the client's first 48 hours in residential crisis stabilization.
new text end
new text begin Subd. 11. new text end
new text begin Shift exchange. new text end
new text begin
A license holder must ensure that treatment team members
working on different shifts exchange information about a client as necessary to effectively
care for the client and to follow and update a client's treatment plan and individual abuse
prevention plan.
new text end
new text begin Subd. 12. new text end
new text begin Daily documentation. new text end
new text begin
(a) For each day that a client is present in the program,
the license holder must provide a daily summary in the client's file that includes observations
about the client's behavior and symptoms, including any critical incidents in which the client
was involved.
new text end
new text begin
(b) For each day that a client is not present in the program, the license holder must
document the reason for a client's absence in the client's file.
new text end
new text begin Subd. 13. new text end
new text begin
Access to a mental health professional, clinical trainee, certified
rehabilitation specialist, or mental health practitioner.
new text end
new text begin
Treatment team members must
have access in person or by telephone to a mental health professional, clinical trainee,
certified rehabilitation specialist, or mental health practitioner within 30 minutes. The license
holder must maintain a schedule of mental health professionals, clinical trainees, certified
rehabilitation specialists, or mental health practitioners who will be available and contact
information to reach them. The license holder must keep the schedule current and make the
schedule readily available to treatment team members.
new text end
new text begin Subd. 14. new text end
new text begin Weekly team meetings. new text end
new text begin
(a) The license holder must hold weekly team meetings
and ancillary meetings according to this subdivision.
new text end
new text begin
(b) A mental health professional or certified rehabilitation specialist must hold at least
one team meeting each calendar week and be physically present at the team meeting. All
treatment team members, including treatment team members who work on a part-time or
intermittent basis, must participate in a minimum of one team meeting during each calendar
week when the treatment team member is working for the license holder. The license holder
must document all weekly team meetings, including the names of meeting attendees.
new text end
new text begin
(c) If a treatment team member cannot participate in a weekly team meeting, the treatment
team member must participate in an ancillary meeting. A mental health professional, certified
rehabilitation specialist, clinical trainee, or mental health practitioner who participated in
the most recent weekly team meeting may lead the ancillary meeting. During the ancillary
meeting, the treatment team member leading the ancillary meeting must review the
information that was shared at the most recent weekly team meeting, including revisions
to client treatment plans and other information that the treatment supervisors exchanged
with treatment team members. The license holder must document all ancillary meetings,
including the names of meeting attendees.
new text end
new text begin Subd. 15. new text end
new text begin Intensive residential treatment services admission criteria. new text end
new text begin
(a) An eligible
client for intensive residential treatment services is an individual who:
new text end
new text begin
(1) is age 18 or older;
new text end
new text begin
(2) is diagnosed with a mental illness;
new text end
new text begin
(3) because of a mental illness, has a substantial disability and functional impairment
in three or more areas listed in section 245I.10, subdivision 9, clause (4), that markedly
reduce the individual's self-sufficiency;
new text end
new text begin
(4) has one or more of the following: a history of recurring or prolonged inpatient
hospitalizations during the past year, significant independent living instability, homelessness,
or very frequent use of mental health and related services with poor outcomes for the
individual; and
new text end
new text begin
(5) in the written opinion of a mental health professional, needs mental health services
that available community-based services cannot provide, or is likely to experience a mental
health crisis or require a more restrictive setting if the individual does not receive intensive
rehabilitative mental health services.
new text end
new text begin
(b) The license holder must not limit or restrict intensive residential treatment services
to a client based solely on:
new text end
new text begin
(1) the client's substance use;
new text end
new text begin
(2) the county in which the client resides; or
new text end
new text begin
(3) whether the client elects to receive other services for which the client may be eligible,
including case management services.
new text end
new text begin
(c) This subdivision does not prohibit the license holder from restricting admissions of
individuals who present an imminent risk of harm or danger to themselves or others.
new text end
new text begin Subd. 16. new text end
new text begin Residential crisis stabilization services admission criteria. new text end
new text begin
An eligible client
for residential crisis stabilization is an individual who is age 18 or older and meets the
eligibility criteria in section 256B.0624, subdivision 3.
new text end
new text begin Subd. 17. new text end
new text begin Admissions referrals and determinations. new text end
new text begin
(a) The license holder must
identify the information that the license holder needs to make a determination about a
person's admission referral.
new text end
new text begin
(b) The license holder must:
new text end
new text begin
(1) always be available to receive referral information about a person seeking admission
to the license holder's program;
new text end
new text begin
(2) respond to the referral source within eight hours of receiving a referral and, within
eight hours, communicate with the referral source about what information the license holder
needs to make a determination concerning the person's admission;
new text end
new text begin
(3) consider the license holder's staffing ratio and the areas of treatment team members'
competency when determining whether the license holder is able to meet the needs of a
person seeking admission; and
new text end
new text begin
(4) determine whether to admit a person within 72 hours of receiving all necessary
information from the referral source.
new text end
new text begin Subd. 18. new text end
new text begin Discharge standards. new text end
new text begin
(a) When a license holder discharges a client from a
program, the license holder must categorize the discharge as a successful discharge,
program-initiated discharge, or non-program-initiated discharge according to the criteria in
this subdivision. The license holder must meet the standards associated with the type of
discharge according to this subdivision.
new text end
new text begin
(b) To successfully discharge a client from a program, the license holder must ensure
that the following criteria are met:
new text end
new text begin
(1) the client must substantially meet the client's documented treatment plan goals and
objectives;
new text end
new text begin
(2) the client must complete discharge planning with the treatment team; and
new text end
new text begin
(3) the client and treatment team must arrange for the client to receive continuing care
at a less intensive level of care after discharge.
new text end
new text begin
(c) Prior to successfully discharging a client from a program, the license holder must
complete the client's discharge summary and provide the client with a copy of the client's
discharge summary in plain language that includes:
new text end
new text begin
(1) a brief review of the client's problems and strengths during the period that the license
holder provided services to the client;
new text end
new text begin
(2) the client's response to the client's treatment plan;
new text end
new text begin
(3) the goals and objectives that the license holder recommends that the client addresses
during the first three months following the client's discharge from the program;
new text end
new text begin
(4) the recommended actions, supports, and services that will assist the client with a
successful transition from the program to another setting;
new text end
new text begin
(5) the client's crisis plan; and
new text end
new text begin
(6) the client's forwarding address and telephone number.
new text end
new text begin
(d) For a non-program-initiated discharge of a client from a program, the following
criteria must be met:
new text end
new text begin
(1)(i) the client has withdrawn the client's consent for treatment; (ii) the license holder
has determined that the client has the capacity to make an informed decision; and (iii) the
client does not meet the criteria for an emergency hold under section 253B.051, subdivision
2;
new text end
new text begin
(2) the client has left the program against staff person advice;
new text end
new text begin
(3) an entity with legal authority to remove the client has decided to remove the client
from the program; or
new text end
new text begin
(4) a source of payment for the services is no longer available.
new text end
new text begin
(e) Within ten days of a non-program-initiated discharge of a client from a program, the
license holder must complete the client's discharge summary in plain language that includes:
new text end
new text begin
(1) the reasons for the client's discharge;
new text end
new text begin
(2) a description of attempts by staff persons to enable the client to continue treatment
or to consent to treatment; and
new text end
new text begin
(3) recommended actions, supports, and services that will assist the client with a
successful transition from the program to another setting.
new text end
new text begin
(f) For a program-initiated discharge of a client from a program, the following criteria
must be met:
new text end
new text begin
(1) the client is competent but has not participated in treatment or has not followed the
program rules and regulations and the client has not participated to such a degree that the
program's level of care is ineffective or unsafe for the client, despite multiple, documented
attempts that the license holder has made to address the client's lack of participation in
treatment;
new text end
new text begin
(2) the client has not made progress toward the client's treatment goals and objectives
despite the license holder's persistent efforts to engage the client in treatment, and the license
holder has no reasonable expectation that the client will make progress at the program's
level of care nor does the client require the program's level of care to maintain the current
level of functioning;
new text end
new text begin
(3) a court order or the client's legal status requires the client to participate in the program
but the client has left the program against staff person advice; or
new text end
new text begin
(4) the client meets criteria for a more intensive level of care and a more intensive level
of care is available to the client.
new text end
new text begin
(g) Prior to a program-initiated discharge of a client from a program, the license holder
must consult the client, the client's family and other natural supports, and the client's case
manager, if applicable, to review the issues involved in the program's decision to discharge
the client from the program. During the discharge review process, which must not exceed
five working days, the license holder must determine whether the license holder, treatment
team, and any interested persons can develop additional strategies to resolve the issues
leading to the client's discharge and to permit the client to have an opportunity to continue
receiving services from the license holder. The license holder may temporarily remove a
client from the program facility during the five-day discharge review period. The license
holder must document the client's discharge review in the client's file.
new text end
new text begin
(h) Prior to a program-initiated discharge of a client from the program, the license holder
must complete the client's discharge summary and provide the client with a copy of the
discharge summary in plain language that includes:
new text end
new text begin
(1) the reasons for the client's discharge;
new text end
new text begin
(2) the alternatives to discharge that the license holder considered or attempted to
implement;
new text end
new text begin
(3) the names of each individual who is involved in the decision to discharge the client
and a description of each individual's involvement; and
new text end
new text begin
(4) recommended actions, supports, and services that will assist the client with a
successful transition from the program to another setting.
new text end
new text begin Subd. 19. new text end
new text begin Program facility. new text end
new text begin
(a) The license holder must be licensed or certified as a
board and lodging facility, supervised living facility, or a boarding care home by the
Department of Health.
new text end
new text begin
(b) The license holder must have a capacity of five to 16 beds and the program must not
be declared as an institution for mental disease.
new text end
new text begin
(c) The license holder must furnish each program location to meet the psychological,
emotional, and developmental needs of clients.
new text end
new text begin
(d) The license holder must provide one living room or lounge area per program location.
There must be space available to provide services according to each client's treatment plan,
such as an area for learning recreation time skills and areas for learning independent living
skills, such as laundering clothes and preparing meals.
new text end
new text begin
(e) The license holder must ensure that each program location allows each client to have
privacy. Each client must have privacy during assessment interviews and counseling sessions.
Each client must have a space designated for the client to see outside visitors at the program
facility.
new text end
new text begin Subd. 20. new text end
new text begin Physical separation of services. new text end
new text begin
If the license holder offers services to
individuals who are not receiving intensive residential treatment services or residential
stabilization at the program location, the license holder must inform the commissioner and
submit a plan for approval to the commissioner about how and when the license holder will
provide services. The license holder must only provide services to clients who are not
receiving intensive residential treatment services or residential crisis stabilization in an area
that is physically separated from the area in which the license holder provides clients with
intensive residential treatment services or residential crisis stabilization.
new text end
new text begin Subd. 21. new text end
new text begin Dividing staff time between locations. new text end
new text begin
A license holder must obtain approval
from the commissioner prior to providing intensive residential treatment services or
residential crisis stabilization to clients in more than one program location under one license
and dividing one staff person's time between program locations during the same work period.
new text end
new text begin Subd. 22. new text end
new text begin Additional policy and procedure requirements. new text end
new text begin
(a) In addition to the policies
and procedures in section 245I.03, the license holder must establish, enforce, and maintain
the policies and procedures in this subdivision.
new text end
new text begin
(b) The license holder must have policies and procedures for receiving referrals and
making admissions determinations about referred persons under subdivisions 14 to 16.
new text end
new text begin
(c) The license holder must have policies and procedures for discharging clients under
subdivision 17. In the policies and procedures, the license holder must identify the staff
persons who are authorized to discharge clients from the program.
new text end
new text begin Subd. 23. new text end
new text begin Quality assurance and improvement plan. new text end
new text begin
(a) A license holder must develop
a written quality assurance and improvement plan that includes a plan to:
new text end
new text begin
(1) encourage ongoing consultation between members of the treatment team;
new text end
new text begin
(2) obtain and evaluate feedback about services from clients, family and other natural
supports, referral sources, and staff persons;
new text end
new text begin
(3) measure and evaluate client outcomes in the program;
new text end
new text begin
(4) review critical incidents in the program;
new text end
new text begin
(5) examine the quality of clinical services in the program; and
new text end
new text begin
(6) self-monitor the license holder's compliance with this chapter.
new text end
new text begin
(b) At least annually, the license holder must review, evaluate, and update the license
holder's quality assurance and improvement plan. The license holder's review must:
new text end
new text begin
(1) document the actions that the license holder will take in response to the information
that the license holder obtains from the monitoring activities in the plan; and
new text end
new text begin
(2) establish goals for improving the license holder's services to clients during the next
year.
new text end
new text begin Subd. 24. new text end
new text begin Application. new text end
new text begin
When an applicant requests licensure to provide intensive
residential treatment services, residential crisis stabilization, or both to clients, the applicant
must submit, on forms that the commissioner provides, any documents that the commissioner
requires.
new text end
Sec. 17.
new text begin
[256B.0671] COVERED MENTAL HEALTH SERVICES.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) "Clinical trainee" means a staff person who is qualified
under section 245I.04, subdivision 6.
new text end
new text begin
(b) "Mental health practitioner" means a staff person who is qualified under section
245I.04, subdivision 4.
new text end
new text begin
(c) "Mental health professional" means a staff person who is qualified under section
245I.04, subdivision 2.
new text end
new text begin Subd. 2. new text end
new text begin Generally. new text end
new text begin
(a) An individual, organization, or government entity providing
mental health services to a client under this section must obtain a criminal background study
of each staff person or volunteer who is providing direct contact services to a client.
new text end
new text begin
(b) An individual, organization, or government entity providing mental health services
to a client under this section must comply with all responsibilities that chapter 245I assigns
to a license holder, except section 245I.011, subdivision 1, unless all of the individual's,
organization's, or government entity's treatment staff are qualified as mental health
professionals.
new text end
new text begin
(c) An individual, organization, or government entity providing mental health services
to a client under this section must comply with the following requirements if all of the
license holder's treatment staff are qualified as mental health professionals:
new text end
new text begin
(1) provider qualifications and scopes of practice under section 245I.04;
new text end
new text begin
(2) maintaining and updating personnel files under section 245I.07;
new text end
new text begin
(3) documenting under section 245I.08;
new text end
new text begin
(4) maintaining and updating client files under section 245I.09;
new text end
new text begin
(5) completing client assessments and treatment planning under section 245I.10;
new text end
new text begin
(6) providing clients with health services and medications under section 245I.11; and
new text end
new text begin
(7) respecting and enforcing client rights under section 245I.12.
new text end
new text begin Subd. 3. new text end
new text begin Adult day treatment services. new text end
new text begin
(a) Subject to federal approval, medical
assistance covers adult day treatment (ADT) services that are provided under contract with
the county board. Adult day treatment payment is subject to the conditions in paragraphs
(b) to (e). The provider must make reasonable and good faith efforts to report individual
client outcomes to the commissioner using instruments, protocols, and forms approved by
the commissioner.
new text end
new text begin
(b) Adult day treatment is an intensive psychotherapeutic treatment to reduce or relieve
the effects of mental illness on a client to enable the client to benefit from a lower level of
care and to live and function more independently in the community. Adult day treatment
services must be provided to a client to stabilize the client's mental health and to improve
the client's independent living and socialization skills. Adult day treatment must consist of
at least one hour of group psychotherapy and must include group time focused on
rehabilitative interventions or other therapeutic services that a multidisciplinary team provides
to each client. Adult day treatment services are not a part of inpatient or residential treatment
services. The following providers may apply to become adult day treatment providers:
new text end
new text begin
(1) a hospital accredited by the Joint Commission on Accreditation of Health
Organizations and licensed under sections 144.50 to 144.55;
new text end
new text begin
(2) a community mental health center under section 256B.0625, subdivision 5; or
new text end
new text begin
(3) an entity that is under contract with the county board to operate a program that meets
the requirements of section 245.4712, subdivision 2, and Minnesota Rules, parts 9505.0170
to 9505.0475.
new text end
new text begin
(c) An adult day treatment (ADT) services provider must:
new text end
new text begin
(1) ensure that the commissioner has approved of the organization as an adult day
treatment provider organization;
new text end
new text begin
(2) ensure that a multidisciplinary team provides ADT services to a group of clients. A
mental health professional must supervise each multidisciplinary staff person who provides
ADT services;
new text end
new text begin
(3) make ADT services available to the client at least two days a week for at least three
consecutive hours per day. ADT services may be longer than three hours per day, but medical
assistance may not reimburse a provider for more than 15 hours per week;
new text end
new text begin
(4) provide ADT services to each client that includes group psychotherapy by a mental
health professional or clinical trainee and daily rehabilitative interventions by a mental
health professional, clinical trainee, or mental health practitioner; and
new text end
new text begin
(5) include ADT services in the client's individual treatment plan, when appropriate.
The adult day treatment provider must:
new text end
new text begin
(i) complete a functional assessment of each client under section 245I.10, subdivision
9;
new text end
new text begin
(ii) notwithstanding section 245I.10, subdivision 8, review the client's progress and
update the individual treatment plan at least every 90 days until the client is discharged
from the program; and
new text end
new text begin
(iii) include a discharge plan for the client in the client's individual treatment plan.
new text end
new text begin
(d) To be eligible for adult day treatment, a client must:
new text end
new text begin
(1) be 18 years of age or older;
new text end
new text begin
(2) not reside in a nursing facility, hospital, institute of mental disease, or state-operated
treatment center unless the client has an active discharge plan that indicates a move to an
independent living setting within 180 days;
new text end
new text begin
(3) have the capacity to engage in rehabilitative programming, skills activities, and
psychotherapy in the structured, therapeutic setting of an adult day treatment program and
demonstrate measurable improvements in functioning resulting from participation in the
adult day treatment program;
new text end
new text begin
(4) have a level of care assessment under section 245I.02, subdivision 19, recommending
that the client participate in services with the level of intensity and duration of an adult day
treatment program; and
new text end
new text begin
(5) have the recommendation of a mental health professional for adult day treatment
services. The mental health professional must find that adult day treatment services are
medically necessary for the client.
new text end
new text begin
(e) Medical assistance does not cover the following services as adult day treatment
services:
new text end
new text begin
(1) services that are primarily recreational or that are provided in a setting that is not
under medical supervision, including sports activities, exercise groups, craft hours, leisure
time, social hours, meal or snack time, trips to community activities, and tours;
new text end
new text begin
(2) social or educational services that do not have or cannot reasonably be expected to
have a therapeutic outcome related to the client's mental illness;
new text end
new text begin
(3) consultations with other providers or service agency staff persons about the care or
progress of a client;
new text end
new text begin
(4) prevention or education programs that are provided to the community;
new text end
new text begin
(5) day treatment for clients with a primary diagnosis of a substance use disorder;
new text end
new text begin
(6) day treatment provided in the client's home;
new text end
new text begin
(7) psychotherapy for more than two hours per day; and
new text end
new text begin
(8) participation in meal preparation and eating that is not part of a clinical treatment
plan to address the client's eating disorder.
new text end
new text begin Subd. 4. new text end
new text begin Explanation of findings. new text end
new text begin
(a) Subject to federal approval, medical assistance
covers an explanation of findings that a mental health professional or clinical trainee provides
when the provider has obtained the authorization from the client or the client's representative
to release the information.
new text end
new text begin
(b) A mental health professional or clinical trainee provides an explanation of findings
to assist the client or related parties in understanding the results of the client's testing or
diagnostic assessment and the client's mental illness, and provides professional insight that
the client or related parties need to carry out a client's treatment plan. Related parties may
include the client's family and other natural supports and other service providers working
with the client.
new text end
new text begin
(c) An explanation of findings is not paid for separately when a mental health professional
or clinical trainee explains the results of psychological testing or a diagnostic assessment
to the client or the client's representative as part of the client's psychological testing or a
diagnostic assessment.
new text end
new text begin Subd. 5. new text end
new text begin Family psychoeducation services. new text end
new text begin
(a) Subject to federal approval, medical
assistance covers family psychoeducation services provided to a child up to age 21 with a
diagnosed mental health condition when identified in the child's individual treatment plan
and provided by a mental health professional or a clinical trainee who has determined it
medically necessary to involve family members in the child's care.
new text end
new text begin
(b) "Family psychoeducation services" means information or demonstration provided
to an individual or family as part of an individual, family, multifamily group, or peer group
session to explain, educate, and support the child and family in understanding a child's
symptoms of mental illness, the impact on the child's development, and needed components
of treatment and skill development so that the individual, family, or group can help the child
to prevent relapse, prevent the acquisition of comorbid disorders, and achieve optimal mental
health and long-term resilience.
new text end
new text begin Subd. 6. new text end
new text begin Dialectical behavior therapy. new text end
new text begin
(a) Subject to federal approval, medical assistance
covers intensive mental health outpatient treatment for dialectical behavior therapy for
adults. A dialectical behavior therapy provider must make reasonable and good faith efforts
to report individual client outcomes to the commissioner using instruments and protocols
that are approved by the commissioner.
new text end
new text begin
(b) "Dialectical behavior therapy" means an evidence-based treatment approach that a
mental health professional or clinical trainee provides to a client or a group of clients in an
intensive outpatient treatment program using a combination of individualized rehabilitative
and psychotherapeutic interventions. A dialectical behavior therapy program involves:
individual dialectical behavior therapy, group skills training, telephone coaching, and team
consultation meetings.
new text end
new text begin
(c) To be eligible for dialectical behavior therapy, a client must:
new text end
new text begin
(1) be 18 years of age or older;
new text end
new text begin
(2) have mental health needs that available community-based services cannot meet or
that the client must receive concurrently with other community-based services;
new text end
new text begin
(3) have either:
new text end
new text begin
(i) a diagnosis of borderline personality disorder; or
new text end
new text begin
(ii) multiple mental health diagnoses, exhibit behaviors characterized by impulsivity or
intentional self-harm, and be at significant risk of death, morbidity, disability, or severe
dysfunction in multiple areas of the client's life;
new text end
new text begin
(4) be cognitively capable of participating in dialectical behavior therapy as an intensive
therapy program and be able and willing to follow program policies and rules to ensure the
safety of the client and others; and
new text end
new text begin
(5) be at significant risk of one or more of the following if the client does not receive
dialectical behavior therapy:
new text end
new text begin
(i) having a mental health crisis;
new text end
new text begin
(ii) requiring a more restrictive setting such as hospitalization;
new text end
new text begin
(iii) decompensating; or
new text end
new text begin
(iv) engaging in intentional self-harm behavior.
new text end
new text begin
(d) Individual dialectical behavior therapy combines individualized rehabilitative and
psychotherapeutic interventions to treat a client's suicidal and other dysfunctional behaviors
and to reinforce a client's use of adaptive skillful behaviors. A mental health professional
or clinical trainee must provide individual dialectical behavior therapy to a client. A mental
health professional or clinical trainee providing dialectical behavior therapy to a client must:
new text end
new text begin
(1) identify, prioritize, and sequence the client's behavioral targets;
new text end
new text begin
(2) treat the client's behavioral targets;
new text end
new text begin
(3) assist the client in applying dialectical behavior therapy skills to the client's natural
environment through telephone coaching outside of treatment sessions;
new text end
new text begin
(4) measure the client's progress toward dialectical behavior therapy targets;
new text end
new text begin
(5) help the client manage mental health crises and life-threatening behaviors; and
new text end
new text begin
(6) help the client learn and apply effective behaviors when working with other treatment
providers.
new text end
new text begin
(e) Group skills training combines individualized psychotherapeutic and psychiatric
rehabilitative interventions conducted in a group setting to reduce the client's suicidal and
other dysfunctional coping behaviors and restore function. Group skills training must teach
the client adaptive skills in the following areas: (1) mindfulness; (2) interpersonal
effectiveness; (3) emotional regulation; and (4) distress tolerance.
new text end
new text begin
(f) Group skills training must be provided by two mental health professionals or by a
mental health professional co-facilitating with a clinical trainee or a mental health practitioner.
Individual skills training must be provided by a mental health professional, a clinical trainee,
or a mental health practitioner.
new text end
new text begin
(g) Before a program provides dialectical behavior therapy to a client, the commissioner
must certify the program as a dialectical behavior therapy provider. To qualify for
certification as a dialectical behavior therapy provider, a provider must:
new text end
new text begin
(1) allow the commissioner to inspect the provider's program;
new text end
new text begin
(2) provide evidence to the commissioner that the program's policies, procedures, and
practices meet the requirements of this subdivision and chapter 245I;
new text end
new text begin
(3) be enrolled as a MHCP provider; and
new text end
new text begin
(4) have a manual that outlines the program's policies, procedures, and practices that
meet the requirements of this subdivision.
new text end
new text begin Subd. 7. new text end
new text begin Mental health clinical care consultation. new text end
new text begin
(a) Subject to federal approval,
medical assistance covers clinical care consultation for a person up to age 21 who is
diagnosed with a complex mental health condition or a mental health condition that co-occurs
with other complex and chronic conditions, when described in the person's individual
treatment plan and provided by a mental health professional or a clinical trainee.
new text end
new text begin
(b) "Clinical care consultation" means communication from a treating mental health
professional to other providers or educators not under the treatment supervision of the
treating mental health professional who are working with the same client to inform, inquire,
and instruct regarding the client's symptoms; strategies for effective engagement, care, and
intervention needs; and treatment expectations across service settings and to direct and
coordinate clinical service components provided to the client and family.
new text end
new text begin Subd. 8. new text end
new text begin Neuropsychological assessment. new text end
new text begin
(a) Subject to federal approval, medical
assistance covers a client's neuropsychological assessment.
new text end
new text begin
(b) Neuropsychological assessment" means a specialized clinical assessment of the
client's underlying cognitive abilities related to thinking, reasoning, and judgment that is
conducted by a qualified neuropsychologist. A neuropsychological assessment must include
a face-to-face interview with the client, interpretation of the test results, and preparation
and completion of a report.
new text end
new text begin
(c) A client is eligible for a neuropsychological assessment if the client meets at least
one of the following criteria:
new text end
new text begin
(1) the client has a known or strongly suspected brain disorder based on the client's
medical history or the client's prior neurological evaluation, including a history of significant
head trauma, brain tumor, stroke, seizure disorder, multiple sclerosis, neurodegenerative
disorder, significant exposure to neurotoxins, central nervous system infection, metabolic
or toxic encephalopathy, fetal alcohol syndrome, or congenital malformation of the brain;
or
new text end
new text begin
(2) the client has cognitive or behavioral symptoms that suggest that the client has an
organic condition that cannot be readily attributed to functional psychopathology or suspected
neuropsychological impairment in addition to functional psychopathology. The client's
symptoms may include:
new text end
new text begin
(i) having a poor memory or impaired problem solving;
new text end
new text begin
(ii) experiencing change in mental status evidenced by lethargy, confusion, or
disorientation;
new text end
new text begin
(iii) experiencing a deteriorating level of functioning;
new text end
new text begin
(iv) displaying a marked change in behavior or personality;
new text end
new text begin
(v) in a child or an adolescent, having significant delays in acquiring academic skill or
poor attention relative to peers;
new text end
new text begin
(vi) in a child or an adolescent, having reached a significant plateau in expected
development of cognitive, social, emotional, or physical functioning relative to peers; and
new text end
new text begin
(vii) in a child or an adolescent, significant inability to develop expected knowledge,
skills, or abilities to adapt to new or changing cognitive, social, emotional, or physical
demands.
new text end
new text begin
(d) The neuropsychological assessment must be completed by a neuropsychologist who:
new text end
new text begin
(1) was awarded a diploma by the American Board of Clinical Neuropsychology, the
American Board of Professional Neuropsychology, or the American Board of Pediatric
Neuropsychology;
new text end
new text begin
(2) earned a doctoral degree in psychology from an accredited university training program
and:
new text end
new text begin
(i) completed an internship or its equivalent in a clinically relevant area of professional
psychology;
new text end
new text begin
(ii) completed the equivalent of two full-time years of experience and specialized training,
at least one of which is at the postdoctoral level, supervised by a clinical neuropsychologist
in the study and practice of clinical neuropsychology and related neurosciences; and
new text end
new text begin
(iii) holds a current license to practice psychology independently according to sections
144.88 to 144.98;
new text end
new text begin
(3) is licensed or credentialed by another state's board of psychology examiners in the
specialty of neuropsychology using requirements equivalent to requirements specified by
one of the boards named in clause (1); or
new text end
new text begin
(4) was approved by the commissioner as an eligible provider of neuropsychological
assessments prior to December 31, 2010.
new text end
new text begin Subd. 9. new text end
new text begin Neuropsychological testing. new text end
new text begin
(a) Subject to federal approval, medical assistance
covers neuropsychological testing for clients.
new text end
new text begin
(b) "Neuropsychological testing" means administering standardized tests and measures
designed to evaluate the client's ability to attend to, process, interpret, comprehend,
communicate, learn, and recall information and use problem solving and judgment.
new text end
new text begin
(c) Medical assistance covers neuropsychological testing of a client when the client:
new text end
new text begin
(1) has a significant mental status change that is not a result of a metabolic disorder and
that has failed to respond to treatment;
new text end
new text begin
(2) is a child or adolescent with a significant plateau in expected development of
cognitive, social, emotional, or physical function relative to peers;
new text end
new text begin
(3) is a child or adolescent with a significant inability to develop expected knowledge,
skills, or abilities to adapt to new or changing cognitive, social, physical, or emotional
demands; or
new text end
new text begin
(4) has a significant behavioral change, memory loss, or suspected neuropsychological
impairment in addition to functional psychopathology, or other organic brain injury or one
of the following:
new text end
new text begin
(i) traumatic brain injury;
new text end
new text begin
(ii) stroke;
new text end
new text begin
(iii) brain tumor;
new text end
new text begin
(iv) substance use disorder;
new text end
new text begin
(v) cerebral anoxic or hypoxic episode;
new text end
new text begin
(vi) central nervous system infection or other infectious disease;
new text end
new text begin
(vii) neoplasms or vascular injury of the central nervous system;
new text end
new text begin
(viii) neurodegenerative disorders;
new text end
new text begin
(ix) demyelinating disease;
new text end
new text begin
(x) extrapyramidal disease;
new text end
new text begin
(xi) exposure to systemic or intrathecal agents or cranial radiation known to be associated
with cerebral dysfunction;
new text end
new text begin
(xii) systemic medical conditions known to be associated with cerebral dysfunction,
including renal disease, hepatic encephalopathy, cardiac anomaly, sickle cell disease, and
related hematologic anomalies, and autoimmune disorders, including lupus, erythematosus,
or celiac disease;
new text end
new text begin
(xiii) congenital genetic or metabolic disorders known to be associated with cerebral
dysfunction, including phenylketonuria, craniofacial syndromes, or congenital hydrocephalus;
new text end
new text begin
(xiv) severe or prolonged nutrition or malabsorption syndromes; or
new text end
new text begin
(xv) a condition presenting in a manner difficult for a clinician to distinguish between
the neurocognitive effects of a neurogenic syndrome, including dementia or encephalopathy;
and a major depressive disorder when adequate treatment for major depressive disorder has
not improved the client's neurocognitive functioning; or another disorder, including autism,
selective mutism, anxiety disorder, or reactive attachment disorder.
new text end
new text begin
(d) Neuropsychological testing must be administered or clinically supervised by a
qualified neuropsychologist under subdivision 8, paragraph (c).
new text end
new text begin
(e) Medical assistance does not cover neuropsychological testing of a client when the
testing is:
new text end
new text begin
(1) primarily for educational purposes;
new text end
new text begin
(2) primarily for vocational counseling or training;
new text end
new text begin
(3) for personnel or employment testing;
new text end
new text begin
(4) a routine battery of psychological tests given to the client at the client's inpatient
admission or during a client's continued inpatient stay; or
new text end
new text begin
(5) for legal or forensic purposes.
new text end
new text begin Subd. 10. new text end
new text begin Psychological testing. new text end
new text begin
(a) Subject to federal approval, medical assistance
covers psychological testing of a client.
new text end
new text begin
(b) "Psychological testing" means the use of tests or other psychometric instruments to
determine the status of a client's mental, intellectual, and emotional functioning.
new text end
new text begin
(c) The psychological testing must:
new text end
new text begin
(1) be administered or supervised by a licensed psychologist qualified under section
245I.04, subdivision 2, clause (3), who is competent in the area of psychological testing;
and
new text end
new text begin
(2) be validated in a face-to-face interview between the client and a licensed psychologist
or a clinical trainee in psychology under the treatment supervision of a licensed psychologist
under section 245I.06.
new text end
new text begin
(d) A licensed psychologist must supervise the administration, scoring, and interpretation
of a client's psychological tests when a clinical psychology trainee, technician, psychometrist,
or psychological assistant or a computer-assisted psychological testing program completes
the psychological testing of the client. The report resulting from the psychological testing
must be signed by the licensed psychologist who conducts the face-to-face interview with
the client. The licensed psychologist or a staff person who is under treatment supervision
must place the client's psychological testing report in the client's record and release one
copy of the report to the client and additional copies to individuals authorized by the client
to receive the report.
new text end
new text begin Subd. 11. new text end
new text begin Psychotherapy. new text end
new text begin
(a) Subject to federal approval, medical assistance covers
psychotherapy for a client.
new text end
new text begin
(b) "Psychotherapy" means treatment of a client with mental illness that applies to the
most appropriate psychological, psychiatric, psychosocial, or interpersonal method that
conforms to prevailing community standards of professional practice to meet the mental
health needs of the client. Medical assistance covers psychotherapy if a mental health
professional or a clinical trainee provides psychotherapy to a client.
new text end
new text begin
(c) "Individual psychotherapy" means psychotherapy that a mental health professional
or clinical trainee designs for a client.
new text end
new text begin
(d) "Family psychotherapy" means psychotherapy that a mental health professional or
clinical trainee designs for a client and one or more of the client's family members or primary
caregiver whose participation is necessary to accomplish the client's treatment goals. Family
members or primary caregivers participating in a therapy session do not need to be eligible
for medical assistance for medical assistance to cover family psychotherapy. For purposes
of this paragraph, "primary caregiver whose participation is necessary to accomplish the
client's treatment goals" excludes shift or facility staff persons who work at the client's
residence. Medical assistance payments for family psychotherapy are limited to face-to-face
sessions during which the client is present throughout the session, unless the mental health
professional or clinical trainee believes that the client's exclusion from the family
psychotherapy session is necessary to meet the goals of the client's individual treatment
plan. If the client is excluded from a family psychotherapy session, a mental health
professional or clinical trainee must document the reason for the client's exclusion and the
length of time that the client is excluded. The mental health professional must also document
any reason that a member of the client's family is excluded from a psychotherapy session.
new text end
new text begin
(e) Group psychotherapy is appropriate for a client who, because of the nature of the
client's emotional, behavioral, or social dysfunctions, can benefit from treatment in a group
setting. For a group of three to eight clients, at least one mental health professional or clinical
trainee must provide psychotherapy to the group. For a group of nine to 12 clients, a team
of at least two mental health professionals or two clinical trainees or one mental health
professional and one clinical trainee must provide psychotherapy to the group. Medical
assistance will cover group psychotherapy for a group of no more than 12 persons.
new text end
new text begin
(f) A multiple-family group psychotherapy session is eligible for medical assistance if
a mental health professional or clinical trainee designs the psychotherapy session for at least
two but not more than five families. A mental health professional or clinical trainee must
design multiple-family group psychotherapy sessions to meet the treatment needs of each
client. If the client is excluded from a psychotherapy session, the mental health professional
or clinical trainee must document the reason for the client's exclusion and the length of time
that the client was excluded. The mental health professional or clinical trainee must document
any reason that a member of the client's family was excluded from a psychotherapy session.
new text end
new text begin Subd. 12. new text end
new text begin Partial hospitalization. new text end
new text begin
(a) Subject to federal approval, medical assistance
covers a client's partial hospitalization.
new text end
new text begin
(b) "Partial hospitalization" means a provider's time-limited, structured program of
psychotherapy and other therapeutic services, as defined in United States Code, title 42,
chapter 7, subchapter XVIII, part E, section 1395x(ff), that a multidisciplinary staff person
provides in an outpatient hospital facility or community mental health center that meets
Medicare requirements to provide partial hospitalization services to a client.
new text end
new text begin
(c) Partial hospitalization is an appropriate alternative to inpatient hospitalization for a
client who is experiencing an acute episode of mental illness who meets the criteria for an
inpatient hospital admission under Minnesota Rules, part 9505.0520, subpart 1, and who
has family and community resources that support the client's residence in the community.
Partial hospitalization consists of multiple intensive short-term therapeutic services for a
client that a multidisciplinary staff person provides to a client to treat the client's mental
illness.
new text end
new text begin Subd. 13. new text end
new text begin Diagnostic assessments. new text end
new text begin
Subject to federal approval, medical assistance covers
a client's diagnostic assessments that a mental health professional or clinical trainee completes
under section 245I.10.
new text end
Sec. 18. new text begin DIRECTION TO COMMISSIONER; SINGLE COMPREHENSIVE
LICENSE STRUCTURE.
new text end
new text begin
The commissioner of human services, in consultation with stakeholders including
counties, tribes, managed care organizations, provider organizations, advocacy groups, and
clients and clients' families, shall develop recommendations to develop a single
comprehensive licensing structure for mental health service programs, including outpatient
and residential services for adults and children. The recommendations must prioritize
program integrity, the welfare of clients and clients' families, improved integration of mental
health and substance use disorder services, and the reduction of administrative burden on
providers.
new text end
Sec. 19. new text begin EFFECTIVE DATE.
new text end
new text begin
This article is effective upon federal approval or July 1, 2022, whichever is later. The
commissioner shall notify the revisor of statutes when federal approval is obtained.
new text end
ARTICLE 17
CRISIS RESPONSE SERVICES
Section 1.
Minnesota Statutes 2020, section 245.469, subdivision 1, is amended to read:
Subdivision 1.
Availability of emergency services.
deleted text begin By July 1, 1988,deleted text end new text begin (a)new text end County boards
must provide or contract for enough emergency services within the county to meet the needs
of adultsnew text begin , children, and familiesnew text end in the county who are experiencing an emotional crisis or
mental illness. deleted text begin Clients may be required to pay a fee according to section 245.481.deleted text end new text begin Emergency
service providers must not delay the timely provision of emergency services to a client
because of the unwillingness or inability of the client to pay for services. new text end Emergency services
must include assessment, crisis intervention, and appropriate case disposition. Emergency
services must:
(1) promote the safety and emotional stability of deleted text begin adults with mental illness or emotional
crisesdeleted text end new text begin each clientnew text end ;
(2) minimize further deterioration of deleted text begin adults with mental illness or emotional crisesdeleted text end new text begin each
clientnew text end ;
(3) help deleted text begin adults with mental illness or emotional crisesdeleted text end new text begin each clientnew text end to obtain ongoing care
and treatment; deleted text begin and
deleted text end
(4) prevent placement in settings that are more intensive, costly, or restrictive than
necessary and appropriate to meet client needsdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(5) provide support, psychoeducation, and referrals to each client's family members,
service providers, and other third parties on behalf of the client in need of emergency
services.
new text end
new text begin
(b) If a county provides engagement services under section 253B.041, the county's
emergency service providers must refer clients to engagement services when the client
meets the criteria for engagement services.
new text end
Sec. 2.
Minnesota Statutes 2020, section 245.469, subdivision 2, is amended to read:
Subd. 2.
Specific requirements.
(a) The county board shall require that all service
providers of emergency services to adults with mental illness provide immediate direct
access to a mental health professional during regular business hours. For evenings, weekends,
and holidays, the service may be by direct toll-free telephone access to a mental health
professional, deleted text begin adeleted text end new text begin clinical trainee, ornew text end mental health practitionerdeleted text begin , or until January 1, 1991, a
designated person with training in human services who receives clinical supervision from
a mental health professionaldeleted text end .
(b) The commissioner may waive the requirement in paragraph (a) that the evening,
weekend, and holiday service be provided by a mental health professionalnew text begin , clinical trainee,new text end
or mental health practitioner deleted text begin after January 1, 1991,deleted text end if the county documents that:
(1) mental health professionalsnew text begin , clinical trainees,new text end or mental health practitioners are
unavailable to provide this service;
(2) services are provided by a designated person with training in human services who
receives deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision from a mental health professional; and
(3) the service provider is not also the provider of fire and public safety emergency
services.
(c) The commissioner may waive the requirement in paragraph (b), clause (3), that the
evening, weekend, and holiday service not be provided by the provider of fire and public
safety emergency services if:
(1) every person who will be providing the first telephone contact has received at least
eight hours of training on emergency mental health services deleted text begin reviewed by the state advisory
council on mental health and thendeleted text end approved by the commissioner;
(2) every person who will be providing the first telephone contact will annually receive
at least four hours of continued training on emergency mental health services deleted text begin reviewed by
the state advisory council on mental health and thendeleted text end approved by the commissioner;
(3) the local social service agency has provided public education about available
emergency mental health services and can assure potential users of emergency services that
their calls will be handled appropriately;
(4) the local social service agency agrees to provide the commissioner with accurate
data on the number of emergency mental health service calls received;
(5) the local social service agency agrees to monitor the frequency and quality of
emergency services; and
(6) the local social service agency describes how it will comply with paragraph (d).
(d) Whenever emergency service during nonbusiness hours is provided by anyone other
than a mental health professional, a mental health professional must be available on call for
an emergency assessment and crisis intervention services, and must be available for at least
telephone consultation within 30 minutes.
Sec. 3.
Minnesota Statutes 2020, section 245.4879, subdivision 1, is amended to read:
Subdivision 1.
Availability of emergency services.
County boards must provide or
contract for deleted text begin enoughdeleted text end mental health emergency services deleted text begin within the county to meet the needs
of children, and children's families when clinically appropriate, in the county who are
experiencing an emotional crisis or emotional disturbance. The county board shall ensure
that parents, providers, and county residents are informed about when and how to access
emergency mental health services for children. A child or the child's parent may be required
to pay a fee according to section 245.481. Emergency service providers shall not delay the
timely provision of emergency service because of delays in determining this fee or because
of the unwillingness or inability of the parent to pay the fee. Emergency services must
include assessment, crisis intervention, and appropriate case disposition. Emergency services
must:deleted text end new text begin according to section 245.469.
new text end
deleted text begin
(1) promote the safety and emotional stability of children with emotional disturbances
or emotional crises;
deleted text end
deleted text begin
(2) minimize further deterioration of the child with emotional disturbance or emotional
crisis;
deleted text end
deleted text begin
(3) help each child with an emotional disturbance or emotional crisis to obtain ongoing
care and treatment; and
deleted text end
deleted text begin
(4) prevent placement in settings that are more intensive, costly, or restrictive than
necessary and appropriate to meet the child's needs.
deleted text end
Sec. 4.
Minnesota Statutes 2020, section 256B.0624, is amended to read:
256B.0624 deleted text begin ADULTdeleted text end CRISIS RESPONSE SERVICES COVERED.
Subdivision 1.
Scope.
deleted text begin Medical assistance covers adult mental health crisis response
services as defined in subdivision 2, paragraphs (c) to (e),deleted text end new text begin (a) new text end Subject to federal approval,
deleted text begin if provided to a recipient as defined in subdivision 3 and provided by a qualified provider
entity as defined in this section and by a qualified individual provider working within the
provider's scope of practice and as defined in this subdivision and identified in the recipient's
individual crisis treatment plan as defined in subdivision 11 and if determined to be medically
necessarydeleted text end new text begin medical assistance covers medically necessary crisis response services when the
services are provided according to the standards in this sectionnew text end .
new text begin
(b) Subject to federal approval, medical assistance covers medically necessary residential
crisis stabilization for adults when the services are provided by an entity licensed under and
meeting the standards in section 245I.23 or an entity with an adult foster care license meeting
the standards in this section.
new text end
new text begin
(c) The provider entity must make reasonable and good faith efforts to report individual
client outcomes to the commissioner using instruments and protocols approved by the
commissioner.
new text end
Subd. 2.
Definitions.
For purposes of this section, the following terms have the meanings
given them.
deleted text begin
(a) "Mental health crisis" is an adult behavioral, emotional, or psychiatric situation
which, but for the provision of crisis response services, would likely result in significantly
reduced levels of functioning in primary activities of daily living, or in an emergency
situation, or in the placement of the recipient in a more restrictive setting, including, but
not limited to, inpatient hospitalization.
deleted text end
deleted text begin
(b) "Mental health emergency" is an adult behavioral, emotional, or psychiatric situation
which causes an immediate need for mental health services and is consistent with section
62Q.55.
deleted text end
deleted text begin
A mental health crisis or emergency is determined for medical assistance service
reimbursement by a physician, a mental health professional, or crisis mental health
practitioner with input from the recipient whenever possible.
deleted text end
new text begin
(a) "Certified rehabilitation specialist" means a staff person who is qualified under section
245I.04, subdivision 8.
new text end
new text begin
(b) "Clinical trainee" means a staff person who is qualified under section 245I.04,
subdivision 6.
new text end
(c) "deleted text begin Mental healthdeleted text end Crisis assessment" means an immediate face-to-face assessment by
a physician, a mental health professional, or deleted text begin mental health practitioner under the clinical
supervision of a mental health professional, following a screening that suggests that the
adult may be experiencing a mental health crisis or mental health emergency situation. It
includes, when feasible, assessing whether the person might be willing to voluntarily accept
treatment, determining whether the person has an advance directive, and obtaining
information and history from involved family members or caretakersdeleted text end new text begin a qualified member
of a crisis team, as described in subdivision 6anew text end .
(d) "deleted text begin Mental health mobiledeleted text end Crisis intervention deleted text begin servicesdeleted text end " means face-to-face, short-term
intensive mental health services initiated during a mental health crisis deleted text begin or mental health
emergencydeleted text end to help the recipient cope with immediate stressors, identify and utilize available
resources and strengths, engage in voluntary treatment, and begin to return to the recipient's
baseline level of functioning. deleted text begin The services, including screening and treatment plan
recommendations, must be culturally and linguistically appropriate.
deleted text end
deleted text begin
(1) This service is provided on site by a mobile crisis intervention team outside of an
inpatient hospital setting. Mental health mobile crisis intervention services must be available
24 hours a day, seven days a week.
deleted text end
deleted text begin
(2) The initial screening must consider other available services to determine which
service intervention would best address the recipient's needs and circumstances.
deleted text end
deleted text begin
(3) The mobile crisis intervention team must be available to meet promptly face-to-face
with a person in mental health crisis or emergency in a community setting or hospital
emergency room.
deleted text end
deleted text begin
(4) The intervention must consist of a mental health crisis assessment and a crisis
treatment plan.
deleted text end
deleted text begin
(5) The team must be available to individuals who are experiencing a co-occurring
substance use disorder, who do not need the level of care provided in a detoxification facility.
deleted text end
deleted text begin
(6) The treatment plan must include recommendations for any needed crisis stabilization
services for the recipient, including engagement in treatment planning and family
psychoeducation.
deleted text end
new text begin
(e) "Crisis screening" means a screening of a client's potential mental health crisis
situation under subdivision 6.
new text end
deleted text begin (e)deleted text end new text begin (f)new text end "deleted text begin Mental healthdeleted text end Crisis stabilization deleted text begin servicesdeleted text end " means individualized mental health
services provided to a recipient deleted text begin following crisis intervention servicesdeleted text end which are designed
to restore the recipient to the recipient's prior functional level. deleted text begin Mental healthdeleted text end Crisis
stabilization services may be provided in the recipient's home, the home of a family member
or friend of the recipient, another community setting, deleted text begin ordeleted text end a short-term supervised, licensed
residential programnew text begin , or an emergency departmentnew text end . deleted text begin Mental health crisis stabilization does
not include partial hospitalization or day treatment. Mental healthdeleted text end Crisis stabilization services
includes family psychoeducation.
new text begin
(g) "Crisis team" means the staff of a provider entity who are supervised and prepared
to provide mobile crisis services to a client in a potential mental health crisis situation.
new text end
new text begin
(h) "Mental health certified family peer specialist" means a staff person who is qualified
under section 245I.04, subdivision 12.
new text end
new text begin
(i) "Mental health certified peer specialist" means a staff person who is qualified under
section 245I.04, subdivision 10.
new text end
new text begin
(j) "Mental health crisis" is a behavioral, emotional, or psychiatric situation that, without
the provision of crisis response services, would likely result in significantly reducing the
recipient's levels of functioning in primary activities of daily living, in an emergency situation
under section 62Q.55, or in the placement of the recipient in a more restrictive setting,
including but not limited to inpatient hospitalization.
new text end
new text begin
(k) "Mental health practitioner" means a staff person who is qualified under section
245I.04, subdivision 4.
new text end
new text begin
(l) "Mental health professional" means a staff person who is qualified under section
245I.04, subdivision 2.
new text end
new text begin
(m) "Mental health rehabilitation worker" means a staff person who is qualified under
section 245I.04, subdivision 14.
new text end
new text begin
(n) "Mobile crisis services" means screening, assessment, intervention, and
community-based stabilization, excluding residential crisis stabilization, that is provided to
a recipient.
new text end
Subd. 3.
Eligibility.
deleted text begin
An eligible recipient is an individual who:
deleted text end
deleted text begin
(1) is age 18 or older;
deleted text end
deleted text begin
(2) is screened as possibly experiencing a mental health crisis or emergency where a
mental health crisis assessment is needed; and
deleted text end
deleted text begin
(3) is assessed as experiencing a mental health crisis or emergency, and mental health
crisis intervention or crisis intervention and stabilization services are determined to be
medically necessary.
deleted text end
new text begin
(a) A recipient is eligible for crisis assessment services when the recipient has screened
positive for a potential mental health crisis during a crisis screening.
new text end
new text begin
(b) A recipient is eligible for crisis intervention services and crisis stabilization services
when the recipient has been assessed during a crisis assessment to be experiencing a mental
health crisis.
new text end
Subd. 4.
Provider entity standards.
(a) A deleted text begin provider entity is an entity that meets the
standards listed in paragraph (c) anddeleted text end new text begin mobile crisis provider must benew text end :
(1) deleted text begin isdeleted text end a county board operated entity; deleted text begin or
deleted text end
new text begin
(2) an Indian health services facility or facility owned and operated by a tribe or Tribal
organization operating under United States Code, title 325, section 450f; or
new text end
deleted text begin (2) isdeleted text end new text begin (3)new text end a provider entity that is under contract with the county board in the county
where the potential crisis or emergency is occurring. To provide services under this section,
the provider entity must directly provide the services; or if services are subcontracted, the
provider entity must maintain responsibility for services and billing.
new text begin
(b) A mobile crisis provider must meet the following standards:
new text end
new text begin
(1) ensure that crisis screenings, crisis assessments, and crisis intervention services are
available to a recipient 24 hours a day, seven days a week;
new text end
new text begin
(2) be able to respond to a call for services in a designated service area or according to
a written agreement with the local mental health authority for an adjacent area;
new text end
new text begin
(3) have at least one mental health professional on staff at all times and at least one
additional staff member capable of leading a crisis response in the community; and
new text end
new text begin
(4) provide the commissioner with information about the number of requests for service,
the number of people that the provider serves face-to-face, outcomes, and the protocols that
the provider uses when deciding when to respond in the community.
new text end
deleted text begin (b)deleted text end new text begin (c)new text end A provider entity that provides crisis stabilization services in a residential setting
under subdivision 7 is not required to meet the requirements of deleted text begin paragraphdeleted text end new text begin paragraphsnew text end (a)deleted text begin ,
clauses (1) and (2)deleted text end new text begin and (b)new text end , but must meet all other requirements of this subdivision.
deleted text begin (c) The adult mental healthdeleted text end new text begin (d) Anew text end crisis deleted text begin responsedeleted text end services provider deleted text begin entitydeleted text end must have the
capacity to meet and carry out the new text begin standards in section 245I.011, subdivision 5, and the
new text end following standards:
(1) deleted text begin has the capacity to recruit, hire, and manage and train mental health professionals,
practitioners, and rehabilitation workersdeleted text end new text begin ensures that staff persons provide support for a
recipient's family and natural supports, by enabling the recipient's family and natural supports
to observe and participate in the recipient's treatment, assessments, and planning servicesnew text end ;
(2) has adequate administrative ability to ensure availability of services;
deleted text begin
(3) is able to ensure adequate preservice and in-service training;
deleted text end
deleted text begin (4)deleted text end new text begin (3)new text end is able to ensure that staff providing these services are skilled in the delivery of
mental health crisis response services to recipients;
deleted text begin (5)deleted text end new text begin (4)new text end is able to ensure that staff are deleted text begin capable ofdeleted text end implementing culturally specific treatment
identified in the deleted text begin individualdeleted text end new text begin crisisnew text end treatment plan that is meaningful and appropriate as
determined by the recipient's culture, beliefs, values, and language;
deleted text begin (6)deleted text end new text begin (5)new text end is able to ensure enough flexibility to respond to the changing intervention and
care needs of a recipient as identified by the recipient new text begin or family membernew text end during the service
partnership between the recipient and providers;
deleted text begin (7)deleted text end new text begin (6)new text end is able to ensure that deleted text begin mental health professionals and mental health practitionersdeleted text end new text begin
staffnew text end have the communication tools and procedures to communicate and consult promptly
about crisis assessment and interventions as services occur;
deleted text begin (8)deleted text end new text begin (7)new text end is able to coordinate these services with county emergency services, community
hospitals, ambulance, transportation services, social services, law enforcementnew text begin , engagement
servicesnew text end , and mental health crisis services through regularly scheduled interagency meetings;
deleted text begin
(9) is able to ensure that mental health crisis assessment and mobile crisis intervention
services are available 24 hours a day, seven days a week;
deleted text end
deleted text begin (10)deleted text end new text begin (8)new text end is able to ensure that services are coordinated with other deleted text begin mentaldeleted text end new text begin behavioralnew text end
health service providers, county mental health authorities, or federally recognized American
Indian authorities and others as necessary, with the consent of the deleted text begin adultdeleted text end new text begin recipient or parent
or guardiannew text end . Services must also be coordinated with the recipient's case manager if the deleted text begin adultdeleted text end new text begin
recipientnew text end is receiving case management services;
deleted text begin (11)deleted text end new text begin (9)new text end is able to ensure that crisis intervention services are provided in a manner
consistent with sections 245.461 to 245.486new text begin and 245.487 to 245.4879new text end ;
deleted text begin
(12) is able to submit information as required by the state;
deleted text end
deleted text begin
(13) maintains staff training and personnel files;
deleted text end
new text begin
(10) is able to coordinate detoxification services for the recipient according to Minnesota
Rules, parts 9530.6605 to 9530.6655, or withdrawal management according to chapter 245F;
new text end
deleted text begin (14)deleted text end new text begin (11)new text end is able to establish and maintain a quality assurance and evaluation plan to
evaluate the outcomes of services and recipient satisfaction;new text begin and
new text end
deleted text begin
(15) is able to keep records as required by applicable laws;
deleted text end
deleted text begin
(16) is able to comply with all applicable laws and statutes;
deleted text end
deleted text begin (17)deleted text end new text begin (12)new text end is an enrolled medical assistance providerdeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(18) develops and maintains written policies and procedures regarding service provision
and administration of the provider entity, including safety of staff and recipients in high-risk
situations.
deleted text end
Subd. 4a.
Alternative provider standards.
If a county new text begin or tribe new text end demonstrates that, due
to geographic or other barriers, it is not feasible to provide mobile crisis intervention services
according to the standards in subdivision 4, paragraph deleted text begin (c), clause (9)deleted text end new text begin (b)new text end , the commissioner
may approve deleted text begin a crisis response provider based ondeleted text end an alternative plan proposed by a county
or deleted text begin group of countiesdeleted text end new text begin tribenew text end . The alternative plan must:
(1) result in increased access and a reduction in disparities in the availability of new text begin mobile
new text end crisis services;
(2) provide mobile new text begin crisis new text end services outside of the usual nine-to-five office hours and on
weekends and holidays; and
(3) comply with standards for emergency mental health services in section 245.469.
Subd. 5.
deleted text begin Mobiledeleted text end Crisis new text begin assessment and new text end intervention staff qualifications.
deleted text begin For provision
of adult mental health mobile crisis intervention services, a mobile crisis intervention team
is comprised of at least two mental health professionals as defined in section 245.462,
subdivision 18, clauses (1) to (6), or a combination of at least one mental health professional
and one mental health practitioner as defined in section 245.462, subdivision 17, with the
required mental health crisis training and under the clinical supervision of a mental health
professional on the team. The team must have at least two people with at least one member
providing on-site crisis intervention services when needed.deleted text end new text begin (a) Qualified individual staff of
a qualified provider entity must provide crisis assessment and intervention services to a
recipient. A staff member providing crisis assessment and intervention services to a recipient
must be qualified as a:
new text end
new text begin
(1) mental health professional;
new text end
new text begin
(2) clinical trainee;
new text end
new text begin
(3) mental health practitioner;
new text end
new text begin
(4) mental health certified family peer specialist; or
new text end
new text begin
(5) mental health certified peer specialist.
new text end
new text begin
(b) When crisis assessment and intervention services are provided to a recipient in the
community, a mental health professional, clinical trainee, or mental health practitioner must
lead the response.
new text end
new text begin
(c) The 30 hours of ongoing training required by section 245I.05, subdivision 4, paragraph
(b), must be specific to providing crisis services to children and adults and include training
about evidence-based practices identified by the commissioner of health to reduce the
recipient's risk of suicide and self-injurious behavior.
new text end
new text begin (d) new text end Team members must be experienced in deleted text begin mental healthdeleted text end new text begin crisisnew text end assessment, crisis
intervention techniques, treatment engagement strategies, working with families, and clinical
decision-making under emergency conditions and have knowledge of local services and
resources. deleted text begin The team must recommend and coordinate the team's services with appropriate
local resources such as the county social services agency, mental health services, and local
law enforcement when necessary.
deleted text end
Subd. 6.
Crisis deleted text begin assessment and mobile intervention treatment planningdeleted text end new text begin screeningnew text end .
(a)
deleted text begin Prior to initiating mobile crisis intervention services, a screening of the potential crisis
situation must be conducted.deleted text end The new text begin crisis new text end screening may use the resources of deleted text begin crisis assistance
anddeleted text end emergency services as defined in deleted text begin sections 245.462, subdivision 6, anddeleted text end new text begin sectionnew text end 245.469,
subdivisions 1 and 2. The new text begin crisis new text end screening must gather information, determine whether a
new text begin mental health new text end crisis situation exists, identify parties involved, and determine an appropriate
response.
new text begin
(b) When conducting the crisis screening of a recipient, a provider must:
new text end
new text begin
(1) employ evidence-based practices to reduce the recipient's risk of suicide and
self-injurious behavior;
new text end
new text begin
(2) work with the recipient to establish a plan and time frame for responding to the
recipient's mental health crisis, including responding to the recipient's immediate need for
support by telephone or text message until the provider can respond to the recipient
face-to-face;
new text end
new text begin
(3) document significant factors in determining whether the recipient is experiencing a
mental health crisis, including prior requests for crisis services, a recipient's recent
presentation at an emergency department, known calls to 911 or law enforcement, or
information from third parties with knowledge of a recipient's history or current needs;
new text end
new text begin
(4) accept calls from interested third parties and consider the additional needs or potential
mental health crises that the third parties may be experiencing;
new text end
new text begin
(5) provide psychoeducation, including means reduction, to relevant third parties
including family members or other persons living with the recipient; and
new text end
new text begin
(6) consider other available services to determine which service intervention would best
address the recipient's needs and circumstances.
new text end
new text begin
(c) For the purposes of this section, the following situations indicate a positive screen
for a potential mental health crisis and the provider must prioritize providing a face-to-face
crisis assessment of the recipient, unless a provider documents specific evidence to show
why this was not possible, including insufficient staffing resources, concerns for staff or
recipient safety, or other clinical factors:
new text end
new text begin
(1) the recipient presents at an emergency department or urgent care setting and the
health care team at that location requested crisis services; or
new text end
new text begin
(2) a peace officer requested crisis services for a recipient who is potentially subject to
transportation under section 253B.051.
new text end
new text begin
(d) A provider is not required to have direct contact with the recipient to determine that
the recipient is experiencing a potential mental health crisis. A mobile crisis provider may
gather relevant information about the recipient from a third party to establish the recipient's
need for services and potential safety factors.
new text end
new text begin Subd. 6a. new text end
new text begin Crisis assessment. new text end
deleted text begin (b)deleted text end new text begin (a)new text end If a deleted text begin crisis existsdeleted text end new text begin recipient screens positive for
potential mental health crisisnew text end , a crisis assessment must be completed. A crisis assessment
evaluates any immediate needs for which deleted text begin emergencydeleted text end services are needed and, as time
permits, the recipient's current life situation, new text begin health information, including current
medications, new text end sources of stress, mental health problems and symptoms, strengths, cultural
considerations, support network, vulnerabilities, current functioning, and the recipient's
preferences as communicated directly by the recipient, or as communicated in a health care
directive as described in chapters 145C and 253B, the new text begin crisis new text end treatment plan described under
deleted text begin paragraph (d)deleted text end new text begin subdivision 11new text end , a crisis prevention plan, or a wellness recovery action plan.
new text begin
(b) A provider must conduct a crisis assessment at the recipient's location whenever
possible.
new text end
new text begin
(c) Whenever possible, the assessor must attempt to include input from the recipient and
the recipient's family and other natural supports to assess whether a crisis exists.
new text end
new text begin
(d) A crisis assessment includes: (1) determining (i) whether the recipient is willing to
voluntarily engage in treatment, or (ii) whether the recipient has an advance directive, and
(2) gathering the recipient's information and history from involved family or other natural
supports.
new text end
new text begin
(e) A crisis assessment must include coordinated response with other health care providers
if the assessment indicates that a recipient needs detoxification, withdrawal management,
or medical stabilization in addition to crisis response services. If the recipient does not need
an acute level of care, a team must serve an otherwise eligible recipient who has a
co-occurring substance use disorder.
new text end
new text begin
(f) If, after completing a crisis assessment of a recipient, a provider refers a recipient to
an intensive setting, including an emergency department, inpatient hospitalization, or
residential crisis stabilization, one of the crisis team members who completed or conferred
about the recipient's crisis assessment must immediately contact the referral entity and
consult with the triage nurse or other staff responsible for intake at the referral entity. During
the consultation, the crisis team member must convey key findings or concerns that led to
the recipient's referral. Following the immediate consultation, the provider must also send
written documentation upon completion. The provider must document if these releases
occurred with authorization by the recipient, the recipient's legal guardian, or as allowed
by section 144.293, subdivision 5.
new text end
new text begin Subd. 6b. new text end
new text begin Crisis intervention services. new text end
deleted text begin (c)deleted text end new text begin (a)new text end If the crisis assessment determines mobile
crisis intervention services are needed, the new text begin crisis new text end intervention services must be provided
promptly. As opportunity presents during the intervention, at least two members of the
mobile crisis intervention team must confer directly or by telephone about the new text begin crisis
new text end assessment, new text begin crisis new text end treatment plan, and actions taken and needed. At least one of the team
members must be deleted text begin on sitedeleted text end providing new text begin face-to-face new text end crisis intervention services. If providing
deleted text begin on-sitedeleted text end crisis intervention services, a new text begin clinical trainee or new text end mental health practitioner must seek
deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision as required in subdivision 9.
new text begin
(b) If a provider delivers crisis intervention services while the recipient is absent, the
provider must document the reason for delivering services while the recipient is absent.
new text end
deleted text begin (d)deleted text end new text begin (c)new text end The mobile crisis intervention team must develop deleted text begin an initial, briefdeleted text end new text begin anew text end crisis treatment
plan deleted text begin as soon as appropriate but no later than 24 hours after the initial face-to-face interventiondeleted text end new text begin
according to subdivision 11new text end . deleted text begin The plan must address the needs and problems noted in the
crisis assessment and include deleted text end deleted text begin measurable short-term goals, cultural considerations, and
frequency and type of services to be provided to achieve the goals and reduce or eliminate
the crisis. The treatment plan must be updated as needed to reflect current goals and services.
deleted text end
deleted text begin (e)deleted text end new text begin (d)new text end The new text begin mobile crisis intervention new text end team must document which deleted text begin short-term goalsdeleted text end new text begin crisis
treatment plan goals and objectivesnew text end have been met and when no further crisis intervention
services are required.
deleted text begin (f)deleted text end new text begin (e)new text end If the recipient's new text begin mental health new text end crisis is stabilized, but the recipient needs a referral
to other services, the team must provide referrals to these services. If the recipient has a
case manager, planning for other services must be coordinated with the case manager. If
the recipient is unable to follow up on the referral, the team must link the recipient to the
service and follow up to ensure the recipient is receiving the service.
deleted text begin (g)deleted text end new text begin (f)new text end If the recipient's new text begin mental health new text end crisis is stabilized and the recipient does not have
an advance directive, the case manager or crisis team shall offer to work with the recipient
to develop one.
Subd. 7.
Crisis stabilization services.
(a) Crisis stabilization services must be provided
by qualified staff of a crisis stabilization services provider entity and must meet the following
standards:
(1) a crisis deleted text begin stabilizationdeleted text end treatment plan must be developed deleted text begin whichdeleted text end new text begin thatnew text end meets the criteria
in subdivision 11;
(2) staff must be qualified as defined in subdivision 8; deleted text begin and
deleted text end
(3) new text begin crisis stabilization new text end services must be delivered according to the new text begin crisis new text end treatment plan
and include face-to-face contact with the recipient by qualified staff for further assessment,
help with referrals, updating of the crisis deleted text begin stabilizationdeleted text end treatment plan, deleted text begin supportive counseling,deleted text end
skills training, and collaboration with other service providers in the communitydeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(4) if a provider delivers crisis stabilization services while the recipient is absent, the
provider must document the reason for delivering services while the recipient is absent.
new text end
deleted text begin
(b) If crisis stabilization services are provided in a supervised, licensed residential setting,
the recipient must be contacted face-to-face daily by a qualified mental health practitioner
or mental health professional. The program must have 24-hour-a-day residential staffing
which may include staff who do not meet the qualifications in subdivision 8. The residential
staff must have 24-hour-a-day immediate direct or telephone access to a qualified mental
health professional or practitioner.
deleted text end
deleted text begin (c)deleted text end new text begin (b)new text end If crisis stabilization services are provided in a supervised, licensed residential
setting that serves no more than four adult residents, and one or more individuals are present
at the setting to receive residential crisis stabilization deleted text begin servicesdeleted text end , the residential staff must
include, for at least eight hours per day, at least one deleted text begin individual who meets the qualifications
in subdivision 8, paragraph (a), clause (1) or (2)deleted text end new text begin mental health professional, clinical trainee,
certified rehabilitation specialist, or mental health practitionernew text end .
deleted text begin
(d) If crisis stabilization services are provided in a supervised, licensed residential setting
that serves more than four adult residents, and one or more are recipients of crisis stabilization
services, the residential staff must include, for 24 hours a day, at least one individual who
meets the qualifications in subdivision 8. During the first 48 hours that a recipient is in the
residential program, the residential program must have at least two staff working 24 hours
a day. Staffing levels may be adjusted thereafter according to the needs of the recipient as
specified in the crisis stabilization treatment plan.
deleted text end
Subd. 8.
deleted text begin Adultdeleted text end Crisis stabilization staff qualifications.
(a) deleted text begin Adultdeleted text end Mental health crisis
stabilization services must be provided by qualified individual staff of a qualified provider
entity. deleted text begin Individual provider staff must have the following qualificationsdeleted text end new text begin A staff member
providing crisis stabilization services to a recipient must be qualified as anew text end :
(1) deleted text begin be adeleted text end mental health professional deleted text begin as defined in section 245.462, subdivision 18, clauses
(1) to (6)deleted text end ;
(2) deleted text begin be adeleted text end new text begin certified rehabilitation specialist;
new text end
new text begin
(3) clinical trainee;
new text end
new text begin (4)new text end mental health practitioner deleted text begin as defined in section 245.462, subdivision 17. The mental
health practitioner must work under the clinical supervision of a mental health professionaldeleted text end ;
new text begin
(5) mental health certified family peer specialist;
new text end
deleted text begin (3) be adeleted text end new text begin (6) mental healthnew text end certified peer specialist deleted text begin under section 256B.0615. The certified
peer specialist must work under the clinical supervision of a mental health professionaldeleted text end ; or
deleted text begin (4) be adeleted text end new text begin (7)new text end mental health rehabilitation worker deleted text begin who meets the criteria in section
256B.0623, subdivision 5, paragraph (a), clause (4); works under the direction of a mental
health practitioner as defined in section 245.462, subdivision 17, or under direction of a
mental health professional; and works under the clinical supervision of a mental health
professionaldeleted text end .
(b) deleted text begin Mental health practitioners and mental health rehabilitation workers must have
completed at least 30 hours of training in crisis intervention and stabilization during the
past two years.deleted text end new text begin The 30 hours of ongoing training required in section 245I.05, subdivision
4, paragraph (b), must be specific to providing crisis services to children and adults and
include training about evidence-based practices identified by the commissioner of health
to reduce a recipient's risk of suicide and self-injurious behavior.
new text end
Subd. 9.
Supervision.
new text begin Clinical trainees and new text end mental health practitioners may provide
crisis assessment and deleted text begin mobiledeleted text end crisis intervention services if the following deleted text begin clinicaldeleted text end new text begin treatmentnew text end
supervision requirements are met:
(1) the mental health provider entity must accept full responsibility for the services
provided;
(2) the mental health professional of the provider entitydeleted text begin , who is an employee or under
contract with the provider entity,deleted text end must be immediately available by phone or in person for
deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision;
(3) the mental health professional is consulted, in person or by phone, during the first
three hours when a new text begin clinical trainee or new text end mental health practitioner provides deleted text begin on-site servicedeleted text end new text begin
crisis assessment or crisis intervention servicesnew text end ;new text begin and
new text end
(4) the mental health professional must:
(i) review and approvenew text begin , as defined in section 245I.02, subdivision 2,new text end of the tentative
crisis assessment and crisis treatment plannew text begin within 24 hours of first providing services to the
recipient, notwithstanding section 245I.08, subdivision 3new text end ;new text begin and
new text end
(ii) document the consultationdeleted text begin ; anddeleted text end new text begin required in clause (3).
new text end
deleted text begin
(iii) sign the crisis assessment and treatment plan within the next business day;
deleted text end
deleted text begin
(5) if the mobile crisis intervention services continue into a second calendar day, a mental
health professional must contact the recipient face-to-face on the second day to provide
services and update the crisis treatment plan; and
deleted text end
deleted text begin
(6) the on-site observation must be documented in the recipient's record and signed by
the mental health professional.
deleted text end
deleted text begin Subd. 10. deleted text end
deleted text begin Recipient file. deleted text end
deleted text begin
Providers of mobile crisis intervention or crisis stabilization
services must maintain a file for each recipient containing the following information:
deleted text end
deleted text begin
(1) individual crisis treatment plans signed by the recipient, mental health professional,
and mental health practitioner who developed the crisis treatment plan, or if the recipient
refused to sign the plan, the date and reason stated by the recipient as to why the recipient
would not sign the plan;
deleted text end
deleted text begin
(2) signed release forms;
deleted text end
deleted text begin
(3) recipient health information and current medications;
deleted text end
deleted text begin
(4) emergency contacts for the recipient;
deleted text end
deleted text begin
(5) case records which document the date of service, place of service delivery, signature
of the person providing the service, and the nature, extent, and units of service. Direct or
telephone contact with the recipient's family or others should be documented;
deleted text end
deleted text begin
(6) required clinical supervision by mental health professionals;
deleted text end
deleted text begin
(7) summary of the recipient's case reviews by staff;
deleted text end
deleted text begin
(8) any written information by the recipient that the recipient wants in the file; and
deleted text end
deleted text begin
(9) an advance directive, if there is one available.
deleted text end
deleted text begin
Documentation in the file must comply with all requirements of the commissioner.
deleted text end
Subd. 11.
new text begin Crisis new text end treatment plan.
deleted text begin
The individual crisis stabilization treatment plan must
include, at a minimum:
deleted text end
deleted text begin
(1) a list of problems identified in the assessment;
deleted text end
deleted text begin
(2) a list of the recipient's strengths and resources;
deleted text end
deleted text begin
(3) concrete, measurable short-term goals and tasks to be achieved, including time frames
for achievement;
deleted text end
deleted text begin
(4) specific objectives directed toward the achievement of each one of the goals;
deleted text end
deleted text begin
(5) documentation of the participants involved in the service planning. The recipient, if
possible, must be a participant. The recipient or the recipient's legal guardian must sign the
service plan or documentation must be provided why this was not possible. A copy of the
plan must be given to the recipient and the recipient's legal guardian. The plan should include
services arranged, including specific providers where applicable;
deleted text end
deleted text begin
(6) planned frequency and type of services initiated;
deleted text end
deleted text begin
(7) a crisis response action plan if a crisis should occur;
deleted text end
deleted text begin
(8) clear progress notes on outcome of goals;
deleted text end
deleted text begin
(9) a written plan must be completed within 24 hours of beginning services with the
recipient; and
deleted text end
deleted text begin
(10) a treatment plan must be developed by a mental health professional or mental health
practitioner under the clinical supervision of a mental health professional. The mental health
professional must approve and sign all treatment plans.
deleted text end
new text begin
(a) Within 24 hours of the recipient's admission, the provider entity must complete the
recipient's crisis treatment plan. The provider entity must:
new text end
new text begin
(1) base the recipient's crisis treatment plan on the recipient's crisis assessment;
new text end
new text begin
(2) consider crisis assistance strategies that have been effective for the recipient in the
past;
new text end
new text begin
(3) for a child recipient, use a child-centered, family-driven, and culturally appropriate
planning process that allows the recipient's parents and guardians to observe or participate
in the recipient's individual and family treatment services, assessment, and treatment
planning;
new text end
new text begin
(4) for an adult recipient, use a person-centered, culturally appropriate planning process
that allows the recipient's family and other natural supports to observe or participate in
treatment services, assessment, and treatment planning;
new text end
new text begin
(5) identify the participants involved in the recipient's treatment planning. The recipient,
if possible, must be a participant;
new text end
new text begin
(6) identify the recipient's initial treatment goals, measurable treatment objectives, and
specific interventions that the license holder will use to help the recipient engage in treatment;
new text end
new text begin
(7) include documentation of referral to and scheduling of services, including specific
providers where applicable;
new text end
new text begin
(8) ensure that the recipient or the recipient's legal guardian approves under section
245I.02, subdivision 2, of the recipient's crisis treatment plan unless a court orders the
recipient's treatment plan under chapter 253B. If the recipient or the recipient's legal guardian
disagrees with the crisis treatment plan, the license holder must document in the client file
the reasons why the recipient disagrees with the crisis treatment plan; and
new text end
new text begin
(9) ensure that a treatment supervisor approves under section 245I.02, subdivision 2, of
the recipient's treatment plan within 24 hours of the recipient's admission if a mental health
practitioner or clinical trainee completes the crisis treatment plan, notwithstanding section
245I.08, subdivision 3.
new text end
new text begin
(b) The provider entity must provide the recipient and the recipient's legal guardian with
a copy of the recipient's crisis treatment plan.
new text end
Subd. 12.
Excluded services.
The following services are excluded from reimbursement
under this section:
(1) room and board services;
(2) services delivered to a recipient while admitted to an inpatient hospital;
(3) recipient transportation costs may be covered under other medical assistance
provisions, but transportation services are not an adult mental health crisis response service;
(4) services provided and billed by a provider who is not enrolled under medical
assistance to provide adult mental health crisis response services;
(5) services performed by volunteers;
(6) direct billing of time spent "on call" when not delivering services to a recipient;
(7) provider service time included in case management reimbursement. When a provider
is eligible to provide more than one type of medical assistance service, the recipient must
have a choice of provider for each service, unless otherwise provided for by law;
(8) outreach services to potential recipients; deleted text begin and
deleted text end
(9) a mental health service that is not medically necessarydeleted text begin .deleted text end new text begin ;
new text end
new text begin
(10) services that a residential treatment center licensed under Minnesota Rules, chapter
2960, provides to a client;
new text end
new text begin
(11) partial hospitalization or day treatment; and
new text end
new text begin
(12) a crisis assessment that a residential provider completes when a daily rate is paid
for the recipient's crisis stabilization.
new text end
Sec. 5. new text begin EFFECTIVE DATE.
new text end
new text begin
This article is effective upon federal approval or July 1, 2022, whichever is later. The
commissioner shall notify the revisor of statutes when federal approval is obtained.
new text end
ARTICLE 18
UNIFORM SERVICE STANDARDS; CONFORMING CHANGES
Section 1.
Minnesota Statutes 2020, section 62A.152, subdivision 3, is amended to read:
Subd. 3.
Provider discrimination prohibited.
All group policies and group subscriber
contracts that provide benefits for mental or nervous disorder treatments in a hospital must
provide direct reimbursement for those services if performed by a mental health professionaldeleted text begin ,
as defined in sections 245.462, subdivision 18, clauses (1) to (5); and 245.4871, subdivision
27, clauses (1) to (5)deleted text end new text begin qualified according to section 245I.04, subdivision 2new text end , to the extent that
the services and treatment are within the scope of mental health professional licensure.
This subdivision is intended to provide payment of benefits for mental or nervous disorder
treatments performed by a licensed mental health professional in a hospital and is not
intended to change or add benefits for those services provided in policies or contracts to
which this subdivision applies.
Sec. 2.
Minnesota Statutes 2020, section 62A.3094, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
(a) For purposes of this section, the terms defined in
paragraphs (b) to (d) have the meanings given.
(b) "Autism spectrum disorders" means the conditions as determined by criteria set forth
in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders of
the American Psychiatric Association.
(c) "Medically necessary care" means health care services appropriate, in terms of type,
frequency, level, setting, and duration, to the enrollee's condition, and diagnostic testing
and preventative services. Medically necessary care must be consistent with generally
accepted practice parameters as determined by physicians and licensed psychologists who
typically manage patients who have autism spectrum disorders.
(d) "Mental health professional" means a mental health professional deleted text begin as defined in section
245.4871, subdivision 27deleted text end new text begin who is qualified according to section 245I.04, subdivision 2new text end ,
clause (1), (2), (3), (4), or (6), who has training and expertise in autism spectrum disorder
and child development.
Sec. 3.
Minnesota Statutes 2020, section 62Q.096, is amended to read:
62Q.096 CREDENTIALING OF PROVIDERS.
If a health plan company has initially credentialed, as providers in its provider network,
individual providers employed by or under contract with an entity that:
(1) is authorized to bill under section 256B.0625, subdivision 5;
(2) deleted text begin meets the requirements of Minnesota Rules, parts 9520.0750 to 9520.0870deleted text end new text begin is a mental
health clinic certified under section 245I.20new text end ;
(3) is designated an essential community provider under section 62Q.19; and
(4) is under contract with the health plan company to provide mental health services,
the health plan company must continue to credential at least the same number of providers
from that entity, as long as those providers meet the health plan company's credentialing
standards.
A health plan company shall not refuse to credential these providers on the grounds that
their provider network has a sufficient number of providers of that type.
Sec. 4.
Minnesota Statutes 2020, section 144.651, subdivision 2, is amended to read:
Subd. 2.
Definitions.
For the purposes of this section, "patient" means a person who is
admitted to an acute care inpatient facility for a continuous period longer than 24 hours, for
the purpose of diagnosis or treatment bearing on the physical or mental health of that person.
For purposes of subdivisions 4 to 9, 12, 13, 15, 16, and 18 to 20, "patient" also means a
person who receives health care services at an outpatient surgical center or at a birth center
licensed under section 144.615. "Patient" also means a minor who is admitted to a residential
program as defined in section 253C.01. For purposes of subdivisions 1, 3 to 16, 18, 20 and
30, "patient" also means any person who is receiving mental health treatment on an outpatient
basis or in a community support program or other community-based program. "Resident"
means a person who is admitted to a nonacute care facility including extended care facilities,
nursing homes, and boarding care homes for care required because of prolonged mental or
physical illness or disability, recovery from injury or disease, or advancing age. For purposes
of all subdivisions except subdivisions 28 and 29, "resident" also means a person who is
admitted to a facility licensed as a board and lodging facility under Minnesota Rules, parts
4625.0100 to 4625.2355, new text begin a boarding care home under sections 144.50 to 144.56, new text end or a
supervised living facility under Minnesota Rules, parts 4665.0100 to 4665.9900, and which
operates a rehabilitation program licensed under chapter 245G new text begin or 245I, new text end or Minnesota Rules,
parts 9530.6510 to 9530.6590.
Sec. 5.
Minnesota Statutes 2020, section 144D.01, subdivision 4, is amended to read:
Subd. 4.
Housing with services establishment or establishment.
(a) "Housing with
services establishment" or "establishment" means:
(1) an establishment providing sleeping accommodations to one or more adult residents,
at least 80 percent of which are 55 years of age or older, and offering or providing, for a
fee, one or more regularly scheduled health-related services or two or more regularly
scheduled supportive services, whether offered or provided directly by the establishment
or by another entity arranged for by the establishment; or
(2) an establishment that registers under section 144D.025.
(b) Housing with services establishment does not include:
(1) a nursing home licensed under chapter 144A;
(2) a hospital, certified boarding care home, or supervised living facility licensed under
sections 144.50 to 144.56;
(3) a board and lodging establishment licensed under chapter 157 and Minnesota Rules,
parts 9520.0500 to 9520.0670, or under chapter 245D deleted text begin ordeleted text end new text begin ,new text end 245Gnew text begin , or 245Inew text end ;
(4) a board and lodging establishment which serves as a shelter for battered women or
other similar purpose;
(5) a family adult foster care home licensed by the Department of Human Services;
(6) private homes in which the residents are related by kinship, law, or affinity with the
providers of services;
(7) residential settings for persons with developmental disabilities in which the services
are licensed under chapter 245D;
(8) a home-sharing arrangement such as when an elderly or disabled person or
single-parent family makes lodging in a private residence available to another person in
exchange for services or rent, or both;
(9) a duly organized condominium, cooperative, common interest community, or owners'
association of the foregoing where at least 80 percent of the units that comprise the
condominium, cooperative, or common interest community are occupied by individuals
who are the owners, members, or shareholders of the units;
(10) services for persons with developmental disabilities that are provided under a license
under chapter 245D; or
(11) a temporary family health care dwelling as defined in sections 394.307 and 462.3593.
Sec. 6.
Minnesota Statutes 2020, section 144G.08, subdivision 7, as amended by Laws
2020, Seventh Special Session chapter 1, article 6, section 5, is amended to read:
Subd. 7.
Assisted living facility.
"Assisted living facility" means a facility that provides
sleeping accommodations and assisted living services to one or more adults. Assisted living
facility includes assisted living facility with dementia care, and does not include:
(1) emergency shelter, transitional housing, or any other residential units serving
exclusively or primarily homeless individuals, as defined under section 116L.361;
(2) a nursing home licensed under chapter 144A;
(3) a hospital, certified boarding care, or supervised living facility licensed under sections
144.50 to 144.56;
(4) a lodging establishment licensed under chapter 157 and Minnesota Rules, parts
9520.0500 to 9520.0670, or under chapter 245D deleted text begin ordeleted text end new text begin ,new text end 245Gnew text begin , or 245Inew text end ;
(5) services and residential settings licensed under chapter 245A, including adult foster
care and services and settings governed under the standards in chapter 245D;
(6) a private home in which the residents are related by kinship, law, or affinity with the
provider of services;
(7) a duly organized condominium, cooperative, and common interest community, or
owners' association of the condominium, cooperative, and common interest community
where at least 80 percent of the units that comprise the condominium, cooperative, or
common interest community are occupied by individuals who are the owners, members, or
shareholders of the units;
(8) a temporary family health care dwelling as defined in sections 394.307 and 462.3593;
(9) a setting offering services conducted by and for the adherents of any recognized
church or religious denomination for its members exclusively through spiritual means or
by prayer for healing;
(10) housing financed pursuant to sections 462A.37 and 462A.375, units financed with
low-income housing tax credits pursuant to United States Code, title 26, section 42, and
units financed by the Minnesota Housing Finance Agency that are intended to serve
individuals with disabilities or individuals who are homeless, except for those developments
that market or hold themselves out as assisted living facilities and provide assisted living
services;
(11) rental housing developed under United States Code, title 42, section 1437, or United
States Code, title 12, section 1701q;
(12) rental housing designated for occupancy by only elderly or elderly and disabled
residents under United States Code, title 42, section 1437e, or rental housing for qualifying
families under Code of Federal Regulations, title 24, section 983.56;
(13) rental housing funded under United States Code, title 42, chapter 89, or United
States Code, title 42, section 8011;
(14) a covered setting as defined in section 325F.721, subdivision 1, paragraph (b); or
(15) any establishment that exclusively or primarily serves as a shelter or temporary
shelter for victims of domestic or any other form of violence.
Sec. 7.
Minnesota Statutes 2020, section 148B.5301, subdivision 2, is amended to read:
Subd. 2.
Supervision.
(a) To qualify as a LPCC, an applicant must have completed
4,000 hours of post-master's degree supervised professional practice in the delivery of
clinical services in the diagnosis and treatment of mental illnesses and disorders in both
children and adults. The supervised practice shall be conducted according to the requirements
in paragraphs (b) to (e).
(b) The supervision must have been received under a contract that defines clinical practice
and supervision from a mental health professional deleted text begin as defined in section 245.462, subdivision
18, clauses (1) to (6), or 245.4871, subdivision 27, clauses (1) to (6)deleted text end new text begin who is qualified
according to section 245I.04, subdivision 2new text end , or by a board-approved supervisor, who has at
least two years of postlicensure experience in the delivery of clinical services in the diagnosis
and treatment of mental illnesses and disorders. All supervisors must meet the supervisor
requirements in Minnesota Rules, part 2150.5010.
(c) The supervision must be obtained at the rate of two hours of supervision per 40 hours
of professional practice. The supervision must be evenly distributed over the course of the
supervised professional practice. At least 75 percent of the required supervision hours must
be received in person. The remaining 25 percent of the required hours may be received by
telephone or by audio or audiovisual electronic device. At least 50 percent of the required
hours of supervision must be received on an individual basis. The remaining 50 percent
may be received in a group setting.
(d) The supervised practice must include at least 1,800 hours of clinical client contact.
(e) The supervised practice must be clinical practice. Supervision includes the observation
by the supervisor of the successful application of professional counseling knowledge, skills,
and values in the differential diagnosis and treatment of psychosocial function, disability,
or impairment, including addictions and emotional, mental, and behavioral disorders.
Sec. 8.
Minnesota Statutes 2020, section 148E.120, subdivision 2, is amended to read:
Subd. 2.
Alternate supervisors.
(a) The board may approve an alternate supervisor as
determined in this subdivision. The board shall approve up to 25 percent of the required
supervision hours by a deleted text begin licenseddeleted text end mental health professional who is competent and qualified
to provide supervision according to the mental health professional's respective licensing
board, as established by section deleted text begin 245.462, subdivision 18, clauses (1) to (6), or 245.4871,
subdivision 27, clauses (1) to (6)deleted text end new text begin 245I.04, subdivision 2new text end .
(b) The board shall approve up to 100 percent of the required supervision hours by an
alternate supervisor if the board determines that:
(1) there are five or fewer supervisors in the county where the licensee practices social
work who meet the applicable licensure requirements in subdivision 1;
(2) the supervisor is an unlicensed social worker who is employed in, and provides the
supervision in, a setting exempt from licensure by section 148E.065, and who has
qualifications equivalent to the applicable requirements specified in sections 148E.100 to
148E.115;
(3) the supervisor is a social worker engaged in authorized social work practice in Iowa,
Manitoba, North Dakota, Ontario, South Dakota, or Wisconsin, and has the qualifications
equivalent to the applicable requirements in sections 148E.100 to 148E.115; or
(4) the applicant or licensee is engaged in nonclinical authorized social work practice
outside of Minnesota and the supervisor meets the qualifications equivalent to the applicable
requirements in sections 148E.100 to 148E.115, or the supervisor is an equivalent mental
health professional, as determined by the board, who is credentialed by a state, territorial,
provincial, or foreign licensing agency; or
(5) the applicant or licensee is engaged in clinical authorized social work practice outside
of Minnesota and the supervisor meets qualifications equivalent to the applicable
requirements in section 148E.115, or the supervisor is an equivalent mental health
professional as determined by the board, who is credentialed by a state, territorial, provincial,
or foreign licensing agency.
(c) In order for the board to consider an alternate supervisor under this section, the
licensee must:
(1) request in the supervision plan and verification submitted according to section
148E.125 that an alternate supervisor conduct the supervision; and
(2) describe the proposed supervision and the name and qualifications of the proposed
alternate supervisor. The board may audit the information provided to determine compliance
with the requirements of this section.
Sec. 9.
Minnesota Statutes 2020, section 148F.11, subdivision 1, is amended to read:
Subdivision 1.
Other professionals.
(a) Nothing in this chapter prevents members of
other professions or occupations from performing functions for which they are qualified or
licensed. This exception includes, but is not limited to: licensed physicians; registered nurses;
licensed practical nurses; licensed psychologists and licensed psychological practitioners;
members of the clergy provided such services are provided within the scope of regular
ministries; American Indian medicine men and women; licensed attorneys; probation officers;
licensed marriage and family therapists; licensed social workers; social workers employed
by city, county, or state agencies; licensed professional counselors; licensed professional
clinical counselors; licensed school counselors; registered occupational therapists or
occupational therapy assistants; Upper Midwest Indian Council on Addictive Disorders
(UMICAD) certified counselors when providing services to Native American people; city,
county, or state employees when providing assessments or case management under Minnesota
Rules, chapter 9530; and individuals defined in section 256B.0623, subdivision 5, paragraph
(a), clauses (1) deleted text begin and (2)deleted text end new text begin to (6)new text end , providing deleted text begin integrated dual diagnosisdeleted text end new text begin co-occurring substance
use disordernew text end treatment in adult mental health rehabilitative programs certified new text begin or licensed
new text end by the Department of Human Services under section new text begin 245I.23, new text end 256B.0622new text begin ,new text end or 256B.0623.
(b) Nothing in this chapter prohibits technicians and resident managers in programs
licensed by the Department of Human Services from discharging their duties as provided
in Minnesota Rules, chapter 9530.
(c) Any person who is exempt from licensure under this section must not use a title
incorporating the words "alcohol and drug counselor" or "licensed alcohol and drug
counselor" or otherwise hold himself or herself out to the public by any title or description
stating or implying that he or she is engaged in the practice of alcohol and drug counseling,
or that he or she is licensed to engage in the practice of alcohol and drug counseling, unless
that person is also licensed as an alcohol and drug counselor. Persons engaged in the practice
of alcohol and drug counseling are not exempt from the board's jurisdiction solely by the
use of one of the titles in paragraph (a).
Sec. 10.
Minnesota Statutes 2020, section 245.462, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
The definitions in this section apply to sections 245.461 to
deleted text begin 245.486deleted text end new text begin 245.4863new text end .
Sec. 11.
Minnesota Statutes 2020, section 245.462, subdivision 6, is amended to read:
Subd. 6.
Community support services program.
"Community support services program"
means services, other than inpatient or residential treatment services, provided or coordinated
by an identified program and staff under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health
professional designed to help adults with serious and persistent mental illness to function
and remain in the community. A community support services program includes:
(1) client outreach,
(2) medication monitoring,
(3) assistance in independent living skills,
(4) development of employability and work-related opportunities,
(5) crisis assistance,
(6) psychosocial rehabilitation,
(7) help in applying for government benefits, and
(8) housing support services.
The community support services program must be coordinated with the case management
services specified in section 245.4711.
Sec. 12.
Minnesota Statutes 2020, section 245.462, subdivision 8, is amended to read:
Subd. 8.
Day treatment services.
"Day treatment," "day treatment services," or "day
treatment program" means deleted text begin a structured program of treatment and care provided to an adult
in or by: (1) a hospital accredited by the joint commission on accreditation of health
organizations and licensed under sections 144.50 to 144.55; (2) a community mental health
center under section 245.62; or (3) an entity that is under contract with the county board to
operate a program that meets the requirements of section 245.4712, subdivision 2, and
Minnesota Rules, parts 9505.0170 to 9505.0475. Day treatment consists of group
psychotherapy and other intensive therapeutic services that are provided at least two days
a week by a multidisciplinary staff under the clinical supervision of a mental health
professional. Day treatment may include education and consultation provided to families
and other individuals as part of the treatment process. The services are aimed at stabilizing
the adult's mental health status, providing mental health services, and developing and
improving the adult's independent living and socialization skills. The goal of day treatment
is to reduce or relieve mental illness and to enable the adult to live in the community. Day
treatment services are not a part of inpatient or residential treatment services. Day treatment
services are distinguished from day care by their structured therapeutic program of
psychotherapy services. The commissioner may limit medical assistance reimbursement
for day treatment to 15 hours per week per persondeleted text end new text begin the treatment services described by section
256B.0671, subdivision 3new text end .
Sec. 13.
Minnesota Statutes 2020, section 245.462, subdivision 9, is amended to read:
Subd. 9.
Diagnostic assessment.
deleted text begin (a)deleted text end "Diagnostic assessment" has the meaning given in
deleted text begin Minnesota Rules, part 9505.0370, subpart 11, and is delivered as provided in Minnesota
Rules, part 9505.0372, subpart 1, items A, B, C, and E. Diagnostic assessment includes a
standard, extended, or brief diagnostic assessment, or an adult updatedeleted text end new text begin section 245I.10,
subdivisions 4 to 6new text end .
deleted text begin
(b) A brief diagnostic assessment must include a face-to-face interview with the client
and a written evaluation of the client by a mental health professional or a clinical trainee,
as provided in Minnesota Rules, part 9505.0371, subpart 5, item C. The professional or
clinical trainee must gather initial components of a standard diagnostic assessment, including
the client's:
deleted text end
deleted text begin
(1) age;
deleted text end
deleted text begin
(2) description of symptoms, including reason for referral;
deleted text end
deleted text begin
(3) history of mental health treatment;
deleted text end
deleted text begin
(4) cultural influences and their impact on the client; and
deleted text end
deleted text begin
(5) mental status examination.
deleted text end
deleted text begin
(c) On the basis of the initial components, the professional or clinical trainee must draw
a provisional clinical hypothesis. The clinical hypothesis may be used to address the client's
immediate needs or presenting problem.
deleted text end
deleted text begin
(d) Treatment sessions conducted under authorization of a brief assessment may be used
to gather additional information necessary to complete a standard diagnostic assessment or
an extended diagnostic assessment.
deleted text end
deleted text begin
(e) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item A, subitem (1),
unit (b), prior to completion of a client's initial diagnostic assessment, a client is eligible
for psychological testing as part of the diagnostic process.
deleted text end
deleted text begin
(f) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item A, subitem (1),
unit (c), prior to completion of a client's initial diagnostic assessment, but in conjunction
with the diagnostic assessment process, a client is eligible for up to three individual or family
psychotherapy sessions or family psychoeducation sessions or a combination of the above
sessions not to exceed three sessions.
deleted text end
deleted text begin
(g) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item B, subitem (3),
unit (a), a brief diagnostic assessment may be used for a client's family who requires a
language interpreter to participate in the assessment.
deleted text end
Sec. 14.
Minnesota Statutes 2020, section 245.462, subdivision 14, is amended to read:
Subd. 14.
Individual treatment plan.
"Individual treatment plan" means deleted text begin a written plan
of intervention, treatment, and services for an adult with mental illness that is developed
by a service provider under the clinical supervision of a mental health professional on the
basis of a diagnostic assessment. The plan identifies goals and objectives of treatment,
treatment strategy, a schedule for accomplishing treatment goals and objectives, and the
individual responsible for providing treatment to the adult with mental illnessdeleted text end new text begin the formulation
of planned services that are responsive to the needs and goals of a client. An individual
treatment plan must be completed according to section 245I.10, subdivisions 7 and 8new text end .
Sec. 15.
Minnesota Statutes 2020, section 245.462, subdivision 16, is amended to read:
Subd. 16.
Mental health funds.
"Mental health funds" are funds expended under sections
245.73 and 256E.12, federal mental health block grant funds, and funds expended under
section 256D.06 to facilities licensed under new text begin section 245I.23 or new text end Minnesota Rules, parts
9520.0500 to 9520.0670.
Sec. 16.
Minnesota Statutes 2020, section 245.462, subdivision 17, is amended to read:
Subd. 17.
Mental health practitioner.
deleted text begin (a)deleted text end "Mental health practitioner" means a new text begin staff
new text end person deleted text begin providing services to adults with mental illness or children with emotional disturbance
who is qualified in at least one of the ways described in paragraphs (b) to (g). A mental
health practitioner for a child client must have training working with children. A mental
health practitioner for an adult client must have training working with adultsdeleted text end new text begin qualified
according to section 245I.04, subdivision 4new text end .
deleted text begin
(b) For purposes of this subdivision, a practitioner is qualified through relevant
coursework if the practitioner completes at least 30 semester hours or 45 quarter hours in
behavioral sciences or related fields and:
deleted text end
deleted text begin
(1) has at least 2,000 hours of supervised experience in the delivery of services to adults
or children with:
deleted text end
deleted text begin
(i) mental illness, substance use disorder, or emotional disturbance; or
deleted text end
deleted text begin
(ii) traumatic brain injury or developmental disabilities and completes training on mental
illness, recovery from mental illness, mental health de-escalation techniques, co-occurring
mental illness and substance abuse, and psychotropic medications and side effects;
deleted text end
deleted text begin
(2) is fluent in the non-English language of the ethnic group to which at least 50 percent
of the practitioner's clients belong, completes 40 hours of training in the delivery of services
to adults with mental illness or children with emotional disturbance, and receives clinical
supervision from a mental health professional at least once a week until the requirement of
2,000 hours of supervised experience is met;
deleted text end
deleted text begin
(3) is working in a day treatment program under section 245.4712, subdivision 2; or
deleted text end
deleted text begin
(4) has completed a practicum or internship that (i) requires direct interaction with adults
or children served, and (ii) is focused on behavioral sciences or related fields.
deleted text end
deleted text begin
(c) For purposes of this subdivision, a practitioner is qualified through work experience
if the person:
deleted text end
deleted text begin
(1) has at least 4,000 hours of supervised experience in the delivery of services to adults
or children with:
deleted text end
deleted text begin
(i) mental illness, substance use disorder, or emotional disturbance; or
deleted text end
deleted text begin
(ii) traumatic brain injury or developmental disabilities and completes training on mental
illness, recovery from mental illness, mental health de-escalation techniques, co-occurring
mental illness and substance abuse, and psychotropic medications and side effects; or
deleted text end
deleted text begin
(2) has at least 2,000 hours of supervised experience in the delivery of services to adults
or children with:
deleted text end
deleted text begin
(i) mental illness, emotional disturbance, or substance use disorder, and receives clinical
supervision as required by applicable statutes and rules from a mental health professional
at least once a week until the requirement of 4,000 hours of supervised experience is met;
or
deleted text end
deleted text begin
(ii) traumatic brain injury or developmental disabilities; completes training on mental
illness, recovery from mental illness, mental health de-escalation techniques, co-occurring
mental illness and substance abuse, and psychotropic medications and side effects; and
receives clinical supervision as required by applicable statutes and rules at least once a week
from a mental health professional until the requirement of 4,000 hours of supervised
experience is met.
deleted text end
deleted text begin
(d) For purposes of this subdivision, a practitioner is qualified through a graduate student
internship if the practitioner is a graduate student in behavioral sciences or related fields
and is formally assigned by an accredited college or university to an agency or facility for
clinical training.
deleted text end
deleted text begin
(e) For purposes of this subdivision, a practitioner is qualified by a bachelor's or master's
degree if the practitioner:
deleted text end
deleted text begin
(1) holds a master's or other graduate degree in behavioral sciences or related fields; or
deleted text end
deleted text begin
(2) holds a bachelor's degree in behavioral sciences or related fields and completes a
practicum or internship that (i) requires direct interaction with adults or children served,
and (ii) is focused on behavioral sciences or related fields.
deleted text end
deleted text begin
(f) For purposes of this subdivision, a practitioner is qualified as a vendor of medical
care if the practitioner meets the definition of vendor of medical care in section 256B.02,
subdivision 7, paragraphs (b) and (c), and is serving a federally recognized tribe.
deleted text end
deleted text begin
(g) For purposes of medical assistance coverage of diagnostic assessments, explanations
of findings, and psychotherapy under section 256B.0625, subdivision 65, a mental health
practitioner working as a clinical trainee means that the practitioner's clinical supervision
experience is helping the practitioner gain knowledge and skills necessary to practice
effectively and independently. This may include supervision of direct practice, treatment
team collaboration, continued professional learning, and job management. The practitioner
must also:
deleted text end
deleted text begin
(1) comply with requirements for licensure or board certification as a mental health
professional, according to the qualifications under Minnesota Rules, part 9505.0371, subpart
5, item A, including supervised practice in the delivery of mental health services for the
treatment of mental illness; or
deleted text end
deleted text begin
(2) be a student in a bona fide field placement or internship under a program leading to
completion of the requirements for licensure as a mental health professional according to
the qualifications under Minnesota Rules, part 9505.0371, subpart 5, item A.
deleted text end
deleted text begin
(h) For purposes of this subdivision, "behavioral sciences or related fields" has the
meaning given in section 256B.0623, subdivision 5, paragraph (d).
deleted text end
deleted text begin
(i) Notwithstanding the licensing requirements established by a health-related licensing
board, as defined in section 214.01, subdivision 2, this subdivision supersedes any other
statute or rule.
deleted text end
Sec. 17.
Minnesota Statutes 2020, section 245.462, subdivision 18, is amended to read:
Subd. 18.
Mental health professional.
"Mental health professional" means a new text begin staff new text end person
deleted text begin providing clinical services in the treatment of mental illness who is qualified in at least one
of the following ways:deleted text end new text begin who is qualified according to section 245I.04, subdivision 2.
new text end
deleted text begin
(1) in psychiatric nursing: a registered nurse who is licensed under sections 148.171 to
148.285; and:
deleted text end
deleted text begin
(i) who is certified as a clinical specialist or as a nurse practitioner in adult or family
psychiatric and mental health nursing by a national nurse certification organization; or
deleted text end
deleted text begin
(ii) who has a master's degree in nursing or one of the behavioral sciences or related
fields from an accredited college or university or its equivalent, with at least 4,000 hours
of post-master's supervised experience in the delivery of clinical services in the treatment
of mental illness;
deleted text end
deleted text begin
(2) in clinical social work: a person licensed as an independent clinical social worker
under chapter 148D, or a person with a master's degree in social work from an accredited
college or university, with at least 4,000 hours of post-master's supervised experience in
the delivery of clinical services in the treatment of mental illness;
deleted text end
deleted text begin
(3) in psychology: an individual licensed by the Board of Psychology under sections
148.88 to 148.98 who has stated to the Board of Psychology competencies in the diagnosis
and treatment of mental illness;
deleted text end
deleted text begin
(4) in psychiatry: a physician licensed under chapter 147 and certified by the American
Board of Psychiatry and Neurology or eligible for board certification in psychiatry, or an
osteopathic physician licensed under chapter 147 and certified by the American Osteopathic
Board of Neurology and Psychiatry or eligible for board certification in psychiatry;
deleted text end
deleted text begin
(5) in marriage and family therapy: the mental health professional must be a marriage
and family therapist licensed under sections 148B.29 to 148B.39 with at least two years of
post-master's supervised experience in the delivery of clinical services in the treatment of
mental illness;
deleted text end
deleted text begin
(6) in licensed professional clinical counseling, the mental health professional shall be
a licensed professional clinical counselor under section 148B.5301 with at least 4,000 hours
of post-master's supervised experience in the delivery of clinical services in the treatment
of mental illness; or
deleted text end
deleted text begin
(7) in allied fields: a person with a master's degree from an accredited college or university
in one of the behavioral sciences or related fields, with at least 4,000 hours of post-master's
supervised experience in the delivery of clinical services in the treatment of mental illness.
deleted text end
Sec. 18.
Minnesota Statutes 2020, section 245.462, subdivision 21, is amended to read:
Subd. 21.
Outpatient services.
"Outpatient services" means mental health services,
excluding day treatment and community support services programs, provided by or under
the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional to adults with mental
illness who live outside a hospital. Outpatient services include clinical activities such as
individual, group, and family therapy; individual treatment planning; diagnostic assessments;
medication management; and psychological testing.
Sec. 19.
Minnesota Statutes 2020, section 245.462, subdivision 23, is amended to read:
Subd. 23.
Residential treatment.
"Residential treatment" means a 24-hour-a-day program
under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional, in a community
residential setting other than an acute care hospital or regional treatment center inpatient
unit, that must be licensed as a residential treatment program for adults with mental illness
under new text begin chapter 245I, new text end Minnesota Rules, parts 9520.0500 to 9520.0670new text begin ,new text end or other rules adopted
by the commissioner.
Sec. 20.
Minnesota Statutes 2020, section 245.462, is amended by adding a subdivision
to read:
new text begin Subd. 27. new text end
new text begin Treatment supervision. new text end
new text begin
"Treatment supervision" means the treatment
supervision described by section 245I.06.
new text end
Sec. 21.
Minnesota Statutes 2020, section 245.4661, subdivision 5, is amended to read:
Subd. 5.
Planning for pilot projects.
(a) Each local plan for a pilot project, with the
exception of the placement of a Minnesota specialty treatment facility as defined in paragraph
(c), must be developed under the direction of the county board, or multiple county boards
acting jointly, as the local mental health authority. The planning process for each pilot shall
include, but not be limited to, mental health consumers, families, advocates, local mental
health advisory councils, local and state providers, representatives of state and local public
employee bargaining units, and the department of human services. As part of the planning
process, the county board or boards shall designate a managing entity responsible for receipt
of funds and management of the pilot project.
(b) For Minnesota specialty treatment facilities, the commissioner shall issue a request
for proposal for regions in which a need has been identified for services.
(c) For purposes of this section, "Minnesota specialty treatment facility" is defined as
an intensive residential treatment service new text begin licensed new text end under deleted text begin section 256B.0622, subdivision 2,
paragraph (b)deleted text end new text begin chapter 245Inew text end .
Sec. 22.
Minnesota Statutes 2020, section 245.4662, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
(a) For purposes of this section, the following terms have
the meanings given them.
(b) "Community partnership" means a project involving the collaboration of two or more
eligible applicants.
(c) "Eligible applicant" means an eligible county, Indian tribe, mental health service
provider, hospital, or community partnership. Eligible applicant does not include a
state-operated direct care and treatment facility or program under chapter 246.
(d) "Intensive residential treatment services" has the meaning given in section 256B.0622deleted text begin ,
subdivision 2deleted text end .
(e) "Metropolitan area" means the seven-county metropolitan area, as defined in section
473.121, subdivision 2.
Sec. 23.
Minnesota Statutes 2020, section 245.467, subdivision 2, is amended to read:
Subd. 2.
Diagnostic assessment.
deleted text begin
All providers of residential, acute care hospital inpatient,
and regional treatment centers must complete a diagnostic assessment for each of their
clients within five days of admission. Providers of day treatment services must complete a
diagnostic assessment within five days after the adult's second visit or within 30 days after
intake, whichever occurs first. In cases where a diagnostic assessment is available and has
been completed within three years preceding admission, only an adult diagnostic assessment
update is necessary. An "adult diagnostic assessment update" means a written summary by
a mental health professional of the adult's current mental health status and service needs
and includes a face-to-face interview with the adult. If the adult's mental health status has
changed markedly since the adult's most recent diagnostic assessment, a new diagnostic
assessment is required. Compliance with the provisions of this subdivision does not ensure
eligibility for medical assistance reimbursement under chapter 256B.
deleted text end
new text begin
Providers of services
governed by this section must complete a diagnostic assessment according to the standards
of section 245I.10, subdivisions 4 to 6.
new text end
Sec. 24.
Minnesota Statutes 2020, section 245.467, subdivision 3, is amended to read:
Subd. 3.
Individual treatment plans.
deleted text begin
All providers of outpatient services, day treatment
services, residential treatment, acute care hospital inpatient treatment, and all regional
treatment centers must develop an individual treatment plan for each of their adult clients.
The individual treatment plan must be based on a diagnostic assessment. To the extent
possible, the adult client shall be involved in all phases of developing and implementing
the individual treatment plan. Providers of residential treatment and acute care hospital
inpatient treatment, and all regional treatment centers must develop the individual treatment
plan within ten days of client intake and must review the individual treatment plan every
90 days after intake. Providers of day treatment services must develop the individual
treatment plan before the completion of five working days in which service is provided or
within 30 days after the diagnostic assessment is completed or obtained, whichever occurs
first. Providers of outpatient services must develop the individual treatment plan within 30
days after the diagnostic assessment is completed or obtained or by the end of the second
session of an outpatient service, not including the session in which the diagnostic assessment
was provided, whichever occurs first. Outpatient and day treatment services providers must
review the individual treatment plan every 90 days after intake.
deleted text end
new text begin
Providers of services
governed by this section must complete an individual treatment plan according to the
standards of section 245I.10, subdivisions 7 and 8.
new text end
Sec. 25.
Minnesota Statutes 2020, section 245.470, subdivision 1, is amended to read:
Subdivision 1.
Availability of outpatient services.
(a) County boards must provide or
contract for enough outpatient services within the county to meet the needs of adults with
mental illness residing in the county. Services may be provided directly by the county
through county-operated deleted text begin mental health centers ordeleted text end mental health clinics deleted text begin approved by the
commissioner under section 245.69, subdivision 2deleted text end new text begin meeting the standards of chapter 245Inew text end ;
by contract with privately operated deleted text begin mental health centers ordeleted text end mental health clinics deleted text begin approved
by the commissioner under section 245.69, subdivision 2deleted text end new text begin meeting the standards of chapter
245Inew text end ; by contract with hospital mental health outpatient programs certified by the Joint
Commission on Accreditation of Hospital Organizations; or by contract with a deleted text begin licenseddeleted text end
mental health professional deleted text begin as defined in section 245.462, subdivision 18, clauses (1) to (6)deleted text end .
Clients may be required to pay a fee according to section 245.481. Outpatient services
include:
(1) conducting diagnostic assessments;
(2) conducting psychological testing;
(3) developing or modifying individual treatment plans;
(4) making referrals and recommending placements as appropriate;
(5) treating an adult's mental health needs through therapy;
(6) prescribing and managing medication and evaluating the effectiveness of prescribed
medication; and
(7) preventing placement in settings that are more intensive, costly, or restrictive than
necessary and appropriate to meet client needs.
(b) County boards may request a waiver allowing outpatient services to be provided in
a nearby trade area if it is determined that the client can best be served outside the county.
Sec. 26.
Minnesota Statutes 2020, section 245.4712, subdivision 2, is amended to read:
Subd. 2.
Day treatment services provided.
(a) Day treatment services must be developed
as a part of the community support services available to adults with serious and persistent
mental illness residing in the county. Adults may be required to pay a fee according to
section 245.481. Day treatment services must be designed to:
(1) provide a structured environment for treatment;
(2) provide support for residing in the community;
(3) prevent placement in settings that are more intensive, costly, or restrictive than
necessary and appropriate to meet client need;
(4) coordinate with or be offered in conjunction with a local education agency's special
education program; and
(5) operate on a continuous basis throughout the year.
(b) deleted text begin For purposes of complying with medical assistance requirements, an adult day
treatment program must comply with the method of clinical supervision specified in
Minnesota Rules, part 9505.0371, subpart 4. The clinical supervision must be performed
by a qualified supervisor who satisfies the requirements of Minnesota Rules, part 9505.0371,
subpart 5.deleted text end new text begin An adult day treatment program must comply with medical assistance requirements
in section 256B.0671, subdivision 3.
new text end
deleted text begin
A day treatment program must demonstrate compliance with this clinical supervision
requirement by the commissioner's review and approval of the program according to
Minnesota Rules, part 9505.0372, subpart 8.
deleted text end
(c) County boards may request a waiver from including day treatment services if they
can document that:
(1) an alternative plan of care exists through the county's community support services
for clients who would otherwise need day treatment services;
(2) day treatment, if included, would be duplicative of other components of the
community support services; and
(3) county demographics and geography make the provision of day treatment services
cost ineffective and infeasible.
Sec. 27.
Minnesota Statutes 2020, section 245.472, subdivision 2, is amended to read:
Subd. 2.
Specific requirements.
Providers of residential services must be licensed under
new text begin chapter 245I or new text end applicable rules adopted by the commissioner deleted text begin and must be clinically
supervised by a mental health professional. Persons employed in facilities licensed under
Minnesota Rules, parts 9520.0500 to 9520.0670, in the capacity of program director as of
July 1, 1987, in accordance with Minnesota Rules, parts 9520.0500 to 9520.0670, may be
allowed to continue providing clinical supervision within a facility, provided they continue
to be employed as a program director in a facility licensed under Minnesota Rules, parts
9520.0500 to 9520.0670deleted text end .new text begin Residential services must be provided under treatment supervision.
new text end
Sec. 28.
Minnesota Statutes 2020, section 245.4863, is amended to read:
245.4863 INTEGRATED CO-OCCURRING DISORDER TREATMENT.
(a) The commissioner shall require individuals who perform chemical dependency
assessments to screen clients for co-occurring mental health disorders, and staff who perform
mental health diagnostic assessments to screen for co-occurring substance use disorders.
Screening tools must be approved by the commissioner. If a client screens positive for a
co-occurring mental health or substance use disorder, the individual performing the screening
must document what actions will be taken in response to the results and whether further
assessments must be performed.
(b) Notwithstanding paragraph (a), screening is not required when:
(1) the presence of co-occurring disorders was documented for the client in the past 12
months;
(2) the client is currently receiving co-occurring disorders treatment;
(3) the client is being referred for co-occurring disorders treatment; or
(4) a mental health professionaldeleted text begin , as defined in Minnesota Rules, part 9505.0370, subpart
18,deleted text end who is competent to perform diagnostic assessments of co-occurring disorders is
performing a diagnostic assessment deleted text begin that meets the requirements in Minnesota Rules, part
9533.0090, subpart 5,deleted text end to identify whether the client may have co-occurring mental health
and chemical dependency disorders. If an individual is identified to have co-occurring
mental health and substance use disorders, the assessing mental health professional must
document what actions will be taken to address the client's co-occurring disorders.
(c) The commissioner shall adopt rules as necessary to implement this section. The
commissioner shall ensure that the rules are effective on July 1, 2013, thereby establishing
a certification process for integrated dual disorder treatment providers and a system through
which individuals receive integrated dual diagnosis treatment if assessed as having both a
substance use disorder and either a serious mental illness or emotional disturbance.
(d) The commissioner shall apply for any federal waivers necessary to secure, to the
extent allowed by law, federal financial participation for the provision of integrated dual
diagnosis treatment to persons with co-occurring disorders.
Sec. 29.
Minnesota Statutes 2020, section 245.4871, subdivision 9a, is amended to read:
Subd. 9a.
Crisis deleted text begin assistancedeleted text end new text begin planningnew text end .
"Crisis deleted text begin assistancedeleted text end new text begin planningnew text end " means deleted text begin assistance to
the child, the child's family, and all providers of services to the child to: recognize factors
precipitating a mental health crisis, identify behaviors related to the crisis, and be informed
of available resources to resolve the crisis. Crisis assistance requires the development of a
plan which addresses prevention and intervention strategies to be used in a potential crisis.
Other interventions include: (1) arranging for admission to acute care hospital inpatient
treatmentdeleted text end new text begin the development of a written plan to assist a child and the child's family in
preventing and addressing a potential crisis and is distinct from mobile crisis services defined
in section 256B.0624. The plan must address prevention, deescalation, and intervention
strategies to be used in a crisis. The plan identifies factors that might precipitate a crisis,
behaviors or symptoms related to the emergence of a crisis, and the resources available to
resolve a crisis. The plan must address the following potential needs: (1) acute carenew text end ; (2)
crisis placement; (3) community resources for follow-up; and (4) emotional support to the
family during crisis. new text begin When appropriate for the child's needs, the plan must include strategies
to reduce the child's risk of suicide and self-injurious behavior.new text end Crisis deleted text begin assistancedeleted text end new text begin planningnew text end
does not include services designed to secure the safety of a child who is at risk of abuse or
neglect or necessary emergency services.
Sec. 30.
Minnesota Statutes 2020, section 245.4871, subdivision 10, is amended to read:
Subd. 10.
Day treatment services.
"Day treatment," "day treatment services," or "day
treatment program" means a structured program of treatment and care provided to a child
in:
(1) an outpatient hospital accredited by the Joint Commission on Accreditation of Health
Organizations and licensed under sections 144.50 to 144.55;
(2) a community mental health center under section 245.62;
(3) an entity that is under contract with the county board to operate a program that meets
the requirements of section 245.4884, subdivision 2, and Minnesota Rules, parts 9505.0170
to 9505.0475; deleted text begin or
deleted text end
(4) an entity that operates a program that meets the requirements of section 245.4884,
subdivision 2, and Minnesota Rules, parts 9505.0170 to 9505.0475, that is under contract
with an entity that is under contract with a county boarddeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(5) a program certified under section 256B.0943.
new text end
Day treatment consists of group psychotherapy and other intensive therapeutic services
that are provided for a minimum two-hour time block by a multidisciplinary staff under the
deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional. Day treatment may include
education and consultation provided to families and other individuals as an extension of the
treatment process. The services are aimed at stabilizing the child's mental health status, and
developing and improving the child's daily independent living and socialization skills. Day
treatment services are distinguished from day care by their structured therapeutic program
of psychotherapy services. Day treatment services are not a part of inpatient hospital or
residential treatment services.
A day treatment service must be available to a child up to 15 hours a week throughout
the year and must be coordinated with, integrated with, or part of an education program
offered by the child's school.
Sec. 31.
Minnesota Statutes 2020, section 245.4871, subdivision 11a, is amended to read:
Subd. 11a.
Diagnostic assessment.
deleted text begin (a)deleted text end "Diagnostic assessment" has the meaning given
in deleted text begin Minnesota Rules, part 9505.0370, subpart 11, and is delivered as provided in Minnesota
Rules, part 9505.0372, subpart 1, items A, B, C, and E. Diagnostic assessment includes a
standard, extended, or brief diagnostic assessment, or an adult updatedeleted text end new text begin section 245I.10,
subdivisions 4 to 6new text end .
deleted text begin
(b) A brief diagnostic assessment must include a face-to-face interview with the client
and a written evaluation of the client by a mental health professional or a clinical trainee,
as provided in Minnesota Rules, part 9505.0371, subpart 5, item C. The professional or
clinical trainee must gather initial components of a standard diagnostic assessment, including
the client's:
deleted text end
deleted text begin
(1) age;
deleted text end
deleted text begin
(2) description of symptoms, including reason for referral;
deleted text end
deleted text begin
(3) history of mental health treatment;
deleted text end
deleted text begin
(4) cultural influences and their impact on the client; and
deleted text end
deleted text begin
(5) mental status examination.
deleted text end
deleted text begin
(c) On the basis of the brief components, the professional or clinical trainee must draw
a provisional clinical hypothesis. The clinical hypothesis may be used to address the client's
immediate needs or presenting problem.
deleted text end
deleted text begin
(d) Treatment sessions conducted under authorization of a brief assessment may be used
to gather additional information necessary to complete a standard diagnostic assessment or
an extended diagnostic assessment.
deleted text end
deleted text begin
(e) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item A, subitem (1),
unit (b), prior to completion of a client's initial diagnostic assessment, a client is eligible
for psychological testing as part of the diagnostic process.
deleted text end
deleted text begin
(f) Notwithstanding Minnesota Rules, part 9505.0371, subpart 2, item A, subitem (1),
unit (c), prior to completion of a client's initial diagnostic assessment, but in conjunction
with the diagnostic assessment process, a client is eligible for up to three individual or family
psychotherapy sessions or family psychoeducation sessions or a combination of the above
sessions not to exceed three sessions.
deleted text end
Sec. 32.
Minnesota Statutes 2020, section 245.4871, subdivision 17, is amended to read:
Subd. 17.
Family community support services.
"Family community support services"
means services provided under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health
professional and designed to help each child with severe emotional disturbance to function
and remain with the child's family in the community. Family community support services
do not include acute care hospital inpatient treatment, residential treatment services, or
regional treatment center services. Family community support services include:
(1) client outreach to each child with severe emotional disturbance and the child's family;
(2) medication monitoring where necessary;
(3) assistance in developing independent living skills;
(4) assistance in developing parenting skills necessary to address the needs of the child
with severe emotional disturbance;
(5) assistance with leisure and recreational activities;
(6) crisis deleted text begin assistancedeleted text end new text begin planningnew text end , including crisis placement and respite care;
(7) professional home-based family treatment;
(8) foster care with therapeutic supports;
(9) day treatment;
(10) assistance in locating respite care and special needs day care; and
(11) assistance in obtaining potential financial resources, including those benefits listed
in section 245.4884, subdivision 5.
Sec. 33.
Minnesota Statutes 2020, section 245.4871, subdivision 21, is amended to read:
Subd. 21.
Individual treatment plan.
"Individual treatment plan" means deleted text begin a written plan
of intervention, treatment, and services for a child with an emotional disturbance that is
developed by a service provider under the clinical supervision of a mental health professional
on the basis of a diagnostic assessment. An individual treatment plan for a child must be
developed in conjunction with the family unless clinically inappropriate. The plan identifies
goals and objectives of treatment, treatment strategy, a schedule for accomplishing treatment
goals and objectives, and the individuals responsible for providing treatment to the child
with an emotional disturbancedeleted text end new text begin the formulation of planned services that are responsive to
the needs and goals of a client. An individual treatment plan must be completed according
to section 245I.10, subdivisions 7 and 8new text end .
Sec. 34.
Minnesota Statutes 2020, section 245.4871, subdivision 26, is amended to read:
Subd. 26.
Mental health practitioner.
"Mental health practitioner" deleted text begin has the meaning
given in section 245.462, subdivision 17deleted text end new text begin means a staff person who is qualified according
to section 245I.04, subdivision 4new text end .
Sec. 35.
Minnesota Statutes 2020, section 245.4871, subdivision 27, is amended to read:
Subd. 27.
Mental health professional.
"Mental health professional" means a new text begin staff new text end person
deleted text begin providing clinical services in the diagnosis and treatment of children's emotional disorders.
A mental health professional must have training and experience in working with children
consistent with the age group to which the mental health professional is assigned. A mental
health professional must be qualified in at least one of the following ways:deleted text end new text begin who is qualified
according to section 245I.04, subdivision 2.
new text end
deleted text begin
(1) in psychiatric nursing, the mental health professional must be a registered nurse who
is licensed under sections 148.171 to 148.285 and who is certified as a clinical specialist in
child and adolescent psychiatric or mental health nursing by a national nurse certification
organization or who has a master's degree in nursing or one of the behavioral sciences or
related fields from an accredited college or university or its equivalent, with at least 4,000
hours of post-master's supervised experience in the delivery of clinical services in the
treatment of mental illness;
deleted text end
deleted text begin
(2) in clinical social work, the mental health professional must be a person licensed as
an independent clinical social worker under chapter 148D, or a person with a master's degree
in social work from an accredited college or university, with at least 4,000 hours of
post-master's supervised experience in the delivery of clinical services in the treatment of
mental disorders;
deleted text end
deleted text begin
(3) in psychology, the mental health professional must be an individual licensed by the
board of psychology under sections 148.88 to 148.98 who has stated to the board of
psychology competencies in the diagnosis and treatment of mental disorders;
deleted text end
deleted text begin
(4) in psychiatry, the mental health professional must be a physician licensed under
chapter 147 and certified by the American Board of Psychiatry and Neurology or eligible
for board certification in psychiatry or an osteopathic physician licensed under chapter 147
and certified by the American Osteopathic Board of Neurology and Psychiatry or eligible
for board certification in psychiatry;
deleted text end
deleted text begin
(5) in marriage and family therapy, the mental health professional must be a marriage
and family therapist licensed under sections 148B.29 to 148B.39 with at least two years of
post-master's supervised experience in the delivery of clinical services in the treatment of
mental disorders or emotional disturbances;
deleted text end
deleted text begin
(6) in licensed professional clinical counseling, the mental health professional shall be
a licensed professional clinical counselor under section 148B.5301 with at least 4,000 hours
of post-master's supervised experience in the delivery of clinical services in the treatment
of mental disorders or emotional disturbances; or
deleted text end
deleted text begin
(7) in allied fields, the mental health professional must be a person with a master's degree
from an accredited college or university in one of the behavioral sciences or related fields,
with at least 4,000 hours of post-master's supervised experience in the delivery of clinical
services in the treatment of emotional disturbances.
deleted text end
Sec. 36.
Minnesota Statutes 2020, section 245.4871, subdivision 29, is amended to read:
Subd. 29.
Outpatient services.
"Outpatient services" means mental health services,
excluding day treatment and community support services programs, provided by or under
the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional to children with emotional
disturbances who live outside a hospital. Outpatient services include clinical activities such
as individual, group, and family therapy; individual treatment planning; diagnostic
assessments; medication management; and psychological testing.
Sec. 37.
Minnesota Statutes 2020, section 245.4871, subdivision 31, is amended to read:
Subd. 31.
Professional home-based family treatment.
"Professional home-based family
treatment" means intensive mental health services provided to children because of an
emotional disturbance (1) who are at risk of out-of-home placement; (2) who are in
out-of-home placement; or (3) who are returning from out-of-home placement. Services
are provided to the child and the child's family primarily in the child's home environment.
Services may also be provided in the child's school, child care setting, or other community
setting appropriate to the child. Services must be provided on an individual family basis,
must be child-oriented and family-oriented, and must be designed using information from
diagnostic and functional assessments to meet the specific mental health needs of the child
and the child's family. Examples of services are: (1) individual therapy; (2) family therapy;
(3) client outreach; (4) assistance in developing individual living skills; (5) assistance in
developing parenting skills necessary to address the needs of the child; (6) assistance with
leisure and recreational services; (7) crisis deleted text begin assistancedeleted text end new text begin planningnew text end , including crisis respite care
and arranging for crisis placement; and (8) assistance in locating respite and child care.
Services must be coordinated with other services provided to the child and family.
Sec. 38.
Minnesota Statutes 2020, section 245.4871, subdivision 32, is amended to read:
Subd. 32.
Residential treatment.
"Residential treatment" means a 24-hour-a-day program
under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional, in a community
residential setting other than an acute care hospital or regional treatment center inpatient
unit, that must be licensed as a residential treatment program for children with emotional
disturbances under Minnesota Rules, parts 2960.0580 to 2960.0700, or other rules adopted
by the commissioner.
Sec. 39.
Minnesota Statutes 2020, section 245.4871, subdivision 34, is amended to read:
Subd. 34.
Therapeutic support of foster care.
"Therapeutic support of foster care"
means the mental health training and mental health support services and deleted text begin clinicaldeleted text end new text begin treatmentnew text end
supervision provided by a mental health professional to foster families caring for children
with severe emotional disturbance to provide a therapeutic family environment and support
for the child's improved functioning.new text begin Therapeutic support of foster care includes services
provided under section 256B.0946.
new text end
Sec. 40.
Minnesota Statutes 2020, section 245.4871, is amended by adding a subdivision
to read:
new text begin Subd. 36. new text end
new text begin Treatment supervision. new text end
new text begin
"Treatment supervision" means the treatment
supervision described by section 245I.06.
new text end
Sec. 41.
Minnesota Statutes 2020, section 245.4876, subdivision 2, is amended to read:
Subd. 2.
Diagnostic assessment.
deleted text begin
All residential treatment facilities and acute care
hospital inpatient treatment facilities that provide mental health services for children must
complete a diagnostic assessment for each of their child clients within five working days
of admission. Providers of day treatment services for children must complete a diagnostic
assessment within five days after the child's second visit or 30 days after intake, whichever
occurs first. In cases where a diagnostic assessment is available and has been completed
within 180 days preceding admission, only updating is necessary. "Updating" means a
written summary by a mental health professional of the child's current mental health status
and service needs. If the child's mental health status has changed markedly since the child's
most recent diagnostic assessment, a new diagnostic assessment is required. Compliance
with the provisions of this subdivision does not ensure eligibility for medical assistance
reimbursement under chapter 256B.
deleted text end
new text begin
Providers of services governed by this section shall
complete a diagnostic assessment according to the standards of section 245I.10, subdivisions
4 to 6.
new text end
Sec. 42.
Minnesota Statutes 2020, section 245.4876, subdivision 3, is amended to read:
Subd. 3.
Individual treatment plans.
deleted text begin
All providers of outpatient services, day treatment
services, professional home-based family treatment, residential treatment, and acute care
hospital inpatient treatment, and all regional treatment centers that provide mental health
services for children must develop an individual treatment plan for each child client. The
individual treatment plan must be based on a diagnostic assessment. To the extent appropriate,
the child and the child's family shall be involved in all phases of developing and
implementing the individual treatment plan. Providers of residential treatment, professional
home-based family treatment, and acute care hospital inpatient treatment, and regional
treatment centers must develop the individual treatment plan within ten working days of
client intake or admission and must review the individual treatment plan every 90 days after
intake, except that the administrative review of the treatment plan of a child placed in a
residential facility shall be as specified in sections 260C.203 and 260C.212, subdivision 9.
Providers of day treatment services must develop the individual treatment plan before the
completion of five working days in which service is provided or within 30 days after the
diagnostic assessment is completed or obtained, whichever occurs first. Providers of
outpatient services must develop the individual treatment plan within 30 days after the
diagnostic assessment is completed or obtained or by the end of the second session of an
outpatient service, not including the session in which the diagnostic assessment was provided,
whichever occurs first. Providers of outpatient and day treatment services must review the
individual treatment plan every 90 days after intake.
deleted text end
new text begin
Providers of services governed by this
section shall complete an individual treatment plan according to the standards of section
245I.10, subdivisions 7 and 8.
new text end
Sec. 43.
Minnesota Statutes 2020, section 245.488, subdivision 1, is amended to read:
Subdivision 1.
Availability of outpatient services.
(a) County boards must provide or
contract for enough outpatient services within the county to meet the needs of each child
with emotional disturbance residing in the county and the child's family. Services may be
provided directly by the county through county-operated deleted text begin mental health centers ordeleted text end mental
health clinics deleted text begin approved by the commissioner under section 245.69, subdivision 2deleted text end new text begin meeting
the standards of chapter 245Inew text end ; by contract with privately operated deleted text begin mental health centers ordeleted text end
mental health clinics deleted text begin approved by the commissioner under section 245.69, subdivision 2deleted text end new text begin
meeting the standards of chapter 245Inew text end ; by contract with hospital mental health outpatient
programs certified by the Joint Commission on Accreditation of Hospital Organizations;
or by contract with a deleted text begin licenseddeleted text end mental health professional deleted text begin as defined in section 245.4871,
subdivision 27, clauses (1) to (6)deleted text end . A child or a child's parent may be required to pay a fee
based in accordance with section 245.481. Outpatient services include:
(1) conducting diagnostic assessments;
(2) conducting psychological testing;
(3) developing or modifying individual treatment plans;
(4) making referrals and recommending placements as appropriate;
(5) treating the child's mental health needs through therapy; and
(6) prescribing and managing medication and evaluating the effectiveness of prescribed
medication.
(b) County boards may request a waiver allowing outpatient services to be provided in
a nearby trade area if it is determined that the child requires necessary and appropriate
services that are only available outside the county.
(c) Outpatient services offered by the county board to prevent placement must be at the
level of treatment appropriate to the child's diagnostic assessment.
Sec. 44.
Minnesota Statutes 2020, section 245.4901, subdivision 2, is amended to read:
Subd. 2.
Eligible applicants.
An eligible applicant for school-linked mental health grants
is an entity that is:
(1) new text begin a mental health clinic new text end certified under deleted text begin Minnesota Rules, parts 9520.0750 to 9520.0870deleted text end new text begin
section 245I.20new text end ;
(2) a community mental health center under section 256B.0625, subdivision 5;
(3) an Indian health service facility or a facility owned and operated by a tribe or tribal
organization operating under United States Code, title 25, section 5321;
(4) a provider of children's therapeutic services and supports as defined in section
256B.0943; or
(5) enrolled in medical assistance as a mental health or substance use disorder provider
agency and employs at least two full-time equivalent mental health professionals qualified
according to section deleted text begin 245I.16deleted text end new text begin 245I.04new text end , subdivision 2, or two alcohol and drug counselors
licensed or exempt from licensure under chapter 148F who are qualified to provide clinical
services to children and families.
Sec. 45.
Minnesota Statutes 2020, section 245.62, subdivision 2, is amended to read:
Subd. 2.
Definition.
A community mental health center is a private nonprofit corporation
or public agency approved under the deleted text begin rules promulgated by the commissioner pursuant to
subdivision 4deleted text end new text begin standards of section 256B.0625, subdivision 5new text end .
Sec. 46.
Minnesota Statutes 2020, section 245.735, subdivision 3, is amended to read:
Subd. 3.
Certified community behavioral health clinics.
(a) The commissioner shall
establish a state certification process for certified community behavioral health clinics
(CCBHCs). Entities that choose to be CCBHCs must:
(1) comply with the CCBHC criteria published by the United States Department of
Health and Human Services;
(2) employ or contract for clinic staff who have backgrounds in diverse disciplines,
including licensed mental health professionals and licensed alcohol and drug counselors,
and staff who are culturally and linguistically trained to meet the needs of the population
the clinic serves;
(3) ensure that clinic services are available and accessible to individuals and families of
all ages and genders and that crisis management services are available 24 hours per day;
(4) establish fees for clinic services for individuals who are not enrolled in medical
assistance using a sliding fee scale that ensures that services to patients are not denied or
limited due to an individual's inability to pay for services;
(5) comply with quality assurance reporting requirements and other reporting
requirements, including any required reporting of encounter data, clinical outcomes data,
and quality data;
(6) provide crisis mental health and substance use services, withdrawal management
services, emergency crisis intervention services, and stabilization services; screening,
assessment, and diagnosis services, including risk assessments and level of care
determinations; person- and family-centered treatment planning; outpatient mental health
and substance use services; targeted case management; psychiatric rehabilitation services;
peer support and counselor services and family support services; and intensive
community-based mental health services, including mental health services for members of
the armed forces and veterans;
(7) provide coordination of care across settings and providers to ensure seamless
transitions for individuals being served across the full spectrum of health services, including
acute, chronic, and behavioral needs. Care coordination may be accomplished through
partnerships or formal contracts with:
(i) counties, health plans, pharmacists, pharmacies, rural health clinics, federally qualified
health centers, inpatient psychiatric facilities, substance use and detoxification facilities, or
community-based mental health providers; and
(ii) other community services, supports, and providers, including schools, child welfare
agencies, juvenile and criminal justice agencies, Indian health services clinics, tribally
licensed health care and mental health facilities, urban Indian health clinics, Department of
Veterans Affairs medical centers, outpatient clinics, drop-in centers, acute care hospitals,
and hospital outpatient clinics;
(8) be deleted text begin certified asdeleted text end mental health clinics deleted text begin under section 245.69, subdivision 2deleted text end new text begin meeting the
standards of chapter 245Inew text end ;
(9) deleted text begin comply with standards relating to mental health services in Minnesota Rules, parts
9505.0370 to 9505.0372deleted text end new text begin be a co-occurring disorder specialistnew text end ;
(10) be licensed to provide substance use disorder treatment under chapter 245G;
(11) be certified to provide children's therapeutic services and supports under section
256B.0943;
(12) be certified to provide adult rehabilitative mental health services under section
256B.0623;
(13) be enrolled to provide mental health crisis response services under deleted text begin sectionsdeleted text end new text begin sectionnew text end
256B.0624 deleted text begin and 256B.0944deleted text end ;
(14) be enrolled to provide mental health targeted case management under section
256B.0625, subdivision 20;
(15) comply with standards relating to mental health case management in Minnesota
Rules, parts 9520.0900 to 9520.0926;
(16) provide services that comply with the evidence-based practices described in
paragraph (e); and
(17) comply with standards relating to peer services under sections 256B.0615,
256B.0616, and 245G.07, subdivision 1, paragraph (a), clause (5), as applicable when peer
services are provided.
(b) If an entity is unable to provide one or more of the services listed in paragraph (a),
clauses (6) to (17), the commissioner may certify the entity as a CCBHC, if the entity has
a current contract with another entity that has the required authority to provide that service
and that meets federal CCBHC criteria as a designated collaborating organization, or, to
the extent allowed by the federal CCBHC criteria, the commissioner may approve a referral
arrangement. The CCBHC must meet federal requirements regarding the type and scope of
services to be provided directly by the CCBHC.
(c) Notwithstanding any other law that requires a county contract or other form of county
approval for certain services listed in paragraph (a), clause (6), a clinic that otherwise meets
CCBHC requirements may receive the prospective payment under section 256B.0625,
subdivision 5m, for those services without a county contract or county approval. As part of
the certification process in paragraph (a), the commissioner shall require a letter of support
from the CCBHC's host county confirming that the CCBHC and the county or counties it
serves have an ongoing relationship to facilitate access and continuity of care, especially
for individuals who are uninsured or who may go on and off medical assistance.
(d) When the standards listed in paragraph (a) or other applicable standards conflict or
address similar issues in duplicative or incompatible ways, the commissioner may grant
variances to state requirements if the variances do not conflict with federal requirements.
If standards overlap, the commissioner may substitute all or a part of a licensure or
certification that is substantially the same as another licensure or certification. The
commissioner shall consult with stakeholders, as described in subdivision 4, before granting
variances under this provision. For the CCBHC that is certified but not approved for
prospective payment under section 256B.0625, subdivision 5m, the commissioner may
grant a variance under this paragraph if the variance does not increase the state share of
costs.
(e) The commissioner shall issue a list of required evidence-based practices to be
delivered by CCBHCs, and may also provide a list of recommended evidence-based practices.
The commissioner may update the list to reflect advances in outcomes research and medical
services for persons living with mental illnesses or substance use disorders. The commissioner
shall take into consideration the adequacy of evidence to support the efficacy of the practice,
the quality of workforce available, and the current availability of the practice in the state.
At least 30 days before issuing the initial list and any revisions, the commissioner shall
provide stakeholders with an opportunity to comment.
(f) The commissioner shall recertify CCBHCs at least every three years. The
commissioner shall establish a process for decertification and shall require corrective action,
medical assistance repayment, or decertification of a CCBHC that no longer meets the
requirements in this section or that fails to meet the standards provided by the commissioner
in the application and certification process.
Sec. 47.
Minnesota Statutes 2020, section 245A.04, subdivision 5, is amended to read:
Subd. 5.
Commissioner's right of access.
(a) When the commissioner is exercising the
powers conferred by this chapter, deleted text begin sections 245.69 anddeleted text end new text begin sectionnew text end 626.557, and chapter 260E,
the commissioner must be given access to:
(1) the physical plant and grounds where the program is provided;
(2) documents and records, including records maintained in electronic format;
(3) persons served by the program; and
(4) staff and personnel records of current and former staff whenever the program is in
operation and the information is relevant to inspections or investigations conducted by the
commissioner. Upon request, the license holder must provide the commissioner verification
of documentation of staff work experience, training, or educational requirements.
The commissioner must be given access without prior notice and as often as the
commissioner considers necessary if the commissioner is investigating alleged maltreatment,
conducting a licensing inspection, or investigating an alleged violation of applicable laws
or rules. In conducting inspections, the commissioner may request and shall receive assistance
from other state, county, and municipal governmental agencies and departments. The
applicant or license holder shall allow the commissioner to photocopy, photograph, and
make audio and video tape recordings during the inspection of the program at the
commissioner's expense. The commissioner shall obtain a court order or the consent of the
subject of the records or the parents or legal guardian of the subject before photocopying
hospital medical records.
(b) Persons served by the program have the right to refuse to consent to be interviewed,
photographed, or audio or videotaped. Failure or refusal of an applicant or license holder
to fully comply with this subdivision is reasonable cause for the commissioner to deny the
application or immediately suspend or revoke the license.
Sec. 48.
Minnesota Statutes 2020, section 245A.10, subdivision 4, is amended to read:
Subd. 4.
License or certification fee for certain programs.
(a) Child care centers shall
pay an annual nonrefundable license fee based on the following schedule:
| Licensed Capacity |
Child Care Center License Fee |
|
| 1 to 24 persons |
$200 |
|
| 25 to 49 persons |
$300 |
|
| 50 to 74 persons |
$400 |
|
| 75 to 99 persons |
$500 |
|
| 100 to 124 persons |
$600 |
|
| 125 to 149 persons |
$700 |
|
| 150 to 174 persons |
$800 |
|
| 175 to 199 persons |
$900 |
|
| 200 to 224 persons |
$1,000 |
|
| 225 or more persons |
$1,100 |
(b)(1) A program licensed to provide one or more of the home and community-based
services and supports identified under chapter 245D to persons with disabilities or age 65
and older, shall pay an annual nonrefundable license fee based on revenues derived from
the provision of services that would require licensure under chapter 245D during the calendar
year immediately preceding the year in which the license fee is paid, according to the
following schedule:
| License Holder Annual Revenue |
License Fee |
|
| less than or equal to $10,000 |
$200 |
|
| greater than $10,000 but less than or equal to $25,000 |
$300 |
|
| greater than $25,000 but less than or equal to $50,000 |
$400 |
|
| greater than $50,000 but less than or equal to $100,000 |
$500 |
|
| greater than $100,000 but less than or equal to $150,000 |
$600 |
|
| greater than $150,000 but less than or equal to $200,000 |
$800 |
|
| greater than $200,000 but less than or equal to $250,000 |
$1,000 |
|
| greater than $250,000 but less than or equal to $300,000 |
$1,200 |
|
| greater than $300,000 but less than or equal to $350,000 |
$1,400 |
|
| greater than $350,000 but less than or equal to $400,000 |
$1,600 |
|
| greater than $400,000 but less than or equal to $450,000 |
$1,800 |
|
| greater than $450,000 but less than or equal to $500,000 |
$2,000 |
|
| greater than $500,000 but less than or equal to $600,000 |
$2,250 |
|
| greater than $600,000 but less than or equal to $700,000 |
$2,500 |
|
| greater than $700,000 but less than or equal to $800,000 |
$2,750 |
|
| greater than $800,000 but less than or equal to $900,000 |
$3,000 |
|
| greater than $900,000 but less than or equal to $1,000,000 |
$3,250 |
|
| greater than $1,000,000 but less than or equal to $1,250,000 |
$3,500 |
|
| greater than $1,250,000 but less than or equal to $1,500,000 |
$3,750 |
|
| greater than $1,500,000 but less than or equal to $1,750,000 |
$4,000 |
|
| greater than $1,750,000 but less than or equal to $2,000,000 |
$4,250 |
|
| greater than $2,000,000 but less than or equal to $2,500,000 |
$4,500 |
|
| greater than $2,500,000 but less than or equal to $3,000,000 |
$4,750 |
|
| greater than $3,000,000 but less than or equal to $3,500,000 |
$5,000 |
|
| greater than $3,500,000 but less than or equal to $4,000,000 |
$5,500 |
|
| greater than $4,000,000 but less than or equal to $4,500,000 |
$6,000 |
|
| greater than $4,500,000 but less than or equal to $5,000,000 |
$6,500 |
|
| greater than $5,000,000 but less than or equal to $7,500,000 |
$7,000 |
|
| greater than $7,500,000 but less than or equal to $10,000,000 |
$8,500 |
|
| greater than $10,000,000 but less than or equal to $12,500,000 |
$10,000 |
|
| greater than $12,500,000 but less than or equal to $15,000,000 |
$14,000 |
|
| greater than $15,000,000 |
$18,000 |
(2) If requested, the license holder shall provide the commissioner information to verify
the license holder's annual revenues or other information as needed, including copies of
documents submitted to the Department of Revenue.
(3) At each annual renewal, a license holder may elect to pay the highest renewal fee,
and not provide annual revenue information to the commissioner.
(4) A license holder that knowingly provides the commissioner incorrect revenue amounts
for the purpose of paying a lower license fee shall be subject to a civil penalty in the amount
of double the fee the provider should have paid.
(5) Notwithstanding clause (1), a license holder providing services under one or more
licenses under chapter 245B that are in effect on May 15, 2013, shall pay an annual license
fee for calendar years 2014, 2015, and 2016, equal to the total license fees paid by the license
holder for all licenses held under chapter 245B for calendar year 2013. For calendar year
2017 and thereafter, the license holder shall pay an annual license fee according to clause
(1).
(c) A chemical dependency treatment program licensed under chapter 245G, to provide
chemical dependency treatment shall pay an annual nonrefundable license fee based on the
following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$600 |
|
| 25 to 49 persons |
$800 |
|
| 50 to 74 persons |
$1,000 |
|
| 75 to 99 persons |
$1,200 |
|
| 100 or more persons |
$1,400 |
(d) A chemical dependency program licensed under Minnesota Rules, parts 9530.6510
to 9530.6590, to provide detoxification services shall pay an annual nonrefundable license
fee based on the following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$760 |
|
| 25 to 49 persons |
$960 |
|
| 50 or more persons |
$1,160 |
(e) Except for child foster care, a residential facility licensed under Minnesota Rules,
chapter 2960, to serve children shall pay an annual nonrefundable license fee based on the
following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$1,000 |
|
| 25 to 49 persons |
$1,100 |
|
| 50 to 74 persons |
$1,200 |
|
| 75 to 99 persons |
$1,300 |
|
| 100 or more persons |
$1,400 |
(f) A residential facility licensed under new text begin section 245I.23 or new text end Minnesota Rules, parts
9520.0500 to 9520.0670, to serve persons with mental illness shall pay an annual
nonrefundable license fee based on the following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$2,525 |
|
| 25 or more persons |
$2,725 |
(g) A residential facility licensed under Minnesota Rules, parts 9570.2000 to 9570.3400,
to serve persons with physical disabilities shall pay an annual nonrefundable license fee
based on the following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$450 |
|
| 25 to 49 persons |
$650 |
|
| 50 to 74 persons |
$850 |
|
| 75 to 99 persons |
$1,050 |
|
| 100 or more persons |
$1,250 |
(h) A program licensed to provide independent living assistance for youth under section
245A.22 shall pay an annual nonrefundable license fee of $1,500.
(i) A private agency licensed to provide foster care and adoption services under Minnesota
Rules, parts 9545.0755 to 9545.0845, shall pay an annual nonrefundable license fee of $875.
(j) A program licensed as an adult day care center licensed under Minnesota Rules, parts
9555.9600 to 9555.9730, shall pay an annual nonrefundable license fee based on the
following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$500 |
|
| 25 to 49 persons |
$700 |
|
| 50 to 74 persons |
$900 |
|
| 75 to 99 persons |
$1,100 |
|
| 100 or more persons |
$1,300 |
(k) A program licensed to provide treatment services to persons with sexual psychopathic
personalities or sexually dangerous persons under Minnesota Rules, parts 9515.3000 to
9515.3110, shall pay an annual nonrefundable license fee of $20,000.
(l) A deleted text begin mental health center ordeleted text end mental health clinic deleted text begin requesting certification for purposes
of insurance and subscriber contract reimbursement under Minnesota Rules, parts 9520.0750
to 9520.0870deleted text end new text begin certified under section 245I.20new text end deleted text begin ,deleted text end shall pay deleted text begin adeleted text end new text begin an annual nonrefundablenew text end certification
fee of $1,550 deleted text begin per yeardeleted text end . If the deleted text begin mentaldeleted text end deleted text begin health center ordeleted text end mental health clinic provides services
at a primary location with satellite facilities, the satellite facilities shall be certified with the
primary location without an additional charge.
Sec. 49.
Minnesota Statutes 2020, section 245A.65, subdivision 2, is amended to read:
Subd. 2.
Abuse prevention plans.
All license holders shall establish and enforce ongoing
written program abuse prevention plans and individual abuse prevention plans as required
under section 626.557, subdivision 14.
(a) The scope of the program abuse prevention plan is limited to the population, physical
plant, and environment within the control of the license holder and the location where
licensed services are provided. In addition to the requirements in section 626.557, subdivision
14, the program abuse prevention plan shall meet the requirements in clauses (1) to (5).
(1) The assessment of the population shall include an evaluation of the following factors:
age, gender, mental functioning, physical and emotional health or behavior of the client;
the need for specialized programs of care for clients; the need for training of staff to meet
identified individual needs; and the knowledge a license holder may have regarding previous
abuse that is relevant to minimizing risk of abuse for clients.
(2) The assessment of the physical plant where the licensed services are provided shall
include an evaluation of the following factors: the condition and design of the building as
it relates to the safety of the clients; and the existence of areas in the building which are
difficult to supervise.
(3) The assessment of the environment for each facility and for each site when living
arrangements are provided by the agency shall include an evaluation of the following factors:
the location of the program in a particular neighborhood or community; the type of grounds
and terrain surrounding the building; the type of internal programming; and the program's
staffing patterns.
(4) The license holder shall provide an orientation to the program abuse prevention plan
for clients receiving services. If applicable, the client's legal representative must be notified
of the orientation. The license holder shall provide this orientation for each new person
within 24 hours of admission, or for persons who would benefit more from a later orientation,
the orientation may take place within 72 hours.
(5) The license holder's governing body or the governing body's delegated representative
shall review the plan at least annually using the assessment factors in the plan and any
substantiated maltreatment findings that occurred since the last review. The governing body
or the governing body's delegated representative shall revise the plan, if necessary, to reflect
the review results.
(6) A copy of the program abuse prevention plan shall be posted in a prominent location
in the program and be available upon request to mandated reporters, persons receiving
services, and legal representatives.
(b) In addition to the requirements in section 626.557, subdivision 14, the individual
abuse prevention plan shall meet the requirements in clauses (1) and (2).
(1) The plan shall include a statement of measures that will be taken to minimize the
risk of abuse to the vulnerable adult when the individual assessment required in section
626.557, subdivision 14, paragraph (b), indicates the need for measures in addition to the
specific measures identified in the program abuse prevention plan. The measures shall
include the specific actions the program will take to minimize the risk of abuse within the
scope of the licensed services, and will identify referrals made when the vulnerable adult
is susceptible to abuse outside the scope or control of the licensed services. When the
assessment indicates that the vulnerable adult does not need specific risk reduction measures
in addition to those identified in the program abuse prevention plan, the individual abuse
prevention plan shall document this determination.
(2) An individual abuse prevention plan shall be developed for each new person as part
of the initial individual program plan or service plan required under the applicable licensing
rulenew text begin or statutenew text end . The review and evaluation of the individual abuse prevention plan shall be
done as part of the review of the program plan deleted text begin ordeleted text end new text begin ,new text end service plannew text begin , or treatment plannew text end . The person
receiving services shall participate in the development of the individual abuse prevention
plan to the full extent of the person's abilities. If applicable, the person's legal representative
shall be given the opportunity to participate with or for the person in the development of
the plan. The interdisciplinary team shall document the review of all abuse prevention plans
at least annually, using the individual assessment and any reports of abuse relating to the
person. The plan shall be revised to reflect the results of this review.
Sec. 50.
Minnesota Statutes 2020, section 245D.02, subdivision 20, is amended to read:
Subd. 20.
Mental health crisis intervention team.
"Mental health crisis intervention
team" means a mental health crisis response provider as identified in section 256B.0624deleted text begin ,
subdivision 2, paragraph (d), for adults, and in section 256B.0944, subdivision 1, paragraph
(d), for childrendeleted text end .
Sec. 51.
Minnesota Statutes 2020, section 254B.05, subdivision 5, is amended to read:
Subd. 5.
Rate requirements.
(a) The commissioner shall establish rates for substance
use disorder services and service enhancements funded under this chapter.
(b) Eligible substance use disorder treatment services include:
(1) outpatient treatment services that are licensed according to sections 245G.01 to
245G.17, or applicable tribal license;
(2) comprehensive assessments provided according to sections 245.4863, paragraph (a),
and 245G.05;
(3) care coordination services provided according to section 245G.07, subdivision 1,
paragraph (a), clause (5);
(4) peer recovery support services provided according to section 245G.07, subdivision
2, clause (8);
(5) on July 1, 2019, or upon federal approval, whichever is later, withdrawal management
services provided according to chapter 245F;
(6) medication-assisted therapy services that are licensed according to sections 245G.01
to 245G.17 and 245G.22, or applicable tribal license;
(7) medication-assisted therapy plus enhanced treatment services that meet the
requirements of clause (6) and provide nine hours of clinical services each week;
(8) high, medium, and low intensity residential treatment services that are licensed
according to sections 245G.01 to 245G.17 and 245G.21 or applicable tribal license which
provide, respectively, 30, 15, and five hours of clinical services each week;
(9) hospital-based treatment services that are licensed according to sections 245G.01 to
245G.17 or applicable tribal license and licensed as a hospital under sections 144.50 to
144.56;
(10) adolescent treatment programs that are licensed as outpatient treatment programs
according to sections 245G.01 to 245G.18 or as residential treatment programs according
to Minnesota Rules, parts 2960.0010 to 2960.0220, and 2960.0430 to 2960.0490, or
applicable tribal license;
(11) high-intensity residential treatment services that are licensed according to sections
245G.01 to 245G.17 and 245G.21 or applicable tribal license, which provide 30 hours of
clinical services each week provided by a state-operated vendor or to clients who have been
civilly committed to the commissioner, present the most complex and difficult care needs,
and are a potential threat to the community; and
(12) room and board facilities that meet the requirements of subdivision 1a.
(c) The commissioner shall establish higher rates for programs that meet the requirements
of paragraph (b) and one of the following additional requirements:
(1) programs that serve parents with their children if the program:
(i) provides on-site child care during the hours of treatment activity that:
(A) is licensed under chapter 245A as a child care center under Minnesota Rules, chapter
9503; or
(B) meets the licensure exclusion criteria of section 245A.03, subdivision 2, paragraph
(a), clause (6), and meets the requirements under section 245G.19, subdivision 4; or
(ii) arranges for off-site child care during hours of treatment activity at a facility that is
licensed under chapter 245A as:
(A) a child care center under Minnesota Rules, chapter 9503; or
(B) a family child care home under Minnesota Rules, chapter 9502;
(2) culturally specific programs as defined in section 254B.01, subdivision 4a, or
programs or subprograms serving special populations, if the program or subprogram meets
the following requirements:
(i) is designed to address the unique needs of individuals who share a common language,
racial, ethnic, or social background;
(ii) is governed with significant input from individuals of that specific background; and
(iii) employs individuals to provide individual or group therapy, at least 50 percent of
whom are of that specific background, except when the common social background of the
individuals served is a traumatic brain injury or cognitive disability and the program employs
treatment staff who have the necessary professional training, as approved by the
commissioner, to serve clients with the specific disabilities that the program is designed to
serve;
(3) programs that offer medical services delivered by appropriately credentialed health
care staff in an amount equal to two hours per client per week if the medical needs of the
client and the nature and provision of any medical services provided are documented in the
client file; and
(4) programs that offer services to individuals with co-occurring mental health and
chemical dependency problems if:
(i) the program meets the co-occurring requirements in section 245G.20;
(ii) 25 percent of the counseling staff are deleted text begin licenseddeleted text end mental health professionalsdeleted text begin , as defined
in section 245.462, subdivision 18, clauses (1) to (6)deleted text end new text begin qualified according to section 245I.04,
subdivision 2new text end , or are students or licensing candidates under the supervision of a licensed
alcohol and drug counselor supervisor and deleted text begin licenseddeleted text end mental health professional, except that
no more than 50 percent of the mental health staff may be students or licensing candidates
with time documented to be directly related to provisions of co-occurring services;
(iii) clients scoring positive on a standardized mental health screen receive a mental
health diagnostic assessment within ten days of admission;
(iv) the program has standards for multidisciplinary case review that include a monthly
review for each client that, at a minimum, includes a deleted text begin licenseddeleted text end mental health professional
and licensed alcohol and drug counselor, and their involvement in the review is documented;
(v) family education is offered that addresses mental health and substance abuse disorders
and the interaction between the two; and
(vi) co-occurring counseling staff shall receive eight hours of co-occurring disorder
training annually.
(d) In order to be eligible for a higher rate under paragraph (c), clause (1), a program
that provides arrangements for off-site child care must maintain current documentation at
the chemical dependency facility of the child care provider's current licensure to provide
child care services. Programs that provide child care according to paragraph (c), clause (1),
must be deemed in compliance with the licensing requirements in section 245G.19.
(e) Adolescent residential programs that meet the requirements of Minnesota Rules,
parts 2960.0430 to 2960.0490 and 2960.0580 to 2960.0690, are exempt from the requirements
in paragraph (c), clause (4), items (i) to (iv).
(f) Subject to federal approval, chemical dependency services that are otherwise covered
as direct face-to-face services may be provided via two-way interactive video. The use of
two-way interactive video must be medically appropriate to the condition and needs of the
person being served. Reimbursement shall be at the same rates and under the same conditions
that would otherwise apply to direct face-to-face services. The interactive video equipment
and connection must comply with Medicare standards in effect at the time the service is
provided.
(g) For the purpose of reimbursement under this section, substance use disorder treatment
services provided in a group setting without a group participant maximum or maximum
client to staff ratio under chapter 245G shall not exceed a client to staff ratio of 48 to one.
At least one of the attending staff must meet the qualifications as established under this
chapter for the type of treatment service provided. A recovery peer may not be included as
part of the staff ratio.
Sec. 52.
Minnesota Statutes 2020, section 256B.0615, subdivision 1, is amended to read:
Subdivision 1.
Scope.
Medical assistance covers mental health certified peer specialist
services, as established in subdivision 2, subject to federal approval, if provided to recipients
who are eligible for services under sections 256B.0622, 256B.0623, and 256B.0624 and
are provided by a new text begin mental health new text end certified peer specialist who has completed the training
under subdivision 5new text begin and is qualified according to section 245I.04, subdivision 10new text end .
Sec. 53.
Minnesota Statutes 2020, section 256B.0615, subdivision 5, is amended to read:
Subd. 5.
Certified peer specialist training and certification.
The commissioner of
human services shall develop a training and certification process for certified peer specialistsdeleted text begin ,
who must be at least 21 years of agedeleted text end . The candidates must have had a primary diagnosis of
mental illness, be a current or former consumer of mental health services, and must
demonstrate leadership and advocacy skills and a strong dedication to recovery. The training
curriculum must teach participating consumers specific skills relevant to providing peer
support to other consumers. In addition to initial training and certification, the commissioner
shall develop ongoing continuing educational workshops on pertinent issues related to peer
support counseling.
Sec. 54.
Minnesota Statutes 2020, section 256B.0616, subdivision 1, is amended to read:
Subdivision 1.
Scope.
Medical assistance covers mental health certified family peer
specialists services, as established in subdivision 2, subject to federal approval, if provided
to recipients who have an emotional disturbance or severe emotional disturbance under
chapter 245, and are provided by a new text begin mental health new text end certified family peer specialist who has
completed the training under subdivision 5new text begin and is qualified according to section 245I.04,
subdivision 12new text end . A family peer specialist cannot provide services to the peer specialist's
family.
Sec. 55.
Minnesota Statutes 2020, section 256B.0616, subdivision 3, is amended to read:
Subd. 3.
Eligibility.
Family peer support services may be deleted text begin located indeleted text end new text begin provided to recipients
ofnew text end inpatient hospitalization, partial hospitalization, residential treatment, new text begin intensive new text end treatment
new text begin in new text end foster care, day treatment, children's therapeutic services and supports, or crisis services.
Sec. 56.
Minnesota Statutes 2020, section 256B.0616, subdivision 5, is amended to read:
Subd. 5.
Certified family peer specialist training and certification.
The commissioner
shall develop a training and certification process for certified family peer specialists deleted text begin who
must be at least 21 years of agedeleted text end . The candidates must have raised or be currently raising a
child with a mental illness, have had experience navigating the children's mental health
system, and must demonstrate leadership and advocacy skills and a strong dedication to
family-driven and family-focused services. The training curriculum must teach participating
family peer specialists specific skills relevant to providing peer support to other parents. In
addition to initial training and certification, the commissioner shall develop ongoing
continuing educational workshops on pertinent issues related to family peer support
counseling.
Sec. 57.
Minnesota Statutes 2020, section 256B.0622, subdivision 1, is amended to read:
Subdivision 1.
Scope.
new text begin (a) new text end Subject to federal approval, medical assistance covers medically
necessary, assertive community treatment deleted text begin for clients as defined in subdivision 2a and
intensive residential treatment services for clients as defined in subdivision 3,deleted text end when the
services are provided by an entity new text begin certified under and new text end meeting the standards in this section.
new text begin
(b) Subject to federal approval, medical assistance covers medically necessary, intensive
residential treatment services when the services are provided by an entity licensed under
and meeting the standards in section 245I.23.
new text end
new text begin
(c) The provider entity must make reasonable and good faith efforts to report individual
client outcomes to the commissioner, using instruments and protocols approved by the
commissioner.
new text end
Sec. 58.
Minnesota Statutes 2020, section 256B.0622, subdivision 2, is amended to read:
Subd. 2.
Definitions.
(a) For purposes of this section, the following terms have the
meanings given them.
(b) "ACT team" means the group of interdisciplinary mental health staff who work as
a team to provide assertive community treatment.
(c) "Assertive community treatment" means intensive nonresidential treatment and
rehabilitative mental health services provided according to the assertive community treatment
model. Assertive community treatment provides a single, fixed point of responsibility for
treatment, rehabilitation, and support needs for clients. Services are offered 24 hours per
day, seven days per week, in a community-based setting.
(d) "Individual treatment plan" means deleted text begin the document that results from a person-centered
planning process of determining real-life outcomes with clients and developing strategies
to achieve those outcomesdeleted text end new text begin a plan described by section 245I.10, subdivisions 7 and 8new text end .
deleted text begin
(e) "Assertive engagement" means the use of collaborative strategies to engage clients
to receive services.
deleted text end
deleted text begin
(f) "Benefits and finance support" means assisting clients in capably managing financial
affairs. Services include, but are not limited to, assisting clients in applying for benefits;
assisting with redetermination of benefits; providing financial crisis management; teaching
and supporting budgeting skills and asset development; and coordinating with a client's
representative payee, if applicable.
deleted text end
deleted text begin
(g) "Co-occurring disorder treatment" means the treatment of co-occurring mental illness
and substance use disorders and is characterized by assertive outreach, stage-wise
comprehensive treatment, treatment goal setting, and flexibility to work within each stage
of treatment. Services include, but are not limited to, assessing and tracking clients' stages
of change readiness and treatment; applying the appropriate treatment based on stages of
change, such as outreach and motivational interviewing techniques to work with clients in
earlier stages of change readiness and cognitive behavioral approaches and relapse prevention
to work with clients in later stages of change; and facilitating access to community supports.
deleted text end
deleted text begin (h)deleted text end new text begin (e)new text end "Crisis assessment and intervention" means mental health crisis response services
as defined in section 256B.0624, subdivision 2deleted text begin , paragraphs (c) to (e)deleted text end .
deleted text begin
(i) "Employment services" means assisting clients to work at jobs of their choosing.
Services must follow the principles of the individual placement and support (IPS)
employment model, including focusing on competitive employment; emphasizing individual
client preferences and strengths; ensuring employment services are integrated with mental
health services; conducting rapid job searches and systematic job development according
to client preferences and choices; providing benefits counseling; and offering all services
in an individualized and time-unlimited manner. Services shall also include educating clients
about opportunities and benefits of work and school and assisting the client in learning job
skills, navigating the work place, and managing work relationships.
deleted text end
deleted text begin
(j) "Family psychoeducation and support" means services provided to the client's family
and other natural supports to restore and strengthen the client's unique social and family
relationships. Services include, but are not limited to, individualized psychoeducation about
the client's illness and the role of the family and other significant people in the therapeutic
process; family intervention to restore contact, resolve conflict, and maintain relationships
with family and other significant people in the client's life; ongoing communication and
collaboration between the ACT team and the family; introduction and referral to family
self-help programs and advocacy organizations that promote recovery and family
engagement, individual supportive counseling, parenting training, and service coordination
to help clients fulfill parenting responsibilities; coordinating services for the child and
restoring relationships with children who are not in the client's custody; and coordinating
with child welfare and family agencies, if applicable. These services must be provided with
the client's agreement and consent.
deleted text end
deleted text begin
(k) "Housing access support" means assisting clients to find, obtain, retain, and move
to safe and adequate housing of their choice. Housing access support includes, but is not
limited to, locating housing options with a focus on integrated independent settings; applying
for housing subsidies, programs, or resources; assisting the client in developing relationships
with local landlords; providing tenancy support and advocacy for the individual's tenancy
rights at the client's home; and assisting with relocation.
deleted text end
deleted text begin (l)deleted text end new text begin (f)new text end "Individual treatment team" means a minimum of three members of the ACT team
who are responsible for consistently carrying out most of a client's assertive community
treatment services.
deleted text begin
(m) "Intensive residential treatment services treatment team" means all staff who provide
intensive residential treatment services under this section to clients. At a minimum, this
includes the clinical supervisor; mental health professionals as defined in section 245.462,
subdivision 18, clauses (1) to (6); mental health practitioners as defined in section 245.462,
subdivision 17; mental health rehabilitation workers under section 256B.0623, subdivision
5, paragraph (a), clause (4); and mental health certified peer specialists under section
256B.0615.
deleted text end
deleted text begin
(n) "Intensive residential treatment services" means short-term, time-limited services
provided in a residential setting to clients 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.
deleted text end
deleted text begin
(o) "Medication assistance and support" means assisting clients in accessing medication,
developing the ability to take medications with greater independence, and providing
medication setup. This includes the prescription, administration, and order of medication
by appropriate medical staff.
deleted text end
deleted text begin
(p) "Medication education" means educating clients on the role and effects of medications
in treating symptoms of mental illness and the side effects of medications.
deleted text end
deleted text begin
(q) "Overnight staff" means a member of the intensive residential treatment services
team who is responsible during hours when clients are typically asleep.
deleted text end
deleted text begin
(r) "Mental health certified peer specialist services" has the meaning given in section
256B.0615.
deleted text end
deleted text begin
(s) "Physical health services" means any service or treatment to meet the physical health
needs of the client to support the client's mental health recovery. Services include, but are
not limited to, education on primary health issues, including wellness education; medication
administration and monitoring; providing and coordinating medical screening and follow-up;
scheduling routine and acute medical and dental care visits; tobacco cessation strategies;
assisting clients in attending appointments; communicating with other providers; and
integrating all physical and mental health treatment.
deleted text end
deleted text begin (t)deleted text end new text begin (g)new text end "Primary team member" means the person who leads and coordinates the activities
of the individual treatment team and is the individual treatment team member who has
primary responsibility for establishing and maintaining a therapeutic relationship with the
client on a continuing basis.
deleted text begin
(u) "Rehabilitative mental health services" means mental health services that are
rehabilitative and enable the client to develop and enhance psychiatric stability, social
competencies, personal and emotional adjustment, independent living, parenting skills, and
community skills, when these abilities are impaired by the symptoms of mental illness.
deleted text end
deleted text begin
(v) "Symptom management" means supporting clients in identifying and targeting the
symptoms and occurrence patterns of their mental illness and developing strategies to reduce
the impact of those symptoms.
deleted text end
deleted text begin
(w) "Therapeutic interventions" means empirically supported techniques to address
specific symptoms and behaviors such as anxiety, psychotic symptoms, emotional
dysregulation, and trauma symptoms. Interventions include empirically supported
psychotherapies including, but not limited to, cognitive behavioral therapy, exposure therapy,
acceptance and commitment therapy, interpersonal therapy, and motivational interviewing.
deleted text end
deleted text begin
(x) "Wellness self-management and prevention" means a combination of approaches to
working with the client to build and apply skills related to recovery, and to support the client
in participating in leisure and recreational activities, civic participation, and meaningful
structure.
deleted text end
new text begin
(h) "Certified rehabilitation specialist" means a staff person who is qualified according
to section 245I.04, subdivision 8.
new text end
new text begin
(i) "Clinical trainee" means a staff person who is qualified according to section 245I.04,
subdivision 6.
new text end
new text begin
(j) "Mental health certified peer specialist" means a staff person who is qualified
according to section 245I.04, subdivision 10.
new text end
new text begin
(k) "Mental health practitioner" means a staff person who is qualified according to section
245I.04, subdivision 4.
new text end
new text begin
(l) "Mental health professional" means a staff person who is qualified according to
section 245I.04, subdivision 2.
new text end
new text begin
(m) "Mental health rehabilitation worker" means a staff person who is qualified according
to section 245I.04, subdivision 14.
new text end
Sec. 59.
Minnesota Statutes 2020, section 256B.0622, subdivision 3a, is amended to read:
Subd. 3a.
Provider certification and contract requirements for assertive community
treatment.
(a) The assertive community treatment provider must:
(1) have a contract with the host county to provide assertive community treatment
services; and
(2) have each ACT team be certified by the state following the certification process and
procedures developed by the commissioner. The certification process determines whether
the ACT team meets the standards for assertive community treatment under this section deleted text begin as
well asdeleted text end new text begin , the standards in chapter 245I as required in section 245I.011, subdivision 5, andnew text end
minimum program fidelity standards as measured by a nationally recognized fidelity tool
approved by the commissioner. Recertification must occur at least every three years.
(b) An ACT team certified under this subdivision must meet the following standards:
(1) have capacity to recruit, hire, manage, and train required ACT team members;
(2) have adequate administrative ability to ensure availability of services;
deleted text begin
(3) ensure adequate preservice and ongoing training for staff;
deleted text end
deleted text begin
(4) ensure that staff is capable of implementing culturally specific services that are
culturally responsive and appropriate as determined by the client's culture, beliefs, values,
and language as identified in the individual treatment plan;
deleted text end
deleted text begin (5)deleted text end new text begin (3)new text end ensure flexibility in service delivery to respond to the changing and intermittent
care needs of a client as identified by the client and the individual treatment plan;
deleted text begin
(6) develop and maintain client files, individual treatment plans, and contact charting;
deleted text end
deleted text begin
(7) develop and maintain staff training and personnel files;
deleted text end
deleted text begin
(8) submit information as required by the state;
deleted text end
deleted text begin (9)deleted text end new text begin (4)new text end keep all necessary records required by law;
deleted text begin
(10) comply with all applicable laws;
deleted text end
deleted text begin (11)deleted text end new text begin (5)new text end be an enrolled Medicaid provider;new text begin and
new text end
deleted text begin (12)deleted text end new text begin (6)new text end establish and maintain a quality assurance plan to determine specific service
outcomes and the client's satisfaction with servicesdeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(13) develop and maintain written policies and procedures regarding service provision
and administration of the provider entity.
deleted text end
(c) The commissioner may intervene at any time and decertify an ACT team with cause.
The commissioner shall establish a process for decertification of an ACT team and shall
require corrective action, medical assistance repayment, or decertification of an ACT team
that no longer meets the requirements in this section or that fails to meet the clinical quality
standards or administrative standards provided by the commissioner in the application and
certification process. The decertification is subject to appeal to the state.
Sec. 60.
Minnesota Statutes 2020, section 256B.0622, subdivision 4, is amended to read:
Subd. 4.
Provider entity licensure and contract requirements for intensive residential
treatment services.
deleted text begin
(a) The intensive residential treatment services provider entity must:
deleted text end
deleted text begin
(1) be licensed under Minnesota Rules, parts 9520.0500 to 9520.0670;
deleted text end
deleted text begin
(2) not exceed 16 beds per site; and
deleted text end
deleted text begin
(3) comply with the additional standards in this section.
deleted text end
deleted text begin (b)deleted text end new text begin (a)new text end The commissioner shall develop procedures for counties and providers to submit
other documentation as needed to allow the commissioner to determine whether the standards
in this section are met.
deleted text begin (c)deleted text end new text begin (b)new text end A provider entity must specify in the provider entity's application what geographic
area and populations will be served by the proposed program. A provider entity must
document that the capacity or program specialties of existing programs are not sufficient
to meet the service needs of the target population. A provider entity must submit evidence
of ongoing relationships with other providers and levels of care to facilitate referrals to and
from the proposed program.
deleted text begin (d)deleted text end new text begin (c)new text end A provider entity must submit documentation that the provider entity requested
a statement of need from each county board and tribal authority that serves as a local mental
health authority in the proposed service area. The statement of need must specify if the local
mental health authority supports or does not support the need for the proposed program and
the basis for this determination. If a local mental health authority does not respond within
60 days of the receipt of the request, the commissioner shall determine the need for the
program based on the documentation submitted by the provider entity.
Sec. 61.
Minnesota Statutes 2020, section 256B.0622, subdivision 7, is amended to read:
Subd. 7.
Assertive community treatment service standards.
(a) ACT teams must offer
and have the capacity to directly provide the following services:
(1) assertive engagementnew text begin using collaborative strategies to encourage clients to receive
servicesnew text end ;
(2) benefits and finance supportnew text begin that assists clients to capably manage financial affairs.
Services include but are not limited to assisting clients in applying for benefits, assisting
with redetermination of benefits, providing financial crisis management, teaching and
supporting budgeting skills and asset development, and coordinating with a client's
representative payee, if applicablenew text end ;
(3) co-occurring new text begin substance use new text end disorder treatmentnew text begin as defined in section 245I.02,
subdivision 11new text end ;
(4) crisis assessment and intervention;
(5) employment servicesnew text begin that assist clients to work at jobs of the clients' choosing.
Services must follow the principles of the individual placement and support employment
model, including focusing on competitive employment, emphasizing individual client
preferences and strengths, ensuring employment services are integrated with mental health
services, conducting rapid job searches and systematic job development according to client
preferences and choices, providing benefits counseling, and offering all services in an
individualized and time-unlimited manner. Services must also include educating clients
about opportunities and benefits of work and school and assisting the client in learning job
skills, navigating the workplace, workplace accommodations, and managing work
relationshipsnew text end ;
(6) family psychoeducation and supportnew text begin provided to the client's family and other natural
supports to restore and strengthen the client's unique social and family relationships. Services
include but are not limited to individualized psychoeducation about the client's illness and
the role of the family and other significant people in the therapeutic process; family
intervention to restore contact, resolve conflict, and maintain relationships with family and
other significant people in the client's life; ongoing communication and collaboration between
the ACT team and the family; introduction and referral to family self-help programs and
advocacy organizations that promote recovery and family engagement, individual supportive
counseling, parenting training, and service coordination to help clients fulfill parenting
responsibilities; coordinating services for the child and restoring relationships with children
who are not in the client's custody; and coordinating with child welfare and family agencies,
if applicable. These services must be provided with the client's agreement and consentnew text end ;
(7) housing access supportnew text begin that assists clients to find, obtain, retain, and move to safe
and adequate housing of their choice. Housing access support includes but is not limited to
locating housing options with a focus on integrated independent settings; applying for
housing subsidies, programs, or resources; assisting the client in developing relationships
with local landlords; providing tenancy support and advocacy for the individual's tenancy
rights at the client's home; and assisting with relocationnew text end ;
(8) medication assistance and supportnew text begin that assists clients in accessing medication,
developing the ability to take medications with greater independence, and providing
medication setup. Medication assistance and support includes assisting the client with the
prescription, administration, and ordering of medication by appropriate medical staffnew text end ;
(9) medication educationnew text begin that educates clients on the role and effects of medications in
treating symptoms of mental illness and the side effects of medicationsnew text end ;
(10) mental health certified peer specialists servicesnew text begin according to section 256B.0615new text end ;
(11) physical health servicesnew text begin to meet the physical health needs of the client to support
the client's mental health recovery. Services include but are not limited to education on
primary health and wellness issues, medication administration and monitoring, providing
and coordinating medical screening and follow-up, scheduling routine and acute medical
and dental care visits, tobacco cessation strategies, assisting clients in attending appointments,
communicating with other providers, and integrating all physical and mental health treatmentnew text end ;
(12) rehabilitative mental health servicesnew text begin as defined in section 245I.02, subdivision 33new text end ;
(13) symptom managementnew text begin that supports clients in identifying and targeting the symptoms
and occurrence patterns of their mental illness and developing strategies to reduce the impact
of those symptomsnew text end ;
(14) therapeutic interventionsnew text begin to address specific symptoms and behaviors such as
anxiety, psychotic symptoms, emotional dysregulation, and trauma symptoms. Interventions
include empirically supported psychotherapies including but not limited to cognitive
behavioral therapy, exposure therapy, acceptance and commitment therapy, interpersonal
therapy, and motivational interviewingnew text end ;
(15) wellness self-management and preventionnew text begin that includes a combination of approaches
to working with the client to build and apply skills related to recovery, and to support the
client in participating in leisure and recreational activities, civic participation, and meaningful
structurenew text end ; and
(16) other services based on client needs as identified in a client's assertive community
treatment individual treatment plan.
(b) ACT teams must ensure the provision of all services necessary to meet a client's
needs as identified in the client's individual treatment plan.
Sec. 62.
Minnesota Statutes 2020, section 256B.0622, subdivision 7a, is amended to read:
Subd. 7a.
Assertive community treatment team staff requirements and roles.
(a)
The required treatment staff qualifications and roles for an ACT team are:
(1) the team leader:
(i) shall be a deleted text begin licenseddeleted text end mental health professional deleted text begin who is qualified under Minnesota Rules,
part 9505.0371, subpart 5, item Adeleted text end . Individuals who are not licensed but who are eligible
for licensure and are otherwise qualified may also fulfill this role but must obtain full
licensure within 24 months of assuming the role of team leader;
(ii) must be an active member of the ACT team and provide some direct services to
clients;
(iii) must be a single full-time staff member, dedicated to the ACT team, who is
responsible for overseeing the administrative operations of the team, providing deleted text begin clinical
oversightdeleted text end new text begin treatment supervisionnew text end of services in conjunction with the psychiatrist or psychiatric
care provider, and supervising team members to ensure delivery of best and ethical practices;
and
(iv) must be available to provide overall deleted text begin clinical oversightdeleted text end new text begin treatment supervisionnew text end to the
ACT team after regular business hours and on weekends and holidays. The team leader may
delegate this duty to another qualified member of the ACT team;
(2) the psychiatric care provider:
(i) must be a deleted text begin licensed psychiatrist certified by the American Board of Psychiatry and
Neurology or eligible for board certification or certified by the American Osteopathic Board
of Neurology and Psychiatry or eligible for board certification, or a psychiatric nurse who
is qualified under Minnesota Rules, part 9505.0371, subpart 5, item Adeleted text end new text begin mental health
professional permitted to prescribe psychiatric medications as part of the mental health
professional's scope of practicenew text end . The psychiatric care provider must have demonstrated
clinical experience working with individuals with serious and persistent mental illness;
(ii) shall collaborate with the team leader in sharing overall clinical responsibility for
screening and admitting clients; monitoring clients' treatment and team member service
delivery; educating staff on psychiatric and nonpsychiatric medications, their side effects,
and health-related conditions; actively collaborating with nurses; and helping provide deleted text begin clinicaldeleted text end new text begin
treatmentnew text end supervision to the team;
(iii) shall fulfill the following functions for assertive community treatment clients:
provide assessment and treatment of clients' symptoms and response to medications, including
side effects; provide brief therapy to clients; provide diagnostic and medication education
to clients, with medication decisions based on shared decision making; monitor clients'
nonpsychiatric medical conditions and nonpsychiatric medications; and conduct home and
community visits;
(iv) shall serve as the point of contact for psychiatric treatment if a client is hospitalized
for mental health treatment and shall communicate directly with the client's inpatient
psychiatric care providers to ensure continuity of care;
(v) shall have a minimum full-time equivalency that is prorated at a rate of 16 hours per
50 clients. Part-time psychiatric care providers shall have designated hours to work on the
team, with sufficient blocks of time on consistent days to carry out the provider's clinical,
supervisory, and administrative responsibilities. No more than two psychiatric care providers
may share this role;
(vi) may not provide specific roles and responsibilities by telemedicine unless approved
by the commissioner; and
(vii) shall provide psychiatric backup to the program after regular business hours and
on weekends and holidays. The psychiatric care provider may delegate this duty to another
qualified psychiatric provider;
(3) the nursing staff:
(i) shall consist of one to three registered nurses or advanced practice registered nurses,
of whom at least one has a minimum of one-year experience working with adults with
serious mental illness and a working knowledge of psychiatric medications. No more than
two individuals can share a full-time equivalent position;
(ii) are responsible for managing medication, administering and documenting medication
treatment, and managing a secure medication room; and
(iii) shall develop strategies, in collaboration with clients, to maximize taking medications
as prescribed; screen and monitor clients' mental and physical health conditions and
medication side effects; engage in health promotion, prevention, and education activities;
communicate and coordinate services with other medical providers; facilitate the development
of the individual treatment plan for clients assigned; and educate the ACT team in monitoring
psychiatric and physical health symptoms and medication side effects;
(4) the co-occurring disorder specialist:
(i) shall be a full-time equivalent co-occurring disorder specialist who has received
specific training on co-occurring disorders that is consistent with national evidence-based
practices. The training must include practical knowledge of common substances and how
they affect mental illnesses, the ability to assess substance use disorders and the client's
stage of treatment, motivational interviewing, and skills necessary to provide counseling to
clients at all different stages of change and treatment. The co-occurring disorder specialist
may also be an individual who is a licensed alcohol and drug counselor as described in
section 148F.01, subdivision 5, or a counselor who otherwise meets the training, experience,
and other requirements in section 245G.11, subdivision 5. No more than two co-occurring
disorder specialists may occupy this role; and
(ii) shall provide or facilitate the provision of co-occurring disorder treatment to clients.
The co-occurring disorder specialist shall serve as a consultant and educator to fellow ACT
team members on co-occurring disorders;
(5) the vocational specialist:
(i) shall be a full-time vocational specialist who has at least one-year experience providing
employment services or advanced education that involved field training in vocational services
to individuals with mental illness. An individual who does not meet these qualifications
may also serve as the vocational specialist upon completing a training plan approved by the
commissioner;
(ii) shall provide or facilitate the provision of vocational services to clients. The vocational
specialist serves as a consultant and educator to fellow ACT team members on these services;
and
(iii) deleted text begin shoulddeleted text end new text begin mustnew text end not refer individuals to receive any type of vocational services or linkage
by providers outside of the ACT team;
(6) the mental health certified peer specialist:
(i) shall be a full-time equivalent deleted text begin mental health certified peer specialist as defined in
section 256B.0615deleted text end . No more than two individuals can share this position. The mental health
certified peer specialist is a fully integrated team member who provides highly individualized
services in the community and promotes the self-determination and shared decision-making
abilities of clients. This requirement may be waived due to workforce shortages upon
approval of the commissioner;
(ii) must provide coaching, mentoring, and consultation to the clients to promote recovery,
self-advocacy, and self-direction, promote wellness management strategies, and assist clients
in developing advance directives; and
(iii) must model recovery values, attitudes, beliefs, and personal action to encourage
wellness and resilience, provide consultation to team members, promote a culture where
the clients' points of view and preferences are recognized, understood, respected, and
integrated into treatment, and serve in a manner equivalent to other team members;
(7) the program administrative assistant shall be a full-time office-based program
administrative assistant position assigned to solely work with the ACT team, providing a
range of supports to the team, clients, and families; and
(8) additional staff:
(i) shall be based on team size. Additional treatment team staff may include deleted text begin licenseddeleted text end
mental health professionals deleted text begin as defined in Minnesota Rules, part 9505.0371, subpart 5, item
Adeleted text end ; new text begin clinical trainees; certified rehabilitation specialists; new text end mental health practitioners deleted text begin as defined
in section 245.462, subdivision 17; a mental health practitioner working as a clinical trainee
according to Minnesota Rules, part 9505.0371, subpart 5, item Cdeleted text end ; or mental health
rehabilitation workers deleted text begin as defined in section 256B.0623, subdivision 5, paragraph (a), clause
(4)deleted text end . These individuals shall have the knowledge, skills, and abilities required by the
population served to carry out rehabilitation and support functions; and
(ii) shall be selected based on specific program needs or the population served.
(b) Each ACT team must clearly document schedules for all ACT team members.
(c) Each ACT team member must serve as a primary team member for clients assigned
by the team leader and are responsible for facilitating the individual treatment plan process
for those clients. The primary team member for a client is the responsible team member
knowledgeable about the client's life and circumstances and writes the individual treatment
plan. The primary team member provides individual supportive therapy or counseling, and
provides primary support and education to the client's family and support system.
(d) Members of the ACT team must have strong clinical skills, professional qualifications,
experience, and competency to provide a full breadth of rehabilitation services. Each staff
member shall be proficient in their respective discipline and be able to work collaboratively
as a member of a multidisciplinary team to deliver the majority of the treatment,
rehabilitation, and support services clients require to fully benefit from receiving assertive
community treatment.
(e) Each ACT team member must fulfill training requirements established by the
commissioner.
Sec. 63.
Minnesota Statutes 2020, section 256B.0622, subdivision 7b, is amended to read:
Subd. 7b.
Assertive community treatment program size and opportunities.
(a) Each
ACT team shall maintain an annual average caseload that does not exceed 100 clients.
Staff-to-client ratios shall be based on team size as follows:
(1) a small ACT team must:
(i) employ at least six but no more than seven full-time treatment team staff, excluding
the program assistant and the psychiatric care provider;
(ii) serve an annual average maximum of no more than 50 clients;
(iii) ensure at least one full-time equivalent position for every eight clients served;
(iv) schedule ACT team staff for at least eight-hour shift coverage on weekdays and
on-call duty to provide crisis services and deliver services after hours when staff are not
working;
(v) provide crisis services during business hours if the small ACT team does not have
sufficient staff numbers to operate an after-hours on-call system. During all other hours,
the ACT team may arrange for coverage for crisis assessment and intervention services
through a reliable crisis-intervention provider as long as there is a mechanism by which the
ACT team communicates routinely with the crisis-intervention provider and the on-call
ACT team staff are available to see clients face-to-face when necessary or if requested by
the crisis-intervention services provider;
(vi) adjust schedules and provide staff to carry out the needed service activities in the
evenings or on weekend days or holidays, when necessary;
(vii) arrange for and provide psychiatric backup during all hours the psychiatric care
provider is not regularly scheduled to work. If availability of the ACT team's psychiatric
care provider during all hours is not feasible, alternative psychiatric prescriber backup must
be arranged and a mechanism of timely communication and coordination established in
writing; and
(viii) be composed of, at minimum, one full-time team leader, at least 16 hours each
week per 50 clients of psychiatric provider time, or equivalent if fewer clients, one full-time
equivalent nursing, one full-time deleted text begin substance abusedeleted text end new text begin co-occurring disordernew text end specialist, one
full-time equivalent mental health certified peer specialist, one full-time vocational specialist,
one full-time program assistant, and at least one additional full-time ACT team member
who has mental health professionalnew text begin , certified rehabilitation specialist, clinical trainee,new text end or
new text begin mental health new text end practitioner status; and
(2) a midsize ACT team shall:
(i) be composed of, at minimum, one full-time team leader, at least 16 hours of psychiatry
time for 51 clients, with an additional two hours for every six clients added to the team, 1.5
to two full-time equivalent nursing staff, one full-time deleted text begin substance abusedeleted text end new text begin co-occurring disordernew text end
specialist, one full-time equivalent mental health certified peer specialist, one full-time
vocational specialist, one full-time program assistant, and at least 1.5 to two additional
full-time equivalent ACT members, with at least one dedicated full-time staff member with
mental health professional status. Remaining team members may have mental health
professionalnew text begin , certified rehabilitation specialist, clinical trainee,new text end or new text begin mental health new text end practitioner
status;
(ii) employ seven or more treatment team full-time equivalents, excluding the program
assistant and the psychiatric care provider;
(iii) serve an annual average maximum caseload of 51 to 74 clients;
(iv) ensure at least one full-time equivalent position for every nine clients served;
(v) schedule ACT team staff for a minimum of ten-hour shift coverage on weekdays
and six- to eight-hour shift coverage on weekends and holidays. In addition to these minimum
specifications, staff are regularly scheduled to provide the necessary services on a
client-by-client basis in the evenings and on weekends and holidays;
(vi) schedule ACT team staff on-call duty to provide crisis services and deliver services
when staff are not working;
(vii) have the authority to arrange for coverage for crisis assessment and intervention
services through a reliable crisis-intervention provider as long as there is a mechanism by
which the ACT team communicates routinely with the crisis-intervention provider and the
on-call ACT team staff are available to see clients face-to-face when necessary or if requested
by the crisis-intervention services provider; and
(viii) arrange for and provide psychiatric backup during all hours the psychiatric care
provider is not regularly scheduled to work. If availability of the psychiatric care provider
during all hours is not feasible, alternative psychiatric prescriber backup must be arranged
and a mechanism of timely communication and coordination established in writing;
(3) a large ACT team must:
(i) be composed of, at minimum, one full-time team leader, at least 32 hours each week
per 100 clients, or equivalent of psychiatry time, three full-time equivalent nursing staff,
one full-time deleted text begin substance abusedeleted text end new text begin co-occurring disordernew text end specialist, one full-time equivalent
mental health certified peer specialist, one full-time vocational specialist, one full-time
program assistant, and at least two additional full-time equivalent ACT team members, with
at least one dedicated full-time staff member with mental health professional status.
Remaining team members may have mental health professional or mental health practitioner
status;
(ii) employ nine or more treatment team full-time equivalents, excluding the program
assistant and psychiatric care provider;
(iii) serve an annual average maximum caseload of 75 to 100 clients;
(iv) ensure at least one full-time equivalent position for every nine individuals served;
(v) schedule staff to work two eight-hour shifts, with a minimum of two staff on the
second shift providing services at least 12 hours per day weekdays. For weekends and
holidays, the team must operate and schedule ACT team staff to work one eight-hour shift,
with a minimum of two staff each weekend day and every holiday;
(vi) schedule ACT team staff on-call duty to provide crisis services and deliver services
when staff are not working; and
(vii) arrange for and provide psychiatric backup during all hours the psychiatric care
provider is not regularly scheduled to work. If availability of the ACT team psychiatric care
provider during all hours is not feasible, alternative psychiatric backup must be arranged
and a mechanism of timely communication and coordination established in writing.
(b) An ACT team of any size may have a staff-to-client ratio that is lower than the
requirements described in paragraph (a) upon approval by the commissioner, but may not
exceed a one-to-ten staff-to-client ratio.
Sec. 64.
Minnesota Statutes 2020, section 256B.0622, subdivision 7d, is amended to read:
Subd. 7d.
Assertive community treatment assessment and individual treatment
plan.
(a) An initial assessmentdeleted text begin , including a diagnostic assessment that meets the requirements
of Minnesota Rules, part 9505.0372, subpart 1, and a 30-day treatment plandeleted text end shall be
completed the day of the client's admission to assertive community treatment by the ACT
team leader or the psychiatric care provider, with participation by designated ACT team
members and the client. new text begin The initial assessment must include obtaining or completing a
standard diagnostic assessment according to section 245I.10, subdivision 6, and completing
a 30-day individual treatment plan. new text end The team leader, psychiatric care provider, or other
mental health professional designated by the team leader or psychiatric care provider, must
update the client's diagnostic assessment at least annually.
(b) deleted text begin An initialdeleted text end new text begin Anew text end functional assessment must be completed deleted text begin within ten days of intake and
updated every six months for assertive community treatment, or prior to discharge from the
service, whichever comes firstdeleted text end new text begin according to section 245I.10, subdivision 9new text end .
deleted text begin
(c) Within 30 days of the client's assertive community treatment admission, the ACT
team shall complete an in-depth assessment of the domains listed under section 245.462,
subdivision 11a.
deleted text end
deleted text begin (d)deleted text end Each part of the deleted text begin in-depthdeleted text end new text begin functionalnew text end assessment areas shall be completed by each
respective team specialist or an ACT team member with skill and knowledge in the area
being assessed. deleted text begin The assessments are based upon all available information, including that
from client interview family and identified natural supports, and written summaries from
other agencies, including police, courts, county social service agencies, outpatient facilities,
and inpatient facilities, where applicable.
deleted text end
deleted text begin (e)deleted text end new text begin (c)new text end Between 30 and 45 days after the client's admission to assertive community
treatment, the entire ACT team must hold a comprehensive case conference, where all team
members, including the psychiatric provider, present information discovered from the
completed deleted text begin in-depthdeleted text end assessments and provide treatment recommendations. The conference
must serve as the basis for the first deleted text begin six-monthdeleted text end new text begin individualnew text end treatment plan, which must be
written by the primary team member.
deleted text begin (f)deleted text end new text begin (d)new text end The client's psychiatric care provider, primary team member, and individual
treatment team members shall assume responsibility for preparing the written narrative of
the results from the psychiatric and social functioning history timeline and the comprehensive
assessment.
deleted text begin (g)deleted text end new text begin (e)new text end The primary team member and individual treatment team members shall be
assigned by the team leader in collaboration with the psychiatric care provider by the time
of the first treatment planning meeting or 30 days after admission, whichever occurs first.
deleted text begin (h)deleted text end new text begin (f)new text end Individual treatment plans must be developed through the following treatment
planning process:
(1) The individual treatment plan shall be developed in collaboration with the client and
the client's preferred natural supports, and guardian, if applicable and appropriate. The ACT
team shall evaluate, together with each client, the client's needs, strengths, and preferences
and develop the individual treatment plan collaboratively. The ACT team shall make every
effort to ensure that the client and the client's family and natural supports, with the client's
consent, are in attendance at the treatment planning meeting, are involved in ongoing
meetings related to treatment, and have the necessary supports to fully participate. The
client's participation in the development of the individual treatment plan shall be documented.
(2) The client and the ACT team shall work together to formulate and prioritize the
issues, set goals, research approaches and interventions, and establish the plan. The plan is
individually tailored so that the treatment, rehabilitation, and support approaches and
interventions achieve optimum symptom reduction, help fulfill the personal needs and
aspirations of the client, take into account the cultural beliefs and realities of the individual,
and improve all the aspects of psychosocial functioning that are important to the client. The
process supports strengths, rehabilitation, and recovery.
(3) Each client's individual treatment plan shall identify service needs, strengths and
capacities, and barriers, and set specific and measurable short- and long-term goals for each
service need. The individual treatment plan must clearly specify the approaches and
interventions necessary for the client to achieve the individual goals, when the interventions
shall happen, and identify which ACT team member shall carry out the approaches and
interventions.
(4) The primary team member and the individual treatment team, together with the client
and the client's family and natural supports with the client's consent, are responsible for
reviewing and rewriting the treatment goals and individual treatment plan whenever there
is a major decision point in the client's course of treatment or at least every six months.
(5) The primary team member shall prepare a summary that thoroughly describes in
writing the client's and the individual treatment team's evaluation of the client's progress
and goal attainment, the effectiveness of the interventions, and the satisfaction with services
since the last individual treatment plan. The client's most recent diagnostic assessment must
be included with the treatment plan summary.
(6) The individual treatment plan and review must be deleted text begin signeddeleted text end new text begin approvednew text end or acknowledged
by the client, the primary team member, the team leader, the psychiatric care provider, and
all individual treatment team members. A copy of the deleted text begin signeddeleted text end new text begin approvednew text end individual treatment
plan deleted text begin isdeleted text end new text begin must benew text end made available to the client.
Sec. 65.
Minnesota Statutes 2020, section 256B.0623, subdivision 1, is amended to read:
Subdivision 1.
Scope.
new text begin Subject to federal approval, new text end medical assistance covers new text begin medically
necessary new text end adult rehabilitative mental health services deleted text begin as defined in subdivision 2, subject to
federal approval, if provided to recipients as defined in subdivision 3 and provided by a
qualified provider entity meeting the standards in this section and by a qualified individual
provider working within the provider's scope of practice and identified in the recipient's
individual treatment plan as defined in section 245.462, subdivision 14, and if determined
to be medically necessary according to section 62Q.53deleted text end new text begin when the services are provided by
an entity meeting the standards in this sectionnew text end .new text begin The provider entity must make reasonable
and good faith efforts to report individual client outcomes to the commissioner, using
instruments and protocols approved by the commissioner.
new text end
Sec. 66.
Minnesota Statutes 2020, section 256B.0623, subdivision 2, is amended to read:
Subd. 2.
Definitions.
For purposes of this section, the following terms have the meanings
given them.
(a) "Adult rehabilitative mental health services" means deleted text begin mental health services which are
rehabilitative and enable the recipient to develop and enhance psychiatric stability, social
competencies, personal and emotional adjustment, independent living, parenting skills, and
community skills, when these abilities are impaired by the symptoms of mental illness.
Adult rehabilitative mental health services are also appropriate when provided to enable a
recipient to retain stability and functioning, if the recipient would be at risk of significant
functional decompensation or more restrictive service settings without these servicesdeleted text end new text begin the
services described in section 245I.02, subdivision 33new text end .
deleted text begin
(1) Adult rehabilitative mental health services instruct, assist, and support the recipient
in areas such as: interpersonal communication skills, community resource utilization and
integration skills, crisis assistance, relapse prevention skills, health care directives, budgeting
and shopping skills, healthy lifestyle skills and practices, cooking and nutrition skills,
transportation skills, medication education and monitoring, mental illness symptom
management skills, household management skills, employment-related skills, parenting
skills, and transition to community living services.
deleted text end
deleted text begin
(2) These services shall be provided to the recipient on a one-to-one basis in the recipient's
home or another community setting or in groups.
deleted text end
(b) "Medication education services" means services provided individually or in groups
which focus on educating the recipient about mental illness and symptoms; the role and
effects of medications in treating symptoms of mental illness; and the side effects of
medications. Medication education is coordinated with medication management services
and does not duplicate it. Medication education services are provided by physicians, advanced
practice registered nurses, pharmacists, physician assistants, or registered nurses.
(c) "Transition to community living services" means services which maintain continuity
of contact between the rehabilitation services provider and the recipient and which facilitate
discharge from a hospital, residential treatment program deleted text begin under Minnesota Rules, chapter
9505deleted text end , board and lodging facility, or nursing home. Transition to community living services
are not intended to provide other areas of adult rehabilitative mental health services.
Sec. 67.
Minnesota Statutes 2020, section 256B.0623, subdivision 3, is amended to read:
Subd. 3.
Eligibility.
An eligible recipient is an individual who:
(1) is age 18 or older;
(2) is diagnosed with a medical condition, such as mental illness or traumatic brain
injury, for which adult rehabilitative mental health services are needed;
(3) has substantial disability and functional impairment in three or more of the areas
listed in section deleted text begin 245.462, subdivision 11adeleted text end new text begin 245I.10, subdivision 9, clause (4)new text end , so that
self-sufficiency is markedly reduced; and
(4) has had a recent new text begin standard new text end diagnostic assessment deleted text begin or an adult diagnostic assessment
updatedeleted text end by a qualified professional that documents adult rehabilitative mental health services
are medically necessary to address identified disability and functional impairments and
individual recipient goals.
Sec. 68.
Minnesota Statutes 2020, section 256B.0623, subdivision 4, is amended to read:
Subd. 4.
Provider entity standards.
(a) The provider entity must be certified by the
state following the certification process and procedures developed by the commissioner.
(b) The certification process is a determination as to whether the entity meets the standards
in this deleted text begin subdivisiondeleted text end new text begin section and chapter 245I, as required in section 245I.011, subdivision 5new text end .
The certification must specify which adult rehabilitative mental health services the entity
is qualified to provide.
(c) A noncounty provider entity must obtain additional certification from each county
in which it will provide services. The additional certification must be based on the adequacy
of the entity's knowledge of that county's local health and human service system, and the
ability of the entity to coordinate its services with the other services available in that county.
A county-operated entity must obtain this additional certification from any other county in
which it will provide services.
(d) new text begin State-level new text end recertification must occur at least every three years.
(e) The commissioner may intervene at any time and decertify providers with cause.
The decertification is subject to appeal to the state. A county board may recommend that
the state decertify a provider for cause.
(f) The adult rehabilitative mental health services provider entity must meet the following
standards:
(1) have capacity to recruit, hire, manage, and train deleted text begin mental health professionals, mental
health practitioners, and mental health rehabilitation workersdeleted text end new text begin qualified staffnew text end ;
(2) have adequate administrative ability to ensure availability of services;
deleted text begin
(3) ensure adequate preservice and inservice and ongoing training for staff;
deleted text end
deleted text begin (4)deleted text end new text begin (3)new text end ensure that deleted text begin mental health professionals, mental health practitioners, and mental
health rehabilitation workersdeleted text end new text begin staffnew text end are skilled in the delivery of the specific adult rehabilitative
mental health services provided to the individual eligible recipient;
deleted text begin
(5) ensure that staff is capable of implementing culturally specific services that are
culturally competent and appropriate as determined by the recipient's culture, beliefs, values,
and language as identified in the individual treatment plan;
deleted text end
deleted text begin (6)deleted text end new text begin (4)new text end ensure enough flexibility in service delivery to respond to the changing and
intermittent care needs of a recipient as identified by the recipient and the individual treatment
plan;
deleted text begin
(7) ensure that the mental health professional or mental health practitioner, who is under
the clinical supervision of a mental health professional, involved in a recipient's services
participates in the development of the individual treatment plan;
deleted text end
deleted text begin (8)deleted text end new text begin (5)new text end assist the recipient in arranging needed crisis assessment, intervention, and
stabilization services;
deleted text begin (9)deleted text end new text begin (6)new text end ensure that services are coordinated with other recipient mental health services
providers and the county mental health authority and the federally recognized American
Indian authority and necessary others after obtaining the consent of the recipient. Services
must also be coordinated with the recipient's case manager or care coordinator if the recipient
is receiving case management or care coordination services;
deleted text begin
(10) develop and maintain recipient files, individual treatment plans, and contact charting;
deleted text end
deleted text begin
(11) develop and maintain staff training and personnel files;
deleted text end
deleted text begin
(12) submit information as required by the state;
deleted text end
deleted text begin
(13) establish and maintain a quality assurance plan to evaluate the outcome of services
provided;
deleted text end
deleted text begin (14)deleted text end new text begin (7)new text end keep all necessary records required by law;
deleted text begin (15)deleted text end new text begin (8)new text end deliver services as required by section 245.461;
deleted text begin
(16) comply with all applicable laws;
deleted text end
deleted text begin (17)deleted text end new text begin (9)new text end be an enrolled Medicaid provider;new text begin and
new text end
deleted text begin (18)deleted text end new text begin (10)new text end maintain a quality assurance plan to determine specific service outcomes and
the recipient's satisfaction with servicesdeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(19) develop and maintain written policies and procedures regarding service provision
and administration of the provider entity.
deleted text end
Sec. 69.
Minnesota Statutes 2020, section 256B.0623, subdivision 5, is amended to read:
Subd. 5.
Qualifications of provider staff.
deleted text begin (a)deleted text end Adult rehabilitative mental health services
must be provided by qualified individual provider staff of a certified provider entity.
Individual provider staff must be qualified deleted text begin under one of the following criteriadeleted text end new text begin asnew text end :
(1) a mental health professional deleted text begin as defined in section 245.462, subdivision 18, clauses
(1) to (6). If the recipient has a current diagnostic assessment by a licensed mental health
professional as defined in section 245.462, subdivision 18, clauses (1) to (6), recommending
receipt of adult mental health rehabilitative services, the definition of mental health
professional for purposes of this section includes a person who is qualified under section
245.462, subdivision 18, clause (7), and who holds a current and valid national certification
as a certified rehabilitation counselor or certified psychosocial rehabilitation practitionerdeleted text end new text begin
who is qualified according to section 245I.04, subdivision 2new text end ;
(2)new text begin a certified rehabilitation specialist who is qualified according to section 245I.04,
subdivision 8;
new text end
new text begin
(3) a clinical trainee who is qualified according to section 245I.04, subdivision 6;
new text end
new text begin (4)new text end a mental health practitioner deleted text begin as defined in section 245.462, subdivision 17. The mental
health practitioner must work under the clinical supervision of a mental health professionaldeleted text end new text begin
qualified according to section 245I.04, subdivision 4new text end ;
deleted text begin (3)deleted text end new text begin (5)new text end a new text begin mental health new text end certified peer specialist deleted text begin under section 256B.0615. The certified
peer specialist must work under the clinical supervision of a mental health professionaldeleted text end new text begin who
is qualified according to section 245I.04, subdivision 10new text end ; or
deleted text begin (4)deleted text end new text begin (6)new text end a mental health rehabilitation workernew text begin who is qualified according to section 245I.04,
subdivision 14new text end . deleted text begin A mental health rehabilitation worker means a staff person working under
the direction of a mental health practitioner or mental health professional and under the
clinical supervision of a mental health professional in the implementation of rehabilitative
mental health services as identified in the recipient's individual treatment plan who:
deleted text end
deleted text begin
(i) is at least 21 years of age;
deleted text end
deleted text begin
(ii) has a high school diploma or equivalent;
deleted text end
deleted text begin
(iii) has successfully completed 30 hours of training during the two years immediately
prior to the date of hire, or before provision of direct services, in all of the following areas:
recovery from mental illness, mental health de-escalation techniques, recipient rights,
recipient-centered individual treatment planning, behavioral terminology, mental illness,
co-occurring mental illness and substance abuse, psychotropic medications and side effects,
functional assessment, local community resources, adult vulnerability, recipient
confidentiality; and
deleted text end
deleted text begin
(iv) meets the qualifications in paragraph (b).
deleted text end
deleted text begin
(b) In addition to the requirements in paragraph (a), a mental health rehabilitation worker
must also meet the qualifications in clause (1), (2), or (3):
deleted text end
deleted text begin
(1) has an associates of arts degree, two years of full-time postsecondary education, or
a total of 15 semester hours or 23 quarter hours in behavioral sciences or related fields; is
a registered nurse; or within the previous ten years has:
deleted text end
deleted text begin
(i) three years of personal life experience with serious mental illness;
deleted text end
deleted text begin
(ii) three years of life experience as a primary caregiver to an adult with a serious mental
illness, traumatic brain injury, substance use disorder, or developmental disability; or
deleted text end
deleted text begin
(iii) 2,000 hours of supervised work experience in the delivery of mental health services
to adults with a serious mental illness, traumatic brain injury, substance use disorder, or
developmental disability;
deleted text end
deleted text begin
(2)(i) is fluent in the non-English language or competent in the culture of the ethnic
group to which at least 20 percent of the mental health rehabilitation worker's clients belong;
deleted text end
deleted text begin
(ii) receives during the first 2,000 hours of work, monthly documented individual clinical
supervision by a mental health professional;
deleted text end
deleted text begin
(iii) has 18 hours of documented field supervision by a mental health professional or
mental health practitioner during the first 160 hours of contact work with recipients, and at
least six hours of field supervision quarterly during the following year;
deleted text end
deleted text begin
(iv) has review and cosignature of charting of recipient contacts during field supervision
by a mental health professional or mental health practitioner; and
deleted text end
deleted text begin
(v) has 15 hours of additional continuing education on mental health topics during the
first year of employment and 15 hours during every additional year of employment; or
deleted text end
deleted text begin
(3) for providers of crisis residential services, intensive residential treatment services,
partial hospitalization, and day treatment services:
deleted text end
deleted text begin
(i) satisfies clause (2), items (ii) to (iv); and
deleted text end
deleted text begin
(ii) has 40 hours of additional continuing education on mental health topics during the
first year of employment.
deleted text end
deleted text begin
(c) A mental health rehabilitation worker who solely acts and is scheduled as overnight
staff is not required to comply with paragraph (a), clause (4), item (iv).
deleted text end
deleted text begin
(d) For purposes of this subdivision, "behavioral sciences or related fields" means an
education from an accredited college or university and includes but is not limited to social
work, psychology, sociology, community counseling, family social science, child
development, child psychology, community mental health, addiction counseling, counseling
and guidance, special education, and other fields as approved by the commissioner.
deleted text end
Sec. 70.
Minnesota Statutes 2020, section 256B.0623, subdivision 6, is amended to read:
Subd. 6.
Required deleted text begin training anddeleted text end supervision.
deleted text begin
(a) Mental health rehabilitation workers
must receive ongoing continuing education training of at least 30 hours every two years in
areas of mental illness and mental health services and other areas specific to the population
being served. Mental health rehabilitation workers must also be subject to the ongoing
direction and clinical supervision standards in paragraphs (c) and (d).
deleted text end
deleted text begin
(b) Mental health practitioners must receive ongoing continuing education training as
required by their professional license; or if the practitioner is not licensed, the practitioner
must receive ongoing continuing education training of at least 30 hours every two years in
areas of mental illness and mental health services. Mental health practitioners must meet
the ongoing clinical supervision standards in paragraph (c).
deleted text end
deleted text begin
(c) Clinical supervision may be provided by a full- or part-time qualified professional
employed by or under contract with the provider entity. Clinical supervision may be provided
by interactive videoconferencing according to procedures developed by the commissioner.
A mental health professional providing clinical supervision of staff delivering adult
rehabilitative mental health services must provide the following guidance:
deleted text end
deleted text begin
(1) review the information in the recipient's file;
deleted text end
deleted text begin
(2) review and approve initial and updates of individual treatment plans;
deleted text end
new text begin
(a) A treatment supervisor providing treatment supervision required by section 245I.06
must:
new text end
deleted text begin (3)deleted text end new text begin (1)new text end meet with deleted text begin mental health rehabilitation workers and practitioners, individually or
in small groups,deleted text end new text begin staff receiving treatment supervisionnew text end at least monthly to discuss treatment
topics of interest deleted text begin to the workers and practitioners;
deleted text end
deleted text begin (4) meet with mental health rehabilitation workers and practitioners, individually or in
small groups, at least monthly to discussdeleted text end new text begin andnew text end treatment plans of recipientsdeleted text begin , and approve by
signature and document in the recipient's file any resulting plan updatesdeleted text end ;new text begin and
new text end
deleted text begin (5)deleted text end new text begin (2)new text end meet at least monthly with the directing new text begin clinical trainee or new text end mental health
practitioner, if there is one, to review needs of the adult rehabilitative mental health services
program, review staff on-site observations and evaluate mental health rehabilitation workers,
plan staff training, review program evaluation and development, and consult with the
directing new text begin clinical trainee or mental health new text end practitionerdeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(6) be available for urgent consultation as the individual recipient needs or the situation
necessitates.
deleted text end
deleted text begin (d)deleted text end new text begin (b)new text end An adult rehabilitative mental health services provider entity must have a treatment
director who is a deleted text begin mental health practitioner ordeleted text end mental health professionalnew text begin clinical trainee,
certified rehabilitation specialist, or mental health practitionernew text end . The treatment director must
deleted text begin ensure the followingdeleted text end :
(1) deleted text begin while delivering direct services to recipients, a newly hired mental health rehabilitation
worker must be directly observed delivering services to recipients by a mental health
practitioner or mental health professional for at least six hours per 40 hours worked during
the first 160 hours that the mental health rehabilitation worker worksdeleted text end new text begin ensure the direct
observation of mental health rehabilitation workers required by section 245I.06, subdivision
3, is providednew text end ;
deleted text begin
(2) the mental health rehabilitation worker must receive ongoing on-site direct service
observation by a mental health professional or mental health practitioner for at least six
hours for every six months of employment;
deleted text end
deleted text begin
(3) progress notes are reviewed from on-site service observation prepared by the mental
health rehabilitation worker and mental health practitioner for accuracy and consistency
with actual recipient contact and the individual treatment plan and goals;
deleted text end
deleted text begin (4)deleted text end new text begin (2) ensurenew text end immediate availability by phone or in person for consultation by a mental
health professionalnew text begin , certified rehabilitation specialist, clinical trainee,new text end or a mental health
practitioner to the mental health rehabilitation deleted text begin servicesdeleted text end worker during service provision;
deleted text begin
(5) oversee the identification of changes in individual recipient treatment strategies,
revise the plan, and communicate treatment instructions and methodologies as appropriate
to ensure that treatment is implemented correctly;
deleted text end
deleted text begin (6)deleted text end new text begin (3)new text end model service practices which: respect the recipient, include the recipient in
planning and implementation of the individual treatment plan, recognize the recipient's
strengths, collaborate and coordinate with other involved parties and providers;
deleted text begin (7)deleted text end new text begin (4)new text end ensure that new text begin clinical trainees, new text end mental health practitionersnew text begin ,new text end and mental health
rehabilitation workers are able to effectively communicate with the recipients, significant
others, and providers; and
deleted text begin (8)deleted text end new text begin (5)new text end oversee the record of the results of deleted text begin on-sitedeleted text end new text begin directnew text end observation deleted text begin and chartingdeleted text end new text begin , progress
notenew text end evaluationnew text begin ,new text end and corrective actions taken to modify the work of the new text begin clinical trainees,
new text end mental health practitionersnew text begin ,new text end and mental health rehabilitation workers.
deleted text begin (e)deleted text end new text begin (c)new text end A new text begin clinical trainee or new text end mental health practitioner who is providing treatment direction
for a provider entity must receive new text begin treatment new text end supervision at least monthly deleted text begin from a mental
health professionaldeleted text end to:
(1) identify and plan for general needs of the recipient population served;
(2) identify and plan to address provider entity program needs and effectiveness;
(3) identify and plan provider entity staff training and personnel needs and issues; and
(4) plan, implement, and evaluate provider entity quality improvement programs.
Sec. 71.
Minnesota Statutes 2020, section 256B.0623, subdivision 9, is amended to read:
Subd. 9.
Functional assessment.
new text begin (a) new text end Providers of adult rehabilitative mental health
services must complete a written functional assessment deleted text begin as defined in section 245.462,
subdivision 11adeleted text end new text begin according to section 245I.10, subdivision 9new text end , for each recipient. deleted text begin The functional
assessment must be completed within 30 days of intake, and reviewed and updated at least
every six months after it is developed, unless there is a significant change in the functioning
of the recipient. If there is a significant change in functioning, the assessment must be
updated. A single functional assessment can meet case management and adult rehabilitative
mental health services requirements if agreed to by the recipient. Unless the recipient refuses,
the recipient must have significant participation in the development of the functional
assessment.
deleted text end
new text begin
(b) When a provider of adult rehabilitative mental health services completes a written
functional assessment, the provider must also complete a level of care assessment as defined
in section 245I.02, subdivision 19, for the recipient.
new text end
Sec. 72.
Minnesota Statutes 2020, section 256B.0623, subdivision 12, is amended to read:
Subd. 12.
Additional requirements.
(a) Providers of adult rehabilitative mental health
services must comply with the requirements relating to referrals for case management in
section 245.467, subdivision 4.
(b) Adult rehabilitative mental health services are provided for most recipients in the
recipient's home and community. Services may also be provided at the home of a relative
or significant other, job site, psychosocial clubhouse, drop-in center, social setting, classroom,
or other places in the community. Except for "transition to community services," the place
of service does not include a regional treatment center, nursing home, residential treatment
facility licensed under Minnesota Rules, parts 9520.0500 to 9520.0670 (Rule 36)new text begin , or section
245I.23new text end , or an acute care hospital.
(c) Adult rehabilitative mental health services may be provided in group settings if
appropriate to each participating recipient's needs and new text begin individual new text end treatment plan. A group
is defined as two to ten clients, at least one of whom is a recipient, who is concurrently
receiving a service which is identified in this section. The service and group must be specified
in the recipient's new text begin individual new text end treatment plan. No more than two qualified staff may bill
Medicaid for services provided to the same group of recipients. If two adult rehabilitative
mental health workers bill for recipients in the same group session, they must each bill for
different recipients.
new text begin
(d) Adult rehabilitative mental health services are appropriate if provided to enable a
recipient to retain stability and functioning, when the recipient is at risk of significant
functional decompensation or requiring more restrictive service settings without these
services.
new text end
new text begin
(e) Adult rehabilitative mental health services instruct, assist, and support the recipient
in areas including: interpersonal communication skills, community resource utilization and
integration skills, crisis planning, relapse prevention skills, health care directives, budgeting
and shopping skills, healthy lifestyle skills and practices, cooking and nutrition skills,
transportation skills, medication education and monitoring, mental illness symptom
management skills, household management skills, employment-related skills, parenting
skills, and transition to community living services.
new text end
new text begin
(f) Community intervention, including consultation with relatives, guardians, friends,
employers, treatment providers, and other significant individuals, is appropriate when
directed exclusively to the treatment of the client.
new text end
Sec. 73.
Minnesota Statutes 2020, section 256B.0625, subdivision 3b, is amended to read:
Subd. 3b.
Telemedicine services.
(a) Medical assistance covers medically necessary
services and consultations delivered by a licensed health care provider via telemedicine in
the same manner as if the service or consultation was delivered in person. Coverage is
limited to three telemedicine services per enrollee per calendar week, except as provided
in paragraph (f). Telemedicine services shall be paid at the full allowable rate.
(b) The commissioner shall establish criteria that a health care provider must attest to
in order to demonstrate the safety or efficacy of delivering a particular service via
telemedicine. The attestation may include that the health care provider:
(1) has identified the categories or types of services the health care provider will provide
via telemedicine;
(2) has written policies and procedures specific to telemedicine services that are regularly
reviewed and updated;
(3) has policies and procedures that adequately address patient safety before, during,
and after the telemedicine service is rendered;
(4) has established protocols addressing how and when to discontinue telemedicine
services; and
(5) has an established quality assurance process related to telemedicine services.
(c) As a condition of payment, a licensed health care provider must document each
occurrence of a health service provided by telemedicine to a medical assistance enrollee.
Health care service records for services provided by telemedicine must meet the requirements
set forth in Minnesota Rules, part 9505.2175, subparts 1 and 2, and must document:
(1) the type of service provided by telemedicine;
(2) the time the service began and the time the service ended, including an a.m. and p.m.
designation;
(3) the licensed health care provider's basis for determining that telemedicine is an
appropriate and effective means for delivering the service to the enrollee;
(4) the mode of transmission of the telemedicine service and records evidencing that a
particular mode of transmission was utilized;
(5) the location of the originating site and the distant site;
(6) if the claim for payment is based on a physician's telemedicine consultation with
another physician, the written opinion from the consulting physician providing the
telemedicine consultation; and
(7) compliance with the criteria attested to by the health care provider in accordance
with paragraph (b).
(d) For purposes of this subdivision, unless otherwise covered under this chapter,
"telemedicine" is defined as the delivery of health care services or consultations while the
patient is at an originating site and the licensed health care provider is at a distant site. A
communication between licensed health care providers, or a licensed health care provider
and a patient that consists solely of a telephone conversation, e-mail, or facsimile transmission
does not constitute telemedicine consultations or services. Telemedicine may be provided
by means of real-time two-way, interactive audio and visual communications, including the
application of secure video conferencing or store-and-forward technology to provide or
support health care delivery, which facilitate the assessment, diagnosis, consultation,
treatment, education, and care management of a patient's health care.
(e) For purposes of this section, "licensed health care provider" means a licensed health
care provider under section 62A.671, subdivision 6, a community paramedic as defined
under section 144E.001, subdivision 5f, deleted text begin ordeleted text end new text begin a clinical trainee who is qualified according to
section 245I.04, subdivision 6,new text end a mental health practitioner deleted text begin defined under section 245.462,
subdivision 17, or 245.4871, subdivision 26, working under the general supervision of a
mental health professionaldeleted text end new text begin qualified according to section 245I.04, subdivision 4new text end , and a
community health worker who meets the criteria under subdivision 49, paragraph (a); "health
care provider" is defined under section 62A.671, subdivision 3; and "originating site" is
defined under section 62A.671, subdivision 7.
(f) The limit on coverage of three telemedicine services per enrollee per calendar week
does not apply if:
(1) the telemedicine services provided by the licensed health care provider are for the
treatment and control of tuberculosis; and
(2) the services are provided in a manner consistent with the recommendations and best
practices specified by the Centers for Disease Control and Prevention and the commissioner
of health.
Sec. 74.
Minnesota Statutes 2020, section 256B.0625, subdivision 5, is amended to read:
Subd. 5.
Community mental health center services.
Medical assistance covers
community mental health center services provided by a community mental health center
that meets the requirements in paragraphs (a) to (j).
(a) The provider is deleted text begin licensed under Minnesota Rules, parts 9520.0750 to 9520.0870deleted text end new text begin
certified as a mental health clinic under section 245I.20new text end .
(b)deleted text begin The provider provides mental health services under the clinical supervision of a
deleted text end deleted text begin mental health professional who is licensed for independent practice at the doctoral level or
deleted text end deleted text begin by a board-certified psychiatrist or a psychiatrist who is eligible for board certification.
deleted text end deleted text begin Clinical supervision has the meaning given in Minnesota Rules, part 9505.0370, subpart 6.deleted text end
new text begin In addition to the policies and procedures required by section 245I.03, the provider must
establish, enforce, and maintain policies and procedures for the oversight of clinical services
by a doctoral level psychologist or a board-certified or board-eligible psychiatrist. These
policies and procedures must be developed with the involvement of a doctoral level
psychologist and a board-certified or board-eligible psychiatrist. These policies and
procedures must include:
new text end
new text begin
(1) requirements for when to seek clinical consultation with a doctoral level psychologist
or a board-certified or board-eligible psychiatrist;
new text end
new text begin
(2) requirements for the involvement of a doctoral level psychologist or a board-certified
or board-eligible psychiatrist in the direction of clinical services; and
new text end
new text begin
(3) involvement of a doctoral level psychologist or a board-certified or board-eligible
psychiatrist in quality improvement initiatives and review as part of a multidisciplinary care
team.
new text end
(c) The provider must be a private nonprofit corporation or a governmental agency and
have a community board of directors as specified by section 245.66.
(d) The provider must have a sliding fee scale that meets the requirements in section
245.481, and agree to serve within the limits of its capacity all individuals residing in its
service delivery area.
(e) At a minimum, the provider must provide the following outpatient mental health
services: new text begin a new text end diagnostic assessment; explanation of findings; family, group, and individual
psychotherapy, including crisis intervention psychotherapy services, deleted text begin multiple family group
psychotherapy,deleted text end psychological testing, and medication management. In addition, the provider
must provide or be capable of providing upon request of the local mental health authority
day treatment servicesnew text begin , multiple family group psychotherapy,new text end and professional home-based
mental health services. The provider must have the capacity to provide such services to
specialized populations such as the elderly, families with children, persons who are seriously
and persistently mentally ill, and children who are seriously emotionally disturbed.
(f) The provider must be capable of providing the services specified in paragraph (e) to
individuals who are deleted text begin diagnosed with bothdeleted text end new text begin dually diagnosed withnew text end mental illness or emotional
disturbance, and deleted text begin chemical dependencydeleted text end new text begin substance use disordernew text end , and to individualsnew text begin who arenew text end
dually diagnosed with a mental illness or emotional disturbance and developmental disability.
(g) The provider must provide 24-hour emergency care services or demonstrate the
capacity to assist recipients in need of such services to access such services on a 24-hour
basis.
(h) The provider must have a contract with the local mental health authority to provide
one or more of the services specified in paragraph (e).
(i) The provider must agree, upon request of the local mental health authority, to enter
into a contract with the county to provide mental health services not reimbursable under
the medical assistance program.
(j) The provider may not be enrolled with the medical assistance program as both a
hospital and a community mental health center. The community mental health center's
administrative, organizational, and financial structure must be separate and distinct from
that of the hospital.
new text begin
(k) The commissioner may require the provider to annually attest, on forms that the
commissioner provides, to meeting the requirements in this subdivision.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
Paragraphs (e), (f), and (k) are effective the day following final
enactment.
new text end
Sec. 75.
Minnesota Statutes 2020, section 256B.0625, subdivision 19c, is amended to
read:
Subd. 19c.
Personal care.
Medical assistance covers personal care assistance services
provided by an individual who is qualified to provide the services according to subdivision
19a and sections 256B.0651 to 256B.0654, provided in accordance with a plan, and
supervised by a qualified professional.
"Qualified professional" means a mental health professional deleted text begin as defined in section 245.462,
subdivision 18, clauses (1) to (6), or 245.4871, subdivision 27, clauses (1) to (6)deleted text end ; a registered
nurse as defined in sections 148.171 to 148.285, a licensed social worker as defined in
sections 148E.010 and 148E.055, or a qualified designated coordinator under section
245D.081, subdivision 2. The qualified professional shall perform the duties required in
section 256B.0659.
Sec. 76.
Minnesota Statutes 2020, section 256B.0625, subdivision 28a, is amended to
read:
Subd. 28a.
Licensed physician assistant services.
(a) Medical assistance covers services
performed by a licensed physician assistant if the service is otherwise covered under this
chapter as a physician service and if the service is within the scope of practice of a licensed
physician assistant as defined in section 147A.09.
(b) Licensed physician assistants, who are supervised by a physician certified by the
American Board of Psychiatry and Neurology or eligible for board certification in psychiatry,
may bill for medication management and evaluation and management services provided to
medical assistance enrollees in inpatient hospital settings, and in outpatient settings after
the licensed physician assistant completes 2,000 hours of clinical experience in the evaluation
and treatment of mental health, consistent with their authorized scope of practice, as defined
in section 147A.09, with the exception of performing psychotherapy or diagnostic
assessments or providing deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision.
Sec. 77.
Minnesota Statutes 2020, section 256B.0625, subdivision 42, is amended to read:
Subd. 42.
Mental health professional.
Notwithstanding Minnesota Rules, part
9505.0175, subpart 28, the definition of a mental health professional deleted text begin shall include a person
who isdeleted text end qualified deleted text begin as specified indeleted text end new text begin according tonew text end section deleted text begin 245.462, subdivision 18, clauses (1) to
(6); or 245.4871, subdivision 27, clauses (1) to (6)deleted text end new text begin 245I.04, subdivision 2new text end , for the purpose
of this section and Minnesota Rules, parts 9505.0170 to 9505.0475.
Sec. 78.
Minnesota Statutes 2020, section 256B.0625, subdivision 48, is amended to read:
Subd. 48.
Psychiatric consultation to primary care practitioners.
Medical assistance
covers consultation provided by a deleted text begin psychiatrist, a psychologist, an advanced practice registered
nurse certified in psychiatric mental health, a licensed independent clinical social worker,
as defined in section 245.462, subdivision 18, clause (2), or a licensed marriage and family
therapist, as defined in section 245.462, subdivision 18, clause (5)deleted text end new text begin mental health professional
qualified according to section 245I.04, subdivision 2, except a licensed professional clinical
counselor licensed under section 148B.5301new text end , 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.
Sec. 79.
Minnesota Statutes 2020, section 256B.0625, subdivision 49, is amended to read:
Subd. 49.
Community health worker.
(a) Medical assistance covers the care
coordination and patient education services provided by a community health worker if the
community health worker hasdeleted text begin :
deleted text end
deleted text begin (1)deleted text end received a certificate from the Minnesota State Colleges and Universities System
approved community health worker curriculumdeleted text begin ; ordeleted text end new text begin .
new text end
deleted text begin
(2) at least five years of supervised experience with an enrolled physician, registered
nurse, advanced practice registered nurse, mental health professional as defined in section
245.462, subdivision 18, clauses (1) to (6), and section 245.4871, subdivision 27, clauses
(1) to (5), or dentist, or at least five years of supervised experience by a certified public
health nurse operating under the direct authority of an enrolled unit of government.
deleted text end
deleted text begin
Community health workers eligible for payment under clause (2) must complete the
certification program by January 1, 2010, to continue to be eligible for payment.
deleted text end
(b) Community health workers must work under the supervision of a medical assistance
enrolled physician, registered nurse, advanced practice registered nurse, mental health
professional deleted text begin as defined in section 245.462, subdivision 18, clauses (1) to (6), and section
245.4871, subdivision 27, clauses (1) to (5)deleted text end , or dentist, or work under the supervision of a
certified public health nurse operating under the direct authority of an enrolled unit of
government.
(c) Care coordination and patient education services covered under this subdivision
include, but are not limited to, services relating to oral health and dental care.
Sec. 80.
Minnesota Statutes 2020, section 256B.0625, subdivision 56a, is amended to
read:
Subd. 56a.
Officer-involved community-based care coordination.
(a) Medical
assistance covers officer-involved community-based care coordination for an individual
who:
(1) has screened positive for benefiting from treatment for a mental illness or substance
use disorder using a tool approved by the commissioner;
(2) does not require the security of a public detention facility and is not considered an
inmate of a public institution as defined in Code of Federal Regulations, title 42, section
435.1010;
(3) meets the eligibility requirements in section 256B.056; and
(4) has agreed to participate in officer-involved community-based care coordination.
(b) Officer-involved community-based care coordination means navigating services to
address a client's mental health, chemical health, social, economic, and housing needs, or
any other activity targeted at reducing the incidence of jail utilization and connecting
individuals with existing covered services available to them, including, but not limited to,
targeted case management, waiver case management, or care coordination.
(c) Officer-involved community-based care coordination must be provided by an
individual who is an employee of or is under contract with a county, or is an employee of
or under contract with an Indian health service facility or facility owned and operated by a
tribe or a tribal organization operating under Public Law 93-638 as a 638 facility to provide
officer-involved community-based care coordination and is qualified under one of the
following criteria:
(1) a deleted text begin licenseddeleted text end mental health professional deleted text begin as defined in section 245.462, subdivision 18,
clauses (1) to (6)deleted text end ;
(2)new text begin a clinical trainee qualified according to section 245I.04, subdivision 6, working under
the treatment supervision of a mental health professional according to section 245I.06;
new text end
new text begin (3)new text end a mental health practitioner deleted text begin as defined in section 245.462, subdivision 17deleted text end new text begin qualified
according to section 245I.04, subdivision 4new text end , working under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision
of a mental health professionalnew text begin according to section 245I.06new text end ;
deleted text begin (3)deleted text end new text begin (4)new text end a new text begin mental health new text end certified peer specialist deleted text begin under section 256B.0615deleted text end new text begin qualified
according to section 245I.04, subdivision 10new text end , working under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision
of a mental health professionalnew text begin according to section 245I.06new text end ;
(4) an individual qualified as an alcohol and drug counselor under section 245G.11,
subdivision 5; or
(5) a recovery peer qualified under section 245G.11, subdivision 8, working under the
supervision of an individual qualified as an alcohol and drug counselor under section
245G.11, subdivision 5.
(d) Reimbursement is allowed for up to 60 days following the initial determination of
eligibility.
(e) Providers of officer-involved community-based care coordination shall annually
report to the commissioner on the number of individuals served, and number of the
community-based services that were accessed by recipients. The commissioner shall ensure
that services and payments provided under officer-involved community-based care
coordination do not duplicate services or payments provided under section 256B.0625,
subdivision 20, 256B.0753, 256B.0755, or 256B.0757.
(f) Notwithstanding section 256B.19, subdivision 1, the nonfederal share of cost for
officer-involved community-based care coordination services shall be provided by the
county providing the services, from sources other than federal funds or funds used to match
other federal funds.
Sec. 81.
Minnesota Statutes 2020, section 256B.0757, subdivision 4c, is amended to read:
Subd. 4c.
Behavioral health home services staff qualifications.
(a) A behavioral health
home services provider must maintain staff with required professional qualifications
appropriate to the setting.
(b) If behavioral health home services are offered in a mental health setting, the
integration specialist must be a registered nurse licensed under the Minnesota Nurse Practice
Act, sections 148.171 to 148.285.
(c) If behavioral health home services are offered in a primary care setting, the integration
specialist must be a mental health professional deleted text begin as defined indeleted text end new text begin who is qualified according tonew text end
section deleted text begin 245.462, subdivision 18, clauses (1) to (6), or 245.4871, subdivision 27, clauses (1)
to (6)deleted text end new text begin 245I.04, subdivision 2new text end .
(d) If behavioral health home services are offered in either a primary care setting or
mental health setting, the systems navigator must be a mental health practitioner deleted text begin as defined
indeleted text end new text begin who is qualified according tonew text end section deleted text begin 245.462, subdivision 17deleted text end new text begin 245I.04, subdivision 4new text end , or
a community health worker as defined in section 256B.0625, subdivision 49.
(e) If behavioral health home services are offered in either a primary care setting or
mental health setting, the qualified health home specialist must be one of the following:
(1) a new text begin mental health certified new text end peer deleted text begin supportdeleted text end specialist deleted text begin as defined indeleted text end new text begin who is qualified
according tonew text end section deleted text begin 256B.0615deleted text end new text begin 245I.04, subdivision 10new text end ;
(2) a new text begin mental health certified new text end family peer deleted text begin supportdeleted text end specialist deleted text begin as defined indeleted text end new text begin who is qualified
according tonew text end section deleted text begin 256B.0616deleted text end new text begin 245I.04, subdivision 12new text end ;
(3) a case management associate as defined in section 245.462, subdivision 4, paragraph
(g), or 245.4871, subdivision 4, paragraph (j);
(4) a mental health rehabilitation worker deleted text begin as defined indeleted text end new text begin who is qualified according tonew text end
section deleted text begin 256B.0623, subdivision 5, clause (4)deleted text end new text begin 245I.04, subdivision 14new text end ;
(5) a community paramedic as defined in section 144E.28, subdivision 9;
(6) a peer recovery specialist as defined in section 245G.07, subdivision 1, clause (5);
or
(7) a community health worker as defined in section 256B.0625, subdivision 49.
Sec. 82.
Minnesota Statutes 2020, section 256B.0941, subdivision 1, is amended to read:
Subdivision 1.
Eligibility.
(a) An individual who is eligible for mental health treatment
services in a psychiatric residential treatment facility must meet all of the following criteria:
(1) before admission, services are determined to be medically necessary according to
Code of Federal Regulations, title 42, section 441.152;
(2) is younger than 21 years of age at the time of admission. Services may continue until
the individual meets criteria for discharge or reaches 22 years of age, whichever occurs
first;
(3) has a mental health diagnosis as defined in the most recent edition of the Diagnostic
and Statistical Manual for Mental Disorders, as well as clinical evidence of severe aggression,
or a finding that the individual is a risk to self or others;
(4) has functional impairment and a history of difficulty in functioning safely and
successfully in the community, school, home, or job; an inability to adequately care for
one's physical needs; or caregivers, guardians, or family members are unable to safely fulfill
the individual's needs;
(5) requires psychiatric residential treatment under the direction of a physician to improve
the individual's condition or prevent further regression so that services will no longer be
needed;
(6) utilized and exhausted other community-based mental health services, or clinical
evidence indicates that such services cannot provide the level of care needed; and
(7) was referred for treatment in a psychiatric residential treatment facility by a deleted text begin qualifieddeleted text end
mental health professional deleted text begin licensed as defined indeleted text end new text begin qualified according tonew text end section deleted text begin 245.4871,
subdivision 27, clauses (1) to (6)deleted text end new text begin 245I.04, subdivision 2new text end .
(b) The commissioner shall provide oversight and review the use of referrals for clients
admitted to psychiatric residential treatment facilities to ensure that eligibility criteria,
clinical services, and treatment planning reflect clinical, state, and federal standards for
psychiatric residential treatment facility level of care. The commissioner shall coordinate
the production of a statewide list of children and youth who meet the medical necessity
criteria for psychiatric residential treatment facility level of care and who are awaiting
admission. The commissioner and any recipient of the list shall not use the statewide list to
direct admission of children and youth to specific facilities.
Sec. 83.
Minnesota Statutes 2020, section 256B.0943, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
For purposes of this section, the following terms have the
meanings given them.
(a) "Children's therapeutic services and supports" means the flexible package of mental
health services for children who require varying therapeutic and rehabilitative levels of
intervention to treat a diagnosed emotional disturbance, as defined in section 245.4871,
subdivision 15, or a diagnosed mental illness, as defined in section 245.462, subdivision
20. The services are time-limited interventions that are delivered using various treatment
modalities and combinations of services designed to reach treatment outcomes identified
in the individual treatment plan.
deleted text begin
(b) "Clinical supervision" means the overall responsibility of the mental health
professional for the control and direction of individualized treatment planning, service
delivery, and treatment review for each client. A mental health professional who is an
enrolled Minnesota health care program provider accepts full professional responsibility
for a supervisee's actions and decisions, instructs the supervisee in the supervisee's work,
and oversees or directs the supervisee's work.
deleted text end
deleted text begin (c)deleted text end new text begin (b)new text end "Clinical trainee" means a deleted text begin mental health practitioner who meets the qualifications
specified in Minnesota Rules, part 9505.0371, subpart 5, item Cdeleted text end new text begin staff person who is qualified
according to section 245I.04, subdivision 6new text end .
deleted text begin (d)deleted text end new text begin (c)new text end "Crisis deleted text begin assistancedeleted text end new text begin planningnew text end " has the meaning given in section 245.4871, subdivision
9a. deleted text begin Crisis assistance entails the development of a written plan to assist a child's family to
contend with a potential crisis and is distinct from the immediate provision of crisis
intervention services.
deleted text end
deleted text begin (e)deleted text end new text begin (d)new text end "Culturally competent provider" means a provider who understands and can
utilize to a client's benefit the client's culture when providing services to the client. A provider
may be culturally competent because the provider is of the same cultural or ethnic group
as the client or the provider has developed the knowledge and skills through training and
experience to provide services to culturally diverse clients.
deleted text begin (f)deleted text end new text begin (e)new text end "Day treatment program" for children means a site-based structured mental health
program consisting of psychotherapy for three or more individuals and individual or group
skills training provided by a deleted text begin multidisciplinarydeleted text end team, under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision
of a mental health professional.
deleted text begin (g)deleted text end new text begin (f)new text end "new text begin Standard new text end diagnostic assessment" deleted text begin has the meaning given in Minnesota Rules, part
9505.0372, subpart 1deleted text end new text begin means the assessment described in 245I.10, subdivision 6new text end .
deleted text begin (h)deleted text end new text begin (g)new text end "Direct service time" means the time that a mental health professional, clinical
trainee, mental health practitioner, or mental health behavioral aide spends face-to-face with
a client and the client's family or providing covered telemedicine services. Direct service
time includes time in which the provider obtains a client's history, develops a client's
treatment plan, records individual treatment outcomes, or provides service components of
children's therapeutic services and supports. Direct service time does not include time doing
work before and after providing direct services, including scheduling or maintaining clinical
records.
deleted text begin (i)deleted text end new text begin (h)new text end "Direction of mental health behavioral aide" means the activities of a mental
health professionalnew text begin , clinical trainee,new text end or mental health practitioner in guiding the mental
health behavioral aide in providing services to a client. The direction of a mental health
behavioral aide must be based on the client's deleted text begin individualizeddeleted text end new text begin individualnew text end treatment plan and
meet the requirements in subdivision 6, paragraph (b), clause (5).
deleted text begin (j)deleted text end new text begin (i)new text end "Emotional disturbance" has the meaning given in section 245.4871, subdivision
15.
deleted text begin (k)deleted text end new text begin (j)new text end "Individual behavioral plan" means a plan of intervention, treatment, and services
for a child written by a mental health professional new text begin or a clinical trainee new text end or mental health
practitionerdeleted text begin ,deleted text end under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional, to
guide the work of the mental health behavioral aide. The individual behavioral plan may
be incorporated into the child's individual treatment plan so long as the behavioral plan is
separately communicable to the mental health behavioral aide.
deleted text begin (l)deleted text end new text begin (k)new text end "Individual treatment plan" deleted text begin has the meaning given in Minnesota Rules, part
9505.0371, subpart 7deleted text end new text begin means the plan described in section 245I.10, subdivisions 7 and 8new text end .
deleted text begin (m)deleted text end new text begin (l)new text end "Mental health behavioral aide services" means medically necessary one-on-one
activities performed by a deleted text begin trained paraprofessional qualified as provided in subdivision 7,
paragraph (b), clause (3)deleted text end new text begin mental health behavioral aide qualified according to section 245I.04,
subdivision 16new text end , to assist a child retain or generalize psychosocial skills as previously trained
by a mental health professionalnew text begin , clinical trainee,new text end or mental health practitioner and as described
in the child's individual treatment plan and individual behavior plan. Activities involve
working directly with the child or child's family as provided in subdivision 9, paragraph
(b), clause (4).
new text begin
(m) "Mental health certified family peer specialist" means a staff person who is qualified
according to section 245I.04, subdivision 12.
new text end
(n) "Mental health practitioner" deleted text begin has the meaning given in section 245.462, subdivision
17, except that a practitioner working in a day treatment setting may qualify as a mental
health practitioner if the practitioner holds a bachelor's degree in one of the behavioral
sciences or related fields from an accredited college or university, and: (1) has at least 2,000
hours of clinically supervised experience in the delivery of mental health services to clients
with mental illness; (2) is fluent in the language, other than English, of the cultural group
that makes up at least 50 percent of the practitioner's clients, completes 40 hours of training
on the delivery of services to clients with mental illness, and receives clinical supervision
from a mental health professional at least once per week until meeting the required 2,000
hours of supervised experience; or (3) receives 40 hours of training on the delivery of
deleted text end deleted text begin services to clients with mental illness within six months of employment, and clinical
supervision from a mental health professional at least once per week until meeting the
required 2,000 hours of supervised experiencedeleted text end new text begin means a staff person who is qualified according
to section 245I.04, subdivision 4new text end .
(o) "Mental health professional" means deleted text begin an individual as defined in Minnesota Rules,
part 9505.0370, subpart 18deleted text end new text begin a staff person who is qualified according to section 245I.04,
subdivision 2new text end .
(p) "Mental health service plan development" includes:
(1) the development, review, and revision of a child's individual treatment plan, deleted text begin as
provided in Minnesota Rules, part 9505.0371, subpart 7,deleted text end including involvement of the client
or client's parents, primary caregiver, or other person authorized to consent to mental health
services for the client, and including arrangement of treatment and support activities specified
in the individual treatment plan; and
(2) administering new text begin and reporting the new text end standardized outcome deleted text begin measurement instruments,
determined and updated by the commissionerdeleted text end new text begin measurements in section 245I.10, subdivision
6, paragraph (d), clauses (3) and (4), and other standardized outcome measurements approved
by the commissionernew text end , as periodically needed to evaluate the effectiveness of treatment deleted text begin for
children receiving clinical services and reporting outcome measures, as required by the
commissionerdeleted text end .
(q) "Mental illness," for persons at least age 18 but under age 21, has the meaning given
in section 245.462, subdivision 20, paragraph (a).
(r) "Psychotherapy" means the treatment deleted text begin of mental or emotional disorders or
maladjustment by psychological means. Psychotherapy may be provided in many modalities
in accordance with Minnesota Rules, part 9505.0372, subpart 6, including patient and/or
family psychotherapy; family psychotherapy; psychotherapy for crisis; group psychotherapy;
or multiple-family psychotherapy. Beginning with the American Medical Association's
Current Procedural Terminology, standard edition, 2014, the procedure "individual
psychotherapy" is replaced with "patient and/or family psychotherapy," a substantive change
that permits the therapist to work with the client's family without the client present to obtain
information about the client or to explain the client's treatment plan to the family.
Psychotherapy is appropriate for crisis response when a child has become dysregulated or
experienced new trauma since the diagnostic assessment was completed and needs
psychotherapy to address issues not currently included in the child's individual treatment
plandeleted text end new text begin described in section 256B.0671, subdivision 11new text end .
(s) "Rehabilitative services" or "psychiatric rehabilitation services" means deleted text begin a series or
multidisciplinary combination of psychiatric and psychosocialdeleted text end interventions to: (1) restore
a child or adolescent to an age-appropriate developmental trajectory that had been disrupted
by a psychiatric illness; or (2) enable the child to self-monitor, compensate for, cope with,
counteract, or replace psychosocial skills deficits or maladaptive skills acquired over the
course of a psychiatric illness. Psychiatric rehabilitation services for children combine
new text begin coordinated new text end psychotherapy to address internal psychological, emotional, and intellectual
processing deficits, and skills training to restore personal and social functioning. Psychiatric
rehabilitation services establish a progressive series of goals with each achievement building
upon a prior achievement. deleted text begin Continuing progress toward goals is expected, and rehabilitative
potential ceases when successive improvement is not observable over a period of time.
deleted text end
(t) "Skills training" means individual, family, or group training, delivered by or under
the supervision of a mental health professional, designed to facilitate the acquisition of
psychosocial skills that are medically necessary to rehabilitate the child to an age-appropriate
developmental trajectory heretofore disrupted by a psychiatric illness or to enable the child
to self-monitor, compensate for, cope with, counteract, or replace skills deficits or
maladaptive skills acquired over the course of a psychiatric illness. Skills training is subject
to the service delivery requirements under subdivision 9, paragraph (b), clause (2).
new text begin
(u) "Treatment supervision" means the supervision described in section 245I.06.
new text end
Sec. 84.
Minnesota Statutes 2020, section 256B.0943, subdivision 2, is amended to read:
Subd. 2.
Covered service components of children's therapeutic services and
supports.
(a) Subject to federal approval, medical assistance covers medically necessary
children's therapeutic services and supports deleted text begin as defined in this section thatdeleted text end new text begin when the services
are provided bynew text end an eligible provider entity certified under deleted text begin subdivision 4 provides to a client
eligible under subdivision 3deleted text end new text begin and meeting the standards in this sectionnew text end .new text begin The provider entity
must make reasonable and good faith efforts to report individual client outcomes to the
commissioner, using instruments and protocols approved by the commissioner.
new text end
(b) The service components of children's therapeutic services and supports are:
(1) patient and/or family psychotherapy, family psychotherapy, psychotherapy for crisis,
and group psychotherapy;
(2) individual, family, or group skills training provided by a mental health professionalnew text begin ,
clinical trainee,new text end or mental health practitioner;
(3) crisis deleted text begin assistancedeleted text end new text begin planningnew text end ;
(4) mental health behavioral aide services;
(5) direction of a mental health behavioral aide;
(6) mental health service plan development; and
(7) children's day treatment.
Sec. 85.
Minnesota Statutes 2020, section 256B.0943, subdivision 3, is amended to read:
Subd. 3.
Determination of client eligibility.
new text begin (a) new text end A client's eligibility to receive children's
therapeutic services and supports under this section shall be determined based on a new text begin standard
new text end diagnostic assessment by a mental health professional or a deleted text begin mental health practitioner who
meets the requirements of a clinical trainee as defined in Minnesota Rules, part 9505.0371,
subpart 5, item C,deleted text end new text begin clinical traineenew text end that is performed within one year before the initial start
of service. The new text begin standard new text end diagnostic assessment must deleted text begin meet the requirements for a standard
or extended diagnostic assessment as defined in Minnesota Rules, part 9505.0372, subpart
1, items B and C, anddeleted text end :
deleted text begin
(1) include current diagnoses, including any differential diagnosis, in accordance with
all criteria for a complete diagnosis and diagnostic profile as specified in the current edition
of the Diagnostic and Statistical Manual of the American Psychiatric Association, or, for
children under age five, as specified in the current edition of the Diagnostic Classification
of Mental Health Disorders of Infancy and Early Childhood;
deleted text end
deleted text begin (2)deleted text end new text begin (1)new text end determine whether a child under age 18 has a diagnosis of emotional disturbance
or, if the person is between the ages of 18 and 21, whether the person has a mental illness;
deleted text begin (3)deleted text end new text begin (2)new text end document children's therapeutic services and supports as medically necessary to
address an identified disability, functional impairment, and the individual client's needs and
goals;new text begin and
new text end
deleted text begin (4)deleted text end new text begin (3)new text end be used in the development of the deleted text begin individualizeddeleted text end new text begin individualnew text end treatment plandeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(5) 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 an adult diagnostic update as defined in Minnesota Rules, part 9505.0371,
subpart 2, item E.
deleted text end
new text begin
(b) Notwithstanding paragraph (a), a client may be determined to be eligible for up to
five days of day treatment under this section based on a hospital's medical history and
presentation examination of the client.
new text end
Sec. 86.
Minnesota Statutes 2020, section 256B.0943, subdivision 4, is amended to read:
Subd. 4.
Provider entity certification.
(a) The commissioner shall establish an initial
provider entity application and certification process and recertification process to determine
whether a provider entity has an administrative and clinical infrastructure that meets the
requirements in subdivisions 5 and 6. A provider entity must be certified for the three core
rehabilitation services of psychotherapy, skills training, and crisis deleted text begin assistancedeleted text end new text begin planningnew text end . The
commissioner shall recertify a provider entity at least every three years. The commissioner
shall establish a process for decertification of a provider entity and shall require corrective
action, medical assistance repayment, or decertification of a provider entity that no longer
meets the requirements in this section or that fails to meet the clinical quality standards or
administrative standards provided by the commissioner in the application and certification
process.
(b) For purposes of this section, a provider entity must new text begin meet the standards in this section
and chapter 245I, as required in section 245I.011, subdivision 5, and new text end be:
(1) an Indian health services facility or a facility owned and operated by a tribe or tribal
organization operating as a 638 facility under Public Law 93-638 certified by the state;
(2) a county-operated entity certified by the state; or
(3) a noncounty entity certified by the state.
Sec. 87.
Minnesota Statutes 2020, section 256B.0943, subdivision 5, is amended to read:
Subd. 5.
Provider entity administrative infrastructure requirements.
(a) deleted text begin To be an
eligible provider entity under this section, a provider entity must have an administrative
infrastructure that establishes authority and accountability for decision making and oversight
of functions, including finance, personnel, system management, clinical practice, and
individual treatment outcomes measurement.deleted text end An eligible provider entity shall demonstrate
the availability, by means of employment or contract, of at least one backup mental health
professional in the event of the primary mental health professional's absence. deleted text begin The provider
must have written policies and procedures that it reviews and updates every three years and
distributes to staff initially and upon each subsequent update.
deleted text end
(b) deleted text begin The administrative infrastructure writtendeleted text end new text begin In addition to the policies and procedures
required by section 245I.03, thenew text end policies and procedures must include:
deleted text begin
(1) personnel procedures, including a process for: (i) recruiting, hiring, training, and
retention of culturally and linguistically competent providers; (ii) conducting a criminal
background check on all direct service providers and volunteers; (iii) investigating, reporting,
and acting on violations of ethical conduct standards; (iv) investigating, reporting, and acting
on violations of data privacy policies that are compliant with federal and state laws; (v)
utilizing volunteers, including screening applicants, training and supervising volunteers,
and providing liability coverage for volunteers; and (vi) documenting that each mental
health professional, mental health practitioner, or mental health behavioral aide meets the
applicable provider qualification criteria, training criteria under subdivision 8, and clinical
supervision or direction of a mental health behavioral aide requirements under subdivision
6;
deleted text end
deleted text begin (2)deleted text end new text begin (1)new text end fiscal procedures, including internal fiscal control practices and a process for
collecting revenue that is compliant with federal and state laws;new text begin and
new text end
deleted text begin (3)deleted text end new text begin (2)new text end a client-specific treatment outcomes measurement system, including baseline
measures, to measure a client's progress toward achieving mental health rehabilitation goals.
deleted text begin Effective July 1, 2017, to be eligible for medical assistance payment, a provider entity must
report individual client outcomes to the commissioner, using instruments and protocols
approved by the commissioner; and
deleted text end
deleted text begin
(4) a process to establish and maintain individual client records. The client's records
must include:
deleted text end
deleted text begin
(i) the client's personal information;
deleted text end
deleted text begin
(ii) forms applicable to data privacy;
deleted text end
deleted text begin
(iii) the client's diagnostic assessment, updates, results of tests, individual treatment
plan, and individual behavior plan, if necessary;
deleted text end
deleted text begin
(iv) documentation of service delivery as specified under subdivision 6;
deleted text end
deleted text begin
(v) telephone contacts;
deleted text end
deleted text begin
(vi) discharge plan; and
deleted text end
deleted text begin
(vii) if applicable, insurance information.
deleted text end
(c) A provider entity that uses a restrictive procedure with a client must meet the
requirements of section 245.8261.
Sec. 88.
Minnesota Statutes 2020, section 256B.0943, subdivision 5a, is amended to read:
Subd. 5a.
Background studies.
The requirements for background studies under deleted text begin thisdeleted text end
section new text begin 245I.011, subdivision 4, paragraph (d), new text end may be met by a children's therapeutic
services and supports services agency through the commissioner's NETStudy system as
provided under sections 245C.03, subdivision 7, and 245C.10, subdivision 8.
Sec. 89.
Minnesota Statutes 2020, section 256B.0943, subdivision 6, is amended to read:
Subd. 6.
Provider entity clinical infrastructure requirements.
(a) To be an eligible
provider entity under this section, a provider entity must have a clinical infrastructure that
utilizes diagnostic assessment, deleted text begin individualizeddeleted text end new text begin individualnew text end treatment plans, service delivery,
and individual treatment plan review that are culturally competent, child-centered, and
family-driven to achieve maximum benefit for the client. The provider entity must review,
and update as necessary, the clinical policies and procedures every three years, must distribute
the policies and procedures to staff initially and upon each subsequent update, and must
train staff accordingly.
(b) The clinical infrastructure written policies and procedures must include policies and
procedures fornew text begin meeting the requirements in this subdivisionnew text end :
(1) providing or obtaining a client's new text begin standard new text end diagnostic assessment, including a new text begin standard
new text end diagnostic assessment deleted text begin performed by an outside or independent clinician, that identifies acute
and chronic clinical disorders, co-occurring medical conditions, and sources of psychological
and environmental problems, including baselines, and a functional assessment. The functional
assessment component must clearly summarize the client's individual strengths and needs.deleted text end
When required components of the new text begin standard new text end diagnostic assessmentdeleted text begin , such as baseline measures,deleted text end
are not provided in an outside or independent assessment or deleted text begin when baseline measuresdeleted text end cannot
be attained deleted text begin in a one-session standard diagnostic assessmentdeleted text end new text begin immediatelynew text end , the provider entity
must determine the missing information within 30 days and amend the child's new text begin standard
new text end diagnostic assessment or incorporate the deleted text begin baselinesdeleted text end new text begin informationnew text end into the child's individual
treatment plan;
(2) developing an individual treatment plan deleted text begin that:deleted text end new text begin ;
new text end
deleted text begin
(i) is based on the information in the client's diagnostic assessment and baselines;
deleted text end
deleted text begin
(ii) identified goals and objectives of treatment, treatment strategy, schedule for
accomplishing treatment goals and objectives, and the individuals responsible for providing
treatment services and supports;
deleted text end
deleted text begin
(iii) is developed after completion of the client's diagnostic assessment by a mental health
professional or clinical trainee and before the provision of children's therapeutic services
and supports;
deleted text end
deleted text begin
(iv) is developed through a child-centered, family-driven, culturally appropriate planning
process, including allowing parents and guardians to observe or participate in individual
and family treatment services, assessment, and treatment planning;
deleted text end
deleted text begin
(v) is reviewed at least once every 90 days and revised to document treatment progress
on each treatment objective and next goals or, if progress is not documented, to document
changes in treatment; and
deleted text end
deleted text begin
(vi) is signed by the clinical supervisor and by the client or by the client's parent or other
person authorized by statute to consent to mental health services for the client. A client's
parent may approve the client's individual treatment plan by secure electronic signature or
by documented oral approval that is later verified by written signature;
deleted text end
(3) developing an individual behavior plan that documents deleted text begin treatment strategiesdeleted text end new text begin and
describes interventionsnew text end to be provided by the mental health behavioral aide. The individual
behavior plan must include:
(i) detailed instructions on the deleted text begin treatment strategies to be provideddeleted text end new text begin psychosocial skills to
be practicednew text end ;
(ii) time allocated to each deleted text begin treatment strategydeleted text end new text begin interventionnew text end ;
(iii) methods of documenting the child's behavior;
(iv) methods of monitoring the child's progress in reaching objectives; and
(v) goals to increase or decrease targeted behavior as identified in the individual treatment
plan;
(4) providing deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision plans for deleted text begin mental health practitioners and
mental health behavioral aides. A mental health professional must document the clinical
supervision the professional provides by cosigning individual treatment plans and making
entries in the client's record on supervisory activities. The clinical supervisor also shall
document supervisee-specific supervision in the supervisee's personnel file. Clinicaldeleted text end new text begin staff
according to section 245I.06. Treatmentnew text end supervision does not include the authority to make
or terminate court-ordered placements of the child. A deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervisor must be
available for urgent consultation as required by the individual client's needs or the situationdeleted text begin .
Clinical supervision may occur individually or in a small group to discuss treatment and
review progress toward goals. The focus of clinical supervision must be the client's treatment
needs and progress and the mental health practitioner's or behavioral aide's ability to provide
servicesdeleted text end ;
(4a) meeting day treatment program conditions in items (i) deleted text begin to (iii)deleted text end new text begin and (ii)new text end :
(i) the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervisor must be present and available on the premises more
than 50 percent of the time in a provider's standard working week during which the supervisee
is providing a mental health service;new text begin and
new text end
deleted text begin
(ii) the diagnosis and the client's individual treatment plan or a change in the diagnosis
or individual treatment plan must be made by or reviewed, approved, and signed by the
clinical supervisor; and
deleted text end
deleted text begin (iii)deleted text end new text begin (ii)new text end every 30 days, the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervisor must review and sign the record
indicating the supervisor has reviewed the client's care for all activities in the preceding
30-day period;
(4b) meeting the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision standards in items (i) deleted text begin to (iv)deleted text end new text begin and (ii)new text end for
all other services provided under CTSS:
deleted text begin
(i) medical assistance shall reimburse for services provided by a mental health practitioner
who is delivering services that fall within the scope of the practitioner's practice and who
is supervised by a mental health professional who accepts full professional responsibility;
deleted text end
deleted text begin
(ii) medical assistance shall reimburse for services provided by a mental health behavioral
aide who is delivering services that fall within the scope of the aide's practice and who is
supervised by a mental health professional who accepts full professional responsibility and
has an approved plan for clinical supervision of the behavioral aide. Plans must be developed
in accordance with supervision standards defined in Minnesota Rules, part 9505.0371,
subpart 4, items A to D;
deleted text end
deleted text begin (iii)deleted text end new text begin (i)new text end the mental health professional is required to be present at the site of service
delivery for observation as clinically appropriate when the new text begin clinical trainee, new text end mental health
practitionernew text begin ,new text end or mental health behavioral aide is providing CTSS services; and
deleted text begin (iv)deleted text end new text begin (ii)new text end when conducted, the on-site presence of the mental health professional must be
documented in the child's record and signed by the mental health professional who accepts
full professional responsibility;
(5) providing direction to a mental health behavioral aide. For entities that employ mental
health behavioral aides, the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervisor must be employed by the provider
entity or other provider certified to provide mental health behavioral aide services to ensure
necessary and appropriate oversight for the client's treatment and continuity of care. The
deleted text begin mental health professional or mental health practitionerdeleted text end new text begin staffnew text end giving direction must begin
with the goals on the deleted text begin individualizeddeleted text end new text begin individualnew text end treatment plan, and instruct the mental health
behavioral aide on how to implement therapeutic activities and interventions that will lead
to goal attainment. The deleted text begin professional or practitionerdeleted text end new text begin staffnew text end giving direction must also instruct
the mental health behavioral aide about the client's diagnosis, functional status, and other
characteristics that are likely to affect service delivery. Direction must also include
determining that the mental health behavioral aide has the skills to interact with the client
and the client's family in ways that convey personal and cultural respect and that the aide
actively solicits information relevant to treatment from the family. The aide must be able
to clearly explain or demonstrate the activities the aide is doing with the client and the
activities' relationship to treatment goals. Direction is more didactic than is supervision and
requires the deleted text begin professional or practitionerdeleted text end new text begin staffnew text end providing it to continuously evaluate the mental
health behavioral aide's ability to carry out the activities of the deleted text begin individualizeddeleted text end new text begin individualnew text end
treatment plan and the deleted text begin individualizeddeleted text end new text begin individualnew text end behavior plan. When providing direction,
the deleted text begin professional or practitionerdeleted text end new text begin staffnew text end must:
(i) review progress notes prepared by the mental health behavioral aide for accuracy and
consistency with diagnostic assessment, treatment plan, and behavior goals and the
deleted text begin professional or practitionerdeleted text end new text begin staffnew text end must approve and sign the progress notes;
(ii) identify changes in treatment strategies, revise the individual behavior plan, and
communicate treatment instructions and methodologies as appropriate to ensure that treatment
is implemented correctly;
(iii) demonstrate family-friendly behaviors that support healthy collaboration among
the child, the child's family, and providers as treatment is planned and implemented;
(iv) ensure that the mental health behavioral aide is able to effectively communicate
with the child, the child's family, and the provider; deleted text begin and
deleted text end
(v) record the results of any evaluation and corrective actions taken to modify the work
of the mental health behavioral aide;new text begin and
new text end
new text begin
(vi) ensure the immediate accessibility of a mental health professional, clinical trainee,
or mental health practitioner to the behavioral aide during service delivery;
new text end
(6) providing service delivery that implements the individual treatment plan and meets
the requirements under subdivision 9; and
(7) individual treatment plan review. The review must determine the extent to which
the services have met each of the goals and objectives in the treatment plan. The review
must assess the client's progress and ensure that services and treatment goals continue to
be necessary and appropriate to the client and the client's family or foster family. deleted text begin Revision
of the individual treatment plan does not require a new diagnostic assessment unless the
client's mental health status has changed markedly. The updated treatment plan must be
signed by the clinical supervisor and by the client, if appropriate, and by the client's parent
or other person authorized by statute to give consent to the mental health services for the
child.
deleted text end
Sec. 90.
Minnesota Statutes 2020, section 256B.0943, subdivision 7, is amended to read:
Subd. 7.
Qualifications of individual and team providers.
(a) An individual or team
provider working within the scope of the provider's practice or qualifications may provide
service components of children's therapeutic services and supports that are identified as
medically necessary in a client's individual treatment plan.
(b) An individual provider must be qualified asnew text begin anew text end :
(1) deleted text begin adeleted text end mental health professional deleted text begin as defined in subdivision 1, paragraph (o)deleted text end ; deleted text begin or
deleted text end
(2) deleted text begin adeleted text end new text begin clinical trainee;
new text end
new text begin (3)new text end mental health practitioner deleted text begin or clinical trainee. The mental health practitioner or clinical
trainee must work under the clinical supervision of a mental health professionaldeleted text end ; deleted text begin or
deleted text end
new text begin
(4) mental health certified family peer specialist; or
new text end
deleted text begin (3) adeleted text end new text begin (5)new text end mental health behavioral aide deleted text begin working under the clinical supervision of a mental
health professional to implement the rehabilitative mental health services previously
introduced by a mental health professional or practitioner and identified in the client's
individual treatment plan and individual behavior plan.
deleted text end
deleted text begin
(A) A level I mental health behavioral aide must:
deleted text end
deleted text begin
(i) be at least 18 years old;
deleted text end
deleted text begin
(ii) have a high school diploma or commissioner of education-selected high school
equivalency certification or two years of experience as a primary caregiver to a child with
severe emotional disturbance within the previous ten years; and
deleted text end
deleted text begin
(iii) meet preservice and continuing education requirements under subdivision 8.
deleted text end
deleted text begin
(B) A level II mental health behavioral aide must:
deleted text end
deleted text begin
(i) be at least 18 years old;
deleted text end
deleted text begin
(ii) have an associate or bachelor's degree or 4,000 hours of experience in delivering
clinical services in the treatment of mental illness concerning children or adolescents or
complete a certificate program established under subdivision 8a; and
deleted text end
deleted text begin
(iii) meet preservice and continuing education requirements in subdivision 8.
deleted text end
(c) A day treatment deleted text begin multidisciplinarydeleted text end team must include at least one mental health
professional or clinical trainee and one mental health practitioner.
Sec. 91.
Minnesota Statutes 2020, section 256B.0943, subdivision 9, is amended to read:
Subd. 9.
Service delivery criteria.
(a) In delivering services under this section, a certified
provider entity must ensure that:
(1) deleted text begin each individual provider's caseload size permits the provider to deliver services to
both clients with severe, complex needs and clients with less intensive needs.deleted text end the provider's
caseload size should reasonably enable the provider to play an active role in service planning,
monitoring, and delivering services to meet the client's and client's family's needs, as specified
in each client's individual treatment plan;
(2) site-based programs, including day treatment programs, provide staffing and facilities
to ensure the client's health, safety, and protection of rights, and that the programs are able
to implement each client's individual treatment plan; and
(3) a day treatment program is provided to a group of clients by a deleted text begin multidisciplinarydeleted text end team
under the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision of a mental health professional. The day treatment
program must be provided in and by: (i) an outpatient hospital accredited by the Joint
Commission on Accreditation of Health Organizations and licensed under sections 144.50
to 144.55; (ii) a community mental health center under section 245.62; or (iii) an entity that
is certified under subdivision 4 to operate a program that meets the requirements of section
245.4884, subdivision 2, and Minnesota Rules, parts 9505.0170 to 9505.0475. The day
treatment program must stabilize the client's mental health status while developing and
improving the client's independent living and socialization skills. The goal of the day
treatment program must be to reduce or relieve the effects of mental illness and provide
training to enable the client to live in the community. The program must be available
year-round at least three to five days per week, two or three hours per day, unless the normal
five-day school week is shortened by a holiday, weather-related cancellation, or other
districtwide reduction in a school week. A child transitioning into or out of day treatment
must receive a minimum treatment of one day a week for a two-hour time block. The
two-hour time block must include at least one hour of patient and/or family or group
psychotherapy. The remainder of the structured treatment program may include patient
and/or family or group psychotherapy, and individual or group skills training, if included
in the client's individual treatment plan. Day treatment programs are not part of inpatient
or residential treatment services. When a day treatment group that meets the minimum group
size requirement temporarily falls below the minimum group size because of a member's
temporary absence, medical assistance covers a group session conducted for the group
members in attendance. A day treatment program may provide fewer than the minimally
required hours for a particular child during a billing period in which the child is transitioning
into, or out of, the program.
(b) To be eligible for medical assistance payment, a provider entity must deliver the
service components of children's therapeutic services and supports in compliance with the
following requirements:
(1) deleted text begin patient and/or family, family, and group psychotherapy must be delivered as specified
in Minnesota Rules, part 9505.0372, subpart 6.deleted text end psychotherapy to address the child's
underlying mental health disorder must be documented as part of the child's ongoing
treatment. A provider must deliver, or arrange for, medically necessary psychotherapy,
unless the child's parent or caregiver chooses not to receive it. When a provider delivering
other services to a child under this section deems it not medically necessary to provide
psychotherapy to the child for a period of 90 days or longer, the provider entity must
document the medical reasons why psychotherapy is not necessary. When a provider
determines that a child needs psychotherapy but psychotherapy cannot be delivered due to
a shortage of licensed mental health professionals in the child's community, the provider
must document the lack of access in the child's medical record;
(2) individual, family, or group skills training deleted text begin must be provided by a mental health
professional or a mental health practitioner who is delivering services that fall within the
scope of the provider's practice and is supervised by a mental health professional who
accepts full professional responsibility for the training. Skills trainingdeleted text end is subject to the
following requirements:
(i) a mental health professional, clinical trainee, or mental health practitioner shall provide
skills training;
(ii) skills training delivered to a child or the child's family must be targeted to the specific
deficits or maladaptations of the child's mental health disorder and must be prescribed in
the child's individual treatment plan;
(iii) the mental health professional delivering or supervising the delivery of skills training
must document any underlying psychiatric condition and must document how skills training
is being used in conjunction with psychotherapy to address the underlying condition;
(iv) skills training delivered to the child's family must teach skills needed by parents to
enhance the child's skill development, to help the child utilize daily life skills taught by a
mental health professional, clinical trainee, or mental health practitioner, and to develop or
maintain a home environment that supports the child's progressive use of skills;
(v) group skills training may be provided to multiple recipients who, because of the
nature of their emotional, behavioral, or social dysfunction, can derive mutual benefit from
interaction in a group setting, which must be staffed as follows:
(A) one mental health professional deleted text begin or onedeleted text end new text begin ,new text end clinical traineenew text begin ,new text end or mental health practitioner
deleted text begin under supervision of a licensed mental health professionaldeleted text end must work with a group of three
to eight clients; or
(B) new text begin any combination of new text end two mental health professionals, deleted text begin twodeleted text end clinical traineesnew text begin ,new text end or mental
health practitioners deleted text begin under supervision of a licensed mental health professional, or one mental
health professional or clinical trainee and one mental health practitionerdeleted text end must work with a
group of nine to 12 clients;
(vi) a mental health professional, clinical trainee, or mental health practitioner must have
taught the psychosocial skill before a mental health behavioral aide may practice that skill
with the client; and
(vii) for group skills training, when a skills group that meets the minimum group size
requirement temporarily falls below the minimum group size because of a group member's
temporary absence, the provider may conduct the session for the group members in
attendance;
(3) crisis deleted text begin assistancedeleted text end new text begin planningnew text end to a child and family must include development of a written
plan that anticipates the particular factors specific to the child that may precipitate a
psychiatric crisis for the child in the near future. The written plan must document actions
that the family should be prepared to take to resolve or stabilize a crisis, such as advance
arrangements for direct intervention and support services to the child and the child's family.
Crisis deleted text begin assistancedeleted text end new text begin planningnew text end must include preparing resources designed to address abrupt or
substantial changes in the functioning of the child or the child's family when sudden change
in behavior or a loss of usual coping mechanisms is observed, or the child begins to present
a danger to self or others;
(4) mental health behavioral aide services must be medically necessary treatment services,
identified in the child's individual treatment plan and individual behavior plan, deleted text begin which are
performed minimally by a paraprofessional qualified according to subdivision 7, paragraph
(b), clause (3),deleted text end and which are designed to improve the functioning of the child in the
progressive use of developmentally appropriate psychosocial skills. Activities involve
working directly with the child, child-peer groupings, or child-family groupings to practice,
repeat, reintroduce, and master the skills defined in subdivision 1, paragraph (t), as previously
taught by a mental health professional, clinical trainee, or mental health practitioner including:
(i) providing cues or prompts in skill-building peer-to-peer or parent-child interactions
so that the child progressively recognizes and responds to the cues independently;
(ii) performing as a practice partner or role-play partner;
(iii) reinforcing the child's accomplishments;
(iv) generalizing skill-building activities in the child's multiple natural settings;
(v) assigning further practice activities; and
(vi) intervening as necessary to redirect the child's target behavior and to de-escalate
behavior that puts the child or other person at risk of injury.
To be eligible for medical assistance payment, mental health behavioral aide services must
be delivered to a child who has been diagnosed with an emotional disturbance or a mental
illness, as provided in subdivision 1, paragraph (a). The mental health behavioral aide must
implement treatment strategies in the individual treatment plan and the individual behavior
plan as developed by the mental health professional, clinical trainee, or mental health
practitioner providing direction for the mental health behavioral aide. The mental health
behavioral aide must document the delivery of services in written progress notes. Progress
notes must reflect implementation of the treatment strategies, as performed by the mental
health behavioral aide and the child's responses to the treatment strategies;new text begin and
new text end
deleted text begin
(5) direction of a mental health behavioral aide must include the following:
deleted text end
deleted text begin
(i) ongoing face-to-face observation of the mental health behavioral aide delivering
services to a child by a mental health professional or mental health practitioner for at least
a total of one hour during every 40 hours of service provided to a child; and
deleted text end
deleted text begin
(ii) immediate accessibility of the mental health professional, clinical trainee, or mental
health practitioner to the mental health behavioral aide during service provision;
deleted text end
deleted text begin (6)deleted text end new text begin (5)new text end mental health service plan development must be performed in consultation with
the child's family and, when appropriate, with other key participants in the child's life by
the child's treating mental health professional or clinical trainee or by a mental health
practitioner and approved by the treating mental health professional. Treatment plan drafting
consists of development, review, and revision by face-to-face or electronic communication.
The provider must document events, including the time spent with the family and other key
participants in the child's life to deleted text begin review, revise, and signdeleted text end new text begin approvenew text end the individual treatment
plan. deleted text begin Notwithstanding Minnesota Rules, part 9505.0371, subpart 7,deleted text end Medical assistance
covers service plan development before completion of the child's individual treatment plan.
Service plan development is covered only if a treatment plan is completed for the child. If
upon review it is determined that a treatment plan was not completed for the child, the
commissioner shall recover the payment for the service plan developmentdeleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(7) to be eligible for payment, a diagnostic assessment must be complete with regard to
all required components, including multiple assessment appointments required for an
extended diagnostic assessment and the written report. Dates of the multiple assessment
appointments must be noted in the client's clinical record.
deleted text end
Sec. 92.
Minnesota Statutes 2020, section 256B.0943, subdivision 11, is amended to read:
Subd. 11.
Documentation and billing.
deleted text begin (a)deleted text end A provider entity must document the services
it provides under this section. The provider entity must ensure that documentation complies
with Minnesota Rules, parts 9505.2175 and 9505.2197. Services billed under this section
that are not documented according to this subdivision shall be subject to monetary recovery
by the commissioner. Billing for covered service components under subdivision 2, paragraph
(b), must not include anything other than direct service time.
deleted text begin
(b) An individual mental health provider must promptly document the following in a
client's record after providing services to the client:
deleted text end
deleted text begin
(1) each occurrence of the client's mental health service, including the date, type, start
and stop times, scope of the service as described in the child's individual treatment plan,
and outcome of the service compared to baselines and objectives;
deleted text end
deleted text begin
(2) the name, dated signature, and credentials of the person who delivered the service;
deleted text end
deleted text begin
(3) contact made with other persons interested in the client, including representatives
of the courts, corrections systems, or schools. The provider must document the name and
date of each contact;
deleted text end
deleted text begin
(4) any contact made with the client's other mental health providers, case manager,
family members, primary caregiver, legal representative, or the reason the provider did not
contact the client's family members, primary caregiver, or legal representative, if applicable;
deleted text end
deleted text begin
(5) required clinical supervision directly related to the identified client's services and
needs, as appropriate, with co-signatures of the supervisor and supervisee; and
deleted text end
deleted text begin
(6) the date when services are discontinued and reasons for discontinuation of services.
deleted text end
Sec. 93.
Minnesota Statutes 2020, section 256B.0946, subdivision 1, is amended to read:
Subdivision 1.
Required covered service components.
(a) deleted text begin Effective May 23, 2013,
anddeleted text end Subject to federal approval, medical assistance covers medically necessary intensive
treatment services deleted text begin described under paragraph (b) thatdeleted text end new text begin when the servicesnew text end are provided by a
provider entity deleted text begin eligible under subdivision 3 to a client eligible under subdivision 2 who is
placed in a foster home licensed under Minnesota Rules, parts 2960.3000 to 2960.3340, or
placed in a foster home licensed under the regulations established by a federally recognized
Minnesota tribedeleted text end new text begin certified under and meeting the standards in this sectionnew text end .new text begin The provider entity
must make reasonable and good faith efforts to report individual client outcomes to the
commissioner, using instruments and protocols approved by the commissioner.
new text end
(b) Intensive treatment services to children with mental illness residing in foster family
settings that comprise specific required service components provided in clauses (1) to (5)
are reimbursed by medical assistance when they meet the following standards:
(1) psychotherapy provided by a mental health professional deleted text begin as defined in Minnesota
Rules, part 9505.0371, subpart 5, item A,deleted text end or a clinical traineedeleted text begin , as defined in Minnesota
Rules, part 9505.0371, subpart 5, item Cdeleted text end ;
(2) crisis deleted text begin assistance provided according to standards for children's therapeutic services
and supports in section 256B.0943deleted text end new text begin planningnew text end ;
(3) individual, family, and group psychoeducation servicesdeleted text begin , defined in subdivision 1a,
paragraph (q),deleted text end provided by a mental health professional or a clinical trainee;
(4) clinical care consultationdeleted text begin , as defined in subdivision 1a, anddeleted text end provided by a mental
health professional or a clinical trainee; and
(5) service delivery payment requirements as provided under subdivision 4.
Sec. 94.
Minnesota Statutes 2020, section 256B.0946, subdivision 1a, is amended to read:
Subd. 1a.
Definitions.
For the purposes of this section, the following terms have the
meanings given them.
(a) "Clinical care consultation" means communication from a treating clinician to other
providers working with the same client to inform, inquire, and instruct regarding the client's
symptoms, strategies for effective engagement, care and intervention needs, and treatment
expectations across service settings, including but not limited to the client's school, social
services, day care, probation, home, primary care, medication prescribers, disabilities
services, and other mental health providers and to direct and coordinate clinical service
components provided to the client and family.
deleted text begin
(b) "Clinical supervision" means the documented time a clinical supervisor and supervisee
spend together to discuss the supervisee's work, to review individual client cases, and for
the supervisee's professional development. It includes the documented oversight and
supervision responsibility for planning, implementation, and evaluation of services for a
client's mental health treatment.
deleted text end
deleted text begin
(c) "Clinical supervisor" means the mental health professional who is responsible for
clinical supervision.
deleted text end
deleted text begin (d)deleted text end new text begin (b)new text end "Clinical trainee" deleted text begin has the meaning given in Minnesota Rules, part 9505.0371,
subpart 5, item C;deleted text end new text begin means a staff person who is qualified according to section 245I.04,
subdivision 6.
new text end
deleted text begin (e)deleted text end new text begin (c)new text end "Crisis deleted text begin assistancedeleted text end new text begin planningnew text end " has the meaning given in section 245.4871, subdivision
9adeleted text begin , including the development of a plan that addresses prevention and intervention strategies
to be used in a potential crisis, but does not include actual crisis interventiondeleted text end .
deleted text begin (f)deleted text end new text begin (d)new text end "Culturally appropriate" means providing mental health services in a manner that
incorporates the child's cultural influencesdeleted text begin , as defined in Minnesota Rules, part 9505.0370,
subpart 9,deleted text end into interventions as a way to maximize resiliency factors and utilize cultural
strengths and resources to promote overall wellness.
deleted text begin (g)deleted text end new text begin (e)new text end "Culture" means the distinct ways of living and understanding the world that are
used by a group of people and are transmitted from one generation to another or adopted
by an individual.
deleted text begin (h)deleted text end new text begin (f)new text end "new text begin Standard new text end diagnostic assessment" deleted text begin has the meaning given in Minnesota Rules, part
9505.0370, subpart 11deleted text end new text begin means the assessment described in section 245I.10, subdivision 6new text end .
deleted text begin (i)deleted text end new text begin (g)new text end "Family" means a person who is identified by the client or the client's parent or
guardian as being important to the client's mental health treatment. Family may include,
but is not limited to, parents, foster parents, children, spouse, committed partners, former
spouses, persons related by blood or adoption, persons who are a part of the client's
permanency plan, or persons who are presently residing together as a family unit.
deleted text begin (j)deleted text end new text begin (h)new text end "Foster care" has the meaning given in section 260C.007, subdivision 18.
deleted text begin (k)deleted text end new text begin (i)new text end "Foster family setting" means the foster home in which the license holder resides.
deleted text begin (l)deleted text end new text begin (j)new text end "Individual treatment plan" deleted text begin has the meaning given in Minnesota Rules, part
9505.0370, subpart 15deleted text end new text begin means the plan described in section 245I.10, subdivisions 7 and 8new text end .
deleted text begin
(m) "Mental health practitioner" has the meaning given in section 245.462, subdivision
17, and a mental health practitioner working as a clinical trainee according to Minnesota
Rules, part 9505.0371, subpart 5, item C.
deleted text end
new text begin
(k) "Mental health certified family peer specialist" means a staff person who is qualified
according to section 245I.04, subdivision 12.
new text end
deleted text begin (n)deleted text end new text begin (l)new text end "Mental health professional" deleted text begin has the meaning given in Minnesota Rules, part
9505.0370, subpart 18deleted text end new text begin means a staff person who is qualified according to section 245I.04,
subdivision 2new text end .
deleted text begin (o)deleted text end new text begin (m)new text end "Mental illness" has the meaning given in deleted text begin Minnesota Rules, part 9505.0370,
subpart 20deleted text end new text begin section 245I.02, subdivision 29new text end .
deleted text begin (p)deleted text end new text begin (n)new text end "Parent" has the meaning given in section 260C.007, subdivision 25.
deleted text begin (q)deleted text end new text begin (o)new text end "Psychoeducation services" means information or demonstration provided to an
individual, family, or group to explain, educate, and support the individual, family, or group
in understanding a child's symptoms of mental illness, the impact on the child's development,
and needed components of treatment and skill development so that the individual, family,
or group can help the child to prevent relapse, prevent the acquisition of comorbid disorders,
and achieve optimal mental health and long-term resilience.
deleted text begin (r)deleted text end new text begin (p)new text end "Psychotherapy" deleted text begin has the meaning given in Minnesota Rules, part 9505.0370,
subpart 27deleted text end new text begin means the treatment described in section 256B.0671, subdivision 11new text end .
deleted text begin (s)deleted text end new text begin (q)new text end "Team consultation and treatment planning" means the coordination of treatment
plans and consultation among providers in a group concerning the treatment needs of the
child, including disseminating the child's treatment service schedule to all members of the
service team. Team members must include all mental health professionals working with the
child, a parent, the child unless the team lead or parent deem it clinically inappropriate, and
at least two of the following: an individualized education program case manager; probation
agent; children's mental health case manager; child welfare worker, including adoption or
guardianship worker; primary care provider; foster parent; and any other member of the
child's service team.
new text begin
(r) "Trauma" has the meaning given in section 245I.02, subdivision 38.
new text end
new text begin
(s) "Treatment supervision" means the supervision described under section 245I.06.
new text end
Sec. 95.
Minnesota Statutes 2020, section 256B.0946, subdivision 2, is amended to read:
Subd. 2.
Determination of client eligibility.
An eligible recipient is an individual, from
birth through age 20, who is currently placed in a foster home licensed under Minnesota
Rules, parts 2960.3000 to 2960.3340, new text begin or placed in a foster home licensed under the
regulations established by a federally recognized Minnesota tribe, new text end and has receivednew text begin : (1)new text end a
new text begin standard new text end diagnostic assessment deleted text begin and an evaluation of level of care needed, as defined in
paragraphs (a) and (b).deleted text end new text begin within 180 days before the start of service that documents that
intensive treatment services are medically necessary within a foster family setting to
ameliorate identified symptoms and functional impairments; and (2) a level of care
assessment as defined in section 245I.02, subdivision 19, that demonstrates that the individual
requires intensive intervention without 24-hour medical monitoring, and a functional
assessment as defined in section 245I.02, subdivision 17. The level of care assessment and
the functional assessment must include information gathered from the placing county, tribe,
or case manager.
new text end
deleted text begin
(a) The diagnostic assessment must:
deleted text end
deleted text begin
(1) meet criteria described in Minnesota Rules, part 9505.0372, subpart 1, and be
conducted by a mental health professional or a clinical trainee;
deleted text end
deleted text begin
(2) determine whether or not a child meets the criteria for mental illness, as defined in
Minnesota Rules, part 9505.0370, subpart 20;
deleted text end
deleted text begin
(3) document that intensive treatment services are medically necessary within a foster
family setting to ameliorate identified symptoms and functional impairments;
deleted text end
deleted text begin
(4) be performed within 180 days before the start of service; and
deleted text end
deleted text begin
(5) be completed as either a standard or extended diagnostic assessment annually to
determine continued eligibility for the service.
deleted text end
deleted text begin
(b) The evaluation of level of care must be conducted by the placing county, tribe, or
case manager in conjunction with the diagnostic assessment as described by Minnesota
Rules, part 9505.0372, subpart 1, item B, using a validated tool approved by the
commissioner of human services and not subject to the rulemaking process, consistent with
section 245.4885, subdivision 1, paragraph (d), the result of which evaluation demonstrates
that the child requires intensive intervention without 24-hour medical monitoring. The
commissioner shall update the list of approved level of care tools annually and publish on
the department's website.
deleted text end
Sec. 96.
Minnesota Statutes 2020, section 256B.0946, subdivision 3, is amended to read:
Subd. 3.
Eligible mental health services providers.
(a) Eligible providers for intensive
children's mental health services in a foster family setting must be certified by the state and
have a service provision contract with a county board or a reservation tribal council and
must be able to demonstrate the ability to provide all of the services required in this sectionnew text begin
and meet the standards in chapter 245I, as required in section 245I.011, subdivision 5new text end .
(b) For purposes of this section, a provider agency must be:
(1) a county-operated entity certified by the state;
(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
(3) a noncounty entity.
(c) Certified providers that do not meet the service delivery standards required in this
section shall be subject to a decertification process.
(d) For the purposes of this section, all services delivered to a client must be provided
by a mental health professional or a clinical trainee.
Sec. 97.
Minnesota Statutes 2020, section 256B.0946, subdivision 4, is amended to read:
Subd. 4.
Service delivery payment requirements.
(a) To be eligible for payment under
this section, a provider must develop and practice written policies and procedures for
intensive treatment in foster care, consistent with subdivision 1, paragraph (b), and comply
with the following requirements in paragraphs (b) to deleted text begin (n)deleted text end new text begin (l)new text end .
deleted text begin
(b) A qualified clinical supervisor, as defined in and performing in compliance with
Minnesota Rules, part 9505.0371, subpart 5, item D, must supervise the treatment and
provision of services described in this section.
deleted text end
deleted text begin
(c) Each client receiving treatment services must receive an extended diagnostic
assessment, as described in Minnesota Rules, part 9505.0372, subpart 1, item C, within 30
days of enrollment in this service unless the client has a previous extended diagnostic
assessment that the client, parent, and mental health professional agree still accurately
describes the client's current mental health functioning.
deleted text end
deleted text begin (d)deleted text end new text begin (b)new text end Each previous and current mental health, school, and physical health treatment
provider must be contacted to request documentation of treatment and assessments that the
eligible client has received. This information must be reviewed and incorporated into the
new text begin standard new text end diagnostic assessment and team consultation and treatment planning review process.
deleted text begin (e)deleted text end new text begin (c)new text end Each client receiving treatment must be assessed for a trauma history, and the
client's treatment plan must document how the results of the assessment will be incorporated
into treatment.
new text begin
(d) The level of care assessment as defined in section 245I.02, subdivision 19, and
functional assessment as defined in section 245I.02, subdivision 17, must be updated at
least every 90 days or prior to discharge from the service, whichever comes first.
new text end
deleted text begin (f)deleted text end new text begin (e)new text end Each client receiving treatment services must have an individual treatment plan
that is reviewed, evaluated, and deleted text begin signeddeleted text end new text begin approvednew text end every 90 days using the team consultation
and treatment planning processdeleted text begin , as defined in subdivision 1a, paragraph (s)deleted text end .
deleted text begin (g)deleted text end new text begin (f) Clinicalnew text end care consultationdeleted text begin , as defined in subdivision 1a, paragraph (a),deleted text end must be
provided in accordance with the client's individual treatment plan.
deleted text begin (h)deleted text end new text begin (g)new text end Each client must have a crisis deleted text begin assistancedeleted text end plan within ten days of initiating services
and must have access to clinical phone support 24 hours per day, seven days per week,
during the course of treatment. The crisis plan must demonstrate coordination with the local
or regional mobile crisis intervention team.
deleted text begin (i)deleted text end new text begin (h)new text end Services must be delivered and documented at least three days per week, equaling
at least six hours of treatment per week, unless reduced units of service are specified on the
treatment plan as part of transition or on a discharge plan to another service or level of care.
deleted text begin Documentation must comply with Minnesota Rules, parts 9505.2175 and 9505.2197.
deleted text end
deleted text begin (j)deleted text end new text begin (i)new text end Location of service delivery must be in the client's home, day care setting, school,
or other community-based setting that is specified on the client's individualized treatment
plan.
deleted text begin (k)deleted text end new text begin (j)new text end Treatment must be developmentally and culturally appropriate for the client.
deleted text begin (l)deleted text end new text begin (k)new text end Services must be delivered in continual collaboration and consultation with the
client's medical providers and, in particular, with prescribers of psychotropic medications,
including those prescribed on an off-label basis. Members of the service team must be aware
of the medication regimen and potential side effects.
deleted text begin (m)deleted text end new text begin (l)new text end Parents, siblings, foster parents, and members of the child's permanency plan
must be involved in treatment and service delivery unless otherwise noted in the treatment
plan.
deleted text begin (n)deleted text end new text begin (m)new text end Transition planning for the child must be conducted starting with the first
treatment plan and must be addressed throughout treatment to support the child's permanency
plan and postdischarge mental health service needs.
Sec. 98.
Minnesota Statutes 2020, section 256B.0946, subdivision 6, is amended to read:
Subd. 6.
Excluded services.
(a) Services in clauses (1) to (7) are not covered under this
section and are not eligible for medical assistance payment as components of intensive
treatment in foster care services, but may be billed separately:
(1) inpatient psychiatric hospital treatment;
(2) mental health targeted case management;
(3) partial hospitalization;
(4) medication management;
(5) children's mental health day treatment services;
(6) crisis response services under section deleted text begin 256B.0944deleted text end new text begin 256B.0624new text end ; deleted text begin and
deleted text end
(7) transportationdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(8) mental health certified family peer specialist services under section 256B.0616.
new text end
(b) Children receiving intensive treatment in foster care services are not eligible for
medical assistance reimbursement for the following services while receiving intensive
treatment in foster care:
(1) psychotherapy and skills training components of children's therapeutic services and
supports under section deleted text begin 256B.0625, subdivision 35bdeleted text end new text begin 256B.0943new text end ;
(2) mental health behavioral aide services as defined in section 256B.0943, subdivision
1, paragraph deleted text begin (m)deleted text end new text begin (l)new text end ;
(3) home and community-based waiver services;
(4) mental health residential treatment; and
(5) room and board costs as defined in section 256I.03, subdivision 6.
Sec. 99.
Minnesota Statutes 2020, section 256B.0947, subdivision 1, is amended to read:
Subdivision 1.
Scope.
deleted text begin Effective November 1, 2011, anddeleted text end Subject to federal approval,
medical assistance covers medically necessary, intensive nonresidential rehabilitative mental
health services deleted text begin as defined in subdivision 2, for recipients as defined in subdivision 3,deleted text end when
the services are provided by an entity meeting the standards in this section.new text begin The provider
entity must make reasonable and good faith efforts to report individual client outcomes to
the commissioner, using instruments and protocols approved by the commissioner.
new text end
Sec. 100.
Minnesota Statutes 2020, section 256B.0947, 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 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, as adapted for youth, and are directed to recipients
deleted text begin ages 16, 17, 18, 19, or 20 with a serious mental illness or co-occurring mental illness and
substance abuse addictiondeleted text end who require intensive services to prevent admission to an inpatient
psychiatric hospital or placement in a residential treatment facility or who require intensive
services to step down from inpatient or residential care to community-based care.
(b) "Co-occurring mental illness and substance deleted text begin abuse addictiondeleted text end new text begin use disordernew text end " means a
dual diagnosis of at least one form of mental illness and at least one substance use disorder.
Substance use disorders include alcohol or drug abuse or dependence, excluding nicotine
use.
(c) "new text begin Standard new text end diagnostic assessment" deleted text begin has the meaning given to it in Minnesota Rules,
part 9505.0370, subpart 11. A diagnostic assessment must be provided according to
Minnesota Rules, part 9505.0372, subpart 1, and for this section must incorporate a
determination of the youth's necessary level of care using a standardized functional
assessment instrument approved and periodically updated by the commissionerdeleted text end new text begin means the
assessment described in section 245I.10, subdivision 6new text end .
deleted text begin
(d) "Education specialist" means an individual with knowledge and experience working
with youth regarding special education requirements and goals, special education plans,
and coordination of educational activities with health care activities.
deleted text end
deleted text begin
(e) "Housing access support" means an ancillary activity to help an individual find,
obtain, retain, and move to safe and adequate housing. Housing access support does not
provide monetary assistance for rent, damage deposits, or application fees.
deleted text end
deleted text begin
(f) "Integrated dual disorders treatment" means the integrated treatment of co-occurring
mental illness and substance use disorders by a team of cross-trained clinicians within the
same program, and is characterized by assertive outreach, stage-wise comprehensive
treatment, treatment goal setting, and flexibility to work within each stage of treatment.
deleted text end
deleted text begin (g)deleted text end new text begin (d)new text end "Medication education services" means services provided individually or in
groups, which focus on:
(1) educating the client and client's family or significant nonfamilial supporters about
mental illness and symptoms;
(2) the role and effects of medications in treating symptoms of mental illness; and
(3) the side effects of medications.
Medication education is coordinated with medication management services and does not
duplicate it. Medication education services are provided by physicians, pharmacists, or
registered nurses with certification in psychiatric and mental health care.
deleted text begin
(h) "Peer specialist" means an employed team member who is a mental health certified
peer specialist according to section 256B.0615 and also a former children's mental health
consumer who:
deleted text end
deleted text begin
(1) provides direct services to clients including social, emotional, and instrumental
support and outreach;
deleted text end
deleted text begin
(2) assists younger peers to identify and achieve specific life goals;
deleted text end
deleted text begin
(3) works directly with clients to promote the client's self-determination, personal
responsibility, and empowerment;
deleted text end
deleted text begin
(4) assists youth with mental illness to regain control over their lives and their
developmental process in order to move effectively into adulthood;
deleted text end
deleted text begin
(5) provides training and education to other team members, consumer advocacy
organizations, and clients on resiliency and peer support; and
deleted text end
deleted text begin
(6) meets the following criteria:
deleted text end
deleted text begin
(i) is at least 22 years of age;
deleted text end
deleted text begin
(ii) has had a diagnosis of mental illness, as defined in Minnesota Rules, part 9505.0370,
subpart 20, or co-occurring mental illness and substance abuse addiction;
deleted text end
deleted text begin
(iii) is a former consumer of child and adolescent mental health services, or a former or
current consumer of adult mental health services for a period of at least two years;
deleted text end
deleted text begin
(iv) has at least a high school diploma or equivalent;
deleted text end
deleted text begin
(v) has successfully completed training requirements determined and periodically updated
by the commissioner;
deleted text end
deleted text begin
(vi) is willing to disclose the individual's own mental health history to team members
and clients; and
deleted text end
deleted text begin
(vii) must be free of substance use problems for at least one year.
deleted text end
new text begin
(e) "Mental health professional" means a staff person who is qualified according to
section 245I.04, subdivision 2.
new text end
deleted text begin (i)deleted text end new text begin (f)new text end "Provider agency" means a for-profit or nonprofit organization established to
administer an assertive community treatment for youth team.
deleted text begin (j)deleted text end new text begin (g)new text end "Substance use disorders" means one or more of the disorders defined in the
diagnostic and statistical manual of mental disorders, current edition.
deleted text begin (k)deleted text end new text begin (h)new text end "Transition services" means:
(1) activities, materials, consultation, and coordination that ensures continuity of the
client's care in advance of and in preparation for the client's move from one stage of care
or life to another by maintaining contact with the client and assisting the client to establish
provider relationships;
(2) providing the client with knowledge and skills needed posttransition;
(3) establishing communication between sending and receiving entities;
(4) supporting a client's request for service authorization and enrollment; and
(5) establishing and enforcing procedures and schedules.
A youth's transition from the children's mental health system and services to the adult
mental health system and services and return to the client's home and entry or re-entry into
community-based mental health services following discharge from an out-of-home placement
or inpatient hospital stay.
deleted text begin (l)deleted text end new text begin (i)new text end "Treatment team" means all staff who provide services to recipients under this
section.
deleted text begin (m)deleted text end new text begin (j)new text end "Family peer specialist" means a staff person new text begin who is new text end qualified under section
256B.0616.
Sec. 101.
Minnesota Statutes 2020, section 256B.0947, subdivision 3, is amended to read:
Subd. 3.
Client eligibility.
An eligible recipient is an individual who:
(1) is age 16, 17, 18, 19, or 20; and
(2) is diagnosed with a serious mental illness or co-occurring mental illness and substance
deleted text begin abuse addictiondeleted text end new text begin use disordernew text end , for which intensive nonresidential rehabilitative mental health
services are needed;
(3) has received a deleted text begin level-of-care determination, using an instrument approved by the
commissionerdeleted text end new text begin level of care assessment as defined in section 245I.02, subdivision 19new text end , that
indicates a need for intensive integrated intervention without 24-hour medical monitoring
and a need for extensive collaboration among multiple providers;
(4) hasnew text begin receivednew text end anew text begin functional assessment as defined in section 245I.02, subdivision 17,
that indicatesnew text end functional impairment and a history of difficulty in functioning safely and
successfully in the community, school, home, or job; or who is likely to need services from
the adult mental health system within the next two years; and
(5) has had a recent new text begin standard new text end diagnostic assessmentdeleted text begin , as provided in Minnesota Rules,
part 9505.0372, subpart 1, by a mental health professional who is qualified under Minnesota
Rules, part 9505.0371, subpart 5, item A,deleted text end that documents that intensive nonresidential
rehabilitative mental health services are medically necessary to ameliorate identified
symptoms and functional impairments and to achieve individual transition goals.
Sec. 102.
Minnesota Statutes 2020, section 256B.0947, subdivision 3a, is amended to
read:
Subd. 3a.
Required service components.
deleted text begin
(a) Subject to federal approval, medical
assistance covers all medically necessary intensive nonresidential rehabilitative mental
health services and supports, as defined in this section, under a single daily rate per client.
Services and supports must be delivered by an eligible provider under subdivision 5 to an
eligible client under subdivision 3.
deleted text end
deleted text begin (b)deleted text end new text begin (a)new text end Intensive nonresidential rehabilitative mental health services, supports, and
ancillary activities new text begin are new text end covered by deleted text begin thedeleted text end new text begin anew text end single daily rate per client must include the following,
as needed by the individual client:
(1) individual, family, and group psychotherapy;
(2) individual, family, and group skills training, as defined in section 256B.0943,
subdivision 1, paragraph (t);
(3) crisis deleted text begin assistancedeleted text end new text begin planningnew text end as defined in section 245.4871, subdivision 9adeleted text begin , which
includes recognition of factors precipitating a mental health crisis, identification of behaviors
related to the crisis, and the development of a plan to address prevention, intervention, and
follow-up strategies to be used in the lead-up to or onset of, and conclusion of, a mental
health crisis; crisis assistance does not mean crisis response services or crisis intervention
services provided in section 256B.0944deleted text end ;
(4) medication management provided by a physician or an advanced practice registered
nurse with certification in psychiatric and mental health care;
(5) mental health case management as provided in section 256B.0625, subdivision 20;
(6) medication education services as defined in this section;
(7) care coordination by a client-specific lead worker assigned by and responsible to the
treatment team;
(8) psychoeducation of and consultation and coordination with the client's biological,
adoptive, or foster family and, in the case of a youth living independently, the client's
immediate nonfamilial support network;
(9) clinical consultation to a client's employer or school or to other service agencies or
to the courts to assist in managing the mental illness or co-occurring disorder and to develop
client support systems;
(10) coordination with, or performance of, crisis intervention and stabilization services
as defined in section deleted text begin 256B.0944deleted text end new text begin 256B.0624new text end ;
deleted text begin
(11) assessment of a client's treatment progress and effectiveness of services using
standardized outcome measures published by the commissioner;
deleted text end
deleted text begin (12)deleted text end new text begin (11)new text end transition services deleted text begin as defined in this sectiondeleted text end ;
deleted text begin (13) integrated dual disorders treatment as defined in this sectiondeleted text end new text begin (12) co-occurring
substance use disorder treatment as defined in section 245I.02, subdivision 11new text end ; and
deleted text begin (14)deleted text end new text begin (13)new text end housing access supportnew text begin that assists clients to find, obtain, retain, and move to
safe and adequate housing. Housing access support does not provide monetary assistance
for rent, damage deposits, or application feesnew text end .
deleted text begin (c)deleted text end new text begin (b)new text end The provider shall ensure and document the following by means of performing
the required function or by contracting with a qualified person or entity:
deleted text begin (1)deleted text end client access to crisis intervention services, as defined in section deleted text begin 256B.0944deleted text end new text begin
256B.0624new text end , and available 24 hours per day and seven days per weekdeleted text begin ;deleted text end new text begin .
new text end
deleted text begin
(2) completion of an extended diagnostic assessment, as defined in Minnesota Rules,
part 9505.0372, subpart 1, item C; and
deleted text end
deleted text begin
(3) determination of the client's needed level of care using an instrument approved and
periodically updated by the commissioner.
deleted text end
Sec. 103.
Minnesota Statutes 2020, section 256B.0947, subdivision 5, is amended to read:
Subd. 5.
Standards for intensive nonresidential rehabilitative providers.
(a) Services
must deleted text begin be provided by a provider entity as provided in subdivision 4deleted text end new text begin meet the standards in
this section and chapter 245I as required in section 245I.011, subdivision 5new text end .
(b) The treatment team for intensive nonresidential rehabilitative mental health services
comprises both permanently employed core team members and client-specific team members
as follows:
(1) deleted text begin The core treatment team is an entity that operates under the direction of an
independently licensed mental health professional, who is qualified under Minnesota Rules,
part 9505.0371, subpart 5, item A, and that assumes comprehensive clinical responsibility
for clients.deleted text end Based on professional qualifications and client needs, clinically qualified core
team members are assigned on a rotating basis as the client's lead worker to coordinate a
client's care. The core team must comprise at least four full-time equivalent direct care staff
and must new text begin minimally new text end includedeleted text begin , but is not limited todeleted text end :
(i) deleted text begin an independently licenseddeleted text end new text begin anew text end mental health professionaldeleted text begin , qualified under Minnesota
Rules, part 9505.0371, subpart 5, item A,deleted text end who serves as team leader to provide administrative
direction and deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervision to the team;
(ii) an advanced-practice registered nurse with certification in psychiatric or mental
health care or a board-certified child and adolescent psychiatrist, either of which must be
credentialed to prescribe medications;
(iii) a licensed alcohol and drug counselor who is also trained in mental health
interventions; and
(iv) a new text begin mental health certified new text end peer specialist deleted text begin as defined in subdivision 2, paragraph (h)deleted text end new text begin
who is qualified according to section 245I.04, subdivision 10, and is also a former children's
mental health consumernew text end .
(2) The core team may also include any of the following:
(i) additional mental health professionals;
(ii) a vocational specialist;
(iii) an educational specialistnew text begin with knowledge and experience working with youth
regarding special education requirements and goals, special education plans, and coordination
of educational activities with health care activitiesnew text end ;
(iv) a child and adolescent psychiatrist who may be retained on a consultant basis;
(v)new text begin a clinical trainee qualified according to section 245I.04, subdivision 6;
new text end
new text begin (vi)new text end a mental health practitionerdeleted text begin , as defined in section 245.4871, subdivision 26deleted text end new text begin qualified
according to section 245I.04, subdivision 4new text end ;
deleted text begin (vi)deleted text end new text begin (vii)new text end a case management service provider, as defined in section 245.4871, subdivision
4;
deleted text begin (vii)deleted text end new text begin (viii)new text end a housing access specialist; and
deleted text begin (viii)deleted text end new text begin (ix)new text end a family peer specialist as defined in subdivision 2, paragraph (m).
(3) A treatment team may include, in addition to those in clause (1) or (2), ad hoc
members not employed by the team who consult on a specific client and who must accept
overall clinical direction from the treatment team for the duration of the client's placement
with the treatment team and must be paid by the provider agency at the rate for a typical
session by that provider with that client or at a rate negotiated with the client-specific
member. Client-specific treatment team members may include:
(i) the mental health professional treating the client prior to placement with the treatment
team;
(ii) the client's current substance deleted text begin abusedeleted text end new text begin usenew text end counselor, if applicable;
(iii) a lead member of the client's individualized education program team or school-based
mental health provider, if applicable;
(iv) a representative from the client's health care home or primary care clinic, as needed
to ensure integration of medical and behavioral health care;
(v) the client's probation officer or other juvenile justice representative, if applicable;
and
(vi) the client's current vocational or employment counselor, if applicable.
(c) The deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervisor shall be an active member of the treatment team
and shall function as a practicing clinician at least on a part-time basis. The treatment team
shall meet with the deleted text begin clinicaldeleted text end new text begin treatmentnew text end supervisor at least weekly to discuss recipients' progress
and make rapid adjustments to meet recipients' needs. The team meeting must include
client-specific case reviews and general treatment discussions among team members.
Client-specific case reviews and planning must be documented in the individual client's
treatment record.
(d) The staffing ratio must not exceed ten clients to one full-time equivalent treatment
team position.
(e) The treatment team shall serve no more than 80 clients at any one time. Should local
demand exceed the team's capacity, an additional team must be established rather than
exceed this limit.
(f) Nonclinical staff shall have prompt access in person or by telephone to a mental
health practitionernew text begin , clinical trainee,new text end or mental health professional. The provider shall have
the capacity to promptly and appropriately respond to emergent needs and make any
necessary staffing adjustments to ensure the health and safety of clients.
(g) The intensive nonresidential rehabilitative mental health services provider shall
participate in evaluation of the assertive community treatment for youth (Youth ACT) model
as conducted by the commissioner, including the collection and reporting of data and the
reporting of performance measures as specified by contract with the commissioner.
(h) A regional treatment team may serve multiple counties.
Sec. 104.
Minnesota Statutes 2020, section 256B.0947, subdivision 6, is amended to read:
Subd. 6.
Service standards.
The standards in this subdivision apply to intensive
nonresidential rehabilitative mental health services.
(a) The treatment team must use team treatment, not an individual treatment model.
(b) Services must be available at times that meet client needs.
(c) Services must be age-appropriate and meet the specific needs of the client.
(d) The deleted text begin initial functional assessment must be completed within ten days of intake anddeleted text end new text begin
level of care assessment as defined in section 245I.02, subdivision 19, and functional
assessment as defined in section 245I.02, subdivision 17, must benew text end updated at least every deleted text begin six
monthsdeleted text end new text begin 90 days new text end or prior to discharge from the service, whichever comes first.
(e) An individual treatment plan mustnew text begin be completed for each client, according to section
245I.10, subdivisions 7 and 8, and, additionally, mustnew text end :
deleted text begin
(1) be based on the information in the client's diagnostic assessment and baselines;
deleted text end
deleted text begin
(2) identify goals and objectives of treatment, a treatment strategy, a schedule for
accomplishing treatment goals and objectives, and the individuals responsible for providing
treatment services and supports;
deleted text end
deleted text begin
(3) be developed after completion of the client's diagnostic assessment by a mental health
professional or clinical trainee and before the provision of children's therapeutic services
and supports;
deleted text end
deleted text begin
(4) be developed through a child-centered, family-driven, culturally appropriate planning
process, including allowing parents and guardians to observe or participate in individual
and family treatment services, assessments, and treatment planning;
deleted text end
deleted text begin
(5) be reviewed at least once every six months and revised to document treatment progress
on each treatment objective and next goals or, if progress is not documented, to document
changes in treatment;
deleted text end
deleted text begin
(6) be signed by the clinical supervisor and by the client or by the client's parent or other
person authorized by statute to consent to mental health services for the client. A client's
parent may approve the client's individual treatment plan by secure electronic signature or
by documented oral approval that is later verified by written signature;
deleted text end
deleted text begin (7)deleted text end new text begin (1)new text end be completed in consultation with the client's current therapist and key providers
and provide for ongoing consultation with the client's current therapist to ensure therapeutic
continuity and to facilitate the client's return to the community. For clients under the age of
18, the treatment team must consult with parents and guardians in developing the treatment
plan;
deleted text begin (8)deleted text end new text begin (2)new text end if a need for substance use disorder treatment is indicated by validated assessment:
(i) identify goals, objectives, and strategies of substance use disorder treatment;
new text begin (ii)new text end develop a schedule for accomplishingnew text begin substance use disordernew text end treatment goals and
objectives; and
new text begin (iii)new text end identify the individuals responsible for providingnew text begin substance use disordernew text end treatment
services and supports;
deleted text begin
(ii) be reviewed at least once every 90 days and revised, if necessary;
deleted text end
deleted text begin
(9) be signed by the clinical supervisor and by the client and, if the client is a minor, by
the client's parent or other person authorized by statute to consent to mental health treatment
and substance use disorder treatment for the client; and
deleted text end
deleted text begin (10)deleted text end new text begin (3)new text end provide for the client's transition out of intensive nonresidential rehabilitative
mental health services by defining the team's actions to assist the client and subsequent
providers in the transition to less intensive or "stepped down" servicesdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(4) notwithstanding section 245I.10, subdivision 8, be reviewed at least every 90 days
and revised to document treatment progress or, if progress is not documented, to document
changes in treatment.
new text end
(f) The treatment team shall actively and assertively engage the client's family members
and significant others by establishing communication and collaboration with the family and
significant others and educating the family and significant others about the client's mental
illness, symptom management, and the family's role in treatment, unless the team knows or
has reason to suspect that the client has suffered or faces a threat of suffering any physical
or mental injury, abuse, or neglect from a family member or significant other.
(g) For a client age 18 or older, the treatment team may disclose to a family member,
other relative, or a close personal friend of the client, or other person identified by the client,
the protected health information directly relevant to such person's involvement with the
client's care, as provided in Code of Federal Regulations, title 45, part 164.502(b). If the
client is present, the treatment team shall obtain the client's agreement, provide the client
with an opportunity to object, or reasonably infer from the circumstances, based on the
exercise of professional judgment, that the client does not object. If the client is not present
or is unable, by incapacity or emergency circumstances, to agree or object, the treatment
team may, in the exercise of professional judgment, determine whether the disclosure is in
the best interests of the client and, if so, disclose only the protected health information that
is directly relevant to the family member's, relative's, friend's, or client-identified person's
involvement with the client's health care. The client may orally agree or object to the
disclosure and may prohibit or restrict disclosure to specific individuals.
(h) The treatment team shall provide interventions to promote positive interpersonal
relationships.
Sec. 105.
Minnesota Statutes 2020, section 256B.0947, subdivision 7, is amended to read:
Subd. 7.
Medical assistance payment and rate setting.
(a) Payment for services in this
section must be based on one daily encounter rate per provider inclusive of the following
services received by an eligible client in a given calendar day: all rehabilitative services,
supports, and ancillary activities under this section, staff travel time to provide rehabilitative
services under this section, and crisis response services under section deleted text begin 256B.0944deleted text end new text begin 256B.0624new text end .
(b) Payment must not be made to more than one entity for each client 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 shall determine how to distribute
the payment among the members.
(c) The commissioner shall establish regional cost-based rates for entities that will bill
medical assistance for nonresidential intensive rehabilitative mental health services. In
developing these rates, the commissioner shall consider:
(1) the cost for similar services in the health care trade area;
(2) actual costs incurred by entities providing the services;
(3) the intensity and frequency of services to be provided to each client;
(4) the degree to which clients will receive services other than services under this section;
and
(5) the costs of other services that will be separately reimbursed.
(d) The rate for a provider must not exceed the rate charged by that provider for the
same service to other payers.
Sec. 106.
Minnesota Statutes 2020, section 256B.0949, subdivision 2, is amended to read:
Subd. 2.
Definitions.
(a) The terms used in this section have the meanings given in this
subdivision.
(b) "Agency" means the legal entity that is enrolled with Minnesota health care programs
as a medical assistance provider according to Minnesota Rules, part 9505.0195, to provide
EIDBI services and that has the legal responsibility to ensure that its employees or contractors
carry out the responsibilities defined in this section. Agency includes a licensed individual
professional who practices independently and acts as an agency.
(c) "Autism spectrum disorder or a related condition" or "ASD or a related condition"
means either autism spectrum disorder (ASD) as defined in the current version of the
Diagnostic and Statistical Manual of Mental Disorders (DSM) or a condition that is found
to be closely related to ASD, as identified under the current version of the DSM, and meets
all of the following criteria:
(1) is severe and chronic;
(2) results in impairment of adaptive behavior and function similar to that of a person
with ASD;
(3) requires treatment or services similar to those required for a person with ASD; and
(4) results in substantial functional limitations in three core developmental deficits of
ASD: social or interpersonal interaction; functional communication, including nonverbal
or social communication; and restrictive or repetitive behaviors or hyperreactivity or
hyporeactivity to sensory input; and may include deficits or a high level of support in one
or more of the following domains:
(i) behavioral challenges and self-regulation;
(ii) cognition;
(iii) learning and play;
(iv) self-care; or
(v) safety.
(d) "Person" means a person under 21 years of age.
(e) "Clinical supervision" means the overall responsibility for the control and direction
of EIDBI service delivery, including individual treatment planning, staff supervision,
individual treatment plan progress monitoring, and treatment review for each person. Clinical
supervision is provided by a qualified supervising professional (QSP) who takes full
professional responsibility for the service provided by each supervisee.
(f) "Commissioner" means the commissioner of human services, unless otherwise
specified.
(g) "Comprehensive multidisciplinary evaluation" or "CMDE" means a comprehensive
evaluation of a person to determine medical necessity for EIDBI services based on the
requirements in subdivision 5.
(h) "Department" means the Department of Human Services, unless otherwise specified.
(i) "Early intensive developmental and behavioral intervention benefit" or "EIDBI
benefit" means a variety of individualized, intensive treatment modalities approved and
published by the commissioner that are based in behavioral and developmental science
consistent with best practices on effectiveness.
(j) "Generalizable goals" means results or gains that are observed during a variety of
activities over time with different people, such as providers, family members, other adults,
and people, and in different environments including, but not limited to, clinics, homes,
schools, and the community.
(k) "Incident" means when any of the following occur:
(1) an illness, accident, or injury that requires first aid treatment;
(2) a bump or blow to the head; or
(3) an unusual or unexpected event that jeopardizes the safety of a person or staff,
including a person leaving the agency unattended.
(l) "Individual treatment plan" or "ITP" means the person-centered, individualized written
plan of care that integrates and coordinates person and family information from the CMDE
for a person who meets medical necessity for the EIDBI benefit. An individual treatment
plan must meet the standards in subdivision 6.
(m) "Legal representative" means the parent of a child who is under 18 years of age, a
court-appointed guardian, or other representative with legal authority to make decisions
about service for a person. For the purpose of this subdivision, "other representative with
legal authority to make decisions" includes a health care agent or an attorney-in-fact
authorized through a health care directive or power of attorney.
(n) "Mental health professional" deleted text begin has the meaning given indeleted text end new text begin means a staff person who is
qualified according tonew text end section deleted text begin 245.4871, subdivision 27, clauses (1) to (6)deleted text end new text begin 245I.04,
subdivision 2new text end .
(o) "Person-centered" means a service that both responds to the identified needs, interests,
values, preferences, and desired outcomes of the person or the person's legal representative
and respects the person's history, dignity, and cultural background and allows inclusion and
participation in the person's community.
(p) "Qualified EIDBI provider" means a person who is a QSP or a level I, level II, or
level III treatment provider.
Sec. 107.
Minnesota Statutes 2020, section 256B.0949, subdivision 4, is amended to read:
Subd. 4.
Diagnosis.
(a) A diagnosis of ASD or a related condition must:
(1) be based upon current DSM criteria including direct observations of the person and
information from the person's legal representative or primary caregivers;
(2) be completed by either (i) a licensed physician or advanced practice registered nurse
or (ii) a mental health professional; and
(3) meet the requirements of deleted text begin Minnesota Rules, part 9505.0372, subpart 1, items B and
Cdeleted text end new text begin a standard diagnostic assessment according to section 245I.10, subdivision 6new text end .
(b) Additional assessment information may be considered to complete a diagnostic
assessment including specialized tests administered through special education evaluations
and licensed school personnel, and from professionals licensed in the fields of medicine,
speech and language, psychology, occupational therapy, and physical therapy. A diagnostic
assessment may include treatment recommendations.
Sec. 108.
Minnesota Statutes 2020, section 256B.0949, subdivision 5a, is amended to
read:
Subd. 5a.
Comprehensive multidisciplinary evaluation provider qualification.
A
CMDE provider must:
(1) be a licensed physician, advanced practice registered nurse, a mental health
professional, or a deleted text begin mental health practitioner who meets the requirements of adeleted text end clinical trainee
deleted text begin as defined in Minnesota Rules, part 9505.0371, subpart 5, item Cdeleted text end new text begin who is qualified according
to section 245I.04, subdivision 6new text end ;
(2) have at least 2,000 hours of clinical experience in the evaluation and treatment of
people with ASD or a related condition or equivalent documented coursework at the graduate
level by an accredited university in the following content areas: ASD or a related condition
diagnosis, ASD or a related condition treatment strategies, and child development; and
(3) be able to diagnose, evaluate, or provide treatment within the provider's scope of
practice and professional license.
Sec. 109.
Minnesota Statutes 2020, section 256B.25, subdivision 3, is amended to read:
Subd. 3.
Payment exceptions.
The limitation in subdivision 2 shall not apply to:
(1) payment of Minnesota supplemental assistance funds to recipients who reside in
facilities which are involved in litigation contesting their designation as an institution for
treatment of mental disease;
(2) payment or grants to a boarding care home or supervised living facility licensed by
the Department of Human Services under Minnesota Rules, parts 2960.0130 to 2960.0220
deleted text begin ordeleted text end new text begin ,new text end 2960.0580 to 2960.0700,new text begin ornew text end 9520.0500 to 9520.0670, or new text begin under new text end chapter 245Gnew text begin or 245Inew text end ,
or payment to recipients who reside in these facilities;
(3) payments or grants to a boarding care home or supervised living facility which are
ineligible for certification under United States Code, title 42, sections 1396-1396p;
(4) payments or grants otherwise specifically authorized by statute or rule.
Sec. 110.
Minnesota Statutes 2020, section 256B.761, is amended to read:
256B.761 REIMBURSEMENT FOR MENTAL HEALTH SERVICES.
(a) Effective for services rendered on or after July 1, 2001, payment for medication
management provided to psychiatric patients, outpatient mental health services, day treatment
services, home-based mental health services, and family community support services shall
be paid at the lower of (1) submitted charges, or (2) 75.6 percent of the 50th percentile of
1999 charges.
(b) Effective July 1, 2001, the medical assistance rates for outpatient mental health
services provided by an entity that operates: (1) a Medicare-certified comprehensive
outpatient rehabilitation facility; and (2) a facility that was certified prior to January 1, 1993,
with at least 33 percent of the clients receiving rehabilitation services in the most recent
calendar year who are medical assistance recipients, will be increased by 38 percent, when
those services are provided within the comprehensive outpatient rehabilitation facility and
provided to residents of nursing facilities owned by the entity.
deleted text begin
(c) The commissioner shall establish three levels of payment for mental health diagnostic
assessment, based on three levels of complexity. The aggregate payment under the tiered
rates must not exceed the projected aggregate payments for mental health diagnostic
assessment under the previous single rate. The new rate structure is effective January 1,
2011, or upon federal approval, whichever is later.
deleted text end
deleted text begin (d)deleted text end new text begin (c)new text end In addition to rate increases otherwise provided, the commissioner may restructure
coverage policy and rates to improve access to adult rehabilitative mental health services
under section 256B.0623 and related mental health support services under section 256B.021,
subdivision 4, paragraph (f), clause (2). For state fiscal years 2015 and 2016, the projected
state share of increased costs due to this paragraph is transferred from adult mental health
grants under sections 245.4661 and 256E.12. The transfer for fiscal year 2016 is a permanent
base adjustment for subsequent fiscal years. Payments made to managed care plans and
county-based purchasing plans under sections 256B.69, 256B.692, and 256L.12 shall reflect
the rate changes described in this paragraph.
deleted text begin (e)deleted text end new text begin (d)new text end Any ratables effective before July 1, 2015, do not apply to early intensive
developmental and behavioral intervention (EIDBI) benefits described in section 256B.0949.
Sec. 111.
Minnesota Statutes 2020, section 256B.763, is amended to read:
256B.763 CRITICAL ACCESS MENTAL HEALTH RATE INCREASE.
(a) For services defined in paragraph (b) and rendered on or after July 1, 2007, payment
rates shall be increased by 23.7 percent over the rates in effect on January 1, 2006, for:
(1) psychiatrists and advanced practice registered nurses with a psychiatric specialty;
(2) community mental health centers under section 256B.0625, subdivision 5; and
(3) mental health clinics deleted text begin and centersdeleted text end certified under deleted text begin Minnesota Rules, parts 9520.0750
to 9520.0870deleted text end new text begin section 245I.20new text end , or hospital outpatient psychiatric departments that are
designated as essential community providers under section 62Q.19.
(b) This increase applies to group skills training when provided as a component of
children's therapeutic services and support, psychotherapy, medication management,
evaluation and management, diagnostic assessment, explanation of findings, psychological
testing, neuropsychological services, direction of behavioral aides, and inpatient consultation.
(c) This increase does not apply to rates that are governed by section 256B.0625,
subdivision 30, or 256B.761, paragraph (b), other cost-based rates, rates that are negotiated
with the county, rates that are established by the federal government, or rates that increased
between January 1, 2004, and January 1, 2005.
(d) The commissioner shall adjust rates paid to prepaid health plans under contract with
the commissioner to reflect the rate increases provided in paragraphs (a), (e), and (f). The
prepaid health plan must pass this rate increase to the providers identified in paragraphs (a),
(e), (f), and (g).
(e) Payment rates shall be increased by 23.7 percent over the rates in effect on December
31, 2007, for:
(1) medication education services provided on or after January 1, 2008, by adult
rehabilitative mental health services providers certified under section 256B.0623; and
(2) mental health behavioral aide services provided on or after January 1, 2008, by
children's therapeutic services and support providers certified under section 256B.0943.
(f) For services defined in paragraph (b) and rendered on or after January 1, 2008, by
children's therapeutic services and support providers certified under section 256B.0943 and
not already included in paragraph (a), payment rates shall be increased by 23.7 percent over
the rates in effect on December 31, 2007.
(g) Payment rates shall be increased by 2.3 percent over the rates in effect on December
31, 2007, for individual and family skills training provided on or after January 1, 2008, by
children's therapeutic services and support providers certified under section 256B.0943.
(h) For services described in paragraphs (b), (e), and (g) and rendered on or after July
1, 2017, payment rates for mental health clinics deleted text begin and centersdeleted text end certified under deleted text begin Minnesota Rules,
parts 9520.0750 to 9520.0870deleted text end new text begin section 245I.20new text end , that are not designated as essential community
providers under section 62Q.19 shall be equal to payment rates for mental health clinics
deleted text begin and centersdeleted text end certified under deleted text begin Minnesota Rules, parts 9520.0750 to 9520.0870deleted text end new text begin section 245I.20new text end ,
that are designated as essential community providers under section 62Q.19. In order to
receive increased payment rates under this paragraph, a provider must demonstrate a
commitment to serve low-income and underserved populations by:
(1) charging for services on a sliding-fee schedule based on current poverty income
guidelines; and
(2) not restricting access or services because of a client's financial limitation.
Sec. 112.
Minnesota Statutes 2020, section 256P.01, subdivision 6a, is amended to read:
Subd. 6a.
Qualified professional.
(a) For illness, injury, or incapacity, a "qualified
professional" means a licensed physician, physician assistant, advanced practice registered
nurse, physical therapist, occupational therapist, or licensed chiropractor, according to their
scope of practice.
(b) For developmental disability, learning disability, and intelligence testing, a "qualified
professional" means a licensed physician, physician assistant, advanced practice registered
nurse, licensed independent clinical social worker, licensed psychologist, certified school
psychologist, or certified psychometrist working under the supervision of a licensed
psychologist.
(c) For mental health, a "qualified professional" means a licensed physician, advanced
practice registered nurse, or qualified mental health professional under section deleted text begin 245.462,
subdivision 18, clauses (1) to (6)deleted text end new text begin 245I.04, subdivision 2new text end .
(d) For substance use disorder, a "qualified professional" means a licensed physician, a
qualified mental health professional under section 245.462, subdivision 18, clauses (1) to
(6), or an individual as defined in section 245G.11, subdivision 3, 4, or 5.
Sec. 113.
Minnesota Statutes 2020, section 295.50, subdivision 9b, is amended to read:
Subd. 9b.
Patient services.
(a) "Patient services" means inpatient and outpatient services
and other goods and services provided by hospitals, surgical centers, or health care providers.
They include the following health care goods and services provided to a patient or consumer:
(1) bed and board;
(2) nursing services and other related services;
(3) use of hospitals, surgical centers, or health care provider facilities;
(4) medical social services;
(5) drugs, biologicals, supplies, appliances, and equipment;
(6) other diagnostic or therapeutic items or services;
(7) medical or surgical services;
(8) items and services furnished to ambulatory patients not requiring emergency care;
and
(9) emergency services.
(b) "Patient services" does not include:
(1) services provided to nursing homes licensed under chapter 144A;
(2) examinations for purposes of utilization reviews, insurance claims or eligibility,
litigation, and employment, including reviews of medical records for those purposes;
(3) services provided to and by community residential mental health facilities licensed
under new text begin section 245I.23 or new text end Minnesota Rules, parts 9520.0500 to 9520.0670, and to and by
residential treatment programs for children with severe emotional disturbance licensed or
certified under chapter 245A;
(4) services provided under the following programs: day treatment services as defined
in section 245.462, subdivision 8; assertive community treatment as described in section
256B.0622; adult rehabilitative mental health services as described in section 256B.0623;
deleted text begin adultdeleted text end crisis response services as described in section 256B.0624; new text begin and new text end children's therapeutic
services and supports as described in section 256B.0943; deleted text begin and children's mental health crisis
response services as described in section 256B.0944;
deleted text end
(5) services provided to and by community mental health centers as defined in section
245.62, subdivision 2;
(6) services provided to and by assisted living programs and congregate housing
programs;
(7) hospice care services;
(8) home and community-based waivered services under chapter 256S and sections
256B.49 and 256B.501;
(9) targeted case management services under sections 256B.0621; 256B.0625,
subdivisions 20, 20a, 33, and 44; and 256B.094; and
(10) services provided to the following: supervised living facilities for persons with
developmental disabilities licensed under Minnesota Rules, parts 4665.0100 to 4665.9900;
housing with services establishments required to be registered under chapter 144D; board
and lodging establishments providing only custodial services that are licensed under chapter
157 and registered under section 157.17 to provide supportive services or health supervision
services; adult foster homes as defined in Minnesota Rules, part 9555.5105; day training
and habilitation services for adults with developmental disabilities as defined in section
252.41, subdivision 3; boarding care homes as defined in Minnesota Rules, part 4655.0100;
adult day care services as defined in section 245A.02, subdivision 2a; and home health
agencies as defined in Minnesota Rules, part 9505.0175, subpart 15, or licensed under
chapter 144A.
Sec. 114.
Minnesota Statutes 2020, section 325F.721, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
(a) For the purposes of this section, the following terms have
the meanings given them.
(b) "Covered setting" means an unlicensed setting providing sleeping accommodations
to one or more adult residents, at least 80 percent of which are 55 years of age or older, and
offering or providing, for a fee, supportive services. For the purposes of this section, covered
setting does not mean:
(1) emergency shelter, transitional housing, or any other residential units serving
exclusively or primarily homeless individuals, as defined under section 116L.361;
(2) a nursing home licensed under chapter 144A;
(3) a hospital, certified boarding care, or supervised living facility licensed under sections
144.50 to 144.56;
(4) a lodging establishment licensed under chapter 157 and Minnesota Rules, parts
9520.0500 to 9520.0670, or under chapter 245D deleted text begin ordeleted text end new text begin ,new text end 245Gnew text begin , or 245Inew text end ;
(5) services and residential settings licensed under chapter 245A, including adult foster
care and services and settings governed under the standards in chapter 245D;
(6) private homes in which the residents are related by kinship, law, or affinity with the
providers of services;
(7) a duly organized condominium, cooperative, and common interest community, or
owners' association of the condominium, cooperative, and common interest community
where at least 80 percent of the units that comprise the condominium, cooperative, or
common interest community are occupied by individuals who are the owners, members, or
shareholders of the units;
(8) temporary family health care dwellings as defined in sections 394.307 and 462.3593;
(9) settings offering services conducted by and for the adherents of any recognized
church or religious denomination for its members exclusively through spiritual means or
by prayer for healing;
(10) housing financed pursuant to sections 462A.37 and 462A.375, units financed with
low-income housing tax credits pursuant to United States Code, title 26, section 42, and
units financed by the Minnesota Housing Finance Agency that are intended to serve
individuals with disabilities or individuals who are homeless, except for those developments
that market or hold themselves out as assisted living facilities and provide assisted living
services;
(11) rental housing developed under United States Code, title 42, section 1437, or United
States Code, title 12, section 1701q;
(12) rental housing designated for occupancy by only elderly or elderly and disabled
residents under United States Code, title 42, section 1437e, or rental housing for qualifying
families under Code of Federal Regulations, title 24, section 983.56;
(13) rental housing funded under United States Code, title 42, chapter 89, or United
States Code, title 42, section 8011; or
(14) an assisted living facility licensed under chapter 144G.
(c) "'I'm okay' check services" means providing a service to, by any means, check on
the safety of a resident.
(d) "Resident" means a person entering into written contract for housing and services
with a covered setting.
(e) "Supportive services" means:
(1) assistance with laundry, shopping, and household chores;
(2) housekeeping services;
(3) provision of meals or assistance with meals or food preparation;
(4) help with arranging, or arranging transportation to, medical, social, recreational,
personal, or social services appointments; or
(5) provision of social or recreational services.
Arranging for services does not include making referrals or contacting a service provider
in an emergency.
Sec. 115. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2020, sections 245.462, subdivision 4a; 245.4879, subdivision
2; 245.62, subdivisions 3 and 4; 245.69, subdivision 2; 256B.0615, subdivision 2; 256B.0616,
subdivision 2; 256B.0622, subdivisions 3 and 5a; 256B.0623, subdivisions 7, 8, 10, and 11;
256B.0625, subdivisions 5l, 35a, 35b, 61, 62, and 65; 256B.0943, subdivisions 8 and 10;
256B.0944; and 256B.0946, subdivision 5,
new text end
new text begin
are repealed.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Rules, parts 9505.0370; 9505.0371; 9505.0372; 9520.0010; 9520.0020;
9520.0030; 9520.0040; 9520.0050; 9520.0060; 9520.0070; 9520.0080; 9520.0090;
9520.0100; 9520.0110; 9520.0120; 9520.0130; 9520.0140; 9520.0150; 9520.0160;
9520.0170; 9520.0180; 9520.0190; 9520.0200; 9520.0210; 9520.0230; 9520.0750;
9520.0760; 9520.0770; 9520.0780; 9520.0790; 9520.0800; 9520.0810; 9520.0820;
9520.0830; 9520.0840; 9520.0850; 9520.0860; and 9520.0870,
new text end
new text begin
are repealed.
new text end
Sec. 116. new text begin EFFECTIVE DATE.
new text end
new text begin
This article is effective upon federal approval or July 1, 2022, whichever is later, unless
otherwise noted. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
ARTICLE 19
MISCELLANEOUS
Section 1.
new text begin
[62A.082] NONDISCRIMINATION IN ACCESS TO TRANSPLANTS.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For the purposes of this section, the following terms have
the meanings given unless the context clearly requires otherwise.
new text end
new text begin
(b) "Disability" has the meaning given in section 363A.03, subdivision 12.
new text end
new text begin
(c) "Enrollee" means a natural person covered by a health plan or group health plan and
includes an insured, policy holder, subscriber, covered person, member, contract holder, or
certificate holder.
new text end
new text begin
(d) "Organ transplant" means the transplantation or transfusion of a part of a human
body into the body of another for the purpose of treating or curing a medical condition.
new text end
new text begin Subd. 2. new text end
new text begin Transplant discrimination prohibited. new text end
new text begin
A health plan or group health plan
that provides coverage for anatomical gifts, organ transplants, or related treatment and
services shall not:
new text end
new text begin
(1) deny coverage to an enrollee based on the enrollee's disability;
new text end
new text begin
(2) deny eligibility, or continued eligibility, to enroll or to renew coverage under the
terms of the health plan or group health plan solely for the purpose of avoiding the
requirements of this section;
new text end
new text begin
(3) penalize or otherwise reduce or limit the reimbursement of a health care provider,
or provide monetary or nonmonetary incentives to a health care provider, to induce the
provider to provide care to a patient in a manner inconsistent with this section; or
new text end
new text begin
(4) reduce or limit an enrollee's coverage benefits because of the enrollee's disability for
medical services and other services related to organ transplantation performed pursuant to
this section as determined in consultation with the enrollee's treating health care provider
and the enrollee.
new text end
new text begin Subd. 3. new text end
new text begin Collective bargaining. new text end
new text begin
In the case of a group health plan maintained pursuant
to one or more collective bargaining agreements between employee representatives and one
or more employers, any plan amendment made pursuant to a collective bargaining agreement
relating to the plan which amends the plan solely to conform to any requirement imposed
pursuant to this section shall not be treated as a termination of the collective bargaining
agreement.
new text end
new text begin Subd. 4. new text end
new text begin Coverage limitation. new text end
new text begin
Nothing in this section shall be deemed to require a health
plan or group health plan to provide coverage for a medically inappropriate organ transplant.
new text end
Sec. 2.
new text begin
[119B.195] RETAINING EARLY EDUCATORS THROUGH ATTAINING
INCENTIVES NOW (REETAIN) GRANT PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment; purpose. new text end
new text begin
The retaining early educators through attaining
incentives now (REETAIN) grant program is established to provide competitive grants to
incentivize well-trained child care professionals to remain in the workforce. The overall
goal of the REETAIN grant program is to create more consistent care for children over time.
new text end
new text begin Subd. 2. new text end
new text begin Administration. new text end
new text begin
The commissioner shall administer the REETAIN grant
program through a grant to a nonprofit with the demonstrated ability to manage benefit
programs for child care professionals. Up to ten percent of grant money may be used for
administration of the grant program.
new text end
new text begin Subd. 3. new text end
new text begin Application. new text end
new text begin
Applicants must apply for the REETAIN grant program using
the forms and according to timelines established by the commissioner.
new text end
new text begin Subd. 4. new text end
new text begin Eligibility. new text end
new text begin
(a) To be eligible for a grant, an applicant must:
new text end
new text begin
(1) be licensed to provide child care or work for a licensed child care program;
new text end
new text begin
(2) work directly with children at least 30 hours per week;
new text end
new text begin
(3) have worked in the applicant's current position for at least 12 months;
new text end
new text begin
(4) agree to work in the early childhood care and education field for at least 12 months
upon receiving a grant under this section;
new text end
new text begin
(5) have a career lattice step of five or higher;
new text end
new text begin
(6) not be a current teacher education and compensation helps scholarship recipient; and
new text end
new text begin
(7) meet any other requirements determined by the commissioner.
new text end
new text begin
(b) Grant recipients must sign a contract agreeing to remain in the early childhood care
and education field for 12 months.
new text end
new text begin Subd. 5. new text end
new text begin Grant awards. new text end
new text begin
Grant awards must be made annually and may be made up to
an amount per recipient determined by the commissioner. Grant recipients may use grant
money for program supplies, training, or personal expenses.
new text end
new text begin Subd. 6. new text end
new text begin Report. new text end
new text begin
By January 1 each year, the commissioner must report to the legislative
committees with jurisdiction over child care about the number of grants awarded to recipients
and outcomes of the grant program since the last report.
new text end
Sec. 3.
Minnesota Statutes 2020, section 260E.31, subdivision 1, is amended to read:
Subdivision 1.
Reports required.
(a) Except as provided in paragraph (b), a person
mandated to report under this chapter shall immediately report to the local welfare agency
if the person knows or has reason to believe that a woman is pregnant and has used a
controlled substance for a nonmedical purpose during the pregnancy, including but not
limited to tetrahydrocannabinol, or has consumed alcoholic beverages during the pregnancy
in any way that is habitual or excessive.
(b) A health care professional or a social service professional who is mandated to report
under this chapter is exempt from reporting under paragraph (a) deleted text begin a woman's use or
consumption of tetrahydrocannabinol or alcoholic beverages during pregnancydeleted text end if the
professional is providing new text begin or collaborating with other professionals to provide new text end the woman
with prenatal carenew text begin , postpartum care,new text end or other health care servicesnew text begin , including care of the
woman's infantnew text end . new text begin If the woman does not continue to receive regular prenatal or postpartum
care, after the woman's health care professional has made attempts to contact the woman,
then the professional is required to report under paragraph (a).
new text end
(c) Any person may make a voluntary report if the person knows or has reason to believe
that a woman is pregnant and has used a controlled substance for a nonmedical purpose
during the pregnancy, including but not limited to tetrahydrocannabinol, or has consumed
alcoholic beverages during the pregnancy in any way that is habitual or excessive.
(d) An oral report shall be made immediately by telephone or otherwise. An oral report
made by a person required to report shall be followed within 72 hours, exclusive of weekends
and holidays, by a report in writing to the local welfare agency. Any report shall be of
sufficient content to identify the pregnant woman, the nature and extent of the use, if known,
and the name and address of the reporter. The local welfare agency shall accept a report
made under paragraph (c) notwithstanding refusal by a voluntary reporter to provide the
reporter's name or address as long as the report is otherwise sufficient.
(e) For purposes of this section, "prenatal care" means the comprehensive package of
medical and psychological support provided throughout the pregnancy.
Sec. 4.
new text begin
[363A.50] NONDISCRIMINATION IN ACCESS TO TRANSPLANTS.
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 terms have
the meanings given unless the context clearly requires otherwise.
new text end
new text begin
(b) "Anatomical gift" has the meaning given in section 525A.02, subdivision 4.
new text end
new text begin
(c) "Auxiliary aids and services" include, but are not limited to:
new text end
new text begin
(1) qualified interpreters or other effective methods of making aurally delivered materials
available to individuals with hearing impairments;
new text end
new text begin
(2) qualified readers, taped texts, texts in accessible electronic format, or other effective
methods of making visually delivered materials available to individuals with visual
impairments;
new text end
new text begin
(3) the provision of information in a format that is accessible for individuals with
cognitive, neurological, developmental, intellectual, or physical disabilities;
new text end
new text begin
(4) the provision of supported decision-making services; and
new text end
new text begin
(5) the acquisition or modification of equipment or devices.
new text end
new text begin
(d) "Covered entity" means:
new text end
new text begin
(1) any licensed provider of health care services, including licensed health care
practitioners, hospitals, nursing facilities, laboratories, intermediate care facilities, psychiatric
residential treatment facilities, institutions for individuals with intellectual or developmental
disabilities, and prison health centers; or
new text end
new text begin
(2) any entity responsible for matching anatomical gift donors to potential recipients.
new text end
new text begin
(e) "Disability" has the meaning given in section 363A.03, subdivision 12.
new text end
new text begin
(f) "Organ transplant" means the transplantation or infusion of a part of a human body
into the body of another for the purpose of treating or curing a medical condition.
new text end
new text begin
(g) "Qualified individual" means an individual who, with or without available support
networks, the provision of auxiliary aids and services, or reasonable modifications to policies
or practices, meets the essential eligibility requirements for the receipt of an anatomical
gift.
new text end
new text begin
(h) "Reasonable modifications" include, but are not limited to:
new text end
new text begin
(1) communication with individuals responsible for supporting an individual with
postsurgical and post-transplantation care, including medication; and
new text end
new text begin
(2) consideration of support networks available to the individual, including family,
friends, and home and community-based services, including home and community-based
services funded through Medicaid, Medicare, another health plan in which the individual
is enrolled, or any program or source of funding available to the individual, in determining
whether the individual is able to comply with post-transplant medical requirements.
new text end
new text begin
(i) "Supported decision making" has the meaning given in section 524.5-102, subdivision
16a.
new text end
new text begin Subd. 2. new text end
new text begin Prohibition of discrimination. new text end
new text begin
(a) A covered entity may not on the basis of a
qualified individual's mental or physical disability:
new text end
new text begin
(1) deem an individual ineligible to receive an anatomical gift or organ transplant;
new text end
new text begin
(2) deny medical or related organ transplantation services, including evaluation, surgery,
counseling, and postoperative treatment and care;
new text end
new text begin
(3) refuse to refer the individual to a transplant center or other related specialist for the
purpose of evaluation or receipt of an anatomical gift or organ transplant;
new text end
new text begin
(4) refuse to place an individual on an organ transplant waiting list or place the individual
at a lower-priority position on the list than the position at which the individual would have
been placed if not for the individual's disability; or
new text end
new text begin
(5) decline insurance coverage for any procedure associated with the receipt of the
anatomical gift or organ transplant, including post-transplantation and postinfusion care.
new text end
new text begin
(b) Notwithstanding paragraph (a), a covered entity may take an individual's disability
into account when making treatment or coverage recommendations or decisions, solely to
the extent that the physical or mental disability has been found by a physician, following
an individualized evaluation of the potential recipient to be medically significant to the
provision of the anatomical gift or organ transplant. The provisions of this section may not
be deemed to require referrals or recommendations for, or the performance of, medically
inappropriate organ transplants.
new text end
new text begin
(c) If an individual has the necessary support system to assist the individual in complying
with post-transplant medical requirements, an individual's inability to independently comply
with those requirements may not be deemed to be medically significant for the purposes of
paragraph (b).
new text end
new text begin
(d) A covered entity must make reasonable modifications to policies, practices, or
procedures, when such modifications are necessary to make services such as
transplantation-related counseling, information, coverage, or treatment available to qualified
individuals with disabilities, unless the entity can demonstrate that making such modifications
would fundamentally alter the nature of such services.
new text end
new text begin
(e) A covered entity must take such steps as may be necessary to ensure that no qualified
individual with a disability is denied services such as transplantation-related counseling,
information, coverage, or treatment because of the absence of auxiliary aids and services,
unless the entity can demonstrate that taking such steps would fundamentally alter the nature
of the services being offered or result in an undue burden.
new text end
new text begin
(f) A covered entity must otherwise comply with the requirements of Titles II and III of
the Americans with Disabilities Act of 1990, the Americans with Disabilities Act
Amendments Act of 2008, and the Minnesota Human Rights Act.
new text end
new text begin
(g) The provisions of this section apply to each part of the organ transplant process.
new text end
new text begin Subd. 3. new text end
new text begin Remedies. new text end
new text begin
In addition to all other remedies available under this chapter, any
individual who has been subjected to discrimination in violation of this section may initiate
a civil action in a court of competent jurisdiction to enjoin violations of this section.
new text end
Sec. 5. new text begin CHILD CARE FACILITY REVITALIZATION GRANT PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Child care facility revitalization grants. new text end
new text begin
(a) The commissioner of human
services shall distribute child care facility revitalization grant funds to county human services
agencies for grant awards to eligible child care providers to be used to reopen a closed child
care program facility or to maintain or improve an operating child care program facility.
The commissioner shall distribute grant funds to counties on a per capita basis proportionate
to the county's population.
new text end
new text begin
(b) The commissioner shall develop a grant application form for use by counties that at
least requires the applicant to submit a plan and proposed budget for reopening, repairing,
or improving the child care program. The plan must include amounts and explanations of
how grant funds will be used to maintain or improve an open child care program facility in
compliance with the authorized uses of grant funds under subdivision 5.
new text end
new text begin
(c) The commissioner shall make grant funds available to counties beginning August 1,
2021.
new text end
new text begin Subd. 2. new text end
new text begin Eligible programs. new text end
new text begin
(a) The following programs are eligible to receive a child
care facility revitalization grant under this section:
new text end
new text begin
(1) family and group family day care homes licensed under Minnesota Rules, chapter
9502;
new text end
new text begin
(2) child care centers licensed under Minnesota Rules, chapter 9503;
new text end
new text begin
(3) certified license-exempt child care centers under Minnesota Statutes, chapter 245H;
and
new text end
new text begin
(4) Tribally licensed child care programs.
new text end
new text begin
(b) Eligible programs must also be located outside the metropolitan area as defined in
Minnesota Statutes, section 473.121, subdivision 2, and must not be:
new text end
new text begin
(1) the subject of a finding of fraud;
new text end
new text begin
(2) prohibited from receiving public funds under Minnesota Statutes, section 245.095;
or
new text end
new text begin
(3) under revocation, suspension, temporary immediate suspension, or decertification,
regardless of whether the action is under appeal.
new text end
new text begin Subd. 3. new text end
new text begin Requirements to receive a child care facility revitalization grant. new text end
new text begin
To receive
funds under this section, an eligible program must complete the application developed by
the commissioner and distributed to counties, attesting and agreeing in writing that the
program intends to remain operating and serving children and that the program will pay
back any grant award if the program permanently closes within one year of receiving the
grant award. Providers who close permanently within one year for any reason are subject
to recovery of funds after program closure. Permanent closures must be reported to the
Department of Human Services using a form prescribed by the commissioner.
new text end
new text begin Subd. 4. new text end
new text begin Grant award amounts. new text end
new text begin
(a) An eligible child care program may receive up to
$15,000 to reopen a closed family child care site.
new text end
new text begin
(b) An eligible child care program may receive up to $100,000 to reopen a closed child
care center site.
new text end
new text begin
(c) An eligible child care program may receive up to $7,500 to repair or update an open
and operating family child care program setting.
new text end
new text begin
(d) An eligible child care program may receive up to $50,000 to repair or update an open
and operating child care center.
new text end
new text begin Subd. 5. new text end
new text begin Authorized uses of grant funds. new text end
new text begin
Eligible programs may use child care facility
revitalization grant funds for:
new text end
new text begin
(1) facility maintenance or improvements;
new text end
new text begin
(2) personal protective equipment or cleaning and sanitation supplies and services;
new text end
new text begin
(3) purchases or updates to equipment and supplies to respond to the COVID-19 public
health emergency; or
new text end
new text begin
(4) other goods and services necessary to maintain or resume child care services.
new text end
Sec. 6. new text begin COVID-19 PUBLIC HEALTH SUPPORT FUNDS FOR CHILD CARE
PROGRAMS.
new text end
new text begin Subdivision 1. new text end
new text begin Public health support funds. new text end
new text begin
(a) The commissioner of human services
shall distribute COVID-19 public health support funds to eligible child care programs to
support the higher costs to operate safely as defined by state and federal public health
guidance, including but not limited to efforts to create smaller and consistent child groupings,
screening procedures, quarantine periods, cleaning and sanitation, additional sick leave,
substitute teachers, supports for distance learning and incentive pay, and other public health
measures that prevent transmission of COVID-19 and protect families and staff.
new text end
new text begin
(b) The commissioner shall distribute monthly base grant awards under subdivision 4
for a distribution period beginning June 2021 through May 2023. Any funds remaining as
of June 1, 2023, may be distributed as monthly base grant awards in the same amount
distributed for May 2023 until either September 30, 2023, or until the funds expire, whichever
is sooner.
new text end
new text begin Subd. 2. new text end
new text begin Eligible programs. new text end
new text begin
(a) The following programs are eligible to receive public
health support funds under this section:
new text end
new text begin
(1) family and group family day care homes licensed under Minnesota Rules, chapter
9502;
new text end
new text begin
(2) child care centers licensed under Minnesota Rules, chapter 9503;
new text end
new text begin
(3) certified license-exempt child care centers under Minnesota Statutes, chapter 245H;
and
new text end
new text begin
(4) Tribally licensed child care programs.
new text end
new text begin
(b) Programs must not be:
new text end
new text begin
(1) the subject of a finding of fraud;
new text end
new text begin
(2) prohibited from receiving public funds under Minnesota Statutes, section 245.095;
or
new text end
new text begin
(3) under revocation, suspension, temporary immediate suspension, or decertification,
regardless of whether the action is under appeal.
new text end
new text begin
(c) Public health support funds under this section must be made available to all eligible
programs on a noncompetitive basis.
new text end
new text begin Subd. 3. new text end
new text begin Requirements to receive public health support funds. new text end
new text begin
(a) To receive funds
under this section, an eligible program must complete a monthly application for COVID-19
public health support funds, attesting and agreeing in writing that the program has been
operating and serving children during each month's funding period. An applicant program
must further attest and agree in writing that the program intends to remain operating and
serving children through the remainder of each month's funding period. Exceptions to this
operating requirement are:
new text end
new text begin
(1) service disruptions that are necessary due to public health guidance to protect the
safety and health of children and child care programs issued by the Centers for Disease
Control and Prevention, commissioner of health, commissioner of human services, or a
local public health agency; and
new text end
new text begin
(2) planned temporary closures for provider vacation and holidays for up to three weeks
over the duration of the funding months beginning June 1, 2021, but not sequentially.
new text end
new text begin
Temporary closures must be reported to the Department of Human Services using a form
prescribed by the commissioner. For licensed and certified centers, only temporary closures
of the entire program need to be reported; classroom closures or other operating adjustments
do not need to be reported.
new text end
new text begin
(b) Providers who close permanently for any reason are subject to recovery of funds for
any period of time after program closure. Permanent closures must be reported to the
Department of Human Services using a form prescribed by the commissioner.
new text end
new text begin
(c) Notwithstanding paragraphs (a) and (b), if the commissioner determines that the
temporary or permanent closure of one program is undertaken to ensure the continued
availability of services to children by another program, the commissioner may issue the
closed program's public health support funds to the program that has agreed to accept the
children previously cared for by the closed program whether or not all the children choose
to go to the remaining program and whether or not the remaining program is already receiving
public health support funds.
new text end
new text begin
(d) To receive funds under this section, an eligible program must:
new text end
new text begin
(1) continue to comply with all other requirements listed in the application for 2021
COVID-19 public health support funds; and
new text end
new text begin
(2) prioritize use of these funds during the monthly award periods, and must use the
funds to cover costs incurred during the peacetime emergency declared by the governor
relating to COVID-19. At least 72.5 percent of funds must be used for payroll salaries or
employee benefits.
new text end
new text begin Subd. 4. new text end
new text begin Maximum base payment to programs. new text end
new text begin
(a) An eligible family child care
program may receive up to $1,200 in monthly public health support funds.
new text end
new text begin
(b) An eligible licensed child care center may receive up to $8,500 in monthly public
health support funds.
new text end
new text begin
(c) An eligible certified child care center may receive up to $3,000 in monthly public
health support funds.
new text end
new text begin
(d) The commissioner of human services shall calculate monthly base payment amounts
that are proportionate to the amount of funds available for a given funding period.
new text end
Sec. 7. new text begin DIRECTION TO THE COMMISSIONER OF HUMAN SERVICES; PARENT
AWARE VALIDATION STUDY.
new text end
new text begin
The commissioner shall contract with an independent third-party evaluator to complete
a validation study that evaluates whether the program's standards, indicators, and other
measures are effectively measuring program quality and educational outcomes. The
third-party evaluator shall report on the results of the study to the commissioner and the
chairs and ranking minority members of the legislative committees with jurisdiction over
child care by February 1, 2024. The commissioner shall not update current Parent Aware
standards and indicators until the validation study is complete.
new text end
Sec. 8. new text begin GRANTS TO EXPAND ACCESS TO CHILD CARE FOR CHILDREN
WITH DISABILITIES.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The commissioner of human services must establish
competitive grants to expand access to licensed family child care providers or licensed child
care centers for children with disabilities including medical complexities. Grants must be
awarded to counties or tribes and must be used to assist family child care providers or child
care centers to serve children with disabilities in inclusive settings alongside children without
disabilities. Competitive grants must be awarded to at least two applicants beginning no
later than December 1, 2021.
new text end
new text begin Subd. 2. new text end
new text begin Commissioner's duties. new text end
new text begin
To implement these grants, the commissioner must:
new text end
new text begin
(1) develop a request for proposals with stakeholder input;
new text end
new text begin
(2) develop procedures for data collection, qualitative and quantitative measurement of
programmatic outcomes, and reporting requirements for grantees;
new text end
new text begin
(3) convene a working group of grantees, grantee partners, and participating families to
assess progress on grant activities, share best practices, and collect and review data on grant
activities; and
new text end
new text begin
(4) based on information gathered throughout the grant period and at the conclusion of
the grant period, provide a report to the chairs and ranking minority members of the
legislative committees with jurisdiction over health and human services regarding grant
activities, with legislative recommendations for implementing inclusive child care statewide.
The report must be made available to the public.
new text end
new text begin Subd. 3. new text end
new text begin Grant activities. new text end
new text begin
Grantees must use grant money to expand access to inclusive
family child care providers or child care centers to children with disabilities, which may
include:
new text end
new text begin
(1) onetime needs to equip a child care setting to serve children with disabilities, such
as:
new text end
new text begin
(i) environmental modifications;
new text end
new text begin
(ii) accessibility modifications;
new text end
new text begin
(iii) sensory adaptation;
new text end
new text begin
(iv) training and staff time for training; or
new text end
new text begin
(v) equipment purchase;
new text end
new text begin
(2) ongoing medical or disability-related services for children with disabilities in inclusive
child care settings, such as:
new text end
new text begin
(i) mental health supports;
new text end
new text begin
(ii) inclusion specialist services;
new text end
new text begin
(iii) home care nursing;
new text end
new text begin
(iv) behavioral supports;
new text end
new text begin
(v) coaching or training for staff;
new text end
new text begin
(vi) substitute teaching time; or
new text end
new text begin
(vii) enhanced rate for increased staff-to-child ratio; and
new text end
new text begin
(3) other expenses determined by the grantee and family child care provider or child
care center partners to be necessary to serve children with disabilities in inclusive child care
settings.
new text end
new text begin Subd. 4. new text end
new text begin Requirements for grantees. new text end
new text begin
Upon receipt of grant money and throughout the
grant period, grant recipients must:
new text end
new text begin
(1) partner with at least three family child care providers or child care centers, each of
which must meet one of the following criteria:
new text end
new text begin
(i) serve ten or fewer children, including at least one child with a disability who is not
a family member of the family child care provider or of an employee of the child care center;
new text end
new text begin
(ii) serve 11 to 30 children, including at least two children with disabilities; or
new text end
new text begin
(iii) serve more than 30 children, including at least three children with disabilities;
new text end
new text begin
(2) develop and use a process to ensure that grant funding be used to support children
with disabilities who, without the additional supports made available through the grant,
would have difficulty accessing inclusive child care settings;
new text end
new text begin
(3) pursue funding for ongoing services needed for children with disabilities in inclusive
child care settings, such as:
new text end
new text begin
(i) Medicaid or private health insurance coverage;
new text end
new text begin
(ii) additional grant funding; or
new text end
new text begin
(iii) other sources of county, state, or federal funds; and
new text end
new text begin
(4) explore and seek opportunities to use existing federal funds to provide ongoing
support to family child care providers or child care centers serving children with disabilities.
Grantees must seek to minimize family financial obligations for child care for a child with
disabilities beyond what child care would cost for a child without disabilities.
new text end
new text begin Subd. 5. new text end
new text begin Reporting. new text end
new text begin
Grantees must report semiannually to the commissioner according
to the manner specified by the commissioner on the following:
new text end
new text begin
(1) additional supports needed to serve children with disabilities in inclusive child care
settings;
new text end
new text begin
(2) costs for additional supports;
new text end
new text begin
(3) billing best practices;
new text end
new text begin
(4) available funding sources;
new text end
new text begin
(5) processes for identifying families of children with disabilities who could benefit
from grant activities and connecting them with family child care providers or child care
centers interested in serving them; and
new text end
new text begin
(6) processes used to determine whether a child is a child with a disability and means
of prioritizing grant funding to serve children with significant support needs associated with
their disability.
new text end
Sec. 9. new text begin WORKING GROUP; AFFORDABLE HIGH QUALITY CHILD CARE AND
EARLY EDUCATION FOR ALL FAMILIES.
new text end
new text begin Subdivision 1. new text end
new text begin Goal. new text end
new text begin
It is the goal of the state of Minnesota for all families to have access
to affordable high quality child care and early education, for children from birth up to age
five, that enriches, nurtures, and supports children and their families. This goal will be
achieved by:
new text end
new text begin
(1) creating a system under which family costs for child care and early education are
affordable;
new text end
new text begin
(2) ensuring that a child's access to high quality child care and early education is not
determined by the child's race, income, or zip code; and
new text end
new text begin
(3) ensuring that Minnesota's early childhood educators are qualified, diverse, supported,
and equitably compensated regardless of setting.
new text end
new text begin Subd. 2. new text end
new text begin Working group; establishment. new text end
new text begin
(a) The commissioner of human services
shall coordinate through the Minnesota Children's Cabinet to establish a working group that
includes, but is not limited to members of the State Advisory Council on Early Childhood
Care and Education. The group shall include early childhood care and education providers;
parents; organizations that provide training and other supports to providers; business
associations; children's advocates; and representatives from the Departments of Human
Services, Health, and Education. The working group shall be convened as necessary to
develop a plan to achieve the goal in subdivision 1 by January 1, 2031.
new text end
new text begin
(b) The plan must incorporate strategies that:
new text end
new text begin
(1) create a system under which family costs of child care and early education are
affordable;
new text end
new text begin
(2) ensure that a child's access to high quality child care and early education is not
determined by the child's race, income, or zip code; and
new text end
new text begin
(3) ensure that Minnesota has early childhood educators who are qualified, diverse,
supported, and equitably compensated regardless of setting.
new text end
new text begin Subd. 3. new text end
new text begin Required reports. new text end
new text begin
By July 1, 2022, the working group must submit to the
governor and the chairs and ranking minority members of the legislative committees with
jurisdiction over early childhood programs an interim report on the working group's
preliminary findings and draft implementation plans relating to the plan required under
subdivision 2. By February 1, 2023, the working group must submit to the governor and
the chairs and ranking minority members of the legislative committees with jurisdiction
over early childhood programs a final report on the working group's recommendations and
implementation proposals relating to the plan required under subdivision 2.
new text end
Sec. 10. new text begin DIRECTION TO COMMISSIONER OF HUMAN SERVICES; REPORT
ON PARTICIPATION IN EARLY CHILDHOOD PROGRAMS BY CHILDREN IN
FOSTER CARE.
new text end
new text begin Subdivision 1. new text end
new text begin Reporting requirement. new text end
new text begin
(a) The commissioner of human services shall
report on the participation in early care and education programs by children under age six
who have experienced foster care, as defined in Minnesota Statutes, section 260C.007,
subdivision 18, at any time during the reporting period.
new text end
new text begin
(b) For purposes of this section, "early care and education program" means Early Head
Start and Head Start under the federal Improving Head Start for School Readiness Act of
2007; special education programs under Minnesota Statutes, chapter 125A; early learning
scholarships under Minnesota Statutes, section 124D.165; school readiness under Minnesota
Statutes, sections 124D.15 and 124D.16; school readiness plus under Laws 2017, First
Special Session chapter 5, article 8, section 9; voluntary prekindergarten under Minnesota
Statutes, section 124D.151; child care assistance under Minnesota Statutes, chapter 119B;
and other programs as determined by the commissioner.
new text end
new text begin Subd. 2. new text end
new text begin Report content. new text end
new text begin
(a) The report shall provide counts and rates of participation
by early care and education program and child's race, ethnicity, age, and county of residence.
The report shall use the most current administrative data and include recommendations for
collecting any data listed in this paragraph that is not currently available.
new text end
new text begin
(b) The report shall include recommendations to:
new text end
new text begin
(1) provide the data described in paragraph (a) on an annual basis as part of the report
required under Minnesota Statutes, section 257.0725;
new text end
new text begin
(2) facilitate children's continued participation in early care and education programs
after reunification, adoption, or transfer of permanent legal and physical custody; and
new text end
new text begin
(3) regularly report measures of early childhood well-being for children who have
experienced foster care. "Measures of early childhood well-being" include developmental
screening, school readiness assessments, well-child medical visits, and other indicators as
determined by the commissioner, in consultation with the commissioners of health, education,
and management and budget, county social service and public health agencies, and school
districts.
new text end
new text begin
(c) The report shall include an implementation plan to increase the rates of participation
among children and their foster families in early care and education programs, including
processes for referrals and follow-up. The plan shall be developed in collaboration with
affected communities and families, incorporating their experiences and feedback. County
social service and public health agencies and school districts shall also collaborate on the
plan's development and implementation strategy.
new text end
new text begin
(d) The report shall identify barriers to be addressed to ensure that early care and
education programs are responsive to the cultural, logistical, and racial equity concerns and
needs of children's foster families and families of origin, and the report shall identify methods
to ensure the experiences and feedback from children's foster families and families of origin
are included in the ongoing implementation of early care and education programs.
new text end
new text begin Subd. 3. new text end
new text begin Submission to legislature. new text end
new text begin
By June 30, 2022, the commissioner shall submit
an interim report, and by December 1, 2022, the commissioner shall submit the final report
required under this section to the chairs and ranking minority members of the legislative
committees with jurisdiction over human services, early childhood, and education.
new text end
Sec. 11. new text begin CHILD CARE AND DEVELOPMENT BLOCK GRANT ALLOCATION;
AFFORDABLE HIGH QUALITY CHILD CARE AND EARLY EDUCATION FOR
ALL FAMILIES WORKING GROUP.
new text end
new text begin
The commissioner of human services shall allocate up to $500,000 in fiscal year 2022
from the amount that Minnesota received under the American Rescue Plan Act, Public Law
117-2, section 2201, for the child care and development block grant for the affordable high
quality child care and early education for all families working group. This is a onetime
allocation and is available until June 30, 2023.
new text end
Sec. 12. new text begin CHILD CARE AND DEVELOPMENT BLOCK GRANT ALLOCATION;
CHILD CARE WORKFORCE DEVELOPMENT GRANTS.
new text end
new text begin
The commissioner of human services shall allocate $750,000 in fiscal year 2022 and
$750,000 in fiscal year 2023 from the amount that Minnesota received under the American
Rescue Plan Act, Public Law 117-2, section 2201, for the child care and development block
grant for grants to nonprofit organizations to provide economically challenged individuals
the jobs skills training, career counseling, and job placement assistance necessary to begin
a career path in child care. By January 1, 2024, the commissioner shall report to the chairs
and ranking minority members of the legislative committees with jurisdiction over child
care on the outcomes of the grant program, including the effects on the child care workforce.
This is a onetime allocation.
new text end
Sec. 13. new text begin CHILD CARE AND DEVELOPMENT BLOCK GRANT ALLOCATION;
JERRY RELPH FAMILY SUPPORTS AND IMPROVEMENT PLAN.
new text end
new text begin
The commissioner of human services shall allocate $4,500,000 in fiscal year 2022 and
$4,500,000 in fiscal year 2023 from the amount that Minnesota received under the American
Rescue Plan Act, Public Law 117-2, section 2201, for the child care and development block
grant for grants to counties, beginning October 1, 2021, to coordinate a two-year, voluntary
information sharing program between county agencies, child care providers, early childhood
education providers, and parents of families who qualify for or are currently receiving child
care assistance, to communicate the needs and circumstances of the participating families
and children that prohibit, complicate, or otherwise limit access to or the effectiveness of
the child care assistance program, and to evaluate the outcomes of other assistance programs
for which the families are eligible. The information sharing program may include data
sharing under Minnesota Statutes, section 13.32, subdivision 12. Grant award amounts shall
be distributed annually and allocated to counties on a per capita basis, based on the number
of children enrolled in the child care assistance program as of July 1 of each year in the
county receiving grant funding. By February 1, 2023, and February 1, 2024, the commissioner
of human services shall provide an interim and final report to the chairs and ranking minority
members of the legislative committees with jurisdiction over the child care assistance
program on the results of the project, including any recommendations for improvements to
the child care assistance program to better meet the needs of participating families and
children.
new text end
Sec. 14. new text begin CHILD CARE AND DEVELOPMENT BLOCK GRANT ALLOCATION;
REETAIN GRANT PROGRAM.
new text end
new text begin
The commissioner of human services shall allocate $375,000 in fiscal year 2022 and
$375,000 in fiscal year 2023 from the amount that Minnesota received under the American
Rescue Plan Act, Public Law 117-2, section 2201, for the child care and development block
grant, for REETAIN grants under Minnesota Statutes, section 119B.195. This is a onetime
allocation.
new text end
Sec. 15. new text begin CHILD CARE STABILIZATION FUND ALLOCATION; CHILD CARE
PROVIDER STARTUP GRANTS.
new text end
new text begin
(a) The commissioner of human services shall allocate $10,000,000 in fiscal year 2022
and $10,000,000 in fiscal year 2023 from the amount that Minnesota received under the
American Rescue Plan Act, Public Law 117-2, section 2202, for the child care stabilization
fund for grants to local communities to increase the supply of quality child care providers
to support economic development. At least 60 percent of grant funds must go to communities
located outside of the seven-county metropolitan area as defined under Minnesota Statutes,
section 473.121, subdivision 2. Grant recipients must obtain a 50 percent nonstate match
to grant funds in either cash or in-kind contributions. Grant funds available under this section
must be used to implement projects to reduce the child care shortage in the state, including
but not limited to funding for child care business start-ups or expansion, training, facility
modifications or improvements required for licensing, and assistance with licensing and
other regulatory requirements. In awarding grants, the commissioner must give priority to
communities that have demonstrated a shortage of child care providers in the area. This is
a onetime allocation.
new text end
new text begin
(b) Within one year of receiving grant funds, grant recipients must report to the
commissioner on the outcomes of the grant program, including but not limited to the number
of new providers, the number of additional child care provider jobs created, the number of
additional child care slots, and the amount of cash and in-kind local funds invested.
new text end
Sec. 16. new text begin CHILD CARE STABILIZATION FUND ALLOCATION; CHILD CARE
BUSINESS TRAINING PROGRAM.
new text end
new text begin
The commissioner of human services shall allocate $3,000,000 in fiscal year 2022 from
the amount that Minnesota received under the American Rescue Plan Act, Public Law 117-2,
section 2202, for the child care stabilization fund for a grant, through a competitive bidding
process, to a nonprofit organization with expertise in small business advising to operate a
business training program for child care providers and to create materials that could be used,
free of charge, for start-up, expansion, and operation of child care businesses statewide,
with the goal of helping new and existing child care businesses in underserved areas of the
state become profitable and sustainable. The commissioner shall report data on outcomes
and recommendations for replication of this training program throughout Minnesota to the
governor and the chairs and ranking minority members of the committees of the house of
representatives and the senate with jurisdiction over child care by December 15, 2023. This
is a onetime allocation and is available until June 30, 2023.
new text end
Sec. 17. new text begin CHILD CARE STABILIZATION FUND ALLOCATION; PUBLIC HEALTH
SUPPORT FUNDS FOR CHILD CARE PROGRAMS.
new text end
new text begin
(a) The commissioner of human services shall allocate $252,000,000 in fiscal year 2022
from the amount that Minnesota received under the American Rescue Plan Act, Public Law
117-2, section 2202, for the child care stabilization fund for the public health support funds
for child care programs in section 36. This is a onetime allocation and is available until
September 30, 2023.
new text end
new text begin
(b) Of the amount allocated under paragraph (a), $60,000,000 is for the three-month
funding period from June to August 2021; $50,000,000 is for the three-month funding period
from September to November 2021; $40,000,000 is for the three-month funding period
from December 2021 to February 2022; $30,000,000 is for the three-month funding period
from March to May 2022; $25,000,000 is for the three-month funding period from June to
August 2022; $20,000,000 is for the three-month funding period from September to
November 2022; $15,000,000 is for the three-month funding period from December 2022
to February 2023; and $10,000,000 is for the three-month funding period from March to
May 2023. The commissioner shall adjust grant award amounts in accordance with the
amounts available for each three-month funding period.
new text end
new text begin
(c) Of the amount allocated under paragraph (a), up to $2,000,000 is for administrative
costs.
new text end
Sec. 18. new text begin CHILD CARE STABILIZATION FUND ALLOCATION; CHILD CARE
FACILITY REVITALIZATION GRANTS.
new text end
new text begin
The commissioner of human services shall allocate $50,000,000 in fiscal year 2022 from
the amount that Minnesota received under the American Rescue Plan Act, Public Law 117-2,
section 2202, for the child care stabilization fund for child care facility revitalization grants.
Of this amount, up to $1,500,000 is for administrative costs. This is a onetime allocation
and is available until September 30, 2023.
new text end
ARTICLE 20
FORECAST ADJUSTMENTS
Section 1. new text begin DEPARTMENT OF HUMAN SERVICES FORECAST ADJUSTMENT.
|
new text begin
The dollar amounts shown in the columns marked "Appropriations" are added to or, if
shown in parentheses, are subtracted from the appropriations in Laws 2019, First Special
Session chapter 9, article 14, from the general fund, or any other fund named, to the
commissioner of human services for the purposes specified in this article, to be available
for the fiscal year indicated for each purpose. The figure "2021" used in this article means
that the appropriations listed are available for the fiscal year ending June 30, 2021.
new text end
|
new text begin
APPROPRIATIONS new text end |
||||||
|
new text begin
Available for the Year new text end |
||||||
|
new text begin
Ending June 30 new text end |
||||||
|
new text begin
2021 new text end |
||||||
Sec. 2. new text begin COMMISSIONER OF HUMAN
|
||||||
new text begin Subdivision 1. new text end
new text begin
Total Appropriation
|
new text begin
$ new text end |
new text begin
(816,996,000) new text end |
||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
2021 new text end |
||
|
new text begin
General new text end |
new text begin
(745,266,000) new text end |
|
|
new text begin
Health Care Access new text end |
new text begin
(36,893,000) new text end |
|
|
new text begin
Federal TANF new text end |
new text begin
(34,837,000) new text end |
|
new text begin Subd. 2. new text end
new text begin
Forecasted Programs
|
|||||
|
new text begin
(a) Minnesota Family Investment Program (MFIP)/Diversionary Work Program (DWP) new text end |
|||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
2021 new text end |
||
|
new text begin
General new text end |
new text begin
59,004,000 new text end |
|
|
new text begin
Federal TANF new text end |
new text begin
(34,843,000) new text end |
|
|
new text begin
(b) MFIP Child Care Assistance new text end |
new text begin
(54,158,000) new text end |
|||||
|
new text begin
(c) General Assistance new text end |
new text begin
3,925,000 new text end |
|||||
|
new text begin
(d) Minnesota Supplemental Aid new text end |
new text begin
3,849,000 new text end |
|||||
|
new text begin
(e) Housing Support new text end |
new text begin
3,022,000 new text end |
|||||
|
new text begin
(f) Northstar Care for Children new text end |
new text begin
(8,639,000) new text end |
|||||
|
new text begin
(g) MinnesotaCare new text end |
new text begin
(36,893,000) new text end |
|||||
new text begin
This appropriation is from the health care
access fund.
new text end
|
new text begin
(h) Medical Assistance new text end |
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
2021 new text end |
||
|
new text begin
General new text end |
new text begin
(694,938,000) new text end |
|
|
new text begin
Health Care Access new text end |
new text begin
-0- new text end |
|
|
new text begin
(i) Alternative Care new text end |
new text begin
247,000 new text end |
|||||
|
new text begin
(j) Consolidated Chemical Dependency Treatment Fund (CCDTF) Entitlement new text end |
new text begin
(57,578,000) new text end |
|||||
new text begin Subd. 3. new text end
new text begin
Technical Activities
|
new text begin
6,000 new text end |
|||||
new text begin
This appropriation is from the federal TANF
fund.
new text end
Sec. 3. new text begin EFFECTIVE DATE.
new text end
new text begin
Sections 1 and 2 are effective the day following final enactment.
new text end
ARTICLE 21
APPROPRIATIONS
Section 1. new text begin HEALTH AND HUMAN SERVICES APPROPRIATIONS.
|
new text begin
The sums shown in the columns marked "Appropriations" are appropriated to the agencies
and for the purposes specified in this article. The appropriations are from the general fund,
or another named fund, and are available for the fiscal years indicated for each purpose.
The figures "2022" and "2023" used in this article mean that the appropriations listed under
them are available for the fiscal year ending June 30, 2022, or June 30, 2023, respectively.
"The first year" is fiscal year 2022. "The second year" is fiscal year 2023. "The biennium"
is fiscal years 2022 and 2023.
new text end
|
new text begin
APPROPRIATIONS new text end |
||||||
|
new text begin
Available for the Year new text end |
||||||
|
new text begin
Ending June 30 new text end |
||||||
|
new text begin
2022 new text end |
new text begin
2023 new text end |
|||||
Sec. 2. new text begin COMMISSIONER OF HUMAN
|
||||||
new text begin Subdivision 1. new text end
new text begin
Total Appropriation
|
new text begin
$ new text end |
new text begin
9,032,821,000 new text end |
new text begin
$ new text end |
new text begin
9,546,659,000 new text end |
||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
2022 new text end |
new text begin
2023 new text end |
|
|
new text begin
General new text end |
new text begin
7,901,148,000 new text end |
new text begin
8,331,896,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
4,299,000 new text end |
new text begin
4,299,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
828,441,000 new text end |
new text begin
923,123,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
293,477,000 new text end |
new text begin
282,885,000 new text end |
|
new text begin
Lottery Prize new text end |
new text begin
2,896,000 new text end |
new text begin
1,896,000 new text end |
|
new text begin
Opiate Epidemic Response new text end |
new text begin
2,560,000 new text end |
new text begin
2,560,000 new text end |
new text begin
The amounts that may be spent for each
purpose are specified in the following
subdivisions.
new text end
new text begin Subd. 2. new text end
new text begin
TANF Maintenance of Effort
|
||||||
new text begin
(a) Nonfederal Expenditures. The
commissioner shall ensure that sufficient
qualified nonfederal expenditures are made
each year to meet the state's maintenance of
effort (MOE) requirements of the TANF block
grant specified under Code of Federal
Regulations, title 45, section 263.1. In order
to meet these basic TANF/MOE requirements,
the commissioner may report as TANF/MOE
expenditures only nonfederal money expended
for allowable activities listed in the following
clauses:
new text end
new text begin
(1) MFIP cash, diversionary work program,
and food assistance benefits under Minnesota
Statutes, chapter 256J;
new text end
new text begin
(2) the child care assistance programs under
Minnesota Statutes, sections 119B.03 and
119B.05, and county child care administrative
costs under Minnesota Statutes, section
119B.15;
new text end
new text begin
(3) state and county MFIP administrative costs
under Minnesota Statutes, chapters 256J and
256K;
new text end
new text begin
(4) state, county, and tribal MFIP employment
services under Minnesota Statutes, chapters
256J and 256K;
new text end
new text begin
(5) expenditures made on behalf of legal
noncitizen MFIP recipients who qualify for
the MinnesotaCare program under Minnesota
Statutes, chapter 256L;
new text end
new text begin
(6) qualifying working family credit
expenditures under Minnesota Statutes, section
290.0671;
new text end
new text begin
(7) qualifying Minnesota education credit
expenditures under Minnesota Statutes, section
290.0674; and
new text end
new text begin
(8) qualifying Head Start expenditures under
Minnesota Statutes, section 119A.50.
new text end
new text begin
(b) Nonfederal Expenditures; Reporting.
For the activities listed in paragraph (a),
clauses (2) to (8), the commissioner may
report only expenditures that are excluded
from the definition of assistance under Code
of Federal Regulations, title 45, section
260.31.
new text end
new text begin
(c) Limitation; Exceptions. The
commissioner must not claim an amount of
TANF/MOE in excess of the 75 percent
standard in Code of Federal Regulations, title
45, section 263.1(a)(2), except:
new text end
new text begin
(1) to the extent necessary to meet the 80
percent standard under Code of Federal
Regulations, title 45, section 263.1(a)(1), if it
is determined by the commissioner that the
state will not meet the TANF work
participation target rate for the current year;
new text end
new text begin
(2) to provide any additional amounts under
Code of Federal Regulations, title 45, section
264.5, that relate to replacement of TANF
funds due to the operation of TANF penalties;
and
new text end
new text begin
(3) to provide any additional amounts that may
contribute to avoiding or reducing TANF work
participation penalties through the operation
of the excess MOE provisions of Code of
Federal Regulations, title 45, section 261.43
(a)(2).
new text end
new text begin
(d) Supplemental Expenditures. For the
purposes of paragraph (c), the commissioner
may supplement the MOE claim with working
family credit expenditures or other qualified
expenditures to the extent such expenditures
are otherwise available after considering the
expenditures allowed in this subdivision.
new text end
new text begin
(e) Reduction of Appropriations; Exception.
The requirement in Minnesota Statutes, section
256.011, subdivision 3, that federal grants or
aids secured or obtained under that subdivision
be used to reduce any direct appropriations
provided by law, does not apply if the grants
or aids are federal TANF funds.
new text end
new text begin
(f) IT Appropriations Generally. This
appropriation includes funds for information
technology projects, services, and support.
Notwithstanding Minnesota Statutes, section
16E.0466, funding for information technology
project costs shall be incorporated into the
service level agreement and paid to the Office
of MN.IT Services by the Department of
Human Services under the rates and
mechanism specified in that agreement.
new text end
new text begin
(g) Receipts for Systems Project.
Appropriations and federal receipts for
information systems projects for MAXIS,
PRISM, MMIS, ISDS, METS, and SSIS must
be deposited in the state systems account
authorized in Minnesota Statutes, section
256.014. Money appropriated for information
systems projects approved by the
commissioner of the Office of MN.IT
Services, funded by the legislature, and
approved by the commissioner of management
and budget may be transferred from one
project to another and from development to
operations as the commissioner of human
services considers necessary. Any unexpended
balance in the appropriation for these projects
does not cancel and is available for ongoing
development and operations.
new text end
new text begin
(h) Federal SNAP Education and Training
Grants. Federal funds available during fiscal
years 2022 and 2023 for Supplemental
Nutrition Assistance Program Education and
Training and SNAP Quality Control
Performance Bonus grants are appropriated
to the commissioner of human services for the
purposes allowable under the terms of the
federal award. This paragraph is effective the
day following final enactment.
new text end
new text begin Subd. 3. new text end
new text begin
Central Office; Operations
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
162,667,000 new text end |
new text begin
157,780,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
4,174,000 new text end |
new text begin
4,174,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
16,966,000 new text end |
new text begin
16,966,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
100,000 new text end |
new text begin
100,000 new text end |
new text begin
(a) Administrative Recovery; Set-Aside. The
commissioner may invoice local entities
through the SWIFT accounting system as an
alternative means to recover the actual cost of
administering the following provisions:
new text end
new text begin
(1) Minnesota Statutes, section 125A.744,
subdivision 3;
new text end
new text begin
(2) Minnesota Statutes, section 245.495,
paragraph (b);
new text end
new text begin
(3) Minnesota Statutes, section 256B.0625,
subdivision 20, paragraph (k);
new text end
new text begin
(4) Minnesota Statutes, section 256B.0924,
subdivision 6, paragraph (g);
new text end
new text begin
(5) Minnesota Statutes, section 256B.0945,
subdivision 4, paragraph (d); and
new text end
new text begin
(6) Minnesota Statutes, section 256F.10,
subdivision 6, paragraph (b).
new text end
new text begin
(b) Background Studies. $2,074,000 in fiscal
year 2022 is from the general fund to provide
a credit to providers who paid for emergency
background studies in NETStudy 2.0. This is
a onetime appropriation.
new text end
new text begin
(c) On-Site Background Study
Fingerprinting Contract. $837,000 in fiscal
year 2022 is from the general fund for a
qualified contractor to conduct on-site
background study fingerprinting to address
the background study backlog. This is a
onetime appropriation.
new text end
new text begin
(d) Fraud Prevention Investigation Grants.
$425,000 in fiscal year 2022 and $425,000 in
fiscal year 2023 are from the general fund for
grants to counties for fraud prevention
investigation.
new text end
new text begin
(e) Base Level Adjustment. The general fund
base is $157,169,000 in fiscal year 2024 and
$157,202,000 in fiscal year 2025.
new text end
new text begin Subd. 4. new text end
new text begin
Central Office; Children and Families
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
17,684,000 new text end |
new text begin
18,189,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
2,582,000 new text end |
new text begin
2,582,000 new text end |
new text begin
(a) Indian Child Welfare Training.
$1,012,000 in fiscal year 2022 and $993,000
in fiscal year 2023 are from the general fund
for establishment and operation of the Tribal
Training and Certification Partnership at the
University of Minnesota, Duluth campus, to
provide training, establish federal Indian Child
Welfare Act and Minnesota Indian Family
Preservation Act training requirements for
county child welfare workers, and develop
Indigenous child welfare training for American
Indian Tribes. The general fund base for this
appropriation is $1,053,000 in fiscal year 2024
and $1,053,000 in fiscal year 2025.
new text end
new text begin
(b) Report on Participation in Early
Childhood Programs by Children in Foster
Care. $200,000 in fiscal year 2022 and
$90,000 in fiscal year 2023 are from the
general fund for the interim and final reports
on participation in early childhood programs
by children in foster care. This is a onetime
appropriation.
new text end
new text begin
(c) Ombudsperson for Child Care
Providers. $242,000 in fiscal year 2022 and
$242,000 in fiscal year 2023 are from the
general fund for the ombudsperson for child
care providers under Minnesota Statutes,
section 119B.27.
new text end
new text begin
(d) Parent Aware Validation Study.
$204,000 in fiscal year 2022 and $476,000 in
fiscal year 2023 are from the general fund to
contract with an independent third-party
evaluator to conduct a validation study of the
Parent Aware program. The general fund base
for this appropriation is $255,000 in fiscal year
2024 and $0 in fiscal year 2025.
new text end
new text begin
(e) Base Level Adjustment. The general fund
base is $18,168,000 in fiscal year 2024 and
$17,913,000 in fiscal year 2025.
new text end
new text begin Subd. 5. new text end
new text begin
Central Office; Health Care
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
23,830,000 new text end |
new text begin
23,886,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
28,168,000 new text end |
new text begin
28,168,000 new text end |
new text begin
(a) Expanding Telehealth Delivery Options
Study. $270,000 in fiscal year 2022 and
$195,000 in fiscal year 2023 are from the
general fund for contracts related to the study
of the viability of the use of audio-only
communication as a permitted option for
delivering services through telehealth within
the public health care programs. The general
fund base for this appropriation is $20,000 in
fiscal year 2024 and $0 in fiscal year 2025.
new text end
new text begin
(b) Base Level Adjustment. The general fund
base is $23,712,000 in fiscal year 2024 and
$23,296,000 in fiscal year 2025.
new text end
new text begin Subd. 6. new text end
new text begin
Central Office; Continuing Care for
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
19,193,000 new text end |
new text begin
19,101,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
125,000 new text end |
new text begin
125,000 new text end |
new text begin
new text begin Base Level Adjustment.new text end The general fund
base is $19,161,000 in fiscal year 2024 and
$19,174,000 in fiscal year 2025.
new text end
new text begin Subd. 7. new text end
new text begin
Central Office; Community Supports
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
36,041,000 new text end |
new text begin
34,645,000 new text end |
|
new text begin
Lottery Prize new text end |
new text begin
163,000 new text end |
new text begin
163,000 new text end |
|
new text begin
Opiate Epidemic Response new text end |
new text begin
60,000 new text end |
new text begin
60,000 new text end |
new text begin
(a) Substance Use Disorder Provider
Reduction in Regulatory Requirements.
$125,000 in fiscal year 2022 and $75,000 in
fiscal year 2023 are from the general fund for
a contract with a vendor to develop statewide
system improvements to minimize regulatory
paperwork for substance use disorder
programs. This is a onetime appropriation.
new text end
new text begin
(b) Substance Use Disorder Provider
Payment Modifications. $200,000 in fiscal
year 2022 is from the general fund for a
contract for a qualified vendor to conduct rate
modeling and develop frameworks for all
substance use disorder treatment rates. This
is a onetime appropriation.
new text end
new text begin
(c) Substance Use Disorder Technical
Assistance Centers. $250,000 in fiscal year
2022 and $250,000 in fiscal year 2023 are
from the general fund for one or more
technical assistance centers for substance use
disorder treatment providers.
new text end
new text begin
(d) new text begin Study on Sober Housing Program.new text end
$77,000 in fiscal year 2022 and $13,000 in
fiscal year 2023 are from the general fund to
conduct a sober housing program study. This
is a onetime appropriation.
new text end
new text begin
(e) Intensive Rehabilitation Mental Health
Services Modifications. $80,000 in fiscal year
2022 and $160,000 in fiscal year 2023 are
from the general fund for a contract with a
third party to provide specialized age-based
training to intensive rehabilitation mental
health treatment teams.
new text end
new text begin
(f) new text begin Base Level Adjustment.new text end The general fund
base is $34,056,000 in fiscal year 2024 and
$33,980,000 in fiscal year 2025. The opiate
epidemic response fund base is $60,000 in
fiscal year 2024 and $0 in fiscal year 2025.
new text end
new text begin Subd. 8. new text end
new text begin
Forecasted Programs; MFIP/DWP
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
91,358,000 new text end |
new text begin
88,094,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
110,140,000 new text end |
new text begin
104,819,000 new text end |
new text begin Subd. 9. new text end
new text begin
Forecasted Programs; MFIP Child Care
|
new text begin
103,171,000 new text end |
new text begin
110,179,000 new text end |
||||
new text begin Subd. 10. new text end
new text begin
Forecasted Programs; General
|
new text begin
53,574,000 new text end |
new text begin
52,785,000 new text end |
||||
new text begin
(a) General Assistance Standard. The
commissioner shall set the monthly standard
of assistance for general assistance units
consisting of an adult recipient who is
childless and unmarried or living apart from
parents or a legal guardian at $203. The
commissioner may reduce this amount
according to Laws 1997, chapter 85, article 3,
section 54.
new text end
new text begin
(b) Emergency General Assistance Limit.
The amount appropriated for emergency
general assistance is limited to no more than
$6,729,812 in fiscal year 2022 and $6,729,812
in fiscal year 2023. Funds to counties shall be
allocated by the commissioner using the
allocation method under Minnesota Statutes,
section 256D.06.
new text end
new text begin Subd. 11. new text end
new text begin
Forecasted Programs; Minnesota
|
new text begin
51,779,000 new text end |
new text begin
52,486,000 new text end |
||||
new text begin Subd. 12. new text end
new text begin
Forecasted Programs; Housing
|
new text begin
186,039,000 new text end |
new text begin
196,054,000 new text end |
||||
new text begin Subd. 13. new text end
new text begin
Forecasted Programs; Northstar Care
|
new text begin
107,034,000 new text end |
new text begin
121,246,000 new text end |
||||
new text begin Subd. 14. new text end
new text begin
Forecasted Programs; MinnesotaCare
|
new text begin
168,664,000 new text end |
new text begin
262,425,000 new text end |
||||
new text begin
This appropriation is from the health care
access fund.
new text end
new text begin Subd. 15. new text end
new text begin
Forecasted Programs; Medical
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
6,108,426,000 new text end |
new text begin
6,494,258,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
611,178,000 new text end |
new text begin
612,099,000 new text end |
new text begin
(a) Behavioral Health Services. $1,000,000
in fiscal year 2022 and $1,000,000 in fiscal
year 2023 are from the general fund for
behavioral health services provided by
hospitals identified under Minnesota Statutes,
section 256.969, subdivision 2b, paragraph
(a), clause (4). The increase in payments shall
be made by increasing the adjustment under
Minnesota Statutes, section 256.969,
subdivision 2b, paragraph (e), clause (2).
new text end
new text begin
(b) Retainer Payments for Home and
Community-Based Service Providers.
$61,070,000 in fiscal year 2022 is from the
general fund for retainer payments for home
and community-based service providers. This
is a onetime appropriation and is available
until June 30, 2023.
new text end
new text begin
(c) Personal Care Assistance Service Rate
Increase. $18,688,000 in fiscal year 2022 and
$57,460,000 in fiscal year 2023 are from the
general fund for the personal care assistance
service rate increases described in this act. The
general fund base for this appropriation is
$60,899,000 in fiscal year 2024 and
$63,766,000 in fiscal year 2025.
new text end
new text begin
(d) Home Care Service Rate Increase.
$4,800,000 in fiscal year 2022 and $4,926,000
in fiscal year 2023 are from the general fund
for home care service rate increases described
in this act. The general fund base for this
appropriation is $5,064,000 in fiscal year 2024
and $5,210,000 in fiscal year 2025.
new text end
new text begin
(e) Elderly Waiver Rate Increase.
$6,057,000 in fiscal year 2022 and $6,136,000
in fiscal year 2023 are from the general fund
for elderly waiver service rate increases
described in this act. The base for this
appropriation is $6,707,000 in fiscal year 2024
and $7,357,000 in fiscal year 2025.
new text end
new text begin Subd. 16. new text end
new text begin
Forecasted Programs; Alternative
|
new text begin
45,487,000 new text end |
new text begin
45,185,000 new text end |
||||
new text begin
new text begin Alternative Care Transfer.new text end Any money
allocated to the alternative care program that
is not spent for the purposes indicated does
not cancel but must be transferred to the
medical assistance account.
new text end
new text begin Subd. 17. new text end
new text begin
Forecasted Programs; Behavioral
|
new text begin
96,255,000 new text end |
new text begin
120,721,000 new text end |
||||
new text begin Subd. 18. new text end
new text begin
Grant Programs; Support Services
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
8,715,000 new text end |
new text begin
8,715,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
101,311,000 new text end |
new text begin
96,984,000 new text end |
new text begin
(a) new text begin MFIP Consolidated Fund.new text end $5,000,000 in
fiscal year 2022 and $673,000 in fiscal year
2023 are from the federal TANF fund for the
MFIP consolidated fund under Minnesota
Statutes, section 256J.626. The federal TANF
fund base for this appropriation is $5,000,000
in fiscal year 2024 and $5,000,000 in fiscal
year 2025.
new text end
new text begin
(b) Base Level Adjustment. The federal
TANF fund base is $101,311,000 in fiscal year
2024 and $101,311,000 in fiscal year 2025.
new text end
new text begin Subd. 19. new text end
new text begin
Grant Programs; Basic Sliding Fee
|
new text begin
53,350,000 new text end |
new text begin
53,362,000 new text end |
||||
new text begin
new text begin Base Level Adjustment.new text end The general fund
base is $53,366,000 in fiscal year 2024 and
$53,366,000 in fiscal year 2025.
new text end
new text begin Subd. 20. new text end
new text begin
Grant Programs; Child Care
|
new text begin
1,737,000 new text end |
new text begin
1,737,000 new text end |
||||
new text begin Subd. 21. new text end
new text begin
Grant Programs; Child Support
|
new text begin
50,000 new text end |
new text begin
50,000 new text end |
||||
new text begin Subd. 22. new text end
new text begin
Grant Programs; Children's Services
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
52,503,000 new text end |
new text begin
52,218,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
140,000 new text end |
new text begin
140,000 new text end |
new text begin
(a) new text begin Title IV-E Adoption Assistance.new text end (1) The
commissioner shall allocate funds from the
Title IV-E reimbursement to the state from
the Fostering Connections to Success and
Increasing Adoptions Act for adoptive, foster,
and kinship families as required in Minnesota
Statutes, section 256N.261.
new text end
new text begin
(2) Additional federal reimbursement to the
state as a result of the Fostering Connections
to Success and Increasing Adoptions Act's
expanded eligibility for Title IV-E adoption
assistance is for postadoption, foster care,
adoption, and kinship services, including a
parent-to-parent support network.
new text end
new text begin
(b) new text begin Initial Implementation of
Court-Appointed Counsel in Child
Protection Proceedings.new text end $520,000 in fiscal
year 2022 and $520,000 in fiscal year 2023
are from the general fund for county costs
related to court-appointed counsel in child
protection proceedings pursuant to Minnesota
Statutes, section 260C.163, subdivision 3. The
commissioner shall distribute funds to counties
that do not currently provide court-appointed
counsel to all parents, guardians, or custodians
who qualify for court-appointed counsel at
emergency protective care hearings for
reimbursement of costs related to providing
this counsel.
new text end
new text begin Subd. 23. new text end
new text begin
Grant Programs; Children and
|
new text begin
63,251,000 new text end |
new text begin
63,856,000 new text end |
||||
new text begin
(a) Family First Prevention Services Act
Implementation. $2,000,000 in fiscal year
2022 and $2,000,000 in fiscal year 2023 are
from the general fund for grants to lead
agencies for reduced Title IV-E federal
reimbursement for room and board costs.
new text end
new text begin
(b) Additional Funding for Community
Action Programs. $1,000,000 in fiscal year
2022 and $1,000,000 in fiscal year 2023 are
from the general fund for community action
programs.
new text end
new text begin Subd. 24. new text end
new text begin
Grant Programs; Children and
|
new text begin
22,990,000 new text end |
new text begin
22,740,000 new text end |
||||
new text begin
(a) Minnesota Food Assistance Program.
Unexpended funds for the Minnesota food
assistance program for fiscal year 2022 do not
cancel but are available in fiscal year 2023.
new text end
new text begin
(b) Grant to Minnesota Association for
Volunteer Administration. $250,000 in fiscal
year 2022 is from the general fund for a grant
to the Minnesota Association for Volunteer
Administration to administer needs-based
volunteerism subgrants. This is a onetime
appropriation and is available until June 30,
2023.
new text end
new text begin Subd. 25. new text end
new text begin
Grant Programs; Health Care Grants
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
3,711,000 new text end |
new text begin
3,711,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
3,465,000 new text end |
new text begin
3,465,000 new text end |
new text begin Subd. 26. new text end
new text begin
Grant Programs; Other Long-Term
|
new text begin
1,925,000 new text end |
new text begin
1,925,000 new text end |
||||
new text begin Subd. 27. new text end
new text begin
Grant Programs; Aging and Adult
|
new text begin
32,995,000 new text end |
new text begin
32,995,000 new text end |
||||
new text begin
Customized Living Quality Improvement
Grants. $500,000 in fiscal year 2022 and
$500,000 in fiscal year 2023 are from the
general fund for customized living quality
improvement grants under Minnesota Statutes,
section 256.479.
new text end
new text begin Subd. 28. new text end
new text begin
Grant Programs; Deaf and
|
new text begin
2,886,000 new text end |
new text begin
2,886,000 new text end |
||||
new text begin Subd. 29. new text end
new text begin
Grant Programs; Disabilities Grants
|
new text begin
23,291,000 new text end |
new text begin
22,903,000 new text end |
||||
new text begin
(a) new text begin Parent-to-Parent Peer Support.new text end $125,000
in fiscal year 2022 and $125,000 in fiscal year
2023 are from the general fund for a grant to
an alliance member of Parent to Parent USA
to support the alliance member's
parent-to-parent peer support program for
families of children with a disability or special
health care need.
new text end
new text begin
(b) new text begin Self-Advocacy Grants.new text end (1) $143,000 in
fiscal year 2022 and $143,000 in fiscal year
2023 are from the general fund for a grant
under Minnesota Statutes, section 256.477,
subdivision 1.
new text end
new text begin
(2) $105,000 in fiscal year 2022 and $105,000
in fiscal year 2023 are from the general fund
for subgrants under Minnesota Statutes,
section 256.477, subdivision 2.
new text end
new text begin
(c) new text begin Minnesota Inclusion Initiative Grants.new text end
$150,000 in fiscal year 2022 and $150,000 in
fiscal year 2023 are from the general fund for
grants under Minnesota Statutes, section
256.4772.
new text end
new text begin
(d) new text begin Grants to Expand Access to Child Care
for Children with Disabilities. new text end $250,000 in
fiscal year 2022 and $250,000 in fiscal year
2023 are from the general fund for grants to
expand access to child care for children with
disabilities. The commissioner may use up to
seven percent of the appropriation for
administration and technical assistance. This
is a onetime appropriation.
new text end
new text begin
(e) Parenting with a Disability Pilot Project.
$250,000 in fiscal year 2022 and $250,000 in
fiscal year 2023 are from the general fund for
the parenting with a disability pilot project.
This is a onetime appropriation.
new text end
new text begin
(f) Base Level Adjustment. The general fund
base is $22,403,000 in fiscal year 2024 and
$22,403,000 in fiscal year 2025.
new text end
new text begin Subd. 30. new text end
new text begin
Grant Programs; Housing Support
|
new text begin
11,364,000 new text end |
new text begin
10,364,000 new text end |
||||
new text begin
Integrated Community-Based Housing Pilot
Project.
new text end
new text begin
$1,000,000 in fiscal year 2022 is from
the general fund for competitive grants to
nonprofits for the initial phase of the integrated
community-based housing pilot project. The
commissioner shall award competitive grants
for the planning, design, construction,
acquisition, and rehabilitation of permanent
supportive housing that provides integrated
community-based settings for people with
disabilities and elderly individuals seeking to
remain in their communities. This is a onetime
appropriation and is available until June 30,
2023.
new text end
new text begin Subd. 31. new text end
new text begin
Grant Programs; Adult Mental Health
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
83,323,000 new text end |
new text begin
83,324,000 new text end |
|
new text begin
Opiate Epidemic Response new text end |
new text begin
2,000,000 new text end |
new text begin
2,000,000 new text end |
new text begin
Base Level Adjustment. The opiate epidemic
response fund base is $2,000,000 in fiscal year
2024 and $2,000,000 in fiscal year 2025.
new text end
new text begin Subd. 32. new text end
new text begin
Grant Programs; Child Mental Health
|
new text begin
25,726,000 new text end |
new text begin
25,726,000 new text end |
||||
new text begin Subd. 33. new text end
new text begin
Grant Programs; Chemical
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
2,636,000 new text end |
new text begin
2,636,000 new text end |
|
new text begin
Lottery Prize new text end |
new text begin
2,733,000 new text end |
new text begin
1,733,000 new text end |
|
new text begin
Opiate Epidemic Response new text end |
new text begin
500,000 new text end |
new text begin
500,000 new text end |
new text begin
(a) Problem Gambling. $225,000 in fiscal
year 2022 and $225,000 in fiscal year 2023
are from the lottery prize fund for a grant to
the state affiliate recognized by the National
Council on Problem Gambling. The affiliate
must provide services to increase public
awareness of problem gambling, education,
and training for individuals and organizations
providing effective treatment services to
problem gamblers and their families, and
research related to problem gambling.
new text end
new text begin
(b) Support Grants Problem Gambling
Services. $2,508,000 in fiscal year 2022 and
$1,508,000 in fiscal year 2023 are from the
lottery prize fund for a grant to the state
affiliate recognized by the National Council
on Problem Gambling for problem gambling
assessments; nonresidential and residential
treatment of problem gambling and gambling
disorder; training for gambling treatment
providers and other behavioral health services
providers; and research projects that evaluate
awareness, prevention, education, treatment
service, and recovery supports related to
problem gambling and gambling disorder.
new text end
new text begin
(c) Project ECHO Chemical Dependency
Support Grants. Notwithstanding Laws 2019,
chapter 63, article 3, section 1, paragraph (f),
the opiate epidemic response fund base is
increased by $400,000 in fiscal year 2025 for
grants of $200,000 to CHI St. Gabriel's Health
Family Medical Center for the opioid-focused
Project ECHO program and $200,000 to
Hennepin Health Care for the opioid-focused
Project ECHO program.
new text end
new text begin
(d) Base Level Adjustment. The opiate
epidemic response fund base is $500,000 in
fiscal year 2024 and $400,000 in fiscal year
2025.
new text end
new text begin Subd. 34. new text end
new text begin
Direct Care and Treatment -
|
||||||
new text begin
new text begin Transfer Authority.new text end Money appropriated to
budget activities under this subdivision and
subdivisions 35 to 38 may be transferred
between budget activities and between years
of the biennium with the approval of the
commissioner of management and budget.
new text end
new text begin Subd. 35. new text end
new text begin
Direct Care and Treatment - Mental
|
new text begin
129,197,000 new text end |
new text begin
129,197,000 new text end |
||||
new text begin
Transfer Authority. Money appropriated to
support the continued operations of the
Community Addiction Recovery Enterprise
(C.A.R.E.) program may be transferred to the
enterprise fund for C.A.R.E.
new text end
new text begin Subd. 36. new text end
new text begin
Direct Care and Treatment -
|
new text begin
17,176,000 new text end |
new text begin
17,176,000 new text end |
||||
new text begin
Transfer Authority. Money appropriated to
support the continued operations of the
Minnesota State Operated Community
Services (MSOCS) program may be
transferred to the enterprise fund for MSOCS.
new text end
new text begin Subd. 37. new text end
new text begin
Direct Care and Treatment - Forensic
|
new text begin
115,644,000 new text end |
new text begin
115,644,000 new text end |
||||
new text begin Subd. 38. new text end
new text begin
Direct Care and Treatment - Sex
|
new text begin
96,285,000 new text end |
new text begin
96,285,000 new text end |
||||
new text begin
new text begin Transfer Authority.new text end Money appropriated for
the Minnesota sex offender program may be
transferred between fiscal years of the
biennium with the approval of the
commissioner of management and budget.
new text end
new text begin Subd. 39. new text end
new text begin
Direct Care and Treatment -
|
new text begin
49,855,000 new text end |
new text begin
49,837,000 new text end |
||||
new text begin
new text begin Plan to Address Effects on Community of
Certain State-Operated Services.new text end $18,000
in fiscal year 2022 is from the general fund to
develop a plan to ameliorate the effects of
repeated incidents occurring at Minnesota
state-operated community services programs.
This is a onetime appropriation.
new text end
new text begin Subd. 40. new text end
new text begin
Technical Activities
|
new text begin
79,204,000 new text end |
new text begin
78,260,000 new text end |
||||
new text begin
This appropriation is from the federal TANF
fund.
new text end
new text begin
Base Level Adjustment. The federal TANF
fund base is $71,493,000 in fiscal year 2024
and $71,493,000 in fiscal year 2025.
new text end
Sec. 3. new text begin COMMISSIONER OF HEALTH
|
||||||
new text begin Subdivision 1. new text end
new text begin
Total Appropriation
|
new text begin
$ new text end |
new text begin
256,042,000 new text end |
new text begin
$ new text end |
new text begin
258,539,000 new text end |
||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
2022 new text end |
new text begin
2023 new text end |
|
|
new text begin
General new text end |
new text begin
138,366,000 new text end |
new text begin
141,159,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
68,451,000 new text end |
new text begin
68,835,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
37,512,000 new text end |
new text begin
36,832,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
11,713,000 new text end |
new text begin
11,713,000 new text end |
new text begin
The amounts that may be spent for each
purpose are specified in the following
subdivisions.
new text end
new text begin Subd. 2. new text end
new text begin
Health Improvement
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
99,644,000 new text end |
new text begin
103,466,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
9,140,000 new text end |
new text begin
9,140,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
37,512,000 new text end |
new text begin
36,832,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
11,713,000 new text end |
new text begin
11,713,000 new text end |
new text begin
(a) TANF Appropriations. (1) $3,579,000 in
fiscal year 2022 and $3,579,000 in fiscal year
2023 are from the TANF fund for home
visiting and nutritional services listed under
Minnesota Statutes, section 145.882,
subdivision 7, clauses (6) and (7). Funds must
be distributed to community health boards
according to Minnesota Statutes, section
145A.131, subdivision 1;
new text end
new text begin
(2) $2,000,000 in fiscal year 2022 and
$2,000,000 in fiscal year 2023 are from the
TANF fund for decreasing racial and ethnic
disparities in infant mortality rates under
Minnesota Statutes, section 145.928,
subdivision 7;
new text end
new text begin
(3) $4,978,000 in fiscal year 2022 and
$4,978,000 in fiscal year 2023 are from the
TANF fund for the family home visiting grant
program according to Minnesota Statutes,
section 145A.17. $4,000,000 of the funding
in each fiscal year must be distributed to
community health boards according to
Minnesota Statutes, section 145A.131,
subdivision 1. $978,000 of the funding in each
fiscal year must be distributed to tribal
governments according to Minnesota Statutes,
section 145A.14, subdivision 2a;
new text end
new text begin
(4) $1,156,000 in fiscal year 2022 and
$1,156,000 in fiscal year 2023 are from the
TANF fund for family planning grants under
Minnesota Statutes, section 145.925; and
new text end
new text begin
(5) the commissioner may use up to 6.23
percent of the funds appropriated from the
TANF fund each fiscal year to conduct the
ongoing evaluations required under Minnesota
Statutes, section 145A.17, subdivision 7, and
training and technical assistance as required
under Minnesota Statutes, section 145A.17,
subdivisions 4 and 5.
new text end
new text begin
(b) TANF Carryforward. Any unexpended
balance of the TANF appropriation in the first
year of the biennium does not cancel but is
available for the second year.
new text end
new text begin
(c) Comprehensive Advanced Life Support
Educational Program. $100,000 in fiscal
year 2022 and $100,000 in fiscal year 2023
are from the general fund for the
comprehensive advanced life support
educational program under Minnesota Statutes,
section 144.6062.
new text end
new text begin
(d) Study on Revenue Recapture and
Uncompensated Care. $50,000 in fiscal year
2022 is from the general fund for an evaluation
of the impact of the revenue recapture
provisions under the Revenue Recapture Act
under Minnesota Statutes, chapter 270A, on
hospital uncompensated care. The
commissioner shall submit the results of the
evaluation to the chairs and ranking minority
members of the legislative committees with
jurisdiction over health and human services
policy and finance by January 1, 2022.
new text end
new text begin
(e) Study of Telehealth. $175,000 in fiscal
year 2022 and $1,465,000 in fiscal year 2023
are from the general fund for contracts related
to the study of the impact of telehealth
payment methodologies and expansion on the
coverage and provision of telehealth services
under public health care programs and private
health insurance. The general fund base for
this appropriation is $34,000 in fiscal year
2024 and $0 in fiscal year 2025.
new text end
new text begin
(f) Reduced Funding for Statewide Health
Improvement Program. The health care
access fund base for the statewide health
improvement program is reduced by
$10,000,000 in fiscal year 2022 and
$10,000,000 in fiscal year 2023.
new text end
new text begin
(g) Increased Funding for Local Public
Health Grants. The health care access fund
base is increased by $10,000,000 in fiscal year
2022 and $10,000,000 in fiscal year 2023 for
local public health grants and $5,000,000 in
fiscal year 2022 and $5,000,000 in fiscal year
2023 are from the general fund for local public
health grants.
new text end
new text begin
(h) Appropriation Elimination; e-Health
Advisory Committee. The general fund
appropriation is reduced by $97,000 in fiscal
year 2022 and $97,000 in fiscal year 2023 for
the elimination of the e-Health Advisory
Committee.
new text end
new text begin
(i) Evidence-Based Home Visiting Grants;
Base Reallocation. $16,500,000 in fiscal year
2022 and $16,500,000 in fiscal year 2023 are
from the general fund base for home visiting
grants under Minnesota Statutes, section
145.87.
new text end
new text begin
(j) Home Visiting Grants; Base Reduction.
The general fund base for home visiting grants
is reduced by $400,000 in fiscal year 2022 and
$400,000 in fiscal year 2023. This is a onetime
reduction.
new text end
new text begin
(k) Eliminating Health Disparities; Base
Reduction. The general fund base for
eliminating health disparities grants under
Minnesota Statutes, section 145.928, is
reduced by $275,000 in fiscal year 2022. This
is a onetime reduction.
new text end
new text begin
(l) Grant for Model Curriculum for
Hospitals on Antiracism and Implicit Bias.
$275,000 in fiscal year 2022 is from the
general fund for a grant to the University of
Minnesota to develop a model curriculum on
antiracism and implicit bias for hospitals with
obstetric care and birth centers to provide
continuing education to staff who care for
pregnant and postpartum patients. The model
curriculum must be evidence-based. This is a
onetime appropriation.
new text end
new text begin
(m) Nurse Family Partnership Programs.
The general fund base includes $2,000,000 in
fiscal year 2022 and $2,000,000 in fiscal year
2023 for grants to community health boards
and tribal nations under Minnesota Statutes,
section 145A.145. Any unexpended funds
appropriated in the first year of the biennium
are available to be awarded as grants under
Minnesota Statutes, section 145A.145, in the
second year of the same biennium.
new text end
new text begin
(n) Base Level Adjustments. The general
fund base is $101,369,000 in fiscal year 2024
and $101,051,000 in fiscal year 2025.
new text end
new text begin
The health care access fund base is
$37,432,000 in fiscal year 2024 and
$36,832,000 in fiscal year 2025.
new text end
new text begin Subd. 3. new text end
new text begin
Health Protection
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
27,170,000 new text end |
new text begin
26,141,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
59,311,000 new text end |
new text begin
59,695,000 new text end |
new text begin
Base Level Adjustments. The general fund
base is $26,154,000 in fiscal year 2024 and
$26,154,000 in fiscal year 2025.
new text end
new text begin Subd. 4. new text end
new text begin
Health Operations
|
new text begin
11,552,000 new text end |
new text begin
11,552,000 new text end |
||||
Sec. 4. new text begin HEALTH-RELATED BOARDS
|
||||||
new text begin Subdivision 1. new text end
new text begin
Total Appropriation
|
new text begin
$ new text end |
new text begin
27,507,000 new text end |
new text begin
$ new text end |
new text begin
26,943,000 new text end |
||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
2022 new text end |
new text begin
2023 new text end |
|
|
new text begin
State Government Special Revenue new text end |
new text begin
27,431,000 new text end |
new text begin
26,867,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
76,000 new text end |
new text begin
76,000 new text end |
new text begin
This appropriation is from the state
government special revenue fund unless
specified otherwise. The amounts that may be
spent for each purpose are specified in the
following subdivisions.
new text end
new text begin Subd. 2. new text end
new text begin
Board of Behavioral Health and
|
new text begin
868,000 new text end |
new text begin
868,000 new text end |
||||
new text begin Subd. 3. new text end
new text begin
Board of Chiropractic Examiners
|
new text begin
666,000 new text end |
new text begin
666,000 new text end |
||||
new text begin Subd. 4. new text end
new text begin
Board of Dentistry
|
new text begin
4,228,000 new text end |
new text begin
3,753,000 new text end |
||||
new text begin
(a) Administrative Services Unit - Operating
Costs. Of this appropriation, $2,738,000 in
fiscal year 2022 and $2,263,000 in fiscal year
2023 are for operating costs of the
administrative services unit. The
administrative services unit may receive and
expend reimbursements for services it
performs for other agencies.
new text end
new text begin
(b) Administrative Services Unit - Volunteer
Health Care Provider Program. Of this
appropriation, $150,000 in fiscal year 2022
and $150,000 in fiscal year 2023 are to pay
for medical professional liability coverage
required under Minnesota Statutes, section
214.40.
new text end
new text begin
(c) Administrative Services Unit -
Retirement Costs. Of this appropriation in
fiscal year 2022, $475,000 is for the
administrative services unit to pay for the
retirement costs of health-related board
employees. This funding may be transferred
to the health board incurring retirement costs.
Any board that has an unexpended balance for
an amount transferred under this paragraph
shall transfer the unexpended amount to the
administrative services unit. This is a onetime
appropriation and is available until June 30,
2023.
new text end
new text begin
(d) Administrative Services Unit - Contested
Cases and Other Legal Proceedings. Of this
appropriation, $200,000 in fiscal year 2022
and $200,000 in fiscal year 2023 are for costs
of contested case hearings and other
unanticipated costs of legal proceedings
involving health-related boards funded under
this section. Upon certification by a
health-related board to the administrative
services unit that costs will be incurred and
that there is insufficient money available to
pay for the costs out of money currently
available to that board, the administrative
services unit is authorized to transfer money
from this appropriation to the board for
payment of those costs with the approval of
the commissioner of management and budget.
The commissioner of management and budget
must require any board that has an unexpended
balance for an amount transferred under this
paragraph to transfer the unexpended amount
to the administrative services unit to be
deposited in the state government special
revenue fund.
new text end
new text begin Subd. 5. new text end
new text begin
Board of Dietetics and Nutrition
|
new text begin
164,000 new text end |
new text begin
164,000 new text end |
||||
new text begin Subd. 6. new text end
new text begin
Board of Executives for Long-Term
|
new text begin
693,000 new text end |
new text begin
635,000 new text end |
||||
new text begin Subd. 7. new text end
new text begin
Board of Marriage and Family Therapy
|
new text begin
406,000 new text end |
new text begin
406,000 new text end |
||||
new text begin Subd. 8. new text end
new text begin
Board of Medical Practice
|
new text begin
5,912,000 new text end |
new text begin
5,868,000 new text end |
||||
new text begin
Health Professional Services Program. This
appropriation includes $1,002,000 in fiscal
year 2022 and $1,002,000 in fiscal year 2023
for the health professional services program.
new text end
new text begin Subd. 9. new text end
new text begin
Board of Nursing
|
new text begin
5,345,000 new text end |
new text begin
5,355,000 new text end |
||||
new text begin Subd. 10. new text end
new text begin
Board of Occupational Therapy
|
new text begin
456,000 new text end |
new text begin
456,000 new text end |
||||
new text begin Subd. 11. new text end
new text begin
Board of Optometry
|
new text begin
238,000 new text end |
new text begin
238,000 new text end |
||||
new text begin Subd. 12. new text end
new text begin
Board of Pharmacy
|
new text begin
4,479,000 new text end |
new text begin
4,479,000 new text end |
||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
State Government Special Revenue new text end |
new text begin
4,403,000 new text end |
new text begin
4,403,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
76,000 new text end |
new text begin
76,000 new text end |
new text begin
The health care access fund base is $76,000
in fiscal year 2024, $38,000 in fiscal year
2025, and $0 in fiscal year 2026.
new text end
new text begin Subd. 13. new text end
new text begin
Board of Physical Therapy
|
new text begin
564,000 new text end |
new text begin
564,000 new text end |
||||
new text begin Subd. 14. new text end
new text begin
Board of Podiatric Medicine
|
new text begin
214,000 new text end |
new text begin
214,000 new text end |
||||
new text begin Subd. 15. new text end
new text begin
Board of Psychology
|
new text begin
1,355,000 new text end |
new text begin
1,355,000 new text end |
||||
new text begin Subd. 16. new text end
new text begin
Board of Social Work
|
new text begin
1,556,000 new text end |
new text begin
1,559,000 new text end |
||||
new text begin Subd. 17. new text end
new text begin
Board of Veterinary Medicine
|
new text begin
363,000 new text end |
new text begin
363,000 new text end |
||||
Sec. 5. new text begin EMERGENCY MEDICAL SERVICES
|
new text begin
$ new text end |
new text begin
4,576,000 new text end |
new text begin
$ new text end |
new text begin
4,576,000 new text end |
||
new text begin
Regional Grants. $800,000 in fiscal year
2022 and $800,000 in fiscal year 2023 are for
regional emergency medical services
programs, to be distributed equally to the eight
emergency medical service regions under
Minnesota Statutes, section 144E.50.
new text end
Sec. 6. new text begin COUNCIL ON DISABILITY
|
new text begin
$ new text end |
new text begin
1,022,000 new text end |
new text begin
$ new text end |
new text begin
1,038,000 new text end |
||
Sec. 7. new text begin OMBUDSMAN FOR MENTAL
|
new text begin
$ new text end |
new text begin
2,487,000 new text end |
new text begin
$ new text end |
new text begin
2,536,000 new text end |
||
new text begin
Department of Psychiatry Monitoring.
$100,000 in fiscal year 2022 and $100,000 in
fiscal year 2023 are for monitoring the
Department of Psychiatry at the University of
Minnesota.
new text end
Sec. 8. new text begin OMBUDSPERSONS FOR FAMILIES
|
new text begin
$ new text end |
new text begin
733,000 new text end |
new text begin
$ new text end |
new text begin
744,000 new text end |
||
Sec. 9. new text begin LEGISLATIVE COORDINATING
|
new text begin
$ new text end |
new text begin
222,000 new text end |
new text begin
$ new text end |
new text begin
76,000 new text end |
||
new text begin
(a) Legislative Task Force on Human
Services Background Study
Disqualifications. $132,000 in fiscal year
2022 and $76,000 in fiscal year 2023 are from
the general fund for the Legislative Task Force
on Human Services Background Study
Eligibility. This is a onetime appropriation.
new text end
new text begin
(b) Task Force on a Public-Private
Telepresence Strategy. $90,000 in fiscal year
2022 is from the general fund for the task force
on person-centered telepresence platform
strategy.
new text end
Sec. 10. new text begin SUPREME COURT
|
new text begin
$ new text end |
new text begin
30,000 new text end |
new text begin
$ new text end |
new text begin
-0- new text end |
||
Sec. 11. new text begin COMMISSIONER OF
|
new text begin
$ new text end |
new text begin
-0- new text end |
new text begin
$ new text end |
new text begin
-0- new text end |
||
new text begin
Notwithstanding Laws 2019, chapter 63,
article 3, section 1, paragraph (e), the opiate
epidemic response fund base is increased by
$300,000 in fiscal year 2025 for the evaluation
activities described under Minnesota Statutes,
section 256.042, subdivision 1, paragraph (c).
new text end
Sec. 12.
Laws 2008, chapter 364, section 17, is amended to read:
Sec. 17. APPROPRIATIONS.
deleted text begin
(a) $261,000 is appropriated from the state government special revenue fund to the
commissioner of health for the purposes of this act for fiscal year 2009. Base level funding
for this appropriation shall be $77,000 for fiscal years beginning on or after July 1, 2009.
deleted text end
deleted text begin
(b) Of the appropriation in paragraph (a), $116,000 in fiscal year 2009 is for the study
and report required in section 12, $145,000 in fiscal year 2009 shall be transferred to the
general fund, and $77,000 shall be transferred for each fiscal year beginning on or after July
1, 2009.
deleted text end
deleted text begin (c)deleted text end new text begin (a)new text end $145,000 is appropriated from the general fund to the commissioner of human
services for fiscal year 2009 for the actuarial and other department costs associated with
additional reporting requirements for health plans and county-based purchasing plans. Base
level funding for this appropriation for fiscal years beginning on or after July 1, 2009, shall
be $135,000 each year.
deleted text begin (d)deleted text end new text begin (b)new text end $96,000 is appropriated from the general fund to the commissioner of human
services for fiscal year 2009 for the study authorized in section 11, clause (3). This
appropriation is onetime.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2021.
new text end
Sec. 13.
Laws 2019, First Special Session chapter 9, article 14, section 3, as amended by
Laws 2019, First Special Session chapter 12, section 6, is amended to read:
Sec. 3. COMMISSIONER OF HEALTH
|
||||||
Subdivision 1.Total Appropriation
|
$ |
231,829,000 |
$ |
deleted text begin
236,188,000
deleted text end
new text begin
233,979,000 new text end |
||
| Appropriations by Fund |
||
| 2020 |
2021 |
|
| General |
124,381,000 |
126,276,000 |
| State Government Special Revenue |
58,450,000 |
deleted text begin
61,367,000
deleted text end
new text begin
59,158,000 new text end |
| Health Care Access |
37,285,000 |
36,832,000 |
| Federal TANF |
11,713,000 |
11,713,000 |
The amounts that may be spent for each
purpose are specified in the following
subdivisions.
Subd. 2.Health Improvement
|
||||||
| Appropriations by Fund |
||
| General |
94,980,000 |
96,117,000 |
| State Government Special Revenue |
7,614,000 |
deleted text begin
7,558,000
deleted text end
new text begin
6,924,000 new text end |
| Health Care Access |
37,285,000 |
36,832,000 |
| Federal TANF |
11,713,000 |
11,713,000 |
(a) TANF Appropriations. (1) $3,579,000 in
fiscal year 2020 and $3,579,000 in fiscal year
2021 are from the TANF fund for home
visiting and nutritional services under
Minnesota Statutes, section 145.882,
subdivision 7, clauses (6) and (7). Funds must
be distributed to community health boards
according to Minnesota Statutes, section
145A.131, subdivision 1;
(2) $2,000,000 in fiscal year 2020 and
$2,000,000 in fiscal year 2021 are from the
TANF fund for decreasing racial and ethnic
disparities in infant mortality rates under
Minnesota Statutes, section 145.928,
subdivision 7;
(3) $4,978,000 in fiscal year 2020 and
$4,978,000 in fiscal year 2021 are from the
TANF fund for the family home visiting grant
program under Minnesota Statutes, section
145A.17. $4,000,000 of the funding in each
fiscal year must be distributed to community
health boards according to Minnesota Statutes,
section 145A.131, subdivision 1. $978,000 of
the funding in each fiscal year must be
distributed to tribal governments according to
Minnesota Statutes, section 145A.14,
subdivision 2a;
(4) $1,156,000 in fiscal year 2020 and
$1,156,000 in fiscal year 2021 are from the
TANF fund for family planning grants under
Minnesota Statutes, section 145.925; and
(5) The commissioner may use up to 6.23
percent of the amounts appropriated from the
TANF fund each year to conduct the ongoing
evaluations required under Minnesota Statutes,
section 145A.17, subdivision 7, and training
and technical assistance as required under
Minnesota Statutes, section 145A.17,
subdivisions 4 and 5.
(b) TANF Carryforward. Any unexpended
balance of the TANF appropriation in the first
year of the biennium does not cancel but is
available for the second year.
(c) Comprehensive Suicide Prevention.
$2,730,000 in fiscal year 2020 and $2,730,000
in fiscal year 2021 are from the general fund
for a comprehensive, community-based suicide
prevention strategy. The funds are allocated
as follows:
(1) $955,000 in fiscal year 2020 and $955,000
in fiscal year 2021 are for community-based
suicide prevention grants authorized in
Minnesota Statutes, section 145.56,
subdivision 2. Specific emphasis must be
placed on those communities with the greatest
disparities. The base for this appropriation is
$1,291,000 in fiscal year 2022 and $1,291,000
in fiscal year 2023;
(2) $683,000 in fiscal year 2020 and $683,000
in fiscal year 2021 are to support
evidence-based training for educators and
school staff and purchase suicide prevention
curriculum for student use statewide, as
authorized in Minnesota Statutes, section
145.56, subdivision 2. The base for this
appropriation is $913,000 in fiscal year 2022
and $913,000 in fiscal year 2023;
(3) $137,000 in fiscal year 2020 and $137,000
in fiscal year 2021 are to implement the Zero
Suicide framework with up to 20 behavioral
and health care organizations each year to treat
individuals at risk for suicide and support
those individuals across systems of care upon
discharge. The base for this appropriation is
$205,000 in fiscal year 2022 and $205,000 in
fiscal year 2023;
(4) $955,000 in fiscal year 2020 and $955,000
in fiscal year 2021 are to develop and fund a
Minnesota-based network of National Suicide
Prevention Lifeline, providing statewide
coverage. The base for this appropriation is
$1,321,000 in fiscal year 2022 and $1,321,000
in fiscal year 2023; and
(5) the commissioner may retain up to 18.23
percent of the appropriation under this
paragraph to administer the comprehensive
suicide prevention strategy.
(d) Statewide Tobacco Cessation. $1,598,000
in fiscal year 2020 and $2,748,000 in fiscal
year 2021 are from the general fund for
statewide tobacco cessation services under
Minnesota Statutes, section 144.397. The base
for this appropriation is $2,878,000 in fiscal
year 2022 and $2,878,000 in fiscal year 2023.
(e) Health Care Access Survey. $225,000 in
fiscal year 2020 and $225,000 in fiscal year
2021 are from the health care access fund to
continue and improve the Minnesota Health
Care Access Survey. These appropriations
may be used in either year of the biennium.
(f) Community Solutions for Healthy Child
Development Grant Program. $1,000,000
in fiscal year 2020 and $1,000,000 in fiscal
year 2021 are for the community solutions for
healthy child development grant program to
promote health and racial equity for young
children and their families under article 11,
section 107. The commissioner may use up to
23.5 percent of the total appropriation for
administration. The base for this appropriation
is $1,000,000 in fiscal year 2022, $1,000,000
in fiscal year 2023, and $0 in fiscal year 2024.
(g) Domestic Violence and Sexual Assault
Prevention Program. $375,000 in fiscal year
2020 and $375,000 in fiscal year 2021 are
from the general fund for the domestic
violence and sexual assault prevention
program under article 11, section 108. This is
a onetime appropriation.
(h) Skin Lightening Products Public
Awareness Grant Program. $100,000 in
fiscal year 2020 and $100,000 in fiscal year
2021 are from the general fund for a skin
lightening products public awareness and
education grant program. This is a onetime
appropriation.
(i) Cannabinoid Products Workgroup.
$8,000 in fiscal year 2020 is from the state
government special revenue fund for the
cannabinoid products workgroup. This is a
onetime appropriation.
(j) Base Level Adjustments. The general fund
base is $96,742,000 in fiscal year 2022 and
$96,742,000 in fiscal year 2023. The health
care access fund base is $37,432,000 in fiscal
year 2022 and $36,832,000 in fiscal year 2023.
Subd. 3.Health Protection
|
||||||
| Appropriations by Fund |
||
| General |
18,803,000 |
19,774,000 |
| State Government Special Revenue |
50,836,000 |
deleted text begin
53,809,000
deleted text end
new text begin
52,234,000 new text end |
(a) Public Health Laboratory Equipment.
$840,000 in fiscal year 2020 and $655,000 in
fiscal year 2021 are from the general fund for
equipment for the public health laboratory.
This is a onetime appropriation and is
available until June 30, 2023.
(b) Base Level Adjustment. The general fund
base is $19,119,000 in fiscal year 2022 and
$19,119,000 in fiscal year 2023. The state
government special revenue fund base is
$53,782,000 in fiscal year 2022 and
$53,782,000 in fiscal year 2023.
Subd. 4.Health Operations
|
10,598,000 |
10,385,000 |
||||
Base Level Adjustment. The general fund
base is $10,912,000 in fiscal year 2022 and
$10,912,000 in fiscal year 2023.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment and
the reductions in subdivisions 1 to 3 are onetime reductions.
new text end
Sec. 14. new text begin RETURN OF PAYMENTS FOR JENSEN SETTLEMENT COSTS.
new text end
new text begin
If the state receives funds disbursed from the United States District Court for the District
of Minnesota registry related to Jensen v. Minnesota Department of Human Services, Civ.
No. 09-1775 (DWF/BRT), then the commissioner shall deposit the disbursed funds, estimated
to be $613,000, into an account in the general fund, and the balance of the account is
appropriated to the commissioner of human services for the disability services system reform
efforts of the Disability Services Division. The commissioner of human services shall
allocate all of these funds to the operating budget of the Disability Services Division. By
January 1, 2023, the commissioner of human services shall report to the chairs and ranking
minority members of the legislative committees and divisions with jurisdiction over human
services on the uses of the funds appropriated under this section.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective retroactively from December 6, 2020.
new text end
Sec. 15. new text begin APPROPRIATION; CORONAVIRUS RELIEF FUND REFINANCING.
new text end
new text begin
The commissioner of management and budget shall review all appropriations and transfers
from the general fund in Laws 2020, chapters 66, 70, 71, and 74, to determine whether those
appropriations and transfers are eligible expenditures from the coronavirus relief fund. The
commissioner shall designate $13,500,000 of general fund appropriations and transfers in
Laws 2020, chapters 66, 70, 71, and 74, as eligible expenditures from the coronavirus relief
fund. $13,500,000 of the appropriations and transfers designated by the commissioner are
canceled to the general fund. The commissioner may designate a portion of an appropriation
or transfer for cancellation. $13,500,000 is appropriated from the coronavirus relief fund
for the purposes of the original general fund appropriation.
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. 16. new text begin APPROPRIATION; REFINANCING AND CANCELLATION OF
EMERGENCY CHILD CARE GRANTS.
new text end
new text begin
$26,623,000 in fiscal year 2020 is appropriated from the federal coronavirus relief fund
to the commissioner of human services to replace $26,623,000 of the general fund
appropriation in Laws 2020, chapter 71, article 1, section 2, subdivision 9. $26,623,000 of
the appropriation in Laws 2020, chapter 71, article 1, section 2, subdivision 9, is canceled
to the general fund. This is a onetime appropriation.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective retroactively from March 29, 2020.
new text end
Sec. 17. new text begin APPROPRIATION; MINNESOTACARE.
new text end
new text begin
$44,000 in fiscal year 2021 is appropriated from the health care access fund to the
commissioner of human services for MinnesotaCare. This is a onetime appropriation.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective June 30, 2021.
new text end
Sec. 18. new text begin REDUCTION IN APPROPRIATION AND CANCELLATION; HEALTH
IMPROVEMENT.
new text end
new text begin
The fiscal year 2021 general fund appropriation in Laws 2019, First Special Session
chapter 9, article 14, section 3, subdivision 2, is reduced by $2,410,000 and canceled to the
general fund.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective June 30, 2021.
new text end
Sec. 19. new text begin ENHANCED FEDERAL MEDICAL ASSISTANCE PERCENTAGE FOR
HOME AND COMMUNITY-BASED SERVICES; DEPOSIT.
new text end
new text begin
Beginning April 1, 2021, the commissioner of management and budget shall deposit in
the health care access fund all amounts, estimated to be $478,017,000, attributable to the
enhanced federal medical assistance percentage for home and community-based services
authorized in section 9817 of the federal American Rescue Plan Act, Public Law 117-2.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective retroactively from April 1, 2021.
new text end
Sec. 20. new text begin ENHANCED FEDERAL MEDICAL ASSISTANCE PERCENTAGE FOR
HOME AND COMMUNITY-BASED SERVICES; TRANSFERS.
new text end
new text begin
(a) The commissioner of management and budget shall transfer $76,643,000 in fiscal
year 2022, $47,883,000 in fiscal year 2023, $50,749,000 in fiscal year 2024, and $53,069,000
in fiscal year 2025 from the health care access fund to the general fund to meet the
maintenance of effort requirement under section 9817 of the federal American Rescue Plan
Act, Public Law 117-2.
new text end
new text begin
(b) The commissioner of management and budget shall transfer $249,673,000 in fiscal
year 2022 from the health care access fund to the general fund to meet the maintenance of
effort requirement under section 9817 of the federal American Rescue Plan Act, Public Law
117-2. This section expires June 30, 2025.
new text end
Sec. 21. new text begin ENHANCED FEDERAL MEDICAL ASSISTANCE PERCENTAGE.
new text end
new text begin
Notwithstanding Minnesota Statutes, section 256.011, subdivision 3, beginning January
1, 2022, any amount attributable to the enhanced Federal Medical Assistance Percentage
(FMAP) under section 6008 of the Families First Coronavirus Response Act, Public Law
116-127, shall be deposited in the health care access fund.
new text end
Sec. 22. new text begin TRANSFERS.
new text end
new text begin Subdivision 1. new text end
new text begin Grants. new text end
new text begin
The commissioner of human services, with the approval of the
commissioner of management and budget, may transfer unencumbered appropriation balances
for the biennium ending June 30, 2023, within fiscal years among the MFIP, general
assistance, medical assistance, MinnesotaCare, MFIP child care assistance under Minnesota
Statutes, section 119B.05, Minnesota supplemental aid program, group residential housing
program, the entitlement portion of Northstar Care for Children under Minnesota Statutes,
chapter 256N, and the entitlement portion of the chemical dependency consolidated treatment
fund, and between fiscal years of the biennium. The commissioner shall inform the chairs
and ranking minority members of the senate Health and Human Services Finance Division
and the house of representatives Health and Human Services Finance Committee quarterly
about transfers made under this subdivision.
new text end
new text begin Subd. 2. new text end
new text begin Administration. new text end
new text begin
Positions, salary money, and nonsalary administrative money
may be transferred within the Departments of Health and Human Services as the
commissioners consider necessary, with the advance approval of the commissioner of
management and budget. The commissioners shall inform the chairs and ranking minority
members of the legislative committees with jurisdiction over health and human services
finance quarterly about transfers made under this section.
new text end
Sec. 23. new text begin INDIRECT COSTS NOT TO FUND PROGRAMS.
new text end
new text begin
The commissioners of health and human services shall not use indirect cost allocations
to pay for the operational costs of any program for which they are responsible.
new text end
Sec. 24. new text begin APPROPRIATION ENACTED MORE THAN ONCE.
new text end
new text begin
If an appropriation in this act is enacted more than once in the 2021 legislative session,
the appropriation must be given effect only once.
new text end
Sec. 25. new text begin EXPIRATION OF UNCODIFIED LANGUAGE.
new text end
new text begin
All uncodified language contained in this article expires on June 30, 2023, unless a
different expiration date is explicit.
new text end
Sec. 26. new text begin EFFECTIVE DATE.
new text end
new text begin
This article is effective July 1, 2021, unless a different effective date is specified.
new text end
APPENDIX
Repealed Minnesota Statutes: S2360-2
16A.724 HEALTH CARE ACCESS FUND.
Subd. 2.
Transfers.
(a) Notwithstanding section 295.581, to the extent available resources in the health care access fund exceed expenditures in that fund, effective for the biennium beginning July 1, 2007, the commissioner of management and budget shall transfer the excess funds from the health care access fund to the general fund on June 30 of each year, provided that the amount transferred in fiscal year 2016 shall not exceed $48,000,000, the amount in fiscal year 2017 shall not exceed $122,000,000, and the amount in any fiscal biennium thereafter shall not exceed $244,000,000. The purpose of this transfer is to meet the rate increase required under section 256B.04, subdivision 25.
(b) For fiscal years 2006 to 2011, MinnesotaCare shall be a forecasted program, and, if necessary, the commissioner shall reduce these transfers from the health care access fund to the general fund to meet annual MinnesotaCare expenditures or, if necessary, transfer sufficient funds from the general fund to the health care access fund to meet annual MinnesotaCare expenditures.
62A.67 SHORT TITLE.
Sections 62A.67 to 62A.672 may be cited as the "Minnesota Telemedicine Act."
62A.671 DEFINITIONS.
Subdivision 1.
Applicability.
For purposes of sections 62A.67 to 62A.672, the terms defined in this section have the meanings given.
Subd. 2.
Distant site.
"Distant site" means a site at which a licensed health care provider is located while providing health care services or consultations by means of telemedicine.
Subd. 3.
Health care provider.
"Health care provider" has the meaning provided in section 62A.63, subdivision 2.
Subd. 4.
Health carrier.
"Health carrier" has the meaning provided in section 62A.011, subdivision 2.
Subd. 5.
Health plan.
"Health plan" means a health plan as defined in section 62A.011, subdivision 3, and includes dental plans as defined in section 62Q.76, subdivision 3, but does not include dental plans that provide indemnity-based benefits, regardless of expenses incurred and are designed to pay benefits directly to the policyholder.
Subd. 6.
Licensed health care provider.
"Licensed health care provider" means a health care provider who is:
(1) licensed under chapter 147, 147A, 148, 148B, 148E, 148F, 150A, or 153; a mental health professional as defined under section 245.462, subdivision 18, or 245.4871, subdivision 27; or vendor of medical care defined in section 256B.02, subdivision 7; and
(2) authorized within their respective scope of practice to provide the particular service with no supervision or under general supervision.
Subd. 7.
Originating site.
"Originating site" means a site including, but not limited to, a health care facility at which a patient is located at the time health care services are provided to the patient by means of telemedicine.
Subd. 8.
Store-and-forward technology.
"Store-and-forward technology" means the transmission of a patient's medical information from an originating site to a health care provider at a distant site without the patient being present, or the delivery of telemedicine that does not occur in real time via synchronous transmissions.
Subd. 9.
Telemedicine.
"Telemedicine" means the delivery of health care services or consultations while the patient is at an originating site and the licensed health care provider is at a distant site. A communication between licensed health care providers that consists solely of a telephone conversation, e-mail, or facsimile transmission does not constitute telemedicine consultations or services. A communication between a licensed health care provider and a patient that consists solely of an e-mail or facsimile transmission does not constitute telemedicine consultations or services. Telemedicine may be provided by means of real-time two-way, interactive audio and visual communications, including the application of secure video conferencing or store-and-forward technology to provide or support health care delivery, which facilitate the assessment, diagnosis, consultation, treatment, education, and care management of a patient's health care.
62A.672 COVERAGE OF TELEMEDICINE SERVICES.
Subdivision 1.
Coverage of telemedicine.
(a) A health plan sold, issued, or renewed by a health carrier for which coverage of benefits begins on or after January 1, 2017, shall include coverage for telemedicine benefits in the same manner as any other benefits covered under the policy, plan, or contract, and shall comply with the regulations of this section.
(b) Nothing in this section shall be construed to:
(1) require a health carrier to provide coverage for services that are not medically necessary;
(2) prohibit a health carrier from establishing criteria that a health care provider must meet to demonstrate the safety or efficacy of delivering a particular service via telemedicine for which the health carrier does not already reimburse other health care providers for delivering via telemedicine, so long as the criteria are not unduly burdensome or unreasonable for the particular service; or
(3) prevent a health carrier from requiring a health care provider to agree to certain documentation or billing practices designed to protect the health carrier or patients from fraudulent claims so long as the practices are not unduly burdensome or unreasonable for the particular service.
Subd. 2.
Parity between telemedicine and in-person services.
A health carrier shall not exclude a service for coverage solely because the service is provided via telemedicine and is not provided through in-person consultation or contact between a licensed health care provider and a patient.
Subd. 3.
Reimbursement for telemedicine services.
(a) A health carrier shall reimburse the distant site licensed health care provider for covered services delivered via telemedicine on the same basis and at the same rate as the health carrier would apply to those services if the services had been delivered in person by the distant site licensed health care provider.
(b) It is not a violation of this subdivision for a health carrier to include a deductible, co-payment, or coinsurance requirement for a health care service provided via telemedicine, provided that the deductible, co-payment, or coinsurance is not in addition to, and does not exceed, the deductible, co-payment, or coinsurance applicable if the same services were provided through in-person contact.
136A.29 POWERS; DUTIES.
Subd. 4.
Mutual agreement; staff, equipment, office space.
By mutual agreement between the authority and the office, authority staff employees may also be members of the office staff. By mutual agreement, authority employees may be provided office space in the office of the Office of Higher Education, and said employees may make use of equipment, supplies, and office space, provided that the authority fully reimburses the office for salaries and for space, equipment, supplies, and materials used. In the absence of such mutual agreement between the authority and the office, the authority may maintain an office at such place or places as it may designate.
144E.27 EDUCATION PROGRAMS; BOARD APPROVAL.
Subdivision 1.
Education program instructor.
An education program instructor must be an emergency medical responder, EMT, AEMT, paramedic, physician, physician assistant, or registered nurse.
Subd. 1a.
Approval required.
(a) All education programs for an emergency medical responder must be approved by the board.
(b) To be approved by the board, an education program must:
(1) submit an application prescribed by the board that includes:
(i) type and length of course to be offered;
(ii) names, addresses, and qualifications of the program medical director, program education coordinator, and instructors;
(iii) admission criteria for students; and
(iv) materials and equipment to be used;
(2) for each course, implement the most current version of the United States Department of Transportation EMS Education Standards, or its equivalent as determined by the board applicable to Emergency Medical Responder registration education;
(3) have a program medical director and a program coordinator;
(4) have at least one instructor for every ten students at the practical skill stations;
(5) retain documentation of program approval by the board, course outline, and student information; and
(6) submit the appropriate fee as required under section 144E.29.
(c) The National EMS Education Standards by the NHTSA, United States Department of Transportation contains the minimal entry level of knowledge and skills for emergency medical responders. Medical directors of emergency medical responder groups may expand the knowledge and skill set.
151.19 REGISTRATION; FEES.
Subd. 3.
Sale of federally restricted medical gases.
(a) A person or establishment not licensed as a pharmacy or a practitioner must not engage in the retail sale or dispensing of federally restricted medical gases without first obtaining a registration from the board and paying the applicable fee specified in section 151.065. The registration must be displayed in a conspicuous place in the business for which it is issued and expires on the date set by the board. It is unlawful for a person to sell or dispense federally restricted medical gases unless a certificate has been issued to that person by the board.
(b) Application for a medical gas dispenser registration under this section must be made in a manner specified by the board.
(c) A registration must not be issued or renewed for a medical gas dispenser located within the state unless the applicant agrees to operate in a manner prescribed by federal and state law and according to the rules adopted by the board. A license must not be issued for a medical gas dispenser located outside of the state unless the applicant agrees to operate in a manner prescribed by federal law and, when dispensing medical gases for residents of this state, the laws of this state and Minnesota Rules.
(d) A registration must not be issued or renewed for a medical gas dispenser that is required to be licensed or registered by the state in which it is physically located unless the applicant supplies the board with proof of the licensure or registration. The board may, by rule, establish standards for the registration of a medical gas dispenser that is not required to be licensed or registered by the state in which it is physically located.
(e) The board must require a separate registration for each medical gas dispenser located within the state and for each facility located outside of the state from which medical gases are dispensed to residents of this state.
(f) Prior to the issuance of an initial or renewed registration for a medical gas dispenser, the board may require the medical gas dispenser to pass an inspection conducted by an authorized representative of the board. In the case of a medical gas dispenser located outside of the state, the board may require the applicant to pay the cost of the inspection, in addition to the license fee in section 151.065, unless the applicant furnishes the board with a report, issued by the appropriate regulatory agency of the state in which the facility is located, of an inspection that has occurred within the 24 months immediately preceding receipt of the license application by the board. The board may deny licensure unless the applicant submits documentation satisfactory to the board that any deficiencies noted in an inspection report have been corrected.
245.462 DEFINITIONS.
Subd. 4a.
Clinical supervision.
"Clinical supervision" means the oversight responsibility for individual treatment plans and individual mental health service delivery, including that provided by the case manager. Clinical supervision must be accomplished by full or part-time employment of or contracts with mental health professionals. Clinical supervision must be documented by the mental health professional cosigning individual treatment plans and by entries in the client's record regarding supervisory activities.
245.4871 DEFINITIONS.
Subd. 32a.
Responsible social services agency.
"Responsible social services agency" is defined in section 260C.007, subdivision 27a.
245.4879 EMERGENCY SERVICES.
Subd. 2.
Specific requirements.
(a) The county board shall require that all service providers of emergency services to the child with an emotional disturbance provide immediate direct access to a mental health professional during regular business hours. For evenings, weekends, and holidays, the service may be by direct toll-free telephone access to a mental health professional, a mental health practitioner, or until January 1, 1991, a designated person with training in human services who receives clinical supervision from a mental health professional.
(b) The commissioner may waive the requirement in paragraph (a) that the evening, weekend, and holiday service be provided by a mental health professional or mental health practitioner after January 1, 1991, if the county documents that:
(1) mental health professionals or mental health practitioners are unavailable to provide this service;
(2) services are provided by a designated person with training in human services who receives clinical supervision from a mental health professional; and
(3) the service provider is not also the provider of fire and public safety emergency services.
(c) The commissioner may waive the requirement in paragraph (b), clause (3), that the evening, weekend, and holiday service not be provided by the provider of fire and public safety emergency services if:
(1) every person who will be providing the first telephone contact has received at least eight hours of training on emergency mental health services reviewed by the state advisory council on mental health and then approved by the commissioner;
(2) every person who will be providing the first telephone contact will annually receive at least four hours of continued training on emergency mental health services reviewed by the state advisory council on mental health and then approved by the commissioner;
(3) the local social service agency has provided public education about available emergency mental health services and can assure potential users of emergency services that their calls will be handled appropriately;
(4) the local social service agency agrees to provide the commissioner with accurate data on the number of emergency mental health service calls received;
(5) the local social service agency agrees to monitor the frequency and quality of emergency services; and
(6) the local social service agency describes how it will comply with paragraph (d).
(d) When emergency service during nonbusiness hours is provided by anyone other than a mental health professional, a mental health professional must be available on call for an emergency assessment and crisis intervention services, and must be available for at least telephone consultation within 30 minutes.
245.62 COMMUNITY MENTAL HEALTH CENTER.
Subd. 3.
Clinical supervisor.
All community mental health center services shall be provided under the clinical supervision of a licensed psychologist licensed under sections 148.88 to 148.98, or a physician who is board certified or eligible for board certification in psychiatry, and who is licensed under section 147.02.
Subd. 4.
Rules.
The commissioner shall promulgate rules to establish standards for the designation of an agency as a community mental health center. These standards shall include, but are not limited to:
(1) provision of mental health services in the prevention, identification, treatment and aftercare of emotional disorders, chronic and acute mental illness, developmental disabilities, and alcohol and drug abuse and dependency, including the services listed in section 245.61 except detoxification services;
(2) establishment of a community mental health center board pursuant to section 245.66; and
(3) approval pursuant to section 245.69, subdivision 2.
245.69 ADDITIONAL DUTIES OF COMMISSIONER.
Subd. 2.
Approval of centers and clinics.
The commissioner of human services has the authority to approve or disapprove public and private mental health centers and public and private mental health clinics for the purposes of section 62A.152, subdivision 2. For the purposes of this subdivision the commissioner shall promulgate rules in accordance with sections 14.001 to 14.69. The rules shall require each applicant to pay a fee to cover costs of processing applications and determining compliance with the rules and this subdivision. The commissioner may contract with any state agency, individual, corporation or association to which the commissioner shall delegate all but final approval and disapproval authority to determine compliance or noncompliance.
(a) Each approved mental health center and each approved mental health clinic shall have a multidisciplinary team of professional staff persons as required by rule. A mental health center or mental health clinic may provide the staffing required by rule by means of written contracts with professional persons or with other health care providers. Any personnel qualifications developed by rule shall be consistent with any personnel standards developed pursuant to chapter 214.
(b) Each approved mental health clinic and each approved mental health center shall establish a written treatment plan for each outpatient for whom services are reimbursable through insurance or public assistance. The treatment plan shall be developed in accordance with the rules and shall include a patient history, treatment goals, a statement of diagnosis and a treatment strategy. The clinic or center shall provide access to hospital admission as a bed patient as needed by any outpatient. The clinic or center shall ensure ongoing consultation among and availability of all members of the multidisciplinary team.
(c) As part of the required consultation, members of the multidisciplinary team shall meet at least twice monthly to conduct case reviews, peer consultations, treatment plan development and in-depth case discussion. Written minutes of these meetings shall be kept at the clinic or center for three years.
(d) Each approved center or clinic shall establish mechanisms for quality assurance and submit documentation concerning the mechanisms to the commissioner as required by rule, including:
(1) continuing education of each professional staff person;
(2) an ongoing internal utilization and peer review plan and procedures;
(3) mechanisms of staff supervision; and
(4) procedures for review by the commissioner or a delegate.
(e) The commissioner shall disapprove an applicant, or withdraw approval of a clinic or center, which the commissioner finds does not comply with the requirements of the rules or this subdivision. A clinic or center which is disapproved or whose approval is withdrawn is entitled to a contested case hearing and judicial review pursuant to sections 14.01 to 14.69.
(f) Data on individuals collected by approved clinics and centers, including written minutes of team meetings, is private data on individuals within the welfare system as provided in chapter 13.
(g) Each center or clinic that is approved and in compliance with the commissioner's existing rule on July 1, 1980, is approved for purposes of section 62A.152, subdivision 2, until rules are promulgated to implement this section.
245.735 EXCELLENCE IN MENTAL HEALTH DEMONSTRATION PROJECT.
Subdivision 1.
Excellence in Mental Health demonstration project.
The commissioner shall develop and execute projects to reform the mental health system by participating in the Excellence in Mental Health demonstration project.
Subd. 2.
Federal proposal.
The commissioner shall develop and submit to the United States Department of Health and Human Services a proposal for the Excellence in Mental Health demonstration project. The proposal shall include any necessary state plan amendments, waivers, requests for new funding, realignment of existing funding, and other authority necessary to implement the projects specified in subdivision 3.
Subd. 4.
Public participation.
In developing and implementing CCBHCs under subdivision 3, the commissioner shall consult, collaborate, and partner with stakeholders, including but not limited to mental health providers, substance use disorder treatment providers, advocacy organizations, licensed mental health professionals, counties, tribes, hospitals, other health care providers, and Minnesota public health care program enrollees who receive mental health services and their families.
252.28 COMMISSIONER OF HUMAN SERVICES; DUTIES.
Subdivision 1.
Determinations; redeterminations.
In conjunction with the appropriate county boards, the commissioner of human services shall determine, and shall redetermine at least every four years, the need, anticipated growth or decline in need until the next anticipated redetermination, location, size, and program of public and private day training and habilitation services for persons with developmental disabilities. This subdivision does not apply to semi-independent living services and residential-based habilitation services provided to four or fewer persons at a single site funded as home and community-based services. A determination of need shall not be required for a change in ownership.
Subd. 5.
Appeals.
A county may appeal a determination of need, size, location, or program according to chapter 14. Notice of appeals must be provided to the commissioner within 30 days after the receipt of the commissioner's determination.
252A.02 DEFINITIONS.
Subd. 8.
Public conservator.
"Public conservator" means the commissioner of human services when exercising some, but not all the powers designated in section 252A.111.
Subd. 10.
Conservatee.
"Conservatee" means a person with a developmental disability for whom the court has appointed a public conservator.
252A.21 GENERAL PROVISIONS.
Subd. 3.
Terminology.
Whenever the term "guardian" is used in sections 252A.01 to 252A.21, it shall include "conservator," and the term "ward" shall include "conservatee" unless another intention clearly appears from the context.
256B.0615 MENTAL HEALTH CERTIFIED PEER SPECIALIST.
Subd. 2.
Establishment.
The commissioner of human services shall establish a certified peer specialist program model, which:
(1) provides nonclinical peer support counseling by certified peer specialists;
(2) provides a part of a wraparound continuum of services in conjunction with other community mental health services;
(3) is individualized to the consumer; and
(4) promotes socialization, recovery, self-sufficiency, self-advocacy, development of natural supports, and maintenance of skills learned in other support services.
256B.0616 MENTAL HEALTH CERTIFIED FAMILY PEER SPECIALIST.
Subd. 2.
Establishment.
The commissioner of human services shall establish a certified family peer specialists program model which:
(1) provides nonclinical family peer support counseling, building on the strengths of families and helping them achieve desired outcomes;
(2) collaborates with others providing care or support to the family;
(3) provides nonadversarial advocacy;
(4) promotes the individual family culture in the treatment milieu;
(5) links parents to other parents in the community;
(6) offers support and encouragement;
(7) assists parents in developing coping mechanisms and problem-solving skills;
(8) promotes resiliency, self-advocacy, development of natural supports, and maintenance of skills learned in other support services;
(9) establishes and provides peer-led parent support groups; and
(10) increases the child's ability to function better within the child's home, school, and community by educating parents on community resources, assisting with problem solving, and educating parents on mental illnesses.
256B.0622 ASSERTIVE COMMUNITY TREATMENT AND INTENSIVE RESIDENTIAL TREATMENT SERVICES.
Subd. 3.
Eligibility for intensive residential treatment services.
An eligible client for intensive residential treatment services is an individual who:
(1) is age 18 or older;
(2) is eligible for medical assistance;
(3) is diagnosed with a mental illness;
(4) because of a mental illness, has substantial disability and functional impairment in three or more of the areas listed in section 245.462, subdivision 11a, so that self-sufficiency is markedly reduced;
(5) has one or more of the following: a history of recurring or prolonged inpatient hospitalizations in the past year, significant independent living instability, homelessness, or very frequent use of mental health and related services yielding poor outcomes; and
(6) in the written opinion of a licensed mental health professional, has the need for mental health services that cannot be met with other available community-based services, or is likely to experience a mental health crisis or require a more restrictive setting if intensive rehabilitative mental health services are not provided.
Subd. 5a.
Standards for intensive residential rehabilitative mental health services.
(a) The standards in this subdivision apply to intensive residential mental health services.
(b) The provider of intensive residential treatment services must have sufficient staff to provide 24-hour-per-day coverage to deliver the rehabilitative services described in the treatment plan and to safely supervise and direct the activities of clients, given the client's level of behavioral and psychiatric stability, cultural needs, and vulnerability. The provider must have the capacity within the facility to provide integrated services for chemical dependency, illness management services, and family education, when appropriate.
(c) At a minimum:
(1) staff must provide direction and supervision whenever clients are present in the facility;
(2) staff must remain awake during all work hours;
(3) there must be a staffing ratio of at least one to nine clients for each day and evening shift. If more than nine clients are present at the residential site, there must be a minimum of two staff during day and evening shifts, one of whom must be a mental health practitioner or mental health professional;
(4) if services are provided to clients who need the services of a medical professional, the provider shall ensure that these services are provided either by the provider's own medical staff or through referral to a medical professional; and
(5) the provider must ensure the timely availability of a licensed registered nurse, either directly employed or under contract, who is responsible for ensuring the effectiveness and safety of medication administration in the facility and assessing clients for medication side effects and drug interactions.
(d) Services must be provided by qualified staff as defined in section 256B.0623, subdivision 5, who are trained and supervised according to section 256B.0623, subdivision 6, except that mental health rehabilitation workers acting as overnight staff are not required to comply with section 256B.0623, subdivision 5, paragraph (a), clause (4), item (iv).
(e) The clinical supervisor must be an active member of the intensive residential services treatment team. The team must meet with the clinical supervisor at least weekly to discuss clients' progress and make rapid adjustments to meet clients' needs. The team meeting shall include client-specific case reviews and general treatment discussions among team members. Client-specific case reviews and planning must be documented in the client's treatment record.
(f) 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 ensure the health and safety of clients.
(g) The initial functional assessment must be completed within ten days of intake and updated at least every 30 days, or prior to discharge from the service, whichever comes first.
(h) The initial individual treatment plan must be completed within 24 hours of admission. Within ten days of admission, the initial treatment plan must be refined and further developed, except for providers certified according to Minnesota Rules, parts 9533.0010 to 9533.0180. The individual treatment plan must be reviewed with the client and updated at least monthly.
256B.0623 ADULT REHABILITATIVE MENTAL HEALTH SERVICES COVERED.
Subd. 7.
Personnel file.
The adult rehabilitative mental health services provider entity must maintain a personnel file on each staff. Each file must contain:
(1) an annual performance review;
(2) a summary of on-site service observations and charting review;
(3) a criminal background check of all direct service staff;
(4) evidence of academic degree and qualifications;
(5) a copy of professional license;
(6) any job performance recognition and disciplinary actions;
(7) any individual staff written input into own personnel file;
(8) all clinical supervision provided; and
(9) documentation of compliance with continuing education requirements.
Subd. 8.
Diagnostic assessment.
Providers of adult rehabilitative mental health services must complete a diagnostic assessment as defined in section 245.462, subdivision 9, within five days after the recipient's second visit or within 30 days after intake, whichever occurs first. In cases where a diagnostic assessment is available that reflects the recipient's current status, and has been completed within three years preceding admission, an adult diagnostic assessment update must be completed. An update shall include a face-to-face interview with the recipient and a written summary by a mental health professional of the recipient's current mental health status and service needs. If the recipient's mental health status has changed significantly since the adult's most recent diagnostic assessment, a new diagnostic assessment is required.
Subd. 10.
Individual treatment plan.
All providers of adult rehabilitative mental health services must develop and implement an individual treatment plan for each recipient. The provisions in clauses (1) and (2) apply:
(1) Individual treatment plan means a plan of intervention, treatment, and services for an individual recipient written by a mental health professional or by a mental health practitioner under the clinical supervision of a mental health professional. The individual treatment plan must be based on diagnostic and functional assessments. To the extent possible, the development and implementation of a treatment plan must be a collaborative process involving the recipient, and with the permission of the recipient, the recipient's family and others in the recipient's support system. Providers of adult rehabilitative mental health services must develop the individual treatment plan within 30 calendar days of intake. The treatment plan must be updated at least every six months thereafter, or more often when there is significant change in the recipient's situation or functioning, or in services or service methods to be used, or at the request of the recipient or the recipient's legal guardian.
(2) The individual treatment plan must include:
(i) a list of problems identified in the assessment;
(ii) the recipient's strengths and resources;
(iii) concrete, measurable goals to be achieved, including time frames for achievement;
(iv) specific objectives directed toward the achievement of each one of the goals;
(v) documentation of participants in the treatment planning. The recipient, if possible, must be a participant. The recipient or the recipient's legal guardian must sign the treatment plan, or documentation must be provided why this was not possible. A copy of the plan must be given to the recipient or legal guardian. Referral to formal services must be arranged, including specific providers where applicable;
(vi) cultural considerations, resources, and needs of the recipient must be included;
(vii) planned frequency and type of services must be initiated; and
(viii) clear progress notes on outcome of goals.
(3) The individual community support plan defined in section 245.462, subdivision 12, may serve as the individual treatment plan if there is involvement of a mental health case manager, and with the approval of the recipient. The individual community support plan must include the criteria in clause (2).
Subd. 11.
Recipient file.
Providers of adult rehabilitative mental health services must maintain a file for each recipient that contains the following information:
(1) diagnostic assessment or verification of its location that is current and that was reviewed by a mental health professional who is employed by or under contract with the provider entity;
(2) functional assessments;
(3) individual treatment plans signed by the recipient and the mental health professional, or if the recipient refused to sign the plan, the date and reason stated by the recipient as to why the recipient would not sign the plan;
(4) recipient history;
(5) signed release forms;
(6) recipient health information and current medications;
(7) emergency contacts for the recipient;
(8) case records which document the date of service, the place of service delivery, signature of the person providing the service, nature, extent and units of service, and place of service delivery;
(9) contacts, direct or by telephone, with recipient's family or others, other providers, or other resources for service coordination;
(10) summary of recipient case reviews by staff; and
(11) written information by the recipient that the recipient requests be included in the file.
256B.0625 COVERED SERVICES.
Subd. 5l.
Intensive mental health outpatient treatment.
Medical assistance covers intensive mental health outpatient treatment for dialectical behavioral therapy. The commissioner shall establish:
(1) certification procedures to ensure that providers of these services are qualified; and
(2) treatment protocols including required service components and criteria for admission, continued treatment, and discharge.
Subd. 35a.
Children's mental health crisis response services.
Medical assistance covers children's mental health crisis response services according to section 256B.0944.
Subd. 35b.
Children's therapeutic services and supports.
Medical assistance covers children's therapeutic services and supports according to section 256B.0943.
Subd. 61.
Family psychoeducation services.
Effective July 1, 2013, or upon federal approval, whichever is later, medical assistance covers family psychoeducation services provided to a child up to age 21 with a diagnosed mental health condition when identified in the child's individual treatment plan and provided by a licensed mental health professional, as defined in Minnesota Rules, part 9505.0371, subpart 5, item A, or a clinical trainee, as defined in Minnesota Rules, part 9505.0371, subpart 5, item C, who has determined it medically necessary to involve family members in the child's care. For the purposes of this subdivision, "family psychoeducation services" means information or demonstration provided to an individual or family as part of an individual, family, multifamily group, or peer group session to explain, educate, and support the child and family in understanding a child's symptoms of mental illness, the impact on the child's development, and needed components of treatment and skill development so that the individual, family, or group can help the child to prevent relapse, prevent the acquisition of comorbid disorders, and achieve optimal mental health and long-term resilience.
Subd. 62.
Mental health clinical care consultation.
Effective July 1, 2013, or upon federal approval, whichever is later, medical assistance covers clinical care consultation for a person up to age 21 who is diagnosed with a complex mental health condition or a mental health condition that co-occurs with other complex and chronic conditions, when described in the person's individual treatment plan and provided by a licensed mental health professional, as defined in Minnesota Rules, part 9505.0371, subpart 5, item A, or a clinical trainee, as defined in Minnesota Rules, part 9505.0371, subpart 5, item C. For the purposes of this subdivision, "clinical care consultation" means communication from a treating mental health professional to other providers or educators not under the clinical supervision of the treating mental health professional who are working with the same client to inform, inquire, and instruct regarding the client's symptoms; strategies for effective engagement, care, and intervention needs; and treatment expectations across service settings; and to direct and coordinate clinical service components provided to the client and family.
Subd. 65.
Outpatient mental health services.
Medical assistance covers diagnostic assessment, explanation of findings, and psychotherapy according to Minnesota Rules, part 9505.0372, when the mental health services are performed by a mental health practitioner working as a clinical trainee according to section 245.462, subdivision 17, paragraph (g).
256B.0943 CHILDREN'S THERAPEUTIC SERVICES AND SUPPORTS.
Subd. 8.
Required preservice and continuing education.
(a) A provider entity shall establish a plan to provide preservice and continuing education for staff. The plan must clearly describe the type of training necessary to maintain current skills and obtain new skills and that relates to the provider entity's goals and objectives for services offered.
(b) A provider that employs a mental health behavioral aide under this section must require the mental health behavioral aide to complete 30 hours of preservice training. The preservice training must include parent team training. The preservice training must include 15 hours of in-person training of a mental health behavioral aide in mental health services delivery and eight hours of parent team training. Curricula for parent team training must be approved in advance by the commissioner. Components of parent team training include:
(1) partnering with parents;
(2) fundamentals of family support;
(3) fundamentals of policy and decision making;
(4) defining equal partnership;
(5) complexities of the parent and service provider partnership in multiple service delivery systems due to system strengths and weaknesses;
(6) sibling impacts;
(7) support networks; and
(8) community resources.
(c) A provider entity that employs a mental health practitioner and a mental health behavioral aide to provide children's therapeutic services and supports under this section must require the mental health practitioner and mental health behavioral aide to complete 20 hours of continuing education every two calendar years. The continuing education must be related to serving the needs of a child with emotional disturbance in the child's home environment and the child's family.
(d) The provider entity must document the mental health practitioner's or mental health behavioral aide's annual completion of the required continuing education. The documentation must include the date, subject, and number of hours of the continuing education, and attendance records, as verified by the staff member's signature, job title, and the instructor's name. The provider entity must keep documentation for each employee, including records of attendance at professional workshops and conferences, at a central location and in the employee's personnel file.
Subd. 10.
Service authorization.
Children's therapeutic services and supports are subject to authorization criteria and standards published by the commissioner according to section 256B.0625, subdivision 25.
256B.0944 CHILDREN'S MENTAL HEALTH CRISIS RESPONSE SERVICES.
Subdivision 1.
Definitions.
For purposes of this section, the following terms have the meanings given them.
(a) "Mental health crisis" means a child's behavioral, emotional, or psychiatric situation that, but for the provision of crisis response services to the child, would likely result in significantly reduced levels of functioning in primary activities of daily living, an emergency situation, or the child's placement in a more restrictive setting, including, but not limited to, inpatient hospitalization.
(b) "Mental health emergency" means a child's behavioral, emotional, or psychiatric situation that causes an immediate need for mental health services and is consistent with section 62Q.55. A physician, mental health professional, or crisis mental health practitioner determines a mental health crisis or emergency for medical assistance reimbursement with input from the client and the client's family, if possible.
(c) "Mental health crisis assessment" means an immediate face-to-face assessment by a physician, mental health professional, or mental health practitioner under the clinical supervision of a mental health professional, following a screening that suggests the child may be experiencing a mental health crisis or mental health emergency situation.
(d) "Mental health mobile crisis intervention services" means face-to-face, short-term intensive mental health services initiated during a mental health crisis or mental health emergency. Mental health mobile crisis services must help the recipient cope with immediate stressors, identify and utilize available resources and strengths, and begin to return to the recipient's baseline level of functioning. Mental health mobile services must be provided on site by a mobile crisis intervention team outside of an inpatient hospital setting.
(e) "Mental health crisis stabilization services" means individualized mental health services provided to a recipient following crisis intervention services that are designed to restore the recipient to the recipient's prior functional level. The individual treatment plan recommending mental health crisis stabilization must be completed by the intervention team or by staff after an inpatient or urgent care visit. Mental health crisis stabilization services may be provided in the recipient's home, the home of a family member or friend of the recipient, schools, another community setting, or a short-term supervised, licensed residential program if the service is not included in the facility's cost pool or per diem. Mental health crisis stabilization is not reimbursable when provided as part of a partial hospitalization or day treatment program.
Subd. 2.
Medical assistance coverage.
Medical assistance covers medically necessary children's mental health crisis response services, subject to federal approval, if provided to an eligible recipient under subdivision 3, by a qualified provider entity under subdivision 4 or a qualified individual provider working within the provider's scope of practice, and identified in the recipient's individual crisis treatment plan under subdivision 8.
Subd. 3.
Eligibility.
An eligible recipient is an individual who:
(1) is eligible for medical assistance;
(2) is under age 18 or between the ages of 18 and 21;
(3) is screened as possibly experiencing a mental health crisis or mental health emergency where a mental health crisis assessment is needed;
(4) is assessed as experiencing a mental health crisis or mental health emergency, and mental health mobile crisis intervention or mental health crisis stabilization services are determined to be medically necessary; and
(5) meets the criteria for emotional disturbance or mental illness.
Subd. 4.
Provider entity standards.
(a) A crisis intervention and crisis stabilization provider entity must meet the administrative and clinical standards specified in section 256B.0943, subdivisions 5 and 6, meet the standards listed in paragraph (b), and be:
(1) an Indian health service facility or facility owned and operated by a tribe or a tribal organization operating under Public Law 93-638 as a 638 facility;
(2) a county board-operated entity; or
(3) a provider entity that is under contract with the county board in the county where the potential crisis or emergency is occurring.
(b) The children's mental health crisis response services provider entity must:
(1) ensure that mental health crisis assessment and mobile crisis intervention services are available 24 hours a day, seven days a week;
(2) directly provide the services or, if services are subcontracted, the provider entity must maintain clinical responsibility for services and billing;
(3) ensure that crisis intervention services are provided in a manner consistent with sections 245.487 to 245.4889; and
(4) develop and maintain written policies and procedures regarding service provision that include safety of staff and recipients in high-risk situations.
Subd. 4a.
Alternative provider standards.
If a provider entity demonstrates that, due to geographic or other barriers, it is not feasible to provide mobile crisis intervention services 24 hours a day, seven days a week, according to the standards in subdivision 4, paragraph (b), clause (1), the commissioner may approve a crisis response provider based on an alternative plan proposed by a provider entity. The alternative plan must:
(1) result in increased access and a reduction in disparities in the availability of crisis services; and
(2) provide mobile services outside of the usual nine-to-five office hours and on weekends and holidays.
Subd. 5.
Mobile crisis intervention staff qualifications.
(a) To provide children's mental health mobile crisis intervention services, a mobile crisis intervention team must include:
(1) at least two mental health professionals as defined in section 256B.0943, subdivision 1, paragraph (o); or
(2) a combination of at least one mental health professional and one mental health practitioner as defined in section 245.4871, subdivision 26, with the required mental health crisis training and under the clinical supervision of a mental health professional on the team.
(b) The team must have at least two people with at least one member providing on-site crisis intervention services when needed. Team members must be experienced in mental health assessment, crisis intervention techniques, and clinical decision making under emergency conditions and have knowledge of local services and resources. The team must recommend and coordinate the team's services with appropriate local resources, including the county social services agency, mental health service providers, and local law enforcement, if necessary.
Subd. 6.
Initial screening and crisis assessment planning.
(a) Before initiating mobile crisis intervention services, a screening of the potential crisis situation must be conducted. The screening may use the resources of crisis assistance and emergency services as defined in sections 245.4871, subdivision 14, and 245.4879, subdivisions 1 and 2. The screening must gather information, determine whether a crisis situation exists, identify the parties involved, and determine an appropriate response.
(b) If a crisis exists, a crisis assessment must be completed. A crisis assessment must evaluate any immediate needs for which emergency services are needed and, as time permits, the recipient's current life situation, sources of stress, mental health problems and symptoms, strengths, cultural considerations, support network, vulnerabilities, and current functioning.
(c) If the crisis assessment determines mobile crisis intervention services are needed, the intervention services must be provided promptly. As the opportunity presents itself during the intervention, at least two members of the mobile crisis intervention team must confer directly or by telephone about the assessment, treatment plan, and actions taken and needed. At least one of the team members must be on site providing crisis intervention services. If providing on-site crisis intervention services, a mental health practitioner must seek clinical supervision as required under subdivision 9.
(d) The mobile crisis intervention team must develop an initial, brief crisis treatment plan as soon as appropriate but no later than 24 hours after the initial face-to-face intervention. The plan must address the needs and problems noted in the crisis assessment and include measurable short-term goals, cultural considerations, and frequency and type of services to be provided to achieve the goals and reduce or eliminate the crisis. The crisis treatment plan must be updated as needed to reflect current goals and services. The team must involve the client and the client's family in developing and implementing the plan.
(e) The team must document in progress notes which short-term goals have been met and when no further crisis intervention services are required.
(f) If the client's crisis is stabilized, but the client needs a referral for mental health crisis stabilization services or to other services, the team must provide a referral to these services. If the recipient has a case manager, planning for other services must be coordinated with the case manager.
Subd. 7.
Crisis stabilization services.
Crisis stabilization services must be provided by a mental health professional or a mental health practitioner, as defined in section 245.462, subdivision 17, who works under the clinical supervision of a mental health professional and for a crisis stabilization services provider entity and must meet the following standards:
(1) a crisis stabilization treatment plan must be developed which meets the criteria in subdivision 8;
(2) services must be delivered according to the treatment plan and include face-to-face contact with the recipient by qualified staff for further assessment, help with referrals, updating the crisis stabilization treatment plan, supportive counseling, skills training, and collaboration with other service providers in the community; and
(3) mental health practitioners must have completed at least 30 hours of training in crisis intervention and stabilization during the past two years.
Subd. 8.
Treatment plan.
(a) The individual crisis stabilization treatment plan must include, at a minimum:
(1) a list of problems identified in the assessment;
(2) a list of the recipient's strengths and resources;
(3) concrete, measurable short-term goals and tasks to be achieved, including time frames for achievement of the goals;
(4) specific objectives directed toward the achievement of each goal;
(5) documentation of the participants involved in the service planning;
(6) planned frequency and type of services initiated;
(7) a crisis response action plan if a crisis should occur; and
(8) clear progress notes on the outcome of goals.
(b) The client, if clinically appropriate, must be a participant in the development of the crisis stabilization treatment plan. The client or the client's legal guardian must sign the service plan or documentation must be provided why this was not possible. A copy of the plan must be given to the client and the client's legal guardian. The plan should include services arranged, including specific providers where applicable.
(c) A treatment plan must be developed by a mental health professional or mental health practitioner under the clinical supervision of a mental health professional. A written plan must be completed within 24 hours of beginning services with the client.
Subd. 9.
Supervision.
(a) A mental health practitioner may provide crisis assessment and mobile crisis intervention services if the following clinical supervision requirements are met:
(1) the mental health provider entity must accept full responsibility for the services provided;
(2) the mental health professional of the provider entity, who is an employee or under contract with the provider entity, must be immediately available by telephone or in person for clinical supervision;
(3) the mental health professional is consulted, in person or by telephone, during the first three hours when a mental health practitioner provides on-site service; and
(4) the mental health professional must review and approve the tentative crisis assessment and crisis treatment plan, document the consultation, and sign the crisis assessment and treatment plan within the next business day.
(b) If the mobile crisis intervention services continue into a second calendar day, a mental health professional must contact the client face-to-face on the second day to provide services and update the crisis treatment plan. The on-site observation must be documented in the client's record and signed by the mental health professional.
Subd. 10.
Client record.
The provider must maintain a file for each client that complies with the requirements under section 256B.0943, subdivision 11, and contains the following information:
(1) individual crisis treatment plans signed by the recipient, mental health professional, and mental health practitioner who developed the crisis treatment plan, or if the recipient refused to sign the plan, the date and reason stated by the recipient for not signing the plan;
(2) signed release of information forms;
(3) recipient health information and current medications;
(4) emergency contacts for the recipient;
(5) case records that document the date of service, place of service delivery, signature of the person providing the service, and the nature, extent, and units of service. Direct or telephone contact with the recipient's family or others should be documented;
(6) required clinical supervision by mental health professionals;
(7) summary of the recipient's case reviews by staff; and
(8) any written information by the recipient that the recipient wants in the file.
Subd. 11.
Excluded services.
The following services are excluded from reimbursement under this section:
(1) room and board services;
(2) services delivered to a recipient while admitted to an inpatient hospital;
(3) transportation services under children's mental health crisis response service;
(4) services provided and billed by a provider who is not enrolled under medical assistance to provide children's mental health crisis response services;
(5) crisis response services provided by a residential treatment center to clients in their facility;
(6) services performed by volunteers;
(7) direct billing of time spent "on call" when not delivering services to a recipient;
(8) provider service time included in case management reimbursement;
(9) outreach services to potential recipients; and
(10) a mental health service that is not medically necessary.
256B.0946 INTENSIVE TREATMENT IN FOSTER CARE.
Subd. 5.
Service authorization.
The commissioner will administer authorizations for services under this section in compliance with section 256B.0625, subdivision 25.
256B.097 STATE QUALITY ASSURANCE, QUALITY IMPROVEMENT, AND LICENSING SYSTEM.
Subdivision 1.
Scope.
(a) In order to improve the quality of services provided to Minnesotans with disabilities and to meet the requirements of the federally approved home and community-based waivers under section 1915c of the Social Security Act, a State Quality Assurance, Quality Improvement, and Licensing System for Minnesotans receiving disability services is enacted. This system is a partnership between the Department of Human Services and the State Quality Council established under subdivision 3.
(b) This system is a result of the recommendations from the Department of Human Services' licensing and alternative quality assurance study mandated under Laws 2005, First Special Session chapter 4, article 7, section 57, and presented to the legislature in February 2007.
(c) The disability services eligible under this section include:
(1) the home and community-based services waiver programs for persons with developmental disabilities under section 256B.092, subdivision 4, or section 256B.49, including brain injuries and services for those who qualify for nursing facility level of care or hospital facility level of care and any other services licensed under chapter 245D;
(2) home care services under section 256B.0651;
(3) family support grants under section 252.32;
(4) consumer support grants under section 256.476;
(5) semi-independent living services under section 252.275; and
(6) services provided through an intermediate care facility for the developmentally disabled.
(d) For purposes of this section, the following definitions apply:
(1) "commissioner" means the commissioner of human services;
(2) "council" means the State Quality Council under subdivision 3;
(3) "Quality Assurance Commission" means the commission under section 256B.0951; and
(4) "system" means the State Quality Assurance, Quality Improvement and Licensing System under this section.
Subd. 2.
Duties of commissioner of human services.
(a) The commissioner of human services shall establish the State Quality Council under subdivision 3.
(b) The commissioner shall initially delegate authority to perform licensing functions and activities according to section 245A.16 to a host county in Region 10. The commissioner must not license or reimburse a participating facility, program, or service located in Region 10 if the commissioner has received notification from the host county that the facility, program, or service has failed to qualify for licensure.
(c) The commissioner may conduct random licensing inspections based on outcomes adopted under section 256B.0951, subdivision 3, at facilities or programs, and of services eligible under this section. The role of the random inspections is to verify that the system protects the safety and well-being of persons served and maintains the availability of high-quality services for persons with disabilities.
(d) The commissioner shall ensure that the federal home and community-based waiver requirements are met and that incidents that may have jeopardized safety and health or violated services-related assurances, civil and human rights, and other protections designed to prevent abuse, neglect, and exploitation, are reviewed, investigated, and acted upon in a timely manner.
(e) The commissioner shall seek a federal waiver by July 1, 2012, to allow intermediate care facilities for persons with developmental disabilities to participate in this system.
Subd. 3.
State Quality Council.
(a) There is hereby created a State Quality Council which must define regional quality councils, and carry out a community-based, person-directed quality review component, and a comprehensive system for effective incident reporting, investigation, analysis, and follow-up.
(b) By August 1, 2011, the commissioner of human services shall appoint the members of the initial State Quality Council. Members shall include representatives from the following groups:
(1) disability service recipients and their family members;
(2) during the first four years of the State Quality Council, there must be at least three members from the Region 10 stakeholders. As regional quality councils are formed under subdivision 4, each regional quality council shall appoint one member;
(3) disability service providers;
(4) disability advocacy groups; and
(5) county human services agencies and staff from the Department of Human Services and Ombudsman for Mental Health and Developmental Disabilities.
(c) Members of the council who do not receive a salary or wages from an employer for time spent on council duties may receive a per diem payment when performing council duties and functions.
(d) The State Quality Council shall:
(1) assist the Department of Human Services in fulfilling federally mandated obligations by monitoring disability service quality and quality assurance and improvement practices in Minnesota;
(2) establish state quality improvement priorities with methods for achieving results and provide an annual report to the legislative committees with jurisdiction over policy and funding of disability services on the outcomes, improvement priorities, and activities undertaken by the commission during the previous state fiscal year;
(3) identify issues pertaining to financial and personal risk that impede Minnesotans with disabilities from optimizing choice of community-based services; and
(4) recommend to the chairs and ranking minority members of the legislative committees with jurisdiction over human services and civil law by January 15, 2014, statutory and rule changes related to the findings under clause (3) that promote individualized service and housing choices balanced with appropriate individualized protection.
(e) The State Quality Council, in partnership with the commissioner, shall:
(1) approve and direct implementation of the community-based, person-directed system established in this section;
(2) recommend an appropriate method of funding this system, and determine the feasibility of the use of Medicaid, licensing fees, as well as other possible funding options;
(3) approve measurable outcomes in the areas of health and safety, consumer evaluation, education and training, providers, and systems;
(4) establish variable licensure periods not to exceed three years based on outcomes achieved; and
(5) in cooperation with the Quality Assurance Commission, design a transition plan for licensed providers from Region 10 into the alternative licensing system.
(f) The State Quality Council shall notify the commissioner of human services that a facility, program, or service has been reviewed by quality assurance team members under subdivision 4, paragraph (b), clause (13), and qualifies for a license.
(g) The State Quality Council, in partnership with the commissioner, shall establish an ongoing review process for the system. The review shall take into account the comprehensive nature of the system which is designed to evaluate the broad spectrum of licensed and unlicensed entities that provide services to persons with disabilities. The review shall address efficiencies and effectiveness of the system.
(h) The State Quality Council may recommend to the commissioner certain variances from the standards governing licensure of programs for persons with disabilities in order to improve the quality of services so long as the recommended variances do not adversely affect the health or safety of persons being served or compromise the qualifications of staff to provide services.
(i) The safety standards, rights, or procedural protections referenced under subdivision 2, paragraph (c), shall not be varied. The State Quality Council may make recommendations to the commissioner or to the legislature in the report required under paragraph (c) regarding alternatives or modifications to the safety standards, rights, or procedural protections referenced under subdivision 2, paragraph (c).
(j) The State Quality Council may hire staff to perform the duties assigned in this subdivision.
Subd. 4.
Regional quality councils.
(a) The commissioner shall establish, as selected by the State Quality Council, regional quality councils of key stakeholders, including regional representatives of:
(1) disability service recipients and their family members;
(2) disability service providers;
(3) disability advocacy groups; and
(4) county human services agencies and staff from the Department of Human Services and Ombudsman for Mental Health and Developmental Disabilities.
(b) Each regional quality council shall:
(1) direct and monitor the community-based, person-directed quality assurance system in this section;
(2) approve a training program for quality assurance team members under clause (13);
(3) review summary reports from quality assurance team reviews and make recommendations to the State Quality Council regarding program licensure;
(4) make recommendations to the State Quality Council regarding the system;
(5) resolve complaints between the quality assurance teams, counties, providers, persons receiving services, their families, and legal representatives;
(6) analyze and review quality outcomes and critical incident data reporting incidents of life safety concerns immediately to the Department of Human Services licensing division;
(7) provide information and training programs for persons with disabilities and their families and legal representatives on service options and quality expectations;
(8) disseminate information and resources developed to other regional quality councils;
(9) respond to state-level priorities;
(10) establish regional priorities for quality improvement;
(11) submit an annual report to the State Quality Council on the status, outcomes, improvement priorities, and activities in the region;
(12) choose a representative to participate on the State Quality Council and assume other responsibilities consistent with the priorities of the State Quality Council; and
(13) recruit, train, and assign duties to members of quality assurance teams, taking into account the size of the service provider, the number of services to be reviewed, the skills necessary for the team members to complete the process, and ensure that no team member has a financial, personal, or family relationship with the facility, program, or service being reviewed or with anyone served at the facility, program, or service. Quality assurance teams must be comprised of county staff, persons receiving services or the person's families, legal representatives, members of advocacy organizations, providers, and other involved community members. Team members must complete the training program approved by the regional quality council and must demonstrate performance-based competency. Team members may be paid a per diem and reimbursed for expenses related to their participation in the quality assurance process.
(c) The commissioner shall monitor the safety standards, rights, and procedural protections for the monitoring of psychotropic medications and those identified under sections 245.825; 245.91 to 245.97; 245A.09, subdivision 2, paragraph (c), clauses (2) and (5); 245A.12; 245A.13; 252.41, subdivision 9; 256B.092, subdivision 1b, clause (7); and 626.557; and chapter 260E.
(d) The regional quality councils may hire staff to perform the duties assigned in this subdivision.
(e) The regional quality councils may charge fees for their services.
(f) The quality assurance process undertaken by a regional quality council consists of an evaluation by a quality assurance team of the facility, program, or service. The process must include an evaluation of a random sample of persons served. The sample must be representative of each service provided. The sample size must be at least five percent but not less than two persons served. All persons must be given the opportunity to be included in the quality assurance process in addition to those chosen for the random sample.
(g) A facility, program, or service may contest a licensing decision of the regional quality council as permitted under chapter 245A.
Subd. 5.
Annual survey of service recipients.
The commissioner, in consultation with the State Quality Council, shall conduct an annual independent statewide survey of service recipients, randomly selected, to determine the effectiveness and quality of disability services. The survey must be consistent with the system performance expectations of the Centers for Medicare and Medicaid Services (CMS) Quality Framework. The survey must analyze whether desired outcomes for persons with different demographic, diagnostic, health, and functional needs, who are receiving different types of services in different settings and with different costs, have been achieved. Annual statewide and regional reports of the results must be published and used to assist regions, counties, and providers to plan and measure the impact of quality improvement activities.
Subd. 6.
Mandated reporters.
Members of the State Quality Council under subdivision 3, the regional quality councils under subdivision 4, and quality assurance team members under subdivision 4, paragraph (b), clause (13), are mandated reporters as defined in sections 260E.06, subdivision 1, and 626.5572, subdivision 16.
256B.4905 HOME AND COMMUNITY-BASED SERVICES POLICY STATEMENT.
Subdivision 1.
Employment first policy.
It is the policy of this state that all working-age Minnesotans with disabilities can work, want to work, and can achieve competitive integrated employment, and that each working-age Minnesotan with a disability be offered the opportunity to work and earn a competitive wage before being offered other supports and services.
Subd. 2.
Employment first implementation for disability waiver services.
The commissioner of human services shall ensure that:
(1) the disability waivers under sections 256B.092 and 256B.49 support the presumption that all working-age Minnesotans with disabilities can work, want to work, and can achieve competitive integrated employment; and
(2) each waiver recipient of working age be offered, after an informed decision-making process and during a person-centered planning process, the opportunity to work and earn a competitive wage before being offered exclusively day services as defined in section 245D.03, subdivision 1, paragraph (c), clause (4), or successor provisions.
Subd. 3.
Independent living first policy.
It is the policy of this state that all adult Minnesotans with disabilities can and want to live independently with proper supports and services and that each adult Minnesotan with a disability be offered the opportunity to live as independently as possible before being offered supports and services in provider-controlled settings.
Subd. 4.
Independent living first implementation for disability waiver services.
The commissioner of human services shall ensure that:
(1) the disability waivers under sections 256B.092 and 256B.49 support the presumption that all adult Minnesotans with disabilities can and want to live independently with proper services and supports as needed; and
(2) each adult waiver recipient be offered, after an informed decision-making process and during a person-centered planning process, the opportunity to live as independently as possible before being offered customized living services provided in a single family home or residential supports and services as defined in section 245D.03, subdivision 1, paragraph (c), clause (3), or successor provisions, unless the residential supports and services are provided in a family adult foster care residence under a shared living option as described in Laws 2013, chapter 108, article 7, section 62.
Subd. 5.
Self-direction first policy.
It is the policy of this state that adult Minnesotans with disabilities and families of children with disabilities can and want to use self-directed services and supports and that each adult Minnesotan with a disability and each family of the child with a disability be offered the opportunity to choose self-directed services and supports before being offered services and supports that are not self-directed.
Subd. 6.
Self-directed first implementation for disability waiver services.
The commissioner of human services shall ensure that:
(1) the disability waivers under sections 256B.092 and 256B.49 support the presumption that adult Minnesotans with disabilities and families of children with disabilities can and want to use self-directed services and supports, including self-directed funding options; and
(2) each waiver recipient be offered, after an informed decision-making process and during a person-centered planning process, the opportunity to choose self-directed services and supports, including self-directed funding options, before being offered services and supports that are not self-directed.
256D.051 SNAP EMPLOYMENT AND TRAINING PROGRAM.
Subdivision 1.
SNAP employment and training program.
The commissioner shall implement a SNAP employment and training program in order to meet the SNAP employment and training participation requirements of the United States Department of Agriculture. Unless exempt under subdivision 3a, each adult recipient in the unit must participate in the SNAP employment and training program each month that the person is eligible for SNAP benefits. The person's participation in SNAP employment and training services must begin no later than the first day of the calendar month following the determination of eligibility for SNAP benefits. With the county agency's consent, and to the extent of available resources, the person may voluntarily continue to participate in SNAP employment and training services for up to three additional consecutive months immediately following termination of SNAP benefits in order to complete the provisions of the person's employability development plan.
Subd. 1a.
Notices and sanctions.
(a) At the time the county agency notifies the household that it is eligible for SNAP benefits, the county agency must inform all mandatory employment and training services participants as identified in subdivision 1 in the household that they must comply with all SNAP employment and training program requirements each month, including the requirement to attend an initial orientation to the SNAP employment and training program and that SNAP eligibility will end unless the participants comply with the requirements specified in the notice.
(b) A participant who fails without good cause to comply with SNAP employment and training program requirements of this section, including attendance at orientation, will lose SNAP eligibility for the following periods:
(1) for the first occurrence, for one month or until the person complies with the requirements not previously complied with, whichever is longer;
(2) for the second occurrence, for three months or until the person complies with the requirements not previously complied with, whichever is longer; or
(3) for the third and any subsequent occurrence, for six months or until the person complies with the requirements not previously complied with, whichever is longer.
If the participant is not the SNAP head of household, the person shall be considered an ineligible household member for SNAP purposes. If the participant is the SNAP head of household, the entire household is ineligible for SNAP as provided in Code of Federal Regulations, title 7, section 273.7(g). "Good cause" means circumstances beyond the control of the participant, such as illness or injury, illness or injury of another household member requiring the participant's presence, a household emergency, or the inability to obtain child care for children between the ages of six and 12 or to obtain transportation needed in order for the participant to meet the SNAP employment and training program participation requirements.
(c) The county agency shall mail or hand deliver a notice to the participant not later than five days after determining that the participant has failed without good cause to comply with SNAP employment and training program requirements which specifies the requirements that were not complied with, the factual basis for the determination of noncompliance, and the right to reinstate eligibility upon a showing of good cause for failure to meet the requirements. The notice must ask the reason for the noncompliance and identify the participant's appeal rights. The notice must request that the participant inform the county agency if the participant believes that good cause existed for the failure to comply and must state that the county agency intends to terminate eligibility for SNAP benefits due to failure to comply with SNAP employment and training program requirements.
(d) If the county agency determines that the participant did not comply during the month with all SNAP employment and training program requirements that were in effect, and if the county agency determines that good cause was not present, the county must provide a ten-day notice of termination of SNAP benefits. The amount of SNAP benefits that are withheld from the household and determination of the impact of the sanction on other household members is governed by Code of Federal Regulations, title 7, section 273.7.
(e) The participant may appeal the termination of SNAP benefits under the provisions of section 256.045.
Subd. 2.
County agency duties.
(a) The county agency shall provide to SNAP benefit recipients a SNAP employment and training program. The program must include:
(1) orientation to the SNAP employment and training program;
(2) an individualized employability assessment and an individualized employability development plan that includes assessment of literacy, ability to communicate in the English language, educational and employment history, and that estimates the length of time it will take the participant to obtain employment. The employability assessment and development plan must be completed in consultation with the participant, must assess the participant's assets, barriers, and strengths, and must identify steps necessary to overcome barriers to employment. A copy of the employability development plan must be provided to the registrant;
(3) referral to available accredited remedial or skills training programs designed to address participant's barriers to employment;
(4) referral to available programs that provide subsidized or unsubsidized employment as necessary;
(5) a job search program, including job seeking skills training; and
(6) other activities, to the extent of available resources designed by the county agency to prepare the participant for permanent employment.
In order to allow time for job search, the county agency may not require an individual to participate in the SNAP employment and training program for more than 32 hours a week. The county agency shall require an individual to spend at least eight hours a week in job search or other SNAP employment and training program activities.
(b) The county agency shall prepare an annual plan for the operation of its SNAP employment and training program. The plan must be submitted to and approved by the commissioner of employment and economic development. The plan must include:
(1) a description of the services to be offered by the county agency;
(2) a plan to coordinate the activities of all public entities providing employment-related services in order to avoid duplication of effort and to provide services more efficiently;
(3) a description of the factors that will be taken into account when determining a client's employability development plan; and
(4) provisions to ensure that the county agency's employment and training service provider provides each recipient with an orientation, employability assessment, and employability development plan as specified in paragraph (a), clauses (1) and (2), within 30 days of the recipient's eligibility for assistance.
Subd. 2a.
Duties of commissioner.
In addition to any other duties imposed by law, the commissioner shall:
(1) based on this section and section 256D.052 and Code of Federal Regulations, title 7, section 273.7, supervise the administration of SNAP employment and training services to county agencies;
(2) disburse money appropriated for SNAP employment and training services to county agencies based upon the county's costs as specified in section 256D.051, subdivision 6c;
(3) accept and supervise the disbursement of any funds that may be provided by the federal government or from other sources for use in this state for SNAP employment and training services;
(4) cooperate with other agencies including any agency of the United States or of another state in all matters concerning the powers and duties of the commissioner under this section and section 256D.052; and
(5) in cooperation with the commissioner of employment and economic development, ensure that each component of an employment and training program carried out under this section is delivered through a statewide workforce development system, unless the component is not available locally through such a system.
Subd. 3.
Participant duties.
In order to receive SNAP assistance, a registrant shall: (1) cooperate with the county agency in all aspects of the SNAP employment and training program; (2) accept any suitable employment, including employment offered through the Job Training Partnership Act, and other employment and training options; and (3) participate in SNAP employment and training activities assigned by the county agency. The county agency may terminate assistance to a registrant who fails to cooperate in the SNAP employment and training program, as provided in subdivision 1a.
Subd. 3a.
Requirement to register work.
(a) To the extent required under Code of Federal Regulations, title 7, section 273.7(a), each applicant for and recipient of SNAP benefits is required to register for work as a condition of eligibility for SNAP benefits. Applicants and recipients are registered by signing an application or annual reapplication for SNAP benefits, and must be informed that they are registering for work by signing the form.
(b) The commissioner shall determine, within federal requirements, persons required to participate in the SNAP employment and training program.
(c) The following SNAP benefit recipients are exempt from mandatory participation in SNAP employment and training services:
(1) recipients of benefits under the Minnesota family investment program, Minnesota supplemental aid program, or the general assistance program;
(2) a child;
(3) a recipient over age 55;
(4) a recipient who has a mental or physical illness, injury, or incapacity which is expected to continue for at least 30 days and which impairs the recipient's ability to obtain or retain employment as evidenced by professional certification or the receipt of temporary or permanent disability benefits issued by a private or government source;
(5) a parent or other household member responsible for the care of either a dependent child in the household who is under age six or a person in the household who is professionally certified as having a physical or mental illness, injury, or incapacity. Only one parent or other household member may claim exemption under this provision;
(6) a recipient receiving unemployment insurance or who has applied for unemployment insurance and has been required to register for work with the Department of Employment and Economic Development as part of the unemployment insurance application process;
(7) a recipient participating each week in a drug addiction or alcohol abuse treatment and rehabilitation program, provided the operators of the treatment and rehabilitation program, in consultation with the county agency, recommend that the recipient not participate in the SNAP employment and training program;
(8) a recipient employed or self-employed for 30 or more hours per week at employment paying at least minimum wage, or who earns wages from employment equal to or exceeding 30 hours multiplied by the federal minimum wage; or
(9) a student enrolled at least half time in any school, training program, or institution of higher education. When determining if a student meets this criteria, the school's, program's or institution's criteria for being enrolled half time shall be used.
Subd. 3b.
Orientation.
The county agency or its employment and training service provider must provide an orientation to SNAP employment and training services to each nonexempt SNAP benefit recipient within 30 days of the date that SNAP eligibility is determined. The orientation must inform the participant of the requirement to participate in services, the date, time, and address to report to for services, the name and telephone number of the SNAP employment and training service provider, the consequences for failure without good cause to comply, the services and support services available through SNAP employment and training services and other providers of similar services, and must encourage the participant to view the SNAP benefits program as a temporary means of supplementing the family's food needs until the family achieves self-sufficiency through employment. The orientation may be provided through audio-visual methods, but the participant must have the opportunity for face-to-face interaction with county agency staff.
Subd. 6b.
Federal reimbursement.
(a) Federal financial participation from the United States Department of Agriculture for SNAP employment and training expenditures that are eligible for reimbursement through the SNAP employment and training program are dedicated funds and are annually appropriated to the commissioner of human services for the operation of the SNAP employment and training program.
(b) The appropriation must be used for skill attainment through employment, training, and support services for SNAP participants.
(c) Federal financial participation for the nonstate portion of SNAP employment and training costs must be paid to the county agency or service provider that incurred the costs.
Subd. 6c.
Program funding.
Within the limits of available resources, the commissioner shall reimburse the actual costs of county agencies and their employment and training service providers for the provision of SNAP employment and training services, including participant support services, direct program services, and program administrative activities. The cost of services for each county's SNAP employment and training program shall not exceed the annual allocated amount. No more than 15 percent of program funds may be used for administrative activities. The county agency may expend county funds in excess of the limits of this subdivision without state reimbursement.
Program funds shall be allocated based on the county's average number of SNAP eligible cases as compared to the statewide total number of such cases. The average number of cases shall be based on counts of cases as of March 31, June 30, September 30, and December 31 of the previous calendar year. The commissioner may reallocate unexpended money appropriated under this section to those county agencies that demonstrate a need for additional funds.
Subd. 7.
Registrant status.
A registrant under this section is not an employee for the purposes of workers' compensation, unemployment benefits, retirement, or civil service laws, and shall not perform work ordinarily performed by a regular public employee.
Subd. 8.
Voluntary quit.
A person who is required to participate in SNAP employment and training services is not eligible for SNAP benefits if, without good cause, the person refuses a legitimate offer of, or quits, suitable employment within 60 days before the date of application. A person who is required to participate in SNAP employment and training services and, without good cause, voluntarily quits suitable employment or refuses a legitimate offer of suitable employment while receiving SNAP benefits shall be terminated from the SNAP program as specified in subdivision 1a.
Subd. 9.
Subcontractors.
A county agency may, at its option, subcontract any or all of the duties under this section to a public or private entity approved by the commissioner of employment and economic development.
Subd. 18.
Work experience placements.
(a) To the extent of available resources, each county agency must establish and operate a work experience component in the SNAP employment and training program for recipients who are subject to a federal limit of three months of SNAP eligibility in any 36-month period. The purpose of the work experience component is to enhance the participant's employability, self-sufficiency, and to provide meaningful, productive work activities.
(b) The commissioner shall assist counties in the design and implementation of these components. The commissioner must ensure that job placements under a work experience component comply with section 256J.72. Written or oral concurrence with job duties of persons placed under the community work experience program shall be obtained from the appropriate exclusive bargaining representative.
(c) Worksites developed under this section are limited to projects that serve a useful public service such as health, social service, environmental protection, education, urban and rural development and redevelopment, welfare, recreation, public facilities, public safety, community service, services to aged citizens or citizens with a disability, and child care. To the extent possible, the prior training, skills, and experience of a recipient must be used in making appropriate work experience assignments.
(d) Structured, supervised volunteer work with an agency or organization that is monitored by the county service provider may, with the approval of the county agency, be used as a work experience placement.
(e) As a condition of placing a person receiving SNAP benefits in a program under this subdivision, the county agency shall first provide the recipient the opportunity:
(1) for placement in suitable subsidized or unsubsidized employment through participation in job search under section 256D.051; or
(2) for placement in suitable employment through participation in on-the-job training, if such employment is available.
(f) The county agency shall limit the maximum monthly number of hours that any participant may work in a work experience placement to a number equal to the amount of the family's monthly SNAP benefit allotment divided by the greater of the federal minimum wage or the applicable state minimum wage.
After a participant has been assigned to a position for nine months, the participant may not continue in that assignment unless the maximum number of hours a participant works is no greater than the amount of the SNAP benefit divided by the rate of pay for individuals employed in the same or similar occupations by the same employer at the same site.
(g) The participant's employability development plan must include the length of time needed in the work experience program, the need to continue job seeking activities while participating in work experience, and the participant's employment goals.
(h) After each six months of a recipient's participation in a work experience job placement, and at the conclusion of each work experience assignment under this section, the county agency shall reassess and revise, as appropriate, the participant's employability development plan.
(i) A participant has good cause for failure to cooperate with a work experience job placement if, in the judgment of the employment and training service provider, the reason for failure is reasonable and justified. Good cause for purposes of this section is defined in subdivision 1a, paragraph (b).
(j) A recipient who has failed without good cause to participate in or comply with the work experience job placement shall be terminated from participation in work experience job activities. If the recipient is not exempt from mandatory SNAP employment and training program participation under subdivision 3a, the recipient will be assigned to other mandatory program activities. If the recipient is exempt from mandatory participation but is participating as a volunteer, the person shall be terminated from the SNAP employment and training program.
256D.052 LITERACY TRAINING FOR RECIPIENTS.
Subd. 3.
Participant literacy transportation costs.
Within the limits of the state appropriation the county agency must provide transportation to enable Supplemental Nutrition Assistance Program (SNAP) employment and training participants to participate in literacy training under this section. The state shall reimburse county agencies for the costs of providing transportation under this section up to the amount of the state appropriation. Counties must make every effort to ensure that child care is available as needed by recipients who are pursuing literacy training.
259A.70 REIMBURSEMENT OF NONRECURRING ADOPTION EXPENSES.
(a) The commissioner of human services shall provide reimbursement to an adoptive parent for costs incurred in an adoption of a child with special needs according to section 259A.10, subdivision 2. Reimbursement shall be made for expenses that are reasonable and necessary for the adoption to occur, subject to a maximum of $2,000. The expenses must directly relate to the legal adoption of the child, must not be incurred in violation of state or federal law, and must not have been reimbursed from other sources or funds.
(b) Children who have special needs but are not citizens or residents of the United States and were either adopted in another country or brought to this country for the purposes of adoption are categorically ineligible for this reimbursement program, except if the child meets the eligibility criteria after the dissolution of the international adoption.
(c) An adoptive parent, in consultation with the responsible child-placing agency, may request reimbursement of nonrecurring adoption expenses by submitting a complete application, according to the requirements and procedures and on forms prescribed by the commissioner.
(d) The commissioner shall determine the child's eligibility for adoption expense reimbursement under title IV-E of the Social Security Act, United States Code, title 42, sections 670 to 676. If determined eligible, the commissioner of human services shall sign the agreement for nonrecurring adoption expense reimbursement, making this a fully executed agreement. To be eligible, the agreement must be fully executed prior to the child's adoption finalization.
(e) An adoptive parent who has an adoption assistance agreement under section 259A.15, subdivision 2, is not required to make a separate application for reimbursement of nonrecurring adoption expenses for the child who is the subject of that agreement.
(f) If determined eligible, the adoptive parent shall submit reimbursement requests within 21 months of the date of the child's adoption decree, and according to requirements and procedures prescribed by the commissioner.
Repealed Minnesota Session Laws: S2360-2
Laws 2019, First Special Session chapter 9, article 5, section 90 by Laws 2021, First Special Session chapter 7, article 13, section 79
Sec. 90. DAY TRAINING AND HABILITATION DISABILITY WAIVER RATE SYSTEM TRANSITION GRANTS.
(a) The commissioner of human services shall establish annual grants to day training and habilitation providers that are projected to experience a funding gap upon the full implementation of Minnesota Statutes, section 256B.4914.
(b) In order to be eligible for a grant under this section, a day training and habilitation disability waiver provider must:
(1) serve at least 100 waiver service participants;
(2) be projected to receive a reduction in annual revenue from medical assistance for day services during the first year of full implementation of disability waiver rate system framework rates under Minnesota Statutes, section 256B.4914, of at least 15 percent and at least $300,000 compared to the annual medical assistance revenue for day services the provider received during the last full year during which banded rates under Minnesota Statutes, section 256B.4913, subdivision 4a, were effective; and
(3) agree to develop, submit, and implement a sustainability plan as provided in paragraph
(c) A recipient of a grant under this section must develop a sustainability plan in partnership with the commissioner of human services. The sustainability plan must include:
(1) a review of all the provider's costs and an assessment of whether the provider is implementing available cost-control options appropriately;
(2) a review of all the provider's revenue and an assessment of whether the provider is leveraging available resources appropriately; and
(3) a practical strategy for closing the funding gap described in paragraph (b), clause (2).
(d) The commissioner of human services shall provide technical assistance and financial management advice to grant recipients as they develop and implement their sustainability plans.
(e) In order to be eligible for an annual grant renewal, a grant recipient must demonstrate to the commissioner of human services that it made a good faith effort to close the revenue gap described in paragraph (b), clause (2).
Repealed Minnesota Rule: S2360-2
9505.0370 DEFINITIONS.
Subpart 1.
Scope.
For parts 9505.0370 to 9505.0372, the following terms have the meanings given them.
Subp. 2.
Adult day treatment.
"Adult day treatment" or "adult day treatment program" means a structured program of treatment and care.
Subp. 4.
Client.
"Client" means an eligible recipient who is determined to have or who is being assessed for a mental illness as specified in part 9505.0371.
Subp. 5.
Clinical summary.
"Clinical summary" means a written description of a clinician's formulation of the cause of the client's mental health symptoms, the client's prognosis, and the likely consequences of the symptoms; how the client meets the criteria for the diagnosis by describing the client's symptoms, the duration of symptoms, and functional impairment; an analysis of the client's other symptoms, strengths, relationships, life situations, cultural influences, and health concerns and their potential interaction with the diagnosis and formulation of the client's mental health condition; and alternative diagnoses that were considered and ruled out.
Subp. 6.
Clinical supervision.
"Clinical supervision" means the documented time a clinical supervisor and supervisee spend together to discuss the supervisee's work, to review individual client cases, and for the supervisee's professional development. It includes the documented oversight and supervision responsibility for planning, implementation, and evaluation of services for a client's mental health treatment.
Subp. 7.
Clinical supervisor.
"Clinical supervisor" means the mental health professional who is responsible for clinical supervision.
Subp. 8.
Cultural competence or culturally competent.
"Cultural competence" or "culturally competent" means the mental health provider's:
A.
awareness of the provider's own cultural background, and the related assumptions, values, biases, and preferences that influence assessment and intervention processes;
B.
ability and will to respond to the unique needs of an individual client that arise from the client's culture;
C.
ability to utilize the client's culture as a resource and as a means to optimize mental health care; and
D.
willingness to seek educational, consultative, and learning experiences to expand knowledge of and increase effectiveness with culturally diverse populations.
Subp. 9.
Cultural influences.
"Cultural influences" means historical, geographical, and familial factors that affect assessment and intervention processes. Cultural influences that are relevant to the client may include the client's:
Subp. 10.
Culture.
"Culture" means the distinct ways of living and understanding the world that are used by a group of people and are transmitted from one generation to another or adopted by an individual.
Subp. 11.
Diagnostic assessment.
"Diagnostic assessment" means a written assessment that documents a clinical and functional face-to-face evaluation of the client's mental health, including the nature, severity and impact of behavioral difficulties, functional impairment, and subjective distress of the client, and identifies the client's strengths and resources.
Subp. 12.
Dialectical behavior therapy.
"Dialectical behavior therapy" means an evidence-based treatment approach provided in an intensive outpatient treatment program using a combination of individualized rehabilitative and psychotherapeutic interventions. A dialectical behavior therapy program is certified by the commissioner and involves the following service components: individual dialectical behavior therapy, group skills training, telephone coaching, and team consultation meetings.
Subp. 13.
Explanation of findings.
"Explanation of findings" means the explanation of a client's diagnostic assessment, psychological testing, treatment program, and consultation with culturally informed mental health consultants as required under parts 9520.0900 to 9520.0926, or other accumulated data and recommendations to the client, client's family, primary caregiver, or other responsible persons.
Subp. 14.
Family.
"Family" means a person who is identified by the client or the client's parent or guardian as being important to the client's mental health treatment. Family may include, but is not limited to, parents, children, spouse, committed partners, former spouses, persons related by blood or adoption, or persons who are presently residing together as a family unit.
Subp. 15.
Individual treatment plan.
"Individual treatment plan" means a written plan that outlines and defines the course of treatment. It delineates the goals, measurable objectives, target dates for achieving specific goals, main participants in treatment process, and recommended services that are based on the client's diagnostic assessment and other meaningful data that are needed to aid the client's recovery and enhance resiliency.
Subp. 16.
Medication management.
"Medication management" means a service that determines the need for or effectiveness of the medication prescribed for the treatment of a client's symptoms of a mental illness.
Subp. 17.
Mental health practitioner.
"Mental health practitioner" means a person who is qualified according to part 9505.0371, subpart 5, items B and C, and provides mental health services to a client with a mental illness under the clinical supervision of a mental health professional.
Subp. 18.
Mental health professional.
"Mental health professional" means a person who is enrolled to provide medical assistance services and is qualified according to part 9505.0371, subpart 5, item A.
Subp. 19.
Mental health telehealth.
"Mental health telehealth" has the meaning given in Minnesota Statutes, section 256B.0625, subdivision 46.
Subp. 20.
Mental illness.
"Mental illness" has the meaning given in Minnesota Statutes, section 245.462, subdivision 20. "Mental illness" includes "emotional disturbance" as defined in Minnesota Statutes, section 245.4871, subdivision 15.
Subp. 21.
Multidisciplinary staff.
"Multidisciplinary staff" means a group of individuals from diverse disciplines who come together to provide services to clients under part 9505.0372, subparts 8, 9, and 10.
Subp. 22.
Neuropsychological assessment.
"Neuropsychological assessment" means a specialized clinical assessment of the client's underlying cognitive abilities related to thinking, reasoning, and judgment that is conducted by a qualified neuropsychologist.
Subp. 23.
Neuropsychological testing.
"Neuropsychological testing" means administering standardized tests and measures designed to evaluate the client's ability to attend to, process, interpret, comprehend, communicate, learn and recall information; and use problem-solving and judgment.
Subp. 24.
Partial hospitalization program.
"Partial hospitalization program" means a provider's time-limited, structured program of psychotherapy and other therapeutic services, as defined in United States Code, title 42, chapter 7, subchapter XVIII, part E, section 1395x, (ff), that is provided in an outpatient hospital facility or community mental health center that meets Medicare requirements to provide partial hospitalization services.
Subp. 25.
Primary caregiver.
"Primary caregiver" means a person, other than the facility staff, who has primary legal responsibility for providing the client with food, clothing, shelter, direction, guidance, and nurturance.
Subp. 26.
Psychological testing.
"Psychological testing" means the use of tests or other psychometric instruments to determine the status of the recipient's mental, intellectual, and emotional functioning.
Subp. 27.
Psychotherapy.
"Psychotherapy" means treatment of a client with mental illness that applies the most appropriate psychological, psychiatric, psychosocial, or interpersonal method that conforms to prevailing community standards of professional practice to meet the mental health needs of the client.
9505.0371 MEDICAL ASSISTANCE COVERAGE REQUIREMENTS FOR OUTPATIENT MENTAL HEALTH SERVICES.
Subpart 1.
Purpose.
This part describes the requirements that outpatient mental health services must meet to receive medical assistance reimbursement.
Subp. 2.
Client eligibility for mental health services.
The following requirements apply to mental health services:
A.
The provider must use a diagnostic assessment as specified in part 9505.0372 to determine a client's eligibility for mental health services under this part, except:
(1)
prior to completion of a client's initial diagnostic assessment, a client is eligible for:
(c)
either one individual psychotherapy session, one family psychotherapy session, or one group psychotherapy session; and
(2)
for a client who is not currently receiving mental health services covered by medical assistance, a crisis assessment as specified in Minnesota Statutes, section 256B.0624 or 256B.0944, conducted in the past 60 days may be used to allow up to ten sessions of mental health services within a 12-month period.
B.
A brief diagnostic assessment must meet the requirements of part 9505.0372, subpart 1, item D, and:
(1)
may be used to allow up to ten sessions of mental health services as specified in part 9505.0372 within a 12-month period before a standard or extended diagnostic assessment is required when the client is:
(b)
an existing client who has had fewer than ten sessions of psychotherapy in the previous 12 months and is projected to need fewer than ten sessions of psychotherapy in the next 12 months, or who only needs medication management; and
(2)
may be used for a subsequent annual assessment, if based upon the client's treatment history and the provider's clinical judgment, the client will need ten or fewer sessions of mental health services in the upcoming 12-month period; and
(3)
must not be used for:
(a)
a client or client's family who requires a language interpreter to participate in the assessment unless the client meets the requirements of subitem (1), unit (b), or (2); or
(b)
more than ten sessions of mental health services in a 12-month period. If, after completion of ten sessions of mental health services, the mental health professional determines the need for additional sessions, a standard assessment or extended assessment must be completed.
C.
For a child, a new standard or extended diagnostic assessment must be completed:
(3)
when the child's mental health condition has changed markedly since the child's most recent diagnostic assessment; or
(4)
when the child's current mental health condition does not meet criteria of the child's current diagnosis.
D.
For an adult, a new standard diagnostic assessment or extended diagnostic assessment must be completed:
(1)
when the adult does not meet the criteria for a brief diagnostic assessment or an adult diagnostic assessment update;
(2)
at least every three years following the initial diagnostic assessment for an adult who receives mental health services;
(3)
when the adult's mental health condition has changed markedly since the adult's most recent diagnostic assessment; or
(4)
when the adult's current mental health condition does not meet criteria of the current diagnosis.
E.
An adult diagnostic assessment update must be completed at least annually unless a new standard or extended diagnostic assessment is performed. An adult diagnostic assessment update must include an update of the most recent standard or extended diagnostic assessment and any recent adult diagnostic assessment updates that have occurred since the last standard or extended diagnostic assessment.
Subp. 3.
Authorization for mental health services.
Mental health services under this part are subject to authorization criteria and standards published by the commissioner according to Minnesota Statutes, section 256B.0625, subdivision 25.
Subp. 4.
Clinical supervision.
A.
Clinical supervision must be based on each supervisee's written supervision plan and must:
(3)
promote cultural competency by:
(a)
developing the supervisee's knowledge of cultural norms of behavior for individual clients and generally for the clients served by the supervisee regarding the client's cultural influences, age, class, gender, sexual orientation, literacy, and mental or physical disability;
(b)
addressing how the supervisor's and supervisee's own cultures and privileges affect service delivery;
(c)
developing the supervisee's ability to assess their own cultural competence and to identify when consultation or referral of the client to another provider is needed; and
(d)
emphasizing the supervisee's commitment to maintaining cultural competence as an ongoing process;
(4)
recognize that the client's family has knowledge about the client and will continue to play a role in the client's life and encourage participation among the client, client's family, and providers as treatment is planned and implemented; and
(5)
monitor, evaluate, and document the supervisee's performance of assessment, treatment planning, and service delivery.
B.
Clinical supervision must be conducted by a qualified supervisor using individual or group supervision. Individual or group face-to-face supervision may be conducted via electronic communications that utilize interactive telecommunications equipment that includes at a minimum audio and video equipment for two-way, real-time, interactive communication between the supervisor and supervisee, and meet the equipment and connection standards of part 9505.0370, subpart 19.
(2)
Group supervision means one clinical supervisor and two to six supervisees in face-to-face supervision.
C.
The supervision plan must be developed by the supervisor and the supervisee. The plan must be reviewed and updated at least annually. For new staff the plan must be completed and implemented within 30 days of the new staff person's employment. The supervision plan must include:
(1)
the name and qualifications of the supervisee and the name of the agency in which the supervisee is being supervised;
(3)
the number of hours of individual and group supervision to be completed by the supervisee including whether supervision will be in person or by some other method approved by the commissioner;
(4)
the policy and method that the supervisee must use to contact the clinical supervisor during service provision to a supervisee;
D.
Clinical supervision must be recorded in the supervisee's supervision record. The documentation must include:
E.
Clinical supervision pertinent to client treatment changes must be recorded by a case notation in the client record after supervision occurs.
Subp. 5.
Qualified providers.
Medical assistance covers mental health services according to part 9505.0372 when the services are provided by mental health professionals or mental health practitioners qualified under this subpart.
A.
A mental health professional must be qualified in one of the following ways:
(1)
in clinical social work, a person must be licensed as an independent clinical social worker by the Minnesota Board of Social Work under Minnesota Statutes, chapter 148D until August 1, 2011, and thereafter under Minnesota Statutes, chapter 148E;
(2)
in psychology, a person licensed by the Minnesota Board of Psychology under Minnesota Statutes, sections 148.88 to 148.98, who has stated to the board competencies in the diagnosis and treatment of mental illness;
(3)
in psychiatry, a physician licensed under Minnesota Statutes, chapter 147, who is certified by the American Board of Psychiatry and Neurology or is eligible for board certification;
(4)
in marriage and family therapy, a person licensed as a marriage and family therapist by the Minnesota Board of Marriage and Family Therapy under Minnesota Statutes, sections 148B.29 to 148B.39, and defined in parts 5300.0100 to 5300.0350;
(5)
in professional counseling, a person licensed as a professional clinical counselor by the Minnesota Board of Behavioral Health and Therapy under Minnesota Statutes, section 148B.5301;
(6)
a tribally approved mental health care professional, who meets the standards in Minnesota Statutes, section 256B.02, subdivision 7, paragraphs (b) and (c), and who is serving a federally recognized Indian tribe; or
(7)
in psychiatric nursing, a registered nurse who is licensed under Minnesota Statutes, sections 148.171 to 148.285, and meets one of the following criteria:
(b)
for children, is certified as a nurse practitioner in child or adolescent or family psychiatric and mental health nursing by a national nurse certification organization; or
(c)
for adults, is certified as a nurse practitioner in adult or family psychiatric and mental health nursing by a national nurse certification organization.
B.
A mental health practitioner for a child client must have training working with children. A mental health practitioner for an adult client must have training working with adults. A mental health practitioner must be qualified in at least one of the following ways:
(1)
holds a bachelor's degree in one of the behavioral sciences or related fields from an accredited college or university; and
(a)
has at least 2,000 hours of supervised experience in the delivery of mental health services to clients with mental illness; or
(b)
is fluent in the non-English language of the cultural group to which at least 50 percent of the practitioner's clients belong, completes 40 hours of training in the delivery of services to clients with mental illness, and receives clinical supervision from a mental health professional at least once a week until the requirements of 2,000 hours of supervised experience are met;
(2)
has at least 6,000 hours of supervised experience in the delivery of mental health services to clients with mental illness. Hours worked as a mental health behavioral aide I or II under Minnesota Statutes, section 256B.0943, subdivision 7, may be included in the 6,000 hours of experience for child clients;
(3)
is a graduate student in one of the mental health professional disciplines defined in item A and is formally assigned by an accredited college or university to an agency or facility for clinical training;
(4)
holds a master's or other graduate degree in one of the mental health professional disciplines defined in item A from an accredited college or university; or
(5)
is an individual who meets the standards in Minnesota Statutes, section 256B.02, subdivision 7, paragraphs (b) and (c), who is serving a federally recognized Indian tribe.
C.
Medical assistance covers diagnostic assessment, explanation of findings, and psychotherapy performed by a mental health practitioner working as a clinical trainee when:
(1)
the mental health practitioner is:
(a)
complying with requirements for licensure or board certification as a mental health professional, as defined in item A, including supervised practice in the delivery of mental health services for the treatment of mental illness; or
(b)
a student in a bona fide field placement or internship under a program leading to completion of the requirements for licensure as a mental health professional defined in item A; and
(2)
the mental health practitioner's clinical supervision experience is helping the practitioner gain knowledge and skills necessary to practice effectively and independently. This may include supervision of:
D.
A clinical supervisor must:
(2)
hold a license without restrictions that has been in good standing for at least one year while having performed at least 1,000 hours of clinical practice;
(3)
be approved, certified, or in some other manner recognized as a qualified clinical supervisor by the person's professional licensing board, when this is a board requirement;
(4)
be competent as demonstrated by experience and graduate-level training in the area of practice and the activities being supervised;
(5)
not be the supervisee's blood or legal relative or cohabitant, or someone who has acted as the supervisee's therapist within the past two years;
(6)
have experience and skills that are informed by advanced training, years of experience, and mastery of a range of competencies that demonstrate the following:
(d)
ability to give clear direction to mental health staff related to alternative strategies when a client is struggling with moving towards recovery; and
(7)
accept full professional liability for a supervisee's direction of a client's mental health services;
(8)
instruct a supervisee in the supervisee's work, and oversee the quality and outcome of the supervisee's work with clients;
(9)
review, approve, and sign the diagnostic assessment, individual treatment plans, and treatment plan reviews of clients treated by a supervisee;
(10)
review and approve the progress notes of clients treated by the supervisee according to the supervisee's supervision plan;
(14)
ensure that each supervisee receives the guidance and support needed to provide treatment services in areas where the supervisee practices;
(15)
establish an evaluation process that identifies the performance and competence of each supervisee; and
(16)
document clinical supervision of each supervisee and securely maintain the documentation record.
Subp. 6.
Release of information.
Providers who receive a request for client information and providers who request client information must:
A.
comply with data practices and medical records standards in Minnesota Statutes, chapter 13, and Code of Federal Regulations, title 45, part 164; and
B.
subject to the limitations in item A, promptly provide client information, including a written diagnostic assessment, to other providers who are treating the client to ensure that the client will get services without undue delay.
Subp. 7.
Individual treatment plan.
Except as provided in subpart 2, item A, subitem (1), a medical assistance payment is available only for services provided in accordance with the client's written individual treatment plan (ITP). The client must be involved in the development, review, and revision of the client's ITP. For all mental health services, except as provided in subpart 2, item A, subitem (1), and medication management, the ITP and subsequent revisions of the ITP must be signed by the client before treatment begins. The mental health professional or practitioner shall request the client, or other person authorized by statute to consent to mental health services for the client, to sign the client's ITP or revision of the ITP. In the case of a child, the child's parent, primary caregiver, or other person authorized by statute to consent to mental health services for the child shall be asked to sign the child's ITP and revisions of the ITP. If the client or authorized person refuses to sign the plan or a revision of the plan, the mental health professional or mental health practitioner shall note on the plan the refusal to sign the plan and the reason or reasons for the refusal. A client's individual treatment plan must be:
B.
developed by identifying the client's service needs and considering relevant cultural influences to identify planned interventions that contain specific treatment goals and measurable objectives for the client; and
C.
reviewed at least once every 90 days, and revised as necessary. Revisions to the initial individual treatment plan do not require a new diagnostic assessment unless the client's mental health status has changed markedly as provided in subpart 2.
Subp. 8.
Documentation.
To obtain medical assistance payment for an outpatient mental health service, a mental health professional or a mental health practitioner must promptly document:
A.
in the client's mental health record:
(1)
each occurrence of service to the client including the date, type of service, start and stop time, scope of the mental health service, name and title of the person who gave the service, and date of documentation; and
(2)
all diagnostic assessments and other assessments, psychological test results, treatment plans, and treatment plan reviews;
B.
the provider's contact with persons interested in the client such as representatives of the courts, corrections systems, or schools, or the client's other mental health providers, case manager, family, primary caregiver, legal representative, including the name and date of the contact or, if applicable, the reason the client's family, primary caregiver, or legal representative was not contacted; and
C.
dates that treatment begins and ends and reason for the discontinuation of the mental health service.
Subp. 9.
Service coordination.
The provider must coordinate client services as authorized by the client as follows:
A.
When a recipient receives mental health services from more than one mental health provider, each provider must coordinate mental health services they provide to the client with other mental health service providers to ensure services are provided in the most efficient manner to achieve maximum benefit for the client.
B.
The mental health provider must coordinate mental health care with the client's physical health provider.
Subp. 10.
Telehealth services.
Mental health services in part 9505.0372 covered as direct face-to-face services may be provided via two-way interactive video if it is medically appropriate to the client's condition and needs. The interactive video equipment and connection must comply with Medicare standards that are in effect at the time of service. The commissioner may specify parameters within which mental health services can be provided via telehealth.
9505.0372 COVERED SERVICES.
Subpart 1.
Diagnostic assessment.
Medical assistance covers four types of diagnostic assessments when they are provided in accordance with the requirements in this subpart.
A.
To be eligible for medical assistance payment, a diagnostic assessment must:
(1)
identify a mental health diagnosis and recommended mental health services, which are the factual basis to develop the recipient's mental health services and treatment plan; or
B.
A standard diagnostic assessment must include a face-to-face interview with the client and contain a written evaluation of a client by a mental health professional or practitioner working under clinical supervision as a clinical trainee according to part 9505.0371, subpart 5, item C. The standard diagnostic assessment must be done within the cultural context of the client and must include relevant information about:
(1)
the client's current life situation, including the client's:
(e)
significant personal relationships, including the client's evaluation of relationship quality;
(2)
the reason for the assessment, including the client's:
(g)
health history and family health history, including physical, chemical, and mental health history; and
(4)
the assessment of client's needs based on the client's baseline measurements, symptoms, behavior, skills, abilities, resources, vulnerabilities, and safety needs;
(5)
the screenings used to determine the client's substance use, abuse, or dependency and other standardized screening instruments determined by the commissioner;
(6)
assessment methods and use of standardized assessment tools by the provider as determined and periodically updated by the commissioner;
(7)
the client's clinical summary, recommendations, and prioritization of needed mental health, ancillary or other services, client and family participation in assessment and service preferences, and referrals to services required by statute or rule; and
(8)
the client data that is adequate to support the findings on all axes of the current edition of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association; and any differential diagnosis.
C.
An extended diagnostic assessment must include a face-to-face interview with the client and contain a written evaluation of a client by a mental health professional or practitioner working under clinical supervision as a clinical trainee according to part 9505.0371, subpart 5, item C. The face-to-face interview is conducted over three or more assessment appointments because the client's complex needs necessitate significant additional assessment time. Complex needs are those caused by acuity of psychotic disorder; cognitive or neurocognitive impairment; need to consider past diagnoses and determine their current applicability; co-occurring substance abuse use disorder; or disruptive or changing environments, communication barriers, or cultural considerations as documented in the assessment. For child clients, the appointments may be conducted outside the diagnostician's office for face-to-face consultation and information gathering with family members, doctors, caregivers, teachers, and other providers, with or without the child present, and may involve directly observing the child in various settings that the child frequents such as home, school, or care settings. To complete the diagnostic assessment with adult clients, the appointments may be conducted outside of the diagnostician's office for face-to-face assessment with the adult client. The appointment may involve directly observing the adult client in various settings that the adult frequents, such as home, school, job, service settings, or community settings. The appointments may include face-to-face meetings with the adult client and the client's family members, doctors, caregivers, teachers, social support network members, recovery support resource representatives, and other providers for consultation and information gathering for the diagnostic assessment. The components of an extended diagnostic assessment include the following relevant information:
(1)
for children under age 5:
(b)
an early childhood mental status exam that assesses the client's developmental, social, and emotional functioning and style both within the family and with the examiner and includes:
iii.
self-regulation, including sensory regulation, unusual behaviors, activity level, attention span, and frustration tolerance;
iv.
physical aspects, including motor function, muscle tone, coordination, tics, abnormal movements, and seizure activity;
vii.
affect and mood, including modes of expression, range, responsiveness, duration, and intensity;
(2)
for children ages 5 to 18, completion of other assessment standards for children as determined and periodically revised by the commissioner; and
(3)
for adults, completion of other assessment standards for adults as determined and periodically revised by the commissioner.
D.
A brief diagnostic assessment must include a face-to-face interview with the client and a written evaluation of the client by a mental health professional or practitioner working under clinical supervision as a clinical trainee according to part 9505.0371, subpart 5, item C. The professional or practitioner must gather initial background information using the components of a standard diagnostic assessment in item B, subitems (1), (2), unit (b), (3), and (5), and draw a provisional clinical hypothesis. The clinical hypothesis may be used to address the client's immediate needs or presenting problem. Treatment sessions conducted under authorization of a brief assessment may be used to gather additional information necessary to complete a standard diagnostic assessment or an extended diagnostic assessment.
E.
Adult diagnostic assessment update includes a face-to-face interview with the client, and contains a written evaluation of the client by a mental health professional or practitioner working under clinical supervision as a clinical trainee according to part 9505.0371, subpart 5, item C, who reviews a standard or extended diagnostic assessment. The adult diagnostic assessment update must update the most recent assessment document in writing in the following areas:
(1)
review of the client's life situation, including an interview with the client about the client's current life situation, and a written update of those parts where significant new or changed information exists, and documentation where there has not been significant change;
(2)
review of the client's presenting problems, including an interview with the client about current presenting problems and a written update of those parts where there is significant new or changed information, and note parts where there has not been significant change;
(3)
screenings for substance use, abuse, or dependency and other screenings as determined by the commissioner;
(5)
assessment of client's needs based on the client's baseline measurements, symptoms, behavior, skills, abilities, resources, vulnerabilities, and safety needs;
(6)
the client's clinical summary, recommendations, and prioritization of needed mental health, ancillary, or other services, client and family participation in assessment and service preferences, and referrals to services required by statute or rule; and
(7)
the client's diagnosis on all axes of the current edition of the Diagnostic and Statistical Manual and any differential diagnosis.
Subp. 2.
Neuropsychological assessment.
A neuropsychological assessment must include a face-to-face interview with the client, the interpretation of the test results, and preparation and completion of a report. A client is eligible for a neuropsychological assessment if at least one of the following criteria is met:
A.
There is a known or strongly suspected brain disorder based on medical history or neurological evaluation such as a history of significant head trauma, brain tumor, stroke, seizure disorder, multiple sclerosis, neurodegenerative disorders, significant exposure to neurotoxins, central nervous system infections, metabolic or toxic encephalopathy, fetal alcohol syndrome, or congenital malformations of the brain; or
B.
In the absence of a medically verified brain disorder based on medical history or neurological evaluation, there are cognitive or behavioral symptoms that suggest that the client has an organic condition that cannot be readily attributed to functional psychopathology, or suspected neuropsychological impairment in addition to functional psychopathology. Examples include:
(5)
in children or adolescents, significant delays in academic skill acquisition or poor attention relative to peers;
(6)
in children or adolescents, significant plateau in expected development of cognitive, social, emotional, or physical function, relative to peers; and
(7)
in children or adolescents, significant inability to develop expected knowledge, skills, or abilities as required to adapt to new or changing cognitive, social, emotional, or physical demands.
C.
If neither criterion in item A nor B is fulfilled, neuropsychological evaluation is not indicated.
D.
The neuropsychological assessment must be conducted by a neuropsychologist with competence in the area of neuropsychological assessment as stated to the Minnesota Board of Psychology who:
(1)
was awarded a diploma by the American Board of Clinical Neuropsychology, the American Board of Professional Neuropsychology, or the American Board of Pediatric Neuropsychology;
(2)
earned a doctoral degree in psychology from an accredited university training program:
(a)
completed an internship, or its equivalent, in a clinically relevant area of professional psychology;
(b)
completed the equivalent of two full-time years of experience and specialized training, at least one which is at the postdoctoral level, in the study and practices of clinical neuropsychology and related neurosciences supervised by a clinical neuropsychologist; and
(3)
is licensed or credentialed by another state's board of psychology examiners in the specialty of neuropsychology using requirements equivalent to requirements specified by one of the boards named in subitem (1); or
(4)
was approved by the commissioner as an eligible provider of neuropsychological assessment prior to December 31, 2010.
Subp. 3.
Neuropsychological testing.
A.
Medical assistance covers neuropsychological testing when the client has either:
(1)
a significant mental status change that is not a result of a metabolic disorder that has failed to respond to treatment;
(2)
in children or adolescents, a significant plateau in expected development of cognitive, social, emotional, or physical function, relative to peers;
(3)
in children or adolescents, significant inability to develop expected knowledge, skills, or abilities, as required to adapt to new or changing cognitive, social, physical, or emotional demands; or
(4)
a significant behavioral change, memory loss, or suspected neuropsychological impairment in addition to functional psychopathology, or other organic brain injury or one of the following:
(k)
exposure to systemic or intrathecal agents or cranial radiation known to be associated with cerebral dysfunction;
(l)
systemic medical conditions known to be associated with cerebral dysfunction, including renal disease, hepatic encephalopathy, cardiac anomaly, sickle cell disease, and related hematologic anomalies, and autoimmune disorders such as lupus, erythematosis, or celiac disease;
(m)
congenital genetic or metabolic disorders known to be associated with cerebral dysfunction, such as phenylketonuria, craniofacial syndromes, or congenital hydrocephalus;
(o)
a condition presenting in a manner making it difficult for a clinician to distinguish between:
ii.
a major depressive disorder when adequate treatment for major depressive disorder has not resulted in improvement in neurocognitive function, or another disorder such as autism, selective mutism, anxiety disorder, or reactive attachment disorder.
B.
Neuropsychological testing must be administered or clinically supervised by a neuropsychologist qualified as defined in subpart 2, item D.
Subp. 4.
Psychological testing.
Psychological testing must meet the following requirements:
A.
The psychological testing must:
(1)
be administered or clinically supervised by a licensed psychologist with competence in the area of psychological testing as stated to the Minnesota Board of Psychology; and
(2)
be validated in a face-to-face interview between the client and a licensed psychologist or a mental health practitioner working as a clinical psychology trainee as required by part 9505.0371, subpart 5, item C, under the clinical supervision of a licensed psychologist according to part 9505.0371, subpart 5, item A, subitem (2).
B.
The administration, scoring, and interpretation of the psychological tests must be done under the clinical supervision of a licensed psychologist when performed by a technician, psychometrist, or psychological assistant or as part of a computer-assisted psychological testing program.
Subp. 5.
Explanations of findings.
To be eligible for medical assistance payment, the mental health professional providing the explanation of findings must obtain the authorization of the client or the client's representative to release the information as required in part 9505.0371, subpart 6. Explanation of findings is provided to the client, client's family, and caregivers, or to other providers to help them understand the results of the testing or diagnostic assessment, better understand the client's illness, and provide professional insight needed to carry out a plan of treatment. An explanation of findings is not paid separately when the results of psychological testing or a diagnostic assessment are explained to the client or the client's representative as part of the psychological testing or a diagnostic assessment.
Subp. 6.
Psychotherapy.
Medical assistance covers psychotherapy as conducted by a mental health professional or a mental health practitioner as defined in part 9505.0371, subpart 5, item C, as provided in this subpart.
B.
Family psychotherapy is designed for the client and one or more family members or the client's primary caregiver whose participation is necessary to accomplish the client's treatment goals. Family members or primary caregivers participating in a therapy session do not need to be eligible for medical assistance. For purposes of this subpart, the phrase "whose participation is necessary to accomplish the client's treatment goals" does not include shift or facility staff members at the client's residence. Medical assistance payment for family psychotherapy is limited to face-to-face sessions at which the client is present throughout the family psychotherapy session unless the mental health professional believes the client's absence from the family psychotherapy session is necessary to carry out the client's individual treatment plan. If the client is excluded, the mental health professional must document the reason for and the length of time of the exclusion. The mental health professional must also document the reason or reasons why a member of the client's family is excluded.
C.
Group psychotherapy is appropriate for individuals who because of the nature of their emotional, behavioral, or social dysfunctions can derive mutual benefit from treatment in a group setting. For a group of three to eight persons, one mental health professional or practitioner is required to conduct the group. For a group of nine to 12 persons, a team of at least two mental health professionals or two mental health practitioners or one mental health professional and one mental health practitioner is required to co-conduct the group. Medical assistance payment is limited to a group of no more than 12 persons.
D.
A multiple-family group psychotherapy session is eligible for medical assistance payment if the psychotherapy session is designed for at least two but not more than five families. Multiple-family group psychotherapy is clearly directed toward meeting the identified treatment needs of each client as indicated in client's treatment plan. If the client is excluded, the mental health professional or practitioner must document the reason for and the length of the time of the exclusion. The mental health professional or practitioner must document the reasons why a member of the client's family is excluded.
Subp. 7.
Medication management.
The determination or evaluation of the effectiveness of a client's prescribed drug must be carried out by a physician or by an advanced practice registered nurse, as defined in Minnesota Statutes, sections 148.171 to 148.285, who is qualified in psychiatric nursing.
Subp. 8.
Adult day treatment.
Adult day treatment payment limitations include the following conditions.
A.
Adult day treatment must consist of at least one hour of group psychotherapy, and must include group time focused on rehabilitative interventions, or other therapeutic services that are provided by a multidisciplinary staff. Adult day treatment is an intensive psychotherapeutic treatment. The services must stabilize the client's mental health status, and develop and improve the client's independent living and socialization skills. The goal of adult day treatment is to reduce or relieve the effects of mental illness so that an individual is able to benefit from a lower level of care and to enable the client to live and function more independently in the community. Day treatment services are not a part of inpatient or residential treatment services.
B.
To be eligible for medical assistance payment, a day treatment program must:
(2)
be provided to a group of clients by a multidisciplinary staff under the clinical supervision of a mental health professional;
(3)
be available to the client at least two days a week for at least three consecutive hours per day. The day treatment may be longer than three hours per day, but medical assistance must not reimburse a provider for more than 15 hours per week;
(4)
include group psychotherapy done by a mental health professional, or mental health practitioner qualified according to part 9505.0371, subpart 5, item C, and rehabilitative interventions done by a mental health professional or mental health practitioner daily;
(5)
be included in the client's individual treatment plan as necessary and appropriate. The individual treatment plan must include attainable, measurable goals as they relate to services and must be completed before the first day treatment session. The vendor must review the recipient's progress and update the treatment plan at least every 30 days until the client is discharged and include an available discharge plan for the client in the treatment plan; and
C.
To be eligible for adult day treatment, a recipient must:
(2)
not be residing in a nursing facility, hospital, institute of mental disease, or regional treatment center, unless the recipient has an active discharge plan that indicates a move to an independent living arrangement within 180 days;
(4)
have the capacity to engage in the rehabilitative nature, the structured setting, and the therapeutic parts of psychotherapy and skills activities of a day treatment program and demonstrate measurable improvements in the recipient's functioning related to the recipient's mental illness that would result from participating in the day treatment program;
(5)
have at least three areas of functional impairment as determined by a functional assessment with the domains prescribed by Minnesota Statutes, section 245.462, subdivision 11a;
(6)
have a level of care determination that supports the need for the level of intensity and duration of a day treatment program; and
(7)
be determined to need day treatment by a mental health professional who must deem the day treatment services medically necessary.
D.
The following services are not covered by medical assistance if they are provided by a day treatment program:
(1)
a service that is primarily recreation-oriented or that is provided in a setting that is not medically supervised. This includes: sports activities, exercise groups, craft hours, leisure time, social hours, meal or snack time, trips to community activities, and tours;
(2)
a social or educational service that does not have or cannot reasonably be expected to have a therapeutic outcome related to the client's mental illness;
(3)
consultation with other providers or service agency staff about the care or progress of a client;
(8)
participation in meal preparation and eating that is not part of a clinical treatment plan to address the client's eating disorder.
Subp. 9.
Partial hospitalization.
Partial hospitalization is a covered service when it is an appropriate alternative to inpatient hospitalization for a client who is experiencing an acute episode of mental illness that meets the criteria for an inpatient hospital admission as specified in part 9505.0520, subpart 1, and who has the family and community resources necessary and appropriate to support the client's residence in the community. Partial hospitalization consists of multiple intensive short-term therapeutic services provided by a multidisciplinary staff to treat the client's mental illness.
Subp. 10.
Dialectical behavior therapy (DBT).
Dialectical behavior therapy (DBT) treatment services must meet the following criteria:
A.
DBT must be provided according to this subpart and Minnesota Statutes, section 256B.0625, subdivision 5l.
B.
DBT is an outpatient service that is determined to be medically necessary by either: (1) a mental health professional qualified according to part 9505.0371, subpart 5, or (2) a mental health practitioner working as a clinical trainee according to part 9505.0371, subpart 5, item C, who is under the clinical supervision of a mental health professional according to part 9505.0371, subpart 5, item D, with specialized skill in dialectical behavior therapy. The treatment recommendation must be based upon a comprehensive evaluation that includes a diagnostic assessment and functional assessment of the client, and review of the client's prior treatment history. Treatment services must be provided pursuant to the client's individual treatment plan and provided to a client who satisfies the criteria in item C.
C.
To be eligible for DBT, a client must:
(1)
have mental health needs that cannot be met with other available community-based services or that must be provided concurrently with other community-based services;
(2)
meet one of the following criteria:
(b)
have multiple mental health diagnoses and exhibit behaviors characterized by impulsivity, intentional self-harm behavior, and be at significant risk of death, morbidity, disability, or severe dysfunction across multiple life areas;
(3)
understand and be cognitively capable of participating in DBT as an intensive therapy program and be able and willing to follow program policies and rules ensuring safety of self and others; and
D.
The treatment components of DBT are individual therapy and group skills as follows:
(1)
Individual DBT combines individualized rehabilitative and psychotherapeutic interventions to treat suicidal and other dysfunctional behaviors and reinforce the use of adaptive skillful behaviors. The therapist must:
(c)
generalize DBT skills to the client's natural environment through telephone coaching outside of the treatment session;
(f)
help the client learn and apply effective behaviors when working with other treatment providers.
(2)
Individual DBT therapy is provided by a mental health professional or a mental health practitioner working as a clinical trainee, according to part 9505.0371, subpart 5, item C, under the supervision of a licensed mental health professional according to part 9505.0371, subpart 5, item D.
(3)
Group DBT skills training combines individualized psychotherapeutic and psychiatric rehabilitative interventions conducted in a group format to reduce the client's suicidal and other dysfunctional coping behaviors and restore function by teaching the client adaptive skills in the following areas:
(4)
Group DBT skills training is provided by two mental health professionals, or by a mental health professional cofacilitating with a mental health practitioner.
(5)
The need for individual DBT skills training must be determined by a mental health professional or a mental health practitioner working as a clinical trainee, according to part 9505.0371, subpart 5, item C, under the supervision of a licensed mental health professional according to part 9505.0371, subpart 5, item D.
E.
A program must be certified by the commissioner as a DBT provider. To qualify for certification, a provider must:
(1)
hold current accreditation as a DBT program from a nationally recognized certification body approved by the commissioner or submit to the commissioner's inspection and provide evidence that the DBT program's policies, procedures, and practices will continuously meet the requirements of this subpart;
(4)
have a manual that outlines the DBT program's policies, procedures, and practices which meet the requirements of this subpart.
F.
The DBT treatment team must consist of persons who are trained in DBT treatment. The DBT treatment team may include persons from more than one agency. Professional and clinical affiliations with the DBT team must be delineated:
(1)
A DBT team leader must:
(a)
be a mental health professional employed by, affiliated with, or contracted by a DBT program certified by the commissioner;
(c)
have knowledge of and ability to apply the principles and DBT practices that are consistent with evidence-based practices.
(2)
DBT team members who provide individual DBT or group skills training must:
(a)
be a mental health professional or be a mental health practitioner, who is employed by, affiliated with, or contracted with a DBT program certified by the commissioner;
(b)
have or obtain appropriate competencies and working knowledge of DBT principles and practices within the first six months of becoming a part of the DBT program;
(c)
have or obtain knowledge of and ability to apply the principles and practices of DBT consistently with evidence-based practices within the first six months of working at the DBT program;
(e)
require mental health practitioners to have ongoing clinical supervision by a mental health professional who has appropriate competencies and working knowledge of DBT principles and practices.
Subp. 11.
Noncovered services.
The mental health services in items A to J are not eligible for medical assistance payment under this part:
B.
a neuropsychological assessment carried out by a person other than a neuropsychologist who is qualified according to part 9505.0372, subpart 2, item D;
C.
a service ordered by a court that is solely for legal purposes and not related to the recipient's diagnosis or treatment for mental illness;
D.
services dealing with external, social, or environmental factors that do not directly address the recipient's physical or mental health;
E.
a service that is only for a vocational purpose or an educational purpose that is not mental health related;
9520.0010 STATUTORY AUTHORITY AND PURPOSE.
Parts 9520.0010 to 9520.0230 provide methods and procedures relating to the establishment and operation of area-wide, comprehensive, community-based mental health, developmental disability, and chemical dependency programs under state grant-in-aid as provided under Minnesota Statutes, sections 245.61 to 245.69. Minnesota Statutes, sections 245.61 to 245.69 are entitled The Community Mental Health Services Act. For purposes of these parts, "community mental health services" includes services to persons who have mental or emotional disorders or other psychiatric disabilities, developmental disabilities, and chemical dependency, including drug abuse and alcoholism.
9520.0020 BOARD DUTIES.
The community mental health board has the responsibility for ensuring the planning, development, implementation, coordination, and evaluation of the community comprehensive mental health program for the mentally ill/behaviorally disabled, developmentally disabled, and chemically dependent populations in the geographic area it serves. It also has the responsibility for ensuring delivery of services designated by statute.
9520.0030 DEFINITIONS.
Parts 9520.0040 and 9520.0050 also set forth definitions of community mental health centers and community mental health clinics.
9520.0040 COMMUNITY MENTAL HEALTH CENTER.
A community mental health center means an agency which includes all of the following:
B.
Provides as a minimum the following services for individuals with mental or emotional disorders, developmental disabilities, alcoholism, drug abuse, and other psychiatric conditions. The extent of each service to be provided by the center shall be indicated in the program plan, which is to reflect the problems, needs, and resources of the community served:
(1)
collaborative and cooperative services with public health and other groups for programs of prevention of mental illness, developmental disability, alcoholism, drug abuse, and other psychiatric disorders;
(2)
informational and educational services to schools, courts, health and welfare agencies, both public and private;
(4)
consultative services to schools, courts, and health and welfare agencies, both public and private;
(6)
rehabilitative services, particularly for those who have received prior treatment in an inpatient facility.
C.
Provides or contracts for detoxification, evaluation, and referral for chemical dependency services (Minnesota Statutes, section 254A.08).
D.
Provides specific coordination for mentally ill/behaviorally disabled, developmental disability, and chemical dependency programs. (Minnesota Statutes, sections 254A.07 and 245.61).
E.
Has a competent multidisciplinary mental health/developmental disability/chemical dependency professional team whose members meet the professional standards in their respective fields.
F.
The professional mental health team is qualified by specific mental health training and experience and shall include as a minimum the services of each of the following:
(2)
a doctoral clinical, counseling, or health care psychologist, who is licensed under Minnesota Statutes, sections 148.88 to 148.98; and one or both of the following:
(3)
a clinical social worker with a master's degree in social work from an accredited college or university; and/or
(4)
a clinical psychiatric nurse with a master's degree from an accredited college or university and is registered under Minnesota Statutes, section 148.171. The master's degree shall be in psychiatric nursing or a related psychiatric nursing program such as public health nursing with mental health major, maternal and child health with mental health major, etc.
G.
The multidisciplinary staff shall be sufficient in number to implement and operate the described program of the center. In addition to the above, this team should include other professionals, paraprofessionals, and disciplines, particularly in the preventive and rehabilitative components of the program, subject to review and approval of job descriptions and qualifications by the commissioner. If any of the minimum required professional staff are not immediately available, the commissioner may approve and make grants for the operation of the center, provided that the board and director can show evidence acceptable to the commissioner that they are making sincere, reasonable, and ongoing efforts to acquire such staff and show evidence of how the specialized functions of the required professionals are being met. The services being rendered by employed personnel shall be consistent with their professional discipline.
9520.0050 COMMUNITY MENTAL HEALTH CLINIC.
Subpart 1.
Definitions.
A community mental health clinic is an agency which devotes, as its major service, at least two-thirds of its resources for outpatient mental health diagnosis, treatment, and consultation by a multidisciplinary professional mental health team. The multidisciplinary professional mental health team is qualified by special mental health training and experience and shall include as a minimum the services of each of the following:
B.
a doctoral clinical, or counseling or health care psychologist who is licensed under Minnesota Statutes, sections 148.88 to 148.98; and one or both of the following:
C.
a clinical social worker with a master's degree in social work from an accredited college or university; and/or
D.
a clinical psychiatric nurse with a master's degree from an accredited college or university and is registered under Minnesota Statutes, section 148.171. The master's degree shall be in psychiatric nursing or a related psychiatric nursing program such as public health with a mental health major, maternal and child health with a mental health major.
Subp. 2.
Other members of multidisciplinary team.
The multidisciplinary team shall be sufficient in number to implement and operate the described program of the clinic. In addition to the above, this team should include other professionals, paraprofessionals and disciplines, particularly in the preventive and rehabilitative components of the program, subject to review and approval of job descriptions and qualifications by the commissioner.
Subp. 3.
Efforts to acquire staff.
If any of the minimum required professional staff are not immediately available, the commissioner may approve and make grants for the operation of the clinic, provided that the board and director can show evidence acceptable to the commissioner that they are making sincere, reasonable, and ongoing efforts to acquire such staff and evidence of how the specialized functions of the required professional positions are being met. The services being rendered by employed personnel shall be consistent with their professional discipline.
9520.0060 ANNUAL PLAN AND BUDGET.
On or before the date designated by the commissioner, each year the chair of the community mental health board or director of the community mental health program, provided for in Minnesota Statutes, section 245.62, shall submit an annual plan identifying program priorities in accordance with state grant-in-aid guidelines, and a budget on prescribed report forms for the next state fiscal year, together with the recommendations of the community mental health board, to the commissioner of human services for approval as provided under Minnesota Statutes, section 245.63.
9520.0070 FISCAL AFFILIATES.
Other providers of community mental health services may affiliate with the community mental health center and may be approved and eligible for state grant-in-aid funds. The state funding for other community mental health services shall be contingent upon appropriate inclusion in the center's community mental health plan for the continuum of community mental health services and conformity with the state's appropriate disability plan for mental health, developmental disability, or chemical dependency. Fiscal affiliates (funded contracting agencies) providing specialized services under contract must meet all rules and standards that apply to the services they are providing.
9520.0080 OTHER REQUIRED REPORTS.
The program director of the community mental health program shall provide the commissioner of human services with such reports of program activities as the commissioner may require.
9520.0090 FUNDING.
All state community mental health funding shall go directly to the community mental health board or to a human service board established pursuant to Laws of Minnesota 1975, chapter 402, which itself provides or contracts with another agency to provide the community mental health program. Such programs must meet the standards and rules for community mental health programs as enunciated in parts 9520.0010 to 9520.0230 in accordance with Laws of Minnesota 1975, chapter 402.
9520.0100 OPERATION OF OTHER PROGRAMS.
When the governing authority of the community mental health program operates other programs, services, or activities, only the community mental health center program shall be subject to these parts.
9520.0110 APPLICATIONS AND AGREEMENTS BY LOCAL COUNTIES.
New applications for state assistance or applications for renewal of support must be accompanied by an agreement executed by designated signatories on behalf of the participating counties that specifies the involved counties, the amount and source of local funds in each case, and the period of support. The local funds to be used to match state grant-in-aid must be assured in writing on Department of Human Services forms by the local funding authority(ies).
9520.0120 USE OF MATCHING FUNDS.
Funds utilized by the director as authorized by the community mental health board to match a state grant-in-aid must be available to that director for expenditures for the same general purpose as the state grant-in-aid funds.
9520.0130 QUARTERLY REPORTS.
The director of the community mental health program shall, within 20 days after the end of the quarter, submit quarterly prescribed reports to the commissioner of human services (controller's office), containing all receipts, expenditures, and cash balance, subject to an annual audit by the commissioner or his/her designee.
9520.0140 PAYMENTS.
Payments on approved grants will be made subsequent to the department's receipt of the program's quarterly reporting forms, unless the commissioner of human services has determined that funds allocated to a program are not needed for that program. Payments shall be in an amount of at least equal to the quarterly allocation minus any unexpended balance from the previous quarter providing this payment does not exceed the program grant award. In the event the program does not report within the prescribed time, the department will withhold the process of the program's payment until the next quarterly cycle.
9520.0150 FEES.
No fees shall be charged until the director with approval of the community mental health board has established fee schedules for the services rendered and they have been submitted to the commissioner of human services at least two months prior to the effective date thereof and have been approved by him/her. All fees shall conform to the approved schedules, which are accessible to the public.
9520.0160 SUPPLEMENTAL AWARDS.
The commissioner of human services may make supplemental awards to the community mental health boards.
9520.0170 WITHDRAWAL OF FUNDS.
The commissioner of human services may withdraw funds from any program that is not administered in accordance with its approved plan and budget. Written notice of such intended action will be provided to the director and community mental health board. Opportunity for hearing before the commissioner or his/her designee shall be provided.
9520.0180 BUDGET TRANSFERS.
Community mental health boards may make budget transfers within specified limits during any fiscal year without prior approval of the department. The specified limit which can be transferred in any fiscal year between program activity budgets shall be up to ten percent or up to $5,000 whichever is less. Transfers within an activity can be made into or out of line items with a specified limit of up to ten percent or up to $5,000 whichever is less. No line item can be increased or decreased by more than $5,000 or ten percent in a fiscal year without prior approval of the commissioner. Transfers above the specified limits can be made with prior approval from the commissioner. All transfers within and into program budget activities and/or line items must have prior approval by the community mental health board and this approval must be reflected in the minutes of its meeting, it must be reported to the commissioner with the reasons therefor, including a statement of how the transfer will affect program objectives.
9520.0190 BUDGET ADJUSTMENTS.
Budget adjustments made necessary by funding limitations shall be made by the commissioner and provided in writing to the director and board of the community mental health center.
9520.0200 CENTER DIRECTOR.
Every community mental health board receiving state funds for a community mental health program shall have a center director, who is the full-time qualified professional staff member who serves as the executive officer. To be considered qualified, the individual must have professional training to at least the level of graduate degree in his/her clinical and/or administrative discipline, which is relevant to MH-DD-CD and a minimum of two years experience in community mental health programs. The center director is responsible for the planning/design, development, coordination, and evaluation of a comprehensive, area-wide program and for the overall administration of services operated by the board.
The center director shall be appointed by the community mental health board and shall be approved by the commissioner of human services.
9520.0210 DEADLINE FOR APPROVAL OR DENIAL OF REQUEST FOR APPROVAL STATUS.
The commissioner shall approve or deny, in whole or in part, an application for state financial assistance within 90 days of receipt of the grant-in-aid application or by the beginning of the state fiscal year, whichever is the later.
9520.0230 ADVISORY COMMITTEE.
Subpart 1.
Purpose.
To assist the community mental health board in meeting its responsibilities as described in Minnesota Statutes, section 245.68 and to provide opportunity for broad community representation necessary for effective comprehensive mental health, developmental disability, and chemical dependency program planning, each community mental health board shall appoint a separate advisory committee in at least the three disability areas of mental health, developmental disability, and chemical dependency.
Subp. 2.
Membership.
The advisory committees shall consist of residents of the geographic area served who are interested and knowledgeable in the area governed by such committee.
Subp. 3.
Nominations for membership.
Nominations for appointments as members of the advisory committees are to be made to the community mental health board from agencies, organizations, groups, and individuals within the area served by the community mental health center. Appointments to the advisory committees are made by the community mental health board.
Subp. 4.
Board member on committee.
One community mental health board member shall serve on each advisory committee.
Subp. 5.
Nonprovider members.
Each advisory committee shall have at least one-half of its membership composed of individuals who are not providers of services to the three disability groups.
Subp. 6.
Representative membership.
Membership of each advisory committee shall generally reflect the population distribution of the service delivery area of the community mental health center.
Subp. 7.
Chairperson appointed.
The community mental health board shall appoint a chairperson for each advisory committee. The chairperson shall not be a community mental health board member nor a staff member. The power to appoint the chairperson may be delegated by the community mental health board to the individual advisory committee.
Subp. 8.
Committee responsibility to board.
Each advisory committee shall be directly responsible to the community mental health board. Direct communication shall be effected and maintained through contact between the chairperson of the particular advisory committee, or his/her designee, and the chairperson of the community mental health board, or his/her designee.
Subp. 9.
Staff.
Staff shall be assigned by the director to serve the staffing needs of each advisory committee.
Subp. 10.
Study groups and task forces.
Each advisory committee may appoint study groups and task forces upon consultation with the community mental health board. It is strongly recommended that specific attention be given to the aging and children and youth populations.
Subp. 12.
Annual report required.
Each advisory committee must make a formal written and oral report on its work to the community mental health board at least annually.
Subp. 13.
Minutes.
Each advisory committee shall submit copies of minutes of their meetings to the community mental health board and to the Department of Human Services (respective disability group program divisions).
Subp. 14.
Duties of advisory committee.
The advisory committees shall be charged by the community mental health board with assisting in the identification of the community's needs for mentally ill/behaviorally disabled, developmental disability, and chemical dependency programs. The advisory committee also assists the community mental health board in determining priorities for the community programs. Based on the priorities, each advisory committee shall recommend to the community mental health board ways in which the limited available community resources (work force, facilities, and finances) can be put to maximum and optimal use.
Subp. 15.
Recommendations.
The advisory committee recommendations made to the community mental health board shall be included as a separate section in the grant-in-aid request submitted to the Department of Human Services by the community mental health board.
Subp. 16.
Assessment of programs.
The advisory committees shall assist the community mental health board in assessing the programs carried on by the community mental health board, and make recommendations regarding the reordering of priorities and modifying of programs where necessary.
9520.0750 PURPOSE.
Parts 9520.0750 to 9520.0870 establish standards for approval of mental health centers and mental health clinics for purposes of insurance and subscriber contract reimbursement under Minnesota Statutes, section 62A.152.
9520.0760 DEFINITIONS.
Subpart 1.
Scope.
As used in parts 9520.0760 to 9520.0870, the following terms have the meanings given them.
Subp. 2.
Application.
"Application" means the formal statement by a center to the commissioner, on the forms created for this purpose, requesting recognition as meeting the requirements of Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870.
Subp. 3.
Approval.
"Approval" means the determination by the commissioner that the applicant center has met the minimum standards of Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870, and is therefore eligible to claim reimbursement for outpatient clinical services under the terms of Minnesota Statutes, section 62A.152. Approval of a center under these parts does not mean approval of a multidisciplinary staff person of such center to claim reimbursement from medical assistance or other third-party payors when practicing privately. Approval of a center under these parts does not mean approval of such center to claim reimbursement from medical assistance.
Subp. 4.
Case review.
"Case review" means a consultation process thoroughly examining a client's condition and treatment. It includes review of the client's reason for seeking treatment, diagnosis and assessment, and the individual treatment plan; review of the appropriateness, duration, and outcome of treatment provided; and treatment recommendations.
Subp. 5.
Center.
"Center" means a public or private health and human services facility which provides clinical services in the treatment of mental illness. It is an abbreviated term used in place of "mental health center" or "mental health clinic" throughout parts 9520.0750 to 9520.0870.
Subp. 6.
Client.
"Client" means a person accepted by the center to receive clinical services in the diagnosis and treatment of mental illness.
Subp. 7.
Clinical services.
"Clinical services" means services provided to a client to diagnose, describe, predict, and explain that client's status relative to a disabling condition or problem, and where necessary, to treat the client to reduce impairment due to that condition. Clinical services also include individual treatment planning, case review, record keeping required for treatment, peer review, and supervision.
Subp. 8.
Commissioner.
"Commissioner" means the commissioner of the Minnesota Department of Human Services or a designated representative.
Subp. 9.
Competent.
"Competent" means having sufficient knowledge of and proficiency in a specific mental illness assessment or treatment service, technique, method, or procedure, documented by experience, education, training, and certification, to be able to provide it to a client with little or no supervision.
Subp. 10.
Consultation.
"Consultation" means the process of deliberating or conferring between multidisciplinary staff regarding a client and the client's treatment.
Subp. 11.
Deferral.
"Deferral" means the determination by the commissioner that the applicant center does not meet the minimum standards of Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870 and is not approved, but is granted a period of time to comply with these standards and receive a second review without reapplication.
Subp. 13.
Disapproval or withdrawal of approval.
"Disapproval" or "withdrawal of approval" means a determination by the commissioner that the applicant center does not meet the minimum standards of Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870.
Subp. 14.
Discipline.
"Discipline" means a branch of professional knowledge or skill acquired through a specific course of study and training and usually documented by a specific educational degree or certification of proficiency. Examples of the mental health disciplines include but are not limited to psychiatry, psychology, clinical social work, and psychiatric nursing.
Subp. 15.
Documentation.
"Documentation" means the automatically or manually produced and maintained evidence that can be read by person or machine, and that will attest to the compliance with requirements of Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870.
Subp. 16.
Individual treatment plan.
"Individual treatment plan" means a written plan of intervention and treatment developed on the basis of assessment results for a specific client, and updated as necessary. The plan specifies the goals and objectives in measurable terms, states the treatment strategy, and identifies responsibilities of multidisciplinary staff.
Subp. 17.
Mental health practitioner.
"Mental health practitioner" means a staff person providing clinical services in the treatment of mental illness who is qualified in at least one of the following ways:
A.
by having a bachelor's degree in one of the behavioral sciences or related fields from an accredited college or university and 2,000 hours of supervised experience in the delivery of clinical services in the treatment of mental illness;
B.
by having 6,000 hours of supervised experience in the delivery of clinical services in the treatment of mental illness;
C.
by being a graduate student in one of the behavioral sciences or related fields formally assigned to the center for clinical training by an accredited college or university; or
D.
by having a master's or other graduate degree in one of the behavioral sciences or related fields from an accredited college or university.
Documentation of compliance with part 9520.0800, subpart 4, item B is required for designation of work as supervised experience in the delivery of clinical services. Documentation of the accreditation of a college or university shall be a listing in Accredited Institutions of Postsecondary Education Programs, Candidates for the year the degree was issued. The master's degree in behavioral sciences or related fields shall include a minimum of 28 semester hours of graduate course credit in mental health theory and supervised clinical training, as documented by an official transcript.
Subp. 18.
Mental health professional.
"Mental health professional" has the meaning given in Minnesota Statutes, section 245.462, subdivision 18.
Subp. 19.
Mental illness.
"Mental illness" means a condition which results in an inability to interpret the environment realistically and in impaired functioning in primary aspects of daily living such as personal relations, living arrangements, work, and recreation, and which is listed in the clinical manual of the International Classification of Diseases (ICD-9-CM), Ninth Revision (1980), code range 290.0-302.99 or 306.0-316, or the corresponding code in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III), Third Edition (1980), Axes I, II or III. These publications are available from the State Law Library.
Subp. 20.
Multidisciplinary staff.
"Multidisciplinary staff" means the mental health professionals and mental health practitioners employed by or under contract to the center to provide outpatient clinical services in the treatment of mental illness.
Subp. 21.
Serious violations of policies and procedures.
"Serious violations of policies and procedures" means a violation which threatens the health, safety, or rights of clients or center staff; the repeated nonadherence to center policies and procedures; and the nonadherence to center policies and procedures which result in noncompliance with Minnesota Statutes, section 245.69, subdivision 2 and parts 9520.0760 to 9520.0870.
Subp. 22.
Treatment strategy.
"Treatment strategy" means the particular form of service delivery or intervention which specifically addresses the client's characteristics and mental illness, and describes the process for achievement of individual treatment plan goals.
9520.0770 ORGANIZATIONAL STRUCTURE OF CENTER.
Subpart 1.
Basic unit.
The center or the facility of which it is a unit shall be legally constituted as a partnership, corporation, or government agency. The center shall be either the entire facility or a clearly identified unit within the facility which is administratively and clinically separate from the rest of the facility. All business shall be conducted in the name of the center or facility, except medical assistance billing by individually enrolled providers when the center is not enrolled.
Subp. 2.
Purpose, services.
The center shall document that the prevention, diagnosis, and treatment of mental illness are the main purposes of the center. If the center is a unit within a facility, the rest of the facility shall not provide clinical services in the outpatient treatment of mental illness. The facility may provide services other than clinical services in the treatment of mental illness, including medical services, chemical dependency services, social services, training, and education. The provision of these additional services is not reviewed in granting approval to the center under parts 9520.0760 to 9520.0870.
Subp. 3.
Governing body.
The center shall have a governing body. The governing body shall provide written documentation of its source of authority. The governing body shall be legally responsible for the implementation of the standards set forth in Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870 through the establishment of written policy and procedures.
Subp. 4.
Chart or statement of organization.
The center shall have an organizational chart or statement which specifies the relationships among the governing body, any administrative and support staff, mental health professional staff, and mental health practitioner staff; their respective areas of responsibility; the lines of authority involved; the formal liaison between administrative and clinical staff; and the relationship of the center to the rest of the facility and any additional services provided.
9520.0780 SECONDARY LOCATIONS.
Subpart 1.
Main and satellite offices.
The center shall notify the commissioner of all center locations. If there is more than one center location, the center shall designate one as the main office and all secondary locations as satellite offices. The main office as a unit and the center as a whole shall be in compliance with part 9520.0810. The main office shall function as the center records and documentation storage area and house most administrative functions for the center. Each satellite office shall:
E.
ensure that a mental health professional is at the satellite office and competent to supervise and intervene in the clinical services provided there, whenever the satellite office is open;
F.
ensure that its multidisciplinary staff have access to and interact with main center staff for consultation, supervision, and peer review; and
G.
ensure that clients have access to all clinical services provided in the treatment of mental illness and the multidisciplinary staff of the center.
Subp. 2.
Noncompliance.
If the commissioner determines that a secondary location is not in compliance with subpart 1, it is not a satellite office. Outpatient clinical services in the treatment of mental illness delivered by the center or facility of which it is a unit shall cease at that location, or the application shall be disapproved.
9520.0790 MINIMUM TREATMENT STANDARDS.
Subpart 1.
Multidisciplinary approach.
The center shall document that services are provided in a multidisciplinary manner. That documentation shall include evidence that staff interact in providing clinical services, that the services provided to a client involve all needed disciplines represented on the center staff, and that staff participate in case review and consultation procedures as described in subpart 6.
Subp. 2.
Intake and case assignment.
The center shall establish an intake or admission procedure which outlines the intake process, including the determination of the appropriateness of accepting a person as a client by reviewing the client's condition and need for treatment, the clinical services offered by the center, and other available resources. The center shall document that case assignment for assessment, diagnosis, and treatment is made to a multidisciplinary staff person who is competent in the service, in the recommended treatment strategy and in treating the individual client characteristics. Responsibility for each case shall remain with a mental health professional.
Subp. 3.
Assessment and diagnostic process.
The center shall establish an assessment and diagnostic process that determines the client's condition and need for clinical services. The assessment of each client shall include clinical consideration of the client's general physical, medical, developmental, family, social, psychiatric, and psychological history and current condition. The diagnostic statement shall include the diagnosis based on the codes in the International Classification of Diseases or the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders and refer to the pertinent assessment data. The diagnosis shall be by or under the supervision of and signed by a psychiatrist or licensed psychologist. The diagnostic assessment, as defined by Minnesota Statutes, sections 245.462, subdivision 9, for adults, and 245.4871, subdivision 11, for children, must be provided by a licensed mental health professional in accordance with Minnesota Statutes, section 245.467, subdivision 2.
Subp. 4.
Treatment planning.
The individual treatment plan, based upon a diagnostic assessment of mental illness, shall be jointly developed by the client and the mental health professional. This planning procedure shall ensure that the client has been informed in the following areas: assessment of the client condition; treatment alternatives; possible outcomes and side effects of treatment; treatment recommendations; approximate length, cost, and hoped-for outcome of treatment; the client's rights and responsibilities in implementation of the individual treatment plan; staff rights and responsibilities in the treatment process; the Government Data Practices Act; and procedures for reporting grievances and alleged violation of client rights. If the client is considering chemotherapy, hospitalization, or other medical treatment, the appropriate medical staff person shall inform the client of the treatment alternatives, the effects of the medical procedures, and possible side effects. Clinical services shall be appropriate to the condition, age, sex, socioeconomic, and ethnic background of the client, and provided in the least restrictive manner. Clinical services shall be provided according to the individual treatment plan and existing professional codes of ethics.
Subp. 5.
Client record.
The center shall maintain a client record for each client. The record must document the assessment process, the development and updating of the treatment plan, the treatment provided and observed client behaviors and response to treatment, and serve as data for the review and evaluation of the treatment provided to a client. The record shall include:
G.
when necessary, the client's authorization to release private information, and client information obtained from outside sources;
H.
at the closing of the case, a statement of the reason for termination, current client condition, and the treatment outcome; and
Subp. 6.
Consultation; case review.
The center shall establish standards for case review and encourage the ongoing consultation among multidisciplinary staff. The multidisciplinary staff shall attend staff meetings at least twice monthly for a minimum of four hours per month, or a minimum of two hours per month if the multidisciplinary staff person provides clinical services in the treatment of mental illness less than 15 hours per week. The purpose of these meetings shall be case review and consultation. Written minutes of the meeting shall be maintained at the center for at least three years after the meeting.
Subp. 7.
Referrals.
If the necessary treatment or the treatment desired by the client is not available at the center, the center shall facilitate appropriate referrals. The multidisciplinary staff person shall discuss with the client the reason for the referral, potential treatment resources, and what the process will involve. The staff person shall assist in the process to ensure continuity of the planned treatment.
Subp. 8.
Emergency service.
The center shall ensure that clinical services to treat mental illness are available to clients on an emergency basis.
Subp. 9.
Access to hospital.
The center shall document that it has access to hospital admission for psychiatric inpatient care, and shall provide that access when needed by a client. This requirement for access does not require direct hospital admission privileges on the part of qualified multidisciplinary staff.
9520.0800 MINIMUM QUALITY ASSURANCE STANDARDS.
Subpart 1.
Policies and procedures.
The center shall develop written policies and procedures and shall document the implementation of these policies and procedures for each treatment standard and each quality assurance standard in subparts 2 to 7. The policies shall be approved by the governing body. The procedures shall indicate what actions or accomplishments are to be performed, who is responsible for each action, and any documentation or required forms. Multidisciplinary staff shall have access to a copy of the policies and procedures at all times.
Subp. 2.
Peer review.
The center shall have a multidisciplinary peer review system to assess the manner in which multidisciplinary staff provide clinical services in the treatment of mental illness. Peer review shall include the examination of clinical services to determine if the treatment provided was effective, necessary, and sufficient and of client records to determine if the recorded information is necessary and sufficient. The system shall ensure review of a randomly selected sample of five percent or six cases, whichever is less, of the annual caseload of each mental health professional by other mental health professional staff. Peer review findings shall be discussed with staff involved in the case and followed up by any necessary corrective action. Peer review records shall be maintained at the center.
Subp. 3.
Internal utilization review.
The center shall have a system of internal utilization review to examine the quality and efficiency of resource usage and clinical service delivery. The center shall develop and carry out a review procedure consistent with its size and organization which includes collection or review of information, analysis or interpretation of information, and application of findings to center operations. The review procedure shall minimally include, within any three year period of time, review of the appropriateness of intake, the provision of certain patterns of services, and the duration of treatment. Criteria may be established for treatment length and the provision of services for certain client conditions. Utilization review records shall be maintained, with an annual report to the governing body for applicability of findings to center operations.
Subp. 4.
Staff supervision.
Staff supervision:
A.
The center shall have a clinical evaluation and supervision procedure which identifies each multidisciplinary staff person's areas of competence and documents that each multidisciplinary staff person receives the guidance and support needed to provide clinical services for the treatment of mental illness in the areas they are permitted to practice.
B.
A mental health professional shall be responsible for the supervision of the mental health practitioner, including approval of the individual treatment plan and bimonthly case review of every client receiving clinical services from the practitioner. This supervision shall include a minimum of one hour of face-to-face, client-specific supervisory contact for each 40 hours of clinical services in the treatment of mental illness provided by the practitioner.
Subp. 5.
Continuing education.
The center shall require that each multidisciplinary staff person attend a minimum of 36 clock hours every two years of academic or practical course work and training. This education shall augment job-related knowledge, understanding, and skills to update or enhance staff competencies in the delivery of clinical services to treat mental illness. Continued licensure as a mental health professional may be substituted for the continuing education requirement of this subpart.
Subp. 6.
Violations of standards.
The center shall have procedures for the reporting and investigating of alleged unethical, illegal, or grossly negligent acts, and of the serious violation of written policies and procedures. The center shall document that the reported behaviors have been reviewed and that responsible disciplinary or corrective action has been taken if the behavior was substantiated. The procedures shall address both client and staff reporting of complaints or grievances regarding center procedures, staff, and services. Clients and staff shall be informed they may file the complaint with the department if it was not resolved to mutual satisfaction. The center shall have procedures for the reporting of suspected abuse or neglect of clients, in accordance with Minnesota Statutes, chapter 260E and sections 611A.32, subdivision 5, and 626.557.
Subp. 7.
Data classification.
Client information compiled by the center, including client records and minutes of case review and consultation meetings, shall be protected as private data under the Minnesota Government Data Practices Act.
9520.0810 MINIMUM STAFFING STANDARDS.
Subpart 1.
Required staff.
Required staff:
A.
The multidisciplinary staff of a center shall consist of at least four mental health professionals. At least two of the mental health professionals shall each be employed or under contract for a minimum of 35 hours a week by the center. Those two mental health professionals shall be of different disciplines.
C.
The mental health professional employed or under contract to the center to meet the requirement of item B shall be at the main office of the center and providing clinical services in the treatment of mental illness at least eight hours every two weeks.
Subp. 2.
Additional staff; staffing balance.
Additional mental health professional staff may be employed by or under contract to the center provided that no single mental health discipline or combination of allied fields shall comprise more than 60 percent of the full-time equivalent mental health professional staff. This provision does not apply to a center with fewer than six full-time equivalent mental health professional staff. Mental health practitioners may also be employed by or under contract to a center to provide clinical services for the treatment of mental illness in their documented area of competence. Mental health practitioners shall not comprise more than 25 percent of the full-time equivalent multidisciplinary staff. In determination of full-time equivalence, only time spent in clinical services for the treatment of mental illness shall be considered.
Subp. 3.
Multidisciplinary staff records.
The center shall maintain records sufficient to document that the center has determined and verified the clinical service qualifications of each multidisciplinary staff person, and sufficient to document each multidisciplinary staff person's terms of employment.
9520.0820 APPLICATION PROCEDURES.
Subpart 1.
Form.
A facility seeking approval as a center for insurance reimbursement of its outpatient clinical services in treatment of mental illness must make formal application to the commissioner for such approval. The application form for this purpose may be obtained from the Mental Illness Program Division of the department. The application form shall require only information which is required by statute or rule, and shall require the applicant center to explain and provide documentation of compliance with the minimum standards in Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870.
Subp. 2.
Fee.
Each application shall be accompanied by payment of the nonrefundable application fee. The fee shall be established and adjusted in accordance with Minnesota Statutes, section 16A.128 to cover the costs to the department in implementing Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870.
Subp. 3.
Completed application.
The application is considered complete on the date the application fee and all information required in the application form are received by the department.
9520.0830 REVIEW OF APPLICANT CENTERS.
Subpart 1.
Site visit.
The formal review shall begin after the completed application has been received, and shall include an examination of the written application and a visit to the center. The applicant center shall be offered a choice of site visit dates, with at least one date falling within 60 days of the date on which the department receives the complete application. The site visit shall include interviews with multidisciplinary staff and examination of a random sample of client records, consultation minutes, quality assurance reports, and multidisciplinary staff records.
Subp. 2.
Documentation.
If implementation of a procedure is too recent to be reliably documented, a written statement of the planned implementation shall be accepted as documentation on the initial application. The evidence of licensure or accreditation through another regulating body shall be accepted as documentation of a specific procedure when the required minimum standard of that body is the same or higher than a specific provision of parts 9520.0760 to 9520.0870.
9520.0840 DECISION ON APPLICATION.
Subpart 1.
Written report.
Upon completion of the site visit, a report shall be written. The report shall include a statement of findings, a recommendation to approve, defer, or disapprove the application, and the reasons for the recommendation.
Subp. 2.
Written notice to center.
The applicant center shall be sent written notice of approval, deferral, or disapproval within 30 days of the completion of the site visit. If the decision is a deferral or a disapproval, the notice shall indicate the specific areas of noncompliance.
Subp. 3.
Noncompliance with statutes and rules.
An application shall be disapproved or deferred if it is the initial application of a center, when the applicant center is not in compliance with Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870.
Subp. 4.
Deferral of application.
If an application is deferred, the length of deferral shall not exceed 180 days. If the areas of noncompliance stated in the deferral notice are not satisfactorily corrected by the end of the deferral period, the application shall be disapproved. The applicant center shall allow the commissioner to inspect the center at any time during the deferral period, whether or not the site visit has been announced in advance. A site visit shall occur only during normal working hours of the center and shall not disrupt the normal functioning of the center. At any time during the deferral period, the applicant center may submit documentation indicating correction of noncompliance. The application shall then be approved or disapproved. At any time during the deferral period, the applicant center may submit a written request to the commissioner to change the application status to disapproval. The request shall be complied with within 14 days of receiving this written request. The applicant center is not an approved center for purposes of Minnesota Statutes, section 62A.152 during a deferral period.
Subp. 5.
Effective date of decision.
The effective date of a decision is the date the commissioner signs a letter notifying the applicant center of that decision.
9520.0850 APPEALS.
If an application is disapproved or approval is withdrawn, a contested case hearing and judicial review as provided in Minnesota Statutes, sections 14.48 to 14.69, may be requested by the center within 30 days of the commissioner's decision.
9520.0860 POSTAPPROVAL REQUIREMENTS.
Subpart 1.
Duration of approval.
Initial approval of an application is valid for 12 months from the effective date, subsequent approvals for 24 months, except when approval is withdrawn according to the criteria in subpart 4.
Subp. 2.
Reapplication.
The center shall contact the department for reapplication forms, and submit the completed application at least 90 days prior to the expected expiration date. If an approved center has met the conditions of Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870, including reapplication when required, its status as an approved center shall remain in effect pending department processing of the reapplication.
Subp. 3.
Restrictions.
The approval is issued only for the center named in the application and is not transferable or assignable to another center. The approval is issued only for the center location named in the application and is not transferable or assignable to another location. If the commissioner is notified in writing at least 30 days in advance of a change in center location and can determine that compliance with all provisions of Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870 are maintained, the commissioner shall continue the approval of the center at the new location.
Subp. 4.
Noncompliance.
Changes in center organization, staffing, treatment, or quality assurance procedures that affect the ability of the center to comply with the minimum standards of Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870 shall be reported in writing by the center to the commissioner within 15 days of occurrence. Review of the change shall be conducted by the commissioner. A center with changes resulting in noncompliance in minimum standards shall receive written notice and may have up to 180 days to correct the areas of noncompliance before losing approval status. Interim procedures to resolve the noncompliance on a temporary basis shall be developed and submitted in writing to the commissioner for approval within 30 days of the commissioner's determination of the noncompliance. Nonreporting within 15 days of occurrence of a change that results in noncompliance, failure to develop an approved interim procedure within 30 days of the determination of the noncompliance, or nonresolution of the noncompliance within 180 days shall result in the immediate withdrawal of approval status.
Serious violation of policies or procedures, professional association or board sanctioning or loss of licensure for unethical practices, or the conviction of violating a state or federal statute shall be reported in writing by the center to the commissioner within ten days of the substantiation of such behavior. Review of this report and the action taken by the center shall be conducted by the commissioner. Approval shall be withdrawn immediately unless the commissioner determines that: the center acted with all proper haste and thoroughness in investigating the behavior, the center acted with all proper haste and thoroughness in taking appropriate disciplinary and corrective action, and that no member of the governing body was a party to the behavior. Failure to report such behavior within ten days of its substantiation shall result in immediate withdrawal of approval.
Subp. 5.
Compliance reports.
The center may be required to submit written information to the department during the approval period to document that the center has maintained compliance with the rule and center procedures. The center shall allow the commissioner to inspect the center at any time during the approval period, whether or not the site visit has been announced in advance. A site visit shall occur only during normal working hours of the center and shall not disrupt the normal functioning of the center.
9520.0870 VARIANCES.
Subpart 1.
When allowed.
The standards and procedures established by parts 9520.0760 to 9520.0860 may be varied by the commissioner. Standards and procedures established by statute shall not be varied.
Subp. 2.
Request procedure.
A request for a variance must be submitted in writing to the commissioner, accompanying or following the submission of a completed application for approval under Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870. The request shall state:
B.
the specific reasons why the standard or procedure cannot be or should not be complied with; and
C.
the equivalent standard or procedure the center will establish to achieve the intent of the standard or procedure to be varied.
Subp. 3.
Decision procedure.
Upon receiving the variance request, the commissioner shall consult with a panel of experts in the mental health disciplines regarding the request. Criteria for granting a variance shall be the commissioner's determination that subpart 2, items A to C are met. Hardship shall not be a sufficient reason to grant a variance. No variance shall be granted that would threaten the health, safety, or rights of clients. Variances granted by the commissioner shall specify in writing the alternative standards or procedures to be implemented and any specific conditions or limitations imposed on the variance by the commissioner. Variances denied by the commissioner shall specify in writing the reason for the denial.
Subp. 4.
Notification.
The commissioner shall send the center a written notice granting or not granting the variance within 90 days of receiving the written variance request. This notice shall not be construed as approval or disapproval of the center under Minnesota Statutes, section 245.69, subdivision 2, and parts 9520.0760 to 9520.0870.
9530.6800
[Repealed, L 2021 c 30 art 2 s 5]
9530.6810
[Repealed, L 2021 c 30 art 2 s 5]