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SF 2361

1st Engrossment - 82nd Legislature (2001 - 2002) Posted on 12/15/2009 12:00am

KEY: stricken = removed, old language.
underscored = added, new language.
  1.1                          A bill for an act 
  1.2             relating to the operation of state government; 
  1.3             modifying provisions relating to health; health 
  1.4             department; human services; human services department; 
  1.5             long-term care; medical assistance; general assistance 
  1.6             medical care; MinnesotaCare; prescription drug 
  1.7             program; home and community-based waivers; services 
  1.8             for persons with disabilities; group residential 
  1.9             housing; state-operated services; chemical dependency; 
  1.10            mental health; Minnesota family investment program; 
  1.11            general assistance program; child support enforcement; 
  1.12            adoption; children in need of protection or services; 
  1.13            termination of parental rights; child protection; 
  1.14            veterans nursing homes board; health-related licensing 
  1.15            boards; emergency medical services regulatory board; 
  1.16            Minnesota state council on disability; ombudsman for 
  1.17            mental health and mental retardation; ombudsman for 
  1.18            families; adding an informed consent provision for 
  1.19            abortion procedures; requiring reports; appropriating 
  1.20            money; amending Minnesota Statutes 2000, sections 
  1.21            13.46, subdivision 4; 13.461, subdivision 17; 13B.06, 
  1.22            subdivisions 4, 7; 15A.083, subdivision 4; 16A.06, by 
  1.23            adding a subdivision; 16A.87; 62A.095, subdivision 1; 
  1.24            62A.48, subdivision 4, by adding subdivisions; 
  1.25            62J.152, subdivision 8; 62J.451, subdivision 5; 
  1.26            62J.692, subdivision 7; 62J.694, subdivision 2; 
  1.27            62Q.19, subdivision 2; 62S.01, by adding subdivisions; 
  1.28            62S.26; 103I.101, subdivision 6; 103I.112; 103I.208, 
  1.29            subdivisions 1, 2; 103I.235, subdivision 1; 103I.525, 
  1.30            subdivisions 2, 6, 8, 9; 103I.531, subdivisions 2, 6, 
  1.31            8, 9; 103I.535, subdivisions 2, 6, 8, 9; 103I.541, 
  1.32            subdivisions 2b, 4, 5; 103I.545; 116L.11, subdivision 
  1.33            4; 116L.12, subdivisions 4, 5; 116L.13, subdivision 1; 
  1.34            121A.15, by adding subdivisions; 144.057; 144.0721, 
  1.35            subdivision 1; 144.1202, subdivision 4; 144.122; 
  1.36            144.1464; 144.148, subdivision 2; 144.1494, 
  1.37            subdivisions 1, 3, 4; 144.1496; 144.226, subdivision 
  1.38            4; 144.396, subdivision 7; 144.98, subdivision 3; 
  1.39            144A.071, subdivisions 1, 1a, 2, 4a; 144A.073, 
  1.40            subdivision 2; 145.881, subdivision 2; 145.882, 
  1.41            subdivision 7, by adding a subdivision; 145.885, 
  1.42            subdivision 2; 145.925, subdivision 1; 148.212; 
  1.43            148.263, subdivision 2; 148.284; 150A.10, by adding a 
  1.44            subdivision; 157.16, subdivision 3; 157.22; 214.001, 
  1.45            by adding a subdivision; 214.002, subdivision 1; 
  1.46            214.01, by adding a subdivision; 214.104; 241.272, 
  2.1             subdivision 6; 242.192; 245.462, subdivision 18, by 
  2.2             adding subdivisions; 245.466, subdivision 2; 245.470, 
  2.3             by adding a subdivision; 245.474, subdivision 2, by 
  2.4             adding a subdivision; 245.4871, subdivision 27, by 
  2.5             adding subdivisions; 245.4875, subdivision 2; 
  2.6             245.4876, subdivision 1, by adding a subdivision; 
  2.7             245.488, by adding a subdivision; 245.4885, 
  2.8             subdivision 1; 245.4886, subdivision 1; 245.98, by 
  2.9             adding a subdivision; 245.982; 245.99, subdivision 4; 
  2.10            245A.03, subdivision 2b; 245A.04, subdivisions 3, 3a, 
  2.11            3b, 3c, 3d; 245A.05; 245A.06; 245A.07; 245A.08; 
  2.12            245A.13, subdivisions 7, 8; 245A.16, subdivision 1; 
  2.13            245B.08, subdivision 3; 252.275, subdivision 4b; 
  2.14            253.28, by adding a subdivision; 253B.02, subdivision 
  2.15            10; 253B.03, subdivisions 5, 10, by adding a 
  2.16            subdivision; 253B.04, subdivisions 1, 1a, by adding a 
  2.17            subdivision; 253B.045, subdivision 6; 253B.05, 
  2.18            subdivision 1; 253B.07, subdivision 1; 253B.09, 
  2.19            subdivision 1; 253B.10, subdivision 4; 254B.03, 
  2.20            subdivision 1; 254B.09, by adding a subdivision; 
  2.21            256.01, subdivision 2, by adding a subdivision; 
  2.22            256.045, subdivisions 3, 3b, 4; 256.476, subdivisions 
  2.23            1, 2, 3, 4, 5, 8, by adding a subdivision; 256.741, 
  2.24            subdivisions 1, 5, 8; 256.955, subdivisions 2, 2a, 7, 
  2.25            by adding a subdivision; 256.9657, subdivision 2; 
  2.26            256.969, subdivision 3a, by adding a subdivision; 
  2.27            256.975, by adding subdivisions; 256.979, subdivisions 
  2.28            5, 6; 256.98, subdivision 8; 256B.02, subdivision 7; 
  2.29            256B.04, by adding a subdivision; 256B.055, 
  2.30            subdivision 3a; 256B.056, subdivisions 1a, 4, 4b; 
  2.31            256B.057, subdivisions 2, 9, by adding subdivisions; 
  2.32            256B.061; 256B.0625, subdivisions 7, 13, 13a, 17, 17a, 
  2.33            18a, 19a, 19c, 20, 30, 34, by adding subdivisions; 
  2.34            256B.0627, subdivisions 1, 2, 4, 5, 7, 8, 10, 11, by 
  2.35            adding subdivisions; 256B.0635, subdivisions 1, 2; 
  2.36            256B.0644; 256B.0911, subdivisions 1, 3, 5, 6, 7, by 
  2.37            adding subdivisions; 256B.0913, subdivisions 1, 2, 4, 
  2.38            5, 6, 7, 8, 9, 10, 11, 12, 13, 14; 256B.0915, 
  2.39            subdivisions 1d, 3, 5; 256B.0917, by adding a 
  2.40            subdivision; 256B.093, subdivision 3; 256B.431, 
  2.41            subdivision 2e, by adding subdivisions; 256B.433, 
  2.42            subdivision 3a; 256B.434, subdivision 4; 256B.49, by 
  2.43            adding subdivisions; 256B.5012, subdivision 3, by 
  2.44            adding subdivisions; 256B.69, subdivisions 4, 5c, 23, 
  2.45            by adding a subdivision; 256B.75; 256B.76; 256D.053, 
  2.46            subdivision 1; 256D.35, by adding subdivisions; 
  2.47            256D.425, subdivision 1; 256D.44, subdivision 5; 
  2.48            256I.05, subdivisions 1d, 1e, by adding a subdivision; 
  2.49            256J.08, subdivision 55a, by adding a subdivision; 
  2.50            256J.21, subdivision 2; 256J.24, subdivisions 2, 9, 
  2.51            10; 256J.31, subdivision 12; 256J.32, subdivision 4; 
  2.52            256J.37, subdivision 9; 256J.39, subdivision 2; 
  2.53            256J.42, subdivisions 1, 3, 4, 5; 256J.45, 
  2.54            subdivisions 1, 2; 256J.46, subdivision 1; 256J.48, 
  2.55            subdivision 1, by adding a subdivision; 256J.49, 
  2.56            subdivisions 2, 13, by adding a subdivision; 256J.50, 
  2.57            subdivisions 5, 10, by adding a subdivision; 256J.515; 
  2.58            256J.52, subdivisions 2, 3, 6; 256J.53, subdivisions 
  2.59            1, 2, 3; 256J.56; 256J.62, subdivisions 2a, 9; 
  2.60            256J.625; 256J.645; 256K.03, subdivisions 1, 5; 
  2.61            256K.07; 256L.01, subdivision 4; 256L.04, subdivision 
  2.62            2; 256L.05, subdivision 2; 256L.06, subdivision 3; 
  2.63            256L.07, subdivisions 1, 2, 3, by adding subdivisions; 
  2.64            256L.12, by adding a subdivision; 256L.15, 
  2.65            subdivisions 1, 2; 256L.16; 257.0725; 260C.201, 
  2.66            subdivision 1; 326.38; 393.07, by adding a 
  2.67            subdivision; 518.551, subdivision 13; 518.5513, 
  2.68            subdivision 5; 518.575, subdivision 1; 518.5851, by 
  2.69            adding a subdivision; 518.5853, by adding a 
  2.70            subdivision; 518.6111, subdivision 5; 518.6195; 
  2.71            518.64, subdivision 2; 518.641, subdivisions 1, 2, 3, 
  3.1             by adding a subdivision; 548.091, subdivision 1a; 
  3.2             609.115, subdivision 9; 611.23; 626.556, subdivisions 
  3.3             2, 10, 10b, 10d, 10e, 10f, 10i, 11, 12, by adding a 
  3.4             subdivision; 245.814, subdivision 1; 626.557, 
  3.5             subdivisions 3, 9d, 12b; 626.5572, subdivision 17; 
  3.6             626.559, subdivision 2; Laws 1998, chapter 404, 
  3.7             section 18, subdivision 4; Laws 1998, chapter 407, 
  3.8             article 8, section 9; Laws 1999, chapter 152, section 
  3.9             4; Laws 1999, chapter 216, article 1, section 13, 
  3.10            subdivision 4; Laws 1999, chapter 245, article 3, 
  3.11            section 45, as amended; Laws 1999, chapter 245, 
  3.12            article 4, section 110; Laws 1999, chapter 245, 
  3.13            article 10, section 10, as amended; Laws 2000, chapter 
  3.14            364, section 2; proposing coding for new law in 
  3.15            Minnesota Statutes, chapters 62Q; 62S; 116L; 144; 
  3.16            144A; 145; 214; 241; 244; 246; 256; 256B; 256J; 299A; 
  3.17            repealing Minnesota Statutes 2000, sections 16A.76; 
  3.18            116L.12, subdivisions 2, 7; 144.148, subdivision 8; 
  3.19            144A.16; 145.882, subdivisions 3, 4; 145.9245; 
  3.20            145.927; 256.01, subdivision 18; 256.476, subdivision 
  3.21            7; 256.955, subdivision 2b; 256B.0635, subdivision 3; 
  3.22            256B.0911, subdivisions 2, 2a, 4, 8, 9; 256B.0912; 
  3.23            256B.0913, subdivisions 3, 15a, 15b, 15c, 16; 
  3.24            256B.0915, subdivisions 3a, 3b, 3c; 256B.434, 
  3.25            subdivision 5; 256B.49, subdivisions 1, 2, 3, 4, 5, 6, 
  3.26            7, 8, 9, 10; 256D.066; 256E.06, subdivision 2b; 
  3.27            256J.08, subdivision 50a; 256J.12, subdivision 3; 
  3.28            256J.32, subdivision 7a; 256J.43; 256J.49, subdivision 
  3.29            11; 256J.53, subdivision 4; 256L.15, subdivision 3; 
  3.30            518.641, subdivisions 4, 5; Laws 1997, chapter 203, 
  3.31            article 9, section 21; Laws 1998, chapter 404, section 
  3.32            18, subdivision 4; Laws 1998, chapter 407, article 6, 
  3.33            section 111; Laws 2000, chapter 488, article 10, 
  3.34            section 28; Laws 2000, chapter 488, article 10, 
  3.35            section 30; Minnesota Rules, parts 4655.6810; 
  3.36            4655.6820; 4655.6830; 4658.1600; 4658.1605; 4658.1610; 
  3.37            4658.1690; 9505.2390; 9505.2395; 9505.2396; 9505.2400; 
  3.38            9505.2405; 9505.2410; 9505.2413; 9505.2415; 9505.2420; 
  3.39            9505.2425; 9505.2426; 9505.2430; 9505.2435; 9505.2440; 
  3.40            9505.2445; 9505.2450; 9505.2455; 9505.2458; 9505.2460; 
  3.41            9505.2465; 9505.2470; 9505.2473; 9505.2475; 9505.2480; 
  3.42            9505.2485; 9505.2486; 9505.2490; 9505.2495; 9505.2496; 
  3.43            9505.2500; 9505.3010; 9505.3015; 9505.3020; 9505.3025; 
  3.44            9505.3030; 9505.3035; 9505.3040; 9505.3065; 9505.3085; 
  3.45            9505.3135; 9505.3500; 9505.3510; 9505.3520; 9505.3530; 
  3.46            9505.3535; 9505.3540; 9505.3545; 9505.3550; 9505.3560; 
  3.47            9505.3570; 9505.3575; 9505.3580; 9505.3585; 9505.3600; 
  3.48            9505.3610; 9505.3620; 9505.3622; 9505.3624; 9505.3626; 
  3.49            9505.3630; 9505.3635; 9505.3640; 9505.3645; 9505.3650; 
  3.50            9505.3660; 9505.3670; 9546.0010; 9546.0020; 9546.0030; 
  3.51            9546.0040; 9546.0050; 9546.0060. 
  3.52  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  3.53                             ARTICLE 1 
  3.54                        DEPARTMENT OF HEALTH 
  3.55     Section 1.  Minnesota Statutes 2000, section 62J.152, 
  3.56  subdivision 8, is amended to read: 
  3.57     Subd. 8.  [REPEALER.] This section and sections 62J.15 and 
  3.58  62J.156 are repealed effective July 1, 2001 2005. 
  3.59     Sec. 2.  Minnesota Statutes 2000, section 62J.451, 
  3.60  subdivision 5, is amended to read: 
  3.61     Subd. 5.  [HEALTH CARE ELECTRONIC DATA INTERCHANGE 
  4.1   SYSTEM.] (a) The health data institute shall establish an 
  4.2   electronic data interchange system that electronically 
  4.3   transmits, collects, archives, and provides users of data with 
  4.4   the data necessary for their specific interests, in order to 
  4.5   promote a high quality, cost-effective, consumer-responsive 
  4.6   health care system.  This public-private information system 
  4.7   shall be developed to make health care claims processing and 
  4.8   financial settlement transactions more efficient and to provide 
  4.9   an efficient, unobtrusive method for meeting the shared 
  4.10  electronic data interchange needs of consumers, group 
  4.11  purchasers, providers, and the state. 
  4.12     (b) The health data institute shall operate the Minnesota 
  4.13  center for health care electronic data interchange established 
  4.14  in section 62J.57, and shall integrate the goals, objectives, 
  4.15  and activities of the center with those of the health data 
  4.16  institute's electronic data interchange system. 
  4.17     Sec. 3.  Minnesota Statutes 2000, section 103I.101, 
  4.18  subdivision 6, is amended to read: 
  4.19     Subd. 6.  [FEES FOR VARIANCES.] The commissioner shall 
  4.20  charge a nonrefundable application fee of $120 $150 to cover the 
  4.21  administrative cost of processing a request for a variance or 
  4.22  modification of rules adopted by the commissioner under this 
  4.23  chapter. 
  4.24     [EFFECTIVE DATE.] This section is effective July 1, 2002. 
  4.25     Sec. 4.  Minnesota Statutes 2000, section 103I.112, is 
  4.26  amended to read: 
  4.27     103I.112 [FEE EXEMPTIONS FOR STATE AND LOCAL GOVERNMENT.] 
  4.28     (a) The commissioner of health may not charge fees required 
  4.29  under this chapter to a federal agency, state agency, or a local 
  4.30  unit of government or to a subcontractor performing work for the 
  4.31  state agency or local unit of government.  
  4.32     (b) "Local unit of government" means a statutory or home 
  4.33  rule charter city, town, county, or soil and water conservation 
  4.34  district, watershed district, an organization formed for the 
  4.35  joint exercise of powers under section 471.59, a board of health 
  4.36  or community health board, or other special purpose district or 
  5.1   authority with local jurisdiction in water and related land 
  5.2   resources management. 
  5.3      [EFFECTIVE DATE.] This section is effective July 1, 2002. 
  5.4      Sec. 5.  Minnesota Statutes 2000, section 103I.208, 
  5.5   subdivision 1, is amended to read: 
  5.6      Subdivision 1.  [WELL NOTIFICATION FEE.] The well 
  5.7   notification fee to be paid by a property owner is:  
  5.8      (1) for a new well, $120 $150, which includes the state 
  5.9   core function fee; 
  5.10     (2) for a well sealing, $20 $30 for each well, which 
  5.11  includes the state core function fee, except that for monitoring 
  5.12  wells constructed on a single property, having depths within a 
  5.13  25 foot range, and sealed within 48 hours of start of 
  5.14  construction, a single fee of $20 $30; and 
  5.15     (3) for construction of a dewatering well, $120 $150, which 
  5.16  includes the state core function fee, for each well except a 
  5.17  dewatering project comprising five or more wells shall be 
  5.18  assessed a single fee of $600 $750 for the wells recorded on the 
  5.19  notification. 
  5.20     [EFFECTIVE DATE.] This section is effective July 1, 2002. 
  5.21     Sec. 6.  Minnesota Statutes 2000, section 103I.208, 
  5.22  subdivision 2, is amended to read: 
  5.23     Subd. 2.  [PERMIT FEE.] The permit fee to be paid by a 
  5.24  property owner is:  
  5.25     (1) for a well that is not in use under a maintenance 
  5.26  permit, $100 $125 annually; 
  5.27     (2) for construction of a monitoring well, $120 $150, which 
  5.28  includes the state core function fee; 
  5.29     (3) for a monitoring well that is unsealed under a 
  5.30  maintenance permit, $100 $125 annually; 
  5.31     (4) for monitoring wells used as a leak detection device at 
  5.32  a single motor fuel retail outlet, a single petroleum bulk 
  5.33  storage site excluding tank farms, or a single agricultural 
  5.34  chemical facility site, the construction permit fee 
  5.35  is $120 $150, which includes the state core function fee, per 
  5.36  site regardless of the number of wells constructed on the site, 
  6.1   and the annual fee for a maintenance permit for unsealed 
  6.2   monitoring wells is $100 $125 per site regardless of the number 
  6.3   of monitoring wells located on site; 
  6.4      (5) for a groundwater thermal exchange device, in addition 
  6.5   to the notification fee for wells, $120 $150, which includes the 
  6.6   state core function fee; 
  6.7      (6) for a vertical heat exchanger, $120 $150; 
  6.8      (7) for a dewatering well that is unsealed under a 
  6.9   maintenance permit, $100 $125 annually for each well, except a 
  6.10  dewatering project comprising more than five wells shall be 
  6.11  issued a single permit for $500 $625 annually for wells recorded 
  6.12  on the permit; and 
  6.13     (8) for excavating holes for the purpose of installing 
  6.14  elevator shafts, $120 $150 for each hole. 
  6.15     [EFFECTIVE DATE.] This section is effective July 1, 2002. 
  6.16     Sec. 7.  Minnesota Statutes 2000, section 103I.235, 
  6.17  subdivision 1, is amended to read: 
  6.18     Subdivision 1.  [DISCLOSURE OF WELLS TO BUYER.] (a) Before 
  6.19  signing an agreement to sell or transfer real property, the 
  6.20  seller must disclose in writing to the buyer information about 
  6.21  the status and location of all known wells on the property, by 
  6.22  delivering to the buyer either a statement by the seller that 
  6.23  the seller does not know of any wells on the property, or a 
  6.24  disclosure statement indicating the legal description and 
  6.25  county, and a map drawn from available information showing the 
  6.26  location of each well to the extent practicable.  In the 
  6.27  disclosure statement, the seller must indicate, for each well, 
  6.28  whether the well is in use, not in use, or sealed.  
  6.29     (b) At the time of closing of the sale, the disclosure 
  6.30  statement information, name and mailing address of the buyer, 
  6.31  and the quartile, section, township, and range in which each 
  6.32  well is located must be provided on a well disclosure 
  6.33  certificate signed by the seller or a person authorized to act 
  6.34  on behalf of the seller. 
  6.35     (c) A well disclosure certificate need not be provided if 
  6.36  the seller does not know of any wells on the property and the 
  7.1   deed or other instrument of conveyance contains the statement:  
  7.2   "The Seller certifies that the Seller does not know of any wells 
  7.3   on the described real property."  
  7.4      (d) If a deed is given pursuant to a contract for deed, the 
  7.5   well disclosure certificate required by this subdivision shall 
  7.6   be signed by the buyer or a person authorized to act on behalf 
  7.7   of the buyer.  If the buyer knows of no wells on the property, a 
  7.8   well disclosure certificate is not required if the following 
  7.9   statement appears on the deed followed by the signature of the 
  7.10  grantee or, if there is more than one grantee, the signature of 
  7.11  at least one of the grantees:  "The Grantee certifies that the 
  7.12  Grantee does not know of any wells on the described real 
  7.13  property."  The statement and signature of the grantee may be on 
  7.14  the front or back of the deed or on an attached sheet and an 
  7.15  acknowledgment of the statement by the grantee is not required 
  7.16  for the deed to be recordable. 
  7.17     (e) This subdivision does not apply to the sale, exchange, 
  7.18  or transfer of real property:  
  7.19     (1) that consists solely of a sale or transfer of severed 
  7.20  mineral interests; or 
  7.21     (2) that consists of an individual condominium unit as 
  7.22  described in chapters 515 and 515B. 
  7.23     (f) For an area owned in common under chapter 515 or 515B 
  7.24  the association or other responsible person must report to the 
  7.25  commissioner by July 1, 1992, the location and status of all 
  7.26  wells in the common area.  The association or other responsible 
  7.27  person must notify the commissioner within 30 days of any change 
  7.28  in the reported status of wells. 
  7.29     (g) For real property sold by the state under section 
  7.30  92.67, the lessee at the time of the sale is responsible for 
  7.31  compliance with this subdivision. 
  7.32     (h) If the seller fails to provide a required well 
  7.33  disclosure certificate, the buyer, or a person authorized to act 
  7.34  on behalf of the buyer, may sign a well disclosure certificate 
  7.35  based on the information provided on the disclosure statement 
  7.36  required by this section or based on other available information.
  8.1      (i) A county recorder or registrar of titles may not record 
  8.2   a deed or other instrument of conveyance dated after October 31, 
  8.3   1990, for which a certificate of value is required under section 
  8.4   272.115, or any deed or other instrument of conveyance dated 
  8.5   after October 31, 1990, from a governmental body exempt from the 
  8.6   payment of state deed tax, unless the deed or other instrument 
  8.7   of conveyance contains the statement made in accordance with 
  8.8   paragraph (c) or (d) or is accompanied by the well disclosure 
  8.9   certificate containing all the information required by paragraph 
  8.10  (b) or (d).  The county recorder or registrar of titles must not 
  8.11  accept a certificate unless it contains all the required 
  8.12  information.  The county recorder or registrar of titles shall 
  8.13  note on each deed or other instrument of conveyance accompanied 
  8.14  by a well disclosure certificate that the well disclosure 
  8.15  certificate was received.  The notation must include the 
  8.16  statement "No wells on property" if the disclosure certificate 
  8.17  states there are no wells on the property.  The well disclosure 
  8.18  certificate shall not be filed or recorded in the records 
  8.19  maintained by the county recorder or registrar of titles.  After 
  8.20  noting "No wells on property" on the deed or other instrument of 
  8.21  conveyance, the county recorder or registrar of titles shall 
  8.22  destroy or return to the buyer the well disclosure certificate.  
  8.23  The county recorder or registrar of titles shall collect from 
  8.24  the buyer or the person seeking to record a deed or other 
  8.25  instrument of conveyance, a fee of $20 $30 for receipt of a 
  8.26  completed well disclosure certificate.  By the tenth day of each 
  8.27  month, the county recorder or registrar of titles shall transmit 
  8.28  the well disclosure certificates to the commissioner of health.  
  8.29  By the tenth day after the end of each calendar quarter, the 
  8.30  county recorder or registrar of titles shall transmit to the 
  8.31  commissioner of health $17.50 $27.50 of the fee for each well 
  8.32  disclosure certificate received during the quarter.  The 
  8.33  commissioner shall maintain the well disclosure certificate for 
  8.34  at least six years.  The commissioner may store the certificate 
  8.35  as an electronic image.  A copy of that image shall be as valid 
  8.36  as the original. 
  9.1      (j) No new well disclosure certificate is required under 
  9.2   this subdivision if the buyer or seller, or a person authorized 
  9.3   to act on behalf of the buyer or seller, certifies on the deed 
  9.4   or other instrument of conveyance that the status and number of 
  9.5   wells on the property have not changed since the last previously 
  9.6   filed well disclosure certificate.  The following statement, if 
  9.7   followed by the signature of the person making the statement, is 
  9.8   sufficient to comply with the certification requirement of this 
  9.9   paragraph:  "I am familiar with the property described in this 
  9.10  instrument and I certify that the status and number of wells on 
  9.11  the described real property have not changed since the last 
  9.12  previously filed well disclosure certificate."  The 
  9.13  certification and signature may be on the front or back of the 
  9.14  deed or on an attached sheet and an acknowledgment of the 
  9.15  statement is not required for the deed or other instrument of 
  9.16  conveyance to be recordable. 
  9.17     (k) The commissioner in consultation with county recorders 
  9.18  shall prescribe the form for a well disclosure certificate and 
  9.19  provide well disclosure certificate forms to county recorders 
  9.20  and registrars of titles and other interested persons. 
  9.21     (l) Failure to comply with a requirement of this 
  9.22  subdivision does not impair: 
  9.23     (1) the validity of a deed or other instrument of 
  9.24  conveyance as between the parties to the deed or instrument or 
  9.25  as to any other person who otherwise would be bound by the deed 
  9.26  or instrument; or 
  9.27     (2) the record, as notice, of any deed or other instrument 
  9.28  of conveyance accepted for filing or recording contrary to the 
  9.29  provisions of this subdivision. 
  9.30     [EFFECTIVE DATE.] This section is effective July 1, 2002. 
  9.31     Sec. 8.  Minnesota Statutes 2000, section 103I.525, 
  9.32  subdivision 2, is amended to read: 
  9.33     Subd. 2.  [APPLICATION FEE.] The application fee for a well 
  9.34  contractor's license is $50 $75.  The commissioner may not act 
  9.35  on an application until the application fee is paid.  
  9.36     [EFFECTIVE DATE.] This section is effective July 1, 2002. 
 10.1      Sec. 9.  Minnesota Statutes 2000, section 103I.525, 
 10.2   subdivision 6, is amended to read: 
 10.3      Subd. 6.  [LICENSE FEE.] The fee for a well contractor's 
 10.4   license is $250, except the fee for an individual well 
 10.5   contractor's license is $50 $75. 
 10.6      [EFFECTIVE DATE.] This section is effective July 1, 2002. 
 10.7      Sec. 10.  Minnesota Statutes 2000, section 103I.525, 
 10.8   subdivision 8, is amended to read: 
 10.9      Subd. 8.  [RENEWAL.] (a) A licensee must file an 
 10.10  application and a renewal application fee to renew the license 
 10.11  by the date stated in the license.  
 10.12     (b) The renewal application fee shall be set by the 
 10.13  commissioner under section 16A.1285 for a well contractor's 
 10.14  license is $250.  
 10.15     (c) The renewal application must include information that 
 10.16  the applicant has met continuing education requirements 
 10.17  established by the commissioner by rule.  
 10.18     (d) At the time of the renewal, the commissioner must have 
 10.19  on file all properly completed well reports, well sealing 
 10.20  reports, reports of excavations to construct elevator shafts, 
 10.21  well permits, and well notifications for work conducted by the 
 10.22  licensee since the last license renewal. 
 10.23     [EFFECTIVE DATE.] This section is effective July 1, 2002. 
 10.24     Sec. 11.  Minnesota Statutes 2000, section 103I.525, 
 10.25  subdivision 9, is amended to read: 
 10.26     Subd. 9.  [INCOMPLETE OR LATE RENEWAL.] If a licensee fails 
 10.27  to submit all information required for renewal in subdivision 8 
 10.28  or submits the application and information after the required 
 10.29  renewal date: 
 10.30     (1) the licensee must include an additional a late fee set 
 10.31  by the commissioner of $75; and 
 10.32     (2) the licensee may not conduct activities authorized by 
 10.33  the well contractor's license until the renewal application, 
 10.34  renewal application fee, late fee, and all other information 
 10.35  required in subdivision 8 are submitted. 
 10.36     [EFFECTIVE DATE.] This section is effective July 1, 2002. 
 11.1      Sec. 12.  Minnesota Statutes 2000, section 103I.531, 
 11.2   subdivision 2, is amended to read: 
 11.3      Subd. 2.  [APPLICATION FEE.] The application fee for a 
 11.4   limited well/boring contractor's license is $50 $75.  The 
 11.5   commissioner may not act on an application until the application 
 11.6   fee is paid.  
 11.7      [EFFECTIVE DATE.] This section is effective July 1, 2002. 
 11.8      Sec. 13.  Minnesota Statutes 2000, section 103I.531, 
 11.9   subdivision 6, is amended to read: 
 11.10     Subd. 6.  [LICENSE FEE.] The fee for a limited well/boring 
 11.11  contractor's license is $50 $75.  
 11.12     [EFFECTIVE DATE.] This section is effective July 1, 2002. 
 11.13     Sec. 14.  Minnesota Statutes 2000, section 103I.531, 
 11.14  subdivision 8, is amended to read: 
 11.15     Subd. 8.  [RENEWAL.] (a) A person must file an application 
 11.16  and a renewal application fee to renew the limited well/boring 
 11.17  contractor's license by the date stated in the license.  
 11.18     (b) The renewal application fee shall be set by the 
 11.19  commissioner under section 16A.1285 for a limited well/boring 
 11.20  contractor's license is $75.  
 11.21     (c) The renewal application must include information that 
 11.22  the applicant has met continuing education requirements 
 11.23  established by the commissioner by rule.  
 11.24     (d) At the time of the renewal, the commissioner must have 
 11.25  on file all properly completed well sealing reports, well 
 11.26  permits, vertical heat exchanger permits, and well notifications 
 11.27  for work conducted by the licensee since the last license 
 11.28  renewal. 
 11.29     [EFFECTIVE DATE.] This section is effective July 1, 2002. 
 11.30     Sec. 15.  Minnesota Statutes 2000, section 103I.531, 
 11.31  subdivision 9, is amended to read: 
 11.32     Subd. 9.  [INCOMPLETE OR LATE RENEWAL.] If a licensee fails 
 11.33  to submit all information required for renewal in subdivision 8 
 11.34  or submits the application and information after the required 
 11.35  renewal date: 
 11.36     (1) the licensee must include an additional a late fee set 
 12.1   by the commissioner of $75; and 
 12.2      (2) the licensee may not conduct activities authorized by 
 12.3   the limited well/boring contractor's license until the renewal 
 12.4   application, renewal application fee, and late fee, and all 
 12.5   other information required in subdivision 8 are submitted. 
 12.6      [EFFECTIVE DATE.] This section is effective July 1, 2002. 
 12.7      Sec. 16.  Minnesota Statutes 2000, section 103I.535, 
 12.8   subdivision 2, is amended to read: 
 12.9      Subd. 2.  [APPLICATION FEE.] The application fee for an 
 12.10  elevator shaft contractor's license is $50 $75.  The 
 12.11  commissioner may not act on an application until the application 
 12.12  fee is paid. 
 12.13     [EFFECTIVE DATE.] This section is effective July 1, 2002. 
 12.14     Sec. 17.  Minnesota Statutes 2000, section 103I.535, 
 12.15  subdivision 6, is amended to read: 
 12.16     Subd. 6.  [LICENSE FEE.] The fee for an elevator shaft 
 12.17  contractor's license is $50 $75.  
 12.18     [EFFECTIVE DATE.] This section is effective July 1, 2002. 
 12.19     Sec. 18.  Minnesota Statutes 2000, section 103I.535, 
 12.20  subdivision 8, is amended to read: 
 12.21     Subd. 8.  [RENEWAL.] (a) A person must file an application 
 12.22  and a renewal application fee to renew the license by the date 
 12.23  stated in the license.  
 12.24     (b) The renewal application fee shall be set by the 
 12.25  commissioner under section 16A.1285 for an elevator shaft 
 12.26  contractor's license is $75.  
 12.27     (c) The renewal application must include information that 
 12.28  the applicant has met continuing education requirements 
 12.29  established by the commissioner by rule.  
 12.30     (d) At the time of renewal, the commissioner must have on 
 12.31  file all reports and permits for elevator shaft work conducted 
 12.32  by the licensee since the last license renewal. 
 12.33     [EFFECTIVE DATE.] This section is effective July 1, 2002. 
 12.34     Sec. 19.  Minnesota Statutes 2000, section 103I.535, 
 12.35  subdivision 9, is amended to read: 
 12.36     Subd. 9.  [INCOMPLETE OR LATE RENEWAL.] If a licensee fails 
 13.1   to submit all information required for renewal in subdivision 8 
 13.2   or submits the application and information after the required 
 13.3   renewal date: 
 13.4      (1) the licensee must include an additional a late fee set 
 13.5   by the commissioner of $75; and 
 13.6      (2) the licensee may not conduct activities authorized by 
 13.7   the elevator shaft contractor's license until the renewal 
 13.8   application, renewal application fee, and late fee, and all 
 13.9   other information required in subdivision 8 are submitted. 
 13.10     [EFFECTIVE DATE.] This section is effective July 1, 2002. 
 13.11     Sec. 20.  Minnesota Statutes 2000, section 103I.541, 
 13.12  subdivision 2b, is amended to read: 
 13.13     Subd. 2b.  [APPLICATION FEE.] The application fee for a 
 13.14  monitoring well contractor registration is $50 $75.  The 
 13.15  commissioner may not act on an application until the application 
 13.16  fee is paid.  
 13.17     [EFFECTIVE DATE.] This section is effective July 1, 2002. 
 13.18     Sec. 21.  Minnesota Statutes 2000, section 103I.541, 
 13.19  subdivision 4, is amended to read: 
 13.20     Subd. 4.  [RENEWAL.] (a) A person must file an application 
 13.21  and a renewal application fee to renew the registration by the 
 13.22  date stated in the registration.  
 13.23     (b) The renewal application fee shall be set by the 
 13.24  commissioner under section 16A.1285 for a monitoring well 
 13.25  contractor's registration is $75.  
 13.26     (c) The renewal application must include information that 
 13.27  the applicant has met continuing education requirements 
 13.28  established by the commissioner by rule.  
 13.29     (d) At the time of the renewal, the commissioner must have 
 13.30  on file all well reports, well sealing reports, well permits, 
 13.31  and notifications for work conducted by the registered person 
 13.32  since the last registration renewal. 
 13.33     [EFFECTIVE DATE.] This section is effective July 1, 2002. 
 13.34     Sec. 22.  Minnesota Statutes 2000, section 103I.541, 
 13.35  subdivision 5, is amended to read: 
 13.36     Subd. 5.  [INCOMPLETE OR LATE RENEWAL.] If a registered 
 14.1   person submits a renewal application after the required renewal 
 14.2   date: 
 14.3      (1) the registered person must include an additional a late 
 14.4   fee set by the commissioner of $75; and 
 14.5      (2) the registered person may not conduct activities 
 14.6   authorized by the monitoring well contractor's registration 
 14.7   until the renewal application, renewal application fee, late 
 14.8   fee, and all other information required in subdivision 4 are 
 14.9   submitted. 
 14.10     [EFFECTIVE DATE.] This section is effective July 1, 2002. 
 14.11     Sec. 23.  Minnesota Statutes 2000, section 103I.545, is 
 14.12  amended to read: 
 14.13     103I.545 [REGISTRATION OF DRILLING MACHINES REQUIRED.] 
 14.14     Subdivision 1.  [DRILLING MACHINE.] (a) A person may not 
 14.15  use a drilling machine such as a cable tool, rotary tool, hollow 
 14.16  rod tool, or auger for a drilling activity requiring a license 
 14.17  or registration under this chapter unless the drilling machine 
 14.18  is registered with the commissioner.  
 14.19     (b) A person must apply for the registration on forms 
 14.20  prescribed by the commissioner and submit a $50 $75 registration 
 14.21  fee. 
 14.22     (c) A registration is valid for one year.  
 14.23     Subd. 2.  [PUMP HOIST.] (a) A person may not use a machine 
 14.24  such as a pump hoist for an activity requiring a license or 
 14.25  registration under this chapter to repair wells or borings, seal 
 14.26  wells or borings, or install pumps unless the machine is 
 14.27  registered with the commissioner.  
 14.28     (b) A person must apply for the registration on forms 
 14.29  prescribed by the commissioner and submit a $50 $75 registration 
 14.30  fee. 
 14.31     (c) A registration is valid for one year. 
 14.32     [EFFECTIVE DATE.] This section is effective July 1, 2002. 
 14.33     Sec. 24.  Minnesota Statutes 2000, section 144.1202, 
 14.34  subdivision 4, is amended to read: 
 14.35     Subd. 4.  [AGREEMENT; CONDITIONS OF IMPLEMENTATION.] (a) An 
 14.36  agreement entered into before August 2, 2002 2003, must remain 
 15.1   in effect until terminated under the Atomic Energy Act of 1954, 
 15.2   United States Code, title 42, section 2021, paragraph (j).  The 
 15.3   governor may not enter into an initial agreement with the 
 15.4   Nuclear Regulatory Commission after August 1, 2002 2003.  If an 
 15.5   agreement is not entered into by August 1, 2002 2003, any rules 
 15.6   adopted under this section are repealed effective August 1, 2002 
 15.7   2003. 
 15.8      (b) An agreement authorized under subdivision 1 must be 
 15.9   approved by law before it may be implemented. 
 15.10     Sec. 25.  [144.1205] [RADIOACTIVE MATERIAL; SOURCE AND 
 15.11  SPECIAL NUCLEAR MATERIAL; FEES; INSPECTION.] 
 15.12     Subdivision 1.  [APPLICATION AND LICENSE RENEWAL FEE.] When 
 15.13  a license is required for radioactive material or source or 
 15.14  special nuclear material by a rule adopted under section 
 15.15  144.1202, subdivision 2, an application fee according to 
 15.16  subdivision 4 must be paid upon initial application for a 
 15.17  license.  The licensee must renew the license 60 days before the 
 15.18  expiration date of the license by paying a license renewal fee 
 15.19  equal to the application fee under subdivision 4.  The 
 15.20  expiration date of a license is the date set by the United 
 15.21  States Nuclear Regulatory Commission before transfer of the 
 15.22  licensing program under section 144.1202 and thereafter as 
 15.23  specified by rule of the commissioner of health. 
 15.24     Subd. 2.  [ANNUAL FEE.] A licensee must pay an annual fee 
 15.25  at least 60 days before the anniversary date of the issuance of 
 15.26  the license.  The annual fee is an amount equal to 80 percent of 
 15.27  the application fee under subdivision 4, rounded to the nearest 
 15.28  whole dollar. 
 15.29     Subd. 3.  [FEE CATEGORIES; INCORPORATION OF FEDERAL 
 15.30  LICENSING CATEGORIES.] (a) Fee categories under this section are 
 15.31  equivalent to the licensing categories used by the United States 
 15.32  Nuclear Regulatory Commission under Code of Federal Regulations, 
 15.33  title 10, parts 30 to 36, 39, 40, 70, 71, and 150, except as 
 15.34  provided in paragraph (b). 
 15.35     (b) The category of "Academic, small" is the type of 
 15.36  license required for the use of radioactive materials in a 
 16.1   teaching institution.  Radioactive materials are limited to ten 
 16.2   radionuclides not to exceed a total activity amount of one curie.
 16.3      Subd. 4.  [APPLICATION FEE.] A licensee must pay an 
 16.4   application fee as follows: 
 16.5   Radioactive material,  Application    U.S. Nuclear Regulatory
 16.6   source and             fee            Commission licensing
 16.7   special material                      category as reference
 16.9   Type A broadscope      $20,000        Medical institution type A
 16.10  Type B broadscope      $15,000        Research and development
 16.11                                        type B
 16.12  Type C broadscope      $10,000        Academic type C
 16.13  Medical use            $4,000         Medical
 16.14                                        Medical institution
 16.15                                        Medical private practice
 16.16  Mobile nuclear                                                 
 16.17  medical laboratory     $4,000         Mobile medical laboratory
 16.18  Medical special use                                     
 16.19  sealed sources         $6,000         Teletherapy
 16.20                                        High dose rate remote
 16.21                                        afterloaders
 16.22                                        Stereotactic
 16.23                                        radiosurgery devices
 16.24  In vitro testing       $2,300         In vitro testing
 16.25                                        laboratories
 16.26  Measuring gauge,
 16.27  sealed sources         $2,000         Fixed gauges
 16.28                                        Portable gauges
 16.29                                        Analytical instruments
 16.30                                        Measuring systems - other
 16.31  Gas chromatographs     $1,200         Gas chromatographs
 16.32  Manufacturing and 
 16.33  distribution           $14,700        Manufacturing and 
 16.34                                        distribution - other
 16.35  Distribution only      $8,800         Distribution of
 16.36                                        radioactive material
 17.1                                         for commercial use only
 17.2   Other services         $1,500         Other services
 17.3   Nuclear medicine 
 17.4   pharmacy               $4,100         Nuclear pharmacy
 17.5   Waste disposal         $9,400         Waste disposal service
 17.6                                         prepackage
 17.7                                         Waste disposal service
 17.8                                         processing/repackage
 17.9   Waste storage only     $7,000         To receive and store
 17.10                                        radioactive material waste
 17.11  Industrial
 17.12  radiography            $8,400         Industrial radiography
 17.13                                        fixed location
 17.14                                        Industrial radiography
 17.15                                        portable/temporary sites
 17.16  Irradiator - 
 17.17  self-shielded          $4,100         Irradiators self-shielded
 17.18                                        less than 10,000 curies
 17.19  Irradiator - 
 17.20  less than 10,000 Ci    $7,500         Irradiators less than
 17.21                                        10,000 curies
 17.22  Irradiator - 
 17.23  more than 10,000 Ci    $11,500        Irradiators greater than
 17.24                                        10,000 curies
 17.25  Research and
 17.26  development,
 17.27  no distribution        $4,100         Research and development
 17.28  Radioactive material 
 17.29  possession only        $1,000         Byproduct possession only
 17.30  Source material        $1,000         Source material shielding
 17.31  Special nuclear 
 17.32  material, less than 
 17.33  200 grams              $1,000         Special nuclear material
 17.34                                        plutonium-neutron sources
 17.35                                        less than 200 grams
 17.36  Pacemaker
 18.1   manufacturing          $1,000         Pacemaker byproduct
 18.2                                         and/or special nuclear
 18.3                                         material - medical
 18.4                                         institution
 18.5   General license
 18.6   distribution           $2,100         General license
 18.7                                         distribution
 18.8   General license 
 18.9   distribution, exempt   $1,500         General license 
 18.10                                        distribution -
 18.11                                        certain exempt items
 18.12  Academic, small        $1,000         Possession limit of ten
 18.13                                        radionuclides, not to
 18.14                                        exceed a total of one curie
 18.15                                        of activity
 18.16  Veterinary             $2,000         Veterinary use
 18.17  Well logging           $5,000         Well logging
 18.18     Subd. 5.  [PENALTY FOR LATE PAYMENT.] An annual fee or a 
 18.19  license renewal fee submitted to the commissioner after the due 
 18.20  date specified by rule must be accompanied by an additional 
 18.21  amount equal to 25 percent of the fee due. 
 18.22     Subd. 6.  [INSPECTIONS.] The commissioner of health shall 
 18.23  make periodic safety inspections of the radioactive material and 
 18.24  source and special nuclear material of a licensee.  The 
 18.25  commissioner shall prescribe the frequency of safety inspections 
 18.26  by rule. 
 18.27     Subd. 7.  [RECOVERY OF REINSPECTION COST.] If the 
 18.28  commissioner finds serious violations of public health standards 
 18.29  during an inspection under subdivision 6, the licensee must pay 
 18.30  all costs associated with subsequent reinspection of the 
 18.31  source.  The costs shall be the actual costs incurred by the 
 18.32  commissioner and include, but are not limited to, labor, 
 18.33  transportation, per diem, materials, legal fees, testing, and 
 18.34  monitoring costs. 
 18.35     Subd. 8.  [RECIPROCITY FEE.] A licensee submitting an 
 18.36  application for reciprocal recognition of a materials license 
 19.1   issued by another agreement state or the United States Nuclear 
 19.2   Regulatory Commission for a period of 180 days or less during a 
 19.3   calendar year must pay one-half of the application fee specified 
 19.4   under subdivision 4.  For a period of 181 days or more, the 
 19.5   licensee must pay the entire application fee under subdivision 4.
 19.6      Subd. 9.  [FEES FOR LICENSE AMENDMENTS.] A licensee must 
 19.7   pay a fee to amend a license as follows: 
 19.8      (1) to amend a license requiring no license review 
 19.9   including, but not limited to, facility name change or removal 
 19.10  of a previously authorized user, no fee; 
 19.11     (2) to amend a license requiring review including, but not 
 19.12  limited to, addition of isotopes, procedure changes, new 
 19.13  authorized users, or a new radiation safety officer, $200; and 
 19.14     (3) to amend a license requiring review and a site visit 
 19.15  including, but not limited to, facility move or addition of 
 19.16  processes, $400. 
 19.17     [EFFECTIVE DATE.] This section is effective July 1, 2002. 
 19.18     Sec. 26.  Minnesota Statutes 2000, section 144.122, is 
 19.19  amended to read: 
 19.20     144.122 [LICENSE, PERMIT, AND SURVEY FEES.] 
 19.21     (a) The state commissioner of health, by rule, may 
 19.22  prescribe reasonable procedures and fees for filing with the 
 19.23  commissioner as prescribed by statute and for the issuance of 
 19.24  original and renewal permits, licenses, registrations, and 
 19.25  certifications issued under authority of the commissioner.  The 
 19.26  expiration dates of the various licenses, permits, 
 19.27  registrations, and certifications as prescribed by the rules 
 19.28  shall be plainly marked thereon.  Fees may include application 
 19.29  and examination fees and a penalty fee for renewal applications 
 19.30  submitted after the expiration date of the previously issued 
 19.31  permit, license, registration, and certification.  The 
 19.32  commissioner may also prescribe, by rule, reduced fees for 
 19.33  permits, licenses, registrations, and certifications when the 
 19.34  application therefor is submitted during the last three months 
 19.35  of the permit, license, registration, or certification period.  
 19.36  Fees proposed to be prescribed in the rules shall be first 
 20.1   approved by the department of finance.  All fees proposed to be 
 20.2   prescribed in rules shall be reasonable.  The fees shall be in 
 20.3   an amount so that the total fees collected by the commissioner 
 20.4   will, where practical, approximate the cost to the commissioner 
 20.5   in administering the program.  All fees collected shall be 
 20.6   deposited in the state treasury and credited to the state 
 20.7   government special revenue fund unless otherwise specifically 
 20.8   appropriated by law for specific purposes. 
 20.9      (b) The commissioner may charge a fee for voluntary 
 20.10  certification of medical laboratories and environmental 
 20.11  laboratories, and for environmental and medical laboratory 
 20.12  services provided by the department, without complying with 
 20.13  paragraph (a) or chapter 14.  Fees charged for environment and 
 20.14  medical laboratory services provided by the department must be 
 20.15  approximately equal to the costs of providing the services.  
 20.16     (c) The commissioner may develop a schedule of fees for 
 20.17  diagnostic evaluations conducted at clinics held by the services 
 20.18  for children with handicaps program.  All receipts generated by 
 20.19  the program are annually appropriated to the commissioner for 
 20.20  use in the maternal and child health program. 
 20.21     (d) The commissioner, for fiscal years 1996 and beyond, 
 20.22  shall set license fees for hospitals and nursing homes that are 
 20.23  not boarding care homes at the following levels: 
 20.24  Joint Commission on Accreditation of Healthcare 
 20.25  Organizations (JCAHO hospitals)      $1,017
 20.26                                       $7,055
 20.27  Non-JCAHO hospitals                  $762 plus $34 per bed
 20.28                                       $4,680 plus $234 per bed
 20.29  Nursing home                         $78 plus $19 per bed
 20.30     For fiscal years 1996 and beyond, the commissioner shall 
 20.31  set license fees for outpatient surgical centers, boarding care 
 20.32  homes, and supervised living facilities at the following levels: 
 20.33  Outpatient surgical centers          $517
 20.34                                       $1,512
 20.35  Boarding care homes                  $78 plus $19 per bed
 20.36                                       $183 plus $91 per bed
 21.1   Supervised living facilities         $78 plus $19 per bed
 21.2                                        $183 plus $91 per bed.
 21.3      (e) Unless prohibited by federal law, the commissioner of 
 21.4   health shall charge applicants the following fees to cover the 
 21.5   cost of any initial certification surveys required to determine 
 21.6   a provider's eligibility to participate in the Medicare or 
 21.7   Medicaid program: 
 21.8   Prospective payment surveys for          $  900
 21.9   hospitals
 21.11  Swing bed surveys for nursing homes      $1,200
 21.13  Psychiatric hospitals                    $1,400
 21.15  Rural health facilities                  $1,100
 21.17  Portable X-ray providers                 $  500
 21.19  Home health agencies                     $1,800
 21.21  Outpatient therapy agencies              $  800
 21.23  End stage renal dialysis providers       $2,100
 21.25  Independent therapists                   $  800
 21.27  Comprehensive rehabilitation             $1,200
 21.28  outpatient facilities
 21.30  Hospice providers                        $1,700
 21.32  Ambulatory surgical providers            $1,800
 21.34  Hospitals                                $4,200
 21.36  Other provider categories or             Actual surveyor costs:
 21.37  additional resurveys required            average surveyor cost x
 21.38  to complete initial certification        number of hours for the
 21.39                                           survey process.
 21.40     These fees shall be submitted at the time of the 
 21.41  application for federal certification and shall not be 
 21.42  refunded.  All fees collected after the date that the imposition 
 21.43  of fees is not prohibited by federal law shall be deposited in 
 21.44  the state treasury and credited to the state government special 
 21.45  revenue fund. 
 21.46     Sec. 27.  Minnesota Statutes 2000, section 144.1464, is 
 21.47  amended to read: 
 21.48     144.1464 [SUMMER HEALTH CARE INTERNS.] 
 21.49     Subdivision 1.  [SUMMER INTERNSHIPS.] The commissioner of 
 21.50  health, through a contract with a nonprofit organization as 
 21.51  required by subdivision 4, shall award grants to hospitals and, 
 22.1   clinics, nursing facilities, and home care providers to 
 22.2   establish a secondary and post-secondary summer health care 
 22.3   intern program.  The purpose of the program is to expose 
 22.4   interested secondary and post-secondary pupils to various 
 22.5   careers within the health care profession. 
 22.6      Subd. 2.  [CRITERIA.] (a) The commissioner, through the 
 22.7   organization under contract, shall award grants to 
 22.8   hospitals and, clinics, nursing facilities, and home care 
 22.9   providers that agree to:  
 22.10     (1) provide secondary and post-secondary summer health care 
 22.11  interns with formal exposure to the health care profession; 
 22.12     (2) provide an orientation for the secondary and 
 22.13  post-secondary summer health care interns; 
 22.14     (3) pay one-half the costs of employing the secondary and 
 22.15  post-secondary summer health care intern, based on an overall 
 22.16  hourly wage that is at least the minimum wage but does not 
 22.17  exceed $6 an hour; 
 22.18     (4) interview and hire secondary and post-secondary pupils 
 22.19  for a minimum of six weeks and a maximum of 12 weeks; and 
 22.20     (5) employ at least one secondary student for each 
 22.21  post-secondary student employed, to the extent that there are 
 22.22  sufficient qualifying secondary student applicants. 
 22.23     (b) In order to be eligible to be hired as a secondary 
 22.24  summer health intern by a hospital or, clinic, nursing facility, 
 22.25  or home care provider, a pupil must: 
 22.26     (1) intend to complete high school graduation requirements 
 22.27  and be between the junior and senior year of high school; and 
 22.28     (2) be from a school district in proximity to the facility; 
 22.29  and 
 22.30     (3) provide the facility with a letter of recommendation 
 22.31  from a health occupations or science educator. 
 22.32     (c) In order to be eligible to be hired as a post-secondary 
 22.33  summer health care intern by a hospital or clinic, a pupil must: 
 22.34     (1) intend to complete a health care training program or a 
 22.35  two-year or four-year degree program and be planning on 
 22.36  enrolling in or be enrolled in that training program or degree 
 23.1   program; and 
 23.2      (2) be enrolled in a Minnesota educational institution or 
 23.3   be a resident of the state of Minnesota; priority must be given 
 23.4   to applicants from a school district or an educational 
 23.5   institution in proximity to the facility; and 
 23.6      (3) provide the facility with a letter of recommendation 
 23.7   from a health occupations or science educator. 
 23.8      (d) Hospitals and, clinics, nursing facilities, and home 
 23.9   care providers awarded grants may employ pupils as secondary and 
 23.10  post-secondary summer health care interns beginning on or after 
 23.11  June 15, 1993, if they agree to pay the intern, during the 
 23.12  period before disbursement of state grant money, with money 
 23.13  designated as the facility's 50 percent contribution towards 
 23.14  internship costs.  
 23.15     Subd. 3.  [GRANTS.] The commissioner, through the 
 23.16  organization under contract, shall award separate grants to 
 23.17  hospitals and, clinics, nursing facilities, and home care 
 23.18  providers meeting the requirements of subdivision 2.  The grants 
 23.19  must be used to pay one-half of the costs of employing secondary 
 23.20  and post-secondary pupils in a hospital or, clinic, nursing 
 23.21  facility, or home care setting during the course of the 
 23.22  program.  No more than 50 percent of the participants may be 
 23.23  post-secondary students, unless the program does not receive 
 23.24  enough qualified secondary applicants per fiscal year.  No more 
 23.25  than five pupils may be selected from any secondary or 
 23.26  post-secondary institution to participate in the program and no 
 23.27  more than one-half of the number of pupils selected may be from 
 23.28  the seven-county metropolitan area. 
 23.29     Subd. 4.  [CONTRACT.] The commissioner shall contract with 
 23.30  a statewide, nonprofit organization representing facilities at 
 23.31  which secondary and post-secondary summer health care interns 
 23.32  will serve, to administer the grant program established by this 
 23.33  section.  Grant funds that are not used in one fiscal year may 
 23.34  be carried over to the next fiscal year.  The organization 
 23.35  awarded the grant shall provide the commissioner with any 
 23.36  information needed by the commissioner to evaluate the program, 
 24.1   in the form and at the times specified by the commissioner. 
 24.2      Sec. 28.  Minnesota Statutes 2000, section 144.148, 
 24.3   subdivision 2, is amended to read: 
 24.4      Subd. 2.  [PROGRAM.] The commissioner of health shall award 
 24.5   rural hospital capital improvement grants to eligible rural 
 24.6   hospitals.  A grant shall not exceed $300,000 $1,000,000 per 
 24.7   hospital. Prior to the receipt of any grant, the hospital must 
 24.8   certify to the commissioner that at least one-quarter of the 
 24.9   grant amount, which may include in-kind services, is available 
 24.10  for the same purposes from nonstate resources. 
 24.11     Sec. 29.  Minnesota Statutes 2000, section 144.1494, 
 24.12  subdivision 1, is amended to read: 
 24.13     Subdivision 1.  [CREATION OF ACCOUNT.] A rural physician 
 24.14  Education account is accounts are established in the health care 
 24.15  access fund and the general fund.  The commissioner shall use 
 24.16  money from the account to establish a loan forgiveness program 
 24.17  for medical residents agreeing to practice in designated rural 
 24.18  areas, as defined by the commissioner.  Appropriations made 
 24.19  to this account these accounts do not cancel and are available 
 24.20  until expended, except that at the end of each biennium the 
 24.21  commissioner shall cancel to the health care access fund or 
 24.22  general fund, as applicable, any remaining unobligated 
 24.23  balance in this accounts. 
 24.24     Sec. 30.  Minnesota Statutes 2000, section 144.1494, 
 24.25  subdivision 3, is amended to read: 
 24.26     Subd. 3.  [LOAN FORGIVENESS.] For each fiscal year after 
 24.27  1995, The commissioner may accept up to 12 22 applicants a year 
 24.28  who are medical residents for participation in the loan 
 24.29  forgiveness program with payment for the first 12 applicants 
 24.30  accepted to be made out of the health care access fund education 
 24.31  account and payment for the remaining applicants accepted to be 
 24.32  made out of the general fund education account.  The 12 resident 
 24.33  applicants may be in any year of residency training; however, 
 24.34  priority must be given to the following categories of residents 
 24.35  in descending order:  third year residents, second year 
 24.36  residents, and first year residents. Applicants are responsible 
 25.1   for securing their own loans.  Applicants chosen to participate 
 25.2   in the loan forgiveness program may designate for each year of 
 25.3   medical school, up to a maximum of four years, an agreed amount, 
 25.4   not to exceed $10,000, as a qualified loan.  For each year that 
 25.5   a participant serves as a physician in a designated rural area, 
 25.6   up to a maximum of four years, the commissioner shall annually 
 25.7   pay an amount equal to one year of qualified loans.  
 25.8   Participants who move their practice from one designated rural 
 25.9   area to another remain eligible for loan repayment.  In 
 25.10  addition, in any year that a resident participating in the loan 
 25.11  forgiveness program serves at least four weeks during a year of 
 25.12  residency substituting for a rural physician to temporarily 
 25.13  relieve the rural physician of rural practice commitments to 
 25.14  enable the rural physician to take a vacation, engage in 
 25.15  activities outside the practice area, or otherwise be relieved 
 25.16  of rural practice commitments, the participating resident may 
 25.17  designate up to an additional $2,000, above the $10,000 yearly 
 25.18  maximum.  
 25.19     Sec. 31.  Minnesota Statutes 2000, section 144.1494, 
 25.20  subdivision 4, is amended to read: 
 25.21     Subd. 4.  [PENALTY FOR NONFULFILLMENT.] If a participant 
 25.22  does not fulfill the required three-year minimum commitment of 
 25.23  service in a designated rural area, the commissioner shall 
 25.24  collect from the participant the amount paid under the loan 
 25.25  forgiveness program.  The commissioner shall deposit the money 
 25.26  collected in the rural physician education account collections 
 25.27  in the health care access fund or the general fund, as 
 25.28  applicable, to be credited to the accounts established in 
 25.29  subdivision 1.  The commissioner shall allow waivers of all or 
 25.30  part of the money owed the commissioner if emergency 
 25.31  circumstances prevented fulfillment of the three-year service 
 25.32  commitment.  
 25.33     Sec. 32.  Minnesota Statutes 2000, section 144.1496, is 
 25.34  amended to read: 
 25.35     144.1496 [NURSES IN NURSING HOMES OR, ICFMRS, OR HOME 
 25.36  HEALTH CARE AGENCIES.] 
 26.1      Subdivision 1.  [CREATION OF THE ACCOUNT.] An Education 
 26.2   account accounts in the health care access fund is and the 
 26.3   general fund are established for a loan forgiveness program for 
 26.4   nurses who agree to practice nursing in a nursing home or, 
 26.5   intermediate care facility for persons with mental retardation 
 26.6   or related conditions, or home health care agency.  The account 
 26.7   consists accounts consist of money appropriated by the 
 26.8   legislature and repayments and penalties collected under 
 26.9   subdivision 4.  Money from the account accounts must be used for 
 26.10  a loan forgiveness program. 
 26.11     Subd. 2.  [ELIGIBILITY.] To be eligible to participate in 
 26.12  the loan forgiveness program, a person enrolled in a program of 
 26.13  study designed to prepare the person to become a registered 
 26.14  nurse or licensed practical nurse must submit an application to 
 26.15  the commissioner before completion of a nursing education 
 26.16  program.  A nurse who is selected to participate must sign a 
 26.17  contract to agree to serve a minimum one-year service obligation 
 26.18  providing nursing services in a licensed nursing home or, 
 26.19  intermediate care facility for persons with mental retardation 
 26.20  or related conditions, or home health care agency, which shall 
 26.21  begin no later than March following completion of a nursing 
 26.22  program or loan forgiveness program selection.  
 26.23     Subd. 3.  [LOAN FORGIVENESS.] The commissioner may accept 
 26.24  up to ten 177 applicants a year with payment for the first ten 
 26.25  applicants accepted to be made out of the health care access 
 26.26  fund education account and payment for the remaining applicants 
 26.27  accepted to be made out of the general fund education account.  
 26.28  Applicants are responsible for securing their own loans.  For 
 26.29  each year of nursing education, for up to two years, applicants 
 26.30  accepted into the loan forgiveness program may designate an 
 26.31  agreed amount, not to exceed $3,000, as a qualified loan.  For 
 26.32  each year that a participant practices nursing in a nursing home 
 26.33  or, intermediate care facility for persons with mental 
 26.34  retardation or related conditions, or home health care agency, 
 26.35  up to a maximum of two years, the commissioner shall annually 
 26.36  repay an amount equal to one year of qualified loans.  
 27.1   Participants who move from one nursing home or, intermediate 
 27.2   care facility for persons with mental retardation or related 
 27.3   conditions, or home health care agency to another remain 
 27.4   eligible for loan repayment.  
 27.5      Subd. 4.  [PENALTY FOR NONFULFILLMENT.] If a participant 
 27.6   does not fulfill the service commitment required under 
 27.7   subdivision 3 for full repayment of all qualified loans, the 
 27.8   commissioner shall collect from the participant 100 percent of 
 27.9   any payments made for qualified loans and interest at a rate 
 27.10  established according to section 270.75.  The commissioner shall 
 27.11  deposit the collections in the health care access fund or the 
 27.12  general fund, as applicable, to be credited to the account 
 27.13  accounts established in subdivision 1.  The commissioner may 
 27.14  grant a waiver of all or part of the money owed as a result of a 
 27.15  nonfulfillment penalty if emergency circumstances prevented 
 27.16  fulfillment of the required service commitment. 
 27.17     Subd. 5.  [RULES.] The commissioner may adopt rules to 
 27.18  implement this section. 
 27.19     Sec. 33.  [144.1499] [PROMOTION OF HEALTH CARE AND 
 27.20  LONG-TERM CARE CAREERS.] 
 27.21     The commissioner of health, in consultation with an 
 27.22  organization representing health care employers, long-term care 
 27.23  employers, and educational institutions, may make grants to 
 27.24  qualifying consortia as defined in section 116L.11, subdivision 
 27.25  4, for intergenerational programs to encourage middle and high 
 27.26  school students to work and volunteer in health care and 
 27.27  long-term care settings.  To qualify for a grant under this 
 27.28  section, a consortium shall:  
 27.29     (1) develop a health and long-term care careers curriculum 
 27.30  that provides career exploration and training in national skill 
 27.31  standards for health care and long-term care and that is 
 27.32  consistent with Minnesota graduation standards and other related 
 27.33  requirements; 
 27.34     (2) offer programs for high school students that provide 
 27.35  training in health and long-term care careers with credits that 
 27.36  articulate into post-secondary programs; and 
 28.1      (3) provide technical support to the participating health 
 28.2   care and long-term care employer to enable the use of the 
 28.3   employer's facilities and programs for kindergarten to grade 12 
 28.4   health and long-term care careers education.  
 28.5      Sec. 34.  [144.1501] [RURAL PHARMACISTS LOAN FORGIVENESS.] 
 28.6      Subdivision 1.  [DEFINITIONS.] (a) For purposes of this 
 28.7   section, the terms defined in this subdivision have the meanings 
 28.8   given them. 
 28.9      (b) "Designated rural area" means:  
 28.10     (1) an area in Minnesota outside the counties of Anoka, 
 28.11  Carver, Dakota, Hennepin, Ramsey, Scott, and Washington, 
 28.12  excluding the cities of Duluth, Mankato, Moorhead, Rochester, 
 28.13  and St. Cloud; or 
 28.14     (2) a municipal corporation, as defined under section 
 28.15  471.634, that is physically located, in whole or in part, in an 
 28.16  area defined as a designated rural area under clause (1).  
 28.17     Designated rural areas may be further defined by the 
 28.18  commissioner of health to reflect a shortage of pharmacists as 
 28.19  indicated by the ratio of pharmacists to population and the 
 28.20  distance to the next nearest pharmacy. 
 28.21     (c) "Qualifying educational loans" means government, 
 28.22  commercial, and foundation loans for actual costs paid for 
 28.23  tuition, reasonable education expenses, and reasonable living 
 28.24  expenses related to the graduate or undergraduate education of a 
 28.25  pharmacist. 
 28.26     Subd. 2.  [CREATION OF ACCOUNT; LOAN FORGIVENESS 
 28.27  PROGRAM.] A rural pharmacist education account is established in 
 28.28  the general fund.  The commissioner of health shall use money 
 28.29  from the account to establish a loan forgiveness program for 
 28.30  pharmacists who agree to practice in designated rural areas.  
 28.31  The commissioner may seek advice in establishing the program 
 28.32  from the pharmacists association, the University of Minnesota, 
 28.33  and other interested parties. 
 28.34     Subd. 3.  [ELIGIBILITY.] To be eligible to participate in 
 28.35  the loan forgiveness program, a pharmacy student must submit an 
 28.36  application to the commissioner of health while attending a 
 29.1   program of study designed to prepare the individual to become a 
 29.2   licensed pharmacist.  For fiscal year 2002, applicants may have 
 29.3   graduated from a pharmacy program in calendar year 2001.  A 
 29.4   pharmacy student who is accepted into the loan forgiveness 
 29.5   program must sign a contract to agree to serve a minimum 
 29.6   three-year service obligation within a designated rural area, 
 29.7   which shall begin no later than March 31 of the first year 
 29.8   following completion of a pharmacy program or residency.  If 
 29.9   fewer applications are submitted by pharmacy students than there 
 29.10  are participant slots available, the commissioner may consider 
 29.11  applications submitted by pharmacy program graduates who are 
 29.12  licensed pharmacists.  Pharmacists selected for loan forgiveness 
 29.13  must comply with all terms and conditions of this section.  
 29.14     Subd. 4.  [LOAN FORGIVENESS.] The commissioner of health 
 29.15  may accept up to 14 applicants per year for participation in the 
 29.16  loan forgiveness program.  Applicants are responsible for 
 29.17  securing their own loans.  The commissioner shall select 
 29.18  participants based on their suitability for rural practice, as 
 29.19  indicated by rural experience or training.  The commissioner 
 29.20  shall give preference to applicants closest to completing their 
 29.21  training.  For each year that a participant serves as a 
 29.22  pharmacist in a designated rural area as required under 
 29.23  subdivision 3, up to a maximum of four years, the commissioner 
 29.24  shall make annual disbursements directly to the participant 
 29.25  equivalent to $5,000 per year of service, not to exceed $20,000 
 29.26  or the balance of the qualifying educational loans, whichever is 
 29.27  less.  Before receiving loan repayment disbursements and as 
 29.28  requested, the participant must complete and return to the 
 29.29  commissioner an affidavit of practice form provided by the 
 29.30  commissioner verifying that the participant is practicing as 
 29.31  required in an eligible area.  The participant must provide the 
 29.32  commissioner with verification that the full amount of loan 
 29.33  repayment disbursement received by the participant has been 
 29.34  applied toward the qualifying educational loans.  After each 
 29.35  disbursement, verification must be received by the commissioner 
 29.36  and approved before the next loan repayment disbursement is 
 30.1   made. Participants who move their practice from one designated 
 30.2   rural area to another remain eligible for loan repayment. 
 30.3      Subd. 5.  [PENALTY FOR NONFULFILLMENT.] If a participant 
 30.4   does not fulfill the service commitment under subdivision 3, the 
 30.5   commissioner of health shall collect from the participant 100 
 30.6   percent of any payments made for qualified educational loans and 
 30.7   interest at a rate established according to section 270.75.  The 
 30.8   commissioner shall deposit the money collected in the rural 
 30.9   pharmacist education account established under subdivision 2. 
 30.10     Subd. 6.  [SUSPENSION OR WAIVER OF OBLIGATION.] Payment or 
 30.11  service obligations cancel in the event of a participant's 
 30.12  death.  The commissioner of health may waive or suspend payment 
 30.13  or service obligations in cases of total and permanent 
 30.14  disability or long-term temporary disability lasting for more 
 30.15  than two years.  The commissioner shall evaluate all other 
 30.16  requests for suspension or waivers on a case-by-case basis and 
 30.17  may grant a waiver of all or part of the money owed as a result 
 30.18  of a nonfulfillment penalty if emergency circumstances prevented 
 30.19  fulfillment of the required service commitment. 
 30.20     Sec. 35.  [144.1502] [DENTISTS LOAN FORGIVENESS.] 
 30.21     Subdivision 1.  [DEFINITION.] For purposes of this section, 
 30.22  "qualifying educational loans" means government, commercial, and 
 30.23  foundation loans for actual costs paid for tuition, reasonable 
 30.24  education expenses, and reasonable living expenses related to 
 30.25  the graduate or undergraduate education of a dentist. 
 30.26     Subd. 2.  [CREATION OF ACCOUNT; LOAN FORGIVENESS 
 30.27  PROGRAM.] A dentist education account is established in the 
 30.28  general fund.  The commissioner of health shall use money from 
 30.29  the account to establish a loan forgiveness program for dentists 
 30.30  who agree to care for substantial numbers of state public 
 30.31  program participants and other low- to moderate-income uninsured 
 30.32  patients. 
 30.33     Subd. 3.  [ELIGIBILITY.] To be eligible to participate in 
 30.34  the loan forgiveness program, a dental student must submit an 
 30.35  application to the commissioner of health while attending a 
 30.36  program of study designed to prepare the individual to become a 
 31.1   licensed dentist.  For fiscal year 2002, applicants may have 
 31.2   graduated from a dentistry program in calendar year 2001.  A 
 31.3   dental student who is accepted into the loan forgiveness program 
 31.4   must sign a contract to agree to serve a minimum three-year 
 31.5   service obligation during which at least 25 percent of the 
 31.6   dentist's yearly patient encounters are delivered to state 
 31.7   public program enrollees or patients receiving sliding fee 
 31.8   schedule discounts through a formal sliding fee schedule meeting 
 31.9   the standards established by the United States Department of 
 31.10  Health and Human Services under Code of Federal Regulations, 
 31.11  title 42, section 51, chapter 303.  The service obligation shall 
 31.12  begin no later than March 31 of the first year following 
 31.13  completion of training.  If fewer applications are submitted by 
 31.14  dental students than there are participant slots available, the 
 31.15  commissioner may consider applications submitted by dental 
 31.16  program graduates who are licensed dentists.  Dentists selected 
 31.17  for loan forgiveness must comply with all terms and conditions 
 31.18  of this section.  
 31.19     Subd. 4.  [LOAN FORGIVENESS.] The commissioner of health 
 31.20  may accept up to 14 applicants per year for participation in the 
 31.21  loan forgiveness program.  Applicants are responsible for 
 31.22  securing their own loans.  The commissioner shall select 
 31.23  participants based on their suitability for practice serving 
 31.24  public program patients, as indicated by experience or 
 31.25  training.  The commissioner shall give preference to applicants 
 31.26  who have attended a Minnesota dentistry educational institution 
 31.27  and to applicants closest to completing their training.  For 
 31.28  each year that a participant meets the service obligation 
 31.29  required under subdivision 3, up to a maximum of four years, the 
 31.30  commissioner shall make annual disbursements directly to the 
 31.31  participant equivalent to $10,000 per year of service, not to 
 31.32  exceed $40,000 or the balance of the qualifying educational 
 31.33  loans, whichever is less.  Before receiving loan repayment 
 31.34  disbursements and as requested, the participant must complete 
 31.35  and return to the commissioner an affidavit of practice form 
 31.36  provided by the commissioner verifying that the participant is 
 32.1   practicing as required under subdivision 3.  The participant 
 32.2   must provide the commissioner with verification that the full 
 32.3   amount of loan repayment disbursement received by the 
 32.4   participant has been applied toward the designated loans.  After 
 32.5   each disbursement, verification must be received by the 
 32.6   commissioner and approved before the next loan repayment 
 32.7   disbursement is made.  Participants who move their practice 
 32.8   remain eligible for loan repayment as long as they practice as 
 32.9   required under subdivision 3. 
 32.10     Subd. 5.  [PENALTY FOR NONFULFILLMENT.] If a participant 
 32.11  does not fulfill the service commitment under subdivision 3, the 
 32.12  commissioner of health shall collect from the participant 100 
 32.13  percent of any payments made for qualified educational loans and 
 32.14  interest at a rate established according to section 270.75.  The 
 32.15  commissioner shall deposit the money collected in the dentist 
 32.16  education account established under subdivision 2. 
 32.17     Subd. 6.  [SUSPENSION OR WAIVER OF OBLIGATION.] Payment or 
 32.18  service obligations cancel in the event of a participant's 
 32.19  death.  The commissioner of health may waive or suspend payment 
 32.20  or service obligations in cases of total and permanent 
 32.21  disability or long-term temporary disability lasting for more 
 32.22  than two years.  The commissioner shall evaluate all other 
 32.23  requests for suspension or waivers on a case-by-case basis and 
 32.24  may grant a waiver of all or part of the money owed as a result 
 32.25  of a nonfulfillment penalty if emergency circumstances prevented 
 32.26  fulfillment of the required service commitment. 
 32.27     Sec. 36.  [144.1503] [RURAL MENTAL HEALTH PROFESSIONAL LOAN 
 32.28  FORGIVENESS.] 
 32.29     Subdivision 1.  [DEFINITIONS.] (a) For purposes of this 
 32.30  section, the terms defined in this subdivision have the meanings 
 32.31  given them. 
 32.32     (b) "Designated rural area" means: 
 32.33     (1) an area in Minnesota outside the counties of Anoka, 
 32.34  Carver, Dakota, Hennepin, Ramsey, Scott, and Washington, 
 32.35  excluding the cities of Duluth, Mankato, Moorhead, Rochester, 
 32.36  and St. Cloud; or 
 33.1      (2) a municipal corporation, as defined under section 
 33.2   471.634, that is physically located, in whole or in part, in an 
 33.3   area defined as a designated rural area under clause (1). 
 33.4      (c) "Mental health professional" means a psychologist, 
 33.5   clinical social worker, marriage and family therapist, or 
 33.6   psychiatric nurse. 
 33.7      (d) "Qualifying educational loans" means government, 
 33.8   commercial, and foundation loans for actual costs paid for 
 33.9   tuition, reasonable education expenses, and reasonable living 
 33.10  expenses related to the graduate or undergraduate education of a 
 33.11  mental health professional. 
 33.12     Subd. 2.  [CREATION OF ACCOUNT; LOAN FORGIVENESS 
 33.13  PROGRAM.] A rural mental health professional education account 
 33.14  is established in the general fund.  The commissioner of health 
 33.15  shall use money from the account to establish a loan forgiveness 
 33.16  program for mental health professionals who agree to practice in 
 33.17  designated rural areas. 
 33.18     Subd. 3.  [ELIGIBILITY.] To be eligible to participate in 
 33.19  the loan forgiveness program, a mental health professional 
 33.20  student must submit an application to the commissioner of health 
 33.21  while attending a program of study designed to prepare the 
 33.22  individual to become a mental health professional.  For fiscal 
 33.23  year 2002, applicants may have graduated from a mental health 
 33.24  professional educational program in calendar year 2001.  A 
 33.25  mental health professional student who is accepted into the loan 
 33.26  forgiveness program must sign a contract to agree to serve a 
 33.27  minimum three-year service obligation within a designated rural 
 33.28  area, which shall begin no later than March 31 of the first year 
 33.29  following completion of a mental health professional educational 
 33.30  program.  
 33.31     Subd. 4.  [LOAN FORGIVENESS.] The commissioner of health 
 33.32  may accept up to 12 applicants per year for participation in the 
 33.33  loan forgiveness program.  Applicants are responsible for 
 33.34  securing their own loans.  The commissioner shall select 
 33.35  participants based on their suitability for rural practice, as 
 33.36  indicated by rural experience or training.  The commissioner 
 34.1   shall give preference to applicants who have attended a 
 34.2   Minnesota mental health professional educational institution and 
 34.3   to applicants closest to completing their training.  For each 
 34.4   year that a participant serves as a mental health professional 
 34.5   in a designated rural area as required under subdivision 3, up 
 34.6   to a maximum of four years, the commissioner shall make annual 
 34.7   disbursements directly to the participant equivalent to $4,000 
 34.8   per year of service, not to exceed $16,000 or the balance of the 
 34.9   qualifying educational loans, whichever is less.  Before 
 34.10  receiving loan repayment disbursements and as requested, the 
 34.11  participant must complete and return to the commissioner an 
 34.12  affidavit of practice form provided by the commissioner 
 34.13  verifying that the participant is practicing as required in an 
 34.14  eligible area.  The participant must provide the commissioner 
 34.15  with verification that the full amount of loan repayment 
 34.16  disbursement received by the participant has been applied toward 
 34.17  the qualifying educational loans.  After each disbursement, 
 34.18  verification must be received by the commissioner and approved 
 34.19  before the next loan repayment disbursement is made.  
 34.20  Participants who move their practice from one designated rural 
 34.21  area to another remain eligible for loan repayment. 
 34.22     Subd. 5.  [PENALTY FOR NONFULFILLMENT.] If a participant 
 34.23  does not fulfill the service commitment under subdivision 3, the 
 34.24  commissioner of health shall collect from the participant 100 
 34.25  percent of any payments made for qualified educational loans and 
 34.26  interest at a rate established according to section 270.75.  The 
 34.27  commissioner shall deposit the money collected in the rural 
 34.28  mental health professional education account established under 
 34.29  subdivision 2. 
 34.30     Subd. 6.  [SUSPENSION OR WAIVER OF OBLIGATION.] Payment or 
 34.31  service obligations cancel in the event of a participant's 
 34.32  death.  The commissioner of health may waive or suspend payment 
 34.33  or service obligations in cases of total and permanent 
 34.34  disability or long-term temporary disability lasting for more 
 34.35  than two years.  The commissioner shall evaluate all other 
 34.36  requests for suspension or waivers on a case-by-case basis and 
 35.1   may grant a waiver of all or part of the money owed as a result 
 35.2   of a nonfulfillment penalty if emergency circumstances prevented 
 35.3   fulfillment of the required service commitment. 
 35.4      Sec. 37.  [144.1504] [RURAL HEALTH CARE TECHNICIANS LOAN 
 35.5   FORGIVENESS.] 
 35.6      Subdivision 1.  [DEFINITIONS.] (a) For purposes of this 
 35.7   section, the terms defined in this subdivision have the meanings 
 35.8   given them. 
 35.9      (b) "Clinical laboratory scientist" means a person who 
 35.10  performs and interprets results of medical tests that require 
 35.11  the exercise of independent judgment and responsibility, with 
 35.12  minimal supervision by the director or supervisor, in only those 
 35.13  specialties or subspecialties in which the person is qualified 
 35.14  by education, training, and experience and has demonstrated 
 35.15  ongoing competency by certification or other means.  A clinical 
 35.16  laboratory scientist may also be called a medical technologist. 
 35.17     (c) "Clinical laboratory technician" means any person other 
 35.18  than a medical laboratory director, clinical laboratory 
 35.19  scientist, or trainee who functions under the supervision of a 
 35.20  medical laboratory director or clinical laboratory scientist and 
 35.21  performs diagnostic and analytical laboratory tests in only 
 35.22  those specialties or subspecialties in which the person is 
 35.23  qualified by education, training, and experience and has 
 35.24  demonstrated ongoing competency by certification or other 
 35.25  means.  A clinical laboratory technician may also be called a 
 35.26  medical technician. 
 35.27     (d) "Designated rural area" means: 
 35.28     (1) an area in Minnesota outside the counties of Anoka, 
 35.29  Carver, Dakota, Hennepin, Ramsey, Scott, and Washington, 
 35.30  excluding the cities of Duluth, Mankato, Moorhead, Rochester, 
 35.31  and St. Cloud; or 
 35.32     (2) a municipal corporation, as defined under section 
 35.33  471.634, that is physically located, in whole or in part, in an 
 35.34  area defined as a designated rural area under clause (1). 
 35.35     (e) "Health care technician" means a clinical laboratory 
 35.36  scientist, clinical laboratory technician, radiologic 
 36.1   technologist, dental hygienist, dental assistant, or paramedic. 
 36.2      (f) "Paramedic" means a person certified under chapter 144E 
 36.3   by the emergency medical services regulatory board as an 
 36.4   emergency medical technician-paramedic.  
 36.5      (g) "Qualifying educational loans" means government, 
 36.6   commercial, and foundation loans for actual costs paid for 
 36.7   tuition, reasonable education expenses, and reasonable living 
 36.8   expenses related to the graduate or undergraduate education of a 
 36.9   health care technician. 
 36.10     (h) "Radiologic technologist" means a person, other than a 
 36.11  licensed physician, who has demonstrated competency by 
 36.12  certification, registration, or other means for administering 
 36.13  medical imaging or radiation therapy procedures to other persons 
 36.14  for medical purposes.  Radiologic technologist includes, but is 
 36.15  not limited to, radiographers, radiation therapists, and nuclear 
 36.16  medicine technologists. 
 36.17     Subd. 2.  [CREATION OF ACCOUNT; LOAN FORGIVENESS 
 36.18  PROGRAM.] A rural health care technician education account is 
 36.19  established in the general fund.  The commissioner of health 
 36.20  shall use money from the account to establish a loan forgiveness 
 36.21  program for health care technicians who agree to practice in 
 36.22  designated rural areas. 
 36.23     Subd. 3.  [ELIGIBILITY.] To be eligible to participate in 
 36.24  the loan forgiveness program, a health care technician student 
 36.25  must submit an application to the commissioner of health while 
 36.26  attending a program of study designed to prepare the individual 
 36.27  to become a health care technician.  For fiscal year 2002, 
 36.28  applicants may have graduated from a health care technician 
 36.29  program in calendar year 2001.  A health care technician student 
 36.30  who is accepted into the loan forgiveness program must sign a 
 36.31  contract to agree to serve a minimum one-year service obligation 
 36.32  within a designated rural area, which shall begin no later than 
 36.33  March 31 of the first year following completion of a health care 
 36.34  technician program. 
 36.35     Subd. 4.  [LOAN FORGIVENESS.] The commissioner of health 
 36.36  may accept up to 30 applicants per year for participation in the 
 37.1   loan forgiveness program.  Applicants are responsible for 
 37.2   securing their own loans.  The commissioner shall select 
 37.3   participants based on their suitability for rural practice, as 
 37.4   indicated by rural experience or training.  The commissioner 
 37.5   shall give preference to applicants who have attended a 
 37.6   Minnesota health care technician educational institution and to 
 37.7   applicants closest to completing their training.  For each year 
 37.8   that a participant serves as a health care technician in a 
 37.9   designated rural area as required under subdivision 3, up to a 
 37.10  maximum of two years, the commissioner shall make annual 
 37.11  disbursements directly to the participant equivalent to $2,500 
 37.12  per year of service, not to exceed $5,000 or the balance of the 
 37.13  qualifying educational loans, whichever is less.  Before 
 37.14  receiving loan repayment disbursements and as requested, the 
 37.15  participant must complete and return to the commissioner an 
 37.16  affidavit of practice form provided by the commissioner 
 37.17  verifying that the participant is practicing as required in an 
 37.18  eligible area.  The participant must provide the commissioner 
 37.19  with verification that the full amount of loan repayment 
 37.20  disbursement received by the participant has been applied toward 
 37.21  the qualifying educational loans.  After each disbursement, 
 37.22  verification must be received by the commissioner and approved 
 37.23  before the next loan repayment disbursement is made.  
 37.24  Participants who move their practice from one designated rural 
 37.25  area to another remain eligible for loan repayment. 
 37.26     Subd. 5.  [PENALTY FOR NONFULFILLMENT.] If a participant 
 37.27  does not fulfill the service commitment under subdivision 3, the 
 37.28  commissioner of health shall collect from the participant 100 
 37.29  percent of any payments made for qualified educational loans and 
 37.30  interest at a rate established according to section 270.75.  The 
 37.31  commissioner shall deposit the money collected in the rural 
 37.32  health care technician education account established under 
 37.33  subdivision 2. 
 37.34     Subd. 6.  [SUSPENSION OR WAIVER OF OBLIGATION.] Payment or 
 37.35  service obligations cancel in the event of a participant's 
 37.36  death.  The commissioner of health may waive or suspend payment 
 38.1   or service obligations in cases of total and permanent 
 38.2   disability or long-term temporary disability lasting for more 
 38.3   than two years.  The commissioner shall evaluate all other 
 38.4   requests for suspension or waivers on a case-by-case basis and 
 38.5   may grant a waiver of all or part of the money owed as a result 
 38.6   of a nonfulfillment penalty if emergency circumstances prevented 
 38.7   fulfillment of the required service commitment. 
 38.8      Sec. 38.  Minnesota Statutes 2000, section 144.226, 
 38.9   subdivision 4, is amended to read: 
 38.10     Subd. 4.  [VITAL RECORDS SURCHARGE.] In addition to any fee 
 38.11  prescribed under subdivision 1, there is a nonrefundable 
 38.12  surcharge of $3 $2 for each certified and noncertified birth or 
 38.13  death record, and for a certification that the record cannot be 
 38.14  found.  The local or state registrar shall forward this amount 
 38.15  to the state treasurer to be deposited into the state government 
 38.16  special revenue fund.  This surcharge shall not be charged under 
 38.17  those circumstances in which no fee for a birth or death record 
 38.18  is permitted under subdivision 1, paragraph (a).  This surcharge 
 38.19  requirement expires June 30, 2002. 
 38.20     Sec. 39.  [144.3805] [HEALTH STANDARDS.] 
 38.21     Subdivision 1.  [CRITERIA.] When establishing or revising 
 38.22  safe drinking water standards, the commissioner of health shall 
 38.23  adopt standards that adequately protect children and adults with 
 38.24  a margin of safety that provides a reasonable certainty of no 
 38.25  harm to child and adult health, by taking into account the risk 
 38.26  of cancer and effects on each of the following health outcomes: 
 38.27     (1) general infant and child development; 
 38.28     (2) development of the brain and nervous system; 
 38.29     (3) respiratory function; 
 38.30     (4) immunologic suppression or hypersensitization; 
 38.31     (5) endocrine (hormonal) function; and 
 38.32     (6) any other important health outcomes identified by the 
 38.33  commissioner.  
 38.34     Subd. 2.  [MARGIN OF SAFETY.] If there is insufficient 
 38.35  information to establish with reasonable certainty, for cancer 
 38.36  or any health outcome under subdivision 1, that child health 
 39.1   will not be harmed, the commissioner shall adopt a specific 
 39.2   margin of safety for that health outcome or risk that shall be 
 39.3   included in the overall margin of safety to protect human health.
 39.4      Sec. 40.  Minnesota Statutes 2000, section 144.396, 
 39.5   subdivision 7, is amended to read: 
 39.6      Subd. 7.  [LOCAL PUBLIC HEALTH PROMOTION AND PROTECTION.] 
 39.7   The commissioner shall distribute the funds available under 
 39.8   section 144.395, subdivision 2, paragraph (c), clause (3) for 
 39.9   the following: 
 39.10     (1) to community health boards for local health promotion 
 39.11  and protection activities for local health initiatives other 
 39.12  than tobacco prevention aimed at high risk health behaviors 
 39.13  among youth.  The commissioner shall distribute these funds to 
 39.14  the community health boards based on demographics and other 
 39.15  need-based factors relating to health; 
 39.16     (2) for activities that improve the health and learning 
 39.17  environment of school-aged children; and 
 39.18     (3) for competitive grants to public-private partnerships 
 39.19  focusing on the state school health issues identified by the 
 39.20  commissioner. 
 39.21     Sec. 41.  Minnesota Statutes 2000, section 144.98, 
 39.22  subdivision 3, is amended to read: 
 39.23     Subd. 3.  [FEES.] (a) An application for certification 
 39.24  under subdivision 1 must be accompanied by the biennial fee 
 39.25  specified in this subdivision.  The fees are for: 
 39.26     (1) nonrefundable base certification fee, $500 $1,200; and 
 39.27     (2) test category certification fees: 
 39.28  Test Category                                  Certification Fee
 39.29  Clean water program bacteriology                      $200 $600
 39.30  Safe drinking water program bacteriology                   $600
 39.31  Clean water program inorganic chemistry, 
 39.32    fewer than four constituents                        $100 $600
 39.33  Safe drinking water program inorganic chemistry, 
 39.34    four or more constituents                           $300 $600
 39.35  Clean water program chemistry metals, 
 39.36    fewer than four constituents                        $200 $800
 40.1   Safe drinking water program chemistry metals, 
 40.2     four or more constituents                           $500 $800
 40.3   Resource conservation and recovery program 
 40.4     chemistry metals                                         $800
 40.5   Clean water program volatile organic compounds      $600 $1,200
 40.6   Safe drinking water program 
 40.7     volatile organic compounds                             $1,200
 40.8   Resource conservation and recovery program 
 40.9     volatile organic compounds                             $1,200
 40.10  Underground storage tank program
 40.11    volatile organic compounds                             $1,200
 40.12  Clean water program other organic compounds         $600 $1,200
 40.13  Safe drinking water program other organic compounds      $1,200
 40.14  Resource conservation and recovery program
 40.15    other organic compounds                                $1,200
 40.16     (b) The total biennial certification fee is the base fee 
 40.17  plus the applicable test category fees.  The biennial 
 40.18  certification fee for a contract laboratory is 1.5 times the 
 40.19  total certification fee. 
 40.20     (c) Laboratories located outside of this state that require 
 40.21  an on-site survey will be assessed an additional $1,200 $2,500 
 40.22  fee. 
 40.23     (d) Fees must be set so that the total fees support the 
 40.24  laboratory certification program.  Direct costs of the 
 40.25  certification service include program administration, 
 40.26  inspections, the agency's general support costs, and attorney 
 40.27  general costs attributable to the fee function. 
 40.28     (e) A change fee shall be assessed if a laboratory requests 
 40.29  additional analytes or methods at any time other than when 
 40.30  applying for or renewing its certification.  The change fee is 
 40.31  equal to the test category certification fee for the analyte.  
 40.32     (f) A variance fee shall be assessed if a laboratory 
 40.33  requests and is granted a variance from a rule adopted under 
 40.34  this section.  The variance fee is $500 per variance. 
 40.35     (g) Refunds or credits shall not be made for analytes or 
 40.36  methods requested but not approved.  
 41.1      (h) Certification of a laboratory shall not be awarded 
 41.2   until all fees are paid. 
 41.3      Sec. 42.  [145.4241] [DEFINITIONS.] 
 41.4      Subdivision 1.  [APPLICABILITY.] As used in sections 
 41.5   145.4241 to 145.4246, the following terms have the meaning given 
 41.6   them. 
 41.7      Subd. 2.  [ABORTION.] "Abortion" includes an act, 
 41.8   procedure, or use of any instrument, medicine, or drug which is 
 41.9   supplied or prescribed for or administered to a woman known to 
 41.10  be pregnant with the intention to terminate the pregnancy with 
 41.11  an intention other than to increase the probability of live 
 41.12  birth, to preserve the life or health of the child after live 
 41.13  birth, or to remove a dead fetus. 
 41.14     Subd. 3.  [ATTEMPT TO PERFORM AN ABORTION.] "Attempt to 
 41.15  perform an abortion" means an act, or an omission of a 
 41.16  statutorily required act, that, under the circumstances as the 
 41.17  actor believes them to be, constitutes a substantial step in a 
 41.18  course of conduct planned to culminate in the performance of an 
 41.19  abortion in Minnesota in violation of sections 145.4241 to 
 41.20  145.4246. 
 41.21     Subd. 4.  [MEDICAL EMERGENCY.] "Medical emergency" means 
 41.22  any condition that, on the basis of the physician's good faith 
 41.23  clinical judgment, complicates the medical condition of a 
 41.24  pregnant female to the extent that: 
 41.25     (1) an immediate abortion of her pregnancy is necessary to 
 41.26  avert her death; or 
 41.27     (2) a 24-hour delay in performing an abortion creates a 
 41.28  serious risk of substantial injury or impairment of a major 
 41.29  bodily function. 
 41.30     Subd. 5.  [PHYSICIAN.] "Physician" means a person licensed 
 41.31  under chapter 147. 
 41.32     Subd. 6.  [PROBABLE GESTATIONAL AGE OF THE FETUS.] 
 41.33  "Probable gestational age of the fetus" means what will, in the 
 41.34  judgment of the physician, with reasonable probability, be the 
 41.35  gestational age of the fetus at the time the abortion is planned 
 41.36  to be performed. 
 42.1      Sec. 43.  [145.4242] [INFORMED CONSENT.] 
 42.2      (a) No abortion shall be performed in this state except 
 42.3   with the voluntary and informed consent of the female upon whom 
 42.4   the abortion is to be performed.  Except in the case of a 
 42.5   medical emergency, consent to an abortion is voluntary and 
 42.6   informed only if the female is told the following, by telephone 
 42.7   or in person, by the physician who is to perform the abortion, 
 42.8   the referring physician, a registered nurse, or a licensed 
 42.9   practical nurse, at least 24 hours prior to the abortion: 
 42.10     (1) the particular medical risks associated with the 
 42.11  particular abortion procedure to be employed including, when 
 42.12  medically accurate, the risks of infection, hemorrhage, breast 
 42.13  cancer, danger to subsequent pregnancies, and infertility; 
 42.14     (2) the probable gestational age of the fetus at the time 
 42.15  the abortion is to be performed; 
 42.16     (3) the medical risks associated with carrying to term; 
 42.17     (4) that medical assistance benefits may be available for 
 42.18  prenatal care, childbirth, and neonatal care; 
 42.19     (5) that the father is liable to assist in the support of 
 42.20  her child except under certain circumstances, even in instances 
 42.21  when the father has offered to pay for the abortion; 
 42.22     (6) the availability of a toll-free number and Web site 
 42.23  that can provide information on support services during 
 42.24  pregnancy and while the child is dependent and offer 
 42.25  alternatives to abortion; and 
 42.26     (7) that she has the right to review the printed materials 
 42.27  described in section 145.4243, and the printed materials are 
 42.28  available on the state Web site.  
 42.29     (b) The physician or the physician's agent shall orally 
 42.30  inform the female that the materials have been provided by the 
 42.31  state of Minnesota and that they describe the unborn child and 
 42.32  list agencies that offer alternatives to abortion. 
 42.33     (c) The physician or the physician's agent shall orally 
 42.34  inform the female of the Web site address and toll-free number. 
 42.35     (d) If the female chooses to view the materials, they shall 
 42.36  either be given to her at least 24 hours before the abortion or 
 43.1   mailed to her at least 72 hours before the abortion by first 
 43.2   class mail, or at the woman's request, by certified mail, 
 43.3   restricted delivery to addressee, which means the postal 
 43.4   employee may only deliver the mail to the addressee.  The 
 43.5   envelope used by the physician shall not identify the name of 
 43.6   the physician or the physician's clinic or business. 
 43.7      (e) If a physical examination, tests, or the availability 
 43.8   of other information to the physician subsequently indicates, in 
 43.9   the medical judgment of the physician, a revision of the 
 43.10  information previously supplied to the patient, that revised 
 43.11  information may be communicated to the patient at any time prior 
 43.12  to the performance of the abortion. 
 43.13     Sec. 44.  [145.4243] [PRINTED INFORMATION.] 
 43.14     Subdivision 1.  [MATERIALS.] (a) Within 90 days after the 
 43.15  effective date of sections 145.4241 to 145.4246, the department 
 43.16  of health shall cause to be published, in English and in each 
 43.17  language that is the primary language of two percent or more of 
 43.18  the state's population, the printed materials described in 
 43.19  paragraphs (b) and (c) in such a way as to ensure that the 
 43.20  information is easily comprehensible. 
 43.21     (b) The materials must be designed to inform the female of 
 43.22  the probable anatomical and physiological characteristics of the 
 43.23  fetus at two-week gestational increments from the time when a 
 43.24  female can be known to be pregnant to full term, including any 
 43.25  relevant information on the possibility of the fetus' survival 
 43.26  and pictures or drawings representing the development of the 
 43.27  fetus at two-week gestational increments, provided that any such 
 43.28  pictures or drawings must contain the dimensions of the fetus 
 43.29  and must be realistic and appropriate for the stage of pregnancy 
 43.30  depicted.  The materials must be objective, nonjudgmental, and 
 43.31  designed to convey only accurate scientific information about 
 43.32  the fetus at the various gestational ages. 
 43.33     (c) The materials must contain objective information 
 43.34  describing the methods of abortion procedures commonly employed, 
 43.35  the medical risks commonly associated with each procedure, the 
 43.36  possible detrimental psychological effects of abortion, and the 
 44.1   medical risks commonly associated with carrying a child to term. 
 44.2      Subd. 2.  [TYPEFACE; AVAILABILITY.] The materials referred 
 44.3   to in this section must be printed in a typeface large enough to 
 44.4   be clearly legible.  The materials required under this section 
 44.5   must be available from the department of health upon request and 
 44.6   in appropriate number to any person, facility, or hospital at no 
 44.7   cost. 
 44.8      Sec. 45.  [145.4244] [PROCEDURE IN CASE OF MEDICAL 
 44.9   EMERGENCY.] 
 44.10     When a medical emergency compels the performance of an 
 44.11  abortion, the physician shall inform the female, prior to the 
 44.12  abortion if possible, of the medical indications supporting the 
 44.13  physician's judgment that an abortion is necessary to avert her 
 44.14  death or that a 24-hour delay in conformance with section 
 44.15  145.4242 creates a serious risk of substantial injury or 
 44.16  impairment of a major bodily function. 
 44.17     Sec. 46.  [145.4245] [TOLL-FREE TELEPHONE NUMBER AND WEB 
 44.18  SITE.] 
 44.19     Subdivision 1.  [RIGHT TO KNOW.] All pregnant women have 
 44.20  the right to know information about resources available to 
 44.21  assist them and their families.  The commissioner of health 
 44.22  shall establish and maintain a statewide toll-free telephone 
 44.23  number available seven days a week to provide information and 
 44.24  referrals to local community resources to assist women and 
 44.25  families through pregnancy and childbirth and while the child is 
 44.26  dependent. 
 44.27     Subd. 2.  [INFORMATION.] The toll-free telephone number 
 44.28  must provide information regarding community resources on the 
 44.29  following topics: 
 44.30     (1) information regarding avoiding unplanned pregnancies; 
 44.31     (2) prenatal care, including the need for an initial risk 
 44.32  screening and assessment; 
 44.33     (3) adoption; 
 44.34     (4) health education, including the importance of good 
 44.35  nutrition during pregnancy and the risks associated with alcohol 
 44.36  and tobacco use during pregnancy; 
 45.1      (5) available social services, including medical assistance 
 45.2   benefits for prenatal care, childbirth, and neonatal care; 
 45.3      (6) legal assistance in obtaining child support; and 
 45.4      (7) community support services and other resources to 
 45.5   enhance family strengths and reduce the possibility of family 
 45.6   violence. 
 45.7      Subd. 3.  [WEB SITE.] The commissioner shall design and 
 45.8   maintain a secure Web site to provide the information described 
 45.9   under subdivision 2 and section 145.4243 with a minimum 
 45.10  resolution of 72 PPI.  The Web site shall provide the toll-free 
 45.11  information and referral telephone number described under 
 45.12  subdivision 2. 
 45.13     Sec. 47.  [145.4246] [ENFORCEMENT PENALTIES.] 
 45.14     Subdivision 1.  [STANDING.] A person with standing may 
 45.15  maintain an action against the performance or attempted 
 45.16  performance of abortions in violation of section 145.4242.  
 45.17  Those with standing are: 
 45.18     (1) a woman upon whom an abortion in violation of section 
 45.19  145.4242 has been performed or attempted to be performed; and 
 45.20     (2) the parent of an unemancipated minor upon whom an 
 45.21  abortion in violation of section 145.4242 has been, is about to 
 45.22  be, or was attempted to be performed; and 
 45.23     (3) attorney general of the state of Minnesota. 
 45.24     Subd. 2.  [INJUNCTIONS.] Parties bringing actions against 
 45.25  the performance or attempted performance of abortions in 
 45.26  violation of section 145.4242 may seek temporary restraining 
 45.27  orders, preliminary injunctions, and injunctions related only to 
 45.28  the physician or facility where the violation occurred in 
 45.29  accordance with the Rules of Civil Procedure.  Persons with 
 45.30  standing must bring any actions within six months of the date of 
 45.31  the performed or attempted performance of abortions in violation 
 45.32  of section 145.4242.  
 45.33     Subd. 3.  [CONTEMPT.] Any person knowingly violating the 
 45.34  terms of an injunction against the performance or attempted 
 45.35  performance of abortions in violation of section 145.4242 is 
 45.36  subject to civil contempt, and shall be fined no more than 
 46.1   $1,000 for the first violation, no more than $5,000 for the 
 46.2   second violation, no more than $10,000 for the third violation, 
 46.3   and for each successive violation an amount sufficient to deter 
 46.4   future violations.  The fine shall be the exclusive penalty for 
 46.5   a violation.  Each performance or attempted performance of 
 46.6   abortion in violation of section 145.4242 is a separate 
 46.7   violation.  No fine shall be assessed against the woman on whom 
 46.8   an abortion is performed or attempted. 
 46.9      Subd. 4.  [REALLOCATION OF THE FINE.] Any fines collected 
 46.10  under this section must be sent to a special account at the 
 46.11  Minnesota department of health to be used for materials cited in 
 46.12  section 145.4243. 
 46.13     Sec. 48.  [145.4247] [CUMULATIVE RIGHTS.] 
 46.14     The provisions of sections 145.4241 to 145.4246 are 
 46.15  cumulative with existing law regarding an individual's right to 
 46.16  consent to medical treatment and shall not impair any existing 
 46.17  right any patient may have under the common law or statutes of 
 46.18  this state. 
 46.19     Sec. 49.  [145.56] [SUICIDE PREVENTION.] 
 46.20     Subdivision 1.  [SUICIDE PREVENTION PLAN.] The commissioner 
 46.21  of health shall refine, coordinate, and implement the state's 
 46.22  suicide prevention plan using an evidence-based, public health 
 46.23  approach focused on prevention, in collaboration with the 
 46.24  commissioner of human services; the commissioner of public 
 46.25  safety; the commissioner of children, families, and learning; 
 46.26  and appropriate agencies, organizations, and institutions in the 
 46.27  community.  
 46.28     Subd. 2.  [COMMUNITY-BASED PROGRAMS.] (a) The commissioner 
 46.29  shall establish a grant program to fund: 
 46.30     (1) community-based programs to provide education, 
 46.31  outreach, and advocacy services to populations who may be at 
 46.32  risk for suicide; 
 46.33     (2) community-based programs that educate community helpers 
 46.34  and gatekeepers, such as family members, spiritual leaders, 
 46.35  coaches, and business owners, employers, and coworkers on how to 
 46.36  prevent suicide by encouraging help-seeking behaviors; 
 47.1      (3) community-based programs that educate populations at 
 47.2   risk for suicide and community helpers and gatekeepers that must 
 47.3   include information on the symptoms of depression and other 
 47.4   psychiatric illnesses, the warning signs of suicide, skills for 
 47.5   preventing suicides, and making or seeking effective referrals 
 47.6   to intervention and community resources; and 
 47.7      (4) community-based programs to provide evidence-based 
 47.8   suicide prevention and intervention education to school staff, 
 47.9   parents, and students in grades kindergarten through 12.  
 47.10     Subd. 3.  [WORKPLACE AND PROFESSIONAL EDUCATION.] (a) The 
 47.11  commissioner shall promote the use of employee assistance and 
 47.12  workplace programs to support employees with depression and 
 47.13  other psychiatric illnesses and substance abuse disorders, and 
 47.14  refer them to services.  The commissioner shall collaborate with 
 47.15  employer and professional associations, unions, and safety 
 47.16  councils.  
 47.17     (b) The commissioner shall provide training and technical 
 47.18  assistance to local public health and other community-based 
 47.19  professionals to provide for integrated implementation of best 
 47.20  practices for preventing suicide.  
 47.21     Subd. 4.  [COLLECTION AND REPORTING SUICIDE DATA.] The 
 47.22  commissioner shall coordinate with federal, regional, local, and 
 47.23  other state agencies to collect, analyze, and annually issue a 
 47.24  public report on Minnesota-specific data on suicide and suicidal 
 47.25  behaviors.  
 47.26     Subd. 5.  [PERIODIC EVALUATIONS; BIENNIAL REPORTS.] The 
 47.27  commissioner shall conduct periodic evaluations of the impact of 
 47.28  and outcomes from implementation of the state's suicide 
 47.29  prevention plan and each of the activities specified in this 
 47.30  section.  Beginning July 1, 2004, and July 1 of each 
 47.31  even-numbered year thereafter, the commissioner shall report the 
 47.32  results of these evaluations to the chairs of the policy and 
 47.33  finance committees in the house and senate with jurisdiction 
 47.34  over health and human services issues.  
 47.35     Sec. 50.  Minnesota Statutes 2000, section 145.881, 
 47.36  subdivision 2, is amended to read: 
 48.1      Subd. 2.  [DUTIES.] The advisory task force shall meet on a 
 48.2   regular basis to perform the following duties:  
 48.3      (a) review and report on the health care needs of mothers 
 48.4   and children throughout the state of Minnesota; 
 48.5      (b) review and report on the type, frequency and impact of 
 48.6   maternal and child health care services provided to mothers and 
 48.7   children under existing maternal and child health care programs, 
 48.8   including programs administered by the commissioner of health; 
 48.9      (c) establish, review, and report to the commissioner a 
 48.10  list of program guidelines and criteria which the advisory task 
 48.11  force considers essential to providing an effective maternal and 
 48.12  child health care program to low income populations and high 
 48.13  risk persons and fulfilling the purposes defined in section 
 48.14  145.88; 
 48.15     (d) review staff recommendations of the department of 
 48.16  health regarding maternal and child health grant awards before 
 48.17  the awards are made; 
 48.18     (e) make recommendations to the commissioner for the use of 
 48.19  other federal and state funds available to meet maternal and 
 48.20  child health needs; 
 48.21     (f) make recommendations to the commissioner of health on 
 48.22  priorities for funding the following maternal and child health 
 48.23  services:  (1) prenatal, delivery and postpartum care, (2) 
 48.24  comprehensive health care for children, especially from birth 
 48.25  through five years of age, (3) adolescent health services, (4) 
 48.26  family planning services, (5) preventive dental care, (6) 
 48.27  special services for chronically ill and handicapped children 
 48.28  and (7) any other services which promote the health of mothers 
 48.29  and children; and 
 48.30     (g) make recommendations to the commissioner of health on 
 48.31  the process to distribute, award and administer the maternal and 
 48.32  child health block grant funds; and 
 48.33     (h) review the measures that are used to define the 
 48.34  variables of the funding distribution formula in section 
 48.35  145.882, subdivision 4a, every two years and make 
 48.36  recommendations to the commissioner of health for changes based 
 49.1   upon principles established by the advisory task force for this 
 49.2   purpose.  
 49.3      Sec. 51.  Minnesota Statutes 2000, section 145.882, is 
 49.4   amended by adding a subdivision to read: 
 49.5      Subd. 4a.  [ALLOCATION TO COMMUNITY HEALTH BOARDS.] (a) 
 49.6   Federal maternal and child health block grant money remaining 
 49.7   after distributions made under subdivision 2 and money 
 49.8   appropriated for allocation to community health boards must be 
 49.9   allocated according to paragraphs (b) to (d) to community health 
 49.10  boards as defined in section 145A.02, subdivision 5.  
 49.11     (b) All community health boards must receive 95 percent of 
 49.12  the funding awarded to them for the 1998-1999 funding cycle.  If 
 49.13  the amount of state and federal funding available is less than 
 49.14  95 percent of the amount awarded to community health boards for 
 49.15  the 1998-1999 funding cycle, the available funding must be 
 49.16  apportioned to reflect a proportional decrease for each 
 49.17  recipient.  
 49.18     (c) The federal and state funding remaining after 
 49.19  distributions made under paragraph (b) must be allocated to each 
 49.20  community health board based on the following three variables: 
 49.21     (1) 25 percent based on the maternal and child population 
 49.22  in the area served by the community health board; 
 49.23     (2) 50 percent based on the following factors as determined 
 49.24  by averaging the data available for the three most current years:
 49.25     (i) the proportion of infants in the area served by the 
 49.26  community health board whose weight at birth is less than 2,500 
 49.27  grams; 
 49.28     (ii) the proportion of mothers in the area served by the 
 49.29  community health board who received inadequate or no prenatal 
 49.30  care; 
 49.31     (iii) the proportion of births in the area served by the 
 49.32  community health board to women under age 19; and 
 49.33     (iv) the proportion of births in the area served by the 
 49.34  community health board to American Indians and women of color; 
 49.35  and 
 49.36     (3) 25 percent based on the income of the maternal and 
 50.1   child population in the area served by the community health 
 50.2   board. 
 50.3      (d) Each variable must be expressed as a city or county 
 50.4   score consisting of the city or county frequency of each 
 50.5   variable divided by the statewide frequency of the variable.  A 
 50.6   total score for each city or county jurisdiction must be 
 50.7   computed by totaling the scores of the three variables.  Each 
 50.8   community health board must be allocated an amount equal to the 
 50.9   total score obtained for the city, county, or counties in its 
 50.10  area multiplied by the amount of money available. 
 50.11     Sec. 52.  Minnesota Statutes 2000, section 145.882, 
 50.12  subdivision 7, is amended to read: 
 50.13     Subd. 7.  [USE OF BLOCK GRANT MONEY.] (a) Maternal and 
 50.14  child health block grant money allocated to a community health 
 50.15  board or community health services area under this section must 
 50.16  be used for qualified programs for high risk and low-income 
 50.17  individuals.  Block grant money must be used for programs that: 
 50.18     (1) specifically address the highest risk populations, 
 50.19  particularly low-income and minority groups with a high rate of 
 50.20  infant mortality and children with low birth weight, by 
 50.21  providing services, including prepregnancy family planning 
 50.22  services, calculated to produce measurable decreases in infant 
 50.23  mortality rates, instances of children with low birth weight, 
 50.24  and medical complications associated with pregnancy and 
 50.25  childbirth, including infant mortality, low birth rates, and 
 50.26  medical complications arising from chemical abuse by a mother 
 50.27  during pregnancy; 
 50.28     (2) specifically target pregnant women whose age, medical 
 50.29  condition, maternal history, or chemical abuse substantially 
 50.30  increases the likelihood of complications associated with 
 50.31  pregnancy and childbirth or the birth of a child with an 
 50.32  illness, disability, or special medical needs; 
 50.33     (3) specifically address the health needs of young children 
 50.34  who have or are likely to have a chronic disease or disability 
 50.35  or special medical needs, including physical, neurological, 
 50.36  emotional, and developmental problems that arise from chemical 
 51.1   abuse by a mother during pregnancy; 
 51.2      (4) provide family planning and preventive medical care for 
 51.3   specifically identified target populations, such as minority and 
 51.4   low-income teenagers, in a manner calculated to decrease the 
 51.5   occurrence of inappropriate pregnancy and minimize the risk of 
 51.6   complications associated with pregnancy and childbirth; or 
 51.7      (5) specifically address the frequency and severity of 
 51.8   childhood injuries and other child and adolescent health 
 51.9   problems in high risk target populations by providing services 
 51.10  calculated to produce measurable decreases in mortality and 
 51.11  morbidity.  However, money may be used for this purpose only if 
 51.12  the community health board's application includes program 
 51.13  components for the purposes in clauses (1) to (4) in the 
 51.14  proposed geographic service area and the total expenditure for 
 51.15  injury-related programs under this clause does not exceed ten 
 51.16  percent of the total allocation under subdivision 3. 
 51.17     (b) Maternal and child health block grant money may be used 
 51.18  for purposes other than the purposes listed in this subdivision 
 51.19  only under the following conditions:  
 51.20     (1) the community health board or community health services 
 51.21  area can demonstrate that existing programs fully address the 
 51.22  needs of the highest risk target populations described in this 
 51.23  subdivision; or 
 51.24     (2) the money is used to continue projects that received 
 51.25  funding before creation of the maternal and child health block 
 51.26  grant in 1981. 
 51.27     (c) (b) Projects that received funding before creation of 
 51.28  the maternal and child health block grant in 1981, must be 
 51.29  allocated at least the amount of maternal and child health 
 51.30  special project grant funds received in 1989, unless (1) the 
 51.31  local board of health provides equivalent alternative funding 
 51.32  for the project from another source; or (2) the local board of 
 51.33  health demonstrates that the need for the specific services 
 51.34  provided by the project has significantly decreased as a result 
 51.35  of changes in the demographic characteristics of the population, 
 51.36  or other factors that have a major impact on the demand for 
 52.1   services.  If the amount of federal funding to the state for the 
 52.2   maternal and child health block grant is decreased, these 
 52.3   projects must receive a proportional decrease as required in 
 52.4   subdivision 1.  Increases in allocation amounts to local boards 
 52.5   of health under subdivision 4 may be used to increase funding 
 52.6   levels for these projects may be continued at the discretion of 
 52.7   the community health board. 
 52.8      Sec. 53.  Minnesota Statutes 2000, section 145.885, 
 52.9   subdivision 2, is amended to read: 
 52.10     Subd. 2.  [ADDITIONAL REQUIREMENTS FOR COMMUNITY BOARDS OF 
 52.11  HEALTH.] Applications by community health boards as defined in 
 52.12  section 145A.02, subdivision 5, under section 145.882, 
 52.13  subdivision 3 4a, must also contain a summary of the process 
 52.14  used to develop the local program, including evidence that the 
 52.15  community health board notified local public and private 
 52.16  providers of the availability of funding through the community 
 52.17  health board for maternal and child health services; a list of 
 52.18  all public and private agency requests for grants submitted to 
 52.19  the community health board indicating which requests were 
 52.20  included in the grant application; and an explanation of how 
 52.21  priorities were established for selecting the requests to be 
 52.22  included in the grant application.  The community health board 
 52.23  shall include, with the grant application, a written statement 
 52.24  of the criteria to be applied to public and private agency 
 52.25  requests for funding. 
 52.26     Sec. 54.  Minnesota Statutes 2000, section 145.925, 
 52.27  subdivision 1, is amended to read: 
 52.28     Subdivision 1.  [ELIGIBLE ORGANIZATIONS; PURPOSE.] The 
 52.29  commissioner of health may make special grants to cities, 
 52.30  counties, groups of cities or counties, or nonprofit 
 52.31  corporations to provide prepregnancy family planning 
 52.32  services.  No funds received under this section shall be used to 
 52.33  provide abortion services. 
 52.34     Sec. 55.  [145.9263] [PROMOTING HEALTHY LIFESTYLES AMONG 
 52.35  YOUTH.] 
 52.36     Subdivision 1.  [ESTABLISHMENT.] The commissioner shall 
 53.1   establish a grant program to promote healthy behavior among 
 53.2   youth. 
 53.3      Subd. 2.  [LOCAL GRANTS.] The commissioner shall award 
 53.4   competitive grants to eligible applicants for projects and 
 53.5   initiatives directed at promoting healthy lifestyles such as 
 53.6   proper nutrition, the need for physical exercise, and the 
 53.7   avoidance of other unhealthy behaviors.  The project areas for 
 53.8   grants include; 
 53.9      (1) after-school programs that focus on leadership, youth 
 53.10  mentoring and peer counseling, academic support, and 
 53.11  after-school enrichment; 
 53.12     (2) programs that provide education and support for youth 
 53.13  and parents that support healthy behaviors and self-sufficiency; 
 53.14     (3) youth development programs; or 
 53.15     (4) programs that focus on ethnic or cultural enrichment.  
 53.16     Subd. 3.  [HIGH-RISK COMMUNITY YOUTH GRANTS.] (a) the 
 53.17  commissioner shall award grants to communities that have 
 53.18  significant risk factors for unhealthy youth behaviors and that 
 53.19  currently have in place youth development programs. 
 53.20     (b) To be eligible for a grant under this subdivision, an 
 53.21  applicant must be a tribal government or a community health 
 53.22  board as defined in section 145A.02.  Applicants must submit 
 53.23  proposals to the commissioner.  A proposal must specify the 
 53.24  strategies to be implemented.  Strategies may include youth 
 53.25  mentoring programs, academic support programs, and parent 
 53.26  support and education programs.  Applicants must demonstrate 
 53.27  that a proposed project: 
 53.28     (1) is research-based or based on proven effective 
 53.29  strategies; 
 53.30     (2) is designed to coordinate with related youth risk 
 53.31  behavior reduction activities; 
 53.32     (3) involves youth and parents in the project's development 
 53.33  and implementation; 
 53.34     (4) reflects racially and ethnically appropriate 
 53.35  approaches; and 
 53.36     (5) will be implemented through or with persons or 
 54.1   community-based organizations that reflect the race or ethnicity 
 54.2   of the population to be reached. 
 54.3      Subd. 4.  [PUBLIC AWARENESS.] The commissioner shall 
 54.4   coordinate a public/private partnership to provide a statewide 
 54.5   outreach campaign directed at youth on the importance of a 
 54.6   healthy lifestyle and the health consequences of poor nutrition 
 54.7   and the lack of physical exercise in terms of obesity and other 
 54.8   health problems.  The campaign shall include culturally specific 
 54.9   and community-based messages.  
 54.10     Subd. 5.  [PROCESS.] (a) The commissioner, in consultation 
 54.11  with community partners, shall develop the criteria and 
 54.12  procedures to allocate the grants under this section.  In 
 54.13  developing the criteria, the commissioner shall establish an 
 54.14  administrative cost limit for grant recipients.  The outcomes 
 54.15  established under subdivision 6 must be specified to the grant 
 54.16  recipients receiving grants under this section at the time the 
 54.17  grant is awarded.  The commissioner may require an applicant to 
 54.18  enter into a collaborative agreement with the local public 
 54.19  health entity.  
 54.20     (b) Eligible applicants may include, but are not limited 
 54.21  to, nonprofit organizations, community clinics, and social 
 54.22  service organizations.  Applicants must submit proposals to the 
 54.23  commissioner.  The proposals must specify the strategies to be 
 54.24  implemented and must take into account the need for a 
 54.25  coordinated local effort.  
 54.26     (c) The commissioner shall give priority to programs that: 
 54.27     (1) are designed to coordinate with related youth risk 
 54.28  behavior reduction activities; 
 54.29     (2) involve youth and parents in the development and 
 54.30  implementation; 
 54.31     (3) are implemented through or with community-based 
 54.32  organizations reflecting the race and ethnicity of the 
 54.33  population to be needed; and 
 54.34     (4) reflect racial and ethnic appropriate approaches.  
 54.35     Subd. 6.  [MEASURABLE OUTCOMES.] The commissioner, in 
 54.36  consultation with other public and private nonprofit 
 55.1   organizations interested in youth development efforts, shall 
 55.2   establish measurable outcomes to determine the effectiveness of 
 55.3   the grants receiving funds under this section.  
 55.4      Subd. 7.  [COORDINATION.] The commissioner shall coordinate 
 55.5   the projects and initiatives funded under this section with 
 55.6   other efforts at the local, state, and national level to avoid 
 55.7   duplication and promote complimentary efforts.  
 55.8      Subd. 8.  [EVALUATION.] (a) Using the outcome measures 
 55.9   established in subdivision 6, the commissioner shall conduct a 
 55.10  biennial evaluation of the efforts funded under this section.  
 55.11     (b) Grant recipients shall cooperate with the commissioner 
 55.12  of health in the evaluation and provide the commissioner with 
 55.13  the information necessary to conduct the evaluation.  
 55.14     Subd. 9.  [REPORT.] The commissioner shall submit biennial 
 55.15  reports to the legislature on the activities of the projects 
 55.16  funded under this section and the results of the biennial 
 55.17  evaluation.  These reports are due by January 15 of every other 
 55.18  year, beginning in the year 2004. 
 55.19     Sec. 56.  [145.9268] [COMMUNITY CLINIC GRANTS.] 
 55.20     Subdivision 1.  [DEFINITION.] For purposes of this section, 
 55.21  "eligible community clinic" means: 
 55.22     (1) a clinic that provides services under conditions as 
 55.23  defined in Minnesota Rules, part 9505.0255, and utilizes a 
 55.24  sliding fee scale to determine eligibility for charity care; 
 55.25     (2) an Indian tribal government or Indian health service 
 55.26  unit; or 
 55.27     (3) a consortium of clinics comprised of entities under 
 55.28  clause (1) or (2). 
 55.29     Subd. 2.  [GRANTS AUTHORIZED.] The commissioner of health 
 55.30  shall award grants to eligible community clinics to improve the 
 55.31  ongoing viability of Minnesota's clinic-based safety net 
 55.32  providers.  Grants shall be awarded to support the capacity of 
 55.33  eligible community clinics to serve low-income populations, 
 55.34  reduce current or future uncompensated care burdens, or provide 
 55.35  for improved care delivery infrastructure. 
 55.36     Subd. 3.  [ALLOCATION OF GRANTS.] (a) To receive a grant 
 56.1   under this section, an eligible community clinic must submit an 
 56.2   application to the commissioner of health by the deadline 
 56.3   established by the commissioner.  A grant may be awarded upon 
 56.4   the signing of a grant contract. 
 56.5      (b) An application must be on a form and contain 
 56.6   information as specified by the commissioner but at a minimum 
 56.7   must contain: 
 56.8      (1) a description of the project for which grant funds will 
 56.9   be used; 
 56.10     (2) a description of the problem the proposed project will 
 56.11  address; and 
 56.12     (3) a description of achievable objectives, a workplan, and 
 56.13  a timeline for project completion. 
 56.14     (c) The commissioner shall review each application to 
 56.15  determine whether the application is complete and whether the 
 56.16  applicant and the project are eligible for a grant.  In 
 56.17  evaluating applications according to paragraph (e), the 
 56.18  commissioner shall establish criteria including, but not limited 
 56.19  to:  the priority level of the project; the applicant's 
 56.20  thoroughness and clarity in describing the problem; a 
 56.21  description of the applicant's proposed project; the manner in 
 56.22  which the applicant will demonstrate the effectiveness of the 
 56.23  project; and evidence of efficiencies and effectiveness gained 
 56.24  through collaborative efforts.  The commissioner may also take 
 56.25  into account other relevant factors, including, but not limited 
 56.26  to, the percentage for which uninsured patients represent the 
 56.27  applicant's patient base.  During application review, the 
 56.28  commissioner may request additional information about a proposed 
 56.29  project, including information on project cost.  Failure to 
 56.30  provide the information requested disqualifies an applicant.  
 56.31  The commissioner has discretion over the number of grants 
 56.32  awarded. 
 56.33     (d) In determining which eligible community clinics will 
 56.34  receive grants under this section, the commissioner shall give 
 56.35  preference to those grant applications that show evidence of 
 56.36  collaboration with other eligible community clinics, hospitals, 
 57.1   health care providers, or community organizations.  In addition, 
 57.2   the commissioner shall give priority, in declining order, to 
 57.3   grant applications for projects that: 
 57.4      (1) establish, update, or improve information, data 
 57.5   collection, or billing systems; 
 57.6      (2) procure, modernize, remodel, or replace equipment used 
 57.7   an the delivery of direct patient care at a clinic; 
 57.8      (3) provide improvements for care delivery, such as 
 57.9   increased translation and interpretation services; 
 57.10     (4) provide a direct offset to expenses incurred for 
 57.11  charity care services; or 
 57.12     (5) other projects determined by the commissioner to 
 57.13  improve the ability of applicants to provide care to the 
 57.14  vulnerable populations they serve. 
 57.15     Subd. 4.  [EVALUATION.] The commissioner of health shall 
 57.16  evaluate the overall effectiveness of the grant program.  The 
 57.17  commissioner shall collect progress reports to evaluate the 
 57.18  grant program from the eligible community clinics receiving 
 57.19  grants. 
 57.20     Sec. 57.  [145.9269] [ELIMINATING HEALTH DISPARITIES.] 
 57.21     Subdivision 1.  [STATE-COMMUNITY PARTNERSHIPS.] The 
 57.22  commissioner, in partnership with culturally based community 
 57.23  organizations; the Indian affairs council as defined in section 
 57.24  3.922; the council on affairs of Chicano/Latino people as 
 57.25  defined in section 3.9223; the council on Black Minnesotans as 
 57.26  defined in section 3.9225; the council on Asian-Pacific 
 57.27  Minnesotans as defined in section 3.9226; community health 
 57.28  boards; and tribal governments, shall develop and implement a 
 57.29  comprehensive coordinated plan to reduce health disparities 
 57.30  experienced by American Indians and communities of color in 
 57.31  infant mortality, breast and cervical cancer screening, 
 57.32  HIV/AIDS/STDs, immunizations, cardiovascular disease, diabetes, 
 57.33  injury, and violence.  
 57.34     Subd. 2.  [MEASURABLE OUTCOMES.] The commissioner, in 
 57.35  consultation with community partners, shall establish measurable 
 57.36  outcomes to determine the effectiveness of the grants and other 
 58.1   activities receiving funds under this section in reducing health 
 58.2   disparities.  The goal of the grants shall be to decrease by 
 58.3   one-half the ratio of American Indians and communities of color 
 58.4   specific health condition rates to white rates in the areas 
 58.5   identified in subdivision 1.  
 58.6      Subd. 3.  [STATEWIDE ASSESSMENT.] The commissioner shall 
 58.7   enhance current data tools to assure a statewide assessment of 
 58.8   the risk behaviors associated with the areas identified in 
 58.9   subdivision 1.  This statewide assessment must be used to 
 58.10  establish a baseline to measure the effect of activities funded 
 58.11  under this section.  To the extent feasible, the commissioner of 
 58.12  health must conduct the assessment so that the results may be 
 58.13  compared to nationwide data.  Data collected and used for 
 58.14  assessment must not identify an individual according to section 
 58.15  13.05, subdivision 7.  
 58.16     Subd. 4.  [TECHNICAL ASSISTANCE.] The commissioner shall 
 58.17  provide the necessary expertise to community organizations to 
 58.18  ensure that submitted proposals are likely to be successful in 
 58.19  reducing health disparities.  The commissioner shall provide 
 58.20  grant recipients with guidance and training on strategies 
 58.21  related to reducing the health disparities identified in this 
 58.22  section.  The commissioner shall also provide grant recipients 
 58.23  with assistance in the development of evaluation of local 
 58.24  community activities.  
 58.25     Subd. 5.  [PROCESS.] (a) The commissioner shall, in 
 58.26  consultation with community partners, develop the criteria and 
 58.27  procedures to allocate the grants under this section.  In 
 58.28  developing the criteria, the commissioner shall establish an 
 58.29  administrative cost limit for grant recipients.  The outcomes 
 58.30  established under subdivision 2 must be specified to the grant 
 58.31  recipients receiving grants under this section at the time the 
 58.32  grant is awarded.  
 58.33     (b) A grant recipient must coordinate the activities 
 58.34  related to reducing health disparities with other grant 
 58.35  recipients receiving funding under this section within the 
 58.36  recipient's service area.  
 59.1      Subd. 6.  [COMMUNITY GRANT PROGRAM.] (a) The commissioner 
 59.2   shall award grants to eligible applicants for local or regional 
 59.3   projects and initiatives directed at reducing health 
 59.4   disparities.  Grant proposals must address one or more of the 
 59.5   following priority areas:  
 59.6      (1) decreasing racial and ethnic disparities in infant 
 59.7   mortality rates; 
 59.8      (2) decreasing racial and ethnic disparities in morbidity 
 59.9   and mortality rates relating to breast and cervical cancer; 
 59.10     (3) decreasing racial and ethnic disparities in morbidity 
 59.11  and mortality rates relating to HIV/AIDS/STDs; 
 59.12     (4) increasing adult and child immunization rates in racial 
 59.13  and ethnic populations; 
 59.14     (5) decreasing racial and ethnic disparities in morbidity 
 59.15  and mortality rates relating to cardiovascular disease; 
 59.16     (6) decreasing racial and ethnic disparities in morbidity 
 59.17  and mortality rates relating to diabetes; and 
 59.18     (7) decreasing racial and ethnic disparities in morbidity 
 59.19  and mortality rates relating to injury or violence. 
 59.20     (b) The commissioner may award up to 20 percent of the 
 59.21  funds available as planning grants.  Planning grant proposals 
 59.22  must be used to address such areas as community assessment, 
 59.23  determining community priority areas, coordination activities, 
 59.24  and development of community-supported strategies.  
 59.25     (c) Eligible applicants may include, but are not limited 
 59.26  to, faith-based organizations, social service organizations, 
 59.27  community nonprofit organizations, and community clinics.  
 59.28  Applicants must submit proposals to the commissioner and must 
 59.29  demonstrate partnerships with local public health.  The 
 59.30  proposals must specify the strategies to be implemented to 
 59.31  reduce one or more of the project areas listed under subdivision 
 59.32  6, paragraph (a), and must be targeted to achieve the outcomes 
 59.33  established in subdivision 2.  
 59.34     (d) The commissioner must give priority to applicants who 
 59.35  demonstrate that the proposed project or initiative: 
 59.36     (1) is supported by the community the applicant will be 
 60.1   serving; 
 60.2      (2) is research based or based on promising strategies; 
 60.3      (3) is designed to compliment other related community 
 60.4   activities; 
 60.5      (4) utilizes strategies that positively impacts more than 
 60.6   one priority area; and 
 60.7      (5) is implemented through or with community-based 
 60.8   organizations that reflect the race or ethnicity of the 
 60.9   population to be reached.  
 60.10     Subd. 7.  [LOCAL PUBLIC HEALTH.] The commissioner shall 
 60.11  award grants to community health boards for local health 
 60.12  promotion and protection activities aimed at reducing maternal 
 60.13  and child health disparities between whites and American Indians 
 60.14  and populations of color.  Local public health must submit 
 60.15  proposals to the commissioner and must demonstrate partnerships 
 60.16  with culturally based community organizations or with tribal 
 60.17  governments.  The commissioner shall distribute these funds to 
 60.18  community health boards according to the formula in section 
 60.19  145.882, subdivision 4.  
 60.20     Subd. 8.  [TRIBAL GOVERNMENTS.] The commissioner shall 
 60.21  award grants to American Indian tribal governments for 
 60.22  implementation of community interventions to reduce health 
 60.23  disparities for the project areas listed under subdivision 6, 
 60.24  paragraph (a), and must be targeted to achieve the outcomes 
 60.25  established in subdivision 2.  Tribal governments must submit 
 60.26  proposals to the commissioner and must demonstrate partnerships 
 60.27  with local public health.  The distribution formula shall be 
 60.28  determined by the commissioner, in consultation with the tribal 
 60.29  governments.  
 60.30     Subd. 9.  [REFUGEE AND IMMIGRANT HEALTH.] The commissioner 
 60.31  shall distribute funds to community health boards for health 
 60.32  screening and follow-up services for foreign-born persons.  
 60.33  Distribution shall be based on the following criteria: 
 60.34     (1) cases of pulmonary tuberculosis; 
 60.35     (2) cases of extrapulmonary tuberculosis; 
 60.36     (3) the number of months providing directly observed 
 61.1   therapy to cases of uninsured tuberculosis or extrapulmonary 
 61.2   tuberculosis; and 
 61.3      (4) the number of new refugees in the service area within 
 61.4   the fiscal year.  
 61.5   The commissioner, in cooperation with the affected local public 
 61.6   health departments, shall determine reimbursement rates within 
 61.7   the given appropriations. 
 61.8      Subd. 10.  [COORDINATION.] The commissioner shall 
 61.9   coordinate the projects and initiatives funded under this 
 61.10  section with other efforts at the local, state, or national 
 61.11  level to avoid duplication of effort and promote complimentary 
 61.12  efforts.  
 61.13     Subd. 11.  [EVALUATION.] Using the outcome measures 
 61.14  established in subdivision 2, the commissioner shall conduct a 
 61.15  biennial evaluation of the community grants program, community 
 61.16  health board activities, and tribal government activities funded 
 61.17  under this section.  Grant recipients, tribal governments, and 
 61.18  community health boards shall cooperate with the commissioner in 
 61.19  the evaluation and provide the commissioner with the information 
 61.20  necessary to conduct the evaluation.  
 61.21     Subd. 12.  [REPORT.] The commissioner shall submit a 
 61.22  biennial report to the legislature on the local community 
 61.23  projects, tribal government, and community health board 
 61.24  prevention activities funded under this section.  These reports 
 61.25  must include information on grant recipients, activities that 
 61.26  were conducted using grant funds, evaluation data and outcome 
 61.27  measures, if available.  These reports are due by January 15 of 
 61.28  every other year, beginning in the year 2004.  
 61.29     Sec. 58.  Minnesota Statutes 2000, section 157.16, 
 61.30  subdivision 3, is amended to read: 
 61.31     Subd. 3.  [ESTABLISHMENT FEES; DEFINITIONS.] (a) The 
 61.32  following fees are required for food and beverage service 
 61.33  establishments, hotels, motels, lodging establishments, and 
 61.34  resorts licensed under this chapter.  Food and beverage service 
 61.35  establishments must pay the highest applicable fee under 
 61.36  paragraph (e), clause (1), (2), (3), or (4), and establishments 
 62.1   serving alcohol must pay the highest applicable fee under 
 62.2   paragraph (e), clause (6) or (7).  The license fee for new 
 62.3   operators previously licensed under this chapter for the same 
 62.4   calendar year is one-half of the appropriate annual license fee, 
 62.5   plus any penalty that may be required.  The license fee for 
 62.6   operators opening on or after October 1 is one-half of the 
 62.7   appropriate annual license fee, plus any penalty that may be 
 62.8   required. 
 62.9      (b) All food and beverage service establishments, except 
 62.10  special event food stands, and all hotels, motels, lodging 
 62.11  establishments, and resorts shall pay an annual base fee of 
 62.12  $100 $145. 
 62.13     (c) A special event food stand shall pay a flat fee 
 62.14  of $30 $35 annually.  "Special event food stand" means a fee 
 62.15  category where food is prepared or served in conjunction with 
 62.16  celebrations, county fairs, or special events from a special 
 62.17  event food stand as defined in section 157.15. 
 62.18     (d) In addition to the base fee in paragraph (b), each food 
 62.19  and beverage service establishment, other than a special event 
 62.20  food stand, and each hotel, motel, lodging establishment, and 
 62.21  resort shall pay an additional annual fee for each fee category 
 62.22  as specified in this paragraph: 
 62.23     (1) Limited food menu selection, $30 $40.  "Limited food 
 62.24  menu selection" means a fee category that provides one or more 
 62.25  of the following: 
 62.26     (i) prepackaged food that receives heat treatment and is 
 62.27  served in the package; 
 62.28     (ii) frozen pizza that is heated and served; 
 62.29     (iii) a continental breakfast such as rolls, coffee, juice, 
 62.30  milk, and cold cereal; 
 62.31     (iv) soft drinks, coffee, or nonalcoholic beverages; or 
 62.32     (v) cleaning for eating, drinking, or cooking utensils, 
 62.33  when the only food served is prepared off site. 
 62.34     (2) Small establishment, including boarding establishments, 
 62.35  $55 $75.  "Small establishment" means a fee category that has no 
 62.36  salad bar and meets one or more of the following: 
 63.1      (i) possesses food service equipment that consists of no 
 63.2   more than a deep fat fryer, a grill, two hot holding containers, 
 63.3   and one or more microwave ovens; 
 63.4      (ii) serves dipped ice cream or soft serve frozen desserts; 
 63.5      (iii) serves breakfast in an owner-occupied bed and 
 63.6   breakfast establishment; 
 63.7      (iv) is a boarding establishment; or 
 63.8      (v) meets the equipment criteria in clause (3), item (i) or 
 63.9   (ii), and has a maximum patron seating capacity of not more than 
 63.10  50.  
 63.11     (3) Medium establishment, $150 $210.  "Medium establishment"
 63.12  means a fee category that meets one or more of the following: 
 63.13     (i) possesses food service equipment that includes a range, 
 63.14  oven, steam table, salad bar, or salad preparation area; 
 63.15     (ii) possesses food service equipment that includes more 
 63.16  than one deep fat fryer, one grill, or two hot holding 
 63.17  containers; or 
 63.18     (iii) is an establishment where food is prepared at one 
 63.19  location and served at one or more separate locations. 
 63.20     Establishments meeting criteria in clause (2), item (v), 
 63.21  are not included in this fee category.  
 63.22     (4) Large establishment, $250 $350.  "Large establishment" 
 63.23  means either: 
 63.24     (i) a fee category that (A) meets the criteria in clause 
 63.25  (3), items (i) or (ii), for a medium establishment, (B) seats 
 63.26  more than 175 people, and (C) offers the full menu selection an 
 63.27  average of five or more days a week during the weeks of 
 63.28  operation; or 
 63.29     (ii) a fee category that (A) meets the criteria in clause 
 63.30  (3), item (iii), for a medium establishment, and (B) prepares 
 63.31  and serves 500 or more meals per day. 
 63.32     (5) Other food and beverage service, including food carts, 
 63.33  mobile food units, seasonal temporary food stands, and seasonal 
 63.34  permanent food stands, $30 $40. 
 63.35     (6) Beer or wine table service, $30 $40.  "Beer or wine 
 63.36  table service" means a fee category where the only alcoholic 
 64.1   beverage service is beer or wine, served to customers seated at 
 64.2   tables. 
 64.3      (7) Alcoholic beverage service, other than beer or wine 
 64.4   table service, $75 $105. 
 64.5      "Alcohol beverage service, other than beer or wine table 
 64.6   service" means a fee category where alcoholic mixed drinks are 
 64.7   served or where beer or wine are served from a bar. 
 64.8      (8) Lodging per sleeping accommodation unit, $4 $6, 
 64.9   including hotels, motels, lodging establishments, and resorts, 
 64.10  up to a maximum of $400 $600.  "Lodging per sleeping 
 64.11  accommodation unit" means a fee category including the number of 
 64.12  guest rooms, cottages, or other rental units of a hotel, motel, 
 64.13  lodging establishment, or resort; or the number of beds in a 
 64.14  dormitory. 
 64.15     (9) First public swimming pool, $100 $140; each additional 
 64.16  public swimming pool, $50 $80.  "Public swimming pool" means a 
 64.17  fee category that has the meaning given in Minnesota Rules, part 
 64.18  4717.0250, subpart 8. 
 64.19     (10) First spa, $50 $80; each additional spa, $25 $40.  
 64.20  "Spa pool" means a fee category that has the meaning given in 
 64.21  Minnesota Rules, part 4717.0250, subpart 9. 
 64.22     (11) Private sewer or water, $30 $40.  "Individual private 
 64.23  water" means a fee category with a water supply other than a 
 64.24  community public water supply as defined in Minnesota Rules, 
 64.25  chapter 4720.  "Individual private sewer" means a fee category 
 64.26  with an individual sewage treatment system which uses subsurface 
 64.27  treatment and disposal. 
 64.28     (e) A fee is not required for a food and beverage service 
 64.29  establishment operated by a school as defined in sections 
 64.30  120A.05, subdivisions 9, 11, 13, and 17 and 120A.22. 
 64.31     (f) A fee of $150 for review of the construction plans must 
 64.32  accompany the initial license application for food and beverage 
 64.33  service establishments, hotels, motels, lodging establishments, 
 64.34  or resorts. 
 64.35     (g) (f) When existing food and beverage service 
 64.36  establishments, hotels, motels, lodging establishments, or 
 65.1   resorts are extensively remodeled, a fee of $150 must be 
 65.2   submitted with the remodeling plans. 
 65.3      (h) (g) Seasonal temporary food stands and special event 
 65.4   food stands are not required to submit construction or 
 65.5   remodeling plans for review. 
 65.6      Sec. 59.  Minnesota Statutes 2000, section 157.22, is 
 65.7   amended to read: 
 65.8      157.22 [EXEMPTIONS.] 
 65.9      This chapter shall not be construed to apply to: 
 65.10     (1) interstate carriers under the supervision of the United 
 65.11  States Department of Health and Human Services; 
 65.12     (2) any building constructed and primarily used for 
 65.13  religious worship; 
 65.14     (3) any building owned, operated, and used by a college or 
 65.15  university in accordance with health regulations promulgated by 
 65.16  the college or university under chapter 14; 
 65.17     (4) any person, firm, or corporation whose principal mode 
 65.18  of business is licensed under sections 28A.04 and 28A.05, is 
 65.19  exempt at that premises from licensure as a food or beverage 
 65.20  establishment; provided that the holding of any license pursuant 
 65.21  to sections 28A.04 and 28A.05 shall not exempt any person, firm, 
 65.22  or corporation from the applicable provisions of this chapter or 
 65.23  the rules of the state commissioner of health relating to food 
 65.24  and beverage service establishments; 
 65.25     (5) family day care homes and group family day care homes 
 65.26  governed by sections 245A.01 to 245A.16; 
 65.27     (6) nonprofit senior citizen centers for the sale of 
 65.28  home-baked goods; and 
 65.29     (7) food not prepared at an establishment and brought in by 
 65.30  individuals attending a potluck event for consumption at the 
 65.31  potluck event.  An organization sponsoring a potluck event under 
 65.32  this clause may advertise the potluck event to the public 
 65.33  through any means.  Individuals who are not members of an 
 65.34  organization sponsoring a potluck event under this clause may 
 65.35  attend the potluck event and consume the food at the event.  
 65.36  Licensed food establishments cannot be sponsors of potluck 
 66.1   events.  Potluck event food shall not be brought into a licensed 
 66.2   food establishment kitchen; and 
 66.3      (8) a home school in which a child is provided instruction 
 66.4   at home.  
 66.5      Sec. 60.  Minnesota Statutes 2000, section 326.38, is 
 66.6   amended to read: 
 66.7      326.38 [LOCAL REGULATIONS.] 
 66.8      Any city having a system of waterworks or sewerage, or any 
 66.9   town in which reside over 5,000 people exclusive of any 
 66.10  statutory cities located therein, or the metropolitan airports 
 66.11  commission, may, by ordinance, adopt local regulations providing 
 66.12  for plumbing permits, bonds, approval of plans, and inspections 
 66.13  of plumbing, which regulations are not in conflict with the 
 66.14  plumbing standards on the same subject prescribed by the state 
 66.15  commissioner of health.  No city or such town shall prohibit 
 66.16  plumbers licensed by the state commissioner of health from 
 66.17  engaging in or working at the business, except cities and 
 66.18  statutory cities which, prior to April 21, 1933, by ordinance 
 66.19  required the licensing of plumbers.  Any city by ordinance may 
 66.20  prescribe regulations, reasonable standards, and inspections and 
 66.21  grant permits to any person, firm, or corporation engaged in the 
 66.22  business of installing water softeners, who is not licensed as a 
 66.23  master plumber or journeyman plumber by the state commissioner 
 66.24  of health, to connect water softening and water filtering 
 66.25  equipment to private residence water distribution systems, where 
 66.26  provision has been previously made therefor and openings left 
 66.27  for that purpose or by use of cold water connections to a 
 66.28  domestic water heater; where it is not necessary to rearrange, 
 66.29  make any extension or alteration of, or addition to any pipe, 
 66.30  fixture or plumbing connected with the water system except to 
 66.31  connect the water softener, and provided the connections so made 
 66.32  comply with minimum standards prescribed by the state 
 66.33  commissioner of health. 
 66.34     Sec. 61.  [MEDICATIONS DISPENSED IN SCHOOLS STUDY.] 
 66.35     (a) The commissioner of health, in consultation with the 
 66.36  board of nursing, shall study the relationship between the Nurse 
 67.1   Practice Act, Minnesota Statutes, sections 148.171 to 148.285; 
 67.2   and 121A.22, which specifies the administration of medications 
 67.3   in schools and the activities authorized under these sections, 
 67.4   including the administration of prescription and nonprescription 
 67.5   medications and medications needed by students to manage a 
 67.6   chronic illness.  The commissioner shall also make 
 67.7   recommendations on necessary statutory changes needed to promote 
 67.8   student health and safety in relation to administering 
 67.9   medications in schools and addressing the changing health needs 
 67.10  of students.  
 67.11     (b) The commissioner shall convene a work group to assist 
 67.12  in the study and recommendations.  The work group shall consist 
 67.13  of representatives of the commissioner of human services; the 
 67.14  commissioner of children, families, and learning; the board of 
 67.15  nursing; the board of teaching; school nurses; parents; school 
 67.16  administrators; school board associations; the American Academy 
 67.17  of Pediatrics; and the Minnesota Nurse's Association. 
 67.18     (c) The commissioner shall submit these recommendations and 
 67.19  any recommended statutory changes to the legislature by January 
 67.20  15, 2002.  
 67.21     Sec. 62.  [REPEALER.] 
 67.22     Minnesota Statutes 2000, sections 144.148, subdivision 8; 
 67.23  145.882, subdivisions 3 and 4; and 145.927, are repealed. 
 67.24                             ARTICLE 2 
 67.25                            HEALTH CARE 
 67.26     Section 1.  Minnesota Statutes 2000, section 16A.87, is 
 67.27  amended to read: 
 67.28     16A.87 [TOBACCO SETTLEMENT FUND.] 
 67.29     Subdivision 1.  [ESTABLISHMENT; PURPOSE.] The tobacco 
 67.30  settlement fund is established as a clearing account in the 
 67.31  state treasury.  
 67.32     Subd. 2.  [DEPOSIT OF MONEY.] The commissioner shall credit 
 67.33  to the tobacco settlement fund the tobacco settlement payments 
 67.34  received by the state on September 5, 1998, January 4, 1999, 
 67.35  January 3, 2000, and January 2, 2001, January 2, 2002, and 
 67.36  January 2, 2003, as a result of the settlement of the lawsuit 
 68.1   styled as State v. Philip Morris Inc., No. C1-94-8565 (Minnesota 
 68.2   District Court, Second Judicial District).  
 68.3      Subd. 3.  [APPROPRIATION.] (a) Of the amounts credited to 
 68.4   the fund prior to June 30, 2001, 61 percent is appropriated for 
 68.5   transfer to the tobacco use prevention and local public health 
 68.6   endowment fund created in section 144.395 and 39 percent is 
 68.7   appropriated for transfer to the medical education endowment 
 68.8   fund created in section 62J.694. 
 68.9      (b) The entire amount credited to the fund from the 
 68.10  payments made on January 2, 2002, and on January 2, 2003, are 
 68.11  appropriated for transfer to the children's health care 
 68.12  endowment fund created in section 256.952.  
 68.13     Subd. 4.  [SUNSET.] The tobacco settlement fund expires 
 68.14  June 30, 2015.  
 68.15     Sec. 2.  Minnesota Statutes 2000, section 62A.095, 
 68.16  subdivision 1, is amended to read: 
 68.17     Subdivision 1.  [APPLICABILITY.] (a) No health plan shall 
 68.18  be offered, sold, or issued to a resident of this state, or to 
 68.19  cover a resident of this state, unless the health plan complies 
 68.20  with subdivision 2. 
 68.21     (b) Health plans providing benefits under health care 
 68.22  programs administered by the commissioner of human services are 
 68.23  not subject to the limits described in subdivision 2 but are 
 68.24  subject to the right of subrogation provisions under section 
 68.25  256B.37 and the lien provisions under section 256.015; 256B.042; 
 68.26  256D.03, subdivision 8; or 256L.03, subdivision 6. 
 68.27     Sec. 3.  Minnesota Statutes 2000, section 62J.692, 
 68.28  subdivision 7, is amended to read: 
 68.29     Subd. 7.  [TRANSFERS FROM THE COMMISSIONER OF HUMAN 
 68.30  SERVICES.] (a) The amount transferred according to section 
 68.31  256B.69, subdivision 5c, paragraph (a), clause (3), shall be 
 68.32  distributed to the University of Minnesota academic health 
 68.33  center.  
 68.34     (b) The amount transferred according to section 256B.69, 
 68.35  subdivision 5c, paragraph (a), clause (4), shall be distributed 
 68.36  to the Hennepin county medical center.  
 69.1      (c) The amount transferred according to section 256B.69, 
 69.2   subdivision 5c, paragraph (a), clause (2), shall be distributed 
 69.3   by the commissioner to clinical medical education programs that 
 69.4   meet the qualifications of subdivision 3 based on a distribution 
 69.5   formula that reflects a summation of two factors: 
 69.6      (1) an education factor, which is determined by the total 
 69.7   number of eligible trainee FTEs and the total statewide average 
 69.8   costs per trainee, by type of trainee, in each clinical medical 
 69.9   education program; and 
 69.10     (2) a public program volume factor, which is determined by 
 69.11  the total volume of public program revenue received by each 
 69.12  training site as a percentage of all public program revenue 
 69.13  received by all training sites in the fund pool created under 
 69.14  this subdivision.  
 69.15     In this formula, the education factor shall be weighted at 
 69.16  50 percent and the public program volume factor shall be 
 69.17  weighted at 50 percent. 
 69.18     (b) (d) Public program revenue for the formula in paragraph 
 69.19  (a) (c) shall include revenue from medical assistance, prepaid 
 69.20  medical assistance, general assistance medical care, and prepaid 
 69.21  general assistance medical care. 
 69.22     (c) Training sites that receive no public program revenue 
 69.23  shall be ineligible for funds available under this 
 69.24  subdivision paragraph (c).  
 69.25     Sec. 4.  Minnesota Statutes 2000, section 62J.694, 
 69.26  subdivision 2, is amended to read: 
 69.27     Subd. 2.  [EXPENDITURES.] (a) Up to five percent of the 
 69.28  fair market value of the fund is appropriated for medical 
 69.29  education activities in the state of Minnesota.  The 
 69.30  appropriations are to be transferred quarterly for the purposes 
 69.31  identified in the following paragraphs.  
 69.32     (b) For fiscal year 2000, 70 percent of the appropriation 
 69.33  in paragraph (a) is for transfer to the board of regents for the 
 69.34  instructional costs of health professional programs at the 
 69.35  academic health center and affiliated teaching institutions, and 
 69.36  30 percent of the appropriation is for transfer to the 
 70.1   commissioner of health to be distributed for medical education 
 70.2   under section 62J.692.  
 70.3      (c) For fiscal year 2001, 49 percent of the appropriation 
 70.4   in paragraph (a) is for transfer to the board of regents for the 
 70.5   instructional costs of health professional programs at the 
 70.6   academic health center and affiliated teaching institutions, and 
 70.7   51 percent is for transfer to the commissioner of health to be 
 70.8   distributed for medical education under section 62J.692. 
 70.9      (d) For fiscal year 2002, and each year thereafter, 42 
 70.10  percent of the appropriation in paragraph (a) may be 
 70.11  appropriated by another law for the instructional costs of 
 70.12  health professional programs at publicly funded academic health 
 70.13  centers and affiliated teaching institutions is for transfer to 
 70.14  the commissioner of human services to be used to increase the 
 70.15  capitation payments under section 256B.69, and 58 percent is for 
 70.16  transfer to the commissioner of health to be distributed for 
 70.17  medical education under section 62J.692. 
 70.18     (e) A maximum of $150,000 of each annual appropriation to 
 70.19  the commissioner of health in paragraph (d) may be used by the 
 70.20  commissioner for administrative expenses associated with 
 70.21  implementing section 62J.692.  
 70.22     Sec. 5.  Minnesota Statutes 2000, section 62Q.19, 
 70.23  subdivision 2, is amended to read: 
 70.24     Subd. 2.  [APPLICATION.] (a) Any provider may apply to the 
 70.25  commissioner for designation as an essential community provider 
 70.26  by submitting an application form developed by the 
 70.27  commissioner.  Except as provided in paragraph (d), applications 
 70.28  must be accepted within two years after the effective date of 
 70.29  the rules adopted by the commissioner to implement this section. 
 70.30     (b) Each application submitted must be accompanied by an 
 70.31  application fee in an amount determined by the commissioner.  
 70.32  The fee shall be no more than what is needed to cover the 
 70.33  administrative costs of processing the application. 
 70.34     (c) The name, address, contact person, and the date by 
 70.35  which the commissioner's decision is expected to be made shall 
 70.36  be classified as public data under section 13.41.  All other 
 71.1   information contained in the application form shall be 
 71.2   classified as private data under section 13.41 until the 
 71.3   application has been approved, approved as modified, or denied 
 71.4   by the commissioner.  Once the decision has been made, all 
 71.5   information shall be classified as public data unless the 
 71.6   applicant designates and the commissioner determines that the 
 71.7   information contains trade secret information. 
 71.8      (d) The commissioner shall accept an application for 
 71.9   designation as an essential community provider until June 30, 
 71.10  2001, from: 
 71.11     (1) one applicant that is a nonprofit community health care 
 71.12  facility, certified as a medical assistance provider effective 
 71.13  April 1, 1998, that provides culturally competent health care to 
 71.14  an underserved Southeast Asian immigrant and refugee population 
 71.15  residing in the immediate neighborhood of the facility; 
 71.16     (2) one applicant that is a nonprofit home health care 
 71.17  provider, certified as a Medicare and a medical assistance 
 71.18  provider that provides culturally competent home health care 
 71.19  services to a low-income culturally diverse population; 
 71.20     (3) up to five applicants that are nonprofit community 
 71.21  mental health centers certified as medical assistance providers 
 71.22  that provide mental health services to children with serious 
 71.23  emotional disturbance and their families or to adults with 
 71.24  serious and persistent mental illness; and 
 71.25     (4) one applicant that is a nonprofit provider certified as 
 71.26  a medical assistance provider that provides mental health, child 
 71.27  development, and family services to children with physical and 
 71.28  mental health disorders and their families. 
 71.29     (e) The commissioner shall accept applications for 
 71.30  designation as an essential community provider until June 30, 
 71.31  2002, from an alternative school authorized under sections 
 71.32  123A.05 to 123A.08 or under section 124D.68 and a charter school 
 71.33  authorized under section 124D.10.  For these schools, the 
 71.34  essential community provider designation applies for mental 
 71.35  health services delivered by a licensed health care or social 
 71.36  services practitioner to a child currently enrolled in the 
 72.1   school. 
 72.2      Sec. 6.  [145.495] [HEALTH CARE SAFETY NET ENDOWMENT FUND.] 
 72.3      Subdivision 1.  [CREATION.] The health care safety net 
 72.4   endowment fund is created in the state treasury.  The state 
 72.5   board of investment shall invest the fund under section 11A.24.  
 72.6   All earnings of the fund must be credited to the fund.  The 
 72.7   principal of the fund must be maintained inviolate, except that 
 72.8   the principal may be used to make expenditures from the fund for 
 72.9   the purposes specified in this section. 
 72.10     Subd. 2.  [EXPENDITURES.] (a) For fiscal year 2003, and 
 72.11  each year thereafter, up to five percent of the average of the 
 72.12  fair market values of the fund for the preceding 12 months is 
 72.13  appropriated for the purposes identified in clauses (1) to (4): 
 72.14     (1) 26.7 percent is appropriated to the commissioner of 
 72.15  health to distributed as grants to community clinics in 
 72.16  accordance in section 145.928; 
 72.17     (2) 26.7 percent is appropriated to the commissioner of 
 72.18  commerce to be paid to the Minnesota comprehensive health 
 72.19  association for the exclusive purpose of reducing the 
 72.20  association's operating deficit assessment for the year; 
 72.21     (3) 33.3 percent is appropriated to the commissioner of 
 72.22  health to be distributed as rural hospital capital improvement 
 72.23  grants in accordance with section 144.148; and 
 72.24     (4) 13.3 percent is appropriated to the commissioner of 
 72.25  human services to be distributed as dental access grants in 
 72.26  accordance with section 256B.53.  If the amount appropriated is 
 72.27  not used within that fiscal year for dental access grants, the 
 72.28  commissioner of finance shall transfer the remaining amount to 
 72.29  the commissioner of health to be added to the amount to be 
 72.30  distributed as rural hospital capital improvement grants for the 
 72.31  next fiscal year. 
 72.32     Subd. 3.  [ENDOWMENT FUND NOT TO SUPPLANT EXISTING 
 72.33  FUNDS.] Appropriations from the fund must not be used as a 
 72.34  substitute for traditional sources of funding for health care 
 72.35  programs.  Any local political subdivision of the state 
 72.36  receiving money under this section must ensure that existing 
 73.1   local financial efforts remain in place.  
 73.2      Subd. 4.  [HEALTH CARE SAFETY NET ENDOWMENT FUND.] 
 73.3      If the health care safety net endowment fund created under 
 73.4   subdivision 1 is repealed, the commissioner of finance shall 
 73.5   transfer the principal and any remaining interest to the health 
 73.6   care access fund. 
 73.7      Sec. 7.  Minnesota Statutes 2000, section 150A.10, is 
 73.8   amended by adding a subdivision to read: 
 73.9      Subd. 1a.  [LIMITED AUTHORIZATION FOR DENTAL 
 73.10  HYGIENISTS.] (a) Notwithstanding subdivision 1, a dental 
 73.11  hygienist licensed under this chapter may be employed or 
 73.12  retained by a health care facility to perform dental hygiene 
 73.13  services described under paragraph (b) without the patient first 
 73.14  being examined by a licensed dentist if the dental hygienist: 
 73.15     (1) has two years practical clinical experience with a 
 73.16  licensed dentist within the preceding five years; and 
 73.17     (2) has entered into a collaborative agreement with a 
 73.18  licensed dentist that designates authorization for the services 
 73.19  provided by the dental hygienist. 
 73.20     (b) The dental hygiene services authorized to be performed 
 73.21  by a dental hygienist under this subdivision are limited to 
 73.22  removal of deposits and stains from the surfaces of the teeth, 
 73.23  application of topical preventive or prophylactic agents, 
 73.24  polishing and smoothing restorations, and performance of root 
 73.25  planing and soft-tissue curettage.  The dental hygienist shall 
 73.26  not place pit and fissure sealants, unless the patient has been 
 73.27  recently examined and the treatment planned by a licensed 
 73.28  dentist.  The dental hygienist shall not perform injections of 
 73.29  anesthetic agents or the administration of nitrous oxide unless 
 73.30  under the indirect supervision of a licensed dentist.  The 
 73.31  performance of dental hygiene services in a health care facility 
 73.32  is limited to patients, students, and residents of the 
 73.33  facility.  A dental hygienist must refer patients to a licensed 
 73.34  dentist for dental diagnosis, treatment planning, and dental 
 73.35  treatment. 
 73.36     (c) A collaborating dentist must be licensed under this 
 74.1   chapter and may enter into a collaborative agreement with more 
 74.2   than one dental hygienist.  The collaborative agreement must be 
 74.3   maintained by the dentist and the dental hygienist and must be 
 74.4   made available to the board upon request.  
 74.5      (d) For the purposes of this subdivision, a "health care 
 74.6   facility" is limited to a hospital; nursing home; home health 
 74.7   agency; group home serving the elderly, disabled, or juveniles; 
 74.8   state-operated facility licensed by the commissioner of human 
 74.9   services or the commissioner of corrections; and federal, state, 
 74.10  or local public health facility, community clinic, or tribal 
 74.11  clinic.  
 74.12     (e) For purposes of this subdivision, "a collaborative 
 74.13  agreement" means an agreement with a licensed dentist who 
 74.14  authorizes and accepts responsibility for the services performed 
 74.15  by the dental hygienist.  The services authorized under this 
 74.16  subdivision and the collaborative agreement may be performed 
 74.17  without the presence of a licensed dentist and may be performed 
 74.18  at a location other than the usual place of practice of the 
 74.19  dentist or dental hygienist and without a dentist's diagnosis 
 74.20  and treatment plan. 
 74.21     Sec. 8.  Minnesota Statutes 2000, section 256.01, 
 74.22  subdivision 2, is amended to read: 
 74.23     Subd. 2.  [SPECIFIC POWERS.] Subject to the provisions of 
 74.24  section 241.021, subdivision 2, the commissioner of human 
 74.25  services shall: 
 74.26     (1) Administer and supervise all forms of public assistance 
 74.27  provided for by state law and other welfare activities or 
 74.28  services as are vested in the commissioner.  Administration and 
 74.29  supervision of human services activities or services includes, 
 74.30  but is not limited to, assuring timely and accurate distribution 
 74.31  of benefits, completeness of service, and quality program 
 74.32  management.  In addition to administering and supervising human 
 74.33  services activities vested by law in the department, the 
 74.34  commissioner shall have the authority to: 
 74.35     (a) require county agency participation in training and 
 74.36  technical assistance programs to promote compliance with 
 75.1   statutes, rules, federal laws, regulations, and policies 
 75.2   governing human services; 
 75.3      (b) monitor, on an ongoing basis, the performance of county 
 75.4   agencies in the operation and administration of human services, 
 75.5   enforce compliance with statutes, rules, federal laws, 
 75.6   regulations, and policies governing welfare services and promote 
 75.7   excellence of administration and program operation; 
 75.8      (c) develop a quality control program or other monitoring 
 75.9   program to review county performance and accuracy of benefit 
 75.10  determinations; 
 75.11     (d) require county agencies to make an adjustment to the 
 75.12  public assistance benefits issued to any individual consistent 
 75.13  with federal law and regulation and state law and rule and to 
 75.14  issue or recover benefits as appropriate; 
 75.15     (e) delay or deny payment of all or part of the state and 
 75.16  federal share of benefits and administrative reimbursement 
 75.17  according to the procedures set forth in section 256.017; 
 75.18     (f) make contracts with and grants to public and private 
 75.19  agencies and organizations, both profit and nonprofit, and 
 75.20  individuals, using appropriated funds; and 
 75.21     (g) enter into contractual agreements with federally 
 75.22  recognized Indian tribes with a reservation in Minnesota to the 
 75.23  extent necessary for the tribe to operate a federally approved 
 75.24  family assistance program or any other program under the 
 75.25  supervision of the commissioner.  The commissioner shall consult 
 75.26  with the affected county or counties in the contractual 
 75.27  agreement negotiations, if the county or counties wish to be 
 75.28  included, in order to avoid the duplication of county and tribal 
 75.29  assistance program services.  The commissioner may establish 
 75.30  necessary accounts for the purposes of receiving and disbursing 
 75.31  funds as necessary for the operation of the programs. 
 75.32     (2) Inform county agencies, on a timely basis, of changes 
 75.33  in statute, rule, federal law, regulation, and policy necessary 
 75.34  to county agency administration of the programs. 
 75.35     (3) Administer and supervise all child welfare activities; 
 75.36  promote the enforcement of laws protecting handicapped, 
 76.1   dependent, neglected and delinquent children, and children born 
 76.2   to mothers who were not married to the children's fathers at the 
 76.3   times of the conception nor at the births of the children; 
 76.4   license and supervise child-caring and child-placing agencies 
 76.5   and institutions; supervise the care of children in boarding and 
 76.6   foster homes or in private institutions; and generally perform 
 76.7   all functions relating to the field of child welfare now vested 
 76.8   in the state board of control. 
 76.9      (4) Administer and supervise all noninstitutional service 
 76.10  to handicapped persons, including those who are visually 
 76.11  impaired, hearing impaired, or physically impaired or otherwise 
 76.12  handicapped.  The commissioner may provide and contract for the 
 76.13  care and treatment of qualified indigent children in facilities 
 76.14  other than those located and available at state hospitals when 
 76.15  it is not feasible to provide the service in state hospitals. 
 76.16     (5) Assist and actively cooperate with other departments, 
 76.17  agencies and institutions, local, state, and federal, by 
 76.18  performing services in conformity with the purposes of Laws 
 76.19  1939, chapter 431. 
 76.20     (6) Act as the agent of and cooperate with the federal 
 76.21  government in matters of mutual concern relative to and in 
 76.22  conformity with the provisions of Laws 1939, chapter 431, 
 76.23  including the administration of any federal funds granted to the 
 76.24  state to aid in the performance of any functions of the 
 76.25  commissioner as specified in Laws 1939, chapter 431, and 
 76.26  including the promulgation of rules making uniformly available 
 76.27  medical care benefits to all recipients of public assistance, at 
 76.28  such times as the federal government increases its participation 
 76.29  in assistance expenditures for medical care to recipients of 
 76.30  public assistance, the cost thereof to be borne in the same 
 76.31  proportion as are grants of aid to said recipients. 
 76.32     (7) Establish and maintain any administrative units 
 76.33  reasonably necessary for the performance of administrative 
 76.34  functions common to all divisions of the department. 
 76.35     (8) Act as designated guardian of both the estate and the 
 76.36  person of all the wards of the state of Minnesota, whether by 
 77.1   operation of law or by an order of court, without any further 
 77.2   act or proceeding whatever, except as to persons committed as 
 77.3   mentally retarded.  For children under the guardianship of the 
 77.4   commissioner whose interests would be best served by adoptive 
 77.5   placement, the commissioner may contract with a licensed 
 77.6   child-placing agency to provide adoption services.  A contract 
 77.7   with a licensed child-placing agency must be designed to 
 77.8   supplement existing county efforts and may not replace existing 
 77.9   county programs, unless the replacement is agreed to by the 
 77.10  county board and the appropriate exclusive bargaining 
 77.11  representative or the commissioner has evidence that child 
 77.12  placements of the county continue to be substantially below that 
 77.13  of other counties.  Funds encumbered and obligated under an 
 77.14  agreement for a specific child shall remain available until the 
 77.15  terms of the agreement are fulfilled or the agreement is 
 77.16  terminated. 
 77.17     (9) Act as coordinating referral and informational center 
 77.18  on requests for service for newly arrived immigrants coming to 
 77.19  Minnesota. 
 77.20     (10) The specific enumeration of powers and duties as 
 77.21  hereinabove set forth shall in no way be construed to be a 
 77.22  limitation upon the general transfer of powers herein contained. 
 77.23     (11) Establish county, regional, or statewide schedules of 
 77.24  maximum fees and charges which may be paid by county agencies 
 77.25  for medical, dental, surgical, hospital, nursing and nursing 
 77.26  home care and medicine and medical supplies under all programs 
 77.27  of medical care provided by the state and for congregate living 
 77.28  care under the income maintenance programs. 
 77.29     (12) Have the authority to conduct and administer 
 77.30  experimental projects to test methods and procedures of 
 77.31  administering assistance and services to recipients or potential 
 77.32  recipients of public welfare.  To carry out such experimental 
 77.33  projects, it is further provided that the commissioner of human 
 77.34  services is authorized to waive the enforcement of existing 
 77.35  specific statutory program requirements, rules, and standards in 
 77.36  one or more counties.  The order establishing the waiver shall 
 78.1   provide alternative methods and procedures of administration, 
 78.2   shall not be in conflict with the basic purposes, coverage, or 
 78.3   benefits provided by law, and in no event shall the duration of 
 78.4   a project exceed four years.  It is further provided that no 
 78.5   order establishing an experimental project as authorized by the 
 78.6   provisions of this section shall become effective until the 
 78.7   following conditions have been met: 
 78.8      (a) The secretary of health and human services of the 
 78.9   United States has agreed, for the same project, to waive state 
 78.10  plan requirements relative to statewide uniformity. 
 78.11     (b) A comprehensive plan, including estimated project 
 78.12  costs, shall be approved by the legislative advisory commission 
 78.13  and filed with the commissioner of administration.  
 78.14     (13) According to federal requirements, establish 
 78.15  procedures to be followed by local welfare boards in creating 
 78.16  citizen advisory committees, including procedures for selection 
 78.17  of committee members. 
 78.18     (14) Allocate federal fiscal disallowances or sanctions 
 78.19  which are based on quality control error rates for the aid to 
 78.20  families with dependent children program formerly codified in 
 78.21  sections 256.72 to 256.87, medical assistance, or food stamp 
 78.22  program in the following manner:  
 78.23     (a) One-half of the total amount of the disallowance shall 
 78.24  be borne by the county boards responsible for administering the 
 78.25  programs.  For the medical assistance and the AFDC program 
 78.26  formerly codified in sections 256.72 to 256.87, disallowances 
 78.27  shall be shared by each county board in the same proportion as 
 78.28  that county's expenditures for the sanctioned program are to the 
 78.29  total of all counties' expenditures for the AFDC program 
 78.30  formerly codified in sections 256.72 to 256.87, and medical 
 78.31  assistance programs.  For the food stamp program, sanctions 
 78.32  shall be shared by each county board, with 50 percent of the 
 78.33  sanction being distributed to each county in the same proportion 
 78.34  as that county's administrative costs for food stamps are to the 
 78.35  total of all food stamp administrative costs for all counties, 
 78.36  and 50 percent of the sanctions being distributed to each county 
 79.1   in the same proportion as that county's value of food stamp 
 79.2   benefits issued are to the total of all benefits issued for all 
 79.3   counties.  Each county shall pay its share of the disallowance 
 79.4   to the state of Minnesota.  When a county fails to pay the 
 79.5   amount due hereunder, the commissioner may deduct the amount 
 79.6   from reimbursement otherwise due the county, or the attorney 
 79.7   general, upon the request of the commissioner, may institute 
 79.8   civil action to recover the amount due. 
 79.9      (b) Notwithstanding the provisions of paragraph (a), if the 
 79.10  disallowance results from knowing noncompliance by one or more 
 79.11  counties with a specific program instruction, and that knowing 
 79.12  noncompliance is a matter of official county board record, the 
 79.13  commissioner may require payment or recover from the county or 
 79.14  counties, in the manner prescribed in paragraph (a), an amount 
 79.15  equal to the portion of the total disallowance which resulted 
 79.16  from the noncompliance, and may distribute the balance of the 
 79.17  disallowance according to paragraph (a).  
 79.18     (15) Develop and implement special projects that maximize 
 79.19  reimbursements and result in the recovery of money to the 
 79.20  state.  For the purpose of recovering state money, the 
 79.21  commissioner may enter into contracts with third parties.  Any 
 79.22  recoveries that result from projects or contracts entered into 
 79.23  under this paragraph shall be deposited in the state treasury 
 79.24  and credited to a special account until the balance in the 
 79.25  account reaches $1,000,000.  When the balance in the account 
 79.26  exceeds $1,000,000, the excess shall be transferred and credited 
 79.27  to the general fund.  All money in the account is appropriated 
 79.28  to the commissioner for the purposes of this paragraph. 
 79.29     (16) Have the authority to make direct payments to 
 79.30  facilities providing shelter to women and their children 
 79.31  according to section 256D.05, subdivision 3.  Upon the written 
 79.32  request of a shelter facility that has been denied payments 
 79.33  under section 256D.05, subdivision 3, the commissioner shall 
 79.34  review all relevant evidence and make a determination within 30 
 79.35  days of the request for review regarding issuance of direct 
 79.36  payments to the shelter facility.  Failure to act within 30 days 
 80.1   shall be considered a determination not to issue direct payments.
 80.2      (17) Have the authority to establish and enforce the 
 80.3   following county reporting requirements:  
 80.4      (a) The commissioner shall establish fiscal and statistical 
 80.5   reporting requirements necessary to account for the expenditure 
 80.6   of funds allocated to counties for human services programs.  
 80.7   When establishing financial and statistical reporting 
 80.8   requirements, the commissioner shall evaluate all reports, in 
 80.9   consultation with the counties, to determine if the reports can 
 80.10  be simplified or the number of reports can be reduced. 
 80.11     (b) The county board shall submit monthly or quarterly 
 80.12  reports to the department as required by the commissioner.  
 80.13  Monthly reports are due no later than 15 working days after the 
 80.14  end of the month.  Quarterly reports are due no later than 30 
 80.15  calendar days after the end of the quarter, unless the 
 80.16  commissioner determines that the deadline must be shortened to 
 80.17  20 calendar days to avoid jeopardizing compliance with federal 
 80.18  deadlines or risking a loss of federal funding.  Only reports 
 80.19  that are complete, legible, and in the required format shall be 
 80.20  accepted by the commissioner.  
 80.21     (c) If the required reports are not received by the 
 80.22  deadlines established in clause (b), the commissioner may delay 
 80.23  payments and withhold funds from the county board until the next 
 80.24  reporting period.  When the report is needed to account for the 
 80.25  use of federal funds and the late report results in a reduction 
 80.26  in federal funding, the commissioner shall withhold from the 
 80.27  county boards with late reports an amount equal to the reduction 
 80.28  in federal funding until full federal funding is received.  
 80.29     (d) A county board that submits reports that are late, 
 80.30  illegible, incomplete, or not in the required format for two out 
 80.31  of three consecutive reporting periods is considered 
 80.32  noncompliant.  When a county board is found to be noncompliant, 
 80.33  the commissioner shall notify the county board of the reason the 
 80.34  county board is considered noncompliant and request that the 
 80.35  county board develop a corrective action plan stating how the 
 80.36  county board plans to correct the problem.  The corrective 
 81.1   action plan must be submitted to the commissioner within 45 days 
 81.2   after the date the county board received notice of noncompliance.
 81.3      (e) The final deadline for fiscal reports or amendments to 
 81.4   fiscal reports is one year after the date the report was 
 81.5   originally due.  If the commissioner does not receive a report 
 81.6   by the final deadline, the county board forfeits the funding 
 81.7   associated with the report for that reporting period and the 
 81.8   county board must repay any funds associated with the report 
 81.9   received for that reporting period. 
 81.10     (f) The commissioner may not delay payments, withhold 
 81.11  funds, or require repayment under paragraph (c) or (e) if the 
 81.12  county demonstrates that the commissioner failed to provide 
 81.13  appropriate forms, guidelines, and technical assistance to 
 81.14  enable the county to comply with the requirements.  If the 
 81.15  county board disagrees with an action taken by the commissioner 
 81.16  under paragraph (c) or (e), the county board may appeal the 
 81.17  action according to sections 14.57 to 14.69. 
 81.18     (g) Counties subject to withholding of funds under 
 81.19  paragraph (c) or forfeiture or repayment of funds under 
 81.20  paragraph (e) shall not reduce or withhold benefits or services 
 81.21  to clients to cover costs incurred due to actions taken by the 
 81.22  commissioner under paragraph (c) or (e). 
 81.23     (18) Allocate federal fiscal disallowances or sanctions for 
 81.24  audit exceptions when federal fiscal disallowances or sanctions 
 81.25  are based on a statewide random sample for the foster care 
 81.26  program under title IV-E of the Social Security Act, United 
 81.27  States Code, title 42, in direct proportion to each county's 
 81.28  title IV-E foster care maintenance claim for that period. 
 81.29     (19) Be responsible for ensuring the detection, prevention, 
 81.30  investigation, and resolution of fraudulent activities or 
 81.31  behavior by applicants, recipients, and other participants in 
 81.32  the human services programs administered by the department. 
 81.33     (20) Require county agencies to identify overpayments, 
 81.34  establish claims, and utilize all available and cost-beneficial 
 81.35  methodologies to collect and recover these overpayments in the 
 81.36  human services programs administered by the department. 
 82.1      (21) Have the authority to administer a drug rebate program 
 82.2   for drugs purchased pursuant to the prescription drug program 
 82.3   established under section 256.955 after the beneficiary's 
 82.4   satisfaction of any deductible established in the program.  The 
 82.5   commissioner shall require a rebate agreement from all 
 82.6   manufacturers of covered drugs as defined in section 256B.0625, 
 82.7   subdivision 13.  Rebate agreements for prescription drugs 
 82.8   delivered on or after July 1, 2002, must include rebates for 
 82.9   individuals covered under the prescription drug program who are 
 82.10  under 65 years of age.  For each drug, the amount of the rebate 
 82.11  shall be equal to the basic rebate as defined for purposes of 
 82.12  the federal rebate program in United States Code, title 42, 
 82.13  section 1396r-8(c)(1).  This basic rebate shall be applied to 
 82.14  single-source and multiple-source drugs.  The manufacturers must 
 82.15  provide full payment within 30 days of receipt of the state 
 82.16  invoice for the rebate within the terms and conditions used for 
 82.17  the federal rebate program established pursuant to section 1927 
 82.18  of title XIX of the Social Security Act.  The manufacturers must 
 82.19  provide the commissioner with any information necessary to 
 82.20  verify the rebate determined per drug.  The rebate program shall 
 82.21  utilize the terms and conditions used for the federal rebate 
 82.22  program established pursuant to section 1927 of title XIX of the 
 82.23  Social Security Act. 
 82.24     (22) Have the authority to administer the federal drug 
 82.25  rebate program for drugs purchased under the medical assistance 
 82.26  program as allowed by section 1927 of title XIX of the Social 
 82.27  Security Act and according to the terms and conditions of 
 82.28  section 1927.  Rebates shall be collected for all drugs that 
 82.29  have been dispensed or administered in an outpatient setting and 
 82.30  that are from manufacturers who have signed a rebate agreement 
 82.31  with the United States Department of Health and Human Services. 
 82.32     (22) (23) Operate the department's communication systems 
 82.33  account established in Laws 1993, First Special Session chapter 
 82.34  1, article 1, section 2, subdivision 2, to manage shared 
 82.35  communication costs necessary for the operation of the programs 
 82.36  the commissioner supervises.  A communications account may also 
 83.1   be established for each regional treatment center which operates 
 83.2   communications systems.  Each account must be used to manage 
 83.3   shared communication costs necessary for the operations of the 
 83.4   programs the commissioner supervises.  The commissioner may 
 83.5   distribute the costs of operating and maintaining communication 
 83.6   systems to participants in a manner that reflects actual usage. 
 83.7   Costs may include acquisition, licensing, insurance, 
 83.8   maintenance, repair, staff time and other costs as determined by 
 83.9   the commissioner.  Nonprofit organizations and state, county, 
 83.10  and local government agencies involved in the operation of 
 83.11  programs the commissioner supervises may participate in the use 
 83.12  of the department's communications technology and share in the 
 83.13  cost of operation.  The commissioner may accept on behalf of the 
 83.14  state any gift, bequest, devise or personal property of any 
 83.15  kind, or money tendered to the state for any lawful purpose 
 83.16  pertaining to the communication activities of the department.  
 83.17  Any money received for this purpose must be deposited in the 
 83.18  department's communication systems accounts.  Money collected by 
 83.19  the commissioner for the use of communication systems must be 
 83.20  deposited in the state communication systems account and is 
 83.21  appropriated to the commissioner for purposes of this section. 
 83.22     (23) (24) Receive any federal matching money that is made 
 83.23  available through the medical assistance program for the 
 83.24  consumer satisfaction survey.  Any federal money received for 
 83.25  the survey is appropriated to the commissioner for this 
 83.26  purpose.  The commissioner may expend the federal money received 
 83.27  for the consumer satisfaction survey in either year of the 
 83.28  biennium. 
 83.29     (24) (25) Incorporate cost reimbursement claims from First 
 83.30  Call Minnesota and Greater Twin Cities United Way into the 
 83.31  federal cost reimbursement claiming processes of the department 
 83.32  according to federal law, rule, and regulations.  Any 
 83.33  reimbursement received is appropriated to the commissioner and 
 83.34  shall be disbursed to First Call Minnesota and Greater Twin 
 83.35  Cities United Way according to normal department payment 
 83.36  schedules. 
 84.1      (25) (26) Develop recommended standards for foster care 
 84.2   homes that address the components of specialized therapeutic 
 84.3   services to be provided by foster care homes with those services.
 84.4      Sec. 9.  [256.952] [CHILDREN'S HEALTH CARE ENDOWMENT FUND.] 
 84.5      Subdivision 1.  [CREATION.] The children's health care 
 84.6   endowment fund is created in the state treasury.  The state 
 84.7   board of investment shall invest the fund under section 11A.24.  
 84.8   All earnings of the fund must be credited to the fund.  The 
 84.9   principal of the fund must be maintained inviolate, except that 
 84.10  the principal may be used to make expenditures from the fund for 
 84.11  the purposes specified in this section. 
 84.12     Subd. 2.  [EXPENDITURES.] (a) For fiscal year 2003, up to 
 84.13  five percent of the average of the fair market values of the 
 84.14  fund for the preceding six months is appropriated to the 
 84.15  commissioner of human services to provide coverage for 
 84.16  low-income children in the MinnesotaCare program.  
 84.17     (b) For fiscal year 2004 and each year thereafter, up to 
 84.18  five percent of the average of the fair market values of the 
 84.19  fund for the preceding 12 months is appropriated to the 
 84.20  commissioner of human services to provide coverage for 
 84.21  low-income children in the MinnesotaCare program.  
 84.22     Sec. 10.  Minnesota Statutes 2000, section 256.955, 
 84.23  subdivision 2, is amended to read: 
 84.24     Subd. 2.  [DEFINITIONS.] (a) For purposes of this section, 
 84.25  the following definitions apply. 
 84.26     (b) "Health plan" has the meaning provided in section 
 84.27  62Q.01, subdivision 3. 
 84.28     (c) "Health plan company" has the meaning provided in 
 84.29  section 62Q.01, subdivision 4. 
 84.30     (d) "Qualified individual" means an individual who meets 
 84.31  the requirements described in subdivision 2a or 2b, and: 
 84.32     (1) who is not determined eligible for medical assistance 
 84.33  according to section 256B.0575, who is not determined eligible 
 84.34  for medical assistance or general assistance medical care 
 84.35  without a spenddown, or who is not enrolled in MinnesotaCare; 
 84.36     (2) is not enrolled in prescription drug coverage under a 
 85.1   health plan; 
 85.2      (3) is not enrolled in prescription drug coverage under a 
 85.3   Medicare supplement plan, as defined in sections 62A.31 to 
 85.4   62A.44, or policies, contracts, or certificates that supplement 
 85.5   Medicare issued by health maintenance organizations or those 
 85.6   policies, contracts, or certificates governed by section 1833 or 
 85.7   1876 of the federal Social Security Act, United States Code, 
 85.8   title 42, section 1395, et seq., as amended; 
 85.9      (4) has not had coverage described in clauses (2) and (3) 
 85.10  for at least four months prior to application for the program; 
 85.11  and 
 85.12     (5) is a permanent resident of Minnesota as defined in 
 85.13  section 256L.09. 
 85.14     (e) For purposes of clauses (2) and (3), prescription drug 
 85.15  coverage does not include: 
 85.16     (1) a Medicare risk product that provides prescription drug 
 85.17  coverage of less than $450 per year; or 
 85.18     (2) a Medicare cost product that provides prescription drug 
 85.19  coverage that provides a maximum benefit on brand name drugs of 
 85.20  nor more than $500 per year. 
 85.21     [EFFECTIVE DATE.] This section is effective January 1, 2002.
 85.22     Sec. 11.  Minnesota Statutes 2000, section 256.955, 
 85.23  subdivision 2a, is amended to read: 
 85.24     Subd. 2a.  [ELIGIBILITY.] An individual satisfying the 
 85.25  following requirements and the requirements described in 
 85.26  subdivision 2, paragraph (d), is eligible for the prescription 
 85.27  drug program: 
 85.28     (1) is at least 65 years of age or older; and 
 85.29     (2) is eligible as a qualified Medicare beneficiary 
 85.30  according to section 256B.057, subdivision 3 or 3a, or is 
 85.31  eligible under section 256B.057, subdivision 3 or 3a, and is 
 85.32  also eligible for medical assistance or general assistance 
 85.33  medical care with a spenddown as defined in section 256B.056, 
 85.34  subdivision 5 enrollee whose assets are no more than $10,000 for 
 85.35  a single individual and $18,000 for a married couple or family 
 85.36  of two or more, using the asset methodology for aged, blind, or 
 86.1   disabled individuals specified in section 256B.056, subdivision 
 86.2   1a; and 
 86.3      (2) has a household income that does not exceed 150 percent 
 86.4   of the federal poverty guidelines, using the income methodology 
 86.5   for aged, blind, or disabled individuals specified in section 
 86.6   256B.056, subdivision 1a. 
 86.7      [EFFECTIVE DATE.] This section is effective January 1, 2002.
 86.8      Sec. 12.  Minnesota Statutes 2000, section 256.955, 
 86.9   subdivision 7, is amended to read: 
 86.10     Subd. 7.  [COST SHARING.] Program enrollees must satisfy 
 86.11  a $420 annual monthly deductible, based upon expenditures for 
 86.12  prescription drugs, to be paid in $35 monthly increments.  The 
 86.13  monthly deductible must be calculated by the commissioner based 
 86.14  upon the household income of the enrollee expressed as a 
 86.15  percentage of the federal poverty guidelines, using the 
 86.16  following sliding scale: 
 86.17            Household Income          Monthly Deductible
 86.18              of Enrollee
 86.19       not more than 120 percent             $35
 86.20       more than 120 percent
 86.21       but not more than 125 percent         $43
 86.22       more than 125 percent
 86.23       but not more than 130 percent         $52
 86.24       more than 130 percent
 86.25       but not more than 135 percent         $60
 86.26       more than 135 percent 
 86.27       but not more than 140 percent         $68
 86.28       more than 140 percent
 86.29       but not more than 145 percent         $77
 86.30       more than 145 percent
 86.31       but not more than 150 percent         $85
 86.32     [EFFECTIVE DATE.] This section is effective January 1, 2002.
 86.33     Sec. 13.  Minnesota Statutes 2000, section 256.955, is 
 86.34  amended by adding a subdivision to read: 
 86.35     Subd. 10.  [DEDICATED ACCOUNT.] (a) The Minnesota 
 86.36  prescription drug dedicated account is established in the state 
 87.1   treasury.  The commissioner of finance shall credit to the 
 87.2   account all rebates paid under section 256.01, subdivision 1, 
 87.3   clause (21), any appropriations designated for the prescription 
 87.4   drug program and any federal funds received by the state to 
 87.5   implement a senior prescription drug program.  The commissioner 
 87.6   of finance shall ensure that account money is invested under 
 87.7   section 11A.25.  All money earned by the account must be 
 87.8   credited to the account.  
 87.9      (b) Money in the account is appropriated to the 
 87.10  commissioner of human services for the prescription drug program.
 87.11     [EFFECTIVE DATE.] This section is effective July 1, 2001.  
 87.12     Sec. 14.  [256.956] [PURCHASING ALLIANCE STOP-LOSS FUND.] 
 87.13     Subdivision 1.  [DEFINITIONS.] For purposes of this 
 87.14  section, the following definitions apply:  
 87.15     (a) "Commissioner" means the commissioner of human services.
 87.16     (b) "Health plan" means a policy, contract, or certificate 
 87.17  issued by a health plan company to a qualifying purchasing 
 87.18  alliance.  Any health plan issued to the members of a qualifying 
 87.19  purchasing alliance must meet the requirements of chapter 62L.  
 87.20     (c) "Health plan company" means: 
 87.21     (1) a health carrier as defined under section 62A.011, 
 87.22  subdivision 2; 
 87.23     (2) a community integrated service network operating under 
 87.24  chapter 62N; or 
 87.25     (3) an accountable provider network operating under chapter 
 87.26  62T.  
 87.27     (d) "Qualifying employer" means an employer who: 
 87.28     (1) is a member of a qualifying purchasing alliance; 
 87.29     (2) has at least one employee but no more than ten 
 87.30  employees or is a sole proprietor or farmer; 
 87.31     (3) did not offer employer-subsidized health care coverage 
 87.32  to its employees for at least 12 months prior to joining the 
 87.33  purchasing alliance; and 
 87.34     (4) is offering health coverage through the purchasing 
 87.35  alliance to all employees who work at least 20 hours per week 
 87.36  unless the employee is eligible for Medicare. 
 88.1   For purposes of this subdivision, "employer-subsidized health 
 88.2   coverage" means health coverage for which the employer pays at 
 88.3   least 50 percent of the cost of coverage for the employee.  
 88.4      (e) "Qualifying enrollee" means an employee of a qualifying 
 88.5   employer or the employee's dependent covered by a health plan.  
 88.6      (f) "Qualifying purchasing alliance" means a purchasing 
 88.7   alliance as defined in section 62T.01, subdivision 2, that: 
 88.8      (1) meets the requirements of chapter 62T; 
 88.9      (2) services a geographic area located in outstate 
 88.10  Minnesota, excluding the city of Duluth; and 
 88.11     (3) is organized and operating before May 1, 2001. 
 88.12     The criteria used by the qualifying purchasing alliance for 
 88.13  membership must be approved by the commissioner of health.  A 
 88.14  qualifying purchasing alliance may begin enrolling qualifying 
 88.15  employers after July 1, 2001, with enrollment ending by December 
 88.16  31, 2003.  
 88.17     Subd. 2.  [CREATION OF ACCOUNT.] A purchasing alliance 
 88.18  stop-loss fund account is established in the general fund.  The 
 88.19  commissioner shall use the money to establish a stop-loss fund 
 88.20  from which a health plan company may receive reimbursement for 
 88.21  claims paid for qualifying enrollees.  The account consists of 
 88.22  money appropriated by the legislature.  Money from the account 
 88.23  must be used for the stop-loss fund.  
 88.24     Subd. 3.  [REIMBURSEMENT.] (a) A health plan company may 
 88.25  receive reimbursement from the fund for 90 percent of the 
 88.26  portion of the claim that exceeds $30,000 but not of the portion 
 88.27  that exceeds $100,000 in a calendar year for a qualifying 
 88.28  enrollee.  
 88.29     (b) Claims shall be reported and funds shall be distributed 
 88.30  on a calendar-year basis.  Claims shall be eligible for 
 88.31  reimbursement only for the calendar year in which the claims 
 88.32  were paid.  
 88.33     (c) Once claims paid on behalf of a qualifying enrollee 
 88.34  reach $100,000 in a given calendar year, no further claims may 
 88.35  be submitted for reimbursement on behalf of that enrollee in 
 88.36  that calendar year.  
 89.1      Subd. 4.  [REQUEST PROCESS.] (a) Each health plan company 
 89.2   must submit a request for reimbursement from the fund on a form 
 89.3   prescribed by the commissioner.  Requests for payment must be 
 89.4   submitted no later than April 1 following the end of the 
 89.5   calendar year for which the reimbursement request is being made, 
 89.6   beginning April 1, 2002. 
 89.7      (b) The commissioner may require a health plan company to 
 89.8   submit claims data as needed in connection with the 
 89.9   reimbursement request.  
 89.10     Subd. 5.  [DISTRIBUTION.] (a) The commissioner shall 
 89.11  calculate the total claims reimbursement amount for all 
 89.12  qualifying health plan companies for the calendar year for which 
 89.13  claims are being reported and shall distribute the stop-loss 
 89.14  funds on an annual basis.  
 89.15     (b) In the event that the total amount requested for 
 89.16  reimbursement by the health plan companies for a calendar year 
 89.17  exceeds the funds available for distribution for claims paid by 
 89.18  all health plan companies during the same calendar year, the 
 89.19  commissioner shall provide for the pro rata distribution of the 
 89.20  available funds.  Each health plan company shall be eligible to 
 89.21  receive only a proportionate amount of the available funds as 
 89.22  the health plan company's total eligible claims paid compares to 
 89.23  the total eligible claims paid by all health plan companies.  
 89.24     (c) In the event that funds available for distribution for 
 89.25  claims paid by all health plan companies during a calendar year 
 89.26  exceed the total amount requested for reimbursement by all 
 89.27  health plan companies during the same calendar year, any excess 
 89.28  funds shall be reallocated for distribution in the next calendar 
 89.29  year.  
 89.30     Subd. 6.  [DATA.] Upon the request of the commissioner, 
 89.31  each health plan company shall furnish such data as the 
 89.32  commissioner deems necessary to administer the fund.  The 
 89.33  commissioner may require that such data be submitted on a per 
 89.34  enrollee, aggregate, or categorical basis.  Any data submitted 
 89.35  under this section shall be classified as private data or 
 89.36  nonpublic data as defined in section 13.02. 
 90.1      Subd. 7.  [DELEGATION.] The commissioner may delegate any 
 90.2   or all of the commissioner's administrative duties to another 
 90.3   state agency or to a private contractor.  
 90.4      Subd. 8.  [REPORT.] The commissioner of commerce, in 
 90.5   consultation with the office of rural health and the qualifying 
 90.6   purchasing alliances, shall evaluate the extent to which the 
 90.7   purchasing alliance stop-loss fund increases the availability of 
 90.8   employer-subsidized health care coverage for residents residing 
 90.9   in the geographic areas served by the qualifying purchasing 
 90.10  alliances.  A preliminary report must be submitted to the 
 90.11  legislature by February 15, 2003, and a final report must be 
 90.12  submitted by February 15, 2004.  
 90.13     Subd. 9.  [SUNSET.] This section shall expire January 1, 
 90.14  2005.  
 90.15     Sec. 15.  [256.958] [RETIRED DENTIST PROGRAM.] 
 90.16     Subdivision 1.  [PROGRAM.] The commissioner of human 
 90.17  services shall establish a program to reimburse a retired 
 90.18  dentist for the dentist's license fee and for the reasonable 
 90.19  cost of malpractice insurance compared to other dentists in the 
 90.20  community in exchange for the dentist providing 100 hours of 
 90.21  dental services on a volunteer basis within a 12-month period at 
 90.22  a community dental clinic or a dental training clinic located at 
 90.23  a Minnesota state college or university.  
 90.24     Subd. 2.  [DOCUMENTATION.] Upon completion of the required 
 90.25  hours, the retired dentist shall submit to the commissioner the 
 90.26  following: 
 90.27     (1) documentation of the service provided; 
 90.28     (2) the cost of malpractice insurance for the 12-month 
 90.29  period; and 
 90.30     (3) the cost of the license.  
 90.31     Subd. 3.  [REIMBURSEMENT.] Upon receipt of the information 
 90.32  described in subdivision 2, the commissioner shall provide 
 90.33  reimbursement to the retired dentist for the cost of malpractice 
 90.34  insurance for the previous 12-month period and the cost of the 
 90.35  license.  
 90.36     Sec. 16.  [256.959] [DENTAL PRACTICE DONATION PROGRAM.] 
 91.1      Subdivision 1.  [ESTABLISHMENT.] The commissioner of human 
 91.2   services shall establish a dental practice donation program that 
 91.3   coordinates the donation of a qualifying dental practice to a 
 91.4   qualified charitable organization and assists in locating a 
 91.5   dentist licensed under chapter 150A who wishes to maintain the 
 91.6   dental practice.  
 91.7      Subd. 2.  [QUALIFYING DENTAL PRACTICE.] To qualify for the 
 91.8   dental practice donation program, a dental practice must meet 
 91.9   the following requirements: 
 91.10     (1) the dental practice must be owned by the donating 
 91.11  dentist; 
 91.12     (2) the dental practice must be located in a designated 
 91.13  underserved area of the state as defined by the commissioner; 
 91.14  and 
 91.15     (3) the practice must be equipped with the basic dental 
 91.16  equipment necessary to maintain a dental practice as determined 
 91.17  by the commissioner.  
 91.18     Subd. 3.  [COORDINATION.] The commissioner shall establish 
 91.19  a procedure for dentists to donate their dental practices to a 
 91.20  qualified charitable organization.  The commissioner shall 
 91.21  authorize a practice for donation only if it meets the 
 91.22  requirements of subdivision 2 and there is a licensed dentist 
 91.23  who is interested in entering into an agreement as described in 
 91.24  subdivision 4.  Upon donation of the practice, the commissioner 
 91.25  shall provide the donating dentist with a statement verifying 
 91.26  that a donation of the practice was made to a qualifying 
 91.27  charitable organization for purposes of state and federal income 
 91.28  tax returns.  
 91.29     Subd. 4.  [DONATED DENTAL PRACTICE AGREEMENT.] (a) A 
 91.30  dentist accepting the donated practice must enter into an 
 91.31  agreement with the qualified charitable organization to maintain 
 91.32  the dental practice for a minimum of five years at the donated 
 91.33  practice site and to provide services to underserved populations 
 91.34  up to a preagreed percentage of patients served.  
 91.35     (b) The agreement must include the terms for the recovery 
 91.36  of the donated dental practice if the dentist accepting the 
 92.1   practice does not fulfill the service commitment required under 
 92.2   this subdivision.  
 92.3      (c) Any costs associated with operating the dental practice 
 92.4   during the service commitment time period are the financial 
 92.5   responsibility of the dentist accepting the practice. 
 92.6      Sec. 17.  Minnesota Statutes 2000, section 256.9657, 
 92.7   subdivision 2, is amended to read: 
 92.8      Subd. 2.  [HOSPITAL SURCHARGE.] (a) Effective October 1, 
 92.9   1992, each Minnesota hospital except facilities of the federal 
 92.10  Indian Health Service and regional treatment centers shall pay 
 92.11  to the medical assistance account a surcharge equal to 1.4 
 92.12  percent of net patient revenues excluding net Medicare revenues 
 92.13  reported by that provider to the health care cost information 
 92.14  system according to the schedule in subdivision 4.  
 92.15     (b) Effective July 1, 1994, the surcharge under paragraph 
 92.16  (a) is increased to 1.56 percent. 
 92.17     (c) Notwithstanding the Medicare cost finding and allowable 
 92.18  cost principles, the hospital surcharge is not an allowable cost 
 92.19  for purposes of rate setting under sections 256.9685 to 256.9695.
 92.20     Sec. 18.  Minnesota Statutes 2000, section 256.969, is 
 92.21  amended by adding a subdivision to read: 
 92.22     Subd. 26.  [GREATER MINNESOTA PAYMENT ADJUSTMENT AFTER JUNE 
 92.23  30, 2001.] (a) For admissions occurring after June 30, 2001, the 
 92.24  commissioner shall pay fee-for-service inpatient admissions for 
 92.25  the diagnosis-related groups specified in paragraph (b) at 
 92.26  hospitals located outside of the seven-county metropolitan area 
 92.27  at the higher of: 
 92.28     (1) the hospital's current payment rate for the diagnostic 
 92.29  category to which the diagnosis-related group belongs, exclusive 
 92.30  of disproportionate population adjustments received under 
 92.31  subdivision 9 and hospital payment adjustments received under 
 92.32  subdivision 23; or 
 92.33     (2) 90 percent of the average payment rate for that 
 92.34  diagnostic category for hospitals located within the 
 92.35  seven-county metropolitan area, exclusive of disproportionate 
 92.36  population adjustments received under subdivision 9 and hospital 
 93.1   payment adjustments received under subdivisions 20 and 23. 
 93.2      (b) The payment increases provided in paragraph (a) apply 
 93.3   to the following diagnosis-related groups, as they fall within 
 93.4   the diagnostic categories: 
 93.5      (1) 370 cesarean section with complicating diagnosis; 
 93.6      (2) 371 cesarean section without complicating diagnosis; 
 93.7      (3) 372 vaginal delivery with complicating diagnosis; 
 93.8      (4) 373 vaginal delivery without complicating diagnosis; 
 93.9      (5) 386 extreme immaturity and respiratory distress 
 93.10  syndrome, neonate; 
 93.11     (6) 388 full-term neonates with other problems; 
 93.12     (7) 390 prematurity without major problems; 
 93.13     (8) 391 normal newborn; 
 93.14     (9) 385 neonate, died or transferred to another acute care 
 93.15  facility; 
 93.16     (10) 425 acute adjustment reaction and psychosocial 
 93.17  dysfunction; 
 93.18     (11) 430 psychoses; 
 93.19     (12) 431 childhood mental disorders; and 
 93.20     (13) 164-167 appendectomy. 
 93.21     Sec. 19.  Minnesota Statutes 2000, section 256B.02, 
 93.22  subdivision 7, is amended to read: 
 93.23     Subd. 7.  "Vendor of medical care" means any person or 
 93.24  persons furnishing, within the scope of the vendor's respective 
 93.25  license, any or all of the following goods or services:  
 93.26  medical, surgical, hospital, optical, visual, dental and nursing 
 93.27  services; drugs and medical supplies; appliances; laboratory, 
 93.28  diagnostic, and therapeutic services; nursing home and 
 93.29  convalescent care; screening and health assessment services 
 93.30  provided by public health nurses as defined in section 145A.02, 
 93.31  subdivision 18; health care services provided at the residence 
 93.32  of the patient if the services are performed by a public health 
 93.33  nurse and the nurse indicates in a statement submitted under 
 93.34  oath that the services were actually provided; oral language 
 93.35  interpreter services for persons of limited English proficiency 
 93.36  when necessary to access health care; and such other medical 
 94.1   services or supplies provided or prescribed by persons 
 94.2   authorized by state law to give such services and supplies.  The 
 94.3   term includes, but is not limited to, directors and officers of 
 94.4   corporations or members of partnerships who, either individually 
 94.5   or jointly with another or others, have the legal control, 
 94.6   supervision, or responsibility of submitting claims for 
 94.7   reimbursement to the medical assistance program.  The term only 
 94.8   includes directors and officers of corporations who personally 
 94.9   receive a portion of the distributed assets upon liquidation or 
 94.10  dissolution, and their liability is limited to the portion of 
 94.11  the claim that bears the same proportion to the total claim as 
 94.12  their share of the distributed assets bears to the total 
 94.13  distributed assets. 
 94.14     Sec. 20.  Minnesota Statutes 2000, section 256B.04, is 
 94.15  amended by adding a subdivision to read: 
 94.16     Subd. 1b.  [ADMINISTRATIVE SERVICES.] Notwithstanding 
 94.17  subdivision 1, the commissioner may contract with federally 
 94.18  recognized Indian tribes with a reservation in Minnesota for the 
 94.19  provision of early and periodic screening, diagnosis, and 
 94.20  treatment administrative services for American Indian children, 
 94.21  in accordance with the Code of Federal Regulations, title 42, 
 94.22  section 441, subpart B, and Minnesota Rules, part 9505.1693, 
 94.23  when the tribe chooses to provide such services.  For purposes 
 94.24  of this subdivision, "American Indian" has the meaning given to 
 94.25  persons to whom services will be provided in the Code of Federal 
 94.26  Regulations, title 42, section 36.12.  Notwithstanding Minnesota 
 94.27  Rules, part 9505.1748, subpart 1, the commissioner, the local 
 94.28  agency, and the tribe may contract with any entity for the 
 94.29  provision of early and periodic screening, diagnosis, and 
 94.30  treatment administrative services. 
 94.31     Sec. 21.  Minnesota Statutes 2000, section 256B.055, 
 94.32  subdivision 3a, is amended to read: 
 94.33     Subd. 3a.  [MFIP-S FAMILIES; FAMILIES ELIGIBLE UNDER PRIOR 
 94.34  AFDC RULES.] (a) Beginning January 1, 1998, or on the date that 
 94.35  MFIP-S is implemented in counties, medical assistance may be 
 94.36  paid for a person receiving public assistance under the MFIP-S 
 95.1   program.  Beginning July 1, 2002, medical assistance may be paid 
 95.2   for a person who would have been eligible, but for excess income 
 95.3   or assets, under the state's AFDC plan in effect as of July 16, 
 95.4   1996, with the base AFDC standard increased according to section 
 95.5   256B.056, subdivision 4.  
 95.6      (b) Beginning January 1, 1998, July 1, 2002, medical 
 95.7   assistance may be paid for a person who would have been eligible 
 95.8   for public assistance under the income and resource assets 
 95.9   standards, or who would have been eligible but for excess income 
 95.10  or assets, under the state's AFDC plan in effect as of July 16, 
 95.11  1996, as required by the Personal Responsibility and Work 
 95.12  Opportunity Reconciliation Act of 1996 (PRWORA), Public Law 
 95.13  Number 104-193 with the base AFDC rate increased according to 
 95.14  section 256B.056, subdivision 4. 
 95.15     [EFFECTIVE DATE.] This section is effective July 1, 2002. 
 95.16     Sec. 22.  Minnesota Statutes 2000, section 256B.056, 
 95.17  subdivision 1a, is amended to read: 
 95.18     Subd. 1a.  [INCOME AND ASSETS GENERALLY.] Unless 
 95.19  specifically required by state law or rule or federal law or 
 95.20  regulation, the methodologies used in counting income and assets 
 95.21  to determine eligibility for medical assistance for persons 
 95.22  whose eligibility category is based on blindness, disability, or 
 95.23  age of 65 or more years, the methodologies for the supplemental 
 95.24  security income program shall be used.  For children eligible 
 95.25  for home and community-based waiver services whose eligibility 
 95.26  for medical assistance is determined without regard to parental 
 95.27  income, or for children eligible under section 256B.055, 
 95.28  subdivision 12, child support payments, including any payments 
 95.29  made by an obligor in satisfaction of or in addition to a 
 95.30  temporary or permanent order for child support, and social 
 95.31  security payments, are not counted as income.  For families and 
 95.32  children, which includes all other eligibility categories, the 
 95.33  methodologies under the state's AFDC plan in effect as of July 
 95.34  16, 1996, as required by the Personal Responsibility and Work 
 95.35  Opportunity Reconciliation Act of 1996 (PRWORA), Public Law 
 95.36  Number 104-193, shall be used.  Effective upon federal approval, 
 96.1   in-kind contributions to, and payments made on behalf of, a 
 96.2   recipient, by an obligor, in satisfaction of or in addition to a 
 96.3   temporary or permanent order for child support or maintenance, 
 96.4   shall be considered income to the recipient.  For these 
 96.5   purposes, a "methodology" does not include an asset or income 
 96.6   standard, or accounting method, or method of determining 
 96.7   effective dates. 
 96.8      [EFFECTIVE DATE.] This section is effective July 1, 2001, 
 96.9   or the date upon which federal rules published in the Federal 
 96.10  Register at 66FR2316 become effective, whichever is later. 
 96.11     Sec. 23.  Minnesota Statutes 2000, section 256B.056, 
 96.12  subdivision 4, is amended to read: 
 96.13     Subd. 4.  [INCOME.] To be eligible for medical assistance, 
 96.14  a person eligible under section 256B.055, subdivision 7, not 
 96.15  receiving supplemental security income program payments, and 
 96.16  families and children may have an income up to 133-1/3 percent 
 96.17  of the AFDC income standard in effect under the July 16, 1996, 
 96.18  AFDC state plan.  Effective July 1, 2000, the base AFDC standard 
 96.19  in effect on July 16, 1996, shall be increased by three percent. 
 96.20  Effective July 1, 2001, or the date upon which federal rules 
 96.21  published in the Federal Register at 66FR2316 become effective, 
 96.22  whichever is later, the income limit for a person eligible under 
 96.23  this subdivision shall be increased by 3.2 percent.  Effective 
 96.24  January 1, 2000, and each successive January, recipients of 
 96.25  supplemental security income may have an income up to the 
 96.26  supplemental security income standard in effect on that date.  
 96.27  In computing income to determine eligibility of persons who are 
 96.28  not residents of long-term care facilities, the commissioner 
 96.29  shall disregard increases in income as required by Public Law 
 96.30  Numbers 94-566, section 503; 99-272; and 99-509.  Veterans aid 
 96.31  and attendance benefits and Veterans Administration unusual 
 96.32  medical expense payments are considered income to the recipient. 
 96.33     Sec. 24.  Minnesota Statutes 2000, section 256B.056, 
 96.34  subdivision 4b, is amended to read: 
 96.35     Subd. 4b.  [INCOME VERIFICATION.] The local agency shall 
 96.36  not require a monthly income verification form for a recipient 
 97.1   who is a resident of a long-term care facility and who has 
 97.2   monthly earned income of $80 or less.  The commissioner or 
 97.3   county agency shall use electronic verification as the primary 
 97.4   method of income verification.  If there is a discrepancy in the 
 97.5   electronic verification, an individual may be required to submit 
 97.6   additional verification.  
 97.7      Sec. 25.  Minnesota Statutes 2000, section 256B.057, 
 97.8   subdivision 2, is amended to read: 
 97.9      Subd. 2.  [CHILDREN.] A child one two through five 18 years 
 97.10  of age in a family whose countable income is less no greater 
 97.11  than 133 185 percent of the federal poverty guidelines for the 
 97.12  same family size, is eligible for medical assistance.  A child 
 97.13  six through 18 years of age, who was born after September 30, 
 97.14  1983, in a family whose countable income is less than 100 
 97.15  percent of the federal poverty guidelines for the same family 
 97.16  size is eligible for medical assistance.  Countable income means 
 97.17  gross income minus child support paid according to a court order 
 97.18  and dependent care costs deducted from income under the state's 
 97.19  AFDC plan in effect as of July 16, 1996.  
 97.20     [EFFECTIVE DATE.] This section is effective July 1, 2002. 
 97.21     Sec. 26.  Minnesota Statutes 2000, section 256B.057, 
 97.22  subdivision 9, is amended to read: 
 97.23     Subd. 9.  [EMPLOYED PERSONS WITH DISABILITIES.] (a) Medical 
 97.24  assistance may be paid for a person who is employed and who: 
 97.25     (1) meets the definition of disabled under the supplemental 
 97.26  security income program; 
 97.27     (2) is at least 16 but less than 65 years of age; 
 97.28     (3) meets the asset limits in paragraph (b); and 
 97.29     (4) pays a premium, if required, under paragraph (c).  
 97.30  Any spousal income or assets shall be disregarded for purposes 
 97.31  of eligibility and premium determinations. 
 97.32     After the month of enrollment, a person enrolled in medical 
 97.33  assistance under this subdivision who is temporarily unable to 
 97.34  work and without receipt of earned income due to a medical 
 97.35  condition, as verified by a physician, or who has involuntarily 
 97.36  left employment may retain eligibility for up to four calendar 
 98.1   months. 
 98.2      (b) For purposes of determining eligibility under this 
 98.3   subdivision, a person's assets must not exceed $20,000, 
 98.4   excluding: 
 98.5      (1) all assets excluded under section 256B.056; 
 98.6      (2) retirement accounts, including individual accounts, 
 98.7   401(k) plans, 403(b) plans, Keogh plans, and pension plans; and 
 98.8      (3) medical expense accounts set up through the person's 
 98.9   employer. 
 98.10     (c) A person whose earned and unearned income is equal to 
 98.11  or greater than 200 than 100 percent of federal poverty 
 98.12  guidelines for the applicable family size must pay a premium to 
 98.13  be eligible for medical assistance under this subdivision.  The 
 98.14  premium shall be equal to ten percent of the person's gross 
 98.15  earned and unearned income above 200 percent of federal poverty 
 98.16  guidelines for the applicable family size up to the cost of 
 98.17  coverage based on the person's gross earned and unearned income 
 98.18  and the applicable family size using a sliding fee scale 
 98.19  established by the commissioner, which begins at one percent of 
 98.20  income at 100 percent of the federal poverty guidelines and 
 98.21  increases to 7.5 percent of income for those with incomes at or 
 98.22  above 300 percent of the federal poverty guidelines.  Annual 
 98.23  adjustments in the premium schedule based upon changes in the 
 98.24  federal poverty guidelines shall be effective for premiums due 
 98.25  in June of each year.  
 98.26     (d) A person's eligibility and premium shall be determined 
 98.27  by the local county agency.  Premiums must be paid to the 
 98.28  commissioner.  All premiums are dedicated to the commissioner. 
 98.29     (e) Any required premium shall be determined at application 
 98.30  and redetermined annually at recertification or when a change in 
 98.31  income or family size occurs. 
 98.32     (f) Premium payment is due upon notification from the 
 98.33  commissioner of the premium amount required.  Premiums may be 
 98.34  paid in installments at the discretion of the commissioner. 
 98.35     (g) Nonpayment of the premium shall result in denial or 
 98.36  termination of medical assistance unless the person demonstrates 
 99.1   good cause for nonpayment.  Good cause exists if the 
 99.2   requirements specified in Minnesota Rules, part 9506.0040, 
 99.3   subpart 7, items B to D, are met.  Nonpayment shall include 
 99.4   payment with a returned, refused, or dishonored instrument.  The 
 99.5   commissioner may require a guaranteed form of payment as the 
 99.6   only means to replace a returned, refused, or dishonored 
 99.7   instrument. 
 99.8      [EFFECTIVE DATE.] This section is effective September 1, 
 99.9   2001. 
 99.10     Sec. 27.  Minnesota Statutes 2000, section 256B.057, is 
 99.11  amended by adding a subdivision to read: 
 99.12     Subd. 10.  [CERTAIN PERSONS NEEDING TREATMENT FOR BREAST OR 
 99.13  CERVICAL CANCER.] (a) Medical assistance may be paid for a 
 99.14  person who: 
 99.15     (1) has been screened for breast or cervical cancer under 
 99.16  the centers for disease control and prevention's national breast 
 99.17  and cervical cancer early detection program established under 
 99.18  United States Code, title 42, sections 300k et seq.; 
 99.19     (2) according to the person's treating health professional, 
 99.20  needs treatment, including diagnostic services necessary to 
 99.21  determine the extent and proper course of treatment, for breast 
 99.22  or cervical cancer, including precancerous conditions and early 
 99.23  stage cancer; 
 99.24     (3) is under age 65; 
 99.25     (4) is not otherwise eligible for medical assistance under 
 99.26  United States Code, title 42, section 1396(a)(10)(A)(i); and 
 99.27     (5) is not otherwise covered under creditable coverage, as 
 99.28  defined under United States Code, title 42, section 300gg(c). 
 99.29     (b) Medical assistance provided for an eligible person 
 99.30  under this subdivision shall be limited to services provided 
 99.31  during the period that the person receives treatment for breast 
 99.32  or cervical cancer. 
 99.33     (c) A person meeting the criteria in paragraph (a) is 
 99.34  eligible for medical assistance without meeting the eligibility 
 99.35  criteria relating to income and assets in section 256B.056, 
 99.36  subdivisions 1a to 5b. 
100.1      Sec. 28.  Minnesota Statutes 2000, section 256B.057, is 
100.2   amended by adding a subdivision to read: 
100.3      Subd. 11.  [AGED, BLIND, OR DISABLED.] (a) To be eligible 
100.4   for medical assistance, a person eligible under section 
100.5   256B.055, subdivision 7, 7a, or 12, may have an income up to 100 
100.6   percent of the federal poverty guidelines. 
100.7      (b) 
100.8      In computing income to determine eligibility of persons who 
100.9   are not residents of long-term care facilities, the commissioner 
100.10  shall disregard increases in income as required by Public Law 
100.11  Numbers 94-566, section 503; 99-272; and 99-509.  Veterans aid 
100.12  and attendance benefits and Veterans Administration unusual 
100.13  medical expense payments are considered income to the recipient. 
100.14     Sec. 29.  Minnesota Statutes 2000, section 256B.061, is 
100.15  amended to read: 
100.16     256B.061 [ELIGIBILITY; RETROACTIVE EFFECT; RESTRICTIONS.] 
100.17     (a) If any individual has been determined to be eligible 
100.18  for medical assistance, it will be made available for care and 
100.19  services included under the plan and furnished in or after the 
100.20  third month before the month in which the individual made 
100.21  application for such assistance, if such individual was, or upon 
100.22  application would have been, eligible for medical assistance at 
100.23  the time the care and services were furnished.  The commissioner 
100.24  may limit, restrict, or suspend the eligibility of an individual 
100.25  for up to one year upon that individual's conviction of a 
100.26  criminal offense related to application for or receipt of 
100.27  medical assistance benefits. 
100.28     (b) On the basis of information provided on the completed 
100.29  application, an applicant who meets the following criteria shall 
100.30  be determined eligible beginning in the month of application: 
100.31     (1) whose gross income is less than 90 percent of the 
100.32  applicable income standard; 
100.33     (2) whose total liquid assets are less than 90 percent of 
100.34  the asset limit; 
100.35     (3) (2) does not reside in a long-term care facility; and 
100.36     (4) (3) meets all other eligibility requirements. 
101.1   The applicant must provide all required verifications within 30 
101.2   days' notice of the eligibility determination or eligibility 
101.3   shall be terminated. 
101.4      (c) Under this chapter and chapter 256D within the limits 
101.5   of the appropriation made available for this purpose, the 
101.6   commissioner shall develop and implement a pilot project 
101.7   establishing presumptive eligibility for children under age 19 
101.8   with family income at or below the medical assistance 
101.9   guidelines.  The commissioner shall select locations such as 
101.10  provider offices, hospitals, clinics, and schools where 
101.11  presumptive eligibility for medical assistance shall be 
101.12  determined on site by a trained staff person.  The commissioner 
101.13  shall expand presumptive eligibility effective July 1, 2002, by 
101.14  selecting additional locations.  The entity determining 
101.15  presumptive eligibility for a child must notify the parent or 
101.16  caretaker at the time of the determination and provide the 
101.17  parent or caretaker with an application form, and within five 
101.18  working days after the date of the presumptive eligibility 
101.19  determination must notify the commissioner.  The presumptive 
101.20  eligibility period ends on the earlier of the date a child is 
101.21  found to be eligible for medical assistance, or the last day of 
101.22  the month after the month of the presumptive eligibility 
101.23  determination if no application for medical assistance has been 
101.24  filed for that child.  
101.25     Sec. 30.  Minnesota Statutes 2000, section 256B.0625, is 
101.26  amended by adding a subdivision to read: 
101.27     Subd. 5a.  [AUTISM BEHAVIOR THERAPY CLINICAL SUPERVISION 
101.28  SERVICES.] (a) Medical assistance covers autism behavior therapy 
101.29  clinical supervision services.  Autism behavior therapy clinical 
101.30  supervision services shall be reimbursed at the same rate as 
101.31  services provided by a mental health professional. 
101.32     (b) Providers enrolled in medical assistance to provide 
101.33  this service or related autism behavior therapy services are not 
101.34  required to hold a contract with a county board, as specified in 
101.35  Minnesota Rules, part 9505.0324, subpart 2. 
101.36     [EFFECTIVE DATE.] This section is effective January 1, 2003.
102.1      Sec. 31.  Minnesota Statutes 2000, section 256B.0625, 
102.2   subdivision 13, is amended to read: 
102.3      Subd. 13.  [DRUGS.] (a) Medical assistance covers drugs, 
102.4   except for fertility drugs when specifically used to enhance 
102.5   fertility, if prescribed by a licensed practitioner and 
102.6   dispensed by a licensed pharmacist, by a physician enrolled in 
102.7   the medical assistance program as a dispensing physician, or by 
102.8   a physician or a nurse practitioner employed by or under 
102.9   contract with a community health board as defined in section 
102.10  145A.02, subdivision 5, for the purposes of communicable disease 
102.11  control.  The commissioner, after receiving recommendations from 
102.12  professional medical associations and professional pharmacist 
102.13  associations, shall designate a formulary committee to advise 
102.14  the commissioner on the names of drugs for which payment is 
102.15  made, recommend a system for reimbursing providers on a set fee 
102.16  or charge basis rather than the present system, and develop 
102.17  methods encouraging use of generic drugs when they are less 
102.18  expensive and equally effective as trademark drugs.  The 
102.19  formulary committee shall consist of nine members, four of whom 
102.20  shall be physicians who are not employed by the department of 
102.21  human services, and a majority of whose practice is for persons 
102.22  paying privately or through health insurance, three of whom 
102.23  shall be pharmacists who are not employed by the department of 
102.24  human services, and a majority of whose practice is for persons 
102.25  paying privately or through health insurance, a consumer 
102.26  representative, and a nursing home representative.  Committee 
102.27  members shall serve three-year terms and shall serve without 
102.28  compensation.  Members may be reappointed once.  
102.29     (b) The commissioner shall establish a drug formulary.  Its 
102.30  establishment and publication shall not be subject to the 
102.31  requirements of the Administrative Procedure Act, but the 
102.32  formulary committee shall review and comment on the formulary 
102.33  contents.  The formulary committee shall review and recommend 
102.34  drugs which require prior authorization.  The formulary 
102.35  committee may recommend drugs for prior authorization directly 
102.36  to the commissioner, as long as opportunity for public input is 
103.1   provided.  Prior authorization may be requested by the 
103.2   commissioner based on medical and clinical criteria before 
103.3   certain drugs are eligible for payment.  Before a drug may be 
103.4   considered for prior authorization at the request of the 
103.5   commissioner:  
103.6      (1) the drug formulary committee must develop criteria to 
103.7   be used for identifying drugs; the development of these criteria 
103.8   is not subject to the requirements of chapter 14, but the 
103.9   formulary committee shall provide opportunity for public input 
103.10  in developing criteria; 
103.11     (2) the drug formulary committee must hold a public forum 
103.12  and receive public comment for an additional 15 days; and 
103.13     (3) the commissioner must provide information to the 
103.14  formulary committee on the impact that placing the drug on prior 
103.15  authorization will have on the quality of patient care and 
103.16  information regarding whether the drug is subject to clinical 
103.17  abuse or misuse.  Prior authorization may be required by the 
103.18  commissioner before certain formulary drugs are eligible for 
103.19  payment.  The formulary shall not include:  
103.20     (i) drugs or products for which there is no federal 
103.21  funding; 
103.22     (ii) over-the-counter drugs, except for antacids, 
103.23  acetaminophen, family planning products, aspirin, insulin, 
103.24  products for the treatment of lice, vitamins for adults with 
103.25  documented vitamin deficiencies, vitamins for children under the 
103.26  age of seven and pregnant or nursing women, and any other 
103.27  over-the-counter drug identified by the commissioner, in 
103.28  consultation with the drug formulary committee, as necessary, 
103.29  appropriate, and cost-effective for the treatment of certain 
103.30  specified chronic diseases, conditions or disorders, and this 
103.31  determination shall not be subject to the requirements of 
103.32  chapter 14; 
103.33     (iii) anorectics, except that medically necessary 
103.34  anorectics shall be covered for a recipient previously diagnosed 
103.35  as having pickwickian syndrome and currently diagnosed as having 
103.36  diabetes and being morbidly obese; 
104.1      (iv) drugs for which medical value has not been 
104.2   established; and 
104.3      (v) drugs from manufacturers who have not signed a rebate 
104.4   agreement with the Department of Health and Human Services 
104.5   pursuant to section 1927 of title XIX of the Social Security Act.
104.6      The commissioner shall publish conditions for prohibiting 
104.7   payment for specific drugs after considering the formulary 
104.8   committee's recommendations.  An honorarium of $100 per meeting 
104.9   and reimbursement for mileage shall be paid to each committee 
104.10  member in attendance.  
104.11     (c) The basis for determining the amount of payment shall 
104.12  be the lower of the actual acquisition costs of the drugs plus a 
104.13  fixed dispensing fee; the maximum allowable cost set by the 
104.14  federal government or by the commissioner plus the fixed 
104.15  dispensing fee; or the usual and customary price charged to the 
104.16  public.  The pharmacy dispensing fee shall be $3.65, except that 
104.17  the dispensing fee for intravenous solutions which must be 
104.18  compounded by the pharmacist shall be $8 per bag, $14 per bag 
104.19  for cancer chemotherapy products, and $30 per bag for total 
104.20  parenteral nutritional products dispensed in one liter 
104.21  quantities, or $44 per bag for total parenteral nutritional 
104.22  products dispensed in quantities greater than one liter.  Actual 
104.23  acquisition cost includes quantity and other special discounts 
104.24  except time and cash discounts.  The actual acquisition cost of 
104.25  a drug shall be estimated by the commissioner, at average 
104.26  wholesale price minus nine percent, except that where a drug has 
104.27  had its wholesale price reduced as a result of the actions of 
104.28  the National Association of Medicaid Fraud Control Units, the 
104.29  estimated actual acquisition cost shall be the reduced average 
104.30  wholesale price, without the nine percent deduction.  The 
104.31  maximum allowable cost of a multisource drug may be set by the 
104.32  commissioner and it shall be comparable to, but no higher than, 
104.33  the maximum amount paid by other third-party payors in this 
104.34  state who have maximum allowable cost programs.  The 
104.35  commissioner shall set maximum allowable costs for multisource 
104.36  drugs that are not on the federal upper limit list as described 
105.1   in United States Code, title 42, chapter 7, section 1396r-8(e), 
105.2   the Social Security Act, and Code of Federal Regulations, title 
105.3   42, part 447, section 447.332.  Establishment of the amount of 
105.4   payment for drugs shall not be subject to the requirements of 
105.5   the Administrative Procedure Act.  An additional dispensing fee 
105.6   of $.30 may be added to the dispensing fee paid to pharmacists 
105.7   for legend drug prescriptions dispensed to residents of 
105.8   long-term care facilities when a unit dose blister card system, 
105.9   approved by the department, is used.  Under this type of 
105.10  dispensing system, the pharmacist must dispense a 30-day supply 
105.11  of drug.  The National Drug Code (NDC) from the drug container 
105.12  used to fill the blister card must be identified on the claim to 
105.13  the department.  The unit dose blister card containing the drug 
105.14  must meet the packaging standards set forth in Minnesota Rules, 
105.15  part 6800.2700, that govern the return of unused drugs to the 
105.16  pharmacy for reuse.  The pharmacy provider will be required to 
105.17  credit the department for the actual acquisition cost of all 
105.18  unused drugs that are eligible for reuse.  Over-the-counter 
105.19  medications must be dispensed in the manufacturer's unopened 
105.20  package.  The commissioner may permit the drug clozapine to be 
105.21  dispensed in a quantity that is less than a 30-day supply.  
105.22  Whenever a generically equivalent product is available, payment 
105.23  shall be on the basis of the actual acquisition cost of the 
105.24  generic drug, unless the prescriber specifically indicates 
105.25  "dispense as written - brand necessary" on the prescription as 
105.26  required by section 151.21, subdivision 2. 
105.27     (d) For purposes of this subdivision, "multisource drugs" 
105.28  means covered outpatient drugs, excluding innovator multisource 
105.29  drugs for which there are two or more drug products, which: 
105.30     (1) are related as therapeutically equivalent under the 
105.31  Food and Drug Administration's most recent publication of 
105.32  "Approved Drug Products with Therapeutic Equivalence 
105.33  Evaluations"; 
105.34     (2) are pharmaceutically equivalent and bioequivalent as 
105.35  determined by the Food and Drug Administration; and 
105.36     (3) are sold or marketed in Minnesota. 
106.1   "Innovator multisource drug" means a multisource drug that was 
106.2   originally marketed under an original new drug application 
106.3   approved by the Food and Drug Administration. 
106.4      (e) The basis for determining the amount of payment for 
106.5   drugs administered in an outpatient setting shall be the lower 
106.6   of the usual and customary cost submitted by the provider; the 
106.7   average wholesale price minus five percent; or the maximum 
106.8   allowable cost set by the federal government under United States 
106.9   Code, title 42, chapter 7, section 1396r-8(e) and Code of 
106.10  Federal Regulations, title 42, section 447.332, or by the 
106.11  commissioner under paragraph (c). 
106.12     Sec. 32.  Minnesota Statutes 2000, section 256B.0625, 
106.13  subdivision 13a, is amended to read: 
106.14     Subd. 13a.  [DRUG UTILIZATION REVIEW BOARD.] A nine-member 
106.15  drug utilization review board is established.  The board is 
106.16  comprised of at least three but no more than four licensed 
106.17  physicians actively engaged in the practice of medicine in 
106.18  Minnesota; at least three licensed pharmacists actively engaged 
106.19  in the practice of pharmacy in Minnesota; and one consumer 
106.20  representative; the remainder to be made up of health care 
106.21  professionals who are licensed in their field and have 
106.22  recognized knowledge in the clinically appropriate prescribing, 
106.23  dispensing, and monitoring of covered outpatient drugs.  The 
106.24  board shall be staffed by an employee of the department who 
106.25  shall serve as an ex officio nonvoting member of the board.  The 
106.26  members of the board shall be appointed by the commissioner and 
106.27  shall serve three-year terms.  The members shall be selected 
106.28  from lists submitted by professional associations.  The 
106.29  commissioner shall appoint the initial members of the board for 
106.30  terms expiring as follows:  three members for terms expiring 
106.31  June 30, 1996; three members for terms expiring June 30, 1997; 
106.32  and three members for terms expiring June 30, 1998.  Members may 
106.33  be reappointed once.  The board shall annually elect a chair 
106.34  from among the members. 
106.35     The commissioner shall, with the advice of the board: 
106.36     (1) implement a medical assistance retrospective and 
107.1   prospective drug utilization review program as required by 
107.2   United States Code, title 42, section 1396r-8(g)(3); 
107.3      (2) develop and implement the predetermined criteria and 
107.4   practice parameters for appropriate prescribing to be used in 
107.5   retrospective and prospective drug utilization review; 
107.6      (3) develop, select, implement, and assess interventions 
107.7   for physicians, pharmacists, and patients that are educational 
107.8   and not punitive in nature; 
107.9      (4) establish a grievance and appeals process for 
107.10  physicians and pharmacists under this section; 
107.11     (5) publish and disseminate educational information to 
107.12  physicians and pharmacists regarding the board and the review 
107.13  program; 
107.14     (6) adopt and implement procedures designed to ensure the 
107.15  confidentiality of any information collected, stored, retrieved, 
107.16  assessed, or analyzed by the board, staff to the board, or 
107.17  contractors to the review program that identifies individual 
107.18  physicians, pharmacists, or recipients; 
107.19     (7) establish and implement an ongoing process to (i) 
107.20  receive public comment regarding drug utilization review 
107.21  criteria and standards, and (ii) consider the comments along 
107.22  with other scientific and clinical information in order to 
107.23  revise criteria and standards on a timely basis; and 
107.24     (8) adopt any rules necessary to carry out this section. 
107.25     The board may establish advisory committees.  The 
107.26  commissioner may contract with appropriate organizations to 
107.27  assist the board in carrying out the board's duties.  The 
107.28  commissioner may enter into contracts for services to develop 
107.29  and implement a retrospective and prospective review program. 
107.30     The board shall report to the commissioner annually on the 
107.31  date the Drug Utilization Review Annual Report is due to the 
107.32  Health Care Financing Administration.  This report is to cover 
107.33  the preceding federal fiscal year.  The commissioner shall make 
107.34  the report available to the public upon request.  The report 
107.35  must include information on the activities of the board and the 
107.36  program; the effectiveness of implemented interventions; 
108.1   administrative costs; and any fiscal impact resulting from the 
108.2   program.  An honorarium of $50 $100 per meeting and 
108.3   reimbursement for mileage shall be paid to each board member in 
108.4   attendance. 
108.5      Sec. 33.  Minnesota Statutes 2000, section 256B.0625, 
108.6   subdivision 17, is amended to read: 
108.7      Subd. 17.  [TRANSPORTATION COSTS.] (a) Medical assistance 
108.8   covers transportation costs incurred solely for obtaining 
108.9   emergency medical care or transportation costs incurred by 
108.10  nonambulatory persons in obtaining emergency or nonemergency 
108.11  medical care when paid directly to an ambulance company, common 
108.12  carrier, or other recognized providers of transportation 
108.13  services.  For the purpose of this subdivision, a person who is 
108.14  incapable of transport by taxicab or bus shall be considered to 
108.15  be nonambulatory. 
108.16     (b) Medical assistance covers special transportation, as 
108.17  defined in Minnesota Rules, part 9505.0315, subpart 1, item F, 
108.18  if the provider receives and maintains a current physician's 
108.19  order by the recipient's attending physician certifying that the 
108.20  recipient has a physical or mental impairment that would 
108.21  prohibit the recipient from safely accessing and using a bus, 
108.22  taxi, other commercial transportation, or private automobile.  
108.23  Special transportation includes driver-assisted service to 
108.24  eligible individuals.  Driver-assisted service includes 
108.25  passenger pickup at and return to the individual's residence or 
108.26  place of business, assistance with admittance of the individual 
108.27  to the medical facility, and assistance in passenger securement 
108.28  or in securing of wheelchairs or stretchers in the vehicle.  The 
108.29  commissioner shall establish maximum medical assistance 
108.30  reimbursement rates for special transportation services for 
108.31  persons who need a wheelchair lift accessible van or 
108.32  stretcher-equipped stretcher-accessible vehicle and for those 
108.33  who do not need a wheelchair lift accessible van or 
108.34  stretcher-equipped stretcher-accessible vehicle.  The average of 
108.35  these two rates per trip must not exceed $15 for the base rate 
108.36  and $1.20 $1.30 per mile.  Special transportation provided to 
109.1   nonambulatory persons who do not need a wheelchair lift 
109.2   accessible van or stretcher-equipped stretcher-accessible 
109.3   vehicle, may be reimbursed at a lower rate than special 
109.4   transportation provided to persons who need a wheelchair lift 
109.5   accessible van or stretcher-equipped stretcher-accessible 
109.6   vehicle.  
109.7      [EFFECTIVE DATE.] This section is effective July 1, 2001.  
109.8      Sec. 34.  Minnesota Statutes 2000, section 256B.0625, 
109.9   subdivision 17a, is amended to read: 
109.10     Subd. 17a.  [PAYMENT FOR AMBULANCE SERVICES.] Effective for 
109.11  services rendered on or after July 1, 1999 2001, medical 
109.12  assistance payments for ambulance services shall be increased by 
109.13  five percent paid at the Medicare reimbursement rate or at the 
109.14  medical assistance payment rate in effect on July 1, 2000, 
109.15  whichever is greater.  
109.16     Sec. 35.  Minnesota Statutes 2000, section 256B.0625, 
109.17  subdivision 18a, is amended to read: 
109.18     Subd. 18a.  [PAYMENT FOR MEALS AND LODGING ACCESS TO 
109.19  MEDICAL SERVICES.] (a) Medical assistance reimbursement for 
109.20  meals for persons traveling to receive medical care may not 
109.21  exceed $5.50 for breakfast, $6.50 for lunch, or $8 for dinner. 
109.22     (b) Medical assistance reimbursement for lodging for 
109.23  persons traveling to receive medical care may not exceed $50 per 
109.24  day unless prior authorized by the local agency. 
109.25     (c) Medical assistance direct mileage reimbursement to the 
109.26  eligible person or the eligible person's driver may not exceed 
109.27  20 cents per mile. 
109.28     (d) Medical assistance covers oral language interpreter 
109.29  services when provided by an enrolled health care provider 
109.30  during the course of providing a direct, person-to-person 
109.31  covered health care service to an enrolled recipient with 
109.32  limited English proficiency. 
109.33     Sec. 36.  Minnesota Statutes 2000, section 256B.0625, 
109.34  subdivision 30, is amended to read: 
109.35     Subd. 30.  [OTHER CLINIC SERVICES.] (a) Medical assistance 
109.36  covers rural health clinic services, federally qualified health 
110.1   center services, nonprofit community health clinic services, 
110.2   public health clinic services, and the services of a clinic 
110.3   meeting the criteria established in rule by the commissioner.  
110.4   Rural health clinic services and federally qualified health 
110.5   center services mean services defined in United States Code, 
110.6   title 42, section 1396d(a)(2)(B) and (C).  Payment for rural 
110.7   health clinic and federally qualified health center services 
110.8   shall be made according to applicable federal law and regulation.
110.9      (b) A federally qualified health center that is beginning 
110.10  initial operation shall submit an estimate of budgeted costs and 
110.11  visits for the initial reporting period in the form and detail 
110.12  required by the commissioner.  A federally qualified health 
110.13  center that is already in operation shall submit an initial 
110.14  report using actual costs and visits for the initial reporting 
110.15  period.  Within 90 days of the end of its reporting period, a 
110.16  federally qualified health center shall submit, in the form and 
110.17  detail required by the commissioner, a report of its operations, 
110.18  including allowable costs actually incurred for the period and 
110.19  the actual number of visits for services furnished during the 
110.20  period, and other information required by the commissioner.  
110.21  Federally qualified health centers that file Medicare cost 
110.22  reports shall provide the commissioner with a copy of the most 
110.23  recent Medicare cost report filed with the Medicare program 
110.24  intermediary for the reporting year which support the costs 
110.25  claimed on their cost report to the state. 
110.26     (c) In order to continue cost-based payment under the 
110.27  medical assistance program according to paragraphs (a) and (b), 
110.28  a federally qualified health center or rural health clinic must 
110.29  apply for designation as an essential community provider within 
110.30  six months of final adoption of rules by the department of 
110.31  health according to section 62Q.19, subdivision 7.  For those 
110.32  federally qualified health centers and rural health clinics that 
110.33  have applied for essential community provider status within the 
110.34  six-month time prescribed, medical assistance payments will 
110.35  continue to be made according to paragraphs (a) and (b) for the 
110.36  first three years after application.  For federally qualified 
111.1   health centers and rural health clinics that either do not apply 
111.2   within the time specified above or who have had essential 
111.3   community provider status for three years, medical assistance 
111.4   payments for health services provided by these entities shall be 
111.5   according to the same rates and conditions applicable to the 
111.6   same service provided by health care providers that are not 
111.7   federally qualified health centers or rural health clinics.  
111.8      (d) Effective July 1, 1999, the provisions of paragraph (c) 
111.9   requiring a federally qualified health center or a rural health 
111.10  clinic to make application for an essential community provider 
111.11  designation in order to have cost-based payments made according 
111.12  to paragraphs (a) and (b) no longer apply. 
111.13     (e) Effective January 1, 2000, payments made according to 
111.14  paragraphs (a) and (b) shall be limited to the cost phase-out 
111.15  schedule of the Balanced Budget Act of 1997. 
111.16     (f) Effective January 1, 2001, each federally qualified 
111.17  health center and rural health clinic may elect to be paid 
111.18  either under the prospective payment system established in 
111.19  United States Code, title 42, section 1396a, (a) or under an 
111.20  alternative payment methodology consistent with the requirements 
111.21  of United States Code, title 42, section 1392a, (a) and approved 
111.22  by the Health Care Financing Administration.  The alternative 
111.23  payment methodology shall be 100 percent of cost as determined 
111.24  according to Medicare cost principles. 
111.25     Sec. 37.  Minnesota Statutes 2000, section 256B.0625, 
111.26  subdivision 34, is amended to read: 
111.27     Subd. 34.  [INDIAN HEALTH SERVICES FACILITIES.] Medical 
111.28  assistance payments to facilities of the Indian health service 
111.29  and facilities operated by a tribe or tribal organization under 
111.30  funding authorized by United States Code, title 25, sections 
111.31  450f to 450n, or title III of the Indian Self-Determination and 
111.32  Education Assistance Act, Public Law Number 93-638, for 
111.33  enrollees who are eligible for federal financial participation, 
111.34  shall be at the option of the facility in accordance with the 
111.35  rate published by the United States Assistant Secretary for 
111.36  Health under the authority of United States Code, title 42, 
112.1   sections 248(a) and 249(b).  General assistance medical care 
112.2   payments to facilities of the Indian health services and 
112.3   facilities operated by a tribe or tribal organization for the 
112.4   provision of outpatient medical care services billed after June 
112.5   30, 1990, must be in accordance with the general assistance 
112.6   medical care rates paid for the same services when provided in a 
112.7   facility other than a facility of the Indian health service or a 
112.8   facility operated by a tribe or tribal 
112.9   organization.  MinnesotaCare payments for enrollees who are not 
112.10  eligible for federal financial participation at facilities of 
112.11  the Indian health service and facilities operated by a tribe or 
112.12  tribal organization for the provision of outpatient medical 
112.13  services must be in accordance with the medical assistance rates 
112.14  paid for the same services when provided in a facility other 
112.15  than a facility of the Indian health service or a facility 
112.16  operated by a tribe or tribal organization. 
112.17     [EFFECTIVE DATE.] This section shall be effective the day 
112.18  following final enactment.  
112.19     Sec. 38.  Minnesota Statutes 2000, section 256B.0625, is 
112.20  amended by adding a subdivision to read: 
112.21     Subd. 43.  [TARGETED CASE MANAGEMENT SERVICES.] Medical 
112.22  assistance covers case management services for vulnerable adults 
112.23  and persons with developmental disabilities not receiving home 
112.24  and community-based waiver services. 
112.25     Sec. 39.  Minnesota Statutes 2000, section 256B.0625, is 
112.26  amended by adding a subdivision to read: 
112.27     Subd. 44.  [TARGETED CASE MANAGEMENT SERVICE FOR CHILDREN 
112.28  UNDER THE AGE OF 19.] Medical assistance, subject to federal 
112.29  approval, covers targeted case management services in accordance 
112.30  with section 256B.0948 for children under the age of 19 who have 
112.31  had at least one previous birth. 
112.32     Sec. 40.  Minnesota Statutes 2000, section 256B.0635, 
112.33  subdivision 1, is amended to read: 
112.34     Subdivision 1.  [INCREASED EMPLOYMENT.] Beginning January 
112.35  1, 1998 (a) Until June 30, 2002, medical assistance may be paid 
112.36  for persons who received MFIP-S or medical assistance for 
113.1   families and children in at least three of six months preceding 
113.2   the month in which the person became ineligible for MFIP-S or 
113.3   medical assistance, if the ineligibility was due to an increase 
113.4   in hours of employment or employment income or due to the loss 
113.5   of an earned income disregard.  In addition, to receive 
113.6   continued assistance under this section, persons who received 
113.7   medical assistance for families and children but did not receive 
113.8   MFIP-S must have had income less than or equal to the assistance 
113.9   standard for their family size under the state's AFDC plan in 
113.10  effect as of July 16, 1996, as required by the Personal 
113.11  Responsibility and Work Opportunity Reconciliation Act of 1996 
113.12  (PRWORA), Public Law Number 104-193, increased according to 
113.13  section 256B.056, subdivision 4, at the time medical assistance 
113.14  eligibility began.  A person who is eligible for extended 
113.15  medical assistance is entitled to six 12 months of assistance 
113.16  without reapplication, unless the assistance unit ceases to 
113.17  include a dependent child.  For a person under 21 years of 
113.18  age, except medical assistance may not be discontinued for that 
113.19  dependent child under 21 years of age within the six-month 
113.20  12-month period of extended eligibility until it has been 
113.21  determined that the person is not otherwise eligible for medical 
113.22  assistance.  Medical assistance may be continued for an 
113.23  additional six months if the person meets all requirements for 
113.24  the additional six months, according to title XIX of the Social 
113.25  Security Act, as amended by section 303 of the Family Support 
113.26  Act of 1988, Public Law Number 100-485. 
113.27     (b) Beginning July 1, 2002, medical assistance for families 
113.28  and children may be paid for persons who were eligible under 
113.29  section 256B.055, subdivision 3a, paragraph (b), in at least 
113.30  three of six months preceding the month in which the person 
113.31  became ineligible under that section if the ineligibility was 
113.32  due to an increase in hours of employment or employment income 
113.33  or due to the loss of an earned income disregard.  A person who 
113.34  is eligible for extended medical assistance is entitled to 12 
113.35  months of assistance without reapplication, unless the 
113.36  assistance unit ceases to include a dependent child, except 
114.1   medical assistance may not be discontinued for that dependent 
114.2   child under 21 years of age within the 12-month period of 
114.3   extended eligibility until it has been determined that the 
114.4   person is not otherwise eligible for medical assistance.  
114.5      [EFFECTIVE DATE.] This section is effective July 1, 2001. 
114.6      Sec. 41.  Minnesota Statutes 2000, section 256B.0635, 
114.7   subdivision 2, is amended to read: 
114.8      Subd. 2.  [INCREASED CHILD OR SPOUSAL SUPPORT.] Beginning 
114.9   January 1, 1998 (a) Until June 30, 2002, medical assistance may 
114.10  be paid for persons who received MFIP-S or medical assistance 
114.11  for families and children in at least three of the six months 
114.12  preceding the month in which the person became ineligible for 
114.13  MFIP-S or medical assistance, if the ineligibility was the 
114.14  result of the collection of child or spousal support under part 
114.15  D of title IV of the Social Security Act.  In addition, to 
114.16  receive continued assistance under this section, persons who 
114.17  received medical assistance for families and children but did 
114.18  not receive MFIP-S must have had income less than or equal to 
114.19  the assistance standard for their family size under the state's 
114.20  AFDC plan in effect as of July 16, 1996, as required by the 
114.21  Personal Responsibility and Work Opportunity Reconciliation Act 
114.22  of 1996 (PRWORA), Public Law Number 104-193 increased according 
114.23  to section 256B.056, subdivision 4, at the time medical 
114.24  assistance eligibility began.  A person who is eligible for 
114.25  extended medical assistance under this subdivision is entitled 
114.26  to four months of assistance without reapplication, unless the 
114.27  assistance unit ceases to include a dependent child.  For a 
114.28  person under 21 years of age, except medical assistance may not 
114.29  be discontinued for that dependent child under 21 years of age 
114.30  within the four-month period of extended eligibility until it 
114.31  has been determined that the person is not otherwise eligible 
114.32  for medical assistance. 
114.33     (b) Beginning July 1, 2002, medical assistance for families 
114.34  and children may be paid for persons who were eligible under 
114.35  section 256B.055, subdivision 3a, paragraph (b), in at least 
114.36  three of the six months preceding the month in which the person 
115.1   became ineligible under that section if the ineligibility was 
115.2   the result of the collection of child or spousal support under 
115.3   part D of title IV of the Social Security Act.  A person who is 
115.4   eligible for extended medical assistance under this subdivision 
115.5   is entitled to four months of assistance without reapplication, 
115.6   unless the assistance unit ceases to include a dependent child, 
115.7   except medical assistance may not be discontinued for that 
115.8   dependent child under 21 years of age within the four-month 
115.9   period of extended eligibility until it has been determined that 
115.10  the person is not otherwise eligible for medical assistance. 
115.11     [EFFECTIVE DATE.] This section is effective July 1, 2001. 
115.12     Sec. 42.  [256B.0637] [PRESUMPTIVE ELIGIBILITY FOR CERTAIN 
115.13  PERSONS NEEDING TREATMENT FOR BREAST OR CERVICAL CANCER.] 
115.14     Medical assistance is available during a presumptive 
115.15  eligibility period for persons who meet the criteria in section 
115.16  256B.057, subdivision 10.  For purposes of this section, the 
115.17  presumptive eligibility period begins on the date on which an 
115.18  entity designated by the commissioner determines based on 
115.19  preliminary information that the person meets the criteria in 
115.20  section 256B.057, subdivision 10.  The presumptive eligibility 
115.21  period ends on the day on which a determination is made as to 
115.22  the person's eligibility, except that if an application is not 
115.23  submitted by the last day of the month following the month 
115.24  during which the determination based on preliminary information 
115.25  is made, the presumptive eligibility period ends on that last 
115.26  day of the month. 
115.27     Sec. 43.  Minnesota Statutes 2000, section 256B.0644, is 
115.28  amended to read: 
115.29     256B.0644 [PARTICIPATION REQUIRED FOR REIMBURSEMENT UNDER 
115.30  OTHER STATE HEALTH CARE PROGRAMS.] 
115.31     A vendor of medical care, as defined in section 256B.02, 
115.32  subdivision 7, and a health maintenance organization, as defined 
115.33  in chapter 62D, must participate as a provider or contractor in 
115.34  the medical assistance program, general assistance medical care 
115.35  program, and MinnesotaCare as a condition of participating as a 
115.36  provider in health insurance plans and programs or contractor 
116.1   for state employees established under section 43A.18, the public 
116.2   employees insurance program under section 43A.316, for health 
116.3   insurance plans offered to local statutory or home rule charter 
116.4   city, county, and school district employees, the workers' 
116.5   compensation system under section 176.135, and insurance plans 
116.6   provided through the Minnesota comprehensive health association 
116.7   under sections 62E.01 to 62E.19.  The limitations on insurance 
116.8   plans offered to local government employees shall not be 
116.9   applicable in geographic areas where provider participation is 
116.10  limited by managed care contracts with the department of human 
116.11  services.  For providers other than health maintenance 
116.12  organizations, participation in the medical assistance program 
116.13  means that (1) the provider accepts new medical assistance, 
116.14  general assistance medical care, and MinnesotaCare patients or 
116.15  (2) at least 20 percent of the provider's patients are covered 
116.16  by medical assistance, general assistance medical care, and 
116.17  MinnesotaCare as their primary source of coverage.  Patients 
116.18  seen on a volunteer basis by the provider at a location other 
116.19  than the provider's usual place of practice may be considered in 
116.20  meeting this participation requirement.  The commissioner shall 
116.21  establish participation requirements for health maintenance 
116.22  organizations.  The commissioner shall provide lists of 
116.23  participating medical assistance providers on a quarterly basis 
116.24  to the commissioner of employee relations, the commissioner of 
116.25  labor and industry, and the commissioner of commerce.  Each of 
116.26  the commissioners shall develop and implement procedures to 
116.27  exclude as participating providers in the program or programs 
116.28  under their jurisdiction those providers who do not participate 
116.29  in the medical assistance program.  The commissioner of employee 
116.30  relations shall implement this section through contracts with 
116.31  participating health and dental carriers. 
116.32     Sec. 44.  Minnesota Statutes 2000, section 256B.0913, 
116.33  subdivision 12, is amended to read: 
116.34     Subd. 12.  [CLIENT PREMIUMS.] (a) A premium is required for 
116.35  all 180-day eligible clients to help pay for the cost of 
116.36  participating in the program.  The amount of the premium for the 
117.1   alternative care client shall be determined as follows: 
117.2      (1) when the alternative care client's income less 
117.3   recurring and predictable medical expenses is greater than the 
117.4   medical assistance income standard but less than 150 percent of 
117.5   the federal poverty guideline, and total assets are less than 
117.6   $10,000, the fee is zero; 
117.7      (2) when the alternative care client's income less 
117.8   recurring and predictable medical expenses is greater than 150 
117.9   percent of the federal poverty guideline, and total assets are 
117.10  less than $10,000, the fee is 25 percent of the cost of 
117.11  alternative care services or the difference between 150 percent 
117.12  of the federal poverty guideline and the client's income less 
117.13  recurring and predictable medical expenses, whichever is less; 
117.14  and 
117.15     (3) when the alternative care client's total assets are 
117.16  greater than $10,000, the fee is 25 percent of the cost of 
117.17  alternative care services.  
117.18     For married persons, total assets are defined as the total 
117.19  marital assets less the estimated community spouse asset 
117.20  allowance, under section 256B.059, if applicable.  For married 
117.21  persons, total income is defined as the client's income less the 
117.22  monthly spousal allotment, under section 256B.058. 
117.23     All alternative care services except case management shall 
117.24  be included in the estimated costs for the purpose of 
117.25  determining 25 percent of the costs. 
117.26     The monthly premium shall be calculated based on the cost 
117.27  of the first full month of alternative care services and shall 
117.28  continue unaltered until the next reassessment is completed or 
117.29  at the end of 12 months, whichever comes first.  Premiums are 
117.30  due and payable each month alternative care services are 
117.31  received unless the actual cost of the services is less than the 
117.32  premium. 
117.33     (b) The fee shall be waived by the commissioner when: 
117.34     (1) a person who is residing in a nursing facility is 
117.35  receiving case management only; 
117.36     (2) a person is applying for medical assistance; 
118.1      (3) a married couple is requesting an asset assessment 
118.2   under the spousal impoverishment provisions; 
118.3      (4) a person is a medical assistance recipient, but has 
118.4   been approved for alternative care-funded assisted living 
118.5   services; 
118.6      (5) a person is found eligible for alternative care, but is 
118.7   not yet receiving alternative care services; or 
118.8      (6) a person's fee under paragraph (a) is less than $25. 
118.9      (c) The county agency must record in the state's receivable 
118.10  system the client's assessed premium amount or the reason the 
118.11  premium has been waived.  The commissioner will bill and collect 
118.12  the premium from the client and forward the amounts collected to 
118.13  the commissioner in the manner and at the times prescribed by 
118.14  the commissioner.  Money collected must be deposited in the 
118.15  general fund and is appropriated to the commissioner for the 
118.16  alternative care program.  The client must supply the county 
118.17  with the client's social security number at the time of 
118.18  application.  If a client fails or refuses to pay the premium 
118.19  due, The county shall supply the commissioner with the client's 
118.20  social security number and other information the commissioner 
118.21  requires to collect the premium from the client.  The 
118.22  commissioner shall collect unpaid premiums using the Revenue 
118.23  Recapture Act in chapter 270A and other methods available to the 
118.24  commissioner.  The commissioner may require counties to inform 
118.25  clients of the collection procedures that may be used by the 
118.26  state if a premium is not paid.  This paragraph does not apply 
118.27  to alternative care pilot projects authorized in Laws 1993, 
118.28  First Special Session chapter 1, article 5, section 133, if a 
118.29  county operating under the pilot project reports the following 
118.30  dollar amounts to the commissioner quarterly: 
118.31     (1) total premiums billed to clients; 
118.32     (2) total collections of premiums billed; and 
118.33     (3) balance of premiums owed by clients. 
118.34  If a county does not adhere to these reporting requirements, the 
118.35  commissioner may terminate the billing, collecting, and 
118.36  remitting portions of the pilot project and require the county 
119.1   involved to operate under the procedures set forth in this 
119.2   paragraph. 
119.3      (d) The commissioner shall begin to adopt emergency or 
119.4   permanent rules governing client premiums within 30 days after 
119.5   July 1, 1991, including criteria for determining when services 
119.6   to a client must be terminated due to failure to pay a premium.  
119.7      Sec. 45.  Minnesota Statutes 2000, section 256B.0913, 
119.8   subdivision 14, is amended to read: 
119.9      Subd. 14.  [REIMBURSEMENT AND RATE ADJUSTMENTS.] (a) 
119.10  Reimbursement for expenditures for the alternative care services 
119.11  as approved by the client's case manager shall be through the 
119.12  invoice processing procedures of the department's Medicaid 
119.13  Management Information System (MMIS).  To receive reimbursement, 
119.14  the county or vendor must submit invoices within 12 months 
119.15  following the date of service.  The county agency and its 
119.16  vendors under contract shall not be reimbursed for services 
119.17  which exceed the county allocation. 
119.18     (b) If a county collects less than 50 percent of the client 
119.19  premiums due under subdivision 12, the commissioner may withhold 
119.20  up to three percent of the county's final alternative care 
119.21  program allocation determined under subdivisions 10 and 11. 
119.22     (c) The county shall negotiate individual rates with 
119.23  vendors and may be reimbursed for actual costs up to the greater 
119.24  of the county's current approved rate or 60 percent of the 
119.25  maximum rate in fiscal year 1994 and 65 percent of the maximum 
119.26  rate in fiscal year 1995 for each alternative care service.  
119.27  Notwithstanding any other rule or statutory provision to the 
119.28  contrary, the commissioner shall not be authorized to increase 
119.29  rates by an annual inflation factor, unless so authorized by the 
119.30  legislature. 
119.31     (d) (c) On July 1, 1993, the commissioner shall increase 
119.32  the maximum rate for home delivered meals to $4.50 per meal. 
119.33     Sec. 46.  [256B.0924] [TARGETED CASE MANAGEMENT SERVICES 
119.34  FOR VULNERABLE ADULTS AND PERSONS WITH DEVELOPMENTAL 
119.35  DISABILITIES.] 
119.36     Subdivision 1.  [PURPOSE.] The state recognizes that 
120.1   targeted case management services can decrease the need for more 
120.2   costly services such as multiple emergency room visits or 
120.3   hospitalizations by linking eligible individuals with less 
120.4   costly services available in the community. 
120.5      Subd. 2.  [DEFINITIONS.] For purposes of this section, the 
120.6   following terms have the meanings given: 
120.7      (a) "Targeted case management" means services which will 
120.8   assist medical assistance eligible persons to gain access to 
120.9   needed medical, social, educational, and other services.  
120.10  Targeted case management does not include therapy, treatment, 
120.11  legal, or outreach services. 
120.12     (b) "Targeted case management for adults" means activities 
120.13  that coordinate and link social and other services designed to 
120.14  help eligible persons gain access to needed protective services, 
120.15  social, health care, mental health, habilitative, educational, 
120.16  vocational, recreational, advocacy, legal, chemical, health, and 
120.17  other related services. 
120.18     Subd. 3.  [ELIGIBILITY.] Persons are eligible to receive 
120.19  targeted case management services under this section if the 
120.20  requirements in paragraphs (a) and (b) are met. 
120.21     (a) The person must be assessed and determined by the local 
120.22  county agency to: 
120.23     (1) be age 18 or older; 
120.24     (2) be receiving medical assistance; 
120.25     (3) have significant functional limitations; and 
120.26     (4) be in need of service coordination to attain or 
120.27  maintain living in an integrated community setting. 
120.28     (b) The person must be a vulnerable adult in need of adult 
120.29  protection as defined in section 626.5572, or is an adult with 
120.30  mental retardation as defined in section 252A.02, subdivision 2, 
120.31  or a related condition as defined in section 252.27, subdivision 
120.32  1a, and is not receiving home and community-based waiver 
120.33  services. 
120.34     Subd. 4.  [TARGETED CASE MANAGEMENT SERVICE 
120.35  ACTIVITIES.] (a) For persons with mental retardation or a 
120.36  related condition, targeted case management services must meet 
121.1   the provisions of section 256B.092. 
121.2      (b) For persons not eligible as a person with mental 
121.3   retardation or a related condition, targeted case management 
121.4   service activities include: 
121.5      (1) an assessment of the person's need for targeted case 
121.6   management services; 
121.7      (2) the development of a written personal service plan; 
121.8      (3) a regular review and revision of the written personal 
121.9   service plan with the recipient and the recipient's legal 
121.10  representative, and others as identified by the recipient, to 
121.11  ensure access to necessary services and supports identified in 
121.12  the plan; 
121.13     (4) effective communication with the recipient and the 
121.14  recipient's legal representative and others identified by the 
121.15  recipient; 
121.16     (5) coordination of referrals for needed services with 
121.17  qualified providers; 
121.18     (6) coordination and monitoring of the overall service 
121.19  delivery to ensure the quality and effectiveness of services; 
121.20     (7) assistance to the recipient and the recipient's legal 
121.21  representative to help make an informed choice of services; 
121.22     (8) advocating on behalf of the recipient when service 
121.23  barriers are encountered or referring the recipient and the 
121.24  recipient's legal representative to an independent advocate; 
121.25     (9) monitoring and evaluating services identified in the 
121.26  personal service plan to ensure personal outcomes are met and to 
121.27  ensure satisfaction with services and service delivery; 
121.28     (10) conducting face-to-face monitoring with the recipient 
121.29  at least twice a year; 
121.30     (11) completing and maintain necessary documentation that 
121.31  supports verifies the activities in this section; 
121.32     (12) coordinating with the medical assistance facility 
121.33  discharge planner in the 180-day period prior to the recipient's 
121.34  discharge into the community; and 
121.35     (13) a personal service plan developed and reviewed at 
121.36  least annually with the recipient and the recipient's legal 
122.1   representative.  The personal service plan must be revised when 
122.2   there is a change in the recipient's status.  The personal 
122.3   service plan must identify: 
122.4      (i) the desired personal short and long-term outcomes; 
122.5      (ii) the recipient's preferences for services and supports, 
122.6   including development of a person-centered plan if requested; 
122.7   and 
122.8      (iii) formal and informal services and supports based on 
122.9   areas of assessment, such as:  social, health, mental health, 
122.10  residence, family, educational and vocational, safety, legal, 
122.11  self-determination, financial, and chemical health as determined 
122.12  by the recipient and the recipient's legal representative and 
122.13  the recipient's support network. 
122.14     Subd. 5.  [PROVIDER STANDARDS.] County boards or providers 
122.15  who contract with the county are eligible to receive medical 
122.16  assistance reimbursement for adult targeted case management 
122.17  services.  To qualify as a provider of targeted case management 
122.18  services the vendor must: 
122.19     (1) have demonstrated the capacity and experience to 
122.20  provide the activities of case management services defined in 
122.21  subdivision 4; 
122.22     (2) be able to coordinate and link community resources 
122.23  needed by the recipient; 
122.24     (3) have the administrative capacity and experience to 
122.25  serve the eligible population in providing services and to 
122.26  ensure quality of services under state and federal requirements; 
122.27     (4) have a financial management system that provides 
122.28  accurate documentation of services and costs under state and 
122.29  federal requirements; 
122.30     (5) have the capacity to document and maintain individual 
122.31  case records complying with state and federal requirements; 
122.32     (6) coordinate with county social service agencies 
122.33  responsible for planning for community social services under 
122.34  chapters 256E and 256F; conducting adult protective 
122.35  investigations under section 626.557, and conducting prepetition 
122.36  screenings for commitments under section 253B.07; 
123.1      (7) coordinate with health care providers to ensure access 
123.2   to necessary health care services; 
123.3      (8) have a procedure in place that notifies the recipient 
123.4   and the recipient's legal representative of any conflict of 
123.5   interest if the contracted targeted case management service 
123.6   provider also provides the recipient's services and supports and 
123.7   provides information on all potential conflicts of interest and 
123.8   obtains the recipient's informed consent and provides the 
123.9   recipient with alternatives; and 
123.10     (9) have demonstrated the capacity to achieve the following 
123.11  performance outcomes:  access, quality, and consumer 
123.12  satisfaction. 
123.13     Subd. 6.  [PAYMENT FOR TARGETED CASE MANAGEMENT.] (a) 
123.14  Medical assistance and MinnesotaCare payment for targeted case 
123.15  management shall be made on a monthly basis.  In order to 
123.16  receive payment for an eligible adult, the provider must 
123.17  document at least one contact per month and not more than two 
123.18  consecutive months without a face-to-face contact with the adult 
123.19  or the adult's legal representative. 
123.20     (b) Payment for targeted case management provided by county 
123.21  staff under this subdivision shall be based on the monthly rate 
123.22  methodology under section 256B.094, subdivision 6, paragraph 
123.23  (b), calculated as one combined average rate together with adult 
123.24  mental health case management under section 256B.0625, 
123.25  subdivision 20.  Billing and payment must identify the 
123.26  recipient's primary population group to allow tracking of 
123.27  revenues. 
123.28     (c) Payment for targeted case management provided by 
123.29  county-contracted vendors shall be based on a monthly rate 
123.30  negotiated by the host county.  The negotiated rate must not 
123.31  exceed the rate charged by the vendor for the same service to 
123.32  other payers.  If the service is provided by a team of 
123.33  contracted vendors, the county may negotiate a team rate with a 
123.34  vendor who is a member of the team.  The team shall determine 
123.35  how to distribute the rate among its members.  No reimbursement 
123.36  received by contracted vendors shall be returned to the county, 
124.1   except to reimburse the county for advance funding provided by 
124.2   the county to the vendor. 
124.3      (d) If the service is provided by a team that includes 
124.4   contracted vendors and county staff, the costs for county staff 
124.5   participation on the team shall be included in the rate for 
124.6   county-provided services.  In this case, the contracted vendor 
124.7   and the county may each receive separate payment for services 
124.8   provided by each entity in the same month.  In order to prevent 
124.9   duplication of services, the county must document, in the 
124.10  recipient's file, the need for team targeted case management and 
124.11  a description of the different roles of the team members. 
124.12     (e) Notwithstanding section 256B.19, subdivision 1, the 
124.13  nonfederal share of costs for targeted case management shall be 
124.14  provided by the recipient's county of responsibility, as defined 
124.15  in sections 256G.01 to 256G.12, from sources other than federal 
124.16  funds or funds used to match other federal funds. 
124.17     (f) The commissioner may suspend, reduce, or terminate 
124.18  reimbursement to a provider that does not meet the reporting or 
124.19  other requirements of this section.  The county of 
124.20  responsibility, as defined in sections 256G.01 to 256G.12, is 
124.21  responsible for any federal disallowances.  The county may share 
124.22  this responsibility with its contracted vendors. 
124.23     (g) The commissioner shall set aside five percent of the 
124.24  federal funds received under this section for use in reimbursing 
124.25  the state for costs of developing and implementing this section. 
124.26     (h) Notwithstanding section 256.025, subdivision 2, 
124.27  payments to counties for targeted case management expenditures 
124.28  under this section shall only be made from federal earnings from 
124.29  services provided under this section.  Payments to contracted 
124.30  vendors shall include both the federal earnings and the county 
124.31  share. 
124.32     (i) Notwithstanding section 256B.041, county payments for 
124.33  the cost of case management services provided by county staff 
124.34  shall not be made to the state treasurer.  For the purposes of 
124.35  targeted case management services provided by county staff under 
124.36  this section, the centralized disbursement of payments to 
125.1   counties under section 256B.041 consists only of federal 
125.2   earnings from services provided under this section. 
125.3      (j) If the recipient is a resident of a nursing facility, 
125.4   intermediate care facility, or hospital, and the recipient's 
125.5   institutional care is paid by medical assistance, payment for 
125.6   targeted case management services under this subdivision is 
125.7   limited to the last 180 days of the recipient's residency in 
125.8   that facility and may not exceed more than six months in a 
125.9   calendar year. 
125.10     (k) Payment for targeted case management services under 
125.11  this subdivision shall not duplicate payments made under other 
125.12  program authorities for the same purpose. 
125.13     (l) Any growth in targeted case management services and 
125.14  cost increases under this section shall be the responsibility of 
125.15  the counties. 
125.16     Subd. 7.  [IMPLEMENTATION AND EVALUATION.] The commissioner 
125.17  of human services in consultation with county boards shall 
125.18  establish a program to accomplish the provisions of subdivisions 
125.19  1 to 6.  The commissioner in consultation with county boards 
125.20  shall establish performance measures to evaluate the 
125.21  effectiveness of the targeted case management services.  If a 
125.22  county fails to meet agreed upon performance measures, the 
125.23  commissioner may authorize contracted providers other than the 
125.24  county.  Providers contracted by the commissioner shall also be 
125.25  subject to the standards in subdivision 6. 
125.26     Sec. 47.  [256B.0948] [TARGETED CASE MANAGEMENT SERVICES 
125.27  FOR CHILDREN UNDER THE AGE OF 19.] 
125.28     Subdivision 1.  [ELIGIBILITY.] An eligible recipient must: 
125.29     (1) be under the age of 19; 
125.30     (2) be enrolled in medical assistance or MinnesotaCare; 
125.31     (3) have had at least one previous birth; and 
125.32     (4) not receiving any other form of targeted case 
125.33  management or case management through home and community-based 
125.34  waiver services.  
125.35     Subd. 2.  [SCOPE.] "Targeted case management services" 
125.36  means the coordination or implementation of social, health, 
126.1   educational, counseling, or other services designed to ensure 
126.2   continued social support to the recipient to prevent or delay a 
126.3   subsequent pregnancy.  
126.4      Subd. 3.  [ELIGIBLE SERVICES.] (a) Case management services 
126.5   include: 
126.6      (1) assessing the recipient's need for medical, social, 
126.7   educational, and other related services; 
126.8      (2) coordinating health, social, educational, and 
126.9   vocational needs with community-based services and programs; 
126.10     (3) providing counseling services, including mentoring, 
126.11  academic support, after-school enrichment, and healthy lifestyle 
126.12  practices; 
126.13     (4) monitoring the needs of the recipient on a regular 
126.14  basis to ensure continued support; and 
126.15     (5) promoting positive parenting. 
126.16     (b) These services shall be provided to the recipient on a 
126.17  one-to-one basis, in the recipient's home, community setting, or 
126.18  in groups.  
126.19     (c) Payment shall be made on a monthly basis.  In order to 
126.20  receive payment, a provider must document at least a 
126.21  face-to-face contact with the recipient.  
126.22     Subd. 4.  [INDIVIDUAL SUPPORT PLAN.] Providers must develop 
126.23  and implement an individual support plan for each recipient.  
126.24  The plan must include concrete, measurable goals to be achieved 
126.25  and specific objectives directed toward the achievement of each 
126.26  goal.  The plan must indicate how collaboration with other 
126.27  services will occur.  
126.28     Subd. 5.  [TARGET POPULATION.] The commissioner shall 
126.29  contract with qualified case managers to provide targeted case 
126.30  management services.  The contract will further define the 
126.31  target population, covered case management services, payment 
126.32  rates, and provider qualifications to ensure that annual 
126.33  spending, including related administrative costs for the 
126.34  nonfederal share of the cost is within the amount appropriated 
126.35  for this purpose.  
126.36     [EFFECTIVE DATE.] This section is effective on January 1, 
127.1   2002, or upon federal approval, whichever is later. 
127.2      Sec. 48.  [256B.195] [ADDITIONAL INTERGOVERNMENTAL 
127.3   TRANSFERS; HOSPITAL PAYMENTS.] 
127.4      Subdivision 1.  [FEDERAL APPROVAL REQUIRED.] Section 
127.5   256.969, subdivision 26, and this section are contingent on 
127.6   federal approval of the intergovernmental transfers and payments 
127.7   to safety net hospitals authorized under this section. 
127.8      Subd. 2.  [PAYMENTS FROM GOVERNMENTAL HOSPITALS.] In 
127.9   addition to any payment required under section 256B.19, 
127.10  effective July 15, 2001, the following government entities shall 
127.11  make the payments indicated before noon on the 15th of each 
127.12  month: 
127.13     (1) Hennepin county, $1,883,000; and 
127.14     (2) Ramsey county, $696,450. 
127.15  These sums shall be part of the designated governmental unit's 
127.16  portion of the nonfederal share of medical assistance costs. 
127.17     Subd. 3.  [PAYMENTS TO CERTAIN SAFETY NET HOSPITALS.] (a) 
127.18  Effective July 15, 2001, the commissioner shall make the 
127.19  following payments to the hospitals indicated after noon on the 
127.20  15th of each month: 
127.21     (1) to Hennepin county medical center, $3,218,000, of which 
127.22  $1,883,000 is to offset the amount of the transfer under 
127.23  subdivision 2 and $1,335,000 is to increase payments for medical 
127.24  assistance admissions; and 
127.25     (2) to Regions hospital, $1,190,250, of which $696,450 is 
127.26  to offset the amount of the transfer under subdivision 2 and 
127.27  $493,800 is to increase payments for medical assistance 
127.28  admissions. 
127.29     (b) This section and section 256.969, subdivision 26, shall 
127.30  apply to fee-for-service payments only and shall not increase 
127.31  capitation payments or payments made based on average rates. 
127.32     (c) Medical assistance rate or payment changes required to 
127.33  obtain federal financial participation under section 62J.692, 
127.34  subdivision 8, shall precede the determination of 
127.35  intergovernmental transfer amounts determined in this 
127.36  subdivision.  Participation in the intergovernmental transfer 
128.1   program shall not result in the offset of any health care 
128.2   provider's receipt of medical assistance payment increases other 
128.3   than limits on rates and payments. 
128.4      Subd. 4.  [ADJUSTMENTS PERMITTED.] (a) The commissioner may 
128.5   adjust the intergovernmental transfers under subdivision 2 and 
128.6   the hospital payments under subdivision 3, after consultation 
128.7   with the nonstate government entities named in this section, 
128.8   based on the commissioner's determination of Medicare upper 
128.9   payment limits and hospital-specific limitations on 
128.10  disproportionate share payments. 
128.11     (b) The ratio of medical assistance payments specified in 
128.12  subdivision 3 to the intergovernmental transfers specified in 
128.13  subdivision 2 shall not be reduced below 170 percent unless a 
128.14  further reduction is required to preserve state budget 
128.15  neutrality. 
128.16     (c) If the federal rules regarding the establishment of the 
128.17  150 percent upper payment limit for certain nonstate public 
128.18  hospitals are rescinded, or if the upper payment limit is 
128.19  otherwise reduced to 100 percent, the ratio of intergovernmental 
128.20  transfers and medical assistance payments among the 
128.21  participating entities named in this section shall be adjusted 
128.22  based on the proportion of medical assistance inpatient hospital 
128.23  admissions from the third previous rate year provided by each 
128.24  participating hospital, and paragraph (b) shall not apply. 
128.25     Subd. 5.  [INCLUSION OF FAIRVIEW UNIVERSITY MEDICAL 
128.26  CENTER.] Upon federal approval of the inclusion of Fairview 
128.27  university medical center in the nonstate government category, 
128.28  the commissioner shall establish an intergovernmental transfer 
128.29  with the University of Minnesota in an amount determined by the 
128.30  commissioner based on the increase in the Medicare upper payment 
128.31  limit due solely to the inclusion of Fairview university medical 
128.32  center as a nonstate government hospital and the amount 
128.33  available under the hospital specific disproportionate share 
128.34  limit.  All of the proceeds of the transfer shall be used to 
128.35  increase payments to Fairview university medical center for 
128.36  medical assistance admissions.  From this payment, Fairview 
129.1   university medical center shall pay to the University of 
129.2   Minnesota the cost of the transfer on the same day the payment 
129.3   is received. 
129.4      Sec. 49.  [256B.53] [DENTAL ACCESS GRANTS.] 
129.5      (a) The commissioner shall award grants to community 
129.6   clinics or other nonprofit community organizations, political 
129.7   subdivisions, professional associations, or other organizations 
129.8   that demonstrate the ability to provide dental services 
129.9   effectively to public program recipients.  Grants may be used to 
129.10  fund the costs related to coordinating access for recipients, 
129.11  developing and implementing patient care criteria, upgrading or 
129.12  establishing new facilities, acquiring furnishings or equipment, 
129.13  recruiting new providers, or other development costs that will 
129.14  improve access to dental care in a region.  
129.15     (b) In awarding grants, the commissioner shall give 
129.16  priority to applicants that plan to serve areas of the state in 
129.17  which the number of dental providers is not currently sufficient 
129.18  to meet the needs of recipients of public programs or uninsured 
129.19  individuals.  The commissioner shall consider the following in 
129.20  awarding the grants:  
129.21     (1) potential to successfully increase access to an 
129.22  underserved population; 
129.23     (2) the long-term viability of the project to improve 
129.24  access beyond the period of initial funding; 
129.25     (3) the efficiency in the use of the funding; and 
129.26     (4) the experience of the applicants in providing services 
129.27  to the target population. 
129.28     (c) The commissioner shall consider grants for the 
129.29  following: 
129.30     (1) implementation of new programs or continued expansion 
129.31  of current access programs that have demonstrated success in 
129.32  providing dental services in underserved areas; 
129.33     (2) a program for mobile or other types of outreach dental 
129.34  clinics in underserved geographic areas; 
129.35     (3) a program for school-based dental clinics in schools 
129.36  with high numbers of children receiving medical assistance; 
130.1      (4) a program testing new models of care that are sensitive 
130.2   to the cultural needs of the recipients; 
130.3      (5) a program creating new educational campaigns that 
130.4   inform individuals of the importance of good oral health and the 
130.5   link between dental disease and overall health status; 
130.6      (6) a program that organizes a network of volunteer 
130.7   dentists to provide dental services to public program recipients 
130.8   or uninsured individuals; and 
130.9      (7) a program that tests new delivery models by creating 
130.10  partnerships between local providers and county public health 
130.11  agencies.  
130.12     (d) The commissioner shall evaluate the effects of the 
130.13  dental access initiatives funded through the dental access 
130.14  grants and submit a report to the legislature by January 15, 
130.15  2003.  
130.16     Sec. 50.  [256B.55] [DENTAL ACCESS ADVISORY COMMITTEE.] 
130.17     Subdivision 1.  [ESTABLISHMENT.] The commissioner shall 
130.18  establish a dental access advisory committee to monitor the 
130.19  purchasing, administration, and coverage of dental care services 
130.20  for the public health care programs to ensure dental care access 
130.21  and quality for public program recipients.  
130.22     Subd. 2.  [MEMBERSHIP.] (a) The membership of the advisory 
130.23  committee shall include, but is not limited to, representatives 
130.24  of dentists, including a dentist practicing in the seven-county 
130.25  metropolitan area and a dentist practicing outside the 
130.26  seven-county metropolitan area; oral surgeons; pediatric 
130.27  dentists; dental hygienists; community clinics; client advocacy 
130.28  groups; public health; health service plans; the University of 
130.29  Minnesota school of dentistry and the department of pediatrics; 
130.30  and the commissioner of health.  
130.31     (b) The advisory committee is governed by section 15.059 
130.32  for membership terms and removal of members.  
130.33     Subd. 3.  [DUTIES.] The advisory committee shall provide 
130.34  recommendations on the following: 
130.35     (1) how to reduce the administrative burden governing 
130.36  dental care coverage policies in order to promote administrative 
131.1   simplification, including prior authorization, coverage limits, 
131.2   and co-payment collections; 
131.3      (2) developing and implementing an action plan to improve 
131.4   the oral health of children and persons with special needs in 
131.5   the state; 
131.6      (3) exploring alternative ways of purchasing and improving 
131.7   access to dental services; 
131.8      (4) developing ways to foster greater responsibility among 
131.9   health care program recipients in seeking and obtaining dental 
131.10  care, including initiatives to keep dental appointments and 
131.11  comply with dental care plans; 
131.12     (5) exploring innovative ways for dental providers to 
131.13  schedule public program patients in order to reduce or minimize 
131.14  the effect of appointment no shows; 
131.15     (6) exploring ways to meet the barriers that may be present 
131.16  in providing dental services to health care program recipients 
131.17  such as language, culture, disability, and lack of 
131.18  transportation; and 
131.19     (7) exploring the possibility of pediatricians, family 
131.20  physicians, and nurse practitioners providing basic oral health 
131.21  screenings and basic preventive dental services.  
131.22     Subd. 4.  [REPORT.] The commissioner shall submit a report 
131.23  by February 1, 2002, and by February 1, 2003, summarizing the 
131.24  activities and recommendations of the advisory committee. 
131.25     Subd. 5.  [SUNSET.] Notwithstanding section 15.059, 
131.26  subdivision 5, this section expires June 30, 2003.  
131.27     Sec. 51.  Minnesota Statutes 2000, section 256B.69, 
131.28  subdivision 4, is amended to read: 
131.29     Subd. 4.  [LIMITATION OF CHOICE.] (a) The commissioner 
131.30  shall develop criteria to determine when limitation of choice 
131.31  may be implemented in the experimental counties.  The criteria 
131.32  shall ensure that all eligible individuals in the county have 
131.33  continuing access to the full range of medical assistance 
131.34  services as specified in subdivision 6.  
131.35     (b) The commissioner shall exempt the following persons 
131.36  from participation in the project, in addition to those who do 
132.1   not meet the criteria for limitation of choice:  
132.2      (1) persons eligible for medical assistance according to 
132.3   section 256B.055, subdivision 1; 
132.4      (2) persons eligible for medical assistance due to 
132.5   blindness or disability as determined by the social security 
132.6   administration or the state medical review team, unless:  
132.7      (i) they are 65 years of age or older,; or 
132.8      (ii) they reside in Itasca county or they reside in a 
132.9   county in which the commissioner conducts a pilot project under 
132.10  a waiver granted pursuant to section 1115 of the Social Security 
132.11  Act; 
132.12     (3) recipients who currently have private coverage through 
132.13  a health maintenance organization; 
132.14     (4) recipients who are eligible for medical assistance by 
132.15  spending down excess income for medical expenses other than the 
132.16  nursing facility per diem expense; 
132.17     (5) recipients who receive benefits under the Refugee 
132.18  Assistance Program, established under United States Code, title 
132.19  8, section 1522(e); 
132.20     (6) children who are both determined to be severely 
132.21  emotionally disturbed and receiving case management services 
132.22  according to section 256B.0625, subdivision 20; and 
132.23     (7) adults who are both determined to be seriously and 
132.24  persistently mentally ill and received case management services 
132.25  according to section 256B.0625, subdivision 20; and 
132.26     (8) persons eligible for medical assistance according to 
132.27  section 256B.057, subdivision 10.  
132.28  Children under age 21 who are in foster placement may enroll in 
132.29  the project on an elective basis.  Individuals excluded under 
132.30  clauses (6) and (7) may choose to enroll on an elective basis.  
132.31     (c) When a child enrolled with a demonstration provider has 
132.32  been identified as receiving mental health services in an 
132.33  alternative school, the alternative school shall notify the 
132.34  commissioner and the child's county of financial 
132.35  responsibility.  The commissioner, in coordination with the 
132.36  county, shall determine whether the child qualifies under 
133.1   paragraph (b) for exclusion from participation in the 
133.2   demonstration project.  If the child qualifies, the county shall 
133.3   contact the child's parent or guardian and offer the option for 
133.4   the child to be excluded from the demonstration project. 
133.5      (d) The commissioner may allow persons with a one-month 
133.6   spenddown who are otherwise eligible to enroll to voluntarily 
133.7   enroll or remain enrolled, if they elect to prepay their monthly 
133.8   spenddown to the state.  
133.9      (e) Beginning on or after July 1, 1997, The commissioner 
133.10  may require those individuals to enroll in the prepaid medical 
133.11  assistance program who otherwise would have been excluded 
133.12  under paragraph (b), clauses (1) and, (3), and (8), and under 
133.13  Minnesota Rules, part 9500.1452, subpart 2, items H, K, and L.  
133.14     (f) Before limitation of choice is implemented, eligible 
133.15  individuals shall be notified and after notification, shall be 
133.16  allowed to choose only among demonstration providers.  The 
133.17  commissioner may assign an individual with private coverage 
133.18  through a health maintenance organization, to the same health 
133.19  maintenance organization for medical assistance coverage, if the 
133.20  health maintenance organization is under contract for medical 
133.21  assistance in the individual's county of residence.  After 
133.22  initially choosing a provider, the recipient is allowed to 
133.23  change that choice only at specified times as allowed by the 
133.24  commissioner.  If a demonstration provider ends participation in 
133.25  the project for any reason, a recipient enrolled with that 
133.26  provider must select a new provider but may change providers 
133.27  without cause once more within the first 60 days after 
133.28  enrollment with the second provider. 
133.29     [EFFECTIVE DATE.] Paragraph (c) of this section is 
133.30  effective the day following final enactment. 
133.31     Sec. 52.  Minnesota Statutes 2000, section 256B.69, 
133.32  subdivision 5c, is amended to read: 
133.33     Subd. 5c.  [MEDICAL EDUCATION AND RESEARCH FUND.] (a) 
133.34  Beginning in January 1999 and each year thereafter: 
133.35     (1) the commissioner of human services shall transfer an 
133.36  amount equal to the reduction in the prepaid medical assistance 
134.1   and prepaid general assistance medical care payments resulting 
134.2   from clause (2), excluding nursing facility and elderly waiver 
134.3   payments and demonstration projects operating under subdivision 
134.4   23, and an amount totaling the amount identified in clauses (3) 
134.5   and (4) to the medical education and research fund established 
134.6   under section 62J.692; 
134.7      (2) until January 1, 2002, the county medical assistance 
134.8   and general assistance medical care capitation base rate prior 
134.9   to plan specific adjustments and after the regional rate 
134.10  adjustments under section 256B.69, subdivision 5b, shall be 
134.11  reduced 6.3 percent for Hennepin county, two percent for the 
134.12  remaining metropolitan counties, and no reduction for 
134.13  nonmetropolitan Minnesota counties; and after January 1, 2002, 
134.14  the county medical assistance and general assistance medical 
134.15  care capitation base rate prior to plan specific adjustments 
134.16  shall be reduced 6.3 percent for Hennepin county, two percent 
134.17  for the remaining metropolitan counties, and 1.6 percent for 
134.18  nonmetropolitan Minnesota counties; and 
134.19     (3) effective July 1, 2001, the amount transferred under 
134.20  section 62J.694, subdivision 2, paragraph (d), to increase the 
134.21  capitation rates plus any federal matching funds; 
134.22     (4) effective July 1, 2001, $600,000 from the capitation 
134.23  rates paid under this section plus any federal matching funds on 
134.24  this amount; and 
134.25     (5) the amount calculated under clause (1) shall not be 
134.26  adjusted for subsequent changes to the capitation payments for 
134.27  periods already paid.  
134.28     (b) This subdivision shall be effective upon approval of a 
134.29  federal waiver which allows federal financial participation in 
134.30  the medical education and research fund. 
134.31     Sec. 53.  Minnesota Statutes 2000, section 256B.69, is 
134.32  amended by adding a subdivision to read: 
134.33     Subd. 6c.  [DENTAL SERVICES DEMONSTRATION PROJECT.] The 
134.34  commissioner shall establish a dental services demonstration 
134.35  project in Crow Wing, Todd, Morrison, Wadena, and Cass counties 
134.36  for provision of dental services to medical assistance, general 
135.1   assistance medical care, and MinnesotaCare recipients.  The 
135.2   commissioner may contract on a prospective per capita payment 
135.3   basis for these dental services with an organization licensed 
135.4   under chapter 62C, 62D, or 62N in accordance with section 
135.5   256B.037 or may establish and administer a fee-for-service 
135.6   system for the reimbursement of dental services.  
135.7      Sec. 54.  Minnesota Statutes 2000, section 256B.69, 
135.8   subdivision 23, is amended to read: 
135.9      Subd. 23.  [ALTERNATIVE INTEGRATED LONG-TERM CARE SERVICES; 
135.10  ELDERLY AND DISABLED PERSONS.] (a) The commissioner may 
135.11  implement demonstration projects to create alternative 
135.12  integrated delivery systems for acute and long-term care 
135.13  services to elderly persons and persons with disabilities as 
135.14  defined in section 256B.77, subdivision 7a, that provide 
135.15  increased coordination, improve access to quality services, and 
135.16  mitigate future cost increases.  The commissioner may seek 
135.17  federal authority to combine Medicare and Medicaid capitation 
135.18  payments for the purpose of such demonstrations.  Medicare funds 
135.19  and services shall be administered according to the terms and 
135.20  conditions of the federal waiver and demonstration provisions.  
135.21  For the purpose of administering medical assistance funds, 
135.22  demonstrations under this subdivision are subject to 
135.23  subdivisions 1 to 22.  The provisions of Minnesota Rules, parts 
135.24  9500.1450 to 9500.1464, apply to these demonstrations, with the 
135.25  exceptions of parts 9500.1452, subpart 2, item B; and 9500.1457, 
135.26  subpart 1, items B and C, which do not apply to persons 
135.27  enrolling in demonstrations under this section.  An initial open 
135.28  enrollment period may be provided.  Persons who disenroll from 
135.29  demonstrations under this subdivision remain subject to 
135.30  Minnesota Rules, parts 9500.1450 to 9500.1464.  When a person is 
135.31  enrolled in a health plan under these demonstrations and the 
135.32  health plan's participation is subsequently terminated for any 
135.33  reason, the person shall be provided an opportunity to select a 
135.34  new health plan and shall have the right to change health plans 
135.35  within the first 60 days of enrollment in the second health 
135.36  plan.  Persons required to participate in health plans under 
136.1   this section who fail to make a choice of health plan shall not 
136.2   be randomly assigned to health plans under these demonstrations. 
136.3   Notwithstanding section 256L.12, subdivision 5, and Minnesota 
136.4   Rules, part 9505.5220, subpart 1, item A, if adopted, for the 
136.5   purpose of demonstrations under this subdivision, the 
136.6   commissioner may contract with managed care organizations, 
136.7   including counties, to serve only elderly persons eligible for 
136.8   medical assistance, elderly and disabled persons, or disabled 
136.9   persons only.  For persons with primary diagnoses of mental 
136.10  retardation or a related condition, serious and persistent 
136.11  mental illness, or serious emotional disturbance, the 
136.12  commissioner must ensure that the county authority has approved 
136.13  the demonstration and contracting design.  Enrollment in these 
136.14  projects for persons with disabilities shall be voluntary until 
136.15  July 1, 2001.  The commissioner shall not implement any 
136.16  demonstration project under this subdivision for persons with 
136.17  primary diagnoses of mental retardation or a related condition, 
136.18  serious and persistent mental illness, or serious emotional 
136.19  disturbance, without approval of the county board of the county 
136.20  in which the demonstration is being implemented. 
136.21     Before implementation of a demonstration project for 
136.22  disabled persons, the commissioner must provide information to 
136.23  appropriate committees of the house of representatives and 
136.24  senate and must involve representatives of affected disability 
136.25  groups in the design of the demonstration projects. 
136.26     (b) A nursing facility reimbursed under the alternative 
136.27  reimbursement methodology in section 256B.434 may, in 
136.28  collaboration with a hospital, clinic, or other health care 
136.29  entity provide services under paragraph (a).  The commissioner 
136.30  shall amend the state plan and seek any federal waivers 
136.31  necessary to implement this paragraph.  
136.32     Sec. 55.  Minnesota Statutes 2000, section 256B.75, is 
136.33  amended to read: 
136.34     256B.75 [HOSPITAL OUTPATIENT REIMBURSEMENT.] 
136.35     (a) For outpatient hospital facility fee payments for 
136.36  services rendered on or after October 1, 1992, the commissioner 
137.1   of human services shall pay the lower of (1) submitted charge, 
137.2   or (2) 32 percent above the rate in effect on June 30, 1992, 
137.3   except for those services for which there is a federal maximum 
137.4   allowable payment.  Effective for services rendered on or after 
137.5   January 1, 2000, payment rates for nonsurgical outpatient 
137.6   hospital facility fees and emergency room facility fees shall be 
137.7   increased by eight percent over the rates in effect on December 
137.8   31, 1999, except for those services for which there is a federal 
137.9   maximum allowable payment.  Services for which there is a 
137.10  federal maximum allowable payment shall be paid at the lower of 
137.11  (1) submitted charge, or (2) the federal maximum allowable 
137.12  payment.  Total aggregate payment for outpatient hospital 
137.13  facility fee services shall not exceed the Medicare upper 
137.14  limit.  If it is determined that a provision of this section 
137.15  conflicts with existing or future requirements of the United 
137.16  States government with respect to federal financial 
137.17  participation in medical assistance, the federal requirements 
137.18  prevail.  The commissioner may, in the aggregate, prospectively 
137.19  reduce payment rates to avoid reduced federal financial 
137.20  participation resulting from rates that are in excess of the 
137.21  Medicare upper limitations. 
137.22     (b) Notwithstanding paragraph (a), payment for outpatient, 
137.23  emergency, and ambulatory surgery hospital facility fee services 
137.24  for critical access hospitals designated under section 144.1483, 
137.25  clause (11), shall be paid on a cost-based payment system that 
137.26  is based on the cost-finding methods and allowable costs of the 
137.27  Medicare program. 
137.28     (c) Effective for services provided on or after July 1, 
137.29  2002, rates that are based on the Medicare outpatient 
137.30  prospective payment system shall be replaced by a budget neutral 
137.31  prospective payment system that is derived using medical 
137.32  assistance data.  The commissioner shall provide a proposal to 
137.33  the 2002 legislature to define and implement this provision. 
137.34     Sec. 56.  Minnesota Statutes 2000, section 256B.76, is 
137.35  amended to read: 
137.36     256B.76 [PHYSICIAN AND DENTAL REIMBURSEMENT.] 
138.1      (a) Effective for services rendered on or after October 1, 
138.2   1992, the commissioner shall make payments for physician 
138.3   services as follows: 
138.4      (1) payment for level one Health Care Finance 
138.5   Administration's common procedural coding system (HCPCS) codes 
138.6   titled "office and other outpatient services," "preventive 
138.7   medicine new and established patient," "delivery, antepartum, 
138.8   and postpartum care," "critical care," Caesarean cesarean 
138.9   delivery and pharmacologic management provided to psychiatric 
138.10  patients, and HCPCS level three codes for enhanced services for 
138.11  prenatal high risk, shall be paid at the lower of (i) submitted 
138.12  charges, or (ii) 25 percent above the rate in effect on June 30, 
138.13  1992.  If the rate on any procedure code within these categories 
138.14  is different than the rate that would have been paid under the 
138.15  methodology in section 256B.74, subdivision 2, then the larger 
138.16  rate shall be paid; 
138.17     (2) payments for all other services shall be paid at the 
138.18  lower of (i) submitted charges, or (ii) 15.4 percent above the 
138.19  rate in effect on June 30, 1992; 
138.20     (3) all physician rates shall be converted from the 50th 
138.21  percentile of 1982 to the 50th percentile of 1989, less the 
138.22  percent in aggregate necessary to equal the above increases 
138.23  except that payment rates for home health agency services shall 
138.24  be the rates in effect on September 30, 1992; 
138.25     (4) effective for services rendered on or after January 1, 
138.26  2000, payment rates for physician and professional services 
138.27  shall be increased by three percent over the rates in effect on 
138.28  December 31, 1999, except for home health agency and family 
138.29  planning agency services; and 
138.30     (5) the increases in clause (4) shall be implemented 
138.31  January 1, 2000, for managed care. 
138.32     (b) Effective for services rendered on or after October 1, 
138.33  1992, the commissioner shall make payments for dental services 
138.34  as follows: 
138.35     (1) dental services shall be paid at the lower of (i) 
138.36  submitted charges, or (ii) 25 percent above the rate in effect 
139.1   on June 30, 1992; 
139.2      (2) dental rates shall be converted from the 50th 
139.3   percentile of 1982 to the 50th percentile of 1989, less the 
139.4   percent in aggregate necessary to equal the above increases; 
139.5      (3) effective for services rendered on or after January 1, 
139.6   2000, payment rates for dental services shall be increased by 
139.7   three percent over the rates in effect on December 31, 1999; 
139.8      (4) the commissioner shall award grants to community 
139.9   clinics or other nonprofit community organizations, political 
139.10  subdivisions, professional associations, or other organizations 
139.11  that demonstrate the ability to provide dental services 
139.12  effectively to public program recipients.  Grants may be used to 
139.13  fund the costs related to coordinating access for recipients, 
139.14  developing and implementing patient care criteria, upgrading or 
139.15  establishing new facilities, acquiring furnishings or equipment, 
139.16  recruiting new providers, or other development costs that will 
139.17  improve access to dental care in a region.  In awarding grants, 
139.18  the commissioner shall give priority to applicants that plan to 
139.19  serve areas of the state in which the number of dental providers 
139.20  is not currently sufficient to meet the needs of recipients of 
139.21  public programs or uninsured individuals.  The commissioner 
139.22  shall consider the following in awarding the grants:  (i) 
139.23  potential to successfully increase access to an underserved 
139.24  population; (ii) the ability to raise matching funds; (iii) the 
139.25  long-term viability of the project to improve access beyond the 
139.26  period of initial funding; (iv) the efficiency in the use of the 
139.27  funding; and (v) the experience of the proposers in providing 
139.28  services to the target population. 
139.29     The commissioner shall monitor the grants and may terminate 
139.30  a grant if the grantee does not increase dental access for 
139.31  public program recipients.  The commissioner shall consider 
139.32  grants for the following: 
139.33     (i) implementation of new programs or continued expansion 
139.34  of current access programs that have demonstrated success in 
139.35  providing dental services in underserved areas; 
139.36     (ii) a pilot program for utilizing hygienists outside of a 
140.1   traditional dental office to provide dental hygiene services; 
140.2   and 
140.3      (iii) a program that organizes a network of volunteer 
140.4   dentists, establishes a system to refer eligible individuals to 
140.5   volunteer dentists, and through that network provides donated 
140.6   dental care services to public program recipients or uninsured 
140.7   individuals. 
140.8      (5) beginning October 1, 1999, the payment for tooth 
140.9   sealants and fluoride treatments shall be the lower of (i) 
140.10  submitted charge, or (ii) 80 percent of median 1997 charges; and 
140.11     (6) (5) the increases listed in clauses (3) and (5) (4) 
140.12  shall be implemented January 1, 2000, for managed care; 
140.13     (6) effective for services provided on or after January 1, 
140.14  2002, payment for diagnostic examinations and dental x-rays 
140.15  provided to children under age 21 shall be the lower of: 
140.16     (i) the submitted charge; or 
140.17     (ii) 70 percent of median 1999 charges; and 
140.18     (7) a dental provider shall be reimbursed for the dental 
140.19  services actually provided to a patient when the dental work 
140.20  scheduled requires more than one appointment and the patient 
140.21  fails to keep the subsequent appointment or appointments.  
140.22     (c) Effective for dental services provided on or after 
140.23  January 1, 2002, the commissioner may increase reimbursement to 
140.24  dentists or dental clinics designated by the commissioner as 
140.25  critical access providers.  The commissioner may increase 
140.26  reimbursement to a critical access provider by up to 30 percent 
140.27  more than would otherwise be paid to that provider.  In 
140.28  determining critical access provider status, the commissioner 
140.29  shall review: 
140.30     (1) the utilization rate for dental services by Minnesota 
140.31  health care program patients in the service area; 
140.32     (2) the level of service provided to Minnesota health care 
140.33  program patients by the dentist or dental clinic; and 
140.34     (3) whether the level of services provided by the dentist 
140.35  or clinic is critical to maintaining an adequate level of access 
140.36  for patients in the service area. 
141.1   If no provider in a service area is designated a critical access 
141.2   provider upon review, the commissioner may designate a dentist 
141.3   or dental clinic as a critical access provider if the dentist or 
141.4   clinic is willing to provide care to Minnesota health care 
141.5   program patients at a level that significantly increases access 
141.6   to dental care within the service area.  The commissioner shall 
141.7   adjust payments to prepaid health plans to reflect increased 
141.8   reimbursement to critical access providers under this paragraph 
141.9   effective January 1, 2002. 
141.10     (d) An entity that operates both a Medicare certified 
141.11  comprehensive outpatient rehabilitation facility and a facility 
141.12  which was certified prior to January 1, 1993, that is licensed 
141.13  under Minnesota Rules, parts 9570.2000 to 9570.3600, and for 
141.14  whom at least 33 percent of the clients receiving rehabilitation 
141.15  services and mental health services in the most recent calendar 
141.16  year are medical assistance recipients, shall be reimbursed by 
141.17  the commissioner for rehabilitation services and mental health 
141.18  services at rates that are 38 percent greater than the maximum 
141.19  reimbursement rate allowed under paragraph (a), clause (2), when 
141.20  those services are (1) provided within the comprehensive 
141.21  outpatient rehabilitation facility and (2) provided to residents 
141.22  of nursing facilities owned by the entity. 
141.23     Sec. 57.  [256B.78] [MEDICAL ASSISTANCE DEMONSTRATION 
141.24  PROJECT FOR FAMILY PLANNING SERVICES.] 
141.25     (a) The commissioner of human services shall establish a 
141.26  medical assistance demonstration project to determine whether 
141.27  improved access to coverage of prepregnancy family planning 
141.28  services reduces medical assistance and MFIP costs. 
141.29     (b) This section is effective upon federal approval of the 
141.30  demonstration project. 
141.31     Sec. 58.  [256B.79] [HEALTH CARE PREVENTIVE SERVICES POOL.] 
141.32     The commissioner of human services shall create an 
141.33  uncompensated care pool to reimburse community clinics and other 
141.34  health care providers that provide initial health care 
141.35  screenings and preventive care services to children who are 
141.36  uninsured.  The commissioner shall establish a process for 
142.1   clinics to apply for reimbursement.  As a condition of receiving 
142.2   payment from this pool, the clinic or provider must offer 
142.3   services ranging from providing information up to on-site 
142.4   enrollment.  
142.5      Sec. 59.  Minnesota Statutes 2000, section 256J.31, 
142.6   subdivision 12, is amended to read: 
142.7      Subd. 12.  [RIGHT TO DISCONTINUE CASH ASSISTANCE.] A 
142.8   participant who is not in vendor payment status may discontinue 
142.9   receipt of the cash assistance portion of the MFIP assistance 
142.10  grant and retain eligibility for child care assistance under 
142.11  section 119B.05 and for medical assistance under sections 
142.12  256B.055, subdivision 3a, and 256B.0635.  For the months a 
142.13  participant chooses to discontinue the receipt of the cash 
142.14  portion of the MFIP grant, the assistance unit accrues months of 
142.15  eligibility to be applied toward eligibility for child care 
142.16  under section 119B.05 and for medical assistance under sections 
142.17  256B.055, subdivision 3a, and 256B.0635. 
142.18     [EFFECTIVE DATE.] This section is effective July 1, 2002. 
142.19     Sec. 60.  Minnesota Statutes 2000, section 256K.03, 
142.20  subdivision 1, is amended to read: 
142.21     Subdivision 1.  [NOTIFICATION OF PROGRAM.] Except for the 
142.22  provisions in this section, the provisions for the MFIP 
142.23  application process shall be followed.  Within two days after 
142.24  receipt of a completed combined application form, the county 
142.25  agency must refer to the provider the applicant who meets the 
142.26  conditions under section 256K.02, and notify the applicant in 
142.27  writing of the program including the following provisions: 
142.28     (1) notification that, as part of the application process, 
142.29  applicants are required to attend orientation, to be followed 
142.30  immediately by a job search; 
142.31     (2) the program provider, the date, time, and location of 
142.32  the scheduled program orientation; 
142.33     (3) the procedures for qualifying for and receiving 
142.34  benefits under the program; 
142.35     (4) the immediate availability of supportive services, 
142.36  including, but not limited to, child care, transportation, 
143.1   medical assistance, and other work-related aid; and 
143.2      (5) the rights, responsibilities, and obligations of 
143.3   participants in the program, including, but not limited to, the 
143.4   grounds for exemptions and deferrals, the consequences for 
143.5   refusing or failing to participate fully, and the appeal process.
143.6      [EFFECTIVE DATE.] This section is effective July 1, 2002. 
143.7      Sec. 61.  Minnesota Statutes 2000, section 256K.07, is 
143.8   amended to read: 
143.9      256K.07 [ELIGIBILITY FOR FOOD STAMPS, MEDICAL ASSISTANCE, 
143.10  AND CHILD CARE.] 
143.11     The participant shall be treated as an MFIP recipient for 
143.12  food stamps, medical assistance, and child care eligibility 
143.13  purposes.  The participant who leaves the program as a result of 
143.14  increased earnings from employment shall be eligible for 
143.15  transitional medical assistance and child care without regard to 
143.16  MFIP receipt in three of the six months preceding ineligibility. 
143.17     [EFFECTIVE DATE.] This section is effective July 1, 2002. 
143.18     Sec. 62.  Minnesota Statutes 2000, section 256L.01, 
143.19  subdivision 4, is amended to read: 
143.20     Subd. 4.  [GROSS INDIVIDUAL OR GROSS FAMILY INCOME.] (a) 
143.21  "Gross individual or gross family income" for farm and nonfarm 
143.22  self-employed means income calculated using as the baseline the 
143.23  adjusted gross income reported on the applicant's federal income 
143.24  tax form for the previous year and adding back in reported 
143.25  depreciation, carryover loss, and net operating loss amounts 
143.26  that apply to the business in which the family is currently 
143.27  engaged.  
143.28     (b) "Gross individual or gross family income" for farm 
143.29  self-employed means income calculated using as the baseline the 
143.30  adjusted gross income reported on the applicant's federal income 
143.31  tax form for the previous year and adding back in reported 
143.32  depreciation amounts that apply to the business in which the 
143.33  family is currently engaged.  
143.34     (c) Applicants shall report the most recent financial 
143.35  situation of the family if it has changed from the period of 
143.36  time covered by the federal income tax form.  The report may be 
144.1   in the form of percentage increase or decrease. 
144.2      [EFFECTIVE DATE.] This section is effective July 1, 2001, 
144.3   or upon receipt of federal approval, whichever is later. 
144.4      Sec. 63.  Minnesota Statutes 2000, section 256L.04, 
144.5   subdivision 2, is amended to read: 
144.6      Subd. 2.  [COOPERATION IN ESTABLISHING THIRD-PARTY 
144.7   LIABILITY, PATERNITY, AND OTHER MEDICAL SUPPORT.] (a) To be 
144.8   eligible for MinnesotaCare, individuals and families must 
144.9   cooperate with the state agency to identify potentially liable 
144.10  third-party payers and assist the state in obtaining third-party 
144.11  payments.  "Cooperation" includes, but is not limited to, 
144.12  identifying any third party who may be liable for care and 
144.13  services provided under MinnesotaCare to the enrollee, providing 
144.14  relevant information to assist the state in pursuing a 
144.15  potentially liable third party, and completing forms necessary 
144.16  to recover third-party payments.  For a child through age 18 
144.17  whose gross family income is equal to or less than 225 percent 
144.18  of the federal poverty guidelines, cooperation also includes 
144.19  providing information about a group health plan in which the 
144.20  child is enrolled or eligible to enroll.  If the health plan is 
144.21  determined cost-effective by the state agency and premiums are 
144.22  paid by the state or local agency or there is no cost to the 
144.23  enrollee, the MinnesotaCare enrollee must enroll or remain 
144.24  enrolled in the group health plan, and the commissioner may 
144.25  exempt the enrollee from the requirements of section 256L.12.  
144.26  For purposes of this subdivision, coverage provided by the 
144.27  Minnesota comprehensive health association under chapter 62E 
144.28  shall not be considered group health plan coverage or 
144.29  cost-effective by the state and local agency. 
144.30     (b) A parent, guardian, relative caretaker, or child 
144.31  enrolled in the MinnesotaCare program must cooperate with the 
144.32  department of human services and the local agency in 
144.33  establishing the paternity of an enrolled child and in obtaining 
144.34  medical care support and payments for the child and any other 
144.35  person for whom the person can legally assign rights, in 
144.36  accordance with applicable laws and rules governing the medical 
145.1   assistance program.  A child shall not be ineligible for or 
145.2   disenrolled from the MinnesotaCare program solely because the 
145.3   child's parent, relative caretaker, or guardian fails to 
145.4   cooperate in establishing paternity or obtaining medical support.
145.5      [EFFECTIVE DATE.] This section is effective July 1, 2002.  
145.6      Sec. 64.  Minnesota Statutes 2000, section 256L.05, 
145.7   subdivision 2, is amended to read: 
145.8      Subd. 2.  [COMMISSIONER'S DUTIES.] The commissioner shall 
145.9   use individuals' social security numbers as identifiers for 
145.10  purposes of administering the plan and conduct data matches to 
145.11  verify income.  Applicants shall submit evidence of individual 
145.12  and family income, earned and unearned, such as the most recent 
145.13  income tax return, wage slips, or other documentation that is 
145.14  determined by the commissioner as necessary to verify income 
145.15  eligibility or county agency shall use electronic verification 
145.16  as the primary method of income verification.  If there is a 
145.17  discrepancy in the electronic verification, an individual may be 
145.18  required to submit additional verification.  In addition, the 
145.19  commissioner shall perform random audits to verify reported 
145.20  income and eligibility.  The commissioner may execute data 
145.21  sharing arrangements with the department of revenue and any 
145.22  other governmental agency in order to perform income 
145.23  verification related to eligibility and premium payment under 
145.24  the MinnesotaCare program. 
145.25     Sec. 65.  Minnesota Statutes 2000, section 256L.06, 
145.26  subdivision 3, is amended to read: 
145.27     Subd. 3.  [ADMINISTRATION AND COMMISSIONER'S DUTIES.] (a) 
145.28  Premiums are dedicated to the commissioner for MinnesotaCare. 
145.29     (b) The commissioner shall develop and implement procedures 
145.30  to:  (1) require enrollees to report changes in income; (2) 
145.31  adjust sliding scale premium payments, based upon changes in 
145.32  enrollee income; and (3) disenroll enrollees from MinnesotaCare 
145.33  for failure to pay required premiums.  Failure to pay includes 
145.34  payment with a dishonored check, a returned automatic bank 
145.35  withdrawal, or a refused credit card or debit card payment.  The 
145.36  commissioner may demand a guaranteed form of payment, including 
146.1   a cashier's check or a money order, as the only means to replace 
146.2   a dishonored, returned, or refused payment. 
146.3      (c) Premiums are calculated on a calendar month basis and 
146.4   may be paid on a monthly, quarterly, or annual basis, with the 
146.5   first payment due upon notice from the commissioner of the 
146.6   premium amount required.  The commissioner shall inform 
146.7   applicants and enrollees of these premium payment options. 
146.8   Premium payment is required before enrollment is complete and to 
146.9   maintain eligibility in MinnesotaCare.  
146.10     (d) Nonpayment of the premium will result in disenrollment 
146.11  from the plan within one calendar month after the due date 
146.12  effective for the calendar month for which the premium was due.  
146.13  Persons disenrolled for nonpayment or who voluntarily terminate 
146.14  coverage from the program may not reenroll until four calendar 
146.15  months have elapsed.  Persons disenrolled for nonpayment who pay 
146.16  all past due premiums as well as current premiums due, including 
146.17  premiums due for the period of disenrollment, within 20 days of 
146.18  disenrollment, shall be reenrolled retroactively to the first 
146.19  day of disenrollment.  Persons disenrolled for nonpayment or who 
146.20  voluntarily terminate coverage from the program may not reenroll 
146.21  for four calendar months unless the person demonstrates good 
146.22  cause for nonpayment.  Good cause does not exist if a person 
146.23  chooses to pay other family expenses instead of the premium.  
146.24  The commissioner shall define good cause in rule. 
146.25     [EFFECTIVE DATE.] This section is effective July 1, 2002. 
146.26     Sec. 66.  Minnesota Statutes 2000, section 256L.07, 
146.27  subdivision 1, is amended to read: 
146.28     Subdivision 1.  [GENERAL REQUIREMENTS.] (a) Children 
146.29  enrolled in the original children's health plan as of September 
146.30  30, 1992, and children who enrolled in the MinnesotaCare program 
146.31  after September 30, 1992, pursuant to Laws 1992, chapter 549, 
146.32  article 4, section 17, who have maintained continuous coverage 
146.33  in the MinnesotaCare program or medical assistance; and children 
146.34  under two; pregnant women; and children through age 18 who have 
146.35  family gross incomes that are equal to or less than 150 225 
146.36  percent of the federal poverty guidelines are eligible without 
147.1   meeting the requirements of subdivision 2, as long as they 
147.2   maintain continuous coverage in the MinnesotaCare program or 
147.3   medical assistance.  Children who apply for MinnesotaCare on or 
147.4   after the implementation date of the employer-subsidized health 
147.5   coverage program as described in Laws 1998, chapter 407, article 
147.6   5, section 45, who have family gross incomes that are equal to 
147.7   or less than 150 percent of the federal poverty guidelines, must 
147.8   meet the requirements of subdivision 2 to be eligible for 
147.9   MinnesotaCare subdivisions 2 and 3. 
147.10     (b) Families enrolled in MinnesotaCare under section 
147.11  256L.04, subdivision 1, whose income increases above 275 percent 
147.12  of the federal poverty guidelines, are no longer eligible for 
147.13  the program and shall be disenrolled by the commissioner.  
147.14  Individuals enrolled in MinnesotaCare under section 256L.04, 
147.15  subdivision 7, whose income increases above 175 percent of the 
147.16  federal poverty guidelines are no longer eligible for the 
147.17  program and shall be disenrolled by the commissioner.  For 
147.18  persons disenrolled under this subdivision, MinnesotaCare 
147.19  coverage terminates the last day of the calendar month following 
147.20  the month in which the commissioner determines that the income 
147.21  of a family or individual exceeds program income limits.  
147.22     (c) Notwithstanding paragraph (b), individuals and families 
147.23  may remain enrolled in MinnesotaCare if ten percent of their 
147.24  annual income is less than the annual premium for a policy with 
147.25  a $500 deductible available through the Minnesota comprehensive 
147.26  health association.  Individuals and families who are no longer 
147.27  eligible for MinnesotaCare under this subdivision shall be given 
147.28  an 18-month notice period from the date that ineligibility is 
147.29  determined before disenrollment.  
147.30     [EFFECTIVE DATE.] This section is effective July 1, 2002. 
147.31     Sec. 67.  Minnesota Statutes 2000, section 256L.07, 
147.32  subdivision 2, is amended to read: 
147.33     Subd. 2.  [MUST NOT HAVE ACCESS TO EMPLOYER-SUBSIDIZED 
147.34  COVERAGE.] (a) To be eligible, a family or individual must not 
147.35  have access to subsidized health coverage through an employer 
147.36  and must not have had access to employer-subsidized coverage 
148.1   through a current employer for 18 months prior to application or 
148.2   reapplication.  A family or individual whose employer-subsidized 
148.3   coverage is lost due to an employer terminating health care 
148.4   coverage as an employee benefit during the previous 18 months is 
148.5   not eligible.  
148.6      (b) This subdivision does not apply to a family or 
148.7   individual who was enrolled in MinnesotaCare within six months 
148.8   or less of reapplication and who no longer has 
148.9   employer-subsidized coverage due to the employer terminating 
148.10  health care coverage as an employee benefit.  
148.11     (c) For purposes of this requirement subdivision, 
148.12  subsidized health coverage means health coverage for which the 
148.13  employer pays at least 50 60 percent of the cost of coverage for 
148.14  the employee or dependent, or a higher percentage as specified 
148.15  by the commissioner.  Children are eligible for 
148.16  employer-subsidized coverage through either parent, including 
148.17  the noncustodial parent.  The commissioner must treat employer 
148.18  contributions to Internal Revenue Code Section 125 plans and any 
148.19  other employer benefits intended to pay health care costs as 
148.20  qualified employer subsidies toward the cost of health coverage 
148.21  for employees for purposes of this subdivision. 
148.22     Sec. 68.  Minnesota Statutes 2000, section 256L.07, 
148.23  subdivision 3, is amended to read: 
148.24     Subd. 3.  [OTHER HEALTH COVERAGE.] (a) Families and 
148.25  individuals enrolled in the MinnesotaCare program must have no 
148.26  health coverage while enrolled or for at least four months prior 
148.27  to application and renewal.  Children enrolled in the original 
148.28  children's health plan and children in families with income 
148.29  equal to or less than 150 percent of the federal poverty 
148.30  guidelines, who have other health insurance, are eligible if the 
148.31  coverage: 
148.32     (1) lacks two or more of the following: 
148.33     (i) basic hospital insurance; 
148.34     (ii) medical-surgical insurance; 
148.35     (iii) prescription drug coverage; 
148.36     (iv) dental coverage; or 
149.1      (v) vision coverage; 
149.2      (2) requires a deductible of $100 or more per person per 
149.3   year; or 
149.4      (3) lacks coverage because the child has exceeded the 
149.5   maximum coverage for a particular diagnosis or the policy 
149.6   excludes a particular diagnosis. 
149.7      The commissioner may change this eligibility criterion for 
149.8   sliding scale premiums in order to remain within the limits of 
149.9   available appropriations.  The requirement of no health coverage 
149.10  does not apply to newborns. 
149.11     (b) Medical assistance, general assistance medical care, 
149.12  and civilian health and medical program of the uniformed 
149.13  service, CHAMPUS, are not considered insurance or health 
149.14  coverage for purposes of the four-month requirement described in 
149.15  this subdivision. 
149.16     (c) For purposes of this subdivision, Medicare Part A or B 
149.17  coverage under title XVIII of the Social Security Act, United 
149.18  States Code, title 42, sections 1395c to 1395w-4, is considered 
149.19  health coverage.  An applicant or enrollee may not refuse 
149.20  Medicare coverage to establish eligibility for MinnesotaCare. 
149.21     (d) Applicants who were recipients of medical assistance or 
149.22  general assistance medical care within one month of application 
149.23  must meet the provisions of this subdivision and subdivision 2. 
149.24     [EFFECTIVE DATE.] This section is effective July 1, 2002. 
149.25     Sec. 69.  Minnesota Statutes 2000, section 256L.07, is 
149.26  amended by adding a subdivision to read: 
149.27     Subd. 5.  [EXEMPTION FOR PERSONS WITH CONTINUATION 
149.28  COVERAGE.] (a) Families with children and individuals who apply 
149.29  for the MinnesotaCare program upon termination from continuation 
149.30  coverage required under federal or state law are exempt from the 
149.31  requirements of subdivision 3. 
149.32     (b) For purposes of paragraph (a), "termination from 
149.33  continuation coverage" means involuntary termination for any 
149.34  reason, other than premium nonpayment by the family or 
149.35  individual, including termination due to reaching the end of the 
149.36  maximum period for continuation coverage required under federal 
150.1   or state law. 
150.2      Sec. 70.  Minnesota Statutes 2000, section 256L.07, is 
150.3   amended by adding a subdivision to read: 
150.4      Subd. 6.  [EXEMPTION FOR PERSONS LOSING COVERAGE AS A 
150.5   DEPENDENT.] Individuals who apply for the MinnesotaCare program 
150.6   upon termination of other health coverage due to loss of status 
150.7   as a dependent are exempt from the requirements of subdivision 3.
150.8      Sec. 71.  Minnesota Statutes 2000, section 256L.12, is 
150.9   amended by adding a subdivision to read: 
150.10     Subd. 11.  [AMERICAN INDIAN ENROLLEES.] For American Indian 
150.11  enrollees, MinnesotaCare shall cover health care services 
150.12  provided at Indian Health Service facilities and facilities 
150.13  operated by a tribe or tribal organization under funding 
150.14  authorized by United States Code, title 25, sections 450f to 
150.15  450n, or title III of the Indian Self-Determination and 
150.16  Education Assistance Act, Public Law Number 93-638, if those 
150.17  services would otherwise be covered under section 256L.03.  
150.18  Payments for services provided under this subdivision shall be 
150.19  made on a fee-for-service basis, and may, at the option of the 
150.20  tribe or tribal organization, be made at the rates authorized 
150.21  under sections 256.969, subdivision 16, and 256B.0625, 
150.22  subdivision 34, for those MinnesotaCare enrollees eligible for 
150.23  coverage at medical assistance rates.  For purposes of this 
150.24  subdivision, "American Indian" has the meaning given to persons 
150.25  to whom services will be provided in the Code of Federal 
150.26  Regulations, title 42, section 36.12. 
150.27     Sec. 72.  Minnesota Statutes 2000, section 256L.15, 
150.28  subdivision 1, is amended to read: 
150.29     Subdivision 1.  [PREMIUM DETERMINATION.] (a) Except as 
150.30  provided in paragraph (b), families with children and 
150.31  individuals shall pay a premium determined according to a 
150.32  sliding fee based on a percentage of the family's gross family 
150.33  income.  
150.34     (b) Children in households with family income equal to or 
150.35  less than 225 percent of the federal poverty guidelines and the 
150.36  parents and relative caretakers of children under the age of 21 
151.1   in households with family income equal to or less than 120 
151.2   percent of the federal poverty guidelines are exempt from paying 
151.3   a premium.  Pregnant women and children under age two are exempt 
151.4   from the provisions of section 256L.06, subdivision 3, paragraph 
151.5   (b), clause (3), requiring disenrollment for failure to pay 
151.6   premiums.  For pregnant women, this exemption continues until 
151.7   the first day of the month following the 60th day postpartum.  
151.8   Women who remain enrolled during pregnancy or the postpartum 
151.9   period, despite nonpayment of premiums, shall be disenrolled on 
151.10  the first of the month following the 60th day postpartum for the 
151.11  penalty period that otherwise applies under section 256L.06, 
151.12  unless they begin paying premiums. 
151.13     Sec. 73.  Minnesota Statutes 2000, section 256L.15, 
151.14  subdivision 2, is amended to read: 
151.15     Subd. 2.  [SLIDING FEE SCALE TO DETERMINE PERCENTAGE OF 
151.16  GROSS INDIVIDUAL OR FAMILY INCOME.] (a) The commissioner shall 
151.17  establish a sliding fee scale to determine the percentage of 
151.18  gross individual or family income that households at different 
151.19  income levels must pay to obtain coverage through the 
151.20  MinnesotaCare program.  The sliding fee scale must be based on 
151.21  the enrollee's gross individual or family income.  The sliding 
151.22  fee scale must contain separate tables based on enrollment of 
151.23  one, two, or three or more persons.  For single adults and 
151.24  families without children, the sliding fee scale begins with a 
151.25  premium of 1.5 percent of gross individual or family income for 
151.26  individuals or families with incomes below the limits for the 
151.27  medical assistance program for families and children in effect 
151.28  on January 1, 1999, and proceeds through the following evenly 
151.29  spaced steps:  1.8, 2.3, 3.1, 3.8, 4.8, 5.9, 7.4, and 8.8 
151.30  percent.  For families with children, the sliding fee scale 
151.31  begins with a premium of 1.5 percent of gross family income with 
151.32  incomes below the children in effect on January 1, 1999, and 
151.33  proceeds through following evenly spaced steps:  1.8, 2.3, 3.1, 
151.34  and 5.0 percent.  These percentages are matched to evenly spaced 
151.35  income steps ranging from the medical assistance income limit 
151.36  for families and children in effect on January 1, 1999, to 275 
152.1   percent of the federal poverty guidelines for the applicable 
152.2   family size, up to a family size of five.  The sliding fee scale 
152.3   for a family of five must be used for families of more than five.
152.4   The sliding fee scale and percentages are not subject to the 
152.5   provisions of chapter 14.  If a family or individual reports 
152.6   increased income after enrollment, premiums shall not be 
152.7   adjusted until eligibility renewal. 
152.8      (b) Enrolled individuals and families whose gross annual 
152.9   income increases above 275 percent of the federal poverty 
152.10  guideline shall pay the maximum premium.  The maximum premium is 
152.11  defined as a base charge for one, two, or three or more 
152.12  enrollees so that if all MinnesotaCare cases paid the maximum 
152.13  premium, the total revenue would equal the total cost of 
152.14  MinnesotaCare medical coverage and administration.  In this 
152.15  calculation, administrative costs shall be assumed to equal ten 
152.16  percent of the total.  The costs of medical coverage for 
152.17  pregnant women and children under age two and the enrollees in 
152.18  these groups shall be excluded from the total.  The maximum 
152.19  premium for two enrollees shall be twice the maximum premium for 
152.20  one, and the maximum premium for three or more enrollees shall 
152.21  be three times the maximum premium for one. 
152.22     Sec. 74.  Minnesota Statutes 2000, section 256L.16, is 
152.23  amended to read: 
152.24     256L.16 [PAYMENT RATES; SERVICES FOR FAMILIES AND CHILDREN 
152.25  UNDER THE MINNESOTACARE HEALTH CARE REFORM WAIVER.] 
152.26     Section 256L.11, subdivision 2, shall not apply to services 
152.27  provided to children families with children who are eligible to 
152.28  receive expanded services according to section 256L.03, 
152.29  subdivision 1a 256L.04, subdivision 1a. 
152.30     Sec. 75.  Laws 1999, chapter 245, article 4, section 110, 
152.31  is amended to read: 
152.32     Sec. 110.  [PROGRAMS FOR SENIOR CITIZENS.] 
152.33     The commissioner of human services shall study the 
152.34  eligibility criteria of and benefits provided to persons age 65 
152.35  and over through the array of cash assistance and health care 
152.36  programs administered by the department, and the extent to which 
153.1   these programs can be combined, simplified, or coordinated to 
153.2   reduce administrative costs and improve access.  The 
153.3   commissioner shall also study potential barriers to enrollment 
153.4   for low-income seniors who would otherwise deplete resources 
153.5   necessary to maintain independent community living.  At a 
153.6   minimum, the study must include an evaluation of asset 
153.7   requirements and enrollment sites.  The commissioner shall 
153.8   report study findings and recommendations to the legislature by 
153.9   June 30, 2001 January 15, 2002. 
153.10     Sec. 76.  [EXPAND DENTAL AUXILIARY PERSONNEL; 
153.11  FOREIGN-TRAINED DENTISTS; DENTAL CLINICS.] 
153.12     Subdivision 1.  [DEVELOPMENT.] (a) The board of dentistry, 
153.13  in consultation with the University of Minnesota school of 
153.14  dentistry, the Minnesota state colleges and universities that 
153.15  offer a dental auxiliary training program, the commissioner of 
153.16  health, and licensed dentists and dental auxiliaries practicing 
153.17  in private practice and at community clinics, shall develop new 
153.18  expanded duties for registered dental assistants and dental 
153.19  hygienists.  The new duties must be performed under direct or 
153.20  indirect supervision of a licensed dentist and must include 
153.21  selected technical dental services.  These expanded duties must 
153.22  be limited to reversible procedures, including, but not be 
153.23  limited to, placement, contouring, and adjustment of amalgam, 
153.24  composite, glass ionomer, and temporary restoration; pit and 
153.25  fissure sealants; and the adaptation and cementation of 
153.26  stainless steel crowns for primary teeth.  These expanded duties 
153.27  shall not include or imply a diagnosis or treatment plan, nor 
153.28  include prescribing medications, cutting hard or soft tissue, or 
153.29  any direct patient care in which formal training has not been 
153.30  completed.  The board shall establish a standard of practice and 
153.31  necessary educational qualifications for certification to 
153.32  perform the new duties. 
153.33     (b) The board shall make recommendations to amend Minnesota 
153.34  Statutes, chapter 150A, to permit a foreign-trained dentist to 
153.35  practice as a dental hygienist or as a registered dental 
153.36  assistant. 
154.1      (c) The board shall submit the proposed changes to 
154.2   Minnesota Statutes, chapter 150A, to the legislature by January 
154.3   15, 2002. 
154.4      Subd. 2.  [DENTAL CLINICS.] The commissioner of health, in 
154.5   consultation with the Minnesota state colleges and universities, 
154.6   shall determine the capital improvements needed to establish 
154.7   community-based dental clinics at state colleges and 
154.8   universities to be used as training sites and as public 
154.9   community-based dental clinics for public program recipients 
154.10  during times when the school is not in session and the clinic is 
154.11  not in use.  The commissioner shall submit the necessary capital 
154.12  improvement costs for start-up equipment and necessary 
154.13  infrastructure as part of the 2002 legislative capital budget 
154.14  requests. 
154.15     Sec. 77.  [FEDERAL WAIVER REQUEST.] 
154.16     The commissioner of human services shall seek federal 
154.17  approval to expand the medical assistance program to provide 
154.18  access to discounted prices for prescription drugs to Medicare 
154.19  beneficiaries with no prescription drug coverage.  Individuals 
154.20  in this expanded coverage group shall receive a discount for 
154.21  prescription drugs equal to the average rebate paid to the 
154.22  medical assistance program by pharmaceutical manufacturers.  
154.23  Upon receipt of the waiver, the commissioner shall submit a 
154.24  proposal to the legislature for implementation of this expansion 
154.25  to individuals with income at or below 200 percent of the 
154.26  federal poverty guidelines. 
154.27     Sec. 78.  [HEALTH STATUS IMPROVEMENT GRANTS.] 
154.28     The commissioner of human services shall award grants to 
154.29  improve the quality of health care services provided to 
154.30  children.  Priority shall be given to grant applications that: 
154.31     (1) develop "best practices guidelines" for primary and 
154.32  preventative health care services to all children in Minnesota, 
154.33  regardless of payor; 
154.34     (2) design and implement community-based education and 
154.35  evaluation programs for physicians and other direct care 
154.36  providers to implement best practice guidelines; and 
155.1      (3) reduce disparities in access to health care services 
155.2   and in health status of Minnesota children.  
155.3      Sec. 79.  [NOTICE OF PREMIUM CHANGES IN THE EMPLOYED 
155.4   PERSONS WITH DISABILITIES PROGRAM.] 
155.5      The commissioner of human services shall provide notice to 
155.6   all medical assistance recipients receiving coverage through the 
155.7   employed persons with disabilities program under Minnesota 
155.8   Statutes, section 256B.057, subdivision 9, of the first new 
155.9   premium schedule in effect on September 1, 2001, at least two 
155.10  months before the month in which the first new premium is due. 
155.11     Sec. 80.  [REPEALER.] 
155.12     (a) Minnesota Statutes 2000, section 16A.76, is repealed 
155.13  effective July 1, 2001. 
155.14     (b) Minnesota Statutes 2000, section 256.955, subdivision 
155.15  2b, is repealed effective January 1, 2002.  
155.16     (c) Minnesota Statutes 2000, sections 256B.0635, 
155.17  subdivision 3; and 256L.15, subdivision 3, are repealed 
155.18  effective July 1, 2002. 
155.19                             ARTICLE 3 
155.20                          CONTINUING CARE 
155.21     Section 1.  Minnesota Statutes 2000, section 245A.13, 
155.22  subdivision 7, is amended to read: 
155.23     Subd. 7.  [RATE RECOMMENDATION.] The commissioner of human 
155.24  services may review rates of a residential program participating 
155.25  in the medical assistance program which is in receivership and 
155.26  that has needs or deficiencies documented by the department of 
155.27  health or the department of human services.  If the commissioner 
155.28  of human services determines that a review of the rate 
155.29  established under section 256B.501 sections 256B.5012 and 
155.30  256B.5013 is needed, the commissioner shall: 
155.31     (1) review the order or determination that cites the 
155.32  deficiencies or needs; and 
155.33     (2) determine the need for additional staff, additional 
155.34  annual hours by type of employee, and additional consultants, 
155.35  services, supplies, equipment, repairs, or capital assets 
155.36  necessary to satisfy the needs or deficiencies. 
156.1      Sec. 2.  Minnesota Statutes 2000, section 245A.13, 
156.2   subdivision 8, is amended to read: 
156.3      Subd. 8.  [ADJUSTMENT TO THE RATE.] Upon review of rates 
156.4   under subdivision 7, the commissioner may adjust the residential 
156.5   program's payment rate.  The commissioner shall review the 
156.6   circumstances, together with the residential program cost report 
156.7   program's most recent income and expense report, to determine 
156.8   whether or not the deficiencies or needs can be corrected or met 
156.9   by reallocating residential program staff, costs, revenues, 
156.10  or any other resources including any investments, efficiency 
156.11  incentives, or allowances.  If the commissioner determines that 
156.12  any deficiency cannot be corrected or the need cannot be met 
156.13  with the payment rate currently being paid, the commissioner 
156.14  shall determine the payment rate adjustment by dividing the 
156.15  additional annual costs established during the commissioner's 
156.16  review by the residential program's actual resident days from 
156.17  the most recent desk-audited cost income and expense report or 
156.18  the estimated resident days in the projected receivership 
156.19  period.  The payment rate adjustment must meet the conditions in 
156.20  Minnesota Rules, parts 9553.0010 to 9553.0080, and remains in 
156.21  effect during the period of the receivership or until another 
156.22  date set by the commissioner.  Upon the subsequent sale, 
156.23  closure, or transfer of the residential program, the 
156.24  commissioner may recover amounts that were paid as payment rate 
156.25  adjustments under this subdivision.  This recovery shall be 
156.26  determined through a review of actual costs and resident days in 
156.27  the receivership period.  The costs the commissioner finds to be 
156.28  allowable shall be divided by the actual resident days for the 
156.29  receivership period.  This rate shall be compared to the rate 
156.30  paid throughout the receivership period, with the difference 
156.31  multiplied by resident days, being the amount to be repaid to 
156.32  the commissioner.  Allowable costs shall be determined by the 
156.33  commissioner as those ordinary, necessary, and related to 
156.34  resident care by prudent and cost-conscious management.  The 
156.35  buyer or transferee shall repay this amount to the commissioner 
156.36  within 60 days after the commissioner notifies the buyer or 
157.1   transferee of the obligation to repay.  This provision does not 
157.2   limit the liability of the seller to the commissioner pursuant 
157.3   to section 256B.0641. 
157.4      Sec. 3.  Minnesota Statutes 2000, section 252.275, 
157.5   subdivision 4b, is amended to read: 
157.6      Subd. 4b.  [GUARANTEED FLOOR.] Each county with an original 
157.7   allocation for the preceding year that is equal to or less than 
157.8   the guaranteed floor minimum index shall have a guaranteed floor 
157.9   equal to its original allocation for the preceding year.  Each 
157.10  county with an original allocation for the preceding year that 
157.11  is greater than the guaranteed floor minimum index shall have a 
157.12  guaranteed floor equal to the lesser of clause (1) or (2): 
157.13     (1) the county's original allocation for the preceding 
157.14  year; or 
157.15     (2) 70 percent of the county's reported expenditures 
157.16  eligible for reimbursement during the 12 months ending on June 
157.17  30 of the preceding calendar year. 
157.18     For calendar year 1993, the guaranteed floor minimum index 
157.19  shall be $20,000.  For each subsequent year, the index shall be 
157.20  adjusted by the projected change in the average value in the 
157.21  United States Department of Labor Bureau of Labor Statistics 
157.22  consumer price index (all urban) for that year. 
157.23     Notwithstanding this subdivision, no county shall be 
157.24  allocated a guaranteed floor of less than $1,000. 
157.25     When the amount of funds available for allocation is less 
157.26  than the amount available in the previous year, each county's 
157.27  previous year allocation shall be reduced in proportion to the 
157.28  reduction in the statewide funding, to establish each county's 
157.29  guaranteed floor. 
157.30     Sec. 4.  Minnesota Statutes 2000, section 254B.03, 
157.31  subdivision 1, is amended to read: 
157.32     Subdivision 1.  [LOCAL AGENCY DUTIES.] (a) Every local 
157.33  agency shall provide chemical dependency services to persons 
157.34  residing within its jurisdiction who meet criteria established 
157.35  by the commissioner for placement in a chemical dependency 
157.36  residential or nonresidential treatment service.  Chemical 
158.1   dependency money must be administered by the local agencies 
158.2   according to law and rules adopted by the commissioner under 
158.3   sections 14.001 to 14.69. 
158.4      (b) In order to contain costs, the county board shall, with 
158.5   the approval of the commissioner of human services, select 
158.6   eligible vendors of chemical dependency services who can provide 
158.7   economical and appropriate treatment.  Unless the local agency 
158.8   is a social services department directly administered by a 
158.9   county or human services board, the local agency shall not be an 
158.10  eligible vendor under section 254B.05.  The commissioner may 
158.11  approve proposals from county boards to provide services in an 
158.12  economical manner or to control utilization, with safeguards to 
158.13  ensure that necessary services are provided.  If a county 
158.14  implements a demonstration or experimental medical services 
158.15  funding plan, the commissioner shall transfer the money as 
158.16  appropriate.  If a county selects a vendor located in another 
158.17  state, the county shall ensure that the vendor is in compliance 
158.18  with the rules governing licensure of programs located in the 
158.19  state. 
158.20     (c) The calendar year 1998 2002 rate for vendors may not 
158.21  increase more than three 3.5 percent above the rate approved in 
158.22  effect on January 1, 1997 2001.  The calendar year 1999 2003 
158.23  rate for vendors may not increase more than three 3.5 percent 
158.24  above the rate in effect on January 1, 1998 2002. 
158.25     (d) A culturally specific vendor that provides assessments 
158.26  under a variance under Minnesota Rules, part 9530.6610, shall be 
158.27  allowed to provide assessment services to persons not covered by 
158.28  the variance. 
158.29     Sec. 5.  Minnesota Statutes 2000, section 254B.09, is 
158.30  amended by adding a subdivision to read: 
158.31     Subd. 8.  [PAYMENTS TO IMPROVE SERVICES TO AMERICAN 
158.32  INDIANS.] The commissioner may set rates for chemical dependency 
158.33  services according to the American Indian Health Improvement 
158.34  Act, Public Law Number 94-437, for eligible vendors.  These 
158.35  rates shall supersede rates set in county purchase of service 
158.36  agreements when payments are made on behalf of clients eligible 
159.1   according to Public Law Number 94-437. 
159.2      Sec. 6.  Minnesota Statutes 2000, section 256.01, is 
159.3   amended by adding a subdivision to read: 
159.4      Subd. 19.  [GRANTS FOR CASE MANAGEMENT SERVICES TO PERSONS 
159.5   WITH HIV OR AIDS.] The commissioner may award grants to eligible 
159.6   vendors for the development, implementation, and evaluation of 
159.7   case management services for individuals infected with the human 
159.8   immunodeficiency virus.  HIV/AIDs case management services will 
159.9   be provided to increase access to cost effective health care 
159.10  services, to reduce the risk of HIV transmission, to ensure that 
159.11  basic client needs are met, and to increase client access to 
159.12  needed community supports or services. 
159.13     Sec. 7.  Minnesota Statutes 2000, section 256.476, 
159.14  subdivision 1, is amended to read: 
159.15     Subdivision 1.  [PURPOSE AND GOALS.] The commissioner of 
159.16  human services shall establish a consumer support grant 
159.17  program to assist for individuals with functional limitations 
159.18  and their families in purchasing and securing supports which the 
159.19  individuals need to live as independently and productively in 
159.20  the community as possible who wish to purchase and secure their 
159.21  own supports.  The commissioner and local agencies shall jointly 
159.22  develop an implementation plan which must include a way to 
159.23  resolve the issues related to county liability.  The program 
159.24  shall: 
159.25     (1) make support grants available to individuals or 
159.26  families as an effective alternative to existing programs and 
159.27  services, such as the developmental disability family support 
159.28  program, the alternative care program, personal care attendant 
159.29  services, home health aide services, and private duty nursing 
159.30  facility services; 
159.31     (2) provide consumers more control, flexibility, and 
159.32  responsibility over the needed supports their services and 
159.33  supports; 
159.34     (3) promote local program management and decision making; 
159.35  and 
159.36     (4) encourage the use of informal and typical community 
160.1   supports. 
160.2      Sec. 8.  Minnesota Statutes 2000, section 256.476, 
160.3   subdivision 2, is amended to read: 
160.4      Subd. 2.  [DEFINITIONS.] For purposes of this section, the 
160.5   following terms have the meanings given them: 
160.6      (a) "County board" means the county board of commissioners 
160.7   for the county of financial responsibility as defined in section 
160.8   256G.02, subdivision 4, or its designated representative.  When 
160.9   a human services board has been established under sections 
160.10  402.01 to 402.10, it shall be considered the county board for 
160.11  the purposes of this section. 
160.12     (b) "Family" means the person's birth parents, adoptive 
160.13  parents or stepparents, siblings or stepsiblings, children or 
160.14  stepchildren, grandparents, grandchildren, niece, nephew, aunt, 
160.15  uncle, or spouse.  For the purposes of this section, a family 
160.16  member is at least 18 years of age. 
160.17     (c) "Functional limitations" means the long-term inability 
160.18  to perform an activity or task in one or more areas of major 
160.19  life activity, including self-care, understanding and use of 
160.20  language, learning, mobility, self-direction, and capacity for 
160.21  independent living.  For the purpose of this section, the 
160.22  inability to perform an activity or task results from a mental, 
160.23  emotional, psychological, sensory, or physical disability, 
160.24  condition, or illness. 
160.25     (d) "Informed choice" means a voluntary decision made by 
160.26  the person or the person's legal representative, after becoming 
160.27  familiarized with the alternatives to: 
160.28     (1) select a preferred alternative from a number of 
160.29  feasible alternatives; 
160.30     (2) select an alternative which may be developed in the 
160.31  future; and 
160.32     (3) refuse any or all alternatives. 
160.33     (e) "Local agency" means the local agency authorized by the 
160.34  county board to carry out the provisions of this section. 
160.35     (f) "Person" or "persons" means a person or persons meeting 
160.36  the eligibility criteria in subdivision 3. 
161.1      (g) "Authorized representative" means an individual 
161.2   designated by the person or their legal representative to act on 
161.3   their behalf.  This individual may be a family member, guardian, 
161.4   representative payee, or other individual designated by the 
161.5   person or their legal representative, if any, to assist in 
161.6   purchasing and arranging for supports.  For the purposes of this 
161.7   section, an authorized representative is at least 18 years of 
161.8   age. 
161.9      (h) "Screening" means the screening of a person's service 
161.10  needs under sections 256B.0911 and 256B.092. 
161.11     (i) "Supports" means services, care, aids, home 
161.12  environmental modifications, or assistance purchased by the 
161.13  person or the person's family.  Examples of supports include 
161.14  respite care, assistance with daily living, and adaptive aids 
161.15  assistive technology.  For the purpose of this section, 
161.16  notwithstanding the provisions of section 144A.43, supports 
161.17  purchased under the consumer support program are not considered 
161.18  home care services. 
161.19     (j) "Program of origination" means the program the 
161.20  individual transferred from when approved for the consumer 
161.21  support grant program. 
161.22     Sec. 9.  Minnesota Statutes 2000, section 256.476, 
161.23  subdivision 3, is amended to read: 
161.24     Subd. 3.  [ELIGIBILITY TO APPLY FOR GRANTS.] (a) A person 
161.25  is eligible to apply for a consumer support grant if the person 
161.26  meets all of the following criteria: 
161.27     (1) the person is eligible for and has been approved to 
161.28  receive services under medical assistance as determined under 
161.29  sections 256B.055 and 256B.056 or the person is eligible for and 
161.30  has been approved to receive services under alternative care 
161.31  services as determined under section 256B.0913 or the person has 
161.32  been approved to receive a grant under the developmental 
161.33  disability family support program under section 252.32; 
161.34     (2) the person is able to direct and purchase the person's 
161.35  own care and supports, or the person has a family member, legal 
161.36  representative, or other authorized representative who can 
162.1   purchase and arrange supports on the person's behalf; 
162.2      (3) the person has functional limitations, requires ongoing 
162.3   supports to live in the community, and is at risk of or would 
162.4   continue institutionalization without such supports; and 
162.5      (4) the person will live in a home.  For the purpose of 
162.6   this section, "home" means the person's own home or home of a 
162.7   person's family member.  These homes are natural home settings 
162.8   and are not licensed by the department of health or human 
162.9   services. 
162.10     (b) Persons may not concurrently receive a consumer support 
162.11  grant if they are: 
162.12     (1) receiving home and community-based services under 
162.13  United States Code, title 42, section 1396h(c); personal care 
162.14  attendant and home health aide services under section 256B.0625; 
162.15  a developmental disability family support grant; or alternative 
162.16  care services under section 256B.0913; or 
162.17     (2) residing in an institutional or congregate care setting.
162.18     (c) A person or person's family receiving a consumer 
162.19  support grant shall not be charged a fee or premium by a local 
162.20  agency for participating in the program.  
162.21     (d) The commissioner may limit the participation of nursing 
162.22  facility residents, residents of intermediate care facilities 
162.23  for persons with mental retardation, and the recipients of 
162.24  services from federal waiver programs in the consumer support 
162.25  grant program if the participation of these individuals will 
162.26  result in an increase in the cost to the state. 
162.27     (e) The commissioner shall establish a budgeted 
162.28  appropriation each fiscal year for the consumer support grant 
162.29  program.  The number of individuals participating in the program 
162.30  will be adjusted so the total amount allocated to counties does 
162.31  not exceed the amount of the budgeted appropriation.  The 
162.32  budgeted appropriation will be adjusted annually to accommodate 
162.33  changes in demand for the consumer support grants. 
162.34     Sec. 10.  Minnesota Statutes 2000, section 256.476, 
162.35  subdivision 4, is amended to read: 
162.36     Subd. 4.  [SUPPORT GRANTS; CRITERIA AND LIMITATIONS.] (a) A 
163.1   county board may choose to participate in the consumer support 
163.2   grant program.  If a county board chooses to participate in the 
163.3   program, the local agency shall establish written procedures and 
163.4   criteria to determine the amount and use of support grants.  
163.5   These procedures must include, at least, the availability of 
163.6   respite care, assistance with daily living, and adaptive aids.  
163.7   The local agency may establish monthly or annual maximum amounts 
163.8   for grants and procedures where exceptional resources may be 
163.9   required to meet the health and safety needs of the person on a 
163.10  time-limited basis, however, the total amount awarded to each 
163.11  individual may not exceed the limits established in subdivision 
163.12  5, paragraph (f). 
163.13     (b) Support grants to a person or a person's family will be 
163.14  provided through a monthly subsidy payment and be in the form of 
163.15  cash, voucher, or direct county payment to vendor.  Support 
163.16  grant amounts must be determined by the local agency.  Each 
163.17  service and item purchased with a support grant must meet all of 
163.18  the following criteria:  
163.19     (1) it must be over and above the normal cost of caring for 
163.20  the person if the person did not have functional limitations; 
163.21     (2) it must be directly attributable to the person's 
163.22  functional limitations; 
163.23     (3) it must enable the person or the person's family to 
163.24  delay or prevent out-of-home placement of the person; and 
163.25     (4) it must be consistent with the needs identified in the 
163.26  service plan, when applicable. 
163.27     (c) Items and services purchased with support grants must 
163.28  be those for which there are no other public or private funds 
163.29  available to the person or the person's family.  Fees assessed 
163.30  to the person or the person's family for health and human 
163.31  services are not reimbursable through the grant. 
163.32     (d) In approving or denying applications, the local agency 
163.33  shall consider the following factors:  
163.34     (1) the extent and areas of the person's functional 
163.35  limitations; 
163.36     (2) the degree of need in the home environment for 
164.1   additional support; and 
164.2      (3) the potential effectiveness of the grant to maintain 
164.3   and support the person in the family environment or the person's 
164.4   own home. 
164.5      (e) At the time of application to the program or screening 
164.6   for other services, the person or the person's family shall be 
164.7   provided sufficient information to ensure an informed choice of 
164.8   alternatives by the person, the person's legal representative, 
164.9   if any, or the person's family.  The application shall be made 
164.10  to the local agency and shall specify the needs of the person 
164.11  and family, the form and amount of grant requested, the items 
164.12  and services to be reimbursed, and evidence of eligibility for 
164.13  medical assistance or alternative care program. 
164.14     (f) Upon approval of an application by the local agency and 
164.15  agreement on a support plan for the person or person's family, 
164.16  the local agency shall make grants to the person or the person's 
164.17  family.  The grant shall be in an amount for the direct costs of 
164.18  the services or supports outlined in the service agreement.  
164.19     (g) Reimbursable costs shall not include costs for 
164.20  resources already available, such as special education classes, 
164.21  day training and habilitation, case management, other services 
164.22  to which the person is entitled, medical costs covered by 
164.23  insurance or other health programs, or other resources usually 
164.24  available at no cost to the person or the person's family. 
164.25     (h) The state of Minnesota, the county boards participating 
164.26  in the consumer support grant program, or the agencies acting on 
164.27  behalf of the county boards in the implementation and 
164.28  administration of the consumer support grant program shall not 
164.29  be liable for damages, injuries, or liabilities sustained 
164.30  through the purchase of support by the individual, the 
164.31  individual's family, or the authorized representative under this 
164.32  section with funds received through the consumer support grant 
164.33  program.  Liabilities include but are not limited to:  workers' 
164.34  compensation liability, the Federal Insurance Contributions Act 
164.35  (FICA), or the Federal Unemployment Tax Act (FUTA).  For 
164.36  purposes of this section, participating county boards and 
165.1   agencies acting on behalf of county boards are exempt from the 
165.2   provisions of section 268.04. 
165.3      Sec. 11.  Minnesota Statutes 2000, section 256.476, 
165.4   subdivision 5, is amended to read: 
165.5      Subd. 5.  [REIMBURSEMENT, ALLOCATIONS, AND REPORTING.] (a) 
165.6   For the purpose of transferring persons to the consumer support 
165.7   grant program from specific programs or services, such as the 
165.8   developmental disability family support program and alternative 
165.9   care program, personal care attendant assistant services, home 
165.10  health aide services, or nursing facility private duty nursing 
165.11  services, the amount of funds transferred by the commissioner 
165.12  between the developmental disability family support program 
165.13  account, the alternative care account, the medical assistance 
165.14  account, or the consumer support grant account shall be based on 
165.15  each county's participation in transferring persons to the 
165.16  consumer support grant program from those programs and services. 
165.17     (b) At the beginning of each fiscal year, county 
165.18  allocations for consumer support grants shall be based on: 
165.19     (1) the number of persons to whom the county board expects 
165.20  to provide consumer supports grants; 
165.21     (2) their eligibility for current program and services; 
165.22     (3) the amount of nonfederal dollars expended on those 
165.23  individuals for those programs and services or, in situations 
165.24  where an individual is unable to obtain the support needed from 
165.25  the program of origination due to the unavailability of service 
165.26  providers at the time or the location where the supports are 
165.27  needed, the allocation will be based on the county's best 
165.28  estimate of the nonfederal dollars that would have been expended 
165.29  if the services had been available; and 
165.30     (4) projected dates when persons will start receiving 
165.31  grants.  County allocations shall be adjusted periodically by 
165.32  the commissioner based on the actual transfer of persons or 
165.33  service openings, and the nonfederal dollars associated with 
165.34  those persons or service openings, to the consumer support grant 
165.35  program. 
165.36     (c) The amount of funds transferred by the commissioner 
166.1   from the alternative care account and the medical assistance 
166.2   account for an individual may be changed if it is determined by 
166.3   the county or its agent that the individual's need for support 
166.4   has changed. 
166.5      (d) The authority to utilize funds transferred to the 
166.6   consumer support grant account for the purposes of implementing 
166.7   and administering the consumer support grant program will not be 
166.8   limited or constrained by the spending authority provided to the 
166.9   program of origination. 
166.10     (e) The commissioner shall may use up to five percent of 
166.11  each county's allocation, as adjusted, for payments to that 
166.12  county for administrative expenses, to be paid as a 
166.13  proportionate addition to reported direct service expenditures. 
166.14     (f) Except as provided in this paragraph, The county 
166.15  allocation for each individual or individual's family cannot 
166.16  exceed 80 percent of the total nonfederal dollars expended on 
166.17  the individual by the program of origination except for the 
166.18  developmental disabilities family support grant program which 
166.19  can be approved up to 100 percent of the nonfederal dollars and 
166.20  in situations as described in paragraph (b), clause (3).  In 
166.21  situations where exceptional need exists or the individual's 
166.22  need for support increases, up to 100 percent of the nonfederal 
166.23  dollars expended may be allocated to the county.  Allocations 
166.24  that exceed 80 percent of the nonfederal dollars expended on the 
166.25  individual by the program of origination must be approved by the 
166.26  commissioner.  The remainder of the amount expended on the 
166.27  individual by the program of origination will be used in the 
166.28  following proportions:  half will be made available to the 
166.29  consumer support grant program and participating counties for 
166.30  consumer training, resource development, and other costs, and 
166.31  half will be returned to the state general fund. 
166.32     (g) The commissioner may recover, suspend, or withhold 
166.33  payments if the county board, local agency, or grantee does not 
166.34  comply with the requirements of this section. 
166.35     (h) Grant funds unexpended by consumers shall return to the 
166.36  state once a year.  The annual return of unexpended grant funds 
167.1   shall occur in the quarter following the end of the state fiscal 
167.2   year. 
167.3      Sec. 12.  Minnesota Statutes 2000, section 256.476, 
167.4   subdivision 8, is amended to read: 
167.5      Subd. 8.  [COMMISSIONER RESPONSIBILITIES.] The commissioner 
167.6   shall: 
167.7      (1) transfer and allocate funds pursuant to this section; 
167.8      (2) determine allocations based on projected and actual 
167.9   local agency use; 
167.10     (3) monitor and oversee overall program spending; 
167.11     (4) evaluate the effectiveness of the program; 
167.12     (5) provide training and technical assistance for local 
167.13  agencies and consumers to help identify potential applicants to 
167.14  the program; and 
167.15     (6) develop guidelines for local agency program 
167.16  administration and consumer information; and 
167.17     (7) apply for a federal waiver or take any other action 
167.18  necessary to maximize federal funding for the program by 
167.19  September 1, 1999. 
167.20     Sec. 13.  Minnesota Statutes 2000, section 256.476, is 
167.21  amended by adding a subdivision to read: 
167.22     Subd. 11.  [CONSUMER SUPPORT GRANT PROGRAM AFTER JULY 1, 
167.23  2001.] (a) Effective July 1, 2001, upon approval of the 1115 
167.24  federal waiver for consumer-directed home care in section 
167.25  256B.0627, subdivision 13, the consumer support grant program 
167.26  shall be limited to 200 persons. 
167.27     (b) If federal approval delays implementation of the 1115 
167.28  waiver or it is denied, additional individuals may receive 
167.29  consumer support grants according to subdivision 5.  The 
167.30  statewide average of medical assistance expenditures for 
167.31  recipients receiving those services during the most recent 
167.32  fiscal year will be used to determine the maximum allowable 
167.33  grant award. 
167.34     (c) Persons receiving consumer support grants prior to July 
167.35  1, 2001, may continue to receive a grant amount established 
167.36  prior to July 1, 2001. 
168.1      Sec. 14.  Minnesota Statutes 2000, section 256B.0625, 
168.2   subdivision 7, is amended to read: 
168.3      Subd. 7.  [PRIVATE DUTY NURSING.] Medical assistance covers 
168.4   private duty nursing services in a recipient's home.  Recipients 
168.5   who are authorized to receive private duty nursing services in 
168.6   their home may use approved hours outside of the home during 
168.7   hours when normal life activities take them outside of their 
168.8   home and when, without the provision of private duty nursing, 
168.9   their health and safety would be jeopardized.  To use private 
168.10  duty nursing services at school, the recipient or responsible 
168.11  party must provide written authorization in the care plan 
168.12  identifying the chosen provider and the daily amount of services 
168.13  to be used at school.  Medical assistance does not cover private 
168.14  duty nursing services for residents of a hospital, nursing 
168.15  facility, intermediate care facility, or a health care facility 
168.16  licensed by the commissioner of health, except as authorized in 
168.17  section 256B.64 for ventilator-dependent recipients in hospitals 
168.18  or unless a resident who is otherwise eligible is on leave from 
168.19  the facility and the facility either pays for the private duty 
168.20  nursing services or forgoes the facility per diem for the leave 
168.21  days that private duty nursing services are used.  Total hours 
168.22  of service and payment allowed for services outside the home 
168.23  cannot exceed that which is otherwise allowed in an in-home 
168.24  setting according to section 256B.0627.  All private duty 
168.25  nursing services must be provided according to the limits 
168.26  established under section 256B.0627.  Private duty nursing 
168.27  services may not be reimbursed if the nurse is the spouse of the 
168.28  recipient or the parent or foster care provider of a recipient 
168.29  who is under age 18, or the recipient's legal guardian. 
168.30     Sec. 15.  Minnesota Statutes 2000, section 256B.0625, 
168.31  subdivision 19a, is amended to read: 
168.32     Subd. 19a.  [PERSONAL CARE ASSISTANT SERVICES.] Medical 
168.33  assistance covers personal care assistant services in a 
168.34  recipient's home.  To qualify for personal care assistant 
168.35  services, recipients or responsible parties must be able to 
168.36  identify the recipient's needs, direct and evaluate task 
169.1   accomplishment, and provide for health and safety.  Approved 
169.2   hours may be used outside the home when normal life activities 
169.3   take them outside the home and when, without the provision of 
169.4   personal care, their health and safety would be jeopardized.  To 
169.5   use personal care assistant services at school, the recipient or 
169.6   responsible party must provide written authorization in the care 
169.7   plan identifying the chosen provider and the daily amount of 
169.8   services to be used at school.  Total hours for services, 
169.9   whether actually performed inside or outside the recipient's 
169.10  home, cannot exceed that which is otherwise allowed for personal 
169.11  care assistant services in an in-home setting according to 
169.12  section 256B.0627.  Medical assistance does not cover personal 
169.13  care assistant services for residents of a hospital, nursing 
169.14  facility, intermediate care facility, health care facility 
169.15  licensed by the commissioner of health, or unless a resident who 
169.16  is otherwise eligible is on leave from the facility and the 
169.17  facility either pays for the personal care assistant services or 
169.18  forgoes the facility per diem for the leave days that personal 
169.19  care assistant services are used.  All personal care assistant 
169.20  services must be provided according to section 256B.0627.  
169.21  Personal care assistant services may not be reimbursed if the 
169.22  personal care assistant is the spouse or legal guardian of the 
169.23  recipient or the parent of a recipient under age 18, or the 
169.24  responsible party or the foster care provider of a recipient who 
169.25  cannot direct the recipient's own care unless, in the case of a 
169.26  foster care provider, a county or state case manager visits the 
169.27  recipient as needed, but not less than every six months, to 
169.28  monitor the health and safety of the recipient and to ensure the 
169.29  goals of the care plan are met.  Parents of adult recipients, 
169.30  adult children of the recipient or adult siblings of the 
169.31  recipient may be reimbursed for personal care assistant services 
169.32  if they are not the recipient's legal guardian and, if they are 
169.33  granted a waiver under section 256B.0627.  Until July 1, 2001, 
169.34  and Notwithstanding the provisions of section 256B.0627, 
169.35  subdivision 4, paragraph (b), clause (4), the noncorporate legal 
169.36  guardian or conservator of an adult, who is not the responsible 
170.1   party and not the personal care provider organization, may be 
170.2   granted a hardship waiver under section 256B.0627, to be 
170.3   reimbursed to provide personal care assistant services to the 
170.4   recipient, and shall not be considered to have a service 
170.5   provider interest for purposes of participation on the screening 
170.6   team under section 256B.092, subdivision 7. 
170.7      Sec. 16.  Minnesota Statutes 2000, section 256B.0625, 
170.8   subdivision 19c, is amended to read: 
170.9      Subd. 19c.  [PERSONAL CARE.] Medical assistance covers 
170.10  personal care assistant services provided by an individual who 
170.11  is qualified to provide the services according to subdivision 
170.12  19a and section 256B.0627, where the services are prescribed by 
170.13  a physician in accordance with a plan of treatment and are 
170.14  supervised by the recipient under the fiscal agent option 
170.15  according to section 256B.0627, subdivision 10, or a qualified 
170.16  professional.  "Qualified professional" means a mental health 
170.17  professional as defined in section 245.462, subdivision 18, or 
170.18  245.4871, subdivision 27; or a registered nurse as defined in 
170.19  sections 148.171 to 148.285.  As part of the assessment, the 
170.20  county public health nurse will consult with assist the 
170.21  recipient or responsible party and to identify the most 
170.22  appropriate person to provide supervision of the personal care 
170.23  assistant.  The qualified professional shall perform the duties 
170.24  described in Minnesota Rules, part 9505.0335, subpart 4.  
170.25     Sec. 17.  Minnesota Statutes 2000, section 256B.0625, 
170.26  subdivision 20, is amended to read: 
170.27     Subd. 20.  [MENTAL HEALTH CASE MANAGEMENT.] (a) To the 
170.28  extent authorized by rule of the state agency, medical 
170.29  assistance covers case management services to persons with 
170.30  serious and persistent mental illness and children with severe 
170.31  emotional disturbance.  Services provided under this section 
170.32  must meet the relevant standards in sections 245.461 to 
170.33  245.4888, the Comprehensive Adult and Children's Mental Health 
170.34  Acts, Minnesota Rules, parts 9520.0900 to 9520.0926, and 
170.35  9505.0322, excluding subpart 10. 
170.36     (b) Entities meeting program standards set out in rules 
171.1   governing family community support services as defined in 
171.2   section 245.4871, subdivision 17, are eligible for medical 
171.3   assistance reimbursement for case management services for 
171.4   children with severe emotional disturbance when these services 
171.5   meet the program standards in Minnesota Rules, parts 9520.0900 
171.6   to 9520.0926 and 9505.0322, excluding subparts 6 and 10. 
171.7      (c) Medical assistance and MinnesotaCare payment for mental 
171.8   health case management shall be made on a monthly basis.  In 
171.9   order to receive payment for an eligible child, the provider 
171.10  must document at least a face-to-face contact with the child, 
171.11  the child's parents, or the child's legal representative.  To 
171.12  receive payment for an eligible adult, the provider must 
171.13  document: 
171.14     (1) at least a face-to-face contact with the adult or the 
171.15  adult's legal representative; or 
171.16     (2) at least a telephone contact with the adult or the 
171.17  adult's legal representative and document a face-to-face contact 
171.18  with the adult or the adult's legal representative within the 
171.19  preceding two months. 
171.20     (d) Payment for mental health case management provided by 
171.21  county or state staff shall be based on the monthly rate 
171.22  methodology under section 256B.094, subdivision 6, paragraph 
171.23  (b), with separate rates calculated for child welfare and mental 
171.24  health, and within mental health, separate rates for children 
171.25  and adults. 
171.26     (e) Payment for mental health case management provided by 
171.27  county-contracted vendors shall be based on a monthly rate 
171.28  negotiated by the host county.  The negotiated rate must not 
171.29  exceed the rate charged by the vendor for the same service to 
171.30  other payers.  If the service is provided by a team of 
171.31  contracted vendors, the county may negotiate a team rate with a 
171.32  vendor who is a member of the team.  The team shall determine 
171.33  how to distribute the rate among its members.  No reimbursement 
171.34  received by contracted vendors shall be returned to the county, 
171.35  except to reimburse the county for advance funding provided by 
171.36  the county to the vendor. 
172.1      (f) If the service is provided by a team which includes 
172.2   contracted vendors and county or state staff, the costs for 
172.3   county or state staff participation in the team shall be 
172.4   included in the rate for county-provided services.  In this 
172.5   case, the contracted vendor and the county may each receive 
172.6   separate payment for services provided by each entity in the 
172.7   same month.  In order to prevent duplication of services, the 
172.8   county must document, in the recipient's file, the need for team 
172.9   case management and a description of the roles of the team 
172.10  members. 
172.11     (g) The commissioner shall calculate the nonfederal share 
172.12  of actual medical assistance and general assistance medical care 
172.13  payments for each county, based on the higher of calendar year 
172.14  1995 or 1996, by service date, project that amount forward to 
172.15  1999, and transfer one-half of the result from medical 
172.16  assistance and general assistance medical care to each county's 
172.17  mental health grants under sections 245.4886 and 256E.12 for 
172.18  calendar year 1999.  The annualized minimum amount added to each 
172.19  county's mental health grant shall be $3,000 per year for 
172.20  children and $5,000 per year for adults.  The commissioner may 
172.21  reduce the statewide growth factor in order to fund these 
172.22  minimums.  The annualized total amount transferred shall become 
172.23  part of the base for future mental health grants for each county.
172.24     (h) Any net increase in revenue to the county as a result 
172.25  of the change in this section must be used to provide expanded 
172.26  mental health services as defined in sections 245.461 to 
172.27  245.4888, the Comprehensive Adult and Children's Mental Health 
172.28  Acts, excluding inpatient and residential treatment.  For 
172.29  adults, increased revenue may also be used for services and 
172.30  consumer supports which are part of adult mental health projects 
172.31  approved under Laws 1997, chapter 203, article 7, section 25.  
172.32  For children, increased revenue may also be used for respite 
172.33  care and nonresidential individualized rehabilitation services 
172.34  as defined in section 245.492, subdivisions 17 and 23.  
172.35  "Increased revenue" has the meaning given in Minnesota Rules, 
172.36  part 9520.0903, subpart 3.  
173.1      (i) Notwithstanding section 256B.19, subdivision 1, the 
173.2   nonfederal share of costs for mental health case management 
173.3   shall be provided by the recipient's county of responsibility, 
173.4   as defined in sections 256G.01 to 256G.12, from sources other 
173.5   than federal funds or funds used to match other federal funds.  
173.6      (j) The commissioner may suspend, reduce, or terminate the 
173.7   reimbursement to a provider that does not meet the reporting or 
173.8   other requirements of this section.  The county of 
173.9   responsibility, as defined in sections 256G.01 to 256G.12, is 
173.10  responsible for any federal disallowances.  The county may share 
173.11  this responsibility with its contracted vendors.  
173.12     (k) The commissioner shall set aside a portion of the 
173.13  federal funds earned under this section to repay the special 
173.14  revenue maximization account under section 256.01, subdivision 
173.15  2, clause (15).  The repayment is limited to: 
173.16     (1) the costs of developing and implementing this section; 
173.17  and 
173.18     (2) programming the information systems. 
173.19     (l) Notwithstanding section 256.025, subdivision 2, 
173.20  payments to counties for case management expenditures under this 
173.21  section shall only be made from federal earnings from services 
173.22  provided under this section.  Payments to contracted vendors 
173.23  shall include both the federal earnings and the county share. 
173.24     (m) Notwithstanding section 256B.041, county payments for 
173.25  the cost of mental health case management services provided by 
173.26  county or state staff shall not be made to the state treasurer.  
173.27  For the purposes of mental health case management services 
173.28  provided by county or state staff under this section, the 
173.29  centralized disbursement of payments to counties under section 
173.30  256B.041 consists only of federal earnings from services 
173.31  provided under this section. 
173.32     (n) Case management services under this subdivision do not 
173.33  include therapy, treatment, legal, or outreach services. 
173.34     (o) If the recipient is a resident of a nursing facility, 
173.35  intermediate care facility, or hospital, and the recipient's 
173.36  institutional care is paid by medical assistance, payment for 
174.1   case management services under this subdivision is limited to 
174.2   the last 30 180 days of the recipient's residency in that 
174.3   facility and may not exceed more than two six months in a 
174.4   calendar year. 
174.5      (p) Payment for case management services under this 
174.6   subdivision shall not duplicate payments made under other 
174.7   program authorities for the same purpose. 
174.8      (q) By July 1, 2000, the commissioner shall evaluate the 
174.9   effectiveness of the changes required by this section, including 
174.10  changes in number of persons receiving mental health case 
174.11  management, changes in hours of service per person, and changes 
174.12  in caseload size. 
174.13     (r) For each calendar year beginning with the calendar year 
174.14  2001, the annualized amount of state funds for each county 
174.15  determined under paragraph (g) shall be adjusted by the county's 
174.16  percentage change in the average number of clients per month who 
174.17  received case management under this section during the fiscal 
174.18  year that ended six months prior to the calendar year in 
174.19  question, in comparison to the prior fiscal year. 
174.20     (s) For counties receiving the minimum allocation of $3,000 
174.21  or $5,000 described in paragraph (g), the adjustment in 
174.22  paragraph (r) shall be determined so that the county receives 
174.23  the higher of the following amounts: 
174.24     (1) a continuation of the minimum allocation in paragraph 
174.25  (g); or 
174.26     (2) an amount based on that county's average number of 
174.27  clients per month who received case management under this 
174.28  section during the fiscal year that ended six months prior to 
174.29  the calendar year in question, in comparison to the prior fiscal 
174.30  year, times the average statewide grant per person per month for 
174.31  counties not receiving the minimum allocation. 
174.32     (t) The adjustments in paragraphs (r) and (s) shall be 
174.33  calculated separately for children and adults. 
174.34     Sec. 18.  Minnesota Statutes 2000, section 256B.0625, is 
174.35  amended by adding a subdivision to read: 
174.36     Subd. 43.  [TARGETED CASE MANAGEMENT.] For purposes of 
175.1   subdivisions 43a to 43h, the following terms have the meanings 
175.2   given them: 
175.3      (1) "home care service recipients" means those individuals 
175.4   receiving the following services under section 256B.0627:  
175.5   skilled nursing visits, home health aide visits, private duty 
175.6   nursing, personal care assistants, or therapies provided through 
175.7   a home health agency; 
175.8      (2) "home care targeted case management" means the 
175.9   provision of targeted case management services for the purpose 
175.10  of assisting home care service recipients to gain access to 
175.11  needed services and supports so that they may remain in the 
175.12  community; 
175.13     (3) "institutions" means hospitals, consistent with Code of 
175.14  Federal Regulations, title 42, section 440.10; regional 
175.15  treatment center inpatient services, consistent with section 
175.16  245.474; nursing facilities; and intermediate care facilities 
175.17  for persons with mental retardation; 
175.18     (4) "relocation targeted case management" means the 
175.19  provision of targeted case management services for the purpose 
175.20  of assisting recipients to gain access to needed services and 
175.21  supports if they choose to move from an institution to the 
175.22  community.  Relocation targeted case management may be provided 
175.23  during the last 180 consecutive days of an eligible recipient's 
175.24  institutional stay; and 
175.25     (5) "targeted case management" means case management 
175.26  services provided to help recipients gain access to needed 
175.27  medical, social, educational, and other services and supports. 
175.28     Sec. 19.  Minnesota Statutes 2000, section 256B.0625, is 
175.29  amended by adding a subdivision to read: 
175.30     Subd. 43a.  [ELIGIBILITY.] The following persons are 
175.31  eligible for relocation targeted case management or home 
175.32  care-targeted case management: 
175.33     (1) medical assistance eligible persons residing in 
175.34  institutions who choose to move into the community are eligible 
175.35  for relocation targeted case management services; and 
175.36     (2) medical assistance eligible persons receiving home care 
176.1   services, who are not eligible for any other medical assistance 
176.2   reimbursable case management service, are eligible for home 
176.3   care-targeted case management services beginning January 1, 2003.
176.4      Sec. 20.  Minnesota Statutes 2000, section 256B.0625, is 
176.5   amended by adding a subdivision to read: 
176.6      Subd. 43b.  [RELOCATION TARGETED CASE MANAGEMENT PROVIDER 
176.7   QUALIFICATIONS.] The following qualifications and certification 
176.8   standards must be met by providers of relocation targeted case 
176.9   management: 
176.10     (a) The commissioner must certify each provider or 
176.11  relocation targeted case management before enrollment.  The 
176.12  certification process shall examine the provider's ability to 
176.13  meet the requirements in this subdivision and other federal and 
176.14  state requirements of this service.  A certified relocation 
176.15  targeted case management provider may subcontract with another 
176.16  provider to deliver relocation targeted case management 
176.17  services.  Subcontracted providers must demonstrate the ability 
176.18  to provide the services outlined in subdivision 43d. 
176.19     (b) A relocation targeted case management provider is an 
176.20  enrolled medical assistance provider who is determined by the 
176.21  commissioner to have all of the following characteristics: 
176.22     (1) the legal authority to provide public welfare under 
176.23  sections 393.01, subdivision 7; and 393.07; or a federally 
176.24  recognized Indian tribe; 
176.25     (2) the demonstrated capacity and experience to provide the 
176.26  components of case management to coordinate and link community 
176.27  resources needed by the eligible population; 
176.28     (3) the administrative capacity and experience to serve the 
176.29  target population for whom it will provide services and ensure 
176.30  quality of services under state and federal requirements; 
176.31     (4) the legal authority to provide complete investigative 
176.32  and protective services under section 626.556, subdivision 10; 
176.33  and child welfare and foster care services under section 393.07, 
176.34  subdivisions 1 and 2; or a federally recognized Indian tribe; 
176.35     (5) a financial management system that provides accurate 
176.36  documentation of services and costs under state and federal 
177.1   requirements; and 
177.2      (6) the capacity to document and maintain individual case 
177.3   records under state and federal requirements. 
177.4   A provider of targeted case management under subdivision 20 may 
177.5   be deemed a certified provider of relocation targeted case 
177.6   management. 
177.7      Sec. 21.  Minnesota Statutes 2000, section 256B.0625, is 
177.8   amended by adding a subdivision to read: 
177.9      Subd. 43c.  [HOME CARE TARGETED CASE MANAGEMENT PROVIDER 
177.10  QUALIFICATIONS.] The following qualifications and certification 
177.11  standards must be met by providers of home care targeted case 
177.12  management. 
177.13     (a) The commissioner must certify each provider of home 
177.14  care targeted case management before enrollment.  The 
177.15  certification process shall examine the provider's ability to 
177.16  meet the requirements in this subdivision and other state and 
177.17  federal requirements of this service. 
177.18     (b) A home care targeted case management provider is an 
177.19  enrolled medical assistance provider who has a minimum of a 
177.20  bachelor's degree, a license in a health or human services 
177.21  field, and is determined by the commissioner to have all of the 
177.22  following characteristics: 
177.23     (1) the demonstrated capacity and experience to provide the 
177.24  components of case management to coordinate and link community 
177.25  resources needed by the eligible population; 
177.26     (2) the administrative capacity and experience to serve the 
177.27  target population for whom it will provide services and ensure 
177.28  quality of services under state and federal requirements; 
177.29     (3) a financial management system that provides accurate 
177.30  documentation of services and costs under state and federal 
177.31  requirements; 
177.32     (4) the capacity to document and maintain individual case 
177.33  records under state and federal requirements; and 
177.34     (5) the capacity to coordinate with county administrative 
177.35  functions. 
177.36     Sec. 22.  Minnesota Statutes 2000, section 256B.0625, is 
178.1   amended by adding a subdivision to read: 
178.2      Subd. 43d.  [ELIGIBLE SERVICES.] Services eligible for 
178.3   medical assistance reimbursement as targeted case management 
178.4   include: 
178.5      (1) assessment of the recipient's need for targeted case 
178.6   management services; 
178.7      (2) development, completion, and regular review of a 
178.8   written individual service plan, which is based upon the 
178.9   assessment of the recipient's needs and choices, and which will 
178.10  ensure access to medical, social, educational, and other related 
178.11  services and supports; 
178.12     (3) routine contact or communication with the recipient, 
178.13  the recipient's family, primary caregiver, legal representative, 
178.14  substitute care provider, service providers, or other relevant 
178.15  persons identified as necessary to the development or 
178.16  implementation of the goals of the individual service plan; 
178.17     (4) coordinating referrals for, and the provision of, case 
178.18  management services for the recipient with appropriate service 
178.19  providers, consistent with section 1902(a)(23) of the Social 
178.20  Security Act; 
178.21     (5) coordinating and monitoring the overall service 
178.22  delivery to ensure quality of services, appropriateness, and 
178.23  continued need; 
178.24     (6) completing and maintaining necessary documentation that 
178.25  supports and verifies the activities in this subdivision; 
178.26     (7) traveling to conduct a visit with the recipient or 
178.27  other relevant person necessary to develop or implement the 
178.28  goals of the individual service plan; and 
178.29     (8) coordinating with the institution discharge planner in 
178.30  the 180-day period before the recipient's discharge. 
178.31     Sec. 23.  Minnesota Statutes 2000, section 256B.0625, is 
178.32  amended by adding a subdivision to read: 
178.33     Subd. 43e.  [TIMELINES.] The following timelines must be 
178.34  met for assigning a case manager: 
178.35     (1) for relocation targeted case management, an eligible 
178.36  recipient must be assigned a case manager who visits the person 
179.1   within 20 working days of requesting one from their county of 
179.2   financial responsibility as determined under chapter 256G.  If a 
179.3   county agency does not provide case management services as 
179.4   required, the recipient may, after written notice to the county 
179.5   agency, obtain targeted-relocation case management services from 
179.6   a home care targeted case management provider under this 
179.7   subdivision; and 
179.8      (2) for home care targeted case management, an eligible 
179.9   recipient must be assigned a case manager within 20 working days 
179.10  of requesting one from a home care targeted case management 
179.11  provider, as defined in subdivision 43c. 
179.12     Sec. 24.  Minnesota Statutes 2000, section 256B.0625, is 
179.13  amended by adding a subdivision to read: 
179.14     Subd. 43f.  [EVALUATION.] The commissioner shall evaluate 
179.15  the delivery of targeted case management, including, but not 
179.16  limited to, access to case management services, consumer 
179.17  satisfaction with case management services, and quality of case 
179.18  management services. 
179.19     Sec. 25.  Minnesota Statutes 2000, section 256B.0625, is 
179.20  amended by adding a subdivision to read: 
179.21     Subd. 43g.  [CONTACT DOCUMENTATION.] The case manager must 
179.22  document each face-to-face and telephone contact with the 
179.23  recipient and others involved in the recipient's individual 
179.24  service plan. 
179.25     Sec. 26.  Minnesota Statutes 2000, section 256B.0625, is 
179.26  amended by adding a subdivision to read: 
179.27     Subd. 43h.  [PAYMENT RATES.] The commissioner shall set 
179.28  payment rates for targeted case management under this 
179.29  subdivision.  Case managers may bill according to the following 
179.30  criteria: 
179.31     (1) for relocation targeted case management, case managers 
179.32  may bill for direct case management activities, including 
179.33  face-to-face and telephone contacts, in the 180 days preceding 
179.34  an eligible recipient's discharge from an institution; 
179.35     (2) for home care targeted case management, case managers 
179.36  may bill for direct case management activities, including 
180.1   face-to-face and telephone contacts; and 
180.2      (3) billings for targeted case management services under 
180.3   this subdivision shall not duplicate payments made under other 
180.4   program authorities for the same purpose. 
180.5      Sec. 27.  Minnesota Statutes 2000, section 256B.0627, 
180.6   subdivision 1, is amended to read: 
180.7      Subdivision 1.  [DEFINITION.] (a) "Activities of daily 
180.8   living" includes eating, toileting, grooming, dressing, bathing, 
180.9   transferring, mobility, and positioning.  
180.10     (b) "Assessment" means a review and evaluation of a 
180.11  recipient's need for home care services conducted in person.  
180.12  Assessments for private duty nursing shall be conducted by a 
180.13  registered private duty nurse.  Assessments for home health 
180.14  agency services shall be conducted by a home health agency 
180.15  nurse.  Assessments for personal care assistant services shall 
180.16  be conducted by the county public health nurse or a certified 
180.17  public health nurse under contract with the county.  A 
180.18  face-to-face assessment must include:  documentation of health 
180.19  status, determination of need, evaluation of service 
180.20  effectiveness, identification of appropriate services, service 
180.21  plan development or modification, coordination of services, 
180.22  referrals and follow-up to appropriate payers and community 
180.23  resources, completion of required reports, recommendation of 
180.24  service authorization, and consumer education.  Once the need 
180.25  for personal care assistant services is determined under this 
180.26  section, the county public health nurse or certified public 
180.27  health nurse under contract with the county is responsible for 
180.28  communicating this recommendation to the commissioner and the 
180.29  recipient.  A face-to-face assessment for personal 
180.30  care assistant services is conducted on those recipients who 
180.31  have never had a county public health nurse assessment.  A 
180.32  face-to-face assessment must occur at least annually or when 
180.33  there is a significant change in the recipient's condition or 
180.34  when there is a change in the need for personal care assistant 
180.35  services.  A service update may substitute for the annual 
180.36  face-to-face assessment when there is not a significant change 
181.1   in recipient condition or a change in the need for personal care 
181.2   assistant service.  A service update or review for temporary 
181.3   increase includes a review of initial baseline data, evaluation 
181.4   of service effectiveness, redetermination of service need, 
181.5   modification of service plan and appropriate referrals, update 
181.6   of initial forms, obtaining service authorization, and on going 
181.7   consumer education.  Assessments for medical assistance home 
181.8   care services for mental retardation or related conditions and 
181.9   alternative care services for developmentally disabled home and 
181.10  community-based waivered recipients may be conducted by the 
181.11  county public health nurse to ensure coordination and avoid 
181.12  duplication.  Assessments must be completed on forms provided by 
181.13  the commissioner within 30 days of a request for home care 
181.14  services by a recipient or responsible party. 
181.15     (b) (c) "Care plan" means a written description of personal 
181.16  care assistant services developed by the qualified 
181.17  professional or the recipient's physician with the recipient or 
181.18  responsible party to be used by the personal care assistant with 
181.19  a copy provided to the recipient or responsible party. 
181.20     (d) "Complex and regular private duty nursing care" means: 
181.21     (1) complex care is private duty nursing provided to 
181.22  recipients who are ventilator dependent or for whom a physician 
181.23  has certified that were it not for private duty nursing the 
181.24  recipient would meet the criteria for inpatient hospital 
181.25  intensive care unit (ICU) level of care; and 
181.26     (2) regular care is private duty nursing provided to all 
181.27  other recipients. 
181.28     (e) "Health-related functions" means functions that can be 
181.29  delegated or assigned by a licensed health care professional 
181.30  under state law to be performed by a personal care attendant. 
181.31     (c) (f) "Home care services" means a health service, 
181.32  determined by the commissioner as medically necessary, that is 
181.33  ordered by a physician and documented in a service plan that is 
181.34  reviewed by the physician at least once every 62 60 days for the 
181.35  provision of home health services, or private duty nursing, or 
181.36  at least once every 365 days for personal care.  Home care 
182.1   services are provided to the recipient at the recipient's 
182.2   residence that is a place other than a hospital or long-term 
182.3   care facility or as specified in section 256B.0625.  
182.4      (g) "Instrumental activities of daily living" includes meal 
182.5   planning and preparation, managing finances, shopping for food, 
182.6   clothing, and other essential items, performing essential 
182.7   household chores, communication by telephone and other media, 
182.8   and getting around and participating in the community. 
182.9      (d) (h) "Medically necessary" has the meaning given in 
182.10  Minnesota Rules, parts 9505.0170 to 9505.0475.  
182.11     (e) (i) "Personal care assistant" means a person who:  
182.12     (1) is at least 18 years old, except for persons 16 to 18 
182.13  years of age who participated in a related school-based job 
182.14  training program or have completed a certified home health aide 
182.15  competency evaluation; 
182.16     (2) is able to effectively communicate with the recipient 
182.17  and personal care provider organization; 
182.18     (3) effective July 1, 1996, has completed one of the 
182.19  training requirements as specified in Minnesota Rules, part 
182.20  9505.0335, subpart 3, items A to D; 
182.21     (4) has the ability to, and provides covered personal 
182.22  care assistant services according to the recipient's care plan, 
182.23  responds appropriately to recipient needs, and reports changes 
182.24  in the recipient's condition to the supervising qualified 
182.25  professional or physician; 
182.26     (5) is not a consumer of personal care assistant services; 
182.27  and 
182.28     (6) is subject to criminal background checks and procedures 
182.29  specified in section 245A.04.  
182.30     (f) (j) "Personal care provider organization" means an 
182.31  organization enrolled to provide personal care assistant 
182.32  services under the medical assistance program that complies with 
182.33  the following:  (1) owners who have a five percent interest or 
182.34  more, and managerial officials are subject to a background study 
182.35  as provided in section 245A.04.  This applies to currently 
182.36  enrolled personal care provider organizations and those agencies 
183.1   seeking enrollment as a personal care provider organization.  An 
183.2   organization will be barred from enrollment if an owner or 
183.3   managerial official of the organization has been convicted of a 
183.4   crime specified in section 245A.04, or a comparable crime in 
183.5   another jurisdiction, unless the owner or managerial official 
183.6   meets the reconsideration criteria specified in section 245A.04; 
183.7   (2) the organization must maintain a surety bond and liability 
183.8   insurance throughout the duration of enrollment and provides 
183.9   proof thereof.  The insurer must notify the department of human 
183.10  services of the cancellation or lapse of policy; and (3) the 
183.11  organization must maintain documentation of services as 
183.12  specified in Minnesota Rules, part 9505.2175, subpart 7, as well 
183.13  as evidence of compliance with personal care assistant training 
183.14  requirements. 
183.15     (g) (k) "Responsible party" means an individual residing 
183.16  with a recipient of personal care assistant services who is 
183.17  capable of providing the supportive care necessary to assist the 
183.18  recipient to live in the community, is at least 18 years old, 
183.19  and is not a personal care assistant.  Responsible parties who 
183.20  are parents of minors or guardians of minors or incapacitated 
183.21  persons may delegate the responsibility to another adult during 
183.22  a temporary absence of at least 24 hours but not more than six 
183.23  months.  The person delegated as a responsible party must be 
183.24  able to meet the definition of responsible party, except that 
183.25  the delegated responsible party is required to reside with the 
183.26  recipient only while serving as the responsible party.  Foster 
183.27  care license holders may be designated the responsible party for 
183.28  residents of the foster care home if case management is provided 
183.29  as required in section 256B.0625, subdivision 19a.  For persons 
183.30  who, as of April 1, 1992, are sharing personal care assistant 
183.31  services in order to obtain the availability of 24-hour 
183.32  coverage, an employee of the personal care provider organization 
183.33  may be designated as the responsible party if case management is 
183.34  provided as required in section 256B.0625, subdivision 19a. 
183.35     (h) (l) "Service plan" means a written description of the 
183.36  services needed based on the assessment developed by the nurse 
184.1   who conducts the assessment together with the recipient or 
184.2   responsible party.  The service plan shall include a description 
184.3   of the covered home care services, frequency and duration of 
184.4   services, and expected outcomes and goals.  The recipient and 
184.5   the provider chosen by the recipient or responsible party must 
184.6   be given a copy of the completed service plan within 30 calendar 
184.7   days of the request for home care services by the recipient or 
184.8   responsible party. 
184.9      (i) (m) "Skilled nurse visits" are provided in a 
184.10  recipient's residence under a plan of care or service plan that 
184.11  specifies a level of care which the nurse is qualified to 
184.12  provide.  These services are: 
184.13     (1) nursing services according to the written plan of care 
184.14  or service plan and accepted standards of medical and nursing 
184.15  practice in accordance with chapter 148; 
184.16     (2) services which due to the recipient's medical condition 
184.17  may only be safely and effectively provided by a registered 
184.18  nurse or a licensed practical nurse; 
184.19     (3) assessments performed only by a registered nurse; and 
184.20     (4) teaching and training the recipient, the recipient's 
184.21  family, or other caregivers requiring the skills of a registered 
184.22  nurse or licensed practical nurse. 
184.23     (n) "Telehomecare" means the use of telecommunications 
184.24  technology by a home health care professional to deliver home 
184.25  health care services, within the professional's scope of 
184.26  practice, to a patient located at a site other than the site 
184.27  where the practitioner is located. 
184.28     [EFFECTIVE DATE.] Paragraph (d) of this section is 
184.29  effective January 1, 2003. 
184.30     Sec. 28.  Minnesota Statutes 2000, section 256B.0627, 
184.31  subdivision 2, is amended to read: 
184.32     Subd. 2.  [SERVICES COVERED.] Home care services covered 
184.33  under this section include:  
184.34     (1) nursing services under section 256B.0625, subdivision 
184.35  6a; 
184.36     (2) private duty nursing services under section 256B.0625, 
185.1   subdivision 7; 
185.2      (3) home health aide services under section 256B.0625, 
185.3   subdivision 6a; 
185.4      (4) personal care assistant services under section 
185.5   256B.0625, subdivision 19a; 
185.6      (5) supervision of personal care assistant services 
185.7   provided by a qualified professional under section 256B.0625, 
185.8   subdivision 19a; 
185.9      (6) consulting qualified professional of personal care 
185.10  assistant services under the fiscal agent intermediary option as 
185.11  specified in subdivision 10; 
185.12     (7) face-to-face assessments by county public health nurses 
185.13  for services under section 256B.0625, subdivision 19a; and 
185.14     (8) service updates and review of temporary increases for 
185.15  personal care assistant services by the county public health 
185.16  nurse for services under section 256B.0625, subdivision 19a. 
185.17     Sec. 29.  Minnesota Statutes 2000, section 256B.0627, 
185.18  subdivision 4, is amended to read: 
185.19     Subd. 4.  [PERSONAL CARE ASSISTANT SERVICES.] (a) The 
185.20  personal care assistant services that are eligible for payment 
185.21  are the following: services and supports furnished to an 
185.22  individual, as needed, to assist in accomplishing activities of 
185.23  daily living; instrumental activities of daily living; 
185.24  health-related functions through hands-on assistance, 
185.25  supervision, and cueing; and redirection and intervention for 
185.26  behavior including observation and monitoring.  
185.27     (b) Payment for services will be made within the limits 
185.28  approved using the prior authorized process established in 
185.29  subdivision 5. 
185.30     (c) The amount and type of services authorized shall be 
185.31  based on an assessment of the recipient's needs in these areas: 
185.32     (1) bowel and bladder care; 
185.33     (2) skin care to maintain the health of the skin; 
185.34     (3) repetitive maintenance range of motion, muscle 
185.35  strengthening exercises, and other tasks specific to maintaining 
185.36  a recipient's optimal level of function; 
186.1      (4) respiratory assistance; 
186.2      (5) transfers and ambulation; 
186.3      (6) bathing, grooming, and hairwashing necessary for 
186.4   personal hygiene; 
186.5      (7) turning and positioning; 
186.6      (8) assistance with furnishing medication that is 
186.7   self-administered; 
186.8      (9) application and maintenance of prosthetics and 
186.9   orthotics; 
186.10     (10) cleaning medical equipment; 
186.11     (11) dressing or undressing; 
186.12     (12) assistance with eating and meal preparation and 
186.13  necessary grocery shopping; 
186.14     (13) accompanying a recipient to obtain medical diagnosis 
186.15  or treatment; 
186.16     (14) assisting, monitoring, or prompting the recipient to 
186.17  complete the services in clauses (1) to (13); 
186.18     (15) redirection, monitoring, and observation that are 
186.19  medically necessary and an integral part of completing the 
186.20  personal care assistant services described in clauses (1) to 
186.21  (14); 
186.22     (16) redirection and intervention for behavior, including 
186.23  observation and monitoring; 
186.24     (17) interventions for seizure disorders, including 
186.25  monitoring and observation if the recipient has had a seizure 
186.26  that requires intervention within the past three months; 
186.27     (18) tracheostomy suctioning using a clean procedure if the 
186.28  procedure is properly delegated by a registered nurse.  Before 
186.29  this procedure can be delegated to a personal care assistant, a 
186.30  registered nurse must determine that the tracheostomy suctioning 
186.31  can be accomplished utilizing a clean rather than a sterile 
186.32  procedure and must ensure that the personal care assistant has 
186.33  been taught the proper procedure; and 
186.34     (19) incidental household services that are an integral 
186.35  part of a personal care service described in clauses (1) to (18).
186.36  For purposes of this subdivision, monitoring and observation 
187.1   means watching for outward visible signs that are likely to 
187.2   occur and for which there is a covered personal care service or 
187.3   an appropriate personal care intervention.  For purposes of this 
187.4   subdivision, a clean procedure refers to a procedure that 
187.5   reduces the numbers of microorganisms or prevents or reduces the 
187.6   transmission of microorganisms from one person or place to 
187.7   another.  A clean procedure may be used beginning 14 days after 
187.8   insertion. 
187.9      (b) (d) The personal care assistant services that are not 
187.10  eligible for payment are the following:  
187.11     (1) services not ordered by the physician; 
187.12     (2) assessments by personal care assistant provider 
187.13  organizations or by independently enrolled registered nurses; 
187.14     (3) services that are not in the service plan; 
187.15     (4) services provided by the recipient's spouse, legal 
187.16  guardian for an adult or child recipient, or parent of a 
187.17  recipient under age 18; 
187.18     (5) services provided by a foster care provider of a 
187.19  recipient who cannot direct the recipient's own care, unless 
187.20  monitored by a county or state case manager under section 
187.21  256B.0625, subdivision 19a; 
187.22     (6) services provided by the residential or program license 
187.23  holder in a residence for more than four persons; 
187.24     (7) services that are the responsibility of a residential 
187.25  or program license holder under the terms of a service agreement 
187.26  and administrative rules; 
187.27     (8) sterile procedures; 
187.28     (9) injections of fluids into veins, muscles, or skin; 
187.29     (10) (9) services provided by parents of adult recipients, 
187.30  adult children, or siblings of the recipient, unless these 
187.31  relatives meet one of the following hardship criteria and the 
187.32  commissioner waives this requirement: 
187.33     (i) the relative resigns from a part-time or full-time job 
187.34  to provide personal care for the recipient; 
187.35     (ii) the relative goes from a full-time to a part-time job 
187.36  with less compensation to provide personal care for the 
188.1   recipient; 
188.2      (iii) the relative takes a leave of absence without pay to 
188.3   provide personal care for the recipient; 
188.4      (iv) the relative incurs substantial expenses by providing 
188.5   personal care for the recipient; or 
188.6      (v) because of labor conditions, special language needs, or 
188.7   intermittent hours of care needed, the relative is needed in 
188.8   order to provide an adequate number of qualified personal care 
188.9   assistants to meet the medical needs of the recipient; 
188.10     (11) (10) homemaker services that are not an integral part 
188.11  of a personal care assistant services; 
188.12     (12) (11) home maintenance, or chore services; 
188.13     (13) (12) services not specified under paragraph (a); and 
188.14     (14) (13) services not authorized by the commissioner or 
188.15  the commissioner's designee. 
188.16     (e) The recipient or responsible party may choose to 
188.17  supervise the personal care assistant or to have a qualified 
188.18  professional, as defined in section 256B.0625, subdivision 19c, 
188.19  provide the supervision.  As required under section 256B.0625, 
188.20  subdivision 19c, the county public health nurse, as a part of 
188.21  the assessment, will consult with the recipient or responsible 
188.22  party to identify the most appropriate person to provide 
188.23  supervision of the personal care assistant.  Health-related 
188.24  delegated tasks performed by the personal care assistant will be 
188.25  under the supervision of a qualified professional or the 
188.26  direction of the recipient's physician.  If the recipient has a 
188.27  qualified professional, Minnesota Rules, part 9505.0335, subpart 
188.28  4, applies. 
188.29     Sec. 30.  Minnesota Statutes 2000, section 256B.0627, 
188.30  subdivision 5, is amended to read: 
188.31     Subd. 5.  [LIMITATION ON PAYMENTS.] Medical assistance 
188.32  payments for home care services shall be limited according to 
188.33  this subdivision.  
188.34     (a)  [LIMITS ON SERVICES WITHOUT PRIOR AUTHORIZATION.] A 
188.35  recipient may receive the following home care services during a 
188.36  calendar year: 
189.1      (1) up to two face-to-face assessments to determine a 
189.2   recipient's need for personal care assistant services; 
189.3      (2) one service update done to determine a recipient's need 
189.4   for personal care assistant services; and 
189.5      (3) up to five nine skilled nurse visits.  
189.6      (b)  [PRIOR AUTHORIZATION; EXCEPTIONS.] All home care 
189.7   services above the limits in paragraph (a) must receive the 
189.8   commissioner's prior authorization, except when: 
189.9      (1) the home care services were required to treat an 
189.10  emergency medical condition that if not immediately treated 
189.11  could cause a recipient serious physical or mental disability, 
189.12  continuation of severe pain, or death.  The provider must 
189.13  request retroactive authorization no later than five working 
189.14  days after giving the initial service.  The provider must be 
189.15  able to substantiate the emergency by documentation such as 
189.16  reports, notes, and admission or discharge histories; 
189.17     (2) the home care services were provided on or after the 
189.18  date on which the recipient's eligibility began, but before the 
189.19  date on which the recipient was notified that the case was 
189.20  opened.  Authorization will be considered if the request is 
189.21  submitted by the provider within 20 working days of the date the 
189.22  recipient was notified that the case was opened; 
189.23     (3) a third-party payor for home care services has denied 
189.24  or adjusted a payment.  Authorization requests must be submitted 
189.25  by the provider within 20 working days of the notice of denial 
189.26  or adjustment.  A copy of the notice must be included with the 
189.27  request; 
189.28     (4) the commissioner has determined that a county or state 
189.29  human services agency has made an error; or 
189.30     (5) the professional nurse determines an immediate need for 
189.31  up to 40 skilled nursing or home health aide visits per calendar 
189.32  year and submits a request for authorization within 20 working 
189.33  days of the initial service date, and medical assistance is 
189.34  determined to be the appropriate payer. 
189.35     (c)  [RETROACTIVE AUTHORIZATION.] A request for retroactive 
189.36  authorization will be evaluated according to the same criteria 
190.1   applied to prior authorization requests.  
190.2      (d)  [ASSESSMENT AND SERVICE PLAN.] Assessments under 
190.3   section 256B.0627, subdivision 1, paragraph (a), shall be 
190.4   conducted initially, and at least annually thereafter, in person 
190.5   with the recipient and result in a completed service plan using 
190.6   forms specified by the commissioner.  Within 30 days of 
190.7   recipient or responsible party request for home care services, 
190.8   the assessment, the service plan, and other information 
190.9   necessary to determine medical necessity such as diagnostic or 
190.10  testing information, social or medical histories, and hospital 
190.11  or facility discharge summaries shall be submitted to the 
190.12  commissioner.  For personal care assistant services: 
190.13     (1) The amount and type of service authorized based upon 
190.14  the assessment and service plan will follow the recipient if the 
190.15  recipient chooses to change providers.  
190.16     (2) If the recipient's medical need changes, the 
190.17  recipient's provider may assess the need for a change in service 
190.18  authorization and request the change from the county public 
190.19  health nurse.  Within 30 days of the request, the public health 
190.20  nurse will determine whether to request the change in services 
190.21  based upon the provider assessment, or conduct a home visit to 
190.22  assess the need and determine whether the change is appropriate. 
190.23     (3) To continue to receive personal care assistant services 
190.24  after the first year, the recipient or the responsible party, in 
190.25  conjunction with the public health nurse, may complete a service 
190.26  update on forms developed by the commissioner according to 
190.27  criteria and procedures in subdivision 1.  
190.28     (e)  [PRIOR AUTHORIZATION.] The commissioner, or the 
190.29  commissioner's designee, shall review the assessment, service 
190.30  update, request for temporary services, service plan, and any 
190.31  additional information that is submitted.  The commissioner 
190.32  shall, within 30 days after receiving a complete request, 
190.33  assessment, and service plan, authorize home care services as 
190.34  follows:  
190.35     (1)  [HOME HEALTH SERVICES.] All home health services 
190.36  provided by a licensed nurse or a home health aide must be prior 
191.1   authorized by the commissioner or the commissioner's designee.  
191.2   Prior authorization must be based on medical necessity and 
191.3   cost-effectiveness when compared with other care options.  When 
191.4   home health services are used in combination with personal care 
191.5   and private duty nursing, the cost of all home care services 
191.6   shall be considered for cost-effectiveness.  The commissioner 
191.7   shall limit nurse and home health aide visits to no more than 
191.8   one visit each per day.  The commissioner, or the commissioner's 
191.9   designee, may authorize up to two skilled nurse visits per day. 
191.10     (2)  [PERSONAL CARE ASSISTANT SERVICES.] (i) All personal 
191.11  care assistant services and supervision by a qualified 
191.12  professional, if requested by the recipient, must be prior 
191.13  authorized by the commissioner or the commissioner's designee 
191.14  except for the assessments established in paragraph (a).  The 
191.15  amount of personal care assistant services authorized must be 
191.16  based on the recipient's home care rating.  A child may not be 
191.17  found to be dependent in an activity of daily living if because 
191.18  of the child's age an adult would either perform the activity 
191.19  for the child or assist the child with the activity and the 
191.20  amount of assistance needed is similar to the assistance 
191.21  appropriate for a typical child of the same age.  Based on 
191.22  medical necessity, the commissioner may authorize: 
191.23     (A) up to two times the average number of direct care hours 
191.24  provided in nursing facilities for the recipient's comparable 
191.25  case mix level; or 
191.26     (B) up to three times the average number of direct care 
191.27  hours provided in nursing facilities for recipients who have 
191.28  complex medical needs or are dependent in at least seven 
191.29  activities of daily living and need physical assistance with 
191.30  eating or have a neurological diagnosis; or 
191.31     (C) up to 60 percent of the average reimbursement rate, as 
191.32  of July 1, 1991, for care provided in a regional treatment 
191.33  center for recipients who have Level I behavior, plus any 
191.34  inflation adjustment as provided by the legislature for personal 
191.35  care service; or 
191.36     (D) up to the amount the commissioner would pay, as of July 
192.1   1, 1991, plus any inflation adjustment provided for home care 
192.2   services, for care provided in a regional treatment center for 
192.3   recipients referred to the commissioner by a regional treatment 
192.4   center preadmission evaluation team.  For purposes of this 
192.5   clause, home care services means all services provided in the 
192.6   home or community that would be included in the payment to a 
192.7   regional treatment center; or 
192.8      (E) up to the amount medical assistance would reimburse for 
192.9   facility care for recipients referred to the commissioner by a 
192.10  preadmission screening team established under section 256B.0911 
192.11  or 256B.092; and 
192.12     (F) a reasonable amount of time for the provision of 
192.13  supervision by a qualified professional of personal 
192.14  care assistant services, if a qualified professional is 
192.15  requested by the recipient or responsible party.  
192.16     (ii) The number of direct care hours shall be determined 
192.17  according to the annual cost report submitted to the department 
192.18  by nursing facilities.  The average number of direct care hours, 
192.19  as established by May 1, 1992, shall be calculated and 
192.20  incorporated into the home care limits on July 1, 1992.  These 
192.21  limits shall be calculated to the nearest quarter hour. 
192.22     (iii) The home care rating shall be determined by the 
192.23  commissioner or the commissioner's designee based on information 
192.24  submitted to the commissioner by the county public health nurse 
192.25  on forms specified by the commissioner.  The home care rating 
192.26  shall be a combination of current assessment tools developed 
192.27  under sections 256B.0911 and 256B.501 with an addition for 
192.28  seizure activity that will assess the frequency and severity of 
192.29  seizure activity and with adjustments, additions, and 
192.30  clarifications that are necessary to reflect the needs and 
192.31  conditions of recipients who need home care including children 
192.32  and adults under 65 years of age.  The commissioner shall 
192.33  establish these forms and protocols under this section and shall 
192.34  use an advisory group, including representatives of recipients, 
192.35  providers, and counties, for consultation in establishing and 
192.36  revising the forms and protocols. 
193.1      (iv) A recipient shall qualify as having complex medical 
193.2   needs if the care required is difficult to perform and because 
193.3   of recipient's medical condition requires more time than 
193.4   community-based standards allow or requires more skill than 
193.5   would ordinarily be required and the recipient needs or has one 
193.6   or more of the following: 
193.7      (A) daily tube feedings; 
193.8      (B) daily parenteral therapy; 
193.9      (C) wound or decubiti care; 
193.10     (D) postural drainage, percussion, nebulizer treatments, 
193.11  suctioning, tracheotomy care, oxygen, mechanical ventilation; 
193.12     (E) catheterization; 
193.13     (F) ostomy care; 
193.14     (G) quadriplegia; or 
193.15     (H) other comparable medical conditions or treatments the 
193.16  commissioner determines would otherwise require institutional 
193.17  care.  
193.18     (v) A recipient shall qualify as having Level I behavior if 
193.19  there is reasonable supporting evidence that the recipient 
193.20  exhibits, or that without supervision, observation, or 
193.21  redirection would exhibit, one or more of the following 
193.22  behaviors that cause, or have the potential to cause: 
193.23     (A) injury to the recipient's own body; 
193.24     (B) physical injury to other people; or 
193.25     (C) destruction of property. 
193.26     (vi) Time authorized for personal care relating to Level I 
193.27  behavior in subclause (v), items (A) to (C), shall be based on 
193.28  the predictability, frequency, and amount of intervention 
193.29  required. 
193.30     (vii) A recipient shall qualify as having Level II behavior 
193.31  if the recipient exhibits on a daily basis one or more of the 
193.32  following behaviors that interfere with the completion of 
193.33  personal care assistant services under subdivision 4, paragraph 
193.34  (a): 
193.35     (A) unusual or repetitive habits; 
193.36     (B) withdrawn behavior; or 
194.1      (C) offensive behavior. 
194.2      (viii) A recipient with a home care rating of Level II 
194.3   behavior in subclause (vii), items (A) to (C), shall be rated as 
194.4   comparable to a recipient with complex medical needs under 
194.5   subclause (iv).  If a recipient has both complex medical needs 
194.6   and Level II behavior, the home care rating shall be the next 
194.7   complex category up to the maximum rating under subclause (i), 
194.8   item (B). 
194.9      (3)  [PRIVATE DUTY NURSING SERVICES.] All private duty 
194.10  nursing services shall be prior authorized by the commissioner 
194.11  or the commissioner's designee.  Prior authorization for private 
194.12  duty nursing services shall be based on medical necessity and 
194.13  cost-effectiveness when compared with alternative care options.  
194.14  The commissioner may authorize medically necessary private duty 
194.15  nursing services in quarter-hour units when: 
194.16     (i) the recipient requires more individual and continuous 
194.17  care than can be provided during a nurse visit; or 
194.18     (ii) the cares are outside of the scope of services that 
194.19  can be provided by a home health aide or personal care assistant.
194.20     The commissioner may authorize: 
194.21     (A) up to two times the average amount of direct care hours 
194.22  provided in nursing facilities statewide for case mix 
194.23  classification "K" as established by the annual cost report 
194.24  submitted to the department by nursing facilities in May 1992; 
194.25     (B) private duty nursing in combination with other home 
194.26  care services up to the total cost allowed under clause (2); 
194.27     (C) up to 16 hours per day if the recipient requires more 
194.28  nursing than the maximum number of direct care hours as 
194.29  established in item (A) and the recipient meets the hospital 
194.30  admission criteria established under Minnesota Rules, parts 
194.31  9505.0500 9505.0501 to 9505.0540.  
194.32     The commissioner may authorize up to 16 hours per day of 
194.33  medically necessary private duty nursing services or up to 24 
194.34  hours per day of medically necessary private duty nursing 
194.35  services until such time as the commissioner is able to make a 
194.36  determination of eligibility for recipients who are 
195.1   cooperatively applying for home care services under the 
195.2   community alternative care program developed under section 
195.3   256B.49, or until it is determined by the appropriate regulatory 
195.4   agency that a health benefit plan is or is not required to pay 
195.5   for appropriate medically necessary health care services.  
195.6   Recipients or their representatives must cooperatively assist 
195.7   the commissioner in obtaining this determination.  Recipients 
195.8   who are eligible for the community alternative care program may 
195.9   not receive more hours of nursing under this section than would 
195.10  otherwise be authorized under section 256B.49.  
195.11     Beginning January 1, 2003, private duty nursing services 
195.12  shall be authorized for complex and regular care according to 
195.13  section 256B.0627. 
195.14     (4)  [VENTILATOR-DEPENDENT RECIPIENTS.] If the recipient is 
195.15  ventilator-dependent, the monthly medical assistance 
195.16  authorization for home care services shall not exceed what the 
195.17  commissioner would pay for care at the highest cost hospital 
195.18  designated as a long-term hospital under the Medicare program.  
195.19  For purposes of this clause, home care services means all 
195.20  services provided in the home that would be included in the 
195.21  payment for care at the long-term hospital.  
195.22  "Ventilator-dependent" means an individual who receives 
195.23  mechanical ventilation for life support at least six hours per 
195.24  day and is expected to be or has been dependent for at least 30 
195.25  consecutive days.  
195.26     (f)  [PRIOR AUTHORIZATION; TIME LIMITS.] The commissioner 
195.27  or the commissioner's designee shall determine the time period 
195.28  for which a prior authorization shall be effective.  If the 
195.29  recipient continues to require home care services beyond the 
195.30  duration of the prior authorization, the home care provider must 
195.31  request a new prior authorization.  Under no circumstances, 
195.32  other than the exceptions in paragraph (b), shall a prior 
195.33  authorization be valid prior to the date the commissioner 
195.34  receives the request or for more than 12 months.  A recipient 
195.35  who appeals a reduction in previously authorized home care 
195.36  services may continue previously authorized services, other than 
196.1   temporary services under paragraph (h), pending an appeal under 
196.2   section 256.045.  The commissioner must provide a detailed 
196.3   explanation of why the authorized services are reduced in amount 
196.4   from those requested by the home care provider.  
196.5      (g)  [APPROVAL OF HOME CARE SERVICES.] The commissioner or 
196.6   the commissioner's designee shall determine the medical 
196.7   necessity of home care services, the level of caregiver 
196.8   according to subdivision 2, and the institutional comparison 
196.9   according to this subdivision, the cost-effectiveness of 
196.10  services, and the amount, scope, and duration of home care 
196.11  services reimbursable by medical assistance, based on the 
196.12  assessment, primary payer coverage determination information as 
196.13  required, the service plan, the recipient's age, the cost of 
196.14  services, the recipient's medical condition, and diagnosis or 
196.15  disability.  The commissioner may publish additional criteria 
196.16  for determining medical necessity according to section 256B.04. 
196.17     (h)  [PRIOR AUTHORIZATION REQUESTS; TEMPORARY SERVICES.] 
196.18  The agency nurse, the independently enrolled private duty nurse, 
196.19  or county public health nurse may request a temporary 
196.20  authorization for home care services by telephone.  The 
196.21  commissioner may approve a temporary level of home care services 
196.22  based on the assessment, and service or care plan information, 
196.23  and primary payer coverage determination information as required.
196.24  Authorization for a temporary level of home care services 
196.25  including nurse supervision is limited to the time specified by 
196.26  the commissioner, but shall not exceed 45 days, unless extended 
196.27  because the county public health nurse has not completed the 
196.28  required assessment and service plan, or the commissioner's 
196.29  determination has not been made.  The level of services 
196.30  authorized under this provision shall have no bearing on a 
196.31  future prior authorization. 
196.32     (i)  [PRIOR AUTHORIZATION REQUIRED IN FOSTER CARE SETTING.] 
196.33  Home care services provided in an adult or child foster care 
196.34  setting must receive prior authorization by the department 
196.35  according to the limits established in paragraph (a). 
196.36     The commissioner may not authorize: 
197.1      (1) home care services that are the responsibility of the 
197.2   foster care provider under the terms of the foster care 
197.3   placement agreement and administrative rules; 
197.4      (2) personal care assistant services when the foster care 
197.5   license holder is also the personal care provider or personal 
197.6   care assistant unless the recipient can direct the recipient's 
197.7   own care, or case management is provided as required in section 
197.8   256B.0625, subdivision 19a; 
197.9      (3) personal care assistant services when the responsible 
197.10  party is an employee of, or under contract with, or has any 
197.11  direct or indirect financial relationship with the personal care 
197.12  provider or personal care assistant, unless case management is 
197.13  provided as required in section 256B.0625, subdivision 19a; or 
197.14     (4) personal care assistant and private duty nursing 
197.15  services when the number of foster care residents is greater 
197.16  than four unless the county responsible for the recipient's 
197.17  foster placement made the placement prior to April 1, 1992, 
197.18  requests that personal care assistant and private duty nursing 
197.19  services be provided, and case management is provided as 
197.20  required in section 256B.0625, subdivision 19a. 
197.21     Sec. 31.  Minnesota Statutes 2000, section 256B.0627, 
197.22  subdivision 7, is amended to read: 
197.23     Subd. 7.  [NONCOVERED HOME CARE SERVICES.] The following 
197.24  home care services are not eligible for payment under medical 
197.25  assistance:  
197.26     (1) skilled nurse visits for the sole purpose of 
197.27  supervision of the home health aide; 
197.28     (2) a skilled nursing visit: 
197.29     (i) only for the purpose of monitoring medication 
197.30  compliance with an established medication program for a 
197.31  recipient; or 
197.32     (ii) to administer or assist with medication 
197.33  administration, including injections, prefilling syringes for 
197.34  injections, or oral medication set-up of an adult recipient, 
197.35  when as determined and documented by the registered nurse, the 
197.36  need can be met by an available pharmacy or the recipient is 
198.1   physically and mentally able to self-administer or prefill a 
198.2   medication; 
198.3      (3) home care services to a recipient who is eligible for 
198.4   covered services including hospice, if elected by the recipient, 
198.5   under the Medicare program or any other insurance held by the 
198.6   recipient; 
198.7      (4) services to other members of the recipient's household; 
198.8      (5) a visit made by a skilled nurse solely to train other 
198.9   home health agency workers; 
198.10     (6) any home care service included in the daily rate of the 
198.11  community-based residential facility where the recipient is 
198.12  residing; 
198.13     (7) nursing and rehabilitation therapy services that are 
198.14  reasonably accessible to a recipient outside the recipient's 
198.15  place of residence, excluding the assessment, counseling and 
198.16  education, and personal assistant care; 
198.17     (8) any home health agency service, excluding personal care 
198.18  assistant services and private duty nursing services, which are 
198.19  performed in a place other than the recipient's residence; and 
198.20     (9) Medicare evaluation or administrative nursing visits on 
198.21  dual-eligible recipients that do not qualify for Medicare visit 
198.22  billing. 
198.23     Sec. 32.  Minnesota Statutes 2000, section 256B.0627, 
198.24  subdivision 8, is amended to read: 
198.25     Subd. 8.  [SHARED PERSONAL CARE ASSISTANT SERVICES.] (a) 
198.26  Medical assistance payments for shared personal care assistance 
198.27  services shall be limited according to this subdivision. 
198.28     (b) Recipients of personal care assistant services may 
198.29  share staff and the commissioner shall provide a rate system for 
198.30  shared personal care assistant services.  For two persons 
198.31  sharing services, the rate paid to a provider shall not exceed 
198.32  1-1/2 times the rate paid for serving a single individual, and 
198.33  for three persons sharing services, the rate paid to a provider 
198.34  shall not exceed twice the rate paid for serving a single 
198.35  individual.  These rates apply only to situations in which all 
198.36  recipients were present and received shared services on the date 
199.1   for which the service is billed.  No more than three persons may 
199.2   receive shared services from a personal care assistant in a 
199.3   single setting. 
199.4      (c) Shared service is the provision of personal 
199.5   care assistant services by a personal care assistant to two or 
199.6   three recipients at the same time and in the same setting.  For 
199.7   the purposes of this subdivision, "setting" means: 
199.8      (1) the home or foster care home of one of the individual 
199.9   recipients; or 
199.10     (2) a child care program in which all recipients served by 
199.11  one personal care assistant are participating, which is licensed 
199.12  under chapter 245A or operated by a local school district or 
199.13  private school; or 
199.14     (3) outside the home or foster care home of one of the 
199.15  recipients when normal life activities take the recipients 
199.16  outside the home.  
199.17     The provisions of this subdivision do not apply when a 
199.18  personal care assistant is caring for multiple recipients in 
199.19  more than one setting. 
199.20     (d) The recipient or the recipient's responsible party, in 
199.21  conjunction with the county public health nurse, shall determine:
199.22     (1) whether shared personal care assistant services is an 
199.23  appropriate option based on the individual needs and preferences 
199.24  of the recipient; and 
199.25     (2) the amount of shared services allocated as part of the 
199.26  overall authorization of personal care assistant services. 
199.27     The recipient or the responsible party, in conjunction with 
199.28  the supervising qualified professional, if a qualified 
199.29  professional is requested by any one of the recipients or 
199.30  responsible parties, shall arrange the setting and grouping of 
199.31  shared services based on the individual needs and preferences of 
199.32  the recipients.  Decisions on the selection of recipients to 
199.33  share services must be based on the ages of the recipients, 
199.34  compatibility, and coordination of their care needs. 
199.35     (e) The following items must be considered by the recipient 
199.36  or the responsible party and the supervising qualified 
200.1   professional, if a qualified professional has been requested by 
200.2   any one of the recipients or responsible parties, and documented 
200.3   in the recipient's health service record: 
200.4      (1) the additional qualifications needed by the personal 
200.5   care assistant to provide care to several recipients in the same 
200.6   setting; 
200.7      (2) the additional training and supervision needed by the 
200.8   personal care assistant to ensure that the needs of the 
200.9   recipient are met appropriately and safely.  The provider must 
200.10  provide on-site supervision by a qualified professional within 
200.11  the first 14 days of shared services, and monthly thereafter, if 
200.12  supervision by a qualified provider has been requested by any 
200.13  one of the recipients or responsible parties; 
200.14     (3) the setting in which the shared services will be 
200.15  provided; 
200.16     (4) the ongoing monitoring and evaluation of the 
200.17  effectiveness and appropriateness of the service and process 
200.18  used to make changes in service or setting; and 
200.19     (5) a contingency plan which accounts for absence of the 
200.20  recipient in a shared services setting due to illness or other 
200.21  circumstances and staffing contingencies. 
200.22     (f) The provider must offer the recipient or the 
200.23  responsible party the option of shared or one-on-one personal 
200.24  care assistant services.  The recipient or the responsible party 
200.25  can withdraw from participating in a shared services arrangement 
200.26  at any time. 
200.27     (g) In addition to documentation requirements under 
200.28  Minnesota Rules, part 9505.2175, a personal care provider must 
200.29  meet documentation requirements for shared personal care 
200.30  assistant services and must document the following in the health 
200.31  service record for each individual recipient sharing services: 
200.32     (1) permission by the recipient or the recipient's 
200.33  responsible party, if any, for the maximum number of shared 
200.34  services hours per week chosen by the recipient; 
200.35     (2) permission by the recipient or the recipient's 
200.36  responsible party, if any, for personal care assistant services 
201.1   provided outside the recipient's residence; 
201.2      (3) permission by the recipient or the recipient's 
201.3   responsible party, if any, for others to receive shared services 
201.4   in the recipient's residence; 
201.5      (4) revocation by the recipient or the recipient's 
201.6   responsible party, if any, of the shared service authorization, 
201.7   or the shared service to be provided to others in the 
201.8   recipient's residence, or the shared service to be provided 
201.9   outside the recipient's residence; 
201.10     (5) supervision of the shared personal care assistant 
201.11  services by the qualified professional, if a qualified 
201.12  professional is requested by one of the recipients or 
201.13  responsible parties, including the date, time of day, number of 
201.14  hours spent supervising the provision of shared services, 
201.15  whether the supervision was face-to-face or another method of 
201.16  supervision, changes in the recipient's condition, shared 
201.17  services scheduling issues and recommendations; 
201.18     (6) documentation by the qualified professional, if a 
201.19  qualified professional is requested by one of the recipients or 
201.20  responsible parties, of telephone calls or other discussions 
201.21  with the personal care assistant regarding services being 
201.22  provided to the recipient who has requested the supervision; and 
201.23     (7) daily documentation of the shared services provided by 
201.24  each identified personal care assistant including: 
201.25     (i) the names of each recipient receiving shared services 
201.26  together; 
201.27     (ii) the setting for the shared services, including the 
201.28  starting and ending times that the recipient received shared 
201.29  services; and 
201.30     (iii) notes by the personal care assistant regarding 
201.31  changes in the recipient's condition, problems that may arise 
201.32  from the sharing of services, scheduling issues, care issues, 
201.33  and other notes as required by the qualified professional, if a 
201.34  qualified professional is requested by one of the recipients or 
201.35  responsible parties. 
201.36     (h) Unless otherwise provided in this subdivision, all 
202.1   other statutory and regulatory provisions relating to personal 
202.2   care assistant services apply to shared services. 
202.3      (i) In the event that supervision by a qualified 
202.4   professional has been requested by one or more recipients, but 
202.5   not by all of the recipients, the supervision duties of the 
202.6   qualified professional shall be limited to only those recipients 
202.7   who have requested the supervision. 
202.8      Nothing in this subdivision shall be construed to reduce 
202.9   the total number of hours authorized for an individual recipient.
202.10     Sec. 33.  Minnesota Statutes 2000, section 256B.0627, 
202.11  subdivision 10, is amended to read: 
202.12     Subd. 10.  [FISCAL AGENT INTERMEDIARY OPTION AVAILABLE FOR 
202.13  PERSONAL CARE ASSISTANT SERVICES.] (a) "Fiscal agent option" is 
202.14  an option that allows the recipient to: 
202.15     (1) use a fiscal agent instead of a personal care provider 
202.16  organization; 
202.17     (2) supervise the personal care assistant; and 
202.18     (3) use a consulting professional. 
202.19     The commissioner may allow a recipient of personal care 
202.20  assistant services to use a fiscal agent intermediary to assist 
202.21  the recipient in paying and accounting for medically necessary 
202.22  covered personal care assistant services authorized in 
202.23  subdivision 4 and within the payment parameters of subdivision 
202.24  5.  Unless otherwise provided in this subdivision, all other 
202.25  statutory and regulatory provisions relating to personal care 
202.26  assistant services apply to a recipient using the fiscal agent 
202.27  intermediary option. 
202.28     (b) The recipient or responsible party shall: 
202.29     (1) hire, and terminate the personal care assistant and 
202.30  consulting professional, with the fiscal agent recruit, hire, 
202.31  and terminate a qualified professional, if a qualified 
202.32  professional is requested by the recipient or responsible party; 
202.33     (2) recruit the personal care assistant and consulting 
202.34  professional and orient and train the personal care assistant in 
202.35  areas that do not require professional delegation as determined 
202.36  by the county public health nurse verify and document the 
203.1   credentials of the qualified professional, if a qualified 
203.2   professional is requested by the recipient or responsible party; 
203.3      (3) supervise and evaluate the personal care assistant in 
203.4   areas that do not require professional delegation as determined 
203.5   in the assessment; 
203.6      (4) cooperate with a consulting develop a service plan 
203.7   based on physician orders and public health nurse assessment 
203.8   with the assistance of a qualified professional and implement 
203.9   recommendations pertaining to the health and safety of the 
203.10  recipient, if a qualified professional is requested by the 
203.11  recipient or responsible party, that addresses the health and 
203.12  safety of the recipient; 
203.13     (5) hire a qualified professional to train and supervise 
203.14  the performance of delegated tasks done by (4) recruit, hire, 
203.15  and terminate the personal care assistant; 
203.16     (6) monitor services and verify in writing the hours worked 
203.17  by the personal care assistant and the consulting (5) orient and 
203.18  train the personal care assistant with assistance as needed from 
203.19  the qualified professional; 
203.20     (7) develop and revise a care plan with assistance from a 
203.21  consulting (6) supervise and evaluate the personal care 
203.22  assistant with assistance as needed from the recipient's 
203.23  physician or the qualified professional; 
203.24     (8) verify and document the credentials of the consulting 
203.25  (7) monitor and verify in writing and report to the fiscal 
203.26  intermediary the number of hours worked by the personal care 
203.27  assistant and the qualified professional; and 
203.28     (9) (8) enter into a written agreement, as specified in 
203.29  paragraph (f). 
203.30     (c) The duties of the fiscal agent intermediary shall be to:
203.31     (1) bill the medical assistance program for personal care 
203.32  assistant and consulting qualified professional services; 
203.33     (2) request and secure background checks on personal care 
203.34  assistants and consulting qualified professionals according to 
203.35  section 245A.04; 
203.36     (3) pay the personal care assistant and consulting 
204.1   qualified professional based on actual hours of services 
204.2   provided; 
204.3      (4) withhold and pay all applicable federal and state 
204.4   taxes; 
204.5      (5) verify and document keep records hours worked by the 
204.6   personal care assistant and consulting qualified professional; 
204.7      (6) make the arrangements and pay unemployment insurance, 
204.8   taxes, workers' compensation, liability insurance, and other 
204.9   benefits, if any; 
204.10     (7) enroll in the medical assistance program as a fiscal 
204.11  agent intermediary; and 
204.12     (8) enter into a written agreement as specified in 
204.13  paragraph (f) before services are provided. 
204.14     (d) The fiscal agent intermediary: 
204.15     (1) may not be related to the recipient, consulting 
204.16  qualified professional, or the personal care assistant; 
204.17     (2) must ensure arm's length transactions with the 
204.18  recipient and personal care assistant; and 
204.19     (3) shall be considered a joint employer of the personal 
204.20  care assistant and consulting qualified professional to the 
204.21  extent specified in this section. 
204.22     The fiscal agent intermediary or owners of the entity that 
204.23  provides fiscal agent intermediary services under this 
204.24  subdivision must pass a criminal background check as required in 
204.25  section 256B.0627, subdivision 1, paragraph (e). 
204.26     (e) If the recipient or responsible party requests a 
204.27  qualified professional, the consulting qualified professional 
204.28  providing assistance to the recipient shall meet the 
204.29  qualifications specified in section 256B.0625, subdivision 19c.  
204.30  The consulting qualified professional shall assist the recipient 
204.31  in developing and revising a plan to meet the 
204.32  recipient's assessed needs, and supervise the performance of 
204.33  delegated tasks, as determined by the public health nurse as 
204.34  assessed by the public health nurse.  In performing this 
204.35  function, the consulting qualified professional must visit the 
204.36  recipient in the recipient's home at least once annually.  
205.1   The consulting qualified professional must report to the local 
205.2   county public health nurse concerns relating to the health and 
205.3   safety of the recipient, and any suspected abuse, neglect, or 
205.4   financial exploitation of the recipient to the appropriate 
205.5   authorities.  
205.6      (f) The fiscal agent intermediary, recipient or responsible 
205.7   party, personal care assistant, and consulting qualified 
205.8   professional shall enter into a written agreement before 
205.9   services are started.  The agreement shall include: 
205.10     (1) the duties of the recipient, qualified professional, 
205.11  personal care assistant, and fiscal agent based on paragraphs 
205.12  (a) to (e); 
205.13     (2) the salary and benefits for the personal care assistant 
205.14  and those providing professional consultation the qualified 
205.15  professional; 
205.16     (3) the administrative fee of the fiscal agent intermediary 
205.17  and services paid for with that fee, including background check 
205.18  fees; 
205.19     (4) procedures to respond to billing or payment complaints; 
205.20  and 
205.21     (5) procedures for hiring and terminating the personal care 
205.22  assistant and those providing professional consultation the 
205.23  qualified professional. 
205.24     (g) The rates paid for personal care assistant services, 
205.25  qualified professional assistance services, and fiscal agency 
205.26  intermediary services under this subdivision shall be the same 
205.27  rates paid for personal care assistant services and qualified 
205.28  professional services under subdivision 2 respectively.  Except 
205.29  for the administrative fee of the fiscal agent intermediary 
205.30  specified in paragraph (f), the remainder of the rates paid to 
205.31  the fiscal agent intermediary must be used to pay for the salary 
205.32  and benefits for the personal care assistant or those providing 
205.33  professional consultation the qualified professional. 
205.34     (h) As part of the assessment defined in subdivision 1, the 
205.35  following conditions must be met to use or continue use of a 
205.36  fiscal agent intermediary: 
206.1      (1) the recipient must be able to direct the recipient's 
206.2   own care, or the responsible party for the recipient must be 
206.3   readily available to direct the care of the personal care 
206.4   assistant; 
206.5      (2) the recipient or responsible party must be 
206.6   knowledgeable of the health care needs of the recipient and be 
206.7   able to effectively communicate those needs; 
206.8      (3) a face-to-face assessment must be conducted by the 
206.9   local county public health nurse at least annually, or when 
206.10  there is a significant change in the recipient's condition or 
206.11  change in the need for personal care assistant services.  The 
206.12  county public health nurse shall determine the services that 
206.13  require professional delegation, if any, and the amount and 
206.14  frequency of related supervision; 
206.15     (4) the recipient cannot select the shared services option 
206.16  as specified in subdivision 8; and 
206.17     (5) parties must be in compliance with the written 
206.18  agreement specified in paragraph (f). 
206.19     (i) The commissioner shall deny, revoke, or suspend the 
206.20  authorization to use the fiscal agent intermediary option if: 
206.21     (1) it has been determined by the consulting qualified 
206.22  professional or local county public health nurse that the use of 
206.23  this option jeopardizes the recipient's health and safety; 
206.24     (2) the parties have failed to comply with the written 
206.25  agreement specified in paragraph (f); or 
206.26     (3) the use of the option has led to abusive or fraudulent 
206.27  billing for personal care assistant services.  
206.28     The recipient or responsible party may appeal the 
206.29  commissioner's action according to section 256.045.  The denial, 
206.30  revocation, or suspension to use the fiscal agent intermediary 
206.31  option shall not affect the recipient's authorized level of 
206.32  personal care assistant services as determined in subdivision 5. 
206.33     Sec. 34.  Minnesota Statutes 2000, section 256B.0627, 
206.34  subdivision 11, is amended to read: 
206.35     Subd. 11.  [SHARED PRIVATE DUTY NURSING CARE OPTION.] (a) 
206.36  Medical assistance payments for shared private duty nursing 
207.1   services by a private duty nurse shall be limited according to 
207.2   this subdivision.  For the purposes of this section, "private 
207.3   duty nursing agency" means an agency licensed under chapter 144A 
207.4   to provide private duty nursing services. 
207.5      (b) Recipients of private duty nursing services may share 
207.6   nursing staff and the commissioner shall provide a rate 
207.7   methodology for shared private duty nursing.  For two persons 
207.8   sharing nursing care, the rate paid to a provider shall not 
207.9   exceed 1.5 times the nonwaivered regular private duty nursing 
207.10  rates paid for serving a single individual who is not ventilator 
207.11  dependent, by a registered nurse or licensed practical nurse.  
207.12  These rates apply only to situations in which both recipients 
207.13  are present and receive shared private duty nursing care on the 
207.14  date for which the service is billed.  No more than two persons 
207.15  may receive shared private duty nursing services from a private 
207.16  duty nurse in a single setting. 
207.17     (c) Shared private duty nursing care is the provision of 
207.18  nursing services by a private duty nurse to two recipients at 
207.19  the same time and in the same setting.  For the purposes of this 
207.20  subdivision, "setting" means: 
207.21     (1) the home or foster care home of one of the individual 
207.22  recipients; or 
207.23     (2) a child care program licensed under chapter 245A or 
207.24  operated by a local school district or private school; or 
207.25     (3) an adult day care service licensed under chapter 245A; 
207.26  or 
207.27     (4) outside the home or foster care home of one of the 
207.28  recipients when normal life activities take the recipients 
207.29  outside the home.  
207.30     This subdivision does not apply when a private duty nurse 
207.31  is caring for multiple recipients in more than one setting. 
207.32     (d) The recipient or the recipient's legal representative, 
207.33  and the recipient's physician, in conjunction with the home 
207.34  health care agency, shall determine: 
207.35     (1) whether shared private duty nursing care is an 
207.36  appropriate option based on the individual needs and preferences 
208.1   of the recipient; and 
208.2      (2) the amount of shared private duty nursing services 
208.3   authorized as part of the overall authorization of nursing 
208.4   services. 
208.5      (e) The recipient or the recipient's legal representative, 
208.6   in conjunction with the private duty nursing agency, shall 
208.7   approve the setting, grouping, and arrangement of shared private 
208.8   duty nursing care based on the individual needs and preferences 
208.9   of the recipients.  Decisions on the selection of recipients to 
208.10  share services must be based on the ages of the recipients, 
208.11  compatibility, and coordination of their care needs. 
208.12     (f) The following items must be considered by the recipient 
208.13  or the recipient's legal representative and the private duty 
208.14  nursing agency, and documented in the recipient's health service 
208.15  record: 
208.16     (1) the additional training needed by the private duty 
208.17  nurse to provide care to two recipients in the same setting and 
208.18  to ensure that the needs of the recipients are met appropriately 
208.19  and safely; 
208.20     (2) the setting in which the shared private duty nursing 
208.21  care will be provided; 
208.22     (3) the ongoing monitoring and evaluation of the 
208.23  effectiveness and appropriateness of the service and process 
208.24  used to make changes in service or setting; 
208.25     (4) a contingency plan which accounts for absence of the 
208.26  recipient in a shared private duty nursing setting due to 
208.27  illness or other circumstances; 
208.28     (5) staffing backup contingencies in the event of employee 
208.29  illness or absence; and 
208.30     (6) arrangements for additional assistance to respond to 
208.31  urgent or emergency care needs of the recipients. 
208.32     (g) The provider must offer the recipient or responsible 
208.33  party the option of shared or one-on-one private duty nursing 
208.34  services.  The recipient or responsible party can withdraw from 
208.35  participating in a shared service arrangement at any time. 
208.36     (h) The private duty nursing agency must document the 
209.1   following in the health service record for each individual 
209.2   recipient sharing private duty nursing care: 
209.3      (1) permission by the recipient or the recipient's legal 
209.4   representative for the maximum number of shared nursing care 
209.5   hours per week chosen by the recipient; 
209.6      (2) permission by the recipient or the recipient's legal 
209.7   representative for shared private duty nursing services provided 
209.8   outside the recipient's residence; 
209.9      (3) permission by the recipient or the recipient's legal 
209.10  representative for others to receive shared private duty nursing 
209.11  services in the recipient's residence; 
209.12     (4) revocation by the recipient or the recipient's legal 
209.13  representative of the shared private duty nursing care 
209.14  authorization, or the shared care to be provided to others in 
209.15  the recipient's residence, or the shared private duty nursing 
209.16  services to be provided outside the recipient's residence; and 
209.17     (5) daily documentation of the shared private duty nursing 
209.18  services provided by each identified private duty nurse, 
209.19  including: 
209.20     (i) the names of each recipient receiving shared private 
209.21  duty nursing services together; 
209.22     (ii) the setting for the shared services, including the 
209.23  starting and ending times that the recipient received shared 
209.24  private duty nursing care; and 
209.25     (iii) notes by the private duty nurse regarding changes in 
209.26  the recipient's condition, problems that may arise from the 
209.27  sharing of private duty nursing services, and scheduling and 
209.28  care issues. 
209.29     (i) Unless otherwise provided in this subdivision, all 
209.30  other statutory and regulatory provisions relating to private 
209.31  duty nursing services apply to shared private duty nursing 
209.32  services. 
209.33     Nothing in this subdivision shall be construed to reduce 
209.34  the total number of private duty nursing hours authorized for an 
209.35  individual recipient under subdivision 5. 
209.36     Sec. 35.  Minnesota Statutes 2000, section 256B.0627, is 
210.1   amended by adding a subdivision to read: 
210.2      Subd. 13.  [CONSUMER-DIRECTED HOME CARE DEMONSTRATION 
210.3   PROJECT.] (a) Upon the receipt of federal waiver authority, the 
210.4   commissioner shall implement a consumer-directed home care 
210.5   demonstration project.  The consumer-directed home care 
210.6   demonstration project must demonstrate and evaluate the outcomes 
210.7   of a consumer-directed service delivery alternative to improve 
210.8   access, increase consumer control and accountability over 
210.9   available resources, and enable the use of supports that are 
210.10  more individualized and cost-effective for eligible medical 
210.11  assistance recipients receiving certain medical assistance home 
210.12  care services.  The consumer-directed home care demonstration 
210.13  project will be administered locally by county agencies, tribal 
210.14  governments, or administrative entities under contract with the 
210.15  state in regions where counties choose not to provide this 
210.16  service. 
210.17     (b) Grant awards for persons who have been receiving 
210.18  medical assistance covered personal care, home health aide, or 
210.19  private duty nursing services for a period of 12 consecutive 
210.20  months or more prior to enrollment in the consumer-directed home 
210.21  care demonstration project will be established on a case-by-case 
210.22  basis using historical service expenditure data.  An average 
210.23  monthly expenditure for each continuing enrollee will be 
210.24  calculated based on historical expenditures made on behalf of 
210.25  the enrollee for personal care, home health aide, or private 
210.26  duty nursing services during the 12 month period directly prior 
210.27  to enrollment in the project.  The grant award will equal 90 
210.28  percent of the average monthly expenditure. 
210.29     (c) Grant awards for project enrollees who have been 
210.30  receiving medical assistance covered personal care, home health 
210.31  aide, or private duty nursing services for a period of less than 
210.32  12 consecutive months prior to project enrollment will be 
210.33  calculated on a case-by-case basis using the service 
210.34  authorization in place at the time of enrollment.  The total 
210.35  number of units of personal care, home health aide, or private 
210.36  duty nursing services the enrollee has been authorized to 
211.1   receive will be converted to the total cost of the authorized 
211.2   services in a given month using the statewide average service 
211.3   payment rates.  To determine an estimated monthly expenditure, 
211.4   the total authorized monthly personal care, home health aide or 
211.5   private duty nursing service costs will be reduced by a 
211.6   percentage rate equivalent to the difference between the 
211.7   statewide average service authorization and the statewide 
211.8   average utilization rate for each of the services by medical 
211.9   assistance eligibles during the most recent fiscal year for 
211.10  which 12 months of data is available.  The grant award will 
211.11  equal 90 percent of the estimated monthly expenditure. 
211.12     Sec. 36.  Minnesota Statutes 2000, section 256B.0627, is 
211.13  amended by adding a subdivision to read: 
211.14     Subd. 14.  [TELEHOMECARE; SKILLED NURSE VISITS.] Medical 
211.15  assistance covers skilled nurse visits according to section 
211.16  256B.0625, subdivision 6a, provided via telehomecare, for 
211.17  services which do not require hands-on care between the home 
211.18  care nurse and recipient.  The provision of telehomecare must be 
211.19  made via live, two-way interactive audiovisual technology and 
211.20  may be augmented by utilizing store-and-forward technologies.  
211.21  Store-and-forward technology includes telehomecare services that 
211.22  do not occur in real time via synchronous transmissions, and 
211.23  that do not require a face-to-face encounter with the recipient 
211.24  for all or any part of any such telehomecare visit.  A 
211.25  communication between the home care nurse and recipient that 
211.26  consists solely of a telephone conversation, facsimile, 
211.27  electronic mail, or a consultation between two health care 
211.28  practitioners, is not to be considered a telehomecare visit.  
211.29  Multiple daily skilled nurse visits provided via telehomecare 
211.30  are allowed.  Coverage of telehomecare is limited to two visits 
211.31  per day.  All skilled nurse visits provided via telehomecare 
211.32  must be prior authorized by the commissioner or the 
211.33  commissioner's designee and will be covered at the same 
211.34  allowable rate as skilled nurse visits provided in-person. 
211.35     Sec. 37.  Minnesota Statutes 2000, section 256B.0627, is 
211.36  amended by adding a subdivision to read: 
212.1      Subd. 15.  [THERAPIES THROUGH HOME HEALTH AGENCIES.] (a)  
212.2   [PHYSICAL THERAPY.] Medical assistance covers physical therapy 
212.3   and related services, including specialized maintenance 
212.4   therapy.  Services provided by a physical therapy assistant 
212.5   shall be reimbursed at the same rate as services performed by a 
212.6   physical therapist when the services of the physical therapy 
212.7   assistant are provided under the direction of a physical 
212.8   therapist who is on the premises.  Services provided by a 
212.9   physical therapy assistant that are provided under the direction 
212.10  of a physical therapist who is not on the premises shall be 
212.11  reimbursed at 65 percent of the physical therapist rate.  
212.12  Direction of the physical therapy assistant must be provided by 
212.13  the physical therapist as described in Minnesota Rules, part 
212.14  9505.0390, subpart 1, item B.  The physical therapist and 
212.15  physical therapist assistant may not both bill for services 
212.16  provided to a recipient on the same day. 
212.17     (b)  [OCCUPATIONAL THERAPY.] Medical assistance covers 
212.18  occupational therapy and related services, including specialized 
212.19  maintenance therapy.  Services provided by an occupational 
212.20  therapy assistant shall be reimbursed at the same rate as 
212.21  services performed by an occupational therapist when the 
212.22  services of the occupational therapy assistant are provided 
212.23  under the direction of the occupational therapist who is on the 
212.24  premises.  Services provided by an occupational therapy 
212.25  assistant under the direction of an occupational therapist who 
212.26  is not on the premises shall be reimbursed at 65 percent of the 
212.27  occupational therapist rate.  Direction of the occupational 
212.28  therapy assistant must be provided by the occupational therapist 
212.29  as described in Minnesota Rules, part 9505.0390, subpart 1, item 
212.30  B.  The occupational therapist and occupational therapist 
212.31  assistant may not both bill for services provided to a recipient 
212.32  on the same day. 
212.33     Sec. 38.  Minnesota Statutes 2000, section 256B.0627, is 
212.34  amended by adding a subdivision to read: 
212.35     Subd. 16.  [HARDSHIP CRITERIA; PRIVATE DUTY NURSING.] (a) 
212.36  Payment is allowed for extraordinary services that require 
213.1   specialized nursing skills and are provided by parents of minor 
213.2   children, spouses, and legal guardians who are providing private 
213.3   duty nursing care under the following conditions: 
213.4      (1) the provision of these services is not legally required 
213.5   of the parents, spouses, or legal guardians; 
213.6      (2) the services are necessary to prevent hospitalization 
213.7   of the recipient; and 
213.8      (3) the recipient is eligible for state plan home care or a 
213.9   home and community-based waiver and one of the following 
213.10  hardship criteria are met: 
213.11     (i) the parent, spouse, or legal guardian resigns from a 
213.12  part-time or full-time job to provide nursing care for the 
213.13  recipient; or 
213.14     (ii) the parent, spouse, or legal guardian goes from a 
213.15  full-time to a part-time job with less compensation to provide 
213.16  nursing care for the recipient; or 
213.17     (iii) the parent, spouse, or legal guardian takes a leave 
213.18  of absence without pay to provide nursing care for the 
213.19  recipient; or 
213.20     (iv) because of labor conditions, special language needs, 
213.21  or intermittent hours of care needed, the parent, spouse, or 
213.22  legal guardian is needed in order to provide adequate private 
213.23  duty nursing services to meet the medical needs of the recipient.
213.24     (b) Private duty nursing may be provided by a parent, 
213.25  spouse, or legal guardian who is a nurse licensed in Minnesota.  
213.26  Private duty nursing services provided by a parent, spouse, or 
213.27  legal guardian cannot be used in lieu of nursing services 
213.28  covered and available under liable third-party payors, including 
213.29  Medicare.  The private duty nursing provided by a parent, 
213.30  spouse, or legal guardian must be included in the service plan.  
213.31  Authorized skilled nursing services provided by the parent, 
213.32  spouse, or legal guardian may not exceed 50 percent of the total 
213.33  approved nursing hours, or eight hours per day, whichever is 
213.34  less, up to a maximum of 40 hours per week.  Nothing in this 
213.35  subdivision precludes the parent's, spouse's, or legal 
213.36  guardian's obligation of assuming the nonreimbursed family 
214.1   responsibilities of emergency backup caregiver and primary 
214.2   caregiver. 
214.3      (c) A parent or a spouse may not be paid to provide private 
214.4   duty nursing care if the parent or spouse fails to pass a 
214.5   criminal background check according to section 245A.04, or if it 
214.6   has been determined by the home health agency, the case manager, 
214.7   or the physician that the private duty nursing care provided by 
214.8   the parent, spouse, or legal guardian is unsafe. 
214.9      Sec. 39.  Minnesota Statutes 2000, section 256B.0627, is 
214.10  amended by adding a subdivision to read: 
214.11     Subd. 17.  [QUALITY ASSURANCE PLAN FOR PERSONAL CARE 
214.12  ASSISTANT SERVICES.] The commissioner shall establish a quality 
214.13  assurance plan for personal care assistant services that 
214.14  includes: 
214.15     (1) performance-based provider agreements; 
214.16     (2) meaningful consumer input, which may include consumer 
214.17  surveys, that measure the extent to which participants receive 
214.18  the services and supports described in the individual plan and 
214.19  participant satisfaction with such services and supports; 
214.20     (3) ongoing monitoring of the health and well-being of 
214.21  consumers; and 
214.22     (4) an ongoing public process for development, 
214.23  implementation, and review of the quality assurance plan.  
214.24     Sec. 40.  Minnesota Statutes 2000, section 256B.0911, is 
214.25  amended by adding a subdivision to read: 
214.26     Subd. 4a.  [PREADMISSION SCREENING OF INDIVIDUALS UNDER 65 
214.27  YEARS OF AGE.] (a) It is the policy of the state of Minnesota to 
214.28  ensure that individuals with disabilities or chronic illness are 
214.29  served in the most integrated setting appropriate to their needs 
214.30  and have the necessary information to make informed choices 
214.31  about home and community-based service options. 
214.32     (b) Individuals under 65 years of age who are admitted to a 
214.33  nursing facility from a hospital must be screened prior to 
214.34  admission as outlined in subdivision 4. 
214.35     (c) Individuals under 65 years of age who are admitted to 
214.36  nursing facilities with only a telephone screening must receive 
215.1   a face-to-face assessment from the long-term care consultation 
215.2   team member of the county in which the facility is located or 
215.3   from the recipient's county case manager within 20 working days 
215.4   of admission. 
215.5      (d) At the face-to-face assessment, the long-term care 
215.6   consultation team member or county case manager must perform the 
215.7   activities required under subdivision 3. 
215.8      (e) For individuals under 21 years of age, the screening or 
215.9   assessment which recommends nursing facility admission must be 
215.10  approved by the commissioner before the individual is admitted 
215.11  to the nursing facility. 
215.12     (f) In the event that an individual under 65 years of age 
215.13  is admitted to a nursing facility on an emergency basis, the 
215.14  county must be notified of the admission on the next working 
215.15  day, and a face-to-face assessment as described in paragraph (c) 
215.16  must be conducted within 20 working days of admission. 
215.17     (g) At the face-to-face assessment, the long-term care 
215.18  consultation team member or the case manager must present 
215.19  information about home and community-based options so the 
215.20  individual can make informed choices.  If the individual chooses 
215.21  home and community-based services, the long-term care 
215.22  consultation team member or case manager must complete a written 
215.23  relocation plan within 20 working days of the visit.  The plan 
215.24  shall describe the services needed to move out of the facility 
215.25  and a timeline for the move which is designed to ensure a smooth 
215.26  transition to the individual's home and community. 
215.27     (h) An individual under 65 years of age residing in a 
215.28  nursing facility shall receive a face-to-face assessment at 
215.29  least every 12 months to review the person's service choices and 
215.30  available alternatives unless the individual indicates, in 
215.31  writing, that annual visits are not desired.  In this case, the 
215.32  individual must receive a face-to-face assessment at least once 
215.33  every 36 months for the same purposes. 
215.34     (i) Notwithstanding the provisions of subdivision 6, the 
215.35  commissioner may pay county agencies directly for face-to-face 
215.36  assessments for individuals who are eligible for medical 
216.1   assistance, under 65 years of age, and being considered for 
216.2   placement or residing in a nursing facility. 
216.3      Sec. 41.  Minnesota Statutes 2000, section 256B.093, 
216.4   subdivision 3, is amended to read: 
216.5      Subd. 3.  [TRAUMATIC BRAIN INJURY PROGRAM DUTIES.] The 
216.6   department shall fund administrative case management under this 
216.7   subdivision using medical assistance administrative funds.  The 
216.8   traumatic brain injury program duties include: 
216.9      (1) recommending to the commissioner in consultation with 
216.10  the medical review agent according to Minnesota Rules, parts 
216.11  9505.0500 to 9505.0540, the approval or denial of medical 
216.12  assistance funds to pay for out-of-state placements for 
216.13  traumatic brain injury services and in-state traumatic brain 
216.14  injury services provided by designated Medicare long-term care 
216.15  hospitals; 
216.16     (2) coordinating the traumatic brain injury home and 
216.17  community-based waiver; 
216.18     (3) approving traumatic brain injury waiver eligibility or 
216.19  care plans or both; 
216.20     (4) providing ongoing technical assistance and consultation 
216.21  to county and facility case managers to facilitate care plan 
216.22  development for appropriate, accessible, and cost-effective 
216.23  medical assistance services; 
216.24     (5) (4) providing technical assistance to promote statewide 
216.25  development of appropriate, accessible, and cost-effective 
216.26  medical assistance services and related policy; 
216.27     (6) (5) providing training and outreach to facilitate 
216.28  access to appropriate home and community-based services to 
216.29  prevent institutionalization; 
216.30     (7) (6) facilitating appropriate admissions, continued stay 
216.31  review, discharges, and utilization review for neurobehavioral 
216.32  hospitals and other specialized institutions; 
216.33     (8) (7) providing technical assistance on the use of prior 
216.34  authorization of home care services and coordination of these 
216.35  services with other medical assistance services; 
216.36     (9) (8) developing a system for identification of nursing 
217.1   facility and hospital residents with traumatic brain injury to 
217.2   assist in long-term planning for medical assistance services.  
217.3   Factors will include, but are not limited to, number of 
217.4   individuals served, length of stay, services received, and 
217.5   barriers to community placement; and 
217.6      (10) (9) providing information, referral, and case 
217.7   consultation to access medical assistance services for 
217.8   recipients without a county or facility case manager.  Direct 
217.9   access to this assistance may be limited due to the structure of 
217.10  the program. 
217.11     Sec. 42.  Minnesota Statutes 2000, section 256B.49, is 
217.12  amended by adding a subdivision to read: 
217.13     Subd. 11.  [AUTHORITY.] (a) The commissioner is authorized 
217.14  to apply for home and community-based service waivers, as 
217.15  authorized under section 1915(c) of the Social Security Act to 
217.16  serve persons under the age of 65 who are determined to require 
217.17  the level of care provided in a nursing home and persons who 
217.18  require the level of care provided in a hospital.  The 
217.19  commissioner shall apply for the home and community-based 
217.20  waivers in order to:  (i) promote the support of persons with 
217.21  disabilities in the most integrated settings; (ii) expand the 
217.22  availability of services for persons who are eligible for 
217.23  medical assistance; (iii) promote cost-effective options to 
217.24  institutional care; and (iv) obtain federal financial 
217.25  participation.  
217.26     (b) The provision of waivered services to medical 
217.27  assistance recipients with disabilities shall comply with the 
217.28  requirements outlined in the federally approved applications for 
217.29  home and community-based services and subsequent amendments, 
217.30  including provision of services according to a service plan 
217.31  designated to meet the needs of the individual.  For purposes of 
217.32  this section, the approved home and community-based application 
217.33  is considered the necessary federal requirement. 
217.34     (c) The commissioner shall seek approval, as authorized 
217.35  under section 1915(c) of the Social Security Act, to allow 
217.36  medical assistance eligibility under this section for children 
218.1   under age 21 without deeming of parental income or assets. 
218.2      (d) The commissioner shall seek approval, as authorized 
218.3   under section 1915(c) of the Social Security Act, to allow 
218.4   medical assistance eligibility under this section for 
218.5   individuals under age 65 without deeming the spouse's income or 
218.6   assets. 
218.7      (e) Prior to submitting to the federal government any 
218.8   proposed changes or amendments to federally approved 
218.9   applications for home and community-based services, the 
218.10  commissioner shall notify interested persons serving on 
218.11  departmental advisory groups and task forces and persons who 
218.12  have requested to be notified. 
218.13     Sec. 43.  Minnesota Statutes 2000, section 256B.49, is 
218.14  amended by adding a subdivision to read: 
218.15     Subd. 12.  [INFORMED CHOICE.] Persons who are determined 
218.16  likely to require the level of care provided in a nursing 
218.17  facility or hospital shall be informed of the home and 
218.18  community-based support alternatives to the provision of 
218.19  inpatient hospital services or nursing facility services.  Each 
218.20  person must be given the choice of either institutional or home 
218.21  and community-based services using the provisions described in 
218.22  section 256B.77, subdivision 2, paragraph (p). 
218.23     Sec. 44.  Minnesota Statutes 2000, section 256B.49, is 
218.24  amended by adding a subdivision to read: 
218.25     Subd. 13.  [CASE MANAGEMENT.] (a) Each recipient of a home 
218.26  and community-based waiver shall be provided case management 
218.27  services by qualified vendors as described in the federally 
218.28  approved waiver application.  The case management service 
218.29  activities provided will include: 
218.30     (1) assessing the needs of the individual within 20 working 
218.31  days of a recipient's request; 
218.32     (2) developing the written individual service plan within 
218.33  ten working days after the assessment is completed; 
218.34     (3) informing the recipient or the recipient's legal 
218.35  guardian or conservator of service options; 
218.36     (4) assisting the recipient in the identification of 
219.1   potential service providers; 
219.2      (5) assisting the recipient to access services; 
219.3      (6) coordinating, evaluating, and monitoring of the 
219.4   services identified in the service plan; 
219.5      (7) completing the annual reviews of the service plan; and 
219.6      (8) informing the recipient or legal representative of the 
219.7   right to have assessments completed and service plans developed 
219.8   within specified time periods, and to appeal county action or 
219.9   inaction under section 256.045, subdivision 3. 
219.10     (b) The case manager may delegate certain aspects of the 
219.11  case management service activities to another individual 
219.12  provided there is oversight by the case manager.  The case 
219.13  manager may not delegate those aspects which require 
219.14  professional judgment including assessments, reassessments, and 
219.15  care plan development. 
219.16     Sec. 45.  Minnesota Statutes 2000, section 256B.49, is 
219.17  amended by adding a subdivision to read: 
219.18     Subd. 14.  [ASSESSMENT AND REASSESSMENT.] (a) Assessments 
219.19  of each recipient's strengths, informal support systems, and 
219.20  need for services shall be completed within 20 working days of 
219.21  the recipient's request.  Reassessment of each recipient's 
219.22  strengths, support systems, and need for services shall be 
219.23  conducted at least every 12 months and at other times when there 
219.24  has been a significant change in the recipient's functioning. 
219.25     (b) Persons with mental retardation or a related condition 
219.26  who apply for services under the nursing facility level waiver 
219.27  programs shall be screened for the appropriate level of care 
219.28  according to section 256B.092. 
219.29     (c) Recipients who are found eligible for home and 
219.30  community-based services under this section before their 65th 
219.31  birthday may remain eligible for these services after their 65th 
219.32  birthday if they continue to meet all other eligibility factors. 
219.33     Sec. 46.  Minnesota Statutes 2000, section 256B.49, is 
219.34  amended by adding a subdivision to read: 
219.35     Subd. 15.  [INDIVIDUALIZED SERVICE PLAN.] Each recipient of 
219.36  home and community-based waivered services shall be provided a 
220.1   copy of the written service plan which: 
220.2      (1) is developed and signed by the recipient within ten 
220.3   working days of the completion of the assessment; 
220.4      (2) meets the assessed needs of the recipient; 
220.5      (3) reasonably ensures the health and safety of the 
220.6   recipient; 
220.7      (4) promotes independence; 
220.8      (5) allows for services to be provided in the most 
220.9   integrated settings; and 
220.10     (6) provides for an informed choice, as defined in section 
220.11  256B.77, subdivision 2, paragraph (p), of service and support 
220.12  providers. 
220.13     Sec. 47.  Minnesota Statutes 2000, section 256B.49, is 
220.14  amended by adding a subdivision to read: 
220.15     Subd. 16.  [SERVICES AND SUPPORTS.] Services and supports 
220.16  included in the home and community-based waivers for persons 
220.17  with disabilities shall meet the requirements set out in United 
220.18  States Code, title 42, section 1396n.  The services and 
220.19  supports, which are offered as alternatives to institutional 
220.20  care, shall promote consumer choice, community inclusion, 
220.21  self-sufficiency, and self-determination.  Beginning January 1, 
220.22  2003, the commissioner shall simplify and improve access to home 
220.23  and community-based services, to the extent possible, through 
220.24  the establishment of a common service menu that is available to 
220.25  eligible recipients regardless of age, disability type, or 
220.26  waiver program.  Consumer-directed community support services 
220.27  shall be offered as an option to all persons eligible for 
220.28  services under subdivision 11 by January 1, 2002.  Services and 
220.29  supports shall be arranged and provided consistent with 
220.30  individualized written plans of care for eligible waiver 
220.31  recipients. 
220.32     Sec. 48.  Minnesota Statutes 2000, section 256B.49, is 
220.33  amended by adding a subdivision to read: 
220.34     Subd. 17.  [COST OF SERVICES AND SUPPORTS.] (a) The 
220.35  commissioner shall ensure that the average per capita 
220.36  expenditures estimated in any fiscal year for home and 
221.1   community-based waiver recipients does not exceed the average 
221.2   per capita expenditures that would have been made to provide 
221.3   institutional services for recipients in the absence of the 
221.4   waiver. 
221.5      (b) The commissioner shall implement on January 1, 2002, 
221.6   one or more aggregate, need-based methods for allocating to 
221.7   local agencies the home and community-based waivered service 
221.8   resources available to support recipients with disabilities in 
221.9   need of the level of care provided in a nursing facility or a 
221.10  hospital.  The commissioner shall allocate resources to single 
221.11  counties and county partnerships in a manner that reflects 
221.12  consideration of: 
221.13     (1) an incentive-based payment process for achieving 
221.14  outcomes; 
221.15     (2) the need for a state-level risk pool; 
221.16     (3) the need for retention of management responsibility at 
221.17  the state agency level; and 
221.18     (4) a phase-in strategy as appropriate. 
221.19     (c) Until the allocation methods described in paragraph (b) 
221.20  are implemented, the annual allowable reimbursement level of 
221.21  home and community-based waiver services shall be the greater of:
221.22     (1) the statewide average payment amount which the 
221.23  recipient is assigned under the waiver reimbursement system in 
221.24  place on June 30, 2001, modified by the percentage of any 
221.25  provider rate increase appropriated for home and community-based 
221.26  services; or 
221.27     (2) an amount approved by the commissioner based on the 
221.28  recipient's extraordinary needs that cannot be met within the 
221.29  current allowable reimbursement level.  The increased 
221.30  reimbursement level must be necessary to allow the recipient to 
221.31  be discharged from an institution or to prevent imminent 
221.32  placement in an institution.  The additional reimbursement may 
221.33  be used to secure environmental modifications; assistive 
221.34  technology and equipment; and increased costs for supervision, 
221.35  training, and support services necessary to address the 
221.36  recipient's extraordinary needs.  The commissioner may approve 
222.1   an increased reimbursement level for up to one year of the 
222.2   recipient's relocation from an institution or up to six months 
222.3   of a determination that a current waiver recipient is at 
222.4   imminent risk of being placed in an institution. 
222.5      (d) Beginning January 1, 2003, medically necessary private 
222.6   duty nursing services will be authorized under this section as 
222.7   complex and regular care according to section 256B.0627.  The 
222.8   rate established by the commissioner for registered nurse or 
222.9   licensed practical nurse services under any home and 
222.10  community-based waiver as of January 1, 2001, shall not be 
222.11  reduced. 
222.12     Sec. 49.  Minnesota Statutes 2000, section 256B.49, is 
222.13  amended by adding a subdivision to read: 
222.14     Subd. 18.  [PAYMENTS.] The commissioner shall reimburse 
222.15  approved vendors from the medical assistance account for the 
222.16  costs of providing home and community-based services to eligible 
222.17  recipients using the invoice processing procedures of the 
222.18  Medicaid management information system (MMIS).  Recipients will 
222.19  be screened and authorized for services according to the 
222.20  federally approved waiver application and its subsequent 
222.21  amendments. 
222.22     Sec. 50.  Minnesota Statutes 2000, section 256B.49, is 
222.23  amended by adding a subdivision to read: 
222.24     Subd. 19.  [HEALTH AND WELFARE.] The commissioner of human 
222.25  services shall take the necessary safeguards to protect the 
222.26  health and welfare of individuals provided services under the 
222.27  waiver. 
222.28     Sec. 51.  Minnesota Statutes 2000, section 256D.35, is 
222.29  amended by adding a subdivision to read: 
222.30     Subd. 11a.  [INSTITUTION.] "Institution" means a hospital, 
222.31  consistent with Code of Federal Regulations, title 42, section 
222.32  440.10; regional treatment center inpatient services, consistent 
222.33  with section 245.474; a nursing facility; and an intermediate 
222.34  care facility for persons with mental retardation. 
222.35     Sec. 52.  Minnesota Statutes 2000, section 256D.35, is 
222.36  amended by adding a subdivision to read: 
223.1      Subd. 18a.  [SHELTER COSTS.] "Shelter costs" means rent, 
223.2   manufactured home lot rentals; monthly principal, interest, 
223.3   insurance premiums, and property taxes due for mortgages or 
223.4   contract for deed costs; costs for utilities, including heating, 
223.5   cooling, electricity, water, and sewerage; garbage collection 
223.6   fees; and the basic service fee for one telephone. 
223.7      Sec. 53.  Minnesota Statutes 2000, section 256D.44, 
223.8   subdivision 5, is amended to read: 
223.9      Subd. 5.  [SPECIAL NEEDS.] In addition to the state 
223.10  standards of assistance established in subdivisions 1 to 4, 
223.11  payments are allowed for the following special needs of 
223.12  recipients of Minnesota supplemental aid who are not residents 
223.13  of a nursing home, a regional treatment center, or a group 
223.14  residential housing facility. 
223.15     (a) The county agency shall pay a monthly allowance for 
223.16  medically prescribed diets payable under the Minnesota family 
223.17  investment program if the cost of those additional dietary needs 
223.18  cannot be met through some other maintenance benefit.  
223.19     (b) Payment for nonrecurring special needs must be allowed 
223.20  for necessary home repairs or necessary repairs or replacement 
223.21  of household furniture and appliances using the payment standard 
223.22  of the AFDC program in effect on July 16, 1996, for these 
223.23  expenses, as long as other funding sources are not available.  
223.24     (c) A fee for guardian or conservator service is allowed at 
223.25  a reasonable rate negotiated by the county or approved by the 
223.26  court.  This rate shall not exceed five percent of the 
223.27  assistance unit's gross monthly income up to a maximum of $100 
223.28  per month.  If the guardian or conservator is a member of the 
223.29  county agency staff, no fee is allowed. 
223.30     (d) The county agency shall continue to pay a monthly 
223.31  allowance of $68 for restaurant meals for a person who was 
223.32  receiving a restaurant meal allowance on June 1, 1990, and who 
223.33  eats two or more meals in a restaurant daily.  The allowance 
223.34  must continue until the person has not received Minnesota 
223.35  supplemental aid for one full calendar month or until the 
223.36  person's living arrangement changes and the person no longer 
224.1   meets the criteria for the restaurant meal allowance, whichever 
224.2   occurs first. 
224.3      (e) A fee of ten percent of the recipient's gross income or 
224.4   $25, whichever is less, is allowed for representative payee 
224.5   services provided by an agency that meets the requirements under 
224.6   SSI regulations to charge a fee for representative payee 
224.7   services.  This special need is available to all recipients of 
224.8   Minnesota supplemental aid regardless of their living 
224.9   arrangement.  
224.10     (f) Notwithstanding the language in this subdivision, an 
224.11  amount equal to the maximum allotment authorized by the federal 
224.12  Food Stamp Program for a single individual which is in effect on 
224.13  the first day of January of the previous year will be added to 
224.14  the standards of assistance established in subdivisions 1 to 4 
224.15  for individuals under the age of 65 who are relocating from an 
224.16  institution and who are shelter needy.  An eligible individual 
224.17  who receives this benefit prior to age 65 may continue to 
224.18  receive the benefit after the age of 65. 
224.19     "Shelter needy" means that the assistance unit incurs 
224.20  monthly shelter costs that exceed 40 percent of the assistance 
224.21  unit's gross income before the application of this special needs 
224.22  standard.  "Gross income" for the purposes of this section is 
224.23  the applicant's or recipient's income as defined in section 
224.24  256D.35, subdivision 10, or the standard specified in 
224.25  subdivision 3, whichever is greater.  A recipient of a federal 
224.26  or state housing subsidy, that limits shelter costs to a 
224.27  percentage of gross income, shall not be considered shelter 
224.28  needy for purposes of this paragraph. 
224.29     Sec. 54.  [SEMI-INDEPENDENT LIVING SERVICES (SILS) STUDY.] 
224.30     The commissioner of human services, in consultation with 
224.31  county representatives and other interested persons, shall 
224.32  develop recommendations revising the funding methodology for 
224.33  SILS as defined in Minnesota Statutes, section 252.275, 
224.34  subdivisions 3, 4, 4b, and 4c, and report by January 15, 2002, 
224.35  to the chair of the house of representatives health and human 
224.36  services finance committee and the chair of the senate health, 
225.1   human services and corrections budget division. 
225.2      Sec. 55.  [WAIVER REQUEST REGARDING SPOUSAL INCOME.] 
225.3      By September 1, 2001, the commissioner of human services 
225.4   shall seek federal approval to allow recipients of home and 
225.5   community-based waivers authorized under Minnesota Statutes, 
225.6   section 256B.49, to choose either a waiver of deeming of spousal 
225.7   income or the spousal impoverishment protections authorized 
225.8   under United States Code, title 42, section 1396r-5, with the 
225.9   addition of the group residential housing rate set according to 
225.10  Minnesota Statutes, section 256I.03, subdivision 5, to the 
225.11  personal needs allowance authorized by Minnesota Statutes, 
225.12  section 256B.0575. 
225.13     Sec. 56.  [GRANTS TO PROVIDE BRAIN INJURY SUPPORT.] 
225.14     Subdivision 1.  [GRANTS.] Within the limits of the 
225.15  appropriations made specifically for this purpose, the 
225.16  commissioner of health shall make grants of up to $300,000 to 
225.17  nonprofit corporations to continue a pilot project that provides 
225.18  information, connects to community resources, and provides 
225.19  support and problem solving on an ongoing basis to individuals 
225.20  with traumatic brain injuries.  
225.21     Subd. 2.  [REPORT.] The commissioner shall prepare a report 
225.22  identifying the results of the pilot project and making 
225.23  recommendations on continuation of the project.  The report must 
225.24  be forwarded to the legislature no later than January 15, 2004. 
225.25     Sec. 57.  [REPEALER.] 
225.26     (a) Minnesota Statutes 2000, sections 145.9245; 256.476, 
225.27  subdivision 7; 256B.0912; 256B.0915, subdivisions 3a, 3b, and 
225.28  3c; 256B.49, subdivisions 1, 2, 3, 4, 5, 6, 7, 8, 9, and 10, are 
225.29  repealed. 
225.30     (b) Minnesota Rules, parts 9505.2455; 9505.2458; 9505.2460; 
225.31  9505.2465; 9505.2470; 9505.2473; 9505.2475; 9505.2480; 
225.32  9505.2485; 9505.2486; 9505.2490; 9505.2495; 9505.2496; 
225.33  9505.2500; 9505.3010; 9505.3015; 9505.3020; 9505.3025; 
225.34  9505.3030; 9505.3035; 9505.3040; 9505.3065; 9505.3085; 
225.35  9505.3135; 9505.3500; 9505.3510; 9505.3520; 9505.3530; 
225.36  9505.3535; 9505.3540; 9505.3545; 9505.3550; 9505.3560; 
226.1   9505.3570; 9505.3575; 9505.3580; 9505.3585; 9505.3600; 
226.2   9505.3610; 9505.3620; 9505.3622; 9505.3624; 9505.3626; 
226.3   9505.3630; 9505.3635; 9505.3640; 9505.3645; 9505.3650; 
226.4   9505.3660; and 9505.3670, are repealed. 
226.5                              ARTICLE 4 
226.6                 CONSUMER INFORMATION AND ASSISTANCE 
226.7                       AND COMMUNITY-BASED CARE 
226.8      Section 1.  Minnesota Statutes 2000, section 256.975, is 
226.9   amended by adding a subdivision to read: 
226.10     Subd. 7.  [CONSUMER INFORMATION AND ASSISTANCE; SENIOR 
226.11  LINKAGE.] (a) The Minnesota board on aging shall operate a 
226.12  statewide information and assistance service to aid older 
226.13  Minnesotans and their families in making informed choices about 
226.14  long-term care options and health care benefits.  Language 
226.15  services to persons with limited English language skills must be 
226.16  made available.  The service, known as Senior LinkAge Line, must 
226.17  be available during business hours through a statewide toll-free 
226.18  number and must also be available through the Internet. 
226.19     (b) The service must assist older adults, caregivers, and 
226.20  providers in accessing information about choices in long-term 
226.21  care services that are purchased through private providers or 
226.22  available through public options.  The service must: 
226.23     (1) develop a comprehensive database that includes detailed 
226.24  listings in both consumer- and provider-oriented formats; 
226.25     (2) make the database accessible on the Internet and 
226.26  through other telecommunication and media-related tools; 
226.27     (3) link callers to interactive long-term care screening 
226.28  tools and making these tools available through the Internet by 
226.29  integrating the tools with the database; 
226.30     (4) develop community education materials with a focus on 
226.31  planning for long-term care and evaluating independent living, 
226.32  housing, and service options; 
226.33     (5) conduct an outreach campaign to assist older adults and 
226.34  their caregivers in finding information on the Internet and 
226.35  through other means of communication; 
226.36     (6) implement a messaging system for overflow callers and 
227.1   respond to these callers by the next business day; 
227.2      (7) link callers with county human services and other 
227.3   providers to receive more in-depth assistance and consultation 
227.4   related to long-term care options; and 
227.5      (8) link callers with quality profiles for nursing 
227.6   facilities and other providers developed by the commissioner of 
227.7   human services. 
227.8      Sec. 2.  [256.9754] [COMMUNITY SERVICES DEVELOPMENT GRANTS 
227.9   PROGRAM.] 
227.10     Subdivision 1.  [DEFINITIONS.] For purposes of this 
227.11  section, the following terms have the meanings given. 
227.12     (a) "Community" means a town, township, city, or targeted 
227.13  neighborhood within a city, or a consortium of towns, townships, 
227.14  cities, or targeted neighborhoods within cities. 
227.15     (b) "Older adult services" means any services available 
227.16  under the elderly waiver program or alternative care grant 
227.17  program; nursing facility services; transportation services; 
227.18  respite services; and other community-based services identified 
227.19  as necessary either to maintain lifestyle choices for older 
227.20  Minnesotans or to promote independence. 
227.21     (c) "Older adult" refers to individuals 65 years of age and 
227.22  older. 
227.23     Subd. 2.  [CREATION.] The community services development 
227.24  grants program is created under the administration of the 
227.25  commissioner of human services.  
227.26     Subd. 3.  [PROVISION OF GRANTS.] The commissioner shall 
227.27  make grants available to communities, providers of older adult 
227.28  services identified in subdivision 1, or to a consortium of 
227.29  providers of older adult services, to establish new older adult 
227.30  services.  Grants may be provided for capital and other costs 
227.31  including, but not limited to, start-up and training costs, 
227.32  equipment, and supplies related to the establishment of new 
227.33  older adult services or other residential or service 
227.34  alternatives to nursing facility care.  Grants may also be made 
227.35  to renovate current buildings, provide transportation services, 
227.36  or expand state-funded programs in the area. 
228.1      Subd. 4.  [ELIGIBILITY.] Grants may be awarded only to 
228.2   communities and providers or to a consortium of providers that 
228.3   have a local match of 50 percent of the costs for the project in 
228.4   the form of donations, local tax dollars, in-kind donations, or 
228.5   other local match. 
228.6      Sec. 3.  Minnesota Statutes 2000, section 256B.0911, 
228.7   subdivision 1, is amended to read: 
228.8      Subdivision 1.  [PURPOSE AND GOAL.] (a) The purpose of the 
228.9   preadmission screening program long-term care consultation 
228.10  services is to assist persons with long-term or chronic care 
228.11  needs in making long-term care decisions and selecting options 
228.12  that meet their needs and reflect their preferences.  The 
228.13  availability of, and access to, information and other types of 
228.14  assistance is also intended to prevent or delay certified 
228.15  nursing facility placements by assessing applicants and 
228.16  residents and offering cost-effective alternatives appropriate 
228.17  for the person's needs and to provide transition assistance 
228.18  after admission.  Further, the goal of the program these 
228.19  services is to contain costs associated with unnecessary 
228.20  certified nursing facility admissions.  The commissioners of 
228.21  human services and health shall seek to maximize use of 
228.22  available federal and state funds and establish the broadest 
228.23  program possible within the funding available. 
228.24     (b) These services must be coordinated with services 
228.25  provided under sections 256.975, subdivision 7, and 256.9772, 
228.26  and with services provided by other public and private agencies 
228.27  in the community to offer a variety of cost-effective 
228.28  alternatives to persons with disabilities and elderly persons.  
228.29  The county agency providing long-term care consultation services 
228.30  shall encourage the use of volunteers from families, religious 
228.31  organizations, social clubs, and similar civic and service 
228.32  organizations to provide community-based services. 
228.33     Sec. 4.  Minnesota Statutes 2000, section 256B.0911, is 
228.34  amended by adding a subdivision to read: 
228.35     Subd. 1a.  [DEFINITIONS.] For purposes of this section, the 
228.36  following definitions apply: 
229.1      (a) "Long-term care consultation services" means: 
229.2      (1) providing information and education to the general 
229.3   public regarding availability of the services authorized under 
229.4   this section; 
229.5      (2) an intake process that provides access to the services 
229.6   described in this section; 
229.7      (3) assessment of the health, psychological, and social 
229.8   needs of referred individuals; 
229.9      (4) assistance in identifying services needed to maintain 
229.10  an individual in the least restrictive environment; 
229.11     (5) providing recommendations on cost-effective community 
229.12  services that are available to the individual; 
229.13     (6) development of an individual's community support plan; 
229.14     (7) providing information regarding eligibility for 
229.15  Minnesota health care programs; 
229.16     (8) preadmission screening to determine the need for a 
229.17  nursing facility level of care; 
229.18     (9) preliminary determination of Minnesota health care 
229.19  programs eligibility for individuals who need a nursing facility 
229.20  level of care, with appropriate referrals for final 
229.21  determination; 
229.22     (10) providing recommendations for nursing facility 
229.23  placement when there are no cost-effective community services 
229.24  available; and 
229.25     (11) assistance to transition people back to community 
229.26  settings after facility admission. 
229.27     (b) "Minnesota health care programs" means the medical 
229.28  assistance program under chapter 256B, the alternative care 
229.29  program under section 256B.0913, and the prescription drug 
229.30  program under section 256.955. 
229.31     Sec. 5.  Minnesota Statutes 2000, section 256B.0911, 
229.32  subdivision 3, is amended to read: 
229.33     Subd. 3.  [PERSONS RESPONSIBLE FOR CONDUCTING THE 
229.34  PREADMISSION SCREENING LONG-TERM CARE CONSULTATION TEAM.] (a) A 
229.35  local screening long-term care consultation team shall be 
229.36  established by the county board of commissioners.  Each local 
230.1   screening consultation team shall consist of screeners who are a 
230.2   at least one social worker and a at least one public health 
230.3   nurse from their respective county agencies.  The board may 
230.4   designate public health or social services as the lead agency 
230.5   for long-term care consultation services.  If a county does not 
230.6   have a public health nurse available, it may request approval 
230.7   from the commissioner to assign a county registered nurse with 
230.8   at least one year experience in home care to participate on the 
230.9   team.  The screening team members must confer regarding the most 
230.10  appropriate care for each individual screened.  Two or more 
230.11  counties may collaborate to establish a joint local screening 
230.12  consultation team or teams. 
230.13     (b) In assessing a person's needs, screeners shall have a 
230.14  physician available for consultation and shall consider the 
230.15  assessment of the individual's attending physician, if any.  The 
230.16  individual's physician shall be included if the physician 
230.17  chooses to participate.  Other personnel may be included on the 
230.18  team as deemed appropriate by the county agencies.  The team is 
230.19  responsible for providing long-term care consultation services 
230.20  to all persons located in the county who request the services, 
230.21  regardless of eligibility for Minnesota health care programs. 
230.22     Sec. 6.  Minnesota Statutes 2000, section 256B.0911, is 
230.23  amended by adding a subdivision to read: 
230.24     Subd. 3a.  [ASSESSMENT AND SUPPORT PLANNING.] (a) Persons 
230.25  requesting assessment, services planning, or other assistance 
230.26  intended to support community-based living must be visited by a 
230.27  long-term care consultation team within ten working days after 
230.28  the date on which an assessment was requested or recommended.  
230.29  Assessments must be conducted according to paragraphs (b) to (g).
230.30     (b) The county may utilize a team of either the social 
230.31  worker or public health nurse, or both, to conduct the 
230.32  assessment in a face-to-face interview.  The consultation team 
230.33  members must confer regarding the most appropriate care for each 
230.34  individual screened or assessed. 
230.35     (c) The long-term care consultation team must assess the 
230.36  health and social needs of the person, using an assessment form 
231.1   provided by the commissioner. 
231.2      (d) The team must conduct the assessment in a face-to-face 
231.3   interview with the person being assessed and the person's legal 
231.4   representative, if applicable. 
231.5      (e) The team must provide the person, or the person's legal 
231.6   representative, with written recommendations for facility- or 
231.7   community-based services.  The team must document that the most 
231.8   cost-effective alternatives available were offered to the 
231.9   individual.  For purposes of this requirement, "cost-effective 
231.10  alternatives" means community services and living arrangements 
231.11  that cost the same as or less than nursing facility care. 
231.12     (f) If the person chooses to use community-based services, 
231.13  the team must provide the person or the person's legal 
231.14  representative with a written community support plan, regardless 
231.15  of whether the individual is eligible for Minnesota health care 
231.16  programs.  The person may request assistance in developing a 
231.17  community support plan without participating in a complete 
231.18  assessment. 
231.19     (g) The team must give the person receiving assessment or 
231.20  support planning, or the person's legal representative, 
231.21  materials supplied by the commissioner containing the following 
231.22  information: 
231.23     (1) the purpose of preadmission screening and assessment; 
231.24     (2) information about Minnesota health care programs; 
231.25     (3) the person's freedom to accept or reject the 
231.26  recommendations of the team; 
231.27     (4) the person's right to confidentiality under the 
231.28  Minnesota Government Data Practices Act, chapter 13; and 
231.29     (5) the person's right to appeal the decision regarding the 
231.30  need for nursing facility level of care or the county's final 
231.31  decisions regarding public programs eligibility according to 
231.32  section 256.045, subdivision 3. 
231.33     Sec. 7.  Minnesota Statutes 2000, section 256B.0911, is 
231.34  amended by adding a subdivision to read: 
231.35     Subd. 3b.  [TRANSITION ASSISTANCE.] (a) A long-term care 
231.36  consultation team shall provide assistance to persons residing 
232.1   in a nursing facility, hospital, regional treatment center, or 
232.2   intermediate care facility for persons with mental retardation 
232.3   who request or are referred for assistance.  Transition 
232.4   assistance must include assessment, community support plan 
232.5   development, referrals to Minnesota health care programs, and 
232.6   referrals to programs that provide assistance with housing. 
232.7      (b) The county shall develop transition processes with 
232.8   institutional social workers and discharge planners to ensure 
232.9   that: 
232.10     (1) persons admitted to facilities receive information 
232.11  about transition assistance that is available; 
232.12     (2) the assessment is completed for persons within ten 
232.13  working days of the date of request or recommendation for 
232.14  assessment; and 
232.15     (3) there is a plan for transition and follow-up for the 
232.16  individual's return to the community.  The plan must require 
232.17  notification of other local agencies when a person who may 
232.18  require assistance is screened by one county for admission to a 
232.19  facility located in another county. 
232.20     (c) If a person who is eligible for a Minnesota health care 
232.21  program is admitted to a nursing facility, the nursing facility 
232.22  must include a consultation team member or the case manager in 
232.23  the discharge planning process. 
232.24     Sec. 8.  Minnesota Statutes 2000, section 256B.0911, is 
232.25  amended by adding a subdivision to read: 
232.26     Subd. 3c.  [ACCESS DEMONSTRATIONS.] (a) The commissioner 
232.27  shall establish demonstration projects that are intended to 
232.28  target critical areas for improvement in long-term care 
232.29  consultation services, and to organize resources in a more 
232.30  efficient, effective, and preferred way.  The demonstrations may 
232.31  include: 
232.32     (1) development and implementation of strategies to 
232.33  increase the number of people who leave nursing facilities, 
232.34  hospitals, regional treatment centers, and intermediate care 
232.35  facilities for persons with mental retardation and return to 
232.36  community living, based on demonstration proposals that: 
233.1      (i) focus on transitional planning between care settings; 
233.2      (ii) engage a variety of providers and care settings; 
233.3      (iii) include participants from both greater Minnesota and 
233.4   metro communities; 
233.5      (iv) emphasize regional or other cooperative approaches; 
233.6   and 
233.7      (v) identify potential obstacles to individuals returning 
233.8   to community settings and propose recommendations to address 
233.9   those obstacles and ways to improve the identification of people 
233.10  who need transitional assistance; 
233.11     (2) improved access to and expansion of the availability of 
233.12  long-term care consultation services, and improved integration 
233.13  of these services with other local activities designed to 
233.14  support people in community living; 
233.15     (3) identification of activities that increase public 
233.16  awareness of and information about the various forms of 
233.17  long-term care assistance available, and develop and implement 
233.18  replicable training efforts; and 
233.19     (4) selection of sites based on outcome and other 
233.20  performance criteria outlined in an application process.  
233.21  Projects can be single-county or multicounty managed.  Project 
233.22  budgets may include payments to increase the amount of and 
233.23  encourage innovation in the development of transitional services 
233.24  within demonstration sites.  Payments for increased assessments, 
233.25  support plan development, and other activities, as approved in 
233.26  the budget proposal for selected project sites, shall be 
233.27  incorporated into the reimbursement for long-term care 
233.28  consultation services as described in subdivision 6.  Projected 
233.29  transition assessments included as part of selected 
233.30  demonstration sites shall be calculated at the rate for county 
233.31  case management services.  
233.32     (b) The commissioner of human services shall submit a 
233.33  report to the legislature describing demonstration models, 
233.34  implementation activities, and projected outcomes by February 
233.35  15, 2002.  A final report on the performance of the models and 
233.36  recommendations for strategies to address relocation or 
234.1   transitional assistance shall be completed by December 15, 2003. 
234.2      Sec. 9.  Minnesota Statutes 2000, section 256B.0911, is 
234.3   amended by adding a subdivision to read: 
234.4      Subd. 4a.  [PREADMISSION SCREENING ACTIVITIES RELATED TO 
234.5   NURSING FACILITY ADMISSIONS.] (a) All applicants to Medicaid 
234.6   certified nursing facilities, including certified boarding care 
234.7   facilities, must be screened prior to admission regardless of 
234.8   income, assets, or funding sources for nursing facility care, 
234.9   except as described in subdivision 4b.  The purpose of the 
234.10  screening is to determine the need for nursing facility level of 
234.11  care as described in paragraph (d) and to complete activities 
234.12  required under federal law related to mental illness and mental 
234.13  retardation as outlined in paragraph (b). 
234.14     (b) A person who has a diagnosis or possible diagnosis of 
234.15  mental illness, mental retardation, or a related condition must 
234.16  receive a preadmission screening before admission regardless of 
234.17  the exemptions outlined in subdivision 4b, paragraph (b), to 
234.18  identify the need for further evaluation and specialized 
234.19  services, unless the admission prior to screening is authorized 
234.20  by the local mental health authority or the local developmental 
234.21  disabilities case manager, or unless authorized by the county 
234.22  agency according to Public Law Number 100-508.  
234.23     The following criteria apply to the preadmission screening: 
234.24     (1) the county must use forms and criteria developed by the 
234.25  commissioner to identify persons who require referral for 
234.26  further evaluation and determination of the need for specialized 
234.27  services; and 
234.28     (2) the evaluation and determination of the need for 
234.29  specialized services must be done by: 
234.30     (i) a qualified independent mental health professional, for 
234.31  persons with a primary or secondary diagnosis of a serious 
234.32  mental illness; or 
234.33     (ii) a qualified mental retardation professional, for 
234.34  persons with a primary or secondary diagnosis of mental 
234.35  retardation or related conditions.  For purposes of this 
234.36  requirement, a qualified mental retardation professional must 
235.1   meet the standards for a qualified mental retardation 
235.2   professional under Code of Federal Regulations, title 42, 
235.3   section 483.430. 
235.4      (c) The local county mental health authority or the state 
235.5   mental retardation authority under Public Law Numbers 100-203 
235.6   and 101-508 may prohibit admission to a nursing facility if the 
235.7   individual does not meet the nursing facility level of care 
235.8   criteria or needs specialized services as defined in Public Law 
235.9   Numbers 100-203 and 101-508.  For purposes of this section, 
235.10  "specialized services" for a person with mental retardation or a 
235.11  related condition means active treatment as that term is defined 
235.12  under Code of Federal Regulations, title 42, section 483.440 
235.13  (a)(1). 
235.14     (d) The determination of the need for nursing facility 
235.15  level of care must be made according to criteria developed by 
235.16  the commissioner.  In assessing a person's needs, consultation 
235.17  team members shall have a physician available for consultation 
235.18  and shall consider the assessment of the individual's attending 
235.19  physician, if any.  The individual's physician must be included 
235.20  if the physician chooses to participate.  Other personnel may be 
235.21  included on the team as deemed appropriate by the county. 
235.22     Sec. 10.  Minnesota Statutes 2000, section 256B.0911, is 
235.23  amended by adding a subdivision to read: 
235.24     Subd. 4b.  [EXEMPTIONS AND EMERGENCY ADMISSIONS.] (a) 
235.25  Exemptions from the federal screening requirements outlined in 
235.26  subdivision 4a, paragraphs (b) and (c), are limited to: 
235.27     (1) a person who, having entered an acute care facility 
235.28  from a certified nursing facility, is returning to a certified 
235.29  nursing facility; and 
235.30     (2) a person transferring from one certified nursing 
235.31  facility in Minnesota to another certified nursing facility in 
235.32  Minnesota. 
235.33     (b) Persons who are exempt from preadmission screening for 
235.34  purposes of level of care determination include: 
235.35     (1) persons described in paragraph (a); 
235.36     (2) an individual who has a contractual right to have 
236.1   nursing facility care paid for indefinitely by the veterans' 
236.2   administration; 
236.3      (3) an individual enrolled in a demonstration project under 
236.4   section 256B.69, subdivision 8, at the time of application to a 
236.5   nursing facility; 
236.6      (4) an individual currently being served under the 
236.7   alternative care program or under a home and community-based 
236.8   services waiver authorized under section 1915(c) of the federal 
236.9   Social Security Act; and 
236.10     (5) individuals admitted to a certified nursing facility 
236.11  for a short-term stay, which is expected to be 14 days or less 
236.12  in duration based upon a physician's certification, and who have 
236.13  been assessed and approved for nursing facility admission within 
236.14  the previous six months.  This exemption applies only if the 
236.15  consultation team member determines at the time of the initial 
236.16  assessment of the six-month period that it is appropriate to use 
236.17  the nursing facility for short-term stays and that there is an 
236.18  adequate plan of care for return to the home or community-based 
236.19  setting.  If a stay exceeds 14 days, the individual must be 
236.20  referred no later than the first county working day following 
236.21  the 14th resident day for a screening, which must be completed 
236.22  within five working days of the referral.  The payment 
236.23  limitations in subdivision 7 apply to an individual found at 
236.24  screening to not meet the level of care criteria for admission 
236.25  to a certified nursing facility. 
236.26     (c) Persons admitted to a Medicaid-certified nursing 
236.27  facility from the community on an emergency basis as described 
236.28  in paragraph (d) or from an acute care facility on a nonworking 
236.29  day must be screened the first working day after admission. 
236.30     (d) Emergency admission to a nursing facility prior to 
236.31  screening is permitted when all of the following conditions are 
236.32  met: 
236.33     (1) a person is admitted from the community to a certified 
236.34  nursing or certified boarding care facility during county 
236.35  nonworking hours; 
236.36     (2) a physician has determined that delaying admission 
237.1   until preadmission screening is completed would adversely affect 
237.2   the person's health and safety; 
237.3      (3) there is a recent precipitating event that precludes 
237.4   the client from living safely in the community, such as 
237.5   sustaining an injury, sudden onset of acute illness, or a 
237.6   caregiver's inability to continue to provide care; 
237.7      (4) the attending physician has authorized the emergency 
237.8   placement and has documented the reason that the emergency 
237.9   placement is recommended; and 
237.10     (5) the county is contacted on the first working day 
237.11  following the emergency admission. 
237.12  Transfer of a patient from an acute care hospital to a nursing 
237.13  facility is not considered an emergency except for a person who 
237.14  has received hospital services in the following situations: 
237.15  hospital admission for observation, care in an emergency room 
237.16  without hospital admission, or following hospital 24-hour bed 
237.17  care. 
237.18     Sec. 11.  Minnesota Statutes 2000, section 256B.0911, is 
237.19  amended by adding a subdivision to read: 
237.20     Subd. 4c.  [SCREENING REQUIREMENTS.] (a) A person may be 
237.21  screened for nursing facility admission by telephone or in a 
237.22  face-to-face screening interview.  Consultation team members 
237.23  shall identify each individual's needs using the following 
237.24  categories: 
237.25     (1) the person needs no face-to-face screening interview to 
237.26  determine the need for nursing facility level of care based on 
237.27  information obtained from other health care professionals; 
237.28     (2) the person needs an immediate face-to-face screening 
237.29  interview to determine the need for nursing facility level of 
237.30  care and complete activities required under subdivision 4a; or 
237.31     (3) the person may be exempt from screening requirements as 
237.32  outlined in subdivision 4b, but will need transitional 
237.33  assistance after admission or in-person follow-along after a 
237.34  return home. 
237.35     (b) Persons admitted on a nonemergency basis to a 
237.36  Medicaid-certified nursing facility must be screened prior to 
238.1   admission. 
238.2      (c) The long-term care consultation team shall recommend a 
238.3   case mix classification for persons admitted to a certified 
238.4   nursing facility when sufficient information is received to make 
238.5   that classification.  The nursing facility is authorized to 
238.6   conduct all case mix assessments for persons who have been 
238.7   screened prior to admission for whom the county did not 
238.8   recommend a case mix classification.  The nursing facility is 
238.9   authorized to conduct all case mix assessments for persons 
238.10  admitted to the facility prior to a preadmission screening.  The 
238.11  county retains the responsibility of distributing appropriate 
238.12  case mix forms to the nursing facility. 
238.13     (d) The county screening or intake activity must include 
238.14  processes to identify persons who may require transition 
238.15  assistance as described in subdivision 3b. 
238.16     Sec. 12.  Minnesota Statutes 2000, section 256B.0911, 
238.17  subdivision 5, is amended to read: 
238.18     Subd. 5.  [SIMPLIFICATION OF FORMS ADMINISTRATIVE 
238.19  ACTIVITY.] The commissioner shall minimize the number of forms 
238.20  required in the preadmission screening process provision of 
238.21  long-term care consultation services and shall limit the 
238.22  screening document to items necessary for care community support 
238.23  plan approval, reimbursement, program planning, evaluation, and 
238.24  policy development. 
238.25     Sec. 13.  Minnesota Statutes 2000, section 256B.0911, 
238.26  subdivision 6, is amended to read: 
238.27     Subd. 6.  [PAYMENT FOR PREADMISSION SCREENING LONG-TERM 
238.28  CARE CONSULTATION SERVICES.] (a) The total screening payment for 
238.29  each county must be paid monthly by certified nursing facilities 
238.30  in the county.  The monthly amount to be paid by each nursing 
238.31  facility for each fiscal year must be determined by dividing the 
238.32  county's annual allocation for screenings long-term care 
238.33  consultation services by 12 to determine the monthly payment and 
238.34  allocating the monthly payment to each nursing facility based on 
238.35  the number of licensed beds in the nursing facility.  Payments 
238.36  to counties in which there is no certified nursing facility must 
239.1   be made by increasing the payment rate of the two facilities 
239.2   located nearest to the county seat. 
239.3      (b) The commissioner shall include the total annual payment 
239.4   for screening determined under paragraph (a) for each nursing 
239.5   facility reimbursed under section 256B.431 or 256B.434 according 
239.6   to section 256B.431, subdivision 2b, paragraph (g), or 256B.435. 
239.7      (c) In the event of the layaway, delicensure and 
239.8   decertification, or removal from layaway of 25 percent or more 
239.9   of the beds in a facility, the commissioner may adjust the per 
239.10  diem payment amount in paragraph (b) and may adjust the monthly 
239.11  payment amount in paragraph (a). The effective date of an 
239.12  adjustment made under this paragraph shall be on or after the 
239.13  first day of the month following the effective date of the 
239.14  layaway, delicensure and decertification, or removal from 
239.15  layaway. 
239.16     (d) Payments for screening activities long-term care 
239.17  consultation services are available to the county or counties to 
239.18  cover staff salaries and expenses to provide the screening 
239.19  function services described in subdivision 1a.  The lead agency 
239.20  county shall employ, or contract with other agencies to employ, 
239.21  within the limits of available funding, sufficient personnel 
239.22  to conduct the preadmission screening activity provide long-term 
239.23  care consultation services while meeting the state's long-term 
239.24  care outcomes and objectives as defined in section 256B.0917, 
239.25  subdivision 1.  The local agency county shall be accountable for 
239.26  meeting local objectives as approved by the commissioner in the 
239.27  CSSA biennial plan. 
239.28     (d) (e) Notwithstanding section 256B.0641, overpayments 
239.29  attributable to payment of the screening costs under the medical 
239.30  assistance program may not be recovered from a facility.  
239.31     (e) (f) The commissioner of human services shall amend the 
239.32  Minnesota medical assistance plan to include reimbursement for 
239.33  the local screening consultation teams. 
239.34     (g) The county may bill, as case management services, 
239.35  assessments, support planning, and follow-along provided to 
239.36  persons determined to be eligible for case management under 
240.1   Minnesota health care programs.  No individual or family member 
240.2   shall be charged for an initial assessment or initial support 
240.3   plan development provided under subdivision 3a or 3b. 
240.4      Sec. 14.  Minnesota Statutes 2000, section 256B.0911, 
240.5   subdivision 7, is amended to read: 
240.6      Subd. 7.  [REIMBURSEMENT FOR CERTIFIED NURSING FACILITIES.] 
240.7   (a) Medical assistance reimbursement for nursing facilities 
240.8   shall be authorized for a medical assistance recipient only if a 
240.9   preadmission screening has been conducted prior to admission or 
240.10  the local county agency has authorized an exemption.  Medical 
240.11  assistance reimbursement for nursing facilities shall not be 
240.12  provided for any recipient who the local screener has determined 
240.13  does not meet the level of care criteria for nursing facility 
240.14  placement or, if indicated, has not had a level II PASARR OBRA 
240.15  evaluation as required under the federal Omnibus Budget 
240.16  Reconciliation Act of 1987 completed unless an admission for a 
240.17  recipient with mental illness is approved by the local mental 
240.18  health authority or an admission for a recipient with mental 
240.19  retardation or related condition is approved by the state mental 
240.20  retardation authority. 
240.21     (b) The nursing facility must not bill a person who is not 
240.22  a medical assistance recipient for resident days that preceded 
240.23  the date of completion of screening activities as required under 
240.24  subdivisions 4a, 4b, and 4c.  The nursing facility must include 
240.25  unreimbursed resident days in the nursing facility resident day 
240.26  totals reported to the commissioner. 
240.27     (c) The commissioner shall make a request to the health 
240.28  care financing administration for a waiver allowing screening 
240.29  team approval of Medicaid payments for certified nursing 
240.30  facility care.  An individual has a choice and makes the final 
240.31  decision between nursing facility placement and community 
240.32  placement after the screening team's recommendation, except as 
240.33  provided in paragraphs (b) and (c) subdivision 4a, paragraph (c).
240.34     (c) The local county mental health authority or the state 
240.35  mental retardation authority under Public Law Numbers 100-203 
240.36  and 101-508 may prohibit admission to a nursing facility, if the 
241.1   individual does not meet the nursing facility level of care 
241.2   criteria or needs specialized services as defined in Public Law 
241.3   Numbers 100-203 and 101-508.  For purposes of this section, 
241.4   "specialized services" for a person with mental retardation or a 
241.5   related condition means "active treatment" as that term is 
241.6   defined in Code of Federal Regulations, title 42, section 
241.7   483.440(a)(1). 
241.8      (e) Appeals from the screening team's recommendation or the 
241.9   county agency's final decision shall be made according to 
241.10  section 256.045, subdivision 3. 
241.11     Sec. 15.  Minnesota Statutes 2000, section 256B.0913, 
241.12  subdivision 1, is amended to read: 
241.13     Subdivision 1.  [PURPOSE AND GOALS.] The purpose of the 
241.14  alternative care program is to provide funding for or access to 
241.15  home and community-based services for frail elderly persons, in 
241.16  order to limit nursing facility placements.  The program is 
241.17  designed to support frail elderly persons in their desire to 
241.18  remain in the community as independently and as long as possible 
241.19  and to support informal caregivers in their efforts to provide 
241.20  care for frail elderly people.  Further, the goals of the 
241.21  program are: 
241.22     (1) to contain medical assistance expenditures by providing 
241.23  funding care in the community at a cost the same or less than 
241.24  nursing facility costs; and 
241.25     (2) to maintain the moratorium on new construction of 
241.26  nursing home beds. 
241.27     Sec. 16.  Minnesota Statutes 2000, section 256B.0913, 
241.28  subdivision 2, is amended to read: 
241.29     Subd. 2.  [ELIGIBILITY FOR SERVICES.] Alternative care 
241.30  services are available to all frail older Minnesotans.  This 
241.31  includes: 
241.32     (1) persons who are receiving medical assistance and served 
241.33  under the medical assistance program or the Medicaid waiver 
241.34  program; 
241.35     (2) persons age 65 or older who are not eligible for 
241.36  medical assistance without a spenddown or waiver obligation but 
242.1   who would be eligible for medical assistance within 180 days of 
242.2   admission to a nursing facility and served under subject to 
242.3   subdivisions 4 to 13; and 
242.4      (3) persons who are paying for their services out-of-pocket.
242.5      Sec. 17.  Minnesota Statutes 2000, section 256B.0913, 
242.6   subdivision 4, is amended to read: 
242.7      Subd. 4.  [ELIGIBILITY FOR FUNDING FOR SERVICES FOR 
242.8   NONMEDICAL ASSISTANCE RECIPIENTS.] (a) Funding for services 
242.9   under the alternative care program is available to persons who 
242.10  meet the following criteria: 
242.11     (1) the person has been screened by the county screening 
242.12  team or, if previously screened and served under the alternative 
242.13  care program, assessed by the local county social worker or 
242.14  public health nurse determined by a community assessment under 
242.15  section 256B.0911, to be a person who would require the level of 
242.16  care provided in a nursing facility, but for the provision of 
242.17  services under the alternative care program; 
242.18     (2) the person is age 65 or older; 
242.19     (3) the person would be financially eligible for medical 
242.20  assistance within 180 days of admission to a nursing facility; 
242.21     (4) the person meets the asset transfer requirements of is 
242.22  not ineligible for the medical assistance program due to an 
242.23  asset transfer penalty; 
242.24     (5) the screening team would recommend nursing facility 
242.25  admission or continued stay for the person if alternative care 
242.26  services were not available; 
242.27     (6) the person needs services that are not available at 
242.28  that time in the county funded through other county, state, or 
242.29  federal funding sources; and 
242.30     (7) (6) the monthly cost of the alternative care services 
242.31  funded by the program for this person does not exceed 75 percent 
242.32  of the statewide average monthly medical assistance payment for 
242.33  nursing facility care at the individual's case mix 
242.34  classification weighted average monthly nursing facility rate of 
242.35  the case mix resident class to which the individual alternative 
242.36  care client would be assigned under Minnesota Rules, parts 
243.1   9549.0050 to 9549.0059, less the recipient's maintenance needs 
243.2   allowance as described in section 256B.0915, subdivision 1d, 
243.3   paragraph (a), until the first day of the state fiscal year in 
243.4   which the resident assessment system, under section 256B.437, 
243.5   for nursing home rate determination is implemented.  Effective 
243.6   on the first day of the state fiscal year in which a resident 
243.7   assessment system, under section 256B.437, for nursing home rate 
243.8   determination is implemented and the first day of each 
243.9   subsequent state fiscal year, the monthly cost of alternative 
243.10  care services for this person shall not exceed the alternative 
243.11  care monthly cap for the case mix resident class to which the 
243.12  alternative care client would be assigned under Minnesota Rules, 
243.13  parts 9549.0050 to 9549.0059, which was in effect on the last 
243.14  day of the previous state fiscal year, and adjusted by the 
243.15  greater of any legislatively adopted home and community-based 
243.16  services cost-of-living percentage increase or any legislatively 
243.17  adopted statewide percent rate increase for nursing facilities.  
243.18  This monthly limit does not prohibit the alternative care client 
243.19  from payment for additional services, but in no case may the 
243.20  cost of additional services purchased under this section exceed 
243.21  the difference between the client's monthly service limit 
243.22  defined under section 256B.0915, subdivision 3, and the 
243.23  alternative care program monthly service limit defined in this 
243.24  paragraph.  If medical supplies and equipment or adaptations 
243.25  environmental modifications are or will be purchased for an 
243.26  alternative care services recipient, the costs may be prorated 
243.27  on a monthly basis throughout the year in which they are 
243.28  purchased for up to 12 consecutive months beginning with the 
243.29  month of purchase.  If the monthly cost of a recipient's other 
243.30  alternative care services exceeds the monthly limit established 
243.31  in this paragraph, the annual cost of the alternative care 
243.32  services shall be determined.  In this event, the annual cost of 
243.33  alternative care services shall not exceed 12 times the monthly 
243.34  limit calculated described in this paragraph. 
243.35     (b) Individuals who meet the criteria in paragraph (a) and 
243.36  who have been approved for alternative care funding are called 
244.1   180-day eligible clients. 
244.2      (c) The statewide average payment for nursing facility care 
244.3   is the statewide average monthly nursing facility rate in effect 
244.4   on July 1 of the fiscal year in which the cost is incurred, less 
244.5   the statewide average monthly income of nursing facility 
244.6   residents who are age 65 or older and who are medical assistance 
244.7   recipients in the month of March of the previous fiscal year.  
244.8   This monthly limit does not prohibit the 180-day eligible client 
244.9   from paying for additional services needed or desired.  
244.10     (d) In determining the total costs of alternative care 
244.11  services for one month, the costs of all services funded by the 
244.12  alternative care program, including supplies and equipment, must 
244.13  be included. 
244.14     (e) Alternative care funding under this subdivision is not 
244.15  available for a person who is a medical assistance recipient or 
244.16  who would be eligible for medical assistance without a 
244.17  spenddown, unless authorized by the commissioner or waiver 
244.18  obligation.  A person whose initial application for medical 
244.19  assistance is being processed may be served under the 
244.20  alternative care program for a period up to 60 days.  If the 
244.21  individual is found to be eligible for medical assistance, the 
244.22  county must bill medical assistance must be billed for services 
244.23  payable under the federally approved elderly waiver plan and 
244.24  delivered from the date the individual was found eligible 
244.25  for services reimbursable under the federally approved elderly 
244.26  waiver program plan.  Notwithstanding this provision, upon 
244.27  federal approval, alternative care funds may not be used to pay 
244.28  for any service the cost of which is payable by medical 
244.29  assistance or which is used by a recipient to meet a medical 
244.30  assistance income spenddown or waiver obligation.  
244.31     (f) (c) Alternative care funding is not available for a 
244.32  person who resides in a licensed nursing home or, certified 
244.33  boarding care home, hospital, or intermediate care facility, 
244.34  except for case management services which are being provided in 
244.35  support of the discharge planning process to a nursing home 
244.36  resident or certified boarding care home resident who is 
245.1   ineligible for case management funded by medical assistance. 
245.2      Sec. 18.  Minnesota Statutes 2000, section 256B.0913, 
245.3   subdivision 5, is amended to read: 
245.4      Subd. 5.  [SERVICES COVERED UNDER ALTERNATIVE CARE.] (a) 
245.5   Alternative care funding may be used for payment of costs of: 
245.6      (1) adult foster care; 
245.7      (2) adult day care; 
245.8      (3) home health aide; 
245.9      (4) homemaker services; 
245.10     (5) personal care; 
245.11     (6) case management; 
245.12     (7) respite care; 
245.13     (8) assisted living; 
245.14     (9) residential care services; 
245.15     (10) care-related supplies and equipment; 
245.16     (11) meals delivered to the home; 
245.17     (12) transportation; 
245.18     (13) skilled nursing; 
245.19     (14) chore services; 
245.20     (15) companion services; 
245.21     (16) nutrition services; 
245.22     (17) training for direct informal caregivers; 
245.23     (18) telemedicine devices to monitor recipients in their 
245.24  own homes as an alternative to hospital care, nursing home care, 
245.25  or home visits; and 
245.26     (19) "other services" including includes discretionary 
245.27  funds and direct cash payments to clients, approved by the 
245.28  county agency following approval by the commissioner, subject to 
245.29  the provisions of paragraph (m) (j).  Total annual payments for "
245.30  other services" for all clients within a county may not exceed 
245.31  either ten percent of that county's annual alternative care 
245.32  program base allocation or $5,000, whichever is greater.  In no 
245.33  case shall this amount exceed the county's total annual 
245.34  alternative care program base allocation; and 
245.35     (20) environmental modifications. 
245.36     (b) The county agency must ensure that the funds are not 
246.1   used only to supplement and not to supplant services available 
246.2   through other public assistance or services programs. 
246.3      (c) Unless specified in statute, the service definitions 
246.4   and standards for alternative care services shall be the same as 
246.5   the service definitions and standards defined specified in the 
246.6   federally approved elderly waiver plan.  Except for the county 
246.7   agencies' approval of direct cash payments to clients as 
246.8   described in paragraph (j) or for a provider of supplies and 
246.9   equipment when the monthly cost of the supplies and equipment is 
246.10  less than $250, persons or agencies must be employed by or under 
246.11  a contract with the county agency or the public health nursing 
246.12  agency of the local board of health in order to receive funding 
246.13  under the alternative care program.  Supplies and equipment may 
246.14  be purchased from a vendor not certified to participate in the 
246.15  Medicaid program if the cost for the item is less than that of a 
246.16  Medicaid vendor.  
246.17     (d) The adult foster care rate shall be considered a 
246.18  difficulty of care payment and shall not include room and 
246.19  board.  The adult foster care daily rate shall be negotiated 
246.20  between the county agency and the foster care provider.  The 
246.21  rate established under this section shall not exceed 75 percent 
246.22  of the state average monthly nursing home payment for the case 
246.23  mix classification to which the individual receiving foster care 
246.24  is assigned, and it must allow for other alternative care 
246.25  services to be authorized by the case manager.  The alternative 
246.26  care payment for the foster care service in combination with the 
246.27  payment for other alternative care services, including case 
246.28  management, must not exceed the limit specified in subdivision 
246.29  4, paragraph (a), clause (6). 
246.30     (e) Personal care services may be provided by a personal 
246.31  care provider organization. must meet the service standards 
246.32  defined in the federally approved elderly waiver plan, except 
246.33  that a county agency may contract with a client's relative of 
246.34  the client who meets the relative hardship waiver requirement as 
246.35  defined in section 256B.0627, subdivision 4, paragraph (b), 
246.36  clause (10), to provide personal care services, but must ensure 
247.1   nursing if the county agency ensures supervision of this service 
247.2   by a registered nurse or mental health practitioner.  Covered 
247.3   personal care services defined in section 256B.0627, subdivision 
247.4   4, must meet applicable standards in Minnesota Rules, part 
247.5   9505.0335. 
247.6      (f) A county may use alternative care funds to purchase 
247.7   medical supplies and equipment without prior approval from the 
247.8   commissioner when:  (1) there is no other funding source; (2) 
247.9   the supplies and equipment are specified in the individual's 
247.10  care plan as medically necessary to enable the individual to 
247.11  remain in the community according to the criteria in Minnesota 
247.12  Rules, part 9505.0210, item A; and (3) the supplies and 
247.13  equipment represent an effective and appropriate use of 
247.14  alternative care funds.  A county may use alternative care funds 
247.15  to purchase supplies and equipment from a non-Medicaid certified 
247.16  vendor if the cost for the items is less than that of a Medicaid 
247.17  vendor.  A county is not required to contract with a provider of 
247.18  supplies and equipment if the monthly cost of the supplies and 
247.19  equipment is less than $250.  
247.20     (g) For purposes of this section, residential care services 
247.21  are services which are provided to individuals living in 
247.22  residential care homes.  Residential care homes are currently 
247.23  licensed as board and lodging establishments and are registered 
247.24  with the department of health as providing special 
247.25  services under section 157.17 and are not subject to 
247.26  registration under chapter 144D.  Residential care services are 
247.27  defined as "supportive services" and "health-related services."  
247.28  "Supportive services" means the provision of up to 24-hour 
247.29  supervision and oversight.  Supportive services includes:  (1) 
247.30  transportation, when provided by the residential care center 
247.31  home only; (2) socialization, when socialization is part of the 
247.32  plan of care, has specific goals and outcomes established, and 
247.33  is not diversional or recreational in nature; (3) assisting 
247.34  clients in setting up meetings and appointments; (4) assisting 
247.35  clients in setting up medical and social services; (5) providing 
247.36  assistance with personal laundry, such as carrying the client's 
248.1   laundry to the laundry room.  Assistance with personal laundry 
248.2   does not include any laundry, such as bed linen, that is 
248.3   included in the room and board rate.  "Health-related services" 
248.4   are limited to minimal assistance with dressing, grooming, and 
248.5   bathing and providing reminders to residents to take medications 
248.6   that are self-administered or providing storage for medications, 
248.7   if requested.  Individuals receiving residential care services 
248.8   cannot receive homemaking services funded under this section.  
248.9      (h) (g) For the purposes of this section, "assisted living" 
248.10  refers to supportive services provided by a single vendor to 
248.11  clients who reside in the same apartment building of three or 
248.12  more units which are not subject to registration under chapter 
248.13  144D and are licensed by the department of health as a class A 
248.14  home care provider or a class E home care provider.  Assisted 
248.15  living services are defined as up to 24-hour supervision, and 
248.16  oversight, supportive services as defined in clause (1), 
248.17  individualized home care aide tasks as defined in clause (2), 
248.18  and individualized home management tasks as defined in clause 
248.19  (3) provided to residents of a residential center living in 
248.20  their units or apartments with a full kitchen and bathroom.  A 
248.21  full kitchen includes a stove, oven, refrigerator, food 
248.22  preparation counter space, and a kitchen utensil storage 
248.23  compartment.  Assisted living services must be provided by the 
248.24  management of the residential center or by providers under 
248.25  contract with the management or with the county. 
248.26     (1) Supportive services include:  
248.27     (i) socialization, when socialization is part of the plan 
248.28  of care, has specific goals and outcomes established, and is not 
248.29  diversional or recreational in nature; 
248.30     (ii) assisting clients in setting up meetings and 
248.31  appointments; and 
248.32     (iii) providing transportation, when provided by the 
248.33  residential center only.  
248.34     Individuals receiving assisted living services will not 
248.35  receive both assisted living services and homemaking services.  
248.36  Individualized means services are chosen and designed 
249.1   specifically for each resident's needs, rather than provided or 
249.2   offered to all residents regardless of their illnesses, 
249.3   disabilities, or physical conditions.  
249.4      (2) Home care aide tasks means:  
249.5      (i) preparing modified diets, such as diabetic or low 
249.6   sodium diets; 
249.7      (ii) reminding residents to take regularly scheduled 
249.8   medications or to perform exercises; 
249.9      (iii) household chores in the presence of technically 
249.10  sophisticated medical equipment or episodes of acute illness or 
249.11  infectious disease; 
249.12     (iv) household chores when the resident's care requires the 
249.13  prevention of exposure to infectious disease or containment of 
249.14  infectious disease; and 
249.15     (v) assisting with dressing, oral hygiene, hair care, 
249.16  grooming, and bathing, if the resident is ambulatory, and if the 
249.17  resident has no serious acute illness or infectious disease.  
249.18  Oral hygiene means care of teeth, gums, and oral prosthetic 
249.19  devices.  
249.20     (3) Home management tasks means:  
249.21     (i) housekeeping; 
249.22     (ii) laundry; 
249.23     (iii) preparation of regular snacks and meals; and 
249.24     (iv) shopping.  
249.25     Individuals receiving assisted living services shall not 
249.26  receive both assisted living services and homemaking services.  
249.27  Individualized means services are chosen and designed 
249.28  specifically for each resident's needs, rather than provided or 
249.29  offered to all residents regardless of their illnesses, 
249.30  disabilities, or physical conditions.  Assisted living services 
249.31  as defined in this section shall not be authorized in boarding 
249.32  and lodging establishments licensed according to sections 
249.33  157.011 and 157.15 to 157.22. 
249.34     (i) (h) For establishments registered under chapter 144D, 
249.35  assisted living services under this section means either the 
249.36  services described and licensed in paragraph (g) and delivered 
250.1   by a class E home care provider licensed by the department of 
250.2   health or the services described under section 144A.4605 and 
250.3   delivered by an assisted living home care provider or a class A 
250.4   home care provider licensed by the commissioner of health. 
250.5      (j) For the purposes of this section, reimbursement (i) 
250.6   Payment for assisted living services and residential care 
250.7   services shall be a monthly rate negotiated and authorized by 
250.8   the county agency based on an individualized service plan for 
250.9   each resident and may not cover direct rent or food costs.  The 
250.10  rate 
250.11     (1) The individualized monthly negotiated payment for 
250.12  assisted living services as described in paragraph (g) or (h), 
250.13  and residential care services as described in paragraph (f), 
250.14  shall not exceed the nonfederal share in effect on July 1 of the 
250.15  state fiscal year for which the rate limit is being calculated 
250.16  of the greater of either the statewide or any of the geographic 
250.17  groups' weighted average monthly medical assistance nursing 
250.18  facility payment rate of the case mix resident class to which 
250.19  the 180-day alternative care eligible client would be assigned 
250.20  under Minnesota Rules, parts 9549.0050 to 9549.0059, unless the 
250.21  less the maintenance needs allowance as described in section 
250.22  256B.0915, subdivision 1d, paragraph (a), until the first day of 
250.23  the state fiscal year in which a resident assessment system, 
250.24  under section 256B.437, of nursing home rate determination is 
250.25  implemented.  Effective on the first day of the state fiscal 
250.26  year in which a resident assessment system, under section 
250.27  256B.437, of nursing home rate determination is implemented and 
250.28  the first day of each subsequent state fiscal year, the 
250.29  individualized monthly negotiated payment for the services 
250.30  described in this clause shall not exceed the limit described in 
250.31  this clause which was in effect on the last day of the previous 
250.32  state fiscal year and which has been adjusted by the greater of 
250.33  any legislatively adopted home and community-based services 
250.34  cost-of-living percentage increase or any legislatively adopted 
250.35  statewide percent rate increase for nursing facilities. 
250.36     (2) The individualized monthly negotiated payment for 
251.1   assisted living services are provided by a home care described 
251.2   under section 144A.4605 and delivered by a provider licensed by 
251.3   the department of health as a class A home care provider or an 
251.4   assisted living home care provider and are provided in a 
251.5   building that is registered as a housing with services 
251.6   establishment under chapter 144D and that provides 24-hour 
251.7   supervision in combination with the payment for other 
251.8   alternative care services, including case management, must not 
251.9   exceed the limit specified in subdivision 4, paragraph (a), 
251.10  clause (6). 
251.11     (k) For purposes of this section, companion services are 
251.12  defined as nonmedical care, supervision and oversight, provided 
251.13  to a functionally impaired adult.  Companions may assist the 
251.14  individual with such tasks as meal preparation, laundry and 
251.15  shopping, but do not perform these activities as discrete 
251.16  services.  The provision of companion services does not entail 
251.17  hands-on medical care.  Providers may also perform light 
251.18  housekeeping tasks which are incidental to the care and 
251.19  supervision of the recipient.  This service must be approved by 
251.20  the case manager as part of the care plan.  Companion services 
251.21  must be provided by individuals or organizations who are under 
251.22  contract with the local agency to provide the service.  Any 
251.23  person related to the waiver recipient by blood, marriage or 
251.24  adoption cannot be reimbursed under this service.  Persons 
251.25  providing companion services will be monitored by the case 
251.26  manager. 
251.27     (l) For purposes of this section, training for direct 
251.28  informal caregivers is defined as a classroom or home course of 
251.29  instruction which may include:  transfer and lifting skills, 
251.30  nutrition, personal and physical cares, home safety in a home 
251.31  environment, stress reduction and management, behavioral 
251.32  management, long-term care decision making, care coordination 
251.33  and family dynamics.  The training is provided to an informal 
251.34  unpaid caregiver of a 180-day eligible client which enables the 
251.35  caregiver to deliver care in a home setting with high levels of 
251.36  quality.  The training must be approved by the case manager as 
252.1   part of the individual care plan.  Individuals, agencies, and 
252.2   educational facilities which provide caregiver training and 
252.3   education will be monitored by the case manager. 
252.4      (m) (j) A county agency may make payment from their 
252.5   alternative care program allocation for "other services" 
252.6   provided to an alternative care program recipient if those 
252.7   services prevent, shorten, or delay institutionalization.  These 
252.8   services may which include use of "discretionary funds" for 
252.9   services that are not otherwise defined in this section and 
252.10  direct cash payments to the recipient client for the purpose of 
252.11  purchasing the recipient's services.  The following provisions 
252.12  apply to payments under this paragraph: 
252.13     (1) a cash payment to a client under this provision cannot 
252.14  exceed 80 percent of the monthly payment limit for that client 
252.15  as specified in subdivision 4, paragraph (a), clause (7) (6); 
252.16     (2) a county may not approve any cash payment for a client 
252.17  who meets either of the following: 
252.18     (i) has been assessed as having a dependency in 
252.19  orientation, unless the client has an authorized 
252.20  representative under section 256.476, subdivision 2, paragraph 
252.21  (g), or for a client who.  An "authorized representative" means 
252.22  an individual who is at least 18 years of age and is designated 
252.23  by the person or the person's legal representative to act on the 
252.24  person's behalf.  This individual may be a family member, 
252.25  guardian, representative payee, or other individual designated 
252.26  by the person or the person's legal representative, if any, to 
252.27  assist in purchasing and arranging for supports; or 
252.28     (ii) is concurrently receiving adult foster care, 
252.29  residential care, or assisted living services; 
252.30     (3) any service approved under this section must be a 
252.31  service which meets the purpose and goals of the program as 
252.32  listed in subdivision 1; 
252.33     (4) cash payments must also meet the criteria of and are 
252.34  governed by the procedures and liability protection established 
252.35  in section 256.476, subdivision 4, paragraphs (b) through (h), 
252.36  and recipients of cash grants must meet the requirements in 
253.1   section 256.476, subdivision 10; and cash payments to a person 
253.2   or a person's family will be provided through a monthly payment 
253.3   and be in the form of cash, voucher, or direct county payment to 
253.4   a vendor.  Fees or premiums assessed to the person for 
253.5   eligibility for health and human services are not reimbursable 
253.6   through this service option.  Services and goods purchased 
253.7   through cash payments must be identified in the person's 
253.8   individualized care plan and must meet all of the following 
253.9   criteria: 
253.10     (i) they must be over and above the normal cost of caring 
253.11  for the person if the person did not have functional 
253.12  limitations; 
253.13     (ii) they must be directly attributable to the person's 
253.14  functional limitations; 
253.15     (iii) they must have the potential to be effective at 
253.16  meeting the goals of the program; 
253.17     (iv) they must be consistent with the needs identified in 
253.18  the individualized service plan.  The service plan shall specify 
253.19  the needs of the person and family, the form and amount of 
253.20  payment, the items and services to be reimbursed, and the 
253.21  arrangements for management of the individual grant; and 
253.22     (v) the person, the person's family, or the legal 
253.23  representative shall be provided sufficient information to 
253.24  ensure an informed choice of alternatives.  The local agency 
253.25  shall document this information in the person's care plan, 
253.26  including the type and level of expenditures to be reimbursed; 
253.27     (4) the county, lead agency under contract, or tribal 
253.28  government under contract to administer the alternative care 
253.29  program shall not be liable for damages, injuries, or 
253.30  liabilities sustained through the purchase of direct supports or 
253.31  goods by the person, the person's family, or the authorized 
253.32  representative with funds received through the cash payments 
253.33  under this section.  Liabilities include, but are not limited 
253.34  to, workers' compensation, the Federal Insurance Contributions 
253.35  Act (FICA), or the Federal Unemployment Tax Act (FUTA); 
253.36     (5) persons receiving grants under this section shall have 
254.1   the following responsibilities: 
254.2      (i) spend the grant money in a manner consistent with their 
254.3   individualized service plan with the local agency; 
254.4      (ii) notify the local agency of any necessary changes in 
254.5   the grant-expenditures; 
254.6      (iii) arrange and pay for supports; and 
254.7      (iv) inform the local agency of areas where they have 
254.8   experienced difficulty securing or maintaining supports; and 
254.9      (5) (6) the county shall report client outcomes, services, 
254.10  and costs under this paragraph in a manner prescribed by the 
254.11  commissioner. 
254.12     (k) Upon implementation of direct cash payments to clients 
254.13  under this section, any person determined eligible for the 
254.14  alternative care program who chooses a cash payment approved by 
254.15  the county agency shall receive the cash payment under this 
254.16  section and not under section 256.476 unless the person was 
254.17  receiving a consumer support grant under section 256.476 before 
254.18  implementation of direct cash payments under this section. 
254.19     Sec. 19.  Minnesota Statutes 2000, section 256B.0913, 
254.20  subdivision 6, is amended to read: 
254.21     Subd. 6.  [ALTERNATIVE CARE PROGRAM ADMINISTRATION.] The 
254.22  alternative care program is administered by the county agency.  
254.23  This agency is the lead agency responsible for the local 
254.24  administration of the alternative care program as described in 
254.25  this section.  However, it may contract with the public health 
254.26  nursing service to be the lead agency.  The commissioner may 
254.27  contract with federally recognized Indian tribes with a 
254.28  reservation in Minnesota to serve as the lead agency responsible 
254.29  for the local administration of the alternative care program as 
254.30  described in the contract. 
254.31     Sec. 20.  Minnesota Statutes 2000, section 256B.0913, 
254.32  subdivision 7, is amended to read: 
254.33     Subd. 7.  [CASE MANAGEMENT.] Providers of case management 
254.34  services for persons receiving services funded by the 
254.35  alternative care program must meet the qualification 
254.36  requirements and standards specified in section 256B.0915, 
255.1   subdivision 1b.  The case manager must ensure the health and 
255.2   safety of the individual client and not approve alternative care 
255.3   funding for a client in any setting in which the case manager 
255.4   cannot reasonably ensure the client's health and safety.  The 
255.5   case manager is responsible for the cost-effectiveness of the 
255.6   alternative care individual care plan and must not approve any 
255.7   care plan in which the cost of services funded by alternative 
255.8   care and client contributions exceeds the limit specified in 
255.9   section 256B.0915, subdivision 3, paragraph (b).  The county may 
255.10  allow a case manager employed by the county to delegate certain 
255.11  aspects of the case management activity to another individual 
255.12  employed by the county provided there is oversight of the 
255.13  individual by the case manager.  The case manager may not 
255.14  delegate those aspects which require professional judgment 
255.15  including assessments, reassessments, and care plan development. 
255.16     Sec. 21.  Minnesota Statutes 2000, section 256B.0913, 
255.17  subdivision 8, is amended to read: 
255.18     Subd. 8.  [REQUIREMENTS FOR INDIVIDUAL CARE PLAN.] (a) The 
255.19  case manager shall implement the plan of care for each 180-day 
255.20  eligible alternative care client and ensure that a client's 
255.21  service needs and eligibility are reassessed at least every 12 
255.22  months.  The plan shall include any services prescribed by the 
255.23  individual's attending physician as necessary to allow the 
255.24  individual to remain in a community setting.  In developing the 
255.25  individual's care plan, the case manager should include the use 
255.26  of volunteers from families and neighbors, religious 
255.27  organizations, social clubs, and civic and service organizations 
255.28  to support the formal home care services.  The county shall be 
255.29  held harmless for damages or injuries sustained through the use 
255.30  of volunteers under this subdivision including workers' 
255.31  compensation liability.  The lead agency shall provide 
255.32  documentation to the commissioner verifying that the 
255.33  individual's alternative care is not available at that time 
255.34  through any other public assistance or service program.  The 
255.35  lead agency shall provide documentation in each individual's 
255.36  plan of care and, if requested, to the commissioner that the 
256.1   most cost-effective alternatives available have been offered to 
256.2   the individual and that the individual was free to choose among 
256.3   available qualified providers, both public and private.  The 
256.4   case manager must give the individual a ten-day written notice 
256.5   of any decrease in or termination of alternative care services. 
256.6      (b) If the county administering alternative care services 
256.7   is different than the county of financial responsibility, the 
256.8   care plan may be implemented without the approval of the county 
256.9   of financial responsibility. 
256.10     Sec. 22.  Minnesota Statutes 2000, section 256B.0913, 
256.11  subdivision 9, is amended to read: 
256.12     Subd. 9.  [CONTRACTING PROVISIONS FOR PROVIDERS.] The lead 
256.13  agency shall document to the commissioner that the agency made 
256.14  reasonable efforts to inform potential providers of the 
256.15  anticipated need for services under the alternative care program 
256.16  or waiver programs under sections 256B.0915 and 256B.49, 
256.17  including a minimum of 14 days' written advance notice of the 
256.18  opportunity to be selected as a service provider and an annual 
256.19  public meeting with providers to explain and review the criteria 
256.20  for selection.  The lead agency shall also document to the 
256.21  commissioner that the agency allowed potential providers an 
256.22  opportunity to be selected to contract with the county agency.  
256.23  Funds reimbursed to counties under this subdivision Alternative 
256.24  care funds paid to service providers are subject to audit by the 
256.25  commissioner for fiscal and utilization control.  
256.26     The lead agency must select providers for contracts or 
256.27  agreements using the following criteria and other criteria 
256.28  established by the county: 
256.29     (1) the need for the particular services offered by the 
256.30  provider; 
256.31     (2) the population to be served, including the number of 
256.32  clients, the length of time services will be provided, and the 
256.33  medical condition of clients; 
256.34     (3) the geographic area to be served; 
256.35     (4) quality assurance methods, including appropriate 
256.36  licensure, certification, or standards, and supervision of 
257.1   employees when needed; 
257.2      (5) rates for each service and unit of service exclusive of 
257.3   county administrative costs; 
257.4      (6) evaluation of services previously delivered by the 
257.5   provider; and 
257.6      (7) contract or agreement conditions, including billing 
257.7   requirements, cancellation, and indemnification. 
257.8      The county must evaluate its own agency services under the 
257.9   criteria established for other providers.  The county shall 
257.10  provide a written statement of the reasons for not selecting 
257.11  providers. 
257.12     Sec. 23.  Minnesota Statutes 2000, section 256B.0913, 
257.13  subdivision 10, is amended to read: 
257.14     Subd. 10.  [ALLOCATION FORMULA.] (a) The alternative care 
257.15  appropriation for fiscal years 1992 and beyond shall cover 
257.16  only 180-day alternative care eligible clients.  Prior to July 1 
257.17  of each year, the commissioner shall allocate to county agencies 
257.18  the state funds available for alternative care for persons 
257.19  eligible under subdivision 2. 
257.20     (b) Prior to July 1 of each year, the commissioner shall 
257.21  allocate to county agencies the state funds available for 
257.22  alternative care for persons eligible under subdivision 2.  The 
257.23  allocation for fiscal year 1992 shall be calculated using a base 
257.24  that is adjusted to exclude the medical assistance share of 
257.25  alternative care expenditures.  The adjusted base is calculated 
257.26  by multiplying each county's allocation for fiscal year 1991 by 
257.27  the percentage of county alternative care expenditures for 
257.28  180-day eligible clients.  The percentage is determined based on 
257.29  expenditures for services rendered in fiscal year 1989 or 
257.30  calendar year 1989, whichever is greater.  The adjusted base for 
257.31  each county is the county's current fiscal year base allocation 
257.32  plus any targeted funds approved during the current fiscal 
257.33  year.  Calculations for paragraphs (c) and (d) are to be made as 
257.34  follows:  for each county, the determination of alternative care 
257.35  program expenditures shall be based on payments for services 
257.36  rendered from April 1 through March 31 in the base year, to the 
258.1   extent that claims have been submitted and paid by June 1 of 
258.2   that year.  
258.3      (c) If the county alternative care program expenditures for 
258.4   180-day eligible clients as defined in paragraph (b) are 95 
258.5   percent or more of its the county's adjusted base allocation, 
258.6   the allocation for the next fiscal year is 100 percent of the 
258.7   adjusted base, plus inflation to the extent that inflation is 
258.8   included in the state budget. 
258.9      (d) If the county alternative care program expenditures for 
258.10  180-day eligible clients as defined in paragraph (b) are less 
258.11  than 95 percent of its the county's adjusted base allocation, 
258.12  the allocation for the next fiscal year is the adjusted base 
258.13  allocation less the amount of unspent funds below the 95 percent 
258.14  level. 
258.15     (e) For fiscal year 1992 only, a county may receive an 
258.16  increased allocation if annualized service costs for the month 
258.17  of May 1991 for 180-day eligible clients are greater than the 
258.18  allocation otherwise determined.  A county may apply for this 
258.19  increase by reporting projected expenditures for May to the 
258.20  commissioner by June 1, 1991.  The amount of the allocation may 
258.21  exceed the amount calculated in paragraph (b).  The projected 
258.22  expenditures for May must be based on actual 180-day eligible 
258.23  client caseload and the individual cost of clients' care plans.  
258.24  If a county does not report its expenditures for May, the amount 
258.25  in paragraph (c) or (d) shall be used. 
258.26     (f) Calculations for paragraphs (c) and (d) are to be made 
258.27  as follows:  for each county, the determination of expenditures 
258.28  shall be based on payments for services rendered from April 1 
258.29  through March 31 in the base year, to the extent that claims 
258.30  have been submitted by June 1 of that year.  Calculations for 
258.31  paragraphs (c) and (d) must also include the funds transferred 
258.32  to the consumer support grant program for clients who have 
258.33  transferred to that program from April 1 through March 31 in the 
258.34  base year.  
258.35     (g) For the biennium ending June 30, 2001, the allocation 
258.36  of state funds to county agencies shall be calculated as 
259.1   described in paragraphs (c) and (d).  If the annual legislative 
259.2   appropriation for the alternative care program is inadequate to 
259.3   fund the combined county allocations for fiscal year 2000 or 
259.4   2001 a biennium, the commissioner shall distribute to each 
259.5   county the entire annual appropriation as that county's 
259.6   percentage of the computed base as calculated in paragraph 
259.7   (f) paragraphs (c) and (d). 
259.8      Sec. 24.  Minnesota Statutes 2000, section 256B.0913, 
259.9   subdivision 11, is amended to read: 
259.10     Subd. 11.  [TARGETED FUNDING.] (a) The purpose of targeted 
259.11  funding is to make additional money available to counties with 
259.12  the greatest need.  Targeted funds are not intended to be 
259.13  distributed equitably among all counties, but rather, allocated 
259.14  to those with long-term care strategies that meet state goals. 
259.15     (b) The funds available for targeted funding shall be the 
259.16  total appropriation for each fiscal year minus county 
259.17  allocations determined under subdivision 10 as adjusted for any 
259.18  inflation increases provided in appropriations for the biennium. 
259.19     (c) The commissioner shall allocate targeted funds to 
259.20  counties that demonstrate to the satisfaction of the 
259.21  commissioner that they have developed feasible plans to increase 
259.22  alternative care spending.  In making targeted funding 
259.23  allocations, the commissioner shall use the following priorities:
259.24     (1) counties that received a lower allocation in fiscal 
259.25  year 1991 than in fiscal year 1990.  Counties remain in this 
259.26  priority until they have been restored to their fiscal year 1990 
259.27  level plus inflation; 
259.28     (2) counties that sustain a base allocation reduction for 
259.29  failure to spend 95 percent of the allocation if they 
259.30  demonstrate that the base reduction should be restored; 
259.31     (3) counties that propose projects to divert community 
259.32  residents from nursing home placement or convert nursing home 
259.33  residents to community living; and 
259.34     (4) counties that can otherwise justify program growth by 
259.35  demonstrating the existence of waiting lists, demographically 
259.36  justified needs, or other unmet needs. 
260.1      (d) Counties that would receive targeted funds according to 
260.2   paragraph (c) must demonstrate to the commissioner's 
260.3   satisfaction that the funds would be appropriately spent by 
260.4   showing how the funds would be used to further the state's 
260.5   alternative care goals as described in subdivision 1, and that 
260.6   the county has the administrative and service delivery 
260.7   capability to use them.  
260.8      (e) The commissioner shall request applications by June 1 
260.9   each year, for county agencies to apply for targeted funds by 
260.10  November 1 of each year.  The counties selected for targeted 
260.11  funds shall be notified of the amount of their additional 
260.12  funding by August 1 of each year.  Targeted funds allocated to a 
260.13  county agency in one year shall be treated as part of the 
260.14  county's base allocation for that year in determining 
260.15  allocations for subsequent years.  No reallocations between 
260.16  counties shall be made. 
260.17     (f) The allocation for each year after fiscal year 1992 
260.18  shall be determined using the previous fiscal year's allocation, 
260.19  including any targeted funds, as the base and then applying the 
260.20  criteria under subdivision 10, paragraphs (c), (d), and (f), to 
260.21  the current year's expenditures. 
260.22     Sec. 25.  Minnesota Statutes 2000, section 256B.0913, 
260.23  subdivision 12, is amended to read: 
260.24     Subd. 12.  [CLIENT PREMIUMS.] (a) A premium is required for 
260.25  all 180-day alternative care eligible clients to help pay for 
260.26  the cost of participating in the program.  The amount of the 
260.27  premium for the alternative care client shall be determined as 
260.28  follows: 
260.29     (1) when the alternative care client's income less 
260.30  recurring and predictable medical expenses is greater than the 
260.31  medical assistance income standard recipient's maintenance needs 
260.32  allowance as defined in section 256B.0915, subdivision 1d, 
260.33  paragraph (a), but less than 150 percent of the federal poverty 
260.34  guideline effective on July 1 of the state fiscal year in which 
260.35  the premium is being computed, and total assets are less than 
260.36  $10,000, the fee is zero; 
261.1      (2) when the alternative care client's income less 
261.2   recurring and predictable medical expenses is greater than 150 
261.3   percent of the federal poverty guideline effective on July 1 of 
261.4   the state fiscal year in which the premium is being computed, 
261.5   and total assets are less than $10,000, the fee is 25 percent of 
261.6   the cost of alternative care services or the difference between 
261.7   150 percent of the federal poverty guideline effective on July 1 
261.8   of the state fiscal year in which the premium is being computed 
261.9   and the client's income less recurring and predictable medical 
261.10  expenses, whichever is less; and 
261.11     (3) when the alternative care client's total assets are 
261.12  greater than $10,000, the fee is 25 percent of the cost of 
261.13  alternative care services.  
261.14     For married persons, total assets are defined as the total 
261.15  marital assets less the estimated community spouse asset 
261.16  allowance, under section 256B.059, if applicable.  For married 
261.17  persons, total income is defined as the client's income less the 
261.18  monthly spousal allotment, under section 256B.058. 
261.19     All alternative care services except case management shall 
261.20  be included in the estimated costs for the purpose of 
261.21  determining 25 percent of the costs. 
261.22     The monthly premium shall be calculated based on the cost 
261.23  of the first full month of alternative care services and shall 
261.24  continue unaltered until the next reassessment is completed or 
261.25  at the end of 12 months, whichever comes first.  Premiums are 
261.26  due and payable each month alternative care services are 
261.27  received unless the actual cost of the services is less than the 
261.28  premium. 
261.29     (b) The fee shall be waived by the commissioner when: 
261.30     (1) a person who is residing in a nursing facility is 
261.31  receiving case management only; 
261.32     (2) a person is applying for medical assistance; 
261.33     (3) a married couple is requesting an asset assessment 
261.34  under the spousal impoverishment provisions; 
261.35     (4) a person is a medical assistance recipient, but has 
261.36  been approved for alternative care-funded assisted living 
262.1   services; 
262.2      (5) a person is found eligible for alternative care, but is 
262.3   not yet receiving alternative care services; or 
262.4      (6) (5) a person's fee under paragraph (a) is less than $25.
262.5      (c) The county agency must collect the premium from the 
262.6   client and forward the amounts collected to the commissioner in 
262.7   the manner and at the times prescribed by the commissioner.  
262.8   Money collected must be deposited in the general fund and is 
262.9   appropriated to the commissioner for the alternative care 
262.10  program.  The client must supply the county with the client's 
262.11  social security number at the time of application.  If a client 
262.12  fails or refuses to pay the premium due, the county shall supply 
262.13  the commissioner with the client's social security number and 
262.14  other information the commissioner requires to collect the 
262.15  premium from the client.  The commissioner shall collect unpaid 
262.16  premiums using the Revenue Recapture Act in chapter 270A and 
262.17  other methods available to the commissioner.  The commissioner 
262.18  may require counties to inform clients of the collection 
262.19  procedures that may be used by the state if a premium is not 
262.20  paid.  
262.21     (d) The commissioner shall begin to adopt emergency or 
262.22  permanent rules governing client premiums within 30 days after 
262.23  July 1, 1991, including criteria for determining when services 
262.24  to a client must be terminated due to failure to pay a premium.  
262.25     Sec. 26.  Minnesota Statutes 2000, section 256B.0913, 
262.26  subdivision 13, is amended to read: 
262.27     Subd. 13.  [COUNTY BIENNIAL PLAN.] The county biennial plan 
262.28  for the preadmission screening program long-term care 
262.29  consultation services under section 256B.0911, the alternative 
262.30  care program under this section, and waivers for the elderly 
262.31  under section 256B.0915, and waivers for the disabled under 
262.32  section 256B.49, shall be incorporated into the biennial 
262.33  Community Social Services Act plan and shall meet the 
262.34  regulations and timelines of that plan.  This county biennial 
262.35  plan shall include: 
262.36     (1) information on the administration of the preadmission 
263.1   screening program; 
263.2      (2) information on the administration of the home and 
263.3   community-based services waivers for the elderly under section 
263.4   256B.0915, and for the disabled under section 256B.49; and 
263.5      (3) information on the administration of the alternative 
263.6   care program. 
263.7      Sec. 27.  Minnesota Statutes 2000, section 256B.0913, 
263.8   subdivision 14, is amended to read: 
263.9      Subd. 14.  [REIMBURSEMENT PAYMENT AND RATE ADJUSTMENTS.] (a)
263.10  Reimbursement Payment for expenditures for the provided 
263.11  alternative care services as approved by the client's case 
263.12  manager shall be through the invoice processing procedures of 
263.13  the department's Medicaid Management Information System (MMIS).  
263.14  To receive reimbursement payment, the county or vendor must 
263.15  submit invoices within 12 months following the date of service.  
263.16  The county agency and its vendors under contract shall not be 
263.17  reimbursed for services which exceed the county allocation. 
263.18     (b) If a county collects less than 50 percent of the client 
263.19  premiums due under subdivision 12, the commissioner may withhold 
263.20  up to three percent of the county's final alternative care 
263.21  program allocation determined under subdivisions 10 and 11. 
263.22     (c) The county shall negotiate individual rates with 
263.23  vendors and may be reimbursed authorize service payment for 
263.24  actual costs up to the greater of the county's current approved 
263.25  rate or 60 percent of the maximum rate in fiscal year 1994 and 
263.26  65 percent of the maximum rate in fiscal year 1995 for each 
263.27  alternative care service.  Notwithstanding any other rule or 
263.28  statutory provision to the contrary, the commissioner shall not 
263.29  be authorized to increase rates by an annual inflation factor, 
263.30  unless so authorized by the legislature. 
263.31     (d) On July 1, 1993, the commissioner shall increase the 
263.32  maximum rate for home delivered meals to $4.50 per meal To 
263.33  improve access to community services and eliminate payment 
263.34  disparities between the alternative care program and the elderly 
263.35  waiver program, the commissioner shall establish statewide 
263.36  maximum service rate limits and eliminate county-specific 
264.1   service rate limits. 
264.2      (1) Effective July 1, 2001, for service rate limits, except 
264.3   those in subdivision 5, paragraphs (d) and (i), the rate limit 
264.4   for each service shall be the greater of the alternative care 
264.5   statewide maximum rate or the elderly waiver statewide maximum 
264.6   rate. 
264.7      (2) Counties may negotiate individual service rates with 
264.8   vendors for actual costs up to the statewide maximum service 
264.9   rate limit. 
264.10     Sec. 28.  Minnesota Statutes 2000, section 256B.0915, 
264.11  subdivision 1d, is amended to read: 
264.12     Subd. 1d.  [POSTELIGIBILITY TREATMENT OF INCOME AND 
264.13  RESOURCES FOR ELDERLY WAIVER.] (a) Notwithstanding the 
264.14  provisions of section 256B.056, the commissioner shall make the 
264.15  following amendment to the medical assistance elderly waiver 
264.16  program effective July 1, 1999, or upon federal approval, 
264.17  whichever is later. 
264.18     A recipient's maintenance needs will be an amount equal to 
264.19  the Minnesota supplemental aid equivalent rate as defined in 
264.20  section 256I.03, subdivision 5, plus the medical assistance 
264.21  personal needs allowance as defined in section 256B.35, 
264.22  subdivision 1, paragraph (a), when applying posteligibility 
264.23  treatment of income rules to the gross income of elderly waiver 
264.24  recipients, except for individuals whose income is in excess of 
264.25  the special income standard according to Code of Federal 
264.26  Regulations, title 42, section 435.236.  Recipient maintenance 
264.27  needs shall be adjusted under this provision each July 1. 
264.28     (b) The commissioner of human services shall secure 
264.29  approval of additional elderly waiver slots sufficient to serve 
264.30  persons who will qualify under the revised income standard 
264.31  described in paragraph (a) before implementing section 
264.32  256B.0913, subdivision 16. 
264.33     (c) In implementing this subdivision, the commissioner 
264.34  shall consider allowing persons who would otherwise be eligible 
264.35  for the alternative care program but would qualify for the 
264.36  elderly waiver with a spenddown to remain on the alternative 
265.1   care program. 
265.2      Sec. 29.  Minnesota Statutes 2000, section 256B.0915, 
265.3   subdivision 3, is amended to read: 
265.4      Subd. 3.  [LIMITS OF CASES, RATES, REIMBURSEMENT PAYMENTS, 
265.5   AND FORECASTING.] (a) The number of medical assistance waiver 
265.6   recipients that a county may serve must be allocated according 
265.7   to the number of medical assistance waiver cases open on July 1 
265.8   of each fiscal year.  Additional recipients may be served with 
265.9   the approval of the commissioner. 
265.10     (b) The monthly limit for the cost of waivered services to 
265.11  an individual elderly waiver client shall be the statewide 
265.12  average payment weighted average monthly nursing facility rate 
265.13  of the case mix resident class to which the elderly waiver 
265.14  client would be assigned under the medical assistance case mix 
265.15  reimbursement system.  Minnesota Rules, parts 9549.0050 to 
265.16  9549.0059, less the recipient's maintenance needs allowance as 
265.17  described in subdivision 1d, paragraph (a), until the first day 
265.18  of the state fiscal year in which the resident assessment system 
265.19  as described in section 256B.437 for nursing home rate 
265.20  determination is implemented.  Effective on the first day of the 
265.21  state fiscal year in which the resident assessment system as 
265.22  described in section 256B.437 for nursing home rate 
265.23  determination is implemented and the first day of each 
265.24  subsequent state fiscal year, the monthly limit for the cost of 
265.25  waivered services to an individual elderly waiver client shall 
265.26  be the rate of the case mix resident class to which the waiver 
265.27  client would be assigned under Minnesota Rules, parts 9549.0050 
265.28  to 9549.0059, in effect on the last day of the previous state 
265.29  fiscal year, adjusted by the greater of any legislatively 
265.30  adopted home and community-based services cost-of-living 
265.31  percentage increase or any legislatively adopted statewide 
265.32  percent rate increase for nursing facilities. 
265.33     (c) If extended medical supplies and equipment or 
265.34  adaptations environmental modifications are or will be purchased 
265.35  for an elderly waiver services recipient, the client, the costs 
265.36  may be prorated on a monthly basis throughout the year in which 
266.1   they are purchased for up to 12 consecutive months beginning 
266.2   with the month of purchase.  If the monthly cost of a 
266.3   recipient's other waivered services exceeds the monthly limit 
266.4   established in this paragraph (b), the annual cost of the all 
266.5   waivered services shall be determined.  In this event, the 
266.6   annual cost of all waivered services shall not exceed 12 times 
266.7   the monthly limit calculated in this paragraph.  The statewide 
266.8   average payment rate is calculated by determining the statewide 
266.9   average monthly nursing home rate, effective July 1 of the 
266.10  fiscal year in which the cost is incurred, less the statewide 
266.11  average monthly income of nursing home residents who are age 65 
266.12  or older, and who are medical assistance recipients in the month 
266.13  of March of the previous state fiscal year.  The annual cost 
266.14  divided by 12 of elderly or disabled waivered services of 
266.15  waivered services as described in paragraph (b).  
266.16     (d) For a person who is a nursing facility resident at the 
266.17  time of requesting a determination of eligibility for elderly or 
266.18  disabled waivered services shall be the greater of the monthly 
266.19  payment for:  (i), a monthly conversion limit for the cost of 
266.20  elderly waivered services may be requested.  The monthly 
266.21  conversion limit for the cost of elderly waiver services shall 
266.22  be the resident class assigned under Minnesota Rules, parts 
266.23  9549.0050 to 9549.0059, for that resident in the nursing 
266.24  facility where the resident currently resides; or (ii) the 
266.25  statewide average payment of the case mix resident class to 
266.26  which the resident would be assigned under the medical 
266.27  assistance case mix reimbursement system, provided that until 
266.28  July 1 of the state fiscal year in which the resident assessment 
266.29  system as described in section 256B.437 for nursing home rate 
266.30  determination is implemented.  Effective on July 1 of the state 
266.31  fiscal year in which the resident assessment system as described 
266.32  in section 256B.437 for nursing home rate determination is 
266.33  implemented, the monthly conversion limit for the cost of 
266.34  elderly waiver services shall be the per diem nursing facility 
266.35  rate as determined by the resident assessment system as 
266.36  described in section 256B.437 for that resident in the nursing 
267.1   facility where the resident currently resides multiplied by 365 
267.2   and divided by 12, less the recipient's maintenance needs 
267.3   allowance as described in subdivision 1d.  The limit under this 
267.4   clause only applies to persons discharged from a nursing 
267.5   facility after a minimum 30-day stay and found eligible for 
267.6   waivered services on or after July 1, 1997.  The following costs 
267.7   must be included in determining the total monthly costs for the 
267.8   waiver client: 
267.9      (1) cost of all waivered services, including extended 
267.10  medical supplies and equipment and environmental modifications; 
267.11  and 
267.12     (2) cost of skilled nursing, home health aide, and personal 
267.13  care services reimbursable by medical assistance.  
267.14     (c) (e) Medical assistance funding for skilled nursing 
267.15  services, private duty nursing, home health aide, and personal 
267.16  care services for waiver recipients must be approved by the case 
267.17  manager and included in the individual care plan. 
267.18     (d) For both the elderly waiver and the nursing facility 
267.19  disabled waiver, a county may purchase extended supplies and 
267.20  equipment without prior approval from the commissioner when 
267.21  there is no other funding source and the supplies and equipment 
267.22  are specified in the individual's care plan as medically 
267.23  necessary to enable the individual to remain in the community 
267.24  according to the criteria in Minnesota Rules, part 9505.0210, 
267.25  items A and B.  (f) A county is not required to contract with a 
267.26  provider of supplies and equipment if the monthly cost of the 
267.27  supplies and equipment is less than $250.  
267.28     (e) (g) The adult foster care daily rate for the elderly 
267.29  and disabled waivers shall be considered a difficulty of care 
267.30  payment and shall not include room and board.  The adult foster 
267.31  care service rate shall be negotiated between the county agency 
267.32  and the foster care provider.  The rate established under this 
267.33  section shall not exceed the state average monthly nursing home 
267.34  payment for the case mix classification to which the individual 
267.35  receiving foster care is assigned; the rate must allow for other 
267.36  waiver and medical assistance home care services to be 
268.1   authorized by the case manager.  The elderly waiver payment for 
268.2   the foster care service in combination with the payment for all 
268.3   other elderly waiver services, including case management, must 
268.4   not exceed the limit specified in paragraph (b). 
268.5      (f) The assisted living and residential care service rates 
268.6   for elderly and community alternatives for disabled individuals 
268.7   (CADI) waivers shall be made to the vendor as a monthly rate 
268.8   negotiated with the county agency based on an individualized 
268.9   service plan for each resident.  The rate shall not exceed the 
268.10  nonfederal share of the greater of either the statewide or any 
268.11  of the geographic groups' weighted average monthly medical 
268.12  assistance nursing facility payment rate of the case mix 
268.13  resident class to which the elderly or disabled client would be 
268.14  assigned under Minnesota Rules, parts 9549.0050 to 9549.0059, 
268.15  unless the services are provided by a home care provider 
268.16  licensed by the department of health and are provided in a 
268.17  building that is registered as a housing with services 
268.18  establishment under chapter 144D and that provides 24-hour 
268.19  supervision.  For alternative care assisted living projects 
268.20  established under Laws 1988, chapter 689, article 2, section 
268.21  256, monthly rates may not exceed 65 percent of the greater of 
268.22  either the statewide or any of the geographic groups' weighted 
268.23  average monthly medical assistance nursing facility payment rate 
268.24  for the case mix resident class to which the elderly or disabled 
268.25  client would be assigned under Minnesota Rules, parts 9549.0050 
268.26  to 9549.0059.  The rate may not cover direct rent or food costs. 
268.27     (h) Payment for assisted living service shall be a monthly 
268.28  rate negotiated and authorized by the county agency based on an 
268.29  individualized service plan for each resident and may not cover 
268.30  direct rent or food costs. 
268.31     (1) The individualized monthly negotiated payment for 
268.32  assisted living services as described in section 256B.0913, 
268.33  subdivision 5, paragraph (g) or (h), and residential care 
268.34  services as described in section 256B.0913, subdivision 5, 
268.35  paragraph (f), shall not exceed the nonfederal share, in effect 
268.36  on July 1 of the state fiscal year for which the rate limit is 
269.1   being calculated, of the greater of either the statewide or any 
269.2   of the geographic groups' weighted average monthly nursing 
269.3   facility rate of the case mix resident class to which the 
269.4   elderly waiver eligible client would be assigned under Minnesota 
269.5   Rules, parts 9549.0050 to 9549.0059, less the maintenance needs 
269.6   allowance as described in subdivision 1d, paragraph (a), until 
269.7   the July 1 of the state fiscal year in which the resident 
269.8   assessment system as described in section 256B.437 for nursing 
269.9   home rate determination is implemented.  Effective on July 1 of 
269.10  the state fiscal year in which the resident assessment system as 
269.11  described in section 256B.437 for nursing home rate 
269.12  determination is implemented and July 1 of each subsequent state 
269.13  fiscal year, the individualized monthly negotiated payment for 
269.14  the services described in this clause shall not exceed the limit 
269.15  described in this clause which was in effect on June 30 of the 
269.16  previous state fiscal year and which has been adjusted by the 
269.17  greater of any legislatively adopted home and community-based 
269.18  services cost-of-living percentage increase or any legislatively 
269.19  adopted statewide percent rate increase for nursing facilities. 
269.20     (2) The individualized monthly negotiated payment for 
269.21  assisted living services described in section 144A.4605 and 
269.22  delivered by a provider licensed by the department of health as 
269.23  a Class A home care provider or an assisted living home care 
269.24  provider and provided in a building that is registered as a 
269.25  housing with services establishment under chapter 144D and that 
269.26  provides 24-hour supervision in combination with the payment for 
269.27  other elderly waiver services, including case management, must 
269.28  not exceed the limit specified in paragraph (b). 
269.29     (g) (i) The county shall negotiate individual service rates 
269.30  with vendors and may be reimbursed authorize payment for actual 
269.31  costs up to the greater of the county's current approved rate or 
269.32  60 percent of the maximum rate in fiscal year 1994 and 65 
269.33  percent of the maximum rate in fiscal year 1995 for each service 
269.34  within each program.  Persons or agencies must be employed by or 
269.35  under a contract with the county agency or the public health 
269.36  nursing agency of the local board of health in order to receive 
270.1   funding under the elderly waiver program, except as a provider 
270.2   of supplies and equipment when the monthly cost of the supplies 
270.3   and equipment is less than $250.  
270.4      (h) On July 1, 1993, the commissioner shall increase the 
270.5   maximum rate for home-delivered meals to $4.50 per meal. 
270.6      (i) (j) Reimbursement for the medical assistance recipients 
270.7   under the approved waiver shall be made from the medical 
270.8   assistance account through the invoice processing procedures of 
270.9   the department's Medicaid Management Information System (MMIS), 
270.10  only with the approval of the client's case manager.  The budget 
270.11  for the state share of the Medicaid expenditures shall be 
270.12  forecasted with the medical assistance budget, and shall be 
270.13  consistent with the approved waiver.  
270.14     (k) To improve access to community services and eliminate 
270.15  payment disparities between the alternative care program and the 
270.16  elderly waiver, the commissioner shall establish statewide 
270.17  maximum service rate limits and eliminate county-specific 
270.18  service rate limits. 
270.19     (1) Effective July 1, 2001, for service rate limits, except 
270.20  those described or defined in paragraphs (g) and (h), the rate 
270.21  limit for each service shall be the greater of the alternative 
270.22  care statewide maximum rate or the elderly waiver statewide 
270.23  maximum rate. 
270.24     (2) Counties may negotiate individual service rates with 
270.25  vendors for actual costs up to the statewide maximum service 
270.26  rate limit. 
270.27     (j) (l) Beginning July 1, 1991, the state shall reimburse 
270.28  counties according to the payment schedule in section 256.025 
270.29  for the county share of costs incurred under this subdivision on 
270.30  or after January 1, 1991, for individuals who are receiving 
270.31  medical assistance. 
270.32     (k) For the community alternatives for disabled individuals 
270.33  waiver, and nursing facility disabled waivers, county may use 
270.34  waiver funds for the cost of minor adaptations to a client's 
270.35  residence or vehicle without prior approval from the 
270.36  commissioner if there is no other source of funding and the 
271.1   adaptation: 
271.2      (1) is necessary to avoid institutionalization; 
271.3      (2) has no utility apart from the needs of the client; and 
271.4      (3) meets the criteria in Minnesota Rules, part 9505.0210, 
271.5   items A and B.  
271.6   For purposes of this subdivision, "residence" means the client's 
271.7   own home, the client's family residence, or a family foster 
271.8   home.  For purposes of this subdivision, "vehicle" means the 
271.9   client's vehicle, the client's family vehicle, or the client's 
271.10  family foster home vehicle. 
271.11     (l) The commissioner shall establish a maximum rate unit 
271.12  for baths provided by an adult day care provider that are not 
271.13  included in the provider's contractual daily or hourly rate. 
271.14  This maximum rate must equal the home health aide extended rate 
271.15  and shall be paid for baths provided to clients served under the 
271.16  elderly and disabled waivers. 
271.17     Sec. 30.  Minnesota Statutes 2000, section 256B.0915, 
271.18  subdivision 5, is amended to read: 
271.19     Subd. 5.  [REASSESSMENTS FOR WAIVER CLIENTS.] A 
271.20  reassessment of a client served under the elderly or disabled 
271.21  waiver must be conducted at least every 12 months and at other 
271.22  times when the case manager determines that there has been 
271.23  significant change in the client's functioning.  This may 
271.24  include instances where the client is discharged from the 
271.25  hospital.  
271.26     Sec. 31.  Minnesota Statutes 2000, section 256B.0917, is 
271.27  amended by adding a subdivision to read: 
271.28     Subd. 13.  [COMMUNITY SERVICE GRANTS.] The commissioner 
271.29  shall award contracts for grants to public and private nonprofit 
271.30  agencies to establish services that strengthen a community's 
271.31  ability to provide a system of home and community-based services 
271.32  for elderly persons.  The commissioner shall use a request for 
271.33  proposal process.  Communities that have a planned closure of a 
271.34  nursing facility approved under section 256B.437 shall be given 
271.35  preference for grants.  The commissioner shall consider grants 
271.36  for: 
272.1      (1) caregiver support and respite care projects under 
272.2   subdivision 6; 
272.3      (2) on-site coordination under section 256.9731; 
272.4      (3) the living-at-home/block nurse grant under subdivisions 
272.5   7 to 10; and 
272.6      (4) services identified as needed for community transition. 
272.7      Sec. 32.  [RESPITE CARE.] 
272.8      The Minnesota board on aging shall present recommendations 
272.9   to the legislature by February 1, 2002, on the provision of 
272.10  in-home and out-of-home respite care services on a sliding scale 
272.11  basis under the federal Older Americans Act. 
272.12     Sec. 33.  [REPEALER.] 
272.13     (a) Minnesota Statutes 2000, sections 256B.0911, 
272.14  subdivisions 2, 2a, 4, 8, and 9; 256B.0913, subdivisions 3, 15a, 
272.15  15b, 15c, and 16; and 256B.0915, subdivisions 3a, 3b, and 3c, 
272.16  are repealed. 
272.17     (b) Minnesota Rules, parts 9505.2390; 9505.2395; 9505.2396; 
272.18  9505.2400; 9505.2405; 9505.2410; 9505.2413; 9505.2415; 
272.19  9505.2420; 9505.2425; 9505.2426; 9505.2430; 9505.2435; 
272.20  9505.2440; 9505.2445; 9505.2450; 9505.2455; 9505.2458; 
272.21  9505.2460; 9505.2465; 9505.2470; 9505.2473; 9505.2475; 
272.22  9505.2480; 9505.2485; 9505.2486; 9505.2490; 9505.2495; 
272.23  9505.2496; and 9505.2500, are repealed. 
272.24                             ARTICLE 5 
272.25           LONG-TERM CARE SYSTEM REFORM AND REIMBURSEMENT 
272.26     Section 1.  Minnesota Statutes 2000, section 144.0721, 
272.27  subdivision 1, is amended to read: 
272.28     Subdivision 1.  [APPROPRIATENESS AND QUALITY.] Until the 
272.29  date of implementation of the revised case mix system based on 
272.30  the minimum data set, the commissioner of health shall assess 
272.31  the appropriateness and quality of care and services furnished 
272.32  to private paying residents in nursing homes and boarding care 
272.33  homes that are certified for participation in the medical 
272.34  assistance program under United States Code, title 42, sections 
272.35  1396-1396p.  These assessments shall be conducted until the date 
272.36  of implementation of the revised case mix system based on the 
273.1   minimum data set, in accordance with section 144.072, with the 
273.2   exception of provisions requiring recommendations for changes in 
273.3   the level of care provided to the private paying residents. 
273.4      Sec. 2.  [144.0724] [RESIDENT REIMBURSEMENT 
273.5   CLASSIFICATION.] 
273.6      Subdivision 1.  [RESIDENT REIMBURSEMENT 
273.7   CLASSIFICATIONS.] The commissioner of health shall establish 
273.8   resident reimbursement classifications based upon the 
273.9   assessments of residents of nursing homes and boarding care 
273.10  homes conducted under this section and according to section 
273.11  256B.438.  The reimbursement classifications established under 
273.12  this section shall be implemented after June 30, 2002, but no 
273.13  later than January 1, 2003. 
273.14     Subd. 2.  [DEFINITIONS.] For purposes of this section, the 
273.15  following terms have the meanings given. 
273.16     (a) [ASSESSMENT REFERENCE DATE.] "Assessment reference 
273.17  date" means the last day of the minimum data set observation 
273.18  period.  The date sets the designated endpoint of the common 
273.19  observation period, and all minimum data set items refer back in 
273.20  time from that point. 
273.21     (b) [CASE MIX INDEX.] "Case mix index" means the weighting 
273.22  factors assigned to the RUG-III classifications. 
273.23     (c) [INDEX MAXIMIZATION.] "Index maximization" means 
273.24  classifying a resident who could be assigned to more than one 
273.25  category, to the category with the highest case mix index. 
273.26     (d) [MINIMUM DATA SET.] "Minimum data set" means the 
273.27  assessment instrument specified by the Health Care Financing 
273.28  Administration and designated by the Minnesota department of 
273.29  health. 
273.30     (e) [REPRESENTATIVE.] "Representative" means a person who 
273.31  is the resident's guardian or conservator, the person authorized 
273.32  to pay the nursing home expenses of the resident, a 
273.33  representative of the nursing home ombudsman's office whose 
273.34  assistance has been requested, or any other individual 
273.35  designated by the resident. 
273.36     (f) [RESOURCE UTILIZATION GROUPS OR RUG.] "Resource 
274.1   utilization groups" or "RUG" means the system for grouping a 
274.2   nursing facility's residents according to their clinical and 
274.3   functional status identified in data supplied by the facility's 
274.4   minimum data set. 
274.5      Subd. 3.  [RESIDENT REIMBURSEMENT CLASSIFICATIONS.] (a) 
274.6   Resident reimbursement classifications shall be based on the 
274.7   minimum data set, version 2.0 assessment instrument, or its 
274.8   successor version mandated by the Health Care Financing 
274.9   Administration that nursing facilities are required to complete 
274.10  for all residents.  The commissioner of health shall establish 
274.11  resident classes according to the 34 group, resource utilization 
274.12  groups, version III or RUG-III model.  Resident classes must be 
274.13  established based on the individual items on the minimum data 
274.14  set and must be completed according to the facility manual for 
274.15  case mix classification issued by the Minnesota department of 
274.16  health.  The facility manual for case mix classification shall 
274.17  be drafted by the Minnesota department of health and presented 
274.18  to the chairs of health and human services legislative 
274.19  committees by December 31, 2001. 
274.20     (b) Each resident must be classified based on the 
274.21  information from the minimum data set according to general 
274.22  domains in clauses (1) to (7): 
274.23     (1) extensive services where a resident requires 
274.24  intravenous feeding or medications, suctioning, tracheostomy 
274.25  care, or is on a ventilator or respirator; 
274.26     (2) rehabilitation where a resident requires physical, 
274.27  occupational, or speech therapy; 
274.28     (3) special care where a resident has cerebral palsy; 
274.29  quadriplegia; multiple sclerosis; pressure ulcers; fever with 
274.30  vomiting, weight loss, or dehydration; tube feeding and aphasia; 
274.31  or is receiving radiation therapy; 
274.32     (4) clinically complex status where a resident has burns, 
274.33  coma, septicemia, pneumonia, internal bleeding, chemotherapy, 
274.34  wounds, kidney failure, urinary tract infections, oxygen, or 
274.35  transfusions; 
274.36     (5) impaired cognition where a resident has poor cognitive 
275.1   performance; 
275.2      (6) behavior problems where a resident exhibits wandering, 
275.3   has hallucinations, or is physically or verbally abusive toward 
275.4   others, unless the resident's other condition would place the 
275.5   resident in other categories; and 
275.6      (7) reduced physical functioning where a resident has no 
275.7   special clinical conditions. 
275.8      (c) The commissioner of health shall establish resident 
275.9   classification according to a 34 group model based on the 
275.10  information on the minimum data set and within the general 
275.11  domains listed in paragraph (b), clauses (1) to (7).  Detailed 
275.12  descriptions of each resource utilization group shall be defined 
275.13  in the facility manual for case mix classification issued by the 
275.14  Minnesota department of health.  The 34 groups are described as 
275.15  follows: 
275.16     (1) SE3:  requires four or five extensive services; 
275.17     (2) SE2:  requires two or three extensive services; 
275.18     (3) SE1:  requires one extensive service; 
275.19     (4) RAD:  requires rehabilitation services and is dependent 
275.20  in activity of daily living (ADL) at a count of 17 or 18; 
275.21     (5) RAC:  requires rehabilitation services and ADL count is 
275.22  14 to 16; 
275.23     (6) RAB:  requires rehabilitation services and ADL count is 
275.24  ten to 13; 
275.25     (7) RAA:  requires rehabilitation services and ADL count is 
275.26  four to nine; 
275.27     (8) SSC:  requires special care and ADL count is 17 or 18; 
275.28     (9) SSB:  requires special care and ADL count is 15 or 16; 
275.29     (10) SSA:  requires special care and ADL count is seven to 
275.30  14; 
275.31     (11) CC2:  clinically complex with depression and ADL count 
275.32  is 17 or 18; 
275.33     (12) CC1:  clinically complex with no depression and ADL 
275.34  count is 17 or 18; 
275.35     (13) CB2:  clinically complex with depression and ADL count 
275.36  is 12 to 16; 
276.1      (14) CB1:  clinically complex with no depression and ADL 
276.2   count is 12 to 16; 
276.3      (15) CA2:  clinically complex with depression and ADL count 
276.4   is four to 11; 
276.5      (16) CA1:  clinically complex with no depression and ADL 
276.6   count is four to 11; 
276.7      (17) IB2:  impaired cognition with nursing rehabilitation 
276.8   and ADL count is six to ten; 
276.9      (18) IB1:  impaired cognition with no nursing 
276.10  rehabilitation and ADL count is six to ten; 
276.11     (19) IA2:  impaired cognition with nursing rehabilitation 
276.12  and ADL count is four or five; 
276.13     (20) IA1:  impaired cognition with no nursing 
276.14  rehabilitation and ADL count is four or five; 
276.15     (21) BB2:  behavior problems with nursing rehabilitation 
276.16  and ADL count is six to ten; 
276.17     (22) BB1:  behavior problems with no nursing rehabilitation 
276.18  and ADL count is six to ten; 
276.19     (23) BA2:  behavior problems with nursing rehabilitation 
276.20  and ADL count is four to five; 
276.21     (24) BA1:  behavior problems with no nursing rehabilitation 
276.22  and ADL count is four to five; 
276.23     (25) PE2:  reduced physical functioning with nursing 
276.24  rehabilitation and ADL count is 16 to 18; 
276.25     (26) PE1:  reduced physical functioning with no nursing 
276.26  rehabilitation and ADL count is 16 to 18; 
276.27     (27) PD2:  reduced physical functioning with nursing 
276.28  rehabilitation and ADL count is 11 to 15; 
276.29     (28) PD1:  reduced physical functioning with no nursing 
276.30  rehabilitation and ADL count is 11 to 15; 
276.31     (29) PC2:  reduced physical functioning with nursing 
276.32  rehabilitation and ADL count is nine or ten; 
276.33     (30) PC1:  reduced physical functioning with no nursing 
276.34  rehabilitation and ADL count is nine or ten; 
276.35     (31) PB2:  reduced physical functioning with nursing 
276.36  rehabilitation and ADL count is six to eight; 
277.1      (32) PB1:  reduced physical functioning with no nursing 
277.2   rehabilitation and ADL count is six to eight; 
277.3      (33) PA2:  reduced physical functioning with nursing 
277.4   rehabilitation and ADL count is four or five; and 
277.5      (34) PA1:  reduced physical functioning with no nursing 
277.6   rehabilitation and ADL count is four or five. 
277.7      Subd. 4.  [RESIDENT ASSESSMENT SCHEDULE.] (a) A facility 
277.8   must conduct and electronically submit to the commissioner of 
277.9   health case mix assessments that conform with the assessment 
277.10  schedule defined by the Code of Federal Regulations, title 42, 
277.11  section 483.20, and published by the United States Department of 
277.12  Health and Human Services, Health Care Financing Administration, 
277.13  in the Long Term Care Assessment Instrument User's Manual, 
277.14  version 2.0, October 1995, and subsequent clarifications made in 
277.15  the Long-Term Care Assessment Instrument Questions and Answers, 
277.16  version 2.0, August 1996.  The commissioner of health may 
277.17  substitute successor manuals or question and answer documents 
277.18  published by the United States Department of Health and Human 
277.19  Services, Health Care Financing Administration, to replace or 
277.20  supplement the current version of the manual or document. 
277.21     (b) The assessments used to determine a case mix 
277.22  classification for reimbursement include the following: 
277.23     (1) a new admission assessment must be completed by day 14 
277.24  following admission; 
277.25     (2) an annual assessment must be completed within 366 days 
277.26  of the last comprehensive assessment; 
277.27     (3) a significant change assessment must be completed 
277.28  within 14 days of the identification of a significant change; 
277.29  and 
277.30     (4) the second quarterly assessment following either a new 
277.31  admission assessment, an annual assessment, or a significant 
277.32  change assessment.  Each quarterly assessment must be completed 
277.33  within 92 days of the previous assessment. 
277.34     Subd. 5.  [SHORT STAYS.] (a) A facility must submit to the 
277.35  commissioner of health an initial admission assessment for all 
277.36  residents who stay in the facility less than 14 days. 
278.1      (b) Notwithstanding the admission assessment requirements 
278.2   of paragraph (a), a facility may elect to accept a default rate 
278.3   with a case mix index of 1.0 for all facility residents who stay 
278.4   less than 14 days in lieu of submitting an initial assessment.  
278.5   Facilities may make this election to be effective on the day of 
278.6   implementation of the revised case mix system. 
278.7      (c) After implementation of the revised case mix system, 
278.8   nursing facilities must elect one of the options described in 
278.9   paragraphs (a) and (b) on the annual report to the commissioner 
278.10  of human services filed for each report year ending September 
278.11  30.  The election shall be effective on the following July 1. 
278.12     (d) For residents who are admitted or readmitted and leave 
278.13  the facility on a frequent basis and for whom readmission is 
278.14  expected, the resident may be discharged on an extended leave 
278.15  status.  This status does not require reassessment each time the 
278.16  resident returns to the facility unless a significant change in 
278.17  the resident's status has occurred since the last assessment.  
278.18  The case mix classification for these residents is determined by 
278.19  the facility election made in paragraphs (a) and (b). 
278.20     Subd. 6.  [PENALTIES FOR LATE OR NONSUBMISSION.] A facility 
278.21  that fails to complete or submit an assessment for a RUG-III 
278.22  classification within seven days of the time requirements in 
278.23  subdivisions 4 and 5 is subject to a reduced rate for that 
278.24  resident.  The reduced rate shall be the lowest rate for that 
278.25  facility.  The reduced rate is effective on the day of admission 
278.26  for new admission assessments or on the day that the assessment 
278.27  was due for all other assessments and continues in effect until 
278.28  the first day of the month following the date of submission of 
278.29  the resident's assessment. 
278.30     Subd. 7.  [NOTICE OF RESIDENT REIMBURSEMENT 
278.31  CLASSIFICATION.] (a) A facility must elect between the options 
278.32  in paragraphs (1) and (2) to provide notice to a resident of the 
278.33  resident's case mix classification. 
278.34     (1) The commissioner of health shall provide to a nursing 
278.35  facility a notice for each resident of the reimbursement 
278.36  classification established under subdivision 1.  The notice must 
279.1   inform the resident of the classification that was assigned, the 
279.2   opportunity to review the documentation supporting the 
279.3   classification, the opportunity to obtain clarification from the 
279.4   commissioner, and the opportunity to request a reconsideration 
279.5   of the classification.  The commissioner must send notice of 
279.6   resident classification by first class mail.  A nursing facility 
279.7   is responsible for the distribution of the notice to each 
279.8   resident, to the person responsible for the payment of the 
279.9   resident's nursing home expenses, or to another person 
279.10  designated by the resident.  This notice must be distributed 
279.11  within three working days after the facility's receipt of the 
279.12  notice from the commissioner of health. 
279.13     (2) A facility may choose to provide a classification 
279.14  notice, as prescribed by the commissioner of health, to a 
279.15  resident upon receipt of the confirmation of the case mix 
279.16  classification calculated by a facility or a corrected case mix 
279.17  classification as indicated on the final validation report from 
279.18  the commissioner.  A nursing facility is responsible for the 
279.19  distribution of the notice to each resident, to the person 
279.20  responsible for the payment of the resident's nursing home 
279.21  expenses, or to another person designated by the resident.  This 
279.22  notice must be distributed within three working days after the 
279.23  facility's receipt of the validation report from the 
279.24  commissioner.  If a facility elects this option, the 
279.25  commissioner of health shall provide the facility with a list of 
279.26  residents and their case mix classifications as determined by 
279.27  the commissioner.  A nursing facility may make this election to 
279.28  be effective on the day of implementation of the revised case 
279.29  mix system. 
279.30     (3) After implementation of the revised case mix system, a 
279.31  nursing facility shall elect a notice of resident reimbursement 
279.32  classification procedure as described in paragraph (1) or (2) on 
279.33  the annual report to the commissioner of human services filed 
279.34  for each report year ending September 30.  The election will be 
279.35  effective the following July 1. 
279.36     (b) If a facility submits a correction to an assessment 
280.1   conducted under subdivision 3 that results in a change in case 
280.2   mix classification, the facility shall give written notice to 
280.3   the resident or the resident's representative about the item 
280.4   that was corrected and the reason for the correction.  The 
280.5   notice of corrected assessment may be provided at the same time 
280.6   that the resident or resident's representative is provided the 
280.7   resident's corrected notice of classification. 
280.8      Subd. 8.  [REQUEST FOR RECONSIDERATION OF RESIDENT 
280.9   CLASSIFICATIONS.] (a) The resident, or resident's 
280.10  representative, or the nursing facility or boarding care home 
280.11  may request that the commissioner of health reconsider the 
280.12  assigned reimbursement classification.  The request for 
280.13  reconsideration must be submitted in writing to the commissioner 
280.14  within 30 days of the day the resident or the resident's 
280.15  representative receives the resident classification notice.  The 
280.16  request for reconsideration must include the name of the 
280.17  resident, the name and address of the facility in which the 
280.18  resident resides, the reasons for the reconsideration, the 
280.19  requested classification changes, and documentation supporting 
280.20  the requested classification.  The documentation accompanying 
280.21  the reconsideration request is limited to documentation which 
280.22  establishes that the needs of the resident at the time of the 
280.23  assessment justify a classification which is different than the 
280.24  classification established by the commissioner of health. 
280.25     (b) Upon request, the nursing facility must give the 
280.26  resident or the resident's representative a copy of the 
280.27  assessment form and the other documentation that was given to 
280.28  the commissioner of health to support the assessment findings.  
280.29  The nursing facility shall also provide access to and a copy of 
280.30  other information from the resident's record that has been 
280.31  requested by or on behalf of the resident to support a 
280.32  resident's reconsideration request.  A copy of any requested 
280.33  material must be provided within three working days of receipt 
280.34  of a written request for the information.  If a facility fails 
280.35  to provide the material within this time, it is subject to the 
280.36  issuance of a correction order and penalty assessment under 
281.1   sections 144.653 and 144A.10.  Notwithstanding those sections, 
281.2   any correction order issued under this subdivision must require 
281.3   that the nursing facility immediately comply with the request 
281.4   for information and that as of the date of the issuance of the 
281.5   correction order, the facility shall forfeit to the state a $100 
281.6   fine for the first day of noncompliance, and an increase in the 
281.7   $100 fine by $50 increments for each day the noncompliance 
281.8   continues. 
281.9      (c) In addition to the information required under 
281.10  paragraphs (a) and (b), a reconsideration request from a nursing 
281.11  facility must contain the following information:  (i) the date 
281.12  the reimbursement classification notices were received by the 
281.13  facility; (ii) the date the classification notices were 
281.14  distributed to the resident or the resident's representative; 
281.15  and (iii) a copy of a notice sent to the resident or to the 
281.16  resident's representative.  This notice must inform the resident 
281.17  or the resident's representative that a reconsideration of the 
281.18  resident's classification is being requested, the reason for the 
281.19  request, that the resident's rate will change if the request is 
281.20  approved by the commissioner, the extent of the change, that 
281.21  copies of the facility's request and supporting documentation 
281.22  are available for review, and that the resident also has the 
281.23  right to request a reconsideration.  If the facility fails to 
281.24  provide the required information with the reconsideration 
281.25  request, the request must be denied, and the facility may not 
281.26  make further reconsideration requests on that specific 
281.27  reimbursement classification. 
281.28     (d) Reconsideration by the commissioner must be made by 
281.29  individuals not involved in reviewing the assessment, audit, or 
281.30  reconsideration that established the disputed classification.  
281.31  The reconsideration must be based upon the initial assessment 
281.32  and upon the information provided to the commissioner under 
281.33  paragraphs (a) and (b).  If necessary for evaluating the 
281.34  reconsideration request, the commissioner may conduct on-site 
281.35  reviews.  Within 15 working days of receiving the request for 
281.36  reconsideration, the commissioner shall affirm or modify the 
282.1   original resident classification.  The original classification 
282.2   must be modified if the commissioner determines that the 
282.3   assessment resulting in the classification did not accurately 
282.4   reflect the needs or assessment characteristics of the resident 
282.5   at the time of the assessment.  The resident and the nursing 
282.6   facility or boarding care home shall be notified within five 
282.7   working days after the decision is made.  A decision by the 
282.8   commissioner under this subdivision is the final administrative 
282.9   decision of the agency for the party requesting reconsideration. 
282.10     (e) The resident classification established by the 
282.11  commissioner shall be the classification that applies to the 
282.12  resident while the request for reconsideration is pending. 
282.13     (f) The commissioner may request additional documentation 
282.14  regarding a reconsideration necessary to make an accurate 
282.15  reconsideration determination. 
282.16     Subd. 9.  [AUDIT AUTHORITY.] (a) The commissioner shall 
282.17  audit the accuracy of resident assessments performed under 
282.18  section 256B.438 through desk audits, on-site review of 
282.19  residents and their records, and interviews with staff and 
282.20  families.  The commissioner shall reclassify a resident if the 
282.21  commissioner determines that the resident was incorrectly 
282.22  classified. 
282.23     (b) The commissioner is authorized to conduct on-site 
282.24  audits on an unannounced basis. 
282.25     (c) A facility must grant the commissioner access to 
282.26  examine the medical records relating to the resident assessments 
282.27  selected for audit under this subdivision.  The commissioner may 
282.28  also observe and speak to facility staff and residents. 
282.29     (d) The commissioner shall consider documentation under the 
282.30  time frames for coding items on the minimum data set as set out 
282.31  in the Resident Assessment Instrument Manual published by the 
282.32  Health Care Financing Administration. 
282.33     (e) The commissioner shall develop an audit selection 
282.34  procedure that includes the following factors: 
282.35     (1) The commissioner may target facilities that demonstrate 
282.36  an atypical pattern of scoring minimum data set items, 
283.1   nonsubmission of assessments, late submission of assessments, or 
283.2   a previous history of audit changes of greater than 35 percent.  
283.3   The commissioner shall select at least 20 percent of the most 
283.4   current assessments submitted to the state for audit.  Audits of 
283.5   assessments selected in the targeted facilities must focus on 
283.6   the factors leading to the audit.  If the number of targeted 
283.7   assessments selected does not meet the threshold of 20 percent 
283.8   of the facility residents, then a stratified sample of the 
283.9   remainder of assessments shall be drawn to meet the quota.  If 
283.10  the total change exceeds 35 percent, the commissioner may 
283.11  conduct an expanded audit up to 100 percent of the remaining 
283.12  current assessments. 
283.13     (2) Facilities that are not a part of the targeted group 
283.14  shall be placed in a general pool from which facilities will be 
283.15  selected on a random basis for audit.  Every facility shall be 
283.16  audited annually.  If a facility has two successive audits in 
283.17  which the percentage of change is five percent or less and the 
283.18  facility has not been the subject of a targeted audit in the 
283.19  past 36 months, the facility may be audited biannually.  A 
283.20  stratified sample of 15 percent of the most current assessments 
283.21  shall be selected for audit.  If more than 20 percent of the 
283.22  RUGS-III classifications after the audit are changed, the audit 
283.23  shall be expanded to a second 15 percent sample.  If the total 
283.24  change between the first and second samples exceed 35 percent, 
283.25  the commissioner may expand the audit to all of the remaining 
283.26  assessments. 
283.27     (3) If a facility qualifies for an expanded audit, the 
283.28  commissioner may audit the facility again within six months.  If 
283.29  a facility has two expanded audits within a 24-month period, 
283.30  that facility will be audited at least every six months for the 
283.31  next 18 months. 
283.32     (4) The commissioner may conduct special audits if the 
283.33  commissioner determines that circumstances exist that could 
283.34  alter or affect the validity of case mix classifications of 
283.35  residents.  These circumstances include, but are not limited to, 
283.36  the following:  
284.1      (i) frequent changes in the administration or management of 
284.2   the facility; 
284.3      (ii) an unusually high percentage of residents in a 
284.4   specific case mix classification; 
284.5      (iii) a high frequency in the number of reconsideration 
284.6   requests received from a facility; 
284.7      (iv) frequent adjustments of case mix classifications as 
284.8   the result of reconsiderations or audits; 
284.9      (v) a criminal indictment alleging provider fraud; or 
284.10     (vi) other similar factors that relate to a facility's 
284.11  ability to conduct accurate assessments. 
284.12     (f) Within 15 working days of completing the audit process, 
284.13  the commissioner shall mail the written results of the audit to 
284.14  the facility, along with a written notice for each resident 
284.15  affected to be forwarded by the facility.  The notice must 
284.16  contain the resident's classification and a statement informing 
284.17  the resident, the resident's authorized representative, and the 
284.18  facility of their right to review the commissioner's documents 
284.19  supporting the classification and to request a reconsideration 
284.20  of the classification.  This notice must also include the 
284.21  address and telephone number of the area nursing home ombudsman. 
284.22     Subd. 10.  [TRANSITION.] After implementation of this 
284.23  section, reconsiderations requested for classifications made 
284.24  under section 144.0722, subdivision 1, shall be determined under 
284.25  section 144.0722, subdivision 3. 
284.26     Sec. 3.  Minnesota Statutes 2000, section 144A.071, 
284.27  subdivision 1, is amended to read: 
284.28     Subdivision 1.  [FINDINGS.] The legislature declares that a 
284.29  moratorium on the licensure and medical assistance certification 
284.30  of new nursing home beds and construction projects that 
284.31  exceed $750,000 $1,000,000 is necessary to control nursing home 
284.32  expenditure growth and enable the state to meet the needs of its 
284.33  elderly by providing high quality services in the most 
284.34  appropriate manner along a continuum of care.  
284.35     Sec. 4.  Minnesota Statutes 2000, section 144A.071, 
284.36  subdivision 1a, is amended to read: 
285.1      Subd. 1a.  [DEFINITIONS.] For purposes of sections 144A.071 
285.2   to 144A.073, the following terms have the meanings given them: 
285.3      (a) "attached fixtures" has the meaning given in Minnesota 
285.4   Rules, part 9549.0020, subpart 6. 
285.5      (b) "buildings" has the meaning given in Minnesota Rules, 
285.6   part 9549.0020, subpart 7. 
285.7      (c) "capital assets" has the meaning given in section 
285.8   256B.421, subdivision 16. 
285.9      (d) "commenced construction" means that all of the 
285.10  following conditions were met:  the final working drawings and 
285.11  specifications were approved by the commissioner of health; the 
285.12  construction contracts were let; a timely construction schedule 
285.13  was developed, stipulating dates for beginning, achieving 
285.14  various stages, and completing construction; and all zoning and 
285.15  building permits were applied for. 
285.16     (e) "completion date" means the date on which a certificate 
285.17  of occupancy is issued for a construction project, or if a 
285.18  certificate of occupancy is not required, the date on which the 
285.19  construction project is available for facility use. 
285.20     (f) "construction" means any erection, building, 
285.21  alteration, reconstruction, modernization, or improvement 
285.22  necessary to comply with the nursing home licensure rules. 
285.23     (g) "construction project" means: 
285.24     (1) a capital asset addition to, or replacement of a 
285.25  nursing home or certified boarding care home that results in new 
285.26  space or the remodeling of or renovations to existing facility 
285.27  space; 
285.28     (2) the remodeling or renovation of existing facility space 
285.29  the use of which is modified as a result of the project 
285.30  described in clause (1).  This existing space and the project 
285.31  described in clause (1) must be used for the functions as 
285.32  designated on the construction plans on completion of the 
285.33  project described in clause (1) for a period of not less than 24 
285.34  months; or 
285.35     (3) capital asset additions or replacements that are 
285.36  completed within 12 months before or after the completion date 
286.1   of the project described in clause (1). 
286.2      (h) "new licensed" or "new certified beds" means: 
286.3      (1) newly constructed beds in a facility or the 
286.4   construction of a new facility that would increase the total 
286.5   number of licensed nursing home beds or certified boarding care 
286.6   or nursing home beds in the state; or 
286.7      (2) newly licensed nursing home beds or newly certified 
286.8   boarding care or nursing home beds that result from remodeling 
286.9   of the facility that involves relocation of beds but does not 
286.10  result in an increase in the total number of beds, except when 
286.11  the project involves the upgrade of boarding care beds to 
286.12  nursing home beds, as defined in section 144A.073, subdivision 
286.13  1.  "Remodeling" includes any of the type of conversion, 
286.14  renovation, replacement, or upgrading projects as defined in 
286.15  section 144A.073, subdivision 1. 
286.16     (i) "project construction costs" means the cost of the 
286.17  facility capital asset additions, replacements, renovations, or 
286.18  remodeling projects, construction site preparation costs, and 
286.19  related soft costs.  Project construction costs also include the 
286.20  cost of any remodeling or renovation of existing facility space 
286.21  which is modified as a result of the construction 
286.22  project.  Project construction costs also includes the cost of 
286.23  new technology implemented as part of the construction project. 
286.24     (j) "technology" means information systems or devices that 
286.25  make documentation, charting, and staff time more efficient or 
286.26  encourage and allow for care through alternative settings 
286.27  including, but not limited to, touch screens, monitors, 
286.28  hand-helds, swipe cards, motion detectors, pagers, telemedicine, 
286.29  medication dispensers, and equipment to monitor vital signs and 
286.30  self-injections, and to observe skin and other conditions. 
286.31     Sec. 5.  Minnesota Statutes 2000, section 144A.071, 
286.32  subdivision 2, is amended to read: 
286.33     Subd. 2.  [MORATORIUM.] The commissioner of health, in 
286.34  coordination with the commissioner of human services, shall deny 
286.35  each request for new licensed or certified nursing home or 
286.36  certified boarding care beds except as provided in subdivision 3 
287.1   or 4a, or section 144A.073.  "Certified bed" means a nursing 
287.2   home bed or a boarding care bed certified by the commissioner of 
287.3   health for the purposes of the medical assistance program, under 
287.4   United States Code, title 42, sections 1396 et seq.  
287.5      The commissioner of human services, in coordination with 
287.6   the commissioner of health, shall deny any request to issue a 
287.7   license under section 252.28 and chapter 245A to a nursing home 
287.8   or boarding care home, if that license would result in an 
287.9   increase in the medical assistance reimbursement amount.  
287.10     In addition, the commissioner of health must not approve 
287.11  any construction project whose cost exceeds $750,000 $1,000,000, 
287.12  unless: 
287.13     (a) any construction costs exceeding $750,000 $1,000,000 
287.14  are not added to the facility's appraised value and are not 
287.15  included in the facility's payment rate for reimbursement under 
287.16  the medical assistance program; or 
287.17     (b) the project: 
287.18     (1) has been approved through the process described in 
287.19  section 144A.073; 
287.20     (2) meets an exception in subdivision 3 or 4a; 
287.21     (3) is necessary to correct violations of state or federal 
287.22  law issued by the commissioner of health; 
287.23     (4) is necessary to repair or replace a portion of the 
287.24  facility that was damaged by fire, lightning, groundshifts, or 
287.25  other such hazards, including environmental hazards, provided 
287.26  that the provisions of subdivision 4a, clause (a), are met; 
287.27     (5) as of May 1, 1992, the facility has submitted to the 
287.28  commissioner of health written documentation evidencing that the 
287.29  facility meets the "commenced construction" definition as 
287.30  specified in subdivision 1a, clause (d), or that substantial 
287.31  steps have been taken prior to April 1, 1992, relating to the 
287.32  construction project.  "Substantial steps" require that the 
287.33  facility has made arrangements with outside parties relating to 
287.34  the construction project and include the hiring of an architect 
287.35  or construction firm, submission of preliminary plans to the 
287.36  department of health or documentation from a financial 
288.1   institution that financing arrangements for the construction 
288.2   project have been made; or 
288.3      (6) is being proposed by a licensed nursing facility that 
288.4   is not certified to participate in the medical assistance 
288.5   program and will not result in new licensed or certified beds. 
288.6      Prior to the final plan approval of any construction 
288.7   project, the commissioner of health shall be provided with an 
288.8   itemized cost estimate for the project construction costs.  If a 
288.9   construction project is anticipated to be completed in phases, 
288.10  the total estimated cost of all phases of the project shall be 
288.11  submitted to the commissioner and shall be considered as one 
288.12  construction project.  Once the construction project is 
288.13  completed and prior to the final clearance by the commissioner, 
288.14  the total project construction costs for the construction 
288.15  project shall be submitted to the commissioner.  If the final 
288.16  project construction cost exceeds the dollar threshold in this 
288.17  subdivision, the commissioner of human services shall not 
288.18  recognize any of the project construction costs or the related 
288.19  financing costs in excess of this threshold in establishing the 
288.20  facility's property-related payment rate. 
288.21     The dollar thresholds for construction projects are as 
288.22  follows:  for construction projects other than those authorized 
288.23  in clauses (1) to (6), the dollar threshold 
288.24  is $750,000 $1,000,000.  For projects authorized after July 1, 
288.25  1993, under clause (1), the dollar threshold is the cost 
288.26  estimate submitted with a proposal for an exception under 
288.27  section 144A.073, plus inflation as calculated according to 
288.28  section 256B.431, subdivision 3f, paragraph (a).  For projects 
288.29  authorized under clauses (2) to (4), the dollar threshold is the 
288.30  itemized estimate project construction costs submitted to the 
288.31  commissioner of health at the time of final plan approval, plus 
288.32  inflation as calculated according to section 256B.431, 
288.33  subdivision 3f, paragraph (a). 
288.34     The commissioner of health shall adopt rules to implement 
288.35  this section or to amend the emergency rules for granting 
288.36  exceptions to the moratorium on nursing homes under section 
289.1   144A.073.  
289.2      Sec. 6.  Minnesota Statutes 2000, section 144A.071, 
289.3   subdivision 4a, is amended to read: 
289.4      Subd. 4a.  [EXCEPTIONS FOR REPLACEMENT BEDS.] It is in the 
289.5   best interest of the state to ensure that nursing homes and 
289.6   boarding care homes continue to meet the physical plant 
289.7   licensing and certification requirements by permitting certain 
289.8   construction projects.  Facilities should be maintained in 
289.9   condition to satisfy the physical and emotional needs of 
289.10  residents while allowing the state to maintain control over 
289.11  nursing home expenditure growth. 
289.12     The commissioner of health in coordination with the 
289.13  commissioner of human services, may approve the renovation, 
289.14  replacement, upgrading, or relocation of a nursing home or 
289.15  boarding care home, under the following conditions: 
289.16     (a) to license or certify beds in a new facility 
289.17  constructed to replace a facility or to make repairs in an 
289.18  existing facility that was destroyed or damaged after June 30, 
289.19  1987, by fire, lightning, or other hazard provided:  
289.20     (i) destruction was not caused by the intentional act of or 
289.21  at the direction of a controlling person of the facility; 
289.22     (ii) at the time the facility was destroyed or damaged the 
289.23  controlling persons of the facility maintained insurance 
289.24  coverage for the type of hazard that occurred in an amount that 
289.25  a reasonable person would conclude was adequate; 
289.26     (iii) the net proceeds from an insurance settlement for the 
289.27  damages caused by the hazard are applied to the cost of the new 
289.28  facility or repairs; 
289.29     (iv) the new facility is constructed on the same site as 
289.30  the destroyed facility or on another site subject to the 
289.31  restrictions in section 144A.073, subdivision 5; 
289.32     (v) the number of licensed and certified beds in the new 
289.33  facility does not exceed the number of licensed and certified 
289.34  beds in the destroyed facility; and 
289.35     (vi) the commissioner determines that the replacement beds 
289.36  are needed to prevent an inadequate supply of beds. 
290.1   Project construction costs incurred for repairs authorized under 
290.2   this clause shall not be considered in the dollar threshold 
290.3   amount defined in subdivision 2; 
290.4      (b) to license or certify beds that are moved from one 
290.5   location to another within a nursing home facility, provided the 
290.6   total costs of remodeling performed in conjunction with the 
290.7   relocation of beds does not exceed $750,000 $1,000,000; 
290.8      (c) to license or certify beds in a project recommended for 
290.9   approval under section 144A.073; 
290.10     (d) to license or certify beds that are moved from an 
290.11  existing state nursing home to a different state facility, 
290.12  provided there is no net increase in the number of state nursing 
290.13  home beds; 
290.14     (e) to certify and license as nursing home beds boarding 
290.15  care beds in a certified boarding care facility if the beds meet 
290.16  the standards for nursing home licensure, or in a facility that 
290.17  was granted an exception to the moratorium under section 
290.18  144A.073, and if the cost of any remodeling of the facility does 
290.19  not exceed $750,000 $1,000,000.  If boarding care beds are 
290.20  licensed as nursing home beds, the number of boarding care beds 
290.21  in the facility must not increase beyond the number remaining at 
290.22  the time of the upgrade in licensure.  The provisions contained 
290.23  in section 144A.073 regarding the upgrading of the facilities do 
290.24  not apply to facilities that satisfy these requirements; 
290.25     (f) to license and certify up to 40 beds transferred from 
290.26  an existing facility owned and operated by the Amherst H. Wilder 
290.27  Foundation in the city of St. Paul to a new unit at the same 
290.28  location as the existing facility that will serve persons with 
290.29  Alzheimer's disease and other related disorders.  The transfer 
290.30  of beds may occur gradually or in stages, provided the total 
290.31  number of beds transferred does not exceed 40.  At the time of 
290.32  licensure and certification of a bed or beds in the new unit, 
290.33  the commissioner of health shall delicense and decertify the 
290.34  same number of beds in the existing facility.  As a condition of 
290.35  receiving a license or certification under this clause, the 
290.36  facility must make a written commitment to the commissioner of 
291.1   human services that it will not seek to receive an increase in 
291.2   its property-related payment rate as a result of the transfers 
291.3   allowed under this paragraph; 
291.4      (g) to license and certify nursing home beds to replace 
291.5   currently licensed and certified boarding care beds which may be 
291.6   located either in a remodeled or renovated boarding care or 
291.7   nursing home facility or in a remodeled, renovated, newly 
291.8   constructed, or replacement nursing home facility within the 
291.9   identifiable complex of health care facilities in which the 
291.10  currently licensed boarding care beds are presently located, 
291.11  provided that the number of boarding care beds in the facility 
291.12  or complex are decreased by the number to be licensed as nursing 
291.13  home beds and further provided that, if the total costs of new 
291.14  construction, replacement, remodeling, or renovation exceed ten 
291.15  percent of the appraised value of the facility or $200,000, 
291.16  whichever is less, the facility makes a written commitment to 
291.17  the commissioner of human services that it will not seek to 
291.18  receive an increase in its property-related payment rate by 
291.19  reason of the new construction, replacement, remodeling, or 
291.20  renovation.  The provisions contained in section 144A.073 
291.21  regarding the upgrading of facilities do not apply to facilities 
291.22  that satisfy these requirements; 
291.23     (h) to license as a nursing home and certify as a nursing 
291.24  facility a facility that is licensed as a boarding care facility 
291.25  but not certified under the medical assistance program, but only 
291.26  if the commissioner of human services certifies to the 
291.27  commissioner of health that licensing the facility as a nursing 
291.28  home and certifying the facility as a nursing facility will 
291.29  result in a net annual savings to the state general fund of 
291.30  $200,000 or more; 
291.31     (i) to certify, after September 30, 1992, and prior to July 
291.32  1, 1993, existing nursing home beds in a facility that was 
291.33  licensed and in operation prior to January 1, 1992; 
291.34     (j) to license and certify new nursing home beds to replace 
291.35  beds in a facility acquired by the Minneapolis community 
291.36  development agency as part of redevelopment activities in a city 
292.1   of the first class, provided the new facility is located within 
292.2   three miles of the site of the old facility.  Operating and 
292.3   property costs for the new facility must be determined and 
292.4   allowed under section 256B.431 or 256B.434; 
292.5      (k) to license and certify up to 20 new nursing home beds 
292.6   in a community-operated hospital and attached convalescent and 
292.7   nursing care facility with 40 beds on April 21, 1991, that 
292.8   suspended operation of the hospital in April 1986.  The 
292.9   commissioner of human services shall provide the facility with 
292.10  the same per diem property-related payment rate for each 
292.11  additional licensed and certified bed as it will receive for its 
292.12  existing 40 beds; 
292.13     (l) to license or certify beds in renovation, replacement, 
292.14  or upgrading projects as defined in section 144A.073, 
292.15  subdivision 1, so long as the cumulative total costs of the 
292.16  facility's remodeling projects do not 
292.17  exceed $750,000 $1,000,000; 
292.18     (m) to license and certify beds that are moved from one 
292.19  location to another for the purposes of converting up to five 
292.20  four-bed wards to single or double occupancy rooms in a nursing 
292.21  home that, as of January 1, 1993, was county-owned and had a 
292.22  licensed capacity of 115 beds; 
292.23     (n) to allow a facility that on April 16, 1993, was a 
292.24  106-bed licensed and certified nursing facility located in 
292.25  Minneapolis to layaway all of its licensed and certified nursing 
292.26  home beds.  These beds may be relicensed and recertified in a 
292.27  newly-constructed teaching nursing home facility affiliated with 
292.28  a teaching hospital upon approval by the legislature.  The 
292.29  proposal must be developed in consultation with the interagency 
292.30  committee on long-term care planning.  The beds on layaway 
292.31  status shall have the same status as voluntarily delicensed and 
292.32  decertified beds, except that beds on layaway status remain 
292.33  subject to the surcharge in section 256.9657.  This layaway 
292.34  provision expires July 1, 1998; 
292.35     (o) to allow a project which will be completed in 
292.36  conjunction with an approved moratorium exception project for a 
293.1   nursing home in southern Cass county and which is directly 
293.2   related to that portion of the facility that must be repaired, 
293.3   renovated, or replaced, to correct an emergency plumbing problem 
293.4   for which a state correction order has been issued and which 
293.5   must be corrected by August 31, 1993; 
293.6      (p) to allow a facility that on April 16, 1993, was a 
293.7   368-bed licensed and certified nursing facility located in 
293.8   Minneapolis to layaway, upon 30 days prior written notice to the 
293.9   commissioner, up to 30 of the facility's licensed and certified 
293.10  beds by converting three-bed wards to single or double 
293.11  occupancy.  Beds on layaway status shall have the same status as 
293.12  voluntarily delicensed and decertified beds except that beds on 
293.13  layaway status remain subject to the surcharge in section 
293.14  256.9657, remain subject to the license application and renewal 
293.15  fees under section 144A.07 and shall be subject to a $100 per 
293.16  bed reactivation fee.  In addition, at any time within three 
293.17  years of the effective date of the layaway, the beds on layaway 
293.18  status may be: 
293.19     (1) relicensed and recertified upon relocation and 
293.20  reactivation of some or all of the beds to an existing licensed 
293.21  and certified facility or facilities located in Pine River, 
293.22  Brainerd, or International Falls; provided that the total 
293.23  project construction costs related to the relocation of beds 
293.24  from layaway status for any facility receiving relocated beds 
293.25  may not exceed the dollar threshold provided in subdivision 2 
293.26  unless the construction project has been approved through the 
293.27  moratorium exception process under section 144A.073; 
293.28     (2) relicensed and recertified, upon reactivation of some 
293.29  or all of the beds within the facility which placed the beds in 
293.30  layaway status, if the commissioner has determined a need for 
293.31  the reactivation of the beds on layaway status. 
293.32     The property-related payment rate of a facility placing 
293.33  beds on layaway status must be adjusted by the incremental 
293.34  change in its rental per diem after recalculating the rental per 
293.35  diem as provided in section 256B.431, subdivision 3a, paragraph 
293.36  (c).  The property-related payment rate for a facility 
294.1   relicensing and recertifying beds from layaway status must be 
294.2   adjusted by the incremental change in its rental per diem after 
294.3   recalculating its rental per diem using the number of beds after 
294.4   the relicensing to establish the facility's capacity day 
294.5   divisor, which shall be effective the first day of the month 
294.6   following the month in which the relicensing and recertification 
294.7   became effective.  Any beds remaining on layaway status more 
294.8   than three years after the date the layaway status became 
294.9   effective must be removed from layaway status and immediately 
294.10  delicensed and decertified; 
294.11     (q) to license and certify beds in a renovation and 
294.12  remodeling project to convert 12 four-bed wards into 24 two-bed 
294.13  rooms, expand space, and add improvements in a nursing home 
294.14  that, as of January 1, 1994, met the following conditions:  the 
294.15  nursing home was located in Ramsey county; had a licensed 
294.16  capacity of 154 beds; and had been ranked among the top 15 
294.17  applicants by the 1993 moratorium exceptions advisory review 
294.18  panel.  The total project construction cost estimate for this 
294.19  project must not exceed the cost estimate submitted in 
294.20  connection with the 1993 moratorium exception process; 
294.21     (r) to license and certify up to 117 beds that are 
294.22  relocated from a licensed and certified 138-bed nursing facility 
294.23  located in St. Paul to a hospital with 130 licensed hospital 
294.24  beds located in South St. Paul, provided that the nursing 
294.25  facility and hospital are owned by the same or a related 
294.26  organization and that prior to the date the relocation is 
294.27  completed the hospital ceases operation of its inpatient 
294.28  hospital services at that hospital.  After relocation, the 
294.29  nursing facility's status under section 256B.431, subdivision 
294.30  2j, shall be the same as it was prior to relocation.  The 
294.31  nursing facility's property-related payment rate resulting from 
294.32  the project authorized in this paragraph shall become effective 
294.33  no earlier than April 1, 1996.  For purposes of calculating the 
294.34  incremental change in the facility's rental per diem resulting 
294.35  from this project, the allowable appraised value of the nursing 
294.36  facility portion of the existing health care facility physical 
295.1   plant prior to the renovation and relocation may not exceed 
295.2   $2,490,000; 
295.3      (s) to license and certify two beds in a facility to 
295.4   replace beds that were voluntarily delicensed and decertified on 
295.5   June 28, 1991; 
295.6      (t) to allow 16 licensed and certified beds located on July 
295.7   1, 1994, in a 142-bed nursing home and 21-bed boarding care home 
295.8   facility in Minneapolis, notwithstanding the licensure and 
295.9   certification after July 1, 1995, of the Minneapolis facility as 
295.10  a 147-bed nursing home facility after completion of a 
295.11  construction project approved in 1993 under section 144A.073, to 
295.12  be laid away upon 30 days' prior written notice to the 
295.13  commissioner.  Beds on layaway status shall have the same status 
295.14  as voluntarily delicensed or decertified beds except that they 
295.15  shall remain subject to the surcharge in section 256.9657.  The 
295.16  16 beds on layaway status may be relicensed as nursing home beds 
295.17  and recertified at any time within five years of the effective 
295.18  date of the layaway upon relocation of some or all of the beds 
295.19  to a licensed and certified facility located in Watertown, 
295.20  provided that the total project construction costs related to 
295.21  the relocation of beds from layaway status for the Watertown 
295.22  facility may not exceed the dollar threshold provided in 
295.23  subdivision 2 unless the construction project has been approved 
295.24  through the moratorium exception process under section 144A.073. 
295.25     The property-related payment rate of the facility placing 
295.26  beds on layaway status must be adjusted by the incremental 
295.27  change in its rental per diem after recalculating the rental per 
295.28  diem as provided in section 256B.431, subdivision 3a, paragraph 
295.29  (c).  The property-related payment rate for the facility 
295.30  relicensing and recertifying beds from layaway status must be 
295.31  adjusted by the incremental change in its rental per diem after 
295.32  recalculating its rental per diem using the number of beds after 
295.33  the relicensing to establish the facility's capacity day 
295.34  divisor, which shall be effective the first day of the month 
295.35  following the month in which the relicensing and recertification 
295.36  became effective.  Any beds remaining on layaway status more 
296.1   than five years after the date the layaway status became 
296.2   effective must be removed from layaway status and immediately 
296.3   delicensed and decertified; 
296.4      (u) to license and certify beds that are moved within an 
296.5   existing area of a facility or to a newly constructed addition 
296.6   which is built for the purpose of eliminating three- and 
296.7   four-bed rooms and adding space for dining, lounge areas, 
296.8   bathing rooms, and ancillary service areas in a nursing home 
296.9   that, as of January 1, 1995, was located in Fridley and had a 
296.10  licensed capacity of 129 beds; 
296.11     (v) to relocate 36 beds in Crow Wing county and four beds 
296.12  from Hennepin county to a 160-bed facility in Crow Wing county, 
296.13  provided all the affected beds are under common ownership; 
296.14     (w) to license and certify a total replacement project of 
296.15  up to 49 beds located in Norman county that are relocated from a 
296.16  nursing home destroyed by flood and whose residents were 
296.17  relocated to other nursing homes.  The operating cost payment 
296.18  rates for the new nursing facility shall be determined based on 
296.19  the interim and settle-up payment provisions of Minnesota Rules, 
296.20  part 9549.0057, and the reimbursement provisions of section 
296.21  256B.431, except that subdivision 26, paragraphs (a) and (b), 
296.22  shall not apply until the second rate year after the settle-up 
296.23  cost report is filed.  Property-related reimbursement rates 
296.24  shall be determined under section 256B.431, taking into account 
296.25  any federal or state flood-related loans or grants provided to 
296.26  the facility; 
296.27     (x) to license and certify a total replacement project of 
296.28  up to 129 beds located in Polk county that are relocated from a 
296.29  nursing home destroyed by flood and whose residents were 
296.30  relocated to other nursing homes.  The operating cost payment 
296.31  rates for the new nursing facility shall be determined based on 
296.32  the interim and settle-up payment provisions of Minnesota Rules, 
296.33  part 9549.0057, and the reimbursement provisions of section 
296.34  256B.431, except that subdivision 26, paragraphs (a) and (b), 
296.35  shall not apply until the second rate year after the settle-up 
296.36  cost report is filed.  Property-related reimbursement rates 
297.1   shall be determined under section 256B.431, taking into account 
297.2   any federal or state flood-related loans or grants provided to 
297.3   the facility; 
297.4      (y) to license and certify beds in a renovation and 
297.5   remodeling project to convert 13 three-bed wards into 13 two-bed 
297.6   rooms and 13 single-bed rooms, expand space, and add 
297.7   improvements in a nursing home that, as of January 1, 1994, met 
297.8   the following conditions:  the nursing home was located in 
297.9   Ramsey county, was not owned by a hospital corporation, had a 
297.10  licensed capacity of 64 beds, and had been ranked among the top 
297.11  15 applicants by the 1993 moratorium exceptions advisory review 
297.12  panel.  The total project construction cost estimate for this 
297.13  project must not exceed the cost estimate submitted in 
297.14  connection with the 1993 moratorium exception process; 
297.15     (z) to license and certify up to 150 nursing home beds to 
297.16  replace an existing 285 bed nursing facility located in St. 
297.17  Paul.  The replacement project shall include both the renovation 
297.18  of existing buildings and the construction of new facilities at 
297.19  the existing site.  The reduction in the licensed capacity of 
297.20  the existing facility shall occur during the construction 
297.21  project as beds are taken out of service due to the construction 
297.22  process.  Prior to the start of the construction process, the 
297.23  facility shall provide written information to the commissioner 
297.24  of health describing the process for bed reduction, plans for 
297.25  the relocation of residents, and the estimated construction 
297.26  schedule.  The relocation of residents shall be in accordance 
297.27  with the provisions of law and rule; 
297.28     (aa) to allow the commissioner of human services to license 
297.29  an additional 36 beds to provide residential services for the 
297.30  physically handicapped under Minnesota Rules, parts 9570.2000 to 
297.31  9570.3400, in a 198-bed nursing home located in Red Wing, 
297.32  provided that the total number of licensed and certified beds at 
297.33  the facility does not increase; 
297.34     (bb) to license and certify a new facility in St. Louis 
297.35  county with 44 beds constructed to replace an existing facility 
297.36  in St. Louis county with 31 beds, which has resident rooms on 
298.1   two separate floors and an antiquated elevator that creates 
298.2   safety concerns for residents and prevents nonambulatory 
298.3   residents from residing on the second floor.  The project shall 
298.4   include the elimination of three- and four-bed rooms; 
298.5      (cc) to license and certify four beds in a 16-bed certified 
298.6   boarding care home in Minneapolis to replace beds that were 
298.7   voluntarily delicensed and decertified on or before March 31, 
298.8   1992.  The licensure and certification is conditional upon the 
298.9   facility periodically assessing and adjusting its resident mix 
298.10  and other factors which may contribute to a potential 
298.11  institution for mental disease declaration.  The commissioner of 
298.12  human services shall retain the authority to audit the facility 
298.13  at any time and shall require the facility to comply with any 
298.14  requirements necessary to prevent an institution for mental 
298.15  disease declaration, including delicensure and decertification 
298.16  of beds, if necessary; or 
298.17     (dd) to license and certify 72 beds in an existing facility 
298.18  in Mille Lacs county with 80 beds as part of a renovation 
298.19  project.  The renovation must include construction of an 
298.20  addition to accommodate ten residents with beginning and 
298.21  midstage dementia in a self-contained living unit; creation of 
298.22  three resident households where dining, activities, and support 
298.23  spaces are located near resident living quarters; designation of 
298.24  four beds for rehabilitation in a self-contained area; 
298.25  designation of 30 private rooms; and other improvements; 
298.26     (ee) to license and certify beds in a facility that has 
298.27  undergone replacement or remodeling as part of a planned closure 
298.28  under section 256B.437; 
298.29     (ff) to transfer up to 98 beds of a 129 licensed bed 
298.30  facility located in Anoka county that, as of March 25, 2001, is 
298.31  in the active process of closing, to a 122 licensed bed 
298.32  nonprofit nursing facility located in the city of Columbia 
298.33  Heights, or its affiliate.  The transfer is effective when the 
298.34  receiving facility notifies the commissioner in writing of the 
298.35  number of beds accepted.  The commissioner shall place all 
298.36  transferred beds on layaway status held in the name of the 
299.1   receiving facility.  The layaway adjustment provisions of 
299.2   section 256B.431, subdivision 30, do not apply to this layaway.  
299.3   The receiving facility may only remove the beds from layaway for 
299.4   recertification and relicensure at the receiving facility's 
299.5   current site, or at a newly constructed facility located in 
299.6   Anoka county.  The receiving facility must receive statutory 
299.7   authorization before removing the beds from layaway status; 
299.8      (gg) to license and certify up to 120 new nursing facility 
299.9   beds to replace beds in a facility in Anoka county, which was 
299.10  licensed for 98 beds as of July 1, 2000, provided the new 
299.11  facility is located within four miles of the existing facility 
299.12  and is in Anoka county.  Operating and property rates will be 
299.13  determined and allowed under section 256B.431 and Minnesota 
299.14  Rules, parts 9549.0010 to 9549.0080, or section 256B.434 or 
299.15  256B.435.  The provisions of section 256B.431, subdivision 26, 
299.16  paragraphs (a) and (b), do not apply until the second rate year 
299.17  following settle-up; or 
299.18     (hh) to license and certify a total replacement project of 
299.19  up to 124 beds located in Wilkin county that are in need of 
299.20  relocation from a nursing home substantially destroyed by 
299.21  flood.  The operating cost payment rates for the new nursing 
299.22  facility shall be determined based on the interim and settle-up 
299.23  payment provisions of Minnesota Rules, part 9549.0057, and the 
299.24  reimbursement provisions of section 256B.431, except that 
299.25  section 256B.431, subdivision 26, paragraphs (a) and (b), shall 
299.26  not apply until the second rate year after the settle-up cost 
299.27  report is filed.  Property-related reimbursement rates shall be 
299.28  determined under section 256B.431, taking into account any 
299.29  federal or state flood-related loans or grants provided to the 
299.30  facility. 
299.31     Sec. 7.  Minnesota Statutes 2000, section 144A.073, 
299.32  subdivision 2, is amended to read: 
299.33     Subd. 2.  [REQUEST FOR PROPOSALS.] At the authorization by 
299.34  the legislature of additional medical assistance expenditures 
299.35  for exceptions to the moratorium on nursing homes, the 
299.36  interagency committee shall publish in the State Register a 
300.1   request for proposals for nursing home projects to be licensed 
300.2   or certified under section 144A.071, subdivision 4a, clause 
300.3   (c).  The public notice of this funding and the request for 
300.4   proposals must specify how the approval criteria will be 
300.5   prioritized by the advisory review panel, the interagency 
300.6   long-term care planning committee, and the commissioner.  The 
300.7   notice must describe the information that must accompany a 
300.8   request and state that proposals must be submitted to the 
300.9   interagency committee within 90 days of the date of 
300.10  publication.  The notice must include the amount of the 
300.11  legislative appropriation available for the additional costs to 
300.12  the medical assistance program of projects approved under this 
300.13  section.  If no money is appropriated for a year, the 
300.14  interagency committee shall publish a notice to that effect, and 
300.15  no proposals shall be requested.  If money is appropriated, the 
300.16  interagency committee shall initiate the application and review 
300.17  process described in this section at least twice each biennium 
300.18  and up to four times each biennium, according to dates 
300.19  established by rule.  Authorized funds shall be allocated 
300.20  proportionally to the number of processes.  Funds not encumbered 
300.21  by an earlier process within a biennium shall carry forward to 
300.22  subsequent iterations of the process.  Authorization for 
300.23  expenditures does not carry forward into the following 
300.24  biennium.  To be considered for approval, a proposal must 
300.25  include the following information: 
300.26     (1) whether the request is for renovation, replacement, 
300.27  upgrading, conversion, or relocation; 
300.28     (2) a description of the problem the project is designed to 
300.29  address; 
300.30     (3) a description of the proposed project; 
300.31     (4) an analysis of projected costs of the nursing facility 
300.32  proposal, which are not required to exceed the cost threshold 
300.33  referred to in section 144A.071, subdivision 1, to be considered 
300.34  under this section, including initial construction and 
300.35  remodeling costs; site preparation costs; technology costs; 
300.36  financing costs, including the current estimated long-term 
301.1   financing costs of the proposal, which consists of estimates of 
301.2   the amount and sources of money, reserves if required under the 
301.3   proposed funding mechanism, annual payments schedule, interest 
301.4   rates, length of term, closing costs and fees, insurance costs, 
301.5   and any completed marketing study or underwriting review; and 
301.6   estimated operating costs during the first two years after 
301.7   completion of the project; 
301.8      (5) for proposals involving replacement of all or part of a 
301.9   facility, the proposed location of the replacement facility and 
301.10  an estimate of the cost of addressing the problem through 
301.11  renovation; 
301.12     (6) for proposals involving renovation, an estimate of the 
301.13  cost of addressing the problem through replacement; 
301.14     (7) the proposed timetable for commencing construction and 
301.15  completing the project; 
301.16     (8) a statement of any licensure or certification issues, 
301.17  such as certification survey deficiencies; 
301.18     (9) the proposed relocation plan for current residents if 
301.19  beds are to be closed so that the department of human services 
301.20  can estimate the total costs of a proposal; and 
301.21     (10) other information required by permanent rule of the 
301.22  commissioner of health in accordance with subdivisions 4 and 8. 
301.23     Sec. 8.  [144A.161] [NURSING FACILITY RESIDENT RELOCATION.] 
301.24     Subdivision 1.  [DEFINITIONS.] The definitions in this 
301.25  subdivision apply to subdivisions 2 to 10. 
301.26     (a) "Closure" means the cessation of operations of a 
301.27  nursing home and the delicensure and decertification of all beds 
301.28  within the facility. 
301.29     (b) "Curtailment," "reduction," or "change" refers to any 
301.30  change in operations which would result in or encourage the 
301.31  relocation of residents. 
301.32     (c) "Facility" means a nursing home licensed pursuant to 
301.33  this chapter, or a certified boarding care home licensed 
301.34  pursuant to sections 144.50 to 144.56. 
301.35     (d) "Licensee" means the owner of the facility or the 
301.36  owner's designee or the commissioner of health for a facility in 
302.1   receivership.  
302.2      (e) "Local agency" means the county or multicounty social 
302.3   service agency authorized under sections 393.01 and 393.07, as 
302.4   the agency responsible for providing social services for the 
302.5   county in which the nursing home is located. 
302.6      (f) "Plan" means a process developed under subdivision 3, 
302.7   paragraph (b), for the closure, curtailment, reduction, or 
302.8   change in operations in a facility and the subsequent relocation 
302.9   of residents. 
302.10     (g) "Relocation" means the discharge of a resident and 
302.11  movement of the resident to another facility or living 
302.12  arrangement as a result of the closing, curtailment, reduction, 
302.13  or change in operations of a nursing home or boarding care home. 
302.14     Subd. 2.  [INITIAL NOTICE FROM LICENSEE.] (a) The licensee 
302.15  of the facility shall notify the following parties in writing 
302.16  when there is an intent to close, curtail, reduce, or change 
302.17  operations or services which would result in or encourage the 
302.18  relocation of residents:  the commissioner of health, the 
302.19  commissioner of human services, the local agency, the office of 
302.20  ombudsman for older Minnesotans, and the ombudsman for mental 
302.21  health/mental retardation. 
302.22     (b) The written notice shall include the names, telephone 
302.23  numbers, facsimile numbers, and e-mail addresses of the persons 
302.24  responsible for coordinating the licensee's efforts in the 
302.25  planning process, and the number of residents potentially 
302.26  affected by the closure, curtailment, reduction, or change in 
302.27  operations. 
302.28     Subd. 3.  [PLANNING PROCESS.] (a) The local agency shall, 
302.29  within five working days of receiving initial notice of the 
302.30  licensee's intent to close, curtail, reduce, or change 
302.31  operations, provide the licensee and all parties identified in 
302.32  subdivision 2, paragraph (a), with the names, telephone numbers, 
302.33  facsimile numbers, and e-mail addresses of those persons 
302.34  responsible for coordinating local agency efforts in the 
302.35  planning process. 
302.36     (b) The licensee shall convene a meeting with the local 
303.1   agency to jointly develop a plan regarding the closure, 
303.2   curtailment, or change in facility operations.  The licensee 
303.3   shall notify representatives of the departments of health and 
303.4   human services of the date, time, and location of the meeting so 
303.5   that representatives from the departments may attend.  The 
303.6   licensee must allow a minimum of 28 days for this planning 
303.7   process from the day of the initial notice.  However, the plan 
303.8   may be finalized on an earlier schedule agreed to by all 
303.9   parties.  To the extent practicable, consistent with 
303.10  requirements to protect the safety and health of residents, the 
303.11  commissioner may authorize the planning process under this 
303.12  subdivision to occur concurrent with the 60 day notice required 
303.13  under subdivision 5, paragraph (e).  The plan shall: 
303.14     (1) identify the expected date of closure, curtailment, 
303.15  reduction, or change in operations; 
303.16     (2) outline the process for public notification of the 
303.17  closure, curtailment, reduction, or change in operations; 
303.18     (3) identify and make efforts to include other stakeholders 
303.19  in the planning process; 
303.20     (4) outline the process to ensure 60-day advance written 
303.21  notice to residents, family members, and designated 
303.22  representatives; 
303.23     (5) present an aggregate description of the resident 
303.24  population remaining to be relocated and their needs; 
303.25     (6) outline the individual resident assessment process to 
303.26  be utilized; 
303.27     (7) identify an inventory of available relocation options, 
303.28  including home and community-based services; 
303.29     (8) identify a timeline for submission of the list 
303.30  identified in subdivision 5, paragraph (h); and 
303.31     (9) identify a schedule for the timely completion of each 
303.32  element of the plan.  
303.33     Subd. 4.  [RESPONSIBILITIES OF LICENSEE FOR RESIDENT 
303.34  RELOCATIONS.] The licensee shall provide for the safe, orderly, 
303.35  and appropriate relocation of residents.  The licensee and 
303.36  facility staff shall cooperate with representatives from the 
304.1   local agency, the department of health, the department of human 
304.2   services, the office of ombudsman for older Minnesotans, and 
304.3   ombudsman for mental health/mental retardation, in planning for 
304.4   and implementing the relocation of residents.  The discharge and 
304.5   relocation of residents must comply with all applicable state 
304.6   and federal requirements. 
304.7      Subd. 5.  [RESPONSIBILITIES PRIOR TO RELOCATION.] (a) The 
304.8   licensee shall provide an initial notice as described in 
304.9   subdivision 2, when there is an intent to close, curtail, 
304.10  reduce, or change in operations which would result in or 
304.11  encourage the relocation of residents. 
304.12     (b) The licensee shall establish an interdisciplinary team 
304.13  responsible for coordinating and implementing the plan as 
304.14  outlined in subdivision 3, paragraph (b).  The interdisciplinary 
304.15  team shall include representatives from the local agency, the 
304.16  office of ombudsman for older Minnesotans, facility staff that 
304.17  provide direct care services to the residents, and facility 
304.18  administration. 
304.19     (c) The licensee shall provide a list to the local agency 
304.20  that includes the following information on each resident to be 
304.21  relocated: 
304.22     (1) the resident's name; 
304.23     (2) date of birth; 
304.24     (3) social security number; 
304.25     (4) medical assistance identification number; 
304.26     (5) all diagnoses; and 
304.27     (6) the name and contact information for the resident's 
304.28  family or other designated representative. 
304.29     (d) The licensee shall consult with the local agency on the 
304.30  availability and development of available resources, and on the 
304.31  resident relocation process. 
304.32     (e) At least 60 days before the proposed date of closing, 
304.33  curtailment, reduction, or change in operations as agreed to in 
304.34  the plan, the licensee shall send a written notice of closure, 
304.35  curtailment, reduction, or change in operations to each resident 
304.36  being relocated, the resident's family member or designated 
305.1   representative, and the resident's attending physician.  The 
305.2   notice must include the following: 
305.3      (1) the date of the proposed closure, curtailment, 
305.4   reduction, or change in operations; 
305.5      (2) the name, address, telephone number, facsimile number, 
305.6   and e-mail address of the individual or individuals in the 
305.7   facility responsible for providing assistance and information; 
305.8      (3) notification of upcoming meetings for residents, 
305.9   families and designated representatives, and resident and family 
305.10  councils to discuss the relocation of residents; 
305.11     (4) the name, address, and telephone number of the local 
305.12  agency contact person; 
305.13     (5) the name, address, and telephone number of the office 
305.14  of ombudsman for older Minnesotans and the ombudsman for mental 
305.15  health/mental retardation; and 
305.16     (6) a notice of resident rights during discharge and 
305.17  relocation, in a form approved by the office of ombudsman for 
305.18  older Minnesotans. 
305.19     The notice must comply with all applicable state and 
305.20  federal requirements for notice of transfer or discharge of 
305.21  nursing home residents. 
305.22     (f) The licensee shall request the attending physician 
305.23  provide or arrange for the release of medical information needed 
305.24  to update resident medical records and prepare all required 
305.25  forms and discharge summaries. 
305.26     (g) The licensee shall provide sufficient preparation to 
305.27  residents to ensure safe, orderly and appropriate discharge, and 
305.28  relocation.  The licensee shall assist residents in finding 
305.29  placements that respond to personal preferences, such as desired 
305.30  geographic location.  
305.31     (h) The licensee shall prepare a resource list with several 
305.32  relocation options for each resident.  The list must contain the 
305.33  following information for each relocation option, when 
305.34  applicable: 
305.35     (1) the name, address, and telephone and facsimile numbers 
305.36  of each facility with appropriate, available beds or services; 
306.1      (2) the certification level of the available beds; 
306.2      (3) the types of services available; 
306.3      (4) the name, address, and telephone and facsimile numbers 
306.4   of appropriate available home and community-based placements, 
306.5   services and settings, or other options for individuals with 
306.6   special needs.  
306.7   The list shall be made available to residents and their families 
306.8   or designated representatives, and upon request to the office of 
306.9   ombudsman for older Minnesotans and ombudsman for mental 
306.10  health/mental retardation, and the local agency. 
306.11     (i) Following the establishment of the plan under 
306.12  subdivision 3, paragraph (b), the licensee shall conduct 
306.13  meetings with residents, families and designated 
306.14  representatives, and resident and family councils to notify them 
306.15  of the process for resident relocation.  Representatives from 
306.16  the local county social services agency, the office of ombudsman 
306.17  for older Minnesotans, the ombudsman for mental health and 
306.18  mental retardation, the commissioner of health, and the 
306.19  commissioner of human services shall receive advance notice of 
306.20  the meetings.  
306.21     (j) The licensee shall assist residents desiring to make 
306.22  site visits to facilities with available beds or other 
306.23  appropriate living options to which the resident may relocate, 
306.24  unless it is medically inadvisable, as documented by the 
306.25  attending physician in the resident's care record.  The licensee 
306.26  shall provide transportation for site visits to facilities or 
306.27  other living options within a 50-mile radius to which the 
306.28  resident may relocate.  The licensee shall provide available 
306.29  written materials to residents on a potential new facility or 
306.30  living option. 
306.31     (k) The licensee shall complete an inventory of resident 
306.32  personal possessions and provide a copy of the final inventory 
306.33  to the resident and the resident's designated representative 
306.34  prior to relocation.  The licensee shall be responsible for the 
306.35  transfer of the resident's possessions for all relocations 
306.36  within a 50-mile radius of the facility.  The licensee shall 
307.1   complete the transfer of resident possessions in a timely 
307.2   manner, but no later than the date of the actual physical 
307.3   relocation of the resident. 
307.4      (l) The licensee shall complete a final accounting of 
307.5   personal funds held in trust by the facility and provide a copy 
307.6   of this accounting to the resident and the resident's family or 
307.7   the resident's designated representative.  The licensee shall be 
307.8   responsible for the transfer of all personal funds held in trust 
307.9   by the facility.  The licensee shall complete the transfer of 
307.10  all personal funds in a timely manner. 
307.11     (m) The licensee shall assist residents with the transfer 
307.12  and reconnection of service for telephones or other personal 
307.13  communication devices or services.  The licensee shall pay the 
307.14  costs associated with reestablishing service for telephones or 
307.15  other personal communication devices or services, such as 
307.16  connection fees or other one-time charges.  The transfer or 
307.17  reconnection of personal communication devices or services shall 
307.18  be completed in a timely manner. 
307.19     (n) The licensee shall provide the resident, the resident's 
307.20  family or designated representative, and the resident's 
307.21  attending physician final written notice prior to the relocation 
307.22  of the resident.  The notice must: 
307.23     (1) be provided seven days prior to the actual relocation, 
307.24  unless the resident agrees to waive the right to advance notice; 
307.25  and 
307.26     (2) identify the date of the anticipated relocation and the 
307.27  destination to which the resident is being relocated. 
307.28     (o) The licensee shall provide the receiving facility or 
307.29  other health, housing, or care entity with complete and accurate 
307.30  resident records including information on family members, 
307.31  designated representatives, guardians, social service 
307.32  caseworkers, or other contact information.  These records must 
307.33  also include all information necessary to provide appropriate 
307.34  medical care and social services.  This includes, but is not 
307.35  limited to, information on preadmission screening, Level I and 
307.36  Level II screening, Minimum Data Set (MDS) and all other 
308.1   assessments, resident diagnoses, social, behavioral, and 
308.2   medication information. 
308.3      Subd. 6.  [RESPONSIBILITIES OF THE LICENSEE DURING 
308.4   RELOCATION.] (a) The licensee shall arrange for the safe 
308.5   transport of residents to the new facility or placement. 
308.6      (b) The licensee must ensure that there is no disruption in 
308.7   the provision of meals, medications, or treatments of the 
308.8   resident during the relocation process. 
308.9      (c) Beginning the week following development of the initial 
308.10  relocation plan, the licensee shall submit biweekly status 
308.11  reports to the commissioners of the department of health and the 
308.12  department of human services or their designees, and to the 
308.13  local agency.  The initial status report must identify: 
308.14     (1) the relocation plan developed; 
308.15     (2) the interdisciplinary team members; and 
308.16     (3) the number of residents to be relocated. 
308.17     (d) Subsequent status reports must identify: 
308.18     (1) any modifications to the plan; 
308.19     (2) any change of interdisciplinary team members; 
308.20     (3) the number of residents relocated; 
308.21     (4) the destination to which residents have been relocated; 
308.22     (5) the number of residents remaining to be relocated; and 
308.23     (6) issues or problems encountered during the process and 
308.24  resolution of these issues. 
308.25     Subd. 7.  [RESPONSIBILITIES OF THE LICENSEE FOLLOWING 
308.26  RELOCATION.] The licensee shall retain or make arrangements for 
308.27  the retention of all remaining resident records, for the period 
308.28  required by law.  The licensee shall provide the department of 
308.29  health access to these records.  The licensee shall notify the 
308.30  department of health of the location of any resident records 
308.31  that have not been transferred to the new facility or other 
308.32  health care entity. 
308.33     Subd. 8.  [RESPONSIBILITIES OF THE LOCAL AGENCY.] (a) The 
308.34  local agency shall participate in the meeting as outlined in 
308.35  subdivision 3, paragraph (b), to develop a relocation plan. 
308.36     (b) The local agency shall designate a representative to 
309.1   the interdisciplinary team established by the licensee 
309.2   responsible for coordinating the relocation efforts. 
309.3      (c) The local agency shall serve as a resource in the 
309.4   relocation process. 
309.5      (d) Concurrent with the notice sent to residents from the 
309.6   licensee as provided in subdivision 5, paragraph (e), the local 
309.7   agency shall provide written notice to residents, family, or 
309.8   designated representatives describing: 
309.9      (1) the county's role in the relocation process and in the 
309.10  follow-up to relocations; 
309.11     (2) a local agency contact name, address, and telephone 
309.12  number; and 
309.13     (3) the name, address, and telephone number of the office 
309.14  of ombudsman for older Minnesotans and the ombudsman for mental 
309.15  health/mental retardation. 
309.16     (e) The local agency designee shall meet with appropriate 
309.17  facility staff to coordinate any assistance in the relocation 
309.18  process.  This coordination shall include participating in group 
309.19  meetings with residents, families, and designated 
309.20  representatives to explain the relocation process. 
309.21     (f) The local agency shall monitor compliance with all 
309.22  components of the plan.  If the licensee is not in compliance, 
309.23  the local agency shall notify the commissioners of the 
309.24  department of health and the department of human services. 
309.25     (g) The local agency shall report to the commissioners of 
309.26  health and human services any relocations that endanger the 
309.27  health, safety, or well-being of residents.  The local agency 
309.28  shall pursue remedies to protect the resident during the 
309.29  relocation process, including, but not limited to, assisting the 
309.30  resident with filing an appeal of transfer or discharge, 
309.31  notification of all appropriate licensing boards and agencies, 
309.32  and other remedies available to the county under section 
309.33  626.557, subdivision 10. 
309.34     (h) A member of the local agency staff shall visit 
309.35  residents relocated within one hundred miles of the county 
309.36  within 30 days after the relocation.  Local agency staff shall 
310.1   interview the resident and family or designated representative, 
310.2   observe the resident on site, and review and discuss pertinent 
310.3   medical or social records with facility staff to: 
310.4      (1) assess the adjustment of the resident to the new 
310.5   placement; 
310.6      (2) recommend services or methods to meet any special needs 
310.7   of the resident; and 
310.8      (3) identify residents at risk. 
310.9      (i) The local agency shall have the authority to conduct 
310.10  subsequent follow-up visits in cases where the adjustment of the 
310.11  resident to the new placement is in question. 
310.12     (j) Within 60 days of the completion of the follow-up 
310.13  visits, the local agency shall submit a written summary of the 
310.14  follow-up work to the department of health and the department of 
310.15  human services, in a manner approved by the commissioners. 
310.16     (k) The local agency shall submit to the department of 
310.17  health and the department of human services a report of any 
310.18  issues that may require further review or monitoring. 
310.19     (l) The local agency shall be responsible for the safe and 
310.20  orderly relocation of residents in cases where an emergent need 
310.21  arises or when the licensee has abrogated its responsibilities 
310.22  under the plan. 
310.23     Subd. 9.  [FUNDING.] The commissioner of human services 
310.24  shall negotiate with the local agency to determine an amount of 
310.25  administrative funding within appropriations specified for this 
310.26  purpose to make available to the local agency for the costs of 
310.27  work related to the relocation process in accordance with 
310.28  section 256B.437, subdivision 9. 
310.29     Subd. 10.  [PENALTIES.] According to sections 144.653 and 
310.30  144A.10, the licensee shall be subject to correction orders and 
310.31  civil monetary penalties of up to $500 per day for each 
310.32  violation of this statute. 
310.33     Sec. 9.  [144A.1888] [REUSE OF FACILITIES.] 
310.34     Notwithstanding any local ordinance related to development, 
310.35  planning, or zoning to the contrary, the conversion or reuse of 
310.36  a nursing home that closes or that curtails, reduces, or changes 
311.1   operations shall be considered a conforming use permitted under 
311.2   local law, provided that the facility is converted to another 
311.3   long-term care service approved by a regional planning group 
311.4   under section 256B.437 that serves a smaller number of persons 
311.5   than the number of persons served before the closure or 
311.6   curtailment, reduction, or change in operations. 
311.7      Sec. 10.  Minnesota Statutes 2000, section 256B.431, 
311.8   subdivision 2e, is amended to read: 
311.9      Subd. 2e.  [CONTRACTS FOR SERVICES FOR VENTILATOR-DEPENDENT 
311.10  PERSONS.] The commissioner may contract with a nursing facility 
311.11  eligible to receive medical assistance payments to provide 
311.12  services to a ventilator-dependent person identified by the 
311.13  commissioner according to criteria developed by the 
311.14  commissioner, including:  
311.15     (1) nursing facility care has been recommended for the 
311.16  person by a preadmission screening team; 
311.17     (2) the person has been assessed at case mix classification 
311.18  K; 
311.19     (3) the person has been hospitalized for at least six 
311.20  months and no longer requires inpatient acute care hospital 
311.21  services; and 
311.22     (4) (3) the commissioner has determined that necessary 
311.23  services for the person cannot be provided under existing 
311.24  nursing facility rates.  
311.25     The commissioner may issue a request for proposals to 
311.26  provide services to a ventilator-dependent person to nursing 
311.27  facilities eligible to receive medical assistance payments and 
311.28  shall select nursing facilities from among respondents according 
311.29  to criteria developed by the commissioner, including:  
311.30     (1) the cost-effectiveness and appropriateness of services; 
311.31     (2) the nursing facility's compliance with federal and 
311.32  state licensing and certification standards; and 
311.33     (3) the proximity of the nursing facility to a 
311.34  ventilator-dependent person identified by the commissioner who 
311.35  requires nursing facility placement.  
311.36     The commissioner may negotiate an adjustment to the 
312.1   operating cost payment rate for a nursing facility selected by 
312.2   the commissioner from among respondents to the request for 
312.3   proposals.  The negotiated adjustment must reflect only the 
312.4   actual additional cost of meeting the specialized care needs of 
312.5   a ventilator-dependent person identified by the commissioner for 
312.6   whom necessary services cannot be provided under existing 
312.7   nursing facility rates and which are not otherwise covered under 
312.8   Minnesota Rules, parts 9549.0010 to 9549.0080 or 9505.0170 to 
312.9   9505.0475.  For persons who are initially admitted to a nursing 
312.10  facility before July 1, 2001, and have their payment rate under 
312.11  this subdivision negotiated after July 1, 2001, the negotiated 
312.12  payment rate must not exceed 200 percent of the highest multiple 
312.13  bedroom payment rate for a Minnesota nursing the facility, as 
312.14  initially established by the commissioner for the rate year for 
312.15  case mix classification K.  For persons initially admitted to a 
312.16  nursing facility on or after July 1, 2001, the negotiated 
312.17  payment rate must not exceed 300 percent of the facility's 
312.18  multiple bedroom payment rate for case mix classification K.  
312.19  The negotiated adjustment shall not affect the payment rate 
312.20  charged to private paying residents under the provisions of 
312.21  section 256B.48, subdivision 1. 
312.22     Sec. 11.  Minnesota Statutes 2000, section 256B.431, is 
312.23  amended by adding a subdivision to read: 
312.24     Subd. 31.  [NURSING FACILITY RATE INCREASES BEGINNING JULY 
312.25  1, 2001, AND JULY 1, 2002.] (a) For the rate years beginning 
312.26  July 1, 2001, and July 1, 2002, the commissioner shall make 
312.27  available to each nursing facility reimbursed under this section 
312.28  or section 256B.434 an adjustment of 3.0 percent to the total 
312.29  operating payment rates in effect on June 30, 2001, and June 30, 
312.30  2002, respectively.  The operating payment rate in effect on 
312.31  June 30, 2001, must include the adjustment in subdivision 2i, 
312.32  paragraph (c).  The adjustment must be used to increase the 
312.33  wages of all employees except management fees, the 
312.34  administrator, and central office staff and to pay associated 
312.35  costs for FICA, the Medicare tax, workers' compensation 
312.36  premiums, and federal and state unemployment insurance. 
313.1      Money received by a facility as a result of the additional 
313.2   rate increase provided under this paragraph must be used only 
313.3   for wage increases implemented on or after July 1, 2001, or July 
313.4   1, 2002, respectively, and must not be used for wage increases 
313.5   implemented prior to those dates. 
313.6      (b) Nursing facilities may apply for the wage-related 
313.7   payment rate adjustment calculated under paragraph (a).  The 
313.8   application must be made to the commissioner and contain a plan 
313.9   by which the nursing facility will distribute the payment rate 
313.10  adjustment to employees of the nursing facility.  For nursing 
313.11  facilities in which the employees are represented by an 
313.12  exclusive bargaining representative, an agreement negotiated and 
313.13  agreed to by the employer and the exclusive bargaining 
313.14  representative constitutes the plan.  A negotiated agreement may 
313.15  constitute the plan only if the agreement is finalized after the 
313.16  date of enactment of all increases for the rate year.  The 
313.17  commissioner shall review the plan to ensure that the 
313.18  wage-related payment rate adjustment per diem is used as 
313.19  provided in paragraph (a).  To be eligible, a facility must 
313.20  submit its plan for the wage distribution by December 31 each 
313.21  year.  If a facility's plan for wage distribution is effective 
313.22  for its employees after July 1 of the year that the funds are 
313.23  available, the payment rate adjustment per diem is effective the 
313.24  same date as its plan. 
313.25     (c) A hospital-attached nursing facility may include costs 
313.26  in their distribution plan for wages and wage-related costs of 
313.27  employees in the organization's shared services departments, 
313.28  provided that: 
313.29     (1) the nursing facility and the hospital share common 
313.30  ownership; and 
313.31     (2) adjustments for hospital services using the 
313.32  diagnostic-related grouping payment rates per admission under 
313.33  medical assistance or Medicare are less than three percent 
313.34  during the 12 months prior to the effective date of this 
313.35  increase. 
313.36     If a hospital-attached facility meets the qualifications in 
314.1   this paragraph, the difference between the rate increase 
314.2   approved for nursing facility services and the rate increase 
314.3   approved for hospital services may be permitted as a 
314.4   distribution in the hospital-attached facility's plan regardless 
314.5   of whether the use of those funds is shown as being attributable 
314.6   to employee hours worked in the nursing facility or employee 
314.7   hours worked in the hospital. 
314.8      For the purposes of this paragraph, a hospital-attached 
314.9   nursing facility is one that meets the definition under 
314.10  subdivision 2j, or, in the case of a facility reimbursed under 
314.11  section 256B.434, met this definition at the time their last 
314.12  payment rate was established under Minnesota Rules, parts 
314.13  9549.0010 to 9549.0080, and this section. 
314.14     (d) A copy of the approved distribution plan must be made 
314.15  available to all employees by giving each employee a copy or by 
314.16  posting it in an area of the nursing facility to which all 
314.17  employees have access.  If an employee does not receive the wage 
314.18  adjustment described in the facility's approved plan and is 
314.19  unable to resolve the problem with the facility's management or 
314.20  through the employee's union representative, the employee may 
314.21  contact the commissioner at an address or telephone number 
314.22  provided by the commissioner and included in the approved plan.  
314.23     (e) Notwithstanding section 256B.48, subdivision 1, clause 
314.24  (a), upon the request of a nursing facility, the commissioner 
314.25  may authorize the facility to raise per diem rates for 
314.26  private-pay residents on July 1 by the amount anticipated to be 
314.27  required upon implementation of the wage-related increase 
314.28  available under this subdivision.  The commissioner shall 
314.29  require any amounts collected under this paragraph to be placed 
314.30  in an escrow account until the medical assistance rate is 
314.31  finalized.  The commissioner shall conduct audits as necessary 
314.32  to ensure that: 
314.33     (1) the amounts collected are retained in escrow until 
314.34  medical assistance rates are increased to reflect the 
314.35  wage-related adjustment; and 
314.36     (2) any amounts collected from private-pay residents in 
315.1   excess of the final medical assistance wage-related rate 
315.2   increase are repaid to the private-pay residents with interest 
315.3   at the rate used by the commissioner of revenue for the late 
315.4   payment of taxes and in effect on the date the distribution plan 
315.5   is approved by the commissioner of human services. 
315.6      (f) For the rate year beginning July 1, 2001, the 
315.7   commissioner shall make available to each nursing facility that 
315.8   is reimbursed under this section or section 256B.434 and had 35 
315.9   or fewer admissions during calendar year 2000 an adjustment of 
315.10  1.0 percent to the total operating payment rates in effect on 
315.11  June 30, 2001. 
315.12  The operating payment rate in effect on June 30, 2001, must 
315.13  include the adjustment in subdivision 2i, paragraph (c). 
315.14     Sec. 12.  Minnesota Statutes 2000, section 256B.431, is 
315.15  amended by adding a subdivision to read: 
315.16     Subd. 32.  [PAYMENT DURING FIRST 90 DAYS.] (a) For rate 
315.17  years beginning on or after July 1, 2001, the total payment rate 
315.18  for a facility reimbursed under this section, section 256B.434, 
315.19  or any other section for the first 90 paid days after admission 
315.20  shall be: 
315.21     (1) for the first 30 paid days, the rate shall be 120 
315.22  percent of the facility's medical assistance rate for each case 
315.23  mix class; and 
315.24     (2) for the next 60 paid days after the first 30 paid days, 
315.25  the rate shall be 110 percent of the facility's medical 
315.26  assistance rate for each case mix class. 
315.27     (b) Beginning with the 91st paid day after admission, the 
315.28  payment rate shall be the rate otherwise determined under this 
315.29  section, section 256B.434, or any other section. 
315.30     Sec. 13.  Minnesota Statutes 2000, section 256B.431, is 
315.31  amended by adding a subdivision to read: 
315.32     Subd. 34.  [STAGED REDUCTION IN RATE DISPARITIES.] (a) The 
315.33  commissioner, by June 30, 2001, shall provide each nursing 
315.34  facility with information on how its per diem operating payment 
315.35  rates for each case mix category compare to the median per diem 
315.36  rates for facilities in geographic group three, as determined 
316.1   under Minnesota Rules, part 9549.0052. 
316.2      (b) The commissioner shall provide nursing facilities 
316.3   reimbursed under this section or section 256B.434 with the 
316.4   following staged rate increases, for each case mix category 
316.5   operating payment per diem that is below the median for 
316.6   facilities in geographic group three: 
316.7      (1) effective July 1, 2001, the commissioner shall allow 
316.8   increases in the total operating payment per diems for each 
316.9   facility of up to 38 percent of the difference between that 
316.10  facility's operating payment rate in effect on June 30, 2001, 
316.11  for each case mix category and 85 percent of the median payment 
316.12  rate in effect on June 30, 2001, for that category for 
316.13  facilities in geographic group three; 
316.14     (2) effective July 1, 2002, the commissioner shall allow 
316.15  increases in the total operating payment per diems for each 
316.16  facility by 38 percent of the difference between that facility's 
316.17  operating payment rate in effect on June 30, 2002, for each case 
316.18  mix category and 85 percent of the median payment rate in effect 
316.19  on June 30, 2002, for that category for facilities in geographic 
316.20  group three; and 
316.21     (3) effective July 1, 2003, the commissioner shall allow 
316.22  increases in the total operating payment per diems for each 
316.23  facility by 24 percent of the difference between that facility's 
316.24  operating payment rate in effect on June 30, 2003, for each case 
316.25  mix category and 100 percent of the median payment rate in 
316.26  effect on June 30, 2003, for each case mix category for 
316.27  facilities in geographic group three. 
316.28     (c) In order to receive the rate increases provided in 
316.29  paragraph (b), facilities must apply to the commissioner.  A 
316.30  facility must submit an application for each rate increase by 
316.31  December 31 of the calendar year in which the increase is 
316.32  allowed, using a form provided by the commissioner.  The 
316.33  application must include a plan for use of the rate increase and 
316.34  any other information deemed necessary by the commissioner to 
316.35  determine the amount of an increase that will be allowed.  The 
316.36  commissioner shall deny a request for a rate increase, or reduce 
317.1   the rate increase provided, if the commissioner determines that 
317.2   the proposed plan for using the rate increase is not an approved 
317.3   use of funding under Minnesota Rules, parts 9549.0010 to 
317.4   9549.0080.  A facility whose request has been denied or reduced 
317.5   may reapply for a rate increase.  Rate increases approved by the 
317.6   commissioner shall be effective on the first day of the month 
317.7   following the month which the application was received by the 
317.8   commissioner, but not before July 1 of the year in which it is 
317.9   allowed. 
317.10     (d) A facility must make a copy of the approved application 
317.11  available to residents, their designated representatives, and 
317.12  employees, by posting it in an area of the facility to which 
317.13  these individuals have access, or by providing these individuals 
317.14  with copies.  
317.15     [EFFECTIVE DATE.] This section is effective the day 
317.16  following final enactment. 
317.17     Sec. 14.  Minnesota Statutes 2000, section 256B.433, 
317.18  subdivision 3a, is amended to read: 
317.19     Subd. 3a.  [EXEMPTION FROM REQUIREMENT FOR SEPARATE THERAPY 
317.20  BILLING.] The provisions of subdivision 3 do not apply to 
317.21  nursing facilities that are reimbursed according to the 
317.22  provisions of section 256B.431 and are located in a county 
317.23  participating in the prepaid medical assistance program.  
317.24  Nursing facilities that are reimbursed according to the 
317.25  provisions of section 256B.434 and are located in a county 
317.26  participating in the prepaid medical assistance program are 
317.27  exempt from the maximum therapy rent revenue provisions of 
317.28  subdivision 3, paragraph (c). 
317.29     [EFFECTIVE DATE.] This section is effective the day 
317.30  following final enactment. 
317.31     Sec. 15.  Minnesota Statutes 2000, section 256B.434, 
317.32  subdivision 4, is amended to read: 
317.33     Subd. 4.  [ALTERNATE RATES FOR NURSING FACILITIES.] (a) For 
317.34  nursing facilities which have their payment rates determined 
317.35  under this section rather than section 256B.431, the 
317.36  commissioner shall establish a rate under this subdivision.  The 
318.1   nursing facility must enter into a written contract with the 
318.2   commissioner. 
318.3      (b) A nursing facility's case mix payment rate for the 
318.4   first rate year of a facility's contract under this section is 
318.5   the payment rate the facility would have received under section 
318.6   256B.431. 
318.7      (c) A nursing facility's case mix payment rates for the 
318.8   second and subsequent years of a facility's contract under this 
318.9   section are the previous rate year's contract payment rates plus 
318.10  an inflation adjustment.  The index for the inflation adjustment 
318.11  must be based on the change in the Consumer Price Index-All 
318.12  Items (United States City average) (CPI-U) forecasted by Data 
318.13  Resources, Inc., as forecasted in the fourth quarter of the 
318.14  calendar year preceding the rate year.  The inflation adjustment 
318.15  must be based on the 12-month period from the midpoint of the 
318.16  previous rate year to the midpoint of the rate year for which 
318.17  the rate is being determined.  For the rate years beginning on 
318.18  July 1, 1999, and July 1, 2000, July 1, 2001, and July 1, 2002, 
318.19  this paragraph shall apply only to the property-related payment 
318.20  rate.  In determining the amount of the property-related payment 
318.21  rate adjustment under this paragraph, the commissioner shall 
318.22  determine the proportion of the facility's rates that are 
318.23  property-related based on the facility's most recent cost report.
318.24     (d) The commissioner shall develop additional 
318.25  incentive-based payments of up to five percent above the 
318.26  standard contract rate for achieving outcomes specified in each 
318.27  contract.  The specified facility-specific outcomes must be 
318.28  measurable and approved by the commissioner.  The commissioner 
318.29  may establish, for each contract, various levels of achievement 
318.30  within an outcome.  After the outcomes have been specified the 
318.31  commissioner shall assign various levels of payment associated 
318.32  with achieving the outcome.  Any incentive-based payment cancels 
318.33  if there is a termination of the contract.  In establishing the 
318.34  specified outcomes and related criteria the commissioner shall 
318.35  consider the following state policy objectives: 
318.36     (1) improved cost effectiveness and quality of life as 
319.1   measured by improved clinical outcomes; 
319.2      (2) successful diversion or discharge to community 
319.3   alternatives; 
319.4      (3) decreased acute care costs; 
319.5      (4) improved consumer satisfaction; 
319.6      (5) the achievement of quality; or 
319.7      (6) any additional outcomes proposed by a nursing facility 
319.8   that the commissioner finds desirable. 
319.9      Sec. 16.  [256B.437] [NURSING FACILITY VOLUNTARY CLOSURES 
319.10  AND PLANNING AND DEVELOPMENT OF COMMUNITY-BASED ALTERNATIVES.] 
319.11     Subdivision 1.  [DEFINITIONS.] (a) The definitions in this 
319.12  subdivision apply to subdivisions 2 to 9. 
319.13     (b) "Closure" means the cessation of operations of a 
319.14  nursing facility and delicensure and decertification of all beds 
319.15  within the facility. 
319.16     (c) "Closure plan" means a plan to close a nursing facility 
319.17  and reallocate a portion of the resulting savings to provide 
319.18  planned closure rate adjustments at other facilities. 
319.19     (d) "Commencement of closure" means the date on which 
319.20  residents and designated representatives are notified of a 
319.21  planned closure in accordance with section 144A.161, subdivision 
319.22  5, paragraph (e), as part of an approved closure plan. 
319.23     (e) "Completion of closure" means the date on which the 
319.24  final resident of the nursing facility designated for closure in 
319.25  an approved closure plan is discharged from the facility. 
319.26     (f) "Partial closure" means the delicensure and 
319.27  decertification of a portion of the beds within the facility. 
319.28     (g) "Planned closure rate adjustment" means an increase in 
319.29  a nursing facility's operating rates resulting from a planned 
319.30  closure or a planned partial closure of another facility. 
319.31     Subd. 2.  [REGIONAL LONG-TERM CARE PLANNING AND 
319.32  DEVELOPMENT.] (a) The commissioner of human services shall 
319.33  establish a process to adjust the capacity and distribution of 
319.34  long-term care services to equalize the supply and demand for 
319.35  different types of services.  The process must include community 
319.36  and regional planning, expansion or establishment of needed 
320.1   services, and voluntary nursing facility closures. 
320.2      (b) The commissioner shall issue a request for proposals to 
320.3   contract with regional long-term care planning groups.  At least 
320.4   one of the planning groups must be an American Indian long-term 
320.5   care planning group.  Each group must: 
320.6      (1) consist of county health and social services agencies, 
320.7   consumers, housing agencies, a representative of nursing 
320.8   facilities, a representative of home and community-based 
320.9   services providers, a union representative, and area agencies on 
320.10  aging in the geographic area; and 
320.11     (2) serve an area that has at least 2,000 people who are 85 
320.12  years of age or older.  American Indian long-term care planning 
320.13  groups are exempt from this requirement.  
320.14  In awarding contracts, the commissioner shall give preference to 
320.15  groups that represent an entire area agency on aging region 
320.16  where there is not already a planning and development group 
320.17  established under section 256B.0917.  An area not included in a 
320.18  proposal must be included in a group convened by the area agency 
320.19  on aging of that planning and service area through a contract 
320.20  negotiated by the commissioner. 
320.21     (c) Each regional long-term care planning group shall: 
320.22     (1) conduct a detailed assessment of the region's long-term 
320.23  care services system.  This assessment must be completed within 
320.24  90 days of the contract award and must evaluate the adequacy of 
320.25  nursing facility beds and the impact of potential nursing 
320.26  facility closures.  The commissioner of health and the 
320.27  commissioner of human services, as appropriate, shall provide 
320.28  data to the group on nursing facility bed distribution, 
320.29  housing-with-service options, the closure of nursing facilities 
320.30  in the planning area that occur outside of the planned closure 
320.31  process, the approval of planned closures in the planning area, 
320.32  the addition of new community long-term care services in the 
320.33  area, the closure of existing community long-term care services 
320.34  in the area, and other available data; 
320.35     (2) plan options for increasing community capacity to 
320.36  provide more home and community-based services to reduce 
321.1   reliance on nursing facility services; 
321.2      (3) develop community services alternatives to ensure that 
321.3   sufficient community-based services are available to meet 
321.4   demand; 
321.5      (4) assist a nursing facility in the development of a 
321.6   proposal to the commissioner for voluntary bed closures under 
321.7   this section; 
321.8      (5) monitor the success of alternatives to nursing facility 
321.9   care that are developed that meet the needs of communities; 
321.10     (6) respond to requests from the commissioner for 
321.11  information about long-term care planning and development 
321.12  activities in the region; and 
321.13     (7) review and comment on nursing facility proposals 
321.14  submitted under this section. 
321.15     Subd. 2a.  [PLANNING AND DEVELOPMENT OF COMMUNITY-BASED 
321.16  SERVICES.] (a) The purpose of this subdivision is to promote the 
321.17  planning and development of community-based services prior to 
321.18  the transitioning or closure of nursing facilities.  This 
321.19  process will support early intervention, advocacy, and consumer 
321.20  protection while providing incentives for the nursing facilities 
321.21  to transition to meet community needs. 
321.22     (b) The commissioner shall establish a process to support 
321.23  and facilitate expansion of community-based services under the 
321.24  county-administered alternative care program and the elderly 
321.25  waiver program.  The process shall utilize community assessments 
321.26  and planning developed for the community health services plan 
321.27  and plan update and for the Community Social Services Act plan. 
321.28     (c) The plan shall include recommendations for development 
321.29  of community-based services, and both planning and 
321.30  implementation shall be implemented within the amount of funding 
321.31  made available to the county board for these purposes. 
321.32     (d) The plan, within the funding allocated, shall: 
321.33     (1) identify the need for services for all residents in 
321.34  each community within the county based on demographic and 
321.35  caseload information; 
321.36     (2) involve providers, consumers, cities, townships, and 
322.1   businesses in the planning process; 
322.2      (3) address the need for all alternative care and elderly 
322.3   waiver services for eligible recipients; 
322.4      (4) assess the need for other supportive services such as 
322.5   transit, housing, and workforce and economic development; 
322.6      (5) estimate the cost and timelines for development; and 
322.7      (6) coordinate with the county mental health plan, the 
322.8   community health services plan, and community social services 
322.9   plan. 
322.10     (e) The county board shall cooperate in planning and 
322.11  implementation with any county having a nursing facility that 
322.12  includes their county in the immediate service area within the 
322.13  funding allocated for these purposes. 
322.14     (f) The commissioner of health, in cooperation with the 
322.15  commissioner of human services and county boards, shall jointly 
322.16  report to the legislature by January 15 of each year regarding 
322.17  the development of community-based services, transition or 
322.18  closure of nursing facilities, and consumer outcomes achieved. 
322.19     Subd. 3.  [APPLICATIONS FOR PLANNED CLOSURE OF NURSING 
322.20  FACILITIES.] (a) By July 15, 2001, the commissioner of human 
322.21  services shall implement and announce a program for closure or 
322.22  partial closure of nursing facilities.  The announcement must 
322.23  specify: 
322.24     (1) the criteria in subdivision 4 that will be used by the 
322.25  commissioner to approve or reject applications; 
322.26     (2) the information that must accompany an application; and 
322.27     (3) that applications may combine planned closure rate 
322.28  adjustments with moratorium exception funding, in which case a 
322.29  single application may serve both purposes. 
322.30  Between August 1, 2001, and June 30, 2003, the commissioner may 
322.31  approve planned closures of up to 5,140 nursing facility beds, 
322.32  less the number of licensed beds in facilities that close during 
322.33  the same time period without approved closure plans or that have 
322.34  notified the commissioner of health of their intent to close 
322.35  without an approved closure plan. 
322.36     (b) A facility or facilities reimbursed under section 
323.1   256B.431 or 256B.434 with a closure plan approved by the 
323.2   commissioner under subdivision 6 may assign a planned closure 
323.3   rate adjustment to another facility or facilities that are not 
323.4   closing or in the case of a partial closure, to itself.  A 
323.5   facility may also elect to have a planned closure rate 
323.6   adjustment shared equally by the five nursing facilities with 
323.7   the lowest total operating payment rates in the state 
323.8   development region designated under section 462.385, in which 
323.9   the facility that is closing is located.  The planned closure 
323.10  rate adjustment must be calculated under subdivision 7.  
323.11  Facilities that close without a closure plan, or whose closure 
323.12  plan is not approved by the commissioner, are not eligible to 
323.13  assign a planned closure rate adjustment under subdivision 7.  
323.14  The commissioner shall calculate the amount the facility would 
323.15  have been eligible to assign under subdivision 7, and shall use 
323.16  this amount to provide equal rate adjustments to the five 
323.17  nursing facilities with the lowest total operating payment rates 
323.18  in the state development region designated under section 
323.19  462.385, in which the facility that closed is located. 
323.20     (c) To be considered for approval, an application must 
323.21  include: 
323.22     (1) a description of the proposed closure plan, which must 
323.23  include identification of the facility or facilities to receive 
323.24  a planned closure rate adjustment and the amount and timing of a 
323.25  planned closure rate adjustment proposed for each facility; 
323.26     (2) the proposed timetable for any proposed closure, 
323.27  including the proposed dates for announcement to residents, 
323.28  commencement of closure, and completion of closure; 
323.29     (3) the proposed relocation plan for current residents of 
323.30  any facility designated for closure.  The proposed relocation 
323.31  plan must be designed to comply with all applicable state and 
323.32  federal statutes and regulations, including, but not limited to, 
323.33  section 144A.161; 
323.34     (4) a description of the relationship between the nursing 
323.35  facility that is proposed for closure and the nursing facility 
323.36  or facilities proposed to receive the planned closure rate 
324.1   adjustment.  If these facilities are not under common ownership, 
324.2   copies of any contracts, purchase agreements, or other documents 
324.3   establishing a relationship or proposed relationship must be 
324.4   provided; 
324.5      (5) documentation, in a format approved by the 
324.6   commissioner, that all the nursing facilities receiving a 
324.7   planned closure rate adjustment under the plan have accepted 
324.8   joint and several liability for recovery of overpayments under 
324.9   section 256B.0641, subdivision 2, for the facilities designated 
324.10  for closure under the plan; and 
324.11     (6) comments by the affected regional planning and 
324.12  development groups on the facility proposal. 
324.13     (d) The application must address the criteria listed in 
324.14  subdivision 4. 
324.15     Subd. 4.  [CRITERIA FOR REVIEW OF APPLICATION.] In 
324.16  reviewing and approving closure proposals, the commissioner 
324.17  shall consider, but not be limited to, the following criteria: 
324.18     (1) improved quality of care and quality of life for 
324.19  consumers; 
324.20     (2) closure of a nursing facility that has a poor physical 
324.21  plant; 
324.22     (3) the existence of excess nursing facility beds, measured 
324.23  in terms of beds per thousand persons aged 85 or older.  The 
324.24  excess must be measured in reference to: 
324.25     (i) the county in which the facility is located; 
324.26     (ii) the county and all contiguous counties; 
324.27     (iii) the region in which the facility is located; or 
324.28     (iv) the facility's service area; 
324.29  the facility shall indicate in its application the service area 
324.30  it believes is appropriate for this measurement.  A facility in 
324.31  a county that is in the lowest quartile of counties with 
324.32  reference to beds per thousand persons aged 85 or older is not 
324.33  in an area of excess capacity; 
324.34     (4) low-occupancy rates, provided that the unoccupied beds 
324.35  are not the result of a personnel shortage.  In analyzing 
324.36  occupancy rates, the commissioner shall examine waiting lists in 
325.1   the applicant facility and at facilities in the surrounding 
325.2   area, as determined under clause (3); 
325.3      (5) evidence of coordination between the community planning 
325.4   process and the facility application; 
325.5      (6) proposed usage of funds available from a planned 
325.6   closure rate adjustment for care-related purposes; 
325.7      (7) innovative use planned for the closed facility's 
325.8   physical plant; 
325.9      (8) evidence that the proposal serves the interests of the 
325.10  state; and 
325.11     (9) evidence of other factors that affect the viability of 
325.12  the facility, including excessive nursing pool costs. 
325.13     Subd. 5.  [CERTIFICATION.] Upon receipt of an application 
325.14  for planned closure, the commissioner of human services shall 
325.15  provide a copy of the application to the commissioner of 
325.16  health.  The commissioner of health shall certify to the 
325.17  commissioner of human services within 14 days whether the 
325.18  application, if implemented, will satisfy the requirements of 
325.19  section 144A.161.  The commissioner of human services shall 
325.20  reject all applications for which the commissioner of health 
325.21  fails to make the certification required under this subdivision 
325.22  within 14 days. 
325.23     Subd. 6.  [REVIEW AND APPROVAL OF APPLICATIONS.] (a) The 
325.24  commissioner of human services, in consultation with the 
325.25  commissioner of health, shall approve or disapprove an 
325.26  application within 30 days after receiving it. 
325.27     (b) The commissioner shall not approve an application that 
325.28  results in a closure, curtailment, reduction, or change of 
325.29  operations combined with the establishment of new long-term care 
325.30  facilities or services offered in the existing facilities or in 
325.31  new facilities provided by the same corporation, agency, or 
325.32  individual, unless: 
325.33     (1) the employees at the time of the closure, curtailment, 
325.34  reduction, or change of operations are given by seniority the 
325.35  first priority for hiring into positions for which they are 
325.36  qualified in the new facility or service; and 
326.1      (2) the exclusive bargaining representative at the time of 
326.2   the closure, curtailment, reduction, or change of operations is 
326.3   recognized as the exclusive bargaining representative for the 
326.4   new long-term care facilities or services. 
326.5      (c) Approval of a planned closure expires 18 months after 
326.6   approval by the commissioner of human services, unless 
326.7   commencement of closure has begun. 
326.8      (d) The commissioner of human services may change any 
326.9   provision of the application to which the applicant, the 
326.10  regional planning group, and the commissioner agree. 
326.11     Subd. 7.  [PLANNED CLOSURE RATE ADJUSTMENT.] (a) The 
326.12  commissioner of human services shall calculate the amount of the 
326.13  planned closure rate adjustment available under subdivision 3, 
326.14  paragraph (b), for up to 5,140 beds according to clauses (1) to 
326.15  (4): 
326.16     (1) the amount available is the net reduction of nursing 
326.17  facility beds multiplied by $2,080; 
326.18     (2) the total number of beds in the nursing facility or 
326.19  facilities receiving the planned closure rate adjustment must be 
326.20  identified; 
326.21     (3) capacity days are determined by multiplying the number 
326.22  determined under clause (2) by 365; and 
326.23     (4) the planned closure rate adjustment is the amount 
326.24  available in clause (1), divided by capacity days determined 
326.25  under clause (3). 
326.26     (b) A planned closure rate adjustment under this section is 
326.27  effective on the first day of the month following completion of 
326.28  closure of the facility designated for closure in the 
326.29  application and becomes part of the nursing facility's total 
326.30  operating payment rate. 
326.31     (c) Applicants may use the planned closure rate adjustment 
326.32  to allow for a property payment for a new nursing facility or an 
326.33  addition to an existing nursing facility.  Applications approved 
326.34  under this subdivision are exempt from other requirements for 
326.35  moratorium exceptions under section 144A.073, subdivisions 2 and 
326.36  3. 
327.1      (d) Upon the request of a closing facility, the 
327.2   commissioner must allow the facility a closure rate adjustment 
327.3   equal to a 50 percent payment rate increase to reimburse 
327.4   relocation costs or other costs related to facility closure.  
327.5   This rate increase is effective on the date the facility's 
327.6   occupancy decreases to 90 percent of capacity days after the 
327.7   written notice of closure is distributed under section 144A.161, 
327.8   subdivision 5, and shall remain in effect for a period of up to 
327.9   60 days.  The commissioner shall delay the implementation of the 
327.10  planned closure rate adjustments to offset the cost of this rate 
327.11  adjustment. 
327.12     Subd. 8.  [OTHER RATE ADJUSTMENTS.] Facilities subject to 
327.13  this section remain eligible for any applicable rate adjustments 
327.14  provided under section 256B.431, 256B.434, or any other section. 
327.15     Subd. 9.  [COUNTY COSTS.] The commissioner of human 
327.16  services may allocate up to $400 total state and federal funds 
327.17  per nursing facility bed that is closing, within the limits of 
327.18  the appropriation specified for this purpose, to be used for 
327.19  relocation costs incurred by counties for planned closures under 
327.20  this section or resident relocation under section 144A.161.  To 
327.21  be eligible for this allocation, a county in which a nursing 
327.22  facility closes must provide to the commissioner a detailed 
327.23  statement in a form provided by the commissioner of additional 
327.24  costs, not to exceed $400 per bed closed, that are directly 
327.25  incurred related to the county's required role in the relocation 
327.26  process.  
327.27     [EFFECTIVE DATE.] This section is effective the day 
327.28  following final enactment. 
327.29     Sec. 17.  [256B.438] [IMPLEMENTATION OF A CASE MIX SYSTEM 
327.30  FOR NURSING FACILITIES BASED ON THE MINIMUM DATA SET.] 
327.31     Subdivision 1.  [SCOPE.] This section establishes the 
327.32  method and criteria used to determine resident reimbursement 
327.33  classifications based upon the assessments of residents of 
327.34  nursing homes and boarding care homes whose payment rates are 
327.35  established under section 256B.431, 256B.434, or 256B.435.  
327.36  Resident reimbursement classifications shall be established 
328.1   according to the 34 group, resource utilization groups, version 
328.2   III or RUG-III model as described in section 144.0724.  
328.3   Reimbursement classifications established under this section 
328.4   shall be implemented after June 30, 2002, but no later than 
328.5   January 1, 2003. 
328.6      Subd. 2.  [DEFINITIONS.] For purposes of this section, the 
328.7   following terms have the meanings given. 
328.8      (a) [ASSESSMENT REFERENCE DATE.] "Assessment reference 
328.9   date" has the meaning given in section 144.0724, subdivision 2, 
328.10  paragraph (a). 
328.11     (b) [CASE MIX INDEX.] "Case mix index" has the meaning 
328.12  given in section 144.0724, subdivision 2, paragraph (b). 
328.13     (c) [INDEX MAXIMIZATION.] "Index maximization" has the 
328.14  meaning given in section 144.0724, subdivision 2, paragraph (c). 
328.15     (d) [MINIMUM DATA SET.] "Minimum data set" has the meaning 
328.16  given in section 144.0724, subdivision 2, paragraph (d). 
328.17     (e) [REPRESENTATIVE.] "Representative" has the meaning 
328.18  given in section 144.0724, subdivision 2, paragraph (e). 
328.19     (f) [RESOURCE UTILIZATION GROUPS OR RUG.] "Resource 
328.20  utilization groups" or "RUG" has the meaning given in section 
328.21  144.0724, subdivision 2, paragraph (f). 
328.22     Subd. 3.  [CASE MIX INDICES.] (a) The commissioner of human 
328.23  services shall assign a case mix index to each resident class 
328.24  based on the Health Care Financing Administration's staff time 
328.25  measurement study and adjusted for Minnesota-specific wage 
328.26  indices.  The case mix indices assigned to each resident class 
328.27  shall be published in the Minnesota State Register at least 120 
328.28  days prior to the implementation of the 34 group, RUG-III 
328.29  resident classification system. 
328.30     (b) An index maximization approach shall be used to 
328.31  classify residents. 
328.32     (c) After implementation of the revised case mix system, 
328.33  the commissioner of human services may annually rebase case mix 
328.34  indices and base rates using more current data on average wage 
328.35  rates and staff time measurement studies.  This rebasing shall 
328.36  be calculated under subdivision 7, paragraph (b).  The 
329.1   commissioner shall publish in the Minnesota State Register 
329.2   adjusted case mix indices at least 45 days prior to the 
329.3   effective date of the adjusted case mix indices. 
329.4      Subd. 4.  [RESIDENT ASSESSMENT SCHEDULE.] (a) Nursing 
329.5   facilities shall conduct and submit case mix assessments 
329.6   according to the schedule established by the commissioner of 
329.7   health under section 144.0724, subdivisions 4 and 5. 
329.8      (b) The resident reimbursement classifications established 
329.9   under section 144.0724, subdivision 3, shall be effective the 
329.10  day of admission for new admission assessments.  The effective 
329.11  date for significant change assessments shall be the assessment 
329.12  reference date.  The effective date for annual and second 
329.13  quarterly assessments shall be the first day of the month 
329.14  following assessment reference date. 
329.15     Subd. 5.  [NOTICE OF RESIDENT REIMBURSEMENT 
329.16  CLASSIFICATION.] Nursing facilities shall provide notice to a 
329.17  resident of the resident's case mix classification according to 
329.18  procedures established by the commissioner of health under 
329.19  section 144.0724, subdivision 7. 
329.20     Subd. 6.  [RECONSIDERATION OF RESIDENT CLASSIFICATION.] Any 
329.21  request for reconsideration of a resident classification must be 
329.22  made under section 144.0724, subdivision 8. 
329.23     Subd. 7.  [RATE DETERMINATION UPON TRANSITION TO RUG-III 
329.24  PAYMENT RATES.] (a) The commissioner of human services shall 
329.25  determine payment rates at the time of transition to the RUG 
329.26  based payment model in a facility-specific, budget-neutral 
329.27  manner.  The case mix indices as defined in subdivision 3 shall 
329.28  be used to allocate the case mix adjusted component of total 
329.29  payment across all case mix groups.  To transition from the 
329.30  current calculation methodology to the RUG based methodology, 
329.31  the commissioner of health shall report to the commissioner of 
329.32  human services the resident days classified according to the 
329.33  categories defined in subdivision 3 for the 12-month reporting 
329.34  period ending September 30, 2001, for each nursing facility.  
329.35  The commissioner of human services shall use this data to 
329.36  compute the standardized days for the reporting period under the 
330.1   RUG system. 
330.2      (b) The commissioner of human services shall determine the 
330.3   case mix adjusted component of the rate as follows: 
330.4      (1) determine the case mix portion of the 11 case mix rates 
330.5   in effect on June 30, 2002, or the 34 case mix rates in effect 
330.6   on or after June 30, 2003; 
330.7      (2) multiply each amount in clause (1) by the number of 
330.8   resident days assigned to each group for the reporting period 
330.9   ending September 30, 2001, or the most recent year for which 
330.10  data is available; 
330.11     (3) compute the sum of the amounts in clause (2); 
330.12     (4) determine the total RUG standardized days for the 
330.13  reporting period ending September 30, 2001, or the most recent 
330.14  year for which data is available using the new indices 
330.15  calculated under subdivision 3, paragraph (c); 
330.16     (5) divide the amount in clause (3) by the amount in clause 
330.17  (4) which shall be the average case mix adjusted component of 
330.18  the rate under the RUG method; and 
330.19     (6) multiply this average rate by the case mix weight in 
330.20  subdivision 3 for each RUG group. 
330.21     (c) The noncase mix component will be allocated to each RUG 
330.22  group as a constant amount to determine the transition payment 
330.23  rate.  Any other rate adjustments that are effective on or after 
330.24  July 1, 2002, shall be applied to the transition rates 
330.25  determined under this section. 
330.26     Sec. 18.  [256B.439] [LONG-TERM CARE QUALITY PROFILES.] 
330.27     Subdivision 1.  [DEVELOPMENT AND IMPLEMENTATION OF QUALITY 
330.28  PROFILES.] (a) The commissioner of human services shall develop 
330.29  and implement a quality profile system for nursing facilities 
330.30  and, beginning not later than July 1, 2003, other providers of 
330.31  long-term care services.  The system must be developed and 
330.32  implemented to the extent possible without the collection of 
330.33  significant amounts of new data.  The system must not duplicate 
330.34  the requirements of section 256B.5011, 256B.5012, or 256B.5013. 
330.35  The system must be designed to provide information on quality: 
330.36     (1) to consumers and their families to facilitate informed 
331.1   choices of service providers; 
331.2      (2) to providers to enable them to measure the results of 
331.3   their quality improvement efforts and compare quality 
331.4   achievements with other service providers; and 
331.5      (3) to public and private purchasers of long-term care 
331.6   services to enable them to purchase high-quality care. 
331.7      (b) The system must be developed in consultation with the 
331.8   long-term care task force and representatives of consumers, 
331.9   providers, and labor unions.  Within the limits of available 
331.10  appropriations, the commissioner may employ consultants to 
331.11  assist with this project. 
331.12     Subd. 2.  [QUALITY MEASUREMENT TOOLS.] The commissioner of 
331.13  human services shall identify and apply existing quality 
331.14  measurement tools to: 
331.15     (1) emphasize quality of care and its relationship to 
331.16  quality of life; and 
331.17     (2) address the needs of various users of long-term care 
331.18  services, including, but not limited to, short-stay residents, 
331.19  persons with behavioral problems, persons with dementia, and 
331.20  persons who are members of minority groups. 
331.21  The tools must be identified and applied, to the extent 
331.22  possible, without requiring providers to supply information 
331.23  beyond current state and federal requirements. 
331.24     Subd. 3.  [CONSUMER SURVEYS.] Following identification of 
331.25  the quality measurement tool, the commissioner of human services 
331.26  shall conduct surveys of long-term care service consumers to 
331.27  develop quality profiles of providers.  To the extent possible, 
331.28  surveys must be conducted face-to-face by state employees or 
331.29  contractors.  At the discretion of the commissioner, surveys may 
331.30  be conducted by telephone or by provider staff.  Surveys must be 
331.31  conducted periodically to update quality profiles of individual 
331.32  service providers. 
331.33     Subd. 4.  [DISSEMINATION OF QUALITY PROFILES.] By July 1, 
331.34  2002, the commissioner of human services shall implement a 
331.35  system to disseminate the quality profiles developed from 
331.36  consumer surveys using the quality measurement tools.  Profiles 
332.1   must be disseminated to consumers, providers, and purchasers of 
332.2   long-term care services through all feasible printed and 
332.3   electronic outlets.  The commissioner shall conduct a public 
332.4   awareness campaign to inform potential users regarding profile 
332.5   contents and potential uses. 
332.6      Sec. 19.  Minnesota Statutes 2000, section 256B.5012, 
332.7   subdivision 3, is amended to read: 
332.8      Subd. 3.  [PROPERTY PAYMENT RATE.] (a) The property payment 
332.9   rate effective October 1, 2000, is based on the facility's 
332.10  modified property payment rate in effect on September 30, 2000.  
332.11  The modified property payment rate is the actual property 
332.12  payment rate exclusive of the effect of gains or losses on 
332.13  disposal of capital assets or adjustments for excess 
332.14  depreciation claims.  Effective October 1, 2000, a facility 
332.15  minimum property rate of $8.13 shall be applied to all existing 
332.16  ICF/MR facilities.  Facilities with a modified property payment 
332.17  rate effective September 30, 2000, which is below the minimum 
332.18  property rate shall receive an increase effective October 1, 
332.19  2000, equal to the difference between the minimum property 
332.20  payment rate and the modified property payment rate in effect as 
332.21  of September 30, 2000.  Facilities with a modified property 
332.22  payment rate at or above the minimum property payment rate 
332.23  effective September 30, 2000, shall receive the modified 
332.24  property payment rate effective October 1, 2000. 
332.25     (b) Within the limits of appropriations specifically for 
332.26  this purpose, Facility property payment rates shall be increased 
332.27  annually for inflation, effective January 1, 2002.  The increase 
332.28  shall be based on each facility's property payment rate in 
332.29  effect on September 30, 2000.  Modified property payment rates 
332.30  effective September 30, 2000, shall be arrayed from highest to 
332.31  lowest before applying the minimum property payment rate in 
332.32  paragraph (a).  For modified property payment rates at the 90th 
332.33  percentile or above, the annual inflation increase shall be 
332.34  zero.  For modified property payment rates below the 90th 
332.35  percentile but equal to or above the 75th percentile, the annual 
332.36  inflation increase shall be one percent.  For modified property 
333.1   payment rates below the 75th percentile, the annual inflation 
333.2   increase shall be two percent. 
333.3      Sec. 20.  Minnesota Statutes 2000, section 256B.5012, is 
333.4   amended by adding a subdivision to read: 
333.5      Subd. 4.  [ICF/MR RATE INCREASES BEGINNING JULY 1, 2001, 
333.6   AND JULY 1, 2002.] (a) For the rate years beginning July 1, 
333.7   2001, and July 1, 2002, the commissioner shall make available to 
333.8   each facility reimbursed under this section an adjustment to the 
333.9   total operating payment rate of 3.5 percent.  Of this 
333.10  adjustment, 3.0 percentage points must be used to provide an 
333.11  employee wage increase as provided under paragraph (b) and 0.5 
333.12  percentage points must be used for operating costs. 
333.13     (b) The adjustment under this paragraph must be used to 
333.14  increase the wages of all employees except administrative and 
333.15  central office employees and to pay associated costs for FICA, 
333.16  the Medicare tax, workers' compensation premiums, and federal 
333.17  and state unemployment insurance, provided that this increase 
333.18  must be used only for wage increases implemented on or after the 
333.19  first day of the rate year and must not be used for wage 
333.20  increases implemented prior to that date. 
333.21     (c) For each facility, the commissioner shall make 
333.22  available an adjustment using the percentage specified in 
333.23  paragraph (a) multiplied by the total payment rate, excluding 
333.24  the property-related payment rate, in effect on the preceding 
333.25  June 30.  The total payment rate shall include the adjustment 
333.26  provided in section 256B.501, subdivision 12. 
333.27     (d) A facility whose payment rates are governed by closure 
333.28  agreements, receivership agreements, or Minnesota Rules, part 
333.29  9553.0075, is not eligible for an adjustment otherwise granted 
333.30  under this subdivision.  
333.31     (e) A facility may apply for the wage-related payment rate 
333.32  adjustment provided under paragraph (b).  The application must 
333.33  be made to the commissioner and contain a plan by which the 
333.34  facility will distribute the wage-related portion of the payment 
333.35  rate adjustment to employees of the facility.  For facilities in 
333.36  which the employees are represented by an exclusive bargaining 
334.1   representative, an agreement negotiated and agreed to by the 
334.2   employer and the exclusive bargaining representative constitutes 
334.3   the plan.  A negotiated agreement may constitute the plan only 
334.4   if the agreement is finalized after the date of enactment of all 
334.5   rate increases for the rate year.  The commissioner shall review 
334.6   the plan to ensure that the payment rate adjustment per diem is 
334.7   used as provided in this subdivision.  To be eligible, a 
334.8   facility must submit its plan by March 31, 2002, and March 31, 
334.9   2003, respectively.  If a facility's plan is effective for its 
334.10  employees after the first day of the applicable rate year that 
334.11  the funds are available, the payment rate adjustment per diem is 
334.12  effective the same date as its plan. 
334.13     (f) A copy of the approved distribution plan must be made 
334.14  available to all employees by giving each employee a copy or by 
334.15  posting it in an area of the facility to which all employees 
334.16  have access.  If an employee does not receive the wage 
334.17  adjustment described in the facility's approved plan and is 
334.18  unable to resolve the problem with the facility's management or 
334.19  through the employee's union representative, the employee may 
334.20  contact the commissioner at an address or telephone number 
334.21  provided by the commissioner and included in the approved plan. 
334.22     Sec. 21.  Minnesota Statutes 2000, section 626.557, 
334.23  subdivision 12b, is amended to read: 
334.24     Subd. 12b.  [DATA MANAGEMENT.] (a)  [COUNTY DATA.] In 
334.25  performing any of the duties of this section as a lead agency, 
334.26  the county social service agency shall maintain appropriate 
334.27  records.  Data collected by the county social service agency 
334.28  under this section are welfare data under section 13.46.  
334.29  Notwithstanding section 13.46, subdivision 1, paragraph (a), 
334.30  data under this paragraph that are inactive investigative data 
334.31  on an individual who is a vendor of services are private data on 
334.32  individuals, as defined in section 13.02.  The identity of the 
334.33  reporter may only be disclosed as provided in paragraph (c). 
334.34     Data maintained by the common entry point are confidential 
334.35  data on individuals or protected nonpublic data as defined in 
334.36  section 13.02.  Notwithstanding section 138.163, the common 
335.1   entry point shall destroy data three calendar years after date 
335.2   of receipt. 
335.3      (b)  [LEAD AGENCY DATA.] The commissioners of health and 
335.4   human services shall prepare an investigation memorandum for 
335.5   each report alleging maltreatment investigated under this 
335.6   section.  During an investigation by the commissioner of health 
335.7   or the commissioner of human services, data collected under this 
335.8   section are confidential data on individuals or protected 
335.9   nonpublic data as defined in section 13.02.  Upon completion of 
335.10  the investigation, the data are classified as provided in 
335.11  clauses (1) to (3) and paragraph (c). 
335.12     (1) The investigation memorandum must contain the following 
335.13  data, which are public: 
335.14     (i) the name of the facility investigated; 
335.15     (ii) a statement of the nature of the alleged maltreatment; 
335.16     (iii) pertinent information obtained from medical or other 
335.17  records reviewed; 
335.18     (iv) the identity of the investigator; 
335.19     (v) a summary of the investigation's findings; 
335.20     (vi) statement of whether the report was found to be 
335.21  substantiated, inconclusive, false, or that no determination 
335.22  will be made; 
335.23     (vii) a statement of any action taken by the facility; 
335.24     (viii) a statement of any action taken by the lead agency; 
335.25  and 
335.26     (ix) when a lead agency's determination has substantiated 
335.27  maltreatment, a statement of whether an individual, individuals, 
335.28  or a facility were responsible for the substantiated 
335.29  maltreatment, if known. 
335.30     The investigation memorandum must be written in a manner 
335.31  which protects the identity of the reporter and of the 
335.32  vulnerable adult and may not contain the names or, to the extent 
335.33  possible, data on individuals or private data listed in clause 
335.34  (2). 
335.35     (2) Data on individuals collected and maintained in the 
335.36  investigation memorandum are private data, including: 
336.1      (i) the name of the vulnerable adult; 
336.2      (ii) the identity of the individual alleged to be the 
336.3   perpetrator; 
336.4      (iii) the identity of the individual substantiated as the 
336.5   perpetrator; and 
336.6      (iv) the identity of all individuals interviewed as part of 
336.7   the investigation. 
336.8      (3) Other data on individuals maintained as part of an 
336.9   investigation under this section are private data on individuals 
336.10  upon completion of the investigation. 
336.11     (c)  [IDENTITY OF REPORTER.] The subject of the report may 
336.12  compel disclosure of the name of the reporter only with the 
336.13  consent of the reporter or upon a written finding by a court 
336.14  that the report was false and there is evidence that the report 
336.15  was made in bad faith.  This subdivision does not alter 
336.16  disclosure responsibilities or obligations under the rules of 
336.17  criminal procedure, except that where the identity of the 
336.18  reporter is relevant to a criminal prosecution, the district 
336.19  court shall do an in-camera review prior to determining whether 
336.20  to order disclosure of the identity of the reporter. 
336.21     (d)  [DESTRUCTION OF DATA.] Notwithstanding section 
336.22  138.163, data maintained under this section by the commissioners 
336.23  of health and human services must be destroyed under the 
336.24  following schedule: 
336.25     (1) data from reports determined to be false, two years 
336.26  after the finding was made; 
336.27     (2) data from reports determined to be inconclusive, four 
336.28  years after the finding was made; 
336.29     (3) data from reports determined to be substantiated, seven 
336.30  years after the finding was made; and 
336.31     (4) data from reports which were not investigated by a lead 
336.32  agency and for which there is no final disposition, two years 
336.33  from the date of the report. 
336.34     (e)  [SUMMARY OF REPORTS.] The commissioners of health and 
336.35  human services shall each annually prepare a summary of report 
336.36  to the legislature and the governor on the number and type of 
337.1   reports of alleged maltreatment involving licensed facilities 
337.2   reported under this section, the number of those requiring 
337.3   investigation under this section, and the resolution of those 
337.4   investigations.  The report shall identify: 
337.5      (1) whether and where backlogs of cases result in a failure 
337.6   to conform with statutory time frames; 
337.7      (2) where adequate coverage requires additional 
337.8   appropriations and staffing; and 
337.9      (3) any other trends that affect the safety of vulnerable 
337.10  adults. 
337.11     (f)  [RECORD RETENTION POLICY.] Each lead agency must have 
337.12  a record retention policy. 
337.13     (g)  [EXCHANGE OF INFORMATION.] Lead agencies, prosecuting 
337.14  authorities, and law enforcement agencies may exchange not 
337.15  public data, as defined in section 13.02, if the agency or 
337.16  authority requesting the data determines that the data are 
337.17  pertinent and necessary to the requesting agency in initiating, 
337.18  furthering, or completing an investigation under this section.  
337.19  Data collected under this section must be made available to 
337.20  prosecuting authorities and law enforcement officials, local 
337.21  county agencies, and licensing agencies investigating the 
337.22  alleged maltreatment under this section.  The lead agency shall 
337.23  exchange not public data with the vulnerable adult maltreatment 
337.24  review panel established in section 256.021 if the data are 
337.25  pertinent and necessary for a review requested under that 
337.26  section.  Upon completion of the review, not public data 
337.27  received by the review panel must be returned to the lead agency.
337.28     (h)  [COMPLETION TIME.] Each lead agency shall keep records 
337.29  of the length of time it takes to complete its investigations. 
337.30     (i)  [NOTIFICATION OF OTHER AFFECTED PARTIES.] A lead 
337.31  agency may notify other affected parties and their authorized 
337.32  representative if the agency has reason to believe maltreatment 
337.33  has occurred and determines the information will safeguard the 
337.34  well-being of the affected parties or dispel widespread rumor or 
337.35  unrest in the affected facility. 
337.36     (j)  [FEDERAL REQUIREMENTS.] Under any notification 
338.1   provision of this section, where federal law specifically 
338.2   prohibits the disclosure of patient identifying information, a 
338.3   lead agency may not provide any notice unless the vulnerable 
338.4   adult has consented to disclosure in a manner which conforms to 
338.5   federal requirements. 
338.6      Sec. 22.  Laws 1999, chapter 245, article 3, section 45, as 
338.7   amended by Laws 2000, chapter 312, section 3, is amended to read:
338.8      Sec. 45.  [STATE LICENSURE CONFLICTS WITH FEDERAL 
338.9   REGULATIONS.] 
338.10     (a) Notwithstanding the provisions of Minnesota Rules, part 
338.11  4658.0520, an incontinent resident must be checked according to 
338.12  a specific time interval written in the resident's care plan.  
338.13  The resident's attending physician must authorize in writing any 
338.14  interval longer than two hours unless the resident, if 
338.15  competent, or a family member or legally appointed conservator, 
338.16  guardian, or health care agent of a resident who is not 
338.17  competent, agrees in writing to waive physician involvement in 
338.18  determining this interval. 
338.19     (b) This section expires July 1, 2001 2003. 
338.20     Sec. 23.  Laws 2000, chapter 364, section 2, is amended to 
338.21  read: 
338.22     Sec. 2.  [MORATORIUM EXCEPTION PROCESS.] 
338.23     For fiscal year the biennium beginning July 1, 2000 2001, 
338.24  when approving nursing home moratorium exception projects under 
338.25  Minnesota Statutes, section 144A.073, the commissioner of health 
338.26  shall give priority to proposals a proposal to build a 
338.27  replacement facilities facility in the city of Anoka or within 
338.28  ten miles of the city of Anoka. 
338.29     Sec. 24.  [DEVELOPMENT OF NEW NURSING FACILITY 
338.30  REIMBURSEMENT SYSTEM.] 
338.31     (a) The commissioner of human services shall develop and 
338.32  report to the legislature by January 15, 2003, a system to 
338.33  replace the current nursing facility reimbursement system 
338.34  established under Minnesota Statutes, sections 256B.431, 
338.35  256B.434, and 256B.435. 
338.36     (b) The system must be developed in consultation with the 
339.1   long-term care task force and with representatives of consumers, 
339.2   providers, and labor unions.  Within the limits of available 
339.3   appropriations, the commissioner may employ consultants to 
339.4   assist with this project. 
339.5      (c) The new reimbursement system must: 
339.6      (1) provide incentives to enhance quality of life and 
339.7   quality of care; 
339.8      (2) recognize cost differences in the care of different 
339.9   types of populations, including subacute care and dementia care; 
339.10     (3) establish rates that are sufficient without being 
339.11  excessive; 
339.12     (4) be affordable for the state and for private-pay 
339.13  residents; 
339.14     (5) be sensitive to changing conditions in the long-term 
339.15  care environment; 
339.16     (6) avoid creating access problems related to insufficient 
339.17  funding; 
339.18     (7) allow providers maximum flexibility in their business 
339.19  operations; and 
339.20     (8) recognize the need for capital investment to improve 
339.21  physical plants. 
339.22     (d) Notwithstanding Minnesota Statutes, section 256B.435, 
339.23  the commissioner must not implement a performance-based 
339.24  contracting system for nursing facilities prior to July 1, 2003. 
339.25  The commissioner shall continue to reimburse nursing facilities 
339.26  under Minnesota Statutes, section 256B.431 or 256B.434, until 
339.27  otherwise directed by law. 
339.28     Sec. 25.  [MINIMUM STAFFING STANDARDS REPORT.] 
339.29     By January 15, 2002, the commissioner of health and the 
339.30  commissioner of human services shall report to the legislature 
339.31  on whether they should translate the minimum nurse staffing 
339.32  requirement in Minnesota Statutes, section 144A.04, subdivision 
339.33  7, paragraph (a), upon the transition to the RUG-III 
339.34  classification system, or whether they should establish 
339.35  different time-based standards, and how to accomplish either. 
339.36     Sec. 26.  [TIME MOTION STUDY.] 
340.1      (a) The commissioner of human services shall conduct a time 
340.2   motion study to determine the amount of time devoted to the care 
340.3   of high-need nursing facility residents, including, but not 
340.4   limited to, persons with Alzheimer's disease and other 
340.5   dementias, persons with multiple sclerosis, and persons with 
340.6   mental illness. 
340.7      (b) The commissioner shall report the results of the study 
340.8   to the legislature by January 15, 2003, with an analysis of 
340.9   whether these costs are adequately reimbursed under the current 
340.10  reimbursement system and with recommendations for adjusting 
340.11  nursing facility reimbursement rates as necessary to account for 
340.12  these costs. 
340.13     Sec. 27.  [PROVIDER RATE INCREASES.] 
340.14     (a) The commissioner of human services shall increase 
340.15  reimbursement rates by 3.5 percent each year of the biennium for 
340.16  the providers listed in paragraph (b).  The increases are 
340.17  effective for services rendered on or after July 1 of each year. 
340.18     (b) The rate increases described in this section must be 
340.19  provided to home and community-based waivered services for: 
340.20     (1) persons with mental retardation or related conditions 
340.21  under Minnesota Statutes, section 256B.501; 
340.22     (2) home and community-based waivered services for the 
340.23  elderly under Minnesota Statutes, section 256B.0915; 
340.24     (3) waivered services under community alternatives for 
340.25  disabled individuals under Minnesota Statutes, section 256B.49; 
340.26     (4) community alternative care waivered services under 
340.27  Minnesota Statutes, section 256B.49; 
340.28     (5) traumatic brain injury waivered services under 
340.29  Minnesota Statutes, section 256B.49; 
340.30     (6) nursing services and home health services under 
340.31  Minnesota Statutes, section 256B.0625, subdivision 6a; 
340.32     (7) personal care services and nursing supervision of 
340.33  personal care services under Minnesota Statutes, section 
340.34  256B.0625, subdivision 19a; 
340.35     (8) private duty nursing services under Minnesota Statutes, 
340.36  section 256B.0625, subdivision 7; 
341.1      (9) day training and habilitation services for adults with 
341.2   mental retardation or related conditions under Minnesota 
341.3   Statutes, sections 252.40 to 252.46; 
341.4      (10) alternative care services under Minnesota Statutes, 
341.5   section 256B.0913; 
341.6      (11) adult residential program grants under Minnesota 
341.7   Rules, parts 9535.2000 to 9535.3000; 
341.8      (12) adult and family community support grants under 
341.9   Minnesota Rules, parts 9535.1700 to 9535.1760; 
341.10     (13) the group residential housing supplementary service 
341.11  rate under Minnesota Statutes, section 256I.05, subdivision 1a; 
341.12     (14) adult mental health integrated fund grants under 
341.13  Minnesota Statutes, section 245.4661; 
341.14     (15) semi-independent living services under Minnesota 
341.15  Statutes, section 252.275, including SILS funding under county 
341.16  social services grants formerly funded under Minnesota Statutes, 
341.17  chapter 256I; 
341.18     (16) community support services for deaf and 
341.19  hard-of-hearing adults with mental illness who use or wish to 
341.20  use sign language as their primary means of communication; and 
341.21     (17) living skills training programs for persons with 
341.22  intractable epilepsy who need assistance in the transition to 
341.23  independent living. 
341.24     (c) Providers that receive a rate increase under this 
341.25  section shall use 0.5 percentage points of the additional 
341.26  revenue for operating cost increases and 3.0 percentage points 
341.27  of the additional revenue to increase wages for all employees 
341.28  other than the administrator and central office staff and to pay 
341.29  associated costs for FICA, the Medicare tax, workers' 
341.30  compensation premiums, and federal and state unemployment 
341.31  insurance.  For public employees, the portion of this increase 
341.32  reserved to increase wages for certain staff is available and 
341.33  pay rates shall be increased only to the extent that they comply 
341.34  with laws governing public employees collective bargaining.  
341.35  Money received by a provider for pay increases under this 
341.36  section must be used only for wage increases implemented on or 
342.1   after the first day of the state fiscal year in which the 
342.2   increase is available and must not be used for wage increases 
342.3   implemented prior to that date. 
342.4      (d) A copy of the provider's plan for complying with 
342.5   paragraph (c) must be made available to all employees by giving 
342.6   each employee a copy or by posting it in an area of the 
342.7   provider's operation to which all employees have access.  If an 
342.8   employee does not receive the wage adjustment described in the 
342.9   plan and is unable to resolve the problem with the provider, the 
342.10  employee may contact the employee's union representative.  If 
342.11  the employee is not covered by a collective bargaining 
342.12  agreement, the employee may contact the commissioner at a phone 
342.13  number provided by the commissioner and included in the 
342.14  provider's plan. 
342.15     Sec. 28.  [REGULATORY FLEXIBILITY.] 
342.16     (a) By July 1, 2001, the commissioners of health and human 
342.17  services shall: 
342.18     (1) develop a summary of federal nursing facility and 
342.19  community long-term care regulations that hamper state 
342.20  flexibility and place burdens on the goal of achieving 
342.21  high-quality care and optimum outcomes for consumers of 
342.22  services; and 
342.23     (2) share this summary with the legislature, other states, 
342.24  national groups that advocate for state interests with Congress, 
342.25  and the Minnesota congressional delegation. 
342.26     (b) The commissioners shall conduct ongoing follow-up with 
342.27  the entities to which this summary is provided and with the 
342.28  health care financing administration to achieve maximum 
342.29  regulatory flexibility, including the possibility of pilot 
342.30  projects to demonstrate regulatory flexibility on less than a 
342.31  statewide basis. 
342.32     [EFFECTIVE DATE.] This section is effective the day 
342.33  following final enactment. 
342.34     Sec. 29.  [REPORT.] 
342.35     By January 15, 2003, the commissioner of health and the 
342.36  commissioner of human services shall report to the senate health 
343.1   and family security committee and the house health and human 
343.2   services policy committee on the number of closures that have 
343.3   taken place under this article, alternatives to nursing facility 
343.4   care that have been developed, any problems with access to 
343.5   long-term care services that have resulted, and any 
343.6   recommendations for continuation of the regional long-term care 
343.7   planning process and the closure process after June 30, 2003. 
343.8      Sec. 30.  [REVISOR INSTRUCTION.] 
343.9      The revisor of statutes shall delete any reference to 
343.10  Minnesota Statutes, section 144A.16, in Minnesota Statutes and 
343.11  Minnesota Rules. 
343.12     Sec. 31.  [REPEALER.] 
343.13     (a) Minnesota Statutes 2000, sections 144A.16; and 
343.14  256B.434, subdivision 5, are repealed. 
343.15     (b) Minnesota Rules, parts 4655.6810; 4655.6820; 4655.6830; 
343.16  4658.1600; 4658.1605; 4658.1610; 4658.1690; 9546.0010; 
343.17  9546.0020; 9546.0030; 9546.0040; 9546.0050; and 9546.0060, are 
343.18  repealed. 
343.19                             ARTICLE 6 
343.20                WORKFORCE RECRUITMENT AND RETENTION 
343.21     Section 1.  Minnesota Statutes 2000, section 116L.11, 
343.22  subdivision 4, is amended to read: 
343.23     Subd. 4.  [QUALIFYING CONSORTIUM.] "Qualifying consortium" 
343.24  means an entity that may include includes a public or private 
343.25  institution of higher education, work force center, county, and 
343.26  one or more eligible employers, but must include a public or 
343.27  private institution of higher education and one or more eligible 
343.28  employers employer. 
343.29     Sec. 2.  Minnesota Statutes 2000, section 116L.12, 
343.30  subdivision 4, is amended to read: 
343.31     Subd. 4.  [GRANTS.] Within the limits of available 
343.32  appropriations, the board shall make grants not to exceed 
343.33  $400,000 each to qualifying consortia to operate local, 
343.34  regional, or statewide training and retention programs.  Grants 
343.35  may be made from TANF funds, general fund appropriations, and 
343.36  any other funding sources available to the board, provided the 
344.1   requirements of those funding sources are satisfied.  Grant 
344.2   awards must establish specific, measurable outcomes and 
344.3   timelines for achieving those outcomes. 
344.4      Sec. 3.  Minnesota Statutes 2000, section 116L.12, 
344.5   subdivision 5, is amended to read: 
344.6      Subd. 5.  [LOCAL MATCH REQUIREMENTS.] A consortium must 
344.7   provide at least a 50 percent match from local resources for 
344.8   money appropriated under this section.  The local match 
344.9   requirement must be satisfied on an overall program basis but 
344.10  need not be satisfied for each particular client.  The local 
344.11  match requirement may be reduced for consortia that include a 
344.12  relatively large number of small employers whose financial 
344.13  contribution has been reduced in accordance with section 116L.15.
344.14  In-kind services and expenditures under section 116L.13, 
344.15  subdivision 2, may be used to meet this local match 
344.16  requirement.  The grant application must specify the financial 
344.17  contribution from each member of the consortium satisfy the 
344.18  match requirements established in section 116L.02, paragraph (a).
344.19     Sec. 4.  Minnesota Statutes 2000, section 116L.13, 
344.20  subdivision 1, is amended to read: 
344.21     Subdivision 1.  [MARKETING AND RECRUITMENT.] A qualifying 
344.22  consortium must implement a marketing and outreach strategy to 
344.23  recruit into the health care and human services fields persons 
344.24  from one or more of the potential employee target groups.  
344.25  Recruitment strategies must include: 
344.26     (1) a screening process to evaluate whether potential 
344.27  employees may be disqualified as the result of a required 
344.28  background check or are otherwise unlikely to succeed in the 
344.29  position for which they are being recruited; and 
344.30     (2) a process for modifying course work to meet the 
344.31  training needs of non-English-speaking persons, when appropriate.
344.32     Sec. 5.  [116L.146] [EXPEDITED GRANT PROCESS.] 
344.33     (a) The board may authorize grants not to exceed $50,000 
344.34  each through an expedited grant approval process to: 
344.35     (1) eligible employers to provide training programs for up 
344.36  to 50 workers; or 
345.1      (2) a public or private institution of higher education to: 
345.2      (i) do predevelopment or curriculum development for 
345.3   training programs prior to submission for program funding under 
345.4   section 116L.12; 
345.5      (ii) convert an existing curriculum for distance learning 
345.6   through interactive television or other communication methods; 
345.7   or 
345.8      (iii) enable a training program to be offered when it would 
345.9   otherwise be canceled due to an enrollment shortfall of one or 
345.10  two students when the program is offered in a health-related 
345.11  field with a documented worker shortage and is part of a 
345.12  training program not exceeding two years in length. 
345.13     (b) The board shall develop application procedures and 
345.14  evaluation policies for grants made under this section. 
345.15     Sec. 6.  [256.956] [LONG-TERM CARE EMPLOYEE HEALTH 
345.16  INSURANCE ASSISTANCE PROGRAM.] 
345.17     Subdivision 1.  [DEFINITIONS.] (a) For the purpose of this 
345.18  section, the definitions have the meanings given them.  
345.19     (b) "Commissioner" means the commissioner of human services.
345.20     (c) "Dependent" means an unmarried child who is under the 
345.21  age of 19 years.  For the purpose of this definition, a 
345.22  dependent includes a child for whom an eligible employee or an 
345.23  eligible employee's spouse has been appointed legal guardian or 
345.24  an adopted child as defined under section 62A.27.  A dependent 
345.25  does not include: 
345.26     (1) a child of an eligible employee who is eligible for 
345.27  health coverage through medical assistance without a spenddown 
345.28  or through an employer-subsidized health plan where an employer 
345.29  other than the employer of the eligible employee pays at least 
345.30  50 percent of the cost of coverage for the child; or 
345.31     (2) a child of an eligible employee who is excluded from 
345.32  coverage under title XXI of the Social Security Act, United 
345.33  States Code, title 42, section 1397aa et seq. 
345.34     (d) "Eligible employee" means an individual employed for at 
345.35  least 20 hours by an employer in a position other than as an 
345.36  administrator or in the central office.  An "employee" does not 
346.1   include an individual who:  
346.2      (1) works on a temporary or substitute basis; 
346.3      (2) is hired as an independent contractor; or 
346.4      (3) is a state employee.  
346.5      (e) "Employer" means any of the following: 
346.6      (1) a nursing facility reimbursed under section 256B.431 or 
346.7   256B.434; 
346.8      (2) a facility reimbursed under sections 256B.501 and 
346.9   256B.5011 and Laws 1993, First Special Session chapter 1, 
346.10  article 4, section 11; or 
346.11     (3) a provider who meets the following requirements: 
346.12     (i) provides home and community-based waivered services for 
346.13  persons with mental retardation or related conditions under 
346.14  section 256B.501; home and community-based waivered services for 
346.15  the elderly under section 256B.0915; waivered services under 
346.16  community alternatives for disabled individuals under section 
346.17  256B.49; community alternative care waivered services under 
346.18  section 256B.49; traumatic brain injury waivered services under 
346.19  section 256B.49; nursing services and home health services under 
346.20  section 256B.0625, subdivision 6a; personal care services and 
346.21  nursing supervision of personal care services under section 
346.22  256B.0625, subdivision 19a; private duty nursing services under 
346.23  section 256B.0625, subdivision 7; day training and habilitation 
346.24  services for adults with mental retardation or related 
346.25  conditions under sections 252.40 to 252.46; alternative care 
346.26  services under section 256B.0913; adult residential program 
346.27  grants under Minnesota Rules, parts 9535.2000 to 9535.3000; 
346.28  adult and family community support grants under Minnesota Rules, 
346.29  parts 9535.1700 to 9535.1760; semi-independent living services 
346.30  under section 252.275, including SILS funding under county 
346.31  social services grants formerly funded under chapter 256I; 
346.32  community support services for deaf and hard-of-hearing adults 
346.33  with mental illness who use or wish to use sign language as 
346.34  their primary means of communication; or living skills training 
346.35  programs for persons with intractable epilepsy who need 
346.36  assistance in the transition to independent living; and 
347.1      (ii) the revenue received by the provider from medical 
347.2   assistance that equals or exceeds 20 percent of the total 
347.3   revenue received by the provider from all payment sources.  
347.4   Employer includes both for-profit and nonprofit entities. 
347.5      (f) "Program" means the long-term care employee health 
347.6   insurance assistance program.  
347.7      Subd. 2.  [PROGRAM.] (a) The commissioner shall establish 
347.8   and administer the long-term care employee health insurance 
347.9   assistance program to provide the advantages of pooling for the 
347.10  purchase of health coverage for long-term care employers.  
347.11     (b) The commissioner shall solicit bids from health 
347.12  maintenance organizations licensed under chapter 62D to provide 
347.13  health coverage to the dependents of eligible employees.  Health 
347.14  maintenance organizations shall submit proposals in good faith 
347.15  that meet the requirements of the request for proposal from the 
347.16  commissioner, provided that the requirements can reasonably be 
347.17  met by the health maintenance organization. Coverage shall be 
347.18  offered on a guaranteed-issue and renewal basis.  No health 
347.19  maintenance organization is required to provide coverage to an 
347.20  eligible employee's dependent who does not reside within the 
347.21  health maintenance organization's approved service area.  
347.22     (c) The commissioner shall, consistent with the provisions 
347.23  of this section, determine coverage options, premium 
347.24  arrangements, contractual arrangements, and all other matters 
347.25  necessary to administer the program.  
347.26     (d) The commissioner may extend the program to include 
347.27  coverage for the eligible employee and noneligible employee.  
347.28  The cost of coverage for these employees shall be the 
347.29  responsibility of the employer or employee.  In determining 
347.30  whether to extend the program to include coverage for the 
347.31  employees, the commissioner shall evaluate the feasibility of 
347.32  the state establishing a stop-loss insurance fund for the 
347.33  purpose of lowering the cost of premiums for the employees.  
347.34     (e) The commissioner shall consult with representatives of 
347.35  the long-term care industry on issues related to the 
347.36  administration of the program. 
348.1      Subd. 3.  [EMPLOYER REQUIREMENTS.] (a) All employers may 
348.2   participate in the program subject to the requirements of this 
348.3   section.  The commissioner shall establish procedures for an 
348.4   employer to apply for coverage through this program.  These 
348.5   procedures may include requiring eligible employees to provide 
348.6   relevant financial information to determine the eligibility of 
348.7   their dependents.  
348.8      (b) A participating employer must offer dependent coverage 
348.9   to all employees.  For purposes of this paragraph, dependent 
348.10  includes the children excluded under subdivision 1, paragraph 
348.11  (c). 
348.12     (c) The participating employer must provide to the 
348.13  commissioner any employee information deemed necessary by the 
348.14  commissioner to determine eligibility and premium payments and 
348.15  must notify the commissioner upon a change in an employee's or 
348.16  an employee's dependent's eligibility.  
348.17     (d) The initial term of the employer's coverage must be for 
348.18  at least one year but may be made automatically renewable from 
348.19  term to term in the absence of notice of termination by either 
348.20  the employer or the commissioner.  
348.21     Subd. 4.  [INDIVIDUAL ELIGIBILITY.] (a) The commissioner 
348.22  may require a probationary period for new employees of no more 
348.23  than 90 days before the dependents of a new employee become 
348.24  eligible for coverage through the program. 
348.25     (b) A participating employer may elect to offer coverage 
348.26  through the program to: 
348.27     (1) the eligible and noneligible employees, if the program 
348.28  is extended by the commissioner to include these individuals; 
348.29     (2) children of eligible and noneligible employees who are 
348.30  under the age of 25 years and who are full-time students; and 
348.31     (3) the spouses of eligible and noneligible employees. 
348.32  The cost of coverage for the individuals described in this 
348.33  paragraph, the dependents of noneligible employees, and any 
348.34  child of an eligible or noneligible employee who is not 
348.35  considered a dependent in accordance with subdivision 1, 
348.36  paragraph (c), shall be the responsibility of the employer or 
349.1   employee. 
349.2      (c) The commissioner may require a certain percentage of 
349.3   participation of the individuals described in paragraph (b) 
349.4   before coverage can be offered through the program. 
349.5      Subd. 5.  [COVERAGE.] (a) The health plan offered must meet 
349.6   all applicable requirements of chapters 62A and 62D and sections 
349.7   62J.71 to 62J.73; 62M.01 to 62M.16; 62Q.1055; 62Q.106; 62Q.12; 
349.8   62Q.135; 62Q.14; 62Q.145; 62Q.19; 62Q.23; 62Q.43; 62Q.47; 62Q.52 
349.9   to 62Q.58; and 62Q.68 to 62Q.73.  
349.10     (b) The health plan offered must meet all underwriting 
349.11  requirements of chapter 62L and must provide periodic open 
349.12  enrollments for eligible employees where a choice in coverage 
349.13  exists. 
349.14     (c) The commissioner shall establish the benefits to be 
349.15  provided under this program in accordance with the following: 
349.16     (1) the benefits provided must comply with title XXI of the 
349.17  Social Security Act, United States Code, title 42, section 
349.18  1397aa et seq., and be at least equivalent to the lowest 
349.19  benchmark allowable under title XXI; 
349.20     (2) preventive and restorative dental services must be 
349.21  included; and 
349.22     (3) except for a $20 copay per visit for emergency care, 
349.23  there shall be no deductibles, copayments, or coinsurance 
349.24  requirements. 
349.25     (d) The health plan requirements described in paragraph (c) 
349.26  apply only to coverage offered to the dependents of eligible 
349.27  employees.  
349.28     Subd. 6.  [PREMIUMS.] (a) The commissioner shall determine 
349.29  premium rates and rating methods for the coverage offered 
349.30  through the program.  
349.31     (b) The commissioner shall pay the premiums for the 
349.32  dependents of eligible employees directly to the health 
349.33  maintenance organization.  
349.34     (c) Payment of any remaining premiums must be collected by 
349.35  the participating employer and paid directly to the health 
349.36  maintenance organization. 
350.1      (d) Any premiums paid by the state under this section are 
350.2   not subject to taxes or surcharges imposed under chapter 297I, 
350.3   chapter 295, or section 256.9657 and shall be excluded when 
350.4   determining a health maintenance organization's total premium 
350.5   under section 62E.11.  
350.6      [EFFECTIVE DATE.] This section is effective January 15, 
350.7   2003, or upon federal approval of a federal waiver to receive 
350.8   enhanced matching funds under the state's children's health 
350.9   insurance program, whichever occurs latest. 
350.10     Sec. 7.  Minnesota Statutes 2000, section 256B.431, is 
350.11  amended by adding a subdivision to read: 
350.12     Subd. 33.  [EMPLOYEE SCHOLARSHIP COSTS AND TRAINING IN 
350.13  ENGLISH AS A SECOND LANGUAGE.] (a) For the rate year beginning 
350.14  July 1, 2001, the commissioner shall provide to each nursing 
350.15  facility reimbursed under this section, section 256B.434, or any 
350.16  other section an adjustment of 25 cents to the total operating 
350.17  payment rate to be used: 
350.18     (1) for employee scholarships that satisfy the following 
350.19  requirements: 
350.20     (i) scholarships are available to all employees who work an 
350.21  average of at least 20 hours per week at the facility except the 
350.22  administrator, department supervisors, registered nurses, and 
350.23  licensed practical nurses; and 
350.24     (ii) the course of study is expected to lead to employment 
350.25  in a health-related career, including medical care interpreter 
350.26  services and social work; and 
350.27     (2) to provide job-related training on the job site in 
350.28  English as a second language. 
350.29     (b) A facility receiving a rate adjustment under this 
350.30  subdivision must report to the commissioner on a form supplied 
350.31  by the commissioner the following information:  the amount 
350.32  received from this rate adjustment; the amount used for training 
350.33  in English as a second language; the number of persons receiving 
350.34  the training; the name of the person or entity providing the 
350.35  training; and for each scholarship recipient, the name of the 
350.36  recipient, the amount awarded, the educational institution 
351.1   attended, the nature of the educational program, and the program 
351.2   completion date. 
351.3      (c) Amounts spent by a facility for scholarships or for 
351.4   training in English as a second language that satisfy the 
351.5   requirements of this subdivision shall be included in the 
351.6   facility's total payment rates for the purposes of determining 
351.7   future rates under this section, section 256B.434, or any other 
351.8   section. 
351.9      Sec. 8.  Minnesota Statutes 2000, section 256B.5012, is 
351.10  amended by adding a subdivision to read: 
351.11     Subd. 5.  [EMPLOYEE SCHOLARSHIP COSTS.] (a) For the rate 
351.12  year beginning July 1, 2001, the commissioner shall provide to 
351.13  each facility reimbursed under this section an adjustment of 25 
351.14  cents to the total payment rate to be used: 
351.15     (1) for employee scholarships that satisfy the following 
351.16  requirements: 
351.17     (i) scholarships are available to all employees who work an 
351.18  average of at least 20 hours per week at the facility except the 
351.19  administrator, department supervisors, registered nurses, and 
351.20  licensed practical nurses; and 
351.21     (ii) the course of study is expected to lead to employment 
351.22  in a health-related career, including medical care interpreter 
351.23  services and social work; and 
351.24     (2) to provide job-related training on the job site in 
351.25  English as a second language. 
351.26     (b) A facility receiving a rate adjustment under this 
351.27  subdivision must report to the commissioner on a form supplied 
351.28  by the commissioner the following information:  the amount 
351.29  received from this rate adjustment; the amount used for training 
351.30  in English as a second language; the number of persons receiving 
351.31  the training; the name of the person or entity providing the 
351.32  training; and for each scholarship recipient, the name of the 
351.33  recipient, the amount awarded, the educational institution 
351.34  attended, the nature of the educational program, and the program 
351.35  completion date. 
351.36     (c) Amounts spent by a facility for scholarships or for 
352.1   training in English as a second language that satisfy the 
352.2   requirements of this subdivision shall be included in the 
352.3   facility's total payment rates for the purposes of determining 
352.4   future rates under this section or any other section. 
352.5      Sec. 9.  Minnesota Statutes 2000, section 256L.07, 
352.6   subdivision 2, is amended to read: 
352.7      Subd. 2.  [MUST NOT HAVE ACCESS TO EMPLOYER-SUBSIDIZED 
352.8   COVERAGE.] (a) To be eligible, a family or individual must not 
352.9   have access to subsidized health coverage through an employer 
352.10  and must not have had access to employer-subsidized coverage 
352.11  through a current employer for 18 months prior to application or 
352.12  reapplication.  A family or individual whose employer-subsidized 
352.13  coverage is lost due to an employer terminating health care 
352.14  coverage as an employee benefit during the previous 18 months is 
352.15  not eligible.  
352.16     (b) For purposes of this requirement, subsidized health 
352.17  coverage means health coverage for which the employer pays at 
352.18  least 50 percent of the cost of coverage for the employee or 
352.19  dependent, or a higher percentage as specified by the 
352.20  commissioner.  Children are eligible for employer-subsidized 
352.21  coverage through either parent, including the noncustodial 
352.22  parent.  Children who are eligible for coverage under the 
352.23  long-term care employee health insurance assistance program 
352.24  established under section 256.956 are considered to have access 
352.25  to subsidized health coverage under this subdivision.  The 
352.26  commissioner must treat employer contributions to Internal 
352.27  Revenue Code Section 125 plans and any other employer benefits 
352.28  intended to pay health care costs as qualified employer 
352.29  subsidies toward the cost of health coverage for employees for 
352.30  purposes of this subdivision.  
352.31     [EFFECTIVE DATE.] This section is effective upon 
352.32  implementation of Minnesota Statutes, section 256.956. 
352.33     Sec. 10.  [EMPLOYEE SCHOLARSHIP COSTS.] 
352.34     (a) The commissioner of human services shall increase 
352.35  reimbursement rates by .25 percent for the providers listed in 
352.36  paragraph (d), effective for services rendered on or after July 
353.1   1, 2001, to be used: 
353.2      (1) for employee scholarships that satisfy the following 
353.3   requirements: 
353.4      (i) scholarships are available to all employees who work an 
353.5   average of at least 20 hours per week at the facility except the 
353.6   administrator, department supervisors, registered nurses, and 
353.7   licensed practical nurses; and 
353.8      (ii) the course of study is expected to lead to employment 
353.9   in a health-related career, including medical care interpreter 
353.10  services and social work; and 
353.11     (2) to provide job-related training on the job site in 
353.12  English as a second language. 
353.13     (b) A provider receiving a rate adjustment under this 
353.14  subdivision must report to the commissioner on a form supplied 
353.15  by the commissioner the following information:  the amount 
353.16  received from this rate adjustment; the amount used for training 
353.17  in English as a second language; the number of persons receiving 
353.18  the training; the name of the person or entity providing the 
353.19  training; and for each scholarship recipient, the name of the 
353.20  recipient, the amount awarded, the educational institution 
353.21  attended, the nature of the educational program, and the program 
353.22  completion date. 
353.23     (c) Amounts spent by a provider for scholarships or for 
353.24  training in English as a second language that satisfy the 
353.25  requirements of this section shall be included in the provider's 
353.26  total payment rates for the purposes of determining future rates.
353.27     (d) The rate increases described in this section shall be 
353.28  provided to home and community-based waivered services for 
353.29  persons with mental retardation or related conditions under 
353.30  Minnesota Statutes, section 256B.501; home and community-based 
353.31  waivered services for the elderly under Minnesota Statutes, 
353.32  section 256B.0915; waivered services under community 
353.33  alternatives for disabled individuals under Minnesota Statutes, 
353.34  section 256B.49; community alternative care waivered services 
353.35  under Minnesota Statutes, section 256B.49; traumatic brain 
353.36  injury waivered services under Minnesota Statutes, section 
354.1   256B.49; nursing services and home health services under 
354.2   Minnesota Statutes, section 256B.0625, subdivision 6a; personal 
354.3   care services and nursing supervision of personal care services 
354.4   under Minnesota Statutes, section 256B.0625, subdivision 19a; 
354.5   private duty nursing services under Minnesota Statutes, section 
354.6   256B.0625, subdivision 7; day training and habilitation services 
354.7   for adults with mental retardation or related conditions under 
354.8   Minnesota Statutes, sections 252.40 to 252.46; alternative care 
354.9   services under Minnesota Statutes, section 256B.0913; adult 
354.10  residential program grants under Minnesota Rules, parts 
354.11  9535.2000 to 9535.3000; adult and family community support 
354.12  grants under Minnesota Rules, parts 9535.1700 to 9535.1760; the 
354.13  group residential housing supplementary service rate under 
354.14  section 256I.05, subdivision 1a; adult mental health integrated 
354.15  fund grants under Minnesota Statutes, section 245.4661; and 
354.16  semi-independent living services under Minnesota Statutes, 
354.17  section 252.275. 
354.18     Sec. 11.  [CHIP WAIVER.] 
354.19     The commissioner of human services shall seek all waivers 
354.20  necessary to obtain enhanced matching funds under the state 
354.21  children's health insurance program established as title XXI of 
354.22  the Social Security Act, United States Code, title 42, section 
354.23  1397aa et seq. 
354.24     [EFFECTIVE DATE.] This section is effective the day 
354.25  following final enactment.  
354.26     Sec. 12.  [S-CHIP ALLOTMENT.] Upon implementation of 
354.27  section 256.956, the commissioner shall claim eligible 
354.28  expenditures against Minnesota's available funding under the 
354.29  state children's health insurance program in the following order:
354.30     (1) expenditures made according to Minnesota Statutes, 
354.31  section 256B.057, subdivision 8; 
354.32     (2) expenditures for outreach and other state or local 
354.33  expenditures that are authorized to be claimed under Laws 1998, 
354.34  chapter 407, article 5, section 46; 
354.35     (3) expenditures under the long-term care employee health 
354.36  insurance assistance program; and 
355.1      (4) expenditures that may be eligible for matching funds 
355.2   under S-CHIP that otherwise may be claimed as Medicaid 
355.3   expenditures. 
355.4      [EFFECTIVE DATE.] This section is effective the day 
355.5   following final enactment. 
355.6      Sec. 13.  [REPEALER.] 
355.7      Minnesota Statutes 2000, section 116L.12, subdivisions 2 
355.8   and 7, are repealed. 
355.9                              ARTICLE 7 
355.10                     REGULATION OF SUPPLEMENTAL 
355.11                     NURSING SERVICES AGENCIES 
355.12     Section 1.  Minnesota Statutes 2000, section 144.057, is 
355.13  amended to read: 
355.14     144.057 [BACKGROUND STUDIES ON LICENSEES AND SUPPLEMENTAL 
355.15  NURSING SERVICES AGENCY PERSONNEL.] 
355.16     Subdivision 1.  [BACKGROUND STUDIES REQUIRED.] The 
355.17  commissioner of health shall contract with the commissioner of 
355.18  human services to conduct background studies of: 
355.19     (1) individuals providing services which have direct 
355.20  contact, as defined under section 245A.04, subdivision 3, with 
355.21  patients and residents in hospitals, boarding care homes, 
355.22  outpatient surgical centers licensed under sections 144.50 to 
355.23  144.58; nursing homes and home care agencies licensed under 
355.24  chapter 144A; residential care homes licensed under chapter 
355.25  144B, and board and lodging establishments that are registered 
355.26  to provide supportive or health supervision services under 
355.27  section 157.17; and 
355.28     (2) beginning July 1, 1999, all other employees in nursing 
355.29  homes licensed under chapter 144A, and boarding care homes 
355.30  licensed under sections 144.50 to 144.58.  A disqualification of 
355.31  an individual in this section shall disqualify the individual 
355.32  from positions allowing direct contact or access to patients or 
355.33  residents receiving services; 
355.34     (3) individuals employed by a supplemental nursing services 
355.35  agency, as defined under section 144A.70, who are providing 
355.36  services in health care facilities; and 
356.1      (4) controlling persons of a supplemental nursing services 
356.2   agency, as defined under section 144A.70. 
356.3      If a facility or program is licensed by the department of 
356.4   human services and subject to the background study provisions of 
356.5   chapter 245A and is also licensed by the department of health, 
356.6   the department of human services is solely responsible for the 
356.7   background studies of individuals in the jointly licensed 
356.8   programs. 
356.9      Subd. 2.  [RESPONSIBILITIES OF DEPARTMENT OF HUMAN 
356.10  SERVICES.] The department of human services shall conduct the 
356.11  background studies required by subdivision 1 in compliance with 
356.12  the provisions of chapter 245A and Minnesota Rules, parts 
356.13  9543.3000 to 9543.3090.  For the purpose of this section, the 
356.14  term "residential program" shall include all facilities 
356.15  described in subdivision 1.  The department of human services 
356.16  shall provide necessary forms and instructions, shall conduct 
356.17  the necessary background studies of individuals, and shall 
356.18  provide notification of the results of the studies to the 
356.19  facilities, supplemental nursing services agencies, individuals, 
356.20  and the commissioner of health.  Individuals shall be 
356.21  disqualified under the provisions of chapter 245A and Minnesota 
356.22  Rules, parts 9543.3000 to 9543.3090.  If an individual is 
356.23  disqualified, the department of human services shall notify the 
356.24  facility, the supplemental nursing services agency, and the 
356.25  individual and shall inform the individual of the right to 
356.26  request a reconsideration of the disqualification by submitting 
356.27  the request to the department of health. 
356.28     Subd. 3.  [RECONSIDERATIONS.] The commissioner of health 
356.29  shall review and decide reconsideration requests, including the 
356.30  granting of variances, in accordance with the procedures and 
356.31  criteria contained in chapter 245A and Minnesota Rules, parts 
356.32  9543.3000 to 9543.3090.  The commissioner's decision shall be 
356.33  provided to the individual and to the department of human 
356.34  services.  The commissioner's decision to grant or deny a 
356.35  reconsideration of disqualification is the final administrative 
356.36  agency action. 
357.1      Subd. 4.  [RESPONSIBILITIES OF FACILITIES AND AGENCIES.] 
357.2   Facilities and agencies described in subdivision 1 shall be 
357.3   responsible for cooperating with the departments in implementing 
357.4   the provisions of this section.  The responsibilities imposed on 
357.5   applicants and licensees under chapter 245A and Minnesota Rules, 
357.6   parts 9543.3000 to 9543.3090, shall apply to these 
357.7   facilities and supplemental nursing services agencies.  The 
357.8   provision of section 245A.04, subdivision 3, paragraph (e), 
357.9   shall apply to applicants, licensees, registrants, or an 
357.10  individual's refusal to cooperate with the completion of the 
357.11  background studies.  Supplemental nursing services agencies 
357.12  subject to the registration requirements in section 144A.71 must 
357.13  maintain records verifying compliance with the background study 
357.14  requirements under this section. 
357.15     Sec. 2.  [144A.70] [REGISTRATION OF SUPPLEMENTAL NURSING 
357.16  SERVICES AGENCIES; DEFINITIONS.] 
357.17     Subdivision 1.  [SCOPE.] As used in sections 144A.70 to 
357.18  144A.74, the terms defined in this section have the meanings 
357.19  given them. 
357.20     Subd. 2.  [COMMISSIONER.] "Commissioner" means the 
357.21  commissioner of health. 
357.22     Subd. 3.  [CONTROLLING PERSON.] "Controlling person" means 
357.23  a business entity, officer, program administrator, or director 
357.24  whose responsibilities include the direction of the management 
357.25  or policies of a supplemental nursing services agency.  
357.26  Controlling person also means an individual who, directly or 
357.27  indirectly, beneficially owns an interest in a corporation, 
357.28  partnership, or other business association that is a controlling 
357.29  person. 
357.30     Subd. 4.  [HEALTH CARE FACILITY.] "Health care facility" 
357.31  means a hospital, boarding care home, or outpatient surgical 
357.32  center licensed under sections 144.50 to 144.58; a nursing home 
357.33  or home care agency licensed under chapter 144A; a housing with 
357.34  services establishment registered under chapter 144D; or a board 
357.35  and lodging establishment that is registered to provide 
357.36  supportive or health supervision services under section 157.17. 
358.1      Subd. 5.  [PERSON.] "Person" includes an individual, firm, 
358.2   corporation, partnership, or association. 
358.3      Subd. 6.  [SUPPLEMENTAL NURSING SERVICES 
358.4   AGENCY.] "Supplemental nursing services agency" means a person, 
358.5   firm, corporation, partnership, or association engaged for hire 
358.6   in the business of providing or procuring temporary employment 
358.7   in health care facilities for nurses, nursing assistants, nurse 
358.8   aides, and orderlies.  Supplemental nursing services agency does 
358.9   not include an individual who only engages in providing the 
358.10  individual's services on a temporary basis to health care 
358.11  facilities.  Supplemental nursing services agency also does not 
358.12  include any nursing service agency that is limited to providing 
358.13  temporary nursing personnel solely to one or more health care 
358.14  facilities owned or operated by the same person, firm, 
358.15  corporation, or partnership. 
358.16     Sec. 3.  [144A.71] [SUPPLEMENTAL NURSING SERVICES AGENCY 
358.17  REGISTRATION.] 
358.18     Subdivision 1.  [DUTY TO REGISTER.] A person who operates a 
358.19  supplemental nursing services agency shall register the agency 
358.20  with the commissioner.  Each separate location of the business 
358.21  of a supplemental nursing services agency shall register the 
358.22  agency with the commissioner.  Each separate location of the 
358.23  business of a supplemental nursing services agency shall have a 
358.24  separate registration. 
358.25     Subd. 2.  [APPLICATION INFORMATION AND FEE.] The 
358.26  commissioner shall establish forms and procedures for processing 
358.27  each supplemental nursing services agency registration 
358.28  application.  An application for a supplemental nursing services 
358.29  agency registration must include at least the following: 
358.30     (1) the names and addresses of the owner or owners of the 
358.31  supplemental nursing services agency; 
358.32     (2) if the owner is a corporation, copies of its articles 
358.33  of incorporation and current bylaws, together with the names and 
358.34  addresses of its officers and directors; 
358.35     (3) any other relevant information that the commissioner 
358.36  determines is necessary to properly evaluate an application for 
359.1   registration; and 
359.2      (4) the annual registration fee for a supplemental nursing 
359.3   services agency, which is $891. 
359.4      Subd. 3.  [REGISTRATION NOT TRANSFERABLE.] A registration 
359.5   issued by the commissioner according to this section is 
359.6   effective for a period of one year from the date of its issuance 
359.7   unless the registration is revoked or suspended under section 
359.8   144A.72, subdivision 2, or unless the supplemental nursing 
359.9   services agency is sold or ownership or management is 
359.10  transferred.  When a supplemental nursing services agency is 
359.11  sold or ownership or management is transferred, the registration 
359.12  of the agency must be voided and the new owner or operator may 
359.13  apply for a new registration. 
359.14     Sec. 4.  [144A.72] [REGISTRATION REQUIREMENTS; PENALTIES.] 
359.15     Subdivision 1.  [MINIMUM CRITERIA.] The commissioner shall 
359.16  require that, as a condition of registration: 
359.17     (1) the supplemental nursing services agency shall document 
359.18  that each temporary employee provided to health care facilities 
359.19  currently meets the minimum licensing, training, and continuing 
359.20  education standards for the position in which the employee will 
359.21  be working; 
359.22     (2) the supplemental nursing services agency shall comply 
359.23  with all pertinent requirements relating to the health and other 
359.24  qualifications of personnel employed in health care facilities; 
359.25     (3) the supplemental nursing services agency must not 
359.26  restrict in any manner the employment opportunities of its 
359.27  employees; 
359.28     (4) the supplemental nursing services agency, when 
359.29  supplying temporary employees to a health care facility, and 
359.30  when requested by the facility to do so, shall agree that at 
359.31  least 30 percent of the total personnel hours supplied are 
359.32  during night, holiday, or weekend shifts; 
359.33     (5) the supplemental nursing services agency shall carry 
359.34  medical malpractice insurance to insure against the loss, 
359.35  damage, or expense incident to a claim arising out of the death 
359.36  or injury of any person as the result of negligence or 
360.1   malpractice in the provision of health care services by the 
360.2   supplemental nursing services agency or by any employee of the 
360.3   agency; and 
360.4      (6) the supplemental nursing services agency must not, in 
360.5   any contract with any employee or health care facility, require 
360.6   the payment of liquidated damages, employment fees, or other 
360.7   compensation should the employee be hired as a permanent 
360.8   employee of a health care facility. 
360.9      Subd. 2.  [PENALTIES.] A pattern of failure to comply with 
360.10  this section shall subject the supplemental nursing services 
360.11  agency to revocation or nonrenewal of its registration.  
360.12  Violations of section 144A.74 are subject to a fine equal to 200 
360.13  percent of the amount billed or received in excess of the 
360.14  maximum permitted under that section. 
360.15     Sec. 5.  [144A.73] [COMPLAINT SYSTEM.] 
360.16     The commissioner shall establish a system for reporting 
360.17  complaints against a supplemental nursing services agency or its 
360.18  employees.  Complaints may be made by any member of the public.  
360.19  Written complaints must be forwarded to the employer of each 
360.20  person against whom a complaint is made.  The employer shall 
360.21  promptly report to the commissioner any corrective action taken. 
360.22     Sec. 6.  [144A.74] [MAXIMUM CHARGES.] 
360.23     A supplemental nursing services agency must not bill or 
360.24  receive payments from a health care facility at a rate higher 
360.25  than 150 percent of the average wage rate by employee 
360.26  classification as identified by the commissioner of economic 
360.27  security.  The maximum rate must include all charges for 
360.28  administrative fees, contract fees, or other special charges in 
360.29  addition to the hourly rates for the temporary nursing pool 
360.30  personnel supplied to a nursing home. 
360.31     Sec. 7.  [256B.039] [REPORTING OF SUPPLEMENTAL NURSING 
360.32  SERVICES AGENCY USE.] 
360.33     Beginning March 1, 2002, the commissioner shall to report 
360.34  to the legislature annually on the use of supplemental nursing 
360.35  services, including the number of hours worked by supplemental 
360.36  nursing services agency personnel and payments to supplemental 
361.1   nursing services agencies. 
361.2                              ARTICLE 8 
361.3                       LONG-TERM CARE INSURANCE 
361.4      Section 1.  Minnesota Statutes 2000, section 62A.48, 
361.5   subdivision 4, is amended to read: 
361.6      Subd. 4.  [LOSS RATIO.] The anticipated loss ratio for 
361.7   long-term care policies must not be less than 65 percent for 
361.8   policies issued on a group basis or 60 percent for policies 
361.9   issued on an individual or mass-market basis.  This subdivision 
361.10  does not apply to policies issued on or after January 1, 2002, 
361.11  that comply with sections 62S.021 and 62S.081. 
361.12     [EFFECTIVE DATE.] This section is effective the day 
361.13  following final enactment. 
361.14     Sec. 2.  Minnesota Statutes 2000, section 62A.48, is 
361.15  amended by adding a subdivision to read: 
361.16     Subd. 10.  [REGULATION OF PREMIUMS AND PREMIUM 
361.17  INCREASES.] Policies issued under sections 62A.46 to 62A.56 on 
361.18  or after January 1, 2002, must comply with sections 62S.021, 
361.19  62S.081, 62S.265, and 62S.266 to the same extent as policies 
361.20  issued under chapter 62S. 
361.21     [EFFECTIVE DATE.] This section is effective the day 
361.22  following final enactment. 
361.23     Sec. 3.  Minnesota Statutes 2000, section 62A.48, is 
361.24  amended by adding a subdivision to read: 
361.25     Subd. 11.  [NONFORFEITURE BENEFITS.] Policies issued under 
361.26  sections 62A.46 to 62A.56 on or after January 1, 2002, must 
361.27  comply with section 62S.02, subdivision 2, to the same extent as 
361.28  policies issued under chapter 62S. 
361.29     [EFFECTIVE DATE.] This section is effective the day 
361.30  following final enactment. 
361.31     Sec. 4.  Minnesota Statutes 2000, section 62S.01, is 
361.32  amended by adding a subdivision to read: 
361.33     Subd. 13a.  [EXCEPTIONAL INCREASE.] (a) "Exceptional 
361.34  increase" means only those premium rate increases filed by an 
361.35  insurer as exceptional for which the commissioner determines 
361.36  that the need for the premium rate increase is justified due to 
362.1   changes in laws or rules applicable to long-term care coverage 
362.2   in this state, or due to increased and unexpected utilization 
362.3   that affects the majority of insurers of similar products. 
362.4      (b) Except as provided in section 62S.265, exceptional 
362.5   increases are subject to the same requirements as other premium 
362.6   rate schedule increases.  The commissioner may request a review 
362.7   by an independent actuary or a professional actuarial body of 
362.8   the basis for a request that an increase be considered an 
362.9   exceptional increase.  The commissioner, in determining that the 
362.10  necessary basis for an exceptional increase exists, shall also 
362.11  determine any potential offsets to higher claims costs. 
362.12     [EFFECTIVE DATE.] This section is effective the day 
362.13  following final enactment. 
362.14     Sec. 5.  Minnesota Statutes 2000, section 62S.01, is 
362.15  amended by adding a subdivision to read: 
362.16     Subd. 17a.  [INCIDENTAL.] "Incidental," as used in section 
362.17  62S.265, subdivision 10, means that the value of the long-term 
362.18  care benefits provided is less than ten percent of the total 
362.19  value of the benefits provided over the life of the policy.  
362.20  These values must be measured as of the date of issue. 
362.21     [EFFECTIVE DATE.] This section is effective the day 
362.22  following final enactment. 
362.23     Sec. 6.  Minnesota Statutes 2000, section 62S.01, is 
362.24  amended by adding a subdivision to read: 
362.25     Subd. 23a.  [QUALIFIED ACTUARY.] "Qualified actuary" means 
362.26  a member in good standing of the American Academy of Actuaries. 
362.27     [EFFECTIVE DATE.] This section is effective the day 
362.28  following final enactment. 
362.29     Sec. 7.  Minnesota Statutes 2000, section 62S.01, is 
362.30  amended by adding a subdivision to read: 
362.31     Subd. 25a.  [SIMILAR POLICY FORMS.] "Similar policy forms" 
362.32  means all of the long-term care insurance policies and 
362.33  certificates issued by an insurer in the same long-term care 
362.34  benefit classification as the policy form being considered.  
362.35  Certificates of groups that meet the definition in section 
362.36  62S.01, subdivision 15, clause (1), are not considered similar 
363.1   to certificates or policies otherwise issued as long-term care 
363.2   insurance, but are similar to other comparable certificates with 
363.3   the same long-term care benefit classifications.  For purposes 
363.4   of determining similar policy forms, long-term care benefit 
363.5   classifications are defined as follows:  institutional long-term 
363.6   care benefits only, noninstitutional long-term care benefits 
363.7   only, or comprehensive long-term care benefits. 
363.8      [EFFECTIVE DATE.] This section is effective the day 
363.9   following final enactment. 
363.10     Sec. 8.  [62S.021] [LONG-TERM CARE INSURANCE; INITIAL 
363.11  FILING.] 
363.12     Subdivision 1.  [APPLICABILITY.] This section applies to 
363.13  any long-term care policy issued in this state on or after 
363.14  January 1, 2002, under this chapter or sections 62A.46 to 62A.56.
363.15     Subd. 2.  [REQUIRED SUBMISSION TO COMMISSIONER.] An insurer 
363.16  shall provide the following information to the commissioner 30 
363.17  days prior to making a long-term care insurance form available 
363.18  for sale: 
363.19     (1) a copy of the disclosure documents required in section 
363.20  62S.081; and 
363.21     (2) an actuarial certification consisting of at least the 
363.22  following: 
363.23     (i) a statement that the initial premium rate schedule is 
363.24  sufficient to cover anticipated costs under moderately adverse 
363.25  experience and that the premium rate schedule is reasonably 
363.26  expected to be sustainable over the life of the form with no 
363.27  future premium increases anticipated; 
363.28     (ii) a statement that the policy design and coverage 
363.29  provided have been reviewed and taken into consideration; 
363.30     (iii) a statement that the underwriting and claims 
363.31  adjudication processes have been reviewed and taken into 
363.32  consideration; and 
363.33     (iv) a complete description of the basis for contract 
363.34  reserves that are anticipated to be held under the form, to 
363.35  include: 
363.36     (A) sufficient detail or sample calculations provided so as 
364.1   to have a complete depiction of the reserve amounts to be held; 
364.2      (B) a statement that the assumptions used for reserves 
364.3   contain reasonable margins for adverse experience; 
364.4      (C) a statement that the net valuation premium for renewal 
364.5   years does not increase, except for attained age rating where 
364.6   permitted; 
364.7      (D) a statement that the difference between the gross 
364.8   premium and the net valuation premium for renewal years is 
364.9   sufficient to cover expected renewal expenses, or if such a 
364.10  statement cannot be made, a complete description of the 
364.11  situations in which this does not occur.  An aggregate 
364.12  distribution of anticipated issues may be used as long as the 
364.13  underlying gross premiums maintain a reasonably consistent 
364.14  relationship.  If the gross premiums for certain age groups 
364.15  appear to be inconsistent with this requirement, the 
364.16  commissioner may request a demonstration under item (i) based on 
364.17  a standard age distribution; and 
364.18     (E) either a statement that the premium rate schedule is 
364.19  not less than the premium rate schedule for existing similar 
364.20  policy forms also available from the insurer except for 
364.21  reasonable differences attributable to benefits, or a comparison 
364.22  of the premium schedules for similar policy forms that are 
364.23  currently available from the insurer with an explanation of the 
364.24  differences. 
364.25     Subd. 3.  [ACTUARIAL DEMONSTRATION.] The commissioner may 
364.26  request an actuarial demonstration that benefits are reasonable 
364.27  in relation to premiums.  The actuarial demonstration must 
364.28  include either premium and claim experience on similar policy 
364.29  forms, adjusted for any premium or benefit differences, relevant 
364.30  and credible data from other studies, or both.  If the 
364.31  commissioner asks for additional information under this 
364.32  subdivision, the 30-day time limit in subdivision 2 does not 
364.33  include the time during which the insurer is preparing the 
364.34  requested information. 
364.35     [EFFECTIVE DATE.] This section is effective the day 
364.36  following final enactment. 
365.1      Sec. 9.  [62S.081] [REQUIRED DISCLOSURE OF RATING PRACTICES 
365.2   TO CONSUMERS.] 
365.3      Subdivision 1.  [APPLICATION.] This section applies as 
365.4   follows: 
365.5      (a) Except as provided in paragraph (b), this section 
365.6   applies to any long-term care policy or certificate issued in 
365.7   this state on or after January 1, 2002. 
365.8      (b) For certificates issued on or after the effective date 
365.9   of this section under a policy of group long-term care insurance 
365.10  as defined in section 62S.01, subdivision 15, that was in force 
365.11  on the effective date of this section, this section applies on 
365.12  the policy anniversary following June 30, 2002. 
365.13     Subd. 2.  [REQUIRED DISCLOSURES.] Other than policies for 
365.14  which no applicable premium rate or rate schedule increases can 
365.15  be made, insurers shall provide all of the information listed in 
365.16  this subdivision to the applicant at the time of application or 
365.17  enrollment, unless the method of application does not allow for 
365.18  delivery at that time; in this case, an insurer shall provide 
365.19  all of the information listed in this subdivision to the 
365.20  applicant no later than at the time of delivery of the policy or 
365.21  certificate: 
365.22     (1) a statement that the policy may be subject to rate 
365.23  increases in the future; 
365.24     (2) an explanation of potential future premium rate 
365.25  revisions and the policyholder's or certificate holder's option 
365.26  in the event of a premium rate revision; 
365.27     (3) the premium rate or rate schedules applicable to the 
365.28  applicant that will be in effect until a request is made for an 
365.29  increase; 
365.30     (4) a general explanation of applying premium rate or rate 
365.31  schedule adjustments that must include: 
365.32     (i) a description of when premium rate or rate schedule 
365.33  adjustments will be effective, for example the next anniversary 
365.34  date or the next billing date; and 
365.35     (ii) the right to a revised premium rate or rate schedule 
365.36  as provided in clause (3) if the premium rate or rate schedule 
366.1   is changed; and 
366.2      (5)(i) information regarding each premium rate increase on 
366.3   this policy form or similar policy forms over the past ten years 
366.4   for this state or any other state that, at a minimum, identifies:
366.5      (A) the policy forms for which premium rates have been 
366.6   increased; 
366.7      (B) the calendar years when the form was available for 
366.8   purchase; and 
366.9      (C) the amount or percent of each increase.  The percentage 
366.10  may be expressed as a percentage of the premium rate prior to 
366.11  the increase and may also be expressed as minimum and maximum 
366.12  percentages if the rate increase is variable by rating 
366.13  characteristics; 
366.14     (ii) the insurer may, in a fair manner, provide additional 
366.15  explanatory information related to the rate increases; 
366.16     (iii) an insurer has the right to exclude from the 
366.17  disclosure premium rate increases that apply only to blocks of 
366.18  business acquired from other nonaffiliated insurers or the 
366.19  long-term care policies acquired from other nonaffiliated 
366.20  insurers when those increases occurred prior to the acquisition; 
366.21     (iv) if an acquiring insurer files for a rate increase on a 
366.22  long-term care policy form acquired from nonaffiliated insurers 
366.23  or a block of policy forms acquired from nonaffiliated insurers 
366.24  on or before the later of the effective date of this section, or 
366.25  the end of a 24-month period following the acquisition of the 
366.26  block of policies, the acquiring insurer may exclude that rate 
366.27  increase from the disclosure.  However, the nonaffiliated 
366.28  selling company must include the disclosure of that rate 
366.29  increase according to item (i); and 
366.30     (v) if the acquiring insurer in item (iv) files for a 
366.31  subsequent rate increase, even within the 24-month period, on 
366.32  the same policy form acquired from nonaffiliated insurers or 
366.33  block of policy forms acquired from nonaffiliated insurers 
366.34  referenced in item (iv), the acquiring insurer shall make all 
366.35  disclosures required by this subdivision, including disclosure 
366.36  of the earlier rate increase referenced in item (iv). 
367.1      Subd. 3.  [ACKNOWLEDGMENT.] An applicant shall sign an 
367.2   acknowledgment at the time of application, unless the method of 
367.3   application does not allow for signature at that time, that the 
367.4   insurer made the disclosure required under subdivision 2.  If, 
367.5   due to the method of application, the applicant cannot sign an 
367.6   acknowledgment at the time of application, the applicant shall 
367.7   sign no later than at the time of delivery of the policy or 
367.8   certificate. 
367.9      Subd. 4.  [FORMS.] An insurer shall use the forms in 
367.10  Appendices B and F of the Long-term Care Insurance Model 
367.11  Regulation adopted by the National Association of Insurance 
367.12  Commissioners to comply with the requirements of subdivisions 1 
367.13  and 2. 
367.14     Subd. 5.  [NOTICE OF INCREASE.] An insurer shall provide 
367.15  notice of an upcoming premium rate schedule increase, after the 
367.16  increase has been approved by the commissioner, to all 
367.17  policyholders or certificate holders, if applicable, at least 45 
367.18  days prior to the implementation of the premium rate schedule 
367.19  increase by the insurer.  The notice must include the 
367.20  information required by subdivision 2 when the rate increase is 
367.21  implemented. 
367.22     [EFFECTIVE DATE.] This section is effective the day 
367.23  following final enactment. 
367.24     Sec. 10.  Minnesota Statutes 2000, section 62S.26, is 
367.25  amended to read: 
367.26     62S.26 [LOSS RATIO.] 
367.27     (a) The minimum loss ratio must be at least 60 percent, 
367.28  calculated in a manner which provides for adequate reserving of 
367.29  the long-term care insurance risk.  In evaluating the expected 
367.30  loss ratio, the commissioner shall give consideration to all 
367.31  relevant factors, including: 
367.32     (1) statistical credibility of incurred claims experience 
367.33  and earned premiums; 
367.34     (2) the period for which rates are computed to provide 
367.35  coverage; 
367.36     (3) experienced and projected trends; 
368.1      (4) concentration of experience within early policy 
368.2   duration; 
368.3      (5) expected claim fluctuation; 
368.4      (6) experience refunds, adjustments, or dividends; 
368.5      (7) renewability features; 
368.6      (8) all appropriate expense factors; 
368.7      (9) interest; 
368.8      (10) experimental nature of the coverage; 
368.9      (11) policy reserves; 
368.10     (12) mix of business by risk classification; and 
368.11     (13) product features such as long elimination periods, 
368.12  high deductibles, and high maximum limits. 
368.13     (b) This section does not apply to policies or certificates 
368.14  that are subject to sections 62S.021, 62S.081, and 62S.265, and 
368.15  that comply with those sections. 
368.16     [EFFECTIVE DATE.] This section is effective the day 
368.17  following final enactment. 
368.18     Sec. 11.  [62S.265] [PREMIUM RATE SCHEDULE INCREASES.] 
368.19     Subdivision 1.  [APPLICABILITY.] (a) Except as provided in 
368.20  paragraph (b), this section applies to any long-term care policy 
368.21  or certificate issued in this state on or after January 1, 2002, 
368.22  under this chapter or sections 62A.46 to 62A.56. 
368.23     (b) For certificates issued on or after the effective date 
368.24  of this section under a group long-term care insurance policy as 
368.25  defined in section 62S.01, subdivision 15, issued under this 
368.26  chapter, that was in force on the effective date of this 
368.27  section, this section applies on the policy anniversary 
368.28  following June 30, 2002. 
368.29     Subd. 2.  [NOTICE.] An insurer shall file a requested 
368.30  premium rate schedule increase, including an exceptional 
368.31  increase, to the commissioner for prior approval at least 60 
368.32  days prior to the notice to the policyholders and shall include: 
368.33     (1) all information required by section 62S.081; 
368.34     (2) certification by a qualified actuary that: 
368.35     (i) if the requested premium rate schedule increase is 
368.36  implemented and the underlying assumptions, which reflect 
369.1   moderately adverse conditions, are realized, no further premium 
369.2   rate schedule increases are anticipated; and 
369.3      (ii) the premium rate filing complies with this section; 
369.4      (3) an actuarial memorandum justifying the rate schedule 
369.5   change request that includes: 
369.6      (i) lifetime projections of earned premiums and incurred 
369.7   claims based on the filed premium rate schedule increase and the 
369.8   method and assumptions used in determining the projected values, 
369.9   including reflection of any assumptions that deviate from those 
369.10  used for pricing other forms currently available for sale; 
369.11     (A) annual values for the five years preceding and the 
369.12  three years following the valuation date must be provided 
369.13  separately; 
369.14     (B) the projections must include the development of the 
369.15  lifetime loss ratio, unless the rate increase is an exceptional 
369.16  increase; 
369.17     (C) the projections must demonstrate compliance with 
369.18  subdivision 3; and 
369.19     (D) for exceptional increases, the projected experience 
369.20  must be limited to the increases in claims expenses attributable 
369.21  to the approved reasons for the exceptional increase and, if the 
369.22  commissioner determines that offsets to higher claim costs may 
369.23  exist, the insurer shall use appropriate net projected 
369.24  experience; 
369.25     (ii) disclosure of how reserves have been incorporated in 
369.26  this rate increase whenever the rate increase will trigger 
369.27  contingent benefit upon lapse; 
369.28     (iii) disclosure of the analysis performed to determine why 
369.29  a rate adjustment is necessary, which pricing assumptions were 
369.30  not realized and why, and what other actions taken by the 
369.31  company have been relied upon by the actuary; 
369.32     (iv) a statement that policy design, underwriting, and 
369.33  claims adjudication practices have been taken into 
369.34  consideration; and 
369.35     (v) if it is necessary to maintain consistent premium rates 
369.36  for new certificates and certificates receiving a rate increase, 
370.1   the insurer shall file composite rates reflecting projections of 
370.2   new certificates; 
370.3      (4) a statement that renewal premium rate schedules are not 
370.4   greater than new business premium rate schedules except for 
370.5   differences attributable to benefits, unless sufficient 
370.6   justification is provided to the commissioner; and 
370.7      (5) sufficient information for review and approval of the 
370.8   premium rate schedule increase by the commissioner. 
370.9      Subd. 3.  [REQUIREMENTS PERTAINING TO RATE INCREASES.] All 
370.10  premium rate schedule increases must be determined according to 
370.11  the following requirements: 
370.12     (1) exceptional increases must provide that 70 percent of 
370.13  the present value of projected additional premiums from the 
370.14  exceptional increase will be returned to policyholders in 
370.15  benefits; 
370.16     (2) premium rate schedule increases must be calculated so 
370.17  that the sum of the accumulated value of incurred claims, 
370.18  without the inclusion of active life reserves, and the present 
370.19  value of future projected incurred claims, without the inclusion 
370.20  of active life reserves, will not be less than the sum of the 
370.21  following: 
370.22     (i) the accumulated value of the initial earned premium 
370.23  times 58 percent; 
370.24     (ii) 85 percent of the accumulated value of prior premium 
370.25  rate schedule increases on an earned basis; 
370.26     (iii) the present value of future projected initial earned 
370.27  premiums times 58 percent; and 
370.28     (iv) 85 percent of the present value of future projected 
370.29  premiums not in item (iii) on an earned basis; 
370.30     (3) if a policy form has both exceptional and other 
370.31  increases, the values in clause (2), items (ii) and (iv), must 
370.32  also include 70 percent for exceptional rate increase amounts; 
370.33  and 
370.34     (4) all present and accumulated values used to determine 
370.35  rate increases must use the maximum valuation interest rate for 
370.36  contract reserves permitted for valuation of whole life 
371.1   insurance policies issued in this state on the same date.  The 
371.2   actuary shall disclose as part of the actuarial memorandum the 
371.3   use of any appropriate averages. 
371.4      Subd. 4.  [PROJECTIONS.] For each rate increase that is 
371.5   implemented, the insurer shall file for approval by the 
371.6   commissioner updated projections, as described in subdivision 2, 
371.7   clause (3), item (i), annually for the next three years and 
371.8   include a comparison of actual results to projected values.  The 
371.9   commissioner may extend the period to greater than three years 
371.10  if actual results are not consistent with projected values from 
371.11  prior projections.  For group insurance policies that meet the 
371.12  conditions in subdivision 11, the projections required by this 
371.13  subdivision must be provided to the policyholder in lieu of 
371.14  filing with the commissioner. 
371.15     Subd. 5.  [LIFETIME PROJECTIONS.] If any premium rate in 
371.16  the revised premium rate schedule is greater than 200 percent of 
371.17  the comparable rate in the initial premium schedule, lifetime 
371.18  projections, as described in subdivision 2, clause (3), item 
371.19  (i), must be filed for approval by the commissioner every five 
371.20  years following the end of the required period in subdivision 
371.21  4.  For group insurance policies that meet the conditions in 
371.22  subdivision 11, the projections required by this subdivision 
371.23  must be provided to the policyholder in lieu of filing with the 
371.24  commissioner. 
371.25     Subd. 6.  [EFFECT OF ACTUAL EXPERIENCE.] (a) If the 
371.26  commissioner has determined that the actual experience following 
371.27  a rate increase does not adequately match the projected 
371.28  experience and that the current projections under moderately 
371.29  adverse conditions demonstrate that incurred claims will not 
371.30  exceed proportions of premiums specified in subdivision 3, the 
371.31  commissioner may require the insurer to implement any of the 
371.32  following: 
371.33     (1) premium rate schedule adjustments; or 
371.34     (2) other measures to reduce the difference between the 
371.35  projected and actual experience. 
371.36     (b) In determining whether the actual experience adequately 
372.1   matches the projected experience, consideration must be given to 
372.2   subdivision 2, clause (3), item (v), if applicable. 
372.3      Subd. 7.  [CONTINGENT BENEFIT UPON LAPSE.] If the majority 
372.4   of the policies or certificates to which the increase is 
372.5   applicable are eligible for the contingent benefit upon lapse, 
372.6   the insurer shall file: 
372.7      (1) a plan, subject to commissioner approval, for improved 
372.8   administration or claims processing designed to eliminate the 
372.9   potential for further deterioration of the policy form requiring 
372.10  further premium rate schedule increases, or both, or a 
372.11  demonstration that appropriate administration and claims 
372.12  processing have been implemented or are in effect; otherwise, 
372.13  the commissioner may impose the condition in subdivision 8, 
372.14  paragraph (b); and 
372.15     (2) the original anticipated lifetime loss ratio, and the 
372.16  premium rate schedule increase that would have been calculated 
372.17  according to subdivision 3 had the greater of the original 
372.18  anticipated lifetime loss ratio or 58 percent been used in the 
372.19  calculations described in subdivision 3, clause (2), items (i) 
372.20  and (iii). 
372.21     Subd. 8.  [PROJECTED LAPSE RATES.] (a) For a rate increase 
372.22  filing that meets the following criteria, the commissioner shall 
372.23  review, for all policies included in the filing, the projected 
372.24  lapse rates and past lapse rates during the 12 months following 
372.25  each increase to determine if significant adverse lapsation has 
372.26  occurred or is anticipated: 
372.27     (1) the rate increase is not the first rate increase 
372.28  requested for the specific policy form or forms; 
372.29     (2) the rate increase is not an exceptional increase; and 
372.30     (3) the majority of the policies or certificates to which 
372.31  the increase is applicable are eligible for the contingent 
372.32  benefit upon lapse. 
372.33     (b) If significant adverse lapsation has occurred, is 
372.34  anticipated in the filing, or is evidenced in the actual results 
372.35  as presented in the updated projections provided by the insurer 
372.36  following the requested rate increase, the commissioner may 
373.1   determine that a rate spiral exists.  Following the 
373.2   determination that a rate spiral exists, the commissioner may 
373.3   require the insurer to offer, without underwriting, to all 
373.4   in-force insureds subject to the rate increase, the option to 
373.5   replace existing coverage with one or more reasonably comparable 
373.6   products being offered by the insurer or its affiliates.  The 
373.7   offer must: 
373.8      (1) be subject to the approval of the commissioner; 
373.9      (2) be based upon actuarially sound principles, but not be 
373.10  based upon attained age; and 
373.11     (3) provide that maximum benefits under any new policy 
373.12  accepted by an insured are reduced by comparable benefits 
373.13  already paid under the existing policy. 
373.14     (c) The insurer shall maintain the experience of all the 
373.15  replacement insureds separate from the experience of insureds 
373.16  originally issued the policy forms.  In the event of a request 
373.17  for a rate increase on the policy form, the rate increase must 
373.18  be limited to the lesser of the maximum rate increase determined 
373.19  based on the combined experience and the maximum rate increase 
373.20  determined based only upon the experience of the insureds 
373.21  originally issued the form plus ten percent. 
373.22     Subd. 9.  [PERSISTENT PRACTICE OF INADEQUATE INITIAL 
373.23  RATES.] If the commissioner determines that the insurer has 
373.24  exhibited a persistent practice of filing inadequate initial 
373.25  premium rates for long-term care insurance, the commissioner 
373.26  may, in addition to the provisions of subdivision 8, prohibit 
373.27  the insurer from either of the following: 
373.28     (1) filing and marketing comparable coverage for a period 
373.29  of up to five years; or 
373.30     (2) offering all other similar coverages and limiting 
373.31  marketing of new applications to the products subject to recent 
373.32  premium rate schedule increases. 
373.33     Subd. 10.  [INCIDENTAL LONG-TERM CARE 
373.34  BENEFITS.] Subdivisions 1 to 9 do not apply to policies for 
373.35  which the long-term care benefits provided by the policy are 
373.36  incidental, as defined in section 62S.01, subdivision 17a, if 
374.1   the policy complies with all of the following provisions: 
374.2      (1) the interest credited internally to determine cash 
374.3   value accumulations, including long-term care, if any, are 
374.4   guaranteed not to be less than the minimum guaranteed interest 
374.5   rate for cash value accumulations without long-term care set 
374.6   forth in the policy; 
374.7      (2) the portion of the policy that provides insurance 
374.8   benefits other than long-term care coverage meets the 
374.9   nonforfeiture requirements as applicable in any of the following:
374.10     (i) for life insurance, section 61A.25; 
374.11     (ii) for individual deferred annuities, section 61A.245; 
374.12  and 
374.13     (iii) for variable annuities, section 61A.21; 
374.14     (3) the policy meets the disclosure requirements of 
374.15  sections 62S.10 and 62S.11 if the policy is governed by chapter 
374.16  62S and of section 62A.50 if the policy is governed by sections 
374.17  62A.46 to 62A.56; 
374.18     (4) the portion of the policy that provides insurance 
374.19  benefits other than long-term care coverage meets the 
374.20  requirements as applicable in the following: 
374.21     (i) policy illustrations to the extent required by state 
374.22  law applicable to life insurance; 
374.23     (ii) disclosure requirements in state law applicable to 
374.24  annuities; and 
374.25     (iii) disclosure requirements applicable to variable 
374.26  annuities; and 
374.27     (5) an actuarial memorandum is filed with the commissioner 
374.28  that includes: 
374.29     (i) a description of the basis on which the long-term care 
374.30  rates were determined; 
374.31     (ii) a description of the basis for the reserves; 
374.32     (iii) a summary of the type of policy, benefits, 
374.33  renewability, general marketing method, and limits on ages of 
374.34  issuance; 
374.35     (iv) a description and a table of each actuarial assumption 
374.36  used.  For expenses, an insurer must include percent of premium 
375.1   dollars per policy and dollars per unit of benefits, if any; 
375.2      (v) a description and a table of the anticipated policy 
375.3   reserves and additional reserves to be held in each future year 
375.4   for active lives; 
375.5      (vi) the estimated average annual premium per policy and 
375.6   the average issue age; 
375.7      (vii) a statement as to whether underwriting is performed 
375.8   at the time of application.  The statement must indicate whether 
375.9   underwriting is used and, if used, the statement shall include a 
375.10  description of the type or types of underwriting used, such as 
375.11  medical underwriting or functional assessment underwriting.  
375.12  Concerning a group policy, the statement must indicate whether 
375.13  the enrollee or any dependent will be underwritten and when 
375.14  underwriting occurs; and 
375.15     (viii) a description of the effect of the long-term care 
375.16  policy provision on the required premiums, nonforfeiture values, 
375.17  and reserves on the underlying insurance policy, both for active 
375.18  lives and those in long-term care claim status. 
375.19     Subd. 11.  [LARGE GROUP POLICIES.] Subdivisions 6 and 9 do 
375.20  not apply to group long-term care insurance policies as defined 
375.21  in section 62S.01, subdivision 15, where: 
375.22     (1) the policies insure 250 or more persons, and the 
375.23  policyholder has 5,000 or more eligible employees of a single 
375.24  employer; or 
375.25     (2) the policyholder, and not the certificate holders, pays 
375.26  a material portion of the premium, which is not less than 20 
375.27  percent of the total premium for the group in the calendar year 
375.28  prior to the year in which a rate increase is filed. 
375.29     [EFFECTIVE DATE.] This section is effective the day 
375.30  following final enactment. 
375.31     Sec. 12.  [62S.266] [NONFORFEITURE BENEFIT REQUIREMENT.] 
375.32     Subdivision 1.  [APPLICABILITY.] This section does not 
375.33  apply to life insurance policies or riders containing 
375.34  accelerated long-term care benefits. 
375.35     Subd. 2.  [REQUIREMENT.] An insurer must offer each 
375.36  prospective policyholder a nonforfeiture benefit in compliance 
376.1   with the following requirements: 
376.2      (1) a policy or certificate offered with nonforfeiture 
376.3   benefits must have coverage elements, eligibility, benefit 
376.4   triggers, and benefit length that are the same as coverage to be 
376.5   issued without nonforfeiture benefits.  The nonforfeiture 
376.6   benefit included in the offer must be the benefit described in 
376.7   subdivision 5; and 
376.8      (2) the offer must be in writing if the nonforfeiture 
376.9   benefit is not otherwise described in the outline of coverage or 
376.10  other materials given to the prospective policyholder. 
376.11     Subd. 3.  [EFFECT OF REJECTION OF OFFER.] If the offer 
376.12  required to be made under subdivision 2 is rejected, the insurer 
376.13  shall provide the contingent benefit upon lapse described in 
376.14  this section. 
376.15     Subd. 4.  [CONTINGENT BENEFIT UPON LAPSE.] (a) After 
376.16  rejection of the offer required under subdivision 2, for 
376.17  individual and group policies without nonforfeiture benefits 
376.18  issued after the effective date of this section, the insurer 
376.19  shall provide a contingent benefit upon lapse. 
376.20     (b) If a group policyholder elects to make the 
376.21  nonforfeiture benefit an option to the certificate holder, a 
376.22  certificate shall provide either the nonforfeiture benefit or 
376.23  the contingent benefit upon lapse. 
376.24     (c) The contingent benefit on lapse must be triggered every 
376.25  time an insurer increases the premium rates to a level which 
376.26  results in a cumulative increase of the annual premium equal to 
376.27  or exceeding the percentage of the insured's initial annual 
376.28  premium based on the insured's issue age provided in this 
376.29  paragraph, and the policy or certificate lapses within 120 days 
376.30  of the due date of the premium increase.  Unless otherwise 
376.31  required, policyholders shall be notified at least 30 days prior 
376.32  to the due date of the premium reflecting the rate increase. 
376.33           Triggers for a Substantial Premium Increase 
376.34                      Percent Increase
376.35       Issue Age      Over Initial Premium
376.36       29 and Under            200
377.1           30-34                190
377.2           35-39                170
377.3           40-44                150
377.4           45-49                130
377.5           50-54                110
377.6           55-59                 90
377.7              60                 70
377.8              61                 66
377.9              62                 62
377.10             63                 58
377.11             64                 54
377.12             65                 50
377.13             66                 48
377.14             67                 46
377.15             68                 44
377.16             69                 42
377.17             70                 40
377.18             71                 38
377.19             72                 36
377.20             73                 34
377.21             74                 32
377.22             75                 30
377.23             76                 28
377.24             77                 26
377.25             78                 24
377.26             79                 22
377.27             80                 20
377.28             81                 19
377.29             82                 18
377.30             83                 17
377.31             84                 16
377.32             85                 15
377.33             86                 14
377.34             87                 13
377.35             88                 12
377.36             89                 11
378.1          90 and over            10
378.2      (d) On or before the effective date of a substantial 
378.3   premium increase as defined in paragraph (c), the insurer shall: 
378.4      (1) offer to reduce policy benefits provided by the current 
378.5   coverage without the requirement of additional underwriting so 
378.6   that required premium payments are not increased; 
378.7      (2) offer to convert the coverage to a paid-up status with 
378.8   a shortened benefit period according to the terms of subdivision 
378.9   5.  This option may be elected at any time during the 120-day 
378.10  period referenced in paragraph (c); and 
378.11     (3) notify the policyholder or certificate holder that a 
378.12  default or lapse at any time during the 120-day period 
378.13  referenced in paragraph (c) is deemed to be the election of the 
378.14  offer to convert in clause (2). 
378.15     Subd. 5.  [NONFORFEITURE BENEFITS; REQUIREMENTS.] (a) 
378.16  Benefits continued as nonforfeiture benefits, including 
378.17  contingent benefits upon lapse, must be as described in this 
378.18  subdivision. 
378.19     (b) For purposes of this subdivision, "attained age rating" 
378.20  is defined as a schedule of premiums starting from the issue 
378.21  date which increases with age at least one percent per year 
378.22  prior to age 50, and at least three percent per year beyond age 
378.23  50. 
378.24     (c) For purposes of this subdivision, the nonforfeiture 
378.25  benefit must be of a shortened benefit period providing paid-up, 
378.26  long-term care insurance coverage after lapse.  The same 
378.27  benefits, amounts, and frequency in effect at the time of lapse, 
378.28  but not increased thereafter, will be payable for a qualifying 
378.29  claim, but the lifetime maximum dollars or days of benefits must 
378.30  be determined as specified in paragraph (d). 
378.31     (d) The standard nonforfeiture credit will be equal to 100 
378.32  percent of the sum of all premiums paid, including the premiums 
378.33  paid prior to any changes in benefits.  The insurer may offer 
378.34  additional shortened benefit period options, so long as the 
378.35  benefits for each duration equal or exceed the standard 
378.36  nonforfeiture credit for that duration.  However, the minimum 
379.1   nonforfeiture credit must not be less than 30 times the daily 
379.2   nursing home benefit at the time of lapse.  In either event, the 
379.3   calculation of the nonforfeiture credit is subject to the 
379.4   limitation of this subdivision. 
379.5      (e) The nonforfeiture benefit must begin not later than the 
379.6   end of the third year following the policy or certificate issue 
379.7   date.  The contingent benefit upon lapse must be effective 
379.8   during the first three years as well as thereafter. 
379.9      (f) Notwithstanding paragraph (e), for a policy or 
379.10  certificate with attained age rating, the nonforfeiture benefit 
379.11  must begin on the earlier of: 
379.12     (1) the end of the tenth year following the policy or 
379.13  certificate issue date; or 
379.14     (2) the end of the second year following the date the 
379.15  policy or certificate is no longer subject to attained age 
379.16  rating. 
379.17     (g) Nonforfeiture credits may be used for all care and 
379.18  services qualifying for benefits under the terms of the policy 
379.19  or certificate, up to the limits specified in the policy or 
379.20  certificate. 
379.21     Subd. 6.  [BENEFIT LIMIT.] All benefits paid by the insurer 
379.22  while the policy or certificate is in premium-paying status and 
379.23  in the paid-up status will not exceed the maximum benefits which 
379.24  would be payable if the policy or certificate had remained in 
379.25  premium-paying status. 
379.26     Subd. 7.  [MINIMUM BENEFITS; INDIVIDUAL AND GROUP 
379.27  POLICIES.] There must be no difference in the minimum 
379.28  nonforfeiture benefits as required under this section for group 
379.29  and individual policies. 
379.30     Subd. 8.  [APPLICATION; EFFECTIVE DATES.] This section 
379.31  becomes effective January 1, 2002, and applies as follows: 
379.32     (a) Except as provided in paragraph (b), this section 
379.33  applies to any long-term care policy issued in this state on or 
379.34  after the effective date of this section. 
379.35     (b) For certificates issued on or after the effective date 
379.36  of this section, under a group long-term care insurance policy 
380.1   that was in force on the effective date of this section, the 
380.2   provisions of this section do not apply. 
380.3      Subd. 9.  [EFFECT ON LOSS RATIO.] Premiums charged for a 
380.4   policy or certificate containing nonforfeiture benefits or a 
380.5   contingent benefit on lapse are subject to the loss ratio 
380.6   requirements of section 62A.48, subdivision 4, or 62S.26, 
380.7   treating the policy as a whole, except for policies or 
380.8   certificates that are subject to sections 62S.021, 62S.081, and 
380.9   62S.265 and that comply with those sections. 
380.10     Subd. 10.  [PURCHASED BLOCKS OF BUSINESS.] To determine 
380.11  whether contingent nonforfeiture upon lapse provisions are 
380.12  triggered under subdivision 4, paragraph (c), a replacing 
380.13  insurer that purchased or otherwise assumed a block or blocks of 
380.14  long-term care insurance policies from another insurer shall 
380.15  calculate the percentage increase based on the initial annual 
380.16  premium paid by the insured when the policy was first purchased 
380.17  from the original insurer. 
380.18     Subd. 11.  [LEVEL PREMIUM CONTRACTS.] A nonforfeiture 
380.19  benefit for qualified long-term care insurance contracts that 
380.20  are level premium contracts must be offered that meets the 
380.21  following requirements: 
380.22     (1) the nonforfeiture provision must be appropriately 
380.23  captioned; 
380.24     (2) the nonforfeiture provision must provide a benefit 
380.25  available in the event of a default in the payment of any 
380.26  premiums and must state that the amount of the benefit may be 
380.27  adjusted subsequent to being initially granted only as necessary 
380.28  to reflect changes in claims, persistency, and interest as 
380.29  reflected in changes in rates for premium paying contracts 
380.30  approved by the commissioner for the same contract form; and 
380.31     (3) the nonforfeiture provision must provide at least one 
380.32  of the following: 
380.33     (i) reduced paid-up insurance; 
380.34     (ii) extended term insurance; 
380.35     (iii) shortened benefit period; or 
380.36     (iv) other similar offerings approved by the commissioner. 
381.1      [EFFECTIVE DATE.] This section is effective the day 
381.2   following final enactment. 
381.3      Sec. 13.  Minnesota Statutes 2000, section 256.975, is 
381.4   amended by adding a subdivision to read: 
381.5      Subd. 8.  [PROMOTION OF LONG-TERM CARE INSURANCE.] The 
381.6   Minnesota board on aging, either directly or through contract, 
381.7   shall promote the provision of employer-sponsored, long-term 
381.8   care insurance.  The board shall encourage private and public 
381.9   sector employers to make long-term care insurance available to 
381.10  employees, provide interested employers with information on the 
381.11  long-term care insurance product offered to state employees, and 
381.12  provide technical assistance to employers in designing long-term 
381.13  care insurance products and contacting companies offering 
381.14  long-term care insurance products. 
381.15                             ARTICLE 9 
381.16                 MENTAL HEALTH AND CIVIL COMMITMENT 
381.17     Section 1.  [62Q.471] [EXCLUSION FOR SUICIDE ATTEMPTS 
381.18  PROHIBITED.] 
381.19     (a) No health plan may exclude or reduce coverage for 
381.20  health care for an enrollee that is otherwise covered under the 
381.21  health plan, on the basis that the need for the health care 
381.22  arose out of a suicide or suicide attempt by the enrollee. 
381.23     (b) For purposes of this section, "health plan" has the 
381.24  meaning given in section 62Q.01, subdivision 3, but includes the 
381.25  coverages described in section 62A.011, clauses (7) and (10). 
381.26     [EFFECTIVE DATE.] This section is effective January 1, 
381.27  2002, and applies to contracts issued or renewed on or after 
381.28  that date. 
381.29     Sec. 2.  [62Q.527] [COVERAGE OF NONFORMULARY DRUGS FOR 
381.30  MENTAL ILLNESS AND EMOTIONAL DISTURBANCE.] 
381.31     Subdivision 1.  [DEFINITIONS.] (a) For purposes of this 
381.32  section, the following terms have the meanings given to them. 
381.33     (b) "Emotional disturbance" has the meaning given in 
381.34  section 245.4871, subdivision 15. 
381.35     (c) "Mental illness" has the meaning given in section 
381.36  245.462, subdivision 20, paragraph (a). 
382.1      (d) "Health plan" has the meaning given in section 62Q.01, 
382.2   subdivision 3, but includes the coverages described in clauses 
382.3   (7) and (10).  
382.4      Subd. 2.  [REQUIRED COVERAGE.] A health plan that provides 
382.5   prescription drug coverage must provide coverage for an 
382.6   antipsychotic drug prescribed to treat emotional disturbance or 
382.7   mental illness regardless of whether the drug is in the health 
382.8   plan's drug formulary, if the health care provider prescribing 
382.9   the drug: 
382.10     (1) indicates to the dispensing pharmacist, orally or in 
382.11  writing according to section 151.21, that the prescription must 
382.12  be dispensed as communicated; and 
382.13     (2) certifies in writing to the health plan company that 
382.14  the drug prescribed will best treat the patient's condition.  
382.15  The health plan is not required to provide coverage for the drug 
382.16  if the drug was removed from the formulary for safety reasons.  
382.17  For drugs covered under this section, no health plan company, 
382.18  which has received the certification from the health care 
382.19  provider, may: 
382.20     (i) impose a special deductible, copayment, coinsurance, or 
382.21  other special payment requirement that the health plan does not 
382.22  apply to drugs that are in the health plan's drug formulary; or 
382.23     (ii) require written certification from the prescribing 
382.24  provider each time a prescription is refilled or renewed that 
382.25  the drug prescribed will best treat the patient's condition. 
382.26     Subd. 3.  [CONTINUING CARE.] Enrollees receiving a 
382.27  prescribed drug to treat a diagnosed mental illness or emotional 
382.28  disturbance, may continue to receive the prescribed drug without 
382.29  the imposition of a special deductible, copayment, coinsurance, 
382.30  or other special payment requirements, when a health plan's drug 
382.31  formulary changes or an enrollee changes health plans and the 
382.32  medication has been shown to effectively treat the patient's 
382.33  condition.  In order to be eligible for this continuing care 
382.34  benefit: 
382.35     (1) the patient must have been treated with the drug for 90 
382.36  days prior to a change in a health plan's drug formulary or a 
383.1   change in the enrollee's health plan; 
383.2      (2) the health care provider prescribing the drug indicates 
383.3   to the dispensing pharmacist, orally or in writing according to 
383.4   section 151.21, that the prescription must be dispensed as 
383.5   communicated; and 
383.6      (3) annually certifies in writing to the health plan 
383.7   company that the drug prescribed will best treat the patient's 
383.8   condition.  The health plan is not required to provide coverage 
383.9   for the drug if the drug was removed from the formulary for 
383.10  safety reasons.  
383.11     Subd. 4.  [EXCEPTION TO FORMULARY.] A health plan company 
383.12  shall promptly grant an exception to the formulary when the 
383.13  health care provider prescribing the drug conveys to the health 
383.14  plan that: 
383.15     (1) the formulary drug causes an adverse reaction; 
383.16     (2) the formulary drug is contraindicated; or 
383.17     (3) the prescriber demonstrates to the health plan that a 
383.18  prescription drug must be dispensed as written to provide 
383.19  maximum medical benefit to the patient. 
383.20     [EFFECTIVE DATE.] This section is effective July 1, 2001, 
383.21  and applies to contracts issued or renewed on or after that date.
383.22     Sec. 3.  [62Q.535] [COVERAGE FOR COURT-ORDERED MENTAL 
383.23  HEALTH SERVICES.] 
383.24     Subdivision 1.  [MENTAL HEALTH SERVICES.] For purposes of 
383.25  this section, mental health services means all covered services 
383.26  that are intended to treat or ameliorate an emotional, 
383.27  behavioral, or psychiatric condition and that are covered by the 
383.28  policy, contract, or certificate of coverage of the enrollee's 
383.29  health plan company or by law. 
383.30     Subd. 2.  [COVERAGE REQUIRED.] All health plan companies 
383.31  that provide coverage for mental health services must cover or 
383.32  provide mental health services ordered by a court of competent 
383.33  jurisdiction under a court order that is issued on the basis of 
383.34  a behavioral care evaluation performed by a licensed 
383.35  psychiatrist or a doctoral level licensed psychologist, which 
383.36  includes a diagnosis and an individual treatment plan for care 
384.1   in the most appropriate, least restrictive environment.  The 
384.2   health plan company must be given a copy of the court order and 
384.3   the behavioral care evaluation.  The health plan company shall 
384.4   be financially liable for the evaluation if performed by a 
384.5   participating provider of the health plan company and shall be 
384.6   financially liable for the care included in the court-ordered 
384.7   individual treatment plan if the care is covered by the health 
384.8   plan and ordered to be provided by a participating provider or 
384.9   another provider as required by rule or law.  This court-ordered 
384.10  coverage must not be subject to a separate medical necessity 
384.11  determination by a health plan company under its utilization 
384.12  procedures.  
384.13     [EFFECTIVE DATE.] This section is effective July 1, 2001, 
384.14  and applies to contracts issued or renewed on or after that date.
384.15     Sec. 4.  [244.054] [DISCHARGE PLANS; OFFENDERS WITH SERIOUS 
384.16  AND PERSISTENT MENTAL ILLNESS.] 
384.17     Subdivision 1.  [OFFER TO DEVELOP PLAN.] The commissioner 
384.18  of human services, in collaboration with the commissioner of 
384.19  corrections, shall offer to develop a discharge plan for 
384.20  community-based services for every offender with serious and 
384.21  persistent mental illness, as defined in section 245.462, 
384.22  subdivision 20, paragraph (c), who is being released from a 
384.23  correctional facility.  If an offender is being released 
384.24  pursuant to section 244.05, the offender may choose to have the 
384.25  discharge plan made one of the conditions of the offender's 
384.26  supervised release and shall follow the conditions to the extent 
384.27  that services are available and offered to the offender. 
384.28     Subd. 2.  [CONTENT OF PLAN.] If an offender chooses to have 
384.29  a discharge plan developed, the commissioner of human services 
384.30  shall develop and implement a discharge plan, which must include 
384.31  at least the following: 
384.32     (1) at least 90 days before the offender is due to be 
384.33  discharged, the commissioner of human services shall designate 
384.34  an agent of the department of human services with mental health 
384.35  training to serve as the primary person responsible for carrying 
384.36  out discharge planning activities; 
385.1      (2) at least 75 days before the offender is due to be 
385.2   discharged, the offender's designated agent shall: 
385.3      (i) obtain informed consent and releases of information 
385.4   from the offender that are needed for transition services; 
385.5      (ii) contact the county human services department in the 
385.6   community where the offender expects to reside following 
385.7   discharge, and inform the department of the offender's impending 
385.8   discharge and the planned date of the offender's return to the 
385.9   community; determine whether the county or a designated 
385.10  contracted provider will provide case management services to the 
385.11  offender; refer the offender to the case management services 
385.12  provider; and confirm that the case management services provider 
385.13  will have opened the offender's case prior to the offender's 
385.14  discharge; and 
385.15     (iii) refer the offender to appropriate staff in the county 
385.16  human services department in the community where the offender 
385.17  expects to reside following discharge, for enrollment of the 
385.18  offender if eligible in medical assistance or general assistance 
385.19  medical care, using special procedures established by process 
385.20  and department of human services bulletin; 
385.21     (3) at least 2-1/2 months before discharge, the offender's 
385.22  designated agent shall secure timely appointments for the 
385.23  offender with a psychiatrist no later than 30 days following 
385.24  discharge, and with other program staff at a community mental 
385.25  health provider that is able to serve former offenders with 
385.26  serious and persistent mental illness; 
385.27     (4) at least 30 days before discharge, the offender's 
385.28  designated agent shall convene a predischarge assessment and 
385.29  planning meeting of key staff from the programs in which the 
385.30  offender has participated while in the correctional facility, 
385.31  the offender, and the supervising agent assigned to the 
385.32  offender.  At the meeting, attendees shall provide background 
385.33  information and continuing care recommendations for the 
385.34  offender, including information on the offender's risk for 
385.35  relapse; current medications, including dosage and frequency; 
385.36  therapy and behavioral goals; diagnostic and assessment 
386.1   information, including results of a chemical dependency 
386.2   evaluation; confirmation of appointments with a psychiatrist and 
386.3   other program staff in the community; a relapse prevention plan; 
386.4   continuing care needs; needs for housing, employment, and 
386.5   finance support and assistance; and recommendations for 
386.6   successful community integration, including chemical dependency 
386.7   treatment or support if chemical dependency is a risk factor.  
386.8   Immediately following this meeting, the offender's designated 
386.9   agent shall summarize this background information and continuing 
386.10  care recommendations in a written report; 
386.11     (5) immediately following the predischarge assessment and 
386.12  planning meeting, the provider of mental health case management 
386.13  services who will serve the offender following discharge shall 
386.14  offer to make arrangements and referrals for housing, financial 
386.15  support, benefits assistance, employment counseling, and other 
386.16  services required in sections 245.461 to 245.486; 
386.17     (6) at least ten days before the offender's first scheduled 
386.18  postdischarge appointment with a mental health provider, the 
386.19  offender's designated agent shall transfer the following records 
386.20  to the offender's case management services provider and 
386.21  psychiatrist:  the predischarge assessment and planning report, 
386.22  medical records, and pharmacy records.  These records may be 
386.23  transferred only if the offender provides informed consent for 
386.24  their release; 
386.25     (7) upon discharge, the offender's designated agent shall 
386.26  ensure that the offender leaves the correctional facility with 
386.27  at least a ten-day supply of all necessary medications; and 
386.28     (8) upon discharge, the prescribing authority at the 
386.29  offender's correctional facility shall telephone in 
386.30  prescriptions for all necessary medications to a pharmacy in the 
386.31  community where the offender plans to reside.  The prescriptions 
386.32  must provide at least a 30-day supply of all necessary 
386.33  medications, and must be able to be refilled once for one 
386.34  additional 30-day supply. 
386.35     Sec. 5.  [244.25] [TRANSITIONAL SERVICES FOR MENTALLY ILL 
386.36  OFFENDERS RELEASED FROM PRISON; PILOT PROGRAM.] 
387.1      The commissioner of corrections, in collaboration with the 
387.2   commissioner of human services, shall establish a pilot project 
387.3   grant program with goals and evaluation criteria and make grants 
387.4   to provide startup funding for two counties or two groups of 
387.5   counties to provide transitional housing and other community 
387.6   support services for former state inmates who have been 
387.7   diagnosed with a serious mental illness and who have been 
387.8   discharged from prison.  Grant applicants must submit a proposed 
387.9   comprehensive plan for providing the housing and support 
387.10  services and evaluating the provision of services, and must 
387.11  provide a 25 percent funding match.  The commissioner shall make 
387.12  grants available to successful applicants by February 1, 2002.  
387.13  Grant recipients are eligible for funding under this section for 
387.14  the first three years of operation of their programs for housing 
387.15  and support services.  
387.16     Sec. 6.  Minnesota Statutes 2000, section 245.462, is 
387.17  amended by adding a subdivision to read: 
387.18     Subd. 7a.  [CRISIS INTERVENTION SERVICES.] Crisis 
387.19  intervention services are short-term, intensive, nonresidential 
387.20  mental health services that include assessment, mental health 
387.21  rehabilitative services, and a crisis disposition plan.  Crisis 
387.22  intervention services are intended to help the recipient return 
387.23  to a baseline level of functioning or prevent further harmful 
387.24  consequences due to the psychiatric symptoms. 
387.25     Sec. 7.  Minnesota Statutes 2000, section 245.462, is 
387.26  amended by adding a subdivision to read: 
387.27     Subd. 7b.  [CRISIS STABILIZATION SERVICES.] "Crisis 
387.28  stabilization services" is defined in section 256B.0624, 
387.29  subdivision 2, paragraph (e). 
387.30     Sec. 8.  Minnesota Statutes 2000, section 245.462, is 
387.31  amended by adding a subdivision to read: 
387.32     Subd. 14a.  [MENTAL HEALTH CRISIS.] "Mental health crisis" 
387.33  is defined in section 256B.0624, subdivision 2, paragraph (a). 
387.34     Sec. 9.  Minnesota Statutes 2000, section 245.462, is 
387.35  amended by adding a subdivision to read: 
387.36     Subd. 14b.  [MENTAL HEALTH EMERGENCY.] "Mental health 
388.1   emergency" is defined in section 256B.0624, subdivision 2, 
388.2   paragraph (b). 
388.3      Sec. 10.  Minnesota Statutes 2000, section 245.462, is 
388.4   amended by adding a subdivision to read: 
388.5      Subd. 14c.  [MENTAL HEALTH CRISIS SERVICES.] "Mental health 
388.6   crisis services" means crisis assessment, crisis intervention, 
388.7   and crisis stabilization services.  
388.8      Sec. 11.  Minnesota Statutes 2000, section 245.462, 
388.9   subdivision 18, is amended to read: 
388.10     Subd. 18.  [MENTAL HEALTH PROFESSIONAL.] "Mental health 
388.11  professional" means a person providing clinical services in the 
388.12  treatment of mental illness who is qualified in at least one of 
388.13  the following ways:  
388.14     (1) in psychiatric nursing:  a registered nurse who is 
388.15  licensed under sections 148.171 to 148.285, and who is certified 
388.16  as a clinical specialist in adult psychiatric and mental health 
388.17  nursing by a national nurse certification organization or who 
388.18  has a master's degree in nursing or one of the behavioral 
388.19  sciences or related fields from an accredited college or 
388.20  university or its equivalent, with at least 4,000 hours of 
388.21  post-master's supervised experience in the delivery of clinical 
388.22  services in the treatment of mental illness; 
388.23     (2) in clinical social work:  a person licensed as an 
388.24  independent clinical social worker under section 148B.21, 
388.25  subdivision 6, or a person with a master's degree in social work 
388.26  from an accredited college or university, with at least 4,000 
388.27  hours of post-master's supervised experience in the delivery of 
388.28  clinical services in the treatment of mental illness; 
388.29     (3) in psychology:  a psychologist an individual licensed 
388.30  by the board of psychology under sections 148.88 to 148.98 who 
388.31  has stated to the board of psychology competencies in the 
388.32  diagnosis and treatment of mental illness; 
388.33     (4) in psychiatry:  a physician licensed under chapter 147 
388.34  and certified by the American board of psychiatry and neurology 
388.35  or eligible for board certification in psychiatry; 
388.36     (5) in marriage and family therapy:  the mental health 
389.1   professional must be a marriage and family therapist licensed 
389.2   under sections 148B.29 to 148B.39 with at least two years of 
389.3   post-master's supervised experience in the delivery of clinical 
389.4   services in the treatment of mental illness; or 
389.5      (6) in allied fields:  a person with a master's degree from 
389.6   an accredited college or university in one of the behavioral 
389.7   sciences or related fields, with at least 4,000 hours of 
389.8   post-master's supervised experience in the delivery of clinical 
389.9   services in the treatment of mental illness.  
389.10     Sec. 12.  Minnesota Statutes 2000, section 245.466, 
389.11  subdivision 2, is amended to read: 
389.12     Subd. 2.  [ADULT MENTAL HEALTH SERVICES.] The adult mental 
389.13  health service system developed by each county board must 
389.14  include the following services:  
389.15     (1) education and prevention services in accordance with 
389.16  section 245.468; 
389.17     (2) emergency services in accordance with section 245.469; 
389.18     (3) outpatient services in accordance with section 245.470; 
389.19     (4) community support program services in accordance with 
389.20  section 245.4711; 
389.21     (5) residential treatment services in accordance with 
389.22  section 245.472; 
389.23     (6) acute care hospital inpatient treatment services in 
389.24  accordance with section 245.473; 
389.25     (7) regional treatment center inpatient services in 
389.26  accordance with section 245.474; 
389.27     (8) screening in accordance with section 245.476; and 
389.28     (9) case management in accordance with sections 245.462, 
389.29  subdivision 3; and 245.4711; and 
389.30     (10) mental health crisis services in accordance with 
389.31  section 245.470, subdivision 3. 
389.32     Sec. 13.  Minnesota Statutes 2000, section 245.470, is 
389.33  amended by adding a subdivision to read: 
389.34     Subd. 3.  [MENTAL HEALTH CRISIS SERVICES.] County boards 
389.35  must provide or contract for enough mental health crisis 
389.36  services within the county to meet the needs of adults with 
390.1   mental illness residing in the county who are determined, 
390.2   through an assessment by a mental health professional, to be 
390.3   experiencing a mental health crisis or mental health emergency.  
390.4   The mental health crisis services provided must be medically 
390.5   necessary, as defined in section 62Q.53, subdivision 2, and 
390.6   appropriate or socially necessary for the safety of the adult or 
390.7   others regardless of the setting. 
390.8      Sec. 14.  Minnesota Statutes 2000, section 245.474, 
390.9   subdivision 2, is amended to read: 
390.10     Subd. 2.  [QUALITY OF SERVICE.] The commissioner shall 
390.11  biennially determine the needs of all adults with mental illness 
390.12  who are served by regional treatment centers or at any state 
390.13  facility or program as defined in section 246.50, subdivision 3, 
390.14  by administering a client-based evaluation system.  The 
390.15  client-based evaluation system must include at least the 
390.16  following independent measurements:  behavioral development 
390.17  assessment; habilitation program assessment; medical needs 
390.18  assessment; maladaptive behavioral assessment; and vocational 
390.19  behavior assessment.  The commissioner shall propose by rule 
390.20  establish staff ratios to the legislature for the mental health 
390.21  and support units in regional treatment centers as indicated by 
390.22  the results of the client-based evaluation system and the types 
390.23  of state-operated services needed.  The proposed staffing ratios 
390.24  shall include professional, nursing, direct care, medical, 
390.25  clerical, and support staff based on the client-based evaluation 
390.26  system.  The commissioner shall recompute staffing ratios 
390.27  and recommendations amend rules on staff ratios as necessary on 
390.28  a biennial basis.  
390.29     Sec. 15.  Minnesota Statutes 2000, section 245.474, is 
390.30  amended by adding a subdivision to read: 
390.31     Subd. 4.  [STAFF SAFETY TRAINING.] The commissioner shall 
390.32  by rule require all staff in mental health and support units at 
390.33  regional treatment centers who have contact with persons with 
390.34  mental illness or severe emotional disturbance to be 
390.35  appropriately trained in violence reduction and violence 
390.36  prevention, and shall establish criteria for such training.  
391.1   Training programs shall be developed with input from consumer 
391.2   advocacy organizations, and shall employ violence prevention 
391.3   techniques as preferable to physical interaction. 
391.4      Sec. 16.  Minnesota Statutes 2000, section 245.4871, is 
391.5   amended by adding a subdivision to read: 
391.6      Subd. 9b.  [CRISIS INTERVENTION SERVICES.] Crisis 
391.7   intervention services are short-term, intensive, nonresidential 
391.8   mental health services that include assessment, mental health 
391.9   rehabilitative services, and a crisis disposition plan.  Crisis 
391.10  intervention services are intended to help the recipient return 
391.11  to a baseline level of functioning or prevent further harmful 
391.12  consequences due to the psychiatric symptoms. 
391.13     Sec. 17.  Minnesota Statutes 2000, section 245.4871, is 
391.14  amended by adding a subdivision to read: 
391.15     Subd. 9c.  [CRISIS STABILIZATION SERVICES.] "Crisis 
391.16  stabilization services" is defined in section 256B.0624, 
391.17  subdivision 2, paragraph (e). 
391.18     Sec. 18.  Minnesota Statutes 2000, section 245.4871, is 
391.19  amended by adding a subdivision to read: 
391.20     Subd. 24a.  [MENTAL HEALTH CRISIS.] "Mental health crisis" 
391.21  is defined in section 256B.0624, subdivision 2, paragraph (a). 
391.22     Sec. 19.  Minnesota Statutes 2000, section 245.4871, is 
391.23  amended by adding a subdivision to read: 
391.24     Subd. 24b.  [MENTAL HEALTH EMERGENCY.] "Mental health 
391.25  emergency" is defined in section 256B.0624, subdivision 2, 
391.26  paragraph (b). 
391.27     Sec. 20.  Minnesota Statutes 2000, section 245.4871, is 
391.28  amended by adding a subdivision to read: 
391.29     Subd. 24c.  [MENTAL HEALTH CRISIS SERVICES.] "Mental health 
391.30  crisis services" means crisis assessment, crisis intervention, 
391.31  and crisis stabilization services.  
391.32     Sec. 21.  Minnesota Statutes 2000, section 245.4871, 
391.33  subdivision 27, is amended to read: 
391.34     Subd. 27.  [MENTAL HEALTH PROFESSIONAL.] "Mental health 
391.35  professional" means a person providing clinical services in the 
391.36  diagnosis and treatment of children's emotional disorders.  A 
392.1   mental health professional must have training and experience in 
392.2   working with children consistent with the age group to which the 
392.3   mental health professional is assigned.  A mental health 
392.4   professional must be qualified in at least one of the following 
392.5   ways:  
392.6      (1) in psychiatric nursing, the mental health professional 
392.7   must be a registered nurse who is licensed under sections 
392.8   148.171 to 148.285 and who is certified as a clinical specialist 
392.9   in child and adolescent psychiatric or mental health nursing by 
392.10  a national nurse certification organization or who has a 
392.11  master's degree in nursing or one of the behavioral sciences or 
392.12  related fields from an accredited college or university or its 
392.13  equivalent, with at least 4,000 hours of post-master's 
392.14  supervised experience in the delivery of clinical services in 
392.15  the treatment of mental illness; 
392.16     (2) in clinical social work, the mental health professional 
392.17  must be a person licensed as an independent clinical social 
392.18  worker under section 148B.21, subdivision 6, or a person with a 
392.19  master's degree in social work from an accredited college or 
392.20  university, with at least 4,000 hours of post-master's 
392.21  supervised experience in the delivery of clinical services in 
392.22  the treatment of mental disorders; 
392.23     (3) in psychology, the mental health professional must be a 
392.24  psychologist an individual licensed by the board of psychology 
392.25  under sections 148.88 to 148.98 who has stated to the board of 
392.26  psychology competencies in the diagnosis and treatment of mental 
392.27  disorders; 
392.28     (4) in psychiatry, the mental health professional must be a 
392.29  physician licensed under chapter 147 and certified by the 
392.30  American board of psychiatry and neurology or eligible for board 
392.31  certification in psychiatry; 
392.32     (5) in marriage and family therapy, the mental health 
392.33  professional must be a marriage and family therapist licensed 
392.34  under sections 148B.29 to 148B.39 with at least two years of 
392.35  post-master's supervised experience in the delivery of clinical 
392.36  services in the treatment of mental disorders or emotional 
393.1   disturbances; or 
393.2      (6) in allied fields, the mental health professional must 
393.3   be a person with a master's degree from an accredited college or 
393.4   university in one of the behavioral sciences or related fields, 
393.5   with at least 4,000 hours of post-master's supervised experience 
393.6   in the delivery of clinical services in the treatment of 
393.7   emotional disturbances. 
393.8      Sec. 22.  Minnesota Statutes 2000, section 245.4875, 
393.9   subdivision 2, is amended to read: 
393.10     Subd. 2.  [CHILDREN'S MENTAL HEALTH SERVICES.] The 
393.11  children's mental health service system developed by each county 
393.12  board must include the following services:  
393.13     (1) education and prevention services according to section 
393.14  245.4877; 
393.15     (2) mental health identification and intervention services 
393.16  according to section 245.4878; 
393.17     (3) emergency services according to section 245.4879; 
393.18     (4) outpatient services according to section 245.488; 
393.19     (5) family community support services according to section 
393.20  245.4881; 
393.21     (6) day treatment services according to section 245.4884, 
393.22  subdivision 2; 
393.23     (7) residential treatment services according to section 
393.24  245.4882; 
393.25     (8) acute care hospital inpatient treatment services 
393.26  according to section 245.4883; 
393.27     (9) screening according to section 245.4885; 
393.28     (10) case management according to section 245.4881; 
393.29     (11) therapeutic support of foster care according to 
393.30  section 245.4884, subdivision 4; and 
393.31     (12) professional home-based family treatment according to 
393.32  section 245.4884, subdivision 4; and 
393.33     (13) mental health crisis services according to section 
393.34  245.488, subdivision 3. 
393.35     Sec. 23.  Minnesota Statutes 2000, section 245.4876, 
393.36  subdivision 1, is amended to read: 
394.1      Subdivision 1.  [CRITERIA.] Children's mental health 
394.2   services required by sections 245.487 to 245.4888 must be:  
394.3      (1) based, when feasible, on research findings; 
394.4      (2) based on individual clinical, cultural, and ethnic 
394.5   needs, and other special needs of the children being served; 
394.6      (3) delivered in a manner that improves family functioning 
394.7   when clinically appropriate; 
394.8      (4) provided in the most appropriate, least restrictive 
394.9   setting that meets the requirements in subdivision 1a, and that 
394.10  is available to the county board to meet the child's treatment 
394.11  needs; 
394.12     (5) accessible to all age groups of children; 
394.13     (6) appropriate to the developmental age of the child being 
394.14  served; 
394.15     (7) delivered in a manner that provides accountability to 
394.16  the child for the quality of service delivered and continuity of 
394.17  services to the child during the years the child needs services 
394.18  from the local system of care; 
394.19     (8) provided by qualified individuals as required in 
394.20  sections 245.487 to 245.4888; 
394.21     (9) coordinated with children's mental health services 
394.22  offered by other providers; 
394.23     (10) provided under conditions that protect the rights and 
394.24  dignity of the individuals being served; and 
394.25     (11) provided in a manner and setting most likely to 
394.26  facilitate progress toward treatment goals. 
394.27     Sec. 24.  Minnesota Statutes 2000, section 245.4876, is 
394.28  amended by adding a subdivision to read: 
394.29     Subd. 1a.  [APPROPRIATE SETTING TO RECEIVE SERVICES.] A 
394.30  child must be provided with mental health services in the least 
394.31  restrictive setting that is appropriate to the needs and current 
394.32  condition of the individual child.  For a child to receive 
394.33  mental health services in a residential treatment or acute care 
394.34  hospital inpatient setting, the family may not be required to 
394.35  demonstrate that services were first provided in a less 
394.36  restrictive setting and that the child failed to make progress 
395.1   toward or meet treatment goals in the less restrictive setting. 
395.2      Sec. 25.  Minnesota Statutes 2000, section 245.488, is 
395.3   amended by adding a subdivision to read: 
395.4      Subd. 3.  [MENTAL HEALTH CRISIS SERVICES.] County boards 
395.5   must provide or contract for mental health crisis services 
395.6   within the county to meet the needs of children with emotional 
395.7   disturbance residing in the county who are determined, through 
395.8   an assessment by a mental health professional, to be 
395.9   experiencing a mental health crisis or mental health emergency. 
395.10  The mental health crisis services provided must be medically 
395.11  necessary, as defined in section 62Q.53, subdivision 2, and 
395.12  necessary for the safety of the child or others regardless of 
395.13  the setting. 
395.14     Sec. 26.  Minnesota Statutes 2000, section 245.4885, 
395.15  subdivision 1, is amended to read: 
395.16     Subdivision 1.  [SCREENING REQUIRED.] The county board 
395.17  shall, prior to admission, except in the case of emergency 
395.18  admission, screen all children referred for treatment of severe 
395.19  emotional disturbance to a residential treatment facility or 
395.20  informally admitted to a regional treatment center if public 
395.21  funds are used to pay for the services.  The county board shall 
395.22  also screen all children admitted to an acute care hospital for 
395.23  treatment of severe emotional disturbance if public funds other 
395.24  than reimbursement under chapters 256B and 256D are used to pay 
395.25  for the services.  If a child is admitted to a residential 
395.26  treatment facility or acute care hospital for emergency 
395.27  treatment or held for emergency care by a regional treatment 
395.28  center under section 253B.05, subdivision 1, screening must 
395.29  occur within three working days of admission.  Screening shall 
395.30  determine whether the proposed treatment:  
395.31     (1) is necessary; 
395.32     (2) is appropriate to the child's individual treatment 
395.33  needs; 
395.34     (3) cannot be effectively provided in the child's home; and 
395.35     (4) provides a length of stay as short as possible 
395.36  consistent with the individual child's need. 
396.1      When a screening is conducted, the county board may not 
396.2   determine that referral or admission to a residential treatment 
396.3   facility or acute care hospital is not appropriate solely 
396.4   because services were not first provided to the child in a less 
396.5   restrictive setting and the child failed to make progress toward 
396.6   or meet treatment goals in the less restrictive setting.  
396.7   Screening shall include both a diagnostic assessment and a 
396.8   functional assessment which evaluates family, school, and 
396.9   community living situations.  If a diagnostic assessment or 
396.10  functional assessment has been completed by a mental health 
396.11  professional within 180 days, a new diagnostic or functional 
396.12  assessment need not be completed unless in the opinion of the 
396.13  current treating mental health professional the child's mental 
396.14  health status has changed markedly since the assessment was 
396.15  completed.  The child's parent shall be notified if an 
396.16  assessment will not be completed and of the reasons.  A copy of 
396.17  the notice shall be placed in the child's file.  Recommendations 
396.18  developed as part of the screening process shall include 
396.19  specific community services needed by the child and, if 
396.20  appropriate, the child's family, and shall indicate whether or 
396.21  not these services are available and accessible to the child and 
396.22  family.  
396.23     During the screening process, the child, child's family, or 
396.24  child's legal representative, as appropriate, must be informed 
396.25  of the child's eligibility for case management services and 
396.26  family community support services and that an individual family 
396.27  community support plan is being developed by the case manager, 
396.28  if assigned.  
396.29     Screening shall be in compliance with section 256F.07 or 
396.30  260C.212, whichever applies.  Wherever possible, the parent 
396.31  shall be consulted in the screening process, unless clinically 
396.32  inappropriate.  
396.33     The screening process, and placement decision, and 
396.34  recommendations for mental health services must be documented in 
396.35  the child's record.  
396.36     An alternate review process may be approved by the 
397.1   commissioner if the county board demonstrates that an alternate 
397.2   review process has been established by the county board and the 
397.3   times of review, persons responsible for the review, and review 
397.4   criteria are comparable to the standards in clauses (1) to (4). 
397.5      Sec. 27.  Minnesota Statutes 2000, section 245.4886, 
397.6   subdivision 1, is amended to read: 
397.7      Subdivision 1.  [STATEWIDE PROGRAM; ESTABLISHMENT.] The 
397.8   commissioner shall establish a statewide program to assist 
397.9   counties in providing services to children with severe emotional 
397.10  disturbance as defined in section 245.4871, subdivision 15, and 
397.11  their families; and to young adults meeting the criteria for 
397.12  transition services in section 245.4875, subdivision 8, and 
397.13  their families.  Services must be designed to help each child to 
397.14  function and remain with the child's family in the community.  
397.15  Transition services to eligible young adults must be designed to 
397.16  foster independent living in the community.  The commissioner 
397.17  shall make grants to counties to establish, operate, or contract 
397.18  with private providers to provide the following services in the 
397.19  following order of priority when these cannot be reimbursed 
397.20  under section 256B.0625: 
397.21     (1) family community support services including crisis 
397.22  placement and crisis respite care as specified in section 
397.23  245.4871, subdivision 17; 
397.24     (2) case management services as specified in section 
397.25  245.4871, subdivision 3; 
397.26     (3) day treatment services as specified in section 
397.27  245.4871, subdivision 10; 
397.28     (4) professional home-based family treatment as specified 
397.29  in section 245.4871, subdivision 31; and 
397.30     (5) therapeutic support of foster care as specified in 
397.31  section 245.4871, subdivision 34. 
397.32     Funding appropriated beginning July 1, 1991, must be used 
397.33  by county boards to provide family community support services 
397.34  and case management services.  Additional services shall be 
397.35  provided in the order of priority as identified in this 
397.36  subdivision. 
398.1      Sec. 28.  Minnesota Statutes 2000, section 245.99, 
398.2   subdivision 4, is amended to read: 
398.3      Subd. 4.  [ADMINISTRATION OF CRISIS HOUSING ASSISTANCE.] 
398.4   The commissioner may contract with organizations or government 
398.5   units experienced in housing assistance to operate the program 
398.6   under this section.  This program is not an entitlement.  The 
398.7   commissioner may take any of the following steps whenever the 
398.8   commissioner projects that funds will be inadequate to meet 
398.9   demand in a given fiscal year: 
398.10     (1) transfer funds from mental health grants in the same 
398.11  appropriation; and 
398.12     (2) impose statewide restrictions as to the type and amount 
398.13  of assistance available to each recipient under this program, 
398.14  including reducing the income eligibility level, limiting 
398.15  reimbursement to a percentage of each recipient's costs, 
398.16  limiting housing assistance to 60 days per recipient, or closing 
398.17  the program for the remainder of the fiscal year. 
398.18     Sec. 29.  Minnesota Statutes 2000, section 253.28, is 
398.19  amended by adding a subdivision to read: 
398.20     Subd. 1a.  [STATE-OPERATED SERVICES 
398.21  AUTHORIZATION.] According to section 246.0136, the commissioner 
398.22  of human services is authorized to implement, as an enterprise 
398.23  activity, state-operated adult mental health services developed 
398.24  for the purposes of preventing inpatient hospitalization or 
398.25  facilitating the transition from hospital to community 
398.26  placement, that qualify under the standards for adult mental 
398.27  health rehabilitative services in section 256B.0623 and adult 
398.28  mental health crisis response services in section 256B.0624, 
398.29  once those options are incorporated as part of the approved 
398.30  state medical assistance plan. 
398.31     Sec. 30.  Minnesota Statutes 2000, section 253B.02, 
398.32  subdivision 10, is amended to read: 
398.33     Subd. 10.  [INTERESTED PERSON.] "Interested person" means: 
398.34     (1)  an adult, including but not limited to, a public 
398.35  official, including a local welfare agency acting under section 
398.36  626.5561, and the legal guardian, spouse, parent, legal counsel, 
399.1   adult child, next of kin, or other person designated by a 
399.2   proposed patie