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SF 2361

2nd 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 human services; modifying provisions 
  1.3             relating to health department; health care; continuing 
  1.4             care and home care; consumer information and 
  1.5             assistance and community-based care; long-term care 
  1.6             reform and reimbursement; work force; regulation of 
  1.7             supplemental nursing services agencies; long-term 
  1.8             insurance; mental health and civil commitment; 
  1.9             assistance programs; licensing; adding an informed 
  1.10            consent provision for abortion procedures; creating a 
  1.11            child maltreatment review panel; requiring studies; 
  1.12            adding provisions relating to termination of parental 
  1.13            rights; appropriating money; amending Minnesota 
  1.14            Statutes 2000, sections 13.46, subdivision 4; 13.461, 
  1.15            subdivision 17; 13B.06, subdivision 4; 62A.48, 
  1.16            subdivision 4, by adding subdivisions; 62S.01, by 
  1.17            adding subdivisions; 62S.26; 103I.101, subdivision 6; 
  1.18            103I.112; 103I.208, subdivisions 1, 2; 103I.235, 
  1.19            subdivision 1; 103I.525, subdivisions 2, 6, 8, 9; 
  1.20            103I.531, subdivisions 2, 6, 8, 9; 103I.535, 
  1.21            subdivisions 2, 6, 8, 9; 103I.541, subdivisions 2b, 4, 
  1.22            5; 103I.545; 121A.15, subdivision 6; 135A.14, by 
  1.23            adding a subdivision; 144.057; 144.1202, subdivision 
  1.24            4; 144.122; 144.1222, by adding a subdivision; 
  1.25            144.1464; 144.148, subdivision 2; 144.226, subdivision 
  1.26            4; 144.551, subdivision 1; 144.98, subdivision 3; 
  1.27            144A.071, subdivisions 1, 1a, 2, 4a; 144A.073, 
  1.28            subdivisions 2, 4; 144A.44, subdivision 1; 144A.4605, 
  1.29            subdivision 4; 144A.62, subdivisions 1, 2, 3, 4; 
  1.30            144D.03, subdivision 2; 144D.04, subdivisions 2, 3; 
  1.31            144D.06; 145.881, subdivision 2; 145.882, subdivision 
  1.32            7, by adding a subdivision; 145.885, subdivision 2; 
  1.33            145.924; 145.925, subdivisions 1, 1a; 145A.15, 
  1.34            subdivision 1, by adding a subdivision; 145A.16, 
  1.35            subdivision 1, by adding a subdivision; 148.212; 
  1.36            148B.21, subdivision 6a; 148B.22, subdivision 3; 
  1.37            157.16, subdivision 3; 157.22; 214.104; 245.462, 
  1.38            subdivisions 8, 18, by adding a subdivision; 245.4871, 
  1.39            subdivisions 10, 27; 245.4876, subdivision 1, by 
  1.40            adding a subdivision; 245.4885, subdivision 1; 
  1.41            245.4886, subdivision 1; 245.99, subdivision 4; 
  1.42            245A.03, subdivision 2b; 245A.04, subdivisions 3, 3a, 
  1.43            3b, 3c, 3d; 245A.05; 245A.06; 245A.07; 245A.08; 
  1.44            245A.13, subdivisions 7, 8; 245A.14, by adding a 
  1.45            subdivision; 245A.16, subdivision 1; 245B.08, 
  1.46            subdivision 3; 246.57, by adding a subdivision; 
  2.1             252.275, subdivision 4b; 252A.02, subdivisions 12, 13, 
  2.2             by adding a subdivision; 252A.111, subdivision 6; 
  2.3             252A.16, subdivision 1; 252A.19, subdivision 2; 
  2.4             252A.20, subdivision 1; 254B.02, subdivision 3; 
  2.5             254B.03, subdivision 1; 254B.04, subdivision 1; 
  2.6             254B.09, by adding a subdivision; 256.01, subdivisions 
  2.7             2, 18, by adding a subdivision; 256.045, subdivisions 
  2.8             3, 3b, 4; 256.476, subdivisions 1, 2, 3, 4, 5, 8; 
  2.9             256.482, subdivision 8; 256.955, subdivision 2b; 
  2.10            256.9657, subdivision 2; 256.969, subdivisions 2b, 3a, 
  2.11            by adding a subdivision; 256.973, by adding a 
  2.12            subdivision; 256.975, by adding subdivisions; 256B.04, 
  2.13            by adding a subdivision; 256B.055, subdivision 3a; 
  2.14            256B.056, subdivisions 1a, 3, 4, 5; 256B.057, 
  2.15            subdivision 9, by adding a subdivision; 256B.0625, 
  2.16            subdivisions 3b, 7, 13, 13a, 17, 17a, 18a, 19a, 19c, 
  2.17            20, 30, 34, by adding subdivisions; 256B.0627, 
  2.18            subdivisions 1, 2, 4, 5, 7, 8, 10, 11, by adding 
  2.19            subdivisions; 256B.0635, subdivisions 1, 2; 256B.0911, 
  2.20            subdivisions 1, 3, 5, 6, 7, by adding subdivisions; 
  2.21            256B.0913, subdivisions 1, 2, 4, 5, 6, 7, 8, 9, 10, 
  2.22            11, 12, 13, 14; 256B.0915, subdivisions 1d, 3, 5; 
  2.23            256B.0916, subdivisions 1, 7, 9, by adding a 
  2.24            subdivision; 256B.0917, subdivision 7; 256B.092, 
  2.25            subdivisions 2a, 5; 256B.093, subdivision 3; 256B.095; 
  2.26            256B.0951, subdivisions 1, 3, 4, 5, 7, by adding 
  2.27            subdivisions; 256B.0952, subdivisions 1, 4; 256B.431, 
  2.28            subdivision 17, by adding subdivisions; 256B.434, 
  2.29            subdivision 4, by adding subdivisions; 256B.49, by 
  2.30            adding subdivisions; 256B.501, by adding a 
  2.31            subdivision; 256B.69, subdivisions 4, 5, 5b, 23, by 
  2.32            adding a subdivision; 256B.75; 256B.76; 256D.03, 
  2.33            subdivisions 3, 4; 256D.35, by adding subdivisions; 
  2.34            256D.44, subdivision 5; 256I.05, subdivision 1e; 
  2.35            256J.09, subdivisions 1, 2, 3, by adding subdivisions; 
  2.36            256J.15, by adding a subdivision; 256J.24, subdivision 
  2.37            10; 256J.26, subdivision 1; 256J.31, subdivisions 4, 
  2.38            12; 256J.32, subdivision 7a; 256J.42, by adding a 
  2.39            subdivision; 256J.45, subdivision 1; 256J.46, 
  2.40            subdivisions 1, 2a, by adding a subdivision; 256J.50, 
  2.41            subdivisions 1, 7; 256J.56; 256J.57, subdivision 2; 
  2.42            256J.62, subdivision 9; 256J.625, subdivisions 1, 2, 
  2.43            4; 256J.751; 256K.03, subdivision 1; 256K.07; 256K.25, 
  2.44            subdivisions 1, 3, 4, 5, 6; 256L.06, subdivision 3; 
  2.45            256L.12, subdivision 9, by adding a subdivision; 
  2.46            256L.16; 260C.301, by adding subdivisions; 260C.307, 
  2.47            subdivision 3; 260C.317, by adding a subdivision; 
  2.48            261.062; 268.0122, subdivision 2; 626.556, 
  2.49            subdivisions 3, 3c, 10, 10b, 10d, 10e, 10f, 10i, 11, 
  2.50            12, by adding subdivisions; 626.557, subdivisions 3, 
  2.51            9d; 626.5572, subdivision 17; 626.559, subdivision 2; 
  2.52            Laws 1995, chapter 178, article 2, section 36; Laws 
  2.53            1995, chapter 207, article 3, section 21, as amended; 
  2.54            Laws 1997, chapter 203, article 9, section 21, as 
  2.55            amended; Laws 1999, chapter 152, sections 1, 4; Laws 
  2.56            1999, chapter 245, article 3, section 45, as amended; 
  2.57            Laws 1999, chapter 245, article 4, section 110; 
  2.58            proposing coding for new law in Minnesota Statutes, 
  2.59            chapters 62S; 144; 144A; 145; 145A; 246; 256; 256B; 
  2.60            256I; 256J; 260; 299A; 325F; repealing Minnesota 
  2.61            Statutes 2000, sections 144.0721, subdivision 1; 
  2.62            144.148, subdivision 8; 145.882, subdivisions 3, 4; 
  2.63            145.9245; 145.927; 252A.111, subdivision 3; 256.476, 
  2.64            subdivision 7; 256B.037, subdivision 5; 256B.0635, 
  2.65            subdivision 3; 256B.0911, subdivisions 2, 2a, 4, 8, 9; 
  2.66            256B.0912; 256B.0913, subdivisions 3, 15a, 15b, 15c, 
  2.67            16; 256B.0915, subdivisions 3a, 3b, 3c; 256B.0951, 
  2.68            subdivision 6; 256B.434, subdivision 5; 256B.49, 
  2.69            subdivisions 1, 2, 3, 4, 5, 6, 7, 8, 9, 10; 256E.06, 
  2.70            subdivision 2b; 256J.42, subdivision 4; 256J.44; 
  2.71            256J.46, subdivision 1a; Laws 1995, chapter 178, 
  3.1             article 2, section 48, subdivision 6; Minnesota Rules, 
  3.2             parts 9505.2390; 9505.2395; 9505.2396; 9505.2400; 
  3.3             9505.2405; 9505.2410; 9505.2413; 9505.2415; 9505.2420; 
  3.4             9505.2425; 9505.2426; 9505.2430; 9505.2435; 9505.2440; 
  3.5             9505.2445; 9505.2450; 9505.2455; 9505.2458; 9505.2460; 
  3.6             9505.2465; 9505.2470; 9505.2473; 9505.2475; 9505.2480; 
  3.7             9505.2485; 9505.2486; 9505.2490; 9505.2495; 9505.2496; 
  3.8             9505.2500; 9505.3010; 9505.3015; 9505.3020; 9505.3025; 
  3.9             9505.3030; 9505.3035; 9505.3040; 9505.3065; 9505.3085; 
  3.10            9505.3135; 9505.3500; 9505.3510; 9505.3520; 9505.3530; 
  3.11            9505.3535; 9505.3540; 9505.3545; 9505.3550; 9505.3560; 
  3.12            9505.3570; 9505.3575; 9505.3580; 9505.3585; 9505.3600; 
  3.13            9505.3610; 9505.3620; 9505.3622; 9505.3624; 9505.3626; 
  3.14            9505.3630; 9505.3635; 9505.3640; 9505.3645; 9505.3650; 
  3.15            9505.3660; 9505.3670. 
  3.16  BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 
  3.17                             ARTICLE 1 
  3.18                         HEALTH DEPARTMENT 
  3.19     Section 1.  Minnesota Statutes 2000, section 103I.101, 
  3.20  subdivision 6, is amended to read: 
  3.21     Subd. 6.  [FEES FOR VARIANCES.] The commissioner shall 
  3.22  charge a nonrefundable application fee of $120 $150 to cover the 
  3.23  administrative cost of processing a request for a variance or 
  3.24  modification of rules adopted by the commissioner under this 
  3.25  chapter. 
  3.26     Sec. 2.  Minnesota Statutes 2000, section 103I.112, is 
  3.27  amended to read: 
  3.28     103I.112 [FEE EXEMPTIONS FOR STATE AND LOCAL GOVERNMENT.] 
  3.29     (a) The commissioner of health may not charge fees required 
  3.30  under this chapter to a federal agency, state agency, or a local 
  3.31  unit of government or to a subcontractor performing work for the 
  3.32  state agency or local unit of government.  
  3.33     (b) "Local unit of government" means a statutory or home 
  3.34  rule charter city, town, county, or soil and water conservation 
  3.35  district, watershed district, an organization formed for the 
  3.36  joint exercise of powers under section 471.59, a board of health 
  3.37  or community health board, or other special purpose district or 
  3.38  authority with local jurisdiction in water and related land 
  3.39  resources management. 
  3.40     Sec. 3.  Minnesota Statutes 2000, section 103I.208, 
  3.41  subdivision 1, is amended to read: 
  3.42     Subdivision 1.  [WELL NOTIFICATION FEE.] The well 
  3.43  notification fee to be paid by a property owner is:  
  4.1      (1) for a new well, $120 $150, which includes the state 
  4.2   core function fee; 
  4.3      (2) for a well sealing, $20 $30 for each well, which 
  4.4   includes the state core function fee, except that for monitoring 
  4.5   wells constructed on a single property, having depths within a 
  4.6   25 foot range, and sealed within 48 hours of start of 
  4.7   construction, a single fee of $20 $30; and 
  4.8      (3) for construction of a dewatering well, $120 $150, which 
  4.9   includes the state core function fee, for each well except a 
  4.10  dewatering project comprising five or more wells shall be 
  4.11  assessed a single fee of $600 $750 for the wells recorded on the 
  4.12  notification. 
  4.13     Sec. 4.  Minnesota Statutes 2000, section 103I.208, 
  4.14  subdivision 2, is amended to read: 
  4.15     Subd. 2.  [PERMIT FEE.] The permit fee to be paid by a 
  4.16  property owner is:  
  4.17     (1) for a well that is not in use under a maintenance 
  4.18  permit, $100 $125 annually; 
  4.19     (2) for construction of a monitoring well, $120 $150, which 
  4.20  includes the state core function fee; 
  4.21     (3) for a monitoring well that is unsealed under a 
  4.22  maintenance permit, $100 $125 annually; 
  4.23     (4) for monitoring wells used as a leak detection device at 
  4.24  a single motor fuel retail outlet, a single petroleum bulk 
  4.25  storage site excluding tank farms, or a single agricultural 
  4.26  chemical facility site, the construction permit fee 
  4.27  is $120 $150, which includes the state core function fee, per 
  4.28  site regardless of the number of wells constructed on the site, 
  4.29  and the annual fee for a maintenance permit for unsealed 
  4.30  monitoring wells is $100 $125 per site regardless of the number 
  4.31  of monitoring wells located on site; 
  4.32     (5) for a groundwater thermal exchange device, in addition 
  4.33  to the notification fee for wells, $120 $150, which includes the 
  4.34  state core function fee; 
  4.35     (6) for a vertical heat exchanger, $120 $150; 
  4.36     (7) for a dewatering well that is unsealed under a 
  5.1   maintenance permit, $100 $125 annually for each well, except a 
  5.2   dewatering project comprising more than five wells shall be 
  5.3   issued a single permit for $500 $625 annually for wells recorded 
  5.4   on the permit; and 
  5.5      (8) for excavating holes for the purpose of installing 
  5.6   elevator shafts, $120 $150 for each hole. 
  5.7      Sec. 5.  Minnesota Statutes 2000, section 103I.235, 
  5.8   subdivision 1, is amended to read: 
  5.9      Subdivision 1.  [DISCLOSURE OF WELLS TO BUYER.] (a) Before 
  5.10  signing an agreement to sell or transfer real property, the 
  5.11  seller must disclose in writing to the buyer information about 
  5.12  the status and location of all known wells on the property, by 
  5.13  delivering to the buyer either a statement by the seller that 
  5.14  the seller does not know of any wells on the property, or a 
  5.15  disclosure statement indicating the legal description and 
  5.16  county, and a map drawn from available information showing the 
  5.17  location of each well to the extent practicable.  In the 
  5.18  disclosure statement, the seller must indicate, for each well, 
  5.19  whether the well is in use, not in use, or sealed.  
  5.20     (b) At the time of closing of the sale, the disclosure 
  5.21  statement information, name and mailing address of the buyer, 
  5.22  and the quartile, section, township, and range in which each 
  5.23  well is located must be provided on a well disclosure 
  5.24  certificate signed by the seller or a person authorized to act 
  5.25  on behalf of the seller. 
  5.26     (c) A well disclosure certificate need not be provided if 
  5.27  the seller does not know of any wells on the property and the 
  5.28  deed or other instrument of conveyance contains the statement:  
  5.29  "The Seller certifies that the Seller does not know of any wells 
  5.30  on the described real property."  
  5.31     (d) If a deed is given pursuant to a contract for deed, the 
  5.32  well disclosure certificate required by this subdivision shall 
  5.33  be signed by the buyer or a person authorized to act on behalf 
  5.34  of the buyer.  If the buyer knows of no wells on the property, a 
  5.35  well disclosure certificate is not required if the following 
  5.36  statement appears on the deed followed by the signature of the 
  6.1   grantee or, if there is more than one grantee, the signature of 
  6.2   at least one of the grantees:  "The Grantee certifies that the 
  6.3   Grantee does not know of any wells on the described real 
  6.4   property."  The statement and signature of the grantee may be on 
  6.5   the front or back of the deed or on an attached sheet and an 
  6.6   acknowledgment of the statement by the grantee is not required 
  6.7   for the deed to be recordable. 
  6.8      (e) This subdivision does not apply to the sale, exchange, 
  6.9   or transfer of real property:  
  6.10     (1) that consists solely of a sale or transfer of severed 
  6.11  mineral interests; or 
  6.12     (2) that consists of an individual condominium unit as 
  6.13  described in chapters 515 and 515B. 
  6.14     (f) For an area owned in common under chapter 515 or 515B 
  6.15  the association or other responsible person must report to the 
  6.16  commissioner by July 1, 1992, the location and status of all 
  6.17  wells in the common area.  The association or other responsible 
  6.18  person must notify the commissioner within 30 days of any change 
  6.19  in the reported status of wells. 
  6.20     (g) For real property sold by the state under section 
  6.21  92.67, the lessee at the time of the sale is responsible for 
  6.22  compliance with this subdivision. 
  6.23     (h) If the seller fails to provide a required well 
  6.24  disclosure certificate, the buyer, or a person authorized to act 
  6.25  on behalf of the buyer, may sign a well disclosure certificate 
  6.26  based on the information provided on the disclosure statement 
  6.27  required by this section or based on other available information.
  6.28     (i) A county recorder or registrar of titles may not record 
  6.29  a deed or other instrument of conveyance dated after October 31, 
  6.30  1990, for which a certificate of value is required under section 
  6.31  272.115, or any deed or other instrument of conveyance dated 
  6.32  after October 31, 1990, from a governmental body exempt from the 
  6.33  payment of state deed tax, unless the deed or other instrument 
  6.34  of conveyance contains the statement made in accordance with 
  6.35  paragraph (c) or (d) or is accompanied by the well disclosure 
  6.36  certificate containing all the information required by paragraph 
  7.1   (b) or (d).  The county recorder or registrar of titles must not 
  7.2   accept a certificate unless it contains all the required 
  7.3   information.  The county recorder or registrar of titles shall 
  7.4   note on each deed or other instrument of conveyance accompanied 
  7.5   by a well disclosure certificate that the well disclosure 
  7.6   certificate was received.  The notation must include the 
  7.7   statement "No wells on property" if the disclosure certificate 
  7.8   states there are no wells on the property.  The well disclosure 
  7.9   certificate shall not be filed or recorded in the records 
  7.10  maintained by the county recorder or registrar of titles.  After 
  7.11  noting "No wells on property" on the deed or other instrument of 
  7.12  conveyance, the county recorder or registrar of titles shall 
  7.13  destroy or return to the buyer the well disclosure certificate.  
  7.14  The county recorder or registrar of titles shall collect from 
  7.15  the buyer or the person seeking to record a deed or other 
  7.16  instrument of conveyance, a fee of $20 $30 for receipt of a 
  7.17  completed well disclosure certificate.  By the tenth day of each 
  7.18  month, the county recorder or registrar of titles shall transmit 
  7.19  the well disclosure certificates to the commissioner of health.  
  7.20  By the tenth day after the end of each calendar quarter, the 
  7.21  county recorder or registrar of titles shall transmit to the 
  7.22  commissioner of health $17.50 $27.50 of the fee for each well 
  7.23  disclosure certificate received during the quarter.  The 
  7.24  commissioner shall maintain the well disclosure certificate for 
  7.25  at least six years.  The commissioner may store the certificate 
  7.26  as an electronic image.  A copy of that image shall be as valid 
  7.27  as the original. 
  7.28     (j) No new well disclosure certificate is required under 
  7.29  this subdivision if the buyer or seller, or a person authorized 
  7.30  to act on behalf of the buyer or seller, certifies on the deed 
  7.31  or other instrument of conveyance that the status and number of 
  7.32  wells on the property have not changed since the last previously 
  7.33  filed well disclosure certificate.  The following statement, if 
  7.34  followed by the signature of the person making the statement, is 
  7.35  sufficient to comply with the certification requirement of this 
  7.36  paragraph:  "I am familiar with the property described in this 
  8.1   instrument and I certify that the status and number of wells on 
  8.2   the described real property have not changed since the last 
  8.3   previously filed well disclosure certificate."  The 
  8.4   certification and signature may be on the front or back of the 
  8.5   deed or on an attached sheet and an acknowledgment of the 
  8.6   statement is not required for the deed or other instrument of 
  8.7   conveyance to be recordable. 
  8.8      (k) The commissioner in consultation with county recorders 
  8.9   shall prescribe the form for a well disclosure certificate and 
  8.10  provide well disclosure certificate forms to county recorders 
  8.11  and registrars of titles and other interested persons. 
  8.12     (l) Failure to comply with a requirement of this 
  8.13  subdivision does not impair: 
  8.14     (1) the validity of a deed or other instrument of 
  8.15  conveyance as between the parties to the deed or instrument or 
  8.16  as to any other person who otherwise would be bound by the deed 
  8.17  or instrument; or 
  8.18     (2) the record, as notice, of any deed or other instrument 
  8.19  of conveyance accepted for filing or recording contrary to the 
  8.20  provisions of this subdivision. 
  8.21     Sec. 6.  Minnesota Statutes 2000, section 103I.525, 
  8.22  subdivision 2, is amended to read: 
  8.23     Subd. 2.  [APPLICATION FEE.] The application fee for a well 
  8.24  contractor's license is $50 $75.  The commissioner may not act 
  8.25  on an application until the application fee is paid.  
  8.26     Sec. 7.  Minnesota Statutes 2000, section 103I.525, 
  8.27  subdivision 6, is amended to read: 
  8.28     Subd. 6.  [LICENSE FEE.] The fee for a well contractor's 
  8.29  license is $250, except the fee for an individual well 
  8.30  contractor's license is $50 $75. 
  8.31     Sec. 8.  Minnesota Statutes 2000, section 103I.525, 
  8.32  subdivision 8, is amended to read: 
  8.33     Subd. 8.  [RENEWAL.] (a) A licensee must file an 
  8.34  application and a renewal application fee to renew the license 
  8.35  by the date stated in the license.  
  8.36     (b) The renewal application fee shall be set by the 
  9.1   commissioner under section 16A.1285 for a well contractor's 
  9.2   license is $250.  
  9.3      (c) The renewal application must include information that 
  9.4   the applicant has met continuing education requirements 
  9.5   established by the commissioner by rule.  
  9.6      (d) At the time of the renewal, the commissioner must have 
  9.7   on file all properly completed well reports, well sealing 
  9.8   reports, reports of excavations to construct elevator shafts, 
  9.9   well permits, and well notifications for work conducted by the 
  9.10  licensee since the last license renewal. 
  9.11     Sec. 9.  Minnesota Statutes 2000, section 103I.525, 
  9.12  subdivision 9, is amended to read: 
  9.13     Subd. 9.  [INCOMPLETE OR LATE RENEWAL.] If a licensee fails 
  9.14  to submit all information required for renewal in subdivision 8 
  9.15  or submits the application and information after the required 
  9.16  renewal date: 
  9.17     (1) the licensee must include an additional a late fee set 
  9.18  by the commissioner of $75; and 
  9.19     (2) the licensee may not conduct activities authorized by 
  9.20  the well contractor's license until the renewal application, 
  9.21  renewal application fee, late fee, and all other information 
  9.22  required in subdivision 8 are submitted. 
  9.23     Sec. 10.  Minnesota Statutes 2000, section 103I.531, 
  9.24  subdivision 2, is amended to read: 
  9.25     Subd. 2.  [APPLICATION FEE.] The application fee for a 
  9.26  limited well/boring contractor's license is $50 $75.  The 
  9.27  commissioner may not act on an application until the application 
  9.28  fee is paid.  
  9.29     Sec. 11.  Minnesota Statutes 2000, section 103I.531, 
  9.30  subdivision 6, is amended to read: 
  9.31     Subd. 6.  [LICENSE FEE.] The fee for a limited well/boring 
  9.32  contractor's license is $50 $75.  
  9.33     Sec. 12.  Minnesota Statutes 2000, section 103I.531, 
  9.34  subdivision 8, is amended to read: 
  9.35     Subd. 8.  [RENEWAL.] (a) A person must file an application 
  9.36  and a renewal application fee to renew the limited well/boring 
 10.1   contractor's license by the date stated in the license.  
 10.2      (b) The renewal application fee shall be set by the 
 10.3   commissioner under section 16A.1285 for a limited well/boring 
 10.4   contractor's license is $75.  
 10.5      (c) The renewal application must include information that 
 10.6   the applicant has met continuing education requirements 
 10.7   established by the commissioner by rule.  
 10.8      (d) At the time of the renewal, the commissioner must have 
 10.9   on file all properly completed well sealing reports, well 
 10.10  permits, vertical heat exchanger permits, and well notifications 
 10.11  for work conducted by the licensee since the last license 
 10.12  renewal. 
 10.13     Sec. 13.  Minnesota Statutes 2000, section 103I.531, 
 10.14  subdivision 9, is amended to read: 
 10.15     Subd. 9.  [INCOMPLETE OR LATE RENEWAL.] If a licensee fails 
 10.16  to submit all information required for renewal in subdivision 8 
 10.17  or submits the application and information after the required 
 10.18  renewal date: 
 10.19     (1) the licensee must include an additional a late fee set 
 10.20  by the commissioner of $75; and 
 10.21     (2) the licensee may not conduct activities authorized by 
 10.22  the limited well/boring contractor's license until the renewal 
 10.23  application, renewal application fee, and late fee, and all 
 10.24  other information required in subdivision 8 are submitted. 
 10.25     Sec. 14.  Minnesota Statutes 2000, section 103I.535, 
 10.26  subdivision 2, is amended to read: 
 10.27     Subd. 2.  [APPLICATION FEE.] The application fee for an 
 10.28  elevator shaft contractor's license is $50 $75.  The 
 10.29  commissioner may not act on an application until the application 
 10.30  fee is paid. 
 10.31     Sec. 15.  Minnesota Statutes 2000, section 103I.535, 
 10.32  subdivision 6, is amended to read: 
 10.33     Subd. 6.  [LICENSE FEE.] The fee for an elevator shaft 
 10.34  contractor's license is $50 $75.  
 10.35     Sec. 16.  Minnesota Statutes 2000, section 103I.535, 
 10.36  subdivision 8, is amended to read: 
 11.1      Subd. 8.  [RENEWAL.] (a) A person must file an application 
 11.2   and a renewal application fee to renew the license by the date 
 11.3   stated in the license.  
 11.4      (b) The renewal application fee shall be set by the 
 11.5   commissioner under section 16A.1285 for an elevator shaft 
 11.6   contractor's license is $75.  
 11.7      (c) The renewal application must include information that 
 11.8   the applicant has met continuing education requirements 
 11.9   established by the commissioner by rule.  
 11.10     (d) At the time of renewal, the commissioner must have on 
 11.11  file all reports and permits for elevator shaft work conducted 
 11.12  by the licensee since the last license renewal. 
 11.13     Sec. 17.  Minnesota Statutes 2000, section 103I.535, 
 11.14  subdivision 9, is amended to read: 
 11.15     Subd. 9.  [INCOMPLETE OR LATE RENEWAL.] If a licensee fails 
 11.16  to submit all information required for renewal in subdivision 8 
 11.17  or submits the application and information after the required 
 11.18  renewal date: 
 11.19     (1) the licensee must include an additional a late fee set 
 11.20  by the commissioner of $75; and 
 11.21     (2) the licensee may not conduct activities authorized by 
 11.22  the elevator shaft contractor's license until the renewal 
 11.23  application, renewal application fee, and late fee, and all 
 11.24  other information required in subdivision 8 are submitted. 
 11.25     Sec. 18.  Minnesota Statutes 2000, section 103I.541, 
 11.26  subdivision 2b, is amended to read: 
 11.27     Subd. 2b.  [APPLICATION FEE.] The application fee for a 
 11.28  monitoring well contractor registration is $50 $75.  The 
 11.29  commissioner may not act on an application until the application 
 11.30  fee is paid.  
 11.31     Sec. 19.  Minnesota Statutes 2000, section 103I.541, 
 11.32  subdivision 4, is amended to read: 
 11.33     Subd. 4.  [RENEWAL.] (a) A person must file an application 
 11.34  and a renewal application fee to renew the registration by the 
 11.35  date stated in the registration.  
 11.36     (b) The renewal application fee shall be set by the 
 12.1   commissioner under section 16A.1285 for a monitoring well 
 12.2   contractor's registration is $75.  
 12.3      (c) The renewal application must include information that 
 12.4   the applicant has met continuing education requirements 
 12.5   established by the commissioner by rule.  
 12.6      (d) At the time of the renewal, the commissioner must have 
 12.7   on file all well reports, well sealing reports, well permits, 
 12.8   and notifications for work conducted by the registered person 
 12.9   since the last registration renewal. 
 12.10     Sec. 20.  Minnesota Statutes 2000, section 103I.541, 
 12.11  subdivision 5, is amended to read: 
 12.12     Subd. 5.  [INCOMPLETE OR LATE RENEWAL.] If a registered 
 12.13  person submits a renewal application after the required renewal 
 12.14  date: 
 12.15     (1) the registered person must include an additional a late 
 12.16  fee set by the commissioner of $75; and 
 12.17     (2) the registered person may not conduct activities 
 12.18  authorized by the monitoring well contractor's registration 
 12.19  until the renewal application, renewal application fee, late 
 12.20  fee, and all other information required in subdivision 4 are 
 12.21  submitted. 
 12.22     Sec. 21.  Minnesota Statutes 2000, section 103I.545, is 
 12.23  amended to read: 
 12.24     103I.545 [REGISTRATION OF DRILLING MACHINES REQUIRED.] 
 12.25     Subdivision 1.  [DRILLING MACHINE.] (a) A person may not 
 12.26  use a drilling machine such as a cable tool, rotary tool, hollow 
 12.27  rod tool, or auger for a drilling activity requiring a license 
 12.28  or registration under this chapter unless the drilling machine 
 12.29  is registered with the commissioner.  
 12.30     (b) A person must apply for the registration on forms 
 12.31  prescribed by the commissioner and submit a $50 $75 registration 
 12.32  fee. 
 12.33     (c) A registration is valid for one year.  
 12.34     Subd. 2.  [PUMP HOIST.] (a) A person may not use a machine 
 12.35  such as a pump hoist for an activity requiring a license or 
 12.36  registration under this chapter to repair wells or borings, seal 
 13.1   wells or borings, or install pumps unless the machine is 
 13.2   registered with the commissioner.  
 13.3      (b) A person must apply for the registration on forms 
 13.4   prescribed by the commissioner and submit a $50 $75 registration 
 13.5   fee. 
 13.6      (c) A registration is valid for one year. 
 13.7      [EFFECTIVE DATE.] This section is effective July 1, 2002. 
 13.8      Sec. 22.  Minnesota Statutes 2000, section 121A.15, 
 13.9   subdivision 6, is amended to read: 
 13.10     Subd. 6.  [SUSPENSION OF IMMUNIZATION REQUIREMENT; 
 13.11  MODIFICATION TO SCHEDULE.] (a) The commissioner of health, on 
 13.12  finding that an immunization required pursuant to this section 
 13.13  is not necessary to protect the public's health, may suspend for 
 13.14  one year the requirement that children receive that immunization.
 13.15     (b) During portions of the year in which the legislature is 
 13.16  not meeting in regular or special session, the commissioner of 
 13.17  health may modify the immunization requirements of this section. 
 13.18  A modification made under this paragraph must be part of the 
 13.19  current immunization recommendations of each of the following 
 13.20  organizations:  the United States Public Health Service's 
 13.21  Advisory Committee on Immunization Practices, the American 
 13.22  Academy of Family Physicians, and the American Academy of 
 13.23  Pediatrics.  The commissioner shall modify the immunization 
 13.24  requirements through rulemaking using the expedited process in 
 13.25  section 14.389.  A rule adopted under this paragraph shall be in 
 13.26  effect until the adjournment of the next regular legislative 
 13.27  session held after the rule is adopted.  The commissioner shall 
 13.28  report to the legislature on any rules adopted under this 
 13.29  paragraph during the previous calendar year.  Such reports are 
 13.30  due by January 15 of the year following the calendar year in 
 13.31  which the rule is adopted, except that if a rule is adopted in 
 13.32  January, a report on that rule is due by February 15 of that 
 13.33  year. 
 13.34     Sec. 23.  Minnesota Statutes 2000, section 135A.14, is 
 13.35  amended by adding a subdivision to read: 
 13.36     Subd. 7.  [MODIFICATIONS TO SCHEDULE.] During portions of 
 14.1   the year in which the legislature is not meeting in regular or 
 14.2   special session, the commissioner of health may modify the 
 14.3   immunization requirements of this section.  A modification made 
 14.4   under this subdivision must be part of the current immunization 
 14.5   recommendations of each of the following organizations:  the 
 14.6   United States Public Health Service's Advisory Committee on 
 14.7   Immunization Practices, the American Academy of Family 
 14.8   Physicians, and the American Academy of Pediatrics.  The 
 14.9   commissioner shall modify the immunization requirements through 
 14.10  rulemaking using the expedited process in section 14.389.  A 
 14.11  rule adopted under this subdivision shall be in effect until the 
 14.12  adjournment of the next regular legislative session held after 
 14.13  the rule is adopted.  The commissioner shall report to the 
 14.14  legislature on any rules adopted under this subdivision during 
 14.15  the previous calendar year.  Such reports are due by January 15 
 14.16  of the year following the calendar year in which the rule is 
 14.17  adopted, except that if a rule is adopted in January, a report 
 14.18  on that rule is due by February 15 of that year. 
 14.19     Sec. 24.  [144.0751] [HEALTH STANDARDS.] 
 14.20     When establishing or revising safe drinking water or air 
 14.21  quality standards, the commissioner shall take into account only 
 14.22  peer-reviewed, scientifically acceptable information which 
 14.23  includes a reasonable margin of safety in setting the standards 
 14.24  to adequately protect the health of infants, children, and 
 14.25  adults by taking into consideration each of the following 
 14.26  specific risks: 
 14.27     (1) reproductive development and function; 
 14.28     (2) respiratory function; 
 14.29     (3) immunologic suppression or hypersensitization; 
 14.30     (4) development of the brain and nervous system; 
 14.31     (5) endocrine (hormonal) function; 
 14.32     (6) cancer; 
 14.33     (7) general infant and child development; and 
 14.34     (8) any other important health outcomes identified by the 
 14.35  commissioner. 
 14.36     Sec. 25.  Minnesota Statutes 2000, section 144.1202, 
 15.1   subdivision 4, is amended to read: 
 15.2      Subd. 4.  [AGREEMENT; CONDITIONS OF IMPLEMENTATION.] (a) An 
 15.3   agreement entered into before August 2, 2002 2003, must remain 
 15.4   in effect until terminated under the Atomic Energy Act of 1954, 
 15.5   United States Code, title 42, section 2021, paragraph (j).  The 
 15.6   governor may not enter into an initial agreement with the 
 15.7   Nuclear Regulatory Commission after August 1, 2002 2003.  If an 
 15.8   agreement is not entered into by August 1, 2002 2003, any rules 
 15.9   adopted under this section are repealed effective August 1, 2002 
 15.10  2003. 
 15.11     (b) An agreement authorized under subdivision 1 must be 
 15.12  approved by law before it may be implemented. 
 15.13     Sec. 26.  [144.1205] [RADIOACTIVE MATERIAL; SOURCE AND 
 15.14  SPECIAL NUCLEAR MATERIAL; FEES; INSPECTION.] 
 15.15     Subdivision 1.  [APPLICATION AND LICENSE RENEWAL FEE.] When 
 15.16  a license is required for radioactive material or source or 
 15.17  special nuclear material by a rule adopted under section 
 15.18  144.1202, subdivision 2, an application fee according to 
 15.19  subdivision 4 must be paid upon initial application for a 
 15.20  license.  The licensee must renew the license 60 days before the 
 15.21  expiration date of the license by paying a license renewal fee 
 15.22  equal to the application fee under subdivision 4.  The 
 15.23  expiration date of a license is the date set by the United 
 15.24  States Nuclear Regulatory Commission before transfer of the 
 15.25  licensing program under section 144.1202 and thereafter as 
 15.26  specified by rule of the commissioner of health. 
 15.27     Subd. 2.  [ANNUAL FEE.] A licensee must pay an annual fee 
 15.28  at least 60 days before the anniversary date of the issuance of 
 15.29  the license.  The annual fee is an amount equal to 80 percent of 
 15.30  the application fee under subdivision 4, rounded to the nearest 
 15.31  whole dollar. 
 15.32     Subd. 3.  [FEE CATEGORIES; INCORPORATION OF FEDERAL 
 15.33  LICENSING CATEGORIES.] (a) Fee categories under this section are 
 15.34  equivalent to the licensing categories used by the United States 
 15.35  Nuclear Regulatory Commission under Code of Federal Regulations, 
 15.36  title 10, parts 30 to 36, 39, 40, 70, 71, and 150, except as 
 16.1   provided in paragraph (b). 
 16.2      (b) The category of "Academic, small" is the type of 
 16.3   license required for the use of radioactive materials in a 
 16.4   teaching institution.  Radioactive materials are limited to ten 
 16.5   radionuclides not to exceed a total activity amount of one curie.
 16.6      Subd. 4.  [APPLICATION FEE.] A licensee must pay an 
 16.7   application fee as follows: 
 16.8   Radioactive material,  Application    U.S. Nuclear Regulatory
 16.9   source and             fee            Commission licensing
 16.10  special material                      category as reference
 16.12  Type A broadscope      $20,000        Medical institution type A
 16.13  Type B broadscope      $15,000        Research and development
 16.14                                        type B
 16.15  Type C broadscope      $10,000        Academic type C
 16.16  Medical use            $4,000         Medical
 16.17                                        Medical institution
 16.18                                        Medical private practice
 16.19  Mobile nuclear                                                 
 16.20  medical laboratory     $4,000         Mobile medical laboratory
 16.21  Medical special use                                     
 16.22  sealed sources         $6,000         Teletherapy
 16.23                                        High dose rate remote
 16.24                                        afterloaders
 16.25                                        Stereotactic
 16.26                                        radiosurgery devices
 16.27  In vitro testing       $2,300         In vitro testing
 16.28                                        laboratories
 16.29  Measuring gauge,
 16.30  sealed sources         $2,000         Fixed gauges
 16.31                                        Portable gauges
 16.32                                        Analytical instruments
 16.33                                        Measuring systems - other
 16.34  Gas chromatographs     $1,200         Gas chromatographs
 16.35  Manufacturing and 
 16.36  distribution           $14,700        Manufacturing and 
 17.1                                         distribution - other
 17.2   Distribution only      $8,800         Distribution of
 17.3                                         radioactive material
 17.4                                         for commercial use only
 17.5   Other services         $1,500         Other services
 17.6   Nuclear medicine 
 17.7   pharmacy               $4,100         Nuclear pharmacy
 17.8   Waste disposal         $9,400         Waste disposal service
 17.9                                         prepackage
 17.10                                        Waste disposal service
 17.11                                        processing/repackage
 17.12  Waste storage only     $7,000         To receive and store
 17.13                                        radioactive material waste
 17.14  Industrial
 17.15  radiography            $8,400         Industrial radiography
 17.16                                        fixed location
 17.17                                        Industrial radiography
 17.18                                        portable/temporary sites
 17.19  Irradiator - 
 17.20  self-shielded          $4,100         Irradiators self-shielded
 17.21                                        less than 10,000 curies
 17.22  Irradiator - 
 17.23  less than 10,000 Ci    $7,500         Irradiators less than
 17.24                                        10,000 curies
 17.25  Irradiator - 
 17.26  more than 10,000 Ci    $11,500        Irradiators greater than
 17.27                                        10,000 curies
 17.28  Research and
 17.29  development,
 17.30  no distribution        $4,100         Research and development
 17.31  Radioactive material 
 17.32  possession only        $1,000         By-product possession only
 17.33  Source material        $1,000         Source material shielding
 17.34  Special nuclear 
 17.35  material, less than 
 17.36  200 grams              $1,000         Special nuclear material
 18.1                                         plutonium-neutron sources
 18.2                                         less than 200 grams
 18.3   Pacemaker
 18.4   manufacturing          $1,000         Pacemaker by-product
 18.5                                         and/or special nuclear
 18.6                                         material - medical
 18.7                                         institution
 18.8   General license
 18.9   distribution           $2,100         General license
 18.10                                        distribution
 18.11  General license 
 18.12  distribution, exempt   $1,500         General license 
 18.13                                        distribution -
 18.14                                        certain exempt items
 18.15  Academic, small        $1,000         Possession limit of ten
 18.16                                        radionuclides, not to
 18.17                                        exceed a total of one curie
 18.18                                        of activity
 18.19  Veterinary             $2,000         Veterinary use
 18.20  Well logging           $5,000         Well logging
 18.21     Subd. 5.  [PENALTY FOR LATE PAYMENT.] An annual fee or a 
 18.22  license renewal fee submitted to the commissioner after the due 
 18.23  date specified by rule must be accompanied by an additional 
 18.24  amount equal to 25 percent of the fee due. 
 18.25     Subd. 6.  [INSPECTIONS.] The commissioner of health shall 
 18.26  make periodic safety inspections of the radioactive material and 
 18.27  source and special nuclear material of a licensee.  The 
 18.28  commissioner shall prescribe the frequency of safety inspections 
 18.29  by rule. 
 18.30     Subd. 7.  [RECOVERY OF REINSPECTION COST.] If the 
 18.31  commissioner finds serious violations of public health standards 
 18.32  during an inspection under subdivision 6, the licensee must pay 
 18.33  all costs associated with subsequent reinspection of the 
 18.34  source.  The costs shall be the actual costs incurred by the 
 18.35  commissioner and include, but are not limited to, labor, 
 18.36  transportation, per diem, materials, legal fees, testing, and 
 19.1   monitoring costs. 
 19.2      Subd. 8.  [RECIPROCITY FEE.] A licensee submitting an 
 19.3   application for reciprocal recognition of a materials license 
 19.4   issued by another agreement state or the United States Nuclear 
 19.5   Regulatory Commission for a period of 180 days or less during a 
 19.6   calendar year must pay one-half of the application fee specified 
 19.7   under subdivision 4.  For a period of 181 days or more, the 
 19.8   licensee must pay the entire application fee under subdivision 4.
 19.9      Subd. 9.  [FEES FOR LICENSE AMENDMENTS.] A licensee must 
 19.10  pay a fee to amend a license as follows: 
 19.11     (1) to amend a license requiring no license review 
 19.12  including, but not limited to, facility name change or removal 
 19.13  of a previously authorized user, no fee; 
 19.14     (2) to amend a license requiring review including, but not 
 19.15  limited to, addition of isotopes, procedure changes, new 
 19.16  authorized users, or a new radiation safety officer, $200; and 
 19.17     (3) to amend a license requiring review and a site visit 
 19.18  including, but not limited to, facility move or addition of 
 19.19  processes, $400. 
 19.20     [EFFECTIVE DATE.] This section is effective July 1, 2002. 
 19.21     Sec. 27.  Minnesota Statutes 2000, section 144.122, is 
 19.22  amended to read: 
 19.23     144.122 [LICENSE, PERMIT, AND SURVEY FEES.] 
 19.24     (a) The state commissioner of health, by rule, may 
 19.25  prescribe reasonable procedures and fees for filing with the 
 19.26  commissioner as prescribed by statute and for the issuance of 
 19.27  original and renewal permits, licenses, registrations, and 
 19.28  certifications issued under authority of the commissioner.  The 
 19.29  expiration dates of the various licenses, permits, 
 19.30  registrations, and certifications as prescribed by the rules 
 19.31  shall be plainly marked thereon.  Fees may include application 
 19.32  and examination fees and a penalty fee for renewal applications 
 19.33  submitted after the expiration date of the previously issued 
 19.34  permit, license, registration, and certification.  The 
 19.35  commissioner may also prescribe, by rule, reduced fees for 
 19.36  permits, licenses, registrations, and certifications when the 
 20.1   application therefor is submitted during the last three months 
 20.2   of the permit, license, registration, or certification period.  
 20.3   Fees proposed to be prescribed in the rules shall be first 
 20.4   approved by the department of finance.  All fees proposed to be 
 20.5   prescribed in rules shall be reasonable.  The fees shall be in 
 20.6   an amount so that the total fees collected by the commissioner 
 20.7   will, where practical, approximate the cost to the commissioner 
 20.8   in administering the program.  All fees collected shall be 
 20.9   deposited in the state treasury and credited to the state 
 20.10  government special revenue fund unless otherwise specifically 
 20.11  appropriated by law for specific purposes. 
 20.12     (b) The commissioner may charge a fee for voluntary 
 20.13  certification of medical laboratories and environmental 
 20.14  laboratories, and for environmental and medical laboratory 
 20.15  services provided by the department, without complying with 
 20.16  paragraph (a) or chapter 14.  Fees charged for environment and 
 20.17  medical laboratory services provided by the department must be 
 20.18  approximately equal to the costs of providing the services.  
 20.19     (c) The commissioner may develop a schedule of fees for 
 20.20  diagnostic evaluations conducted at clinics held by the services 
 20.21  for children with handicaps program.  All receipts generated by 
 20.22  the program are annually appropriated to the commissioner for 
 20.23  use in the maternal and child health program. 
 20.24     (d) The commissioner, for fiscal years 1996 and beyond, 
 20.25  shall set license fees for hospitals and nursing homes that are 
 20.26  not boarding care homes at the following levels: 
 20.27  Joint Commission on Accreditation of Healthcare 
 20.28  Organizations (JCAHO hospitals)      $1,017
 20.29                                       $7,055
 20.30  Non-JCAHO hospitals                  $762 plus $34 per bed
 20.31                                       $4,680 plus $234 per bed
 20.32  Nursing home                         $78 plus $19 per bed
 20.33                                       $183 plus $91 per bed
 20.34     For fiscal years 1996 and beyond, The commissioner shall 
 20.35  set license fees for outpatient surgical centers, boarding care 
 20.36  homes, and supervised living facilities at the following levels: 
 21.1   Outpatient surgical centers          $517
 21.2                                        $1,512
 21.3   Boarding care homes                  $78 plus $19 per bed
 21.4                                        $183 plus $91 per bed
 21.5   Supervised living facilities         $78 plus $19 per bed
 21.6                                        $183 plus $91 per bed.
 21.7      (e) Unless prohibited by federal law, the commissioner of 
 21.8   health shall charge applicants the following fees to cover the 
 21.9   cost of any initial certification surveys required to determine 
 21.10  a provider's eligibility to participate in the Medicare or 
 21.11  Medicaid program: 
 21.12  Prospective payment surveys for          $  900
 21.13  hospitals
 21.15  Swing bed surveys for nursing homes      $1,200
 21.17  Psychiatric hospitals                    $1,400
 21.19  Rural health facilities                  $1,100
 21.21  Portable X-ray providers                 $  500
 21.23  Home health agencies                     $1,800
 21.25  Outpatient therapy agencies              $  800
 21.27  End stage renal dialysis providers       $2,100
 21.29  Independent therapists                   $  800
 21.31  Comprehensive rehabilitation             $1,200
 21.32  outpatient facilities
 21.34  Hospice providers                        $1,700
 21.36  Ambulatory surgical providers            $1,800
 21.38  Hospitals                                $4,200
 21.40  Other provider categories or             Actual surveyor costs:
 21.41  additional resurveys required            average surveyor cost x
 21.42  to complete initial certification        number of hours for the
 21.43                                           survey process.
 21.44     These fees shall be submitted at the time of the 
 21.45  application for federal certification and shall not be 
 21.46  refunded.  All fees collected after the date that the imposition 
 21.47  of fees is not prohibited by federal law shall be deposited in 
 21.48  the state treasury and credited to the state government special 
 21.49  revenue fund. 
 21.50     Sec. 28.  Minnesota Statutes 2000, section 144.148, 
 21.51  subdivision 2, is amended to read: 
 22.1      Subd. 2.  [PROGRAM.] (a) The commissioner of health shall 
 22.2   award rural hospital capital improvement grants to eligible 
 22.3   rural hospitals.  Except as provided in paragraph (b), A grant 
 22.4   shall not exceed $300,000 per hospital. Prior to the receipt of 
 22.5   any grant, the hospital must certify to the commissioner that at 
 22.6   least one-quarter of the grant amount, which may include in-kind 
 22.7   services, is available for the same purposes from nonstate 
 22.8   resources.  
 22.9      (b) A grant shall not exceed $1,500,000 per eligible rural 
 22.10  hospital that also satisfies the following criteria: 
 22.11     (1) is the only hospital in a county; 
 22.12     (2) has 25 or fewer licensed hospital beds with a net 
 22.13  hospital operating margin not greater than an average of two 
 22.14  percent over the three fiscal years prior to application; 
 22.15     (3) is located in a medically underserved community (MUC) 
 22.16  or a health professional shortage area (HPSA); 
 22.17     (4) is located near a migrant worker employment site and 
 22.18  regularly treats significant numbers of migrant workers and 
 22.19  their families; and 
 22.20     (5) has not previously received a grant under this section 
 22.21  prior to July 1, 1999. 
 22.22     Sec. 29.  Minnesota Statutes 2000, section 144.226, 
 22.23  subdivision 4, is amended to read: 
 22.24     Subd. 4.  [VITAL RECORDS SURCHARGE.] In addition to any fee 
 22.25  prescribed under subdivision 1, there is a nonrefundable 
 22.26  surcharge of $3 $2 for each certified and noncertified birth or 
 22.27  death record, and for a certification that the record cannot be 
 22.28  found.  The local or state registrar shall forward this amount 
 22.29  to the state treasurer to be deposited into the state government 
 22.30  special revenue fund.  This surcharge shall not be charged under 
 22.31  those circumstances in which no fee for a birth or death record 
 22.32  is permitted under subdivision 1, paragraph (a).  This surcharge 
 22.33  requirement expires June 30, 2002. 
 22.34     Sec. 30.  Minnesota Statutes 2000, section 144.551, 
 22.35  subdivision 1, is amended to read: 
 22.36     Subdivision 1.  [RESTRICTED CONSTRUCTION OR MODIFICATION.] 
 23.1   (a) The following construction or modification may not be 
 23.2   commenced:  
 23.3      (1) any erection, building, alteration, reconstruction, 
 23.4   modernization, improvement, extension, lease, or other 
 23.5   acquisition by or on behalf of a hospital that increases the bed 
 23.6   capacity of a hospital, relocates hospital beds from one 
 23.7   physical facility, complex, or site to another, or otherwise 
 23.8   results in an increase or redistribution of hospital beds within 
 23.9   the state; and 
 23.10     (2) the establishment of a new hospital.  
 23.11     (b) This section does not apply to:  
 23.12     (1) construction or relocation within a county by a 
 23.13  hospital, clinic, or other health care facility that is a 
 23.14  national referral center engaged in substantial programs of 
 23.15  patient care, medical research, and medical education meeting 
 23.16  state and national needs that receives more than 40 percent of 
 23.17  its patients from outside the state of Minnesota; 
 23.18     (2) a project for construction or modification for which a 
 23.19  health care facility held an approved certificate of need on May 
 23.20  1, 1984, regardless of the date of expiration of the 
 23.21  certificate; 
 23.22     (3) a project for which a certificate of need was denied 
 23.23  before July 1, 1990, if a timely appeal results in an order 
 23.24  reversing the denial; 
 23.25     (4) a project exempted from certificate of need 
 23.26  requirements by Laws 1981, chapter 200, section 2; 
 23.27     (5) a project involving consolidation of pediatric 
 23.28  specialty hospital services within the Minneapolis-St. Paul 
 23.29  metropolitan area that would not result in a net increase in the 
 23.30  number of pediatric specialty hospital beds among the hospitals 
 23.31  being consolidated; 
 23.32     (6) a project involving the temporary relocation of 
 23.33  pediatric-orthopedic hospital beds to an existing licensed 
 23.34  hospital that will allow for the reconstruction of a new 
 23.35  philanthropic, pediatric-orthopedic hospital on an existing site 
 23.36  and that will not result in a net increase in the number of 
 24.1   hospital beds.  Upon completion of the reconstruction, the 
 24.2   licenses of both hospitals must be reinstated at the capacity 
 24.3   that existed on each site before the relocation; 
 24.4      (7) the relocation or redistribution of hospital beds 
 24.5   within a hospital building or identifiable complex of buildings 
 24.6   provided the relocation or redistribution does not result in: 
 24.7   (i) an increase in the overall bed capacity at that site; (ii) 
 24.8   relocation of hospital beds from one physical site or complex to 
 24.9   another; or (iii) redistribution of hospital beds within the 
 24.10  state or a region of the state; 
 24.11     (8) relocation or redistribution of hospital beds within a 
 24.12  hospital corporate system that involves the transfer of beds 
 24.13  from a closed facility site or complex to an existing site or 
 24.14  complex provided that:  (i) no more than 50 percent of the 
 24.15  capacity of the closed facility is transferred; (ii) the 
 24.16  capacity of the site or complex to which the beds are 
 24.17  transferred does not increase by more than 50 percent; (iii) the 
 24.18  beds are not transferred outside of a federal health systems 
 24.19  agency boundary in place on July 1, 1983; and (iv) the 
 24.20  relocation or redistribution does not involve the construction 
 24.21  of a new hospital building; 
 24.22     (9) a construction project involving up to 35 new beds in a 
 24.23  psychiatric hospital in Rice county that primarily serves 
 24.24  adolescents and that receives more than 70 percent of its 
 24.25  patients from outside the state of Minnesota; 
 24.26     (10) a project to replace a hospital or hospitals with a 
 24.27  combined licensed capacity of 130 beds or less if:  (i) the new 
 24.28  hospital site is located within five miles of the current site; 
 24.29  and (ii) the total licensed capacity of the replacement 
 24.30  hospital, either at the time of construction of the initial 
 24.31  building or as the result of future expansion, will not exceed 
 24.32  70 licensed hospital beds, or the combined licensed capacity of 
 24.33  the hospitals, whichever is less; 
 24.34     (11) the relocation of licensed hospital beds from an 
 24.35  existing state facility operated by the commissioner of human 
 24.36  services to a new or existing facility, building, or complex 
 25.1   operated by the commissioner of human services; from one 
 25.2   regional treatment center site to another; or from one building 
 25.3   or site to a new or existing building or site on the same 
 25.4   campus; 
 25.5      (12) the construction or relocation of hospital beds 
 25.6   operated by a hospital having a statutory obligation to provide 
 25.7   hospital and medical services for the indigent that does not 
 25.8   result in a net increase in the number of hospital beds; or 
 25.9      (13) a construction project involving the addition of up to 
 25.10  31 new beds in an existing nonfederal hospital in Beltrami 
 25.11  county; or 
 25.12     (14) a construction project involving the addition of up to 
 25.13  eight new beds in an existing nonfederal hospital in Otter Tail 
 25.14  county with 100 licensed acute care beds. 
 25.15     Sec. 31.  [144.585] [HOSPITAL CHARITY CARE AID.] 
 25.16     Subdivision 1.  [PURPOSE.] The purpose of charity care aid 
 25.17  is to help offset excess charity care burdens at Minnesota acute 
 25.18  care, short-term hospitals. 
 25.19     Subd. 2.  [DEFINITIONS.] (a) For purposes of this section, 
 25.20  the terms in this subdivision have the meanings given to them. 
 25.21     (b) "Charity care" is the dollar amount of charity care 
 25.22  adjustments as determined under subdivision 3. 
 25.23     (c) "Cost-to-charge ratio" means a hospital's total 
 25.24  operating expenses over the sum of gross patient revenue and 
 25.25  other operating revenue, as reported to the commissioner of 
 25.26  health under rules adopted under sections 144.695 to 144.703.  
 25.27  The commissioner shall use the most recently available data to 
 25.28  calculate the cost-to-charge ratio. 
 25.29     Subd. 3.  [CHARITY CARE REPORTING.] (a) For a hospital to 
 25.30  report amounts as charity care adjustments, the hospital: 
 25.31     (1) must generate and record a charge; 
 25.32     (2) have a policy on the provision of charity care and must 
 25.33  communicate the policy to the public; 
 25.34     (3) have made a reasonable effort to identify a third party 
 25.35  payer, encourage the patient to enroll in public programs, and 
 25.36  should, to the extent possible, aid the patient in the 
 26.1   enrollment process; and 
 26.2      (4) ensure that the patient meets the charity care criteria 
 26.3   of this subdivision, which must be consistent with statewide 
 26.4   income standards set out in paragraph (c). 
 26.5      (b) In determining whether to classify care as charity 
 26.6   care, the hospital must consider the following: 
 26.7      (1) charity care may include services which the provider is 
 26.8   obligated to render independently of the ability to collect; 
 26.9      (2) charity care may include care provided to low-income 
 26.10  patients who meet the charity care income standards under 
 26.11  paragraph (c) and have partial coverage, but are unable to pay 
 26.12  the remainder of their medical bills.  This does not apply to 
 26.13  that portion of the bill which has been determined to be the 
 26.14  patient's responsibility after a partial charity care 
 26.15  classification; 
 26.16     (3) charity care may include care provided to low-income 
 26.17  patients who may qualify for a public health insurance program 
 26.18  and meet the statewide eligibility criteria for charity care, 
 26.19  but who do not complete the application process for public 
 26.20  insurance despite the facility's best efforts; 
 26.21     (4) charity care may include care to individuals whose 
 26.22  eligibility for charity care was determined through third party 
 26.23  services employed by the hospital for information gathering 
 26.24  purposes only; 
 26.25     (5) charity care may not include contractual allowances, 
 26.26  which is the difference between gross charges and payments 
 26.27  received under contractual arrangements with insurance companies 
 26.28  and payers; 
 26.29     (6) charity care may not include bad debt; 
 26.30     (7) charity care may not include what may be perceived as 
 26.31  underpayments for operating public programs; 
 26.32     (8) charity care may not include cases which are paid 
 26.33  through a charitable contribution through a third party or 
 26.34  facility-related foundation; 
 26.35     (9) charity care may not include unreimbursed costs of 
 26.36  basic or clinical research and of professional education and 
 27.1   training; 
 27.2      (10) charity care may not include professional courtesy 
 27.3   discounts; 
 27.4      (11) charity care may not include community service or 
 27.5   outreach activities; and 
 27.6      (12) charity care may not include services for patients 
 27.7   against whom collection actions where taken which result in a 
 27.8   credit report. 
 27.9      (c) The hospital must use the income standards in this 
 27.10  paragraph for determining charity care eligibility for reporting 
 27.11  purposes.  The hospital does not need to make a patient asset 
 27.12  determination in order to apply charity care income standards. 
 27.13     (1) Care to a patient with a family income at or below 150 
 27.14  percent of the Federal Poverty Guideline (FPG) may be reported 
 27.15  as full charity care or free care. 
 27.16     (2) The hospital's share of discounted charges for care to 
 27.17  a patient with family income below 275 percent of the FPG 
 27.18  qualifies for classification as charity care.  The following 
 27.19  sliding fee schedules apply: 
 27.20     income as     charges paid      corresponding
 27.21      % of FPG       by patient       charity care
 27.22      151-200%           20%               80%
 27.23      201-225%           40%               60%
 27.24      226-250%           60%               40%
 27.25      251-275%           80%               20%
 27.26     (3) Care to a patient is considered medical hardship when 
 27.27  qualified medical expenses, as defined for the purposes of 
 27.28  federal income tax deductibility, exceeds 30 percent of family 
 27.29  income.  Qualified medical expenses may be counted as charity 
 27.30  care in the amount that exceeds 30 percent of family income.  
 27.31  This clause applies even if the patient's family income exceeds 
 27.32  the charity care income standards in clauses (1) and (2). 
 27.33     Subd. 4.  [APPLICATION.] To be eligible for funds under 
 27.34  this section, hospitals must submit an application to the 
 27.35  commissioner of health by the deadline established by the 
 27.36  commissioner.  Applications must meet the criteria as 
 28.1   established by the commissioner, but must contain: 
 28.2      (1) the dollar amount of charity care in the previous year, 
 28.3   as defined in subdivision 3, paragraphs (b) and (c); 
 28.4      (2) a list with the most common diagnoses for which charity 
 28.5   care is provided; and 
 28.6      (3) descriptive aggregate statistics of the characteristics 
 28.7   of patients who receive charity care. 
 28.8      Subd. 5.  [ALLOCATION OF FUNDS.] A hospital's share of the 
 28.9   available charity care aid is equal to that hospital's share of 
 28.10  charity care relative to the total charity care provided by 
 28.11  applicants. 
 28.12     Sec. 32.  Minnesota Statutes 2000, section 144.98, 
 28.13  subdivision 3, is amended to read: 
 28.14     Subd. 3.  [FEES.] (a) An application for certification 
 28.15  under subdivision 1 must be accompanied by the biennial fee 
 28.16  specified in this subdivision.  The fees are for: 
 28.17     (1) nonrefundable base certification fee, $500 $1,200; and 
 28.18     (2) test category certification fees: 
 28.19  Test Category                                  Certification Fee
 28.20  Clean water program bacteriology                      $200 $600
 28.21  Safe drinking water program bacteriology                   $600
 28.22  Clean water program inorganic chemistry, 
 28.23    fewer than four constituents                        $100 $600
 28.24  Safe drinking water program inorganic chemistry, 
 28.25    four or more constituents                           $300 $600
 28.26  Clean water program chemistry metals, 
 28.27    fewer than four constituents                        $200 $800
 28.28  Safe drinking water program chemistry metals, 
 28.29    four or more constituents                           $500 $800
 28.30  Resource conservation and recovery program 
 28.31    chemistry metals                                         $800
 28.32  Clean water program volatile organic compounds      $600 $1,200
 28.33  Safe drinking water program 
 28.34    volatile organic compounds                             $1,200
 28.35  Resource conservation and recovery program 
 28.36    volatile organic compounds                             $1,200
 29.1   Underground storage tank program
 29.2     volatile organic compounds                             $1,200
 29.3   Clean water program other organic compounds         $600 $1,200
 29.4   Safe drinking water program other organic compounds      $1,200
 29.5   Resource conservation and recovery program
 29.6     other organic compounds                                $1,200
 29.7      (b) The total biennial certification fee is the base fee 
 29.8   plus the applicable test category fees.  The biennial 
 29.9   certification fee for a contract laboratory is 1.5 times the 
 29.10  total certification fee. 
 29.11     (c) Laboratories located outside of this state that require 
 29.12  an on-site survey will be assessed an additional $1,200 $2,500 
 29.13  fee. 
 29.14     (d) Fees must be set so that the total fees support the 
 29.15  laboratory certification program.  Direct costs of the 
 29.16  certification service include program administration, 
 29.17  inspections, the agency's general support costs, and attorney 
 29.18  general costs attributable to the fee function. 
 29.19     (e) A change fee shall be assessed if a laboratory requests 
 29.20  additional analytes or methods at any time other than when 
 29.21  applying for or renewing its certification.  The change fee is 
 29.22  equal to the test category certification fee for the analyte.  
 29.23     (f) A variance fee shall be assessed if a laboratory 
 29.24  requests and is granted a variance from a rule adopted under 
 29.25  this section.  The variance fee is $500 per variance. 
 29.26     (g) Refunds or credits shall not be made for analytes or 
 29.27  methods requested but not approved.  
 29.28     (h) Certification of a laboratory shall not be awarded 
 29.29  until all fees are paid. 
 29.30     Sec. 33.  Minnesota Statutes 2000, section 144A.44, 
 29.31  subdivision 1, is amended to read: 
 29.32     Subdivision 1.  [STATEMENT OF RIGHTS.] A person who 
 29.33  receives home care services has these rights: 
 29.34     (1) the right to receive written information about rights 
 29.35  in advance of receiving care or during the initial evaluation 
 29.36  visit before the initiation of treatment, including what to do 
 30.1   if rights are violated; 
 30.2      (2) the right to receive care and services according to a 
 30.3   suitable and up-to-date plan, and subject to accepted medical or 
 30.4   nursing standards, to take an active part in creating and 
 30.5   changing the plan and evaluating care and services; 
 30.6      (3) the right to be told in advance of receiving care about 
 30.7   the services that will be provided, the disciplines that will 
 30.8   furnish care, the frequency of visits proposed to be furnished, 
 30.9   other choices that are available, and the consequences of these 
 30.10  choices including the consequences of refusing these services; 
 30.11     (4) the right to be told in advance of any change in the 
 30.12  plan of care and to take an active part in any change; 
 30.13     (5) the right to refuse services or treatment; 
 30.14     (6) the right to know, in advance, any limits to the 
 30.15  services available from a provider, and the provider's grounds 
 30.16  for a termination of services; 
 30.17     (7) the right to know in advance of receiving care whether 
 30.18  the services are covered by health insurance, medical 
 30.19  assistance, or other health programs, the charges for services 
 30.20  that will not be covered by Medicare, and the charges that the 
 30.21  individual may have to pay; 
 30.22     (8) the right to know what the charges are for services, no 
 30.23  matter who will be paying the bill; 
 30.24     (9) the right to know that there may be other services 
 30.25  available in the community, including other home care services 
 30.26  and providers, and to know where to go for information about 
 30.27  these services; 
 30.28     (10) the right to choose freely among available providers 
 30.29  and to change providers after services have begun, within the 
 30.30  limits of health insurance, medical assistance, or other health 
 30.31  programs; 
 30.32     (11) the right to have personal, financial, and medical 
 30.33  information kept private, and to be advised of the provider's 
 30.34  policies and procedures regarding disclosure of such 
 30.35  information; 
 30.36     (12) the right to be allowed access to records and written 
 31.1   information from records in accordance with section 144.335; 
 31.2      (13) the right to be served by people who are properly 
 31.3   trained and competent to perform their duties; 
 31.4      (14) the right to be treated with courtesy and respect, and 
 31.5   to have the patient's property treated with respect; 
 31.6      (15) the right to be free from physical and verbal abuse; 
 31.7      (16) the right to reasonable, advance notice of changes in 
 31.8   services or charges, including at least ten days' advance notice 
 31.9   of the termination of a service by a provider, except in cases 
 31.10  where: 
 31.11     (i) the recipient of services engages in conduct that 
 31.12  alters the conditions of employment as specified in the 
 31.13  employment contract between the home care provider and the 
 31.14  individual providing home care services, or creates an abusive 
 31.15  or unsafe work environment for the individual providing home 
 31.16  care services; or 
 31.17     (ii) an emergency for the informal caregiver or a 
 31.18  significant change in the recipient's condition has resulted in 
 31.19  service needs that exceed the current service provider agreement 
 31.20  and that cannot be safely met by the home care provider; 
 31.21     (17) the right to a coordinated transfer when there will be 
 31.22  a change in the provider of services; 
 31.23     (18) the right to voice grievances regarding treatment or 
 31.24  care that is, or fails to be, furnished, or regarding the lack 
 31.25  of courtesy or respect to the patient or the patient's property; 
 31.26     (19) the right to know how to contact an individual 
 31.27  associated with the provider who is responsible for handling 
 31.28  problems and to have the provider investigate and attempt to 
 31.29  resolve the grievance or complaint; 
 31.30     (20) the right to know the name and address of the state or 
 31.31  county agency to contact for additional information or 
 31.32  assistance; and 
 31.33     (21) the right to assert these rights personally, or have 
 31.34  them asserted by the patient's family or guardian when the 
 31.35  patient has been judged incompetent, without retaliation. 
 31.36     Sec. 34.  Minnesota Statutes 2000, section 144A.4605, 
 32.1   subdivision 4, is amended to read: 
 32.2      Subd. 4.  [LICENSE REQUIRED.] (a) A housing with services 
 32.3   establishment registered under chapter 144D that is required to 
 32.4   obtain a home care license must obtain an assisted living home 
 32.5   care license according to this section or a class A or class E 
 32.6   license according to rule.  A housing with services 
 32.7   establishment that obtains a class E license under this 
 32.8   subdivision remains subject to the payment limitations in 
 32.9   sections 256B.0913, subdivision 5, paragraph (h), and 256B.0915, 
 32.10  subdivision 3, paragraph (g). 
 32.11     (b) A board and lodging establishment registered for 
 32.12  special services as of December 31, 1996, and also registered as 
 32.13  a housing with services establishment under chapter 144D, must 
 32.14  deliver home care services according to sections 144A.43 to 
 32.15  144A.48, and may apply for a waiver from requirements under 
 32.16  Minnesota Rules, parts 4668.0002 to 4668.0240, to operate a 
 32.17  licensed agency under the standards of section 157.17.  Such 
 32.18  waivers as may be granted by the department will expire upon 
 32.19  promulgation of home care rules implementing section 144A.4605. 
 32.20     (c) An adult foster care provider licensed by the 
 32.21  department of human services and registered under chapter 144D 
 32.22  may continue to provide health-related services under its foster 
 32.23  care license until the promulgation of home care rules 
 32.24  implementing this section. 
 32.25     (d) An assisted living home care provider licensed under 
 32.26  this section must comply with the disclosure provisions of 
 32.27  section 325F.691 to the extent they are applicable. 
 32.28     Sec. 35.  Minnesota Statutes 2000, section 144D.03, 
 32.29  subdivision 2, is amended to read: 
 32.30     Subd. 2.  [REGISTRATION INFORMATION.] The establishment 
 32.31  shall provide the following information to the commissioner in 
 32.32  order to be registered: 
 32.33     (1) the business name, street address, and mailing address 
 32.34  of the establishment; 
 32.35     (2) the name and mailing address of the owner or owners of 
 32.36  the establishment and, if the owner or owners are not natural 
 33.1   persons, identification of the type of business entity of the 
 33.2   owner or owners, and the names and addresses of the officers and 
 33.3   members of the governing body, or comparable persons for 
 33.4   partnerships, limited liability corporations, or other types of 
 33.5   business organizations of the owner or owners; 
 33.6      (3) the name and mailing address of the managing agent, 
 33.7   whether through management agreement or lease agreement, of the 
 33.8   establishment, if different from the owner or owners, and the 
 33.9   name of the on-site manager, if any; 
 33.10     (4) verification that the establishment has entered into an 
 33.11  elderly housing with services contract, as required in section 
 33.12  144D.04, with each resident or resident's representative; 
 33.13     (5) verification that the establishment is complying with 
 33.14  the requirements of section 325F.691, if applicable; 
 33.15     (5) (6) the name and address of at least one natural person 
 33.16  who shall be responsible for dealing with the commissioner on 
 33.17  all matters provided for in sections 144D.01 to 144D.06, and on 
 33.18  whom personal service of all notices and orders shall be made, 
 33.19  and who shall be authorized to accept service on behalf of the 
 33.20  owner or owners and the managing agent, if any; and 
 33.21     (6) (7) the signature of the authorized representative of 
 33.22  the owner or owners or, if the owner or owners are not natural 
 33.23  persons, signatures of at least two authorized representatives 
 33.24  of each owner, one of which shall be an officer of the owner. 
 33.25     Personal service on the person identified under clause (5) 
 33.26  (6) by the owner or owners in the registration shall be 
 33.27  considered service on the owner or owners, and it shall not be a 
 33.28  defense to any action that personal service was not made on each 
 33.29  individual or entity.  The designation of one or more 
 33.30  individuals under this subdivision shall not affect the legal 
 33.31  responsibility of the owner or owners under sections 144D.01 to 
 33.32  144D.06. 
 33.33     Sec. 36.  Minnesota Statutes 2000, section 144D.04, 
 33.34  subdivision 2, is amended to read: 
 33.35     Subd. 2.  [CONTENTS OF CONTRACT.] An elderly housing with 
 33.36  services contract, which need not be entitled as such to comply 
 34.1   with this section, shall include at least the following elements 
 34.2   in itself or through supporting documents or attachments: 
 34.3      (1) name, street address, and mailing address of the 
 34.4   establishment; 
 34.5      (2) the name and mailing address of the owner or owners of 
 34.6   the establishment and, if the owner or owners is not a natural 
 34.7   person, identification of the type of business entity of the 
 34.8   owner or owners; 
 34.9      (3) the name and mailing address of the managing agent, 
 34.10  through management agreement or lease agreement, of the 
 34.11  establishment, if different from the owner or owners; 
 34.12     (4) the name and address of at least one natural person who 
 34.13  is authorized to accept service on behalf of the owner or owners 
 34.14  and managing agent; 
 34.15     (5) statement describing the registration and licensure 
 34.16  status of the establishment and any provider providing 
 34.17  health-related or supportive services under an arrangement with 
 34.18  the establishment; 
 34.19     (6) term of the contract; 
 34.20     (7) description of the services to be provided to the 
 34.21  resident in the base rate to be paid by resident; 
 34.22     (8) description of any additional services available for an 
 34.23  additional fee from the establishment directly or through 
 34.24  arrangements with the establishment; 
 34.25     (9) fee schedules outlining the cost of any additional 
 34.26  services; 
 34.27     (10) description of the process through which the contract 
 34.28  may be modified, amended, or terminated; 
 34.29     (11) description of the establishment's complaint 
 34.30  resolution process available to residents including the 
 34.31  toll-free complaint line for the office of ombudsman for older 
 34.32  Minnesotans; 
 34.33     (12) the resident's designated representative, if any; 
 34.34     (13) the establishment's referral procedures if the 
 34.35  contract is terminated; 
 34.36     (14) criteria used by the establishment to determine who 
 35.1   may continue to reside in the elderly housing with services 
 35.2   establishment; 
 35.3      (15) billing and payment procedures and requirements; 
 35.4      (16) statement regarding the ability of residents to 
 35.5   receive services from service providers with whom the 
 35.6   establishment does not have an arrangement; and 
 35.7      (17) statement regarding the availability of public funds 
 35.8   for payment for residence or services in the establishment. 
 35.9      Sec. 37.  Minnesota Statutes 2000, section 144D.04, 
 35.10  subdivision 3, is amended to read: 
 35.11     Subd. 3.  [CONTRACTS IN PERMANENT FILES.] Elderly housing 
 35.12  with services contracts and related documents executed by each 
 35.13  resident or resident's representative shall be maintained by the 
 35.14  establishment in files from the date of execution until three 
 35.15  years after the contract is terminated.  The contracts and the 
 35.16  written disclosures required under section 325F.691, if 
 35.17  applicable, shall be made available for on-site inspection by 
 35.18  the commissioner upon request at any time. 
 35.19     Sec. 38.  Minnesota Statutes 2000, section 144D.06, is 
 35.20  amended to read: 
 35.21     144D.06 [OTHER LAWS.] 
 35.22     A housing with services establishment shall obtain and 
 35.23  maintain all other licenses, permits, registrations, or other 
 35.24  governmental approvals required of it in addition to 
 35.25  registration under this chapter.  A housing with services 
 35.26  establishment is subject to the provisions of section 325F.691 
 35.27  and chapter 504B. 
 35.28     Sec. 39.  [145.4241] [DEFINITIONS.] 
 35.29     Subdivision 1.  [APPLICABILITY.] As used in sections 
 35.30  145.4241 to 145.4246, the following terms have the meaning given 
 35.31  them. 
 35.32     Subd. 2.  [ABORTION.] "Abortion" includes an act, 
 35.33  procedure, or use of any instrument, medicine, or drug which is 
 35.34  supplied or prescribed for or administered to a woman known to 
 35.35  be pregnant with the intention to terminate the pregnancy with 
 35.36  an intention other than to increase the probability of live 
 36.1   birth, to preserve the life or health of the child after live 
 36.2   birth, or to remove a dead fetus. 
 36.3      Subd. 3.  [ATTEMPT TO PERFORM AN ABORTION.] "Attempt to 
 36.4   perform an abortion" means an act, or an omission of a 
 36.5   statutorily required act, that, under the circumstances as the 
 36.6   actor believes them to be, constitutes a substantial step in a 
 36.7   course of conduct planned to culminate in the performance of an 
 36.8   abortion in Minnesota in violation of sections 145.4241 to 
 36.9   145.4246. 
 36.10     Subd. 4.  [MEDICAL EMERGENCY.] "Medical emergency" means 
 36.11  any condition that, on the basis of the physician's good faith 
 36.12  clinical judgment, complicates the medical condition of a 
 36.13  pregnant female to the extent that: 
 36.14     (1) an immediate abortion of her pregnancy is necessary to 
 36.15  avert her death; or 
 36.16     (2) a 24-hour delay in performing an abortion creates a 
 36.17  serious risk of substantial injury or impairment of a major 
 36.18  bodily function. 
 36.19     Subd. 5.  [PHYSICIAN.] "Physician" means a person licensed 
 36.20  under chapter 147. 
 36.21     Subd. 6.  [PROBABLE GESTATIONAL AGE OF THE FETUS.] 
 36.22  "Probable gestational age of the fetus" means what will, in the 
 36.23  judgment of the physician, with reasonable probability, be the 
 36.24  gestational age of the fetus at the time the abortion is planned 
 36.25  to be performed. 
 36.26     Sec. 40.  [145.4242] [INFORMED CONSENT.] 
 36.27     (a) No abortion shall be performed in this state except 
 36.28  with the voluntary and informed consent of the female upon whom 
 36.29  the abortion is to be performed.  Except in the case of a 
 36.30  medical emergency, consent to an abortion is voluntary and 
 36.31  informed only if the female is told the following, by telephone 
 36.32  or in person, by the physician who is to perform the abortion, 
 36.33  the referring physician, a registered nurse, or a licensed 
 36.34  practical nurse, at least 24 hours prior to the abortion: 
 36.35     (1) the particular medical risks associated with the 
 36.36  particular abortion procedure to be employed including, when 
 37.1   medically accurate, the risks of infection, hemorrhage, breast 
 37.2   cancer, danger to subsequent pregnancies, and infertility; 
 37.3      (2) the probable gestational age of the fetus at the time 
 37.4   the abortion is to be performed; 
 37.5      (3) the medical risks associated with carrying to term; 
 37.6      (4) that medical assistance benefits may be available for 
 37.7   prenatal care, childbirth, and neonatal care; 
 37.8      (5) that the father is liable to assist in the support of 
 37.9   her child except under certain circumstances, even in instances 
 37.10  when the father has offered to pay for the abortion; 
 37.11     (6) the availability of a toll-free number and Web site 
 37.12  that can provide information on support services during 
 37.13  pregnancy and while the child is dependent and offer 
 37.14  alternatives to abortion; and 
 37.15     (7) that she has the right to review the printed materials 
 37.16  described in section 145.4243, and the printed materials are 
 37.17  available on the state Web site.  
 37.18     (b) The physician or the physician's agent shall orally 
 37.19  inform the female that the materials have been provided by the 
 37.20  state of Minnesota and that they describe the unborn child and 
 37.21  list agencies that offer alternatives to abortion. 
 37.22     (c) The physician or the physician's agent shall orally 
 37.23  inform the female of the Web site address and toll-free number. 
 37.24     (d) If the female chooses to view the materials, they shall 
 37.25  either be given to her at least 24 hours before the abortion or 
 37.26  mailed to her at least 72 hours before the abortion by first 
 37.27  class mail, or at the woman's request, by certified mail, 
 37.28  restricted delivery to addressee, which means the postal 
 37.29  employee may only deliver the mail to the addressee.  The 
 37.30  envelope used by the physician shall not identify the name of 
 37.31  the physician or the physician's clinic or business. 
 37.32     (e) If a physical examination, tests, or the availability 
 37.33  of other information to the physician subsequently indicates, in 
 37.34  the medical judgment of the physician, a revision of the 
 37.35  information previously supplied to the patient, that revised 
 37.36  information may be communicated to the patient at any time prior 
 38.1   to the performance of the abortion. 
 38.2      Sec. 41.  [145.4243] [PRINTED INFORMATION.] 
 38.3      Subdivision 1.  [MATERIALS.] (a) Within 90 days after the 
 38.4   effective date of sections 145.4241 to 145.4246, the department 
 38.5   of health shall cause to be published, in English and in each 
 38.6   language that is the primary language of two percent or more of 
 38.7   the state's population, the printed materials described in 
 38.8   paragraphs (b) and (c) in such a way as to ensure that the 
 38.9   information is easily comprehensible. 
 38.10     (b) The materials must be designed to inform the female of 
 38.11  the probable anatomical and physiological characteristics of the 
 38.12  fetus at two-week gestational increments from the time when a 
 38.13  female can be known to be pregnant to full term, including any 
 38.14  relevant information on the possibility of the fetus' survival 
 38.15  and pictures or drawings representing the development of the 
 38.16  fetus at two-week gestational increments, provided that any such 
 38.17  pictures or drawings must contain the dimensions of the fetus 
 38.18  and must be realistic and appropriate for the stage of pregnancy 
 38.19  depicted.  The materials must be objective, nonjudgmental, and 
 38.20  designed to convey only accurate scientific information about 
 38.21  the fetus at the various gestational ages. 
 38.22     (c) The materials must contain objective information 
 38.23  describing the methods of abortion procedures commonly employed, 
 38.24  the medical risks commonly associated with each procedure, the 
 38.25  possible detrimental psychological effects of abortion, and the 
 38.26  medical risks commonly associated with carrying a child to term. 
 38.27     Subd. 2.  [TYPEFACE; AVAILABILITY.] The materials referred 
 38.28  to in this section must be printed in a typeface large enough to 
 38.29  be clearly legible.  The materials required under this section 
 38.30  must be available from the department of health upon request and 
 38.31  in appropriate number to any person, facility, or hospital at no 
 38.32  cost. 
 38.33     Sec. 42.  [145.4244] [PROCEDURE IN CASE OF MEDICAL 
 38.34  EMERGENCY.] 
 38.35     When a medical emergency compels the performance of an 
 38.36  abortion, the physician shall inform the female, prior to the 
 39.1   abortion if possible, of the medical indications supporting the 
 39.2   physician's judgment that an abortion is necessary to avert her 
 39.3   death or that a 24-hour delay in conformance with section 
 39.4   145.4242 creates a serious risk of substantial injury or 
 39.5   impairment of a major bodily function. 
 39.6      Sec. 43.  [145.4245] [TOLL-FREE TELEPHONE NUMBER AND WEB 
 39.7   SITE.] 
 39.8      Subdivision 1.  [RIGHT TO KNOW.] All pregnant women have 
 39.9   the right to know information about resources available to 
 39.10  assist them and their families.  The commissioner of health 
 39.11  shall establish and maintain a statewide toll-free telephone 
 39.12  number available seven days a week to provide information and 
 39.13  referrals to local community resources to assist women and 
 39.14  families through pregnancy and childbirth and while the child is 
 39.15  dependent. 
 39.16     Subd. 2.  [INFORMATION.] The toll-free telephone number 
 39.17  must provide information regarding community resources on the 
 39.18  following topics: 
 39.19     (1) information regarding avoiding unplanned pregnancies; 
 39.20     (2) prenatal care, including the need for an initial risk 
 39.21  screening and assessment; 
 39.22     (3) adoption; 
 39.23     (4) health education, including the importance of good 
 39.24  nutrition during pregnancy and the risks associated with alcohol 
 39.25  and tobacco use during pregnancy; 
 39.26     (5) available social services, including medical assistance 
 39.27  benefits for prenatal care, childbirth, and neonatal care; 
 39.28     (6) legal assistance in obtaining child support; and 
 39.29     (7) community support services and other resources to 
 39.30  enhance family strengths and reduce the possibility of family 
 39.31  violence. 
 39.32     Subd. 3.  [WEB SITE.] The commissioner shall design and 
 39.33  maintain a secure Web site to provide the information described 
 39.34  under subdivision 2 and section 145.4243 with a minimum 
 39.35  resolution of 72 PPI.  The Web site shall provide the toll-free 
 39.36  information and referral telephone number described under 
 40.1   subdivision 2. 
 40.2      Sec. 44.  [145.4246] [ENFORCEMENT PENALTIES.] 
 40.3      Subdivision 1.  [STANDING.] A person with standing may 
 40.4   maintain an action against the performance or attempted 
 40.5   performance of abortions in violation of section 145.4242.  
 40.6   Those with standing are: 
 40.7      (1) a woman upon whom an abortion in violation of section 
 40.8   145.4242 has been performed or attempted to be performed; and 
 40.9      (2) the parent of an unemancipated minor upon whom an 
 40.10  abortion in violation of section 145.4242 has been, is about to 
 40.11  be, or was attempted to be performed; and 
 40.12     (3) attorney general of the state of Minnesota. 
 40.13     Subd. 2.  [INJUNCTIONS.] Parties bringing actions against 
 40.14  the performance or attempted performance of abortions in 
 40.15  violation of section 145.4242 may seek temporary restraining 
 40.16  orders, preliminary injunctions, and injunctions related only to 
 40.17  the physician or facility where the violation occurred in 
 40.18  accordance with the Rules of Civil Procedure.  Persons with 
 40.19  standing must bring any actions within six months of the date of 
 40.20  the performed or attempted performance of abortions in violation 
 40.21  of section 145.4242.  
 40.22     Subd. 3.  [CONTEMPT.] Any person knowingly violating the 
 40.23  terms of an injunction against the performance or attempted 
 40.24  performance of abortions in violation of section 145.4242 is 
 40.25  subject to civil contempt, and shall be fined no more than 
 40.26  $1,000 for the first violation, no more than $5,000 for the 
 40.27  second violation, no more than $10,000 for the third violation, 
 40.28  and for each successive violation an amount sufficient to deter 
 40.29  future violations.  The fine shall be the exclusive penalty for 
 40.30  a violation.  Each performance or attempted performance of 
 40.31  abortion in violation of section 145.4242 is a separate 
 40.32  violation.  No fine shall be assessed against the woman on whom 
 40.33  an abortion is performed or attempted. 
 40.34     Subd. 4.  [REALLOCATION OF THE FINE.] Any fines collected 
 40.35  under this section must be sent to a special account at the 
 40.36  Minnesota department of health to be used for materials cited in 
 41.1   section 145.4243. 
 41.2      Sec. 45.  [145.4247] [CUMULATIVE RIGHTS.] 
 41.3      The provisions of sections 145.4241 to 145.4246 are 
 41.4   cumulative with existing law regarding an individual's right to 
 41.5   consent to medical treatment and shall not impair any existing 
 41.6   right any patient may have under the common law or statutes of 
 41.7   this state. 
 41.8      Sec. 46.  Minnesota Statutes 2000, section 145.881, 
 41.9   subdivision 2, is amended to read: 
 41.10     Subd. 2.  [DUTIES.] The advisory task force shall meet on a 
 41.11  regular basis to perform the following duties:  
 41.12     (a) review and report on the health care needs of mothers 
 41.13  and children throughout the state of Minnesota; 
 41.14     (b) review and report on the type, frequency and impact of 
 41.15  maternal and child health care services provided to mothers and 
 41.16  children under existing maternal and child health care programs, 
 41.17  including programs administered by the commissioner of health; 
 41.18     (c) establish, review, and report to the commissioner a 
 41.19  list of program guidelines and criteria which the advisory task 
 41.20  force considers essential to providing an effective maternal and 
 41.21  child health care program to low income populations and high 
 41.22  risk persons and fulfilling the purposes defined in section 
 41.23  145.88; 
 41.24     (d) review staff recommendations of the department of 
 41.25  health regarding maternal and child health grant awards before 
 41.26  the awards are made; 
 41.27     (e) make recommendations to the commissioner for the use of 
 41.28  other federal and state funds available to meet maternal and 
 41.29  child health needs; 
 41.30     (f) make recommendations to the commissioner of health on 
 41.31  priorities for funding the following maternal and child health 
 41.32  services:  (1) prenatal, delivery and postpartum care, (2) 
 41.33  comprehensive health care for children, especially from birth 
 41.34  through five years of age, (3) adolescent health services, (4) 
 41.35  family planning services, (5) preventive dental care, (6) 
 41.36  special services for chronically ill and handicapped children 
 42.1   and (7) any other services which promote the health of mothers 
 42.2   and children; and 
 42.3      (g) make recommendations to the commissioner of health on 
 42.4   the process to distribute, award and administer the maternal and 
 42.5   child health block grant funds; and 
 42.6      (h) review the measures that are used to define the 
 42.7   variables of the funding distribution formula in section 
 42.8   145.882, subdivision 4a, every two years and make 
 42.9   recommendations to the commissioner of health for changes based 
 42.10  upon principles established by the advisory task force for this 
 42.11  purpose.  
 42.12     Sec. 47.  Minnesota Statutes 2000, section 145.882, is 
 42.13  amended by adding a subdivision to read: 
 42.14     Subd. 4a.  [ALLOCATION TO COMMUNITY HEALTH BOARDS.] (a) 
 42.15  Federal maternal and child health block grant money remaining 
 42.16  after distributions made under subdivision 2 and money 
 42.17  appropriated for allocation to community health boards must be 
 42.18  allocated according to paragraphs (b) to (d) to community health 
 42.19  boards as defined in section 145A.02, subdivision 5.  
 42.20     (b) All community health boards must receive 95 percent of 
 42.21  the funding awarded to them for the 1998-1999 funding cycle.  If 
 42.22  the amount of state and federal funding available is less than 
 42.23  95 percent of the amount awarded to community health boards for 
 42.24  the 1998-1999 funding cycle, the available funding must be 
 42.25  apportioned to reflect a proportional decrease for each 
 42.26  recipient. 
 42.27     (c) The federal and state funding remaining after 
 42.28  distributions made under paragraph (b) must be allocated to each 
 42.29  community health board based on the following three variables: 
 42.30     (1) 25 percent based on the maternal and child population 
 42.31  in the area served by the community health board; 
 42.32     (2) 50 percent based on the following factors, as 
 42.33  determined by averaging the data available for the three most 
 42.34  recent years: 
 42.35     (i) the proportion of infants in the area served by the 
 42.36  community health board whose weight at birth was less than 2,500 
 43.1   grams; 
 43.2      (ii) the proportion of mothers in the area served by the 
 43.3   community health board who received inadequate or no prenatal 
 43.4   care; 
 43.5      (iii) the proportion of births in the area served by the 
 43.6   community health board to women under age 19; and 
 43.7      (iv) the proportion of births in the area served by the 
 43.8   community health board to American Indian women and women of 
 43.9   color; and 
 43.10     (3) 25 percent based on the income of the maternal and 
 43.11  child population in the area served by the community health 
 43.12  board. 
 43.13     (d) Each variable must be expressed as a city or county 
 43.14  score consisting of the city or county frequency of each 
 43.15  variable in relation to the statewide frequency of the 
 43.16  variable.  A total score for each city or county jurisdiction 
 43.17  must be computed by totaling the scores of the three variables.  
 43.18  Each community health board must be allocated an amount equal to 
 43.19  the total score obtained for the city, county, or counties in 
 43.20  its area multiplied by the amount of money available. 
 43.21     Sec. 48.  Minnesota Statutes 2000, section 145.882, 
 43.22  subdivision 7, is amended to read: 
 43.23     Subd. 7.  [USE OF BLOCK GRANT MONEY.] (a) Maternal and 
 43.24  child health block grant money allocated to a community health 
 43.25  board or community health services area under this section must 
 43.26  be used for qualified programs for high risk and low-income 
 43.27  individuals.  Block grant money must be used for programs that: 
 43.28     (1) specifically address the highest risk populations, 
 43.29  particularly low-income and minority groups with a high rate of 
 43.30  infant mortality and children with low birth weight, by 
 43.31  providing services, including excluding prepregnancy family 
 43.32  planning services, calculated to produce measurable decreases in 
 43.33  infant mortality rates, instances of children with low birth 
 43.34  weight, and medical complications associated with pregnancy and 
 43.35  childbirth, including infant mortality, low birth rates, and 
 43.36  medical complications arising from chemical abuse by a mother 
 44.1   during pregnancy; 
 44.2      (2) specifically target pregnant women whose age, medical 
 44.3   condition, maternal history, or chemical abuse substantially 
 44.4   increases the likelihood of complications associated with 
 44.5   pregnancy and childbirth or the birth of a child with an 
 44.6   illness, disability, or special medical needs; 
 44.7      (3) specifically address the health needs of young children 
 44.8   who have or are likely to have a chronic disease or disability 
 44.9   or special medical needs, including physical, neurological, 
 44.10  emotional, and developmental problems that arise from chemical 
 44.11  abuse by a mother during pregnancy; 
 44.12     (4) provide family planning and preventive medical care, 
 44.13  excluding prepregnancy family planning services, for 
 44.14  specifically identified target populations, such as minority and 
 44.15  low-income teenagers, in a manner calculated to decrease the 
 44.16  occurrence of inappropriate pregnancy and minimize the risk of 
 44.17  complications associated with pregnancy and childbirth; or 
 44.18     (5) specifically address the frequency and severity of 
 44.19  childhood injuries and other child and adolescent health 
 44.20  problems in high-risk target populations by providing services, 
 44.21  excluding prepregnancy family planning services, calculated to 
 44.22  produce measurable decreases in mortality and 
 44.23  morbidity.  However, money may be used for this purpose only if 
 44.24  the community health board's application includes program 
 44.25  components for the purposes in clauses (1) to (4) in the 
 44.26  proposed geographic service area and the total expenditure for 
 44.27  injury-related programs under this clause does not exceed ten 
 44.28  percent of the total allocation under subdivision 3. 
 44.29     (b) Maternal and child health block grant money may be used 
 44.30  for purposes other than the purposes listed in this subdivision 
 44.31  only under the following conditions:  
 44.32     (1) the community health board or community health services 
 44.33  area can demonstrate that existing programs fully address the 
 44.34  needs of the highest risk target populations described in this 
 44.35  subdivision; or 
 44.36     (2) the money is used to continue projects that received 
 45.1   funding before creation of the maternal and child health block 
 45.2   grant in 1981. 
 45.3      (c) Projects that received funding before creation of the 
 45.4   maternal and child health block grant in 1981, must be allocated 
 45.5   at least the amount of maternal and child health special project 
 45.6   grant funds received in 1989, unless (1) the local board of 
 45.7   health provides equivalent alternative funding for the project 
 45.8   from another source; or (2) the local board of health 
 45.9   demonstrates that the need for the specific services provided by 
 45.10  the project has significantly decreased as a result of changes 
 45.11  in the demographic characteristics of the population, or other 
 45.12  factors that have a major impact on the demand for services.  If 
 45.13  the amount of federal funding to the state for the maternal and 
 45.14  child health block grant is decreased, these projects must 
 45.15  receive a proportional decrease as required in subdivision 1.  
 45.16  Increases in allocation amounts to local boards of health under 
 45.17  subdivision 4 may be used to increase funding levels for these 
 45.18  projects. 
 45.19     Sec. 49.  Minnesota Statutes 2000, section 145.885, 
 45.20  subdivision 2, is amended to read: 
 45.21     Subd. 2.  [ADDITIONAL REQUIREMENTS FOR COMMUNITY BOARDS OF 
 45.22  HEALTH.] Applications by community health boards as defined in 
 45.23  section 145A.02, subdivision 5, under section 145.882, 
 45.24  subdivision 3 4a, must also contain a summary of the process 
 45.25  used to develop the local program, including evidence that the 
 45.26  community health board notified local public and private 
 45.27  providers of the availability of funding through the community 
 45.28  health board for maternal and child health services; a list of 
 45.29  all public and private agency requests for grants submitted to 
 45.30  the community health board indicating which requests were 
 45.31  included in the grant application; and an explanation of how 
 45.32  priorities were established for selecting the requests to be 
 45.33  included in the grant application.  The community health board 
 45.34  shall include, with the grant application, a written statement 
 45.35  of the criteria to be applied to public and private agency 
 45.36  requests for funding. 
 46.1      Sec. 50.  Minnesota Statutes 2000, section 145.924, is 
 46.2   amended to read: 
 46.3      145.924 [AIDS PREVENTION GRANTS.] 
 46.4      Subdivision 1.  [GRANT AWARDS.] (a) The commissioner may 
 46.5   award grants to boards of health as defined in section 145A.02, 
 46.6   subdivision 2, state agencies, state councils, or nonprofit 
 46.7   corporations to provide evaluation and counseling services to 
 46.8   populations at risk for acquiring human immunodeficiency virus 
 46.9   infection, including, but not limited to, minorities, 
 46.10  adolescents, intravenous drug users, and homosexual men.  
 46.11     (b) The commissioner may award grants to agencies 
 46.12  experienced in providing services to communities of color, for 
 46.13  the design of innovative outreach and education programs for 
 46.14  targeted groups within the community who may be at risk of 
 46.15  acquiring the human immunodeficiency virus infection, including 
 46.16  intravenous drug users and their partners, adolescents, gay and 
 46.17  bisexual individuals and women.  Grants shall be awarded on a 
 46.18  request for proposal basis and shall include funds for 
 46.19  administrative costs.  Priority for grants shall be given to 
 46.20  agencies or organizations that have experience in providing 
 46.21  service to the particular community which the grantee proposes 
 46.22  to serve; that have policymakers representative of the targeted 
 46.23  population; that have experience in dealing with issues relating 
 46.24  to HIV/AIDS; and that have the capacity to deal effectively with 
 46.25  persons of differing sexual orientations.  For purposes of this 
 46.26  paragraph, the "communities of color" are:  the American-Indian 
 46.27  community; the Hispanic community; the African-American 
 46.28  community; and the Asian-Pacific community. 
 46.29     (c) All state grants awarded under this section subdivision 
 46.30  for programs targeted to adolescents shall include the promotion 
 46.31  of abstinence from sexual activity and drug use. 
 46.32     Subd. 2.  [OUTCOMES.] The commissioner, in consultation 
 46.33  with boards of health, agencies, councils, and nonprofit 
 46.34  organizations involved in human immunodeficiency virus infection 
 46.35  prevention efforts shall establish measurable outcomes to 
 46.36  determine the effectiveness of the grants provided under this 
 47.1   section in reducing the number of people who acquire human 
 47.2   immunodeficiency virus, the rates of infection, and average 
 47.3   numbers of sexual partners for populations served by grants 
 47.4   funded under this section. 
 47.5      Subd. 3.  [EVALUATION.] (a) Using the outcomes established 
 47.6   according to subdivision 2, the commissioner shall conduct a 
 47.7   biennial evaluation of activities funded under this section.  
 47.8   The evaluation must include: 
 47.9      (1) the effect of these activities on the number of people 
 47.10  who acquire human immunodeficiency virus and the rates of 
 47.11  infection; 
 47.12     (2) the effect of these activities on average numbers of 
 47.13  sexual partners for populations served by grants funded under 
 47.14  this section; and 
 47.15     (3) a longitudinal tracking of outcomes for targeted 
 47.16  populations who are served under subdivision 1, paragraphs (a) 
 47.17  and (b). 
 47.18     (b) Grant recipients shall cooperate with the commissioner 
 47.19  in the evaluation and shall provide the commissioner with the 
 47.20  information needed to conduct the evaluation.  Beginning January 
 47.21  15, 2003, the results of each evaluation must be submitted to 
 47.22  the chairs of the policy and finance committees in the house and 
 47.23  senate with jurisdiction over health and human services. 
 47.24     Sec. 51.  Minnesota Statutes 2000, section 145.925, 
 47.25  subdivision 1, is amended to read: 
 47.26     Subdivision 1.  [ELIGIBLE ORGANIZATIONS; PURPOSE.] The 
 47.27  commissioner of health may make special grants to cities, 
 47.28  counties, tribal governments, or groups of cities or, counties, 
 47.29  or nonprofit corporations or tribal governments to provide 
 47.30  prepregnancy family planning services. targeted to low-income 
 47.31  and minority populations.  A city, county, tribal government, or 
 47.32  group of cities, counties, or tribal governments that receives a 
 47.33  grant is responsible for ensuring that the grant funds are used 
 47.34  for services targeted to low-income and minority populations, 
 47.35  and must establish a goal for reducing specific pregnancy rates 
 47.36  in the service area.  In determining populations to serve and 
 48.1   services to provide, a city, county, tribal government, or group 
 48.2   of cities, counties, or tribal governments must consider the 
 48.3   spacing of pregnancies in low-income and minority populations in 
 48.4   the service area, teen birth rates in the service area, and the 
 48.5   needs of populations of color in the service area.  A city, 
 48.6   county, tribal government, or group of cities, counties, or 
 48.7   tribal governments may contract for the provision of 
 48.8   prepregnancy family planning services using grant funds provided 
 48.9   under this section only if the contract is specifically 
 48.10  authorized by the governing body of the city, county, or tribal 
 48.11  government that is contracting for the services. 
 48.12     Any organization or an affiliate of an organization which 
 48.13  provides abortions, promotes abortions, or directly refers for 
 48.14  abortions, shall be ineligible to receive funds under this 
 48.15  subdivision. 
 48.16     Sec. 52.  Minnesota Statutes 2000, section 145.925, 
 48.17  subdivision 1a, is amended to read: 
 48.18     Subd. 1a.  [FAMILY PLANNING SERVICES; DEFINED.] "Family 
 48.19  planning services" means counseling by trained personnel 
 48.20  regarding family planning; distribution of information relating 
 48.21  to family planning, referral to licensed physicians or local 
 48.22  health agencies for consultation, examination, medical 
 48.23  treatment, genetic counseling, and prescriptions for the purpose 
 48.24  of family planning; and the distribution of family planning 
 48.25  products, such as charts, thermometers, drugs, medical 
 48.26  preparations, and contraceptive devices.  Family planning 
 48.27  services do not include services that, directly or indirectly, 
 48.28  encourage, counsel, refer, or provide abortions or abortion 
 48.29  referrals.  For purposes of sections 145A.01 to 145A.14, family 
 48.30  planning shall mean voluntary action by individuals to prevent 
 48.31  or aid conception but does not include the performance, or make 
 48.32  referrals for encouragement of voluntary termination of 
 48.33  pregnancy services that, directly or indirectly, encourage, 
 48.34  counsel, refer, or provide abortions or abortion referrals.  
 48.35     Sec. 53.  [145.9257] [TEEN PREGNANCY PREVENTION.] 
 48.36     Subdivision 1.  [GOAL.] It is the goal of the state to 
 49.1   reduce teen pregnancy rates by 24 percent by 2006.  To do so, 
 49.2   the commissioner of health shall establish a grant program to 
 49.3   reduce the rates of unintended teen pregnancies in the state.  
 49.4   If this goal of reducing teen pregnancy rates by 24 percent is 
 49.5   not met by December 31, 2006, this section expires June 30, 
 49.6   2007.  No funds awarded under this section may be used for 
 49.7   medical services or family planning services or for services 
 49.8   that, directly or indirectly, encourage, counsel, refer, or 
 49.9   provide abortions or abortion referrals. 
 49.10     Any organization or an affiliate of an organization which 
 49.11  provides abortions, promotes abortions, or directly refers for 
 49.12  abortions, shall be ineligible to receive funds under this 
 49.13  section. 
 49.14     Subd. 2.  [STATE-COMMUNITY PARTNERSHIPS; PLAN.] The 
 49.15  commissioner, in consultation with the commissioner of children, 
 49.16  families, and learning; the commissioner of human services; the 
 49.17  maternal and child health advisory task force under section 
 49.18  145.881; the Indian affairs council under section 3.922; the 
 49.19  council on affairs of Chicano/Latino people under section 
 49.20  3.9223; the council on Black Minnesotans under section 3.9225; 
 49.21  the council on Asian-Pacific Minnesotans under section 3.9226; 
 49.22  community health boards as defined in section 145A.02; tribal 
 49.23  governments; nonprofit community organizations; and others 
 49.24  interested in teen pregnancy prevention, shall develop and 
 49.25  implement a comprehensive, coordinated plan to reduce the number 
 49.26  of teen pregnancies. 
 49.27     Subd. 3.  [MEASURABLE OUTCOMES.] The commissioner, in 
 49.28  consultation with the commissioners and community partners 
 49.29  listed in subdivision 2, shall establish measurable outcomes to 
 49.30  achieve the goal specified in subdivision 1 and to determine the 
 49.31  effectiveness of the grants provided under this section in 
 49.32  reducing teen pregnancies.  The development of measurable 
 49.33  outcomes must be completed before any funds are distributed 
 49.34  under this section. 
 49.35     Subd. 4.  [STATEWIDE ASSESSMENT.] The commissioner shall 
 49.36  use and enhance current statewide assessments of teen pregnancy 
 50.1   risk behaviors and attitudes among youth to establish a baseline 
 50.2   to measure the statewide effect of teen pregnancy prevention 
 50.3   activities.  To the extent feasible, the commissioner shall 
 50.4   conduct the assessment so that the results may be compared to 
 50.5   national data. 
 50.6      Subd. 5.  [PROCESS.] The commissioner, in consultation with 
 50.7   the commissioners and community partners listed in subdivision 
 50.8   2, shall develop the criteria and procedures used to allocate 
 50.9   grants under this section.  In developing the criteria, the 
 50.10  commissioner shall establish an administrative cost limit for 
 50.11  grant recipients.  At the time a grant is awarded, the 
 50.12  commissioner shall provide a grant recipient with information on 
 50.13  the outcomes established according to subdivision 3. 
 50.14     Subd. 6.  [TEEN PREGNANCY PREVENTION DISPARITY GRANTS.] (a) 
 50.15  The commissioner shall award competitive grants to eligible 
 50.16  applicants for projects to reduce disparities in unintended teen 
 50.17  pregnancy rates for American Indians and populations of color, 
 50.18  as compared with unintended teen pregnancy rates for whites. 
 50.19     (b) No funds awarded under this subdivision may be used for 
 50.20  medical services or family planning services or for services 
 50.21  that, directly or indirectly, encourage, counsel, refer, or 
 50.22  provide abortions or abortion referrals. 
 50.23     Any organization or an affiliate of an organization which 
 50.24  provides abortions, promotes abortions, or directly refers for 
 50.25  abortions, shall be ineligible to receive funds under this 
 50.26  subdivision. 
 50.27     (c) Eligible applicants may include, but are not limited 
 50.28  to, nonprofit organizations, school districts, faith-based 
 50.29  organizations, community health boards, and tribal governments.  
 50.30  Applicants must submit proposals to the commissioner.  A 
 50.31  proposal must specify the strategies to be implemented and must 
 50.32  take into account the need for a coordinated, statewide teen 
 50.33  pregnancy prevention effort.  Strategies may include youth 
 50.34  development programs, after-school enrichment programs, youth 
 50.35  mentoring programs, academic support programs, and abstinence 
 50.36  until marriage education programs. 
 51.1      (d) The commissioner shall give priority to applicants who 
 51.2   demonstrate that their proposed project:  
 51.3      (1) emphasizes abstinence until marriage; 
 51.4      (2) is research-based or based on proven, effective 
 51.5   strategies; 
 51.6      (3) is designed to coordinate with related youth risk 
 51.7   behavior reduction activities; 
 51.8      (4) involves youth and parents in the project's development 
 51.9   and implementation; 
 51.10     (5) reflects racially and ethnically appropriate 
 51.11  approaches; and 
 51.12     (6) will be implemented through or with persons or 
 51.13  community-based organizations that reflect the race or ethnicity 
 51.14  of the population to be reached. 
 51.15     Subd. 7.  [HIGH-RISK COMMUNITY TEEN PREGNANCY PREVENTION 
 51.16  GRANTS.] (a) The commissioner shall award grants to communities 
 51.17  that have significant risk factors for teen pregnancies, that 
 51.18  currently have in place youth development programs, and that are 
 51.19  interested in expanding existing efforts to prevent teen 
 51.20  pregnancies. 
 51.21     (b) No funds awarded under this subdivision may be used for 
 51.22  medical services or family planning services or for services 
 51.23  that, directly or indirectly, encourage, counsel, refer, or 
 51.24  provide abortions or abortion referrals. 
 51.25     Any organization or an affiliate of an organization which 
 51.26  provides abortions, promotes abortions, or directly refers for 
 51.27  abortions, shall be ineligible to receive funds under this 
 51.28  subdivision. 
 51.29     (c) To be eligible for a grant under this subdivision, an 
 51.30  applicant must be a tribal government or a community health 
 51.31  board as defined in section 145A.02.  Applicants must submit 
 51.32  proposals to the commissioner.  A proposal must specify the 
 51.33  strategies to be implemented.  Strategies may include, but are 
 51.34  not limited to, youth development programs, youth mentoring 
 51.35  programs, academic support programs, and abstinence until 
 51.36  marriage education programs.  Applicants must demonstrate that a 
 52.1   proposed project: 
 52.2      (1) emphasizes abstinence until marriage; 
 52.3      (2) is research-based or based on proven, effective 
 52.4   strategies; 
 52.5      (3) is designed to coordinate with related youth risk 
 52.6   behavior reduction activities; 
 52.7      (4) involves youth and parents in the project's development 
 52.8   and implementation; 
 52.9      (5) reflects racially and ethnically appropriate 
 52.10  approaches; and 
 52.11     (6) will be implemented through or with persons or 
 52.12  community-based organizations that reflect the race or ethnicity 
 52.13  of the population to be reached. 
 52.14     (d) Grants may be awarded to up to 15 community health 
 52.15  boards and three tribal governments based on areas having the 
 52.16  highest risk factors for teen pregnancies.  The commissioner 
 52.17  shall award grants based on the following risk factors: 
 52.18     (1) the proportion of teens in the applicant's service area 
 52.19  who are sexually active; 
 52.20     (2) the proportion of births to teens in the applicant's 
 52.21  service area; and 
 52.22     (3) the proportion of births to teens who are American 
 52.23  Indian or of a population of color in the applicant's service 
 52.24  area. 
 52.25     Subd. 8.  [ADOLESCENT PARENT GRANTS.] The commissioner 
 52.26  shall transfer funds to the commissioner of children, families, 
 52.27  and learning to increase the number of adolescent parent grants 
 52.28  currently provided by the commissioner of children, families, 
 52.29  and learning under section 124D.33. 
 52.30     Subd. 9.  [COORDINATION.] The commissioner shall coordinate 
 52.31  the projects and initiatives funded under this section with 
 52.32  other efforts at the local, state, and national levels to avoid 
 52.33  duplication and promote complementary efforts. 
 52.34     Subd. 10.  [EVALUATION.] Using the outcomes established 
 52.35  according to subdivision 3, the commissioner shall conduct a 
 52.36  biennial evaluation of the impact of each teen pregnancy 
 53.1   prevention initiative in this section.  Grant recipients and the 
 53.2   commissioner of children, families, and learning shall cooperate 
 53.3   with the commissioner in the evaluation and shall provide the 
 53.4   commissioner with the information needed to conduct the 
 53.5   evaluation. 
 53.6      Subd. 11.  [REPORT.] By January 15, 2002, and January 15 of 
 53.7   each even-numbered year thereafter, the commissioner shall 
 53.8   submit a report to the legislature on the projects funded under 
 53.9   this section and the results of the biennial evaluation. 
 53.10     Sec. 54.  [145.9268] [COMMUNITY CLINIC GRANTS.] 
 53.11     Subdivision 1.  [DEFINITION.] For purposes of this section, 
 53.12  "eligible community clinic" means: 
 53.13     (1) a clinic that provides services under conditions as 
 53.14  defined in Minnesota Rules, part 9505.0255 or 9505.0380, and 
 53.15  utilizes a sliding fee scale to determine eligibility for 
 53.16  charity care; 
 53.17     (2) an Indian tribal government or Indian health service 
 53.18  unit; or 
 53.19     (3) a consortium of clinics comprised of entities under 
 53.20  clause (1) or (2). 
 53.21     Subd. 2.  [GRANTS AUTHORIZED.] The commissioner of health 
 53.22  shall award grants to eligible community clinics to improve the 
 53.23  ongoing viability of Minnesota's clinic-based safety net 
 53.24  providers.  Grants shall be awarded to support the capacity of 
 53.25  eligible community clinics to serve low-income populations, 
 53.26  reduce current or future uncompensated care burdens, or provide 
 53.27  for improved care delivery infrastructure. 
 53.28     Subd. 3.  [ALLOCATION OF GRANTS.] (a) To receive a grant 
 53.29  under this section, an eligible community clinic must submit an 
 53.30  application to the commissioner of health by the deadline 
 53.31  established by the commissioner.  A grant may be awarded upon 
 53.32  the signing of a grant contract. 
 53.33     (b) An application must be on a form and contain 
 53.34  information as specified by the commissioner but at a minimum 
 53.35  must contain: 
 53.36     (1) a description of the project for which grant funds will 
 54.1   be used; 
 54.2      (2) a description of the problem the proposed project will 
 54.3   address; and 
 54.4      (3) a description of achievable objectives, a workplan, and 
 54.5   a timeline for project completion. 
 54.6      (c) The commissioner shall review each application to 
 54.7   determine whether the application is complete and whether the 
 54.8   applicant and the project are eligible for a grant.  In 
 54.9   evaluating applications according to paragraph (e), the 
 54.10  commissioner shall establish criteria including, but not limited 
 54.11  to:  the priority level of the project; the applicant's 
 54.12  thoroughness and clarity in describing the problem; a 
 54.13  description of the applicant's proposed project; the manner in 
 54.14  which the applicant will demonstrate the effectiveness of the 
 54.15  project; and evidence of efficiencies and effectiveness gained 
 54.16  through collaborative efforts.  The commissioner may also take 
 54.17  into account other relevant factors, including, but not limited 
 54.18  to, the percentage for which uninsured patients represent the 
 54.19  applicant's patient base.  During application review, the 
 54.20  commissioner may request additional information about a proposed 
 54.21  project, including information on project cost.  Failure to 
 54.22  provide the information requested disqualifies an applicant. 
 54.23     (d) A grant awarded to an eligible community clinic may not 
 54.24  exceed $300,000 per eligible community clinic.  For an applicant 
 54.25  applying as a consortium of clinics, a grant may not exceed 
 54.26  $300,000 per clinic included in the consortium.  The 
 54.27  commissioner has discretion over the number of grants awarded. 
 54.28     (e) In determining which eligible community clinics will 
 54.29  receive grants under this section, the commissioner shall give 
 54.30  preference to those grant applications that show evidence of 
 54.31  collaboration with other eligible community clinics, hospitals, 
 54.32  health care providers, or community organizations.  In addition, 
 54.33  the commissioner shall give priority, in declining order, to 
 54.34  grant applications for projects that: 
 54.35     (1) establish, update, or improve information, data 
 54.36  collection, or billing systems; 
 55.1      (2) procure, modernize, remodel, or replace equipment used 
 55.2   an the delivery of direct patient care at a clinic; 
 55.3      (3) provide improvements for care delivery, such as 
 55.4   increased translation and interpretation services; 
 55.5      (4) provide a direct offset to expenses incurred for 
 55.6   charity care services; or 
 55.7      (5) other projects determined by the commissioner to 
 55.8   improve the ability of applicants to provide care to the 
 55.9   vulnerable populations they serve. 
 55.10     Subd. 4.  [EVALUATION.] The commissioner of health shall 
 55.11  evaluate the overall effectiveness of the grant program.  The 
 55.12  commissioner shall collect progress reports to evaluate the 
 55.13  grant program from the eligible community clinics receiving 
 55.14  grants. 
 55.15     Sec. 55.  [145.928] [ELIMINATING HEALTH DISPARITIES.] 
 55.16     Subdivision 1.  [GOAL; ESTABLISHMENT.] It is the goal of 
 55.17  the state, by 2010, to decrease by 50 percent the disparities in 
 55.18  infant mortality rates and adult and child immunization rates 
 55.19  for American Indians and populations of color, as compared with 
 55.20  rates for whites.  To do so and to achieve other measurable 
 55.21  outcomes, the commissioner of health shall establish a program 
 55.22  to close the gap in the health status of American Indians and 
 55.23  populations of color as compared with whites in the following 
 55.24  priority areas:  infant mortality, breast and cervical cancer 
 55.25  screening, HIV/AIDS and sexually transmitted infections, adult 
 55.26  and child immunizations, cardiovascular disease, diabetes, and 
 55.27  accidental injuries and violence.  If this goal of reducing 
 55.28  disparities in infant mortality rates and adult and child 
 55.29  immunization rates is not met by December 31, 2010, this section 
 55.30  expires June 30, 2011. 
 55.31     Subd. 2.  [STATE-COMMUNITY PARTNERSHIPS; PLAN.] The 
 55.32  commissioner, in partnership with culturally-based community 
 55.33  organizations; the Indian affairs council under section 3.922; 
 55.34  the council on affairs of Chicano/Latino people under section 
 55.35  3.9223; the council on Black Minnesotans under section 3.9225; 
 55.36  the council on Asian-Pacific Minnesotans under section 3.9226; 
 56.1   community health boards as defined in section 145A.02; and 
 56.2   tribal governments, shall develop and implement a comprehensive, 
 56.3   coordinated plan to reduce health disparities in the health 
 56.4   disparity priority areas identified in subdivision 1. 
 56.5      Subd. 3.  [MEASURABLE OUTCOMES.] The commissioner, in 
 56.6   consultation with the community partners listed in subdivision 
 56.7   2, shall establish measurable outcomes to achieve the goal 
 56.8   specified in subdivision 1 and to determine the effectiveness of 
 56.9   the grants and other activities funded under this section in 
 56.10  reducing health disparities in the priority areas identified in 
 56.11  subdivision 1.  The development of measurable outcomes must be 
 56.12  completed before any funds are distributed under this section. 
 56.13     Subd. 4.  [STATEWIDE ASSESSMENT.] The commissioner shall 
 56.14  enhance current data tools to ensure a statewide assessment of 
 56.15  the risk behaviors associated with the health disparity priority 
 56.16  areas identified in subdivision 1.  The statewide assessment 
 56.17  must be used to establish a baseline to measure the effect of 
 56.18  activities funded under this section.  To the extent feasible, 
 56.19  the commissioner shall conduct the assessment so that the 
 56.20  results may be compared to national data. 
 56.21     Subd. 5.  [TECHNICAL ASSISTANCE.] The commissioner shall 
 56.22  provide the necessary expertise to grant applicants to ensure 
 56.23  that submitted proposals are likely to be successful in reducing 
 56.24  the health disparities identified in subdivision 1.  The 
 56.25  commissioner shall provide grant recipients with guidance and 
 56.26  training on best or most promising strategies to use to reduce 
 56.27  the health disparities identified in subdivision 1.  The 
 56.28  commissioner shall also assist grant recipients in the 
 56.29  development of materials and procedures to evaluate local 
 56.30  community activities. 
 56.31     Subd. 6.  [PROCESS.] (a) The commissioner, in consultation 
 56.32  with the community partners listed in subdivision 2, shall 
 56.33  develop the criteria and procedures used to allocate grants 
 56.34  under this section.  In developing the criteria, the 
 56.35  commissioner shall establish an administrative cost limit for 
 56.36  grant recipients.  At the time a grant is awarded, the 
 57.1   commissioner must provide a grant recipient with information on 
 57.2   the outcomes established according to subdivision 3. 
 57.3      (b) A grant recipient must coordinate its activities to 
 57.4   reduce health disparities with other entities receiving funds 
 57.5   under this section that are in the grant recipient's service 
 57.6   area. 
 57.7      Subd. 7.  [COMMUNITY GRANT PROGRAM; IMMUNIZATION RATES AND 
 57.8   INFANT MORTALITY RATES.] (a) The commissioner shall award grants 
 57.9   to eligible applicants for local or regional projects and 
 57.10  initiatives directed at reducing health disparities in one or 
 57.11  both of the following priority areas: 
 57.12     (1) decreasing racial and ethnic disparities in infant 
 57.13  mortality rates; or 
 57.14     (2) increasing adult and child immunization rates in 
 57.15  nonwhite racial and ethnic populations. 
 57.16     (b) The commissioner may award up to 20 percent of the 
 57.17  funds available as planning grants.  Planning grants must be 
 57.18  used to address such areas as community assessment, coordination 
 57.19  activities, and development of community supported strategies. 
 57.20     (c) Eligible applicants may include, but are not limited 
 57.21  to, faith-based organizations, social service organizations, 
 57.22  community nonprofit organizations, community health boards, 
 57.23  tribal governments, and community clinics.  Applicants must 
 57.24  submit proposals to the commissioner.  A proposal must specify 
 57.25  the strategies to be implemented to address one or both of the 
 57.26  priority areas listed in paragraph (a) and must be targeted to 
 57.27  achieve the outcomes established according to subdivision 3. 
 57.28     (d) The commissioner shall give priority to applicants who 
 57.29  demonstrate that their proposed project or initiative: 
 57.30     (1) is supported by the community the applicant will serve; 
 57.31     (2) is research-based or based on promising strategies; 
 57.32     (3) is designed to complement other related community 
 57.33  activities; 
 57.34     (4) utilizes strategies that positively impact both 
 57.35  priority areas; 
 57.36     (5) reflects racially and ethnically appropriate 
 58.1   approaches; and 
 58.2      (6) will be implemented through or with community-based 
 58.3   organizations that reflect the race or ethnicity of the 
 58.4   population to be reached. 
 58.5      Subd. 8.  [COMMUNITY GRANT PROGRAM; OTHER HEALTH 
 58.6   DISPARITIES.] (a) The commissioner shall award grants to 
 58.7   eligible applicants for local or regional projects and 
 58.8   initiatives directed at reducing health disparities in one or 
 58.9   more of the following priority areas: 
 58.10     (1) decreasing racial and ethnic disparities in morbidity 
 58.11  and mortality rates from breast and cervical cancer; 
 58.12     (2) decreasing racial and ethnic disparities in morbidity 
 58.13  and mortality rates from HIV/AIDS and sexually transmitted 
 58.14  infections; 
 58.15     (3) decreasing racial and ethnic disparities in morbidity 
 58.16  and mortality rates from cardiovascular disease; 
 58.17     (4) decreasing racial and ethnic disparities in morbidity 
 58.18  and mortality rates from diabetes; or 
 58.19     (5) decreasing racial and ethnic disparities in morbidity 
 58.20  and mortality rates from accidental injuries or violence. 
 58.21     (b) The commissioner may award up to 20 percent of the 
 58.22  funds available as planning grants.  Planning grants must be 
 58.23  used to address such areas as community assessment, determining 
 58.24  community priority areas, coordination activities, and 
 58.25  development of community supported strategies. 
 58.26     (c) Eligible applicants may include, but are not limited 
 58.27  to, faith-based organizations, social service organizations, 
 58.28  community nonprofit organizations, community health boards, 
 58.29  tribal governments, and community clinics.  Applicants shall 
 58.30  submit proposals to the commissioner.  A proposal must specify 
 58.31  the strategies to be implemented to address one or more of the 
 58.32  priority areas listed in paragraph (a) and must be targeted to 
 58.33  achieve the outcomes established according to subdivision 3. 
 58.34     (d) The commissioner shall give priority to applicants who 
 58.35  demonstrate that their proposed project or initiative: 
 58.36     (1) is supported by the community the applicant will serve; 
 59.1      (2) is research-based or based on promising strategies; 
 59.2      (3) is designed to complement other related community 
 59.3   activities; 
 59.4      (4) utilizes strategies that positively impact more than 
 59.5   one priority area; 
 59.6      (5) reflects racially and ethnically appropriate 
 59.7   approaches; and 
 59.8      (6) will be implemented through or with community-based 
 59.9   organizations that reflect the race or ethnicity of the 
 59.10  population to be reached. 
 59.11     Subd. 9.  [REFUGEE AND IMMIGRANT HEALTH.] (a) The 
 59.12  commissioner shall distribute funds to community health boards 
 59.13  for health screening and follow-up services for tuberculosis for 
 59.14  refugees.  Funds shall be distributed based on the following 
 59.15  formula: 
 59.16     (1) $1,500 per refugee with pulmonary tuberculosis in the 
 59.17  community health board's service area; 
 59.18     (2) $500 per refugee with extrapulmonary tuberculosis in 
 59.19  the community health board's service area; 
 59.20     (3) $500 per month of directly observed therapy provided by 
 59.21  the community health board for each uninsured refugee with 
 59.22  pulmonary or extrapulmonary tuberculosis; and 
 59.23     (4) $50 per refugee in the community health board's service 
 59.24  area. 
 59.25     (b) Payments must be made at the end of each state fiscal 
 59.26  year.  The amount paid per tuberculosis case, per month of 
 59.27  directly observed therapy, and per refugee must be 
 59.28  proportionately increased or decreased to fit the actual amount 
 59.29  appropriated for that fiscal year. 
 59.30     Subd. 10.  [COORDINATION.] The commissioner shall 
 59.31  coordinate the projects and initiatives funded under this 
 59.32  section with other efforts at the local, state, or national 
 59.33  level to avoid duplication and promote complementary efforts. 
 59.34     Subd. 11.  [EVALUATION.] Using the outcomes established 
 59.35  according to subdivision 3, the commissioner shall conduct a 
 59.36  biennial evaluation of the community grant programs under 
 60.1   subdivisions 7 and 8.  Grant recipients shall cooperate with the 
 60.2   commissioner in the evaluation and shall provide the 
 60.3   commissioner with the information needed to conduct the 
 60.4   evaluation. 
 60.5      Subd. 12.  [REPORT.] By January 15, 2002, and January 15 of 
 60.6   each even-numbered year thereafter, the commissioner shall 
 60.7   submit a report to the legislature on the local community 
 60.8   projects and community health board activities funded under this 
 60.9   section.  The report must include information on grant 
 60.10  recipients, activities conducted using grant funds, and 
 60.11  evaluation data and outcome measures if available. 
 60.12     Sec. 56.  Minnesota Statutes 2000, section 145A.15, 
 60.13  subdivision 1, is amended to read: 
 60.14     Subdivision 1.  [ESTABLISHMENT.] (a) The commissioner of 
 60.15  health shall expand the current grant program to fund additional 
 60.16  projects designed to prevent child abuse and neglect and reduce 
 60.17  juvenile delinquency by promoting positive parenting, resiliency 
 60.18  in children, and a healthy beginning for children by providing 
 60.19  early intervention services for families in need.  Grant dollars 
 60.20  shall be available to train paraprofessionals to provide in-home 
 60.21  intervention services and to allow public health nurses to do 
 60.22  case management of services.  The grant program shall provide 
 60.23  early intervention services for families in need and will 
 60.24  include: 
 60.25     (1) expansion of current public health nurse and family 
 60.26  aide home visiting programs and public health home visiting 
 60.27  projects which prevent child abuse and neglect, prevent juvenile 
 60.28  delinquency, and build resiliency in children; 
 60.29     (2) early intervention to promote a healthy and nurturing 
 60.30  beginning; 
 60.31     (3) distribution of educational and public information 
 60.32  programs and materials in hospital maternity divisions, 
 60.33  well-baby clinics, obstetrical clinics, and community clinics; 
 60.34  and 
 60.35     (4) training of home visitors in skills necessary for 
 60.36  comprehensive home visiting which promotes a healthy and 
 61.1   nurturing beginning for the child. 
 61.2      (b) No new grants shall be awarded under this section after 
 61.3   June 30, 2001.  Grant contracts awarded and in effect under this 
 61.4   section as of July 1, 2001, shall continue until their 
 61.5   expiration date. 
 61.6      Sec. 57.  Minnesota Statutes 2000, section 145A.15, is 
 61.7   amended by adding a subdivision to read: 
 61.8      Subd. 5.  [EXPIRATION.] This section expires June 30, 2003. 
 61.9      Sec. 58.  Minnesota Statutes 2000, section 145A.16, 
 61.10  subdivision 1, is amended to read: 
 61.11     Subdivision 1.  [ESTABLISHMENT.] The commissioner shall 
 61.12  establish a grant program to fund universally offered home 
 61.13  visiting programs designed to serve all live births in 
 61.14  designated geographic areas.  The commissioner shall designate 
 61.15  the geographic area to be served by each program.  At least one 
 61.16  program must provide home visiting services to families within 
 61.17  the seven-county metropolitan area, and at least one program 
 61.18  must provide home visiting services to families outside the 
 61.19  metropolitan area.  The purpose of the program is to strengthen 
 61.20  families and to promote positive parenting and healthy child 
 61.21  development.  No new grants shall be awarded under this section 
 61.22  after June 30, 2001.  Competitive grant contracts awarded and in 
 61.23  effect under this section as of July 1, 2001, shall expire 
 61.24  December 31, 2003. 
 61.25     Sec. 59.  Minnesota Statutes 2000, section 145A.16, is 
 61.26  amended by adding a subdivision to read: 
 61.27     Subd. 10.  [EXPIRATION.] This section expires December 31, 
 61.28  2003. 
 61.29     Sec. 60.  [145A.17] [FAMILY HOME VISITING PROGRAMS.] 
 61.30     Subdivision 1.  [ESTABLISHMENT; GOALS.] The commissioner 
 61.31  shall establish a program to fund family home visiting programs 
 61.32  designed to foster a healthy beginning for children in families 
 61.33  at or below 200 percent of the federal poverty guidelines, 
 61.34  prevent child abuse and neglect, reduce juvenile delinquency, 
 61.35  promote positive parenting and resiliency in children, and 
 61.36  promote family health and economic self-sufficiency.  A program 
 62.1   funded under this section must serve families at or below 200 
 62.2   percent of the federal poverty guidelines, and other families 
 62.3   determined to be at risk for child abuse, neglect, or juvenile 
 62.4   delinquency.  Programs must give priority for services to 
 62.5   families considered to be in need of services, including but not 
 62.6   limited to families with: 
 62.7      (1) adolescent parents; 
 62.8      (2) a history of alcohol or other drug abuse; 
 62.9      (3) a history of child abuse, domestic abuse, or other 
 62.10  types of violence; 
 62.11     (4) a history of domestic abuse, rape, or other forms of 
 62.12  victimization; 
 62.13     (5) reduced cognitive functioning; 
 62.14     (6) a lack of knowledge of child growth and development 
 62.15  stages; 
 62.16     (7) low resiliency to adversities and environmental 
 62.17  stresses; or 
 62.18     (8) insufficient financial resources to meet family needs. 
 62.19     Subd. 2.  [ALLOCATION OF FUNDS.] The commissioner shall 
 62.20  distribute funds available under this section to community 
 62.21  health boards, as defined in section 145A.02, and to tribal 
 62.22  governments.  Funds shall be distributed to community health 
 62.23  boards as follows:  (1) each community health board shall 
 62.24  receive an allocation of $25,000 per year; and (2) remaining 
 62.25  funds available to community health boards shall be distributed 
 62.26  according to the formula in section 256J.625, subdivision 3.  
 62.27  The commissioner, in consultation with tribal governments, shall 
 62.28  establish a formula for distributing funds to tribal governments.
 62.29     Subd. 3.  [REQUIREMENTS FOR PROGRAMS; PROCESS.] (a) Before 
 62.30  a community health board or tribal government may receive an 
 62.31  allocation under subdivision 2, a community health board or 
 62.32  tribal government must submit a proposal to the commissioner 
 62.33  that includes identification, based on a community assessment, 
 62.34  of the populations at or below 200 percent of the federal 
 62.35  poverty guidelines that will be served and the other populations 
 62.36  that will be served.  Each program that receives funds must: 
 63.1      (1) use either a broad community-based or selective 
 63.2   community-based strategy to provide preventive and early 
 63.3   intervention home visiting services; 
 63.4      (2) offer a home visit by a trained home visitor.  If a 
 63.5   home visit is accepted, the first home visit must occur 
 63.6   prenatally or as soon after birth as possible and must include a 
 63.7   public health nursing assessment by a public health nurse; 
 63.8      (3) offer, at a minimum, information on infant care, child 
 63.9   growth and development, positive parenting, preventing diseases, 
 63.10  preventing exposure to environmental hazards, and support 
 63.11  services available in the community; 
 63.12     (4) provide information on and referrals to health care 
 63.13  services, if needed, including information on health care 
 63.14  coverage for which the child or family may be eligible; and 
 63.15  provide information on preventive services, developmental 
 63.16  assessments, and the availability of public assistance programs 
 63.17  as appropriate; 
 63.18     (5) recruit home visitors who will represent, to the extent 
 63.19  possible, the races, cultures, and languages spoken by families 
 63.20  that may be served; 
 63.21     (6) train and supervise home visitors in accordance with 
 63.22  the requirements established under subdivision 4; 
 63.23     (7) maximize resources and minimize duplication by 
 63.24  coordinating activities with local social and human services 
 63.25  organizations, education organizations, and other appropriate 
 63.26  governmental entities and community-based organizations and 
 63.27  agencies; and 
 63.28     (8) utilize appropriate racial and ethnic approaches to 
 63.29  providing home visiting services. 
 63.30     (b) Funds available under this section shall not be used 
 63.31  for medical services.  The commissioner shall establish an 
 63.32  administrative cost limit for recipients of funds.  The outcome 
 63.33  measures established under subdivision 6 must be specified to 
 63.34  recipients of funds at the time the funds are distributed. 
 63.35     (c) Data collected on individuals served by the home 
 63.36  visiting programs must remain confidential and must not be 
 64.1   disclosed by providers of home visiting services without a 
 64.2   specific informed written consent that identifies disclosures to 
 64.3   be made.  Upon request, agencies providing home visiting 
 64.4   services must provide recipients with information on 
 64.5   disclosures, including the names of entities and individuals 
 64.6   receiving the information and the general purpose of the 
 64.7   disclosure.  Prospective and current recipients of home visiting 
 64.8   services must be told and informed in writing that written 
 64.9   consent for disclosure of data is not required for access to 
 64.10  home visiting services. 
 64.11     Subd. 4.  [TRAINING.] The commissioner shall establish 
 64.12  training requirements for home visitors and minimum requirements 
 64.13  for supervision by a public health nurse.  The requirements for 
 64.14  nurses must be consistent with chapter 148.  Training must 
 64.15  include child development, positive parenting techniques, and 
 64.16  diverse cultural practices in child rearing and family systems. 
 64.17     Subd. 5.  [TECHNICAL ASSISTANCE.] The commissioner shall 
 64.18  provide administrative and technical assistance to each program, 
 64.19  including assistance in data collection and other activities 
 64.20  related to conducting short- and long-term evaluations of the 
 64.21  programs as required under subdivision 7.  The commissioner may 
 64.22  request research and evaluation support from the University of 
 64.23  Minnesota. 
 64.24     Subd. 6.  [OUTCOME MEASURES.] The commissioner shall 
 64.25  establish outcomes to determine the impact of family home 
 64.26  visiting programs funded under this section on the following 
 64.27  areas: 
 64.28     (1) appropriate utilization of preventive health care; 
 64.29     (2) rates of substantiated child abuse and neglect; 
 64.30     (3) rates of unintentional child injuries; and 
 64.31     (4) any additional qualitative goals and quantitative 
 64.32  measures established by the commissioner. 
 64.33     Subd. 7.  [EVALUATION.] Using the qualitative goals and 
 64.34  quantitative outcome measures established under subdivisions 1 
 64.35  and 6, the commissioner shall conduct ongoing evaluations of the 
 64.36  programs funded under this section.  Community health boards and 
 65.1   tribal governments shall cooperate with the commissioner in the 
 65.2   evaluations and shall provide the commissioner with the 
 65.3   information necessary to conduct the evaluations.  As part of 
 65.4   the ongoing evaluations, the commissioner shall rate the impact 
 65.5   of the programs on the outcome measures listed in subdivision 6, 
 65.6   and shall periodically determine whether home visiting programs 
 65.7   are the best way to achieve the qualitative goals established in 
 65.8   subdivision 1 and by the commissioner.  If the commissioner 
 65.9   determines that home visiting programs are not the best way to 
 65.10  achieve these goals, the commissioner shall provide the 
 65.11  legislature with alternative methods for achieving them. 
 65.12     Subd. 8.  [REPORT.] By January 15, 2002, and January 15 of 
 65.13  each even-numbered year thereafter, the commissioner shall 
 65.14  submit a report to the legislature on the family home visiting 
 65.15  programs funded under this section and on the results of the 
 65.16  evaluations conducted under subdivision 7. 
 65.17     Subd. 9.  [NO SUPPLANTING OF EXISTING FUNDS.] Funding 
 65.18  available under this section may be used only to supplement, not 
 65.19  to replace, nonstate funds being used for home visiting services 
 65.20  as of July 1, 2001. 
 65.21     Sec. 61.  Minnesota Statutes 2000, section 157.16, 
 65.22  subdivision 3, is amended to read: 
 65.23     Subd. 3.  [ESTABLISHMENT FEES; DEFINITIONS.] (a) The 
 65.24  following fees are required for food and beverage service 
 65.25  establishments, hotels, motels, lodging establishments, and 
 65.26  resorts licensed under this chapter.  Food and beverage service 
 65.27  establishments must pay the highest applicable fee under 
 65.28  paragraph (e), clause (1), (2), (3), or (4), and establishments 
 65.29  serving alcohol must pay the highest applicable fee under 
 65.30  paragraph (e), clause (6) or (7).  The license fee for new 
 65.31  operators previously licensed under this chapter for the same 
 65.32  calendar year is one-half of the appropriate annual license fee, 
 65.33  plus any penalty that may be required.  The license fee for 
 65.34  operators opening on or after October 1 is one-half of the 
 65.35  appropriate annual license fee, plus any penalty that may be 
 65.36  required.  The fees in paragraphs (b), (c), and (d) effective 
 66.1   until June 30, 2001, shall be phased up as specified in section 
 66.2   64 to the fee amounts effective beginning July 1, 2004.  
 66.3   Notwithstanding section 16A.1285, in fiscal years 2002, 2003, 
 66.4   and 2004, the commissioner shall regulate food and beverage 
 66.5   service establishments, hotels, motels, lodging establishments, 
 66.6   and resorts with the fees collected for that purpose. 
 66.7      (b) All food and beverage service establishments, except 
 66.8   special event food stands, and all hotels, motels, lodging 
 66.9   establishments, and resorts shall pay an annual base fee of $100 
 66.10  until June 30, 2001.  Effective July 1, 2004, the annual base 
 66.11  fee shall be $145. 
 66.12     (c) A special event food stand shall pay a flat fee of $30 
 66.13  annually until June 30, 2001.  Effective July 1, 2004, the 
 66.14  annual flat fee shall be $35.  "Special event food stand" means 
 66.15  a fee category where food is prepared or served in conjunction 
 66.16  with celebrations, county fairs, or special events from a 
 66.17  special event food stand as defined in section 157.15. 
 66.18     (d) In addition to the base fee in paragraph (b), each food 
 66.19  and beverage service establishment, other than a special event 
 66.20  food stand, and each hotel, motel, lodging establishment, and 
 66.21  resort shall pay an additional annual fee for each fee category 
 66.22  as specified in this paragraph: 
 66.23     (1) Limited food menu selection, $30 until June 30, 2001.  
 66.24  Effective July 1, 2004, the annual fee shall be $40.  "Limited 
 66.25  food menu selection" means a fee category that provides one or 
 66.26  more of the following: 
 66.27     (i) prepackaged food that receives heat treatment and is 
 66.28  served in the package; 
 66.29     (ii) frozen pizza that is heated and served; 
 66.30     (iii) a continental breakfast such as rolls, coffee, juice, 
 66.31  milk, and cold cereal; 
 66.32     (iv) soft drinks, coffee, or nonalcoholic beverages; or 
 66.33     (v) cleaning for eating, drinking, or cooking utensils, 
 66.34  when the only food served is prepared off site. 
 66.35     (2) Small establishment, including boarding establishments, 
 66.36  $55 until June 30, 2001.  Effective July 1, 2004, the annual fee 
 67.1   shall be $75.  "Small establishment" means a fee category that 
 67.2   has no salad bar and meets one or more of the following: 
 67.3      (i) possesses food service equipment that consists of no 
 67.4   more than a deep fat fryer, a grill, two hot holding containers, 
 67.5   and one or more microwave ovens; 
 67.6      (ii) serves dipped ice cream or soft serve frozen desserts; 
 67.7      (iii) serves breakfast in an owner-occupied bed and 
 67.8   breakfast establishment; 
 67.9      (iv) is a boarding establishment; or 
 67.10     (v) meets the equipment criteria in clause (3), item (i) or 
 67.11  (ii), and has a maximum patron seating capacity of not more than 
 67.12  50.  
 67.13     (3) Medium establishment, $150 until June 30, 2001.  
 67.14  Effective July 1, 2004, the annual fee shall be $210.  "Medium 
 67.15  establishment" means a fee category that meets one or more of 
 67.16  the following: 
 67.17     (i) possesses food service equipment that includes a range, 
 67.18  oven, steam table, salad bar, or salad preparation area; 
 67.19     (ii) possesses food service equipment that includes more 
 67.20  than one deep fat fryer, one grill, or two hot holding 
 67.21  containers; or 
 67.22     (iii) is an establishment where food is prepared at one 
 67.23  location and served at one or more separate locations. 
 67.24     Establishments meeting criteria in clause (2), item (v), 
 67.25  are not included in this fee category.  
 67.26     (4) Large establishment, $250 until June 30, 2001.  
 67.27  Effective July 1, 2004, the annual fee shall be $350.  "Large 
 67.28  establishment" means either: 
 67.29     (i) a fee category that (A) meets the criteria in clause 
 67.30  (3), items (i) or (ii), for a medium establishment, (B) seats 
 67.31  more than 175 people, and (C) offers the full menu selection an 
 67.32  average of five or more days a week during the weeks of 
 67.33  operation; or 
 67.34     (ii) a fee category that (A) meets the criteria in clause 
 67.35  (3), item (iii), for a medium establishment, and (B) prepares 
 67.36  and serves 500 or more meals per day. 
 68.1      (5) Other food and beverage service, including food carts, 
 68.2   mobile food units, seasonal temporary food stands, and seasonal 
 68.3   permanent food stands, $30 until June 30, 2001.  Effective July 
 68.4   1, 2004, the annual fee shall be $40. 
 68.5      (6) Beer or wine table service, $30 until June 30, 2001.  
 68.6   Effective July 1, 2004, the annual fee shall be $40.  "Beer or 
 68.7   wine table service" means a fee category where the only 
 68.8   alcoholic beverage service is beer or wine, served to customers 
 68.9   seated at tables. 
 68.10     (7) Alcoholic beverage service, other than beer or wine 
 68.11  table service, $75 until June 30, 2001.  Effective July 1, 2004, 
 68.12  the annual fee shall be $105. 
 68.13     "Alcohol beverage service, other than beer or wine table 
 68.14  service" means a fee category where alcoholic mixed drinks are 
 68.15  served or where beer or wine are served from a bar. 
 68.16     (8) Until June 30, 2001, lodging per sleeping accommodation 
 68.17  unit, $4, including hotels, motels, lodging establishments, and 
 68.18  resorts, up to a maximum of $400.  Effective July 1, 2004, 
 68.19  lodging per sleeping accommodation unit, $6, including hotels, 
 68.20  motels, lodging establishments, and resorts, up to a maximum of 
 68.21  $600.  "Lodging per sleeping accommodation unit" means a fee 
 68.22  category including the number of guest rooms, cottages, or other 
 68.23  rental units of a hotel, motel, lodging establishment, or 
 68.24  resort; or the number of beds in a dormitory. 
 68.25     (9) First public swimming pool, $100 until June 30, 2001; 
 68.26  each additional public swimming pool, $50 until June 30, 2001.  
 68.27  Effective July 1, 2004, first public swimming pool, $140; each 
 68.28  additional public swimming pool, $80.  "Public swimming pool" 
 68.29  means a fee category that has the meaning given in Minnesota 
 68.30  Rules, part 4717.0250, subpart 8. 
 68.31     (10) First spa, $50 until June 30, 2001; each additional 
 68.32  spa, $25 until June 30, 2001.  Effective July 1, 2004, first 
 68.33  spa, $80; each additional spa, $40.  "Spa pool" means a fee 
 68.34  category that has the meaning given in Minnesota Rules, part 
 68.35  4717.0250, subpart 9. 
 68.36     (11) Private sewer or water, $30 until June 30, 2001.  
 69.1   Effective July 1, 2004, private sewer or water, $40.  
 69.2   "Individual private water" means a fee category with a water 
 69.3   supply other than a community public water supply as defined in 
 69.4   Minnesota Rules, chapter 4720.  "Individual private sewer" means 
 69.5   a fee category with an individual sewage treatment system which 
 69.6   uses subsurface treatment and disposal. 
 69.7      (e) A fee is not required for a food and beverage service 
 69.8   establishment operated by a school as defined in sections 
 69.9   120A.05, subdivisions 9, 11, 13, and 17 and 120A.22. 
 69.10     (f) A fee of $150 for review of the construction plans must 
 69.11  accompany the initial license application for food and beverage 
 69.12  service establishments, hotels, motels, lodging establishments, 
 69.13  or resorts. 
 69.14     (g) (f) When existing food and beverage service 
 69.15  establishments, hotels, motels, lodging establishments, or 
 69.16  resorts are extensively remodeled, a fee of $150 must be 
 69.17  submitted with the remodeling plans. 
 69.18     (h) (g) Seasonal temporary food stands and special event 
 69.19  food stands are not required to submit construction or 
 69.20  remodeling plans for review. 
 69.21     Sec. 62.  Minnesota Statutes 2000, section 157.22, is 
 69.22  amended to read: 
 69.23     157.22 [EXEMPTIONS.] 
 69.24     This chapter shall not be construed to apply to: 
 69.25     (1) interstate carriers under the supervision of the United 
 69.26  States Department of Health and Human Services; 
 69.27     (2) any building constructed and primarily used for 
 69.28  religious worship; 
 69.29     (3) any building owned, operated, and used by a college or 
 69.30  university in accordance with health regulations promulgated by 
 69.31  the college or university under chapter 14; 
 69.32     (4) any person, firm, or corporation whose principal mode 
 69.33  of business is licensed under sections 28A.04 and 28A.05, is 
 69.34  exempt at that premises from licensure as a food or beverage 
 69.35  establishment; provided that the holding of any license pursuant 
 69.36  to sections 28A.04 and 28A.05 shall not exempt any person, firm, 
 70.1   or corporation from the applicable provisions of this chapter or 
 70.2   the rules of the state commissioner of health relating to food 
 70.3   and beverage service establishments; 
 70.4      (5) family day care homes and group family day care homes 
 70.5   governed by sections 245A.01 to 245A.16; 
 70.6      (6) nonprofit senior citizen centers for the sale of 
 70.7   home-baked goods; and 
 70.8      (7) food not prepared at an establishment and brought in by 
 70.9   individuals attending a potluck event for consumption at the 
 70.10  potluck event.  An organization sponsoring a potluck event under 
 70.11  this clause may advertise the potluck event to the public 
 70.12  through any means.  Individuals who are not members of an 
 70.13  organization sponsoring a potluck event under this clause may 
 70.14  attend the potluck event and consume the food at the event.  
 70.15  Licensed food establishments cannot be sponsors of potluck 
 70.16  events.  Potluck event food shall not be brought into a licensed 
 70.17  food establishment kitchen; and 
 70.18     (8) a home school in which a child is provided instruction 
 70.19  at home. 
 70.20     Sec. 63.  [325F.691] [DISCLOSURE OF SPECIAL CARE STATUS 
 70.21  REQUIRED.] 
 70.22     Subdivision 1.  [PERSONS TO WHOM DISCLOSURE IS 
 70.23  REQUIRED.] Housing with services establishments, as defined in 
 70.24  sections 144D.01 to 144D.07, that secure, segregate, or provide 
 70.25  a special program or special unit for residents with a diagnosis 
 70.26  of probable Alzheimer's disease or a related disorder or that 
 70.27  advertise, market, or otherwise promote the establishment as 
 70.28  providing specialized care for Alzheimer's disease or a related 
 70.29  disorder are considered a "special care unit."  All special care 
 70.30  units shall provide a written disclosure to the following: 
 70.31     (1) the commissioner of health, if requested; 
 70.32     (2) the office of ombudsman for older Minnesotans; and 
 70.33     (3) each person seeking placement within a residence, or 
 70.34  the person's authorized representative, before an agreement to 
 70.35  provide the care is entered into. 
 70.36     Subd. 2.  [CONTENT.] Written disclosure shall include, but 
 71.1   is not limited to, the following: 
 71.2      (1) a statement of the overall philosophy and how it 
 71.3   reflects the special needs of residents with Alzheimer's disease 
 71.4   or other dementias; 
 71.5      (2) the criteria for determining who may reside in the 
 71.6   special care unit; 
 71.7      (3) the process used for assessment and establishment of 
 71.8   the service plan or agreement, including how the plan is 
 71.9   responsive to changes in the resident's condition; 
 71.10     (4) staffing credentials, job descriptions, and staff 
 71.11  duties and availability, including any training specific to 
 71.12  dementia; 
 71.13     (5) physical environment as well as design and security 
 71.14  features that specifically address the needs of residents with 
 71.15  Alzheimer's disease or other dementias; 
 71.16     (6) frequency and type of programs and activities for 
 71.17  residents of the special care unit; 
 71.18     (7) involvement of families in resident care and 
 71.19  availability of family support programs; 
 71.20     (8) fee schedules for additional services to the residents 
 71.21  of the special care unit; and 
 71.22     (9) a statement that residents will be given a written 
 71.23  notice 30 days prior to changes in the fee schedule. 
 71.24     Subd. 3.  [DUTY TO UPDATE.] Substantial changes to 
 71.25  disclosures must be reported to the parties listed in 
 71.26  subdivision 1 at the time the change is made. 
 71.27     Subd. 4.  [REMEDY.] The attorney general may seek the 
 71.28  remedies set forth in section 8.31 for repeated and intentional 
 71.29  violations of this section.  However, no private right of action 
 71.30  may be maintained as provided under section 8.31, subdivision 3a.
 71.31     Sec. 64.  [ESTABLISHMENT FEES DURING TRANSITION PERIOD.] 
 71.32     For fiscal years 2002, 2003, and 2004, the following fees 
 71.33  shall apply to food and beverage service establishments, hotels, 
 71.34  motels, lodging establishments, and resorts for which fees are 
 71.35  established under Minnesota Statutes, section 157.16, 
 71.36  subdivision 3, paragraphs (b), (c), and (d): 
 72.1                           Fiscal Year   Fiscal Year   Fiscal Year
 72.2   Fee Category                2002          2003          2004
 72.3   Annual base fee, all      $111.25       $122.50       $133.75
 72.4   food and beverage
 72.5   service establishments
 72.6   except special event
 72.7   food stands and all
 72.8   hotels, motels, lodging
 72.9   establishments, and
 72.10  resorts
 72.11  Special event food        $ 31.25       $ 32.50       $ 33.75
 72.12  stand
 72.13  Establishment with        $ 32.50       $ 35.00       $ 37.50
 72.14  limited food menu
 72.15  selection
 72.16  Small establishment       $ 60.00       $ 65.00       $ 70.00
 72.17  Medium establishment      $165.00       $180.00       $195.00
 72.18  Large establishment       $275.00       $300.00       $325.00
 72.19  Other food and            $ 32.50       $ 35.00       $ 37.50
 72.20  beverage service
 72.21  Beer or wine table        $ 32.50       $ 35.00       $ 37.50
 72.22  service
 72.23  Alcoholic beverage        $ 82.50       $ 90.00       $ 97.50
 72.24  service other than
 72.25  beer or wine table
 72.26  service
 72.27  Lodging per sleeping    $4.50 per     $5.00 per     $5.50 per
 72.28  accommodation unit,    unit, $450    unit, $500    unit, $550
 72.29  up to a specified         maximum       maximum       maximum
 72.30  maximum
 72.31  First public              $110.00       $120.00       $130.00
 72.32  swimming pool
 72.33  Each additional           $ 57.50       $ 65.00       $ 72.50
 72.34  public swimming pool
 72.35  First spa                 $ 57.50       $ 65.00       $ 72.50
 72.36  Each additional spa       $ 28.75       $ 32.50       $ 36.25
 73.1   Private sewer or          $ 32.50       $ 35.00       $ 37.50
 73.2   water
 73.3      Sec. 65.  [RECOMMENDATIONS; INCENTIVES FOR MAGNET 
 73.4   HOSPITALS.] 
 73.5      The commissioner of health shall develop recommendations 
 73.6   for incentives that may be implemented to increase the number of 
 73.7   magnet hospitals in Minnesota.  These recommendations must be 
 73.8   reported by December 1, 2001 to the chairs of the house and 
 73.9   senate committees with jurisdiction over health and human 
 73.10  services policy and finance issues. 
 73.11     Sec. 66.  [STUDY; REIMBURSEMENT FOR CERTAIN ANTI-TOBACCO 
 73.12  USE EDUCATION ACTIVITIES.] 
 73.13     The commissioner of health, in consultation with persons 
 73.14  who have had laryngectomies to treat larynx cancer, who use 
 73.15  artificial larynxes for communication, and who engage in 
 73.16  anti-tobacco use education activities, shall study and develop 
 73.17  recommendations establishing a program to reimburse these 
 73.18  persons for mileage and other costs associated with traveling to 
 73.19  schools in the state to educate students about the health risks 
 73.20  of tobacco use.  The recommendations must include proposals for 
 73.21  reimbursement levels, a funding source, expenses for which 
 73.22  persons may be reimbursed, and persons eligible for 
 73.23  reimbursement.  The recommendations must be reported to the 
 73.24  chairs of the policy and finance committees in the House and 
 73.25  Senate with jurisdiction over health and human services issues 
 73.26  by January 15, 2002. 
 73.27     Sec. 67.  [STUDY; EFFECTS OF NURSE STAFFING SHORTAGES.] 
 73.28     The commissioner of health, in consultation with consumers, 
 73.29  representatives of the Minnesota nurses association, and 
 73.30  representatives of the Minnesota hospital and healthcare 
 73.31  partnership, shall study and identify the effects of nurse 
 73.32  staffing shortages in health care facilities on patient care and 
 73.33  patient safety.  The results of this study shall be reported by 
 73.34  December 1, 2001 to the chairs of the house and senate 
 73.35  committees with jurisdiction over health and human services 
 73.36  policy issues. 
 74.1      Sec. 68.  [REPEALER.] 
 74.2      (a) Minnesota Statutes 2000, sections 145.882, subdivisions 
 74.3   3 and 4; and 145.927, are repealed. 
 74.4      (b) Minnesota Statutes 2000, section 144.148, subdivision 
 74.5   8, is repealed. 
 74.6      [EFFECTIVE DATE.] Paragraph (b) of this section is 
 74.7   effective the day following final enactment. 
 74.8                              ARTICLE 2 
 74.9                             HEALTH CARE 
 74.10     Section 1.  Minnesota Statutes 2000, section 256.01, 
 74.11  subdivision 2, is amended to read: 
 74.12     Subd. 2.  [SPECIFIC POWERS.] Subject to the provisions of 
 74.13  section 241.021, subdivision 2, the commissioner of human 
 74.14  services shall: 
 74.15     (1) Administer and supervise all forms of public assistance 
 74.16  provided for by state law and other welfare activities or 
 74.17  services as are vested in the commissioner.  Administration and 
 74.18  supervision of human services activities or services includes, 
 74.19  but is not limited to, assuring timely and accurate distribution 
 74.20  of benefits, completeness of service, and quality program 
 74.21  management.  In addition to administering and supervising human 
 74.22  services activities vested by law in the department, the 
 74.23  commissioner shall have the authority to: 
 74.24     (a) require county agency participation in training and 
 74.25  technical assistance programs to promote compliance with 
 74.26  statutes, rules, federal laws, regulations, and policies 
 74.27  governing human services; 
 74.28     (b) monitor, on an ongoing basis, the performance of county 
 74.29  agencies in the operation and administration of human services, 
 74.30  enforce compliance with statutes, rules, federal laws, 
 74.31  regulations, and policies governing welfare services and promote 
 74.32  excellence of administration and program operation; 
 74.33     (c) develop a quality control program or other monitoring 
 74.34  program to review county performance and accuracy of benefit 
 74.35  determinations; 
 74.36     (d) require county agencies to make an adjustment to the 
 75.1   public assistance benefits issued to any individual consistent 
 75.2   with federal law and regulation and state law and rule and to 
 75.3   issue or recover benefits as appropriate; 
 75.4      (e) delay or deny payment of all or part of the state and 
 75.5   federal share of benefits and administrative reimbursement 
 75.6   according to the procedures set forth in section 256.017; 
 75.7      (f) make contracts with and grants to public and private 
 75.8   agencies and organizations, both profit and nonprofit, and 
 75.9   individuals, using appropriated funds; and 
 75.10     (g) enter into contractual agreements with federally 
 75.11  recognized Indian tribes with a reservation in Minnesota to the 
 75.12  extent necessary for the tribe to operate a federally approved 
 75.13  family assistance program or any other program under the 
 75.14  supervision of the commissioner.  The commissioner shall consult 
 75.15  with the affected county or counties in the contractual 
 75.16  agreement negotiations, if the county or counties wish to be 
 75.17  included, in order to avoid the duplication of county and tribal 
 75.18  assistance program services.  The commissioner may establish 
 75.19  necessary accounts for the purposes of receiving and disbursing 
 75.20  funds as necessary for the operation of the programs. 
 75.21     (2) Inform county agencies, on a timely basis, of changes 
 75.22  in statute, rule, federal law, regulation, and policy necessary 
 75.23  to county agency administration of the programs. 
 75.24     (3) Administer and supervise all child welfare activities; 
 75.25  promote the enforcement of laws protecting handicapped, 
 75.26  dependent, neglected and delinquent children, and children born 
 75.27  to mothers who were not married to the children's fathers at the 
 75.28  times of the conception nor at the births of the children; 
 75.29  license and supervise child-caring and child-placing agencies 
 75.30  and institutions; supervise the care of children in boarding and 
 75.31  foster homes or in private institutions; and generally perform 
 75.32  all functions relating to the field of child welfare now vested 
 75.33  in the state board of control. 
 75.34     (4) Administer and supervise all noninstitutional service 
 75.35  to handicapped persons, including those who are visually 
 75.36  impaired, hearing impaired, or physically impaired or otherwise 
 76.1   handicapped.  The commissioner may provide and contract for the 
 76.2   care and treatment of qualified indigent children in facilities 
 76.3   other than those located and available at state hospitals when 
 76.4   it is not feasible to provide the service in state hospitals. 
 76.5      (5) Assist and actively cooperate with other departments, 
 76.6   agencies and institutions, local, state, and federal, by 
 76.7   performing services in conformity with the purposes of Laws 
 76.8   1939, chapter 431. 
 76.9      (6) Act as the agent of and cooperate with the federal 
 76.10  government in matters of mutual concern relative to and in 
 76.11  conformity with the provisions of Laws 1939, chapter 431, 
 76.12  including the administration of any federal funds granted to the 
 76.13  state to aid in the performance of any functions of the 
 76.14  commissioner as specified in Laws 1939, chapter 431, and 
 76.15  including the promulgation of rules making uniformly available 
 76.16  medical care benefits to all recipients of public assistance, at 
 76.17  such times as the federal government increases its participation 
 76.18  in assistance expenditures for medical care to recipients of 
 76.19  public assistance, the cost thereof to be borne in the same 
 76.20  proportion as are grants of aid to said recipients. 
 76.21     (7) Establish and maintain any administrative units 
 76.22  reasonably necessary for the performance of administrative 
 76.23  functions common to all divisions of the department. 
 76.24     (8) Act as designated guardian of both the estate and the 
 76.25  person of all the wards of the state of Minnesota, whether by 
 76.26  operation of law or by an order of court, without any further 
 76.27  act or proceeding whatever, except as to persons committed as 
 76.28  mentally retarded.  For children under the guardianship of the 
 76.29  commissioner whose interests would be best served by adoptive 
 76.30  placement, the commissioner may contract with a licensed 
 76.31  child-placing agency to provide adoption services.  A contract 
 76.32  with a licensed child-placing agency must be designed to 
 76.33  supplement existing county efforts and may not replace existing 
 76.34  county programs, unless the replacement is agreed to by the 
 76.35  county board and the appropriate exclusive bargaining 
 76.36  representative or the commissioner has evidence that child 
 77.1   placements of the county continue to be substantially below that 
 77.2   of other counties.  Funds encumbered and obligated under an 
 77.3   agreement for a specific child shall remain available until the 
 77.4   terms of the agreement are fulfilled or the agreement is 
 77.5   terminated. 
 77.6      (9) Act as coordinating referral and informational center 
 77.7   on requests for service for newly arrived immigrants coming to 
 77.8   Minnesota. 
 77.9      (10) The specific enumeration of powers and duties as 
 77.10  hereinabove set forth shall in no way be construed to be a 
 77.11  limitation upon the general transfer of powers herein contained. 
 77.12     (11) Establish county, regional, or statewide schedules of 
 77.13  maximum fees and charges which may be paid by county agencies 
 77.14  for medical, dental, surgical, hospital, nursing and nursing 
 77.15  home care and medicine and medical supplies under all programs 
 77.16  of medical care provided by the state and for congregate living 
 77.17  care under the income maintenance programs. 
 77.18     (12) Have the authority to conduct and administer 
 77.19  experimental projects to test methods and procedures of 
 77.20  administering assistance and services to recipients or potential 
 77.21  recipients of public welfare.  To carry out such experimental 
 77.22  projects, it is further provided that the commissioner of human 
 77.23  services is authorized to waive the enforcement of existing 
 77.24  specific statutory program requirements, rules, and standards in 
 77.25  one or more counties.  The order establishing the waiver shall 
 77.26  provide alternative methods and procedures of administration, 
 77.27  shall not be in conflict with the basic purposes, coverage, or 
 77.28  benefits provided by law, and in no event shall the duration of 
 77.29  a project exceed four years.  It is further provided that no 
 77.30  order establishing an experimental project as authorized by the 
 77.31  provisions of this section shall become effective until the 
 77.32  following conditions have been met: 
 77.33     (a) The secretary of health and human services of the 
 77.34  United States has agreed, for the same project, to waive state 
 77.35  plan requirements relative to statewide uniformity. 
 77.36     (b) A comprehensive plan, including estimated project 
 78.1   costs, shall be approved by the legislative advisory commission 
 78.2   and filed with the commissioner of administration.  
 78.3      (13) According to federal requirements, establish 
 78.4   procedures to be followed by local welfare boards in creating 
 78.5   citizen advisory committees, including procedures for selection 
 78.6   of committee members. 
 78.7      (14) Allocate federal fiscal disallowances or sanctions 
 78.8   which are based on quality control error rates for the aid to 
 78.9   families with dependent children program formerly codified in 
 78.10  sections 256.72 to 256.87, medical assistance, or food stamp 
 78.11  program in the following manner:  
 78.12     (a) One-half of the total amount of the disallowance shall 
 78.13  be borne by the county boards responsible for administering the 
 78.14  programs.  For the medical assistance and the AFDC program 
 78.15  formerly codified in sections 256.72 to 256.87, disallowances 
 78.16  shall be shared by each county board in the same proportion as 
 78.17  that county's expenditures for the sanctioned program are to the 
 78.18  total of all counties' expenditures for the AFDC program 
 78.19  formerly codified in sections 256.72 to 256.87, and medical 
 78.20  assistance programs.  For the food stamp program, sanctions 
 78.21  shall be shared by each county board, with 50 percent of the 
 78.22  sanction being distributed to each county in the same proportion 
 78.23  as that county's administrative costs for food stamps are to the 
 78.24  total of all food stamp administrative costs for all counties, 
 78.25  and 50 percent of the sanctions being distributed to each county 
 78.26  in the same proportion as that county's value of food stamp 
 78.27  benefits issued are to the total of all benefits issued for all 
 78.28  counties.  Each county shall pay its share of the disallowance 
 78.29  to the state of Minnesota.  When a county fails to pay the 
 78.30  amount due hereunder, the commissioner may deduct the amount 
 78.31  from reimbursement otherwise due the county, or the attorney 
 78.32  general, upon the request of the commissioner, may institute 
 78.33  civil action to recover the amount due. 
 78.34     (b) Notwithstanding the provisions of paragraph (a), if the 
 78.35  disallowance results from knowing noncompliance by one or more 
 78.36  counties with a specific program instruction, and that knowing 
 79.1   noncompliance is a matter of official county board record, the 
 79.2   commissioner may require payment or recover from the county or 
 79.3   counties, in the manner prescribed in paragraph (a), an amount 
 79.4   equal to the portion of the total disallowance which resulted 
 79.5   from the noncompliance, and may distribute the balance of the 
 79.6   disallowance according to paragraph (a).  
 79.7      (15) Develop and implement special projects that maximize 
 79.8   reimbursements and result in the recovery of money to the 
 79.9   state.  For the purpose of recovering state money, the 
 79.10  commissioner may enter into contracts with third parties.  Any 
 79.11  recoveries that result from projects or contracts entered into 
 79.12  under this paragraph shall be deposited in the state treasury 
 79.13  and credited to a special account until the balance in the 
 79.14  account reaches $1,000,000.  When the balance in the account 
 79.15  exceeds $1,000,000, the excess shall be transferred and credited 
 79.16  to the general fund.  All money in the account is appropriated 
 79.17  to the commissioner for the purposes of this paragraph. 
 79.18     (16) Have the authority to make direct payments to 
 79.19  facilities providing shelter to women and their children 
 79.20  according to section 256D.05, subdivision 3.  Upon the written 
 79.21  request of a shelter facility that has been denied payments 
 79.22  under section 256D.05, subdivision 3, the commissioner shall 
 79.23  review all relevant evidence and make a determination within 30 
 79.24  days of the request for review regarding issuance of direct 
 79.25  payments to the shelter facility.  Failure to act within 30 days 
 79.26  shall be considered a determination not to issue direct payments.
 79.27     (17) Have the authority to establish and enforce the 
 79.28  following county reporting requirements:  
 79.29     (a) The commissioner shall establish fiscal and statistical 
 79.30  reporting requirements necessary to account for the expenditure 
 79.31  of funds allocated to counties for human services programs.  
 79.32  When establishing financial and statistical reporting 
 79.33  requirements, the commissioner shall evaluate all reports, in 
 79.34  consultation with the counties, to determine if the reports can 
 79.35  be simplified or the number of reports can be reduced. 
 79.36     (b) The county board shall submit monthly or quarterly 
 80.1   reports to the department as required by the commissioner.  
 80.2   Monthly reports are due no later than 15 working days after the 
 80.3   end of the month.  Quarterly reports are due no later than 30 
 80.4   calendar days after the end of the quarter, unless the 
 80.5   commissioner determines that the deadline must be shortened to 
 80.6   20 calendar days to avoid jeopardizing compliance with federal 
 80.7   deadlines or risking a loss of federal funding.  Only reports 
 80.8   that are complete, legible, and in the required format shall be 
 80.9   accepted by the commissioner.  
 80.10     (c) If the required reports are not received by the 
 80.11  deadlines established in clause (b), the commissioner may delay 
 80.12  payments and withhold funds from the county board until the next 
 80.13  reporting period.  When the report is needed to account for the 
 80.14  use of federal funds and the late report results in a reduction 
 80.15  in federal funding, the commissioner shall withhold from the 
 80.16  county boards with late reports an amount equal to the reduction 
 80.17  in federal funding until full federal funding is received.  
 80.18     (d) A county board that submits reports that are late, 
 80.19  illegible, incomplete, or not in the required format for two out 
 80.20  of three consecutive reporting periods is considered 
 80.21  noncompliant.  When a county board is found to be noncompliant, 
 80.22  the commissioner shall notify the county board of the reason the 
 80.23  county board is considered noncompliant and request that the 
 80.24  county board develop a corrective action plan stating how the 
 80.25  county board plans to correct the problem.  The corrective 
 80.26  action plan must be submitted to the commissioner within 45 days 
 80.27  after the date the county board received notice of noncompliance.
 80.28     (e) The final deadline for fiscal reports or amendments to 
 80.29  fiscal reports is one year after the date the report was 
 80.30  originally due.  If the commissioner does not receive a report 
 80.31  by the final deadline, the county board forfeits the funding 
 80.32  associated with the report for that reporting period and the 
 80.33  county board must repay any funds associated with the report 
 80.34  received for that reporting period. 
 80.35     (f) The commissioner may not delay payments, withhold 
 80.36  funds, or require repayment under paragraph (c) or (e) if the 
 81.1   county demonstrates that the commissioner failed to provide 
 81.2   appropriate forms, guidelines, and technical assistance to 
 81.3   enable the county to comply with the requirements.  If the 
 81.4   county board disagrees with an action taken by the commissioner 
 81.5   under paragraph (c) or (e), the county board may appeal the 
 81.6   action according to sections 14.57 to 14.69. 
 81.7      (g) Counties subject to withholding of funds under 
 81.8   paragraph (c) or forfeiture or repayment of funds under 
 81.9   paragraph (e) shall not reduce or withhold benefits or services 
 81.10  to clients to cover costs incurred due to actions taken by the 
 81.11  commissioner under paragraph (c) or (e). 
 81.12     (18) Allocate federal fiscal disallowances or sanctions for 
 81.13  audit exceptions when federal fiscal disallowances or sanctions 
 81.14  are based on a statewide random sample for the foster care 
 81.15  program under title IV-E of the Social Security Act, United 
 81.16  States Code, title 42, in direct proportion to each county's 
 81.17  title IV-E foster care maintenance claim for that period. 
 81.18     (19) Be responsible for ensuring the detection, prevention, 
 81.19  investigation, and resolution of fraudulent activities or 
 81.20  behavior by applicants, recipients, and other participants in 
 81.21  the human services programs administered by the department. 
 81.22     (20) Require county agencies to identify overpayments, 
 81.23  establish claims, and utilize all available and cost-beneficial 
 81.24  methodologies to collect and recover these overpayments in the 
 81.25  human services programs administered by the department. 
 81.26     (21) Have the authority to administer a drug rebate program 
 81.27  for drugs purchased pursuant to the prescription drug program 
 81.28  established under section 256.955 after the beneficiary's 
 81.29  satisfaction of any deductible established in the program.  The 
 81.30  commissioner shall require a rebate agreement from all 
 81.31  manufacturers of covered drugs as defined in section 256B.0625, 
 81.32  subdivision 13.  Rebate agreements for prescription drugs 
 81.33  delivered on or after July 1, 2002, must include rebates for 
 81.34  individuals covered under the prescription drug program who are 
 81.35  under 65 years of age.  For each drug, the amount of the rebate 
 81.36  shall be equal to the basic rebate as defined for purposes of 
 82.1   the federal rebate program in United States Code, title 42, 
 82.2   section 1396r-8(c)(1).  This basic rebate shall be applied to 
 82.3   single-source and multiple-source drugs.  The manufacturers must 
 82.4   provide full payment within 30 days of receipt of the state 
 82.5   invoice for the rebate within the terms and conditions used for 
 82.6   the federal rebate program established pursuant to section 1927 
 82.7   of title XIX of the Social Security Act.  The manufacturers must 
 82.8   provide the commissioner with any information necessary to 
 82.9   verify the rebate determined per drug.  The rebate program shall 
 82.10  utilize the terms and conditions used for the federal rebate 
 82.11  program established pursuant to section 1927 of title XIX of the 
 82.12  Social Security Act. 
 82.13     (22) Have the authority to administer the federal drug 
 82.14  rebate program for drugs purchased under the medical assistance 
 82.15  program as allowed by section 1927 of title XIX of the Social 
 82.16  Security Act and according to the terms and conditions of 
 82.17  section 1927.  Rebates shall be collected for all drugs that 
 82.18  have been dispensed or administered in an outpatient setting and 
 82.19  that are from manufacturers who have signed a rebate agreement 
 82.20  with the United States Department of Health and Human Services. 
 82.21     (22) (23) Operate the department's communication systems 
 82.22  account established in Laws 1993, First Special Session chapter 
 82.23  1, article 1, section 2, subdivision 2, to manage shared 
 82.24  communication costs necessary for the operation of the programs 
 82.25  the commissioner supervises.  A communications account may also 
 82.26  be established for each regional treatment center which operates 
 82.27  communications systems.  Each account must be used to manage 
 82.28  shared communication costs necessary for the operations of the 
 82.29  programs the commissioner supervises.  The commissioner may 
 82.30  distribute the costs of operating and maintaining communication 
 82.31  systems to participants in a manner that reflects actual usage. 
 82.32  Costs may include acquisition, licensing, insurance, 
 82.33  maintenance, repair, staff time and other costs as determined by 
 82.34  the commissioner.  Nonprofit organizations and state, county, 
 82.35  and local government agencies involved in the operation of 
 82.36  programs the commissioner supervises may participate in the use 
 83.1   of the department's communications technology and share in the 
 83.2   cost of operation.  The commissioner may accept on behalf of the 
 83.3   state any gift, bequest, devise or personal property of any 
 83.4   kind, or money tendered to the state for any lawful purpose 
 83.5   pertaining to the communication activities of the department.  
 83.6   Any money received for this purpose must be deposited in the 
 83.7   department's communication systems accounts.  Money collected by 
 83.8   the commissioner for the use of communication systems must be 
 83.9   deposited in the state communication systems account and is 
 83.10  appropriated to the commissioner for purposes of this section. 
 83.11     (23) (24) Receive any federal matching money that is made 
 83.12  available through the medical assistance program for the 
 83.13  consumer satisfaction survey.  Any federal money received for 
 83.14  the survey is appropriated to the commissioner for this 
 83.15  purpose.  The commissioner may expend the federal money received 
 83.16  for the consumer satisfaction survey in either year of the 
 83.17  biennium. 
 83.18     (24) (25) Incorporate cost reimbursement claims from First 
 83.19  Call Minnesota into the federal cost reimbursement claiming 
 83.20  processes of the department according to federal law, rule, and 
 83.21  regulations.  Any reimbursement received is appropriated to the 
 83.22  commissioner and shall be disbursed to First Call Minnesota 
 83.23  according to normal department payment schedules. 
 83.24     (25) (26) Develop recommended standards for foster care 
 83.25  homes that address the components of specialized therapeutic 
 83.26  services to be provided by foster care homes with those services.
 83.27     Sec. 2.  Minnesota Statutes 2000, section 256.955, 
 83.28  subdivision 2b, is amended to read: 
 83.29     Subd. 2b.  [ELIGIBILITY.] Effective July 1, 2002, an 
 83.30  individual satisfying the following requirements and the 
 83.31  requirements described in subdivision 2, paragraph (d), is 
 83.32  eligible for the prescription drug program: 
 83.33     (1) is under 65 years of age; and 
 83.34     (2) is eligible as a qualified Medicare beneficiary 
 83.35  according to section 256B.057, subdivision 3 or 3a, or is 
 83.36  eligible under section 256B.057, subdivision 3 or 3a, and is 
 84.1   also eligible for medical assistance or general assistance 
 84.2   medical care with a spenddown as defined in section 256B.056, 
 84.3   subdivision 5. 
 84.4      Sec. 3.  [256.956] [PURCHASING ALLIANCE STOP-LOSS FUND.] 
 84.5      Subdivision 1.  [DEFINITIONS.] For purposes of this 
 84.6   section, the following definitions apply:  
 84.7      (a) "Commissioner" means the commissioner of human services.
 84.8      (b) "Health plan" means a policy, contract, or certificate 
 84.9   issued by a health plan company to a qualifying purchasing 
 84.10  alliance.  Any health plan issued to the members of a qualifying 
 84.11  purchasing alliance must meet the requirements of chapter 62L.  
 84.12     (c) "Health plan company" means: 
 84.13     (1) a health carrier as defined under section 62A.011, 
 84.14  subdivision 2; 
 84.15     (2) a community integrated service network operating under 
 84.16  chapter 62N; or 
 84.17     (3) an accountable provider network operating under chapter 
 84.18  62T.  
 84.19     (d) "Qualifying employer" means an employer who: 
 84.20     (1) is a member of a qualifying purchasing alliance; 
 84.21     (2) has at least one employee but no more than ten 
 84.22  employees or is a sole proprietor or farmer; 
 84.23     (3) did not offer employer-subsidized health care coverage 
 84.24  to its employees for at least 12 months prior to joining the 
 84.25  purchasing alliance; and 
 84.26     (4) is offering health coverage through the purchasing 
 84.27  alliance to all employees who work at least 20 hours per week 
 84.28  unless the employee is eligible for Medicare. 
 84.29  For purposes of this subdivision, "employer-subsidized health 
 84.30  coverage" means health coverage for which the employer pays at 
 84.31  least 50 percent of the cost of coverage for the employee.  
 84.32     (e) "Qualifying enrollee" means an employee of a qualifying 
 84.33  employer or the employee's dependent covered by a health plan.  
 84.34     (f) "Qualifying purchasing alliance" means a purchasing 
 84.35  alliance as defined in section 62T.01, subdivision 2, that: 
 84.36     (1) meets the requirements of chapter 62T; 
 85.1      (2) services a geographic area located in outstate 
 85.2   Minnesota, excluding the city of Duluth; and 
 85.3      (3) is organized and operating before May 1, 2001. 
 85.4      The criteria used by the qualifying purchasing alliance for 
 85.5   membership must be approved by the commissioner of health.  A 
 85.6   qualifying purchasing alliance may begin enrolling qualifying 
 85.7   employers after July 1, 2001, with enrollment ending by December 
 85.8   31, 2003.  
 85.9      Subd. 2.  [CREATION OF ACCOUNT.] A purchasing alliance 
 85.10  stop-loss fund account is established in the general fund.  The 
 85.11  commissioner shall use the money to establish a stop-loss fund 
 85.12  from which a health plan company may receive reimbursement for 
 85.13  claims paid for qualifying enrollees.  The account consists of 
 85.14  money appropriated by the legislature.  Money from the account 
 85.15  must be used for the stop-loss fund.  
 85.16     Subd. 3.  [REIMBURSEMENT.] (a) A health plan company may 
 85.17  receive reimbursement from the fund for 90 percent of the 
 85.18  portion of the claim that exceeds $30,000 but not of the portion 
 85.19  that exceeds $100,000 in a calendar year for a qualifying 
 85.20  enrollee.  
 85.21     (b) Claims shall be reported and funds shall be distributed 
 85.22  on a calendar-year basis.  Claims shall be eligible for 
 85.23  reimbursement only for the calendar year in which the claims 
 85.24  were paid.  
 85.25     (c) Once claims paid on behalf of a qualifying enrollee 
 85.26  reach $100,000 in a given calendar year, no further claims may 
 85.27  be submitted for reimbursement on behalf of that enrollee in 
 85.28  that calendar year.  
 85.29     Subd. 4.  [REQUEST PROCESS.] (a) Each health plan company 
 85.30  must submit a request for reimbursement from the fund on a form 
 85.31  prescribed by the commissioner.  Requests for payment must be 
 85.32  submitted no later than April 1 following the end of the 
 85.33  calendar year for which the reimbursement request is being made, 
 85.34  beginning April 1, 2002. 
 85.35     (b) The commissioner may require a health plan company to 
 85.36  submit claims data as needed in connection with the 
 86.1   reimbursement request.  
 86.2      Subd. 5.  [DISTRIBUTION.] (a) The commissioner shall 
 86.3   calculate the total claims reimbursement amount for all 
 86.4   qualifying health plan companies for the calendar year for which 
 86.5   claims are being reported and shall distribute the stop-loss 
 86.6   funds on an annual basis.  
 86.7      (b) In the event that the total amount requested for 
 86.8   reimbursement by the health plan companies for a calendar year 
 86.9   exceeds the funds available for distribution for claims paid by 
 86.10  all health plan companies during the same calendar year, the 
 86.11  commissioner shall provide for the pro rata distribution of the 
 86.12  available funds.  Each health plan company shall be eligible to 
 86.13  receive only a proportionate amount of the available funds as 
 86.14  the health plan company's total eligible claims paid compares to 
 86.15  the total eligible claims paid by all health plan companies.  
 86.16     (c) In the event that funds available for distribution for 
 86.17  claims paid by all health plan companies during a calendar year 
 86.18  exceed the total amount requested for reimbursement by all 
 86.19  health plan companies during the same calendar year, any excess 
 86.20  funds shall be reallocated for distribution in the next calendar 
 86.21  year.  
 86.22     Subd. 6.  [DATA.] Upon the request of the commissioner, 
 86.23  each health plan company shall furnish such data as the 
 86.24  commissioner deems necessary to administer the fund.  The 
 86.25  commissioner may require that such data be submitted on a per 
 86.26  enrollee, aggregate, or categorical basis.  Any data submitted 
 86.27  under this section shall be classified as private data or 
 86.28  nonpublic data as defined in section 13.02. 
 86.29     Subd. 7.  [DELEGATION.] The commissioner may delegate any 
 86.30  or all of the commissioner's administrative duties to another 
 86.31  state agency or to a private contractor.  
 86.32     Subd. 8.  [REPORT.] The commissioner of commerce, in 
 86.33  consultation with the office of rural health and the qualifying 
 86.34  purchasing alliances, shall evaluate the extent to which the 
 86.35  purchasing alliance stop-loss fund increases the availability of 
 86.36  employer-subsidized health care coverage for residents residing 
 87.1   in the geographic areas served by the qualifying purchasing 
 87.2   alliances.  A preliminary report must be submitted to the 
 87.3   legislature by February 15, 2003, and a final report must be 
 87.4   submitted by February 15, 2004.  
 87.5      Subd. 9.  [SUNSET.] This section shall expire January 1, 
 87.6   2005. 
 87.7      Sec. 4.  [256.958] [RETIRED DENTIST PROGRAM.] 
 87.8      Subdivision 1.  [PROGRAM.] The commissioner of human 
 87.9   services shall establish a program to reimburse a retired 
 87.10  dentist for the dentist's license fee and for the cost of 
 87.11  malpractice insurance in exchange for the dentist providing 100 
 87.12  hours of dental services on a volunteer basis within a 12-month 
 87.13  period at a community dental clinic or a dental training clinic 
 87.14  located at a Minnesota state college or university.  
 87.15     Subd. 2.  [DOCUMENTATION.] Upon completion of the required 
 87.16  hours, the retired dentist shall submit to the commissioner the 
 87.17  following: 
 87.18     (1) documentation of service provided; 
 87.19     (2) the cost of malpractice insurance for the 12-month 
 87.20  period; and 
 87.21     (3) the cost of the license.  
 87.22     Subd. 3.  [REIMBURSEMENT.] Upon receipt of the information 
 87.23  described in subdivision 2, the commissioner shall provide 
 87.24  reimbursement to the retired dentist for the cost of malpractice 
 87.25  insurance for the previous 12-month period and the cost of the 
 87.26  license. 
 87.27     Sec. 5.  Minnesota Statutes 2000, section 256.9657, 
 87.28  subdivision 2, is amended to read: 
 87.29     Subd. 2.  [HOSPITAL SURCHARGE.] (a) Effective October 1, 
 87.30  1992, each Minnesota hospital except facilities of the federal 
 87.31  Indian Health Service and regional treatment centers shall pay 
 87.32  to the medical assistance account a surcharge equal to 1.4 
 87.33  percent of net patient revenues excluding net Medicare revenues 
 87.34  reported by that provider to the health care cost information 
 87.35  system according to the schedule in subdivision 4.  
 87.36     (b) Effective July 1, 1994, the surcharge under paragraph 
 88.1   (a) is increased to 1.56 percent. 
 88.2      (c) Notwithstanding the Medicare cost finding and allowable 
 88.3   cost principles, the hospital surcharge is not an allowable cost 
 88.4   for purposes of rate setting under sections 256.9685 to 256.9695.
 88.5      Sec. 6.  Minnesota Statutes 2000, section 256.969, 
 88.6   subdivision 2b, is amended to read: 
 88.7      Subd. 2b.  [OPERATING PAYMENT RATES.] In determining 
 88.8   operating payment rates for admissions occurring on or after the 
 88.9   rate year beginning January 1, 1991, and every two years after, 
 88.10  or more frequently as determined by the commissioner, the 
 88.11  commissioner shall obtain operating data from an updated base 
 88.12  year and, within the limits of available appropriations, 
 88.13  establish operating payment rates per admission for each 
 88.14  hospital based on the cost-finding methods and allowable costs 
 88.15  of the Medicare program in effect during the base year.  Rates 
 88.16  under the general assistance medical care, medical assistance, 
 88.17  and MinnesotaCare programs shall not be rebased to more current 
 88.18  data on January 1, 1997.  The base year operating payment rate 
 88.19  per admission is standardized by the case mix index and adjusted 
 88.20  by the hospital cost index, relative values, and 
 88.21  disproportionate population adjustment.  The cost and charge 
 88.22  data used to establish operating rates shall only reflect 
 88.23  inpatient services covered by medical assistance and shall not 
 88.24  include property cost information and costs recognized in 
 88.25  outlier payments. 
 88.26     Sec. 7.  Minnesota Statutes 2000, section 256.969, is 
 88.27  amended by adding a subdivision to read: 
 88.28     Subd. 26.  [GREATER MINNESOTA PAYMENT ADJUSTMENT AFTER JUNE 
 88.29  30, 2001.] (a) For admissions occurring after June 30, 2001, the 
 88.30  commissioner shall pay all medical assistance inpatient 
 88.31  fee-for-service admissions for the diagnosis-related groups 
 88.32  specified in paragraph (b) at hospitals located outside of the 
 88.33  seven-county metropolitan area at the higher of:  
 88.34     (1) the hospital's current payment rate for the diagnostic 
 88.35  category to which the diagnosis-related group belongs, exclusive 
 88.36  of disproportionate population adjustments received under 
 89.1   subdivision 9 and hospital payment adjustments received under 
 89.2   subdivision 23; or 
 89.3      (2) the rate in clause (1) plus a proportion of the 
 89.4   difference between the current average payment rate for that 
 89.5   diagnostic category for hospitals located within the 
 89.6   seven-county metropolitan area, exclusive of disproportionate 
 89.7   population adjustments received under subdivision 9 and hospital 
 89.8   payment adjustments received under subdivision 23, and the 
 89.9   current rate in clause (1).  This proportion shall be 12.5 
 89.10  percent for the fiscal year beginning July 1, 2001, and shall 
 89.11  increase by 12.5 percentage points for each of the next seven 
 89.12  fiscal years, such that the proportion is 100 percent for the 
 89.13  fiscal year beginning July 1, 2008. 
 89.14     (b) The reimbursement increases provided in paragraph (a) 
 89.15  apply to the following diagnosis-related groups as they fall 
 89.16  within the diagnostic categories: 
 89.17     (1) 370 C-section with complicating diagnosis; 
 89.18     (2) 371 C-section without complicating diagnosis; 
 89.19     (3) 372 vaginal delivery with complicating diagnosis; 
 89.20     (4) 373 vaginal delivery without complicating diagnosis; 
 89.21     (5) 386 extreme immaturity, weight greater than 1,500 
 89.22  grams; 
 89.23     (6) 388 full-term neonates with other problems; 
 89.24     (7) 390 prematurity without major problems; 
 89.25     (8) 391 normal newborn case; 
 89.26     (9) 385 neonate, died or transferred to another health care 
 89.27  facility; 
 89.28     (10) 425 acute adjustment reaction and psychosocial 
 89.29  dysfunctioning; 
 89.30     (11) 430 psychosis; 
 89.31     (12) 431 childhood mental disorders; and 
 89.32     (13) 164-167 appendectomy. 
 89.33     Sec. 8.  Minnesota Statutes 2000, section 256B.04, is 
 89.34  amended by adding a subdivision to read: 
 89.35     Subd. 1b.  [CONTRACT FOR SERVICES FOR AMERICAN INDIAN 
 89.36  CHILDREN.] Notwithstanding subdivision 1, the commissioner may 
 90.1   contract with federally recognized Indian tribes with a 
 90.2   reservation in Minnesota for the provision of early and periodic 
 90.3   screening, diagnosis, and treatment administrative services for 
 90.4   American Indian children, according to Code of Federal 
 90.5   Regulations, title 42, section 441, subpart B, and Minnesota 
 90.6   Rules, part 9505.1693 et seq., when the tribe chooses to provide 
 90.7   such services.  For purposes of this subdivision, "American 
 90.8   Indian" has the meaning given to persons to whom services will 
 90.9   be provided for in Code of Federal Regulations, title 42, 
 90.10  section 36.12.  Notwithstanding Minnesota Rules, part 9505.1748, 
 90.11  subpart 1, the commissioner, the local agency, and the tribe may 
 90.12  contract with any entity for the provision of early and periodic 
 90.13  screening, diagnosis, and treatment administrative services. 
 90.14     [EFFECTIVE DATE.] This section is effective the day 
 90.15  following final enactment. 
 90.16     Sec. 9.  Minnesota Statutes 2000, section 256B.055, 
 90.17  subdivision 3a, is amended to read: 
 90.18     Subd. 3a.  [MFIP-S FAMILIES; FAMILIES ELIGIBLE UNDER PRIOR 
 90.19  AFDC RULES.] (a) Beginning January 1, 1998, or on the date that 
 90.20  MFIP-S is implemented in counties, medical assistance may be 
 90.21  paid for a person receiving public assistance under the MFIP-S 
 90.22  program.  Beginning July 1, 2002, medical assistance may be paid 
 90.23  for a person who would have been eligible, but for excess income 
 90.24  or assets, under the state's AFDC plan in effect as of July 16, 
 90.25  1996, with the base AFDC standard increased by three percent 
 90.26  effective July 1, 2000.  
 90.27     (b) Beginning January 1, 1998, July 1, 2002, medical 
 90.28  assistance may be paid for a person who would have been eligible 
 90.29  for public assistance under the income and resource assets 
 90.30  standards, or who would have been eligible but for excess income 
 90.31  or assets, under the state's AFDC plan in effect as of July 16, 
 90.32  1996, as required by the Personal Responsibility and Work 
 90.33  Opportunity Reconciliation Act of 1996 (PRWORA), Public Law 
 90.34  Number 104-193 with the base AFDC rate increased by three 
 90.35  percent effective July 1, 2000.  
 90.36     [EFFECTIVE DATE.] This section is effective July 1, 2002. 
 91.1      Sec. 10.  Minnesota Statutes 2000, section 256B.056, 
 91.2   subdivision 1a, is amended to read: 
 91.3      Subd. 1a.  [INCOME AND ASSETS GENERALLY.] Unless 
 91.4   specifically required by state law or rule or federal law or 
 91.5   regulation, the methodologies used in counting income and assets 
 91.6   to determine eligibility for medical assistance for persons 
 91.7   whose eligibility category is based on blindness, disability, or 
 91.8   age of 65 or more years, the methodologies for the supplemental 
 91.9   security income program shall be used.  Effective upon federal 
 91.10  approval, for children eligible under section 256B.055, 
 91.11  subdivision 12, or for home and community-based waiver services 
 91.12  whose eligibility for medical assistance is determined without 
 91.13  regard to parental income, child support payments, including any 
 91.14  payments made by an obligor in satisfaction of or in addition to 
 91.15  a temporary or permanent order for child support, social 
 91.16  security payments, and other benefits for basic needs are not 
 91.17  counted as income.  For families and children, which includes 
 91.18  all other eligibility categories, the methodologies under the 
 91.19  state's AFDC plan in effect as of July 16, 1996, as required by 
 91.20  the Personal Responsibility and Work Opportunity Reconciliation 
 91.21  Act of 1996 (PRWORA), Public Law Number 104-193, shall be used.  
 91.22  Effective upon federal approval, in-kind contributions to, and 
 91.23  payments made on behalf of, a recipient, by an obligor, in 
 91.24  satisfaction of or in addition to a temporary or permanent order 
 91.25  for child support or maintenance, shall be considered income to 
 91.26  the recipient.  For these purposes, a "methodology" does not 
 91.27  include an asset or income standard, or accounting method, or 
 91.28  method of determining effective dates. 
 91.29     Sec. 11.  Minnesota Statutes 2000, section 256B.056, 
 91.30  subdivision 3, is amended to read: 
 91.31     Subd. 3.  [ASSET LIMITATIONS.] To be eligible for medical 
 91.32  assistance, a person must not individually own more than $3,000 
 91.33  in assets, or if a member of a household with two family 
 91.34  members, husband and wife, or parent and child, the household 
 91.35  must not own more than $6,000 in assets, plus $200 for each 
 91.36  additional legal dependent.  In addition to these maximum 
 92.1   amounts, an eligible individual or family may accrue interest on 
 92.2   these amounts, but they must be reduced to the maximum at the 
 92.3   time of an eligibility redetermination.  The accumulation of the 
 92.4   clothing and personal needs allowance according to section 
 92.5   256B.35 must also be reduced to the maximum at the time of the 
 92.6   eligibility redetermination.  The value of assets that are not 
 92.7   considered in determining eligibility for medical assistance is 
 92.8   the value of those assets excluded under the AFDC state plan as 
 92.9   of July 16, 1996, as required by the Personal Responsibility and 
 92.10  Work Opportunity Reconciliation Act of 1996 (PRWORA), Public Law 
 92.11  Number 104-193, for families and children, and the supplemental 
 92.12  security income program for aged, blind, and disabled persons, 
 92.13  with the following exceptions: 
 92.14     (a) Household goods and personal effects are not considered.
 92.15     (b) Capital and operating assets of a trade or business 
 92.16  that the local agency determines are necessary to the person's 
 92.17  ability to earn an income are not considered. 
 92.18     (c) Motor vehicles are excluded to the same extent excluded 
 92.19  by the supplemental security income program. 
 92.20     (d) Assets designated as burial expenses are excluded to 
 92.21  the same extent excluded by the supplemental security income 
 92.22  program. 
 92.23     (e) Effective upon federal approval, for a person who no 
 92.24  longer qualifies as an employed person with a disability due to 
 92.25  loss of earnings, assets allowed while eligible for medical 
 92.26  assistance under section 256B.057, subdivision 9, are not 
 92.27  considered for 12 months, beginning with the first month of 
 92.28  ineligibility as an employed person with a disability, to the 
 92.29  extent that the person's total assets remain within the allowed 
 92.30  limits of section 256B.057, subdivision 9, paragraph (b). 
 92.31     Sec. 12.  Minnesota Statutes 2000, section 256B.056, 
 92.32  subdivision 4, is amended to read: 
 92.33     Subd. 4.  [INCOME.] (a) To be eligible for medical 
 92.34  assistance, a person eligible under section 256B.055, 
 92.35  subdivision subdivisions 7, 7a, and 12, not receiving 
 92.36  supplemental security income program payments, and may have 
 93.1   income up to the following specified percentages of the federal 
 93.2   poverty guidelines for the family size effective on April 1 of 
 93.3   each year: 
 93.4      (1) 80 percent, effective July 1, 2002; 
 93.5      (2) 90 percent, effective July 1, 2003; 
 93.6      (3) 100 percent, effective July 1, 2004. 
 93.7   Increases in benefits under title II of the Social Security Act 
 93.8   shall not be counted as income for purposes of this subdivision 
 93.9   until the first day of the second full month following 
 93.10  publication of the change in the federal poverty guidelines. 
 93.11     (b) To be eligible for medical assistance, families and 
 93.12  children may have an income up to 133-1/3 percent of the AFDC 
 93.13  income standard in effect under the July 16, 1996, AFDC state 
 93.14  plan.  Effective July 1, 2000, the base AFDC standard in effect 
 93.15  on July 16, 1996, shall be increased by three percent. Effective 
 93.16  January 1, 2000, and each successive January, recipients of 
 93.17  supplemental security income may have an income up to the 
 93.18  supplemental security income standard in effect on that date. 
 93.19     (c) Effective July 1, 2002, to be eligible for medical 
 93.20  assistance, families and children may have an income up to 100 
 93.21  percent of the federal poverty guidelines for the family size 
 93.22  effective on April 1 of each year. 
 93.23     (d) In computing income to determine eligibility of persons 
 93.24  under paragraphs (a) to (c) who are not residents of long-term 
 93.25  care facilities, the commissioner shall disregard increases in 
 93.26  income as required by Public Law Numbers 94-566, section 503; 
 93.27  99-272; and 99-509.  Veterans aid and attendance benefits and 
 93.28  Veterans Administration unusual medical expense payments are 
 93.29  considered income to the recipient. 
 93.30     Sec. 13.  Minnesota Statutes 2000, section 256B.056, 
 93.31  subdivision 5, is amended to read: 
 93.32     Subd. 5.  [EXCESS INCOME.] A person who has excess income 
 93.33  is eligible for medical assistance if the person has expenses 
 93.34  for medical care that are more than the amount of the person's 
 93.35  excess income, computed by deducting incurred medical expenses 
 93.36  from the excess income to reduce the excess to the income 
 94.1   standard specified in subdivision 4, except that if federal 
 94.2   authorization to use the standard in subdivision 4 is not 
 94.3   obtained, the medically needy standard for purposes of a 
 94.4   spenddown shall be 133 and 1/3 percent of the AFDC income 
 94.5   standard in effect under the July 16, 1996, AFDC state plan, 
 94.6   increased by three percent.  The person shall elect to have the 
 94.7   medical expenses deducted at the beginning of a one-month budget 
 94.8   period or at the beginning of a six-month budget period.  The 
 94.9   commissioner shall allow persons eligible for assistance on a 
 94.10  one-month spenddown basis under this subdivision to elect to pay 
 94.11  the monthly spenddown amount in advance of the month of 
 94.12  eligibility to the state agency in order to maintain eligibility 
 94.13  on a continuous basis.  If the recipient does not pay the 
 94.14  spenddown amount on or before the 20th of the month, the 
 94.15  recipient is ineligible for this option for the following 
 94.16  month.  The local agency shall code the Medicaid Management 
 94.17  Information System (MMIS) to indicate that the recipient has 
 94.18  elected this option.  The state agency shall convey recipient 
 94.19  eligibility information relative to the collection of the 
 94.20  spenddown to providers through the Electronic Verification 
 94.21  System (EVS).  A recipient electing advance payment must pay the 
 94.22  state agency the monthly spenddown amount on or before the 20th 
 94.23  of the month in order to be eligible for this option in the 
 94.24  following month.  
 94.25     Sec. 14.  Minnesota Statutes 2000, section 256B.057, 
 94.26  subdivision 9, is amended to read: 
 94.27     Subd. 9.  [EMPLOYED PERSONS WITH DISABILITIES.] (a) Medical 
 94.28  assistance may be paid for a person who is employed and who: 
 94.29     (1) meets the definition of disabled under the supplemental 
 94.30  security income program; 
 94.31     (2) is at least 16 but less than 65 years of age; 
 94.32     (3) meets the asset limits in paragraph (b); and 
 94.33     (4) pays a premium, if required, under paragraph (c).  
 94.34  Any spousal income or assets shall be disregarded for purposes 
 94.35  of eligibility and premium determinations. 
 94.36     (b) For purposes of determining eligibility under this 
 95.1   subdivision, a person's assets must not exceed $20,000, 
 95.2   excluding: 
 95.3      (1) all assets excluded under section 256B.056; 
 95.4      (2) retirement accounts, including individual accounts, 
 95.5   401(k) plans, 403(b) plans, Keogh plans, and pension plans; and 
 95.6      (3) medical expense accounts set up through the person's 
 95.7   employer. 
 95.8      (c) A person whose earned and unearned income is equal to 
 95.9   or greater than 200 100 percent of federal poverty guidelines 
 95.10  for the applicable family size must pay a premium to be eligible 
 95.11  for medical assistance under this subdivision.  The premium 
 95.12  shall be equal to ten percent of based on the person's gross 
 95.13  earned and unearned income above 200 percent of federal poverty 
 95.14  guidelines for and the applicable family size up to the cost of 
 95.15  coverage, using a sliding fee scale established by the 
 95.16  commissioner which begins at one percent of income at 100 
 95.17  percent of the federal poverty guidelines and gradually 
 95.18  increases to 7.5 percent of income for those with incomes at or 
 95.19  above 300 percent of the federal poverty guidelines. 
 95.20     (d) A person's eligibility and premium shall be determined 
 95.21  by the local county agency.  Premiums must be paid to the 
 95.22  commissioner.  All premiums are dedicated to the commissioner. 
 95.23     (e) Any required premium shall be determined at application 
 95.24  and redetermined annually at recertification or when a change in 
 95.25  income or family size occurs. 
 95.26     (f) Premium payment is due upon notification from the 
 95.27  commissioner of the premium amount required.  Premiums may be 
 95.28  paid in installments at the discretion of the commissioner. 
 95.29     (g) Nonpayment of the premium shall result in denial or 
 95.30  termination of medical assistance unless the person demonstrates 
 95.31  good cause for nonpayment.  Good cause exists if the 
 95.32  requirements specified in Minnesota Rules, part 9506.0040, 
 95.33  subpart 7, items B to D, are met.  Nonpayment shall include 
 95.34  payment with a returned, refused, or dishonored instrument.  The 
 95.35  commissioner may require a guaranteed form of payment as the 
 95.36  only means to replace a returned, refused, or dishonored 
 96.1   instrument. 
 96.2      [EFFECTIVE DATE.] This section is effective September 1, 
 96.3   2001. 
 96.4      Sec. 15.  Minnesota Statutes 2000, section 256B.057, is 
 96.5   amended by adding a subdivision to read: 
 96.6      Subd. 10.  [CERTAIN PERSONS NEEDING TREATMENT FOR BREAST OR 
 96.7   CERVICAL CANCER.] (a) Medical assistance may be paid for a 
 96.8   person who: 
 96.9      (1) has been screened for breast or cervical cancer by the 
 96.10  Minnesota breast and cervical cancer control program, and 
 96.11  program funds have been used to pay for the person's screening; 
 96.12     (2) according to the person's treating health professional, 
 96.13  needs treatment, including diagnostic services necessary to 
 96.14  determine the extent and proper course of treatment, for breast 
 96.15  or cervical cancer, including precancerous conditions and early 
 96.16  stage cancer; 
 96.17     (3) meets the income eligibility guidelines for the 
 96.18  Minnesota breast and cervical cancer control program; 
 96.19     (4) is under age 65; 
 96.20     (5) is not otherwise eligible for medical assistance under 
 96.21  United States Code, title 42, section 1396(a)(10)(A)(i); and 
 96.22     (6) is not otherwise covered under creditable coverage, as 
 96.23  defined under United States Code, title 42, section 300gg(c). 
 96.24     (b) Medical assistance provided for an eligible person 
 96.25  under this subdivision shall be limited to services provided 
 96.26  during the period that the person receives treatment for breast 
 96.27  or cervical cancer. 
 96.28     (c) A person meeting the criteria in paragraph (a) is 
 96.29  eligible for medical assistance without meeting the eligibility 
 96.30  criteria relating to income and assets in section 256B.056, 
 96.31  subdivisions 1a to 5b. 
 96.32     Sec. 16.  Minnesota Statutes 2000, section 256B.0625, 
 96.33  subdivision 3b, is amended to read: 
 96.34     Subd. 3b.  [TELEMEDICINE CONSULTATIONS.] (a) Medical 
 96.35  assistance covers telemedicine consultations.  Telemedicine 
 96.36  consultations must be made via two-way, interactive video or 
 97.1   store-and-forward technology.  Store-and-forward technology 
 97.2   includes telemedicine consultations that do not occur in real 
 97.3   time via synchronous transmissions, and that do not require a 
 97.4   face-to-face encounter with the patient for all or any part of 
 97.5   any such telemedicine consultation.  The patient record must 
 97.6   include a written opinion from the consulting physician 
 97.7   providing the telemedicine consultation.  A communication 
 97.8   between two physicians that consists solely of a telephone 
 97.9   conversation is not a telemedicine consultation.  Coverage is 
 97.10  limited to three telemedicine consultations per recipient per 
 97.11  calendar week.  Telemedicine consultations shall be paid at the 
 97.12  full allowable rate. 
 97.13     (b) This subdivision expires July 1, 2001.  
 97.14     Sec. 17.  Minnesota Statutes 2000, section 256B.0625, is 
 97.15  amended by adding a subdivision to read: 
 97.16     Subd. 5a.  [INTENSIVE EARLY INTERVENTION BEHAVIOR THERAPY 
 97.17  SERVICES FOR CHILDREN WITH AUTISM SPECTRUM DISORDERS.] (a) 
 97.18  [COVERAGE.] Medical assistance covers home-based intensive early 
 97.19  intervention behavior therapy for children with autism spectrum 
 97.20  disorders.  Children with autism spectrum disorder, and their 
 97.21  custodial parents or foster parents, may access other covered 
 97.22  services to treat autism spectrum disorder, and are not required 
 97.23  to receive intensive early intervention behavior therapy 
 97.24  services under this subdivision.  Intensive early intervention 
 97.25  behavior therapy does not include coverage for services to treat 
 97.26  developmental disorders of language, early onset psychosis, 
 97.27  Rett's disorder, selective mutism, social anxiety disorder, 
 97.28  stereotypic movement disorder, dementia, obsessive compulsive 
 97.29  disorder, schizoid personality disorder, avoidant personality 
 97.30  disorder, or reactive attachment disorder.  If a child with 
 97.31  autism spectrum disorder is diagnosed to have one or more of 
 97.32  these conditions, intensive early intervention behavior therapy 
 97.33  includes coverage only for services necessary to treat the 
 97.34  autism spectrum disorder. 
 97.35     (b) [PURPOSE OF INTENSIVE EARLY INTERVENTION BEHAVIOR 
 97.36  THERAPY SERVICES (IEIBTS).] The purpose of IEIBTS is to improve 
 98.1   the child's behavioral functioning, to prevent development of 
 98.2   challenging behaviors, to eliminate autistic behaviors, to 
 98.3   reduce the risk of out-of-home placement, and to establish 
 98.4   independent typical functioning in language and social 
 98.5   behavior.  The procedures used to accomplish these goals are 
 98.6   based upon research in applied behavior analysis. 
 98.7      (c) [ELIGIBLE CHILDREN.] A child is eligible to initiate 
 98.8   IEIBTS if, the child meets the additional eligibility criteria 
 98.9   in paragraph (d) and in a diagnostic assessment by a mental 
 98.10  health professional who is not under the employ of the service 
 98.11  provider, the child: 
 98.12     (1) is found to have an autism spectrum disorder; 
 98.13     (2) has a current IQ of either untestable, or at least 30; 
 98.14     (3) if nonverbal, initiated behavior therapy by 42 months 
 98.15  of age; 
 98.16     (4) if verbal, initiated behavior therapy by 48 months of 
 98.17  age; or 
 98.18     (5) if having an IQ of at least 50, initiated behavior 
 98.19  therapy by 84 months of age. 
 98.20  To continue in IEIBTS, at least one of the child's custodial 
 98.21  parents or foster parents must participate in an average of at 
 98.22  least five hours of documented behavior therapy per week for six 
 98.23  months, and consistently implement behavior therapy 
 98.24  recommendations 24 hours a day.  To continue after six-month 
 98.25  individualized treatment plan (ITP) reviews, the child must show 
 98.26  documented progress toward mastery of six-month benchmark 
 98.27  behavior objectives.  The maximum number of months during which 
 98.28  services may be billed is 54.  If significant progress towards 
 98.29  treatment goals has not been achieved after 24 months of 
 98.30  treatment, treatment must be discontinued. 
 98.31     (d) [ADDITIONAL ELIGIBILITY CRITERIA.] A child is eligible 
 98.32  to initiate IEIBTS if: 
 98.33     (1) in medical and diagnostic assessments by medical and 
 98.34  mental health professionals, it is determined that the child 
 98.35  does not have severe or profound mental retardation; 
 98.36     (2) an accurate assessment of the child's hearing has been 
 99.1   performed, including audiometry if the brain stem auditory 
 99.2   evokes response; 
 99.3      (3) a blood lead test has been performed prior to 
 99.4   initiation of treatment; and 
 99.5      (4) an EEG or neurologic evaluation is done, prior to 
 99.6   initiation of treatment, if the child has a history of staring 
 99.7   spells or developmental regression.  
 99.8      (e) [COVERED SERVICES.] The focus of IEIBTS must be to 
 99.9   treat the principal diagnostic features of the autism spectrum 
 99.10  disorder.  All IEIBTS must be delivered by a team of 
 99.11  practitioners under the consistent supervision of a single 
 99.12  clinical supervisor.  A mental health professional must develop 
 99.13  the ITP for IEIBTS.  The ITP must include six-month benchmark 
 99.14  behavior objectives.  All behavior therapy must be based upon 
 99.15  research in applied behavior analysis, with an emphasis upon 
 99.16  positive reinforcement of carefully task-analyzed skills for 
 99.17  optimum rates of progress.  All behavior therapy must be 
 99.18  consistently applied and generalized throughout the 24-hour day 
 99.19  and seven-day week by all of the child's regular care 
 99.20  providers.  When placing the child in school activities, a 
 99.21  majority of the peers must have no mental health diagnosis, and 
 99.22  the child must have sufficient social skills to succeed with 80 
 99.23  percent of the school activities.  Reactive consequences, such 
 99.24  as redirection, correction, positive practice, or time-out, must 
 99.25  be used only when necessary to improve the child's success when 
 99.26  proactive procedures alone have not been effective.  IEIBTS must 
 99.27  be delivered by a team of behavior therapy practitioners who are 
 99.28  employed under the direction of the same agency.  The team may 
 99.29  deliver up to 200 billable hours per year of direct clinical 
 99.30  supervisor services, up to 750 billable hours per year of senior 
 99.31  behavior therapist services, and up to 1,800 billable hours per 
 99.32  year of direct behavior therapist services.  A one-hour clinical 
 99.33  review meeting for the child, parents, and staff must be 
 99.34  scheduled 50 weeks a year, at which behavior therapy is reviewed 
 99.35  and planned.  At least one-quarter of the annual clinical 
 99.36  supervisor billable hours shall consist of on-site clinical 
100.1   meeting time.  At least one-half of the annual senior behavior 
100.2   therapist billable hours shall consist of direct services to the 
100.3   child or parents.  All of the behavioral therapist billable 
100.4   hours shall consist of direct on-site services to the child or 
100.5   parents.  None of the senior behavior therapist billable hours 
100.6   or behavior therapist billable hours shall consist of clinical 
100.7   meeting time.  If there is any regression of the autistic 
100.8   spectrum disorder after 12 months of therapy, a neurologic 
100.9   consultation must be performed. 
100.10     (f) [PROVIDER QUALIFICATIONS.] The provider agency must be 
100.11  capable of delivering consistent applied behavior analysis 
100.12  (ABA)-based behavior therapy in the home.  The site director of 
100.13  the agency must be a mental health professional certified as a 
100.14  behavior analyst by the Association for Behavior Analysis.  Each 
100.15  clinical supervisor must be certified as a behavior analyst by 
100.16  the Association for Behavior Analysis. 
100.17     (g) [SUPERVISION REQUIREMENTS.] (1) Each behavior therapist 
100.18  practitioner must be continuously supervised while in the home 
100.19  until the practitioner has mastered competencies for independent 
100.20  practice.  Each behavior therapist must have mastered three 
100.21  credits of academic content and practice in an ABA sequence at 
100.22  an accredited university.  A college degree or minimum hours of 
100.23  experience are not required.  Each behavior therapist must 
100.24  continue training through weekly direct observation by the 
100.25  senior behavior therapist, through demonstrated performance in 
100.26  clinical meetings with the clinical supervisor, and annual 
100.27  training in ABA. 
100.28     (2) Each senior behavior therapist practitioner must have 
100.29  mastered the senior behavior therapy competencies, completed one 
100.30  year of practice as a behavior therapist, and six months of 
100.31  co-therapy training with another senior behavior therapist or 
100.32  have an equivalent amount of experience in ABA.  Each senior 
100.33  behavior therapist must have mastered 12 credits of academic 
100.34  content and practice in an ABA sequence at an accredited 
100.35  university.  Each senior behavior therapist must continue 
100.36  training through demonstrated performance in clinical meetings 
101.1   with the clinical supervisor, and annual training in ABA. 
101.2      (3) Each clinical supervisor practitioner must have 
101.3   mastered the clinical supervisor and family consultation 
101.4   competencies, completed two years of practice as a senior 
101.5   behavior therapist and one year of co-therapy training with 
101.6   another clinical supervisor, or equivalent experience in ABA.  
101.7   Each clinical supervisor must continue training through annual 
101.8   training in ABA. 
101.9      (h) [PLACE OF SERVICE.] IEIBTS are provided primarily in 
101.10  the child's home and community.  Services may be provided in the 
101.11  child's natural school or preschool classroom, home of a 
101.12  relative, natural recreational setting, or day care. 
101.13     (i) [PRIOR AUTHORIZATION REQUIREMENTS.] Prior authorization 
101.14  shall be required for services provided after 200 hours of 
101.15  clinical supervisor, 750 hours of senior behavior therapist, or 
101.16  1,800 hours of behavior therapist services per year. 
101.17     (j) [PAYMENT RATES.] The following payment rates apply: 
101.18     (1) for an IEIBTS clinical supervisor practitioner under 
101.19  supervision of a mental health professional, the lower of the 
101.20  submitted charge or $137 per hour unit; 
101.21     (2) for an IEIBTS senior behavior therapist practitioner 
101.22  under supervision of a mental health professional, the lower of 
101.23  the submitted charge or $56 per hour unit; or 
101.24     (3) for an IEIBTS behavior therapist practitioner under 
101.25  supervision of a mental health professional, the lower of the 
101.26  submitted charge or $19 per hour unit. 
101.27  An IEIBTS practitioner may receive payment for travel time which 
101.28  exceeds 50 minutes one-way.  The maximum payment allowed will be 
101.29  $0.51 per minute for up to a maximum of 300 hours per year. 
101.30     For any week during which the above charges are made to 
101.31  medical assistance, payments for the following services are 
101.32  excluded:  supervising mental health professional hours and 
101.33  personal care attendant, home-based mental health, 
101.34  family-community support, or mental health behavioral aide hours.
101.35     (k) [REPORT.] The commissioner shall collect evidence of 
101.36  the effectiveness of intensive early intervention behavior 
102.1   therapy services and present a report to the legislature by July 
102.2   1, 2006. 
102.3      [EFFECTIVE DATE.] This section is effective January 1, 2002.
102.4      Sec. 18.  Minnesota Statutes 2000, section 256B.0625, 
102.5   subdivision 13, is amended to read: 
102.6      Subd. 13.  [DRUGS.] (a) Medical assistance covers drugs, 
102.7   except for fertility drugs when specifically used to enhance 
102.8   fertility, if prescribed by a licensed practitioner and 
102.9   dispensed by a licensed pharmacist, by a physician enrolled in 
102.10  the medical assistance program as a dispensing physician, or by 
102.11  a physician or a nurse practitioner employed by or under 
102.12  contract with a community health board as defined in section 
102.13  145A.02, subdivision 5, for the purposes of communicable disease 
102.14  control.  The commissioner, after receiving recommendations from 
102.15  professional medical associations and professional pharmacist 
102.16  associations, shall designate a formulary committee to advise 
102.17  the commissioner on the names of drugs for which payment is 
102.18  made, recommend a system for reimbursing providers on a set fee 
102.19  or charge basis rather than the present system, and develop 
102.20  methods encouraging use of generic drugs when they are less 
102.21  expensive and equally effective as trademark drugs.  The 
102.22  formulary committee shall consist of nine members, four of whom 
102.23  shall be physicians 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, three of whom 
102.26  shall be pharmacists who are not employed by the department of 
102.27  human services, and a majority of whose practice is for persons 
102.28  paying privately or through health insurance, a consumer 
102.29  representative, and a nursing home representative.  Committee 
102.30  members shall serve three-year terms and shall serve without 
102.31  compensation.  Members may be reappointed once.  
102.32     (b) The commissioner shall establish a drug formulary.  Its 
102.33  establishment and publication shall not be subject to the 
102.34  requirements of the Administrative Procedure Act, but the 
102.35  formulary committee shall review and comment on the formulary 
102.36  contents.  The formulary committee shall review and recommend 
103.1   drugs which require prior authorization.  The formulary 
103.2   committee may recommend drugs for prior authorization directly 
103.3   to the commissioner, as long as opportunity for public input is 
103.4   provided.  Prior authorization may be requested by the 
103.5   commissioner based on medical and clinical criteria before 
103.6   certain drugs are eligible for payment.  Before a drug may be 
103.7   considered for prior authorization at the request of the 
103.8   commissioner:  
103.9      (1) the drug formulary committee must develop criteria to 
103.10  be used for identifying drugs; the development of these criteria 
103.11  is not subject to the requirements of chapter 14, but the 
103.12  formulary committee shall provide opportunity for public input 
103.13  in developing criteria; 
103.14     (2) the drug formulary committee must hold a public forum 
103.15  and receive public comment for an additional 15 days; and 
103.16     (3) the commissioner must provide information to the 
103.17  formulary committee on the impact that placing the drug on prior 
103.18  authorization will have on the quality of patient care and 
103.19  information regarding whether the drug is subject to clinical 
103.20  abuse or misuse.  Prior authorization may be required by the 
103.21  commissioner before certain formulary drugs are eligible for 
103.22  payment.  The formulary shall not include:  
103.23     (i) drugs or products for which there is no federal 
103.24  funding; 
103.25     (ii) over-the-counter drugs, except for antacids, 
103.26  acetaminophen, family planning products, aspirin, insulin, 
103.27  products for the treatment of lice, vitamins for adults with 
103.28  documented vitamin deficiencies, vitamins for children under the 
103.29  age of seven and pregnant or nursing women, and any other 
103.30  over-the-counter drug identified by the commissioner, in 
103.31  consultation with the drug formulary committee, as necessary, 
103.32  appropriate, and cost-effective for the treatment of certain 
103.33  specified chronic diseases, conditions or disorders, and this 
103.34  determination shall not be subject to the requirements of 
103.35  chapter 14; 
103.36     (iii) anorectics, except that medically necessary 
104.1   anorectics shall be covered for a recipient previously diagnosed 
104.2   as having pickwickian syndrome and currently diagnosed as having 
104.3   diabetes and being morbidly obese; 
104.4      (iv) drugs for which medical value has not been 
104.5   established; and 
104.6      (v) drugs from manufacturers who have not signed a rebate 
104.7   agreement with the Department of Health and Human Services 
104.8   pursuant to section 1927 of title XIX of the Social Security Act.
104.9      The commissioner shall publish conditions for prohibiting 
104.10  payment for specific drugs after considering the formulary 
104.11  committee's recommendations.  An honorarium of $100 per meeting 
104.12  and reimbursement for mileage shall be paid to each committee 
104.13  member in attendance.  
104.14     (c) The basis for determining the amount of payment shall 
104.15  be the lower of the actual acquisition costs of the drugs plus a 
104.16  fixed dispensing fee; the maximum allowable cost set by the 
104.17  federal government or by the commissioner plus the fixed 
104.18  dispensing fee; or the usual and customary price charged to the 
104.19  public.  The pharmacy dispensing fee shall be $3.65, except that 
104.20  the dispensing fee for intravenous solutions which must be 
104.21  compounded by the pharmacist shall be $8 per bag, $14 per bag 
104.22  for cancer chemotherapy products, and $30 per bag for total 
104.23  parenteral nutritional products dispensed in one liter 
104.24  quantities, or $44 per bag for total parenteral nutritional 
104.25  products dispensed in quantities greater than one liter.  Actual 
104.26  acquisition cost includes quantity and other special discounts 
104.27  except time and cash discounts.  The actual acquisition cost of 
104.28  a drug shall be estimated by the commissioner, at average 
104.29  wholesale price minus nine percent, except that where a drug has 
104.30  had its wholesale price reduced as a result of the actions of 
104.31  the National Association of Medicaid Fraud Control Units, the 
104.32  estimated actual acquisition cost shall be the reduced average 
104.33  wholesale price, without the nine percent deduction.  The 
104.34  maximum allowable cost of a multisource drug may be set by the 
104.35  commissioner and it shall be comparable to, but no higher than, 
104.36  the maximum amount paid by other third-party payors in this 
105.1   state who have maximum allowable cost programs.  The 
105.2   commissioner shall set maximum allowable costs for multisource 
105.3   drugs that are not on the federal upper limit list as described 
105.4   in United States Code, title 42, chapter 7, section 1396r-8(e), 
105.5   the Social Security Act, and Code of Federal Regulations, title 
105.6   42, part 447, section 447.332.  Establishment of the amount of 
105.7   payment for drugs shall not be subject to the requirements of 
105.8   the Administrative Procedure Act.  An additional dispensing fee 
105.9   of $.30 may be added to the dispensing fee paid to pharmacists 
105.10  for legend drug prescriptions dispensed to residents of 
105.11  long-term care facilities when a unit dose blister card system, 
105.12  approved by the department, is used.  Under this type of 
105.13  dispensing system, the pharmacist must dispense a 30-day supply 
105.14  of drug.  The National Drug Code (NDC) from the drug container 
105.15  used to fill the blister card must be identified on the claim to 
105.16  the department.  The unit dose blister card containing the drug 
105.17  must meet the packaging standards set forth in Minnesota Rules, 
105.18  part 6800.2700, that govern the return of unused drugs to the 
105.19  pharmacy for reuse.  The pharmacy provider will be required to 
105.20  credit the department for the actual acquisition cost of all 
105.21  unused drugs that are eligible for reuse.  Over-the-counter 
105.22  medications must be dispensed in the manufacturer's unopened 
105.23  package.  The commissioner may permit the drug clozapine to be 
105.24  dispensed in a quantity that is less than a 30-day supply.  
105.25  Whenever a generically equivalent product is available, payment 
105.26  shall be on the basis of the actual acquisition cost of the 
105.27  generic drug, unless the prescriber specifically indicates 
105.28  "dispense as written - brand necessary" on the prescription as 
105.29  required by section 151.21, subdivision 2. 
105.30     (d) For purposes of this subdivision, "multisource drugs" 
105.31  means covered outpatient drugs, excluding innovator multisource 
105.32  drugs for which there are two or more drug products, which: 
105.33     (1) are related as therapeutically equivalent under the 
105.34  Food and Drug Administration's most recent publication of 
105.35  "Approved Drug Products with Therapeutic Equivalence 
105.36  Evaluations"; 
106.1      (2) are pharmaceutically equivalent and bioequivalent as 
106.2   determined by the Food and Drug Administration; and 
106.3      (3) are sold or marketed in Minnesota. 
106.4   "Innovator multisource drug" means a multisource drug that was 
106.5   originally marketed under an original new drug application 
106.6   approved by the Food and Drug Administration. 
106.7      (e) The basis for determining the amount of payment for 
106.8   drugs administered in an outpatient setting shall be the lower 
106.9   of the usual and customary cost submitted by the provider; the 
106.10  average wholesale price minus five percent; or the maximum 
106.11  allowable cost set by the federal government under United States 
106.12  Code, title 42, chapter 7, section 1396r-8(e) and Code of 
106.13  Federal Regulations, title 42, section 447.332, or by the 
106.14  commissioner under paragraph (c). 
106.15     Sec. 19.  Minnesota Statutes 2000, section 256B.0625, 
106.16  subdivision 13a, is amended to read: 
106.17     Subd. 13a.  [DRUG UTILIZATION REVIEW BOARD.] A nine-member 
106.18  drug utilization review board is established.  The board is 
106.19  comprised of at least three but no more than four licensed 
106.20  physicians actively engaged in the practice of medicine in 
106.21  Minnesota; at least three licensed pharmacists actively engaged 
106.22  in the practice of pharmacy in Minnesota; and one consumer 
106.23  representative; the remainder to be made up of health care 
106.24  professionals who are licensed in their field and have 
106.25  recognized knowledge in the clinically appropriate prescribing, 
106.26  dispensing, and monitoring of covered outpatient drugs.  The 
106.27  board shall be staffed by an employee of the department who 
106.28  shall serve as an ex officio nonvoting member of the board.  The 
106.29  members of the board shall be appointed by the commissioner and 
106.30  shall serve three-year terms.  The members shall be selected 
106.31  from lists submitted by professional associations.  The 
106.32  commissioner shall appoint the initial members of the board for 
106.33  terms expiring as follows:  three members for terms expiring 
106.34  June 30, 1996; three members for terms expiring June 30, 1997; 
106.35  and three members for terms expiring June 30, 1998.  Members may 
106.36  be reappointed once.  The board shall annually elect a chair 
107.1   from among the members. 
107.2      The commissioner shall, with the advice of the board: 
107.3      (1) implement a medical assistance retrospective and 
107.4   prospective drug utilization review program as required by 
107.5   United States Code, title 42, section 1396r-8(g)(3); 
107.6      (2) develop and implement the predetermined criteria and 
107.7   practice parameters for appropriate prescribing to be used in 
107.8   retrospective and prospective drug utilization review; 
107.9      (3) develop, select, implement, and assess interventions 
107.10  for physicians, pharmacists, and patients that are educational 
107.11  and not punitive in nature; 
107.12     (4) establish a grievance and appeals process for 
107.13  physicians and pharmacists under this section; 
107.14     (5) publish and disseminate educational information to 
107.15  physicians and pharmacists regarding the board and the review 
107.16  program; 
107.17     (6) adopt and implement procedures designed to ensure the 
107.18  confidentiality of any information collected, stored, retrieved, 
107.19  assessed, or analyzed by the board, staff to the board, or 
107.20  contractors to the review program that identifies individual 
107.21  physicians, pharmacists, or recipients; 
107.22     (7) establish and implement an ongoing process to (i) 
107.23  receive public comment regarding drug utilization review 
107.24  criteria and standards, and (ii) consider the comments along 
107.25  with other scientific and clinical information in order to 
107.26  revise criteria and standards on a timely basis; and 
107.27     (8) adopt any rules necessary to carry out this section. 
107.28     The board may establish advisory committees.  The 
107.29  commissioner may contract with appropriate organizations to 
107.30  assist the board in carrying out the board's duties.  The 
107.31  commissioner may enter into contracts for services to develop 
107.32  and implement a retrospective and prospective review program. 
107.33     The board shall report to the commissioner annually on the 
107.34  date the Drug Utilization Review Annual Report is due to the 
107.35  Health Care Financing Administration.  This report is to cover 
107.36  the preceding federal fiscal year.  The commissioner shall make 
108.1   the report available to the public upon request.  The report 
108.2   must include information on the activities of the board and the 
108.3   program; the effectiveness of implemented interventions; 
108.4   administrative costs; and any fiscal impact resulting from the 
108.5   program.  An honorarium of $50 $100 per meeting and 
108.6   reimbursement for mileage shall be paid to each board member in 
108.7   attendance. 
108.8      Sec. 20.  Minnesota Statutes 2000, section 256B.0625, 
108.9   subdivision 17, is amended to read: 
108.10     Subd. 17.  [TRANSPORTATION COSTS.] (a) Medical assistance 
108.11  covers transportation costs incurred solely for obtaining 
108.12  emergency medical care or transportation costs incurred by 
108.13  nonambulatory persons in obtaining emergency or nonemergency 
108.14  medical care when paid directly to an ambulance company, common 
108.15  carrier, or other recognized providers of transportation 
108.16  services.  For the purpose of this subdivision, a person who is 
108.17  incapable of transport by taxicab or bus shall be considered to 
108.18  be nonambulatory. 
108.19     (b) Medical assistance covers special transportation, as 
108.20  defined in Minnesota Rules, part 9505.0315, subpart 1, item F, 
108.21  if the provider receives and maintains a current physician's 
108.22  order by the recipient's attending physician certifying that the 
108.23  recipient has a physical or mental impairment that would 
108.24  prohibit the recipient from safely accessing and using a bus, 
108.25  taxi, other commercial transportation, or private automobile.  
108.26  Special transportation includes driver-assisted service to 
108.27  eligible individuals.  Driver-assisted service includes 
108.28  passenger pickup at and return to the individual's residence or 
108.29  place of business, assistance with admittance of the individual 
108.30  to the medical facility, and assistance in passenger securement 
108.31  or in securing of wheelchairs or stretchers in the vehicle.  The 
108.32  commissioner shall establish maximum medical assistance 
108.33  reimbursement rates for special transportation services for 
108.34  persons who need a wheelchair lift accessible van or 
108.35  stretcher-equipped vehicle and for those who do not need a 
108.36  wheelchair lift accessible van or stretcher-equipped vehicle.  
109.1   The average of these two rates per trip must not exceed $15 for 
109.2   the base rate and $1.20 $1.50 per mile.  Special transportation 
109.3   provided to nonambulatory ambulatory persons who do not need a 
109.4   wheelchair lift van or stretcher-equipped vehicle, may be 
109.5   reimbursed at a lower rate than special transportation provided 
109.6   to persons who need a wheelchair lift van or stretcher-equipped 
109.7   vehicle. 
109.8      Sec. 21.  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 greater of:  (1) the medical assistance 
109.14  reimbursement rate in effect on June 30, 2000; or (2) the 
109.15  current Medicare reimbursement rate for ambulance services. 
109.16     Sec. 22.  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. 23.  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, paragraph (a) or 
111.20  under an alternative payment methodology consistent with the 
111.21  requirements of United States Code, title 42, section 1392a, 
111.22  paragraph (a) and approved by the health care financing 
111.23  administration.  The alternative payment methodology shall be 
111.24  100 percent of cost as determined according to Medicare cost 
111.25  principles. 
111.26     Sec. 24.  Minnesota Statutes 2000, section 256B.0625, 
111.27  subdivision 34, is amended to read: 
111.28     Subd. 34.  [INDIAN HEALTH SERVICES FACILITIES.] Medical 
111.29  assistance payments and MinnesotaCare payments to facilities of 
111.30  the Indian health service and facilities operated by a tribe or 
111.31  tribal organization under funding authorized by United States 
111.32  Code, title 25, sections 450f to 450n, or title III of the 
111.33  Indian Self-Determination and Education Assistance Act, Public 
111.34  Law Number 93-638, for enrollees who are eligible for federal 
111.35  financial participation, shall be at the option of the facility 
111.36  in accordance with the rate published by the United States 
112.1   Assistant Secretary for Health under the authority of United 
112.2   States Code, title 42, sections 248(a) and 249(b).  General 
112.3   assistance medical care payments to facilities of the Indian 
112.4   health services and facilities operated by a tribe or tribal 
112.5   organization for the provision of outpatient medical care 
112.6   services billed after June 30, 1990, must be in accordance with 
112.7   the general assistance medical care rates paid for the same 
112.8   services when provided in a facility other than a facility of 
112.9   the Indian health service or a facility operated by a tribe or 
112.10  tribal organization.  MinnesotaCare payments for enrollees who 
112.11  are not eligible for federal financial participation at 
112.12  facilities of the Indian Health Service and facilities operated 
112.13  by a tribe or tribal organization for the provision of 
112.14  outpatient medical services must be in accordance with the 
112.15  medical assistance rates paid for the same services when 
112.16  provided in a facility other than a facility of the Indian 
112.17  Health Service or a facility operated by a tribe or tribal 
112.18  organization. 
112.19     [EFFECTIVE DATE.] This section is effective the day 
112.20  following final enactment. 
112.21     Sec. 25.  Minnesota Statutes 2000, section 256B.0635, 
112.22  subdivision 1, is amended to read: 
112.23     Subdivision 1.  [INCREASED EMPLOYMENT.] Beginning January 
112.24  1, 1998 (a) Until June 30, 2002, medical assistance may be paid 
112.25  for persons who received MFIP-S or medical assistance for 
112.26  families and children in at least three of six months preceding 
112.27  the month in which the person became ineligible for MFIP-S or 
112.28  medical assistance, if the ineligibility was due to an increase 
112.29  in hours of employment or employment income or due to the loss 
112.30  of an earned income disregard.  In addition, to receive 
112.31  continued assistance under this section, persons who received 
112.32  medical assistance for families and children but did not receive 
112.33  MFIP-S must have had income less than or equal to the assistance 
112.34  standard for their family size under the state's AFDC plan in 
112.35  effect as of July 16, 1996, as required by the Personal 
112.36  Responsibility and Work Opportunity Reconciliation Act of 1996 
113.1   (PRWORA), Public Law Number 104-193, increased by three percent 
113.2   effective July 1, 2000, at the time medical assistance 
113.3   eligibility began.  A person who is eligible for extended 
113.4   medical assistance is entitled to six months of assistance 
113.5   without reapplication, unless the assistance unit ceases to 
113.6   include a dependent child.  For a person under 21 years of age, 
113.7   medical assistance may not be discontinued within the six-month 
113.8   period of extended eligibility until it has been determined that 
113.9   the person is not otherwise eligible for medical assistance.  
113.10  Medical assistance may be continued for an additional six months 
113.11  if the person meets all requirements for the additional six 
113.12  months, according to title XIX of the Social Security Act, as 
113.13  amended by section 303 of the Family Support Act of 1988, Public 
113.14  Law Number 100-485. 
113.15     (b) Beginning July 1, 2002, medical assistance for families 
113.16  and children may be paid for persons who were eligible under 
113.17  section 256B.055, subdivision 3a, paragraph (b), in at least 
113.18  three of six months preceding the month in which the person 
113.19  became ineligible under that section if the ineligibility was 
113.20  due to an increase in hours of employment or employment income 
113.21  or due to the loss of an earned income disregard.  A person who 
113.22  is eligible for extended medical assistance is entitled to six 
113.23  months of assistance without reapplication, unless the 
113.24  assistance unit ceases to include a dependent child, except 
113.25  medical assistance may not be discontinued for that dependent 
113.26  child under 21 years of age within the six-month period of 
113.27  extended eligibility until it has been determined that the 
113.28  person is not otherwise eligible for medical assistance.  
113.29  Medical assistance may be continued for an additional six months 
113.30  if the person meets all requirements for the additional six 
113.31  months, according to title XIX of the Social Security Act, as 
113.32  amended by section 303 of the Family Support Act of 1988, Public 
113.33  Law Number 100-485. 
113.34     [EFFECTIVE DATE.] This section is effective July 1, 2001. 
113.35     Sec. 26.  Minnesota Statutes 2000, section 256B.0635, 
113.36  subdivision 2, is amended to read: 
114.1      Subd. 2.  [INCREASED CHILD OR SPOUSAL SUPPORT.] Beginning 
114.2   January 1, 1998 (a) Until June 30, 2002, medical assistance may 
114.3   be paid for persons who received MFIP-S or medical assistance 
114.4   for families and children in at least three of the six months 
114.5   preceding the month in which the person became ineligible for 
114.6   MFIP-S or medical assistance, if the ineligibility was the 
114.7   result of the collection of child or spousal support under part 
114.8   D of title IV of the Social Security Act.  In addition, to 
114.9   receive continued assistance under this section, persons who 
114.10  received medical assistance for families and children but did 
114.11  not receive MFIP-S must have had income less than or equal to 
114.12  the assistance standard for their family size under the state's 
114.13  AFDC plan in effect as of July 16, 1996, as required by the 
114.14  Personal Responsibility and Work Opportunity Reconciliation Act 
114.15  of 1996 (PRWORA), Public Law Number 104-193 increased by three 
114.16  percent effective July 1, 2000, at the time medical assistance 
114.17  eligibility began.  A person who is eligible for extended 
114.18  medical assistance under this subdivision is entitled to four 
114.19  months of assistance without reapplication, unless the 
114.20  assistance unit ceases to include a dependent child.  For a 
114.21  person under 21 years of age, except medical assistance may not 
114.22  be discontinued for that dependent child under 21 years of age 
114.23  within the four-month period of extended eligibility until it 
114.24  has been determined that the person is not otherwise eligible 
114.25  for medical assistance. 
114.26     (b) Beginning July 1, 2002, medical assistance for families 
114.27  and children may be paid for persons who were eligible under 
114.28  section 256B.055, subdivision 3a, paragraph (b), in at least 
114.29  three of the six months preceding the month in which the person 
114.30  became ineligible under that section if the ineligibility was 
114.31  the result of the collection of child or spousal support under 
114.32  part D of title IV of the Social Security Act.  A person who is 
114.33  eligible for extended medical assistance under this subdivision 
114.34  is entitled to four months of assistance without reapplication, 
114.35  unless the assistance unit ceases to include a dependent child, 
114.36  except medical assistance may not be discontinued for that 
115.1   dependent child under 21 years of age within the four-month 
115.2   period of extended eligibility until it has been determined that 
115.3   the person is not otherwise eligible for medical assistance. 
115.4      [EFFECTIVE DATE.] This section is effective July 1, 2001. 
115.5      Sec. 27.  [256B.0637] [PRESUMPTIVE ELIGIBILITY FOR CERTAIN 
115.6   PERSONS NEEDING TREATMENT FOR BREAST OR CERVICAL CANCER.] 
115.7      Medical assistance is available during a presumptive 
115.8   eligibility period for persons who meet the criteria in section 
115.9   256B.057, subdivision 10.  For purposes of this section, the 
115.10  presumptive eligibility period begins on the date on which an 
115.11  entity designated by the commissioner determines, based on 
115.12  preliminary information, that the person meets the criteria in 
115.13  section 256B.057, subdivision 10.  The presumptive eligibility 
115.14  period ends on the day on which a determination is made as to 
115.15  the person's eligibility, except that if an application is not 
115.16  submitted by the last day of the month following the month 
115.17  during which the determination based on preliminary information 
115.18  is made, the presumptive eligibility period ends on that last 
115.19  day of the month. 
115.20     Sec. 28.  [256B.195] [HEALTH CARE SAFETY NET PRESERVATION.] 
115.21     Subdivision 1.  [INTERGOVERNMENTAL TRANSFERS AND RELATED 
115.22  PAYMENTS.] (a) This section is contingent on federal approval of 
115.23  the intergovernmental transfers and payments to safety net 
115.24  hospitals authorized under this section. 
115.25     (b) In addition to the percentage contribution paid by a 
115.26  county under section 256B.19, subdivision 1, the governmental 
115.27  units designated in this subdivision shall be responsible for an 
115.28  additional portion of the nonfederal share of medical assistance 
115.29  costs attributable to them.  For purposes of this section, 
115.30  "designated governmental unit" means Hennepin county, Ramsey 
115.31  county, or the University of Minnesota.  For purposes of this 
115.32  section, "nonstate, government hospital" means Hennepin County 
115.33  Medical Center, the successor or assignee to St. Paul-Ramsey 
115.34  Medical Center as described in section 383A.91, or Fairview 
115.35  University Medical Center. 
115.36     (c) Effective July 1, 2001, the governmental units 
116.1   designated in paragraph (a) shall in total transfer $2,833,333 
116.2   on a monthly basis to the state Medicaid agency.  The 
116.3   commissioner shall allocate this assessment between the 
116.4   governmental units based on the proportion of the Medicare upper 
116.5   payment limit for each nonstate, government hospital located 
116.6   within the governmental unit to the total Medicare upper payment 
116.7   limit of all participating hospitals in paragraph (b).  
116.8      (d) The commissioner shall distribute the proceeds of this 
116.9   intergovernmental transfer, including the federal Medicaid 
116.10  match, as follows: 
116.11     (1) Proceeds may be no less than the amount of the 
116.12  intergovernmental transfer in paragraph (c) multiplied by 1.75. 
116.13     (2) The remaining proceeds provide funding for hospital 
116.14  charity care aid under section 144.585.  The commissioner of 
116.15  human services shall work with the commissioner of health to 
116.16  assure that hospital charity care aid payments are administered 
116.17  in a manner that generates Medicaid matching funds.  
116.18     (e) The successor or assignee to St. Paul-Ramsey Medical 
116.19  Center shall transfer on a monthly basis to Ramsey county an 
116.20  amount equal to the county assessment under paragraph (c). 
116.21     Subd. 2.  [DETERMINATION OF INTERGOVERNMENTAL TRANSFER 
116.22  AMOUNTS.] Medicaid rate changes, including those required to 
116.23  obtain federal financial participation under section 62J.692, 
116.24  subdivision 8, enacted prior to the effective date of this 
116.25  legislation, shall precede the determination of 
116.26  intergovernmental transfer amounts determined in this section.  
116.27  Participation in the intergovernmental transfer program shall 
116.28  not result in the offset of any nonstate, government hospital's 
116.29  receipt of Medicaid payment increases. 
116.30     Subd. 3.  [STATE PLAN AMENDMENTS.] The commissioner shall 
116.31  amend the state Medicaid plan as necessary to implement this 
116.32  section. 
116.33     Subd. 4.  [PROPORTIONATE ADJUSTMENTS.] (a) The commissioner 
116.34  shall adjust the intergovernmental transfers under subdivision 
116.35  1, paragraph (c), and the payments under subdivision 1, 
116.36  paragraph (d), upon the approval of the designated governmental 
117.1   unit named in subdivision 1, paragraph (b), based on the 
117.2   commissioner's determination of Medicare upper payment limits, 
117.3   hospital-specific federal limitations on disproportionate share 
117.4   payments or to maximize additional federal reimbursements. 
117.5      (b) In the event that:  (i) federal approval is not 
117.6   received for the total intergovernmental transfer amount 
117.7   specified in subdivision 1, paragraph (d), or, (ii) federal 
117.8   rules regarding the establishment of the 150 percent Medicare 
117.9   upper payment limit, section 1102 of the Social Security Act, 
117.10  United States Code, title 42, section 1302, enacted on March 13, 
117.11  2001, are rescinded or, (iii) the federal 150 percent Medicare 
117.12  upper payment limit is reduced to 100 percent, the amount of the 
117.13  intergovernmental transfers and Medicaid payments to the 
117.14  nonstate, government hospitals named in subdivision 1, paragraph 
117.15  (b), shall be adjusted for each hospital based on the proportion 
117.16  of each hospital's Medicaid inpatient hospital days to the total 
117.17  Medicaid inpatient hospital days provided by all participating 
117.18  hospitals.  
117.19     [EFFECTIVE DATE.] This section is effective July 1, 2001. 
117.20     Sec. 29.  Minnesota Statutes 2000, section 256B.69, 
117.21  subdivision 4, is amended to read: 
117.22     Subd. 4.  [LIMITATION OF CHOICE.] The commissioner shall 
117.23  develop criteria to determine when limitation of choice may be 
117.24  implemented in the experimental counties.  The criteria shall 
117.25  ensure that all eligible individuals in the county have 
117.26  continuing access to the full range of medical assistance 
117.27  services as specified in subdivision 6.  The commissioner shall 
117.28  exempt the following persons from participation in the project, 
117.29  in addition to those who do not meet the criteria for limitation 
117.30  of choice:  
117.31     (1) persons eligible for medical assistance according to 
117.32  section 256B.055, subdivision 1; 
117.33     (2) persons eligible for medical assistance due to 
117.34  blindness or disability as determined by the social security 
117.35  administration or the state medical review team, unless:  
117.36     (i) they are 65 years of age or older,; or 
118.1      (ii) they reside in Itasca county or they reside in a 
118.2   county in which the commissioner conducts a pilot project under 
118.3   a waiver granted pursuant to section 1115 of the Social Security 
118.4   Act; 
118.5      (3) recipients who currently have private coverage through 
118.6   a health maintenance organization; 
118.7      (4) recipients who are eligible for medical assistance by 
118.8   spending down excess income for medical expenses other than the 
118.9   nursing facility per diem expense; 
118.10     (5) recipients who receive benefits under the Refugee 
118.11  Assistance Program, established under United States Code, title 
118.12  8, section 1522(e); 
118.13     (6) children who are both determined to be severely 
118.14  emotionally disturbed and receiving case management services 
118.15  according to section 256B.0625, subdivision 20; and 
118.16     (7) adults who are both determined to be seriously and 
118.17  persistently mentally ill and received case management services 
118.18  according to section 256B.0625, subdivision 20; and 
118.19     (8) persons eligible for medical assistance according to 
118.20  section 256B.057, subdivision 10.  
118.21  Children under age 21 who are in foster placement may enroll in 
118.22  the project on an elective basis.  Individuals excluded under 
118.23  clauses (6) and (7) may choose to enroll on an elective basis.  
118.24  The commissioner may allow persons with a one-month spenddown 
118.25  who are otherwise eligible to enroll to voluntarily enroll or 
118.26  remain enrolled, if they elect to prepay their monthly spenddown 
118.27  to the state.  Beginning on or after July 1, 1997, The 
118.28  commissioner may require those individuals to enroll in the 
118.29  prepaid medical assistance program who otherwise would have been 
118.30  excluded under clauses (1) and, (3), and (8), and under 
118.31  Minnesota Rules, part 9500.1452, subpart 2, items H, K, and L.  
118.32  Before limitation of choice is implemented, eligible individuals 
118.33  shall be notified and after notification, shall be allowed to 
118.34  choose only among demonstration providers.  The commissioner may 
118.35  assign an individual with private coverage through a health 
118.36  maintenance organization, to the same health maintenance 
119.1   organization for medical assistance coverage, if the health 
119.2   maintenance organization is under contract for medical 
119.3   assistance in the individual's county of residence.  After 
119.4   initially choosing a provider, the recipient is allowed to 
119.5   change that choice only at specified times as allowed by the 
119.6   commissioner.  If a demonstration provider ends participation in 
119.7   the project for any reason, a recipient enrolled with that 
119.8   provider must select a new provider but may change providers 
119.9   without cause once more within the first 60 days after 
119.10  enrollment with the second provider. 
119.11     Sec. 30.  Minnesota Statutes 2000, section 256B.69, 
119.12  subdivision 5, is amended to read: 
119.13     Subd. 5.  [PROSPECTIVE PER CAPITA PAYMENT.] The 
119.14  commissioner shall establish the method and amount of payments 
119.15  for services.  The commissioner shall annually contract with 
119.16  demonstration providers to provide services consistent with 
119.17  these established methods and amounts for payment.  Payment 
119.18  rates established by the commissioner must be within the limits 
119.19  of available appropriations.  
119.20     If allowed by the commissioner, a demonstration provider 
119.21  may contract with an insurer, health care provider, nonprofit 
119.22  health service plan corporation, or the commissioner, to provide 
119.23  insurance or similar protection against the cost of care 
119.24  provided by the demonstration provider or to provide coverage 
119.25  against the risks incurred by demonstration providers under this 
119.26  section.  The recipients enrolled with a demonstration provider 
119.27  are a permissible group under group insurance laws and chapter 
119.28  62C, the Nonprofit Health Service Plan Corporations Act.  Under 
119.29  this type of contract, the insurer or corporation may make 
119.30  benefit payments to a demonstration provider for services 
119.31  rendered or to be rendered to a recipient.  Any insurer or 
119.32  nonprofit health service plan corporation licensed to do 
119.33  business in this state is authorized to provide this insurance 
119.34  or similar protection.  
119.35     Payments to providers participating in the project are 
119.36  exempt from the requirements of sections 256.966 and 256B.03, 
120.1   subdivision 2.  The commissioner shall complete development of 
120.2   capitation rates for payments before delivery of services under 
120.3   this section is begun.  For payments made during calendar year 
120.4   1990 and later years, the commissioner shall contract with an 
120.5   independent actuary to establish prepayment rates. 
120.6      By January 15, 1996, the commissioner shall report to the 
120.7   legislature on the methodology used to allocate to participating 
120.8   counties available administrative reimbursement for advocacy and 
120.9   enrollment costs.  The report shall reflect the commissioner's 
120.10  judgment as to the adequacy of the funds made available and of 
120.11  the methodology for equitable distribution of the funds.  The 
120.12  commissioner must involve participating counties in the 
120.13  development of the report. 
120.14     Sec. 31.  Minnesota Statutes 2000, section 256B.69, 
120.15  subdivision 5b, is amended to read: 
120.16     Subd. 5b.  [PROSPECTIVE REIMBURSEMENT RATES.] (a) For 
120.17  prepaid medical assistance and general assistance medical care 
120.18  program contract rates set by the commissioner under subdivision 
120.19  5 and effective on or after January 1, 1998, capitation rates 
120.20  for nonmetropolitan counties shall on a weighted average be no 
120.21  less than 88 percent of the capitation rates for metropolitan 
120.22  counties, excluding Hennepin county.  The commissioner shall 
120.23  make a pro rata adjustment in capitation rates paid to counties 
120.24  other than nonmetropolitan counties in order to make this 
120.25  provision budget neutral.  
120.26     (b) For prepaid medical assistance program contract rates 
120.27  set by the commissioner under subdivision 5 and effective on or 
120.28  after January 1, 2001 2002, capitation rates for nonmetropolitan 
120.29  counties shall, on a weighted average, be no less than 89 95 
120.30  percent of the capitation rates for metropolitan counties, 
120.31  excluding Hennepin county.  The commissioner shall make a pro 
120.32  rata adjustment in capitation rates paid to Hennepin county in 
120.33  order to make the portion of the increase between 89 and 95 
120.34  percent budget neutral. 
120.35     (c) This subdivision shall not affect the nongeographically 
120.36  based risk adjusted rates established under section 62Q.03, 
121.1   subdivision 5a, paragraph (f). 
121.2      (d) The commissioner shall require prepaid health plans to 
121.3   use all revenue received from the increase in capitation rates 
121.4   for nonmetropolitan counties from 89 to no less than 95 percent 
121.5   of the capitation rate for metropolitan counties, excluding 
121.6   Hennepin county, to increase reimbursement rates, effective 
121.7   January 1, 2002, for providers under contract with the prepaid 
121.8   health plan to serve enrollees from nonmetropolitan counties. 
121.9      Sec. 32.  Minnesota Statutes 2000, section 256B.69, is 
121.10  amended by adding a subdivision to read: 
121.11     Subd. 6c.  [DENTAL SERVICES DEMONSTRATION PROJECT.] The 
121.12  commissioner shall establish a dental services demonstration 
121.13  project in Crow Wing, Todd, Morrison, Wadena, and Cass counties 
121.14  for provision of dental services to medical assistance, general 
121.15  assistance medical care, and MinnesotaCare recipients.  The 
121.16  commissioner may contract on a prospective per capita payment 
121.17  basis for these dental services with an organization licensed 
121.18  under chapter 62C, 62D, or 62N in accordance with section 
121.19  256B.037 or may establish and administer a fee-for-service 
121.20  system for the reimbursement of dental services.  
121.21     [EFFECTIVE DATE.] This section is effective January 1, 2002.
121.22     Sec. 33.  Minnesota Statutes 2000, section 256B.75, is 
121.23  amended to read: 
121.24     256B.75 [HOSPITAL OUTPATIENT REIMBURSEMENT.] 
121.25     (a) For outpatient hospital facility fee payments for 
121.26  services rendered on or after October 1, 1992, the commissioner 
121.27  of human services shall pay the lower of (1) submitted charge, 
121.28  or (2) 32 percent above the rate in effect on June 30, 1992, 
121.29  except for those services for which there is a federal maximum 
121.30  allowable payment.  Effective for services rendered on or after 
121.31  January 1, 2000, payment rates for nonsurgical outpatient 
121.32  hospital facility fees and emergency room facility fees shall be 
121.33  increased by eight percent over the rates in effect on December 
121.34  31, 1999, except for those services for which there is a federal 
121.35  maximum allowable payment.  Services for which there is a 
121.36  federal maximum allowable payment shall be paid at the lower of 
122.1   (1) submitted charge, or (2) the federal maximum allowable 
122.2   payment.  Total aggregate payment for outpatient hospital 
122.3   facility fee services shall not exceed the Medicare upper 
122.4   limit.  If it is determined that a provision of this section 
122.5   conflicts with existing or future requirements of the United 
122.6   States government with respect to federal financial 
122.7   participation in medical assistance, the federal requirements 
122.8   prevail.  The commissioner may, in the aggregate, prospectively 
122.9   reduce payment rates to avoid reduced federal financial 
122.10  participation resulting from rates that are in excess of the 
122.11  Medicare upper limitations. 
122.12     (b) Notwithstanding paragraph (a), payment for outpatient, 
122.13  emergency, and ambulatory surgery hospital facility fee services 
122.14  for critical access hospitals designated under section 144.1483, 
122.15  clause (11), shall be paid on a cost-based payment system that 
122.16  is based on the cost-finding methods and allowable costs of the 
122.17  Medicare program. 
122.18     (c) Effective for services provided on or after July 1, 
122.19  2002, rates that are based on the Medicare outpatient 
122.20  prospective payment system shall be replaced by a budget neutral 
122.21  prospective payment system that is derived using medical 
122.22  assistance data.  The department shall provide a proposal to the 
122.23  2002 legislature to define and implement this provision. 
122.24     Sec. 34.  Minnesota Statutes 2000, section 256B.76, is 
122.25  amended to read: 
122.26     256B.76 [PHYSICIAN AND DENTAL REIMBURSEMENT.] 
122.27     (a) Effective for services rendered on or after October 1, 
122.28  1992, the commissioner shall make payments for physician 
122.29  services as follows: 
122.30     (1) payment for level one Health Care Finance 
122.31  Administration's common procedural coding system (HCPCS) codes 
122.32  titled "office and other outpatient services," "preventive 
122.33  medicine new and established patient," "delivery, antepartum, 
122.34  and postpartum care," "critical care," Caesarean cesarean 
122.35  delivery and pharmacologic management provided to psychiatric 
122.36  patients, and HCPCS level three codes for enhanced services for 
123.1   prenatal high risk, shall be paid at the lower of (i) submitted 
123.2   charges, or (ii) 25 percent above the rate in effect on June 30, 
123.3   1992.  If the rate on any procedure code within these categories 
123.4   is different than the rate that would have been paid under the 
123.5   methodology in section 256B.74, subdivision 2, then the larger 
123.6   rate shall be paid; 
123.7      (2) payments for all other services shall be paid at the 
123.8   lower of (i) submitted charges, or (ii) 15.4 percent above the 
123.9   rate in effect on June 30, 1992; 
123.10     (3) all physician rates shall be converted from the 50th 
123.11  percentile of 1982 to the 50th percentile of 1989, less the 
123.12  percent in aggregate necessary to equal the above increases 
123.13  except that payment rates for home health agency services shall 
123.14  be the rates in effect on September 30, 1992; 
123.15     (4) effective for services rendered on or after January 1, 
123.16  2000, payment rates for physician and professional services 
123.17  shall be increased by three percent over the rates in effect on 
123.18  December 31, 1999, except for home health agency and family 
123.19  planning agency services; and 
123.20     (5) the increases in clause (4) shall be implemented 
123.21  January 1, 2000, for managed care. 
123.22     (b) Effective for services rendered on or after October 1, 
123.23  1992, the commissioner shall make payments for dental services 
123.24  as follows: 
123.25     (1) dental services shall be paid at the lower of (i) 
123.26  submitted charges, or (ii) 25 percent above the rate in effect 
123.27  on June 30, 1992; 
123.28     (2) dental rates shall be converted from the 50th 
123.29  percentile of 1982 to the 50th percentile of 1989, less the 
123.30  percent in aggregate necessary to equal the above increases; 
123.31     (3) effective for services rendered on or after January 1, 
123.32  2000, payment rates for dental services shall be increased by 
123.33  three percent over the rates in effect on December 31, 1999; 
123.34     (4) the commissioner shall award grants to community 
123.35  clinics or other nonprofit community organizations, political 
123.36  subdivisions, professional associations, or other organizations 
124.1   that demonstrate the ability to provide dental services 
124.2   effectively to public program recipients.  Grants may be used to 
124.3   fund the costs related to coordinating access for recipients, 
124.4   developing and implementing patient care criteria, upgrading or 
124.5   establishing new facilities, acquiring furnishings or equipment, 
124.6   recruiting new providers, or other development costs that will 
124.7   improve access to dental care in a region.  In awarding grants, 
124.8   the commissioner shall give priority to applicants that plan to 
124.9   serve areas of the state in which the number of dental providers 
124.10  is not currently sufficient to meet the needs of recipients of 
124.11  public programs or uninsured individuals.  The commissioner 
124.12  shall consider the following in awarding the grants:  (i) 
124.13  potential to successfully increase access to an underserved 
124.14  population; (ii) the ability to raise matching funds; (iii) the 
124.15  long-term viability of the project to improve access beyond the 
124.16  period of initial funding; (iv) the efficiency in the use of the 
124.17  funding; and (v) the experience of the proposers in providing 
124.18  services to the target population. 
124.19     The commissioner shall monitor the grants and may terminate 
124.20  a grant if the grantee does not increase dental access for 
124.21  public program recipients.  The commissioner shall consider 
124.22  grants for the following: 
124.23     (i) implementation of new programs or continued expansion 
124.24  of current access programs that have demonstrated success in 
124.25  providing dental services in underserved areas; 
124.26     (ii) a pilot program for utilizing hygienists outside of a 
124.27  traditional dental office to provide dental hygiene services; 
124.28  and 
124.29     (iii) a program that organizes a network of volunteer 
124.30  dentists, establishes a system to refer eligible individuals to 
124.31  volunteer dentists, and through that network provides donated 
124.32  dental care services to public program recipients or uninsured 
124.33  individuals. 
124.34     (5) beginning October 1, 1999, the payment for tooth 
124.35  sealants and fluoride treatments shall be the lower of (i) 
124.36  submitted charge, or (ii) 80 percent of median 1997 charges; and 
125.1      (6) the increases listed in clauses (3) and (5) shall be 
125.2   implemented January 1, 2000, for managed care; and 
125.3      (7) effective for services provided on or after October 1, 
125.4   2001, payment for diagnostic examinations and dental x-rays 
125.5   provided to children under age 21 shall be the lower of (i) the 
125.6   submitted charge, or (ii) 85 percent of median 1999 charges.  
125.7      (c) Effective for dental services rendered on or after July 
125.8   1, 2001, the commissioner may increase reimbursements to 
125.9   dentists and dental clinics deemed by the commissioner to be 
125.10  critical access dental providers.  Reimbursement to a critical 
125.11  access dental provider may be increased by not more than 50 
125.12  percent above the reimbursement rate that would otherwise be 
125.13  paid to the provider.  Payments to health plan companies shall 
125.14  be adjusted to reflect increased reimbursements to critical 
125.15  access dental providers as approved by the commissioner.  In 
125.16  determining which dentists and dental clinics shall be deemed 
125.17  critical access dental providers, the commissioner shall review: 
125.18     (1) the utilization rate in the service area in which the 
125.19  dentist or dental clinic operates for dental services to 
125.20  patients covered by medical assistance, general assistance 
125.21  medical care, or MinnesotaCare as their primary source of 
125.22  coverage; 
125.23     (2) the level of services provided by the dentist or dental 
125.24  clinic to patients covered by medical assistance, general 
125.25  assistance medical care, or MinnesotaCare as their primary 
125.26  source of coverage; and 
125.27     (3) whether the level of services provided by the dentist 
125.28  or dental clinic is critical to maintaining adequate levels of 
125.29  patient access within the service area. 
125.30  In the absence of a critical access dental provider in a service 
125.31  area, the commissioner may designate a dentist or dental clinic 
125.32  as a critical access dental provider if the dentist or dental 
125.33  clinic is willing to provide care to patients covered by medical 
125.34  assistance, general assistance medical care, or MinnesotaCare at 
125.35  a level which significantly increases access to dental care in 
125.36  the service area. 
126.1      (d) An entity that operates both a Medicare certified 
126.2   comprehensive outpatient rehabilitation facility and a facility 
126.3   which was certified prior to January 1, 1993, that is licensed 
126.4   under Minnesota Rules, parts 9570.2000 to 9570.3600, and for 
126.5   whom at least 33 percent of the clients receiving rehabilitation 
126.6   services in the most recent calendar year are medical assistance 
126.7   recipients, shall be reimbursed by the commissioner for 
126.8   rehabilitation services at rates that are 38 percent greater 
126.9   than the maximum reimbursement rate allowed under paragraph (a), 
126.10  clause (2), when those services are (1) provided within the 
126.11  comprehensive outpatient rehabilitation facility and (2) 
126.12  provided to residents of nursing facilities owned by the entity. 
126.13     [EFFECTIVE DATE.] This section is effective the day 
126.14  following final enactment. 
126.15     Sec. 35.  [256B.78] [MEDICAL ASSISTANCE DEMONSTRATION 
126.16  PROJECT FOR FAMILY PLANNING SERVICES.] 
126.17     (a) The commissioner of human services shall establish a 
126.18  medical assistance demonstration project to determine whether 
126.19  improved access to coverage of prepregnancy family planning 
126.20  services reduces medical assistance and MFIP costs. 
126.21     (b) This section is effective upon federal approval of the 
126.22  demonstration project. 
126.23     Sec. 36.  Minnesota Statutes 2000, section 256D.03, 
126.24  subdivision 3, is amended to read: 
126.25     Subd. 3.  [GENERAL ASSISTANCE MEDICAL CARE; ELIGIBILITY.] 
126.26  (a) General assistance medical care may be paid for any person 
126.27  who is not eligible for medical assistance under chapter 256B, 
126.28  including eligibility for medical assistance based on a 
126.29  spenddown of excess income according to section 256B.056, 
126.30  subdivision 5, or MinnesotaCare as defined in paragraph (b), 
126.31  except as provided in paragraph (c); and: 
126.32     (1) who is receiving assistance under section 256D.05, 
126.33  except for families with children who are eligible under 
126.34  Minnesota family investment program-statewide (MFIP-S), who is 
126.35  having a payment made on the person's behalf under sections 
126.36  256I.01 to 256I.06, or who resides in group residential housing 
127.1   as defined in chapter 256I and can meet a spenddown using the 
127.2   cost of remedial services received through group residential 
127.3   housing; or 
127.4      (2)(i) who is a resident of Minnesota; and whose equity in 
127.5   assets is not in excess of $1,000 per assistance unit.  Exempt 
127.6   assets, the reduction of excess assets, and the waiver of excess 
127.7   assets must conform to the medical assistance program in chapter 
127.8   256B, with the following exception:  the maximum amount of 
127.9   undistributed funds in a trust that could be distributed to or 
127.10  on behalf of the beneficiary by the trustee, assuming the full 
127.11  exercise of the trustee's discretion under the terms of the 
127.12  trust, must be applied toward the asset maximum; and 
127.13     (ii) who has countable income not in excess of the 
127.14  assistance standards established in section 256B.056, 
127.15  subdivision 4 that does not exceed 133 and 1/3 percent of the 
127.16  AFDC income standard in effect under the July 16, 1996, AFDC 
127.17  state plan, increased by three percent, or whose excess income 
127.18  is spent down according to section 256B.056, subdivision 5, 
127.19  using a six-month budget period.  The method for calculating 
127.20  earned income disregards and deductions for a person who resides 
127.21  with a dependent child under age 21 shall follow section 
127.22  256B.056, subdivision 1a.  However, if a disregard of $30 and 
127.23  one-third of the remainder has been applied to the wage earner's 
127.24  income, the disregard shall not be applied again until the wage 
127.25  earner's income has not been considered in an eligibility 
127.26  determination for general assistance, general assistance medical 
127.27  care, medical assistance, or MFIP-S for 12 consecutive months.  
127.28  The earned income and work expense deductions for a person who 
127.29  does not reside with a dependent child under age 21 shall be the 
127.30  same as the method used to determine eligibility for a person 
127.31  under section 256D.06, subdivision 1, except the disregard of 
127.32  the first $50 of earned income is not allowed; 
127.33     (3) who would be eligible for medical assistance except 
127.34  that the person resides in a facility that is determined by the 
127.35  commissioner or the federal Health Care Financing Administration 
127.36  to be an institution for mental diseases; or 
128.1      (4) who is ineligible for medical assistance under chapter 
128.2   256B or general assistance medical care under any other 
128.3   provision of this section, and is receiving care and 
128.4   rehabilitation services from a nonprofit center established to 
128.5   serve victims of torture.  These individuals are eligible for 
128.6   general assistance medical care only for the period during which 
128.7   they are receiving services from the center.  During this period 
128.8   of eligibility, individuals eligible under this clause shall not 
128.9   be required to participate in prepaid general assistance medical 
128.10  care.  
128.11     (b) Beginning January 1, 2000, applicants or recipients who 
128.12  meet all eligibility requirements of MinnesotaCare as defined in 
128.13  sections 256L.01 to 256L.16, and are: 
128.14     (i) adults with dependent children under 21 whose gross 
128.15  family income is equal to or less than 275 percent of the 
128.16  federal poverty guidelines; or 
128.17     (ii) adults without children with earned income and whose 
128.18  family gross income is between 75 percent of the federal poverty 
128.19  guidelines and the amount set by section 256L.04, subdivision 7, 
128.20  shall be terminated from general assistance medical care upon 
128.21  enrollment in MinnesotaCare. 
128.22     (c) For services rendered on or after July 1, 1997, 
128.23  eligibility is limited to one month prior to application if the 
128.24  person is determined eligible in the prior month.  A 
128.25  redetermination of eligibility must occur every 12 months.  
128.26  Beginning January 1, 2000, Minnesota health care program 
128.27  applications completed by recipients and applicants who are 
128.28  persons described in paragraph (b), may be returned to the 
128.29  county agency to be forwarded to the department of human 
128.30  services or sent directly to the department of human services 
128.31  for enrollment in MinnesotaCare.  If all other eligibility 
128.32  requirements of this subdivision are met, eligibility for 
128.33  general assistance medical care shall be available in any month 
128.34  during which a MinnesotaCare eligibility determination and 
128.35  enrollment are pending.  Upon notification of eligibility for 
128.36  MinnesotaCare, notice of termination for eligibility for general 
129.1   assistance medical care shall be sent to an applicant or 
129.2   recipient.  If all other eligibility requirements of this 
129.3   subdivision are met, eligibility for general assistance medical 
129.4   care shall be available until enrollment in MinnesotaCare 
129.5   subject to the provisions of paragraph (e). 
129.6      (d) The date of an initial Minnesota health care program 
129.7   application necessary to begin a determination of eligibility 
129.8   shall be the date the applicant has provided a name, address, 
129.9   and social security number, signed and dated, to the county 
129.10  agency or the department of human services.  If the applicant is 
129.11  unable to provide an initial application when health care is 
129.12  delivered due to a medical condition or disability, a health 
129.13  care provider may act on the person's behalf to complete the 
129.14  initial application.  The applicant must complete the remainder 
129.15  of the application and provide necessary verification before 
129.16  eligibility can be determined.  The county agency must assist 
129.17  the applicant in obtaining verification if necessary.  On the 
129.18  basis of information provided on the completed application, an 
129.19  applicant who meets the following criteria shall be determined 
129.20  eligible beginning in the month of application: 
129.21     (1) has gross income less than 90 percent of the applicable 
129.22  income standard; 
129.23     (2) has liquid assets that total within $300 of the asset 
129.24  standard; 
129.25     (3) does not reside in a long-term care facility; and 
129.26     (4) meets all other eligibility requirements. 
129.27  The applicant must provide all required verifications within 30 
129.28  days' notice of the eligibility determination or eligibility 
129.29  shall be terminated. 
129.30     (e) County agencies are authorized to use all automated 
129.31  databases containing information regarding recipients' or 
129.32  applicants' income in order to determine eligibility for general 
129.33  assistance medical care or MinnesotaCare.  Such use shall be 
129.34  considered sufficient in order to determine eligibility and 
129.35  premium payments by the county agency. 
129.36     (f) General assistance medical care is not available for a 
130.1   person in a correctional facility unless the person is detained 
130.2   by law for less than one year in a county correctional or 
130.3   detention facility as a person accused or convicted of a crime, 
130.4   or admitted as an inpatient to a hospital on a criminal hold 
130.5   order, and the person is a recipient of general assistance 
130.6   medical care at the time the person is detained by law or 
130.7   admitted on a criminal hold order and as long as the person 
130.8   continues to meet other eligibility requirements of this 
130.9   subdivision.  
130.10     (g) General assistance medical care is not available for 
130.11  applicants or recipients who do not cooperate with the county 
130.12  agency to meet the requirements of medical assistance.  General 
130.13  assistance medical care is limited to payment of emergency 
130.14  services only for applicants or recipients as described in 
130.15  paragraph (b), whose MinnesotaCare coverage is denied or 
130.16  terminated for nonpayment of premiums as required by sections 
130.17  256L.06 and 256L.07.  
130.18     (h) In determining the amount of assets of an individual, 
130.19  there shall be included any asset or interest in an asset, 
130.20  including an asset excluded under paragraph (a), that was given 
130.21  away, sold, or disposed of for less than fair market value 
130.22  within the 60 months preceding application for general 
130.23  assistance medical care or during the period of eligibility.  
130.24  Any transfer described in this paragraph shall be presumed to 
130.25  have been for the purpose of establishing eligibility for 
130.26  general assistance medical care, unless the individual furnishes 
130.27  convincing evidence to establish that the transaction was 
130.28  exclusively for another purpose.  For purposes of this 
130.29  paragraph, the value of the asset or interest shall be the fair 
130.30  market value at the time it was given away, sold, or disposed 
130.31  of, less the amount of compensation received.  For any 
130.32  uncompensated transfer, the number of months of ineligibility, 
130.33  including partial months, shall be calculated by dividing the 
130.34  uncompensated transfer amount by the average monthly per person 
130.35  payment made by the medical assistance program to skilled 
130.36  nursing facilities for the previous calendar year.  The 
131.1   individual shall remain ineligible until this fixed period has 
131.2   expired.  The period of ineligibility may exceed 30 months, and 
131.3   a reapplication for benefits after 30 months from the date of 
131.4   the transfer shall not result in eligibility unless and until 
131.5   the period of ineligibility has expired.  The period of 
131.6   ineligibility begins in the month the transfer was reported to 
131.7   the county agency, or if the transfer was not reported, the 
131.8   month in which the county agency discovered the transfer, 
131.9   whichever comes first.  For applicants, the period of 
131.10  ineligibility begins on the date of the first approved 
131.11  application. 
131.12     (i) When determining eligibility for any state benefits 
131.13  under this subdivision, the income and resources of all 
131.14  noncitizens shall be deemed to include their sponsor's income 
131.15  and resources as defined in the Personal Responsibility and Work 
131.16  Opportunity Reconciliation Act of 1996, title IV, Public Law 
131.17  Number 104-193, sections 421 and 422, and subsequently set out 
131.18  in federal rules. 
131.19     (j)(1) An undocumented noncitizen or a nonimmigrant is 
131.20  ineligible for general assistance medical care other than 
131.21  emergency services.  For purposes of this subdivision, a 
131.22  nonimmigrant is an individual in one or more of the classes 
131.23  listed in United States Code, title 8, section 1101(a)(15), and 
131.24  an undocumented noncitizen is an individual who resides in the 
131.25  United States without the approval or acquiescence of the 
131.26  Immigration and Naturalization Service. 
131.27     (2) This paragraph does not apply to a child under age 18, 
131.28  to a Cuban or Haitian entrant as defined in Public Law Number 
131.29  96-422, section 501(e)(1) or (2)(a), or to a noncitizen who is 
131.30  aged, blind, or disabled as defined in Code of Federal 
131.31  Regulations, title 42, sections 435.520, 435.530, 435.531, 
131.32  435.540, and 435.541, or effective October 1, 1998, to an 
131.33  individual eligible for general assistance medical care under 
131.34  paragraph (a), clause (4), who cooperates with the Immigration 
131.35  and Naturalization Service to pursue any applicable immigration 
131.36  status, including citizenship, that would qualify the individual 
132.1   for medical assistance with federal financial participation. 
132.2      (k) For purposes of paragraphs (g) and (j), "emergency 
132.3   services" has the meaning given in Code of Federal Regulations, 
132.4   title 42, section 440.255(b)(1), except that it also means 
132.5   services rendered because of suspected or actual pesticide 
132.6   poisoning. 
132.7      (l) Notwithstanding any other provision of law, a 
132.8   noncitizen who is ineligible for medical assistance due to the 
132.9   deeming of a sponsor's income and resources, is ineligible for 
132.10  general assistance medical care. 
132.11     Sec. 37.  Minnesota Statutes 2000, section 256D.03, 
132.12  subdivision 4, is amended to read: 
132.13     Subd. 4.  [GENERAL ASSISTANCE MEDICAL CARE; SERVICES.] (a) 
132.14  For a person who is eligible under subdivision 3, paragraph (a), 
132.15  clause (3), general assistance medical care covers, except as 
132.16  provided in paragraph (c): 
132.17     (1) inpatient hospital services; 
132.18     (2) outpatient hospital services; 
132.19     (3) services provided by Medicare certified rehabilitation 
132.20  agencies; 
132.21     (4) prescription drugs and other products recommended 
132.22  through the process established in section 256B.0625, 
132.23  subdivision 13; 
132.24     (5) equipment necessary to administer insulin and 
132.25  diagnostic supplies and equipment for diabetics to monitor blood 
132.26  sugar level; 
132.27     (6) eyeglasses and eye examinations provided by a physician 
132.28  or optometrist; 
132.29     (7) hearing aids; 
132.30     (8) prosthetic devices; 
132.31     (9) laboratory and X-ray services; 
132.32     (10) physician's services; 
132.33     (11) medical transportation; 
132.34     (12) chiropractic services as covered under the medical 
132.35  assistance program; 
132.36     (13) podiatric services; 
133.1      (14) dental services; 
133.2      (15) outpatient services provided by a mental health center 
133.3   or clinic that is under contract with the county board and is 
133.4   established under section 245.62; 
133.5      (16) day treatment services for mental illness provided 
133.6   under contract with the county board; 
133.7      (17) prescribed medications for persons who have been 
133.8   diagnosed as mentally ill as necessary to prevent more 
133.9   restrictive institutionalization; 
133.10     (18) psychological services, medical supplies and 
133.11  equipment, and Medicare premiums, coinsurance and deductible 
133.12  payments; 
133.13     (19) medical equipment not specifically listed in this 
133.14  paragraph when the use of the equipment will prevent the need 
133.15  for costlier services that are reimbursable under this 
133.16  subdivision; 
133.17     (20) services performed by a certified pediatric nurse 
133.18  practitioner, a certified family nurse practitioner, a certified 
133.19  adult nurse practitioner, a certified obstetric/gynecological 
133.20  nurse practitioner, a certified neonatal nurse practitioner, or 
133.21  a certified geriatric nurse practitioner in independent 
133.22  practice, if (1) the service is otherwise covered under this 
133.23  chapter as a physician service, (2) the service provided on an 
133.24  inpatient basis is not included as part of the cost for 
133.25  inpatient services included in the operating payment rate, and 
133.26  (3) the service is within the scope of practice of the nurse 
133.27  practitioner's license as a registered nurse, as defined in 
133.28  section 148.171; 
133.29     (21) services of a certified public health nurse or a 
133.30  registered nurse practicing in a public health nursing clinic 
133.31  that is a department of, or that operates under the direct 
133.32  authority of, a unit of government, if the service is within the 
133.33  scope of practice of the public health nurse's license as a 
133.34  registered nurse, as defined in section 148.171; and 
133.35     (22) telemedicine consultations, to the extent they are 
133.36  covered under section 256B.0625, subdivision 3b.  
134.1      (b) Except as provided in paragraph (c), for a recipient 
134.2   who is eligible under subdivision 3, paragraph (a), clause (1) 
134.3   or (2), general assistance medical care covers the services 
134.4   listed in paragraph (a) with the exception of special 
134.5   transportation services. 
134.6      (c) Gender reassignment surgery and related services are 
134.7   not covered services under this subdivision unless the 
134.8   individual began receiving gender reassignment services prior to 
134.9   July 1, 1995.  
134.10     (d) In order to contain costs, the commissioner of human 
134.11  services shall select vendors of medical care who can provide 
134.12  the most economical care consistent with high medical standards 
134.13  and shall where possible contract with organizations on a 
134.14  prepaid capitation basis to provide these services.  The 
134.15  commissioner shall consider proposals by counties and vendors 
134.16  for prepaid health plans, competitive bidding programs, block 
134.17  grants, or other vendor payment mechanisms designed to provide 
134.18  services in an economical manner or to control utilization, with 
134.19  safeguards to ensure that necessary services are provided.  
134.20  Before implementing prepaid programs in counties with a county 
134.21  operated or affiliated public teaching hospital or a hospital or 
134.22  clinic operated by the University of Minnesota, the commissioner 
134.23  shall consider the risks the prepaid program creates for the 
134.24  hospital and allow the county or hospital the opportunity to 
134.25  participate in the program in a manner that reflects the risk of 
134.26  adverse selection and the nature of the patients served by the 
134.27  hospital, provided the terms of participation in the program are 
134.28  competitive with the terms of other participants considering the 
134.29  nature of the population served.  Payment for services provided 
134.30  pursuant to this subdivision shall be as provided to medical 
134.31  assistance vendors of these services under sections 256B.02, 
134.32  subdivision 8, and 256B.0625.  For payments made during fiscal 
134.33  year 1990 and later years, the commissioner shall consult with 
134.34  an independent actuary in establishing prepayment rates, but 
134.35  shall retain final control over the rate methodology.  Payment 
134.36  rates established by the commissioner must be within the limits 
135.1   of available appropriations.  Notwithstanding the provisions of 
135.2   subdivision 3, an individual who becomes ineligible for general 
135.3   assistance medical care because of failure to submit income 
135.4   reports or recertification forms in a timely manner, shall 
135.5   remain enrolled in the prepaid health plan and shall remain 
135.6   eligible for general assistance medical care coverage through 
135.7   the last day of the month in which the enrollee became 
135.8   ineligible for general assistance medical care. 
135.9      (e) There shall be no copayment required of any recipient 
135.10  of benefits for any services provided under this subdivision.  A 
135.11  hospital receiving a reduced payment as a result of this section 
135.12  may apply the unpaid balance toward satisfaction of the 
135.13  hospital's bad debts. 
135.14     (f) Any county may, from its own resources, provide medical 
135.15  payments for which state payments are not made. 
135.16     (g) Chemical dependency services that are reimbursed under 
135.17  chapter 254B must not be reimbursed under general assistance 
135.18  medical care. 
135.19     (h) The maximum payment for new vendors enrolled in the 
135.20  general assistance medical care program after the base year 
135.21  shall be determined from the average usual and customary charge 
135.22  of the same vendor type enrolled in the base year. 
135.23     (i) The conditions of payment for services under this 
135.24  subdivision are the same as the conditions specified in rules 
135.25  adopted under chapter 256B governing the medical assistance 
135.26  program, unless otherwise provided by statute or rule. 
135.27     Sec. 38.  Minnesota Statutes 2000, section 256J.31, 
135.28  subdivision 12, is amended to read: 
135.29     Subd. 12.  [RIGHT TO DISCONTINUE CASH ASSISTANCE.] A 
135.30  participant who is not in vendor payment status may discontinue 
135.31  receipt of the cash assistance portion of the MFIP assistance 
135.32  grant and retain eligibility for child care assistance under 
135.33  section 119B.05 and for medical assistance under sections 
135.34  256B.055, subdivision 3a, and 256B.0635.  For the months a 
135.35  participant chooses to discontinue the receipt of the cash 
135.36  portion of the MFIP grant, the assistance unit accrues months of 
136.1   eligibility to be applied toward eligibility for child care 
136.2   under section 119B.05 and for medical assistance under sections 
136.3   256B.055, subdivision 3a, and 256B.0635. 
136.4      [EFFECTIVE DATE.] This section is effective July 1, 2002. 
136.5      Sec. 39.  Minnesota Statutes 2000, section 256K.03, 
136.6   subdivision 1, is amended to read: 
136.7      Subdivision 1.  [NOTIFICATION OF PROGRAM.] Except for the 
136.8   provisions in this section, the provisions for the MFIP 
136.9   application process shall be followed.  Within two days after 
136.10  receipt of a completed combined application form, the county 
136.11  agency must refer to the provider the applicant who meets the 
136.12  conditions under section 256K.02, and notify the applicant in 
136.13  writing of the program including the following provisions: 
136.14     (1) notification that, as part of the application process, 
136.15  applicants are required to attend orientation, to be followed 
136.16  immediately by a job search; 
136.17     (2) the program provider, the date, time, and location of 
136.18  the scheduled program orientation; 
136.19     (3) the procedures for qualifying for and receiving 
136.20  benefits under the program; 
136.21     (4) the immediate availability of supportive services, 
136.22  including, but not limited to, child care, transportation, 
136.23  medical assistance, and other work-related aid; and 
136.24     (5) the rights, responsibilities, and obligations of 
136.25  participants in the program, including, but not limited to, the 
136.26  grounds for exemptions and deferrals, the consequences for 
136.27  refusing or failing to participate fully, and the appeal process.
136.28     [EFFECTIVE DATE.] This section is effective July 1, 2002. 
136.29     Sec. 40.  Minnesota Statutes 2000, section 256K.07, is 
136.30  amended to read: 
136.31     256K.07 [ELIGIBILITY FOR FOOD STAMPS, MEDICAL ASSISTANCE, 
136.32  AND CHILD CARE.] 
136.33     The participant shall be treated as an MFIP recipient for 
136.34  food stamps, medical assistance, and child care eligibility 
136.35  purposes.  The participant who leaves the program as a result of 
136.36  increased earnings from employment shall be eligible for 
137.1   transitional medical assistance and child care without regard to 
137.2   MFIP receipt in three of the six months preceding ineligibility. 
137.3      [EFFECTIVE DATE.] This section is effective July 1, 2002. 
137.4      Sec. 41.  Minnesota Statutes 2000, section 256L.06, 
137.5   subdivision 3, is amended to read: 
137.6      Subd. 3.  [ADMINISTRATION AND COMMISSIONER'S DUTIES.] (a) 
137.7   Premiums are dedicated to the commissioner for MinnesotaCare. 
137.8      (b) The commissioner shall develop and implement procedures 
137.9   to:  (1) require enrollees to report changes in income; (2) 
137.10  adjust sliding scale premium payments, based upon changes in 
137.11  enrollee income; and (3) disenroll enrollees from MinnesotaCare 
137.12  for failure to pay required premiums.  Failure to pay includes 
137.13  payment with a dishonored check, a returned automatic bank 
137.14  withdrawal, or a refused credit card or debit card payment.  The 
137.15  commissioner may demand a guaranteed form of payment, including 
137.16  a cashier's check or a money order, as the only means to replace 
137.17  a dishonored, returned, or refused payment. 
137.18     (c) Premiums are calculated on a calendar month basis and 
137.19  may be paid on a monthly, quarterly, or annual basis, with the 
137.20  first payment due upon notice from the commissioner of the 
137.21  premium amount required.  The commissioner shall inform 
137.22  applicants and enrollees of these premium payment options. 
137.23  Premium payment is required before enrollment is complete and to 
137.24  maintain eligibility in MinnesotaCare.  
137.25     (d) Nonpayment of the premium will result in disenrollment 
137.26  from the plan within one calendar month after the due date 
137.27  effective for the calendar month for which the premium was due.  
137.28  Persons disenrolled for nonpayment or who voluntarily terminate 
137.29  coverage from the program may not reenroll until four calendar 
137.30  months have elapsed.  Persons disenrolled for nonpayment who pay 
137.31  all past due premiums as well as current premiums due, including 
137.32  premiums due for the period of disenrollment, within 20 days of 
137.33  disenrollment, shall be reenrolled retroactively to the first 
137.34  day of disenrollment.  Persons disenrolled for nonpayment or who 
137.35  voluntarily terminate coverage from the program may not reenroll 
137.36  for four calendar months unless the person demonstrates good 
138.1   cause for nonpayment.  Good cause does not exist if a person 
138.2   chooses to pay other family expenses instead of the premium.  
138.3   The commissioner shall define good cause in rule. 
138.4      [EFFECTIVE DATE.] This section is effective July 1, 2002. 
138.5      Sec. 42.  Minnesota Statutes 2000, section 256L.12, 
138.6   subdivision 9, is amended to read: 
138.7      Subd. 9.  [RATE SETTING.] Rates will be prospective, per 
138.8   capita, where possible.  The commissioner may allow health plans 
138.9   to arrange for inpatient hospital services on a risk or nonrisk 
138.10  basis.  The commissioner shall consult with an independent 
138.11  actuary to determine appropriate rates.  Rates established by 
138.12  the commissioner must be within the limits of available 
138.13  appropriations. 
138.14     Sec. 43.  Minnesota Statutes 2000, section 256L.12, is 
138.15  amended by adding a subdivision to read: 
138.16     Subd. 11.  [COVERAGE AT INDIAN HEALTH SERVICE 
138.17  FACILITIES.] For American Indian enrollees of MinnesotaCare, 
138.18  MinnesotaCare shall cover health care services provided at 
138.19  Indian Health Service facilities and facilities operated by a 
138.20  tribe or tribal organization under funding authorized by United 
138.21  States Code, title 25, sections 450f to 450n, or title III of 
138.22  the Indian Self-Determination and Education Act, Public Law 
138.23  Number 93-638, if those services would otherwise be covered 
138.24  under section 256L.03.  Payments for services provided under 
138.25  this subdivision shall be made on a fee-for-service basis, and 
138.26  may, at the option of the tribe or organization, be made at the 
138.27  rates authorized under sections 256.969, subdivision 16, and 
138.28  256B.0625, subdivision 34, for those MinnesotaCare enrollees 
138.29  eligible for coverage at medical assistance rates.  For purposes 
138.30  of this subdivision, "American Indian" has the meaning given to 
138.31  persons to whom services will be provided for in the Code of 
138.32  Federal Regulations, title 42, section 36.12. 
138.33     Sec. 44.  Minnesota Statutes 2000, section 256L.16, is 
138.34  amended to read: 
138.35     256L.16 [PAYMENT RATES; SERVICES FOR FAMILIES AND CHILDREN 
138.36  UNDER THE MINNESOTACARE HEALTH CARE REFORM WAIVER.] 
139.1      Section 256L.11, subdivision 2, shall not apply to services 
139.2   provided to children families with children who are eligible to 
139.3   receive expanded services according to section 256L.03, 
139.4   subdivision 1a 256L.04, subdivision 1, paragraph (a). 
139.5      Sec. 45.  Laws 1995, chapter 178, article 2, section 36, is 
139.6   amended to read: 
139.7      Sec. 36.  [EMPOWERMENT ZONES; ADMINISTRATIVE SIMPLIFICATION 
139.8   OF WELFARE LAWS.] 
139.9      (a) The commissioner of human services shall make 
139.10  recommendations to effectuate the changes in federal laws and 
139.11  regulations, state laws and rules, and the state plan to improve 
139.12  the administrative efficiency of the aid to families with 
139.13  dependent children, general assistance, work readiness, family 
139.14  general assistance, medical assistance, general assistance 
139.15  medical care, and food stamp programs.  At a minimum, the 
139.16  following administrative standards and procedures must be 
139.17  changed. 
139.18     The commissioner shall: 
139.19     (1) require income or eligibility reviews no more 
139.20  frequently than annually for cases in which income is normally 
139.21  invariant, as in aid to families with dependent children cases 
139.22  where the only source of household income is Supplemental Social 
139.23  Security Income; 
139.24     (2) permit households to report income annually when the 
139.25  source of income is excluded, such as a minor's earnings; 
139.26     (3) require income or eligibility reviews no more 
139.27  frequently than annually for extended medical assistance cases; 
139.28     (4) require income or eligibility reviews no more 
139.29  frequently than annually for a medical assistance postpartum 
139.30  client, where the client previously had eligibility under a 
139.31  different basis prior to pregnancy or if other household members 
139.32  have eligibility with the same income/basis that applies to the 
139.33  client; 
139.34     (5) (4) permit all income or eligibility reviews for foster 
139.35  care medical assistance cases to use the short application form; 
139.36  and 
140.1      (6) (5) make dependent care expenses declaratory for 
140.2   medical assistance; and 
140.3      (7) permit households to only report gifts worth $100 or 
140.4   more per month. 
140.5      (b) The county's administrative savings resulting from 
140.6   these changes may be allocated to fund any lawful purpose. 
140.7      (c) The recommendations must be provided in a report to the 
140.8   chairs of the appropriate legislative committees by August 1, 
140.9   1995.  The recommendations must include a list of the 
140.10  administrative standards and procedures that require approval by 
140.11  the federal government before implementation, and also which 
140.12  administrative simplification standards and procedures may be 
140.13  implemented by a county prior to receiving a federal waiver. 
140.14     (d) The commissioner shall seek the necessary waivers from 
140.15  the federal government as soon as possible to implement the 
140.16  administrative simplification standards and procedures. 
140.17     Sec. 46.  Laws 1999, chapter 245, article 4, section 110, 
140.18  is amended to read: 
140.19     Sec. 110.  [PROGRAMS FOR SENIOR CITIZENS.] 
140.20     The commissioner of human services shall study the 
140.21  eligibility criteria of and benefits provided to persons age 65 
140.22  and over through the array of cash assistance and health care 
140.23  programs administered by the department, and the extent to which 
140.24  these programs can be combined, simplified, or coordinated to 
140.25  reduce administrative costs and improve access.  The 
140.26  commissioner shall also study potential barriers to enrollment 
140.27  for low-income seniors who would otherwise deplete resources 
140.28  necessary to maintain independent community living.  At a 
140.29  minimum, the study must include an evaluation of asset 
140.30  requirements and enrollment sites.  The commissioner shall 
140.31  report study findings and recommendations to the legislature by 
140.32  June September 30, 2001. 
140.33     Sec. 47.  [NOTICE OF NEW PREMIUM SCHEDULE.] 
140.34     The commissioner of human services shall provide medical 
140.35  assistance enrollees subject to premiums as employed persons 
140.36  with disabilities with prior notice of the new premium schedule 
141.1   established under the section 13 amendment to section 256B.057, 
141.2   subdivision 9, paragraph (c).  This notice must be provided at 
141.3   least two months before the month in which the first premium 
141.4   payment under the new schedule is due. 
141.5      Sec. 48.  [MEDICATION THERAPY MANAGEMENT PILOT PROGRAM.] 
141.6      Subdivision 1.  [ESTABLISHMENT.] The commissioner of human 
141.7   services, in consultation with the advisory committee 
141.8   established under subdivision 2, shall implement, beginning July 
141.9   1, 2001, a two-year medication therapy management pilot program 
141.10  for medical assistance enrollees.  Medication therapy management 
141.11  must be provided by teams of physicians and pharmacists working 
141.12  in collaborative practice, as defined in Minnesota Statutes, 
141.13  section 151.01, subdivision 27, clause (5), to help patients use 
141.14  medications safely and effectively.  The commissioner may enroll 
141.15  individual pharmacists who participate in the pilot program as 
141.16  medical assistance providers and shall seek to ensure that 
141.17  participating pharmacists represent all geographic regions of 
141.18  the state. 
141.19     Subd. 2.  [ADVISORY COMMITTEE.] The commissioner shall 
141.20  establish a ten-member medication therapy management advisory 
141.21  committee, to advise the commissioner in the implementation and 
141.22  administration of the program and the development of eligibility 
141.23  criteria for enrollees and providers and requirements for 
141.24  collaborative practice agreements.  The committee shall be 
141.25  comprised of:  two licensed physicians; two licensed 
141.26  pharmacists; two consumer representatives; three members with 
141.27  expertise in the area of medication therapy management, who may 
141.28  be licensed physicians or licensed pharmacists; and a 
141.29  representative of the commissioner, who shall serve as an 
141.30  ex-officio nonvoting member.  In appointing members who are not 
141.31  consumer representatives, the commissioner shall consider 
141.32  recommendations of associations representing pharmacy and 
141.33  medical practitioners.  The committee is governed by section 
141.34  15.059, except that committee members do not receive 
141.35  compensation or reimbursement for expenses. 
141.36     Subd. 3.  [EVALUATION.] The commissioner shall evaluate the 
142.1   cost-effectiveness of the pilot program and its effect on 
142.2   patient outcomes and quality of care, and shall report to the 
142.3   legislature by December 15, 2003.  The commissioner may contract 
142.4   with a vendor to conduct the evaluation. 
142.5      Sec. 49.  [REGULATORY SIMPLIFICATION FOR STATE HEALTH CARE 
142.6   PROGRAM PROVIDERS.] 
142.7      The commissioner of human services, in consultation with 
142.8   providers participating in state health care programs, shall 
142.9   identify nonfinancial barriers to increased provider enrollment 
142.10  and provider retention in state health care programs, and shall 
142.11  implement procedures to address these barriers.  Areas to be 
142.12  examined by the commissioner shall include, but are not limited 
142.13  to, regulatory complexity and inconsistencies between state 
142.14  health care programs, provider requirements, provision of 
142.15  technical assistance to providers, responsiveness to provider 
142.16  inquiries and complaints, claims processing turnaround times, 
142.17  and policies for rejecting provider claims.  The commissioner 
142.18  shall report to the legislature by February 15, 2002, on any 
142.19  changes to the administration of state health care programs that 
142.20  will be implemented as a result of the study, and present 
142.21  recommendations for any necessary changes in state law. 
142.22     Sec. 50.  [REPEALER.] 
142.23     (a) Minnesota Statutes 2000, section 256B.037, subdivision 
142.24  5, is repealed effective January 1, 2002. 
142.25     (b) Minnesota Statutes 2000, section 256B.0635, subdivision 
142.26  3, is repealed effective July 1, 2002. 
142.27                             ARTICLE 3 
142.28                   CONTINUING CARE AND HOME CARE 
142.29     Section 1.  Minnesota Statutes 2000, section 245A.13, 
142.30  subdivision 7, is amended to read: 
142.31     Subd. 7.  [RATE RECOMMENDATION.] The commissioner of human 
142.32  services may review rates of a residential program participating 
142.33  in the medical assistance program which is in receivership and 
142.34  that has needs or deficiencies documented by the department of 
142.35  health or the department of human services.  If the commissioner 
142.36  of human services determines that a review of the rate 
143.1   established under section 256B.501 sections 256B.5012 and 
143.2   256B.5013 is needed, the commissioner shall: 
143.3      (1) review the order or determination that cites the 
143.4   deficiencies or needs; and 
143.5      (2) determine the need for additional staff, additional 
143.6   annual hours by type of employee, and additional consultants, 
143.7   services, supplies, equipment, repairs, or capital assets 
143.8   necessary to satisfy the needs or deficiencies. 
143.9      Sec. 2.  Minnesota Statutes 2000, section 245A.13, 
143.10  subdivision 8, is amended to read: 
143.11     Subd. 8.  [ADJUSTMENT TO THE RATE.] Upon review of rates 
143.12  under subdivision 7, the commissioner may adjust the residential 
143.13  program's payment rate.  The commissioner shall review the 
143.14  circumstances, together with the residential program cost report 
143.15  program's most recent income and expense report, to determine 
143.16  whether or not the deficiencies or needs can be corrected or met 
143.17  by reallocating residential program staff, costs, revenues, 
143.18  or any other resources including any investments, efficiency 
143.19  incentives, or allowances.  If the commissioner determines that 
143.20  any deficiency cannot be corrected or the need cannot be met 
143.21  with the payment rate currently being paid, the commissioner 
143.22  shall determine the payment rate adjustment by dividing the 
143.23  additional annual costs established during the commissioner's 
143.24  review by the residential program's actual resident days from 
143.25  the most recent desk-audited cost income and expense report or 
143.26  the estimated resident days in the projected receivership 
143.27  period.  The payment rate adjustment must meet the conditions in 
143.28  Minnesota Rules, parts 9553.0010 to 9553.0080, and remains in 
143.29  effect during the period of the receivership or until another 
143.30  date set by the commissioner.  Upon the subsequent sale, 
143.31  closure, or transfer of the residential program, the 
143.32  commissioner may recover amounts that were paid as payment rate 
143.33  adjustments under this subdivision.  This recovery shall be 
143.34  determined through a review of actual costs and resident days in 
143.35  the receivership period.  The costs the commissioner finds to be 
143.36  allowable shall be divided by the actual resident days for the 
144.1   receivership period.  This rate shall be compared to the rate 
144.2   paid throughout the receivership period, with the difference, 
144.3   multiplied by resident days, being the amount to be repaid to 
144.4   the commissioner.  Allowable costs shall be determined by the 
144.5   commissioner as those ordinary, necessary, and related to 
144.6   resident care by prudent and cost-conscious management.  The 
144.7   buyer or transferee shall repay this amount to the commissioner 
144.8   within 60 days after the commissioner notifies the buyer or 
144.9   transferee of the obligation to repay.  This provision does not 
144.10  limit the liability of the seller to the commissioner pursuant 
144.11  to section 256B.0641. 
144.12     Sec. 3.  Minnesota Statutes 2000, section 252.275, 
144.13  subdivision 4b, is amended to read: 
144.14     Subd. 4b.  [GUARANTEED FLOOR.] Each county with an original 
144.15  allocation for the preceding year that is equal to or less than 
144.16  the guaranteed floor minimum index shall have a guaranteed floor 
144.17  equal to its original allocation for the preceding year.  Each 
144.18  county with an original allocation for the preceding year that 
144.19  is greater than the guaranteed floor minimum index shall have a 
144.20  guaranteed floor equal to the lesser of clause (1) or (2): 
144.21     (1) the county's original allocation for the preceding 
144.22  year; or 
144.23     (2) 70 percent of the county's reported expenditures 
144.24  eligible for reimbursement during the 12 months ending on June 
144.25  30 of the preceding calendar year. 
144.26     For calendar year 1993, the guaranteed floor minimum index 
144.27  shall be $20,000.  For each subsequent year, the index shall be 
144.28  adjusted by the projected change in the average value in the 
144.29  United States Department of Labor Bureau of Labor Statistics 
144.30  consumer price index (all urban) for that year. 
144.31     Notwithstanding this subdivision, no county shall be 
144.32  allocated a guaranteed floor of less than $1,000. 
144.33     When the amount of funds available for allocation is less 
144.34  than the amount available in the previous year, each county's 
144.35  previous year allocation shall be reduced in proportion to the 
144.36  reduction in the statewide funding, to establish each county's 
145.1   guaranteed floor. 
145.2      Sec. 4.  Minnesota Statutes 2000, section 254B.02, 
145.3   subdivision 3, is amended to read: 
145.4      Subd. 3.  [RESERVE ACCOUNT.] The commissioner shall 
145.5   allocate money from the reserve account to counties that, during 
145.6   the current fiscal year, have met or exceeded the base level of 
145.7   expenditures for eligible chemical dependency services from 
145.8   local money.  The commissioner shall establish the base level 
145.9   for fiscal year 1988 as the amount of local money used for 
145.10  eligible services in calendar year 1986.  In later years, the 
145.11  base level must be increased in the same proportion as state 
145.12  appropriations to implement Laws 1986, chapter 394, sections 8 
145.13  to 20, are increased.  The base level must be decreased if the 
145.14  fund balance from which allocations are made under section 
145.15  254B.02, subdivision 1, is decreased in later years.  The local 
145.16  match rate for the reserve account is the same rate as applied 
145.17  to the initial allocation.  Reserve account payments must not be 
145.18  included when calculating the county adjustments made according 
145.19  to subdivision 2.  For counties providing medical assistance or 
145.20  general assistance medical care through managed care plans on 
145.21  January 1, 1996, the base year is fiscal year 1995.  For 
145.22  counties beginning provision of managed care after January 1, 
145.23  1996, the base year is the most recent fiscal year before 
145.24  enrollment in managed care begins.  For counties providing 
145.25  managed care, the base level will be increased or decreased in 
145.26  proportion to changes in the fund balance from which allocations 
145.27  are made under subdivision 2, but will be additionally increased 
145.28  or decreased in proportion to the change in county adjusted 
145.29  population made in subdivision 1, paragraphs (b) and 
145.30  (c).  Effective July 1, 2001, funds deposited in the reserve 
145.31  account in excess of those needed to meet obligations for 
145.32  services provided during the biennium under this section and 
145.33  sections 254B.06 and 254B.09 shall cancel to the general fund. 
145.34     Sec. 5.  Minnesota Statutes 2000, section 254B.03, 
145.35  subdivision 1, is amended to read: 
145.36     Subdivision 1.  [LOCAL AGENCY DUTIES.] (a) Every local 
146.1   agency shall provide chemical dependency services to persons 
146.2   residing within its jurisdiction who meet criteria established 
146.3   by the commissioner for placement in a chemical dependency 
146.4   residential or nonresidential treatment service.  Chemical 
146.5   dependency money must be administered by the local agencies 
146.6   according to law and rules adopted by the commissioner under 
146.7   sections 14.001 to 14.69. 
146.8      (b) In order to contain costs, the county board shall, with 
146.9   the approval of the commissioner of human services, select 
146.10  eligible vendors of chemical dependency services who can provide 
146.11  economical and appropriate treatment.  Unless the local agency 
146.12  is a social services department directly administered by a 
146.13  county or human services board, the local agency shall not be an 
146.14  eligible vendor under section 254B.05.  The commissioner may 
146.15  approve proposals from county boards to provide services in an 
146.16  economical manner or to control utilization, with safeguards to 
146.17  ensure that necessary services are provided.  If a county 
146.18  implements a demonstration or experimental medical services 
146.19  funding plan, the commissioner shall transfer the money as 
146.20  appropriate.  If a county selects a vendor located in another 
146.21  state, the county shall ensure that the vendor is in compliance 
146.22  with the rules governing licensure of programs located in the 
146.23  state. 
146.24     (c) The calendar year 1998 2002 rate for vendors may not 
146.25  increase more than three two percent above the rate approved in 
146.26  effect on January 1, 1997 2001.  The calendar year 1999 2003 
146.27  rate for vendors may not increase more than three two percent 
146.28  above the rate in effect on January 1, 1998 2002.  The calendar 
146.29  years 2004 and 2005 rates may not exceed the rate in effect on 
146.30  January 1, 2003. 
146.31     (d) A culturally specific vendor that provides assessments 
146.32  under a variance under Minnesota Rules, part 9530.6610, shall be 
146.33  allowed to provide assessment services to persons not covered by 
146.34  the variance. 
146.35     Sec. 6.  Minnesota Statutes 2000, section 254B.04, 
146.36  subdivision 1, is amended to read: 
147.1      Subdivision 1.  [ELIGIBILITY.] (a) Persons eligible for 
147.2   benefits under Code of Federal Regulations, title 25, part 20, 
147.3   persons eligible for medical assistance benefits under sections 
147.4   256B.055, 256B.056, and 256B.057, subdivisions 1, 2, 5, and 6, 
147.5   or who meet the income standards of section 256B.056, 
147.6   subdivision 4, and persons eligible for general assistance 
147.7   medical care under section 256D.03, subdivision 3, are entitled 
147.8   to chemical dependency fund services.  State money appropriated 
147.9   for this paragraph must be placed in a separate account 
147.10  established for this purpose.  
147.11     Persons with dependent children who are determined to be in 
147.12  need of chemical dependency treatment pursuant to an assessment 
147.13  under section 626.556, subdivision 10, or a case plan under 
147.14  section 260C.201, subdivision 6, or 260C.212, shall be assisted 
147.15  by the local agency to access needed treatment services.  
147.16  Treatment services must be appropriate for the individual or 
147.17  family, which may include long-term care treatment or treatment 
147.18  in a facility that allows the dependent children to stay in the 
147.19  treatment facility.  The county shall pay for out-of-home 
147.20  placement costs, if applicable. 
147.21     (b) A person not entitled to services under paragraph (a), 
147.22  but with family income that is less than the 1997 federal 
147.23  poverty guidelines equivalent of 60 percent of the state median 
147.24  income for a family of like size and composition, shall be 
147.25  eligible to receive chemical dependency fund services within the 
147.26  limit of funds available after persons entitled to services 
147.27  under paragraph (a) have been served appropriated for this group 
147.28  for the fiscal year.  If notified by the state agency of limited 
147.29  funds, a county must give preferential treatment to persons with 
147.30  dependent children who are in need of chemical dependency 
147.31  treatment pursuant to an assessment under section 626.556, 
147.32  subdivision 10, or a case plan under section 260C.201, 
147.33  subdivision 6, or 260C.212.  A county may spend money from its 
147.34  own sources to serve persons under this paragraph.  State money 
147.35  appropriated for this paragraph must be placed in a separate 
147.36  account established for this purpose. 
148.1      (c) Persons whose income is between the 1997 federal 
148.2   poverty guidelines equivalent of 60 percent and 115 percent of 
148.3   the state median income shall be eligible for chemical 
148.4   dependency services on a sliding fee basis, within the limit of 
148.5   funds available, after persons entitled to services under 
148.6   paragraph (a) and persons eligible for services under paragraph 
148.7   (b) have been served appropriated for this group for the fiscal 
148.8   year.  Persons eligible under this paragraph must contribute to 
148.9   the cost of services according to the sliding fee scale 
148.10  established under subdivision 3.  A county may spend money from 
148.11  its own sources to provide services to persons under this 
148.12  paragraph.  State money appropriated for this paragraph must be 
148.13  placed in a separate account established for this purpose. 
148.14     Sec. 7.  Minnesota Statutes 2000, section 254B.09, is 
148.15  amended by adding a subdivision to read: 
148.16     Subd. 8.  [PAYMENTS TO IMPROVE SERVICES TO AMERICAN 
148.17  INDIANS.] The commissioner may set rates for chemical dependency 
148.18  services according to the American Indian Health Improvement 
148.19  Act, Public Law Number 94-437, for eligible vendors.  These 
148.20  rates shall supersede rates set in county purchase of service 
148.21  agreements when payments are made on behalf of clients eligible 
148.22  according to Public Law Number 94-437. 
148.23     Sec. 8.  Minnesota Statutes 2000, section 256.01, is 
148.24  amended by adding a subdivision to read: 
148.25     Subd. 19.  [GRANTS FOR CASE MANAGEMENT SERVICES TO PERSONS 
148.26  WITH HIV OR AIDS.] The commissioner may award grants to eligible 
148.27  vendors for the development, implementation, and evaluation of 
148.28  case management services for individuals infected with the human 
148.29  immunodeficiency virus.  HIV/AIDs case management services will 
148.30  be provided to increase access to cost effective health care 
148.31  services, to reduce the risk of HIV transmission, to ensure that 
148.32  basic client needs are met, and to increase client access to 
148.33  needed community supports or services. 
148.34     Sec. 9.  Minnesota Statutes 2000, section 256.476, 
148.35  subdivision 1, is amended to read: 
148.36     Subdivision 1.  [PURPOSE AND GOALS.] The commissioner of 
149.1   human services shall establish a consumer support grant 
149.2   program to assist for individuals with functional limitations 
149.3   and their families in purchasing and securing supports which the 
149.4   individuals need to live as independently and productively in 
149.5   the community as possible who wish to purchase and secure their 
149.6   own supports.  The commissioner and local agencies shall jointly 
149.7   develop an implementation plan which must include a way to 
149.8   resolve the issues related to county liability.  The program 
149.9   shall: 
149.10     (1) make support grants available to individuals or 
149.11  families as an effective alternative to existing programs and 
149.12  services, such as the developmental disability family support 
149.13  program, the alternative care program, personal care attendant 
149.14  services, home health aide services, and private duty nursing 
149.15  facility services; 
149.16     (2) provide consumers more control, flexibility, and 
149.17  responsibility over the needed supports their services and 
149.18  supports; 
149.19     (3) promote local program management and decision making; 
149.20  and 
149.21     (4) encourage the use of informal and typical community 
149.22  supports. 
149.23     Sec. 10.  Minnesota Statutes 2000, section 256.476, 
149.24  subdivision 2, is amended to read: 
149.25     Subd. 2.  [DEFINITIONS.] For purposes of this section, the 
149.26  following terms have the meanings given them: 
149.27     (a) "County board" means the county board of commissioners 
149.28  for the county of financial responsibility as defined in section 
149.29  256G.02, subdivision 4, or its designated representative.  When 
149.30  a human services board has been established under sections 
149.31  402.01 to 402.10, it shall be considered the county board for 
149.32  the purposes of this section. 
149.33     (b) "Family" means the person's birth parents, adoptive 
149.34  parents or stepparents, siblings or stepsiblings, children or 
149.35  stepchildren, grandparents, grandchildren, niece, nephew, aunt, 
149.36  uncle, or spouse.  For the purposes of this section, a family 
150.1   member is at least 18 years of age. 
150.2      (c) "Functional limitations" means the long-term inability 
150.3   to perform an activity or task in one or more areas of major 
150.4   life activity, including self-care, understanding and use of 
150.5   language, learning, mobility, self-direction, and capacity for 
150.6   independent living.  For the purpose of this section, the 
150.7   inability to perform an activity or task results from a mental, 
150.8   emotional, psychological, sensory, or physical disability, 
150.9   condition, or illness. 
150.10     (d) "Informed choice" means a voluntary decision made by 
150.11  the person or the person's legal representative, after becoming 
150.12  familiarized with the alternatives to: 
150.13     (1) select a preferred alternative from a number of 
150.14  feasible alternatives; 
150.15     (2) select an alternative which may be developed in the 
150.16  future; and 
150.17     (3) refuse any or all alternatives. 
150.18     (e) "Local agency" means the local agency authorized by the 
150.19  county board to carry out the provisions of this section. 
150.20     (f) "Person" or "persons" means a person or persons meeting 
150.21  the eligibility criteria in subdivision 3. 
150.22     (g) "Authorized representative" means an individual 
150.23  designated by the person or their legal representative to act on 
150.24  their behalf.  This individual may be a family member, guardian, 
150.25  representative payee, or other individual designated by the 
150.26  person or their legal representative, if any, to assist in 
150.27  purchasing and arranging for supports.  For the purposes of this 
150.28  section, an authorized representative is at least 18 years of 
150.29  age. 
150.30     (h) "Screening" means the screening of a person's service 
150.31  needs under sections 256B.0911 and 256B.092. 
150.32     (i) "Supports" means services, care, aids, home 
150.33  environmental modifications, or assistance purchased by the 
150.34  person or the person's family.  Examples of supports include 
150.35  respite care, assistance with daily living, and adaptive aids 
150.36  assistive technology.  For the purpose of this section, 
151.1   notwithstanding the provisions of section 144A.43, supports 
151.2   purchased under the consumer support program are not considered 
151.3   home care services. 
151.4      (j) "Program of origination" means the program the 
151.5   individual transferred from when approved for the consumer 
151.6   support grant program. 
151.7      Sec. 11.  Minnesota Statutes 2000, section 256.476, 
151.8   subdivision 3, is amended to read: 
151.9      Subd. 3.  [ELIGIBILITY TO APPLY FOR GRANTS.] (a) A person 
151.10  is eligible to apply for a consumer support grant if the person 
151.11  meets all of the following criteria: 
151.12     (1) the person is eligible for and has been approved to 
151.13  receive services under medical assistance as determined under 
151.14  sections 256B.055 and 256B.056 or the person is eligible for and 
151.15  has been approved to receive services under alternative care 
151.16  services as determined under section 256B.0913 or the person has 
151.17  been approved to receive a grant under the developmental 
151.18  disability family support program under section 252.32; 
151.19     (2) the person is able to direct and purchase the person's 
151.20  own care and supports, or the person has a family member, legal 
151.21  representative, or other authorized representative who can 
151.22  purchase and arrange supports on the person's behalf; 
151.23     (3) the person has functional limitations, requires ongoing 
151.24  supports to live in the community, and is at risk of or would 
151.25  continue institutionalization without such supports; and 
151.26     (4) the person will live in a home.  For the purpose of 
151.27  this section, "home" means the person's own home or home of a 
151.28  person's family member.  These homes are natural home settings 
151.29  and are not licensed by the department of health or human 
151.30  services. 
151.31     (b) Persons may not concurrently receive a consumer support 
151.32  grant if they are: 
151.33     (1) receiving home and community-based services under 
151.34  United States Code, title 42, section 1396h(c); personal care 
151.35  attendant and home health aide services under section 256B.0625; 
151.36  a developmental disability family support grant; or alternative 
152.1   care services under section 256B.0913; or 
152.2      (2) residing in an institutional or congregate care setting.
152.3      (c) A person or person's family receiving a consumer 
152.4   support grant shall not be charged a fee or premium by a local 
152.5   agency for participating in the program.  
152.6      (d) The commissioner may limit the participation of nursing 
152.7   facility residents, residents of intermediate care facilities 
152.8   for persons with mental retardation, and the recipients of 
152.9   services from federal waiver programs in the consumer support 
152.10  grant program if the participation of these individuals will 
152.11  result in an increase in the cost to the state. 
152.12     (e) The commissioner shall establish a budgeted 
152.13  appropriation each fiscal year for the consumer support grant 
152.14  program.  The number of individuals participating in the program 
152.15  will be adjusted so the total amount allocated to counties does 
152.16  not exceed the amount of the budgeted appropriation.  The 
152.17  budgeted appropriation will be adjusted annually to accommodate 
152.18  changes in demand for the consumer support grants. 
152.19     Sec. 12.  Minnesota Statutes 2000, section 256.476, 
152.20  subdivision 4, is amended to read: 
152.21     Subd. 4.  [SUPPORT GRANTS; CRITERIA AND LIMITATIONS.] (a) A 
152.22  county board may choose to participate in the consumer support 
152.23  grant program.  If a county board chooses to participate in the 
152.24  program, the local agency shall establish written procedures and 
152.25  criteria to determine the amount and use of support grants.  
152.26  These procedures must include, at least, the availability of 
152.27  respite care, assistance with daily living, and adaptive aids.  
152.28  The local agency may establish monthly or annual maximum amounts 
152.29  for grants and procedures where exceptional resources may be 
152.30  required to meet the health and safety needs of the person on a 
152.31  time-limited basis, however, the total amount awarded to each 
152.32  individual may not exceed the limits established in subdivision 
152.33  5, paragraph (f). 
152.34     (b) Support grants to a person or a person's family will be 
152.35  provided through a monthly subsidy payment and be in the form of 
152.36  cash, voucher, or direct county payment to vendor.  Support 
153.1   grant amounts must be determined by the local agency.  Each 
153.2   service and item purchased with a support grant must meet all of 
153.3   the following criteria:  
153.4      (1) it must be over and above the normal cost of caring for 
153.5   the person if the person did not have functional limitations; 
153.6      (2) it must be directly attributable to the person's 
153.7   functional limitations; 
153.8      (3) it must enable the person or the person's family to 
153.9   delay or prevent out-of-home placement of the person; and 
153.10     (4) it must be consistent with the needs identified in the 
153.11  service plan, when applicable. 
153.12     (c) Items and services purchased with support grants must 
153.13  be those for which there are no other public or private funds 
153.14  available to the person or the person's family.  Fees assessed 
153.15  to the person or the person's family for health and human 
153.16  services are not reimbursable through the grant. 
153.17     (d) In approving or denying applications, the local agency 
153.18  shall consider the following factors:  
153.19     (1) the extent and areas of the person's functional 
153.20  limitations; 
153.21     (2) the degree of need in the home environment for 
153.22  additional support; and 
153.23     (3) the potential effectiveness of the grant to maintain 
153.24  and support the person in the family environment or the person's 
153.25  own home. 
153.26     (e) At the time of application to the program or screening 
153.27  for other services, the person or the person's family shall be 
153.28  provided sufficient information to ensure an informed choice of 
153.29  alternatives by the person, the person's legal representative, 
153.30  if any, or the person's family.  The application shall be made 
153.31  to the local agency and shall specify the needs of the person 
153.32  and family, the form and amount of grant requested, the items 
153.33  and services to be reimbursed, and evidence of eligibility for 
153.34  medical assistance or alternative care program. 
153.35     (f) Upon approval of an application by the local agency and 
153.36  agreement on a support plan for the person or person's family, 
154.1   the local agency shall make grants to the person or the person's 
154.2   family.  The grant shall be in an amount for the direct costs of 
154.3   the services or supports outlined in the service agreement.  
154.4      (g) Reimbursable costs shall not include costs for 
154.5   resources already available, such as special education classes, 
154.6   day training and habilitation, case management, other services 
154.7   to which the person is entitled, medical costs covered by 
154.8   insurance or other health programs, or other resources usually 
154.9   available at no cost to the person or the person's family. 
154.10     (h) The state of Minnesota, the county boards participating 
154.11  in the consumer support grant program, or the agencies acting on 
154.12  behalf of the county boards in the implementation and 
154.13  administration of the consumer support grant program shall not 
154.14  be liable for damages, injuries, or liabilities sustained 
154.15  through the purchase of support by the individual, the 
154.16  individual's family, or the authorized representative under this 
154.17  section with funds received through the consumer support grant 
154.18  program.  Liabilities include but are not limited to:  workers' 
154.19  compensation liability, the Federal Insurance Contributions Act 
154.20  (FICA), or the Federal Unemployment Tax Act (FUTA).  For 
154.21  purposes of this section, participating county boards and 
154.22  agencies acting on behalf of county boards are exempt from the 
154.23  provisions of section 268.04. 
154.24     Sec. 13.  Minnesota Statutes 2000, section 256.476, 
154.25  subdivision 5, is amended to read: 
154.26     Subd. 5.  [REIMBURSEMENT, ALLOCATIONS, AND REPORTING.] (a) 
154.27  For the purpose of transferring persons to the consumer support 
154.28  grant program from specific programs or services, such as the 
154.29  developmental disability family support program and alternative 
154.30  care program, personal care attendant assistant services, home 
154.31  health aide services, or nursing facility private duty nursing 
154.32  services, the amount of funds transferred by the commissioner 
154.33  between the developmental disability family support program 
154.34  account, the alternative care account, the medical assistance 
154.35  account, or the consumer support grant account shall be based on 
154.36  each county's participation in transferring persons to the 
155.1   consumer support grant program from those programs and services. 
155.2      (b) At the beginning of each fiscal year, county 
155.3   allocations for consumer support grants shall be based on: 
155.4      (1) the number of persons to whom the county board expects 
155.5   to provide consumer supports grants; 
155.6      (2) their eligibility for current program and services; 
155.7      (3) the amount of nonfederal dollars expended on those 
155.8   individuals for those programs and services or, in situations 
155.9   where an individual is unable to obtain the support needed from 
155.10  the program of origination due to the unavailability of service 
155.11  providers at the time or the location where the supports are 
155.12  needed, the allocation will be based on the county's best 
155.13  estimate of the nonfederal dollars that would have been expended 
155.14  if the services had been available; and 
155.15     (4) projected dates when persons will start receiving 
155.16  grants.  County allocations shall be adjusted periodically by 
155.17  the commissioner based on the actual transfer of persons or 
155.18  service openings, and the nonfederal dollars associated with 
155.19  those persons or service openings, to the consumer support grant 
155.20  program. 
155.21     (c) The amount of funds transferred by the commissioner 
155.22  from the alternative care account and the medical assistance 
155.23  account for an individual may be changed if it is determined by 
155.24  the county or its agent that the individual's need for support 
155.25  has changed. 
155.26     (d) The authority to utilize funds transferred to the 
155.27  consumer support grant account for the purposes of implementing 
155.28  and administering the consumer support grant program will not be 
155.29  limited or constrained by the spending authority provided to the 
155.30  program of origination. 
155.31     (e) The commissioner shall may use up to five percent of 
155.32  each county's allocation, as adjusted, for payments to that 
155.33  county for administrative expenses, to be paid as a 
155.34  proportionate addition to reported direct service expenditures. 
155.35     (f) Except as provided in this paragraph, the county 
155.36  allocation for each individual or individual's family cannot 
156.1   exceed 80 percent of the total nonfederal dollars expended on 
156.2   the individual by the program of origination except for the 
156.3   developmental disabilities family support grant program which 
156.4   can be approved up to 100 percent of the nonfederal dollars and 
156.5   in situations as described in paragraph (b), clause (3).  In 
156.6   situations where exceptional need exists or the individual's 
156.7   need for support increases, up to 100 percent of the nonfederal 
156.8   dollars expended by the consumer's program of origination may be 
156.9   allocated to the county.  Allocations that exceed 80 percent of 
156.10  the nonfederal dollars expended on the individual by the program 
156.11  of origination must be approved by the commissioner.  The 
156.12  remainder of the amount expended on the individual by the 
156.13  program of origination will be used in the following 
156.14  proportions:  half will be made available to the consumer 
156.15  support grant program and participating counties for consumer 
156.16  training, resource development, and other costs, and half will 
156.17  be returned to the state general fund. 
156.18     (g) The commissioner may recover, suspend, or withhold 
156.19  payments if the county board, local agency, or grantee does not 
156.20  comply with the requirements of this section. 
156.21     (h) Grant funds unexpended by consumers shall return to the 
156.22  state once a year.  The annual return of unexpended grant funds 
156.23  shall occur in the quarter following the end of the state fiscal 
156.24  year. 
156.25     Sec. 14.  Minnesota Statutes 2000, section 256.476, 
156.26  subdivision 8, is amended to read: 
156.27     Subd. 8.  [COMMISSIONER RESPONSIBILITIES.] The commissioner 
156.28  shall: 
156.29     (1) transfer and allocate funds pursuant to this section; 
156.30     (2) determine allocations based on projected and actual 
156.31  local agency use; 
156.32     (3) monitor and oversee overall program spending; 
156.33     (4) evaluate the effectiveness of the program; 
156.34     (5) provide training and technical assistance for local 
156.35  agencies and consumers to help identify potential applicants to 
156.36  the program; and 
157.1      (6) develop guidelines for local agency program 
157.2   administration and consumer information; and.  
157.3      (7) apply for a federal waiver or take any other action 
157.4   necessary to maximize federal funding for the program by 
157.5   September 1, 1999. 
157.6      Sec. 15.  Minnesota Statutes 2000, section 256B.0625, 
157.7   subdivision 7, is amended to read: 
157.8      Subd. 7.  [PRIVATE DUTY NURSING.] Medical assistance covers 
157.9   private duty nursing services in a recipient's home.  Recipients 
157.10  who are authorized to receive private duty nursing services in 
157.11  their home may use approved hours outside of the home during 
157.12  hours when normal life activities take them outside of their 
157.13  home and when, without the provision of private duty nursing, 
157.14  their health and safety would be jeopardized.  To use private 
157.15  duty nursing services at school, the recipient or responsible 
157.16  party must provide written authorization in the care plan 
157.17  identifying the chosen provider and the daily amount of services 
157.18  to be used at school.  Medical assistance does not cover private 
157.19  duty nursing services for residents of a hospital, nursing 
157.20  facility, intermediate care facility, or a health care facility 
157.21  licensed by the commissioner of health, except as authorized in 
157.22  section 256B.64 for ventilator-dependent recipients in hospitals 
157.23  or unless a resident who is otherwise eligible is on leave from 
157.24  the facility and the facility either pays for the private duty 
157.25  nursing services or forgoes the facility per diem for the leave 
157.26  days that private duty nursing services are used.  Total hours 
157.27  of service and payment allowed for services outside the home 
157.28  cannot exceed that which is otherwise allowed in an in-home 
157.29  setting according to section 256B.0627.  All private duty 
157.30  nursing services must be provided according to the limits 
157.31  established under section 256B.0627.  Private duty nursing 
157.32  services may not be reimbursed if the nurse is the spouse of the 
157.33  recipient or the parent or foster care provider of a recipient 
157.34  who is under age 18, or the recipient's legal guardian. 
157.35     Sec. 16.  Minnesota Statutes 2000, section 256B.0625, 
157.36  subdivision 19a, is amended to read: 
158.1      Subd. 19a.  [PERSONAL CARE ASSISTANT SERVICES.] Medical 
158.2   assistance covers personal care assistant services in a 
158.3   recipient's home.  To qualify for personal care assistant 
158.4   services, recipients or responsible parties must be able to 
158.5   identify the recipient's needs, direct and evaluate task 
158.6   accomplishment, and provide for health and safety.  Approved 
158.7   hours may be used outside the home when normal life activities 
158.8   take them outside the home and when, without the provision of 
158.9   personal care, their health and safety would be jeopardized.  To 
158.10  use personal care assistant services at school, the recipient or 
158.11  responsible party must provide written authorization in the care 
158.12  plan identifying the chosen provider and the daily amount of 
158.13  services to be used at school.  Total hours for services, 
158.14  whether actually performed inside or outside the recipient's 
158.15  home, cannot exceed that which is otherwise allowed for personal 
158.16  care assistant services in an in-home setting according to 
158.17  section 256B.0627.  Medical assistance does not cover personal 
158.18  care assistant services for residents of a hospital, nursing 
158.19  facility, intermediate care facility, health care facility 
158.20  licensed by the commissioner of health, or unless a resident who 
158.21  is otherwise eligible is on leave from the facility and the 
158.22  facility either pays for the personal care assistant services or 
158.23  forgoes the facility per diem for the leave days that personal 
158.24  care assistant services are used.  All personal care services 
158.25  must be provided according to section 256B.0627.  Personal 
158.26  care assistant services may not be reimbursed if the personal 
158.27  care assistant is the spouse or legal guardian of the recipient 
158.28  or the parent of a recipient under age 18, or the responsible 
158.29  party or the foster care provider of a recipient who cannot 
158.30  direct the recipient's own care unless, in the case of a foster 
158.31  care provider, a county or state case manager visits the 
158.32  recipient as needed, but not less than every six months, to 
158.33  monitor the health and safety of the recipient and to ensure the 
158.34  goals of the care plan are met.  Parents of adult recipients, 
158.35  adult children of the recipient or adult siblings of the 
158.36  recipient may be reimbursed for personal care assistant services 
159.1   if they are not the recipient's legal guardian and, if they are 
159.2   granted a waiver under section 256B.0627.  Until July 1, 2001, 
159.3   and Notwithstanding the provisions of section 256B.0627, 
159.4   subdivision 4, paragraph (b), clause (4), the noncorporate legal 
159.5   guardian or conservator of an adult, who is not the responsible 
159.6   party and not the personal care provider organization, may be 
159.7   granted a hardship waiver under section 256B.0627, to be 
159.8   reimbursed to provide personal care assistant services to the 
159.9   recipient, and shall not be considered to have a service 
159.10  provider interest for purposes of participation on the screening 
159.11  team under section 256B.092, subdivision 7. 
159.12     Sec. 17.  Minnesota Statutes 2000, section 256B.0625, 
159.13  subdivision 19c, is amended to read: 
159.14     Subd. 19c.  [PERSONAL CARE.] Medical assistance covers 
159.15  personal care assistant services provided by an individual who 
159.16  is qualified to provide the services according to subdivision 
159.17  19a and section 256B.0627, where the services are prescribed by 
159.18  a physician in accordance with a plan of treatment and are 
159.19  supervised by the recipient under the fiscal agent option 
159.20  according to section 256B.0627, subdivision 10, or a qualified 
159.21  professional.  "Qualified professional" means a mental health 
159.22  professional as defined in section 245.462, subdivision 18, or 
159.23  245.4871, subdivision 27; or a registered nurse as defined in 
159.24  sections 148.171 to 148.285.  As part of the assessment, the 
159.25  county public health nurse will consult with assist the 
159.26  recipient or responsible party and to identify the most 
159.27  appropriate person to provide supervision of the personal care 
159.28  assistant.  The qualified professional shall perform the duties 
159.29  described in Minnesota Rules, part 9505.0335, subpart 4.  
159.30     Sec. 18.  Minnesota Statutes 2000, section 256B.0625, 
159.31  subdivision 20, is amended to read: 
159.32     Subd. 20.  [MENTAL HEALTH CASE MANAGEMENT.] (a) To the 
159.33  extent authorized by rule of the state agency, medical 
159.34  assistance covers case management services to persons with 
159.35  serious and persistent mental illness and children with severe 
159.36  emotional disturbance.  Services provided under this section 
160.1   must meet the relevant standards in sections 245.461 to 
160.2   245.4888, the Comprehensive Adult and Children's Mental Health 
160.3   Acts, Minnesota Rules, parts 9520.0900 to 9520.0926, and 
160.4   9505.0322, excluding subpart 10. 
160.5      (b) Entities meeting program standards set out in rules 
160.6   governing family community support services as defined in 
160.7   section 245.4871, subdivision 17, are eligible for medical 
160.8   assistance reimbursement for case management services for 
160.9   children with severe emotional disturbance when these services 
160.10  meet the program standards in Minnesota Rules, parts 9520.0900 
160.11  to 9520.0926 and 9505.0322, excluding subparts 6 and 10. 
160.12     (c) Medical assistance and MinnesotaCare payment for mental 
160.13  health case management shall be made on a monthly basis.  In 
160.14  order to receive payment for an eligible child, the provider 
160.15  must document at least a face-to-face contact with the child, 
160.16  the child's parents, or the child's legal representative.  To 
160.17  receive payment for an eligible adult, the provider must 
160.18  document: 
160.19     (1) at least a face-to-face contact with the adult or the 
160.20  adult's legal representative; or 
160.21     (2) at least a telephone contact with the adult or the 
160.22  adult's legal representative and document a face-to-face contact 
160.23  with the adult or the adult's legal representative within the 
160.24  preceding two months. 
160.25     (d) Payment for mental health case management provided by 
160.26  county or state staff shall be based on the monthly rate 
160.27  methodology under section 256B.094, subdivision 6, paragraph 
160.28  (b), with separate rates calculated for child welfare and mental 
160.29  health, and within mental health, separate rates for children 
160.30  and adults. 
160.31     (e) Payment for mental health case management provided by 
160.32  county-contracted vendors shall be based on a monthly rate 
160.33  negotiated by the host county.  The negotiated rate must not 
160.34  exceed the rate charged by the vendor for the same service to 
160.35  other payers.  If the service is provided by a team of 
160.36  contracted vendors, the county may negotiate a team rate with a 
161.1   vendor who is a member of the team.  The team shall determine 
161.2   how to distribute the rate among its members.  No reimbursement 
161.3   received by contracted vendors shall be returned to the county, 
161.4   except to reimburse the county for advance funding provided by 
161.5   the county to the vendor. 
161.6      (f) If the service is provided by a team which includes 
161.7   contracted vendors and county or state staff, the costs for 
161.8   county or state staff participation in the team shall be 
161.9   included in the rate for county-provided services.  In this 
161.10  case, the contracted vendor and the county may each receive 
161.11  separate payment for services provided by each entity in the 
161.12  same month.  In order to prevent duplication of services, the 
161.13  county must document, in the recipient's file, the need for team 
161.14  case management and a description of the roles of the team 
161.15  members. 
161.16     (g) The commissioner shall calculate the nonfederal share 
161.17  of actual medical assistance and general assistance medical care 
161.18  payments for each county, based on the higher of calendar year 
161.19  1995 or 1996, by service date, project that amount forward to 
161.20  1999, and transfer one-half of the result from medical 
161.21  assistance and general assistance medical care to each county's 
161.22  mental health grants under sections 245.4886 and 256E.12 for 
161.23  calendar year 1999.  The annualized minimum amount added to each 
161.24  county's mental health grant shall be $3,000 per year for 
161.25  children and $5,000 per year for adults.  The commissioner may 
161.26  reduce the statewide growth factor in order to fund these 
161.27  minimums.  The annualized total amount transferred shall become 
161.28  part of the base for future mental health grants for each county.
161.29     (h) Any net increase in revenue to the county as a result 
161.30  of the change in this section must be used to provide expanded 
161.31  mental health services as defined in sections 245.461 to 
161.32  245.4888, the Comprehensive Adult and Children's Mental Health 
161.33  Acts, excluding inpatient and residential treatment.  For 
161.34  adults, increased revenue may also be used for services and 
161.35  consumer supports which are part of adult mental health projects 
161.36  approved under Laws 1997, chapter 203, article 7, section 25.  
162.1   For children, increased revenue may also be used for respite 
162.2   care and nonresidential individualized rehabilitation services 
162.3   as defined in section 245.492, subdivisions 17 and 23.  
162.4   "Increased revenue" has the meaning given in Minnesota Rules, 
162.5   part 9520.0903, subpart 3.  
162.6      (i) Notwithstanding section 256B.19, subdivision 1, the 
162.7   nonfederal share of costs for mental health case management 
162.8   shall be provided by the recipient's county of responsibility, 
162.9   as defined in sections 256G.01 to 256G.12, from sources other 
162.10  than federal funds or funds used to match other federal funds.  
162.11     (j) The commissioner may suspend, reduce, or terminate the 
162.12  reimbursement to a provider that does not meet the reporting or 
162.13  other requirements of this section.  The county of 
162.14  responsibility, as defined in sections 256G.01 to 256G.12, is 
162.15  responsible for any federal disallowances.  The county may share 
162.16  this responsibility with its contracted vendors.  
162.17     (k) The commissioner shall set aside a portion of the 
162.18  federal funds earned under this section to repay the special 
162.19  revenue maximization account under section 256.01, subdivision 
162.20  2, clause (15).  The repayment is limited to: 
162.21     (1) the costs of developing and implementing this section; 
162.22  and 
162.23     (2) programming the information systems. 
162.24     (l) Notwithstanding section 256.025, subdivision 2, 
162.25  payments to counties for case management expenditures under this 
162.26  section shall only be made from federal earnings from services 
162.27  provided under this section.  Payments to contracted vendors 
162.28  shall include both the federal earnings and the county share. 
162.29     (m) Notwithstanding section 256B.041, county payments for 
162.30  the cost of mental health case management services provided by 
162.31  county or state staff shall not be made to the state treasurer.  
162.32  For the purposes of mental health case management services 
162.33  provided by county or state staff under this section, the 
162.34  centralized disbursement of payments to counties under section 
162.35  256B.041 consists only of federal earnings from services 
162.36  provided under this section. 
163.1      (n) Case management services under this subdivision do not 
163.2   include therapy, treatment, legal, or outreach services. 
163.3      (o) If the recipient is a resident of a nursing facility, 
163.4   intermediate care facility, or hospital, and the recipient's 
163.5   institutional care is paid by medical assistance, payment for 
163.6   case management services under this subdivision is limited to 
163.7   the last 30 180 days of the recipient's residency in that 
163.8   facility and may not exceed more than two six months in a 
163.9   calendar year. 
163.10     (p) Payment for case management services under this 
163.11  subdivision shall not duplicate payments made under other 
163.12  program authorities for the same purpose. 
163.13     (q) By July 1, 2000, the commissioner shall evaluate the 
163.14  effectiveness of the changes required by this section, including 
163.15  changes in number of persons receiving mental health case 
163.16  management, changes in hours of service per person, and changes 
163.17  in caseload size. 
163.18     (r) For each calendar year beginning with the calendar year 
163.19  2001, the annualized amount of state funds for each county 
163.20  determined under paragraph (g) shall be adjusted by the county's 
163.21  percentage change in the average number of clients per month who 
163.22  received case management under this section during the fiscal 
163.23  year that ended six months prior to the calendar year in 
163.24  question, in comparison to the prior fiscal year. 
163.25     (s) For counties receiving the minimum allocation of $3,000 
163.26  or $5,000 described in paragraph (g), the adjustment in 
163.27  paragraph (r) shall be determined so that the county receives 
163.28  the higher of the following amounts: 
163.29     (1) a continuation of the minimum allocation in paragraph 
163.30  (g); or 
163.31     (2) an amount based on that county's average number of 
163.32  clients per month who received case management under this 
163.33  section during the fiscal year that ended six months prior to 
163.34  the calendar year in question, in comparison to the prior fiscal 
163.35  year, times the average statewide grant per person per month for 
163.36  counties not receiving the minimum allocation. 
164.1      (t) The adjustments in paragraphs (r) and (s) shall be 
164.2   calculated separately for children and adults. 
164.3      Sec. 19.  Minnesota Statutes 2000, section 256B.0625, is 
164.4   amended by adding a subdivision to read: 
164.5      Subd. 43.  [TARGETED CASE MANAGEMENT.] For purposes of 
164.6   subdivisions 43a to 43h, the following terms have the meanings 
164.7   given them: 
164.8      (1) "Home care service recipients" means those individuals 
164.9   receiving the following services under section 256B.0627:  
164.10  skilled nursing visits, home health aide visits, private duty 
164.11  nursing, personal care assistants, or therapies provided through 
164.12  a home health agency. 
164.13     (2) "Home care targeted case management" means the 
164.14  provision of targeted case management services for the purpose 
164.15  of assisting home care service recipients to gain access to 
164.16  needed services and supports so that they may remain in the 
164.17  community. 
164.18     (3) "Institutions" means hospitals, consistent with Code of 
164.19  Federal Regulations, title 42, section 440.10; regional 
164.20  treatment center inpatient services, consistent with section 
164.21  245.474; nursing facilities; and intermediate care facilities 
164.22  for persons with mental retardation. 
164.23     (4) "Relocation targeted case management" means the 
164.24  provision of targeted case management services for the purpose 
164.25  of assisting recipients to gain access to needed services and 
164.26  supports if they choose to move from an institution to the 
164.27  community.  Relocation targeted case management may be provided 
164.28  during the last 180 consecutive days of an eligible recipient's 
164.29  institutional stay. 
164.30     (5) "Targeted case management" means case management 
164.31  services provided to help recipients gain access to needed 
164.32  medical, social, educational, and other services and supports. 
164.33     Sec. 20.  Minnesota Statutes 2000, section 256B.0625, is 
164.34  amended by adding a subdivision to read: 
164.35     Subd. 43a.  [ELIGIBILITY.] The following persons are 
164.36  eligible for relocation targeted case management or home care 
165.1   targeted case management: 
165.2      (1) medical assistance eligible persons residing in 
165.3   institutions who choose to move into the community are eligible 
165.4   for relocation targeted case management services; and 
165.5      (2) medical assistance eligible persons receiving home care 
165.6   services, who are not eligible for any other medical assistance 
165.7   reimbursable case management service, are eligible for home care 
165.8   targeted case management services beginning January 1, 2003.  
165.9      Sec. 21.  Minnesota Statutes 2000, section 256B.0625, is 
165.10  amended by adding a subdivision to read: 
165.11     Subd. 43b.  [RELOCATION TARGETED CASE MANAGEMENT PROVIDER 
165.12  QUALIFICATIONS.] The following qualifications and certification 
165.13  standards must be met by providers of relocation targeted case 
165.14  management: 
165.15     (a) The commissioner must certify each provider of 
165.16  relocation targeted case management before enrollment.  The 
165.17  certification process shall examine the provider's ability to 
165.18  meet the requirements in this subdivision and other federal and 
165.19  state requirements of this service.  A certified relocation 
165.20  targeted case management provider may subcontract with another 
165.21  provider to deliver relocation targeted case management 
165.22  services.  Subcontracted providers must demonstrate the ability 
165.23  to provide the services outlined in subdivision 43d. 
165.24     (b) A relocation targeted case management provider is an 
165.25  enrolled medical assistance provider who is determined by the 
165.26  commissioner to have all of the following characteristics: 
165.27     (1) the legal authority to provide public welfare under 
165.28  sections 393.01, subdivision 7; and 393.07, or a federally 
165.29  recognized Indian tribe; 
165.30     (2) the demonstrated capacity and experience to provide the 
165.31  components of case management to coordinate and link community 
165.32  resources needed by the eligible population; 
165.33     (3) the administrative capacity and experience to serve the 
165.34  target population for whom it will provide services and ensure 
165.35  quality of services under state and federal requirements; 
165.36     (4) the legal authority to provide complete investigative 
166.1   and protective services under section 626.556, subdivision 10, 
166.2   and child welfare and foster care services under section 393.07, 
166.3   subdivisions 1 and 2, or a federally recognized Indian tribe; 
166.4      (5) a financial management system that provides accurate 
166.5   documentation of services and costs under state and federal 
166.6   requirements; and 
166.7      (6) the capacity to document and maintain individual case 
166.8   records under state and federal requirements. 
166.9   A provider of targeted case management under subdivision 20 may 
166.10  be deemed a certified provider of relocation targeted case 
166.11  management. 
166.12     Sec. 22. Minnesota Statutes 2000, section 256B.0625, is 
166.13  amended by adding a subdivision to read: 
166.14     Subd. 43c.  [HOME CARE TARGETED CASE MANAGEMENT PROVIDER 
166.15  QUALIFICATIONS.] The following qualifications and certification 
166.16  standards must be met by providers of home care targeted case 
166.17  management. 
166.18     (a) The commissioner must certify each provider of home 
166.19  care targeted case management before enrollment.  The 
166.20  certification process shall examine the provider's ability to 
166.21  meet the requirements in this subdivision and other state and 
166.22  federal requirements of this service. 
166.23     (b) A home care targeted case management provider is an 
166.24  enrolled medical assistance provider who has a minimum of a 
166.25  bachelor's degree or a license in a health or human services 
166.26  field, and is determined by the commissioner to have all of the 
166.27  following characteristics: 
166.28     (1) the demonstrated capacity and experience to provide the 
166.29  components of case management to coordinate and link community 
166.30  resources needed by the eligible population; 
166.31     (2) the administrative capacity and experience to serve the 
166.32  target population for whom it will provide services and ensure 
166.33  quality of services under state and federal requirements; 
166.34     (3) a financial management system that provides accurate 
166.35  documentation of services and costs under state and federal 
166.36  requirements; 
167.1      (4) the capacity to document and maintain individual case 
167.2   records under state and federal requirements; and 
167.3      (5) the capacity to coordinate with county administrative 
167.4   functions. 
167.5      Sec. 23.  Minnesota Statutes 2000, section 256B.0625, is 
167.6   amended by adding a subdivision to read: 
167.7      Subd. 43d.  [ELIGIBLE SERVICES.] Services eligible for 
167.8   medical assistance reimbursement as targeted case management 
167.9   include: 
167.10     (1) assessment of the recipient's need for targeted case 
167.11  management services; 
167.12     (2) development, completion, and regular review of a 
167.13  written individual service plan, which is based upon the 
167.14  assessment of the recipient's needs and choices, and which will 
167.15  ensure access to medical, social, educational, and other related 
167.16  services and supports; 
167.17     (3) routine contact or communication with the recipient, 
167.18  recipient's family, primary caregiver, legal representative, 
167.19  substitute care provider, service providers, or other relevant 
167.20  persons identified as necessary to the development or 
167.21  implementation of the goals of the individual service plan; 
167.22     (4) coordinating referrals for, and the provision of, case 
167.23  management services for the recipient with appropriate service 
167.24  providers, consistent with section 1902(a)(23) of the Social 
167.25  Security Act; 
167.26     (5) coordinating and monitoring the overall service 
167.27  delivery to ensure quality of services, appropriateness, and 
167.28  continued need; 
167.29     (6) completing and maintaining necessary documentation that 
167.30  supports and verifies the activities in this subdivision; 
167.31     (7) traveling to conduct a visit with the recipient or 
167.32  other relevant person necessary to develop or implement the 
167.33  goals of the individual service plan; and 
167.34     (8) coordinating with the institution discharge planner in 
167.35  the 180-day period before the recipient's discharge. 
167.36     Sec. 24.  Minnesota Statutes 2000, section 256B.0625, is 
168.1   amended by adding a subdivision to read: 
168.2      Subd. 43e.  [TIME LINES.] The following time lines must be 
168.3   met for assigning a case manager: 
168.4      (1) for relocation targeted case management, an eligible 
168.5   recipient must be assigned a case manager who visits the person 
168.6   within 20 working days of requesting a case manager from their 
168.7   county of financial responsibility as determined under chapter 
168.8   256G.  If a county agency does not provide case management 
168.9   services as required, the recipient may, after written notice to 
168.10  the county agency, obtain targeted relocation case management 
168.11  services from a home care targeted case management provider, as 
168.12  defined in subdivision 43c; and 
168.13     (2) for home care targeted case management, an eligible 
168.14  recipient must be assigned a case manager within 20 working days 
168.15  of requesting a case manager from a home care targeted case 
168.16  management provider, as defined in subdivision 43c. 
168.17     Sec. 25.  Minnesota Statutes 2000, section 256B.0625, is 
168.18  amended by adding a subdivision to read: 
168.19     Subd. 43f.  [EVALUATION.] The commissioner shall evaluate 
168.20  the delivery of targeted case management, including, but not 
168.21  limited to, access to case management services, consumer 
168.22  satisfaction with case management services, and quality of case 
168.23  management services. 
168.24     Sec. 26.  Minnesota Statutes 2000, section 256B.0625, is 
168.25  amended by adding a subdivision to read: 
168.26     Subd. 43g.  [CONTACT DOCUMENTATION.] The case manager must 
168.27  document each face-to-face and telephone contact with the 
168.28  recipient and others involved in the recipient's individual 
168.29  service plan. 
168.30     Sec. 27.  Minnesota Statutes 2000, section 256B.0625, is 
168.31  amended by adding a subdivision to read: 
168.32     Subd. 43h.  [PAYMENT RATES.] The commissioner shall set 
168.33  payment rates for targeted case management under this 
168.34  subdivision.  Case managers may bill according to the following 
168.35  criteria: 
168.36     (1) for relocation targeted case management, case managers 
169.1   may bill for direct case management activities, including 
169.2   face-to-face and telephone contacts, in the 180 days preceding 
169.3   an eligible recipient's discharge from an institution; 
169.4      (2) for home care targeted case management, case managers 
169.5   may bill for direct case management activities, including 
169.6   face-to-face and telephone contacts; and 
169.7      (3) billings for targeted case management services under 
169.8   this subdivision shall not duplicate payments made under other 
169.9   program authorities for the same purpose. 
169.10     Sec. 28.  Minnesota Statutes 2000, section 256B.0627, 
169.11  subdivision 1, is amended to read: 
169.12     Subdivision 1.  [DEFINITION.] (a) "Activities of daily 
169.13  living" includes eating, toileting, grooming, dressing, bathing, 
169.14  transferring, mobility, and positioning.  
169.15     (b) "Assessment" means a review and evaluation of a 
169.16  recipient's need for home care services conducted in person.  
169.17  Assessments for private duty nursing shall be conducted by a 
169.18  registered private duty nurse.  Assessments for home health 
169.19  agency services shall be conducted by a home health agency 
169.20  nurse.  Assessments for personal care assistant services shall 
169.21  be conducted by the county public health nurse or a certified 
169.22  public health nurse under contract with the county.  A 
169.23  face-to-face assessment must include:  documentation of health 
169.24  status, determination of need, evaluation of service 
169.25  effectiveness, identification of appropriate services, service 
169.26  plan development or modification, coordination of services, 
169.27  referrals and follow-up to appropriate payers and community 
169.28  resources, completion of required reports, recommendation of 
169.29  service authorization, and consumer education.  Once the need 
169.30  for personal care assistant services is determined under this 
169.31  section, the county public health nurse or certified public 
169.32  health nurse under contract with the county is responsible for 
169.33  communicating this recommendation to the commissioner and the 
169.34  recipient.  A face-to-face assessment for personal 
169.35  care assistant services is conducted on those recipients who 
169.36  have never had a county public health nurse assessment.  A 
170.1   face-to-face assessment must occur at least annually or when 
170.2   there is a significant change in the recipient's condition or 
170.3   when there is a change in the need for personal care assistant 
170.4   services.  A service update may substitute for the annual 
170.5   face-to-face assessment when there is not a significant change 
170.6   in recipient condition or a change in the need for personal care 
170.7   assistant service.  A service update or review for temporary 
170.8   increase includes a review of initial baseline data, evaluation 
170.9   of service effectiveness, redetermination of service need, 
170.10  modification of service plan and appropriate referrals, update 
170.11  of initial forms, obtaining service authorization, and on going 
170.12  consumer education.  Assessments for medical assistance home 
170.13  care services for mental retardation or related conditions and 
170.14  alternative care services for developmentally disabled home and 
170.15  community-based waivered recipients may be conducted by the 
170.16  county public health nurse to ensure coordination and avoid 
170.17  duplication.  Assessments must be completed on forms provided by 
170.18  the commissioner within 30 days of a request for home care 
170.19  services by a recipient or responsible party. 
170.20     (b) (c) "Care plan" means a written description of personal 
170.21  care assistant services developed by the qualified 
170.22  professional or the recipient's physician with the recipient or 
170.23  responsible party to be used by the personal care assistant with 
170.24  a copy provided to the recipient or responsible party. 
170.25     (d) "Complex and regular private duty nursing care" means, 
170.26  effective July 1, 2001:  
170.27     (1) complex care is private duty nursing provided to 
170.28  recipients who are ventilator dependent or for whom a physician 
170.29  has certified that were it not for private duty nursing the 
170.30  recipient would meet the criteria for inpatient hospital 
170.31  intensive care unit (ICU) level of care; and 
170.32     (2) regular care is private duty nursing provided to all 
170.33  other recipients. 
170.34     (e) "Health-related functions" means functions that can be 
170.35  delegated or assigned by a licensed health care professional 
170.36  under state law to be performed by a personal care attendant. 
171.1      (c) (f) "Home care services" means a health service, 
171.2   determined by the commissioner as medically necessary, that is 
171.3   ordered by a physician and documented in a service plan that is 
171.4   reviewed by the physician at least once every 62 60 days for the 
171.5   provision of home health services, or private duty nursing, or 
171.6   at least once every 365 days for personal care.  Home care 
171.7   services are provided to the recipient at the recipient's 
171.8   residence that is a place other than a hospital or long-term 
171.9   care facility or as specified in section 256B.0625.  
171.10     (g) "Instrumental activities of daily living" includes meal 
171.11  planning and preparation, managing finances, shopping for food, 
171.12  clothing, and other essential items, performing essential 
171.13  household chores, communication by telephone and other media, 
171.14  and getting around and participating in the community. 
171.15     (d) (h) "Medically necessary" has the meaning given in 
171.16  Minnesota Rules, parts 9505.0170 to 9505.0475.  
171.17     (e) (i) "Personal care assistant" means a person who:  
171.18     (1) is at least 18 years old, except for persons 16 to 18 
171.19  years of age who participated in a related school-based job 
171.20  training program or have completed a certified home health aide 
171.21  competency evaluation; 
171.22     (2) is able to effectively communicate with the recipient 
171.23  and personal care provider organization; 
171.24     (3) effective July 1, 1996, has completed one of the 
171.25  training requirements as specified in Minnesota Rules, part 
171.26  9505.0335, subpart 3, items A to D; 
171.27     (4) has the ability to, and provides covered personal care 
171.28  assistant services according to the recipient's care plan, 
171.29  responds appropriately to recipient needs, and reports changes 
171.30  in the recipient's condition to the supervising qualified 
171.31  professional or physician; 
171.32     (5) is not a consumer of personal care assistant services; 
171.33  and 
171.34     (6) is subject to criminal background checks and procedures 
171.35  specified in section 245A.04.  
171.36     (f) (j) "Personal care provider organization" means an 
172.1   organization enrolled to provide personal care assistant 
172.2   services under the medical assistance program that complies with 
172.3   the following:  (1) owners who have a five percent interest or 
172.4   more, and managerial officials are subject to a background study 
172.5   as provided in section 245A.04.  This applies to currently 
172.6   enrolled personal care provider organizations and those agencies 
172.7   seeking enrollment as a personal care provider organization.  An 
172.8   organization will be barred from enrollment if an owner or 
172.9   managerial official of the organization has been convicted of a 
172.10  crime specified in section 245A.04, or a comparable crime in 
172.11  another jurisdiction, unless the owner or managerial official 
172.12  meets the reconsideration criteria specified in section 245A.04; 
172.13  (2) the organization must maintain a surety bond and liability 
172.14  insurance throughout the duration of enrollment and provides 
172.15  proof thereof.  The insurer must notify the department of human 
172.16  services of the cancellation or lapse of policy; and (3) the 
172.17  organization must maintain documentation of services as 
172.18  specified in Minnesota Rules, part 9505.2175, subpart 7, as well 
172.19  as evidence of compliance with personal care assistant training 
172.20  requirements. 
172.21     (g) (k) "Responsible party" means an individual residing 
172.22  with a recipient of personal care assistant services who is 
172.23  capable of providing the supportive care necessary to assist the 
172.24  recipient to live in the community, is at least 18 years old, 
172.25  and is not a personal care assistant.  Responsible parties who 
172.26  are parents of minors or guardians of minors or incapacitated 
172.27  persons may delegate the responsibility to another adult during 
172.28  a temporary absence of at least 24 hours but not more than six 
172.29  months.  The person delegated as a responsible party must be 
172.30  able to meet the definition of responsible party, except that 
172.31  the delegated responsible party is required to reside with the 
172.32  recipient only while serving as the responsible party.  Foster 
172.33  care license holders may be designated the responsible party for 
172.34  residents of the foster care home if case management is provided 
172.35  as required in section 256B.0625, subdivision 19a.  For persons 
172.36  who, as of April 1, 1992, are sharing personal care assistant 
173.1   services in order to obtain the availability of 24-hour 
173.2   coverage, an employee of the personal care provider organization 
173.3   may be designated as the responsible party if case management is 
173.4   provided as required in section 256B.0625, subdivision 19a. 
173.5      (h) (l) "Service plan" means a written description of the 
173.6   services needed based on the assessment developed by the nurse 
173.7   who conducts the assessment together with the recipient or 
173.8   responsible party.  The service plan shall include a description 
173.9   of the covered home care services, frequency and duration of 
173.10  services, and expected outcomes and goals.  The recipient and 
173.11  the provider chosen by the recipient or responsible party must 
173.12  be given a copy of the completed service plan within 30 calendar 
173.13  days of the request for home care services by the recipient or 
173.14  responsible party. 
173.15     (i) (m) "Skilled nurse visits" are provided in a 
173.16  recipient's residence under a plan of care or service plan that 
173.17  specifies a level of care which the nurse is qualified to 
173.18  provide.  These services are: 
173.19     (1) nursing services according to the written plan of care 
173.20  or service plan and accepted standards of medical and nursing 
173.21  practice in accordance with chapter 148; 
173.22     (2) services which due to the recipient's medical condition 
173.23  may only be safely and effectively provided by a registered 
173.24  nurse or a licensed practical nurse; 
173.25     (3) assessments performed only by a registered nurse; and 
173.26     (4) teaching and training the recipient, the recipient's 
173.27  family, or other caregivers requiring the skills of a registered 
173.28  nurse or licensed practical nurse. 
173.29     (n) "Telehomecare" means the use of telecommunications 
173.30  technology by a home health care professional to deliver home 
173.31  health care services, within the professional's scope of 
173.32  practice, to a patient located at a site other than the site 
173.33  where the practitioner is located. 
173.34     Sec. 29.  Minnesota Statutes 2000, section 256B.0627, 
173.35  subdivision 2, is amended to read: 
173.36     Subd. 2.  [SERVICES COVERED.] Home care services covered 
174.1   under this section include:  
174.2      (1) nursing services under section 256B.0625, subdivision 
174.3   6a; 
174.4      (2) private duty nursing services under section 256B.0625, 
174.5   subdivision 7; 
174.6      (3) home health aide services under section 256B.0625, 
174.7   subdivision 6a; 
174.8      (4) personal care assistant services under section 
174.9   256B.0625, subdivision 19a; 
174.10     (5) supervision of personal care assistant services 
174.11  provided by a qualified professional under section 256B.0625, 
174.12  subdivision 19a; 
174.13     (6) consulting qualified professional of personal care 
174.14  assistant services under the fiscal agent intermediary option as 
174.15  specified in subdivision 10; 
174.16     (7) face-to-face assessments by county public health nurses 
174.17  for services under section 256B.0625, subdivision 19a; and 
174.18     (8) service updates and review of temporary increases for 
174.19  personal care assistant services by the county public health 
174.20  nurse for services under section 256B.0625, subdivision 19a. 
174.21     Sec. 30.  Minnesota Statutes 2000, section 256B.0627, 
174.22  subdivision 4, is amended to read: 
174.23     Subd. 4.  [PERSONAL CARE ASSISTANT SERVICES.] (a) The 
174.24  personal care assistant services that are eligible for payment 
174.25  are the following: services and supports furnished to an 
174.26  individual, as needed, to assist in accomplishing activities of 
174.27  daily living; instrumental activities of daily living; 
174.28  health-related functions through hands-on assistance, 
174.29  supervision, and cuing; and redirection and intervention for 
174.30  behavior including observation and monitoring.  
174.31     (b) Payment for services will be made within the limits 
174.32  approved using the prior authorized process established in 
174.33  subdivision 5. 
174.34     (c) The amount and type of services authorized shall be 
174.35  based on an assessment of the recipient's needs in these areas: 
174.36     (1) bowel and bladder care; 
175.1      (2) skin care to maintain the health of the skin; 
175.2      (3) repetitive maintenance range of motion, muscle 
175.3   strengthening exercises, and other tasks specific to maintaining 
175.4   a recipient's optimal level of function; 
175.5      (4) respiratory assistance; 
175.6      (5) transfers and ambulation; 
175.7      (6) bathing, grooming, and hairwashing necessary for 
175.8   personal hygiene; 
175.9      (7) turning and positioning; 
175.10     (8) assistance with furnishing medication that is 
175.11  self-administered; 
175.12     (9) application and maintenance of prosthetics and 
175.13  orthotics; 
175.14     (10) cleaning medical equipment; 
175.15     (11) dressing or undressing; 
175.16     (12) assistance with eating and meal preparation and 
175.17  necessary grocery shopping; 
175.18     (13) accompanying a recipient to obtain medical diagnosis 
175.19  or treatment; 
175.20     (14) assisting, monitoring, or prompting the recipient to 
175.21  complete the services in clauses (1) to (13); 
175.22     (15) redirection, monitoring, and observation that are 
175.23  medically necessary and an integral part of completing the 
175.24  personal care assistant services described in clauses (1) to 
175.25  (14); 
175.26     (16) redirection and intervention for behavior, including 
175.27  observation and monitoring; 
175.28     (17) interventions for seizure disorders, including 
175.29  monitoring and observation if the recipient has had a seizure 
175.30  that requires intervention within the past three months; 
175.31     (18) tracheostomy suctioning using a clean procedure if the 
175.32  procedure is properly delegated by a registered nurse.  Before 
175.33  this procedure can be delegated to a personal care assistant, a 
175.34  registered nurse must determine that the tracheostomy suctioning 
175.35  can be accomplished utilizing a clean rather than a sterile 
175.36  procedure and must ensure that the personal care assistant has 
176.1   been taught the proper procedure; and 
176.2      (19) incidental household services that are an integral 
176.3   part of a personal care service described in clauses (1) to (18).
176.4   For purposes of this subdivision, monitoring and observation 
176.5   means watching for outward visible signs that are likely to 
176.6   occur and for which there is a covered personal care service or 
176.7   an appropriate personal care intervention.  For purposes of this 
176.8   subdivision, a clean procedure refers to a procedure that 
176.9   reduces the numbers of microorganisms or prevents or reduces the 
176.10  transmission of microorganisms from one person or place to 
176.11  another.  A clean procedure may be used beginning 14 days after 
176.12  insertion. 
176.13     (b) (d) The personal care assistant services that are not 
176.14  eligible for payment are the following:  
176.15     (1) services not ordered by the physician; 
176.16     (2) assessments by personal care assistant provider 
176.17  organizations or by independently enrolled registered nurses; 
176.18     (3) services that are not in the service plan; 
176.19     (4) services provided by the recipient's spouse, legal 
176.20  guardian for an adult or child recipient, or parent of a 
176.21  recipient under age 18; 
176.22     (5) services provided by a foster care provider of a 
176.23  recipient who cannot direct the recipient's own care, unless 
176.24  monitored by a county or state case manager under section 
176.25  256B.0625, subdivision 19a; 
176.26     (6) services provided by the residential or program license 
176.27  holder in a residence for more than four persons; 
176.28     (7) services that are the responsibility of a residential 
176.29  or program license holder under the terms of a service agreement 
176.30  and administrative rules; 
176.31     (8) sterile procedures; 
176.32     (9) injections of fluids into veins, muscles, or skin; 
176.33     (10) services provided by parents of adult recipients, 
176.34  adult children, or siblings of the recipient, unless these 
176.35  relatives meet one of the following hardship criteria and the 
176.36  commissioner waives this requirement: 
177.1      (i) the relative resigns from a part-time or full-time job 
177.2   to provide personal care for the recipient; 
177.3      (ii) the relative goes from a full-time to a part-time job 
177.4   with less compensation to provide personal care for the 
177.5   recipient; 
177.6      (iii) the relative takes a leave of absence without pay to 
177.7   provide personal care for the recipient; 
177.8      (iv) the relative incurs substantial expenses by providing 
177.9   personal care for the recipient; or 
177.10     (v) because of labor conditions, special language needs, or 
177.11  intermittent hours of care needed, the relative is needed in 
177.12  order to provide an adequate number of qualified personal care 
177.13  assistants to meet the medical needs of the recipient; 
177.14     (11) homemaker services that are not an integral part of a 
177.15  personal care assistant services; 
177.16     (12) home maintenance, or chore services; 
177.17     (13) services not specified under paragraph (a); and 
177.18     (14) services not authorized by the commissioner or the 
177.19  commissioner's designee. 
177.20     (e) The recipient or responsible party may choose to 
177.21  supervise the personal care assistant or to have a qualified 
177.22  professional, as defined in section 256B.0625, subdivision 19c, 
177.23  provide the supervision.  As required under section 256B.0625, 
177.24  subdivision 19c, the county public health nurse, as a part of 
177.25  the assessment, will assist the recipient or responsible party 
177.26  to identify the most appropriate person to provide supervision 
177.27  of the personal care assistant.  Health-related delegated tasks 
177.28  performed by the personal care assistant will be under the 
177.29  supervision of a qualified professional or the direction of the 
177.30  recipient's physician.  If the recipient has a qualified 
177.31  professional, Minnesota Rules, part 9505.0335, subpart 4, 
177.32  applies. 
177.33     Sec. 31.  Minnesota Statutes 2000, section 256B.0627, 
177.34  subdivision 5, is amended to read: 
177.35     Subd. 5.  [LIMITATION ON PAYMENTS.] Medical assistance 
177.36  payments for home care services shall be limited according to 
178.1   this subdivision.  
178.2      (a)  [LIMITS ON SERVICES WITHOUT PRIOR AUTHORIZATION.] A 
178.3   recipient may receive the following home care services during a 
178.4   calendar year: 
178.5      (1) up to two face-to-face assessments to determine a 
178.6   recipient's need for personal care assistant services; 
178.7      (2) one service update done to determine a recipient's need 
178.8   for personal care assistant services; and 
178.9      (3) up to five nine skilled nurse visits.  
178.10     (b)  [PRIOR AUTHORIZATION; EXCEPTIONS.] All home care 
178.11  services above the limits in paragraph (a) must receive the 
178.12  commissioner's prior authorization, except when: 
178.13     (1) the home care services were required to treat an 
178.14  emergency medical condition that if not immediately treated 
178.15  could cause a recipient serious physical or mental disability, 
178.16  continuation of severe pain, or death.  The provider must 
178.17  request retroactive authorization no later than five working 
178.18  days after giving the initial service.  The provider must be 
178.19  able to substantiate the emergency by documentation such as 
178.20  reports, notes, and admission or discharge histories; 
178.21     (2) the home care services were provided on or after the 
178.22  date on which the recipient's eligibility began, but before the 
178.23  date on which the recipient was notified that the case was 
178.24  opened.  Authorization will be considered if the request is 
178.25  submitted by the provider within 20 working days of the date the 
178.26  recipient was notified that the case was opened; 
178.27     (3) a third-party payor for home care services has denied 
178.28  or adjusted a payment.  Authorization requests must be submitted 
178.29  by the provider within 20 working days of the notice of denial 
178.30  or adjustment.  A copy of the notice must be included with the 
178.31  request; 
178.32     (4) the commissioner has determined that a county or state 
178.33  human services agency has made an error; or 
178.34     (5) the professional nurse determines an immediate need for 
178.35  up to 40 skilled nursing or home health aide visits per calendar 
178.36  year and submits a request for authorization within 20 working 
179.1   days of the initial service date, and medical assistance is 
179.2   determined to be the appropriate payer. 
179.3      (c)  [RETROACTIVE AUTHORIZATION.] A request for retroactive 
179.4   authorization will be evaluated according to the same criteria 
179.5   applied to prior authorization requests.  
179.6      (d)  [ASSESSMENT AND SERVICE PLAN.] Assessments under 
179.7   section 256B.0627, subdivision 1, paragraph (a), shall be 
179.8   conducted initially, and at least annually thereafter, in person 
179.9   with the recipient and result in a completed service plan using 
179.10  forms specified by the commissioner.  Within 30 days of 
179.11  recipient or responsible party request for home care services, 
179.12  the assessment, the service plan, and other information 
179.13  necessary to determine medical necessity such as diagnostic or 
179.14  testing information, social or medical histories, and hospital 
179.15  or facility discharge summaries shall be submitted to the 
179.16  commissioner.  For personal care assistant services: 
179.17     (1) The amount and type of service authorized based upon 
179.18  the assessment and service plan will follow the recipient if the 
179.19  recipient chooses to change providers.  
179.20     (2) If the recipient's medical need changes, the 
179.21  recipient's provider may assess the need for a change in service 
179.22  authorization and request the change from the county public 
179.23  health nurse.  Within 30 days of the request, the public health 
179.24  nurse will determine whether to request the change in services 
179.25  based upon the provider assessment, or conduct a home visit to 
179.26  assess the need and determine whether the change is appropriate. 
179.27     (3) To continue to receive personal care assistant services 
179.28  after the first year, the recipient or the responsible party, in 
179.29  conjunction with the public health nurse, may complete a service 
179.30  update on forms developed by the commissioner according to 
179.31  criteria and procedures in subdivision 1.  
179.32     (e)  [PRIOR AUTHORIZATION.] The commissioner, or the 
179.33  commissioner's designee, shall review the assessment, service 
179.34  update, request for temporary services, service plan, and any 
179.35  additional information that is submitted.  The commissioner 
179.36  shall, within 30 days after receiving a complete request, 
180.1   assessment, and service plan, authorize home care services as 
180.2   follows:  
180.3      (1)  [HOME HEALTH SERVICES.] All home health services 
180.4   provided by a licensed nurse or a home health aide must be prior 
180.5   authorized by the commissioner or the commissioner's designee.  
180.6   Prior authorization must be based on medical necessity and 
180.7   cost-effectiveness when compared with other care options.  When 
180.8   home health services are used in combination with personal care 
180.9   and private duty nursing, the cost of all home care services 
180.10  shall be considered for cost-effectiveness.  The commissioner 
180.11  shall limit nurse and home health aide visits to no more than 
180.12  one visit each per day.  The commissioner, or the commissioner's 
180.13  designee, may authorize up to two skilled nurse visits per day. 
180.14     (2)  [PERSONAL CARE ASSISTANT SERVICES.] (i) All personal 
180.15  care assistant services and supervision by a qualified 
180.16  professional, if requested by the recipient, must be prior 
180.17  authorized by the commissioner or the commissioner's designee 
180.18  except for the assessments established in paragraph (a).  The 
180.19  amount of personal care assistant services authorized must be 
180.20  based on the recipient's home care rating.  A child may not be 
180.21  found to be dependent in an activity of daily living if because 
180.22  of the child's age an adult would either perform the activity 
180.23  for the child or assist the child with the activity and the 
180.24  amount of assistance needed is similar to the assistance 
180.25  appropriate for a typical child of the same age.  Based on 
180.26  medical necessity, the commissioner may authorize: 
180.27     (A) up to two times the average number of direct care hours 
180.28  provided in nursing facilities for the recipient's comparable 
180.29  case mix level; or 
180.30     (B) up to three times the average number of direct care 
180.31  hours provided in nursing facilities for recipients who have 
180.32  complex medical needs or are dependent in at least seven 
180.33  activities of daily living and need physical assistance with 
180.34  eating or have a neurological diagnosis; or 
180.35     (C) up to 60 percent of the average reimbursement rate, as 
180.36  of July 1, 1991, for care provided in a regional treatment 
181.1   center for recipients who have Level I behavior, plus any 
181.2   inflation adjustment as provided by the legislature for personal 
181.3   care service; or 
181.4      (D) up to the amount the commissioner would pay, as of July 
181.5   1, 1991, plus any inflation adjustment provided for home care 
181.6   services, for care provided in a regional treatment center for 
181.7   recipients referred to the commissioner by a regional treatment 
181.8   center preadmission evaluation team.  For purposes of this 
181.9   clause, home care services means all services provided in the 
181.10  home or community that would be included in the payment to a 
181.11  regional treatment center; or 
181.12     (E) up to the amount medical assistance would reimburse for 
181.13  facility care for recipients referred to the commissioner by a 
181.14  preadmission screening team established under section 256B.0911 
181.15  or 256B.092; and 
181.16     (F) a reasonable amount of time for the provision of 
181.17  supervision by a qualified professional of personal 
181.18  care assistant services, if a qualified professional is 
181.19  requested by the recipient or responsible party.  
181.20     (ii) The number of direct care hours shall be determined 
181.21  according to the annual cost report submitted to the department 
181.22  by nursing facilities.  The average number of direct care hours, 
181.23  as established by May 1, 1992, shall be calculated and 
181.24  incorporated into the home care limits on July 1, 1992.  These 
181.25  limits shall be calculated to the nearest quarter hour. 
181.26     (iii) The home care rating shall be determined by the 
181.27  commissioner or the commissioner's designee based on information 
181.28  submitted to the commissioner by the county public health nurse 
181.29  on forms specified by the commissioner.  The home care rating 
181.30  shall be a combination of current assessment tools developed 
181.31  under sections 256B.0911 and 256B.501 with an addition for 
181.32  seizure activity that will assess the frequency and severity of 
181.33  seizure activity and with adjustments, additions, and 
181.34  clarifications that are necessary to reflect the needs and 
181.35  conditions of recipients who need home care including children 
181.36  and adults under 65 years of age.  The commissioner shall 
182.1   establish these forms and protocols under this section and shall 
182.2   use an advisory group, including representatives of recipients, 
182.3   providers, and counties, for consultation in establishing and 
182.4   revising the forms and protocols. 
182.5      (iv) A recipient shall qualify as having complex medical 
182.6   needs if the care required is difficult to perform and because 
182.7   of recipient's medical condition requires more time than 
182.8   community-based standards allow or requires more skill than 
182.9   would ordinarily be required and the recipient needs or has one 
182.10  or more of the following: 
182.11     (A) daily tube feedings; 
182.12     (B) daily parenteral therapy; 
182.13     (C) wound or decubiti care; 
182.14     (D) postural drainage, percussion, nebulizer treatments, 
182.15  suctioning, tracheotomy care, oxygen, mechanical ventilation; 
182.16     (E) catheterization; 
182.17     (F) ostomy care; 
182.18     (G) quadriplegia; or 
182.19     (H) other comparable medical conditions or treatments the 
182.20  commissioner determines would otherwise require institutional 
182.21  care.  
182.22     (v) A recipient shall qualify as having Level I behavior if 
182.23  there is reasonable supporting evidence that the recipient 
182.24  exhibits, or that without supervision, observation, or 
182.25  redirection would exhibit, one or more of the following 
182.26  behaviors that cause, or have the potential to cause: 
182.27     (A) injury to the recipient's own body; 
182.28     (B) physical injury to other people; or 
182.29     (C) destruction of property. 
182.30     (vi) Time authorized for personal care relating to Level I 
182.31  behavior in subclause (v), items (A) to (C), shall be based on 
182.32  the predictability, frequency, and amount of intervention 
182.33  required. 
182.34     (vii) A recipient shall qualify as having Level II behavior 
182.35  if the recipient exhibits on a daily basis one or more of the 
182.36  following behaviors that interfere with the completion of 
183.1   personal care assistant services under subdivision 4, paragraph 
183.2   (a): 
183.3      (A) unusual or repetitive habits; 
183.4      (B) withdrawn behavior; or 
183.5      (C) offensive behavior. 
183.6      (viii) A recipient with a home care rating of Level II 
183.7   behavior in subclause (vii), items (A) to (C), shall be rated as 
183.8   comparable to a recipient with complex medical needs under 
183.9   subclause (iv).  If a recipient has both complex medical needs 
183.10  and Level II behavior, the home care rating shall be the next 
183.11  complex category up to the maximum rating under subclause (i), 
183.12  item (B). 
183.13     (3)  [PRIVATE DUTY NURSING SERVICES.] All private duty 
183.14  nursing services shall be prior authorized by the commissioner 
183.15  or the commissioner's designee.  Prior authorization for private 
183.16  duty nursing services shall be based on medical necessity and 
183.17  cost-effectiveness when compared with alternative care options.  
183.18  The commissioner may authorize medically necessary private duty 
183.19  nursing services in quarter-hour units when: 
183.20     (i) the recipient requires more individual and continuous 
183.21  care than can be provided during a nurse visit; or 
183.22     (ii) the cares are outside of the scope of services that 
183.23  can be provided by a home health aide or personal care assistant.
183.24     The commissioner may authorize: 
183.25     (A) up to two times the average amount of direct care hours 
183.26  provided in nursing facilities statewide for case mix 
183.27  classification "K" as established by the annual cost report 
183.28  submitted to the department by nursing facilities in May 1992; 
183.29     (B) private duty nursing in combination with other home 
183.30  care services up to the total cost allowed under clause (2); 
183.31     (C) up to 16 hours per day if the recipient requires more 
183.32  nursing than the maximum number of direct care hours as 
183.33  established in item (A) and the recipient meets the hospital 
183.34  admission criteria established under Minnesota Rules, parts 
183.35  9505.0500 9505.0501 to 9505.0540.  
183.36     The commissioner may authorize up to 16 hours per day of 
184.1   medically necessary private duty nursing services or up to 24 
184.2   hours per day of medically necessary private duty nursing 
184.3   services until such time as the commissioner is able to make a 
184.4   determination of eligibility for recipients who are 
184.5   cooperatively applying for home care services under the 
184.6   community alternative care program developed under section 
184.7   256B.49, or until it is determined by the appropriate regulatory 
184.8   agency that a health benefit plan is or is not required to pay 
184.9   for appropriate medically necessary health care services.  
184.10  Recipients or their representatives must cooperatively assist 
184.11  the commissioner in obtaining this determination.  Recipients 
184.12  who are eligible for the community alternative care program may 
184.13  not receive more hours of nursing under this section than would 
184.14  otherwise be authorized under section 256B.49.  
184.15     Beginning July 1, 2001, private duty nursing services shall 
184.16  be authorized for complex and regular care according to 
184.17  subdivision 1. 
184.18     (4)  [VENTILATOR-DEPENDENT RECIPIENTS.] If the recipient is 
184.19  ventilator-dependent, the monthly medical assistance 
184.20  authorization for home care services shall not exceed what the 
184.21  commissioner would pay for care at the highest cost hospital 
184.22  designated as a long-term hospital under the Medicare program.  
184.23  For purposes of this clause, home care services means all 
184.24  services provided in the home that would be included in the 
184.25  payment for care at the long-term hospital.  
184.26  "Ventilator-dependent" means an individual who receives 
184.27  mechanical ventilation for life support at least six hours per 
184.28  day and is expected to be or has been dependent for at least 30 
184.29  consecutive days.  
184.30     (f)  [PRIOR AUTHORIZATION; TIME LIMITS.] The commissioner 
184.31  or the commissioner's designee shall determine the time period 
184.32  for which a prior authorization shall be effective.  If the 
184.33  recipient continues to require home care services beyond the 
184.34  duration of the prior authorization, the home care provider must 
184.35  request a new prior authorization.  Under no circumstances, 
184.36  other than the exceptions in paragraph (b), shall a prior 
185.1   authorization be valid prior to the date the commissioner 
185.2   receives the request or for more than 12 months.  A recipient 
185.3   who appeals a reduction in previously authorized home care 
185.4   services may continue previously authorized services, other than 
185.5   temporary services under paragraph (h), pending an appeal under 
185.6   section 256.045.  The commissioner must provide a detailed 
185.7   explanation of why the authorized services are reduced in amount 
185.8   from those requested by the home care provider.  
185.9      (g)  [APPROVAL OF HOME CARE SERVICES.] The commissioner or 
185.10  the commissioner's designee shall determine the medical 
185.11  necessity of home care services, the level of caregiver 
185.12  according to subdivision 2, and the institutional comparison 
185.13  according to this subdivision, the cost-effectiveness of 
185.14  services, and the amount, scope, and duration of home care 
185.15  services reimbursable by medical assistance, based on the 
185.16  assessment, primary payer coverage determination information as 
185.17  required, the service plan, the recipient's age, the cost of 
185.18  services, the recipient's medical condition, and diagnosis or 
185.19  disability.  The commissioner may publish additional criteria 
185.20  for determining medical necessity according to section 256B.04. 
185.21     (h)  [PRIOR AUTHORIZATION REQUESTS; TEMPORARY SERVICES.] 
185.22  The agency nurse, the independently enrolled private duty nurse, 
185.23  or county public health nurse may request a temporary 
185.24  authorization for home care services by telephone.  The 
185.25  commissioner may approve a temporary level of home care services 
185.26  based on the assessment, and service or care plan information, 
185.27  and primary payer coverage determination information as required.
185.28  Authorization for a temporary level of home care services 
185.29  including nurse supervision is limited to the time specified by 
185.30  the commissioner, but shall not exceed 45 days, unless extended 
185.31  because the county public health nurse has not completed the 
185.32  required assessment and service plan, or the commissioner's 
185.33  determination has not been made.  The level of services 
185.34  authorized under this provision shall have no bearing on a 
185.35  future prior authorization. 
185.36     (i)  [PRIOR AUTHORIZATION REQUIRED IN FOSTER CARE SETTING.] 
186.1   Home care services provided in an adult or child foster care 
186.2   setting must receive prior authorization by the department 
186.3   according to the limits established in paragraph (a). 
186.4      The commissioner may not authorize: 
186.5      (1) home care services that are the responsibility of the 
186.6   foster care provider under the terms of the foster care 
186.7   placement agreement and administrative rules; 
186.8      (2) personal care assistant services when the foster care 
186.9   license holder is also the personal care provider or personal 
186.10  care assistant unless the recipient can direct the recipient's 
186.11  own care, or case management is provided as required in section 
186.12  256B.0625, subdivision 19a; 
186.13     (3) personal care assistant services when the responsible 
186.14  party is an employee of, or under contract with, or has any 
186.15  direct or indirect financial relationship with the personal care 
186.16  provider or personal care assistant, unless case management is 
186.17  provided as required in section 256B.0625, subdivision 19a; or 
186.18     (4) personal care assistant and private duty nursing 
186.19  services when the number of foster care residents is greater 
186.20  than four unless the county responsible for the recipient's 
186.21  foster placement made the placement prior to April 1, 1992, 
186.22  requests that personal care assistant and private duty nursing 
186.23  services be provided, and case management is provided as 
186.24  required in section 256B.0625, subdivision 19a. 
186.25     Sec. 32.  Minnesota Statutes 2000, section 256B.0627, 
186.26  subdivision 7, is amended to read: 
186.27     Subd. 7.  [NONCOVERED HOME CARE SERVICES.] The following 
186.28  home care services are not eligible for payment under medical 
186.29  assistance:  
186.30     (1) skilled nurse visits for the sole purpose of 
186.31  supervision of the home health aide; 
186.32     (2) a skilled nursing visit: 
186.33     (i) only for the purpose of monitoring medication 
186.34  compliance with an established medication program for a 
186.35  recipient; or 
186.36     (ii) to administer or assist with medication 
187.1   administration, including injections, prefilling syringes for 
187.2   injections, or oral medication set-up of an adult recipient, 
187.3   when as determined and documented by the registered nurse, the 
187.4   need can be met by an available pharmacy or the recipient is 
187.5   physically and mentally able to self-administer or prefill a 
187.6   medication; 
187.7      (3) home care services to a recipient who is eligible for 
187.8   covered services including hospice, if elected by the recipient, 
187.9   under the Medicare program or any other insurance held by the 
187.10  recipient; 
187.11     (4) services to other members of the recipient's household; 
187.12     (5) a visit made by a skilled nurse solely to train other 
187.13  home health agency workers; 
187.14     (6) any home care service included in the daily rate of the 
187.15  community-based residential facility where the recipient is 
187.16  residing; 
187.17     (7) nursing and rehabilitation therapy services that are 
187.18  reasonably accessible to a recipient outside the recipient's 
187.19  place of residence, excluding the assessment, counseling and 
187.20  education, and personal assistant care; 
187.21     (8) any home health agency service, excluding personal care 
187.22  assistant services and private duty nursing services, which are 
187.23  performed in a place other than the recipient's residence; and 
187.24     (9) Medicare evaluation or administrative nursing visits on 
187.25  dual-eligible recipients that do not qualify for Medicare visit 
187.26  billing. 
187.27     Sec. 33.  Minnesota Statutes 2000, section 256B.0627, 
187.28  subdivision 8, is amended to read: 
187.29     Subd. 8.  [SHARED PERSONAL CARE ASSISTANT SERVICES.] (a) 
187.30  Medical assistance payments for shared personal care assistance 
187.31  services shall be limited according to this subdivision. 
187.32     (b) Recipients of personal care assistant services may 
187.33  share staff and the commissioner shall provide a rate system for 
187.34  shared personal care assistant services.  For two persons 
187.35  sharing services, the rate paid to a provider shall not exceed 
187.36  1-1/2 times the rate paid for serving a single individual, and 
188.1   for three persons sharing services, the rate paid to a provider 
188.2   shall not exceed twice the rate paid for serving a single 
188.3   individual.  These rates apply only to situations in which all 
188.4   recipients were present and received shared services on the date 
188.5   for which the service is billed.  No more than three persons may 
188.6   receive shared services from a personal care assistant in a 
188.7   single setting. 
188.8      (c) Shared service is the provision of personal 
188.9   care assistant services by a personal care assistant to two or 
188.10  three recipients at the same time and in the same setting.  For 
188.11  the purposes of this subdivision, "setting" means: 
188.12     (1) the home or foster care home of one of the individual 
188.13  recipients; or 
188.14     (2) a child care program in which all recipients served by 
188.15  one personal care assistant are participating, which is licensed 
188.16  under chapter 245A or operated by a local school district or 
188.17  private school; or 
188.18     (3) outside the home or foster care home of one of the 
188.19  recipients when normal life activities take the recipients 
188.20  outside the home.  
188.21     The provisions of this subdivision do not apply when a 
188.22  personal care assistant is caring for multiple recipients in 
188.23  more than one setting. 
188.24     (d) The recipient or the recipient's responsible party, in 
188.25  conjunction with the county public health nurse, shall determine:
188.26     (1) whether shared personal care assistant services is an 
188.27  appropriate option based on the individual needs and preferences 
188.28  of the recipient; and 
188.29     (2) the amount of shared services allocated as part of the 
188.30  overall authorization of personal care assistant services. 
188.31     The recipient or the responsible party, in conjunction with 
188.32  the supervising qualified professional, if a qualified 
188.33  professional is requested by any one of the recipients or 
188.34  responsible parties, shall arrange the setting and grouping of 
188.35  shared services based on the individual needs and preferences of 
188.36  the recipients.  Decisions on the selection of recipients to 
189.1   share services must be based on the ages of the recipients, 
189.2   compatibility, and coordination of their care needs. 
189.3      (e) The following items must be considered by the recipient 
189.4   or the responsible party and the supervising qualified 
189.5   professional, if a qualified professional has been requested by 
189.6   any one of the recipients or responsible parties, and documented 
189.7   in the recipient's health service record: 
189.8      (1) the additional qualifications needed by the personal 
189.9   care assistant to provide care to several recipients in the same 
189.10  setting; 
189.11     (2) the additional training and supervision needed by the 
189.12  personal care assistant to ensure that the needs of the 
189.13  recipient are met appropriately and safely.  The provider must 
189.14  provide on-site supervision by a qualified professional within 
189.15  the first 14 days of shared services, and monthly thereafter, if 
189.16  supervision by a qualified provider has been requested by any 
189.17  one of the recipients or responsible parties; 
189.18     (3) the setting in which the shared services will be 
189.19  provided; 
189.20     (4) the ongoing monitoring and evaluation of the 
189.21  effectiveness and appropriateness of the service and process 
189.22  used to make changes in service or setting; and 
189.23     (5) a contingency plan which accounts for absence of the 
189.24  recipient in a shared services setting due to illness or other 
189.25  circumstances and staffing contingencies. 
189.26     (f) The provider must offer the recipient or the 
189.27  responsible party the option of shared or one-on-one personal 
189.28  care assistant services.  The recipient or the responsible party 
189.29  can withdraw from participating in a shared services arrangement 
189.30  at any time. 
189.31     (g) In addition to documentation requirements under 
189.32  Minnesota Rules, part 9505.2175, a personal care provider must 
189.33  meet documentation requirements for shared personal care 
189.34  assistant services and must document the following in the health 
189.35  service record for each individual recipient sharing services: 
189.36     (1) permission by the recipient or the recipient's 
190.1   responsible party, if any, for the maximum number of shared 
190.2   services hours per week chosen by the recipient; 
190.3      (2) permission by the recipient or the recipient's 
190.4   responsible party, if any, for personal care assistant services 
190.5   provided outside the recipient's residence; 
190.6      (3) permission by the recipient or the recipient's 
190.7   responsible party, if any, for others to receive shared services 
190.8   in the recipient's residence; 
190.9      (4) revocation by the recipient or the recipient's 
190.10  responsible party, if any, of the shared service authorization, 
190.11  or the shared service to be provided to others in the 
190.12  recipient's residence, or the shared service to be provided 
190.13  outside the recipient's residence; 
190.14     (5) supervision of the shared personal care assistant 
190.15  services by the qualified professional, if a qualified 
190.16  professional is requested by one of the recipients or 
190.17  responsible parties, including the date, time of day, number of 
190.18  hours spent supervising the provision of shared services, 
190.19  whether the supervision was face-to-face or another method of 
190.20  supervision, changes in the recipient's condition, shared 
190.21  services scheduling issues and recommendations; 
190.22     (6) documentation by the qualified professional, if a 
190.23  qualified professional is requested by one of the recipients or 
190.24  responsible parties, of telephone calls or other discussions 
190.25  with the personal care assistant regarding services being 
190.26  provided to the recipient who has requested the supervision; and 
190.27     (7) daily documentation of the shared services provided by 
190.28  each identified personal care assistant including: 
190.29     (i) the names of each recipient receiving shared services 
190.30  together; 
190.31     (ii) the setting for the shared services, including the 
190.32  starting and ending times that the recipient received shared 
190.33  services; and 
190.34     (iii) notes by the personal care assistant regarding 
190.35  changes in the recipient's condition, problems that may arise 
190.36  from the sharing of services, scheduling issues, care issues, 
191.1   and other notes as required by the qualified professional, if a 
191.2   qualified professional is requested by one of the recipients or 
191.3   responsible parties. 
191.4      (h) Unless otherwise provided in this subdivision, all 
191.5   other statutory and regulatory provisions relating to personal 
191.6   care assistant services apply to shared services. 
191.7      (i) In the event that supervision by a qualified 
191.8   professional has been requested by one or more recipients, but 
191.9   not by all of the recipients, the supervision duties of the 
191.10  qualified professional shall be limited to only those recipients 
191.11  who have requested the supervision. 
191.12     Nothing in this subdivision shall be construed to reduce 
191.13  the total number of hours authorized for an individual recipient.
191.14     Sec. 34.  Minnesota Statutes 2000, section 256B.0627, 
191.15  subdivision 10, is amended to read: 
191.16     Subd. 10.  [FISCAL AGENT INTERMEDIARY OPTION AVAILABLE FOR 
191.17  PERSONAL CARE ASSISTANT SERVICES.] (a) "Fiscal agent option" is 
191.18  an option that allows the recipient to: 
191.19     (1) use a fiscal agent instead of a personal care provider 
191.20  organization; 
191.21     (2) supervise the personal care assistant; and 
191.22     (3) use a consulting professional. 
191.23     The commissioner may allow a recipient of personal care 
191.24  assistant services to use a fiscal agent intermediary to assist 
191.25  the recipient in paying and accounting for medically necessary 
191.26  covered personal care assistant services authorized in 
191.27  subdivision 4 and within the payment parameters of subdivision 
191.28  5.  Unless otherwise provided in this subdivision, all other 
191.29  statutory and regulatory provisions relating to personal care 
191.30  assistant services apply to a recipient using the fiscal agent 
191.31  intermediary option. 
191.32     (b) The recipient or responsible party shall: 
191.33     (1) hire, and terminate the personal care assistant and 
191.34  consulting professional, with the fiscal agent recruit, hire, 
191.35  and terminate a qualified professional, if a qualified 
191.36  professional is requested by the recipient or responsible party; 
192.1      (2) recruit the personal care assistant and consulting 
192.2   professional and orient and train the personal care assistant in 
192.3   areas that do not require professional delegation as determined 
192.4   by the county public health nurse verify and document the 
192.5   credentials of the qualified professional, if a qualified 
192.6   professional is requested by the recipient or responsible party; 
192.7      (3) supervise and evaluate the personal care assistant in 
192.8   areas that do not require professional delegation as determined 
192.9   in the assessment; 
192.10     (4) cooperate with a consulting develop a service plan 
192.11  based on physician orders and public health nurse assessment 
192.12  with the assistance of a qualified professional and implement 
192.13  recommendations pertaining to the health and safety of the 
192.14  recipient, if a qualified professional is requested by the 
192.15  recipient or responsible party, that addresses the health and 
192.16  safety of the recipient; 
192.17     (5) hire a qualified professional to train and supervise 
192.18  the performance of delegated tasks done by (4) recruit, hire, 
192.19  and terminate the personal care assistant; 
192.20     (6) monitor services and verify in writing the hours worked 
192.21  by the personal care assistant and the consulting (5) orient and 
192.22  train the personal care assistant with assistance as needed from 
192.23  the qualified professional; 
192.24     (7) develop and revise a care plan with assistance from a 
192.25  consulting (6) supervise and evaluate the personal care 
192.26  assistant with assistance as needed from the recipient's 
192.27  physician or the qualified professional; 
192.28     (8) verify and document the credentials of the consulting 
192.29  (7) monitor and verify in writing and report to the fiscal 
192.30  intermediary the number of hours worked by the personal care 
192.31  assistant and the qualified professional; and 
192.32     (9) (8) enter into a written agreement, as specified in 
192.33  paragraph (f). 
192.34     (c) The duties of the fiscal agent intermediary shall be to:
192.35     (1) bill the medical assistance program for personal care 
192.36  assistant and consulting qualified professional services; 
193.1      (2) request and secure background checks on personal care 
193.2   assistants and consulting qualified professionals according to 
193.3   section 245A.04; 
193.4      (3) pay the personal care assistant and consulting 
193.5   qualified professional based on actual hours of services 
193.6   provided; 
193.7      (4) withhold and pay all applicable federal and state 
193.8   taxes; 
193.9      (5) verify and document keep records of hours worked by the 
193.10  personal care assistant and consulting qualified professional; 
193.11     (6) make the arrangements and pay unemployment insurance, 
193.12  taxes, workers' compensation, liability insurance, and other 
193.13  benefits, if any; 
193.14     (7) enroll in the medical assistance program as a fiscal 
193.15  agent intermediary; and 
193.16     (8) enter into a written agreement as specified in 
193.17  paragraph (f) before services are provided. 
193.18     (d) The fiscal agent intermediary: 
193.19     (1) may not be related to the recipient, consulting 
193.20  qualified professional, or the personal care assistant; 
193.21     (2) must ensure arm's length transactions with the 
193.22  recipient and personal care assistant; and 
193.23     (3) shall be considered a joint employer of the personal 
193.24  care assistant and consulting qualified professional to the 
193.25  extent specified in this section. 
193.26     The fiscal agent intermediary or owners of the entity that 
193.27  provides fiscal agent intermediary services under this 
193.28  subdivision must pass a criminal background check as required in 
193.29  section 256B.0627, subdivision 1, paragraph (e). 
193.30     (e) If the recipient or responsible party requests a 
193.31  qualified professional, the consulting qualified professional 
193.32  providing assistance to the recipient shall meet the 
193.33  qualifications specified in section 256B.0625, subdivision 19c.  
193.34  The consulting qualified professional shall assist the recipient 
193.35  in developing and revising a plan to meet the 
193.36  recipient's assessed needs, and supervise the performance of 
194.1   delegated tasks, as determined by the public health nurse as 
194.2   assessed by the public health nurse.  In performing this 
194.3   function, the consulting qualified professional must visit the 
194.4   recipient in the recipient's home at least once annually.  
194.5   The consulting qualified professional must report to the local 
194.6   county public health nurse concerns relating to the health and 
194.7   safety of the recipient, and any suspected abuse, neglect, or 
194.8   financial exploitation of the recipient to the appropriate 
194.9   authorities.  
194.10     (f) The fiscal agent intermediary, recipient or responsible 
194.11  party, personal care assistant, and consulting qualified 
194.12  professional shall enter into a written agreement before 
194.13  services are started.  The agreement shall include: 
194.14     (1) the duties of the recipient, qualified professional, 
194.15  personal care assistant, and fiscal agent based on paragraphs 
194.16  (a) to (e); 
194.17     (2) the salary and benefits for the personal care assistant 
194.18  and those providing professional consultation the qualified 
194.19  professional; 
194.20     (3) the administrative fee of the fiscal agent intermediary 
194.21  and services paid for with that fee, including background check 
194.22  fees; 
194.23     (4) procedures to respond to billing or payment complaints; 
194.24  and 
194.25     (5) procedures for hiring and terminating the personal care 
194.26  assistant and those providing professional consultation the 
194.27  qualified professional. 
194.28     (g) The rates paid for personal care assistant services, 
194.29  qualified professional assistance services, and fiscal agency 
194.30  intermediary services under this subdivision shall be the same 
194.31  rates paid for personal care assistant services and qualified 
194.32  professional services under subdivision 2 respectively.  Except 
194.33  for the administrative fee of the fiscal agent intermediary 
194.34  specified in paragraph (f), the remainder of the rates paid to 
194.35  the fiscal agent intermediary must be used to pay for the salary 
194.36  and benefits for the personal care assistant or those providing 
195.1   professional consultation the qualified professional. 
195.2      (h) As part of the assessment defined in subdivision 1, the 
195.3   following conditions must be met to use or continue use of a 
195.4   fiscal agent intermediary: 
195.5      (1) the recipient must be able to direct the recipient's 
195.6   own care, or the responsible party for the recipient must be 
195.7   readily available to direct the care of the personal care 
195.8   assistant; 
195.9      (2) the recipient or responsible party must be 
195.10  knowledgeable of the health care needs of the recipient and be 
195.11  able to effectively communicate those needs; 
195.12     (3) a face-to-face assessment must be conducted by the 
195.13  local county public health nurse at least annually, or when 
195.14  there is a significant change in the recipient's condition or 
195.15  change in the need for personal care assistant services.  The 
195.16  county public health nurse shall determine the services that 
195.17  require professional delegation, if any, and the amount and 
195.18  frequency of related supervision; 
195.19     (4) the recipient cannot select the shared services option 
195.20  as specified in subdivision 8; and 
195.21     (5) parties must be in compliance with the written 
195.22  agreement specified in paragraph (f). 
195.23     (i) The commissioner shall deny, revoke, or suspend the 
195.24  authorization to use the fiscal agent intermediary option if: 
195.25     (1) it has been determined by the consulting qualified 
195.26  professional or local county public health nurse that the use of 
195.27  this option jeopardizes the recipient's health and safety; 
195.28     (2) the parties have failed to comply with the written 
195.29  agreement specified in paragraph (f); or 
195.30     (3) the use of the option has led to abusive or fraudulent 
195.31  billing for personal care assistant services.  
195.32     The recipient or responsible party may appeal the 
195.33  commissioner's action according to section 256.045.  The denial, 
195.34  revocation, or suspension to use the fiscal agent intermediary 
195.35  option shall not affect the recipient's authorized level of 
195.36  personal care assistant services as determined in subdivision 5. 
196.1      Sec. 35.  Minnesota Statutes 2000, section 256B.0627, 
196.2   subdivision 11, is amended to read: 
196.3      Subd. 11.  [SHARED PRIVATE DUTY NURSING CARE OPTION.] (a) 
196.4   Medical assistance payments for shared private duty nursing 
196.5   services by a private duty nurse shall be limited according to 
196.6   this subdivision.  For the purposes of this section, "private 
196.7   duty nursing agency" means an agency licensed under chapter 144A 
196.8   to provide private duty nursing services. 
196.9      (b) Recipients of private duty nursing services may share 
196.10  nursing staff and the commissioner shall provide a rate 
196.11  methodology for shared private duty nursing.  For two persons 
196.12  sharing nursing care, the rate paid to a provider shall not 
196.13  exceed 1.5 times the nonwaivered regular private duty nursing 
196.14  rates paid for serving a single individual who is not ventilator 
196.15  dependent, by a registered nurse or licensed practical nurse.  
196.16  These rates apply only to situations in which both recipients 
196.17  are present and receive shared private duty nursing care on the 
196.18  date for which the service is billed.  No more than two persons 
196.19  may receive shared private duty nursing services from a private 
196.20  duty nurse in a single setting. 
196.21     (c) Shared private duty nursing care is the provision of 
196.22  nursing services by a private duty nurse to two recipients at 
196.23  the same time and in the same setting.  For the purposes of this 
196.24  subdivision, "setting" means: 
196.25     (1) the home or foster care home of one of the individual 
196.26  recipients; or 
196.27     (2) a child care program licensed under chapter 245A or 
196.28  operated by a local school district or private school; or 
196.29     (3) an adult day care service licensed under chapter 245A; 
196.30  or 
196.31     (4) outside the home or foster care home of one of the 
196.32  recipients when normal life activities take the recipients 
196.33  outside the home.  
196.34     This subdivision does not apply when a private duty nurse 
196.35  is caring for multiple recipients in more than one setting. 
196.36     (d) The recipient or the recipient's legal representative, 
197.1   and the recipient's physician, in conjunction with the home 
197.2   health care agency, shall determine: 
197.3      (1) whether shared private duty nursing care is an 
197.4   appropriate option based on the individual needs and preferences 
197.5   of the recipient; and 
197.6      (2) the amount of shared private duty nursing services 
197.7   authorized as part of the overall authorization of nursing 
197.8   services. 
197.9      (e) The recipient or the recipient's legal representative, 
197.10  in conjunction with the private duty nursing agency, shall 
197.11  approve the setting, grouping, and arrangement of shared private 
197.12  duty nursing care based on the individual needs and preferences 
197.13  of the recipients.  Decisions on the selection of recipients to 
197.14  share services must be based on the ages of the recipients, 
197.15  compatibility, and coordination of their care needs. 
197.16     (f) The following items must be considered by the recipient 
197.17  or the recipient's legal representative and the private duty 
197.18  nursing agency, and documented in the recipient's health service 
197.19  record: 
197.20     (1) the additional training needed by the private duty 
197.21  nurse to provide care to two recipients in the same setting and 
197.22  to ensure that the needs of the recipients are met appropriately 
197.23  and safely; 
197.24     (2) the setting in which the shared private duty nursing 
197.25  care will be provided; 
197.26     (3) the ongoing monitoring and evaluation of the 
197.27  effectiveness and appropriateness of the service and process 
197.28  used to make changes in service or setting; 
197.29     (4) a contingency plan which accounts for absence of the 
197.30  recipient in a shared private duty nursing setting due to 
197.31  illness or other circumstances; 
197.32     (5) staffing backup contingencies in the event of employee 
197.33  illness or absence; and 
197.34     (6) arrangements for additional assistance to respond to 
197.35  urgent or emergency care needs of the recipients. 
197.36     (g) The provider must offer the recipient or responsible 
198.1   party the option of shared or one-on-one private duty nursing 
198.2   services.  The recipient or responsible party can withdraw from 
198.3   participating in a shared service arrangement at any time. 
198.4      (h) The private duty nursing agency must document the 
198.5   following in the health service record for each individual 
198.6   recipient sharing private duty nursing care: 
198.7      (1) permission by the recipient or the recipient's legal 
198.8   representative for the maximum number of shared nursing care 
198.9   hours per week chosen by the recipient; 
198.10     (2) permission by the recipient or the recipient's legal 
198.11  representative for shared private duty nursing services provided 
198.12  outside the recipient's residence; 
198.13     (3) permission by the recipient or the recipient's legal 
198.14  representative for others to receive shared private duty nursing 
198.15  services in the recipient's residence; 
198.16     (4) revocation by the recipient or the recipient's legal 
198.17  representative of the shared private duty nursing care 
198.18  authorization, or the shared care to be provided to others in 
198.19  the recipient's residence, or the shared private duty nursing 
198.20  services to be provided outside the recipient's residence; and 
198.21     (5) daily documentation of the shared private duty nursing 
198.22  services provided by each identified private duty nurse, 
198.23  including: 
198.24     (i) the names of each recipient receiving shared private 
198.25  duty nursing services together; 
198.26     (ii) the setting for the shared services, including the 
198.27  starting and ending times that the recipient received shared 
198.28  private duty nursing care; and 
198.29     (iii) notes by the private duty nurse regarding changes in 
198.30  the recipient's condition, problems that may arise from the 
198.31  sharing of private duty nursing services, and scheduling and 
198.32  care issues. 
198.33     (i) Unless otherwise provided in this subdivision, all 
198.34  other statutory and regulatory provisions relating to private 
198.35  duty nursing services apply to shared private duty nursing 
198.36  services. 
199.1      Nothing in this subdivision shall be construed to reduce 
199.2   the total number of private duty nursing hours authorized for an 
199.3   individual recipient under subdivision 5. 
199.4      Sec. 36.  Minnesota Statutes 2000, section 256B.0627, is 
199.5   amended by adding a subdivision to read: 
199.6      Subd. 13.  [CONSUMER-DIRECTED HOME CARE DEMONSTRATION 
199.7   PROJECT.] (a) Upon the receipt of federal waiver authority, the 
199.8   commissioner shall implement a consumer-directed home care 
199.9   demonstration project.  The consumer-directed home care 
199.10  demonstration project must demonstrate and evaluate the outcomes 
199.11  of a consumer-directed service delivery alternative to improve 
199.12  access, increase consumer control and accountability over 
199.13  available resources, and enable the use of supports that are 
199.14  more individualized and cost-effective for eligible medical 
199.15  assistance recipients receiving certain medical assistance home 
199.16  care services.  The consumer-directed home care demonstration 
199.17  project will be administered locally by county agencies, tribal 
199.18  governments, or administrative entities under contract with the 
199.19  state in regions where counties choose not to provide this 
199.20  service. 
199.21     (b) Grant awards for persons who have been receiving 
199.22  medical assistance covered personal care, home health aide, or 
199.23  private duty nursing services for a period of 12 consecutive 
199.24  months or more prior to enrollment in the consumer-directed home 
199.25  care demonstration project will be established on a case-by-case 
199.26  basis using historical service expenditure data.  An average 
199.27  monthly expenditure for each continuing enrollee will be 
199.28  calculated based on historical expenditures made on behalf of 
199.29  the enrollee for personal care, home health aide, or private 
199.30  duty nursing services during the 12 month period directly prior 
199.31  to enrollment in the project.  The grant award will equal 90 
199.32  percent of the average monthly expenditure. 
199.33     (c) Grant awards for project enrollees who have been 
199.34  receiving medical assistance covered personal care, home health 
199.35  aide, or private duty nursing services for a period of less than 
199.36  12 consecutive months prior to project enrollment will be 
200.1   calculated on a case-by-case basis using the service 
200.2   authorization in place at the time of enrollment.  The total 
200.3   number of units of personal care, home health aide, or private 
200.4   duty nursing services the enrollee has been authorized to 
200.5   receive will be converted to the total cost of the authorized 
200.6   services in a given month using the statewide average service 
200.7   payment rates.  To determine an estimated monthly expenditure, 
200.8   the total authorized monthly personal care, home health aide or 
200.9   private duty nursing service costs will be reduced by a 
200.10  percentage rate equivalent to the difference between the 
200.11  statewide average service authorization and the statewide 
200.12  average utilization rate for each of the services by medical 
200.13  assistance eligibles during the most recent fiscal year for 
200.14  which 12 months of data is available.  The grant award will 
200.15  equal 90 percent of the estimated monthly expenditure. 
200.16     (d) The state of Minnesota, county agencies, tribal 
200.17  governments, or administrative entities under contract with the 
200.18  state that participate in the implementation and administration 
200.19  of the consumer-directed home care demonstration project, shall 
200.20  not be liable for damages, injuries, or liabilities sustained 
200.21  through the purchase of support by the individual, the 
200.22  individual's family, or the authorized representative under this 
200.23  section with funds received through the consumer-directed home 
200.24  care demonstration project.  Liabilities include but are not 
200.25  limited to:  workers' compensation liability, the Federal 
200.26  Insurance Contributions Act (FICA), or the Federal Unemployment 
200.27  Tax Act (FUTA). 
200.28     Sec. 37.  Minnesota Statutes 2000, section 256B.0627, is 
200.29  amended by adding a subdivision to read: 
200.30     Subd. 14.  [TELEHOMECARE; SKILLED NURSE VISITS.] Medical 
200.31  assistance covers skilled nurse visits according to section 
200.32  256B.0625, subdivision 6a, provided via telehomecare, for 
200.33  services which do not require hands-on care between the home 
200.34  care nurse and recipient.  The provision of telehomecare must be 
200.35  made via live, two-way interactive audiovisual technology and 
200.36  may be augmented by utilizing store-and-forward technologies.  
201.1   Store-and-forward technology includes telehomecare services that 
201.2   do not occur in real time via synchronous transmissions, and 
201.3   that do not require a face-to-face encounter with the recipient 
201.4   for all or any part of any such telehomecare visit.  
201.5   Individually identifiable patient data obtained through 
201.6   real-time or store-and-forward technology must be maintained in 
201.7   a confidential manner.  If the video is used for research, 
201.8   training, or other purposes unrelated to the care of the 
201.9   patient, the identity of the patient must be concealed.  A 
201.10  communication between the home care nurse and recipient that 
201.11  consists solely of a telephone conversation, facsimile, 
201.12  electronic mail, or a consultation between two health care 
201.13  practitioners, is not to be considered a telehomecare visit.  
201.14  Multiple daily skilled nurse visits provided via telehomecare 
201.15  are allowed.  Coverage of telehomecare is limited to two visits 
201.16  per day.  All skilled nurse visits provided via telehomecare 
201.17  must be prior authorized by the commissioner or the 
201.18  commissioner's designee and will be covered at the same 
201.19  allowable rate as skilled nurse visits provided in-person. 
201.20     Sec. 38.  Minnesota Statutes 2000, section 256B.0627, is 
201.21  amended by adding a subdivision to read: 
201.22     Subd. 15.  [THERAPIES THROUGH HOME HEALTH AGENCIES.] (a)  
201.23  [PHYSICAL THERAPY.] Medical assistance covers physical therapy 
201.24  and related services, including specialized maintenance 
201.25  therapy.  Services provided by a physical therapy assistant 
201.26  shall be reimbursed at the same rate as services performed by a 
201.27  physical therapist when the services of the physical therapy 
201.28  assistant are provided under the direction of a physical 
201.29  therapist who is on the premises.  Services provided by a 
201.30  physical therapy assistant that are provided under the direction 
201.31  of a physical therapist who is not on the premises shall be 
201.32  reimbursed at 65 percent of the physical therapist rate.  
201.33  Direction of the physical therapy assistant must be provided by 
201.34  the physical therapist as described in Minnesota Rules, part 
201.35  9505.0390, subpart 1, item B.  The physical therapist and 
201.36  physical therapist assistant may not both bill for services 
202.1   provided to a recipient on the same day. 
202.2      (b)  [OCCUPATIONAL THERAPY.] Medical assistance covers 
202.3   occupational therapy and related services, including specialized 
202.4   maintenance therapy.  Services provided by an occupational 
202.5   therapy assistant shall be reimbursed at the same rate as 
202.6   services performed by an occupational therapist when the 
202.7   services of the occupational therapy assistant are provided 
202.8   under the direction of the occupational therapist who is on the 
202.9   premises.  Services provided by an occupational therapy 
202.10  assistant under the direction of an occupational therapist who 
202.11  is not on the premises shall be reimbursed at 65 percent of the 
202.12  occupational therapist rate.  Direction of the occupational 
202.13  therapy assistant must be provided by the occupational therapist 
202.14  as described in Minnesota Rules, part 9505.0390, subpart 1, item 
202.15  B.  The occupational therapist and occupational therapist 
202.16  assistant may not both bill for services provided to a recipient 
202.17  on the same day. 
202.18     Sec. 39.  Minnesota Statutes 2000, section 256B.0627, is 
202.19  amended by adding a subdivision to read: 
202.20     Subd. 16.  [HARDSHIP CRITERIA; PRIVATE DUTY NURSING.] (a) 
202.21  Payment is allowed for extraordinary services that require 
202.22  specialized nursing skills and are provided by parents of minor 
202.23  children, spouses, and legal guardians who are providing private 
202.24  duty nursing care under the following conditions: 
202.25     (1) the provision of these services is not legally required 
202.26  of the parents, spouses, or legal guardians; 
202.27     (2) the services are necessary to prevent hospitalization 
202.28  of the recipient; and 
202.29     (3) the recipient is eligible for state plan home care or a 
202.30  home and community-based waiver and one of the following 
202.31  hardship criteria are met: 
202.32     (i) the parent, spouse, or legal guardian resigns from a 
202.33  part-time or full-time job to provide nursing care for the 
202.34  recipient; or 
202.35     (ii) the parent, spouse, or legal guardian goes from a 
202.36  full-time to a part-time job with less compensation to provide 
203.1   nursing care for the recipient; or 
203.2      (iii) the parent, spouse, or legal guardian takes a leave 
203.3   of absence without pay to provide nursing care for the 
203.4   recipient; or 
203.5      (iv) because of labor conditions, special language needs, 
203.6   or intermittent hours of care needed, the parent, spouse, or 
203.7   legal guardian is needed in order to provide adequate private 
203.8   duty nursing services to meet the medical needs of the recipient.
203.9      (b) Private duty nursing may be provided by a parent, 
203.10  spouse, or legal guardian who is a nurse licensed in Minnesota.  
203.11  Private duty nursing services provided by a parent, spouse, or 
203.12  legal guardian cannot be used in lieu of nursing services 
203.13  covered and available under liable third-party payers, including 
203.14  Medicare.  The private duty nursing provided by a parent, 
203.15  spouse, or legal guardian must be included in the service plan.  
203.16  Authorized skilled nursing services provided by the parent, 
203.17  spouse, or legal guardian may not exceed 50 percent of the total 
203.18  approved nursing hours, or eight hours per day, whichever is 
203.19  less, up to a maximum of 40 hours per week.  Nothing in this 
203.20  subdivision precludes the parent's, spouse's, or legal 
203.21  guardian's obligation of assuming the nonreimbursed family 
203.22  responsibilities of emergency backup caregiver and primary 
203.23  caregiver. 
203.24     (c) A parent or a spouse may not be paid to provide private 
203.25  duty nursing care if the parent or spouse fails to pass a 
203.26  criminal background check according to section 245A.04, or if it 
203.27  has been determined by the home health agency, the case manager, 
203.28  or the physician that the private duty nursing care provided by 
203.29  the parent, spouse, or legal guardian is unsafe. 
203.30     Sec. 40.  Minnesota Statutes 2000, section 256B.0627, is 
203.31  amended by adding a subdivision to read: 
203.32     Subd. 17.  [QUALITY ASSURANCE PLAN FOR PERSONAL CARE 
203.33  ASSISTANT SERVICES.] The commissioner shall establish a quality 
203.34  assurance plan for personal care assistant services that 
203.35  includes: 
203.36     (1) performance-based provider agreements; 
204.1      (2) meaningful consumer input, which may include consumer 
204.2   surveys, that measure the extent to which participants receive 
204.3   the services and supports described in the individual plan and 
204.4   participant satisfaction with such services and supports; 
204.5      (3) ongoing monitoring of the health and well-being of 
204.6   consumers; and 
204.7      (4) an ongoing public process for development, 
204.8   implementation, and review of the quality assurance plan.  
204.9      Sec. 41.  Minnesota Statutes 2000, section 256B.0911, is 
204.10  amended by adding a subdivision to read: 
204.11     Subd. 4a.  [PREADMISSION SCREENING OF INDIVIDUALS UNDER 65 
204.12  YEARS OF AGE.] (a) It is the policy of the state of Minnesota to 
204.13  ensure that individuals with disabilities or chronic illness are 
204.14  served in the most integrated setting appropriate to their needs 
204.15  and have the necessary information to make informed choices 
204.16  about home and community-based service options. 
204.17     (b) Individuals under 65 years of age who are admitted to a 
204.18  nursing facility from a hospital must be screened prior to 
204.19  admission as outlined in subdivision 4. 
204.20     (c) Individuals under 65 years of age who are admitted to 
204.21  nursing facilities with only a telephone screening must receive 
204.22  a face-to-face assessment from the long-term care consultation 
204.23  team member of the county in which the facility is located or 
204.24  from the recipient's county case manager within 20 working days 
204.25  of admission. 
204.26     (d) At the face-to-face assessment, the long-term care 
204.27  consultation team member or county case manager must perform the 
204.28  activities required under subdivision 3. 
204.29     (e) For individuals under 21 years of age, the screening or 
204.30  assessment which recommends nursing facility admission must be 
204.31  approved by the commissioner before the individual is admitted 
204.32  to the nursing facility. 
204.33     (f) In the event that an individual under 65 years of age 
204.34  is admitted to a nursing facility on an emergency basis, the 
204.35  county must be notified of the admission on the next working 
204.36  day, and a face-to-face assessment as described in paragraph (c) 
205.1   must be conducted within 20 working days of admission. 
205.2      (g) At the face-to-face assessment, the long-term care 
205.3   consultation team member or the case manager must present 
205.4   information about home and community-based options so the 
205.5   individual can make informed choices.  If the individual chooses 
205.6   home and community-based services, the long-term care 
205.7   consultation team member or case manager must complete a written 
205.8   relocation plan within 20 working days of the visit.  The plan 
205.9   shall describe the services needed to move out of the facility 
205.10  and a time line for the move which is designed to ensure a 
205.11  smooth transition to the individual's home and community. 
205.12     (h) An individual under 65 years of age residing in a 
205.13  nursing facility shall receive a face-to-face assessment at 
205.14  least every 12 months to review the person's service choices and 
205.15  available alternatives unless the individual indicates, in 
205.16  writing, that annual visits are not desired.  In this case, the 
205.17  individual must receive a face-to-face assessment at least once 
205.18  every 36 months for the same purposes. 
205.19     (i) Notwithstanding the provisions of subdivision 6, the 
205.20  commissioner may pay county agencies directly for face-to-face 
205.21  assessments for individuals who are eligible for medical 
205.22  assistance, under 65 years of age, and being considered for 
205.23  placement or residing in a nursing facility. 
205.24     Sec. 42.  Minnesota Statutes 2000, section 256B.0916, 
205.25  subdivision 1, is amended to read: 
205.26     Subdivision 1.  [REDUCTION OF WAITING LIST.] (a) The 
205.27  legislature recognizes that as of January 1, 1999, 3,300 persons 
205.28  with mental retardation or related conditions have been screened 
205.29  and determined eligible for the home and community-based waiver 
205.30  services program for persons with mental retardation or related 
205.31  conditions.  Many wait for several years before receiving 
205.32  service. 
205.33     (b) The waiting list for this program shall be reduced or 
205.34  eliminated by June 30, 2003.  In order to reduce the number of 
205.35  eligible persons waiting for identified services provided 
205.36  through the home and community-based waiver for persons with 
206.1   mental retardation or related conditions, during the period from 
206.2   July 1, 1999, to June 30, 2003, funding shall be increased to 
206.3   add 100 additional eligible persons each year beyond the 
206.4   February 1999 medical assistance forecast. 
206.5      (c) The commissioner shall allocate resources in such a 
206.6   manner as to use all resources budgeted during a biennium for 
206.7   the home and community-based waiver for persons with mental 
206.8   retardation or related conditions according to the priorities 
206.9   listed in subdivision 2, paragraph (b), and then to serve other 
206.10  persons on the waiting list.  Resources allocated for a fiscal 
206.11  year to serve persons affected by public and private sector 
206.12  ICF/MR closures, but not expected to be expended for that 
206.13  purpose, must be reallocated within that fiscal year to serve 
206.14  other persons on the waiting list, and the number of waiver 
206.15  diversion slots shall be adjusted accordingly. 
206.16     (d) For fiscal year 2001, at least one-half of the increase 
206.17  in funding over the previous year provided in the February 1999 
206.18  medical assistance forecast for the home and community-based 
206.19  waiver for persons with mental retardation and related 
206.20  conditions, including changes made by the 1999 legislature, must 
206.21  be used to serve persons who are not affected by public and 
206.22  private sector ICF/MR closures. 
206.23     (e) The commissioner of finance shall not reduce the 
206.24  expenditure forecast for a biennium for which appropriations 
206.25  have been made, if at the time of the forecast there is a 
206.26  waiting list for waiver services for persons with mental 
206.27  retardation or related conditions who need services within the 
206.28  next 30 months.  Funds that would have resulted from a projected 
206.29  reduction in expenditures must be used by the commissioner of 
206.30  human services to serve persons with developmental disabilities 
206.31  through the home and community-based waiver for persons with 
206.32  mental retardation or related conditions. 
206.33     Sec. 43.  Minnesota Statutes 2000, section 256B.0916, is 
206.34  amended by adding a subdivision to read: 
206.35     Subd. 6a.  [STATEWIDE AVAILABILITY OF CONSUMER-DIRECTED 
206.36  COMMUNITY SUPPORT SERVICES.] (a) The commissioner shall submit 
207.1   to the federal Health Care Financing Administration by August 1, 
207.2   2001, an amendment to the home and community-based waiver for 
207.3   persons with mental retardation or related conditions to make 
207.4   consumer-directed community support services available in every 
207.5   county of the state by January 1, 2002. 
207.6      (b) If a county declines to meet the requirements for 
207.7   provision of consumer-directed community supports, the 
207.8   commissioner shall contract with another county, a group of 
207.9   counties, or a private agency to plan for and administer 
207.10  consumer-directed community supports in that county. 
207.11     (c) The state of Minnesota, county agencies, tribal 
207.12  governments, or administrative entities under contract to 
207.13  participate in the implementation and administration of the home 
207.14  and community-based waiver for persons with mental retardation 
207.15  or a related condition, shall not be liable for damages, 
207.16  injuries, or liabilities sustained through the purchase of 
207.17  support by the individual, the individual's family, or the 
207.18  authorized representative with funds received through the 
207.19  consumer-directed community support service under this section.  
207.20  Liabilities include but are not limited to:  workers' 
207.21  compensation liability, the Federal Insurance Contributions Act 
207.22  (FICA), or the Federal Unemployment Tax Act (FUTA). 
207.23     Sec. 44.  Minnesota Statutes 2000, section 256B.0916, 
207.24  subdivision 7, is amended to read: 
207.25     Subd. 7.  [ANNUAL REPORT BY COMMISSIONER.] Beginning 
207.26  October 1, 1999, and each October 1 November 1, 2001, and each 
207.27  November 1 thereafter, the commissioner shall issue an annual 
207.28  report on county and state use of available resources for the 
207.29  home and community-based waiver for persons with mental 
207.30  retardation or related conditions.  For each county or county 
207.31  partnership, the report shall include: 
207.32     (1) the amount of funds allocated but not used; 
207.33     (2) the county specific allowed reserve amount approved and 
207.34  used; 
207.35     (3) the number, ages, and living situations of individuals 
207.36  screened and waiting for services; 
208.1      (4) the urgency of need for services to begin within one, 
208.2   two, or more than two years for each individual; 
208.3      (5) the services needed; 
208.4      (6) the number of additional persons served by approval of 
208.5   increased capacity within existing allocations; 
208.6      (7) results of action by the commissioner to streamline 
208.7   administrative requirements and improve county resource 
208.8   management; and 
208.9      (8) additional action that would decrease the number of 
208.10  those eligible and waiting for waivered services. 
208.11  The commissioner shall specify intended outcomes for the program 
208.12  and the degree to which these specified outcomes are attained. 
208.13     Sec. 45.  Minnesota Statutes 2000, section 256B.0916, 
208.14  subdivision 9, is amended to read: 
208.15     Subd. 9.  [LEGAL REPRESENTATIVE PARTICIPATION EXCEPTION.] 
208.16  The commissioner, in cooperation with representatives of 
208.17  counties, service providers, service recipients, family members, 
208.18  legal representatives and advocates, shall develop criteria to 
208.19  allow legal representatives to be reimbursed for providing 
208.20  specific support services to meet the person's needs when a plan 
208.21  which assures health and safety has been agreed upon and carried 
208.22  out by the legal representative, the person, and the county.  
208.23  Legal representatives providing support under consumer-directed 
208.24  community support services pursuant to section 256B.092, 
208.25  subdivision 4, the home and community-based waiver for persons 
208.26  with mental retardation or related conditions or the consumer 
208.27  support grant program pursuant to section 256B.092, subdivision 
208.28  7 256.476, shall not be considered to have a direct or indirect 
208.29  service provider interest under section 256B.092, subdivision 7, 
208.30  if a health and safety plan which meets the criteria established 
208.31  has been agreed upon and implemented.  By October 1, 1999 August 
208.32  1, 2001, the commissioner shall submit, for federal approval, 
208.33  amendments to allow legal representatives to provide support and 
208.34  receive reimbursement under the consumer-directed community 
208.35  support services section of the home and community-based waiver 
208.36  plan. 
209.1      Sec. 46.  Minnesota Statutes 2000, section 256B.092, 
209.2   subdivision 2a, is amended to read: 
209.3      Subd. 2a.  [MEDICAL ASSISTANCE FOR CASE MANAGEMENT 
209.4   ACTIVITIES UNDER THE STATE PLAN MEDICAID OPTION.] (a) Upon 
209.5   receipt of federal approval, the commissioner shall make 
209.6   payments to approved vendors counties, private individuals, and 
209.7   agencies enrolled as providers of case management services 
209.8   participating in the medical assistance program to reimburse 
209.9   costs for providing case management service activities to 
209.10  medical assistance eligible persons with mental retardation or a 
209.11  related condition, in accordance with the state Medicaid plan, 
209.12  the home and community-based waiver for persons with mental 
209.13  retardation and related conditions plan, and federal 
209.14  requirements and limitations.  
209.15     (b) The commissioner shall ensure that each eligible person 
209.16  is given a choice of county and private agency case management 
209.17  service providers.  Case management service providers are 
209.18  prohibited from providing any other service to the person 
209.19  receiving case management services. 
209.20     Sec. 47.  Minnesota Statutes 2000, section 256B.092, 
209.21  subdivision 5, is amended to read: 
209.22     Subd. 5.  [FEDERAL WAIVERS.] (a) The commissioner shall 
209.23  apply for any federal waivers necessary to secure, to the extent 
209.24  allowed by law, federal financial participation under United 
209.25  States Code, title 42, sections 1396 et seq., as amended, for 
209.26  the provision of services to persons who, in the absence of the 
209.27  services, would need the level of care provided in a regional 
209.28  treatment center or a community intermediate care facility for 
209.29  persons with mental retardation or related conditions.  The 
209.30  commissioner may seek amendments to the waivers or apply for 
209.31  additional waivers under United States Code, title 42, sections 
209.32  1396 et seq., as amended, to contain costs.  The commissioner 
209.33  shall ensure that payment for the cost of providing home and 
209.34  community-based alternative services under the federal waiver 
209.35  plan shall not exceed the cost of intermediate care services 
209.36  including day training and habilitation services that would have 
210.1   been provided without the waivered services.  
210.2      (b) The commissioner, in administering home and 
210.3   community-based waivers for persons with mental retardation and 
210.4   related conditions, shall ensure that day services for eligible 
210.5   persons are not provided by the person's residential service 
210.6   provider, unless the person or the person's legal representative 
210.7   is offered a choice of providers and agrees in writing to 
210.8   provision of day services by the residential service provider.  
210.9   The individual service plan for individuals who choose to have 
210.10  their residential service provider provide their day services 
210.11  must describe how health, safety, and protection needs will be 
210.12  met by frequent and regular contact with persons other than the 
210.13  residential service provider. 
210.14     Sec. 48.  Minnesota Statutes 2000, section 256B.093, 
210.15  subdivision 3, is amended to read: 
210.16     Subd. 3.  [TRAUMATIC BRAIN INJURY PROGRAM DUTIES.] The 
210.17  department shall fund administrative case management under this 
210.18  subdivision using medical assistance administrative funds.  The 
210.19  traumatic brain injury program duties include: 
210.20     (1) recommending to the commissioner in consultation with 
210.21  the medical review agent according to Minnesota Rules, parts 
210.22  9505.0500 to 9505.0540, the approval or denial of medical 
210.23  assistance funds to pay for out-of-state placements for 
210.24  traumatic brain injury services and in-state traumatic brain 
210.25  injury services provided by designated Medicare long-term care 
210.26  hospitals; 
210.27     (2) coordinating the traumatic brain injury home and 
210.28  community-based waiver; 
210.29     (3) approving traumatic brain injury waiver eligibility or 
210.30  care plans or both; 
210.31     (4) providing ongoing technical assistance and consultation 
210.32  to county and facility case managers to facilitate care plan 
210.33  development for appropriate, accessible, and cost-effective 
210.34  medical assistance services; 
210.35     (5) (4) providing technical assistance to promote statewide 
210.36  development of appropriate, accessible, and cost-effective 
211.1   medical assistance services and related policy; 
211.2      (6) (5) providing training and outreach to facilitate 
211.3   access to appropriate home and community-based services to 
211.4   prevent institutionalization; 
211.5      (7) (6) facilitating appropriate admissions, continued stay 
211.6   review, discharges, and utilization review for neurobehavioral 
211.7   hospitals and other specialized institutions; 
211.8      (8) (7) providing technical assistance on the use of prior 
211.9   authorization of home care services and coordination of these 
211.10  services with other medical assistance services; 
211.11     (9) (8) developing a system for identification of nursing 
211.12  facility and hospital residents with traumatic brain injury to 
211.13  assist in long-term planning for medical assistance services.  
211.14  Factors will include, but are not limited to, number of 
211.15  individuals served, length of stay, services received, and 
211.16  barriers to community placement; and 
211.17     (10) (9) providing information, referral, and case 
211.18  consultation to access medical assistance services for 
211.19  recipients without a county or facility case manager.  Direct 
211.20  access to this assistance may be limited due to the structure of 
211.21  the program. 
211.22     Sec. 49.  Minnesota Statutes 2000, section 256B.095, is 
211.23  amended to read: 
211.24     256B.095 [THREE-YEAR QUALITY ASSURANCE PILOT PROJECT 
211.25  ESTABLISHED.] 
211.26     Effective July 1, 1998, an alternative quality assurance 
211.27  licensing system pilot project for programs for persons with 
211.28  developmental disabilities is established in Dodge, Fillmore, 
211.29  Freeborn, Goodhue, Houston, Mower, Olmsted, Rice, Steele, 
211.30  Wabasha, and Winona counties for the purpose of improving the 
211.31  quality of services provided to persons with developmental 
211.32  disabilities.  A county, at its option, may choose to have all 
211.33  programs for persons with developmental disabilities located 
211.34  within the county licensed under chapter 245A using standards 
211.35  determined under the alternative quality assurance licensing 
211.36  system pilot project or may continue regulation of these 
212.1   programs under the licensing system operated by the 
212.2   commissioner.  The pilot project expires on June 30, 2001 2005. 
212.3      Sec. 50.  Minnesota Statutes 2000, section 256B.0951, 
212.4   subdivision 1, is amended to read: 
212.5      Subdivision 1.  [MEMBERSHIP.] The region 10 quality 
212.6   assurance commission is established.  The commission consists of 
212.7   at least 14 but not more than 21 members as follows:  at least 
212.8   three but not more than five members representing advocacy 
212.9   organizations; at least three but not more than five members 
212.10  representing consumers, families, and their legal 
212.11  representatives; at least three but not more than five members 
212.12  representing service providers; at least three but not more than 
212.13  five members representing counties; and the commissioner of 
212.14  human services or the commissioner's designee.  Initial 
212.15  membership of the commission shall be recruited and approved by 
212.16  the region 10 stakeholders group.  Prior to approving the 
212.17  commission's membership, the stakeholders group shall provide to 
212.18  the commissioner a list of the membership in the stakeholders 
212.19  group, as of February 1, 1997, a brief summary of meetings held 
212.20  by the group since July 1, 1996, and copies of any materials 
212.21  prepared by the group for public distribution.  The first 
212.22  commission shall establish membership guidelines for the 
212.23  transition and recruitment of membership for the commission's 
212.24  ongoing existence.  Members of the commission who do not receive 
212.25  a salary or wages from an employer for time spent on commission 
212.26  duties may receive a per diem payment when performing commission 
212.27  duties and functions.  All members may be reimbursed for 
212.28  expenses related to commission activities.  Notwithstanding the 
212.29  provisions of section 15.059, subdivision 5, the commission 
212.30  expires on June 30, 2001 2005. 
212.31     Sec. 51.  Minnesota Statutes 2000, section 256B.0951, 
212.32  subdivision 3, is amended to read: 
212.33     Subd. 3.  [COMMISSION DUTIES.] (a) By October 1, 1997, the 
212.34  commission, in cooperation with the commissioners of human 
212.35  services and health, shall do the following:  (1) approve an 
212.36  alternative quality assurance licensing system based on the 
213.1   evaluation of outcomes; (2) approve measurable outcomes in the 
213.2   areas of health and safety, consumer evaluation, education and 
213.3   training, providers, and systems that shall be evaluated during 
213.4   the alternative licensing process; and (3) establish variable 
213.5   licensure periods not to exceed three years based on outcomes 
213.6   achieved.  For purposes of this subdivision, "outcome" means the 
213.7   behavior, action, or status of a person that can be observed or 
213.8   measured and can be reliably and validly determined. 
213.9      (b) By January 15, 1998, the commission shall approve, in 
213.10  cooperation with the commissioner of human services, a training 
213.11  program for members of the quality assurance teams established 
213.12  under section 256B.0952, subdivision 4. 
213.13     (c) The commission and the commissioner shall establish an 
213.14  ongoing review process for the alternative quality assurance 
213.15  licensing system.  The review shall take into account the 
213.16  comprehensive nature of the alternative system, which is 
213.17  designed to evaluate the broad spectrum of licensed and 
213.18  unlicensed entities that provide services to clients, as 
213.19  compared to the current licensing system.  
213.20     (d) The commission shall contract with an independent 
213.21  entity to conduct a financial review of the alternative quality 
213.22  assurance pilot project.  The review shall take into account the 
213.23  comprehensive nature of the alternative system, which is 
213.24  designed to evaluate the broad spectrum of licensed and 
213.25  unlicensed entities that provide services to clients, as 
213.26  compared to the current licensing system.  The review shall 
213.27  include an evaluation of possible budgetary savings within the 
213.28  department of human services as a result of implementation of 
213.29  the alternative quality assurance pilot project.  If a federal 
213.30  waiver is approved under subdivision 7, the financial review 
213.31  shall also evaluate possible savings within the department of 
213.32  health.  This review must be completed by December 15, 2000. 
213.33     (e) The commission shall submit a report to the legislature 
213.34  by January 15, 2001, on the results of the review process for 
213.35  the alternative quality assurance pilot project, a summary of 
213.36  the results of the independent financial review, and a 
214.1   recommendation on whether the pilot project should be extended 
214.2   beyond June 30, 2001. 
214.3      (f) The commissioner, in consultation with the commission, 
214.4   shall examine the feasibility of expanding the project to other 
214.5   populations or geographic areas and identify barriers to 
214.6   expansion.  The commissioner shall report findings and 
214.7   recommendations to the legislature by December 15, 2004. 
214.8      Sec. 52.  Minnesota Statutes 2000, section 256B.0951, 
214.9   subdivision 4, is amended to read: 
214.10     Subd. 4.  [COMMISSION'S AUTHORITY TO RECOMMEND VARIANCES OF 
214.11  LICENSING STANDARDS.] The commission may recommend to the 
214.12  commissioners of human services and health variances from the 
214.13  standards governing licensure of programs for persons with 
214.14  developmental disabilities in order to improve the quality of 
214.15  services by implementing an alternative developmental 
214.16  disabilities licensing system if the commission determines that 
214.17  the alternative licensing system does not adversely affect the 
214.18  health or safety of persons being served by the licensed program 
214.19  nor compromise the qualifications of staff to provide services. 
214.20     Sec. 53.  Minnesota Statutes 2000, section 256B.0951, 
214.21  subdivision 5, is amended to read: 
214.22     Subd. 5.  [VARIANCE OF CERTAIN STANDARDS PROHIBITED.] The 
214.23  safety standards, rights, or procedural protections under 
214.24  sections 245.825; 245.91 to 245.97; 245A.04, subdivisions 3, 3a, 
214.25  3b, and 3c; 245A.09, subdivision 2, paragraph (c), clauses (2) 
214.26  and (5); 245A.12; 245A.13; 252.41, subdivision 9; 256B.092, 
214.27  subdivisions 1b, clause (7), and 10; 626.556; 626.557, and 
214.28  procedures for the monitoring of psychotropic medications shall 
214.29  not be varied under the alternative licensing system pilot 
214.30  project.  The commission may make recommendations to the 
214.31  commissioners of human services and health or to the legislature 
214.32  regarding alternatives to or modifications of the rules and 
214.33  procedures referenced in this subdivision. 
214.34     Sec. 54.  Minnesota Statutes 2000, section 256B.0951, 
214.35  subdivision 7, is amended to read: 
214.36     Subd. 7.  [WAIVER OF RULES.] The commissioner of health may 
215.1   exempt residents of intermediate care facilities for persons 
215.2   with mental retardation (ICFs/MR) who participate in the 
215.3   three-year quality assurance pilot project established in 
215.4   section 256B.095 from the requirements of Minnesota Rules, 
215.5   chapter 4665, upon approval by the federal government of a 
215.6   waiver of federal certification requirements for ICFs/MR.  The 
215.7   commissioners of health and human services shall apply for any 
215.8   necessary waivers as soon as practicable and shall submit the 
215.9   concept paper to the federal government by June 1, 1998.  
215.10     Sec. 55.  Minnesota Statutes 2000, section 256B.0951, is 
215.11  amended by adding a subdivision to read: 
215.12     Subd. 8.  [FEDERAL WAIVER.] The commissioner of human 
215.13  services shall seek federal authority to waive provisions of 
215.14  intermediate care facilities for persons with mental retardation 
215.15  (ICFs/MR) regulations to enable the demonstration and evaluation 
215.16  of the alternative quality assurance system for ICFs/MR under 
215.17  the project.  The commissioner of human services shall apply for 
215.18  any necessary waivers as soon as practicable. 
215.19     Sec. 56.  Minnesota Statutes 2000, section 256B.0951, is 
215.20  amended by adding a subdivision to read: 
215.21     Subd. 9.  [EVALUATION.] The commission, in consultation 
215.22  with the commissioner of human services, shall conduct an 
215.23  evaluation of the alternative quality assurance system, and 
215.24  present a report to the commissioner by June 30, 2004. 
215.25     Sec. 57.  Minnesota Statutes 2000, section 256B.0952, 
215.26  subdivision 1, is amended to read: 
215.27     Subdivision 1.  [NOTIFICATION.] By January 15, 1998, each 
215.28  affected county shall notify the commission and the 
215.29  commissioners of human services and health as to whether it 
215.30  chooses to implement on July 1, 1998, the alternative licensing 
215.31  system for the pilot project.  A county that does not implement 
215.32  the alternative licensing system on July 1, 1998, may give 
215.33  notice to the commission and the commissioners by January 15, 
215.34  1999, or January 15, 2000, that it will implement the 
215.35  alternative licensing system on the following July 1.  A county 
215.36  that implements the alternative licensing system commits to 
216.1   participate until June 30, 2001.  For each year of the project, 
216.2   region 10 counties shall give notice to the commission and 
216.3   commissioners of human services and health by March 15 of intent 
216.4   to join the quality assurance alternative licensing system, 
216.5   effective July 1 of that year.  A county choosing to participate 
216.6   in the alternative licensing system commits to participate until 
216.7   June 30, 2005.  Counties participating in the quality assurance 
216.8   alternative licensing system as of January 1, 2001, shall notify 
216.9   the commission and the commissioners of human services and 
216.10  health by March 15, 2001, of intent to continue participation.  
216.11  Counties that elect to continue participation must participate 
216.12  in the alternative licensing system until June 30, 2005. 
216.13     Sec. 58.  Minnesota Statutes 2000, section 256B.0952, 
216.14  subdivision 4, is amended to read: 
216.15     Subd. 4.  [APPOINTMENT OF QUALITY ASSURANCE MANAGER.] (a) A 
216.16  county or group of counties that chooses to participate in the 
216.17  alternative licensing system shall designate a quality assurance 
216.18  manager and shall establish quality assurance teams in 
216.19  accordance with subdivision 5.  The manager shall recruit, 
216.20  train, and assign duties to the quality assurance team members.  
216.21  In assigning team members to conduct the quality assurance 
216.22  process at a facility, program, or service, the manager shall 
216.23  take into account the size of the service provider, the number 
216.24  of services to be reviewed, the skills necessary for team 
216.25  members to complete the process, and other relevant factors.  
216.26  The manager shall ensure that no team member has a financial, 
216.27  personal, or family relationship with the facility, program, or 
216.28  service being reviewed or with any clients of the facility, 
216.29  program, or service. 
216.30     (b) Quality assurance teams shall report the findings of 
216.31  their quality assurance reviews to the quality assurance manager.
216.32  The quality assurance manager shall provide the report from the 
216.33  quality assurance team to the county and, upon request, to the 
216.34  commissioners of human services and health, and shall provide a 
216.35  summary of the report to the quality assurance review council.  
216.36     Sec. 59.  Minnesota Statutes 2000, section 256B.49, is 
217.1   amended by adding a subdivision to read: 
217.2      Subd. 11.  [AUTHORITY.] (a) The commissioner is authorized 
217.3   to apply for home and community-based service waivers, as 
217.4   authorized under section 1915(c) of the Social Security Act to 
217.5   serve persons under the age of 65 who are determined to require 
217.6   the level of care provided in a nursing home and persons who 
217.7   require the level of care provided in a hospital.  The 
217.8   commissioner shall apply for the home and community-based 
217.9   waivers in order to:  (i) promote the support of persons with 
217.10  disabilities in the most integrated settings; (ii) expand the 
217.11  availability of services for persons who are eligible for 
217.12  medical assistance; (iii) promote cost-effective options to 
217.13  institutional care; and (iv) obtain federal financial 
217.14  participation.  
217.15     (b) The provision of waivered services to medical 
217.16  assistance recipients with disabilities shall comply with the 
217.17  requirements outlined in the federally approved applications for 
217.18  home and community-based services and subsequent amendments, 
217.19  including provision of services according to a service plan 
217.20  designed to meet the needs of the individual.  For purposes of 
217.21  this section, the approved home and community-based application 
217.22  is considered the necessary federal requirement. 
217.23     (c) The commissioner shall provide interested persons 
217.24  serving on agency advisory committees and task forces, and 
217.25  others upon request, with notice of, and an opportunity to 
217.26  comment on, any changes or amendments to the federally approved 
217.27  applications for home and community-based waivers, prior to 
217.28  their submission to the federal health care financing 
217.29  administration. 
217.30     (d) The commissioner shall seek approval, as authorized 
217.31  under section 1915(c) of the Social Security Act, to allow 
217.32  medical assistance eligibility under this section for children 
217.33  under age 21 without deeming of parental income or assets. 
217.34     (e) The commissioner shall seek approval, as authorized 
217.35  under section 1915(c) of the Social Act, to allow medical 
217.36  assistance eligibility under this section for individuals under 
218.1   age 65 without deeming the spouse's income or assets. 
218.2      Sec. 60.  Minnesota Statutes 2000, section 256B.49, is 
218.3   amended by adding a subdivision to read: 
218.4      Subd. 12.  [INFORMED CHOICE.] Persons who are determined 
218.5   likely to require the level of care provided in a nursing 
218.6   facility or hospital shall be informed of the home and 
218.7   community-based support alternatives to the provision of 
218.8   inpatient hospital services or nursing facility services.  Each 
218.9   person must be given the choice of either institutional or home 
218.10  and community-based services, using the provisions described in 
218.11  section 256B.77, subdivision 2, paragraph (p). 
218.12     Sec. 61.  Minnesota Statutes 2000, section 256B.49, is 
218.13  amended by adding a subdivision to read: 
218.14     Subd. 13.  [CASE MANAGEMENT.] (a) Each recipient of a home 
218.15  and community-based waiver shall be provided case management 
218.16  services by qualified vendors as described in the federally 
218.17  approved waiver application.  The case management service 
218.18  activities provided will include: 
218.19     (1) assessing the needs of the individual within 20 working 
218.20  days of a recipient's request; 
218.21     (2) developing the written individual service plan within 
218.22  ten working days after the assessment is completed; 
218.23     (3) informing the recipient or the recipient's legal 
218.24  guardian or conservator of service options; 
218.25     (4) assisting the recipient in the identification of 
218.26  potential service providers; 
218.27     (5) assisting the recipient to access services; 
218.28     (6) coordinating, evaluating, and monitoring of the 
218.29  services identified in the service plan; 
218.30     (7) completing the annual reviews of the service plan; and 
218.31     (8) informing the recipient or legal representative of the 
218.32  right to have assessments completed and service plans developed 
218.33  within specified time periods, and to appeal county action or 
218.34  inaction under section 256.045, subdivision 3. 
218.35     (b) The case manager may delegate certain aspects of the 
218.36  case management service activities to another individual 
219.1   provided there is oversight by the case manager.  The case 
219.2   manager may not delegate those aspects which require 
219.3   professional judgment including assessments, reassessments, and 
219.4   care plan development. 
219.5      Sec. 62.  Minnesota Statutes 2000, section 256B.49, is 
219.6   amended by adding a subdivision to read: 
219.7      Subd. 14.  [ASSESSMENT AND REASSESSMENT.] (a) Assessments 
219.8   of each recipient's strengths, informal support systems, and 
219.9   need for services shall be completed within 20 working days of 
219.10  the recipient's request.  Reassessment of each recipient's 
219.11  strengths, support systems, and need for services shall be 
219.12  conducted at least every 12 months and at other times when there 
219.13  has been a significant change in the recipient's functioning. 
219.14     (b) Persons with mental retardation or a related condition 
219.15  who apply for services under the nursing facility level waiver 
219.16  programs shall be screened for the appropriate level of care 
219.17  according to section 256B.092. 
219.18     (c) Recipients who are found eligible for home and 
219.19  community-based services under this section before their 65th 
219.20  birthday may remain eligible for these services after their 65th 
219.21  birthday if they continue to meet all other eligibility factors. 
219.22     Sec. 63.  Minnesota Statutes 2000, section 256B.49, is 
219.23  amended by adding a subdivision to read: 
219.24     Subd. 15.  [INDIVIDUALIZED SERVICE PLAN.] Each recipient of 
219.25  home and community-based waivered services shall be provided a 
219.26  copy of the written service plan which: 
219.27     (1) is developed and signed by the recipient within ten 
219.28  working days of the completion of the assessment; 
219.29     (2) meets the assessed needs of the recipient; 
219.30     (3) reasonably ensures the health and safety of the 
219.31  recipient; 
219.32     (4) promotes independence; 
219.33     (5) allows for services to be provided in the most 
219.34  integrated settings; and 
219.35     (6) provides for an informed choice, as defined in section 
219.36  256B.77, subdivision 2, paragraph (p), of service and support 
220.1   providers. 
220.2      Sec. 64.  Minnesota Statutes 2000, section 256B.49, is 
220.3   amended by adding a subdivision to read: 
220.4      Subd. 16.  [SERVICES AND SUPPORTS.] (a) Services and 
220.5   supports included in the home and community-based waivers for 
220.6   persons with disabilities shall meet the requirements set out in 
220.7   United States Code, title 42, section 1396n.  The services and 
220.8   supports, which are offered as alternatives to institutional 
220.9   care, shall promote consumer choice, community inclusion, 
220.10  self-sufficiency, and self-determination. 
220.11     (b) Beginning January 1, 2003, the commissioner shall 
220.12  simplify and improve access to home and community-based waivered 
220.13  services, to the extent possible, through the establishment of a 
220.14  common service menu that is available to eligible recipients 
220.15  regardless of age, disability type, or waiver program. 
220.16     (c) Consumer directed community support services shall be 
220.17  offered as an option to all persons eligible for services under 
220.18  subdivision 11, by January 1, 2002. 
220.19     (d) Services and supports shall be arranged and provided 
220.20  consistent with individualized written plans of care for 
220.21  eligible waiver recipients. 
220.22     (e) The state of Minnesota and county agencies that 
220.23  administer home and community-based waivered services for 
220.24  persons with disabilities, shall not be liable for damages, 
220.25  injuries, or liabilities sustained through the purchase of 
220.26  supports by the individual, the individual's family, or the 
220.27  authorized representative with funds received through the 
220.28  consumer-directed community support service under this section.  
220.29  Liabilities include but are not limited to:  workers' 
220.30  compensation liability, the Federal Insurance Contributions Act 
220.31  (FICA), or the Federal Unemployment Tax Act (FUTA). 
220.32     Sec. 65.  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 July 1, 2001, 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. 
222.8      Sec. 66.  Minnesota Statutes 2000, section 256B.49, is 
222.9   amended by adding a subdivision to read: 
222.10     Subd. 18.  [PAYMENTS.] The commissioner shall reimburse 
222.11  approved vendors from the medical assistance account for the 
222.12  costs of providing home and community-based services to eligible 
222.13  recipients using the invoice processing procedures of the 
222.14  Medicaid management information system (MMIS).  Recipients will 
222.15  be screened and authorized for services according to the 
222.16  federally approved waiver application and its subsequent 
222.17  amendments. 
222.18     Sec. 67.  Minnesota Statutes 2000, section 256B.49, is 
222.19  amended by adding a subdivision to read: 
222.20     Subd. 19.  [HEALTH AND WELFARE.] The commissioner of human 
222.21  services shall take the necessary safeguards to protect the 
222.22  health and welfare of individuals provided services under the 
222.23  waiver. 
222.24     Sec. 68.  Minnesota Statutes 2000, section 256B.49, is 
222.25  amended by adding a subdivision to read: 
222.26     Subd. 20.  [TRAUMATIC BRAIN INJURY AND RELATED CONDITIONS.] 
222.27  The commissioner shall seek to amend the traumatic brain injury 
222.28  waiver to include, as eligible persons, individuals with an 
222.29  acquired or degenerative disease diagnosis where cognitive 
222.30  impairment is present, such as multiple sclerosis. 
222.31     Sec. 69.  Minnesota Statutes 2000, section 256B.69, 
222.32  subdivision 23, is amended to read: 
222.33     Subd. 23.  [ALTERNATIVE INTEGRATED LONG-TERM CARE SERVICES; 
222.34  ELDERLY AND DISABLED PERSONS.] (a) The commissioner may 
222.35  implement demonstration projects to create alternative 
222.36  integrated delivery systems for acute and long-term care 
223.1   services to elderly persons and persons with disabilities as 
223.2   defined in section 256B.77, subdivision 7a, that provide 
223.3   increased coordination, improve access to quality services, and 
223.4   mitigate future cost increases.  The commissioner may seek 
223.5   federal authority to combine Medicare and Medicaid capitation 
223.6   payments for the purpose of such demonstrations.  Medicare funds 
223.7   and services shall be administered according to the terms and 
223.8   conditions of the federal waiver and demonstration provisions.  
223.9   For the purpose of administering medical assistance funds, 
223.10  demonstrations under this subdivision are subject to 
223.11  subdivisions 1 to 22.  The provisions of Minnesota Rules, parts 
223.12  9500.1450 to 9500.1464, apply to these demonstrations, with the 
223.13  exceptions of parts 9500.1452, subpart 2, item B; and 9500.1457, 
223.14  subpart 1, items B and C, which do not apply to persons 
223.15  enrolling in demonstrations under this section.  An initial open 
223.16  enrollment period may be provided.  Persons who disenroll from 
223.17  demonstrations under this subdivision remain subject to 
223.18  Minnesota Rules, parts 9500.1450 to 9500.1464.  When a person is 
223.19  enrolled in a health plan under these demonstrations and the 
223.20  health plan's participation is subsequently terminated for any 
223.21  reason, the person shall be provided an opportunity to select a 
223.22  new health plan and shall have the right to change health plans 
223.23  within the first 60 days of enrollment in the second health 
223.24  plan.  Persons required to participate in health plans under 
223.25  this section who fail to make a choice of health plan shall not 
223.26  be randomly assigned to health plans under these demonstrations. 
223.27  Notwithstanding section 256L.12, subdivision 5, and Minnesota 
223.28  Rules, part 9505.5220, subpart 1, item A, if adopted, for the 
223.29  purpose of demonstrations under this subdivision, the 
223.30  commissioner may contract with managed care organizations, 
223.31  including counties, to serve only elderly persons eligible for 
223.32  medical assistance, elderly and disabled persons, or disabled 
223.33  persons only.  For persons with primary diagnoses of mental 
223.34  retardation or a related condition, serious and persistent 
223.35  mental illness, or serious emotional disturbance, the 
223.36  commissioner must ensure that the county authority has approved 
224.1   the demonstration and contracting design.  Enrollment in these 
224.2   projects for persons with disabilities shall be voluntary until 
224.3   July 1, 2001.  The commissioner shall not implement any 
224.4   demonstration project under this subdivision for persons with 
224.5   primary diagnoses of mental retardation or a related condition, 
224.6   serious and persistent mental illness, or serious emotional 
224.7   disturbance, without approval of the county board of the county 
224.8   in which the demonstration is being implemented. 
224.9      Before implementation of a demonstration project for 
224.10  disabled persons, the commissioner must provide information to 
224.11  appropriate committees of the house of representatives and 
224.12  senate and must involve representatives of affected disability 
224.13  groups in the design of the demonstration projects. 
224.14     (b) A nursing facility reimbursed under the alternative 
224.15  reimbursement methodology in section 256B.434 may, in 
224.16  collaboration with a hospital, clinic, or other health care 
224.17  entity provide services under paragraph (a).  The commissioner 
224.18  shall amend the state plan and seek any federal waivers 
224.19  necessary to implement this paragraph. 
224.20     Sec. 70.  Minnesota Statutes 2000, section 256D.35, is 
224.21  amended by adding a subdivision to read: 
224.22     Subd. 11a.  [INSTITUTION.] "Institution" means:  a 
224.23  hospital, consistent with Code of Federal Regulations, title 42, 
224.24  section 440.10; regional treatment center inpatient services; a 
224.25  nursing facility; and an intermediate care facility for persons 
224.26  with mental retardation. 
224.27     Sec. 71.  Minnesota Statutes 2000, section 256D.35, is 
224.28  amended by adding a subdivision to read: 
224.29     Subd. 18a.  [SHELTER COSTS.] "Shelter costs" means:  rent, 
224.30  manufactured home lot rentals; monthly principal, interest, 
224.31  insurance premiums, and property taxes due for mortgages or 
224.32  contract for deed costs; costs for utilities, including heating, 
224.33  cooling, electricity, water, and sewerage; garbage collection 
224.34  fees; and the basic service fee for one telephone. 
224.35     Sec. 72.  Minnesota Statutes 2000, section 256D.44, 
224.36  subdivision 5, is amended to read: 
225.1      Subd. 5.  [SPECIAL NEEDS.] In addition to the state 
225.2   standards of assistance established in subdivisions 1 to 4, 
225.3   payments are allowed for the following special needs of 
225.4   recipients of Minnesota supplemental aid who are not residents 
225.5   of a nursing home, a regional treatment center, or a group 
225.6   residential housing facility. 
225.7      (a) The county agency shall pay a monthly allowance for 
225.8   medically prescribed diets payable under the Minnesota family 
225.9   investment program if the cost of those additional dietary needs 
225.10  cannot be met through some other maintenance benefit.  
225.11     (b) Payment for nonrecurring special needs must be allowed 
225.12  for necessary home repairs or necessary repairs or replacement 
225.13  of household furniture and appliances using the payment standard 
225.14  of the AFDC program in effect on July 16, 1996, for these 
225.15  expenses, as long as other funding sources are not available.  
225.16     (c) A fee for guardian or conservator service is allowed at 
225.17  a reasonable rate negotiated by the county or approved by the 
225.18  court.  This rate shall not exceed five percent of the 
225.19  assistance unit's gross monthly income up to a maximum of $100 
225.20  per month.  If the guardian or conservator is a member of the 
225.21  county agency staff, no fee is allowed. 
225.22     (d) The county agency shall continue to pay a monthly 
225.23  allowance of $68 for restaurant meals for a person who was 
225.24  receiving a restaurant meal allowance on June 1, 1990, and who 
225.25  eats two or more meals in a restaurant daily.  The allowance 
225.26  must continue until the person has not received Minnesota 
225.27  supplemental aid for one full calendar month or until the 
225.28  person's living arrangement changes and the person no longer 
225.29  meets the criteria for the restaurant meal allowance, whichever 
225.30  occurs first. 
225.31     (e) A fee of ten percent of the recipient's gross income or 
225.32  $25, whichever is less, is allowed for representative payee 
225.33  services provided by an agency that meets the requirements under 
225.34  SSI regulations to charge a fee for representative payee 
225.35  services.  This special need is available to all recipients of 
225.36  Minnesota supplemental aid regardless of their living 
226.1   arrangement.  
226.2      (f) Notwithstanding the language in this subdivision, an 
226.3   amount equal to the maximum allotment authorized by the federal 
226.4   Food Stamp Program for a single individual which is in effect on 
226.5   the first day of January of the previous year will be added to 
226.6   the standards of assistance established in subdivisions 1 to 4 
226.7   for individuals under the age of 65 who are relocating from an 
226.8   institution and who are shelter needy.  An eligible individual 
226.9   who receives this benefit prior to age 65 may continue to 
226.10  receive the benefit after the age of 65. 
226.11     "Shelter needy" means that the assistance unit incurs 
226.12  monthly shelter costs that exceed 40 percent of the assistance 
226.13  unit's gross income before the application of this special needs 
226.14  standard.  "Gross income" for the purposes of this section is 
226.15  the applicant's or recipient's income as defined in section 
226.16  256D.35, subdivision 10, or the standard specified in 
226.17  subdivision 3, whichever is greater.  A recipient of a federal 
226.18  or state housing subsidy, that limits shelter costs to a 
226.19  percentage of gross income, shall not be considered shelter 
226.20  needy for purposes of this paragraph. 
226.21     Sec. 73.  Minnesota Statutes 2000, section 256I.05, 
226.22  subdivision 1e, is amended to read: 
226.23     Subd. 1e.  [SUPPLEMENTARY RATE FOR CERTAIN FACILITIES.] 
226.24  Notwithstanding the provisions of subdivisions 1a and 1c, 
226.25  beginning July 1, 1999 2001, a county agency shall negotiate a 
226.26  supplementary rate in addition to the rate specified in 
226.27  subdivision 1, equal to 25 125 percent of the amount specified 
226.28  in subdivision 1a, including any legislatively authorized 
226.29  inflationary adjustments, for a group residential housing 
226.30  provider that: 
226.31     (1) is located in Hennepin county and has had a group 
226.32  residential housing contract with the county since June 1996; 
226.33     (2) operates in three separate locations a 56-bed 71-bed 
226.34  facility, a and two 40-bed facility, and a 30-bed facility 
226.35  facilities; and 
226.36     (3) serves a chemically dependent clientele, providing 24 
227.1   hours per day supervision and limiting a resident's maximum 
227.2   length of stay to 13 months out of a consecutive 24-month period.
227.3      Sec. 74.  [256I.07] [RESPITE CARE PILOT PROJECT FOR FAMILY 
227.4   ADULT FOSTER CARE PROVIDERS.] 
227.5      Subdivision 1.  [PROGRAM ESTABLISHED.] The state recognizes 
227.6   the importance of developing and maintaining quality family 
227.7   foster care resources.  In order to accomplish that goal, the 
227.8   commissioner shall establish a two-year respite care pilot 
227.9   project for family adult foster care providers in three 
227.10  counties.  This pilot project is intended to provide support to 
227.11  caregivers of adult foster care residents.  The commissioner 
227.12  shall establish a pilot project to accomplish the provisions in 
227.13  subdivisions 2 to 4. 
227.14     Subd. 2.  [ELIGIBILITY.] A family adult foster care home 
227.15  provider as defined under section 144D.01, subdivision 7, who 
227.16  has been licensed for six months is eligible for 30 days of 
227.17  respite care per calendar year.  In cases of emergency, a county 
227.18  social services agency may waive the six-month licensing 
227.19  requirement.  In order to be eligible to receive respite payment 
227.20  from group residential housing and alternative care, a provider 
227.21  must take time off away from their foster care residents.  
227.22     Subd. 3.  [PAYMENT STRUCTURE.] (a) The payment for respite 
227.23  care for an adult foster care resident eligible for only group 
227.24  residential housing shall be based on the current monthly group 
227.25  residential housing base room and board rate and the current 
227.26  maximum monthly group residential housing difficulty of care 
227.27  rate. 
227.28     (b) The payment for respite care for an adult foster care 
227.29  resident eligible for alternative care funds shall be based on 
227.30  the resident's alternative care foster care rate. 
227.31     (c) The payment for respite care for an adult foster care 
227.32  resident eligible for Medicaid home and community-based services 
227.33  waiver funds shall be based on the group residential housing 
227.34  base room and board rate. 
227.35     (d) The total amount available to pay for respite care for 
227.36  a family adult foster care provider shall be based on the number 
228.1   of residents currently served in the foster care home and the 
228.2   source of funding used to pay for each resident's foster care.  
228.3   Respite care must be paid for on a per diem basis and for a full 
228.4   day. 
228.5      Subd. 4.  [PRIVATE PAY RESIDENTS.] Payment for respite care 
228.6   for private pay foster care residents must be arranged between 
228.7   the provider and the resident or the resident's family. 
228.8      Sec. 75.  Laws 1999, chapter 152, section 1, is amended to 
228.9   read: 
228.10     Section 1.  [TASK FORCE.] 
228.11     A day training and habilitation task force is established.  
228.12  Task force membership shall consist of representatives of the 
228.13  commissioner of human services, counties, service consumers, and 
228.14  vendors of day training and habilitation as defined in Minnesota 
228.15  Statutes, section 252.41, subdivision 9, including at least one 
228.16  representative from each association representing day training 
228.17  and habilitation vendors.  Appointments to the task force shall 
228.18  be made by the commissioner of human services and technical 
228.19  assistance shall be provided by the department of human services.
228.20     Sec. 76.  Laws 1999, chapter 152, section 4, is amended to 
228.21  read: 
228.22     Sec. 4.  [REPORT.] 
228.23     The task force shall present a report recommending a new 
228.24  payment rate structure to the legislature by January 15, 2000, 
228.25  and shall make recommendations to the commissioner of human 
228.26  services regarding the implementation of the pilot project for 
228.27  the individualized payment rate structure, so the pilot project 
228.28  can be implemented by July 1, 2002, as required in section 77.  
228.29  The task force expires on March 15, 2000 December 30, 2003. 
228.30     Sec. 77.  [DAY TRAINING AND HABILITATION PAYMENT STRUCTURE 
228.31  PILOT PROJECT.] 
228.32     Subdivision 1.  [INDIVIDUALIZED PAYMENT RATE 
228.33  STRUCTURE.] Notwithstanding Minnesota Statutes, sections 
228.34  252.451, subdivision 5; and 252.46; and Minnesota Rules, part 
228.35  9525.1290, subpart 1, items A and B, the commissioner of human 
228.36  services shall initiate a pilot project and phase-in for the 
229.1   individualized payment rate structure described in this section 
229.2   and section 78.  The pilot project shall include actual 
229.3   transfers of funds, not simulated transfers.  The pilot project 
229.4   may include all or some of the vendors in up to eight counties, 
229.5   with no more than two counties from the seven-county 
229.6   Minneapolis-St. Paul metropolitan area.  Following initiation of 
229.7   the pilot project, the commissioner shall phase in 
229.8   implementation of the individualized payment rate structure to 
229.9   the remaining counties and vendors according to the 
229.10  implementation plan developed by the task force.  The pilot and 
229.11  phase-in shall not extend over more than 18 months and shall be 
229.12  completed by December 31, 2003.  
229.13     Subd. 2.  [SUNSET.] The pilot project shall sunset upon 
229.14  implementation of a new statewide rate structure according to 
229.15  the implementation plan developed by the task force described in 
229.16  subdivision 3, in its report to the legislature on December 1, 
229.17  2001.  The rates of vendors participating in the pilot project 
229.18  must be modified to be consistent with the new statewide rate 
229.19  structure, as implemented. 
229.20     Subd. 3.  [TASK FORCE RESPONSIBILITIES.] The day training 
229.21  and habilitation task force established under Laws 1999, chapter 
229.22  152, section 4, shall evaluate the pilot project authorized 
229.23  under subdivision 1, and by December 1, 2001, shall report to 
229.24  the legislature with an implementation plan, which shall address 
229.25  how and when the pilot project individualized payment rate 
229.26  structure will be implemented statewide, shall ensure that 
229.27  vendors that wish to maintain their current per diem rate may do 
229.28  so within the new payment system, and shall identify criteria 
229.29  that would halt statewide implementation if vendors or clients 
229.30  were adversely affected by the new payment rate structure, and 
229.31  with recommendations for any amendments that should be made 
229.32  before statewide implementation.  These recommendations shall be 
229.33  made in a report to the chairs of the house health and human 
229.34  services policy and finance committees and the senate health and 
229.35  family security committee and finance division. 
229.36     Subd. 4.  [RATE SETTING.] (a) The rate structure under this 
230.1   section is intended to allow a county to authorize an individual 
230.2   rate for each client in the vendor's program based on the needs 
230.3   and expected outcomes of the individual client.  Rates shall be 
230.4   based on an authorized package of services for each individual 
230.5   over a typical time frame.  Rates may be established across 
230.6   multiple sites run by a single vendor. 
230.7      (b) With county concurrence, a vendor shall establish up to 
230.8   four levels of service, A through D, based on the intensity of 
230.9   services provided to an individual client of day training and 
230.10  habilitation services.  Service level A shall be the highest 
230.11  intensity of services, marked primarily, but not exclusively, by 
230.12  a one-to-one client-to-staff ratio.  Service level D shall be 
230.13  the lowest intensity of services.  The county shall document the 
230.14  vendor's description of the type and amount of services 
230.15  associated with each service level. 
230.16     (c) For each vendor, a county board shall establish a 
230.17  dollar value for one hour of service at each of the service 
230.18  levels defined in paragraph (b).  In establishing these values 
230.19  for existing vendors transitioning from the payment rate 
230.20  structure under Minnesota Statutes, section 252.46, subdivision 
230.21  1, the county board shall follow the formula and guidelines 
230.22  developed by the day training and habilitation task force under 
230.23  paragraph (e). 
230.24     (d) A vendor may elect to maintain a single transportation 
230.25  rate or may elect to establish up to five types of 
230.26  transportation services:  public transportation, public special 
230.27  transportation, nonambulatory transportation, out-of-service 
230.28  area transportation, and ambulatory transportation.  For vendors 
230.29  that elect to establish multiple transportation services, the 
230.30  county board shall establish a dollar value for a round trip on 
230.31  each type of transportation service offered through the vendor.  
230.32  With vendor concurrence, the county may also establish a uniform 
230.33  one-way trip value for some or all of the transportation service 
230.34  types. 
230.35     (e) The county board shall ensure that the vendor 
230.36  translates the vendor's existing program and transportation 
231.1   rates to the rates and values in the pilot project by using the 
231.2   conversion calculations for services and transportation approved 
231.3   by the day training and habilitation task force established 
231.4   under Laws 1999, chapter 152, and included in the task force's 
231.5   recommendations to the legislature.  The conversion calculation 
231.6   may be amended by the task force with the approval of the 
231.7   commissioner and any amendments shall become effective upon 
231.8   notification to the pilot project counties from the 
231.9   commissioner.  The calculation shall take the total 
231.10  reimbursement dollars available to the vendor and divide by the 
231.11  units of service expected at each service level and of each 
231.12  transportation type.  In determining the total reimbursement 
231.13  dollars available to a vendor, the vendor shall multiply the 
231.14  vendor's current per diem rate for both services and 
231.15  transportation, including any new rate increases, by the 
231.16  vendor's actual utilization for the year prior to implementation 
231.17  of the pilot project.  Vendors shall be allowed to allocate 
231.18  available reimbursement dollars between service and 
231.19  transportation before the vendor's service level and 
231.20  transportation values are calculated.  After translating its 
231.21  existing service and transportation rates to the service level 
231.22  and transportation values under the pilot, the vendor shall 
231.23  project its expected reimbursement income using the expected 
231.24  service and transportation packages for its existing clients, 
231.25  based on current service authorizations.  If the projected 
231.26  reimbursement income is less than the vendor would have received 
231.27  under the payment structure of Minnesota Statutes, section 
231.28  252.46, the vendor and the county, with the approval of the 
231.29  commissioner, shall adjust the vendor's service level and 
231.30  transportation values to eliminate the shortfall.  The 
231.31  commissioner shall report all adjustments to the day training 
231.32  and habilitation task force for consideration of possible 
231.33  modifications to the pilot project individualized payment rate 
231.34  structure.  
231.35     Subd. 5.  [INDIVIDUAL RATE AUTHORIZATION.] (a) As part of 
231.36  its annual authorization of services for each client under 
232.1   Minnesota Statutes, section 252.44, paragraph (a), clause (1), 
232.2   and Minnesota Rules, part 9525.0016, subpart 12, the county 
232.3   shall authorize and document a service package and a 
232.4   transportation package as follows: 
232.5      (1) the service package shall include the amount and type 
232.6   of services at each applicable service level to be provided to 
232.7   the client over a package period.  An individual client may 
232.8   receive services at multiple service levels over the course of 
232.9   the package period.  The service package rate shall be the sum 
232.10  of the amount of services at each level over the package period, 
232.11  multiplied by the dollar value for each service level; 
232.12     (2) the transportation package shall include the amount and 
232.13  type of transportation services to be provided to the client 
232.14  over the package period.  The transportation package rate shall 
232.15  be the sum of the amount of transportation services, multiplied 
232.16  by the dollar value associated with the type of transportation 
232.17  service authorized for the client; 
232.18     (3) the package period shall be established by the county, 
232.19  and may be one week, two weeks, or one month; and 
232.20     (4) the individual rate authorization may be reviewed and 
232.21  modified by the county at any time and must be reviewed and 
232.22  reauthorized by the county at least annually. 
232.23     (b) For vendors with rates established under this section, 
232.24  a service day under Minnesota Statutes, sections 245B.06 and 
232.25  252.44, includes any day in which a client receives any 
232.26  reimbursable service from a vendor or attends employment 
232.27  arranged by the vendor. 
232.28     Subd. 6.  [BILLING FOR SERVICES.] The vendor shall bill 
232.29  for, and shall be reimbursed for, the service package rate and 
232.30  transportation package rate for the package period as authorized 
232.31  by the county for each client in the vendor's program.  The 
232.32  length of the package period shall not affect the timing or 
232.33  frequency of vendors' submissions of claims for payment under 
232.34  the Medicaid Management Information System II (MMIS) or its 
232.35  successors. 
232.36     Subd. 7.  [NOTIFICATION OF CHANGE IN CLIENT NEEDS.] The 
233.1   vendor shall notify an individual client's case manager if the 
233.2   vendor has knowledge of a material change in the client's needs 
233.3   that may indicate a need for a change in service authorization.  
233.4   Factors that would require such notice include, but are not 
233.5   limited to, significant changes in medical status, residential 
233.6   placement, attendance patterns, behavioral needs, or skill 
233.7   functioning.  The vendor shall notify the case manager as soon 
233.8   as possible but no later than 30 calendar days after becoming 
233.9   aware of the change in needs.  The service authorization for the 
233.10  client shall not change until the county authorizes a new 
233.11  service and transportation package for the client in accordance 
233.12  with the provisions in Minnesota Statutes, section 256B.092. 
233.13     Sec. 78.  [COUNTY BOARD RESPONSIBILITIES.] 
233.14     For each vendor with rates established under section 77, 
233.15  the county board shall document the vendor's description of the 
233.16  type and amount of services associated with each service level, 
233.17  the vendor's service level values, the vendor's transportation 
233.18  values, and the package period that will be used to determine 
233.19  the rate for each individual client.  The county shall establish 
233.20  a package period of one week, two weeks, or one month. 
233.21     Sec. 79.  [STUDY OF DAY TRAINING AND HABILITATION VENDOR 
233.22  RATES.] 
233.23     The commissioner shall identify the vendors with the lowest 
233.24  rates or underfunded programs in the state and make 
233.25  recommendations to reconcile the discrepancies prior to the 
233.26  implementation of the individualized payment rate structure 
233.27  described in sections 77 and 78. 
233.28     Sec. 80.  [FEDERAL APPROVAL.] 
233.29     The commissioner shall seek any amendments to the state 
233.30  Medicaid plan and any waivers necessary to permit implementation 
233.31  of section 77 within the timelines specified. 
233.32     Sec. 81.  [SEMI-INDEPENDENT LIVING SERVICES (SILS) STUDY.] 
233.33     The commissioner of human services, in consultation with 
233.34  county representatives and other interested persons, shall 
233.35  develop recommendations revising the funding methodology for 
233.36  SILS as defined in Minnesota Statutes, section 252.275, 
234.1   subdivisions 3, 4, 4b, and 4c, and report by January 15, 2002, 
234.2   to the chair of the house of representatives health and human 
234.3   services finance committee and the chairs of the senate health, 
234.4   human services, and corrections budget division. 
234.5      Sec. 82.  [WAIVER REQUEST REGARDING SPOUSAL INCOME.] 
234.6      By September 1, 2001, the commissioner of human services 
234.7   shall seek federal approval to allow recipients of home and 
234.8   community-based waivers authorized under Minnesota Statutes, 
234.9   section 256B.49, to choose either a waiver of deeming of spousal 
234.10  income or the spousal impoverishment protections authorized 
234.11  under United States Code, title 42, section 1396r-5, with the 
234.12  addition of the group residential housing rate set according to 
234.13  Minnesota Statutes, section 256I.03, subdivision 5, to the 
234.14  personal needs allowance authorized by Minnesota Statutes, 
234.15  section 256B.0575. 
234.16     Sec. 83.  [PROGRAM OPTIONS FOR CERTAIN PERSONS WITH 
234.17  DEVELOPMENTAL DISABILITIES.] 
234.18     (a) The commissioner of human services shall ensure that 
234.19  services continue to be available to persons with developmental 
234.20  disabilities who were covered by social services supplemental 
234.21  grants prior to July 1, 2001.  Services shall be provided in 
234.22  priority order as follows: 
234.23     (1) to the extent possible, the commissioner shall 
234.24  establish for these persons targeted slots under the home and 
234.25  community-based waivered services program for persons with 
234.26  mental retardation or related conditions; 
234.27     (2) persons accommodated under clause (1) shall, if 
234.28  eligible, receive room and board services through group 
234.29  residential housing under Minnesota Statutes, chapter 256I; and 
234.30     (3) any remaining persons shall continue to receive 
234.31  services through community social services supplemental grants 
234.32  to the affected counties. 
234.33     (b) This section applies only to individuals receiving 
234.34  services under social services supplemental grants as of June 
234.35  30, 2001. 
234.36     Sec. 84.  [FEDERAL APPROVAL.] 
235.1      The commissioner of human services, by September 1, 2001, 
235.2   shall request any federal approval and plan amendments necessary 
235.3   to implement the choice of case manager provision in section 
235.4   256B.092, subdivision 2a, paragraph (b). 
235.5      Sec. 85.  [FEDERAL WAIVER REQUESTS.] 
235.6      The commissioner of human services shall submit to the 
235.7   federal Health Care Financing Administration by September 1, 
235.8   2001, a request for a home and community-based services waiver 
235.9   for day services, including:  community inclusion, supported 
235.10  employment, and day training and habilitation services defined 
235.11  in Minnesota Statutes, section 252.41, subdivision 3, clause 
235.12  (1), for persons eligible for the waiver under Minnesota 
235.13  Statutes, section 256B.092. 
235.14     Sec. 86. [REPEALER.] 
235.15     (a) Minnesota Statutes 2000, sections 256B.0951, 
235.16  subdivision 6; and 256E.06, subdivision 2b, are repealed. 
235.17     (b) Minnesota Statutes 2000, sections 145.9245; 256.476, 
235.18  subdivision 7; 256B.0912; 256B.0915, subdivisions 3a, 3b, and 
235.19  3c; and 256B.49, subdivisions 1, 2, 3, 4, 5, 6, 7, 8, 9, and 10, 
235.20  are repealed. 
235.21     (c) Laws 1995, chapter 178, article 2, section 48, 
235.22  subdivision 6, is repealed. 
235.23     (d) Minnesota Rules, parts 9505.2455; 9505.2458; 9505.2460; 
235.24  9505.2465; 9505.2470; 9505.2473; 9505.2475; 9505.2480; 
235.25  9505.2485; 9505.2486; 9505.2490; 9505.2495; 9505.2496; 
235.26  9505.2500; 9505.3010; 9505.3015; 9505.3020; 9505.3025; 
235.27  9505.3030; 9505.3035; 9505.3040; 9505.3065; 9505.3085; 
235.28  9505.3135; 9505.3500; 9505.3510; 9505.3520; 9505.3530; 
235.29  9505.3535; 9505.3540; 9505.3545; 9505.3550; 9505.3560; 
235.30  9505.3570; 9505.3575; 9505.3580; 9505.3585; 9505.3600; 
235.31  9505.3610; 9505.3620; 9505.3622; 9505.3624; 9505.3626; 
235.32  9505.3630; 9505.3635; 9505.3640; 9505.3645; 9505.3650; 
235.33  9505.3660; and 9505.3670, are repealed. 
235.34                             ARTICLE 4 
235.35                CONSUMER INFORMATION AND ASSISTANCE 
235.36                      AND COMMUNITY-BASED CARE 
236.1      Section 1.  [144A.35] [EXPANSION OF BED DISTRIBUTION STUDY 
236.2   AND CREATION OF CRITICAL ACCESS SITES.] 
236.3      Subdivision 1.  [OLDER ADULT SERVICES DISTRIBUTION 
236.4   STUDY.] The commissioner of health, in coordination with the 
236.5   commissioner of human services, shall monitor and analyze the 
236.6   distribution of older adult services, including, but not limited 
236.7   to, nursing home beds, senior housing, housing with services 
236.8   units, and home and community-based services in the different 
236.9   geographic areas of the state.  The study shall include an 
236.10  analysis of the impact of amendments to the nursing home 
236.11  moratorium law which would allow for transfers of nursing home 
236.12  beds within the state.  The commissioner of health shall submit 
236.13  to the legislature, beginning January 15, 2002, and each January 
236.14  15 thereafter, an assessment of the distribution of long-term 
236.15  health care services by geographic area, with particular 
236.16  attention to service deficits or problems, the designation of 
236.17  critical access service sites, and corrective action plans. 
236.18     Subd. 2.  [CRITICAL ACCESS SERVICE SITE.] "Critical access 
236.19  service site" shall include nursing homes, senior housing, 
236.20  housing with services, and home and community-based services 
236.21  that are certified by the state as necessary providers of health 
236.22  care services to a specific geographic area.  For purposes of 
236.23  this requirement, a "necessary provider of health care services" 
236.24  is a provider that is: 
236.25     (1) located more than 20 miles, defined as official mileage 
236.26  as reported by the Minnesota department of transportation, from 
236.27  the next nearest long-term health care provider; 
236.28     (2) the sole long-term health care provider in the county; 
236.29  or 
236.30     (3) a long-term health care provider located in a medically 
236.31  underserved area or health professional shortage area. 
236.32     Subd. 3.  [IDENTIFICATION OF CRITICAL ACCESS SERVICE 
236.33  SITES.] Based on the results of the analysis completed in 
236.34  subdivision 1, the commissioners of health and human services 
236.35  shall identify and designate long-term health care providers as 
236.36  critical access service sites. 
237.1      Subd. 4.  [CRITICAL ACCESS SERVICE SITES.] The commissioner 
237.2   of health, in consultation with the commissioner of human 
237.3   services, shall: 
237.4      (1) develop and implement specific waivers to regulations 
237.5   governing health care personnel scope of duties, physical plant 
237.6   requirements, and location of community-based services, to 
237.7   address critical access service site older adult service needs; 
237.8      (2) identify payment barriers to the continued operation of 
237.9   older adult services in critical access service sites, and 
237.10  provide recommendations on changes to reimbursement rates to 
237.11  facilitate the continued operation of these services. 
237.12     Sec. 2.  Minnesota Statutes 2000, section 256.973, is 
237.13  amended by adding a subdivision to read: 
237.14     Subd. 6.  [GRANTS FOR HOME-SHARING PROGRAMS.] Grants 
237.15  awarded for home-sharing programs under this section shall be 
237.16  awarded through a request for proposals process every two years 
237.17  according to criteria developed by the commissioner.  In 
237.18  awarding grants, the commissioner shall not give priority to an 
237.19  applicant solely because the applicant has previously received a 
237.20  grant under this section.  Nothing under this subdivision shall 
237.21  prohibit the commissioner from evaluating the performance of a 
237.22  home-sharing program receiving a grant under this section and 
237.23  allocating funds based on the evaluation. 
237.24     Sec. 3.  Minnesota Statutes 2000, section 256.975, is 
237.25  amended by adding a subdivision to read: 
237.26     Subd. 7.  [CONSUMER INFORMATION AND ASSISTANCE; SENIOR 
237.27  LINKAGE.] (a) The Minnesota board on aging shall operate a 
237.28  statewide information and assistance service to aid older 
237.29  Minnesotans and their families in making informed choices about 
237.30  long-term care options and health care benefits.  Language 
237.31  services to persons with limited English language skills may be 
237.32  made available.  The service, known as Senior LinkAge Line, must 
237.33  be available during business hours through a statewide toll-free 
237.34  number and must also be available through the Internet. 
237.35     (b) The service must assist older adults, caregivers, and 
237.36  providers in accessing information about choices in long-term 
238.1   care services that are purchased through private providers or 
238.2   available through public options.  The service must: 
238.3      (1) develop a comprehensive database that includes detailed 
238.4   listings in both consumer- and provider-oriented formats; 
238.5      (2) make the database accessible on the Internet and 
238.6   through other telecommunication and media-related tools; 
238.7      (3) link callers to interactive long-term care screening 
238.8   tools and make these tools available through the Internet by 
238.9   integrating the tools with the database; 
238.10     (4) develop community education materials with a focus on 
238.11  planning for long-term care and evaluating independent living, 
238.12  housing, and service options; 
238.13     (5) conduct an outreach campaign to assist older adults and 
238.14  their caregivers in finding information on the Internet and 
238.15  through other means of communication; 
238.16     (6) implement a messaging system for overflow callers and 
238.17  respond to these callers by the next business day; 
238.18     (7) link callers with county human services and other 
238.19  providers to receive more in-depth assistance and consultation 
238.20  related to long-term care options; and 
238.21     (8) link callers with quality profiles for nursing 
238.22  facilities and other providers developed by the commissioner of 
238.23  health. 
238.24     (c) The Minnesota board on aging shall conduct an 
238.25  evaluation of the effectiveness of the statewide information and 
238.26  assistance, and submit this evaluation to the legislature by 
238.27  December 1, 2002.  The evaluation must include an analysis of 
238.28  funding adequacy, gaps in service delivery, continuity in 
238.29  information between the service and identified linkages, and 
238.30  potential use of private funding to enhance the service. 
238.31     Sec. 4.  [256.9754] [COMMUNITY SERVICES DEVELOPMENT GRANTS 
238.32  PROGRAM.] 
238.33     Subdivision 1.  [DEFINITIONS.] For purposes of this 
238.34  section, the following terms have the meanings given. 
238.35     (a) "Community" means a town, township, city, or targeted 
238.36  neighborhood within a city, or a consortium of towns, townships, 
239.1   cities, or targeted neighborhoods within cities. 
239.2      (b) "Older adult services" means any services available 
239.3   under the elderly waiver program or alternative care grant 
239.4   programs; nursing facility services; transportation services; 
239.5   respite services; and other community-based services identified 
239.6   as necessary either to maintain lifestyle choices for older 
239.7   Minnesotans, or to promote independence. 
239.8      (c) "Older adult" refers to individuals 65 years of age and 
239.9   older. 
239.10     Subd. 2.  [CREATION.] The community services development 
239.11  grants program is created under the administration of the 
239.12  commissioner of human services.  
239.13     Subd. 3.  [PROVISION OF GRANTS.] The commissioner shall 
239.14  make grants available to communities, providers of older adult 
239.15  services identified in subdivision 1, or to a consortium of 
239.16  providers of older adult services, to establish older adult 
239.17  services.  Grants may be provided for capital and other costs 
239.18  including, but not limited to, start-up and training costs, 
239.19  equipment, and supplies related to older adult services or other 
239.20  residential or service alternatives to nursing facility care.  
239.21  Grants may also be made to renovate current buildings, provide 
239.22  transportation services, fund programs that would allow older 
239.23  adults or disabled individuals to stay in their own homes by 
239.24  sharing a home, fund programs that coordinate and manage formal 
239.25  and informal services to older adults in their homes to enable 
239.26  them to live as independently as possible in their own homes as 
239.27  an alternative to nursing home care, or expand state-funded 
239.28  programs in the area. 
239.29     Subd. 4.  [ELIGIBILITY.] Grants may be awarded only to 
239.30  communities and providers or to a consortium of providers that 
239.31  have a local match of 50 percent of the costs for the project in 
239.32  the form of donations, local tax dollars, in-kind donations, 
239.33  fundraising, or other local matches. 
239.34     Subd. 5.  [GRANT PREFERENCE.] The commissioner of human 
239.35  services may award grants to the extent grant funds are 
239.36  available and to the extent applications are approved by the 
240.1   commissioner.  Denial of approval of an application in one year 
240.2   does not preclude submission of an application in a subsequent 
240.3   year.  The maximum grant amount is limited to $750,000. 
240.4      Sec. 5.  Minnesota Statutes 2000, section 256B.0911, 
240.5   subdivision 1, is amended to read: 
240.6      Subdivision 1.  [PURPOSE AND GOAL.] (a) The purpose of the 
240.7   preadmission screening program long-term care consultation 
240.8   services is to assist persons with long-term or chronic care 
240.9   needs in making long-term care decisions and selecting options 
240.10  that meet their needs and reflect their preferences.  The 
240.11  availability of, and access to, information and other types of 
240.12  assistance is also intended to prevent or delay certified 
240.13  nursing facility placements by assessing applicants and 
240.14  residents and offering cost-effective alternatives appropriate 
240.15  for the person's needs and to provide transition assistance 
240.16  after admission.  Further, the goal of the program these 
240.17  services is to contain costs associated with unnecessary 
240.18  certified nursing facility admissions.  The commissioners of 
240.19  human services and health shall seek to maximize use of 
240.20  available federal and state funds and establish the broadest 
240.21  program possible within the funding available. 
240.22     (b) These services must be coordinated with services 
240.23  provided under sections 256.975, subdivision 7, and 256.9772, 
240.24  and with services provided by other public and private agencies 
240.25  in the community to offer a variety of cost-effective 
240.26  alternatives to persons with disabilities and elderly persons.  
240.27  The county agency providing long-term care consultation services 
240.28  shall encourage the use of volunteers from families, religious 
240.29  organizations, social clubs, and similar civic and service 
240.30  organizations to provide community-based services. 
240.31     Sec. 6.  Minnesota Statutes 2000, section 256B.0911, is 
240.32  amended by adding a subdivision to read: 
240.33     Subd. 1a.  [DEFINITIONS.] For purposes of this section, the 
240.34  following definitions apply: 
240.35     (a) "Long-term care consultation services" means: 
240.36     (1) providing information and education to the general 
241.1   public regarding availability of the services authorized under 
241.2   this section; 
241.3      (2) an intake process that provides access to the services 
241.4   described in this section; 
241.5      (3) assessment of the health, psychological, and social 
241.6   needs of referred individuals; 
241.7      (4) assistance in identifying services needed to maintain 
241.8   an individual in the least restrictive environment; 
241.9      (5) providing recommendations on cost-effective community 
241.10  services that are available to the individual; 
241.11     (6) development of an individual's community support plan; 
241.12     (7) providing information regarding eligibility for 
241.13  Minnesota health care programs; 
241.14     (8) preadmission screening to determine the need for a 
241.15  nursing facility level of care; 
241.16     (9) preliminary determination of Minnesota health care 
241.17  programs eligibility for individuals who need a nursing facility 
241.18  level of care, with appropriate referrals for final 
241.19  determination; 
241.20     (10) providing recommendations for nursing facility 
241.21  placement when there are no cost-effective community services 
241.22  available; and 
241.23     (11) assistance to transition people back to community 
241.24  settings after facility admission. 
241.25     (b) "Minnesota health care programs" means the medical 
241.26  assistance program under chapter 256B, the alternative care 
241.27  program under section 256B.0913, and the prescription drug 
241.28  program under section 256.955. 
241.29     Sec. 7.  Minnesota Statutes 2000, section 256B.0911, 
241.30  subdivision 3, is amended to read: 
241.31     Subd. 3.  [PERSONS RESPONSIBLE FOR CONDUCTING THE 
241.32  PREADMISSION SCREENING LONG-TERM CARE CONSULTATION TEAM.] (a) A 
241.33  local screening long-term care consultation team shall be 
241.34  established by the county board of commissioners.  Each local 
241.35  screening consultation team shall consist of screeners who are a 
241.36  at least one social worker and a at least one public health 
242.1   nurse from their respective county agencies.  The board may 
242.2   designate public health or social services as the lead agency 
242.3   for long-term care consultation services.  If a county does not 
242.4   have a public health nurse available, it may request approval 
242.5   from the commissioner to assign a county registered nurse with 
242.6   at least one year experience in home care to participate on the 
242.7   team.  The screening team members must confer regarding the most 
242.8   appropriate care for each individual screened.  Two or more 
242.9   counties may collaborate to establish a joint local screening 
242.10  consultation team or teams. 
242.11     (b) In assessing a person's needs, screeners shall have a 
242.12  physician available for consultation and shall consider the 
242.13  assessment of the individual's attending physician, if any.  The 
242.14  individual's physician shall be included if the physician 
242.15  chooses to participate.  Other personnel may be included on the 
242.16  team as deemed appropriate by the county agencies.  The team is 
242.17  responsible for providing long-term care consultation services 
242.18  to all persons located in the county who request the services, 
242.19  regardless of eligibility for Minnesota health care programs. 
242.20     Sec. 8.  Minnesota Statutes 2000, section 256B.0911, is 
242.21  amended by adding a subdivision to read: 
242.22     Subd. 3a.  [ASSESSMENT AND SUPPORT PLANNING.] (a) Persons 
242.23  requesting assessment, services planning, or other assistance 
242.24  intended to support community-based living must be visited by a 
242.25  long-term care consultation team within ten working days after 
242.26  the date on which an assessment was requested or recommended.  
242.27  Assessments must be conducted according to paragraphs (b) to (g).
242.28     (b) The county may utilize a team of either the social 
242.29  worker or public health nurse, or both, to conduct the 
242.30  assessment in a face-to-face interview.  The consultation team 
242.31  members must confer regarding the most appropriate care for each 
242.32  individual screened or assessed. 
242.33     (c) The long-term care consultation team must assess the 
242.34  health and social needs of the person, using an assessment form 
242.35  provided by the commissioner of human services. 
242.36     (d) The team must conduct the assessment in a face-to-face 
243.1   interview with the person being assessed and the person's legal 
243.2   representative, if applicable. 
243.3      (e) The team must provide the person, or the person's legal 
243.4   representative, with written recommendations for facility- or 
243.5   community-based services.  The team must document that the most 
243.6   cost-effective alternatives available were offered to the 
243.7   individual.  For purposes of this requirement, "cost-effective 
243.8   alternatives" means community services and living arrangements 
243.9   that cost the same as or less than nursing facility care. 
243.10     (f) If the person chooses to use community-based services, 
243.11  the team must provide the person or the person's legal 
243.12  representative with a written community support plan, regardless 
243.13  of whether the individual is eligible for Minnesota health care 
243.14  programs.  The person may request assistance in developing a 
243.15  community support plan without participating in a complete 
243.16  assessment. 
243.17     (g) The team must give the person receiving assessment or 
243.18  support planning, or the person's legal representative, 
243.19  materials supplied by the commissioner of human services 
243.20  containing the following information: 
243.21     (1) the purpose of preadmission screening and assessment; 
243.22     (2) information about Minnesota health care programs; 
243.23     (3) the person's freedom to accept or reject the 
243.24  recommendations of the team; 
243.25     (4) the person's right to confidentiality under the 
243.26  Minnesota Government Data Practices Act, chapter 13; and 
243.27     (5) the person's right to appeal the decision regarding the 
243.28  need for nursing facility level of care or the county's final 
243.29  decisions regarding public programs eligibility according to 
243.30  section 256.045, subdivision 3. 
243.31     Sec. 9.  Minnesota Statutes 2000, section 256B.0911, is 
243.32  amended by adding a subdivision to read: 
243.33     Subd. 3b.  [TRANSITION ASSISTANCE.] (a) A long-term care 
243.34  consultation team shall provide assistance to persons residing 
243.35  in a nursing facility, hospital, regional treatment center, or 
243.36  intermediate care facility for persons with mental retardation 
244.1   who request or are referred for such assistance.  Transition 
244.2   assistance must include assessment, community support plan 
244.3   development, referrals to Minnesota health care programs, and 
244.4   referrals to programs that provide assistance with housing. 
244.5      (b) The county shall develop transition processes with 
244.6   institutional social workers and discharge planners to ensure 
244.7   that: 
244.8      (1) persons admitted to facilities receive information 
244.9   about transition assistance that is available; 
244.10     (2) the assessment is completed for persons within ten 
244.11  working days of the date of request or recommendation for 
244.12  assessment; and 
244.13     (3) there is a plan for transition and follow-up for the 
244.14  individual's return to the community.  The plan must require 
244.15  notification of other local agencies when a person who may 
244.16  require assistance is screened by one county for admission to a 
244.17  facility located in another county. 
244.18     (c) If a person who is eligible for a Minnesota health care 
244.19  program is admitted to a nursing facility, the nursing facility 
244.20  must include a consultation team member or the case manager in 
244.21  the discharge planning process. 
244.22     Sec. 10.  Minnesota Statutes 2000, section 256B.0911, is 
244.23  amended by adding a subdivision to read: 
244.24     Subd. 4a.  [PREADMISSION SCREENING ACTIVITIES RELATED TO 
244.25  NURSING FACILITY ADMISSIONS.] (a) All applicants to Medicaid 
244.26  certified nursing facilities, including certified boarding care 
244.27  facilities, must be screened prior to admission regardless of 
244.28  income, assets, or funding sources for nursing facility care, 
244.29  except as described in subdivision 4b.  The purpose of the 
244.30  screening is to determine the need for nursing facility level of 
244.31  care as described in paragraph (d) and to complete activities 
244.32  required under federal law related to mental illness and mental 
244.33  retardation as outlined in paragraph (b). 
244.34     (b) A person who has a diagnosis or possible diagnosis of 
244.35  mental illness, mental retardation, or a related condition must 
244.36  receive a preadmission screening before admission regardless of 
245.1   the exemptions outlined in subdivision 4b, paragraph (b), to 
245.2   identify the need for further evaluation and specialized 
245.3   services, unless the admission prior to screening is authorized 
245.4   by the local mental health authority or the local developmental 
245.5   disabilities case manager, or unless authorized by the county 
245.6   agency according to Public Law Number 101-508.  
245.7      The following criteria apply to the preadmission screening: 
245.8      (1) the county must use forms and criteria developed by the 
245.9   commissioner of human services to identify persons who require 
245.10  referral for further evaluation and determination of the need 
245.11  for specialized services; and 
245.12     (2) the evaluation and determination of the need for 
245.13  specialized services must be done by: 
245.14     (i) a qualified independent mental health professional, for 
245.15  persons with a primary or secondary diagnosis of a serious 
245.16  mental illness; or 
245.17     (ii) a qualified mental retardation professional, for 
245.18  persons with a primary or secondary diagnosis of mental 
245.19  retardation or related conditions.  For purposes of this 
245.20  requirement, a qualified mental retardation professional must 
245.21  meet the standards for a qualified mental retardation 
245.22  professional under Code of Federal Regulations, title 42, 
245.23  section 483.430. 
245.24     (c) The local county mental health authority or the state 
245.25  mental retardation authority under Public Laws Numbers 100-203 
245.26  and 101-508 may prohibit admission to a nursing facility if the 
245.27  individual does not meet the nursing facility level of care 
245.28  criteria or needs specialized services as defined in Public Laws 
245.29  Numbers 100-203 and 101-508.  For purposes of this section, 
245.30  "specialized services" for a person with mental retardation or a 
245.31  related condition means active treatment as that term is defined 
245.32  under Code of Federal Regulations, title 42, section 483.440, 
245.33  paragraph (a), clause (1). 
245.34     (d) The determination of the need for nursing facility 
245.35  level of care must be made according to criteria developed by 
245.36  the commissioner of human services.  In assessing a person's 
246.1   needs, consultation team members shall have a physician 
246.2   available for consultation and shall consider the assessment of 
246.3   the individual's attending physician, if any.  The individual's 
246.4   physician must be included if the physician chooses to 
246.5   participate.  Other personnel may be included on the team as 
246.6   deemed appropriate by the county. 
246.7      Sec. 11.  Minnesota Statutes 2000, section 256B.0911, is 
246.8   amended by adding a subdivision to read: 
246.9      Subd. 4b.  [EXEMPTIONS AND EMERGENCY ADMISSIONS.] (a) 
246.10  Exemptions from the federal screening requirements outlined in 
246.11  subdivision 4a, paragraphs (b) and (c), are limited to: 
246.12     (1) a person who, having entered an acute care facility 
246.13  from a certified nursing facility, is returning to a certified 
246.14  nursing facility; and 
246.15     (2) a person transferring from one certified nursing 
246.16  facility in Minnesota to another certified nursing facility in 
246.17  Minnesota. 
246.18     (b) Persons who are exempt from preadmission screening for 
246.19  purposes of level of care determination include: 
246.20     (1) persons described in paragraph (a); 
246.21     (2) an individual who has a contractual right to have 
246.22  nursing facility care paid for indefinitely by the veterans' 
246.23  administration; 
246.24     (3) an individual enrolled in a demonstration project under 
246.25  section 256B.69, subdivision 8, at the time of application to a 
246.26  nursing facility; 
246.27     (4) an individual currently being served under the 
246.28  alternative care program or under a home and community-based 
246.29  services waiver authorized under section 1915(c) of the federal 
246.30  Social Security Act; and 
246.31     (5) individuals admitted to a certified nursing facility 
246.32  for a short-term stay, which is expected to be 14 days or less 
246.33  in duration based upon a physician's certification, and who have 
246.34  been assessed and approved for nursing facility admission within 
246.35  the previous six months.  This exemption applies only if the 
246.36  consultation team member determines at the time of the initial 
247.1   assessment of the six-month period that it is appropriate to use 
247.2   the nursing facility for short-term stays and that there is an 
247.3   adequate plan of care for return to the home or community-based 
247.4   setting.  If a stay exceeds 14 days, the individual must be 
247.5   referred no later than the first county working day following 
247.6   the 14th resident day for a screening, which must be completed 
247.7   within five working days of the referral.  The payment 
247.8   limitations in subdivision 7 apply to an individual found at 
247.9   screening to not meet the level of care criteria for admission 
247.10  to a certified nursing facility. 
247.11     (c) Persons admitted to a Medicaid-certified nursing 
247.12  facility from the community on an emergency basis as described 
247.13  in paragraph (d) or from an acute care facility on a nonworking 
247.14  day must be screened the first working day after admission. 
247.15     (d) Emergency admission to a nursing facility prior to 
247.16  screening is permitted when all of the following conditions are 
247.17  met: 
247.18     (1) a person is admitted from the community to a certified 
247.19  nursing or certified boarding care facility during county 
247.20  nonworking hours; 
247.21     (2) a physician has determined that delaying admission 
247.22  until preadmission screening is completed would adversely affect 
247.23  the person's health and safety; 
247.24     (3) there is a recent precipitating event that precludes 
247.25  the client from living safely in the community, such as 
247.26  sustaining an injury, sudden onset of acute illness, or a 
247.27  caregiver's inability to continue to provide care; 
247.28     (4) the attending physician has authorized the emergency 
247.29  placement and has documented the reason that the emergency 
247.30  placement is recommended; and 
247.31     (5) the county is contacted on the first working day 
247.32  following the emergency admission. 
247.33  Transfer of a patient from an acute care hospital to a nursing 
247.34  facility is not considered an emergency except for a person who 
247.35  has received hospital services in the following situations: 
247.36  hospital admission for observation, care in an emergency room 
248.1   without hospital admission, or following hospital 24-hour bed 
248.2   care. 
248.3      Sec. 12.  Minnesota Statutes 2000, section 256B.0911, is 
248.4   amended by adding a subdivision to read: 
248.5      Subd. 4c.  [SCREENING REQUIREMENTS.] (a) A person may be 
248.6   screened for nursing facility admission by telephone or in a 
248.7   face-to-face screening interview.  Consultation team members 
248.8   shall identify each individual's needs using the following 
248.9   categories: 
248.10     (1) the person needs no face-to-face screening interview to 
248.11  determine the need for nursing facility level of care based on 
248.12  information obtained from other health care professionals; 
248.13     (2) the person needs an immediate face-to-face screening 
248.14  interview to determine the need for nursing facility level of 
248.15  care and complete activities required under subdivision 4a; or 
248.16     (3) the person may be exempt from screening requirements as 
248.17  outlined in subdivision 4b, but will need transitional 
248.18  assistance after admission or in-person follow-along after a 
248.19  return home. 
248.20     (b) Persons admitted on a nonemergency basis to a 
248.21  Medicaid-certified nursing facility must be screened prior to 
248.22  admission. 
248.23     (c) The long-term care consultation team shall recommend a 
248.24  case mix classification for persons admitted to a certified 
248.25  nursing facility when sufficient information is received to make 
248.26  that classification.  The nursing facility is authorized to 
248.27  conduct all case mix assessments for persons who have been 
248.28  screened prior to admission for whom the county did not 
248.29  recommend a case mix classification.  The nursing facility is 
248.30  authorized to conduct all case mix assessments for persons 
248.31  admitted to the facility prior to a preadmission screening.  The 
248.32  county retains the responsibility of distributing appropriate 
248.33  case mix forms to the nursing facility. 
248.34     (d) The county screening or intake activity must include 
248.35  processes to identify persons who may require transition 
248.36  assistance as described in subdivision 3b. 
249.1      Sec. 13.  Minnesota Statutes 2000, section 256B.0911, 
249.2   subdivision 5, is amended to read: 
249.3      Subd. 5.  [SIMPLIFICATION OF FORMS ADMINISTRATIVE 
249.4   ACTIVITY.] The commissioner shall minimize the number of forms 
249.5   required in the preadmission screening process provision of 
249.6   long-term care consultation services and shall limit the 
249.7   screening document to items necessary for care community support 
249.8   plan approval, reimbursement, program planning, evaluation, and 
249.9   policy development. 
249.10     Sec. 14.  Minnesota Statutes 2000, section 256B.0911, 
249.11  subdivision 6, is amended to read: 
249.12     Subd. 6.  [PAYMENT FOR PREADMISSION SCREENING LONG-TERM 
249.13  CARE CONSULTATION SERVICES.] (a) The total screening payment for 
249.14  each county must be paid monthly by certified nursing facilities 
249.15  in the county.  The monthly amount to be paid by each nursing 
249.16  facility for each fiscal year must be determined by dividing the 
249.17  county's annual allocation for screenings long-term care 
249.18  consultation services by 12 to determine the monthly payment and 
249.19  allocating the monthly payment to each nursing facility based on 
249.20  the number of licensed beds in the nursing facility.  Payments 
249.21  to counties in which there is no certified nursing facility must 
249.22  be made by increasing the payment rate of the two facilities 
249.23  located nearest to the county seat. 
249.24     (b) The commissioner shall include the total annual payment 
249.25  for screening determined under paragraph (a) for each nursing 
249.26  facility according to section 256B.431, subdivision 2b, 
249.27  paragraph (g), 256B.434, or 256B.435. 
249.28     (c) Payments for screening activities long-term care 
249.29  consultation services are available to the county or counties to 
249.30  cover staff salaries and expenses to provide the screening 
249.31  function services described in subdivision 1a.  The lead agency 
249.32  county shall employ, or contract with other agencies to employ, 
249.33  within the limits of available funding, sufficient personnel 
249.34  to conduct the preadmission screening activity provide long-term 
249.35  care consultation services while meeting the state's long-term 
249.36  care outcomes and objectives as defined in section 256B.0917, 
250.1   subdivision 1.  The local agency county shall be accountable for 
250.2   meeting local objectives as approved by the commissioner in the 
250.3   CSSA biennial plan. 
250.4      (d) Notwithstanding section 256B.0641, overpayments 
250.5   attributable to payment of the screening costs under the medical 
250.6   assistance program may not be recovered from a facility.  
250.7      (e) The commissioner of human services shall amend the 
250.8   Minnesota medical assistance plan to include reimbursement for 
250.9   the local screening consultation teams. 
250.10     (f) The county may bill, as case management services, 
250.11  assessments, support planning, and follow-along provided to 
250.12  persons determined to be eligible for case management under 
250.13  Minnesota health care programs.  No individual or family member 
250.14  shall be charged for an initial assessment or initial support 
250.15  plan development provided under subdivision 3a or 3b. 
250.16     Sec. 15.  Minnesota Statutes 2000, section 256B.0911, 
250.17  subdivision 7, is amended to read: 
250.18     Subd. 7.  [REIMBURSEMENT FOR CERTIFIED NURSING FACILITIES.] 
250.19  (a) Medical assistance reimbursement for nursing facilities 
250.20  shall be authorized for a medical assistance recipient only if a 
250.21  preadmission screening has been conducted prior to admission or 
250.22  the local county agency has authorized an exemption.  Medical 
250.23  assistance reimbursement for nursing facilities shall not be 
250.24  provided for any recipient who the local screener has determined 
250.25  does not meet the level of care criteria for nursing facility 
250.26  placement or, if indicated, has not had a level II PASARR OBRA 
250.27  evaluation as required under the federal Omnibus Reconciliation 
250.28  Act of 1987 completed unless an admission for a recipient with 
250.29  mental illness is approved by the local mental health authority 
250.30  or an admission for a recipient with mental retardation or 
250.31  related condition is approved by the state mental retardation 
250.32  authority. 
250.33     (b) The nursing facility must not bill a person who is not 
250.34  a medical assistance recipient for resident days that preceded 
250.35  the date of completion of screening activities as required under 
250.36  subdivisions 4a, 4b, and 4c.  The nursing facility must include 
251.1   unreimbursed resident days in the nursing facility resident day 
251.2   totals reported to the commissioner. 
251.3      (c) The commissioner shall make a request to the health 
251.4   care financing administration for a waiver allowing screening 
251.5   team approval of Medicaid payments for certified nursing 
251.6   facility care.  An individual has a choice and makes the final 
251.7   decision between nursing facility placement and community 
251.8   placement after the screening team's recommendation, except as 
251.9   provided in paragraphs (b) and (c) subdivision 4a, paragraph (c).
251.10     (c) The local county mental health authority or the state 
251.11  mental retardation authority under Public Law Numbers 100-203 
251.12  and 101-508 may prohibit admission to a nursing facility, if the 
251.13  individual does not meet the nursing facility level of care 
251.14  criteria or needs specialized services as defined in Public Law 
251.15  Numbers 100-203 and 101-508.  For purposes of this section, 
251.16  "specialized services" for a person with mental retardation or a 
251.17  related condition means "active treatment" as that term is 
251.18  defined in Code of Federal Regulations, title 42, section 
251.19  483.440(a)(1). 
251.20     (e) Appeals from the screening team's recommendation or the 
251.21  county agency's final decision shall be made according to 
251.22  section 256.045, subdivision 3. 
251.23     Sec. 16.  Minnesota Statutes 2000, section 256B.0913, 
251.24  subdivision 1, is amended to read: 
251.25     Subdivision 1.  [PURPOSE AND GOALS.] The purpose of the 
251.26  alternative care program is to provide funding for or access to 
251.27  home and community-based services for frail elderly persons, in 
251.28  order to limit nursing facility placements.  The program is 
251.29  designed to support frail elderly persons in their desire to 
251.30  remain in the community as independently and as long as possible 
251.31  and to support informal caregivers in their efforts to provide 
251.32  care for frail elderly people.  Further, the goals of the 
251.33  program are: 
251.34     (1) to contain medical assistance expenditures by providing 
251.35  funding care in the community at a cost the same or less than 
251.36  nursing facility costs; and 
252.1      (2) to maintain the moratorium on new construction of 
252.2   nursing home beds. 
252.3      Sec. 17.  Minnesota Statutes 2000, section 256B.0913, 
252.4   subdivision 2, is amended to read: 
252.5      Subd. 2.  [ELIGIBILITY FOR SERVICES.] Alternative care 
252.6   services are available to all frail older Minnesotans.  This 
252.7   includes: 
252.8      (1) persons who are receiving medical assistance and served 
252.9   under the medical assistance program or the Medicaid waiver 
252.10  program; 
252.11     (2) persons age 65 or older who are not eligible for 
252.12  medical assistance without a spenddown or waiver obligation but 
252.13  who would be eligible for medical assistance within 180 days of 
252.14  admission to a nursing facility and served under subject to 
252.15  subdivisions 4 to 13; and 
252.16     (3) persons who are paying for their services out-of-pocket.
252.17     Sec. 18.  Minnesota Statutes 2000, section 256B.0913, 
252.18  subdivision 4, is amended to read: 
252.19     Subd. 4.  [ELIGIBILITY FOR FUNDING FOR SERVICES FOR 
252.20  NONMEDICAL ASSISTANCE RECIPIENTS.] (a) Funding for services 
252.21  under the alternative care program is available to persons who 
252.22  meet the following criteria: 
252.23     (1) the person has been screened by the county screening 
252.24  team or, if previously screened and served under the alternative 
252.25  care program, assessed by the local county social worker or 
252.26  public health nurse determined by a community assessment under 
252.27  section 256B.0911, to be a person who would require the level of 
252.28  care provided in a nursing facility, but for the provision of 
252.29  services under the alternative care program; 
252.30     (2) the person is age 65 or older; 
252.31     (3) the person would be financially eligible for medical 
252.32  assistance within 180 days of admission to a nursing facility; 
252.33     (4) the person meets the asset transfer requirements of is 
252.34  not ineligible for the medical assistance program due to an 
252.35  asset transfer penalty; 
252.36     (5) the screening team would recommend nursing facility 
253.1   admission or continued stay for the person if alternative care 
253.2   services were not available; 
253.3      (6) the person needs services that are not available at 
253.4   that time in the county funded through other county, state, or 
253.5   federal funding sources; and 
253.6      (7) (6) the monthly cost of the alternative care services 
253.7   funded by the program for this person does not exceed 75 percent 
253.8   of the statewide average monthly medical assistance payment for 
253.9   nursing facility care at the individual's case mix 
253.10  classification weighted average monthly nursing facility rate of 
253.11  the case mix resident class to which the individual alternative 
253.12  care client would be assigned under Minnesota Rules, parts 
253.13  9549.0050 to 9549.0059, less the recipient's maintenance needs 
253.14  allowance as described in section 256B.0915, subdivision 1d, 
253.15  paragraph (a), until the first day of the state fiscal year in 
253.16  which the resident assessment system, under section 256B.437, 
253.17  for nursing home rate determination is implemented.  Effective 
253.18  on the first day of the state fiscal year in which a resident 
253.19  assessment system, under section 256B.437, for nursing home rate 
253.20  determination is implemented and the first day of each 
253.21  subsequent state fiscal year, the monthly cost of alternative 
253.22  care services for this person shall not exceed the alternative 
253.23  care monthly cap for the case mix resident class to which the 
253.24  alternative care client would be assigned under Minnesota Rules, 
253.25  parts 9549.0050 to 9549.0059, which was in effect on the last 
253.26  day of the previous state fiscal year, and adjusted by the 
253.27  greater of any legislatively adopted home and community-based 
253.28  services cost-of-living percentage increase or any legislatively 
253.29  adopted statewide percent rate increase for nursing facilities.  
253.30  This monthly limit does not prohibit the alternative care client 
253.31  from payment for additional services, but in no case may the 
253.32  cost of additional services purchased under this section exceed 
253.33  the difference between the client's monthly service limit 
253.34  defined under section 256B.0915, subdivision 3, and the 
253.35  alternative care program monthly service limit defined in this 
253.36  paragraph.  If medical supplies and equipment or adaptations 
254.1   environmental modifications are or will be purchased for an 
254.2   alternative care services recipient, the costs may be prorated 
254.3   on a monthly basis throughout the year in which they are 
254.4   purchased for up to 12 consecutive months beginning with the 
254.5   month of purchase.  If the monthly cost of a recipient's other 
254.6   alternative care services exceeds the monthly limit established 
254.7   in this paragraph, the annual cost of the alternative care 
254.8   services shall be determined.  In this event, the annual cost of 
254.9   alternative care services shall not exceed 12 times the monthly 
254.10  limit calculated described in this paragraph. 
254.11     (b) Individuals who meet the criteria in paragraph (a) and 
254.12  who have been approved for alternative care funding are called 
254.13  180-day eligible clients. 
254.14     (c) The statewide average payment for nursing facility care 
254.15  is the statewide average monthly nursing facility rate in effect 
254.16  on July 1 of the fiscal year in which the cost is incurred, less 
254.17  the statewide average monthly income of nursing facility 
254.18  residents who are age 65 or older and who are medical assistance 
254.19  recipients in the month of March of the previous fiscal year.  
254.20  This monthly limit does not prohibit the 180-day eligible client 
254.21  from paying for additional services needed or desired.  
254.22     (d) In determining the total costs of alternative care 
254.23  services for one month, the costs of all services funded by the 
254.24  alternative care program, including supplies and equipment, must 
254.25  be included. 
254.26     (e) Alternative care funding under this subdivision is not 
254.27  available for a person who is a medical assistance recipient or 
254.28  who would be eligible for medical assistance without a 
254.29  spenddown, unless authorized by the commissioner or waiver 
254.30  obligation.  A person whose initial application for medical 
254.31  assistance is being processed may be served under the 
254.32  alternative care program for a period up to 60 days.  If the 
254.33  individual is found to be eligible for medical assistance, the 
254.34  county must bill medical assistance must be billed for services 
254.35  payable under the federally approved elderly waiver plan and 
254.36  delivered from the date the individual was found eligible 
255.1   for services reimbursable under the federally approved elderly 
255.2   waiver program plan.  Notwithstanding this provision, upon 
255.3   federal approval, alternative care funds may not be used to pay 
255.4   for any service the cost of which is payable by medical 
255.5   assistance or which is used by a recipient to meet a medical 
255.6   assistance income spenddown or waiver obligation.  
255.7      (f) (c) Alternative care funding is not available for a 
255.8   person who resides in a licensed nursing home or, certified 
255.9   boarding care home, hospital, or intermediate care facility, 
255.10  except for case management services which are being provided in 
255.11  support of the discharge planning process to a nursing home 
255.12  resident or certified boarding care home resident who is 
255.13  ineligible for case management funded by medical assistance. 
255.14     Sec. 19.  Minnesota Statutes 2000, section 256B.0913, 
255.15  subdivision 5, is amended to read: 
255.16     Subd. 5.  [SERVICES COVERED UNDER ALTERNATIVE CARE.] (a) 
255.17  Alternative care funding may be used for payment of costs of: 
255.18     (1) adult foster care; 
255.19     (2) adult day care; 
255.20     (3) home health aide; 
255.21     (4) homemaker services; 
255.22     (5) personal care; 
255.23     (6) case management; 
255.24     (7) respite care; 
255.25     (8) assisted living; 
255.26     (9) residential care services; 
255.27     (10) care-related supplies and equipment; 
255.28     (11) meals delivered to the home; 
255.29     (12) transportation; 
255.30     (13) skilled nursing; 
255.31     (14) chore services; 
255.32     (15) companion services; 
255.33     (16) nutrition services; 
255.34     (17) training for direct informal caregivers; 
255.35     (18) telemedicine devices to monitor recipients in their 
255.36  own homes as an alternative to hospital care, nursing home care, 
256.1   or home visits; and 
256.2      (19) other services including which includes discretionary 
256.3   funds and direct cash payments to clients, approved by the 
256.4   county agency following approval by the commissioner, subject to 
256.5   the provisions of paragraph (m) (j).  Total annual payments for "
256.6   other services" for all clients within a county may not exceed 
256.7   either ten percent of that county's annual alternative care 
256.8   program base allocation or $5,000, whichever is greater.  In no 
256.9   case shall this amount exceed the county's total annual 
256.10  alternative care program base allocation; and 
256.11     (20) environmental modifications. 
256.12     (b) The county agency must ensure that the funds are not 
256.13  used only to supplement and not to supplant services available 
256.14  through other public assistance or services programs. 
256.15     (c) Unless specified in statute, the service definitions 
256.16  and standards for alternative care services shall be the same as 
256.17  the service definitions and standards defined specified in the 
256.18  federally approved elderly waiver plan.  Except for the county 
256.19  agencies' approval of direct cash payments to clients as 
256.20  described in paragraph (j) or for a provider of supplies and 
256.21  equipment when the monthly cost of the supplies and equipment is 
256.22  less than $250, persons or agencies must be employed by or under 
256.23  a contract with the county agency or the public health nursing 
256.24  agency of the local board of health in order to receive funding 
256.25  under the alternative care program.  Supplies and equipment may 
256.26  be purchased from a non-Medicaid certified vendor if the cost 
256.27  for the item is less than that of a Medicaid vendor.  
256.28     (d) The adult foster care rate shall be considered a 
256.29  difficulty of care payment and shall not include room and 
256.30  board.  The adult foster care daily rate shall be negotiated 
256.31  between the county agency and the foster care provider.  The 
256.32  rate established under this section shall not exceed 75 percent 
256.33  of the state average monthly nursing home payment for the case 
256.34  mix classification to which the individual receiving foster care 
256.35  is assigned, and it must allow for other alternative care 
256.36  services to be authorized by the case manager.  The alternative 
257.1   care payment for the foster care service in combination with the 
257.2   payment for other alternative care services, including case 
257.3   management, must not exceed the limit specified in subdivision 
257.4   4, paragraph (a), clause (6). 
257.5      (e) Personal care services may be provided by a personal 
257.6   care provider organization. must meet the service standards 
257.7   defined in the federally approved elderly waiver plan, except 
257.8   that a county agency may contract with a client's relative of 
257.9   the client who meets the relative hardship waiver requirement as 
257.10  defined in section 256B.0627, subdivision 4, paragraph (b), 
257.11  clause (10), to provide personal care services, but must ensure 
257.12  nursing if the county agency ensures supervision of this service 
257.13  by a registered nurse or mental health practitioner.  Covered 
257.14  personal care services defined in section 256B.0627, subdivision 
257.15  4, must meet applicable standards in Minnesota Rules, part 
257.16  9505.0335. 
257.17     (f) A county may use alternative care funds to purchase 
257.18  medical supplies and equipment without prior approval from the 
257.19  commissioner when:  (1) there is no other funding source; (2) 
257.20  the supplies and equipment are specified in the individual's 
257.21  care plan as medically necessary to enable the individual to 
257.22  remain in the community according to the criteria in Minnesota 
257.23  Rules, part 9505.0210, item A; and (3) the supplies and 
257.24  equipment represent an effective and appropriate use of 
257.25  alternative care funds.  A county may use alternative care funds 
257.26  to purchase supplies and equipment from a non-Medicaid certified 
257.27  vendor if the cost for the items is less than that of a Medicaid 
257.28  vendor.  A county is not required to contract with a provider of 
257.29  supplies and equipment if the monthly cost of the supplies and 
257.30  equipment is less than $250.  
257.31     (g) For purposes of this section, residential care services 
257.32  are services which are provided to individuals living in 
257.33  residential care homes.  Residential care homes are currently 
257.34  licensed as board and lodging establishments and are registered 
257.35  with the department of health as providing special 
257.36  services under section 157.17 and are not subject to 
258.1   registration under chapter 144D.  Residential care services are 
258.2   defined as "supportive services" and "health-related services."  
258.3   "Supportive services" means the provision of up to 24-hour 
258.4   supervision and oversight.  Supportive services includes:  (1) 
258.5   transportation, when provided by the residential care center 
258.6   home only; (2) socialization, when socialization is part of the 
258.7   plan of care, has specific goals and outcomes established, and 
258.8   is not diversional or recreational in nature; (3) assisting 
258.9   clients in setting up meetings and appointments; (4) assisting 
258.10  clients in setting up medical and social services; (5) providing 
258.11  assistance with personal laundry, such as carrying the client's 
258.12  laundry to the laundry room.  Assistance with personal laundry 
258.13  does not include any laundry, such as bed linen, that is 
258.14  included in the room and board rate.  "Health-related services" 
258.15  are limited to minimal assistance with dressing, grooming, and 
258.16  bathing and providing reminders to residents to take medications 
258.17  that are self-administered or providing storage for medications, 
258.18  if requested.  Individuals receiving residential care services 
258.19  cannot receive homemaking services funded under this section.  
258.20     (h) (g) For the purposes of this section, "assisted living" 
258.21  refers to supportive services provided by a single vendor to 
258.22  clients who reside in the same apartment building of three or 
258.23  more units which are not subject to registration under chapter 
258.24  144D and are licensed by the department of health as a class A 
258.25  home care provider or a class E home care provider.  Assisted 
258.26  living services are defined as up to 24-hour supervision, and 
258.27  oversight, supportive services as defined in clause (1), 
258.28  individualized home care aide tasks as defined in clause (2), 
258.29  and individualized home management tasks as defined in clause 
258.30  (3) provided to residents of a residential center living in 
258.31  their units or apartments with a full kitchen and bathroom.  A 
258.32  full kitchen includes a stove, oven, refrigerator, food 
258.33  preparation counter space, and a kitchen utensil storage 
258.34  compartment.  Assisted living services must be provided by the 
258.35  management of the residential center or by providers under 
258.36  contract with the management or with the county. 
259.1      (1) Supportive services include:  
259.2      (i) socialization, when socialization is part of the plan 
259.3   of care, has specific goals and outcomes established, and is not 
259.4   diversional or recreational in nature; 
259.5      (ii) assisting clients in setting up meetings and 
259.6   appointments; and 
259.7      (iii) providing transportation, when provided by the 
259.8   residential center only.  
259.9      Individuals receiving assisted living services will not 
259.10  receive both assisted living services and homemaking services.  
259.11  Individualized means services are chosen and designed 
259.12  specifically for each resident's needs, rather than provided or 
259.13  offered to all residents regardless of their illnesses, 
259.14  disabilities, or physical conditions.  
259.15     (2) Home care aide tasks means:  
259.16     (i) preparing modified diets, such as diabetic or low 
259.17  sodium diets; 
259.18     (ii) reminding residents to take regularly scheduled 
259.19  medications or to perform exercises; 
259.20     (iii) household chores in the presence of technically 
259.21  sophisticated medical equipment or episodes of acute illness or 
259.22  infectious disease; 
259.23     (iv) household chores when the resident's care requires the 
259.24  prevention of exposure to infectious disease or containment of 
259.25  infectious disease; and 
259.26     (v) assisting with dressing, oral hygiene, hair care, 
259.27  grooming, and bathing, if the resident is ambulatory, and if the 
259.28  resident has no serious acute illness or infectious disease.  
259.29  Oral hygiene means care of teeth, gums, and oral prosthetic 
259.30  devices.  
259.31     (3) Home management tasks means:  
259.32     (i) housekeeping; 
259.33     (ii) laundry; 
259.34     (iii) preparation of regular snacks and meals; and 
259.35     (iv) shopping.  
259.36     Individuals receiving assisted living services shall not 
260.1   receive both assisted living services and homemaking services.  
260.2   Individualized means services are chosen and designed 
260.3   specifically for each resident's needs, rather than provided or 
260.4   offered to all residents regardless of their illnesses, 
260.5   disabilities, or physical conditions.  Assisted living services 
260.6   as defined in this section shall not be authorized in boarding 
260.7   and lodging establishments licensed according to sections 
260.8   157.011 and 157.15 to 157.22. 
260.9      (i) (h) For establishments registered under chapter 144D, 
260.10  assisted living services under this section means either the 
260.11  services described and licensed in paragraph (g) and delivered 
260.12  by a class E home care provider licensed by the department of 
260.13  health or the services described under section 144A.4605 and 
260.14  delivered by an assisted living home care provider or a class A 
260.15  home care provider licensed by the commissioner of health. 
260.16     (j) For the purposes of this section, reimbursement (i) 
260.17  Payment for assisted living services and residential care 
260.18  services shall be a monthly rate negotiated and authorized by 
260.19  the county agency based on an individualized service plan for 
260.20  each resident and may not cover direct rent or food costs.  The 
260.21  rate 
260.22     (1) The individualized monthly negotiated payment for 
260.23  assisted living services as described in paragraph (g) or (h), 
260.24  and residential care services as described in paragraph (f), 
260.25  shall not exceed the nonfederal share in effect on July 1 of the 
260.26  state fiscal year for which the rate limit is being calculated 
260.27  of the greater of either the statewide or any of the geographic 
260.28  groups' weighted average monthly medical assistance nursing 
260.29  facility payment rate of the case mix resident class to which 
260.30  the 180-day alternative care eligible client would be assigned 
260.31  under Minnesota Rules, parts 9549.0050 to 9549.0059, unless the 
260.32  less the maintenance needs allowance as described in subdivision 
260.33  1d, paragraph (a), until the first day of the state fiscal year 
260.34  in which a resident assessment system, under section 256B.437, 
260.35  of nursing home rate determination is implemented.  Effective on 
260.36  the first day of the state fiscal year in which a resident 
261.1   assessment system, under section 256B.437, of nursing home rate 
261.2   determination is implemented and the first day of each 
261.3   subsequent state fiscal year, the individualized monthly 
261.4   negotiated payment for the services described in this clause 
261.5   shall not exceed the limit described in this clause which was in 
261.6   effect on the last day of the previous state fiscal year and 
261.7   which has been adjusted by the greater of any legislatively 
261.8   adopted home and community-based services cost-of-living 
261.9   percentage increase or any legislatively adopted statewide 
261.10  percent rate increase for nursing facilities. 
261.11     (2) The individualized monthly negotiated payment for 
261.12  assisted living services are provided by a home care described 
261.13  under section 144A.4605 and delivered by a provider licensed by 
261.14  the department of health as a class A home care provider or an 
261.15  assisted living home care provider and are provided in a 
261.16  building that is registered as a housing with services 
261.17  establishment under chapter 144D and that provides 24-hour 
261.18  supervision in combination with the payment for other 
261.19  alternative care services, including case management, must not 
261.20  exceed the limit specified in subdivision 4, paragraph (a), 
261.21  clause (6). 
261.22     (k) For purposes of this section, companion services are 
261.23  defined as nonmedical care, supervision and oversight, provided 
261.24  to a functionally impaired adult.  Companions may assist the 
261.25  individual with such tasks as meal preparation, laundry and 
261.26  shopping, but do not perform these activities as discrete 
261.27  services.  The provision of companion services does not entail 
261.28  hands-on medical care.  Providers may also perform light 
261.29  housekeeping tasks which are incidental to the care and 
261.30  supervision of the recipient.  This service must be approved by 
261.31  the case manager as part of the care plan.  Companion services 
261.32  must be provided by individuals or organizations who are under 
261.33  contract with the local agency to provide the service.  Any 
261.34  person related to the waiver recipient by blood, marriage or 
261.35  adoption cannot be reimbursed under this service.  Persons 
261.36  providing companion services will be monitored by the case 
262.1   manager. 
262.2      (l) For purposes of this section, training for direct 
262.3   informal caregivers is defined as a classroom or home course of 
262.4   instruction which may include:  transfer and lifting skills, 
262.5   nutrition, personal and physical cares, home safety in a home 
262.6   environment, stress reduction and management, behavioral 
262.7   management, long-term care decision making, care coordination 
262.8   and family dynamics.  The training is provided to an informal 
262.9   unpaid caregiver of a 180-day eligible client which enables the 
262.10  caregiver to deliver care in a home setting with high levels of 
262.11  quality.  The training must be approved by the case manager as 
262.12  part of the individual care plan.  Individuals, agencies, and 
262.13  educational facilities which provide caregiver training and 
262.14  education will be monitored by the case manager. 
262.15     (m) (j) A county agency may make payment from their 
262.16  alternative care program allocation for "other services" 
262.17  provided to an alternative care program recipient if those 
262.18  services prevent, shorten, or delay institutionalization.  These 
262.19  services may which include use of "discretionary funds" for 
262.20  services that are not otherwise defined in this section and 
262.21  direct cash payments to the recipient client for the purpose of 
262.22  purchasing the recipient's services.  The following provisions 
262.23  apply to payments under this paragraph: 
262.24     (1) a cash payment to a client under this provision cannot 
262.25  exceed 80 percent of the monthly payment limit for that client 
262.26  as specified in subdivision 4, paragraph (a), clause (7) (6); 
262.27     (2) a county may not approve any cash payment for a client 
262.28  who meets either of the following: 
262.29     (i) has been assessed as having a dependency in 
262.30  orientation, unless the client has an authorized 
262.31  representative under section 256.476, subdivision 2, paragraph 
262.32  (g), or for a client who.  An "authorized representative" means 
262.33  an individual who is at least 18 years of age and is designated 
262.34  by the person or the person's legal representative to act on the 
262.35  person's behalf.  This individual may be a family member, 
262.36  guardian, representative payee, or other individual designated 
263.1   by the person or the person's legal representative, if any, to 
263.2   assist in purchasing and arranging for supports; or 
263.3      (ii) is concurrently receiving adult foster care, 
263.4   residential care, or assisted living services; 
263.5      (3) any service approved under this section must be a 
263.6   service which meets the purpose and goals of the program as 
263.7   listed in subdivision 1; 
263.8      (4) cash payments must also meet the criteria of and are 
263.9   governed by the procedures and liability protection established 
263.10  in section 256.476, subdivision 4, paragraphs (b) through (h), 
263.11  and recipients of cash grants must meet the requirements in 
263.12  section 256.476, subdivision 10; and cash payments to a person 
263.13  or a person's family will be provided through a monthly payment 
263.14  and be in the form of cash, voucher, or direct county payment to 
263.15  vendor.  Fees or premiums assessed to the person for eligibility 
263.16  for health and human services are not reimbursable through this 
263.17  service option.  Services and goods purchased through cash 
263.18  payments must be identified in the person's individualized care 
263.19  plan and must meet all of the following criteria: 
263.20     (i) they must be over and above the normal cost of caring 
263.21  for the person if the person did not have functional 
263.22  limitations; 
263.23     (ii) they must be directly attributable to the person's 
263.24  functional limitations; 
263.25     (iii) they must have the potential to be effective at 
263.26  meeting the goals of the program; 
263.27     (iv) they must be consistent with the needs identified in 
263.28  the individualized service plan.  The service plan shall specify 
263.29  the needs of the person and family, the form and amount of 
263.30  payment, the items and services to be reimbursed, and the 
263.31  arrangements for management of the individual grant; and 
263.32     (v) the person, the person's family, or the legal 
263.33  representative shall be provided sufficient information to 
263.34  ensure an informed choice of alternatives.  The local agency 
263.35  shall document this information in the person's care plan, 
263.36  including the type and level of expenditures to be reimbursed; 
264.1      (4) the county, lead agency under contract, or tribal 
264.2   government under contract to administer the alternative care 
264.3   program shall not be liable for damages, injuries, or 
264.4   liabilities sustained through the purchase of direct supports or 
264.5   goods by the person, the person's family, or the authorized 
264.6   representative with funds received through the cash payments 
264.7   under this section.  Liabilities include, but are not limited 
264.8   to, workers' compensation, the Federal Insurance Contributions 
264.9   Act (FICA), or the Federal Unemployment Tax Act (FUTA); 
264.10     (5) persons receiving grants under this section shall have 
264.11  the following responsibilities: 
264.12     (i) spend the grant money in a manner consistent with their 
264.13  individualized service plan with the local agency; 
264.14     (ii) notify the local agency of any necessary changes in 
264.15  the grant-expenditures; 
264.16     (iii) arrange and pay for supports; and 
264.17     (iv) inform the local agency of areas where they have 
264.18  experienced difficulty securing or maintaining supports; and 
264.19     (5) (6) the county shall report client outcomes, services, 
264.20  and costs under this paragraph in a manner prescribed by the 
264.21  commissioner. 
264.22     (k) Upon implementation of direct cash payments to clients 
264.23  under this section, any person determined eligible for the 
264.24  alternative care program who chooses a cash payment approved by 
264.25  the county agency shall receive the cash payment under this 
264.26  section and not under section 256.476 unless the person was 
264.27  receiving a consumer support grant under section 256.476 before 
264.28  implementation of direct cash payments under this section. 
264.29     Sec. 20.  Minnesota Statutes 2000, section 256B.0913, 
264.30  subdivision 6, is amended to read: 
264.31     Subd. 6.  [ALTERNATIVE CARE PROGRAM ADMINISTRATION.] The 
264.32  alternative care program is administered by the county agency.  
264.33  This agency is the lead agency responsible for the local 
264.34  administration of the alternative care program as described in 
264.35  this section.  However, it may contract with the public health 
264.36  nursing service to be the lead agency.  The commissioner may 
265.1   contract with federally recognized Indian tribes with a 
265.2   reservation in Minnesota to serve as the lead agency responsible 
265.3   for the local administration of the alternative care program as 
265.4   described in the contract. 
265.5      Sec. 21.  Minnesota Statutes 2000, section 256B.0913, 
265.6   subdivision 7, is amended to read: 
265.7      Subd. 7.  [CASE MANAGEMENT.] Providers of case management 
265.8   services for persons receiving services funded by the 
265.9   alternative care program must meet the qualification 
265.10  requirements and standards specified in section 256B.0915, 
265.11  subdivision 1b.  The case manager must ensure the health and 
265.12  safety of the individual client and not approve alternative care 
265.13  funding for a client in any setting in which the case manager 
265.14  cannot reasonably ensure the client's health and safety.  The 
265.15  case manager is responsible for the cost-effectiveness of the 
265.16  alternative care individual care plan and must not approve any 
265.17  care plan in which the cost of services funded by alternative 
265.18  care and client contributions exceeds the limit specified in 
265.19  section 256B.0915, subdivision 3, paragraph (b).  The county may 
265.20  allow a case manager employed by the county to delegate certain 
265.21  aspects of the case management activity to another individual 
265.22  employed by the county provided there is oversight of the 
265.23  individual by the case manager.  The case manager may not 
265.24  delegate those aspects which require professional judgment 
265.25  including assessments, reassessments, and care plan development. 
265.26     Sec. 22.  Minnesota Statutes 2000, section 256B.0913, 
265.27  subdivision 8, is amended to read: 
265.28     Subd. 8.  [REQUIREMENTS FOR INDIVIDUAL CARE PLAN.] (a) The 
265.29  case manager shall implement the plan of care for each 180-day 
265.30  eligible alternative care client and ensure that a client's 
265.31  service needs and eligibility are reassessed at least every 12 
265.32  months.  The plan shall include any services prescribed by the 
265.33  individual's attending physician as necessary to allow the 
265.34  individual to remain in a community setting.  In developing the 
265.35  individual's care plan, the case manager should include the use 
265.36  of volunteers from families and neighbors, religious 
266.1   organizations, social clubs, and civic and service organizations 
266.2   to support the formal home care services.  The county shall be 
266.3   held harmless for damages or injuries sustained through the use 
266.4   of volunteers under this subdivision including workers' 
266.5   compensation liability.  The lead agency shall provide 
266.6   documentation to the commissioner verifying that the 
266.7   individual's alternative care is not available at that time 
266.8   through any other public assistance or service program.  The 
266.9   lead agency shall provide documentation in each individual's 
266.10  plan of care and, if requested, to the commissioner that the 
266.11  most cost-effective alternatives available have been offered to 
266.12  the individual and that the individual was free to choose among 
266.13  available qualified providers, both public and private.  The 
266.14  case manager must give the individual a ten-day written notice 
266.15  of any decrease in or termination of alternative care services. 
266.16     (b) If the county administering alternative care services 
266.17  is different than the county of financial responsibility, the 
266.18  care plan may be implemented without the approval of the county 
266.19  of financial responsibility. 
266.20     Sec. 23.  Minnesota Statutes 2000, section 256B.0913, 
266.21  subdivision 9, is amended to read: 
266.22     Subd. 9.  [CONTRACTING PROVISIONS FOR PROVIDERS.] The lead 
266.23  agency shall document to the commissioner that the agency made 
266.24  reasonable efforts to inform potential providers of the 
266.25  anticipated need for services under the alternative care program 
266.26  or waiver programs under sections 256B.0915 and 256B.49, 
266.27  including a minimum of 14 days' written advance notice of the 
266.28  opportunity to be selected as a service provider and an annual 
266.29  public meeting with providers to explain and review the criteria 
266.30  for selection.  The lead agency shall also document to the 
266.31  commissioner that the agency allowed potential providers an 
266.32  opportunity to be selected to contract with the county agency.  
266.33  Funds reimbursed to counties under this subdivision Alternative 
266.34  care funds paid to service providers are subject to audit by the 
266.35  commissioner for fiscal and utilization control.  
266.36     The lead agency must select providers for contracts or 
267.1   agreements using the following criteria and other criteria 
267.2   established by the county: 
267.3      (1) the need for the particular services offered by the 
267.4   provider; 
267.5      (2) the population to be served, including the number of 
267.6   clients, the length of time services will be provided, and the 
267.7   medical condition of clients; 
267.8      (3) the geographic area to be served; 
267.9      (4) quality assurance methods, including appropriate 
267.10  licensure, certification, or standards, and supervision of 
267.11  employees when needed; 
267.12     (5) rates for each service and unit of service exclusive of 
267.13  county administrative costs; 
267.14     (6) evaluation of services previously delivered by the 
267.15  provider; and 
267.16     (7) contract or agreement conditions, including billing 
267.17  requirements, cancellation, and indemnification. 
267.18     The county must evaluate its own agency services under the 
267.19  criteria established for other providers.  The county shall 
267.20  provide a written statement of the reasons for not selecting 
267.21  providers. 
267.22     Sec. 24.  Minnesota Statutes 2000, section 256B.0913, 
267.23  subdivision 10, is amended to read: 
267.24     Subd. 10.  [ALLOCATION FORMULA.] (a) The alternative care 
267.25  appropriation for fiscal years 1992 and beyond shall cover 
267.26  only 180-day alternative care eligible clients.  Prior to July 1 
267.27  of each year, the commissioner shall allocate to county agencies 
267.28  the state funds available for alternative care for persons 
267.29  eligible under subdivision 2. 
267.30     (b) Prior to July 1 of each year, the commissioner shall 
267.31  allocate to county agencies the state funds available for 
267.32  alternative care for persons eligible under subdivision 2.  The 
267.33  allocation for fiscal year 1992 shall be calculated using a base 
267.34  that is adjusted to exclude the medical assistance share of 
267.35  alternative care expenditures.  The adjusted base is calculated 
267.36  by multiplying each county's allocation for fiscal year 1991 by 
268.1   the percentage of county alternative care expenditures for 
268.2   180-day eligible clients.  The percentage is determined based on 
268.3   expenditures for services rendered in fiscal year 1989 or 
268.4   calendar year 1989, whichever is greater.  The adjusted base for 
268.5   each county is the county's current fiscal year base allocation 
268.6   plus any targeted funds approved during the current fiscal 
268.7   year.  Calculations for paragraphs (c) and (d) are to be made as 
268.8   follows:  for each county, the determination of alternative care 
268.9   program expenditures shall be based on payments for services 
268.10  rendered from April 1 through March 31 in the base year, to the 
268.11  extent that claims have been submitted and paid by June 1 of 
268.12  that year.  
268.13     (c) If the county alternative care program expenditures for 
268.14  180-day eligible clients as defined in paragraph (b) are 95 
268.15  percent or more of its the county's adjusted base allocation, 
268.16  the allocation for the next fiscal year is 100 percent of the 
268.17  adjusted base, plus inflation to the extent that inflation is 
268.18  included in the state budget. 
268.19     (d) If the county alternative care program expenditures for 
268.20  180-day eligible clients as defined in paragraph (b) are less 
268.21  than 95 percent of its the county's adjusted base allocation, 
268.22  the allocation for the next fiscal year is the adjusted base 
268.23  allocation less the amount of unspent funds below the 95 percent 
268.24  level. 
268.25     (e) For fiscal year 1992 only, a county may receive an 
268.26  increased allocation if annualized service costs for the month 
268.27  of May 1991 for 180-day eligible clients are greater than the 
268.28  allocation otherwise determined.  A county may apply for this 
268.29  increase by reporting projected expenditures for May to the 
268.30  commissioner by June 1, 1991.  The amount of the allocation may 
268.31  exceed the amount calculated in paragraph (b).  The projected 
268.32  expenditures for May must be based on actual 180-day eligible 
268.33  client caseload and the individual cost of clients' care plans.  
268.34  If a county does not report its expenditures for May, the amount 
268.35  in paragraph (c) or (d) shall be used. 
268.36     (f) Calculations for paragraphs (c) and (d) are to be made 
269.1   as follows:  for each county, the determination of expenditures 
269.2   shall be based on payments for services rendered from April 1 
269.3   through March 31 in the base year, to the extent that claims 
269.4   have been submitted by June 1 of that year.  Calculations for 
269.5   paragraphs (c) and (d) must also include the funds transferred 
269.6   to the consumer support grant program for clients who have 
269.7   transferred to that program from April 1 through March 31 in the 
269.8   base year.  
269.9      (g) For the biennium ending June 30, 2001, the allocation 
269.10  of state funds to county agencies shall be calculated as 
269.11  described in paragraphs (c) and (d).  If the annual legislative 
269.12  appropriation for the alternative care program is inadequate to 
269.13  fund the combined county allocations for fiscal year 2000 or 
269.14  2001 a biennium, the commissioner shall distribute to each 
269.15  county the entire annual appropriation as that county's 
269.16  percentage of the computed base as calculated in paragraph 
269.17  (f) paragraphs (c) and (d). 
269.18     Sec. 25.  Minnesota Statutes 2000, section 256B.0913, 
269.19  subdivision 11, is amended to read: 
269.20     Subd. 11.  [TARGETED FUNDING.] (a) The purpose of targeted 
269.21  funding is to make additional money available to counties with 
269.22  the greatest need.  Targeted funds are not intended to be 
269.23  distributed equitably among all counties, but rather, allocated 
269.24  to those with long-term care strategies that meet state goals. 
269.25     (b) The funds available for targeted funding shall be the 
269.26  total appropriation for each fiscal year minus county 
269.27  allocations determined under subdivision 10 as adjusted for any 
269.28  inflation increases provided in appropriations for the biennium. 
269.29     (c) The commissioner shall allocate targeted funds to 
269.30  counties that demonstrate to the satisfaction of the 
269.31  commissioner that they have developed feasible plans to increase 
269.32  alternative care spending.  In making targeted funding 
269.33  allocations, the commissioner shall use the following priorities:
269.34     (1) counties that received a lower allocation in fiscal 
269.35  year 1991 than in fiscal year 1990.  Counties remain in this 
269.36  priority until they have been restored to their fiscal year 1990 
270.1   level plus inflation; 
270.2      (2) counties that sustain a base allocation reduction for 
270.3   failure to spend 95 percent of the allocation if they 
270.4   demonstrate that the base reduction should be restored; 
270.5      (3) counties that propose projects to divert community 
270.6   residents from nursing home placement or convert nursing home 
270.7   residents to community living; and 
270.8      (4) counties that can otherwise justify program growth by 
270.9   demonstrating the existence of waiting lists, demographically 
270.10  justified needs, or other unmet needs. 
270.11     (d) Counties that would receive targeted funds according to 
270.12  paragraph (c) must demonstrate to the commissioner's 
270.13  satisfaction that the funds would be appropriately spent by 
270.14  showing how the funds would be used to further the state's 
270.15  alternative care goals as described in subdivision 1, and that 
270.16  the county has the administrative and service delivery 
270.17  capability to use them.  
270.18     (e) The commissioner shall request applications by June 1 
270.19  each year, for county agencies to apply for targeted funds by 
270.20  November 1 of each year.  The counties selected for targeted 
270.21  funds shall be notified of the amount of their additional 
270.22  funding by August 1 of each year.  Targeted funds allocated to a 
270.23  county agency in one year shall be treated as part of the 
270.24  county's base allocation for that year in determining 
270.25  allocations for subsequent years.  No reallocations between 
270.26  counties shall be made. 
270.27     (f) The allocation for each year after fiscal year 1992 
270.28  shall be determined using the previous fiscal year's allocation, 
270.29  including any targeted funds, as the base and then applying the 
270.30  criteria under subdivision 10, paragraphs (c), (d), and (f), to 
270.31  the current year's expenditures. 
270.32     Sec. 26.  Minnesota Statutes 2000, section 256B.0913, 
270.33  subdivision 12, is amended to read: 
270.34     Subd. 12.  [CLIENT PREMIUMS.] (a) A premium is required for 
270.35  all 180-day alternative care eligible clients to help pay for 
270.36  the cost of participating in the program.  The amount of the 
271.1   premium for the alternative care client shall be determined as 
271.2   follows: 
271.3      (1) when the alternative care client's income less 
271.4   recurring and predictable medical expenses is greater than the 
271.5   medical assistance income standard recipient's maintenance needs 
271.6   allowance as defined in section 256B.0915, subdivision 1d, 
271.7   paragraph (a), but less than 150 percent of the federal poverty 
271.8   guideline effective on July 1 of the state fiscal year in which 
271.9   the premium is being computed, and total assets are less than 
271.10  $10,000, the fee is zero; 
271.11     (2) when the alternative care client's income less 
271.12  recurring and predictable medical expenses is greater than 150 
271.13  percent of the federal poverty guideline effective on July 1 of 
271.14  the state fiscal year in which the premium is being computed, 
271.15  and total assets are less than $10,000, the fee is 25 percent of 
271.16  the cost of alternative care services or the difference between 
271.17  150 percent of the federal poverty guideline effective on July 1 
271.18  of the state fiscal year in which the premium is being computed 
271.19  and the client's income less recurring and predictable medical 
271.20  expenses, whichever is less; and 
271.21     (3) when the alternative care client's total assets are 
271.22  greater than $10,000, the fee is 25 percent of the cost of 
271.23  alternative care services.  
271.24     For married persons, total assets are defined as the total 
271.25  marital assets less the estimated community spouse asset 
271.26  allowance, under section 256B.059, if applicable.  For married 
271.27  persons, total income is defined as the client's income less the 
271.28  monthly spousal allotment, under section 256B.058. 
271.29     All alternative care services except case management shall 
271.30  be included in the estimated costs for the purpose of 
271.31  determining 25 percent of the costs. 
271.32     The monthly premium shall be calculated based on the cost 
271.33  of the first full month of alternative care services and shall 
271.34  continue unaltered until the next reassessment is completed or 
271.35  at the end of 12 months, whichever comes first.  Premiums are 
271.36  due and payable each month alternative care services are 
272.1   received unless the actual cost of the services is less than the 
272.2   premium. 
272.3      (b) The fee shall be waived by the commissioner when: 
272.4      (1) a person who is residing in a nursing facility is 
272.5   receiving case management only; 
272.6      (2) a person is applying for medical assistance; 
272.7      (3) a married couple is requesting an asset assessment 
272.8   under the spousal impoverishment provisions; 
272.9      (4) a person is a medical assistance recipient, but has 
272.10  been approved for alternative care-funded assisted living 
272.11  services; 
272.12     (5) a person is found eligible for alternative care, but is 
272.13  not yet receiving alternative care services; or 
272.14     (6) (5) a person's fee under paragraph (a) is less than $25.
272.15     (c) The county agency must record in the state's receivable 
272.16  system the client's assessed premium amount or the reason the 
272.17  premium has been waived.  The commissioner will bill and collect 
272.18  the premium from the client and forward the amounts collected to 
272.19  the commissioner in the manner and at the times prescribed by 
272.20  the commissioner.  Money collected must be deposited in the 
272.21  general fund and is appropriated to the commissioner for the 
272.22  alternative care program.  The client must supply the county 
272.23  with the client's social security number at the time of 
272.24  application.  If a client fails or refuses to pay the premium 
272.25  due, The county shall supply the commissioner with the client's 
272.26  social security number and other information the commissioner 
272.27  requires to collect the premium from the client.  The 
272.28  commissioner shall collect unpaid premiums using the Revenue 
272.29  Recapture Act in chapter 270A and other methods available to the 
272.30  commissioner.  The commissioner may require counties to inform 
272.31  clients of the collection procedures that may be used by the 
272.32  state if a premium is not paid.  
272.33     (d) The commissioner shall begin to adopt emergency or 
272.34  permanent rules governing client premiums within 30 days after 
272.35  July 1, 1991, including criteria for determining when services 
272.36  to a client must be terminated due to failure to pay a premium.  
273.1      Sec. 27.  Minnesota Statutes 2000, section 256B.0913, 
273.2   subdivision 13, is amended to read: 
273.3      Subd. 13.  [COUNTY BIENNIAL PLAN.] The county biennial plan 
273.4   for the preadmission screening program long-term care 
273.5   consultation under section 256B.0911, the alternative care 
273.6   program under this section, and waivers for the elderly under 
273.7   section 256B.0915, and waivers for the disabled under section 
273.8   256B.49, shall be incorporated into the biennial Community 
273.9   Social Services Act plan and shall meet the regulations and 
273.10  timelines of that plan.  This county biennial plan shall include:
273.11     (1) information on the administration of the preadmission 
273.12  screening program; 
273.13     (2) information on the administration of the home and 
273.14  community-based services waivers for the elderly under section 
273.15  256B.0915, and for the disabled under section 256B.49; and 
273.16     (3) information on the administration of the alternative 
273.17  care program. 
273.18     Sec. 28.  Minnesota Statutes 2000, section 256B.0913, 
273.19  subdivision 14, is amended to read: 
273.20     Subd. 14.  [REIMBURSEMENT PAYMENT AND RATE ADJUSTMENTS.] (a)
273.21  Reimbursement Payment for expenditures for the provided 
273.22  alternative care services as approved by the client's case 
273.23  manager shall be through the invoice processing procedures of 
273.24  the department's Medicaid Management Information System (MMIS).  
273.25  To receive reimbursement payment, the county or vendor must 
273.26  submit invoices within 12 months following the date of service.  
273.27  The county agency and its vendors under contract shall not be 
273.28  reimbursed for services which exceed the county allocation. 
273.29     (b) If a county collects less than 50 percent of the client 
273.30  premiums due under subdivision 12, the commissioner may withhold 
273.31  up to three percent of the county's final alternative care 
273.32  program allocation determined under subdivisions 10 and 11. 
273.33     (c) The county shall negotiate individual rates with 
273.34  vendors and may be reimbursed authorize service payment for 
273.35  actual costs up to the greater of the county's current approved 
273.36  rate or 60 percent of the maximum rate in fiscal year 1994 and 
274.1   65 percent of the maximum rate in fiscal year 1995 for each 
274.2   alternative care service.  Notwithstanding any other rule or 
274.3   statutory provision to the contrary, the commissioner shall not 
274.4   be authorized to increase rates by an annual inflation factor, 
274.5   unless so authorized by the legislature. 
274.6      (d) (c) On July 1, 1993, the commissioner shall increase 
274.7   the maximum rate for home delivered meals to $4.50 per meal.  To 
274.8   improve access to community services and eliminate payment 
274.9   disparities between the alternative care program and the elderly 
274.10  waiver program, the commissioner shall establish statewide 
274.11  maximum service rate limits and eliminate county-specific 
274.12  service rate limits. 
274.13     (1) Effective July 1, 2001, for service rate limits, except 
274.14  those in subdivision 5, paragraphs (d) and (j), the rate limit 
274.15  for each service shall be the greater of the alternative care 
274.16  statewide maximum rate or the elderly waiver statewide maximum 
274.17  rate. 
274.18     (2) Counties may negotiate individual service rates with 
274.19  vendors for actual costs up to the statewide maximum service 
274.20  rate limit. 
274.21     Sec. 29.  Minnesota Statutes 2000, section 256B.0915, 
274.22  subdivision 1d, is amended to read: 
274.23     Subd. 1d.  [POSTELIGIBILITY TREATMENT OF INCOME AND 
274.24  RESOURCES FOR ELDERLY WAIVER.] (a) Notwithstanding the 
274.25  provisions of section 256B.056, the commissioner shall make the 
274.26  following amendment to the medical assistance elderly waiver 
274.27  program effective July 1, 1999, or upon federal approval, 
274.28  whichever is later. 
274.29     A recipient's maintenance needs will be an amount equal to 
274.30  the Minnesota supplemental aid equivalent rate as defined in 
274.31  section 256I.03, subdivision 5, plus the medical assistance 
274.32  personal needs allowance as defined in section 256B.35, 
274.33  subdivision 1, paragraph (a), when applying posteligibility 
274.34  treatment of income rules to the gross income of elderly waiver 
274.35  recipients, except for individuals whose income is in excess of 
274.36  the special income standard according to Code of Federal 
275.1   Regulations, title 42, section 435.236.  Recipient maintenance 
275.2   needs shall be adjusted under this provision each July 1. 
275.3      (b) The commissioner of human services shall secure 
275.4   approval of additional elderly waiver slots sufficient to serve 
275.5   persons who will qualify under the revised income standard 
275.6   described in paragraph (a) before implementing section 
275.7   256B.0913, subdivision 16. 
275.8      (c) In implementing this subdivision, the commissioner 
275.9   shall consider allowing persons who would otherwise be eligible 
275.10  for the alternative care program but would qualify for the 
275.11  elderly waiver with a spenddown to remain on the alternative 
275.12  care program. 
275.13     Sec. 30.  Minnesota Statutes 2000, section 256B.0915, 
275.14  subdivision 3, is amended to read: 
275.15     Subd. 3.  [LIMITS OF CASES, RATES, REIMBURSEMENT PAYMENTS, 
275.16  AND FORECASTING.] (a) The number of medical assistance waiver 
275.17  recipients that a county may serve must be allocated according 
275.18  to the number of medical assistance waiver cases open on July 1 
275.19  of each fiscal year.  Additional recipients may be served with 
275.20  the approval of the commissioner. 
275.21     (b) The monthly limit for the cost of waivered services to 
275.22  an individual elderly waiver client shall be the statewide 
275.23  average payment weighted average monthly nursing facility rate 
275.24  of the case mix resident class to which the elderly waiver 
275.25  client would be assigned under the medical assistance case mix 
275.26  reimbursement system.  Minnesota Rules, parts 9549.0050 to 
275.27  9549.0059, less the recipient's maintenance needs allowance as 
275.28  described in subdivision 1d, paragraph (a), until the first day 
275.29  of the state fiscal year in which the resident assessment system 
275.30  as described in section 256B.437 for nursing home rate 
275.31  determination is implemented.  Effective on the first day of the 
275.32  state fiscal year in which the resident assessment system as 
275.33  described in section 256B.437 for nursing home rate 
275.34  determination is implemented and the first day of each 
275.35  subsequent state fiscal year, the monthly limit for the cost of 
275.36  waivered services to an individual elderly waiver client shall 
276.1   be the rate of the case mix resident class to which the waiver 
276.2   client would be assigned under Minnesota Rules, parts 9549.0050 
276.3   to 9549.0059, in effect on the last day of the previous state 
276.4   fiscal year, adjusted by the greater of any legislatively 
276.5   adopted home and community-based services cost-of-living 
276.6   percentage increase or any legislatively adopted statewide 
276.7   percent rate increase for nursing facilities. 
276.8      (c) If extended medical supplies and equipment or 
276.9   adaptations environmental modifications are or will be purchased 
276.10  for an elderly waiver services recipient client, the costs may 
276.11  be prorated on a monthly basis throughout the year in which they 
276.12  are purchased for up to 12 consecutive months beginning with the 
276.13  month of purchase.  If the monthly cost of a recipient's other 
276.14  waivered services exceeds the monthly limit established in this 
276.15  paragraph (b), the annual cost of the all waivered services 
276.16  shall be determined.  In this event, the annual cost of all 
276.17  waivered services shall not exceed 12 times the monthly 
276.18  limit calculated in this paragraph.  The statewide average 
276.19  payment rate is calculated by determining the statewide average 
276.20  monthly nursing home rate, effective July 1 of the fiscal year 
276.21  in which the cost is incurred, less the statewide average 
276.22  monthly income of nursing home residents who are age 65 or 
276.23  older, and who are medical assistance recipients in the month of 
276.24  March of the previous state fiscal year.  The annual cost 
276.25  divided by 12 of elderly or disabled waivered services of 
276.26  waivered services as described in paragraph (b).  
276.27     (d) For a person who is a nursing facility resident at the 
276.28  time of requesting a determination of eligibility for elderly or 
276.29  disabled waivered services shall be the greater of the monthly 
276.30  payment for:  (i), a monthly conversion limit for the cost of 
276.31  elderly waivered services may be requested.  The monthly 
276.32  conversion limit for the cost of elderly waiver services shall 
276.33  be the resident class assigned under Minnesota Rules, parts 
276.34  9549.0050 to 9549.0059, for that resident in the nursing 
276.35  facility where the resident currently resides; or (ii) the 
276.36  statewide average payment of the case mix resident class to 
277.1   which the resident would be assigned under the medical 
277.2   assistance case mix reimbursement system, provided that until 
277.3   July 1 of the state fiscal year in which the resident assessment 
277.4   system as described in section 256B.437 for nursing home rate 
277.5   determination is implemented.  Effective on July 1 of the state 
277.6   fiscal year in which the resident assessment system as described 
277.7   in section 256B.437 for nursing home rate determination is 
277.8   implemented, the monthly conversion limit for the cost of 
277.9   elderly waiver services shall be the per diem nursing facility 
277.10  rate as determined by the resident assessment system as 
277.11  described in section 256B.437 for that resident in the nursing 
277.12  facility where the resident currently resides multiplied by 365 
277.13  and divided by 12, less the recipient's maintenance needs 
277.14  allowance as described in subdivision 1d.  The limit under this 
277.15  clause only applies to persons discharged from a nursing 
277.16  facility after a minimum 30-day stay and found eligible for 
277.17  waivered services on or after July 1, 1997.  The following costs 
277.18  must be included in determining the total monthly costs for the 
277.19  waiver client: 
277.20     (1) cost of all waivered services, including extended 
277.21  medical supplies and equipment and environmental modifications; 
277.22  and 
277.23     (2) cost of skilled nursing, home health aide, and personal 
277.24  care services reimbursable by medical assistance.  
277.25     (c) (e) Medical assistance funding for skilled nursing 
277.26  services, private duty nursing, home health aide, and personal 
277.27  care services for waiver recipients must be approved by the case 
277.28  manager and included in the individual care plan. 
277.29     (d) For both the elderly waiver and the nursing facility 
277.30  disabled waiver, a county may purchase extended supplies and 
277.31  equipment without prior approval from the commissioner when 
277.32  there is no other funding source and the supplies and equipment 
277.33  are specified in the individual's care plan as medically 
277.34  necessary to enable the individual to remain in the community 
277.35  according to the criteria in Minnesota Rules, part 9505.0210, 
277.36  items A and B.  (f) A county is not required to contract with a 
278.1   provider of supplies and equipment if the monthly cost of the 
278.2   supplies and equipment is less than $250.  
278.3      (e) (g) The adult foster care daily rate for the elderly 
278.4   and disabled waivers shall be considered a difficulty of care 
278.5   payment and shall not include room and board.  The adult foster 
278.6   care service rate shall be negotiated between the county agency 
278.7   and the foster care provider.  The rate established under this 
278.8   section shall not exceed the state average monthly nursing home 
278.9   payment for the case mix classification to which the individual 
278.10  receiving foster care is assigned; the rate must allow for other 
278.11  waiver and medical assistance home care services to be 
278.12  authorized by the case manager.  The elderly waiver payment for 
278.13  the foster care service in combination with the payment for all 
278.14  other elderly waiver services, including case management, must 
278.15  not exceed the limit specified in paragraph (b). 
278.16     (f) The assisted living and residential care service rates 
278.17  for elderly and community alternatives for disabled individuals 
278.18  (CADI) waivers shall be made to the vendor as a monthly rate 
278.19  negotiated with the county agency based on an individualized 
278.20  service plan for each resident.  The rate shall not exceed the 
278.21  nonfederal share of the greater of either the statewide or any 
278.22  of the geographic groups' weighted average monthly medical 
278.23  assistance nursing facility payment rate of the case mix 
278.24  resident class to which the elderly or disabled client would be 
278.25  assigned under Minnesota Rules, parts 9549.0050 to 9549.0059, 
278.26  unless the services are provided by a home care provider 
278.27  licensed by the department of health and are provided in a 
278.28  building that is registered as a housing with services 
278.29  establishment under chapter 144D and that provides 24-hour 
278.30  supervision.  For alternative care assisted living projects 
278.31  established under Laws 1988, chapter 689, article 2, section 
278.32  256, monthly rates may not exceed 65 percent of the greater of 
278.33  either the statewide or any of the geographic groups' weighted 
278.34  average monthly medical assistance nursing facility payment rate 
278.35  for the case mix resident class to which the elderly or disabled 
278.36  client would be assigned under Minnesota Rules, parts 9549.0050 
279.1   to 9549.0059.  The rate may not cover direct rent or food costs. 
279.2      (h) Payment for assisted living service shall be a monthly 
279.3   rate negotiated and authorized by the county agency based on an 
279.4   individualized service plan for each resident and may not cover 
279.5   direct rent or food costs. 
279.6      (1) The individualized monthly negotiated payment for 
279.7   assisted living services as described in section 256B.0913, 
279.8   subdivision 5, paragraph (g) or (h), and residential care 
279.9   services as described in section 256B.0913, subdivision 5, 
279.10  paragraph (f), shall not exceed the nonfederal share, in effect 
279.11  on July 1 of the state fiscal year for which the rate limit is 
279.12  being calculated, of the greater of either the statewide or any 
279.13  of the geographic groups' weighted average monthly nursing 
279.14  facility rate of the case mix resident class to which the 
279.15  elderly waiver eligible client would be assigned under Minnesota 
279.16  Rules, parts 9549.0050 to 9549.0059, less the maintenance needs 
279.17  allowance as described in subdivision 1d, paragraph (a), until 
279.18  the July 1 of the state fiscal year in which the resident 
279.19  assessment system as described in section 256B.437 for nursing 
279.20  home rate determination is implemented.  Effective on July 1 of 
279.21  the state fiscal year in which the resident assessment system as 
279.22  described in section 256B.437 for nursing home rate 
279.23  determination is implemented and July 1 of each subsequent state 
279.24  fiscal year, the individualized monthly negotiated payment for 
279.25  the services described in this clause shall not exceed the limit 
279.26  described in this clause which was in effect on June 30 of the 
279.27  previous state fiscal year and which has been adjusted by the 
279.28  greater of any legislatively adopted home and community-based 
279.29  services cost-of-living percentage increase or any legislatively 
279.30  adopted statewide percent rate increase for nursing facilities. 
279.31     (2) The individualized monthly negotiated payment for 
279.32  assisted living services described in section 144A.4605 and 
279.33  delivered by a provider licensed by the department of health as 
279.34  a class A home care provider or an assisted living home care 
279.35  provider and provided in a building that is registered as a 
279.36  housing with services establishment under chapter 144D and that 
280.1   provides 24-hour supervision in combination with the payment for 
280.2   other elderly waiver services, including case management, must 
280.3   not exceed the limit specified in paragraph (b). 
280.4      (g) (i) The county shall negotiate individual service rates 
280.5   with vendors and may be reimbursed authorize payment for actual 
280.6   costs up to the greater of the county's current approved rate or 
280.7   60 percent of the maximum rate in fiscal year 1994 and 65 
280.8   percent of the maximum rate in fiscal year 1995 for each service 
280.9   within each program.  Persons or agencies must be employed by or 
280.10  under a contract with the county agency or the public health 
280.11  nursing agency of the local board of health in order to receive 
280.12  funding under the elderly waiver program, except as a provider 
280.13  of supplies and equipment when the monthly cost of the supplies 
280.14  and equipment is less than $250.  
280.15     (h) On July 1, 1993, the commissioner shall increase the 
280.16  maximum rate for home-delivered meals to $4.50 per meal. 
280.17     (i) (j) Reimbursement for the medical assistance recipients 
280.18  under the approved waiver shall be made from the medical 
280.19  assistance account through the invoice processing procedures of 
280.20  the department's Medicaid Management Information System (MMIS), 
280.21  only with the approval of the client's case manager.  The budget 
280.22  for the state share of the Medicaid expenditures shall be 
280.23  forecasted with the medical assistance budget, and shall be 
280.24  consistent with the approved waiver.  
280.25     (k) To improve access to community services and eliminate 
280.26  payment disparities between the alternative care program and the 
280.27  elderly waiver, the commissioner shall establish statewide 
280.28  maximum service rate limits and eliminate county-specific 
280.29  service rate limits. 
280.30     (1) Effective July 1, 2001, for service rate limits, except 
280.31  those described or defined in paragraphs (g) and (h), the rate 
280.32  limit for each service shall be the greater of the alternative 
280.33  care statewide maximum rate or the elderly waiver statewide 
280.34  maximum rate. 
280.35     (2) Counties may negotiate individual service rates with 
280.36  vendors for actual costs up to the statewide maximum service 
281.1   rate limit. 
281.2      (j) (l) Beginning July 1, 1991, the state shall reimburse 
281.3   counties according to the payment schedule in section 256.025 
281.4   for the county share of costs incurred under this subdivision on 
281.5   or after January 1, 1991, for individuals who are receiving 
281.6   medical assistance. 
281.7      (k) For the community alternatives for disabled individuals 
281.8   waiver, and nursing facility disabled waivers, county may use 
281.9   waiver funds for the cost of minor adaptations to a client's 
281.10  residence or vehicle without prior approval from the 
281.11  commissioner if there is no other source of funding and the 
281.12  adaptation: 
281.13     (1) is necessary to avoid institutionalization; 
281.14     (2) has no utility apart from the needs of the client; and 
281.15     (3) meets the criteria in Minnesota Rules, part 9505.0210, 
281.16  items A and B.  
281.17  For purposes of this subdivision, "residence" means the client's 
281.18  own home, the client's family residence, or a family foster 
281.19  home.  For purposes of this subdivision, "vehicle" means the 
281.20  client's vehicle, the client's family vehicle, or the client's 
281.21  family foster home vehicle. 
281.22     (l) The commissioner shall establish a maximum rate unit 
281.23  for baths provided by an adult day care provider that are not 
281.24  included in the provider's contractual daily or hourly rate. 
281.25  This maximum rate must equal the home health aide extended rate 
281.26  and shall be paid for baths provided to clients served under the 
281.27  elderly and disabled waivers. 
281.28     Sec. 31.  Minnesota Statutes 2000, section 256B.0915, 
281.29  subdivision 5, is amended to read: 
281.30     Subd. 5.  [REASSESSMENTS FOR WAIVER CLIENTS.] A 
281.31  reassessment of a client served under the elderly or disabled 
281.32  waiver must be conducted at least every 12 months and at other 
281.33  times when the case manager determines that there has been 
281.34  significant change in the client's functioning.  This may 
281.35  include instances where the client is discharged from the 
281.36  hospital.  
282.1      Sec. 32.  Minnesota Statutes 2000, section 256B.0917, 
282.2   subdivision 7, is amended to read: 
282.3      Subd. 7.  [CONTRACT.] (a) The commissioner of human 
282.4   services shall execute a contract with Living at Home/Block 
282.5   Nurse Program, Inc. (LAH/BN, Inc.).  The contract shall require 
282.6   LAH/BN, Inc. to: 
282.7      (1) develop criteria for and award grants to establish 
282.8   community-based organizations that will implement 
282.9   living-at-home/block nurse programs throughout the state; 
282.10     (2) award grants to enable current living-at-home/block 
282.11  nurse programs to continue to implement the combined 
282.12  living-at-home/block nurse program model; 
282.13     (3) serve as a state technical assistance center to assist 
282.14  and coordinate the living-at-home/block nurse programs 
282.15  established; and 
282.16     (4) manage contracts with individual living-at-home/block 
282.17  nurse programs. 
282.18     (b) The contract shall be effective July 1, 1997, and 
282.19  section 16B.17 shall not apply. 
282.20     Sec. 33.  [256B.0918] [DEVELOPMENT AND PURPOSE OF MEDICAL 
282.21  ASSISTANCE PILOT PROJECT ON SENIOR SERVICES.] 
282.22     Subdivision 1.  [DEVELOPMENT AND PURPOSE.] The commissioner 
282.23  of human services shall develop a medical assistance pilot 
282.24  project on senior services to determine how converting the 
282.25  delivery of housing, supportive services, and health care for 
282.26  seniors into a flexible voucher program will impact public 
282.27  expenditures for older adult service care and provide an 
282.28  alternative way to purchase services based on consumer choice. 
282.29     Subd. 2.  [FEDERAL WAIVER AUTHORITY.] The commissioner 
282.30  shall apply for any necessary federal waivers or approvals to 
282.31  implement this pilot project.  The commissioner shall submit the 
282.32  waiver request no later than April 15, 2002.  
282.33     Subd. 3.  [REPORT.] The commissioner shall report to the 
282.34  legislature by January 15, 2003, on approval of waivers 
282.35  requested.  Upon federal approval, the commissioner shall seek 
282.36  legislative authorization to implement the pilot project.  Once 
283.1   the pilot project is implemented, participating communities and 
283.2   the commissioner of human services shall collaborate to prepare 
283.3   and issue an annual report each December 1 to the appropriate 
283.4   committee chairs in the senate and house on:  (1) the use of 
283.5   state resources, including other funds leveraged for this 
283.6   initiative; (2) the status of individuals being served in the 
283.7   pilot project; and (3) the cost-effectiveness of the pilot 
283.8   project.  The commissioner shall provide data that may be needed 
283.9   to evaluate the pilot project to communities that request the 
283.10  data. 
283.11     Subd. 4.  [SUNSET.] This section sunsets June 30, 2008. 
283.12     Sec. 34.  [SERVICE ACCESS STUDY.] 
283.13     By February 15, 2002, the commissioner of human services 
283.14  shall submit to the legislature recommendations for creating 
283.15  coordinated service access at the county agency level for both 
283.16  publicly subsidized and nonsubsidized long-term care services 
283.17  and housing options.  The report must: 
283.18     (1) include a plan to coordinate public funding streams to 
283.19  allow low-income, privately paying consumers to purchase 
283.20  services through a sliding fee scale; and 
283.21     (2) evaluate the feasibility of statewide implementation, 
283.22  based upon an evaluation of public cost, consumer preferences 
283.23  and satisfaction, and other relevant factors. 
283.24     Sec. 35.  [RESPITE CARE.] 
283.25     The Minnesota board on aging shall report to the 
283.26  legislature by February 1, 2002, on the provision of in-home and 
283.27  out-of-home respite care services on a sliding scale basis under 
283.28  the federal Older Americans Act. 
283.29     Sec. 36.  [REPEALER.] 
283.30     Minnesota Statutes 2000, sections 256B.0911, subdivisions 
283.31  2, 2a, 4, 8, and 9; and 256B.0913, subdivisions 3, 15a, 15b, 
283.32  15c, and 16; Minnesota Rules, parts 9505.2390; 9505.2395; 
283.33  9505.2396; 9505.2400; 9505.2405; 9505.2410; 9505.2413; 
283.34  9505.2415; 9505.2420; 9505.2425; 9505.2426; 9505.2430; 
283.35  9505.2435; 9505.2440; 9505.2445; 9505.2450; 9505.2455; 
283.36  9505.2458; 9505.2460; 9505.2465; 9505.2470; 9505.2473; 
284.1   9505.2475; 9505.2480; 9505.2485; 9505.2486; 9505.2490; 
284.2   9505.2495; 9505.2496; and 9505.2500, are repealed. 
284.3                              ARTICLE 5 
284.4               LONG-TERM CARE REFORM AND REIMBURSEMENT 
284.5      Section 1.  [144.0724] [RESIDENT REIMBURSEMENT 
284.6   CLASSIFICATION.] 
284.7      Subdivision 1.  [RESIDENT REIMBURSEMENT 
284.8   CLASSIFICATIONS.] The commissioner of health shall establish 
284.9   resident reimbursement classifications based upon the 
284.10  assessments of residents of nursing homes and boarding care 
284.11  homes conducted under this section and according to section 
284.12  256B.437.  The reimbursement classifications established under 
284.13  this section shall be implemented after June 30, 2002, but no 
284.14  later than January 1, 2003. 
284.15     Subd. 2.  [DEFINITIONS.] For purposes of this section, the 
284.16  following terms have the meanings given. 
284.17     (a) [ASSESSMENT REFERENCE DATE.] "Assessment reference 
284.18  date" means the last day of the minimum data set observation 
284.19  period.  The date sets the designated endpoint of the common 
284.20  observation period, and all minimum data set items refer back in 
284.21  time from that point. 
284.22     (b) [CASE MIX INDEX.] "Case mix index" means the weighting 
284.23  factors assigned to the RUG-III classifications. 
284.24     (c) [INDEX MAXIMIZATION.] "Index maximization" means 
284.25  classifying a resident who could be assigned to more than one 
284.26  category, to the category with the highest case mix index. 
284.27     (d) [MINIMUM DATA SET.] "Minimum data set" means the 
284.28  assessment instrument specified by the Health Care Financing 
284.29  Administration and designated by the Minnesota department of 
284.30  health. 
284.31     (e) [REPRESENTATIVE.] "Representative" means a person who 
284.32  is the resident's guardian or conservator, the person authorized 
284.33  to pay the nursing home expenses of the resident, a 
284.34  representative of the nursing home ombudsman's office whose 
284.35  assistance has been requested, or any other individual 
284.36  designated by the resident. 
285.1      (f) [RESOURCE UTILIZATION GROUPS OR RUG.] "Resource 
285.2   utilization groups" or "RUG" means the system for grouping a 
285.3   nursing facility's residents according to their clinical and 
285.4   functional status identified in data supplied by the facility's 
285.5   minimum data set. 
285.6      Subd. 3.  [RESIDENT REIMBURSEMENT CLASSIFICATIONS.] (a) 
285.7   Resident reimbursement classifications shall be based on the 
285.8   minimum data set, version 2.0 assessment instrument, or its 
285.9   successor version mandated by the Health Care Financing 
285.10  Administration that nursing facilities are required to complete 
285.11  for all residents.  The commissioner of health shall establish 
285.12  resident classes according to the 34 group, resource utilization 
285.13  groups, version III or RUG-III model.  Resident classes must be 
285.14  established based on the individual items on the minimum data 
285.15  set and must be completed according to the facility manual for 
285.16  case mix classification issued by the Minnesota department of 
285.17  health.  The facility manual for case mix classification shall 
285.18  be drafted by the Minnesota department of health and presented 
285.19  to the chairs of health and human services legislative 
285.20  committees by December 31, 2001. 
285.21     (b) Each resident must be classified based on the 
285.22  information from the minimum data set according to general 
285.23  domains in clauses (1) to (7): 
285.24     (1) extensive services where a resident requires 
285.25  intravenous feeding or medications, suctioning, tracheostomy 
285.26  care, or is on a ventilator or respirator; 
285.27     (2) rehabilitation where a resident requires physical, 
285.28  occupational, or speech therapy; 
285.29     (3) special care where a resident has cerebral palsy; 
285.30  quadriplegia; multiple sclerosis; pressure ulcers; fever with 
285.31  vomiting, weight loss, or dehydration; tube feeding and aphasia; 
285.32  or is receiving radiation therapy; 
285.33     (4) clinically complex status where a resident has burns, 
285.34  coma, septicemia, pneumonia, internal bleeding, chemotherapy, 
285.35  wounds, kidney failure, urinary tract infections, oxygen, or 
285.36  transfusions; 
286.1      (5) impaired cognition where a resident has poor cognitive 
286.2   performance; 
286.3      (6) behavior problems where a resident exhibits wandering, 
286.4   has hallucinations, or is physically or verbally abusive toward 
286.5   others, unless the resident's other condition would place the 
286.6   resident in other categories; and 
286.7      (7) reduced physical functioning where a resident has no 
286.8   special clinical conditions. 
286.9      (c) The commissioner of health shall establish resident 
286.10  classification according to a 34 group model based on the 
286.11  information on the minimum data set and within the general 
286.12  domains listed in paragraph (b), clauses (1) to (7).  Detailed 
286.13  descriptions of each resource utilization group shall be defined 
286.14  in the facility manual for case mix classification issued by the 
286.15  Minnesota department of health.  The 34 groups are described as 
286.16  follows: 
286.17     (1) SE3:  requires four or five extensive services; 
286.18     (2) SE2:  requires two or three extensive services; 
286.19     (3) SE1:  requires one extensive service; 
286.20     (4) RAD:  requires rehabilitation services and is dependent 
286.21  in activity of daily living (ADL) at a count of 17 or 18; 
286.22     (5) RAC:  requires rehabilitation services and ADL count is 
286.23  14 to 16; 
286.24     (6) RAB:  requires rehabilitation services and ADL count is 
286.25  ten to 13; 
286.26     (7) RAA:  requires rehabilitation services and ADL count is 
286.27  four to nine; 
286.28     (8) SSC:  requires special care and ADL count is 17 or 18; 
286.29     (9) SSB:  requires special care and ADL count is 15 or 16; 
286.30     (10) SSA:  requires special care and ADL count is seven to 
286.31  14; 
286.32     (11) CC2:  clinically complex with depression and ADL count 
286.33  is 17 or 18; 
286.34     (12) CC1:  clinically complex with no depression and ADL 
286.35  count is 17 or 18; 
286.36     (13) CB2:  clinically complex with depression and ADL count 
287.1   is 12 to 16; 
287.2      (14) CB1:  clinically complex with no depression and ADL 
287.3   count is 12 to 16; 
287.4      (15) CA2:  clinically complex with depression and ADL count 
287.5   is four to 11; 
287.6      (16) CA1:  clinically complex with no depression and ADL 
287.7   count is four to 11; 
287.8      (17) IB2:  impaired cognition with nursing rehabilitation 
287.9   and ADL count is six to ten; 
287.10     (18) IB1:  impaired cognition with no nursing 
287.11  rehabilitation and ADL count is six to ten; 
287.12     (19) IA2:  impaired cognition with nursing rehabilitation 
287.13  and ADL count is four or five; 
287.14     (20) IA1:  impaired cognition with no nursing 
287.15  rehabilitation and ADL count is four or five; 
287.16     (21) BB2:  behavior problems with nursing rehabilitation 
287.17  and ADL count is six to ten; 
287.18     (22) BB1:  behavior problems with no nursing rehabilitation 
287.19  and ADL count is six to ten; 
287.20     (23) BA2:  behavior problems with nursing rehabilitation 
287.21  and ADL count is four to five; 
287.22     (24) BA1:  behavior problems with no nursing rehabilitation 
287.23  and ADL count is four to five; 
287.24     (25) PE2:  reduced physical functioning with nursing 
287.25  rehabilitation and ADL count is 16 to 18; 
287.26     (26) PE1:  reduced physical functioning with no nursing 
287.27  rehabilitation and ADL count is 16 to 18; 
287.28     (27) PD2:  reduced physical functioning with nursing 
287.29  rehabilitation and ADL count is 11 to 15; 
287.30     (28) PD1:  reduced physical functioning with no nursing 
287.31  rehabilitation and ADL count is 11 to 15; 
287.32     (29) PC2:  reduced physical functioning with nursing 
287.33  rehabilitation and ADL count is nine or ten; 
287.34     (30) PC1:  reduced physical functioning with no nursing 
287.35  rehabilitation and ADL count is nine or ten; 
287.36     (31) PB2:  reduced physical functioning with nursing 
288.1   rehabilitation and ADL count is six to eight; 
288.2      (32) PB1:  reduced physical functioning with no nursing 
288.3   rehabilitation and ADL count is six to eight; 
288.4      (33) PA2:  reduced physical functioning with nursing 
288.5   rehabilitation and ADL count is four or five; and 
288.6      (34) PA1:  reduced physical functioning with no nursing 
288.7   rehabilitation and ADL count is four or five. 
288.8      Subd. 4.  [RESIDENT ASSESSMENT SCHEDULE.] (a) A facility 
288.9   must conduct and electronically submit to the commissioner of 
288.10  health case mix assessments that conform with the assessment 
288.11  schedule defined by the Code of Federal Regulations, title 42, 
288.12  section 483.20, and published by the United States Department of 
288.13  Health and Human Services, Health Care Financing Administration, 
288.14  in the Long Term Care Assessment Instrument User's Manual, 
288.15  version 2.0, October 1995, and subsequent clarifications made in 
288.16  the Long-Term Care Assessment Instrument Questions and Answers, 
288.17  version 2.0, August 1996.  The commissioner of health may 
288.18  substitute successor manuals or question and answer documents 
288.19  published by the United States Department of Health and Human 
288.20  Services, Health Care Financing Administration, to replace or 
288.21  supplement the current version of the manual or document. 
288.22     (b) The assessments used to determine a case mix 
288.23  classification for reimbursement include the following: 
288.24     (1) a new admission assessment must be completed by day 14 
288.25  following admission; 
288.26     (2) an annual assessment must be completed within 366 days 
288.27  of the last comprehensive assessment; 
288.28     (3) a significant change assessment must be completed 
288.29  within 14 days of the identification of a significant change; 
288.30  and 
288.31     (4) the second quarterly assessment following either a new 
288.32  admission assessment, an annual assessment, or a significant 
288.33  change assessment.  Each quarterly assessment must be completed 
288.34  within 92 days of the previous assessment. 
288.35     Subd. 5.  [SHORT STAYS.] (a) A facility must submit to the 
288.36  commissioner of health an initial admission assessment for all 
289.1   residents who stay in the facility less than 14 days. 
289.2      (b) Notwithstanding the admission assessment requirements 
289.3   of paragraph (a), a facility may elect to accept a default rate 
289.4   with a case mix index of 1.0 for all facility residents who stay 
289.5   less than 14 days in lieu of submitting an initial assessment.  
289.6   Facilities may make this election to be effective on the day of 
289.7   implementation of the revised case mix system. 
289.8      (c) After implementation of the revised case mix system, 
289.9   nursing facilities must elect one of the options described in 
289.10  paragraphs (a) and (b) on the annual report to the commissioner 
289.11  of human services filed for each report year ending September 
289.12  30.  The election shall be effective on the following July 1. 
289.13     (d) For residents who are admitted or readmitted and leave 
289.14  the facility on a frequent basis and for whom readmission is 
289.15  expected, the resident may be discharged on an extended leave 
289.16  status.  This status does not require reassessment each time the 
289.17  resident returns to the facility unless a significant change in 
289.18  the resident's status has occurred since the last assessment.  
289.19  The case mix classification for these residents is determined by 
289.20  the facility election made in paragraphs (a) and (b). 
289.21     Subd. 6.  [PENALTIES FOR LATE OR NONSUBMISSION.] A facility 
289.22  that fails to complete or submit an assessment for a RUG-III 
289.23  classification within seven days of the time requirements in 
289.24  subdivisions 4 and 5 is subject to a reduced rate for that 
289.25  resident.  The reduced rate shall be the lowest rate for that 
289.26  facility.  The reduced rate is effective on the day of admission 
289.27  for new admission assessments or on the day that the assessment 
289.28  was due for all other assessments and continues in effect until 
289.29  the first day of the month following the date of submission of 
289.30  the resident's assessment. 
289.31     Subd. 7.  [NOTICE OF RESIDENT REIMBURSEMENT 
289.32  CLASSIFICATION.] (a) A facility must elect between the options 
289.33  in clauses (1) and (2) to provide notice to a resident of the 
289.34  resident's case mix classification. 
289.35     (1) The commissioner of health shall provide to a nursing 
289.36  facility a notice for each resident of the reimbursement 
290.1   classification established under subdivision 1.  The notice must 
290.2   inform the resident of the classification that was assigned, the 
290.3   opportunity to review the documentation supporting the 
290.4   classification, the opportunity to obtain clarification from the 
290.5   commissioner, and the opportunity to request a reconsideration 
290.6   of the classification.  The commissioner must send notice of 
290.7   resident classification by first class mail.  A nursing facility 
290.8   is responsible for the distribution of the notice to each 
290.9   resident, to the person responsible for the payment of the 
290.10  resident's nursing home expenses, or to another person 
290.11  designated by the resident.  This notice must be distributed 
290.12  within three working days after the facility's receipt of the 
290.13  notice from the commissioner of health. 
290.14     (2) A facility may choose to provide a classification 
290.15  notice, as prescribed by the commissioner of health, to a 
290.16  resident upon receipt of the confirmation of the case mix 
290.17  classification calculated by a facility or a corrected case mix 
290.18  classification as indicated on the final validation report from 
290.19  the commissioner.  A nursing facility is responsible for the 
290.20  distribution of the notice to each resident, to the person 
290.21  responsible for the payment of the resident's nursing home 
290.22  expenses, or to another person designated by the resident.  This 
290.23  notice must be distributed within three working days after the 
290.24  facility's receipt of the validation report from the 
290.25  commissioner.  If a facility elects this option, the 
290.26  commissioner of health shall provide the facility with a list of 
290.27  residents and their case mix classifications as determined by 
290.28  the commissioner.  A nursing facility may make this election to 
290.29  be effective on the day of implementation of the revised case 
290.30  mix system. 
290.31     (3) After implementation of the revised case mix system, a 
290.32  nursing facility shall elect a notice of resident reimbursement 
290.33  classification procedure as described in clause (1) or (2) on 
290.34  the annual report to the commissioner of human services filed 
290.35  for each report year ending September 30.  The election will be 
290.36  effective the following July 1. 
291.1      (b) If a facility submits a correction to an assessment 
291.2   conducted under subdivision 3 that results in a change in case 
291.3   mix classification, the facility shall give written notice to 
291.4   the resident or the resident's representative about the item 
291.5   that was corrected and the reason for the correction.  The 
291.6   notice of corrected assessment may be provided at the same time 
291.7   that the resident or resident's representative is provided the 
291.8   resident's corrected notice of classification. 
291.9      Subd. 8.  [REQUEST FOR RECONSIDERATION OF RESIDENT 
291.10  CLASSIFICATIONS.] (a) The resident, or resident's 
291.11  representative, or the nursing facility or boarding care home 
291.12  may request that the commissioner of health reconsider the 
291.13  assigned reimbursement classification.  The request for 
291.14  reconsideration must be submitted in writing to the commissioner 
291.15  within 30 days of the day the resident or the resident's 
291.16  representative receives the resident classification notice.  The 
291.17  request for reconsideration must include the name of the 
291.18  resident, the name and address of the facility in which the 
291.19  resident resides, the reasons for the reconsideration, the 
291.20  requested classification changes, and documentation supporting 
291.21  the requested classification.  The documentation accompanying 
291.22  the reconsideration request is limited to documentation which 
291.23  establishes that the needs of the resident at the time of the 
291.24  assessment justify a classification which is different than the 
291.25  classification established by the commissioner of health. 
291.26     (b) Upon request, the nursing facility must give the 
291.27  resident or the resident's representative a copy of the 
291.28  assessment form and the other documentation that was given to 
291.29  the commissioner of health to support the assessment findings.  
291.30  The nursing facility shall also provide access to and a copy of 
291.31  other information from the resident's record that has been 
291.32  requested by or on behalf of the resident to support a 
291.33  resident's reconsideration request.  A copy of any requested 
291.34  material must be provided within three working days of receipt 
291.35  of a written request for the information.  If a facility fails 
291.36  to provide the material within this time, it is subject to the 
292.1   issuance of a correction order and penalty assessment under 
292.2   sections 144.653 and 144A.10.  Notwithstanding those sections, 
292.3   any correction order issued under this subdivision must require 
292.4   that the nursing facility immediately comply with the request 
292.5   for information and that as of the date of the issuance of the 
292.6   correction order, the facility shall forfeit to the state a $100 
292.7   fine for the first day of noncompliance, and an increase in the 
292.8   $100 fine by $50 increments for each day the noncompliance 
292.9   continues. 
292.10     (c) In addition to the information required under 
292.11  paragraphs (a) and (b), a reconsideration request from a nursing 
292.12  facility must contain the following information:  (i) the date 
292.13  the reimbursement classification notices were received by the 
292.14  facility; (ii) the date the classification notices were 
292.15  distributed to the resident or the resident's representative; 
292.16  and (iii) a copy of a notice sent to the resident or to the 
292.17  resident's representative.  This notice must inform the resident 
292.18  or the resident's representative that a reconsideration of the 
292.19  resident's classification is being requested, the reason for the 
292.20  request, that the resident's rate will change if the request is 
292.21  approved by the commissioner, the extent of the change, that 
292.22  copies of the facility's request and supporting documentation 
292.23  are available for review, and that the resident also has the 
292.24  right to request a reconsideration.  If the facility fails to 
292.25  provide the required information with the reconsideration 
292.26  request, the request must be denied, and the facility may not 
292.27  make further reconsideration requests on that specific 
292.28  reimbursement classification. 
292.29     (d) Reconsideration by the commissioner must be made by 
292.30  individuals not involved in reviewing the assessment, audit, or 
292.31  reconsideration that established the disputed classification.  
292.32  The reconsideration must be based upon the initial assessment 
292.33  and upon the information provided to the commissioner under 
292.34  paragraphs (a) and (b).  If necessary for evaluating the 
292.35  reconsideration request, the commissioner may conduct on-site 
292.36  reviews.  Within 15 working days of receiving the request for 
293.1   reconsideration, the commissioner shall affirm or modify the 
293.2   original resident classification.  The original classification 
293.3   must be modified if the commissioner determines that the 
293.4   assessment resulting in the classification did not accurately 
293.5   reflect the needs or assessment characteristics of the resident 
293.6   at the time of the assessment.  The resident and the nursing 
293.7   facility or boarding care home shall be notified within five 
293.8   working days after the decision is made.  A decision by the 
293.9   commissioner under this subdivision is the final administrative 
293.10  decision of the agency for the party requesting reconsideration. 
293.11     (e) The resident classification established by the 
293.12  commissioner shall be the classification that applies to the 
293.13  resident while the request for reconsideration is pending. 
293.14     (f) The commissioner may request additional documentation 
293.15  regarding a reconsideration necessary to make an accurate 
293.16  reconsideration determination. 
293.17     Subd. 9.  [AUDIT AUTHORITY.] (a) The commissioner shall 
293.18  audit the accuracy of resident assessments performed under 
293.19  section 256B.437 through desk audits, on-site review of 
293.20  residents and their records, and interviews with staff and 
293.21  families.  The commissioner shall reclassify a resident if the 
293.22  commissioner determines that the resident was incorrectly 
293.23  classified. 
293.24     (b) The commissioner is authorized to conduct on-site 
293.25  audits on an unannounced basis. 
293.26     (c) A facility must grant the commissioner access to 
293.27  examine the medical records relating to the resident assessments 
293.28  selected for audit under this subdivision.  The commissioner may 
293.29  also observe and speak to facility staff and residents. 
293.30     (d) The commissioner shall consider documentation under the 
293.31  time frames for coding items on the minimum data set as set out 
293.32  in the Resident Assessment Instrument Manual published by the 
293.33  Health Care Financing Administration. 
293.34     (e) The commissioner shall develop an audit selection 
293.35  procedure that includes the following factors: 
293.36     (1) The commissioner may target facilities that demonstrate 
294.1   an atypical pattern of scoring minimum data set items, 
294.2   nonsubmission of assessments, late submission of assessments, or 
294.3   a previous history of audit changes of greater than 35 percent.  
294.4   The commissioner shall select at least 20 percent of the most 
294.5   current assessments submitted to the state for audit.  Audits of 
294.6   assessments selected in the targeted facilities must focus on 
294.7   the factors leading to the audit.  If the number of targeted 
294.8   assessments selected does not meet the threshold of 20 percent 
294.9   of the facility residents, then a stratified sample of the 
294.10  remainder of assessments shall be drawn to meet the quota.  If 
294.11  the total change exceeds 35 percent, the commissioner may 
294.12  conduct an expanded audit up to 100 percent of the remaining 
294.13  current assessments. 
294.14     (2) Facilities that are not a part of the targeted group 
294.15  shall be placed in a general pool from which facilities will be 
294.16  selected on a random basis for audit.  Every facility shall be 
294.17  audited annually.  If a facility has two successive audits in 
294.18  which the percentage of change is five percent or less and the 
294.19  facility has not been the subject of a targeted audit in the 
294.20  past 36 months, the facility may be audited biannually.  A 
294.21  stratified sample of 15 percent of the most current assessments 
294.22  shall be selected for audit.  If more than 20 percent of the 
294.23  RUGS-III classifications after the audit are changed, the audit 
294.24  shall be expanded to a second 15 percent sample.  If the total 
294.25  change between the first and second samples exceed 35 percent, 
294.26  the commissioner may expand the audit to all of the remaining 
294.27  assessments. 
294.28     (3) If a facility qualifies for an expanded audit, the 
294.29  commissioner may audit the facility again within six months.  If 
294.30  a facility has two expanded audits within a 24-month period, 
294.31  that facility will be audited at least every six months for the 
294.32  next 18 months. 
294.33     (4) The commissioner may conduct special audits if the 
294.34  commissioner determines that circumstances exist that could 
294.35  alter or affect the validity of case mix classifications of 
294.36  residents.  These circumstances include, but are not limited to, 
295.1   the following:  
295.2      (i) frequent changes in the administration or management of 
295.3   the facility; 
295.4      (ii) an unusually high percentage of residents in a 
295.5   specific case mix classification; 
295.6      (iii) a high frequency in the number of reconsideration 
295.7   requests received from a facility; 
295.8      (iv) frequent adjustments of case mix classifications as 
295.9   the result of reconsiderations or audits; 
295.10     (v) a criminal indictment alleging provider fraud; or 
295.11     (vi) other similar factors that relate to a facility's 
295.12  ability to conduct accurate assessments. 
295.13     (f) Within 15 working days of completing the audit process, 
295.14  the commissioner shall mail the written results of the audit to 
295.15  the facility, along with a written notice for each resident 
295.16  affected to be forwarded by the facility.  The notice must 
295.17  contain the resident's classification and a statement informing 
295.18  the resident, the resident's authorized representative, and the 
295.19  facility of their right to review the commissioner's documents 
295.20  supporting the classification and to request a reconsideration 
295.21  of the classification.  This notice must also include the 
295.22  address and telephone number of the area nursing home ombudsman. 
295.23     Subd. 10.  [TRANSITION.] After implementation of this 
295.24  section, reconsiderations requested for classifications made 
295.25  under section 144.0722, subdivision 1, shall be determined under 
295.26  section 144.0722, subdivision 3. 
295.27     Sec. 2.  Minnesota Statutes 2000, section 144A.071, 
295.28  subdivision 1, is amended to read: 
295.29     Subdivision 1.  [FINDINGS.] The legislature declares that a 
295.30  moratorium on the licensure and medical assistance certification 
295.31  of new nursing home beds and construction projects that 
295.32  exceed $750,000 $1,000,000 is necessary to control nursing home 
295.33  expenditure growth and enable the state to meet the needs of its 
295.34  elderly by providing high quality services in the most 
295.35  appropriate manner along a continuum of care.  
295.36     Sec. 3.  Minnesota Statutes 2000, section 144A.071, 
296.1   subdivision 1a, is amended to read: 
296.2      Subd. 1a.  [DEFINITIONS.] For purposes of sections 144A.071 
296.3   to 144A.073, the following terms have the meanings given them: 
296.4      (a) "attached fixtures" has the meaning given in Minnesota 
296.5   Rules, part 9549.0020, subpart 6. 
296.6      (b) "buildings" has the meaning given in Minnesota Rules, 
296.7   part 9549.0020, subpart 7. 
296.8      (c) "capital assets" has the meaning given in section 
296.9   256B.421, subdivision 16. 
296.10     (d) "commenced construction" means that all of the 
296.11  following conditions were met:  the final working drawings and 
296.12  specifications were approved by the commissioner of health; the 
296.13  construction contracts were let; a timely construction schedule 
296.14  was developed, stipulating dates for beginning, achieving 
296.15  various stages, and completing construction; and all zoning and 
296.16  building permits were applied for. 
296.17     (e) "completion date" means the date on which a certificate 
296.18  of occupancy is issued for a construction project, or if a 
296.19  certificate of occupancy is not required, the date on which the 
296.20  construction project is available for facility use. 
296.21     (f) "construction" means any erection, building, 
296.22  alteration, reconstruction, modernization, or improvement 
296.23  necessary to comply with the nursing home licensure rules. 
296.24     (g) "construction project" means: 
296.25     (1) a capital asset addition to, or replacement of a 
296.26  nursing home or certified boarding care home that results in new 
296.27  space or the remodeling of or renovations to existing facility 
296.28  space; 
296.29     (2) the remodeling or renovation of existing facility space 
296.30  the use of which is modified as a result of the project 
296.31  described in clause (1).  This existing space and the project 
296.32  described in clause (1) must be used for the functions as 
296.33  designated on the construction plans on completion of the 
296.34  project described in clause (1) for a period of not less than 24 
296.35  months; or 
296.36     (3) capital asset additions or replacements that are 
297.1   completed within 12 months before or after the completion date 
297.2   of the project described in clause (1). 
297.3      (h) "new licensed" or "new certified beds" means: 
297.4      (1) newly constructed beds in a facility or the 
297.5   construction of a new facility that would increase the total 
297.6   number of licensed nursing home beds or certified boarding care 
297.7   or nursing home beds in the state; or 
297.8      (2) newly licensed nursing home beds or newly certified 
297.9   boarding care or nursing home beds that result from remodeling 
297.10  of the facility that involves relocation of beds but does not 
297.11  result in an increase in the total number of beds, except when 
297.12  the project involves the upgrade of boarding care beds to 
297.13  nursing home beds, as defined in section 144A.073, subdivision 
297.14  1.  "Remodeling" includes any of the type of conversion, 
297.15  renovation, replacement, or upgrading projects as defined in 
297.16  section 144A.073, subdivision 1. 
297.17     (i) "project construction costs" means the cost of the 
297.18  facility capital asset additions, replacements, renovations, or 
297.19  remodeling projects, construction site preparation costs, and 
297.20  related soft costs.  Project construction costs also include the 
297.21  cost of any remodeling or renovation of existing facility space 
297.22  which is modified as a result of the construction 
297.23  project.  Project construction costs also includes the cost of 
297.24  new technology implemented as part of the construction project. 
297.25     (j) "technology" means information systems or devices that 
297.26  make documentation, charting, and staff time more efficient or 
297.27  encourage and allow for care through alternative settings 
297.28  including, but not limited to, touch screens, monitors, 
297.29  hand-helds, swipe cards, motion detectors, pagers, telemedicine, 
297.30  medication dispensers, and equipment to monitor vital signs and 
297.31  self-injections, and to observe skin and other conditions. 
297.32     Sec. 4.  Minnesota Statutes 2000, section 144A.071, 
297.33  subdivision 2, is amended to read: 
297.34     Subd. 2.  [MORATORIUM.] The commissioner of health, in 
297.35  coordination with the commissioner of human services, shall deny 
297.36  each request for new licensed or certified nursing home or 
298.1   certified boarding care beds except as provided in subdivision 3 
298.2   or 4a, or section 144A.073.  "Certified bed" means a nursing 
298.3   home bed or a boarding care bed certified by the commissioner of 
298.4   health for the purposes of the medical assistance program, under 
298.5   United States Code, title 42, sections 1396 et seq.  
298.6      The commissioner of human services, in coordination with 
298.7   the commissioner of health, shall deny any request to issue a 
298.8   license under section 252.28 and chapter 245A to a nursing home 
298.9   or boarding care home, if that license would result in an 
298.10  increase in the medical assistance reimbursement amount.  
298.11     In addition, the commissioner of health must not approve 
298.12  any construction project whose cost exceeds $750,000 $1,000,000 
298.13  unless: 
298.14     (a) any construction costs exceeding $750,000 $1,000,000 
298.15  are not added to the facility's appraised value and are not 
298.16  included in the facility's payment rate for reimbursement under 
298.17  the medical assistance program; or 
298.18     (b) the project: 
298.19     (1) has been approved through the process described in 
298.20  section 144A.073; 
298.21     (2) meets an exception in subdivision 3 or 4a; 
298.22     (3) is necessary to correct violations of state or federal 
298.23  law issued by the commissioner of health; 
298.24     (4) is necessary to repair or replace a portion of the 
298.25  facility that was damaged by fire, lightning, groundshifts, or 
298.26  other such hazards, including environmental hazards, provided 
298.27  that the provisions of subdivision 4a, clause (a), are met; 
298.28     (5) as of May 1, 1992, the facility has submitted to the 
298.29  commissioner of health written documentation evidencing that the 
298.30  facility meets the "commenced construction" definition as 
298.31  specified in subdivision 1a, clause (d), or that substantial 
298.32  steps have been taken prior to April 1, 1992, relating to the 
298.33  construction project.  "Substantial steps" require that the 
298.34  facility has made arrangements with outside parties relating to 
298.35  the construction project and include the hiring of an architect 
298.36  or construction firm, submission of preliminary plans to the 
299.1   department of health or documentation from a financial 
299.2   institution that financing arrangements for the construction 
299.3   project have been made; or 
299.4      (6) is being proposed by a licensed nursing facility that 
299.5   is not certified to participate in the medical assistance 
299.6   program and will not result in new licensed or certified beds. 
299.7      Prior to the final plan approval of any construction 
299.8   project, the commissioner of health shall be provided with an 
299.9   itemized cost estimate for the project construction costs.  If a 
299.10  construction project is anticipated to be completed in phases, 
299.11  the total estimated cost of all phases of the project shall be 
299.12  submitted to the commissioner and shall be considered as one 
299.13  construction project.  Once the construction project is 
299.14  completed and prior to the final clearance by the commissioner, 
299.15  the total project construction costs for the construction 
299.16  project shall be submitted to the commissioner.  If the final 
299.17  project construction cost exceeds the dollar threshold in this 
299.18  subdivision, the commissioner of human services shall not 
299.19  recognize any of the project construction costs or the related 
299.20  financing costs in excess of this threshold in establishing the 
299.21  facility's property-related payment rate. 
299.22     The dollar thresholds for construction projects are as 
299.23  follows:  for construction projects other than those authorized 
299.24  in clauses (1) to (6), the dollar threshold 
299.25  is $750,000 $1,000,000.  For projects authorized after July 1, 
299.26  1993, under clause (1), the dollar threshold is the cost 
299.27  estimate submitted with a proposal for an exception under 
299.28  section 144A.073, plus inflation as calculated according to 
299.29  section 256B.431, subdivision 3f, paragraph (a).  For projects 
299.30  authorized under clauses (2) to (4), the dollar threshold is the 
299.31  itemized estimate project construction costs submitted to the 
299.32  commissioner of health at the time of final plan approval, plus 
299.33  inflation as calculated according to section 256B.431, 
299.34  subdivision 3f, paragraph (a). 
299.35     The commissioner of health shall adopt rules to implement 
299.36  this section or to amend the emergency rules for granting 
300.1   exceptions to the moratorium on nursing homes under section 
300.2   144A.073.  
300.3      Sec. 5.  Minnesota Statutes 2000, section 144A.071, 
300.4   subdivision 4a, is amended to read: 
300.5      Subd. 4a.  [EXCEPTIONS FOR REPLACEMENT BEDS.] It is in the 
300.6   best interest of the state to ensure that nursing homes and 
300.7   boarding care homes continue to meet the physical plant 
300.8   licensing and certification requirements by permitting certain 
300.9   construction projects.  Facilities should be maintained in 
300.10  condition to satisfy the physical and emotional needs of 
300.11  residents while allowing the state to maintain control over 
300.12  nursing home expenditure growth. 
300.13     The commissioner of health in coordination with the 
300.14  commissioner of human services, may approve the renovation, 
300.15  replacement, upgrading, or relocation of a nursing home or 
300.16  boarding care home, under the following conditions: 
300.17     (a) to license or certify beds in a new facility 
300.18  constructed to replace a facility or to make repairs in an 
300.19  existing facility that was destroyed or damaged after June 30, 
300.20  1987, by fire, lightning, or other hazard provided:  
300.21     (i) destruction was not caused by the intentional act of or 
300.22  at the direction of a controlling person of the facility; 
300.23     (ii) at the time the facility was destroyed or damaged the 
300.24  controlling persons of the facility maintained insurance 
300.25  coverage for the type of hazard that occurred in an amount that 
300.26  a reasonable person would conclude was adequate; 
300.27     (iii) the net proceeds from an insurance settlement for the 
300.28  damages caused by the hazard are applied to the cost of the new 
300.29  facility or repairs; 
300.30     (iv) the new facility is constructed on the same site as 
300.31  the destroyed facility or on another site subject to the 
300.32  restrictions in section 144A.073, subdivision 5; 
300.33     (v) the number of licensed and certified beds in the new 
300.34  facility does not exceed the number of licensed and certified 
300.35  beds in the destroyed facility; and 
300.36     (vi) the commissioner determines that the replacement beds 
301.1   are needed to prevent an inadequate supply of beds. 
301.2   Project construction costs incurred for repairs authorized under 
301.3   this clause shall not be considered in the dollar threshold 
301.4   amount defined in subdivision 2; 
301.5      (b) to license or certify beds that are moved from one 
301.6   location to another within a nursing home facility, provided the 
301.7   total costs of remodeling performed in conjunction with the 
301.8   relocation of beds does not exceed $750,000 $1,000,000; 
301.9      (c) to license or certify beds in a project recommended for 
301.10  approval under section 144A.073; 
301.11     (d) to license or certify beds that are moved from an 
301.12  existing state nursing home to a different state facility, 
301.13  provided there is no net increase in the number of state nursing 
301.14  home beds; 
301.15     (e) to certify and license as nursing home beds boarding 
301.16  care beds in a certified boarding care facility if the beds meet 
301.17  the standards for nursing home licensure, or in a facility that 
301.18  was granted an exception to the moratorium under section 
301.19  144A.073, and if the cost of any remodeling of the facility does 
301.20  not exceed $750,000 $1,000,000.  If boarding care beds are 
301.21  licensed as nursing home beds, the number of boarding care beds 
301.22  in the facility must not increase beyond the number remaining at 
301.23  the time of the upgrade in licensure.  The provisions contained 
301.24  in section 144A.073 regarding the upgrading of the facilities do 
301.25  not apply to facilities that satisfy these requirements; 
301.26     (f) to license and certify up to 40 beds transferred from 
301.27  an existing facility owned and operated by the Amherst H. Wilder 
301.28  Foundation in the city of St. Paul to a new unit at the same 
301.29  location as the existing facility that will serve persons with 
301.30  Alzheimer's disease and other related disorders.  The transfer 
301.31  of beds may occur gradually or in stages, provided the total 
301.32  number of beds transferred does not exceed 40.  At the time of 
301.33  licensure and certification of a bed or beds in the new unit, 
301.34  the commissioner of health shall delicense and decertify the 
301.35  same number of beds in the existing facility.  As a condition of 
301.36  receiving a license or certification under this clause, the 
302.1   facility must make a written commitment to the commissioner of 
302.2   human services that it will not seek to receive an increase in 
302.3   its property-related payment rate as a result of the transfers 
302.4   allowed under this paragraph; 
302.5      (g) to license and certify nursing home beds to replace 
302.6   currently licensed and certified boarding care beds which may be 
302.7   located either in a remodeled or renovated boarding care or 
302.8   nursing home facility or in a remodeled, renovated, newly 
302.9   constructed, or replacement nursing home facility within the 
302.10  identifiable complex of health care facilities in which the 
302.11  currently licensed boarding care beds are presently located, 
302.12  provided that the number of boarding care beds in the facility 
302.13  or complex are decreased by the number to be licensed as nursing 
302.14  home beds and further provided that, if the total costs of new 
302.15  construction, replacement, remodeling, or renovation exceed ten 
302.16  percent of the appraised value of the facility or $200,000, 
302.17  whichever is less, the facility makes a written commitment to 
302.18  the commissioner of human services that it will not seek to 
302.19  receive an increase in its property-related payment rate by 
302.20  reason of the new construction, replacement, remodeling, or 
302.21  renovation.  The provisions contained in section 144A.073 
302.22  regarding the upgrading of facilities do not apply to facilities 
302.23  that satisfy these requirements; 
302.24     (h) to license as a nursing home and certify as a nursing 
302.25  facility a facility that is licensed as a boarding care facility 
302.26  but not certified under the medical assistance program, but only 
302.27  if the commissioner of human services certifies to the 
302.28  commissioner of health that licensing the facility as a nursing 
302.29  home and certifying the facility as a nursing facility will 
302.30  result in a net annual savings to the state general fund of 
302.31  $200,000 or more; 
302.32     (i) to certify, after September 30, 1992, and prior to July 
302.33  1, 1993, existing nursing home beds in a facility that was 
302.34  licensed and in operation prior to January 1, 1992; 
302.35     (j) to license and certify new nursing home beds to replace 
302.36  beds in a facility acquired by the Minneapolis community 
303.1   development agency as part of redevelopment activities in a city 
303.2   of the first class, provided the new facility is located within 
303.3   three miles of the site of the old facility.  Operating and 
303.4   property costs for the new facility must be determined and 
303.5   allowed under section 256B.431 or 256B.434; 
303.6      (k) to license and certify up to 20 new nursing home beds 
303.7   in a community-operated hospital and attached convalescent and 
303.8   nursing care facility with 40 beds on April 21, 1991, that 
303.9   suspended operation of the hospital in April 1986.  The 
303.10  commissioner of human services shall provide the facility with 
303.11  the same per diem property-related payment rate for each 
303.12  additional licensed and certified bed as it will receive for its 
303.13  existing 40 beds; 
303.14     (l) to license or certify beds in renovation, replacement, 
303.15  or upgrading projects as defined in section 144A.073, 
303.16  subdivision 1, so long as the cumulative total costs of the 
303.17  facility's remodeling projects do not 
303.18  exceed $750,000 $1,000,000; 
303.19     (m) to license and certify beds that are moved from one 
303.20  location to another for the purposes of converting up to five 
303.21  four-bed wards to single or double occupancy rooms in a nursing 
303.22  home that, as of January 1, 1993, was county-owned and had a 
303.23  licensed capacity of 115 beds; 
303.24     (n) to allow a facility that on April 16, 1993, was a 
303.25  106-bed licensed and certified nursing facility located in 
303.26  Minneapolis to layaway all of its licensed and certified nursing 
303.27  home beds.  These beds may be relicensed and recertified in a 
303.28  newly-constructed teaching nursing home facility affiliated with 
303.29  a teaching hospital upon approval by the legislature.  The 
303.30  proposal must be developed in consultation with the interagency 
303.31  committee on long-term care planning.  The beds on layaway 
303.32  status shall have the same status as voluntarily delicensed and 
303.33  decertified beds, except that beds on layaway status remain 
303.34  subject to the surcharge in section 256.9657.  This layaway 
303.35  provision expires July 1, 1998; 
303.36     (o) to allow a project which will be completed in 
304.1   conjunction with an approved moratorium exception project for a 
304.2   nursing home in southern Cass county and which is directly 
304.3   related to that portion of the facility that must be repaired, 
304.4   renovated, or replaced, to correct an emergency plumbing problem 
304.5   for which a state correction order has been issued and which 
304.6   must be corrected by August 31, 1993; 
304.7      (p) to allow a facility that on April 16, 1993, was a 
304.8   368-bed licensed and certified nursing facility located in 
304.9   Minneapolis to layaway, upon 30 days prior written notice to the 
304.10  commissioner, up to 30 of the facility's licensed and certified 
304.11  beds by converting three-bed wards to single or double 
304.12  occupancy.  Beds on layaway status shall have the same status as 
304.13  voluntarily delicensed and decertified beds except that beds on 
304.14  layaway status remain subject to the surcharge in section 
304.15  256.9657, remain subject to the license application and renewal 
304.16  fees under section 144A.07 and shall be subject to a $100 per 
304.17  bed reactivation fee.  In addition, at any time within three 
304.18  years of the effective date of the layaway, the beds on layaway 
304.19  status may be: 
304.20     (1) relicensed and recertified upon relocation and 
304.21  reactivation of some or all of the beds to an existing licensed 
304.22  and certified facility or facilities located in Pine River, 
304.23  Brainerd, or International Falls; provided that the total 
304.24  project construction costs related to the relocation of beds 
304.25  from layaway status for any facility receiving relocated beds 
304.26  may not exceed the dollar threshold provided in subdivision 2 
304.27  unless the construction project has been approved through the 
304.28  moratorium exception process under section 144A.073; 
304.29     (2) relicensed and recertified, upon reactivation of some 
304.30  or all of the beds within the facility which placed the beds in 
304.31  layaway status, if the commissioner has determined a need for 
304.32  the reactivation of the beds on layaway status. 
304.33     The property-related payment rate of a facility placing 
304.34  beds on layaway status must be adjusted by the incremental 
304.35  change in its rental per diem after recalculating the rental per 
304.36  diem as provided in section 256B.431, subdivision 3a, paragraph 
305.1   (c).  The property-related payment rate for a facility 
305.2   relicensing and recertifying beds from layaway status must be 
305.3   adjusted by the incremental change in its rental per diem after 
305.4   recalculating its rental per diem using the number of beds after 
305.5   the relicensing to establish the facility's capacity day 
305.6   divisor, which shall be effective the first day of the month 
305.7   following the month in which the relicensing and recertification 
305.8   became effective.  Any beds remaining on layaway status more 
305.9   than three years after the date the layaway status became 
305.10  effective must be removed from layaway status and immediately 
305.11  delicensed and decertified; 
305.12     (q) to license and certify beds in a renovation and 
305.13  remodeling project to convert 12 four-bed wards into 24 two-bed 
305.14  rooms, expand space, and add improvements in a nursing home 
305.15  that, as of January 1, 1994, met the following conditions:  the 
305.16  nursing home was located in Ramsey county; had a licensed 
305.17  capacity of 154 beds; and had been ranked among the top 15 
305.18  applicants by the 1993 moratorium exceptions advisory review 
305.19  panel.  The total project construction cost estimate for this 
305.20  project must not exceed the cost estimate submitted in 
305.21  connection with the 1993 moratorium exception process; 
305.22     (r) to license and certify up to 117 beds that are 
305.23  relocated from a licensed and certified 138-bed nursing facility 
305.24  located in St. Paul to a hospital with 130 licensed hospital 
305.25  beds located in South St. Paul, provided that the nursing 
305.26  facility and hospital are owned by the same or a related 
305.27  organization and that prior to the date the relocation is 
305.28  completed the hospital ceases operation of its inpatient 
305.29  hospital services at that hospital.  After relocation, the 
305.30  nursing facility's status under section 256B.431, subdivision 
305.31  2j, shall be the same as it was prior to relocation.  The 
305.32  nursing facility's property-related payment rate resulting from 
305.33  the project authorized in this paragraph shall become effective 
305.34  no earlier than April 1, 1996.  For purposes of calculating the 
305.35  incremental change in the facility's rental per diem resulting 
305.36  from this project, the allowable appraised value of the nursing 
306.1   facility portion of the existing health care facility physical 
306.2   plant prior to the renovation and relocation may not exceed 
306.3   $2,490,000; 
306.4      (s) to license and certify two beds in a facility to 
306.5   replace beds that were voluntarily delicensed and decertified on 
306.6   June 28, 1991; 
306.7      (t) to allow 16 licensed and certified beds located on July 
306.8   1, 1994, in a 142-bed nursing home and 21-bed boarding care home 
306.9   facility in Minneapolis, notwithstanding the licensure and 
306.10  certification after July 1, 1995, of the Minneapolis facility as 
306.11  a 147-bed nursing home facility after completion of a 
306.12  construction project approved in 1993 under section 144A.073, to 
306.13  be laid away upon 30 days' prior written notice to the 
306.14  commissioner.  Beds on layaway status shall have the same status 
306.15  as voluntarily delicensed or decertified beds except that they 
306.16  shall remain subject to the surcharge in section 256.9657.  The 
306.17  16 beds on layaway status may be relicensed as nursing home beds 
306.18  and recertified at any time within five years of the effective 
306.19  date of the layaway upon relocation of some or all of the beds 
306.20  to a licensed and certified facility located in Watertown, 
306.21  provided that the total project construction costs related to 
306.22  the relocation of beds from layaway status for the Watertown 
306.23  facility may not exceed the dollar threshold provided in 
306.24  subdivision 2 unless the construction project has been approved 
306.25  through the moratorium exception process under section 144A.073. 
306.26     The property-related payment rate of the facility placing 
306.27  beds on layaway status must be adjusted by the incremental 
306.28  change in its rental per diem after recalculating the rental per 
306.29  diem as provided in section 256B.431, subdivision 3a, paragraph 
306.30  (c).  The property-related payment rate for the facility 
306.31  relicensing and recertifying beds from layaway status must be 
306.32  adjusted by the incremental change in its rental per diem after 
306.33  recalculating its rental per diem using the number of beds after 
306.34  the relicensing to establish the facility's capacity day 
306.35  divisor, which shall be effective the first day of the month 
306.36  following the month in which the relicensing and recertification 
307.1   became effective.  Any beds remaining on layaway status more 
307.2   than five years after the date the layaway status became 
307.3   effective must be removed from layaway status and immediately 
307.4   delicensed and decertified; 
307.5      (u) to license and certify beds that are moved within an 
307.6   existing area of a facility or to a newly constructed addition 
307.7   which is built for the purpose of eliminating three- and 
307.8   four-bed rooms and adding space for dining, lounge areas, 
307.9   bathing rooms, and ancillary service areas in a nursing home 
307.10  that, as of January 1, 1995, was located in Fridley and had a 
307.11  licensed capacity of 129 beds; 
307.12     (v) to relocate 36 beds in Crow Wing county and four beds 
307.13  from Hennepin county to a 160-bed facility in Crow Wing county, 
307.14  provided all the affected beds are under common ownership; 
307.15     (w) to license and certify a total replacement project of 
307.16  up to 49 beds located in Norman county that are relocated from a 
307.17  nursing home destroyed by flood and whose residents were 
307.18  relocated to other nursing homes.  The operating cost payment 
307.19  rates for the new nursing facility shall be determined based on 
307.20  the interim and settle-up payment provisions of Minnesota Rules, 
307.21  part 9549.0057, and the reimbursement provisions of section 
307.22  256B.431, except that subdivision 26, paragraphs (a) and (b), 
307.23  shall not apply until the second rate year after the settle-up 
307.24  cost report is filed.  Property-related reimbursement rates 
307.25  shall be determined under section 256B.431, taking into account 
307.26  any federal or state flood-related loans or grants provided to 
307.27  the facility; 
307.28     (x) to license and certify a total replacement project of 
307.29  up to 129 beds located in Polk county that are relocated from a 
307.30  nursing home destroyed by flood and whose residents were 
307.31  relocated to other nursing homes.  The operating cost payment 
307.32  rates for the new nursing facility shall be determined based on 
307.33  the interim and settle-up payment provisions of Minnesota Rules, 
307.34  part 9549.0057, and the reimbursement provisions of section 
307.35  256B.431, except that subdivision 26, paragraphs (a) and (b), 
307.36  shall not apply until the second rate year after the settle-up 
308.1   cost report is filed.  Property-related reimbursement rates 
308.2   shall be determined under section 256B.431, taking into account 
308.3   any federal or state flood-related loans or grants provided to 
308.4   the facility; 
308.5      (y) to license and certify beds in a renovation and 
308.6   remodeling project to convert 13 three-bed wards into 13 two-bed 
308.7   rooms and 13 single-bed rooms, expand space, and add 
308.8   improvements in a nursing home that, as of January 1, 1994, met 
308.9   the following conditions:  the nursing home was located in 
308.10  Ramsey county, was not owned by a hospital corporation, had a 
308.11  licensed capacity of 64 beds, and had been ranked among the top 
308.12  15 applicants by the 1993 moratorium exceptions advisory review 
308.13  panel.  The total project construction cost estimate for this 
308.14  project must not exceed the cost estimate submitted in 
308.15  connection with the 1993 moratorium exception process; 
308.16     (z) to license and certify up to 150 nursing home beds to 
308.17  replace an existing 285 bed nursing facility located in St. 
308.18  Paul.  The replacement project shall include both the renovation 
308.19  of existing buildings and the construction of new facilities at 
308.20  the existing site.  The reduction in the licensed capacity of 
308.21  the existing facility shall occur during the construction 
308.22  project as beds are taken out of service due to the construction 
308.23  process.  Prior to the start of the construction process, the 
308.24  facility shall provide written information to the commissioner 
308.25  of health describing the process for bed reduction, plans for 
308.26  the relocation of residents, and the estimated construction 
308.27  schedule.  The relocation of residents shall be in accordance 
308.28  with the provisions of law and rule; 
308.29     (aa) to allow the commissioner of human services to license 
308.30  an additional 36 beds to provide residential services for the 
308.31  physically handicapped under Minnesota Rules, parts 9570.2000 to 
308.32  9570.3400, in a 198-bed nursing home located in Red Wing, 
308.33  provided that the total number of licensed and certified beds at 
308.34  the facility does not increase; 
308.35     (bb) to license and certify a new facility in St. Louis 
308.36  county with 44 beds constructed to replace an existing facility 
309.1   in St. Louis county with 31 beds, which has resident rooms on 
309.2   two separate floors and an antiquated elevator that creates 
309.3   safety concerns for residents and prevents nonambulatory 
309.4   residents from residing on the second floor.  The project shall 
309.5   include the elimination of three- and four-bed rooms; 
309.6      (cc) to license and certify four beds in a 16-bed certified 
309.7   boarding care home in Minneapolis to replace beds that were 
309.8   voluntarily delicensed and decertified on or before March 31, 
309.9   1992.  The licensure and certification is conditional upon the 
309.10  facility periodically assessing and adjusting its resident mix 
309.11  and other factors which may contribute to a potential 
309.12  institution for mental disease declaration.  The commissioner of 
309.13  human services shall retain the authority to audit the facility 
309.14  at any time and shall require the facility to comply with any 
309.15  requirements necessary to prevent an institution for mental 
309.16  disease declaration, including delicensure and decertification 
309.17  of beds, if necessary; or 
309.18     (dd) to license and certify 72 beds in an existing facility 
309.19  in Mille Lacs county with 80 beds as part of a renovation 
309.20  project.  The renovation must include construction of an 
309.21  addition to accommodate ten residents with beginning and 
309.22  midstage dementia in a self-contained living unit; creation of 
309.23  three resident households where dining, activities, and support 
309.24  spaces are located near resident living quarters; designation of 
309.25  four beds for rehabilitation in a self-contained area; 
309.26  designation of 30 private rooms; and other improvements.; 
309.27     (ee) to license and certify beds in a facility that has 
309.28  undergone replacement or remodeling as part of a planned closure 
309.29  under section 256B.437; 
309.30     (ff) to license and certify a total replacement project of 
309.31  up to 124 beds located in Wilkin county that are in need of 
309.32  relocation from a nursing home substantially destroyed by 
309.33  flood.  The operating cost payment rates for the new nursing 
309.34  facility shall be determined based on the interim and settle-up 
309.35  payment provisions of Minnesota Rules, part 9549.0057, and the 
309.36  reimbursement provisions of section 256B.431, except that 
310.1   section 256B.431, subdivision 26, paragraphs (a) and (b), shall 
310.2   not apply until the second rate year after the settle-up cost 
310.3   report is filed.  Property-related reimbursement rates shall be 
310.4   determined under section 256B.431, taking into account any 
310.5   federal or state flood-related loans or grants provided to the 
310.6   facility; 
310.7      (gg) to allow the commissioner of human services to license 
310.8   an additional nine beds to provide residential services for the 
310.9   physically handicapped under Minnesota Rules, parts 9570.2000 to 
310.10  9570.3400, in a 215-bed nursing home located in Duluth, provided 
310.11  that the total number of licensed and certified beds at the 
310.12  facility does not increase; 
310.13     (hh) to license and certify up to 120 new nursing facility 
310.14  beds to replace beds in a facility in Anoka county, which was 
310.15  licensed for 98 beds as of July 1, 2000, provided the new 
310.16  facility is located within four miles of the existing facility 
310.17  and is in Anoka county.  Operating and property rates shall be 
310.18  determined and allowed under section 256B.431 and Minnesota 
310.19  Rules, parts 9549.0010 to 9549.0080, or section 256B.434 or 
310.20  256B.435.  The provisions of section 256B.431, subdivision 26, 
310.21  paragraphs (a) and (b), do not apply until the second rate year 
310.22  following settle-up; or 
310.23     (ii) to transfer up to 98 beds of a 129-licensed bed 
310.24  facility located in Anoka county that, as of March 25, 2001, is 
310.25  in the active process of closing, to a 122-licensed bed 
310.26  nonprofit nursing facility located in the city of Columbia 
310.27  Heights or its affiliate.  The transfer is effective when the 
310.28  receiving facility notifies the commissioner in writing of the 
310.29  number of beds accepted.  The commissioner shall place all 
310.30  transferred beds on layaway status held in the name of the 
310.31  receiving facility.  The layaway adjustment provisions of 
310.32  section 256B.431, subdivision 30, do not apply to this layaway.  
310.33  The receiving facility may only remove the beds from layaway for 
310.34  recertification and relicensure at the receiving facility's 
310.35  current site, or at a newly constructed facility located in 
310.36  Anoka county.  The receiving facility must receive statutory 
311.1   authorization before removing these beds from layaway. 
311.2      Sec. 6.  Minnesota Statutes 2000, section 144A.073, 
311.3   subdivision 2, is amended to read: 
311.4      Subd. 2.  [REQUEST FOR PROPOSALS.] At the authorization by 
311.5   the legislature of additional medical assistance expenditures 
311.6   for exceptions to the moratorium on nursing homes, the 
311.7   interagency committee shall publish in the State Register a 
311.8   request for proposals for nursing home projects to be licensed 
311.9   or certified under section 144A.071, subdivision 4a, clause 
311.10  (c).  The public notice of this funding and the request for 
311.11  proposals must specify how the approval criteria will be 
311.12  prioritized by the advisory review panel, the interagency 
311.13  long-term care planning committee, and the commissioner.  The 
311.14  notice must describe the information that must accompany a 
311.15  request and state that proposals must be submitted to the 
311.16  interagency committee within 90 days of the date of 
311.17  publication.  The notice must include the amount of the 
311.18  legislative appropriation available for the additional costs to 
311.19  the medical assistance program of projects approved under this 
311.20  section.  If no money is appropriated for a year, the 
311.21  interagency committee shall publish a notice to that effect, and 
311.22  no proposals shall be requested.  If money is appropriated, the 
311.23  interagency committee shall initiate the application and review 
311.24  process described in this section at least twice each biennium 
311.25  and up to four times each biennium, according to dates 
311.26  established by rule.  Authorized funds shall be allocated 
311.27  proportionally to the number of processes.  Funds not encumbered 
311.28  by an earlier process within a biennium shall carry forward to 
311.29  subsequent iterations of the process.  Authorization for 
311.30  expenditures does not carry forward into the following 
311.31  biennium.  To be considered for approval, a proposal must 
311.32  include the following information: 
311.33     (1) whether the request is for renovation, replacement, 
311.34  upgrading, conversion, or relocation; 
311.35     (2) a description of the problem the project is designed to 
311.36  address; 
312.1      (3) a description of the proposed project; 
312.2      (4) an analysis of projected costs of the nursing facility 
312.3   proposal, which are not required to exceed the cost threshold 
312.4   referred to in section 144A.071, subdivision 1, to be considered 
312.5   under this section, including initial construction and 
312.6   remodeling costs; site preparation costs; technology costs; 
312.7   financing costs, including the current estimated long-term 
312.8   financing costs of the proposal, which consists of estimates of 
312.9   the amount and sources of money, reserves if required under the 
312.10  proposed funding mechanism, annual payments schedule, interest 
312.11  rates, length of term, closing costs and fees, insurance costs, 
312.12  and any completed marketing study or underwriting review; and 
312.13  estimated operating costs during the first two years after 
312.14  completion of the project; 
312.15     (5) for proposals involving replacement of all or part of a 
312.16  facility, the proposed location of the replacement facility and 
312.17  an estimate of the cost of addressing the problem through 
312.18  renovation; 
312.19     (6) for proposals involving renovation, an estimate of the 
312.20  cost of addressing the problem through replacement; 
312.21     (7) the proposed timetable for commencing construction and 
312.22  completing the project; 
312.23     (8) a statement of any licensure or certification issues, 
312.24  such as certification survey deficiencies; 
312.25     (9) the proposed relocation plan for current residents if 
312.26  beds are to be closed so that the department of human services 
312.27  can estimate the total costs of a proposal; and 
312.28     (10) other information required by permanent rule of the 
312.29  commissioner of health in accordance with subdivisions 4 and 8. 
312.30     Sec. 7.  Minnesota Statutes 2000, section 144A.073, 
312.31  subdivision 4, is amended to read: 
312.32     Subd. 4.  [CRITERIA FOR REVIEW.] The following criteria 
312.33  shall be used in a consistent manner to compare, evaluate, and 
312.34  rank all proposals submitted.  Except for the criteria specified 
312.35  in clause (3), the application of criteria listed under this 
312.36  subdivision shall not reflect any distinction based on the 
313.1   geographic location of the proposed project: 
313.2      (1) the extent to which the proposal furthers state 
313.3   long-term care goals, including the goals stated in section 
313.4   144A.31, and including the goal of enhancing the availability 
313.5   and use of alternative care services and the goal of reducing 
313.6   the number of long-term care resident rooms with more than two 
313.7   beds; 
313.8      (2) the proposal's long-term effects on state costs 
313.9   including the cost estimate of the project according to section 
313.10  144A.071, subdivision 5a; 
313.11     (3) the extent to which the proposal promotes equitable 
313.12  access to long-term care services in nursing homes through 
313.13  redistribution of the nursing home bed supply, as measured by 
313.14  the number of beds relative to the population 85 or older, 
313.15  projected to the year 2000 by the state demographer, and 
313.16  according to items (i) to (iv): 
313.17     (i) reduce beds in counties where the supply is high, 
313.18  relative to the statewide mean, and increase beds in counties 
313.19  where the supply is low, relative to the statewide mean; 
313.20     (ii) adjust the bed supply so as to create the greatest 
313.21  benefits in improving the distribution of beds; 
313.22     (iii) adjust the existing bed supply in counties so that 
313.23  the bed supply in a county moves toward the statewide mean; and 
313.24     (iv) adjust the existing bed supply so that the 
313.25  distribution of beds as projected for the year 2020 would be 
313.26  consistent with projected need, based on the methodology 
313.27  outlined in the interagency long-term care committee's 1993 
313.28  nursing home bed distribution study; 
313.29     (4) the extent to which the project improves conditions 
313.30  that affect the health or safety of residents, such as narrow 
313.31  corridors, narrow door frames, unenclosed fire exits, and wood 
313.32  frame construction, and similar provisions contained in fire and 
313.33  life safety codes and licensure and certification rules; 
313.34     (5) the extent to which the project improves conditions 
313.35  that affect the comfort or quality of life of residents in a 
313.36  facility or the ability of the facility to provide efficient 
314.1   care, such as a relatively high number of residents in a room; 
314.2   inadequate lighting or ventilation; poor access to bathing or 
314.3   toilet facilities; a lack of available ancillary space for 
314.4   dining rooms, day rooms, or rooms used for other activities; 
314.5   problems relating to heating, cooling, or energy efficiency; 
314.6   inefficient location of nursing stations; narrow corridors; or 
314.7   other provisions contained in the licensure and certification 
314.8   rules; 
314.9      (6) the extent to which the applicant demonstrates the 
314.10  delivery of quality care, as defined in state and federal 
314.11  statutes and rules, to residents as evidenced by the two most 
314.12  recent state agency certification surveys and the applicants' 
314.13  response to those surveys; 
314.14     (7) the extent to which the project removes the need for 
314.15  waivers or variances previously granted by either the licensing 
314.16  agency, certifying agency, fire marshal, or local government 
314.17  entity; and 
314.18     (8) the extent to which the project increases the number of 
314.19  private or single bed rooms; and 
314.20     (9) other factors that may be developed in permanent rule 
314.21  by the commissioner of health that evaluate and assess how the 
314.22  proposed project will further promote or protect the health, 
314.23  safety, comfort, treatment, or well-being of the facility's 
314.24  residents. 
314.25     Sec. 8.  [144A.185] [DEFINITIONS.] 
314.26     Subdivision 1.  [APPLICABILITY.] For purposes of sections 
314.27  144A.185 to 144A.1887, the terms defined in this section have 
314.28  the meanings given them.  
314.29     Subd. 2.  [CLOSURE.] "Closure" means the cessation of 
314.30  operations of a nursing home and the delicensure or 
314.31  decertification of all beds within the facility.  
314.32     Subd. 3.  [CURTAILMENT, REDUCTION, OR CHANGE IN 
314.33  OPERATIONS.] "Curtailment, reduction, or change in operations" 
314.34  means any change in operations or services that would result in 
314.35  or encourage the relocation of residents. 
314.36     Subd. 4.  [FACILITY.] "Facility" means a licensed nursing 
315.1   home or a certified boarding care home licensed according to 
315.2   sections 144.50 to 144.56. 
315.3      Subd. 5.  [LICENSEE.] "Licensee" means the owner of the 
315.4   facility or the owner's designee or the commissioner of health 
315.5   for a facility in receivership. 
315.6      Subd. 6.  [LOCAL AGENCY.] "Local agency" means a county or 
315.7   a multicounty social service agency authorized under section 
315.8   393.01 as the agency responsible for providing social services 
315.9   for the county in which the facility is located.  
315.10     Subd. 7.  [PLAN.] "Plan" means a process developed under 
315.11  section 144A.186 for the closure or curtailment, reduction, or 
315.12  change in operations of a facility and for the subsequent 
315.13  relocation of residents.  
315.14     Subd. 8.  [RELOCATION.] "Relocation" means the discharge of 
315.15  a resident and movement of the resident to another facility or 
315.16  living arrangement as a result of a closure or curtailment, 
315.17  reduction, or change in operations of a facility. 
315.18     Sec. 9.  [144A.1855] [INITIAL NOTICE.] 
315.19     Subdivision 1.  [NOTIFICATION; PARTIES.] A licensee shall 
315.20  notify the following parties in writing when there is an intent 
315.21  to close or curtail, reduce, or change operations which would 
315.22  result in or encourage the relocation of residents:  
315.23     (1) the commissioner of health; 
315.24     (2) the commissioner of human services; 
315.25     (3) the local agency; 
315.26     (4) the office of the ombudsman for older Minnesotans; and 
315.27     (5) the office of the ombudsman for mental health and 
315.28  mental retardation.  
315.29     Subd. 2.  [NOTICE REQUIREMENTS.] The written notice shall 
315.30  include the names, telephone numbers, fax numbers, and e-mail 
315.31  addresses of the persons in the facility who are responsible for 
315.32  coordinating the facility's efforts in the planning process and 
315.33  the number of residents potentially affected by the closure or 
315.34  curtailment, reduction, or change in operations.  
315.35     Sec. 10.  [144A.186] [PLANNING PROCESS.] 
315.36     Subdivision 1.  [LOCAL AGENCY REQUIREMENTS.] (a) A local 
316.1   agency, within five working days of receiving an initial notice 
316.2   from a licensee according to section 144A.1855, shall provide 
316.3   all parties identified in section 144A.1855, subdivision 1, with 
316.4   the names, telephone numbers, fax numbers, and e-mail addresses 
316.5   of those persons who are responsible for coordinating local 
316.6   agency efforts in the planning process. 
316.7      (b) Within ten working days of receipt of the notice under 
316.8   paragraph (a), the local agency and licensee shall meet to 
316.9   develop the relocation plan under subdivision 2.  The local 
316.10  agency shall inform the departments of health and human 
316.11  services, the office of the ombudsman for older Minnesotans, and 
316.12  the office of the ombudsman for mental health and mental 
316.13  retardation of the date, time, and location of the meeting so 
316.14  that their representatives may attend.  The relocation plan must 
316.15  be completed within 45 days, but may be completed earlier 
316.16  according to a schedule agreed to by all parties. 
316.17     Subd. 2.  [RELOCATION PLAN.] (a) The plan shall: 
316.18     (1) identify the expected date of closure or curtailment, 
316.19  reduction, or change in operations; 
316.20     (2) outline the process for public notification of the 
316.21  closure or curtailment, reduction, or change in operations; 
316.22     (3) outline the process to ensure 60-day advance written 
316.23  notice to residents, family members, and designated 
316.24  representatives of residents; 
316.25     (4) present an aggregate description of the resident 
316.26  population remaining to be relocated and the population's needs; 
316.27     (5) outline the individual resident assessment process to 
316.28  be used; 
316.29     (6) identify an inventory of available relocation options, 
316.30  including home and community-based services; 
316.31     (7) identify a timeline for submission of the list required 
316.32  under section 144A.1865, subdivision 3; and 
316.33     (8) identify a schedule for each element of the plan.  
316.34     (b) All parties to the plan shall refrain from any public 
316.35  notification of the intent to close or curtail, reduce, or 
316.36  change operations until a relocation plan has been established.  
317.1      Sec. 11.  [144A.1865] [REQUIREMENTS OF LICENSEE.] 
317.2      Subdivision 1.  [RELOCATION.] The licensee shall provide 
317.3   for the safe, orderly, and appropriate relocation of residents.  
317.4   The licensee and facility staff shall cooperate with 
317.5   representatives from the local agency, the departments of health 
317.6   and human services, the office of the ombudsman for older 
317.7   Minnesotans, and the office of the ombudsman for mental health 
317.8   and mental retardation in planning for and implementing the 
317.9   relocation of residents.  
317.10     Subd. 2.  [INTERDISCIPLINARY TEAM.] The licensee shall 
317.11  establish an interdisciplinary team responsible for coordinating 
317.12  and implementing the plan under section 144A.186, subdivision 
317.13  2.  The interdisciplinary team shall include representatives 
317.14  from the local agency, the office of the ombudsman for older 
317.15  Minnesotans, facility staff who provide direct care services to 
317.16  the residents, and the facility administration.  
317.17     Subd. 3.  [RESIDENT LISTS.] The licensee shall provide a 
317.18  list to the local agency that includes the following information 
317.19  on each resident to be relocated:  
317.20     (1) name; 
317.21     (2) date of birth; 
317.22     (3) social security number; 
317.23     (4) medical assistance ID number; 
317.24     (5) all diagnoses; and 
317.25     (6) name of and contact information for the resident's 
317.26  family or other designated representative.  
317.27     Subd. 4.  [CONSULTATION WITH LOCAL AGENCY.] The licensee 
317.28  shall consult with the local agency on the availability and 
317.29  development of resources and in the resident relocation process. 
317.30     [EFFECTIVE DATE.] This section is effective the day 
317.31  following final enactment. 
317.32     Sec. 12.  [144A.187] [RESIDENT AND PHYSICIAN NOTICE.] 
317.33     Subdivision 1.  [RESIDENT NOTICE REQUIRED.] (a) At least 60 
317.34  days before the proposed date of closure or curtailment, 
317.35  reduction, or change in operations as agreed to in the plan 
317.36  under section 144A.186, the licensee shall send a written notice 
318.1   of closure or curtailment, reduction, or change in operations to 
318.2   each resident being relocated, the resident's family member or 
318.3   designated representative, and the resident's attending 
318.4   physician. 
318.5      (b) The notice must include: 
318.6      (1) the date of the proposed closure or curtailment, 
318.7   reduction, or change in operations; 
318.8      (2) the name, address, telephone number, fax number, and 
318.9   e-mail address of the individuals in the facility responsible 
318.10  for providing assistance and information; 
318.11     (3) a notice of upcoming meetings for residents, families 
318.12  and designated representatives, and resident and family councils 
318.13  to discuss the relocation of residents; 
318.14     (4) the name, address, and telephone number of the local 
318.15  agency contact person; 
318.16     (5) the name, address, and telephone number of the office 
318.17  of the ombudsman for older Minnesotans and the office of the 
318.18  ombudsman for mental health and mental retardation; and 
318.19     (6) a notice of resident rights during discharge and 
318.20  relocation. 
318.21     (c) The notice to residents must comply with all applicable 
318.22  state and federal requirements for notice of transfer or 
318.23  discharge of nursing home residents.  
318.24     Subd. 2.  [MEDICAL INFORMATION REQUEST.] The licensee shall 
318.25  request the attending physician to furnish the licensee with, or 
318.26  arrange for the release of, any medical information needed to 
318.27  update a resident's medical records and to prepare transfer 
318.28  forms and discharge summaries.  
318.29     Sec. 13.  [144A.1875] [RELOCATION OF RESIDENTS.] 
318.30     Subdivision 1.  [PREPARATION; PLACEMENT INFORMATION.] A 
318.31  licensee shall provide sufficient preparation to residents to 
318.32  ensure safe, orderly, and appropriate discharge and relocation.  
318.33  The facility is responsible for assisting residents in finding 
318.34  placement within the resident's desired geographic location 
318.35  using the Senior LinkAge database of the department of human 
318.36  services.  By January 1, 2002, Senior LinkAge line shall make 
319.1   available via a Web site the name, address, and telephone and 
319.2   fax numbers of each facility with available beds, the 
319.3   certification level of the available beds, the types of services 
319.4   available, and the number of beds that are available as updated 
319.5   daily by the licensee.  The Web site shall include the 
319.6   information required by section 256.975, subdivision 7, 
319.7   paragraph (b), clause (1), and home and community-based services 
319.8   and other options for individuals with special needs.  The 
319.9   licensee must provide residents, their families or designated 
319.10  representatives, the office of the ombudsman for older 
319.11  Minnesotans, the office of the ombudsman for mental health and 
319.12  mental retardation, and the local agency with the toll-free 
319.13  number and Web site address for the Senior LinkAge line.  
319.14     Subd. 2.  [RESIDENT AND FAMILY MEETINGS.] After preparing 
319.15  the plan according to section 144A.186, the licensee shall 
319.16  conduct meetings with residents, families and designated 
319.17  representatives, and resident and family councils to notify them 
319.18  of the process for resident relocation.  Representatives from 
319.19  the local agency, the office of the ombudsman for older 
319.20  Minnesotans, the office of the ombudsman for mental health and 
319.21  mental retardation, the departments of health and human services 
319.22  shall receive advance notice of these meetings. 
319.23     Subd. 3.  [PERSONAL PROPERTY.] (a) The licensee shall 
319.24  update the inventory of residents' personal possessions and 
319.25  provide a copy of the final inventory to each resident and the 
319.26  resident's family or designated representative prior to the 
319.27  relocation of the resident.  The licensee is responsible for the 
319.28  timely transfer of a resident's possessions for all relocations 
319.29  within the state and within a 50-mile radius of the facility for 
319.30  relocations outside the state. 
319.31     (b) The licensee shall complete a final accounting of 
319.32  personal funds held in trust by the licensee and provide a copy 
319.33  of the accounting to each resident and the resident's family or 
319.34  designated representative.  The licensee is responsible for the 
319.35  timely transfer of all personal funds held in trust by the 
319.36  licensee. 
320.1      Subd. 4.  [SITE VISITS.] The licensee is responsible for 
320.2   assisting residents desiring to make site visits to facilities 
320.3   or other placements to which the resident may be relocated, 
320.4   unless it is medically inadvisable, as documented by the 
320.5   attending physician in the resident's care record.  The licensee 
320.6   shall provide, or make arrangements for, transportation for site 
320.7   visits to facilities or other placements within a 50-mile radius.
320.8      Subd. 5.  [FINAL NOTICE OF RELOCATION.] (a) Before 
320.9   relocating a resident, the licensee shall provide a final 
320.10  written notice to the resident, the resident's family or 
320.11  designated representative, and the resident's attending 
320.12  physician. 
320.13     (b) The final written notice shall: 
320.14     (1) be provided seven days before the relocation of a 
320.15  resident, unless the resident agrees to waive the resident's 
320.16  right to advance notice; and 
320.17     (2) identify the date of the anticipated relocation and the 
320.18  location to which the resident is being relocated.  
320.19     Subd. 6.  [ADMINISTRATIVE DUTIES.] (a) All administrative 
320.20  duties of the licensee under subdivisions 1, 2, 4, and 5 must be 
320.21  completed before relocation of a resident.  
320.22     (b) The licensee is responsible for providing the receiving 
320.23  facility or other health, housing, or care entity with a 
320.24  complete and accurate resident record, including information on 
320.25  family members, designated representatives, guardians, social 
320.26  service caseworkers, and other contact information.  The record 
320.27  must also include all information necessary to provide 
320.28  appropriate medical care and social services, including, but not 
320.29  limited to, information on preadmission screening, Level I and 
320.30  Level II screening, minimum data set and all other assessments, 
320.31  resident diagnosis, behavior, and medication.  
320.32     (c) For residents with special care needs, the licensee 
320.33  shall consult with the receiving facility or other placement 
320.34  entity and provide staff training or other preparation as needed 
320.35  to assist in providing for the special needs.  
320.36     (d) The licensee shall assist residents with the transfer 
321.1   or reconnection of telephone service.  The licensee shall bear 
321.2   all costs associated with reestablishing telephone service.  
321.3      Subd. 7.  [TRANSPORTATION; CONTINUITY OF CARE.] The 
321.4   licensee shall make arrangements or provide for the 
321.5   transportation of residents to the new facility or placement 
321.6   within the state or within a 50-mile radius for relocations 
321.7   outside the state.  The licensee shall provide a staff person to 
321.8   accompany the resident during transportation, upon request of 
321.9   the resident, the resident's family, or designated 
321.10  representative.  The discharge and relocation of residents must 
321.11  comply with all applicable state and federal requirements and 
321.12  must be conducted in a safe, orderly, and appropriate manner.  
321.13  The licensee must ensure that there is no disruption in 
321.14  providing meals, medications, or treatments of a resident during 
321.15  the relocation process.  
321.16     Sec. 14.  [144A.1885] [RELOCATION REPORTS.] 
321.17     (a) Beginning the week following development of the initial 
321.18  relocation plan under section 144A.186, the licensee shall 
321.19  submit weekly status reports to the commissioners of health and 
321.20  human services, or their designees, and to the local agency. 
321.21     (b) The first status report must identify the relocation 
321.22  plan developed under section 144A.186, the interdisciplinary 
321.23  team members, and the number of residents to be relocated.  
321.24     (c) Subsequent status reports must note any modifications 
321.25  to the relocation plan, any change of interdisciplinary team 
321.26  members or number of residents relocated, the placement 
321.27  destination to which residents have been relocated, and the 
321.28  number of residents remaining to be relocated.  Subsequent 
321.29  status reports must also identify issues or problems encountered 
321.30  during the relocation process and the resolution of these issues.
321.31     Sec. 15.  [144A.1886] [REQUIREMENTS OF LOCAL AGENCY.] 
321.32     Subdivision 1.  [MEETING; REPRESENTATION.] (a) The local 
321.33  agency with the licensee shall convene a meeting to develop a 
321.34  plan according to section 144A.186, subdivision 1, paragraph (b).
321.35     (b) The local agency shall designate a representative to 
321.36  the interdisciplinary team established by the licensee 
322.1   responsible for coordinating the relocation efforts.  
322.2      Subd. 2.  [RESOURCE.] (a) The local agency shall serve as a 
322.3   resource in the relocation process.  
322.4      (b) Concurrent with the notice sent to residents from the 
322.5   licensee according to section 144A.187, subdivision 1, the local 
322.6   agency shall provide written notice to residents, family 
322.7   members, and designated representatives describing: 
322.8      (1) the local agency's role in the relocation process and 
322.9   in the follow-up to relocation; 
322.10     (2) a local agency contact name, address, and telephone 
322.11  number; and 
322.12     (3) the name, address, and telephone number of the office 
322.13  of the ombudsman for older Minnesotans and the office of the 
322.14  ombudsman for mental health and mental retardation.  
322.15     (c) The local agency is responsible for the safe and 
322.16  orderly relocation of residents in cases where an emergent need 
322.17  arises or when the licensee has abrogated the licensee's 
322.18  responsibilities under the relocation plan.  
322.19     Subd. 3.  [COORDINATION; OVERSIGHT.] (a) The local agency 
322.20  shall meet with appropriate facility staff to coordinate any 
322.21  assistance.  Coordination shall include participating in group 
322.22  meetings with residents, family members, and designated 
322.23  representatives to explain the transfer or relocation process.  
322.24     (b) The local agency shall monitor compliance with all 
322.25  components of the relocation plan.  When the licensee is not in 
322.26  compliance, the local agency shall notify the commissioners of 
322.27  health and human services.  
322.28     (c) Except as requested by the resident, family member, or 
322.29  designated representative and within the parameters of the 
322.30  Vulnerable Adults Act, the local agency may halt a relocation 
322.31  that it deems inappropriate or dangerous to the health or safety 
322.32  of a resident. 
322.33     Subd. 4.  [FOLLOW-UP REVIEW.] (a) A member of the local 
322.34  agency staff shall visit residents relocated within 100 miles of 
322.35  the county within 30 days after a relocation.  Local agency 
322.36  staff shall interview the resident and family member or 
323.1   designated representative or shall observe the resident on-site, 
323.2   or both, and review and discuss pertinent medical or social 
323.3   records with appropriate facility staff to assess the adjustment 
323.4   of the resident to the new placement, recommend services or 
323.5   methods to meet any special needs of the resident, and identify 
323.6   residents at risk.  
323.7      (b) The local agency may conduct subsequent follow-up 
323.8   visits in cases where the adjustment of the resident to the new 
323.9   placement is in question.  
323.10     (c) Within 60 days of the completion of the follow-up 
323.11  visits, the local agency shall submit a written summary of the 
323.12  follow-up work to the commissioners of health and human 
323.13  services, in a manner approved by the commissioners.  
323.14     (d) The local agency shall submit a report of any issues 
323.15  that may require further review or monitoring to the 
323.16  commissioner of health. 
323.17     Sec. 16.  [144A.1887] [FUNDING.] 
323.18     (a) Within 60 days of a nursing home ceasing operations, 
323.19  the commissioner of human services shall reimburse nursing homes 
323.20  that are reimbursed under sections 256B.431, 256B.434, and 
323.21  256B.435 for operating costs incurred by the nursing home during 
323.22  the closure process.  The amount to be reimbursed to the nursing 
323.23  home shall be determined by applying paragraphs (b) to (f). 
323.24     (b) The facility shall provide the commissioner of human 
323.25  services with the nursing home's operating costs for the time 
323.26  period of 30 days prior to the notice specified under section 
323.27  144A.16, to 30 days after the nursing home's closure. 
323.28     (c) The nursing home shall provide the commissioner of 
323.29  human services with the number of medical assistance, Medicare, 
323.30  private pay, and other resident days for the period referenced 
323.31  in paragraph (b) by the 11 case mix categories. 
323.32     (d) The commissioner of human services shall calculate a 
323.33  nursing home closure rate by dividing the facility operating 
323.34  costs in paragraph (b) by the total resident days in paragraph 
323.35  (c). 
323.36     (e) The total closure costs attributable to medical 
324.1   assistance shall be determined by multiplying the nursing home 
324.2   closure rate in paragraph (d) by the medical assistance days 
324.3   provided by the nursing facility in paragraph (c). 
324.4      (f) The amount to be reimbursed to the nursing home is 
324.5   equal to the total closure costs in paragraph (e) minus the sum 
324.6   of the nursing facility's 11 operating rates times their 
324.7   respective number of medical assistance days by case mix as 
324.8   referenced in paragraph (c). 
324.9      Sec. 17.  [144A.36] [TRANSITION PLANNING GRANTS.] 
324.10     Subdivision 1.  [DEFINITIONS.] "Eligible nursing home" 
324.11  means any nursing home licensed under sections 144A.01 to 
324.12  144A.16 and certified by the appropriate authority under United 
324.13  States Code, title 42, sections 1396-1396p, to participate as a 
324.14  vendor in the medical assistance program established under 
324.15  chapter 256B. 
324.16     Subd. 2.  [GRANTS AUTHORIZED.] (a) The commissioner shall 
324.17  establish a program of transition planning grants to assist 
324.18  eligible nursing homes in implementing the provisions in 
324.19  paragraphs (b) and (c).  
324.20     (b) Transition planning grants may be used by nursing homes 
324.21  to develop strategic plans which identify the appropriate 
324.22  institutional and noninstitutional settings necessary to meet 
324.23  the older adult service needs of the community.  
324.24     (c) At a minimum, a strategic plan must consist of: 
324.25     (1) a needs assessment to determine what older adult 
324.26  services are needed and desired by the community; 
324.27     (2) an assessment of the appropriate settings in which to 
324.28  provide needed older adult services; 
324.29     (3) an assessment identifying currently available services 
324.30  and their settings in the community; and 
324.31     (4) a transition plan to achieve the needed outcome 
324.32  identified by the assessment. 
324.33     Subd. 3.  [ALLOCATION OF GRANTS.] (a) Eligible nursing 
324.34  homes must apply to the commissioner no later than September 1 
324.35  of each fiscal year for grants awarded in that fiscal year.  A 
324.36  grant shall be awarded upon signing of a grant contract. 
325.1      (b) The commissioner must make a final decision on the 
325.2   funding of each application within 60 days of the deadline for 
325.3   receiving applications. 
325.4      Subd. 4.  [EVALUATION.] The commissioner shall evaluate the 
325.5   overall effectiveness of the grant program.  The commissioner 
325.6   may collect, from the nursing homes receiving grants, the 
325.7   information necessary to evaluate the grant program.  
325.8   Information related to the financial condition of individual 
325.9   nursing homes shall be classified as nonpublic data. 
325.10     Sec. 18.  [144A.37] [ALTERNATIVE NURSING HOME SURVEY 
325.11  PROCESS.] 
325.12     Subdivision 1.  [ALTERNATIVE NURSING HOME SURVEY 
325.13  SCHEDULES.] (a) The commissioner of health shall implement 
325.14  alternative procedures for the nursing home survey process as 
325.15  authorized under this section.  
325.16     (b) These alternative survey process procedures seek to:  
325.17  (1) use department resources more effectively and efficiently to 
325.18  target problem areas; (2) use other existing or new mechanisms 
325.19  to provide objective assessments of quality and to measure 
325.20  quality improvement; (3) provide for frequent collaborative 
325.21  interaction of facility staff and surveyors rather than a 
325.22  punitive approach; and (4) reward a nursing home that has 
325.23  performed very well by extending intervals between full surveys. 
325.24     (c) The commissioner shall pursue changes in federal law 
325.25  necessary to accomplish this process and shall apply for any 
325.26  necessary federal waivers or approval.  If a federal waiver is 
325.27  approved, the commissioner shall promptly submit, to the house 
325.28  and senate committees with jurisdiction over health and human 
325.29  services policy and finance, fiscal estimates for implementing 
325.30  the alternative survey process waiver.  The commissioner shall 
325.31  also pursue any necessary federal law changes during the 107th 
325.32  Congress. 
325.33     (d) The alternative nursing home survey schedule and 
325.34  related educational activities shall not be implemented until 
325.35  funding is appropriated by the legislature. 
325.36     Subd. 2.  [SURVEY INTERVALS.] The commissioner of health 
326.1   must extend the time period between standard surveys up to 30 
326.2   months based on the criteria established in subdivision 4.  In 
326.3   using the alternative survey schedule, the requirement for the 
326.4   statewide average to not exceed 12 months does not apply. 
326.5      Subd. 3.  [COMPLIANCE HISTORY.] The commissioner shall 
326.6   develop a process for identifying the survey cycles for skilled 
326.7   nursing facilities based upon the compliance history of the 
326.8   facility.  This process can use a range of months for survey 
326.9   intervals.  At a minimum, the process must be based on 
326.10  information from the last two survey cycles and shall take into 
326.11  consideration any deficiencies issued as the result of a survey 
326.12  or a complaint investigation during the interval.  A skilled 
326.13  nursing facility with a finding of substandard quality of care 
326.14  or a finding of immediate jeopardy is not entitled to a survey 
326.15  interval greater than 12 months.  The commissioner shall alter 
326.16  the survey cycle for a specific skilled nursing facility based 
326.17  on findings identified through the completion of a survey, a 
326.18  monitoring visit, or a complaint investigation.  The 
326.19  commissioner must also take into consideration information other 
326.20  than the facility's compliance history. 
326.21     Subd. 4.  [CRITERIA FOR SURVEY INTERVAL 
326.22  CLASSIFICATION.] (a) The commissioner shall provide public 
326.23  notice of the classification process and shall identify the 
326.24  selected survey cycles for each skilled nursing facility.  The 
326.25  classification system must be based on an analysis of the 
326.26  findings made during the past two standard survey intervals, but 
326.27  it only takes one survey or complaint finding to modify the 
326.28  interval. 
326.29     (b) The commissioner shall also take into consideration 
326.30  information obtained from residents and family members in each 
326.31  skilled nursing facility and from other sources such as 
326.32  employees and ombudsmen in determining the appropriate survey 
326.33  intervals for facilities. 
326.34     Subd. 5.  [REQUIRED MONITORING.] (a) The commissioner shall 
326.35  conduct at least one monitoring visit on an annual basis for 
326.36  every skilled nursing facility which has been selected for a 
327.1   survey cycle greater than 12 months.  The commissioner shall 
327.2   develop protocols for the monitoring visits which shall be less 
327.3   extensive than the requirements for a standard survey.  The 
327.4   commissioner shall use the criteria in paragraph (b) to 
327.5   determine whether additional monitoring visits to a facility 
327.6   will be required.  
327.7      (b) The criteria shall include, but not be limited to, the 
327.8   following: 
327.9      (1) changes in ownership, administration of the facility, 
327.10  or direction of the facility's nursing service; 
327.11     (2) changes in the facility's quality indicators which 
327.12  might evidence a decline in the facility's quality of care; 
327.13     (3) reductions in staffing or an increase in the 
327.14  utilization of temporary nursing personnel; and 
327.15     (4) complaint information or other information that 
327.16  identifies potential concerns for the quality of the care and 
327.17  services provided in the skilled nursing facility. 
327.18     Subd. 6.  [SURVEY REQUIREMENTS FOR FACILITIES NOT APPROVED 
327.19  FOR EXTENDED SURVEY INTERVALS.] The commissioner shall establish 
327.20  a process for surveying and monitoring of facilities which 
327.21  require a survey interval of less than 15 months.  This 
327.22  information shall identify the steps that the commissioner must 
327.23  take to monitor the facility in addition to the standard survey. 
327.24     Subd. 7.  [IMPACT ON SURVEY AGENCY'S BUDGET.] The 
327.25  implementation of an alternative survey process for the state 
327.26  must not result in any reduction of funding that would have been 
327.27  provided to the state survey agency for survey and enforcement 
327.28  activity based upon the completion of full standard surveys for 
327.29  each skilled nursing facility in the state. 
327.30     Subd. 8.  [EDUCATIONAL ACTIVITIES.] The commissioner shall 
327.31  expand the state survey agency's ability to conduct training and 
327.32  educational efforts for skilled nursing facilities, residents 
327.33  and family members, residents and family councils, long-term 
327.34  care ombudsman programs, and the general public. 
327.35     Subd. 9.  [EVALUATION.] The commissioner shall develop a 
327.36  process for the evaluation of the effectiveness of an 
328.1   alternative survey process conducted under this section. 
328.2      [EFFECTIVE DATE.] This section is effective the day 
328.3   following final enactment. 
328.4      Sec. 19.  [144A.38] [INNOVATIONS IN QUALITY DEMONSTRATION 
328.5   GRANTS.] 
328.6      Subdivision 1.  [PROGRAM ESTABLISHED.] The commissioner of 
328.7   health and the commissioner of human services shall establish a 
328.8   long-term care grant program that demonstrates best practices 
328.9   and innovation for long-term care service delivery and housing.  
328.10  The grants must fund demonstrations that create new means and 
328.11  models for serving the elderly or demonstrate creativity in 
328.12  service provision through the scope of their program or service. 
328.13     Subd. 2.  [ELIGIBILITY.] Grants may only be made to those 
328.14  who provide direct service or housing to the elderly within the 
328.15  state.  Grants may only be made for projects that show 
328.16  innovations and measurable improvement in resident care, quality 
328.17  of life, use of technology, or customer satisfaction. 
328.18     Subd. 3.  [AWARDING OF GRANTS.] (a) Applications for grants 
328.19  must be made to the commissioners on forms prescribed by the 
328.20  commissioners. 
328.21     (b) The commissioners shall review applications and award 
328.22  grants based on the following criteria: 
328.23     (1) improvement in direct care to residents; 
328.24     (2) increase in efficiency through the use of technology; 
328.25     (3) increase in quality of care through the use of 
328.26  technology; 
328.27     (4) increase in the access and delivery of service; 
328.28     (5) enhancement of nursing staff training; 
328.29     (6) the effectiveness of the project as a demonstration; 
328.30  and 
328.31     (7) the immediate transferability of the project to scale. 
328.32     (c) In reviewing applications and awarding grants, the 
328.33  commissioners shall consult with long-term care providers, 
328.34  consumers of long-term care, long-term care researchers, and 
328.35  staff of other state agencies. 
328.36     (d) Grants for eligible projects may not exceed $100,000. 
329.1      Sec. 20.  [144A.39] [LONG-TERM CARE QUALITY PROFILES.] 
329.2      Subdivision l.  [DEVELOPMENT AND IMPLEMENTATION OF QUALITY 
329.3   PROFILES.] (a) The commissioner of health and the commissioner 
329.4   of human services shall develop and implement a quality profile 
329.5   system for nursing facilities and, beginning not later than July 
329.6   1, 2003, other providers of long-term care services, except when 
329.7   the quality profile system would duplicate requirements under 
329.8   sections 256B.5011 and 256B.5013.  The system must be developed 
329.9   and implemented to the extent possible without the collection of 
329.10  new data.  To the extent possible, the system must incorporate 
329.11  or be coordinated with information on quality maintained by area 
329.12  agencies on aging, long-term care trade associations, and other 
329.13  entities.  The system must be designed to provide information on 
329.14  quality: 
329.15     (1) to consumers and their families to facilitate informed 
329.16  choices of service providers; 
329.17     (2) to providers to enable them to measure the results of 
329.18  their quality improvement efforts and compare quality 
329.19  achievements with other service providers; and 
329.20     (3) to public and private purchasers of long-term care 
329.21  services to enable them to purchase high-quality care. 
329.22     (b) The system must be developed in consultation with the 
329.23  long-term care task force, area agencies on aging, and 
329.24  representatives of consumers, providers, and labor unions.  
329.25  Within the limits of available appropriations, the commissioners 
329.26  may employ consultants to assist with this project. 
329.27     Subd. 2.  [QUALITY MEASUREMENT TOOLS.] The commissioners 
329.28  shall identify and apply existing quality measurement tools to: 
329.29     (1) emphasize quality of care and its relationship to 
329.30  quality of life; and 
329.31     (2) address the needs of various users of long-term care 
329.32  services, including, but not limited to, short-stay residents, 
329.33  persons with behavioral problems, persons with dementia, and 
329.34  persons who are members of minority groups. 
329.35  The tools must be identified and applied, to the extent 
329.36  possible, without requiring providers to supply information 
330.1   beyond current state and federal requirements. 
330.2      Subd. 3.  [CONSUMER SURVEYS.] Following identification of 
330.3   the quality measurement tool, the commissioners shall conduct 
330.4   surveys of long-term care service consumers to develop quality 
330.5   profiles of providers.  To the extent possible, surveys must be 
330.6   conducted face-to-face by state employees or contractors.  At 
330.7   the discretion of the commissioners, surveys may be conducted by 
330.8   telephone or by provider staff.  Surveys must be conducted 
330.9   periodically to update quality profiles of individual service 
330.10  providers. 
330.11     Subd. 4.  [DISSEMINATION OF QUALITY PROFILES.] By July 1, 
330.12  2002, the commissioners shall implement a system to disseminate 
330.13  the quality profiles developed from consumer surveys using the 
330.14  quality measurement tool.  Profiles must be disseminated to the 
330.15  Senior LinkAge line and to consumers, providers, and purchasers 
330.16  of long-term care services through all feasible printed and 
330.17  electronic outlets.  The commissioners shall conduct a public 
330.18  awareness campaign to inform potential users regarding profile 
330.19  contents and potential uses. 
330.20     Sec. 21.  Minnesota Statutes 2000, section 256B.431, 
330.21  subdivision 17, is amended to read: 
330.22     Subd. 17.  [SPECIAL PROVISIONS FOR MORATORIUM EXCEPTIONS.] 
330.23  (a) Notwithstanding Minnesota Rules, part 9549.0060, subpart 3, 
330.24  for rate periods beginning on October 1, 1992, and for rate 
330.25  years beginning after June 30, 1993, a nursing facility that (1) 
330.26  has completed a construction project approved under section 
330.27  144A.071, subdivision 4a, clause (m); (2) has completed a 
330.28  construction project approved under section 144A.071, 
330.29  subdivision 4a, and effective after June 30, 1995; or (3) has 
330.30  completed a renovation, replacement, or upgrading project 
330.31  approved under the moratorium exception process in section 
330.32  144A.073 shall be reimbursed for costs directly identified to 
330.33  that project as provided in subdivision 16 and this subdivision. 
330.34     (b) Notwithstanding Minnesota Rules, part 9549.0060, 
330.35  subparts 5, item A, subitems (1) and (3), and 7, item D, 
330.36  allowable interest expense on debt shall include: 
331.1      (1) interest expense on debt related to the cost of 
331.2   purchasing or replacing depreciable equipment, excluding 
331.3   vehicles, not to exceed six percent of the total historical cost 
331.4   of the project; and 
331.5      (2) interest expense on debt related to financing or 
331.6   refinancing costs, including costs related to points, loan 
331.7   origination fees, financing charges, legal fees, and title 
331.8   searches; and issuance costs including bond discounts, bond 
331.9   counsel, underwriter's counsel, corporate counsel, printing, and 
331.10  financial forecasts.  Allowable debt related to items in this 
331.11  clause shall not exceed seven percent of the total historical 
331.12  cost of the project.  To the extent these costs are financed, 
331.13  the straight-line amortization of the costs in this clause is 
331.14  not an allowable cost; and 
331.15     (3) interest on debt incurred for the establishment of a 
331.16  debt reserve fund, net of the interest earned on the debt 
331.17  reserve fund. 
331.18     (c) Debt incurred for costs under paragraph (b) is not 
331.19  subject to Minnesota Rules, part 9549.0060, subpart 5, item A, 
331.20  subitem (5) or (6). 
331.21     (d) The incremental increase in a nursing facility's rental 
331.22  rate, determined under Minnesota Rules, parts 9549.0010 to 
331.23  9549.0080, and this section, resulting from the acquisition of 
331.24  allowable capital assets, and allowable debt and interest 
331.25  expense under this subdivision shall be added to its 
331.26  property-related payment rate and shall be effective on the 
331.27  first day of the month following the month in which the 
331.28  moratorium project was completed. 
331.29     (e) Notwithstanding subdivision 3f, paragraph (a), for rate 
331.30  periods beginning on October 1, 1992, and for rate years 
331.31  beginning after June 30, 1993, the replacement-costs-new per bed 
331.32  limit to be used in Minnesota Rules, part 9549.0060, subpart 4, 
331.33  item B, for a nursing facility that has completed a renovation, 
331.34  replacement, or upgrading project that has been approved under 
331.35  the moratorium exception process in section 144A.073, or that 
331.36  has completed an addition to or replacement of buildings, 
332.1   attached fixtures, or land improvements for which the total 
332.2   historical cost exceeds the lesser of $150,000 or ten percent of 
332.3   the most recent appraised value, must be $47,500 per licensed 
332.4   bed in multiple-bed rooms and $71,250 per licensed bed in a 
332.5   single-bed room.  These amounts must be adjusted annually as 
332.6   specified in subdivision 3f, paragraph (a), beginning January 1, 
332.7   1993. 
332.8      (f) For purposes of this paragraph, a total replacement 
332.9   means the complete replacement of the nursing facility's 
332.10  physical plant through the construction of a new physical plant, 
332.11  the transfer of the nursing facility's license from one physical 
332.12  plant location to another, or a new building addition to 
332.13  relocate beds from three- and four-bed wards.  For total 
332.14  replacement projects completed on or after July 1, 1992, the 
332.15  commissioner shall compute the incremental change in the nursing 
332.16  facility's rental per diem, for rate years beginning on or after 
332.17  July 1, 1995, by replacing its appraised value, including the 
332.18  historical capital asset costs, and the capital debt and 
332.19  interest costs with the new nursing facility's allowable capital 
332.20  asset costs and the related allowable capital debt and interest 
332.21  costs.  If the new nursing facility has decreased its licensed 
332.22  capacity, the aggregate investment per bed limit in subdivision 
332.23  3a, paragraph (c), shall apply.  If the new nursing facility has 
332.24  retained a portion of the original physical plant for nursing 
332.25  facility usage, then a portion of the appraised value prior to 
332.26  the replacement must be retained and included in the calculation 
332.27  of the incremental change in the nursing facility's rental per 
332.28  diem.  For purposes of this part, the original nursing facility 
332.29  means the nursing facility prior to the total replacement 
332.30  project.  The portion of the appraised value to be retained 
332.31  shall be calculated according to clauses (1) to (3): 
332.32     (1) The numerator of the allocation ratio shall be the 
332.33  square footage of the area in the original physical plant which 
332.34  is being retained for nursing facility usage. 
332.35     (2) The denominator of the allocation ratio shall be the 
332.36  total square footage of the original nursing facility physical 
333.1   plant. 
333.2      (3) Each component of the nursing facility's allowable 
333.3   appraised value prior to the total replacement project shall be 
333.4   multiplied by the allocation ratio developed by dividing clause 
333.5   (1) by clause (2). 
333.6      In the case of either type of total replacement as 
333.7   authorized under section 144A.071 or 144A.073, the provisions of 
333.8   this subdivision shall also apply.  For purposes of the 
333.9   moratorium exception authorized under section 144A.071, 
333.10  subdivision 4a, paragraph (s), if the total replacement involves 
333.11  the renovation and use of an existing health care facility 
333.12  physical plant, the new allowable capital asset costs and 
333.13  related debt and interest costs shall include first the 
333.14  allowable capital asset costs and related debt and interest 
333.15  costs of the renovation, to which shall be added the allowable 
333.16  capital asset costs of the existing physical plant prior to the 
333.17  renovation, and if reported by the facility, the related 
333.18  allowable capital debt and interest costs. 
333.19     (g) Notwithstanding Minnesota Rules, part 9549.0060, 
333.20  subpart 11, item C, subitem (2), for a total replacement, as 
333.21  defined in paragraph (f), authorized under section 144A.071 or 
333.22  144A.073 after July 1, 1999, or any building project that is a 
333.23  relocation, renovation, upgrading, or conversion authorized 
333.24  under section 144A.073, completed on or after July 1, 2001, the 
333.25  replacement-costs-new per bed limit shall be $74,280 per 
333.26  licensed bed in multiple-bed rooms, $92,850 per licensed bed in 
333.27  semiprivate rooms with a fixed partition separating the resident 
333.28  beds, and $111,420 per licensed bed in single rooms.  Minnesota 
333.29  Rules, part 9549.0060, subpart 11, item C, subitem (2), does not 
333.30  apply.  These amounts must be adjusted annually as specified in 
333.31  subdivision 3f, paragraph (a), beginning January 1, 2000.  
333.32     (h) For a total replacement, as defined in paragraph (f), 
333.33  authorized under section 144A.073 for a 96-bed nursing home in 
333.34  Carlton county, the replacement-costs-new per bed limit shall be 
333.35  $74,280 per licensed bed in multiple-bed rooms, $92,850 per 
333.36  licensed bed in semiprivate rooms with a fixed partition 
334.1   separating the resident's beds, and $111,420 per licensed bed in 
334.2   a single room.  Minnesota Rules, part 9549.0060, subpart 11, 
334.3   item C, subitem (2), does not apply.  The resulting maximum 
334.4   allowable replacement-costs-new multiplied by 1.25 shall 
334.5   constitute the project's dollar threshold for purposes of 
334.6   application of the limit set forth in section 144A.071, 
334.7   subdivision 2.  The commissioner of health may waive the 
334.8   requirements of section 144A.073, subdivision 3b, paragraph (b), 
334.9   clause (2), on the condition that the other requirements of that 
334.10  paragraph are met. 
334.11     (i) For a renovation authorized under section 144A.073 for 
334.12  a 65-bed nursing home in St. Louis county, the incremental 
334.13  increase in rental rate for purposes of paragraph (d) shall be 
334.14  $8.16, and the total replacement cost, allowable appraised 
334.15  value, allowable debt, and allowable interest shall be increased 
334.16  according to the incremental increase. 
334.17     (j) For a total replacement, as defined in paragraph (f), 
334.18  authorized under section 144A.073 involving a new building 
334.19  addition that relocates beds from three-bed wards for an 80-bed 
334.20  nursing home in Redwood county, the replacement-costs-new per 
334.21  bed limit shall be $74,280 per licensed bed for multiple-bed 
334.22  rooms; $92,850 per licensed bed for semiprivate rooms with a 
334.23  fixed partition separating the beds; and $111,420 per licensed 
334.24  bed for single rooms.  These amounts shall be adjusted annually, 
334.25  beginning January 1, 2001.  Minnesota Rules, part 9549.0060, 
334.26  subpart 11, item C, subitem (2), does not apply.  The resulting 
334.27  maximum allowable replacement-costs-new multiplied by 1.25 shall 
334.28  constitute the project's dollar threshold for purposes of 
334.29  application of the limit set forth in section 144A.071, 
334.30  subdivision 2.  The commissioner of health may waive the 
334.31  requirements of section 144A.073, subdivision 3b, paragraph (b), 
334.32  clause (2), on the condition that the other requirements of that 
334.33  paragraph are met. 
334.34     Sec. 22.  Minnesota Statutes 2000, section 256B.431, is 
334.35  amended by adding a subdivision to read: 
334.36     Subd. 31.  [PAYMENT DURING FIRST 90 DAYS.] (a) For rate 
335.1   years beginning on or after July 1, 2001, the total payment rate 
335.2   for a facility reimbursed under this section, section 256B.434, 
335.3   or any other section for the first 90 days after admission shall 
335.4   be: 
335.5      (1) for the first 30 paid days, the rate shall be 120 
335.6   percent of the facility's medical assistance rate for each case 
335.7   mix class; and 
335.8      (2) for the next 60 days after the first 30 paid days, the 
335.9   rate shall be 110 percent of the facility's medical assistance 
335.10  rate for each case mix class. 
335.11     (b) Beginning with the 91st paid day after admission, the 
335.12  payment rate shall be the rate otherwise determined under this 
335.13  section, section 256B.434, or any other section. 
335.14     (c) This subdivision applies to admissions occurring on or 
335.15  after July 1, 2001. 
335.16     Sec. 23.  Minnesota Statutes 2000, section 256B.431, is 
335.17  amended by adding a subdivision to read: 
335.18     Subd. 32.  [NURSING FACILITY RATE INCREASES BEGINNING JULY 
335.19  1, 2001, AND JULY 1, 2002.] For the rate years beginning July 1, 
335.20  2001, and July 1, 2002, the commissioner shall provide to each 
335.21  nursing facility reimbursed under this section or section 
335.22  256B.434 an adjustment equal to 3.0 percent of the total 
335.23  operating payment rate.  The operating payment rates in effect 
335.24  on June 30, 2001, and June 30, 2002, respectively, shall include 
335.25  the adjustment in subdivision 2i, paragraph (c). 
335.26     Sec. 24.  Minnesota Statutes 2000, section 256B.431, is 
335.27  amended by adding a subdivision to read: 
335.28     Subd. 33.  [ADDITIONAL INCREASES FOR LOW RATE METROPOLITAN 
335.29  AREA FACILITIES.] After the calculation of the increase for the 
335.30  rate year beginning July 1, 2001, in subdivision 32, the 
335.31  commissioner must provide for special increases to facilities 
335.32  determined to be the lowest rate facilities in state development 
335.33  region 11, as defined in section 462.385.  Within this region, 
335.34  the commissioner shall identify the median nursing facility rate 
335.35  by case mix category for all nursing facilities under section 
335.36  256B.431 or 256B.434.  Nursing home rates that are below the 
336.1   median for case mix class A must be adjusted to the set of case 
336.2   mix rates for the facility at the median for case mix class A.  
336.3      Sec. 25.  Minnesota Statutes 2000, section 256B.431, is 
336.4   amended by adding a subdivision to read: 
336.5      Subd. 34.  [RATE FLOOR FOR FACILITIES LOCATED OUTSIDE THE 
336.6   METROPOLITAN AREA.] (a) For the rate year beginning July 1, 
336.7   2001, the commissioner shall adjust operating costs per diem for 
336.8   nursing facilities located outside of state development region 
336.9   11, as defined in section 462.385, reimbursed under this section 
336.10  and sections 256B.434 and 256B.435, as provided in this 
336.11  subdivision. 
336.12     (b) For each nursing facility, the commissioner shall 
336.13  compare the operating costs per diem listed in this paragraph to 
336.14  the operating costs per diem the facility would otherwise 
336.15  receive for the July 1, 2001, rate year after provision of any 
336.16  other rate increases required by this chapter. 
336.17       Case mix classification     Operating costs per diem
336.18                 A                         $ 67.02
336.19                 B                         $ 73.00
336.20                 C                         $ 79.77
336.21                 D                         $ 85.94
336.22                 E                         $ 92.32
336.23                 F                         $ 92.72
336.24                 G                         $ 98.13
336.25                 H                         $108.40
336.26                 I                         $112.03
336.27                 J                         $117.67
336.28                 K                         $129.55
336.29     (c) If a facility's total reimbursement for operating 
336.30  costs, using the case mix classification operating costs per 
336.31  diem listed in paragraph (b), is greater than the total 
336.32  reimbursement for operating costs the facility would otherwise 
336.33  receive, the commissioner shall calculate operating costs per 
336.34  diem for that facility for the rate year beginning July 1, 2001, 
336.35  using the case mix classification operating costs per diem 
336.36  listed in paragraph (b). 
337.1      (d) If a facility's total reimbursement for operating 
337.2   costs, using the case mix classification costs per diem listed 
337.3   in paragraph (b), is less than the total reimbursement for 
337.4   operating costs the facility would otherwise receive, the 
337.5   commissioner shall reimburse that facility for the rate year 
337.6   beginning July 1, 2001, as provided in this section, section 
337.7   256B.434, or 256B.435, whichever is applicable, and shall not 
337.8   calculate operating costs per diem for that facility using the 
337.9   case mix classification operating costs per diem listed in 
337.10  paragraph (b). 
337.11     Sec. 26.  Minnesota Statutes 2000, section 256B.431, is 
337.12  amended by adding a subdivision to read: 
337.13     Subd. 35.  [EXCLUSION OF RAW FOOD COST ADJUSTMENT.] For 
337.14  rate years beginning on or after July 1, 2001, in calculating a 
337.15  nursing facility's operating cost per diem for the purposes of 
337.16  constructing an array, determining a median, or otherwise 
337.17  performing a statistical measure of nursing facility payment 
337.18  rates to be used to determine future rate increases under this 
337.19  section, section 256B.434, or any other section, the 
337.20  commissioner shall exclude adjustments for raw food costs under 
337.21  subdivision 2b, paragraph (h), that are related to providing 
337.22  special diets based on religious beliefs. 
337.23     Sec. 27.  Minnesota Statutes 2000, section 256B.434, 
337.24  subdivision 4, is amended to read: 
337.25     Subd. 4.  [ALTERNATE RATES FOR NURSING FACILITIES.] (a) For 
337.26  nursing facilities which have their payment rates determined 
337.27  under this section rather than section 256B.431, the 
337.28  commissioner shall establish a rate under this subdivision.  The 
337.29  nursing facility must enter into a written contract with the 
337.30  commissioner. 
337.31     (b) A nursing facility's case mix payment rate for the 
337.32  first rate year of a facility's contract under this section is 
337.33  the payment rate the facility would have received under section 
337.34  256B.431. 
337.35     (c) A nursing facility's case mix payment rates for the 
337.36  second and subsequent years of a facility's contract under this 
338.1   section are the previous rate year's contract payment rates plus 
338.2   an inflation adjustment and, for facilities reimbursed under 
338.3   this section or section 256B.431, an adjustment to include the 
338.4   cost of any increase in health department licensing fees for the 
338.5   facility taking effect on or after July 1, 2001.  The index for 
338.6   the inflation adjustment must be based on the change in the 
338.7   Consumer Price Index-All Items (United States City average) 
338.8   (CPI-U) forecasted by Data Resources, Inc., as forecasted in the 
338.9   fourth quarter of the calendar year preceding the rate year.  
338.10  The inflation adjustment must be based on the 12-month period 
338.11  from the midpoint of the previous rate year to the midpoint of 
338.12  the rate year for which the rate is being determined.  For the 
338.13  rate years beginning on July 1, 1999, and July 1, 2000, July 1, 
338.14  2001, and July 1, 2002, this paragraph shall apply only to the 
338.15  property-related payment rate, except that adjustments to 
338.16  include the cost of any increase in health department licensing 
338.17  fees taking effect on or after July 1, 2001, shall be provided.  
338.18  In determining the amount of the property-related payment rate 
338.19  adjustment under this paragraph, the commissioner shall 
338.20  determine the proportion of the facility's rates that are 
338.21  property-related based on the facility's most recent cost report.
338.22     (d) The commissioner shall develop additional 
338.23  incentive-based payments of up to five percent above the 
338.24  standard contract rate for achieving outcomes specified in each 
338.25  contract.  The specified facility-specific outcomes must be 
338.26  measurable and approved by the commissioner.  The commissioner 
338.27  may establish, for each contract, various levels of achievement 
338.28  within an outcome.  After the outcomes have been specified the 
338.29  commissioner shall assign various levels of payment associated 
338.30  with achieving the outcome.  Any incentive-based payment cancels 
338.31  if there is a termination of the contract.  In establishing the 
338.32  specified outcomes and related criteria the commissioner shall 
338.33  consider the following state policy objectives: 
338.34     (1) improved cost effectiveness and quality of life as 
338.35  measured by improved clinical outcomes; 
338.36     (2) successful diversion or discharge to community 
339.1   alternatives; 
339.2      (3) decreased acute care costs; 
339.3      (4) improved consumer satisfaction; 
339.4      (5) the achievement of quality; or 
339.5      (6) any additional outcomes proposed by a nursing facility 
339.6   that the commissioner finds desirable. 
339.7      Sec. 28.  Minnesota Statutes 2000, section 256B.434, is 
339.8   amended by adding a subdivision to read: 
339.9      Subd. 4c.  [FACILITY RATE INCREASES EFFECTIVE JANUARY 1, 
339.10  2002.] For the rate period beginning January 1, 2002, and for 
339.11  the rate year beginning July 1, 2002, a nursing facility in 
339.12  Morrison county licensed for 83 beds shall receive an increase 
339.13  of $2.54 in each case mix payment rate to offset property tax 
339.14  payments due as a result of the facility's conversion from 
339.15  nonprofit to for-profit status.  The increases under this 
339.16  subdivision shall be added following the determination under 
339.17  this chapter of the payment rate for the rate year beginning 
339.18  July 1, 2001, and shall be included in the facility's total 
339.19  payment rates for the purposes of determining future rates under 
339.20  this section or any other section. 
339.21     Sec. 29.  Minnesota Statutes 2000, section 256B.434, is 
339.22  amended by adding a subdivision to read: 
339.23     Subd. 4d.  [FACILITY RATE INCREASES EFFECTIVE JULY 1, 
339.24  2001.] For the rate year beginning July 1, 2001, a nursing 
339.25  facility in Hennepin county licensed for 302 beds shall receive 
339.26  an increase of 29 cents in each case mix payment rate to correct 
339.27  an error in the cost-reporting system that occurred prior to the 
339.28  date that the facility entered the alternative payment 
339.29  demonstration project.  The increases under this subdivision 
339.30  shall be added following the determination under this chapter of 
339.31  the payment rate for the rate year beginning July 1, 2001, and 
339.32  shall be included in the facility's total payment rates for the 
339.33  purposes of determining future rates under this section or any 
339.34  other section. 
339.35     Sec. 30.  Minnesota Statutes 2000, section 256B.434, is 
339.36  amended by adding a subdivision to read: 
340.1      Subd. 4e.  [RATE INCREASE EFFECTIVE JULY 1, 2001.] A 
340.2   nursing facility in Anoka county licensed for 98 beds as of July 
340.3   1, 2000, shall receive an increase of $10 in each case mix rate 
340.4   for the rate year beginning July 1, 2001.  The increases under 
340.5   this subdivision shall be added following the determination 
340.6   under this chapter of the payment rate for the rate year 
340.7   beginning July 1, 2001, and shall be included in the facility's 
340.8   total payment rate for purposes of determining future rates 
340.9   under this section or any other section through June 30, 2004. 
340.10     Sec. 31.  [256B.437] [IMPLEMENTATION OF A CASE MIX SYSTEM 
340.11  FOR NURSING FACILITIES BASED ON THE MINIMUM DATA SET.] 
340.12     Subdivision 1.  [SCOPE.] This section establishes the 
340.13  method and criteria used to determine resident reimbursement 
340.14  classifications based upon the assessments of residents of 
340.15  nursing homes and boarding care homes whose payment rates are 
340.16  established under section 256B.431, 256B.434, or 256B.435.  
340.17  Resident reimbursement classifications shall be established 
340.18  according to the 34 group, resource utilization groups, version 
340.19  III or RUG-III model as described in section 144.0724.  
340.20  Reimbursement classifications established under this section 
340.21  shall be implemented after June 30, 2002, but no later than 
340.22  January 1, 2003. 
340.23     Subd. 2.  [DEFINITIONS.] For purposes of this section, the 
340.24  following terms have the meanings given. 
340.25     (a) [ASSESSMENT REFERENCE DATE.] "Assessment reference 
340.26  date" has the meaning given in section 144.0724, subdivision 2, 
340.27  paragraph (a). 
340.28     (b) [CASE MIX INDEX.] "Case mix index" has the meaning 
340.29  given in section 144.0724, subdivision 2, paragraph (b). 
340.30     (c) [INDEX MAXIMIZATION.] "Index maximization" has the 
340.31  meaning given in section 144.0724, subdivision 2, paragraph (c). 
340.32     (d) [MINIMUM DATA SET.] "Minimum data set" has the meaning 
340.33  given in section 144.0724, subdivision 2, paragraph (d). 
340.34     (e) [REPRESENTATIVE.] "Representative" has the meaning 
340.35  given in section 144.0724, subdivision 2, paragraph (e). 
340.36     (f) [RESOURCE UTILIZATION GROUPS OR RUG.] "Resource 
341.1   utilization groups" or "RUG" has the meaning given in section 
341.2   144.0724, subdivision 2, paragraph (f). 
341.3      Subd. 3.  [CASE MIX INDICES.] (a) The commissioner of human 
341.4   services shall assign a case mix index to each resident class 
341.5   based on the Health Care Financing Administration's staff time 
341.6   measurement study and adjusted for Minnesota-specific wage 
341.7   indices.  The case mix indices assigned to each resident class 
341.8   shall be published in the Minnesota State Register at least 120 
341.9   days prior to the implementation of the 34 group, RUG-III 
341.10  resident classification system. 
341.11     (b) An index maximization approach shall be used to 
341.12  classify residents. 
341.13     (c) After implementation of the revised case mix system, 
341.14  the commissioner of human services may annually rebase case mix 
341.15  indices and base rates using more current data on average wage 
341.16  rates and staff time measurement studies.  This rebasing shall 
341.17  be calculated under subdivision 7, paragraph (b).  The 
341.18  commissioner shall publish in the Minnesota State Register 
341.19  adjusted case mix indices at least 45 days prior to the 
341.20  effective date of the adjusted case mix indices. 
341.21     Subd. 4.  [RESIDENT ASSESSMENT SCHEDULE.] (a) Nursing 
341.22  facilities shall conduct and submit case mix assessments 
341.23  according to the schedule established by the commissioner of 
341.24  health under section 144.0724, subdivisions 4 and 5. 
341.25     (b) The resident reimbursement classifications established 
341.26  under section 144.0724, subdivision 3, shall be effective the 
341.27  day of admission for new admission assessments.  The effective 
341.28  date for significant change assessments shall be the assessment 
341.29  reference date.  The effective date for annual and second 
341.30  quarterly assessments shall be the first day of the month 
341.31  following assessment reference date. 
341.32     Subd. 5.  [NOTICE OF RESIDENT REIMBURSEMENT 
341.33  CLASSIFICATION.] Nursing facilities shall provide notice to a 
341.34  resident of the resident's case mix classification according to 
341.35  procedures established by the commissioner of health under 
341.36  section 144.0724, subdivision 7. 
342.1      Subd. 6.  [RECONSIDERATION OF RESIDENT CLASSIFICATION.] Any 
342.2   request for reconsideration of a resident classification must be 
342.3   made under section 144.0724, subdivision 8. 
342.4      Subd. 7.  [RATE DETERMINATION UPON TRANSITION TO RUG-III 
342.5   PAYMENT RATES.] (a) The commissioner of human services shall 
342.6   determine payment rates at the time of transition to the RUG 
342.7   based payment model in a facility-specific, budget-neutral 
342.8   manner.  The case mix indices as defined in subdivision 3 shall 
342.9   be used to allocate the case mix adjusted component of total 
342.10  payment across all case mix groups.  To transition from the 
342.11  current calculation methodology to the RUG based methodology, 
342.12  the commissioner of health shall report to the commissioner of 
342.13  human services the resident days classified according to the 
342.14  categories defined in subdivision 3 for the 12-month reporting 
342.15  period ending September 30, 2001, for each nursing facility.  
342.16  The commissioner of human services shall use this data to 
342.17  compute the standardized days for the reporting period under the 
342.18  RUG system. 
342.19     (b) The commissioner of human services shall determine the 
342.20  case mix adjusted component of the rate as follows: 
342.21     (1) determine the case mix portion of the 11 case mix rates 
342.22  in effect on June 30, 2002, or the 34 case mix rates in effect 
342.23  on or after June 30, 2003; 
342.24     (2) multiply each amount in clause (1) by the number of 
342.25  resident days assigned to each group for the reporting period 
342.26  ending September 30, 2001, or the most recent year for which 
342.27  data is available; 
342.28     (3) compute the sum of the amounts in clause (2); 
342.29     (4) determine the total RUG standardized days for the 
342.30  reporting period ending September 30, 2001, or the most recent 
342.31  year for which data is available using new indices calculated 
342.32  under subdivision 3, paragraph (c); 
342.33     (5) divide the amount in clause (3) by the amount in clause 
342.34  (4) which shall be the average case mix adjusted component of 
342.35  the rate under the RUG method; and 
342.36     (6) multiply this average rate by the case mix weight in 
343.1   subdivision 3 for each RUG group. 
343.2      (c) The noncase mix component will be allocated to each RUG 
343.3   group as a constant amount to determine the transition payment 
343.4   rate.  Any other rate adjustments that are effective on or after 
343.5   July 1, 2002, shall be applied to the transition rates 
343.6   determined under this section. 
343.7      Sec. 32.  [256B.4371] [NURSING FACILITY VOLUNTARY CLOSURES 
343.8   AND PLANNING AND DEVELOPMENT OF COMMUNITY-BASED ALTERNATIVES.] 
343.9      Subdivision 1.  [DEFINITIONS.] (a) The definitions in this 
343.10  subdivision apply to subdivisions 2 to 9. 
343.11     (b) "Closure" means the cessation of operations of a 
343.12  nursing facility and delicensure and decertification of all beds 
343.13  within the facility. 
343.14     (c) "Commencement of closure" means the date on which 
343.15  residents and designated representatives are notified of a 
343.16  planned closure according to sections 144A.185 to 144A.1887 as 
343.17  part of an approved closure plan. 
343.18     (d) "Completion of closure" means the date on which the 
343.19  final resident of the nursing facility or nursing facilities 
343.20  designated for closure in an approved closure plan is discharged 
343.21  from the facility or facilities. 
343.22     (e) "Closure plan" means a plan to close a nursing facility 
343.23  and reallocate the resulting savings to provide planned closure 
343.24  rate adjustments at other facilities. 
343.25     (f) "Partial closure" means the delicensure and 
343.26  decertification of a portion of the beds within the facility. 
343.27     (g) "Planned closure rate adjustment" means an increase in 
343.28  a nursing facility's operating rates resulting from a partial 
343.29  planned closure of a facility or a planned closure of another 
343.30  facility.  
343.31     Subd. 2.  [PLANNING AND DEVELOPMENT OF COMMUNITY BASED 
343.32  SERVICES.] (a) The commissioner of human services shall 
343.33  establish a process to adjust the capacity and distribution of 
343.34  long-term care services to equalize the supply and demand for 
343.35  different types of services.  This process must include 
343.36  community planning, expansion or establishment of needed 
344.1   services, and analysis of voluntary nursing facility closures. 
344.2      (b) The purpose of this process is to support the planning 
344.3   and development of community-based services.  This process must 
344.4   support early intervention, advocacy, and consumer protection 
344.5   while providing resources and incentives for expanded county 
344.6   planning and for nursing facilities to transition to meet 
344.7   community needs. 
344.8      (c) The process shall support and facilitate expansion of 
344.9   community-based services under the county-administered 
344.10  alternative care program under section 256B.0913 and waivers for 
344.11  elderly under section 256B.0915, including the development of 
344.12  supportive services such as housing and transportation.  The 
344.13  process shall utilize community assessments and planning 
344.14  developed for the community health services plan and plan update 
344.15  and for the community social services act plan. 
344.16     (d) The addendum to the biennial plan shall be submitted 
344.17  annually, beginning in 2001, and shall include recommendations 
344.18  for development of community-based services.  Both planning and 
344.19  implementation shall be implemented within the amount of funding 
344.20  made available to the county board for these purposes. 
344.21     (e) The commissioner of health and the commissioner of 
344.22  human services, as appropriate, shall provide available data 
344.23  necessary for the county, including but not limited to data on 
344.24  nursing facility bed distribution, housing with services 
344.25  options, the closure of nursing facilities that occur outside of 
344.26  the planned closure process, and approval of planned closures in 
344.27  the county and contiguous counties. 
344.28     (f) The plan, within the funding allocated, shall: 
344.29     (1) identify the need for services based on demographic 
344.30  data, service availability, caseload information, and provider 
344.31  information; 
344.32     (2) involve providers, consumers, cities, townships, 
344.33  businesses, and area agencies on aging in the planning process; 
344.34     (3) address the availability of alternative care and 
344.35  elderly waiver services for eligible recipients; 
344.36     (4) address the development of other supportive services, 
345.1   such as transit, housing, and workforce and economic 
345.2   development; and 
345.3      (5) estimate the cost and timelines for development. 
345.4      (g) The biennial plan addendum shall be coordinated with 
345.5   the county mental health plan for inclusion in the community 
345.6   health services plan and included as an addendum to the 
345.7   community social services plan. 
345.8      (h) The county board having financial responsibility for 
345.9   persons present in another county shall cooperate with that 
345.10  county for planning and development of services. 
345.11     (i) The county board shall cooperate in planning and 
345.12  development of community based services with other counties, as 
345.13  necessary, and coordinate planning for long-term care services 
345.14  that involve more than one county, within the funding allocated 
345.15  for these purposes. 
345.16     (j) The commissioners of health and human services, in 
345.17  cooperation with county boards, shall report to the legislature 
345.18  by February 1 of each year, beginning February 1, 2002, 
345.19  regarding the development of community based services, 
345.20  transition or closure of nursing facilities, and consumer 
345.21  outcomes achieved, as documented by each county and reported to 
345.22  the commissioner by December 31 of each year. 
345.23     (k) The process established by the commissioner of human 
345.24  services shall ensure: 
345.25     (1) that counties consider multicounty service areas in 
345.26  developing services that may impact delivery efficiencies; and 
345.27     (2) review and comment by the area agencies on aging, 
345.28  regional development commissions, where they exist, and other 
345.29  planning agencies of the biennial plan addendum. 
345.30     Subd. 3.  [REQUEST FOR APPLICATIONS FOR PLANNED CLOSURE OF 
345.31  NURSING FACILITIES.] (a) By July 15, 2001, the commissioner of 
345.32  human services shall implement and announce a program for 
345.33  closure or partial closure of nursing facilities.  Names and 
345.34  identifying information provided in response to the announcement 
345.35  shall remain private unless approved, according to the timelines 
345.36  established in the plan.  The announcement must specify: 
346.1      (1) the criteria that will be used by the interagency 
346.2   long-term care planning committee established under section 
346.3   144A.31 and the commissioner to approve or reject applications; 
346.4      (2) a requirement for the submission of a letter of intent 
346.5   before the submission of an application; 
346.6      (3) the information that must accompany an application; 
346.7      (4) a schedule for letters of intent, applications, and 
346.8   consideration of applications for a minimum of four review 
346.9   processes to be conducted before June 30, 2003; and 
346.10     (5) that applications may combine planned closure rate 
346.11  adjustments with moratorium exception funding, in which case a 
346.12  single application may serve both purposes. 
346.13  Between October 1, 2001, and June 30, 2003, the commissioner 
346.14  shall approve planned closures of at least 5,140 nursing 
346.15  facility beds, with no more than 2,070 approved for closure 
346.16  prior to July 1, 2002, less the number of licensed beds in 
346.17  facilities that close during the same time period without 
346.18  approved closure plans or have notified the commissioner of 
346.19  health of their intent to close without an approved closure plan.
346.20     (b) A facility or facilities reimbursed under section 
346.21  256B.431, 256B.434, or 256B.435 with a closure plan approved by 
346.22  the commissioner under subdivision 6 may assign a planned 
346.23  closure rate adjustment to another facility that is not closing 
346.24  or facilities that are not closing, or in the case of a partial 
346.25  closure, to the facility undertaking the partial closure.  A 
346.26  facility may also elect to have a planned closure rate 
346.27  adjustment shared equally by the five nursing facilities with 
346.28  the lowest total operating payment rates in the state 
346.29  development region, designated under section 462.385, in which 
346.30  the facility receiving the planned closure rate adjustment is 
346.31  located.  The planned closure rate adjustment must be calculated 
346.32  under subdivision 7.  A planned closure rate adjustment under 
346.33  this section is effective on the first day of the month 
346.34  following completion of closure of all facilities designated for 
346.35  closure in the application and becomes part of the nursing 
346.36  facility's total operating payment rate. 
347.1      Applicants may use the planned closure rate adjustment to 
347.2   allow for a property payment for a new nursing facility or an 
347.3   addition to an existing nursing facility.  Applications approved 
347.4   under this paragraph are exempt from other requirements for 
347.5   moratorium exceptions under section 144A.073, subdivisions 2 and 
347.6   3.  
347.7      Facilities without a closure plan, or whose closure plan is 
347.8   not approved by the commissioner, are not eligible for a planned 
347.9   closure rate adjustment under subdivision 7.  However, the 
347.10  commissioner shall calculate the amount the facility would have 
347.11  received under subdivision 7 and shall use this amount to 
347.12  provide equal rate adjustments to the five nursing facilities 
347.13  with the lowest total operating payment rates in the state 
347.14  development region, designated under section 462.385, in which 
347.15  the facility is located. 
347.16     (c) To be considered for approval, an application must 
347.17  include: 
347.18     (1) a description of the proposed closure plan, which must 
347.19  include identification of the facility or facilities to receive 
347.20  a planned closure rate adjustment and the amount and timing of a 
347.21  planned closure rate adjustment proposed for each facility; 
347.22     (2) the proposed timetable for any proposed closure, 
347.23  including the proposed dates for announcement to residents, 
347.24  commencement of closure, and completion of closure; 
347.25     (3) the proposed relocation plan for current residents of 
347.26  any facility designated for closure.  The proposed relocation 
347.27  plan must be designed to comply with all applicable state and 
347.28  federal statutes and regulations, including, but not limited to, 
347.29  section 144A.16 and Minnesota Rules, parts 4655.6810 to 
347.30  4655.6830, 4658.1600 to 4658.1690, and 9546.0010 to 9546.0060; 
347.31     (4) a description of the relationship between the nursing 
347.32  facility that is proposed for closure and the nursing facility 
347.33  or facilities proposed to receive the planned closure rate 
347.34  adjustment.  If these facilities are not under common ownership, 
347.35  copies of any contracts, purchase agreements, or other documents 
347.36  establishing a relationship or proposed relationship must be 
348.1   provided; 
348.2      (5) documentation, in a format approved by the 
348.3   commissioner, that all the nursing facilities receiving a 
348.4   planned closure rate adjustment under the plan have accepted 
348.5   joint and several liability for recovery of overpayments under 
348.6   section 256B.0641, subdivision 2, for the facilities designated 
348.7   for closure under the plan; and 
348.8      (6) an explanation of how the application coordinates with 
348.9   planning efforts under subdivision 2. 
348.10     (d) The application must address the criteria listed in 
348.11  subdivision 4. 
348.12     Subd. 4.  [CRITERIA FOR REVIEW OF APPLICATION.] In 
348.13  reviewing and approving closure proposals, the commissioner 
348.14  shall consider, but not be limited to, the following criteria: 
348.15     (1) improved quality of care and quality of life for 
348.16  consumers; 
348.17     (2) closure of a nursing facility that has a poor physical 
348.18  plant; 
348.19     (3) the existence of excess nursing facility beds, measured 
348.20  in terms of beds per thousand persons aged 85 or older.  The 
348.21  excess must be measured in reference to: 
348.22     (i) the county in which the facility is located; 
348.23     (ii) the county and all contiguous counties; 
348.24     (iii) the region in which the facility is located; or 
348.25     (iv) the facility's service area. 
348.26  The facility shall indicate in its proposal the area it believes 
348.27  is appropriate for this measurement.  A facility in a county 
348.28  that is in the lowest quartile of counties with reference to 
348.29  beds per thousand persons aged 85 or older is not in an area of 
348.30  excess capacity; 
348.31     (4) low-occupancy rates, provided that the unoccupied beds 
348.32  are not the result of a personnel shortage.  In analyzing 
348.33  occupancy rates, the commissioner shall examine waiting lists in 
348.34  the applicant facility and at facilities in the surrounding 
348.35  area, as determined under clause (3); 
348.36     (5) evidence of a community planning process to determine 
349.1   what services are needed and ensure that needed services are 
349.2   established; 
349.3      (6) innovative use of reinvestment funds; 
349.4      (7) innovative use planned for the closed facility's 
349.5   physical plant; 
349.6      (8) evidence that the proposal serves the interests of the 
349.7   state; and 
349.8      (9) evidence of other factors that affect the viability of 
349.9   the facility, including excessive nursing pool costs. 
349.10     Subd. 5.  [REVIEW AND APPROVAL OF PROPOSALS.] (a) The 
349.11  interagency long-term care planning committee may recommend that 
349.12  the commissioner of human services grant approval, within the 
349.13  limits established in subdivision 3, paragraph (a), to 
349.14  applications that satisfy the requirements of this section.  The 
349.15  interagency committee may appoint an advisory review panel 
349.16  composed of representatives of counties, SAIL projects, 
349.17  consumers, and providers to review proposals and provide 
349.18  comments and recommendations to the committee.  The 
349.19  commissioners of human services and health shall provide staff 
349.20  and technical assistance to the committee for the review and 
349.21  analysis of proposals.  The commissioners of human services and 
349.22  health shall jointly approve or disapprove an application within 
349.23  30 days after receiving the committee's recommendations. 
349.24     (b) Approval of a planned closure expires 18 months after 
349.25  approval by the commissioner of human services, unless 
349.26  commencement of closure has begun. 
349.27     (c) The commissioner of human services may change any 
349.28  provision of the application to which all parties agree. 
349.29     Subd. 6.  [PLANNED CLOSURE RATE ADJUSTMENT.] The 
349.30  commissioner of human services shall calculate the amount of the 
349.31  planned closure rate adjustment available under subdivision 3, 
349.32  paragraph (b), according to clauses (1) to (4): 
349.33     (1) the amount available is the net reduction of nursing 
349.34  facility beds multiplied by $2,080; 
349.35     (2) the total number of beds in the nursing facility 
349.36  receiving the planned closure rate adjustment must be 
350.1   identified; 
350.2      (3) capacity days are determined by multiplying the number 
350.3   determined under clause (2) by 365; and 
350.4      (4) the planned closure rate adjustment is the amount 
350.5   available in clause (1), divided by capacity days determined 
350.6   under clause (3). 
350.7      Subd. 7.  [OTHER RATE ADJUSTMENTS.] Facilities receiving 
350.8   planned closure rate adjustments remain eligible for any 
350.9   applicable rate adjustments provided under section 256B.431, 
350.10  256B.434, or any other section. 
350.11     Subd. 8.  [COUNTY COSTS.] The commissioner of human 
350.12  services shall allocate up to $500 per nursing facility bed that 
350.13  is closing, within the limits of the appropriation specified for 
350.14  this purpose, to be used for relocation costs incurred by 
350.15  counties for planned closures under this section or resident 
350.16  relocation under sections 144A.185 to 144A.1887.  To be eligible 
350.17  for this allocation, a county in which a nursing facility closes 
350.18  must provide to the commissioner a detailed statement in a form 
350.19  provided by the commissioner of additional costs, not to exceed 
350.20  $500 per bed closed, that are directly incurred related to the 
350.21  county's required role in the relocation process. 
350.22     Sec. 33.  Minnesota Statutes 2000, section 256B.501, is 
350.23  amended by adding a subdivision to read: 
350.24     Subd. 14.  [ICF/MR RATE INCREASES BEGINNING JULY 1, 2001, 
350.25  AND JULY 1, 2002.] (a) For the rate periods beginning July 1, 
350.26  2001, and July 1, 2002, the commissioner shall make available to 
350.27  each facility reimbursed under this section, section 256B.5011, 
350.28  and Laws 1993, First Special Session chapter 1, article 4, 
350.29  section 11, an adjustment to the total operating payment rate of 
350.30  3.0 percent. 
350.31     (b) For each facility, the commissioner shall determine the 
350.32  payment rate adjustment using the percentage specified in 
350.33  paragraph (a) multiplied by the total operating payment rate in 
350.34  effect on the last day of the prior rate year, and dividing the 
350.35  resulting amount by the facility's actual resident days.  The 
350.36  total operating payment rate shall include the adjustment 
351.1   provided in subdivision 12. 
351.2      (c) Any facility whose payment rates are governed by 
351.3   closure agreements, receivership agreements, or Minnesota Rules, 
351.4   part 9553.0075, is not eligible for an adjustment otherwise 
351.5   granted under this subdivision.  
351.6      Sec. 34.  Minnesota Statutes 2000, section 256B.76, is 
351.7   amended to read: 
351.8      256B.76 [PHYSICIAN AND DENTAL REIMBURSEMENT.] 
351.9      (a) Effective for services rendered on or after October 1, 
351.10  1992, the commissioner shall make payments for physician 
351.11  services as follows: 
351.12     (1) payment for level one Health Care Finance 
351.13  Administration's common procedural coding system (HCPCS) codes 
351.14  titled "office and other outpatient services," "preventive 
351.15  medicine new and established patient," "delivery, antepartum, 
351.16  and postpartum care," "critical care," Caesarean cesarean 
351.17  delivery and pharmacologic management provided to psychiatric 
351.18  patients, and HCPCS level three codes for enhanced services for 
351.19  prenatal high risk, shall be paid at the lower of (i) submitted 
351.20  charges, or (ii) 25 percent above the rate in effect on June 30, 
351.21  1992.  If the rate on any procedure code within these categories 
351.22  is different than the rate that would have been paid under the 
351.23  methodology in section 256B.74, subdivision 2, then the larger 
351.24  rate shall be paid; 
351.25     (2) payments for all other services shall be paid at the 
351.26  lower of (i) submitted charges, or (ii) 15.4 percent above the 
351.27  rate in effect on June 30, 1992; 
351.28     (3) all physician rates shall be converted from the 50th 
351.29  percentile of 1982 to the 50th percentile of 1989, less the 
351.30  percent in aggregate necessary to equal the above increases 
351.31  except that payment rates for home health agency services shall 
351.32  be the rates in effect on September 30, 1992; 
351.33     (4) effective for services rendered on or after January 1, 
351.34  2000, payment rates for physician and professional services 
351.35  shall be increased by three percent over the rates in effect on 
351.36  December 31, 1999, except for home health agency and family 
352.1   planning agency services; and 
352.2      (5) the increases in clause (4) shall be implemented 
352.3   January 1, 2000, for managed care. 
352.4      (b) Effective for services rendered on or after October 1, 
352.5   1992, the commissioner shall make payments for dental services 
352.6   as follows: 
352.7      (1) dental services shall be paid at the lower of (i) 
352.8   submitted charges, or (ii) 25 percent above the rate in effect 
352.9   on June 30, 1992; 
352.10     (2) dental rates shall be converted from the 50th 
352.11  percentile of 1982 to the 50th percentile of 1989, less the 
352.12  percent in aggregate necessary to equal the above increases; 
352.13     (3) effective for services rendered on or after January 1, 
352.14  2000, payment rates for dental services shall be increased by 
352.15  three percent over the rates in effect on December 31, 1999; 
352.16     (4) the commissioner shall award grants to community 
352.17  clinics or other nonprofit community organizations, political 
352.18  subdivisions, professional associations, or other organizations 
352.19  that demonstrate the ability to provide dental services 
352.20  effectively to public program recipients.  Grants may be used to 
352.21  fund the costs related to coordinating access for recipients, 
352.22  developing and implementing patient care criteria, upgrading or 
352.23  establishing new facilities, acquiring furnishings or equipment, 
352.24  recruiting new providers, or other development costs that will 
352.25  improve access to dental care in a region.  In awarding grants, 
352.26  the commissioner shall give priority to applicants that plan to 
352.27  serve areas of the state in which the number of dental providers 
352.28  is not currently sufficient to meet the needs of recipients of 
352.29  public programs or uninsured individuals.  The commissioner 
352.30  shall consider the following in awarding the grants:  (i) 
352.31  potential to successfully increase access to an underserved 
352.32  population; (ii) the ability to raise matching funds; (iii) the 
352.33  long-term viability of the project to improve access beyond the 
352.34  period of initial funding; (iv) the efficiency in the use of the 
352.35  funding; and (v) the experience of the proposers in providing 
352.36  services to the target population. 
353.1      The commissioner shall monitor the grants and may terminate 
353.2   a grant if the grantee does not increase dental access for 
353.3   public program recipients.  The commissioner shall consider 
353.4   grants for the following: 
353.5      (i) implementation of new programs or continued expansion 
353.6   of current access programs that have demonstrated success in 
353.7   providing dental services in underserved areas; 
353.8      (ii) a pilot program for utilizing hygienists outside of a 
353.9   traditional dental office to provide dental hygiene services; 
353.10  and 
353.11     (iii) a program that organizes a network of volunteer 
353.12  dentists, establishes a system to refer eligible individuals to 
353.13  volunteer dentists, and through that network provides donated 
353.14  dental care services to public program recipients or uninsured 
353.15  individuals. 
353.16     (5) beginning October 1, 1999, the payment for tooth 
353.17  sealants and fluoride treatments shall be the lower of (i) 
353.18  submitted charge, or (ii) 80 percent of median 1997 charges; and 
353.19     (6) the increases listed in clauses (3) and (5) shall be 
353.20  implemented January 1, 2000, for managed care. 
353.21     (c) An entity that operates both a Medicare certified 
353.22  comprehensive outpatient rehabilitation facility and a facility 
353.23  which was certified prior to January 1, 1993, that is licensed 
353.24  under Minnesota Rules, parts 9570.2000 to 9570.3600, and for 
353.25  whom at least 33 percent of the clients receiving rehabilitation 
353.26  services and mental health services in the most recent calendar 
353.27  year are medical assistance recipients, shall be reimbursed by 
353.28  the commissioner for rehabilitation services and mental health 
353.29  services at rates that are 38 percent greater than the maximum 
353.30  reimbursement rate allowed under paragraph (a), clause (2), when 
353.31  those services are (1) provided within the comprehensive 
353.32  outpatient rehabilitation facility and (2) provided to residents 
353.33  of nursing facilities owned by the entity. 
353.34     Sec. 35.  Laws 1995, chapter 207, article 3, section 21, as 
353.35  amended by Laws 1999, chapter 245, article 3, section 43, is 
353.36  amended to read:  
354.1      Sec. 21.  [FACILITY CERTIFICATION.] 
354.2      (a) Notwithstanding Minnesota Statutes, section 252.291, 
354.3   subdivisions 1 and 2, the commissioner of health shall inspect 
354.4   to certify a large community-based facility currently licensed 
354.5   under Minnesota Rules, parts 9525.0215 to 9525.0355, for more 
354.6   than 16 beds and located in Northfield.  The facility may be 
354.7   certified for up to 44 beds.  The commissioner of health must 
354.8   inspect to certify the facility as soon as possible after the 
354.9   effective date of this section.  The commissioner of human 
354.10  services shall work with the facility and affected counties to 
354.11  relocate any current residents of the facility who do not meet 
354.12  the admission criteria for an ICF/MR.  Until January 1, 1999, in 
354.13  order to fund the ICF/MR services and relocations of current 
354.14  residents authorized, the commissioner of human services may 
354.15  transfer on a quarterly basis to the medical assistance account 
354.16  from each affected county's community social service allocation, 
354.17  an amount equal to the state share of medical assistance 
354.18  reimbursement for the residential and day habilitation services 
354.19  funded by medical assistance and provided to clients for whom 
354.20  the county is financially responsible.  
354.21     (b) After January 1, 1999, the commissioner of human 
354.22  services shall fund the services under the state medical 
354.23  assistance program and may transfer on a quarterly basis to the 
354.24  medical assistance account from each affected county's community 
354.25  social service allocation, an amount equal to one-half of the 
354.26  state share of medical assistance reimbursement for the 
354.27  residential and day habilitation services funded by medical 
354.28  assistance and provided to clients for whom the county is 
354.29  financially responsible.  
354.30     (c) Effective July 1, 2001, the commissioner of human 
354.31  services shall fund the entire state share of medical assistance 
354.32  reimbursement for the residential and day habilitation services 
354.33  funded by medical assistance and provided to clients for whom 
354.34  counties are financially responsible from the medical assistance 
354.35  account, and shall not make any transfer from the community 
354.36  social service allocations of affected counties.  
355.1      (d) For nonresidents of Minnesota seeking admission to the 
355.2   facility, Rice county shall be notified in order to assure that 
355.3   appropriate funding is guaranteed from their state or country of 
355.4   residence. 
355.5      Sec. 36.  Laws 1999, chapter 245, article 3, section 45, as 
355.6   amended by Laws 2000, chapter 312, section 3, is amended to read:
355.7      Sec. 45.  [STATE LICENSURE CONFLICTS WITH FEDERAL 
355.8   REGULATIONS.] 
355.9      (a) Notwithstanding the provisions of Minnesota Rules, part 
355.10  4658.0520, an incontinent resident must be checked according to 
355.11  a specific time interval written in the resident's care plan.  
355.12  The resident's attending physician must authorize in writing any 
355.13  interval longer than two hours unless the resident, if 
355.14  competent, or a family member or legally appointed conservator, 
355.15  guardian, or health care agent of a resident who is not 
355.16  competent, agrees in writing to waive physician involvement in 
355.17  determining this interval. 
355.18     (b) This section expires July 1, 2001 2003. 
355.19     Sec. 37.  [DEVELOPMENT OF NEW NURSING FACILITY 
355.20  REIMBURSEMENT SYSTEM.] 
355.21     (a) The commissioner of human services shall develop and 
355.22  report to the legislature by January 15, 2003, a system to 
355.23  replace the current nursing facility reimbursement system 
355.24  established under Minnesota Statutes, sections 256B.431, 
355.25  256B.434, and 256B.435. 
355.26     (b) The system must be developed in consultation with the 
355.27  long-term care task force and with representatives of consumers, 
355.28  providers, and labor unions.  Within the limits of available 
355.29  appropriations, the commissioner may employ consultants to 
355.30  assist with this project. 
355.31     (c) The new reimbursement system must: 
355.32     (1) provide incentives to enhance quality of life and 
355.33  quality of care; 
355.34     (2) recognize cost differences in the care of different 
355.35  types of populations, including subacute care and dementia care; 
355.36     (3) establish rates that are sufficient without being 
356.1   excessive; 
356.2      (4) be affordable for the state and for private-pay 
356.3   residents; 
356.4      (5) be sensitive to changing conditions in the long-term 
356.5   care environment; 
356.6      (6) avoid creating access problems related to insufficient 
356.7   funding; 
356.8      (7) allow providers maximum flexibility in their business 
356.9   operations; 
356.10     (8) recognize the need for capital investment to improve 
356.11  physical plants; and 
356.12     (9) provide incentives for the development and use of 
356.13  private rooms. 
356.14     (d) Notwithstanding Minnesota Statutes, section 256B.435, 
356.15  the commissioner must not implement a performance-based 
356.16  contracting system for nursing facilities prior to July 1, 2003. 
356.17  The commissioner shall continue to reimburse nursing facilities 
356.18  under Minnesota Statutes, section 256B.431 or 256B.434, until 
356.19  otherwise directed by law. 
356.20     (e) The commissioner of human services, in consultation 
356.21  with the commissioner of health, shall conduct or contract for a 
356.22  time study to determine staff time being spent on various case 
356.23  mix categories; recommend adjustments to the case mix weights 
356.24  based on the time study data; and determine whether current 
356.25  staffing standards are adequate for providing quality care based 
356.26  on professional best practice and consumer experience.  If the 
356.27  commissioner determines the current standards are inadequate, 
356.28  the commissioner shall determine an appropriate staffing 
356.29  standard for the various case mix categories and the financial 
356.30  implications of phasing into this standard over the next four 
356.31  years. 
356.32     Sec. 38.  [REPORT ON STANDARDS FOR SUBACUTE CARE FACILITY 
356.33  LICENSURE.] 
356.34     By January 15, 2003, the commissioner of health shall 
356.35  submit a report to the legislature on implementation of a 
356.36  licensure program for subacute care.  This report must include: 
357.1      (1) definitions of subacute care and applicability of the 
357.2   proposed licensure program to various types of licensed 
357.3   facilities; 
357.4      (2) an analysis of whether specific standards for subacute 
357.5   levels of care need to be developed and the potential for 
357.6   increased costs for existing providers of subacute care; 
357.7      (3) recommendations on the applicability of the nursing 
357.8   home moratorium law to the licensure of subacute care facilities 
357.9   or programs; 
357.10     (4) identification of federal regulations guiding the 
357.11  provision of subacute care and whether further state standards 
357.12  are needed; and 
357.13     (5) identification of current and potential reimbursement 
357.14  for subacute care under Medicare, Medicaid, or managed care 
357.15  programs. 
357.16     Sec. 39.  [REGULATORY FLEXIBILITY.] 
357.17     (a) By July 1, 2001, the commissioners of health and human 
357.18  services shall: 
357.19     (1) develop a summary of federal nursing facility and 
357.20  community long-term care regulations that hamper state 
357.21  flexibility and place burdens on the goal of achieving 
357.22  high-quality care and optimum outcomes for consumers of 
357.23  services; and 
357.24     (2) share this summary with the legislature, other states, 
357.25  national groups that advocate for state interests with Congress, 
357.26  and the Minnesota congressional delegation. 
357.27     (b) The commissioners shall conduct ongoing follow-up with 
357.28  the entities to which this summary is provided and with the 
357.29  health care financing administration to achieve maximum 
357.30  regulatory flexibility, including the possibility of pilot 
357.31  projects to demonstrate regulatory flexibility on less than a 
357.32  statewide basis. 
357.33     Sec. 40.  [REPORT.] 
357.34     By January 15, 2003, the commissioner of health and the 
357.35  commissioner of human services shall report to the senate health 
357.36  and family security committee and the house health and human 
358.1   services policy committee on the number of closures that have 
358.2   taken place under Minnesota Statutes, section 256B.437, and any 
358.3   other nursing facility closures that may have taken place, 
358.4   alternatives to nursing facility care that have been developed, 
358.5   any problems with access to long-term care services that have 
358.6   resulted, and any recommendations for continuation of the 
358.7   regional long-term care planning process and the closure process 
358.8   after June 30, 2003. 
358.9      Sec. 41.  [NURSING ASSISTANT; HOME HEALTH AIDE CURRICULUM.] 
358.10     By January 1, 2003, the commissioner of health, in 
358.11  consultation with long-term care consumers, advocates, unions, 
358.12  and trade associations, shall present to the chairs of the 
358.13  legislative committees dealing with health care policy 
358.14  recommendations for updating the nursing assistant and home 
358.15  health aide curriculum (1998 edition) to help students learn 
358.16  front-line survival skills that support job motivation and 
358.17  satisfaction.  These skills include, but are not limited to, 
358.18  working with challenging behaviors, communication skills, stress 
358.19  management including the impact of personal life stress in the 
358.20  work setting, building relationships with families, cultural 
358.21  competencies, and working with death and dying. 
358.22     Sec. 42.  [EVALUATION OF REPORTING REQUIREMENTS.] 
358.23     The commissioners of human services and health, in 
358.24  consultation with interested parties, shall evaluate long-term 
358.25  care provider reporting requirements, balancing the need for 
358.26  public accountability with the need to reduce unnecessary 
358.27  paperwork, and shall eliminate unnecessary reporting 
358.28  requirements, seeking any necessary changes in federal and state 
358.29  law.  The commissioners shall present a progress report by 
358.30  February 1, 2002, to the chairs of the house and senate 
358.31  committees with jurisdiction over health and human services 
358.32  policy and finance. 
358.33     Sec. 43.  [NURSING FACILITY MULTIPLE SCLEROSIS PILOT 
358.34  PROJECT.] 
358.35     (a) For the period from July 1, 2001, to June 30, 2003, the 
358.36  commissioner of human services shall establish and implement a 
359.1   pilot project to contract with nursing facilities eligible to 
359.2   receive medical assistance payments that, at the time of 
359.3   enrollment in the pilot project, serve ten or more persons with 
359.4   a diagnosis of multiple sclerosis.  The commissioner shall 
359.5   negotiate a payment rate with eligible facilities to provide 
359.6   services to persons with multiple sclerosis that must not exceed 
359.7   150 percent of the person's case mix classification payment rate 
359.8   for that facility.  The commissioner may contract with up to six 
359.9   nursing facilities. 
359.10     (b) Facilities may enroll in the pilot project between July 
359.11  1, 2001, and December 31, 2001. 
359.12     (c) The commissioner shall evaluate the additional payments 
359.13  made under the pilot project to determine if the adjustment 
359.14  enables participating facilities to adequately meet the needs 
359.15  for individual care and specialized programming, including 
359.16  programs to meet psychosocial, physiological, and case 
359.17  management needs, without incurring financial losses.  The 
359.18  commissioner of human services, in consultation with the 
359.19  commissioner of health, shall report to the legislature by 
359.20  January 15, 2003, on the results of the project and with a 
359.21  recommendation on whether the project should be made permanent. 
359.22     (d) The negotiated adjustment shall not affect the payment 
359.23  rate charged to private paying residents under the provisions of 
359.24  Minnesota Statutes, section 256B.48, subdivision 1. 
359.25     Sec. 44.  [MINIMUM STAFFING STANDARDS REPORT.] 
359.26     By January 15, 2002, the commissioner of health and the 
359.27  commissioner of human services shall report to the legislature 
359.28  on whether they should translate the minimum nurse staffing 
359.29  requirement in Minnesota Statutes, section 144A.04, subdivision 
359.30  7, paragraph (a), upon the transition to the RUG-III 
359.31  classification system, or whether they should establish 
359.32  different time-based standards, and how to accomplish either. 
359.33     Sec. 45.  [REPEALER.] 
359.34     Minnesota Statutes 2000, sections 144.0721, subdivision 1, 
359.35  and 256B.434, subdivision 5, are repealed. 
359.36                             ARTICLE 6 
360.1                              WORK FORCE 
360.2      Section 1.  Minnesota Statutes 2000, section 144.1464, is 
360.3   amended to read: 
360.4      144.1464 [SUMMER HEALTH CARE INTERNS.] 
360.5      Subdivision 1.  [SUMMER INTERNSHIPS.] The commissioner of 
360.6   health, through a contract with a nonprofit organization as 
360.7   required by subdivision 4, shall award grants to hospitals and, 
360.8   clinics, nursing facilities, and home care providers to 
360.9   establish a secondary and post-secondary summer health care 
360.10  intern program.  The purpose of the program is to expose 
360.11  interested secondary and post-secondary pupils to various 
360.12  careers within the health care profession. 
360.13     Subd. 2.  [CRITERIA.] (a) The commissioner, through the 
360.14  organization under contract, shall award grants to 
360.15  hospitals and, clinics, nursing facilities, and home care 
360.16  providers that agree to:  
360.17     (1) provide secondary and post-secondary summer health care 
360.18  interns with formal exposure to the health care profession; 
360.19     (2) provide an orientation for the secondary and 
360.20  post-secondary summer health care interns; 
360.21     (3) pay one-half the costs of employing the secondary and 
360.22  post-secondary summer health care intern, based on an overall 
360.23  hourly wage that is at least the minimum wage but does not 
360.24  exceed $6 an hour; 
360.25     (4) interview and hire secondary and post-secondary pupils 
360.26  for a minimum of six weeks and a maximum of 12 weeks; and 
360.27     (5) employ at least one secondary student for each 
360.28  post-secondary student employed, to the extent that there are 
360.29  sufficient qualifying secondary student applicants. 
360.30     (b) In order to be eligible to be hired as a secondary 
360.31  summer health intern by a hospital or, clinic, nursing facility, 
360.32  or home care provider, a pupil must: 
360.33     (1) intend to complete high school graduation requirements 
360.34  and be between the junior and senior year of high school; and 
360.35     (2) be from a school district in proximity to the facility; 
360.36  and 
361.1      (3) provide the facility with a letter of recommendation 
361.2   from a health occupations or science educator. 
361.3      (c) In order to be eligible to be hired as a post-secondary 
361.4   summer health care intern by a hospital or clinic, a pupil must: 
361.5      (1) intend to complete a health care training program or a 
361.6   two-year or four-year degree program and be planning on 
361.7   enrolling in or be enrolled in that training program or degree 
361.8   program; and 
361.9      (2) be enrolled in a Minnesota educational institution or 
361.10  be a resident of the state of Minnesota; priority must be given 
361.11  to applicants from a school district or an educational 
361.12  institution in proximity to the facility; and 
361.13     (3) provide the facility with a letter of recommendation 
361.14  from a health occupations or science educator. 
361.15     (d) Hospitals and, clinics, nursing facilities, and home 
361.16  care providers awarded grants may employ pupils as secondary and 
361.17  post-secondary summer health care interns beginning on or after 
361.18  June 15, 1993, if they agree to pay the intern, during the 
361.19  period before disbursement of state grant money, with money 
361.20  designated as the facility's 50 percent contribution towards 
361.21  internship costs.  
361.22     Subd. 3.  [GRANTS.] The commissioner, through the 
361.23  organization under contract, shall award separate grants to 
361.24  hospitals and, clinics, nursing facilities, and home care 
361.25  providers meeting the requirements of subdivision 2.  The grants 
361.26  must be used to pay one-half of the costs of employing secondary 
361.27  and post-secondary pupils in a hospital or, clinic, nursing 
361.28  facility, or home care setting during the course of the 
361.29  program.  No more than 50 percent of the participants may be 
361.30  post-secondary students, unless the program does not receive 
361.31  enough qualified secondary applicants per fiscal year.  No more 
361.32  than five pupils may be selected from any secondary or 
361.33  post-secondary institution to participate in the program and no 
361.34  more than one-half of the number of pupils selected may be from 
361.35  the seven-county metropolitan area. 
361.36     Subd. 4.  [CONTRACT.] The commissioner shall contract with 
362.1   a statewide, nonprofit organization representing facilities at 
362.2   which secondary and post-secondary summer health care interns 
362.3   will serve, to administer the grant program established by this 
362.4   section.  Grant funds that are not used in one fiscal year may 
362.5   be carried over to the next fiscal year.  The organization 
362.6   awarded the grant shall provide the commissioner with any 
362.7   information needed by the commissioner to evaluate the program, 
362.8   in the form and at the times specified by the commissioner. 
362.9      Sec. 2.  [144.1499] [PROMOTION OF HEALTH CARE AND LONG-TERM 
362.10  CARE CAREERS.] 
362.11     The commissioner of health, in consultation with an 
362.12  organization representing health care employers, long-term care 
362.13  employers, and educational institutions, may make grants to 
362.14  qualifying consortia as defined in section 116L.11, subdivision 
362.15  4, for intergenerational programs to encourage middle and high 
362.16  school students to work and volunteer in health care and 
362.17  long-term care settings.  To qualify for a grant under this 
362.18  section, a consortium shall: 
362.19     (1) develop a health and long-term care careers curriculum 
362.20  that provides career exploration and training in national skill 
362.21  standards for health care and long-term care and that is 
362.22  consistent with Minnesota graduation standards and other related 
362.23  requirements; 
362.24     (2) offer programs for high school students that provide 
362.25  training in health and long-term care careers with credits that 
362.26  articulate into post-secondary programs; and 
362.27     (3) provide technical support to the participating health 
362.28  care and long-term care employer to enable the use of the 
362.29  employer's facilities and programs for K-12 health and long-term 
362.30  care careers education. 
362.31     Sec. 3.  Minnesota Statutes 2000, section 144A.62, 
362.32  subdivision 1, is amended to read: 
362.33     Subdivision 1.  [ASSISTANCE WITH EATING AND DRINKING.] (a) 
362.34  Upon federal approval, a nursing home may employ resident 
362.35  attendants to assist with the activities authorized under 
362.36  subdivision 2.  The resident attendant will not shall be counted 
363.1   in the minimum staffing requirements under section 144A.04, 
363.2   subdivision 7. 
363.3      (b) The commissioner shall submit by May July 15, 2000 
363.4   2001, a new request for a federal waiver necessary to implement 
363.5   this section. 
363.6      Sec. 4.  Minnesota Statutes 2000, section 144A.62, 
363.7   subdivision 2, is amended to read: 
363.8      Subd. 2.  [DEFINITION.] (a) "Resident attendant" means an 
363.9   individual who assists residents in a nursing home with the one 
363.10  or more of the following activities of eating and drinking: 
363.11     (1) eating and drinking; and 
363.12     (2) transporting. 
363.13     (b) A resident attendant does not include an individual who:
363.14     (1) is a licensed health professional or a registered 
363.15  dietitian; 
363.16     (2) volunteers without monetary compensation; or 
363.17     (3) is a registered nursing assistant. 
363.18     Sec. 5.  Minnesota Statutes 2000, section 144A.62, 
363.19  subdivision 3, is amended to read: 
363.20     Subd. 3.  [REQUIREMENTS.] (a) A nursing home may not use on 
363.21  a full-time or other paid basis any individual as a resident 
363.22  attendant in the nursing home unless the individual: 
363.23     (1) has completed a training and competency evaluation 
363.24  program encompassing the tasks activities in subdivision 2 that 
363.25  the individual provides; 
363.26     (2) is competent to provide feeding and hydration services 
363.27  those activities; and 
363.28     (3) is under the supervision of the director of nursing. 
363.29     (b) A nursing home may not use a current employee as a 
363.30  resident attendant unless the employee satisfies the 
363.31  requirements of paragraph (a) and volunteers to be used in that 
363.32  capacity. 
363.33     Sec. 6.  Minnesota Statutes 2000, section 144A.62, 
363.34  subdivision 4, is amended to read: 
363.35     Subd. 4.  [EVALUATION.] The training and competency 
363.36  evaluation program may be facility based.  It must include, at a 
364.1   minimum, the training and competency standards for eating and 
364.2   drinking assistance the specific activities the attendant will 
364.3   be conducting contained in the nursing assistant training 
364.4   curriculum. 
364.5      Sec. 7.  Minnesota Statutes 2000, section 148.212, is 
364.6   amended to read: 
364.7      148.212 [TEMPORARY PERMIT.] 
364.8      Upon receipt of the applicable licensure or reregistration 
364.9   fee and permit fee, and in accordance with rules of the board, 
364.10  the board may issue a nonrenewable temporary permit to practice 
364.11  professional or practical nursing to an applicant for licensure 
364.12  or reregistration who is not the subject of a pending 
364.13  investigation or disciplinary action, nor disqualified for any 
364.14  other reason, under the following circumstances: 
364.15     (a) The applicant for licensure by examination under 
364.16  section 148.211, subdivision 1, has graduated from an approved 
364.17  nursing program within the 60 days preceding board receipt of an 
364.18  affidavit of graduation or transcript and has been authorized by 
364.19  the board to write the licensure examination for the first time 
364.20  in the United States.  The permit holder must practice 
364.21  professional or practical nursing under the direct supervision 
364.22  of a registered nurse.  The permit is valid from the date of 
364.23  issue until the date the board takes action on the application 
364.24  or for 60 days whichever occurs first. 
364.25     (b) The applicant for licensure by endorsement under 
364.26  section 148.211, subdivision 2, is currently licensed to 
364.27  practice professional or practical nursing in another state, 
364.28  territory, or Canadian province.  The permit is valid from 
364.29  submission of a proper request until the date of board action on 
364.30  the application. 
364.31     (c) The applicant for licensure by endorsement under 
364.32  section 148.211, subdivision 2, or for reregistration under 
364.33  section 148.231, subdivision 5, is currently registered in a 
364.34  formal, structured refresher course or its equivalent for nurses 
364.35  that includes clinical practice. 
364.36     (d) The applicant for licensure by examination under 
365.1   section 148.211, subdivision 1, as a registered nurse has been 
365.2   issued a commission on graduates of foreign nurse schools 
365.3   certificate, has completed all requirements for licensure except 
365.4   the licensing examination, and has been authorized by the board 
365.5   to write the licensure examination for the first time in the 
365.6   United States.  The permit holder must practice professional 
365.7   nursing under the direct supervision of a registered nurse.  The 
365.8   permit is valid from the date of issue until the date the board 
365.9   takes action on the application or for 60 days, whichever occurs 
365.10  first. 
365.11                             ARTICLE 7 
365.12                     REGULATION OF SUPPLEMENTAL 
365.13                     NURSING SERVICES AGENCIES
365.14     Section 1.  [144A.70] [REGISTRATION OF SUPPLEMENTAL NURSING 
365.15  SERVICES AGENCIES; DEFINITIONS.] 
365.16     Subdivision 1.  [SCOPE.] As used in sections 144A.70 to 
365.17  144A.74, the terms defined in this section have the meanings 
365.18  given them. 
365.19     Subd. 2.  [COMMISSIONER.] "Commissioner" means the 
365.20  commissioner of health. 
365.21     Subd. 3.  [CONTROLLING PERSON.] "Controlling person" means 
365.22  a business entity, officer, program administrator, or director 
365.23  whose responsibilities include the direction of the management 
365.24  or policies of a supplemental nursing services agency.  
365.25  Controlling person also means an individual who, directly or 
365.26  indirectly, beneficially owns an interest in a corporation, 
365.27  partnership, or other business association that is a controlling 
365.28  person. 
365.29     Subd. 4.  [HEALTH CARE FACILITY.] "Health care facility" 
365.30  means a hospital, boarding care home, or outpatient surgical 
365.31  center licensed under sections 144.50 to 144.58, a nursing home 
365.32  or home care agency licensed under this chapter, a residential 
365.33  care home, or a board and lodging establishment that is 
365.34  registered to provide supportive or health supervision services 
365.35  under section 157.17. 
365.36     Subd. 5.  [PERSON.] "Person" includes an individual, firm, 
366.1   corporation, partnership, or association. 
366.2      Subd. 6.  [SUPPLEMENTAL NURSING SERVICES 
366.3   AGENCY.] "Supplemental nursing services agency" means a person, 
366.4   firm, corporation, partnership, or association engaged for hire 
366.5   in the business of providing or procuring temporary employment 
366.6   in health care facilities for nurses, nursing assistants, nurse 
366.7   aides, and orderlies.  Supplemental nursing services agency does 
366.8   not include an individual who only engages in providing the 
366.9   individual's services on a temporary basis to health care 
366.10  facilities.  Supplemental nursing services agency also does not 
366.11  include any nursing services agency that is limited to providing 
366.12  temporary nursing personnel solely to one or more health care 
366.13  facilities owned or operated by the same person, firm, 
366.14  corporation, or partnership. 
366.15     Sec. 2.  [144A.71] [SUPPLEMENTAL NURSING SERVICES AGENCY 
366.16  REGISTRATION.] 
366.17     Subdivision 1.  [DUTY TO REGISTER.] A person who operates a 
366.18  supplemental nursing services agency shall register the agency 
366.19  with the commissioner.  Each separate location of the business 
366.20  of a supplemental nursing services agency shall register the 
366.21  agency with the commissioner.  Each separate location of the 
366.22  business of a supplemental nursing services agency shall have a 
366.23  separate registration. 
366.24     Subd. 2.  [APPLICATION INFORMATION AND FEE.] The 
366.25  commissioner shall establish forms and procedures for processing 
366.26  each supplemental nursing services agency registration 
366.27  application.  An application for a supplemental nursing services 
366.28  agency registration must include at least the following: 
366.29     (1) the names and addresses of the owner or owners of the 
366.30  supplemental nursing services agency; 
366.31     (2) if the owner is a corporation, copies of its articles 
366.32  of incorporation and current bylaws, together with the names and 
366.33  addresses of its officers and directors; 
366.34     (3) any other relevant information that the commissioner 
366.35  determines is necessary to properly evaluate an application for 
366.36  registration; and 
367.1      (4) the annual registration fee for a supplemental nursing 
367.2   services agency, which is $891. 
367.3      Subd. 3.  [REGISTRATION NOT TRANSFERABLE.] A registration 
367.4   issued by the commissioner according to this section is 
367.5   effective for a period of one year from the date of its issuance 
367.6   unless the registration is revoked or suspended under section 
367.7   144A.72, subdivision 2, or unless the supplemental nursing 
367.8   services agency is sold or ownership or management is 
367.9   transferred.  When a supplemental nursing services agency is 
367.10  sold or ownership or management is transferred, the registration 
367.11  of the agency must be voided and the new owner or operator may 
367.12  apply for a new registration. 
367.13     Sec. 3.  [144A.72] [REGISTRATION REQUIREMENTS.] 
367.14     The commissioner shall require that, as a condition of 
367.15  registration: 
367.16     (1) the supplemental nursing services agency shall document 
367.17  that each temporary employee provided to health care facilities 
367.18  currently meets the minimum licensing, training, and continuing 
367.19  education standards for the position in which the employee will 
367.20  be working; 
367.21     (2) the supplemental nursing services agency shall comply 
367.22  with all pertinent requirements relating to the health and other 
367.23  qualifications of personnel employed in health care facilities; 
367.24     (3) the supplemental nursing services agency must not 
367.25  restrict in any manner the employment opportunities of its 
367.26  employees; 
367.27     (4) the supplemental nursing services agency, when 
367.28  supplying temporary employees to a health care facility, and 
367.29  when requested by the facility to do so, shall agree that at 
367.30  least 30 percent of the total personnel hours supplied are 
367.31  during night, holiday, or weekend shifts; 
367.32     (5) the supplemental nursing services agency shall carry 
367.33  medical malpractice insurance to insure against the loss, 
367.34  damage, or expense incident to a claim arising out of the death 
367.35  or injury of any person as the result of negligence or 
367.36  malpractice in the provision of health care services by the 
368.1   supplemental nursing services agency or by any employee of the 
368.2   agency; and 
368.3      (6) the supplemental nursing services agency must not, in 
368.4   any contract with any employee or health care facility, require 
368.5   the payment of liquidated damages, employment fees, or other 
368.6   compensation should the employee be hired as a permanent 
368.7   employee of a health care facility. 
368.8      Sec. 4.  [144A.73] [COMPLAINT SYSTEM.] 
368.9      The commissioner shall establish a system for reporting 
368.10  complaints against a supplemental nursing services agency or its 
368.11  employees.  Complaints may be made by any member of the public.  
368.12  Written complaints must be forwarded to the employer of each 
368.13  person against whom a complaint is made.  The employer shall 
368.14  promptly report to the commissioner any corrective action taken. 
368.15     Sec. 5.  [144A.74] [MAXIMUM CHARGES.] 
368.16     A supplemental nursing services agency must not bill or 
368.17  receive payments from a nursing home licensed under this chapter 
368.18  at a rate higher than 150 percent of the weighted average wage 
368.19  rate for the applicable employee classification for the 
368.20  geographic group to which the nursing home is assigned under 
368.21  chapter 256B.  The weighted average wage rates must be 
368.22  determined by the commissioner of human services and reported to 
368.23  the commissioner of health on an annual basis.  Facilities shall 
368.24  provide information necessary to determine weighted average wage 
368.25  rates to the commissioner of human services in a format 
368.26  requested by the commissioner.  The maximum rate must include 
368.27  all charges for administrative fees, contract fees, or other 
368.28  special charges in addition to the hourly rates for the 
368.29  temporary nursing pool personnel supplied to a nursing home. 
368.30     Sec. 6.  Minnesota Statutes 2000, section 245A.04, 
368.31  subdivision 3, is amended to read: 
368.32     Subd. 3.  [BACKGROUND STUDY OF THE APPLICANT; DEFINITIONS.] 
368.33  (a) Before the commissioner issues a license, the commissioner 
368.34  shall conduct a study of the individuals specified in paragraph 
368.35  (c) (d), clauses (1) to (5), according to rules of the 
368.36  commissioner. 
369.1      Beginning January 1, 1997, the commissioner shall also 
369.2   conduct a study of employees providing direct contact services 
369.3   for nonlicensed personal care provider organizations described 
369.4   in paragraph (c) (d), clause (5). 
369.5      The commissioner shall recover the cost of these background 
369.6   studies through a fee of no more than $12 per study charged to 
369.7   the personal care provider organization.  The fees collected 
369.8   under this paragraph are appropriated to the commissioner for 
369.9   the purpose of conducting background studies. 
369.10     Beginning August 1, 1997, the commissioner shall conduct 
369.11  all background studies required under this chapter for adult 
369.12  foster care providers who are licensed by the commissioner of 
369.13  human services and registered under chapter 144D.  The 
369.14  commissioner shall conduct these background studies in 
369.15  accordance with this chapter.  The commissioner shall initiate a 
369.16  pilot project to conduct up to 5,000 background studies under 
369.17  this chapter in programs with joint licensure as home and 
369.18  community-based services and adult foster care for people with 
369.19  developmental disabilities when the license holder does not 
369.20  reside in the foster care residence. 
369.21     (b) Beginning July 1, 1998, the commissioner shall conduct 
369.22  a background study on individuals specified in 
369.23  paragraph (c) (d), clauses (1) to (5), who perform direct 
369.24  contact services in a nursing home or a home care agency 
369.25  licensed under chapter 144A or a boarding care home licensed 
369.26  under sections 144.50 to 144.58, when the subject of the study 
369.27  resides outside Minnesota; the study must be at least as 
369.28  comprehensive as that of a Minnesota resident and include a 
369.29  search of information from the criminal justice data 
369.30  communications network in the state where the subject of the 
369.31  study resides. 
369.32     (c) Beginning August 1, 2001, the commissioner shall 
369.33  conduct all background studies required under this chapter and 
369.34  initiated by supplemental nursing services agencies registered 
369.35  under chapter 144A.  Studies for the agencies must be initiated 
369.36  annually by each agency.  The commissioner shall conduct the 
370.1   background studies according to this chapter.  The commissioner 
370.2   shall recover the cost of the background studies through a fee 
370.3   of no more than $8 per study, charged to the supplemental 
370.4   nursing services agency.  The fees collected under this 
370.5   paragraph are appropriated to the commissioner for the purpose 
370.6   of conducting background studies. 
370.7      (d) The applicant, license holder, the registrant, bureau 
370.8   of criminal apprehension, the commissioner of health, and county 
370.9   agencies, after written notice to the individual who is the 
370.10  subject of the study, shall help with the study by giving the 
370.11  commissioner criminal conviction data and reports about the 
370.12  maltreatment of adults substantiated under section 626.557 and 
370.13  the maltreatment of minors in licensed programs substantiated 
370.14  under section 626.556.  The individuals to be studied shall 
370.15  include: 
370.16     (1) the applicant; 
370.17     (2) persons over the age of 13 living in the household 
370.18  where the licensed program will be provided; 
370.19     (3) current employees or contractors of the applicant who 
370.20  will have direct contact with persons served by the facility, 
370.21  agency, or program; 
370.22     (4) volunteers or student volunteers who have direct 
370.23  contact with persons served by the program to provide program 
370.24  services, if the contact is not directly supervised by the 
370.25  individuals listed in clause (1) or (3); and 
370.26     (5) any person who, as an individual or as a member of an 
370.27  organization, exclusively offers, provides, or arranges for 
370.28  personal care assistant services under the medical assistance 
370.29  program as authorized under sections 256B.04, subdivision 16, 
370.30  and 256B.0625, subdivision 19a. 
370.31     The juvenile courts shall also help with the study by 
370.32  giving the commissioner existing juvenile court records on 
370.33  individuals described in clause (2) relating to delinquency 
370.34  proceedings held within either the five years immediately 
370.35  preceding the application or the five years immediately 
370.36  preceding the individual's 18th birthday, whichever time period 
371.1   is longer.  The commissioner shall destroy juvenile records 
371.2   obtained pursuant to this subdivision when the subject of the 
371.3   records reaches age 23.  
371.4      For purposes of this section and Minnesota Rules, part 
371.5   9543.3070, a finding that a delinquency petition is proven in 
371.6   juvenile court shall be considered a conviction in state 
371.7   district court. 
371.8      For purposes of this subdivision, "direct contact" means 
371.9   providing face-to-face care, training, supervision, counseling, 
371.10  consultation, or medication assistance to persons served by a 
371.11  program.  For purposes of this subdivision, "directly supervised"
371.12  means an individual listed in clause (1), (3), or (5) is within 
371.13  sight or hearing of a volunteer to the extent that the 
371.14  individual listed in clause (1), (3), or (5) is capable at all 
371.15  times of intervening to protect the health and safety of the 
371.16  persons served by the program who have direct contact with the 
371.17  volunteer. 
371.18     A study of an individual in clauses (1) to (5) shall be 
371.19  conducted at least upon application for initial license or 
371.20  registration and reapplication for a license or registration.  
371.21  The commissioner is not required to conduct a study of an 
371.22  individual at the time of reapplication for a license or if the 
371.23  individual has been continuously affiliated with a foster care 
371.24  provider licensed by the commissioner of human services and 
371.25  registered under chapter 144D, other than a family day care or 
371.26  foster care license, if:  (i) a study of the individual was 
371.27  conducted either at the time of initial licensure or when the 
371.28  individual became affiliated with the license holder; (ii) the 
371.29  individual has been continuously affiliated with the license 
371.30  holder since the last study was conducted; and (iii) the 
371.31  procedure described in paragraph (d) (e) has been implemented 
371.32  and was in effect continuously since the last study was 
371.33  conducted.  For the purposes of this section, a physician 
371.34  licensed under chapter 147 is considered to be continuously 
371.35  affiliated upon the license holder's receipt from the 
371.36  commissioner of health or human services of the physician's 
372.1   background study results.  For individuals who are required to 
372.2   have background studies under clauses (1) to (5) and who have 
372.3   been continuously affiliated with a foster care provider that is 
372.4   licensed in more than one county, criminal conviction data may 
372.5   be shared among those counties in which the foster care programs 
372.6   are licensed.  A county agency's receipt of criminal conviction 
372.7   data from another county agency shall meet the criminal data 
372.8   background study requirements of this section. 
372.9      The commissioner may also conduct studies on individuals 
372.10  specified in clauses (3) and (4) when the studies are initiated 
372.11  by: 
372.12     (i) personnel pool agencies; 
372.13     (ii) temporary personnel agencies; 
372.14     (iii) educational programs that train persons by providing 
372.15  direct contact services in licensed programs; and 
372.16     (iv) professional services agencies that are not licensed 
372.17  and which contract with licensed programs to provide direct 
372.18  contact services or individuals who provide direct contact 
372.19  services. 
372.20     Studies on individuals in items (i) to (iv) must be 
372.21  initiated annually by these agencies, programs, and 
372.22  individuals.  Except for personal care provider 
372.23  organizations and supplemental nursing services agencies, no 
372.24  applicant, license holder, or individual who is the subject of 
372.25  the study shall pay any fees required to conduct the study. 
372.26     (1) At the option of the licensed facility, rather than 
372.27  initiating another background study on an individual required to 
372.28  be studied who has indicated to the licensed facility that a 
372.29  background study by the commissioner was previously completed, 
372.30  the facility may make a request to the commissioner for 
372.31  documentation of the individual's background study status, 
372.32  provided that: 
372.33     (i) the facility makes this request using a form provided 
372.34  by the commissioner; 
372.35     (ii) in making the request the facility informs the 
372.36  commissioner that either: 
373.1      (A) the individual has been continuously affiliated with a 
373.2   licensed facility since the individual's previous background 
373.3   study was completed, or since October 1, 1995, whichever is 
373.4   shorter; or 
373.5      (B) the individual is affiliated only with a personnel pool 
373.6   agency, a temporary personnel agency, an educational program 
373.7   that trains persons by providing direct contact services in 
373.8   licensed programs, or a professional services agency that is not 
373.9   licensed and which contracts with licensed programs to provide 
373.10  direct contact services or individuals who provide direct 
373.11  contact services; and 
373.12     (iii) the facility provides notices to the individual as 
373.13  required in paragraphs (a) to (d) (e), and that the facility is 
373.14  requesting written notification of the individual's background 
373.15  study status from the commissioner.  
373.16     (2) The commissioner shall respond to each request under 
373.17  paragraph (1) with a written or electronic notice to the 
373.18  facility and the study subject.  If the commissioner determines 
373.19  that a background study is necessary, the study shall be 
373.20  completed without further request from a licensed agency or 
373.21  notifications to the study subject.  
373.22     (3) When a background study is being initiated by a 
373.23  licensed facility or a foster care provider that is also 
373.24  registered under chapter 144D, a study subject affiliated with 
373.25  multiple licensed facilities may attach to the background study 
373.26  form a cover letter indicating the additional facilities' names, 
373.27  addresses, and background study identification numbers.  When 
373.28  the commissioner receives such notices, each facility identified 
373.29  by the background study subject shall be notified of the study 
373.30  results.  The background study notice sent to the subsequent 
373.31  agencies shall satisfy those facilities' responsibilities for 
373.32  initiating a background study on that individual. 
373.33     (d) (e) If an individual who is affiliated with a program 
373.34  or facility regulated by the department of human services or 
373.35  department of health or who is affiliated with a nonlicensed 
373.36  personal care provider organization, is convicted of a crime 
374.1   constituting a disqualification under subdivision 3d, the 
374.2   probation officer or corrections agent shall notify the 
374.3   commissioner of the conviction.  The commissioner, in 
374.4   consultation with the commissioner of corrections, shall develop 
374.5   forms and information necessary to implement this paragraph and 
374.6   shall provide the forms and information to the commissioner of 
374.7   corrections for distribution to local probation officers and 
374.8   corrections agents.  The commissioner shall inform individuals 
374.9   subject to a background study that criminal convictions for 
374.10  disqualifying crimes will be reported to the commissioner by the 
374.11  corrections system.  A probation officer, corrections agent, or 
374.12  corrections agency is not civilly or criminally liable for 
374.13  disclosing or failing to disclose the information required by 
374.14  this paragraph.  Upon receipt of disqualifying information, the 
374.15  commissioner shall provide the notifications required in 
374.16  subdivision 3a, as appropriate to agencies on record as having 
374.17  initiated a background study or making a request for 
374.18  documentation of the background study status of the individual.  
374.19  This paragraph does not apply to family day care and child 
374.20  foster care programs. 
374.21     (e) (f) The individual who is the subject of the study must 
374.22  provide the applicant or license holder with sufficient 
374.23  information to ensure an accurate study including the 
374.24  individual's first, middle, and last name; home address, city, 
374.25  county, and state of residence for the past five years; zip 
374.26  code; sex; date of birth; and driver's license number.  The 
374.27  applicant or license holder shall provide this information about 
374.28  an individual in paragraph (c) (d), clauses (1) to (5), on forms 
374.29  prescribed by the commissioner.  By January 1, 2000, for 
374.30  background studies conducted by the department of human 
374.31  services, the commissioner shall implement a system for the 
374.32  electronic transmission of:  (1) background study information to 
374.33  the commissioner; and (2) background study results to the 
374.34  license holder.  The commissioner may request additional 
374.35  information of the individual, which shall be optional for the 
374.36  individual to provide, such as the individual's social security 
375.1   number or race. 
375.2      (f) (g) Except for child foster care, adult foster care, 
375.3   and family day care homes, a study must include information 
375.4   related to names of substantiated perpetrators of maltreatment 
375.5   of vulnerable adults that has been received by the commissioner 
375.6   as required under section 626.557, subdivision 9c, paragraph 
375.7   (i), and the commissioner's records relating to the maltreatment 
375.8   of minors in licensed programs, information from juvenile courts 
375.9   as required in paragraph (c) (d) for persons listed in paragraph 
375.10  (c) (d), clause (2), and information from the bureau of criminal 
375.11  apprehension.  For child foster care, adult foster care, and 
375.12  family day care homes, the study must include information from 
375.13  the county agency's record of substantiated maltreatment of 
375.14  adults, and the maltreatment of minors, information from 
375.15  juvenile courts as required in paragraph (c) (d) for persons 
375.16  listed in paragraph (c) (d), clause (2), and information from 
375.17  the bureau of criminal apprehension.  The commissioner may also 
375.18  review arrest and investigative information from the bureau of 
375.19  criminal apprehension, the commissioner of health, a county 
375.20  attorney, county sheriff, county agency, local chief of police, 
375.21  other states, the courts, or the Federal Bureau of Investigation 
375.22  if the commissioner has reasonable cause to believe the 
375.23  information is pertinent to the disqualification of an 
375.24  individual listed in paragraph (c) (d), clauses (1) to (5).  The 
375.25  commissioner is not required to conduct more than one review of 
375.26  a subject's records from the Federal Bureau of Investigation if 
375.27  a review of the subject's criminal history with the Federal 
375.28  Bureau of Investigation has already been completed by the 
375.29  commissioner and there has been no break in the subject's 
375.30  affiliation with the license holder who initiated the background 
375.31  studies. 
375.32     When the commissioner has reasonable cause to believe that 
375.33  further pertinent information may exist on the subject, the 
375.34  subject shall provide a set of classifiable fingerprints 
375.35  obtained from an authorized law enforcement agency.  For 
375.36  purposes of requiring fingerprints, the commissioner shall be 
376.1   considered to have reasonable cause under, but not limited to, 
376.2   the following circumstances: 
376.3      (1) information from the bureau of criminal apprehension 
376.4   indicates that the subject is a multistate offender; 
376.5      (2) information from the bureau of criminal apprehension 
376.6   indicates that multistate offender status is undetermined; or 
376.7      (3) the commissioner has received a report from the subject 
376.8   or a third party indicating that the subject has a criminal 
376.9   history in a jurisdiction other than Minnesota. 
376.10     (g) (h) An applicant's or, license holder's, or 
376.11  registrant's failure or refusal to cooperate with the 
376.12  commissioner is reasonable cause to disqualify a subject, deny a 
376.13  license application or immediately suspend, suspend, or revoke a 
376.14  license or registration.  Failure or refusal of an individual to 
376.15  cooperate with the study is just cause for denying or 
376.16  terminating employment of the individual if the individual's 
376.17  failure or refusal to cooperate could cause the applicant's 
376.18  application to be denied or the license holder's license to be 
376.19  immediately suspended, suspended, or revoked. 
376.20     (h) (i) The commissioner shall not consider an application 
376.21  to be complete until all of the information required to be 
376.22  provided under this subdivision has been received.  
376.23     (i) (j) No person in paragraph (c) (d), clause (1), (2), 
376.24  (3), (4), or (5), who is disqualified as a result of this 
376.25  section may be retained by the agency in a position involving 
376.26  direct contact with persons served by the program. 
376.27     (j) (k) Termination of persons in paragraph (c) (d), clause 
376.28  (1), (2), (3), (4), or (5), made in good faith reliance on a 
376.29  notice of disqualification provided by the commissioner shall 
376.30  not subject the applicant or license holder to civil liability. 
376.31     (k) (l) The commissioner may establish records to fulfill 
376.32  the requirements of this section. 
376.33     (l) (m) The commissioner may not disqualify an individual 
376.34  subject to a study under this section because that person has, 
376.35  or has had, a mental illness as defined in section 245.462, 
376.36  subdivision 20. 
377.1      (m) (n) An individual subject to disqualification under 
377.2   this subdivision has the applicable rights in subdivision 3a, 
377.3   3b, or 3c. 
377.4      (n) (o) For the purposes of background studies completed by 
377.5   tribal organizations performing licensing activities otherwise 
377.6   required of the commissioner under this chapter, after obtaining 
377.7   consent from the background study subject, tribal licensing 
377.8   agencies shall have access to criminal history data in the same 
377.9   manner as county licensing agencies and private licensing 
377.10  agencies under this chapter. 
377.11     Sec. 7.  [REPORT ON SUPPLEMENTAL NURSING SERVICES AGENCY 
377.12  USE.] 
377.13     Beginning July 1, 2001, through June 30, 2003, the 
377.14  commissioner of human services shall require nursing facilities 
377.15  and other providers of long-term care services to report 
377.16  semiannually on the use of supplemental nursing services, in the 
377.17  form and manner specified by the commissioner.  The information 
377.18  reported must include, but is not limited to: 
377.19     (1) number of hours worked by supplemental nursing services 
377.20  personnel, by job classification, for each month; 
377.21     (2) payments to supplemental nursing services agencies, on 
377.22  a per hour worked basis, by job classification, for each month; 
377.23  and 
377.24     (3) percentage of total monthly work hours provided by 
377.25  supplemental nursing services agency personnel, by job 
377.26  classification, for each shift and for weekdays and weekends. 
377.27                             ARTICLE 8 
377.28                      LONG-TERM CARE INSURANCE 
377.29     Section 1.  Minnesota Statutes 2000, section 62A.48, 
377.30  subdivision 4, is amended to read: 
377.31     Subd. 4.  [LOSS RATIO.] The anticipated loss ratio for 
377.32  long-term care policies must not be less than 65 percent for 
377.33  policies issued on a group basis or 60 percent for policies 
377.34  issued on an individual or mass-market basis.  This subdivision 
377.35  does not apply to policies issued on or after January 1, 2002, 
377.36  that comply with sections 62S.021 and 62S.081. 
378.1      [EFFECTIVE DATE.] This section is effective the day 
378.2   following final enactment. 
378.3      Sec. 2.  Minnesota Statutes 2000, section 62A.48, is 
378.4   amended by adding a subdivision to read: 
378.5      Subd. 10.  [REGULATION OF PREMIUMS AND PREMIUM 
378.6   INCREASES.] Policies issued under sections 62A.46 to 62A.56 on 
378.7   or after January 1, 2002, must comply with sections 62S.021, 
378.8   62S.081, 62S.265, and 62S.266 to the same extent as policies 
378.9   issued under chapter 62S. 
378.10     [EFFECTIVE DATE.] This section is effective the day 
378.11  following final enactment. 
378.12     Sec. 3.  Minnesota Statutes 2000, section 62A.48, is 
378.13  amended by adding a subdivision to read: 
378.14     Subd. 11.  [NONFORFEITURE BENEFITS.] Policies issued under 
378.15  sections 62A.46 to 62A.56 on or after January 1, 2002, must 
378.16  comply with section 62S.02, subdivision 2, to the same extent as 
378.17  policies issued under chapter 62S. 
378.18     [EFFECTIVE DATE.] This section is effective the day 
378.19  following final enactment. 
378.20     Sec. 4.  Minnesota Statutes 2000, section 62S.01, is 
378.21  amended by adding a subdivision to read: 
378.22     Subd. 13a.  [EXCEPTIONAL INCREASE.] (a) "Exceptional 
378.23  increase" means only those premium rate increases filed by an 
378.24  insurer as exceptional for which the commissioner determines 
378.25  that the need for the premium rate increase is justified due to 
378.26  changes in laws or rules applicable to long-term care coverage 
378.27  in this state, or due to increased and unexpected utilization 
378.28  that affects the majority of insurers of similar products. 
378.29     (b) Except as provided in section 62S.265, exceptional 
378.30  increases are subject to the same requirements as other premium 
378.31  rate schedule increases.  The commissioner may request a review 
378.32  by an independent actuary or a professional actuarial body of 
378.33  the basis for a request that an increase be considered an 
378.34  exceptional increase.  The commissioner, in determining that the 
378.35  necessary basis for an exceptional increase exists, shall also 
378.36  determine any potential offsets to higher claims costs. 
379.1      [EFFECTIVE DATE.] This section is effective the day 
379.2   following final enactment. 
379.3      Sec. 5.  Minnesota Statutes 2000, section 62S.01, is 
379.4   amended by adding a subdivision to read: 
379.5      Subd. 17a.  [INCIDENTAL.] "Incidental," as used in section 
379.6   62S.265, subdivision 10, means that the value of the long-term 
379.7   care benefits provided is less than ten percent of the total 
379.8   value of the benefits provided over the life of the policy.  
379.9   These values must be measured as of the date of issue. 
379.10     [EFFECTIVE DATE.] This section is effective the day 
379.11  following final enactment. 
379.12     Sec. 6.  Minnesota Statutes 2000, section 62S.01, is 
379.13  amended by adding a subdivision to read: 
379.14     Subd. 23a.  [QUALIFIED ACTUARY.] "Qualified actuary" means 
379.15  a member in good standing of the American Academy of Actuaries. 
379.16     [EFFECTIVE DATE.] This section is effective the day 
379.17  following final enactment. 
379.18     Sec. 7.  Minnesota Statutes 2000, section 62S.01, is 
379.19  amended by adding a subdivision to read: 
379.20     Subd. 25a.  [SIMILAR POLICY FORMS.] "Similar policy forms" 
379.21  means all of the long-term care insurance policies and 
379.22  certificates issued by an insurer in the same long-term care 
379.23  benefit classification as the policy form being considered.  
379.24  Certificates of groups that meet the definition in section 
379.25  62S.01, subdivision 15, clause (1), are not considered similar 
379.26  to certificates or policies otherwise issued as long-term care 
379.27  insurance, but are similar to other comparable certificates with 
379.28  the same long-term care benefit classifications.  For purposes 
379.29  of determining similar policy forms, long-term care benefit 
379.30  classifications are defined as follows:  institutional long-term 
379.31  care benefits only, noninstitutional long-term care benefits 
379.32  only, or comprehensive long-term care benefits. 
379.33     [EFFECTIVE DATE.] This section is effective the day 
379.34  following final enactment. 
379.35     Sec. 8.  [62S.021] [LONG-TERM CARE INSURANCE; INITIAL 
379.36  FILING.] 
380.1      Subdivision 1.  [APPLICABILITY.] This section applies to 
380.2   any long-term care policy issued in this state on or after 
380.3   January 1, 2002, under this chapter or sections 62A.46 to 62A.56.
380.4      Subd. 2.  [REQUIRED SUBMISSION TO COMMISSIONER.] An insurer 
380.5   shall provide the following information to the commissioner 30 
380.6   days prior to making a long-term care insurance form available 
380.7   for sale: 
380.8      (1) a copy of the disclosure documents required in section 
380.9   62S.081; and 
380.10     (2) an actuarial certification consisting of at least the 
380.11  following: 
380.12     (i) a statement that the initial premium rate schedule is 
380.13  sufficient to cover anticipated costs under moderately adverse 
380.14  experience and that the premium rate schedule is reasonably 
380.15  expected to be sustainable over the life of the form with no 
380.16  future premium increases anticipated; 
380.17     (ii) a statement that the policy design and coverage 
380.18  provided have been reviewed and taken into consideration; 
380.19     (iii) a statement that the underwriting and claims 
380.20  adjudication processes have been reviewed and taken into 
380.21  consideration; and 
380.22     (iv) a complete description of the basis for contract 
380.23  reserves that are anticipated to be held under the form, to 
380.24  include: 
380.25     (A) sufficient detail or sample calculations provided so as 
380.26  to have a complete depiction of the reserve amounts to be held; 
380.27     (B) a statement that the assumptions used for reserves 
380.28  contain reasonable margins for adverse experience; 
380.29     (C) a statement that the net valuation premium for renewal 
380.30  years does not increase, except for attained-age rating where 
380.31  permitted; 
380.32     (D) a statement that the difference between the gross 
380.33  premium and the net valuation premium for renewal years is 
380.34  sufficient to cover expected renewal expenses, or if such a 
380.35  statement cannot be made, a complete description of the 
380.36  situations in which this does not occur.  An aggregate 
381.1   distribution of anticipated issues may be used as long as the 
381.2   underlying gross premiums maintain a reasonably consistent 
381.3   relationship.  If the gross premiums for certain age groups 
381.4   appear to be inconsistent with this requirement, the 
381.5   commissioner may request a demonstration under item (i) based on 
381.6   a standard age distribution; and 
381.7      (E) either a statement that the premium rate schedule is 
381.8   not less than the premium rate schedule for existing similar 
381.9   policy forms also available from the insurer except for 
381.10  reasonable differences attributable to benefits, or a comparison 
381.11  of the premium schedules for similar policy forms that are 
381.12  currently available from the insurer with an explanation of the 
381.13  differences. 
381.14     Subd. 3.  [ACTUARIAL DEMONSTRATION.] The commissioner may 
381.15  request an actuarial demonstration that benefits are reasonable 
381.16  in relation to premiums.  The actuarial demonstration must 
381.17  include either premium and claim experience on similar policy 
381.18  forms, adjusted for any premium or benefit differences, relevant 
381.19  and credible data from other studies, or both.  If the 
381.20  commissioner asks for additional information under this 
381.21  subdivision, the 30-day time limit in subdivision 2 does not 
381.22  include the time during which the insurer is preparing the 
381.23  requested information. 
381.24     [EFFECTIVE DATE.] This section is effective the day 
381.25  following final enactment. 
381.26     Sec. 9.  [62S.081] [REQUIRED DISCLOSURE OF RATING PRACTICES 
381.27  TO CONSUMERS.] 
381.28     Subdivision 1.  [APPLICATION.] This section applies as 
381.29  follows: 
381.30     (a) Except as provided in paragraph (b), this section 
381.31  applies to any long-term care policy or certificate issued in 
381.32  this state on or after January 1, 2002. 
381.33     (b) For certificates issued on or after the effective date 
381.34  of this section under a policy of group long-term care insurance 
381.35  as defined in section 62S.01, subdivision 15, that was in force 
381.36  on the effective date of this section, this section applies on 
382.1   the policy anniversary following June 30, 2002. 
382.2      Subd. 2.  [REQUIRED DISCLOSURES.] Other than policies for 
382.3   which no applicable premium rate or rate schedule increases can 
382.4   be made, insurers shall provide all of the information listed in 
382.5   this subdivision to the applicant at the time of application or 
382.6   enrollment, unless the method of application does not allow for 
382.7   delivery at that time; in this case, an insurer shall provide 
382.8   all of the information listed in this subdivision to the 
382.9   applicant no later than at the time of delivery of the policy or 
382.10  certificate: 
382.11     (1) a statement that the policy may be subject to rate 
382.12  increases in the future; 
382.13     (2) an explanation of potential future premium rate 
382.14  revisions and the policyholder's or certificate holder's option 
382.15  in the event of a premium rate revision; 
382.16     (3) the premium rate or rate schedules applicable to the 
382.17  applicant that will be in effect until a request is made for an 
382.18  increase; 
382.19     (4) a general explanation of applying premium rate or rate 
382.20  schedule adjustments that must include: 
382.21     (i) a description of when premium rate or rate schedule 
382.22  adjustments will be effective, for example the next anniversary 
382.23  date or the next billing date; and 
382.24     (ii) the right to a revised premium rate or rate schedule 
382.25  as provided in clause (3) if the premium rate or rate schedule 
382.26  is changed; and 
382.27     (5)(i) information regarding each premium rate increase on 
382.28  this policy form or similar policy forms over the past ten years 
382.29  for this state or any other state that, at a minimum, identifies:
382.30     (A) the policy forms for which premium rates have been 
382.31  increased; 
382.32     (B) the calendar years when the form was available for 
382.33  purchase; and 
382.34     (C) the amount or percent of each increase.  The percentage 
382.35  may be expressed as a percentage of the premium rate prior to 
382.36  the increase and may also be expressed as minimum and maximum 
383.1   percentages if the rate increase is variable by rating 
383.2   characteristics; 
383.3      (ii) the insurer may, in a fair manner, provide additional 
383.4   explanatory information related to the rate increases; 
383.5      (iii) an insurer has the right to exclude from the 
383.6   disclosure premium rate increases that apply only to blocks of 
383.7   business acquired from other nonaffiliated insurers or the 
383.8   long-term care policies acquired from other nonaffiliated 
383.9   insurers when those increases occurred prior to the acquisition; 
383.10     (iv) if an acquiring insurer files for a rate increase on a 
383.11  long-term care policy form acquired from nonaffiliated insurers 
383.12  or a block of policy forms acquired from nonaffiliated insurers 
383.13  on or before the later of the effective date of this section, or 
383.14  the end of a 24-month period following the acquisition of the 
383.15  block of policies, the acquiring insurer may exclude that rate 
383.16  increase from the disclosure.  However, the nonaffiliated 
383.17  selling company must include the disclosure of that rate 
383.18  increase according to item (i); and 
383.19     (v) if the acquiring insurer in item (iv) files for a 
383.20  subsequent rate increase, even within the 24-month period, on 
383.21  the same policy form acquired from nonaffiliated insurers or 
383.22  block of policy forms acquired from nonaffiliated insurers 
383.23  referenced in item (iv), the acquiring insurer shall make all 
383.24  disclosures required by this subdivision, including disclosure 
383.25  of the earlier rate increase referenced in item (iv). 
383.26     Subd. 3.  [ACKNOWLEDGMENT.] An applicant shall sign an 
383.27  acknowledgment at the time of application, unless the method of 
383.28  application does not allow for signature at that time, that the 
383.29  insurer made the disclosure required under subdivision 2.  If, 
383.30  due to the method of application, the applicant cannot sign an 
383.31  acknowledgment at the time of application, the applicant shall 
383.32  sign no later than at the time of delivery of the policy or 
383.33  certificate. 
383.34     Subd. 4.  [FORMS.] An insurer shall use the forms in 
383.35  Appendices B and F of the Long-term Care Insurance Model 
383.36  Regulation adopted by the National Association of Insurance 
384.1   Commissioners to comply with the requirements of subdivisions 1 
384.2   and 2. 
384.3      Subd. 5.  [NOTICE OF INCREASE.] An insurer shall provide 
384.4   notice of an upcoming premium rate schedule increase, after the 
384.5   increase has been approved by the commissioner, to all 
384.6   policyholders or certificate holders, if applicable, at least 45 
384.7   days prior to the implementation of the premium rate schedule 
384.8   increase by the insurer.  The notice must include the 
384.9   information required by subdivision 2 when the rate increase is 
384.10  implemented. 
384.11     [EFFECTIVE DATE.] This section is effective the day 
384.12  following final enactment. 
384.13     Sec. 10.  Minnesota Statutes 2000, section 62S.26, is 
384.14  amended to read: 
384.15     62S.26 [LOSS RATIO.] 
384.16     (a) The minimum loss ratio must be at least 60 percent, 
384.17  calculated in a manner which provides for adequate reserving of 
384.18  the long-term care insurance risk.  In evaluating the expected 
384.19  loss ratio, the commissioner shall give consideration to all 
384.20  relevant factors, including: 
384.21     (1) statistical credibility of incurred claims experience 
384.22  and earned premiums; 
384.23     (2) the period for which rates are computed to provide 
384.24  coverage; 
384.25     (3) experienced and projected trends; 
384.26     (4) concentration of experience within early policy 
384.27  duration; 
384.28     (5) expected claim fluctuation; 
384.29     (6) experience refunds, adjustments, or dividends; 
384.30     (7) renewability features; 
384.31     (8) all appropriate expense factors; 
384.32     (9) interest; 
384.33     (10) experimental nature of the coverage; 
384.34     (11) policy reserves; 
384.35     (12) mix of business by risk classification; and 
384.36     (13) product features such as long elimination periods, 
385.1   high deductibles, and high maximum limits. 
385.2      (b) This section does not apply to policies or certificates 
385.3   that are subject to sections 62S.021, 62S.081, and 62S.265, and 
385.4   that comply with those sections. 
385.5      [EFFECTIVE DATE.] This section is effective the day 
385.6   following final enactment. 
385.7      Sec. 11.  [62S.265] [PREMIUM RATE SCHEDULE INCREASES.] 
385.8      Subdivision 1.  [APPLICABILITY.] (a) Except as provided in 
385.9   paragraph (b), this section applies to any long-term care policy 
385.10  or certificate issued in this state on or after January 1, 2002, 
385.11  under this chapter or sections 62A.46 to 62A.56. 
385.12     (b) For certificates issued on or after the effective date 
385.13  of this section under a group long-term care insurance policy as 
385.14  defined in section 62S.01, subdivision 15, issued under this 
385.15  chapter, that was in force on the effective date of this 
385.16  section, this section applies on the policy anniversary 
385.17  following June 30, 2002. 
385.18     Subd. 2.  [NOTICE.] An insurer shall file a requested 
385.19  premium rate schedule increase, including an exceptional 
385.20  increase, to the commissioner for prior approval at least 60 
385.21  days prior to the notice to the policyholders and shall include: 
385.22     (1) all information required by section 62S.081; 
385.23     (2) certification by a qualified actuary that: 
385.24     (i) if the requested premium rate schedule increase is 
385.25  implemented and the underlying assumptions, which reflect 
385.26  moderately adverse conditions, are realized, no further premium 
385.27  rate schedule increases are anticipated; and 
385.28     (ii) the premium rate filing complies with this section; 
385.29     (3) an actuarial memorandum justifying the rate schedule 
385.30  change request that includes: 
385.31     (i) lifetime projections of earned premiums and incurred 
385.32  claims based on the filed premium rate schedule increase and the 
385.33  method and assumptions used in determining the projected values, 
385.34  including reflection of any assumptions that deviate from those 
385.35  used for pricing other forms currently available for sale; 
385.36     (A) annual values for the five years preceding and the 
386.1   three years following the valuation date must be provided 
386.2   separately; 
386.3      (B) the projections must include the development of the 
386.4   lifetime loss ratio, unless the rate increase is an exceptional 
386.5   increase; 
386.6      (C) the projections must demonstrate compliance with 
386.7   subdivision 3; and 
386.8      (D) for exceptional increases, the projected experience 
386.9   must be limited to the increases in claims expenses attributable 
386.10  to the approved reasons for the exceptional increase and, if the 
386.11  commissioner determines that offsets to higher claim costs may 
386.12  exist, the insurer shall use appropriate net projected 
386.13  experience; 
386.14     (ii) disclosure of how reserves have been incorporated in 
386.15  this rate increase whenever the rate increase will trigger 
386.16  contingent benefit upon lapse; 
386.17     (iii) disclosure of the analysis performed to determine why 
386.18  a rate adjustment is necessary, which pricing assumptions were 
386.19  not realized and why, and what other actions taken by the 
386.20  company have been relied upon by the actuary; 
386.21     (iv) a statement that policy design, underwriting, and 
386.22  claims adjudication practices have been taken into 
386.23  consideration; and 
386.24     (v) if it is necessary to maintain consistent premium rates 
386.25  for new certificates and certificates receiving a rate increase, 
386.26  the insurer shall file composite rates reflecting projections of 
386.27  new certificates; 
386.28     (4) a statement that renewal premium rate schedules are not 
386.29  greater than new business premium rate schedules except for 
386.30  differences attributable to benefits, unless sufficient 
386.31  justification is provided to the commissioner; and 
386.32     (5) sufficient information for review and approval of the 
386.33  premium rate schedule increase by the commissioner. 
386.34     Subd. 3.  [REQUIREMENTS PERTAINING TO RATE INCREASES.] All 
386.35  premium rate schedule increases must be determined according to 
386.36  the following requirements: 
387.1      (1) exceptional increases must provide that 70 percent of 
387.2   the present value of projected additional premiums from the 
387.3   exceptional increase will be returned to policyholders in 
387.4   benefits; 
387.5      (2) premium rate schedule increases must be calculated so 
387.6   that the sum of the accumulated value of incurred claims, 
387.7   without the inclusion of active life reserves, and the present 
387.8   value of future projected incurred claims, without the inclusion 
387.9   of active life reserves, will not be less than the sum of the 
387.10  following: 
387.11     (i) the accumulated value of the initial earned premium 
387.12  times 58 percent; 
387.13     (ii) 85 percent of the accumulated value of prior premium 
387.14  rate schedule increases on an earned basis; 
387.15     (iii) the present value of future projected initial earned 
387.16  premiums times 58 percent; and 
387.17     (iv) 85 percent of the present value of future projected 
387.18  premiums not in item (iii) on an earned basis; 
387.19     (3) if a policy form has both exceptional and other 
387.20  increases, the values in clause (2), items (ii) and (iv), must 
387.21  also include 70 percent for exceptional rate increase amounts; 
387.22  and 
387.23     (4) all present and accumulated values used to determine 
387.24  rate increases must use the maximum valuation interest rate for 
387.25  contract reserves permitted for valuation of whole life 
387.26  insurance policies issued in this state on the same date.  The 
387.27  actuary shall disclose as part of the actuarial memorandum the 
387.28  use of any appropriate averages. 
387.29     Subd. 4.  [PROJECTIONS.] For each rate increase that is 
387.30  implemented, the insurer shall file for approval by the 
387.31  commissioner updated projections, as described in subdivision 2, 
387.32  clause (3), item (i), annually for the next three years and 
387.33  include a comparison of actual results to projected values.  The 
387.34  commissioner may extend the period to greater than three years 
387.35  if actual results are not consistent with projected values from 
387.36  prior projections.  For group insurance policies that meet the 
388.1   conditions in subdivision 11, the projections required by this 
388.2   subdivision must be provided to the policyholder in lieu of 
388.3   filing with the commissioner. 
388.4      Subd. 5.  [LIFETIME PROJECTIONS.] If any premium rate in 
388.5   the revised premium rate schedule is greater than 200 percent of 
388.6   the comparable rate in the initial premium schedule, lifetime 
388.7   projections, as described in subdivision 2, clause (3), item 
388.8   (i), must be filed for approval by the commissioner every five 
388.9   years following the end of the required period in subdivision 
388.10  4.  For group insurance policies that meet the conditions in 
388.11  subdivision 11, the projections required by this subdivision 
388.12  must be provided to the policyholder in lieu of filing with the 
388.13  commissioner. 
388.14     Subd. 6.  [EFFECT OF ACTUAL EXPERIENCE.] (a) If the 
388.15  commissioner has determined that the actual experience following 
388.16  a rate increase does not adequately match the projected 
388.17  experience and that the current projections under moderately 
388.18  adverse conditions demonstrate that incurred claims will not 
388.19  exceed proportions of premiums specified in subdivision 3, the 
388.20  commissioner may require the insurer to implement any of the 
388.21  following: 
388.22     (1) premium rate schedule adjustments; or 
388.23     (2) other measures to reduce the difference between the 
388.24  projected and actual experience. 
388.25     (b) In determining whether the actual experience adequately 
388.26  matches the projected experience, consideration must be given to 
388.27  subdivision 2, clause (3), item (v), if applicable. 
388.28     Subd. 7.  [CONTINGENT BENEFIT UPON LAPSE.] If the majority 
388.29  of the policies or certificates to which the increase is 
388.30  applicable are eligible for the contingent benefit upon lapse, 
388.31  the insurer shall file: 
388.32     (1) a plan, subject to commissioner approval, for improved 
388.33  administration or claims processing designed to eliminate the 
388.34  potential for further deterioration of the policy form requiring 
388.35  further premium rate schedule increases, or both, or a 
388.36  demonstration that appropriate administration and claims 
389.1   processing have been implemented or are in effect; otherwise, 
389.2   the commissioner may impose the condition in subdivision 8, 
389.3   paragraph (b); and 
389.4      (2) the original anticipated lifetime loss ratio, and the 
389.5   premium rate schedule increase that would have been calculated 
389.6   according to subdivision 3 had the greater of the original 
389.7   anticipated lifetime loss ratio or 58 percent been used in the 
389.8   calculations described in subdivision 3, clause (2), items (i) 
389.9   and (iii). 
389.10     Subd. 8.  [PROJECTED LAPSE RATES.] (a) For a rate increase 
389.11  filing that meets the following criteria, the commissioner shall 
389.12  review, for all policies included in the filing, the projected 
389.13  lapse rates and past lapse rates during the 12 months following 
389.14  each increase to determine if significant adverse lapsation has 
389.15  occurred or is anticipated: 
389.16     (1) the rate increase is not the first rate increase 
389.17  requested for the specific policy form or forms; 
389.18     (2) the rate increase is not an exceptional increase; and 
389.19     (3) the majority of the policies or certificates to which 
389.20  the increase is applicable are eligible for the contingent 
389.21  benefit upon lapse. 
389.22     (b) If significant adverse lapsation has occurred, is 
389.23  anticipated in the filing, or is evidenced in the actual results 
389.24  as presented in the updated projections provided by the insurer 
389.25  following the requested rate increase, the commissioner may 
389.26  determine that a rate spiral exists.  Following the 
389.27  determination that a rate spiral exists, the commissioner may 
389.28  require the insurer to offer, without underwriting, to all 
389.29  in-force insureds subject to the rate increase, the option to 
389.30  replace existing coverage with one or more reasonably comparable 
389.31  products being offered by the insurer or its affiliates.  The 
389.32  offer must: 
389.33     (1) be subject to the approval of the commissioner; 
389.34     (2) be based upon actuarially sound principles, but not be 
389.35  based upon attained age; and 
389.36     (3) provide that maximum benefits under any new policy 
390.1   accepted by an insured will be reduced by comparable benefits 
390.2   already paid under the existing policy. 
390.3      (c) The insurer shall maintain the experience of all the 
390.4   replacement insureds separate from the experience of insureds 
390.5   originally issued the policy forms.  In the event of a request 
390.6   for a rate increase on the policy form, the rate increase must 
390.7   be limited to the lesser of the maximum rate increase determined 
390.8   based on the combined experience and the maximum rate increase 
390.9   determined based only upon the experience of the insureds 
390.10  originally issued the form plus ten percent. 
390.11     Subd. 9.  [PERSISTENT PRACTICE OF INADEQUATE INITIAL 
390.12  RATES.] If the commissioner determines that the insurer has 
390.13  exhibited a persistent practice of filing inadequate initial 
390.14  premium rates for long-term care insurance, the commissioner 
390.15  may, in addition to the provisions of subdivision 8, take either 
390.16  of the following actions: 
390.17     (1) prohibit the insurer from filing and marketing 
390.18  comparable coverage for a period of up to five years; or 
390.19     (2) prohibit the insurer from offering all other similar 
390.20  coverages and limit the insurer's marketing of new applications 
390.21  for the products that are subject to recent premium rate 
390.22  schedule increases. 
390.23     Subd. 10.  [INCIDENTAL LONG-TERM CARE 
390.24  BENEFITS.] Subdivisions 1 to 9 do not apply to policies for 
390.25  which the long-term care benefits provided by the policy are 
390.26  incidental, as defined in section 62S.01, subdivision 17a, if 
390.27  the policy complies with all of the following provisions: 
390.28     (1) the interest credited internally to determine cash 
390.29  value accumulations, including long-term care, if any, are 
390.30  guaranteed not to be less than the minimum guaranteed interest 
390.31  rate for cash value accumulations without long-term care set 
390.32  forth in the policy; 
390.33     (2) the portion of the policy that provides insurance 
390.34  benefits other than long-term care coverage meets the 
390.35  nonforfeiture requirements as applicable in any of the following:
390.36     (i) for life insurance, section 61A.25; 
391.1      (ii) for individual deferred annuities, section 61A.245; 
391.2   and 
391.3      (iii) for variable annuities, section 61A.21; 
391.4      (3) the policy meets the disclosure requirements of 
391.5   sections 62S.10 and 62S.11 if the policy is governed by chapter 
391.6   62S and of section 62A.50 if the policy is governed by sections 
391.7   62A.46 to 62A.56; 
391.8      (4) the portion of the policy that provides insurance 
391.9   benefits other than long-term care coverage meets the 
391.10  requirements as applicable in the following: 
391.11     (i) policy illustrations to the extent required by state 
391.12  law applicable to life insurance; 
391.13     (ii) disclosure requirements in state law applicable to 
391.14  annuities; and 
391.15     (iii) disclosure requirements applicable to variable 
391.16  annuities; and 
391.17     (5) an actuarial memorandum is filed with the commissioner 
391.18  that includes: 
391.19     (i) a description of the basis on which the long-term care 
391.20  rates were determined; 
391.21     (ii) a description of the basis for the reserves; 
391.22     (iii) a summary of the type of policy, benefits, 
391.23  renewability, general marketing method, and limits on ages of 
391.24  issuance; 
391.25     (iv) a description and a table of each actuarial assumption 
391.26  used.  For expenses, an insurer must include percent of premium 
391.27  dollars per policy and dollars per unit of benefits, if any; 
391.28     (v) a description and a table of the anticipated policy 
391.29  reserves and additional reserves to be held in each future year 
391.30  for active lives; 
391.31     (vi) the estimated average annual premium per policy and 
391.32  the average issue age; 
391.33     (vii) a statement as to whether underwriting is performed 
391.34  at the time of application.  The statement must indicate whether 
391.35  underwriting is used and, if used, the statement must include a 
391.36  description of the type or types of underwriting used, such as 
392.1   medical underwriting or functional assessment underwriting.  
392.2   Concerning a group policy, the statement must indicate whether 
392.3   the enrollee or any dependent will be underwritten and when 
392.4   underwriting occurs; and 
392.5      (viii) a description of the effect of the long-term care 
392.6   policy provision on the required premiums, nonforfeiture values, 
392.7   and reserves on the underlying insurance policy, both for active 
392.8   lives and those in long-term care claim status. 
392.9      Subd. 11.  [LARGE GROUP POLICIES.] Subdivisions 6 and 9 do 
392.10  not apply to group long-term care insurance policies as defined 
392.11  in section 62S.01, subdivision 15, where: 
392.12     (1) the policies insure 250 or more persons, and the 
392.13  policyholder has 5,000 or more eligible employees of a single 
392.14  employer; or 
392.15     (2) the policyholder, and not the certificate holders, pays 
392.16  a material portion of the premium, which is not less than 20 
392.17  percent of the total premium for the group in the calendar year 
392.18  prior to the year in which a rate increase is filed. 
392.19     [EFFECTIVE DATE.] This section is effective the day 
392.20  following final enactment. 
392.21     Sec. 12.  [62S.266] [NONFORFEITURE BENEFIT REQUIREMENT.] 
392.22     Subdivision 1.  [APPLICABILITY.] This section does not 
392.23  apply to life insurance policies or riders containing 
392.24  accelerated long-term care benefits. 
392.25     Subd. 2.  [REQUIREMENT.] An insurer must offer each 
392.26  prospective policyholder a nonforfeiture benefit in compliance 
392.27  with the following requirements: 
392.28     (1) a policy or certificate offered with nonforfeiture 
392.29  benefits must have coverage elements, eligibility, benefit 
392.30  triggers, and benefit length that are the same as coverage to be 
392.31  issued without nonforfeiture benefits.  The nonforfeiture 
392.32  benefit included in the offer must be the benefit described in 
392.33  subdivision 5; and 
392.34     (2) the offer must be in writing if the nonforfeiture 
392.35  benefit is not otherwise described in the outline of coverage or 
392.36  other materials given to the prospective policyholder. 
393.1      Subd. 3.  [EFFECT OF REJECTION OF OFFER.] If the offer 
393.2   required to be made under subdivision 2 is rejected, the insurer 
393.3   shall provide the contingent benefit upon lapse described in 
393.4   this section. 
393.5      Subd. 4.  [CONTINGENT BENEFIT UPON LAPSE.] (a) After 
393.6   rejection of the offer required under subdivision 2, for 
393.7   individual and group policies without nonforfeiture benefits 
393.8   issued after the effective date of this section, the insurer 
393.9   shall provide a contingent benefit upon lapse. 
393.10     (b) If a group policyholder elects to make the 
393.11  nonforfeiture benefit an option to the certificate holder, a 
393.12  certificate shall provide either the nonforfeiture benefit or 
393.13  the contingent benefit upon lapse. 
393.14     (c) The contingent benefit on lapse must be triggered every 
393.15  time an insurer increases the premium rates to a level which 
393.16  results in a cumulative increase of the annual premium equal to 
393.17  or exceeding the percentage of the insured's initial annual 
393.18  premium based on the insured's issue age provided in this 
393.19  paragraph, and the policy or certificate lapses within 120 days 
393.20  of the due date of the premium increase.  Unless otherwise 
393.21  required, policyholders shall be notified at least 30 days prior 
393.22  to the due date of the premium reflecting the rate increase. 
393.23           Triggers for a Substantial Premium Increase 
393.24                      Percent Increase
393.25       Issue Age      Over Initial Premium
393.26       29 and Under            200
393.27          30-34                190
393.28          35-39                170
393.29          40-44                150
393.30          45-49                130
393.31          50-54                110
393.32          55-59                 90
393.33             60                 70
393.34             61                 66
393.35             62                 62
393.36             63                 58
394.1              64                 54
394.2              65                 50
394.3              66                 48
394.4              67                 46
394.5              68                 44
394.6              69                 42
394.7              70                 40
394.8              71                 38
394.9              72                 36
394.10             73                 34
394.11             74                 32
394.12             75                 30
394.13             76                 28
394.14             77                 26
394.15             78                 24
394.16             79                 22
394.17             80                 20
394.18             81                 19
394.19             82                 18
394.20             83                 17
394.21             84                 16
394.22             85                 15
394.23             86                 14
394.24             87                 13
394.25             88                 12
394.26             89                 11
394.27         90 and over            10
394.28     (d) On or before the effective date of a substantial 
394.29  premium increase as defined in paragraph (c), the insurer shall: 
394.30     (1) offer to reduce policy benefits provided by the current 
394.31  coverage without the requirement of additional underwriting so 
394.32  that required premium payments are not increased; 
394.33     (2) offer to convert the coverage to a paid-up status with 
394.34  a shortened benefit period according to the terms of subdivision 
394.35  5.  This option may be elected at any time during the 120-day 
394.36  period referenced in paragraph (c); and 
395.1      (3) notify the policyholder or certificate holder that a 
395.2   default or lapse at any time during the 120-day period 
395.3   referenced in paragraph (c) is deemed to be the election of the 
395.4   offer to convert in clause (2). 
395.5      Subd. 5.  [NONFORFEITURE BENEFITS; REQUIREMENTS.] (a) 
395.6   Benefits continued as nonforfeiture benefits, including 
395.7   contingent benefits upon lapse, must be as described in this 
395.8   subdivision. 
395.9      (b) For purposes of this subdivision, "attained age rating" 
395.10  is defined as a schedule of premiums starting from the issue 
395.11  date which increases with age at least one percent per year 
395.12  prior to age 50, and at least three percent per year beyond age 
395.13  50. 
395.14     (c) For purposes of this subdivision, the nonforfeiture 
395.15  benefit must be of a shortened benefit period providing paid-up, 
395.16  long-term care insurance coverage after lapse.  The same 
395.17  benefits, amounts, and frequency in effect at the time of lapse, 
395.18  but not increased thereafter, will be payable for a qualifying 
395.19  claim, but the lifetime maximum dollars or days of benefits must 
395.20  be determined as specified in paragraph (d). 
395.21     (d) The standard nonforfeiture credit is equal to 100 
395.22  percent of the sum of all premiums paid, including the premiums 
395.23  paid prior to any changes in benefits.  The insurer may offer 
395.24  additional shortened benefit period options, so long as the 
395.25  benefits for each duration equal or exceed the standard 
395.26  nonforfeiture credit for that duration.  However, the minimum 
395.27  nonforfeiture credit must not be less than 30 times the daily 
395.28  nursing home benefit at the time of lapse.  In either event, the 
395.29  calculation of the nonforfeiture credit is subject to the 
395.30  limitation of this subdivision. 
395.31     (e) The nonforfeiture benefit must begin not later than the 
395.32  end of the third year following the policy or certificate issue 
395.33  date.  The contingent benefit upon lapse must be effective 
395.34  during the first three years as well as thereafter. 
395.35     (f) Notwithstanding paragraph (e), for a policy or 
395.36  certificate with attained age rating, the nonforfeiture benefit 
396.1   must begin on the earlier of: 
396.2      (1) the end of the tenth year following the policy or 
396.3   certificate issue date; or 
396.4      (2) the end of the second year following the date the 
396.5   policy or certificate is no longer subject to attained age 
396.6   rating. 
396.7      (g) Nonforfeiture credits may be used for all care and 
396.8   services qualifying for benefits under the terms of the policy 
396.9   or certificate, up to the limits specified in the policy or 
396.10  certificate. 
396.11     Subd. 6.  [BENEFIT LIMIT.] All benefits paid by the insurer 
396.12  while the policy or certificate is in premium-paying status and 
396.13  in the paid-up status will not exceed the maximum benefits which 
396.14  would be payable if the policy or certificate had remained in 
396.15  premium-paying status. 
396.16     Subd. 7.  [MINIMUM BENEFITS; INDIVIDUAL AND GROUP 
396.17  POLICIES.] There must be no difference in the minimum 
396.18  nonforfeiture benefits as required under this section for group 
396.19  and individual policies. 
396.20     Subd. 8.  [APPLICATION; EFFECTIVE DATES.] This section 
396.21  becomes effective January 1, 2002, and applies as follows: 
396.22     (a) Except as provided in paragraph (b), this section 
396.23  applies to any long-term care policy issued in this state on or 
396.24  after the effective date of this section. 
396.25     (b) For certificates issued on or after the effective date 
396.26  of this section, under a group long-term care insurance policy 
396.27  that was in force on the effective date of this section, the 
396.28  provisions of this section do not apply. 
396.29     Subd. 9.  [EFFECT ON LOSS RATIO.] Premiums charged for a 
396.30  policy or certificate containing nonforfeiture benefits or a 
396.31  contingent benefit on lapse are subject to the loss ratio 
396.32  requirements of section 62A.48, subdivision 4, or 62S.26, 
396.33  treating the policy as a whole, except for policies or 
396.34  certificates that are subject to sections 62S.021, 62S.081, and 
396.35  62S.265 and that comply with those sections. 
396.36     Subd. 10.  [PURCHASED BLOCKS OF BUSINESS.] To determine 
397.1   whether contingent nonforfeiture upon lapse provisions are 
397.2   triggered under subdivision 4, paragraph (c), a replacing 
397.3   insurer that purchased or otherwise assumed a block or blocks of 
397.4   long-term care insurance policies from another insurer shall 
397.5   calculate the percentage increase based on the initial annual 
397.6   premium paid by the insured when the policy was first purchased 
397.7   from the original insurer. 
397.8      Subd. 11.  [LEVEL PREMIUM CONTRACTS.] A nonforfeiture 
397.9   benefit for qualified long-term care insurance contracts that 
397.10  are level premium contracts must be offered that meets the 
397.11  following requirements: 
397.12     (1) the nonforfeiture provision must be appropriately 
397.13  captioned; 
397.14     (2) the nonforfeiture provision must provide a benefit 
397.15  available in the event of a default in the payment of any 
397.16  premiums and must state that the amount of the benefit may be 
397.17  adjusted subsequent to being initially granted only as necessary 
397.18  to reflect changes in claims, persistency, and interest as 
397.19  reflected in changes in rates for premium paying contracts 
397.20  approved by the commissioner for the same contract form; and 
397.21     (3) the nonforfeiture provision must provide at least one 
397.22  of the following: 
397.23     (i) reduced paid-up insurance; 
397.24     (ii) extended term insurance; 
397.25     (iii) shortened benefit period; or 
397.26     (iv) other similar offerings approved by the commissioner. 
397.27     [EFFECTIVE DATE.] This section is effective the day 
397.28  following final enactment. 
397.29     Sec. 13.  Minnesota Statutes 2000, section 256.975, is 
397.30  amended by adding a subdivision to read: 
397.31     Subd. 8.  [PROMOTION OF LONG-TERM CARE INSURANCE.] The 
397.32  Minnesota board on aging, either directly or through contract, 
397.33  shall promote the provision of employer-sponsored, long-term 
397.34  care insurance.  The board shall encourage private and public 
397.35  sector employers to make long-term care insurance available to 
397.36  employees, provide interested employers with information on the 
398.1   long-term care insurance product offered to state employees, and 
398.2   provide technical assistance to employers in designing long-term 
398.3   care insurance products and contacting companies offering 
398.4   long-term care insurance products. 
398.5      Sec. 14.  [256B.0571] [LONG-TERM CARE PARTNERSHIP.] 
398.6      Subdivision 1.  [DEFINITIONS.] For purposes of this 
398.7   section, the following terms have the meanings given them. 
398.8      (a) "Home care service" means care described in section 
398.9   144A.43. 
398.10     (b) "Long-term care insurance" means a policy described in 
398.11  section 62S.01. 
398.12     (c) "Medical assistance" means the program of medical 
398.13  assistance established under section 256B.01. 
398.14     (d) "Nursing home" means nursing home as described in 
398.15  section 144A.01. 
398.16     (e) "Partnership policy" means a long-term care insurance 
398.17  policy that meets the requirements under chapter 62S. 
398.18     (f) "Partnership program" means the Minnesota partnership 
398.19  for long-term care program established under this section. 
398.20     Subd. 2.  [PARTNERSHIP PROGRAM.] (a) Subject to federal 
398.21  waiver approval, the commissioner of human services, along with 
398.22  the commissioner of commerce, shall establish the Minnesota 
398.23  partnership for long-term care program to provide for the 
398.24  financing of long-term care through a combination of private 
398.25  insurance and medical assistance. 
398.26     (b) An individual who meets the requirements in paragraph 
398.27  (c) is eligible to participate in the partnership program. 
398.28     (c) The individual must: 
398.29     (1) be a Minnesota resident; 
398.30     (2) purchase a partnership policy that is delivered, issued 
398.31  for delivery, or renewed on or after the effective date of this 
398.32  section, and maintains the partnership policy in effect 
398.33  throughout the period of participation in the partnership 
398.34  program; and 
398.35     (3) exhaust the minimum benefits under the partnership 
398.36  policy as described in this section.  Benefits received under a 
399.1   long-term care insurance policy before the effective date of 
399.2   this section do not count toward the exhaustion of benefits 
399.3   required in this subdivision. 
399.4      Subd. 3.  [MEDICAL ASSISTANCE ELIGIBILITY.] (a) Upon 
399.5   application of an individual who meets the requirements 
399.6   described in subdivision 2, the commissioner of human services 
399.7   shall determine the individual's eligibility for medical 
399.8   assistance according to paragraphs (b) and (c). 
399.9      (b) After disregarding financial assets exempted under 
399.10  medical assistance eligibility requirements, the department 
399.11  shall disregard an additional amount of financial assets equal 
399.12  to the dollar amount of coverage under the partnership policy.  
399.13     (c) The department shall consider the individual's income 
399.14  according to medical assistance eligibility requirements. 
399.15     Subd. 4.  [FEDERAL APPROVAL.] (a) The commissioner of human 
399.16  services shall seek appropriate amendments to the medical 
399.17  assistance state plan and shall apply for any necessary waiver 
399.18  of medical assistance requirements by the federal Health Care 
399.19  Financing Administration to implement the partnership program.  
399.20  The state shall not implement the partnership program unless the 
399.21  provisions in paragraphs (b) and (c) apply. 
399.22     (b) The commissioner shall seek any necessary federal 
399.23  waiver of medical assistance requirements. 
399.24     (c) Individuals who receive medical assistance under this 
399.25  section are exempt from estate recovery requirements under 
399.26  section 1917, title XIX of the federal Social Security Act, 
399.27  United States Code, title 42, section 1396p. 
399.28     Subd. 5.  [APPROVED POLICIES.] (a) A partnership policy 
399.29  must meet all of the requirements in paragraphs (b) to (h). 
399.30     (b) Minimum coverage shall be for a period of not less than 
399.31  three years and for a dollar amount equal to 36 months of 
399.32  nursing home care at the minimum daily benefit rate determined 
399.33  and adjusted under paragraph (c).  The policy shall provide for 
399.34  home health care benefits to be substituted for nursing home 
399.35  care benefits on the basis of two home health care days for one 
399.36  nursing home care day. 
400.1      (c) Minimum daily benefits shall be $130 for nursing home 
400.2   care or $65 for home care.  These minimum daily benefit amounts 
400.3   shall be adjusted by the department on October 1 of each year, 
400.4   based on the health care index used under medical assistance for 
400.5   nursing home rate setting.  Adjusted minimum daily benefit 
400.6   amounts shall be rounded to the nearest whole dollar. 
400.7      (d) The insured shall be entitled to designate a third 
400.8   party to receive notice if the policy is about to lapse for 
400.9   nonpayment of premium, and an additional 30-day grace period for 
400.10  payment of premium shall be granted following notification to 
400.11  that person. 
400.12     (e) The policy must cover all of the following services: 
400.13     (1) nursing home stay; 
400.14     (2) home care service; 
400.15     (3) care management; and 
400.16     (4) up to 14 days of nursing care in a hospital while the 
400.17  individual is waiting for long-term care placement.  
400.18     (f) Payment for service under paragraph (e), clause (4), 
400.19  must not exceed the daily benefit amount for nursing home care. 
400.20     (g) A partnership policy must offer both options in 
400.21  paragraph (h) for an adjusted premium. 
400.22     (h) The options are: 
400.23     (1) an elimination period of not more than 100 days; and 
400.24     (2) nonforfeiture benefits for applicants between the ages 
400.25  of 18 and 75. 
400.26                             ARTICLE 9
400.27                 MENTAL HEALTH AND CIVIL COMM