Minnesota Legislature
SF 2995
2nd Unofficial Engrossment - 93rd Legislature (2023 - 2024) Posted on 04/27/2023 09:12pm
3.13 3.14
3.15 3.16 3.17 3.18 3.19 3.20 3.21 3.22 3.23 3.24 3.25 3.26 3.27 3.28 3.29 3.30 3.31 3.32 3.33 3.34 3.35 3.36 3.37 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15 4.16 4.17 4.18 4.19 4.20 4.21 4.22 4.23 4.24 4.25 4.26 4.27 4.28 4.29 4.30 4.31 4.32 4.33 4.34 4.35 5.1 5.2 5.3 5.4 5.5 5.6
5.7 5.8 5.9 5.10 5.11 5.12 5.13 5.14 5.15 5.16 5.17 5.18 5.19 5.20 5.21 5.22 5.23 5.24 5.25 5.26 5.27 5.28 5.29 5.30 5.31 5.32 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 6.10 6.11 6.12 6.13 6.14 6.15 6.16
6.17 6.18 6.19 6.20 6.21 6.22 6.23 6.24 6.25 6.26 6.27 6.28
6.29 6.30 6.31 6.32 6.33 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8
7.9
7.10 7.11 7.12 7.13 7.14 7.15 7.16 7.17 7.18 7.19 7.20 7.21 7.22 7.23 7.24 7.25 7.26 7.27 7.28 7.29 7.30 7.31 7.32 7.33 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 8.9 8.10 8.11 8.12 8.13 8.14 8.15 8.16 8.17 8.18 8.19 8.20 8.21 8.22 8.23 8.24 8.25 8.26 8.27 8.28 8.29 8.30 8.31 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 9.9 9.10 9.11 9.12 9.13 9.14 9.15 9.16 9.17 9.18 9.19 9.20 9.21 9.22 9.23 9.24 9.25 9.26 9.27 9.28 9.29 9.30 9.31 9.32 9.33 9.34 10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 10.9 10.10 10.11 10.12 10.13 10.14 10.15 10.16 10.17 10.18 10.19 10.20 10.21 10.22 10.23 10.24 10.25 10.26 10.27 10.28 10.29 10.30 10.31 10.32 10.33 11.1 11.2 11.3
11.4
11.5 11.6 11.7 11.8 11.9 11.10 11.11 11.12 11.13 11.14 11.15 11.16 11.17 11.18 11.19 11.20 11.21 11.22 11.23 11.24 11.25 11.26 11.27 11.28 11.29 11.30 11.31 11.32 11.33 12.1 12.2 12.3 12.4 12.5 12.6 12.7 12.8 12.9 12.10 12.11 12.12 12.13 12.14 12.15 12.16 12.17 12.18 12.19 12.20 12.21 12.22 12.23 12.24 12.25 12.26 12.27 12.28 12.29 12.30 12.31 12.32 13.1 13.2 13.3 13.4 13.5 13.6 13.7 13.8 13.9 13.10 13.11
13.12 13.13 13.14 13.15 13.16 13.17 13.18 13.19 13.20 13.21 13.22 13.23
13.24
13.25 13.26 13.27 13.28 13.29 13.30 13.31 14.1 14.2
14.3
14.4 14.5 14.6 14.7 14.8 14.9 14.10 14.11 14.12 14.13 14.14 14.15 14.16 14.17 14.18 14.19 14.20 14.21 14.22 14.23 14.24 14.25 14.26 14.27 14.28 14.29 15.1 15.2 15.3 15.4 15.5
15.6
15.7 15.8 15.9 15.10 15.11 15.12 15.13 15.14 15.15 15.16 15.17
15.18
15.19 15.20 15.21
15.22 15.23 15.24 15.25 15.26 15.27 15.28 15.29 15.30 16.1 16.2 16.3 16.4 16.5 16.6 16.7 16.8 16.9 16.10 16.11 16.12 16.13 16.14 16.15 16.16 16.17 16.18 16.19 16.20 16.21 16.22 16.23 16.24 16.25 16.26 16.27 16.28 16.29 17.1 17.2 17.3 17.4 17.5 17.6 17.7 17.8 17.9 17.10 17.11 17.12 17.13 17.14
17.15 17.16
17.17 17.18 17.19 17.20 17.21 17.22 17.23 17.24 17.25 17.26 17.27 17.28 17.29 17.30 17.31 17.32 17.33 18.1 18.2 18.3 18.4 18.5 18.6 18.7 18.8 18.9 18.10 18.11 18.12
18.13 18.14 18.15 18.16 18.17 18.18 18.19 18.20 18.21 18.22 18.23 18.24 18.25 18.26 18.27 18.28 18.29 18.30 18.31 18.32 18.33 18.34 18.35 19.1 19.2 19.3 19.4 19.5 19.6 19.7 19.8 19.9 19.10 19.11 19.12 19.13 19.14 19.15 19.16 19.17 19.18 19.19 19.20 19.21 19.22 19.23 19.24 19.25 19.26 19.27 19.28 19.29 19.30 19.31 19.32 19.33 19.34 20.1 20.2 20.3 20.4 20.5 20.6 20.7 20.8 20.9 20.10 20.11 20.12 20.13 20.14 20.15 20.16 20.17 20.18 20.19 20.20 20.21 20.22 20.23 20.24 20.25 20.26 20.27 20.28 20.29 20.30 20.31 20.32 20.33 20.34 20.35 21.1 21.2 21.3 21.4 21.5 21.6 21.7 21.8 21.9 21.10 21.11 21.12 21.13 21.14 21.15 21.16 21.17 21.18 21.19 21.20 21.21 21.22
21.23
21.24 21.25 21.26 21.27 21.28 21.29 21.30 21.31 21.32 21.33 21.34 22.1 22.2 22.3 22.4 22.5 22.6 22.7 22.8
22.9
22.10 22.11 22.12 22.13 22.14 22.15 22.16 22.17 22.18 22.19 22.20 22.21 22.22 22.23 22.24 22.25 22.26
22.27
22.28 22.29 22.30 22.31 23.1 23.2 23.3
23.4
23.5 23.6 23.7 23.8 23.9 23.10 23.11 23.12 23.13 23.14 23.15 23.16 23.17 23.18 23.19 23.20 23.21 23.22 23.23 23.24
23.25
23.26 23.27 23.28 23.29 23.30 23.31 24.1 24.2
24.3 24.4 24.5
24.6 24.7 24.8 24.9 24.10 24.11 24.12 24.13 24.14 24.15 24.16 24.17 24.18 24.19 24.20 24.21 24.22 24.23 24.24 24.25 24.26 24.27 24.28 24.29 24.30 24.31 24.32 24.33 25.1 25.2 25.3 25.4 25.5 25.6 25.7 25.8 25.9 25.10 25.11 25.12 25.13 25.14 25.15 25.16 25.17 25.18 25.19 25.20 25.21 25.22 25.23 25.24 25.25 25.26 25.27 25.28 25.29 25.30 25.31 25.32 26.1 26.2 26.3 26.4 26.5 26.6 26.7 26.8 26.9 26.10 26.11 26.12 26.13 26.14 26.15 26.16 26.17 26.18 26.19 26.20 26.21 26.22 26.23 26.24 26.25 26.26 26.27 26.28 26.29 26.30 26.31 26.32 26.33 26.34 27.1 27.2 27.3 27.4 27.5 27.6 27.7 27.8 27.9 27.10 27.11 27.12 27.13 27.14 27.15 27.16 27.17 27.18 27.19 27.20 27.21 27.22 27.23 27.24 27.25 27.26 27.27 27.28 27.29 27.30 28.1 28.2 28.3 28.4 28.5 28.6 28.7 28.8 28.9 28.10 28.11 28.12 28.13 28.14 28.15 28.16 28.17 28.18 28.19 28.20 28.21 28.22 28.23 28.24 28.25 28.26 28.27 28.28 28.29 28.30 28.31 29.1 29.2 29.3 29.4 29.5 29.6 29.7 29.8 29.9 29.10 29.11 29.12 29.13 29.14 29.15 29.16 29.17 29.18 29.19 29.20 29.21 29.22 29.23 29.24 29.25 29.26 29.27 29.28 29.29 29.30 29.31 29.32 29.33 29.34 30.1 30.2 30.3 30.4 30.5 30.6 30.7 30.8 30.9 30.10 30.11 30.12 30.13 30.14 30.15 30.16 30.17 30.18 30.19 30.20 30.21 30.22 30.23 30.24
30.25 30.26 30.27
30.28 30.29 30.30 30.31 30.32 30.33 31.1 31.2 31.3 31.4 31.5 31.6 31.7 31.8 31.9 31.10 31.11 31.12 31.13 31.14 31.15 31.16 31.17 31.18 31.19 31.20 31.21 31.22 31.23 31.24 31.25 31.26 31.27 31.28 31.29 31.30 31.31 32.1 32.2 32.3 32.4 32.5 32.6 32.7 32.8 32.9 32.10 32.11 32.12 32.13 32.14 32.15 32.16 32.17 32.18 32.19 32.20 32.21 32.22 32.23 32.24 32.25 32.26
32.27 32.28 32.29
32.30 32.31 32.32 33.1 33.2 33.3 33.4 33.5 33.6 33.7 33.8 33.9 33.10 33.11 33.12 33.13 33.14 33.15 33.16
33.17 33.18 33.19
33.20 33.21 33.22 33.23 33.24 33.25 33.26 33.27 33.28 33.29 33.30 33.31 33.32 33.33 34.1 34.2 34.3 34.4 34.5 34.6 34.7 34.8 34.9 34.10 34.11 34.12 34.13 34.14 34.15 34.16 34.17 34.18 34.19 34.20 34.21 34.22 34.23 34.24 34.25 34.26 34.27 34.28 34.29 34.30 35.1 35.2 35.3
35.4
35.5 35.6 35.7 35.8 35.9 35.10 35.11 35.12 35.13 35.14 35.15 35.16 35.17 35.18 35.19 35.20 35.21 35.22 35.23 35.24 35.25 35.26 35.27 35.28 35.29 36.1 36.2 36.3 36.4 36.5 36.6 36.7 36.8 36.9 36.10 36.11 36.12 36.13 36.14 36.15 36.16 36.17 36.18 36.19 36.20 36.21 36.22 36.23 36.24 36.25 36.26 36.27 36.28 36.29 36.30 36.31 37.1 37.2 37.3 37.4 37.5 37.6 37.7 37.8 37.9 37.10 37.11 37.12 37.13 37.14 37.15 37.16 37.17 37.18 37.19 37.20 37.21
37.22
37.23 37.24 37.25 37.26 37.27 37.28 37.29 37.30 37.31 37.32 38.1 38.2 38.3 38.4 38.5 38.6 38.7 38.8 38.9 38.10 38.11 38.12 38.13 38.14 38.15 38.16 38.17 38.18 38.19 38.20 38.21 38.22 38.23 38.24 38.25 38.26 38.27 38.28 38.29 38.30 38.31 38.32 38.33 38.34 38.35 39.1 39.2 39.3 39.4 39.5 39.6 39.7 39.8 39.9 39.10 39.11 39.12 39.13 39.14 39.15 39.16 39.17 39.18 39.19 39.20 39.21 39.22 39.23 39.24 39.25 39.26 39.27 39.28 39.29 39.30 39.31 39.32 39.33 39.34 39.35 40.1 40.2 40.3 40.4 40.5 40.6 40.7 40.8 40.9 40.10 40.11 40.12 40.13 40.14 40.15 40.16 40.17 40.18 40.19 40.20 40.21 40.22 40.23 40.24 40.25
40.26
40.27 40.28 40.29 40.30 40.31 40.32 40.33 41.1 41.2 41.3 41.4 41.5 41.6 41.7 41.8 41.9 41.10 41.11 41.12 41.13 41.14 41.15 41.16 41.17 41.18 41.19 41.20 41.21 41.22 41.23 41.24 41.25 41.26 41.27 41.28 41.29 41.30 41.31 41.32 41.33 41.34 41.35 42.1 42.2 42.3 42.4 42.5 42.6 42.7 42.8 42.9 42.10 42.11 42.12 42.13 42.14 42.15 42.16 42.17 42.18 42.19 42.20 42.21 42.22 42.23 42.24 42.25 42.26 42.27 42.28 42.29 42.30 42.31 42.32 42.33 42.34 42.35 43.1 43.2 43.3 43.4 43.5 43.6 43.7 43.8 43.9 43.10 43.11 43.12 43.13 43.14 43.15 43.16 43.17 43.18 43.19 43.20 43.21 43.22 43.23 43.24 43.25 43.26 43.27 43.28 43.29 43.30 43.31 43.32 43.33 43.34 44.1 44.2 44.3 44.4 44.5 44.6 44.7 44.8 44.9 44.10 44.11 44.12 44.13 44.14 44.15 44.16 44.17 44.18 44.19 44.20 44.21 44.22 44.23 44.24 44.25 44.26 44.27 44.28 44.29 44.30 44.31 44.32 44.33 45.1 45.2
45.3
45.4 45.5 45.6 45.7 45.8 45.9 45.10 45.11 45.12 45.13 45.14 45.15 45.16 45.17 45.18 45.19 45.20 45.21 45.22 45.23 45.24 45.25 45.26 45.27 45.28 45.29 45.30 45.31 45.32 45.33 46.1 46.2 46.3 46.4 46.5 46.6 46.7 46.8 46.9 46.10 46.11 46.12 46.13 46.14 46.15 46.16 46.17 46.18 46.19 46.20 46.21 46.22 46.23 46.24 46.25 46.26 46.27 46.28 46.29 46.30 46.31 46.32 46.33 46.34 47.1 47.2 47.3
47.4 47.5 47.6 47.7 47.8 47.9 47.10 47.11 47.12 47.13 47.14 47.15 47.16 47.17 47.18 47.19 47.20 47.21 47.22 47.23 47.24 47.25 47.26 47.27 47.28 47.29 47.30 47.31 48.1 48.2 48.3 48.4 48.5 48.6 48.7 48.8 48.9 48.10 48.11 48.12 48.13 48.14 48.15 48.16 48.17 48.18 48.19 48.20 48.21 48.22 48.23 48.24 48.25 48.26 48.27 48.28 48.29 48.30 48.31 48.32 48.33 48.34 49.1 49.2 49.3 49.4 49.5 49.6 49.7 49.8 49.9 49.10 49.11 49.12 49.13 49.14 49.15 49.16 49.17 49.18 49.19 49.20 49.21 49.22 49.23
49.24 49.25 49.26
49.27 49.28 49.29 49.30 49.31 49.32 50.1 50.2 50.3 50.4 50.5 50.6 50.7 50.8 50.9 50.10
50.11 50.12 50.13 50.14 50.15 50.16 50.17 50.18 50.19 50.20 50.21 50.22 50.23 50.24 50.25 50.26
50.27
50.28 50.29 50.30 50.31 51.1 51.2 51.3 51.4 51.5 51.6 51.7 51.8 51.9 51.10
51.11
51.12 51.13 51.14 51.15 51.16 51.17 51.18 51.19 51.20 51.21 51.22 51.23 51.24 51.25 51.26
51.27 51.28
52.1 52.2
52.3 52.4 52.5 52.6 52.7 52.8 52.9 52.10 52.11 52.12 52.13 52.14 52.15 52.16 52.17 52.18 52.19 52.20 52.21 52.22 52.23 52.24 52.25 52.26 52.27 52.28 52.29 52.30 53.1 53.2 53.3 53.4 53.5 53.6 53.7 53.8 53.9 53.10 53.11 53.12 53.13 53.14 53.15 53.16 53.17 53.18 53.19 53.20 53.21 53.22 53.23 53.24 53.25 53.26 53.27 53.28 53.29 53.30 53.31 54.1 54.2 54.3 54.4 54.5 54.6 54.7 54.8 54.9 54.10 54.11 54.12 54.13 54.14 54.15 54.16 54.17 54.18 54.19 54.20 54.21 54.22 54.23 54.24 54.25 54.26 54.27 54.28 54.29 54.30 54.31 55.1 55.2 55.3 55.4 55.5 55.6 55.7 55.8 55.9 55.10 55.11 55.12 55.13 55.14 55.15 55.16 55.17 55.18 55.19 55.20 55.21 55.22 55.23 55.24 55.25 55.26 55.27 55.28 55.29 55.30 55.31 55.32 56.1 56.2 56.3 56.4 56.5 56.6 56.7
56.8 56.9 56.10 56.11 56.12 56.13 56.14 56.15 56.16 56.17 56.18 56.19 56.20 56.21 56.22 56.23 56.24 56.25 56.26 56.27 56.28 56.29 57.1 57.2 57.3 57.4 57.5 57.6 57.7 57.8 57.9
57.10 57.11 57.12 57.13 57.14 57.15 57.16 57.17 57.18 57.19 57.20 57.21 57.22 57.23 57.24 57.25 57.26 57.27 57.28 57.29 57.30 57.31 58.1 58.2 58.3 58.4 58.5 58.6 58.7 58.8 58.9 58.10 58.11 58.12 58.13 58.14 58.15 58.16 58.17 58.18 58.19 58.20 58.21 58.22 58.23 58.24 58.25 58.26 58.27 58.28 58.29 58.30 58.31 59.1 59.2 59.3 59.4 59.5 59.6 59.7 59.8 59.9 59.10 59.11 59.12 59.13 59.14 59.15 59.16 59.17 59.18 59.19 59.20 59.21 59.22 59.23 59.24 59.25 59.26 59.27 59.28 59.29 59.30 60.1 60.2 60.3 60.4 60.5 60.6 60.7 60.8 60.9 60.10 60.11 60.12 60.13 60.14 60.15 60.16 60.17 60.18 60.19 60.20 60.21 60.22 60.23 60.24 60.25 60.26 60.27 60.28
60.29 60.30 60.31 60.32 61.1 61.2 61.3 61.4 61.5 61.6 61.7 61.8 61.9 61.10 61.11 61.12 61.13 61.14 61.15 61.16 61.17 61.18 61.19 61.20 61.21 61.22 61.23 61.24 61.25 61.26 61.27 61.28 61.29 62.1 62.2 62.3 62.4 62.5 62.6 62.7 62.8 62.9 62.10 62.11 62.12 62.13 62.14 62.15 62.16 62.17 62.18 62.19 62.20 62.21 62.22 62.23
62.24 62.25 62.26 62.27 62.28 62.29 62.30 63.1 63.2 63.3 63.4 63.5 63.6 63.7 63.8 63.9 63.10 63.11 63.12 63.13 63.14 63.15 63.16 63.17 63.18 63.19 63.20 63.21 63.22 63.23 63.24 63.25 63.26 63.27 63.28 63.29 63.30 63.31 63.32 64.1 64.2 64.3 64.4 64.5 64.6 64.7 64.8 64.9 64.10 64.11 64.12 64.13 64.14 64.15 64.16 64.17 64.18 64.19 64.20 64.21 64.22 64.23 64.24 64.25 64.26 64.27 64.28 64.29 64.30 64.31 64.32 64.33 64.34 65.1 65.2 65.3 65.4 65.5 65.6 65.7 65.8 65.9 65.10 65.11 65.12 65.13 65.14
65.15 65.16 65.17 65.18 65.19 65.20 65.21 65.22 65.23 65.24 65.25 65.26 65.27 65.28 65.29 65.30 65.31 65.32 66.1 66.2 66.3
66.4 66.5 66.6 66.7 66.8 66.9 66.10 66.11 66.12 66.13
66.14 66.15 66.16 66.17 66.18 66.19 66.20 66.21 66.22 66.23 66.24 66.25 66.26 66.27 66.28 66.29 66.30 66.31 67.1 67.2 67.3 67.4 67.5 67.6 67.7 67.8 67.9 67.10 67.11 67.12 67.13 67.14 67.15 67.16 67.17 67.18 67.19 67.20 67.21
67.22 67.23 67.24 67.25 67.26 67.27 67.28 67.29 67.30 67.31 68.1 68.2 68.3 68.4 68.5
68.6 68.7 68.8 68.9 68.10 68.11 68.12 68.13 68.14 68.15 68.16 68.17 68.18 68.19 68.20 68.21 68.22 68.23 68.24 68.25 68.26 68.27 68.28 68.29 68.30 68.31 68.32 68.33 69.1 69.2 69.3 69.4 69.5 69.6 69.7 69.8 69.9 69.10 69.11 69.12 69.13 69.14 69.15 69.16 69.17 69.18 69.19 69.20 69.21 69.22 69.23 69.24 69.25 69.26 69.27 69.28 69.29 69.30 69.31 69.32 70.1 70.2 70.3 70.4 70.5 70.6 70.7 70.8 70.9 70.10 70.11 70.12 70.13 70.14 70.15 70.16 70.17 70.18 70.19 70.20 70.21 70.22 70.23 70.24 70.25 70.26 70.27 70.28 70.29 70.30 70.31 70.32 71.1 71.2 71.3 71.4 71.5 71.6 71.7 71.8 71.9 71.10 71.11 71.12 71.13 71.14 71.15 71.16 71.17 71.18 71.19 71.20 71.21
71.22 71.23 71.24 71.25 71.26 71.27 71.28 71.29 71.30 71.31 71.32 72.1 72.2 72.3 72.4 72.5 72.6 72.7 72.8 72.9 72.10 72.11 72.12 72.13 72.14 72.15 72.16 72.17 72.18 72.19 72.20 72.21 72.22 72.23 72.24 72.25 72.26 72.27 72.28 72.29 72.30 72.31 72.32 72.33 73.1 73.2 73.3 73.4 73.5 73.6 73.7 73.8 73.9 73.10 73.11 73.12 73.13 73.14 73.15 73.16 73.17 73.18 73.19 73.20 73.21 73.22 73.23 73.24 73.25 73.26 73.27 73.28 73.29 73.30 73.31 73.32 73.33 73.34 74.1 74.2
74.3 74.4 74.5 74.6
74.7 74.8 74.9 74.10 74.11 74.12 74.13 74.14 74.15 74.16 74.17 74.18 74.19 74.20 74.21 74.22 74.23 74.24 74.25 74.26 74.27 74.28
74.29 74.30 75.1 75.2
75.3 75.4 75.5 75.6 75.7 75.8 75.9 75.10 75.11 75.12 75.13 75.14 75.15 75.16 75.17 75.18 75.19 75.20 75.21 75.22 75.23 75.24 75.25 75.26 75.27 75.28 75.29 75.30 75.31 75.32 76.1 76.2 76.3 76.4 76.5 76.6 76.7 76.8 76.9 76.10 76.11
76.12 76.13 76.14 76.15 76.16 76.17 76.18 76.19 76.20 76.21 76.22 76.23
76.24
76.25 76.26 76.27 76.28 76.29 76.30 76.31 77.1 77.2 77.3 77.4 77.5 77.6 77.7 77.8 77.9 77.10 77.11 77.12 77.13 77.14 77.15 77.16 77.17 77.18 77.19 77.20 77.21 77.22 77.23 77.24 77.25 77.26 77.27 77.28 77.29 77.30 77.31 77.32 78.1 78.2 78.3 78.4 78.5 78.6 78.7 78.8 78.9 78.10 78.11 78.12 78.13 78.14 78.15 78.16 78.17 78.18 78.19 78.20 78.21 78.22 78.23 78.24 78.25 78.26
78.27
78.28 78.29 78.30 78.31 78.32 78.33 79.1 79.2 79.3 79.4 79.5 79.6 79.7 79.8
79.9 79.10 79.11 79.12
79.13 79.14 79.15 79.16 79.17 79.18 79.19 79.20 79.21 79.22 79.23 79.24 79.25 79.26 79.27 79.28 79.29 79.30 79.31 79.32 79.33 80.1 80.2 80.3 80.4 80.5 80.6 80.7 80.8 80.9 80.10 80.11 80.12 80.13 80.14 80.15 80.16 80.17 80.18 80.19 80.20 80.21 80.22 80.23 80.24 80.25 80.26 80.27 80.28
80.29
81.1 81.2 81.3 81.4 81.5 81.6 81.7 81.8 81.9 81.10 81.11 81.12 81.13 81.14 81.15 81.16 81.17 81.18 81.19 81.20 81.21 81.22 81.23 81.24 81.25 81.26 81.27
81.28
81.29 81.30 81.31 81.32 82.1 82.2 82.3 82.4 82.5
82.6
82.7 82.8 82.9 82.10 82.11 82.12 82.13 82.14 82.15 82.16 82.17 82.18 82.19 82.20 82.21 82.22 82.23 82.24 82.25 82.26 82.27 82.28 82.29 82.30 82.31 82.32 82.33 82.34 83.1 83.2 83.3 83.4 83.5 83.6 83.7 83.8 83.9 83.10 83.11 83.12 83.13 83.14 83.15 83.16 83.17 83.18 83.19 83.20 83.21 83.22 83.23 83.24 83.25 83.26 83.27 83.28 83.29 83.30 83.31
83.32 83.33 84.1 84.2
84.3 84.4 84.5 84.6 84.7 84.8 84.9
84.10 84.11 84.12
84.13 84.14 84.15 84.16
84.17 84.18 84.19
84.20 84.21 84.22 84.23 84.24 84.25 84.26 84.27 84.28 84.29 84.30 84.31 84.32 85.1 85.2
85.3
85.4 85.5 85.6 85.7 85.8 85.9 85.10 85.11 85.12
85.13 85.14 85.15
85.16 85.17 85.18 85.19 85.20 85.21 85.22 85.23 85.24 85.25 85.26
85.27 85.28 85.29
86.1 86.2 86.3 86.4 86.5 86.6 86.7 86.8 86.9 86.10 86.11 86.12 86.13 86.14 86.15 86.16 86.17 86.18 86.19 86.20 86.21 86.22 86.23 86.24 86.25 86.26 86.27 86.28 86.29 86.30 86.31 86.32 86.33 86.34 87.1 87.2 87.3 87.4 87.5 87.6 87.7 87.8 87.9 87.10
87.11 87.12 87.13 87.14
87.15 87.16 87.17 87.18 87.19 87.20 87.21 87.22 87.23 87.24 87.25 87.26 87.27 87.28 87.29 87.30 87.31 87.32 88.1 88.2 88.3
88.4
88.5 88.6 88.7 88.8 88.9 88.10 88.11 88.12 88.13 88.14 88.15 88.16 88.17 88.18 88.19 88.20 88.21
88.22
88.23 88.24 88.25 88.26 88.27 88.28 88.29 88.30 89.1 89.2 89.3 89.4 89.5 89.6 89.7 89.8 89.9 89.10 89.11 89.12 89.13 89.14 89.15 89.16 89.17 89.18 89.19 89.20 89.21 89.22 89.23 89.24 89.25 89.26 89.27 89.28 89.29 89.30 89.31 89.32 89.33 89.34 90.1 90.2 90.3 90.4 90.5 90.6 90.7 90.8 90.9 90.10 90.11 90.12 90.13 90.14 90.15 90.16 90.17 90.18 90.19 90.20 90.21 90.22 90.23 90.24 90.25 90.26 90.27 90.28 90.29 90.30 90.31 91.1 91.2 91.3 91.4 91.5 91.6 91.7 91.8 91.9 91.10 91.11 91.12 91.13 91.14 91.15 91.16 91.17 91.18 91.19 91.20 91.21 91.22 91.23 91.24 91.25 91.26 91.27 91.28 91.29 91.30 91.31 91.32 92.1 92.2 92.3 92.4 92.5 92.6 92.7 92.8 92.9 92.10 92.11 92.12 92.13 92.14 92.15 92.16 92.17 92.18 92.19 92.20 92.21 92.22
92.23 92.24
92.25 92.26 92.27 92.28 92.29 92.30 92.31
93.1 93.2 93.3 93.4 93.5 93.6 93.7 93.8 93.9 93.10 93.11 93.12 93.13 93.14 93.15 93.16 93.17 93.18 93.19 93.20 93.21 93.22
93.23
93.24 93.25 93.26 93.27 93.28 93.29 93.30 93.31 94.1 94.2 94.3 94.4 94.5 94.6 94.7 94.8 94.9 94.10 94.11 94.12 94.13 94.14 94.15 94.16 94.17 94.18 94.19 94.20 94.21 94.22 94.23 94.24 94.25 94.26 94.27 94.28 94.29 94.30 94.31 94.32 94.33 94.34 95.1 95.2 95.3 95.4 95.5 95.6 95.7
95.8
95.9 95.10 95.11 95.12 95.13 95.14 95.15 95.16 95.17 95.18 95.19 95.20 95.21
95.22 95.23 95.24 95.25 95.26 95.27 95.28 95.29 95.30 95.31
96.1 96.2 96.3 96.4 96.5 96.6 96.7 96.8 96.9 96.10 96.11 96.12 96.13 96.14 96.15 96.16 96.17 96.18 96.19 96.20 96.21 96.22 96.23 96.24 96.25 96.26 96.27 96.28 96.29 96.30 97.1 97.2 97.3 97.4 97.5 97.6 97.7 97.8 97.9 97.10 97.11 97.12 97.13 97.14 97.15 97.16 97.17 97.18 97.19 97.20 97.21 97.22 97.23 97.24 97.25 97.26 97.27 97.28 97.29 97.30 97.31 98.1 98.2 98.3 98.4 98.5 98.6 98.7 98.8 98.9 98.10 98.11 98.12 98.13 98.14 98.15 98.16 98.17 98.18 98.19
98.20 98.21 98.22 98.23 98.24 98.25 98.26 98.27 98.28 98.29 98.30 98.31 98.32 99.1 99.2 99.3 99.4 99.5 99.6 99.7 99.8 99.9 99.10 99.11 99.12 99.13 99.14 99.15 99.16 99.17 99.18 99.19 99.20 99.21 99.22 99.23 99.24 99.25 99.26 99.27 99.28 99.29 99.30 99.31 99.32 100.1 100.2 100.3 100.4 100.5 100.6 100.7 100.8 100.9 100.10 100.11 100.12 100.13 100.14 100.15 100.16 100.17 100.18
100.19 100.20 100.21 100.22 100.23 100.24 100.25 100.26 100.27 100.28 100.29 100.30 100.31 101.1 101.2 101.3 101.4 101.5 101.6 101.7 101.8 101.9 101.10 101.11 101.12 101.13 101.14 101.15 101.16 101.17 101.18 101.19 101.20 101.21 101.22 101.23 101.24 101.25 101.26 101.27 101.28 101.29 101.30 102.1 102.2 102.3 102.4 102.5 102.6 102.7 102.8 102.9 102.10 102.11
102.12 102.13 102.14 102.15 102.16 102.17 102.18 102.19 102.20 102.21 102.22 102.23 102.24 102.25 102.26 102.27 102.28 102.29 102.30 103.1 103.2 103.3 103.4 103.5 103.6 103.7 103.8 103.9 103.10 103.11
103.12 103.13 103.14 103.15 103.16 103.17 103.18 103.19 103.20 103.21 103.22 103.23 103.24 103.25 103.26 103.27 103.28 103.29 103.30 103.31 104.1 104.2 104.3 104.4 104.5 104.6 104.7 104.8 104.9 104.10 104.11 104.12 104.13
104.14 104.15 104.16 104.17 104.18 104.19 104.20 104.21 104.22 104.23
104.24 104.25 104.26 104.27 104.28 104.29 104.30 105.1 105.2 105.3 105.4 105.5 105.6 105.7 105.8 105.9
105.10 105.11 105.12 105.13 105.14 105.15 105.16 105.17 105.18 105.19 105.20
105.21 105.22 105.23 105.24 105.25 105.26 105.27 105.28 105.29 105.30 105.31 106.1 106.2 106.3 106.4 106.5 106.6 106.7 106.8 106.9 106.10
106.11 106.12 106.13 106.14 106.15 106.16 106.17 106.18 106.19 106.20 106.21 106.22 106.23 106.24 106.25 106.26 106.27 106.28 106.29 106.30 107.1 107.2 107.3 107.4 107.5 107.6 107.7 107.8 107.9 107.10 107.11 107.12 107.13 107.14 107.15 107.16 107.17 107.18 107.19 107.20 107.21 107.22 107.23 107.24 107.25 107.26 107.27 107.28 107.29 108.1 108.2 108.3 108.4 108.5 108.6 108.7 108.8 108.9 108.10 108.11 108.12
108.13 108.14 108.15 108.16 108.17 108.18 108.19 108.20 108.21 108.22 108.23 108.24 108.25 108.26 108.27 108.28 108.29 109.1 109.2 109.3 109.4 109.5 109.6 109.7 109.8 109.9 109.10 109.11 109.12 109.13 109.14 109.15 109.16
109.17 109.18 109.19 109.20 109.21 109.22 109.23 109.24 109.25 109.26 109.27 109.28 109.29 109.30 109.31 110.1 110.2 110.3 110.4 110.5 110.6 110.7 110.8 110.9 110.10 110.11 110.12 110.13 110.14
110.15 110.16 110.17 110.18 110.19 110.20 110.21 110.22 110.23 110.24 110.25 110.26 110.27 110.28 110.29 110.30 110.31 111.1 111.2 111.3 111.4 111.5 111.6 111.7 111.8 111.9 111.10 111.11 111.12 111.13 111.14 111.15
111.16 111.17 111.18 111.19 111.20
111.21 111.22 111.23 111.24
111.25 111.26 111.27 111.28 111.29 111.30
112.1 112.2 112.3 112.4 112.5 112.6 112.7 112.8
112.9 112.10 112.11 112.12 112.13 112.14 112.15 112.16 112.17
112.18 112.19 112.20 112.21 112.22 112.23 112.24 112.25 112.26 112.27 112.28 112.29 112.30 113.1 113.2 113.3 113.4 113.5 113.6 113.7 113.8 113.9 113.10 113.11 113.12 113.13 113.14 113.15 113.16 113.17 113.18 113.19 113.20 113.21 113.22 113.23 113.24 113.25 113.26 113.27 113.28 113.29 113.30 113.31 113.32 113.33 114.1 114.2 114.3 114.4 114.5 114.6 114.7 114.8 114.9 114.10 114.11 114.12 114.13 114.14 114.15 114.16 114.17 114.18 114.19 114.20 114.21 114.22 114.23 114.24 114.25 114.26 114.27 114.28 114.29 114.30
115.1 115.2 115.3 115.4 115.5 115.6 115.7 115.8 115.9 115.10 115.11 115.12 115.13 115.14 115.15 115.16 115.17 115.18 115.19 115.20 115.21 115.22 115.23 115.24 115.25 115.26 115.27 115.28 115.29 115.30 115.31 115.32 116.1 116.2
116.3 116.4 116.5 116.6 116.7 116.8 116.9 116.10 116.11 116.12 116.13 116.14 116.15 116.16 116.17 116.18 116.19 116.20 116.21 116.22
116.23 116.24 116.25 116.26 116.27 116.28 116.29 116.30 116.31 117.1 117.2 117.3 117.4 117.5 117.6 117.7 117.8 117.9 117.10 117.11 117.12 117.13 117.14 117.15
117.16 117.17 117.18 117.19 117.20 117.21 117.22 117.23 117.24 117.25 117.26 117.27 117.28 117.29 117.30 118.1 118.2 118.3 118.4 118.5 118.6 118.7 118.8 118.9 118.10 118.11 118.12 118.13 118.14 118.15 118.16 118.17 118.18 118.19 118.20 118.21 118.22
118.23 118.24
118.25 118.26 118.27 118.28 118.29 118.30 118.31 118.32 119.1 119.2 119.3 119.4 119.5 119.6 119.7 119.8 119.9 119.10 119.11 119.12 119.13
119.14 119.15 119.16 119.17 119.18 119.19 119.20 119.21 119.22 119.23 119.24 119.25 119.26 119.27 119.28 119.29 119.30 119.31 119.32
120.1 120.2 120.3 120.4 120.5 120.6 120.7 120.8 120.9 120.10 120.11 120.12 120.13 120.14 120.15 120.16 120.17 120.18 120.19 120.20 120.21 120.22
120.23 120.24 120.25 120.26 120.27 120.28 120.29 120.30 120.31 120.32 120.33 121.1 121.2 121.3 121.4 121.5 121.6 121.7 121.8 121.9 121.10 121.11 121.12 121.13 121.14 121.15 121.16 121.17 121.18 121.19 121.20 121.21 121.22 121.23 121.24 121.25 121.26 121.27 121.28 121.29 121.30 121.31 122.1 122.2 122.3
122.4 122.5 122.6 122.7 122.8 122.9 122.10 122.11 122.12 122.13 122.14 122.15 122.16 122.17 122.18 122.19 122.20 122.21 122.22 122.23 122.24 122.25 122.26 122.27 122.28 122.29 122.30
123.1 123.2 123.3 123.4 123.5 123.6 123.7 123.8 123.9 123.10 123.11 123.12 123.13 123.14 123.15 123.16 123.17 123.18 123.19 123.20 123.21 123.22 123.23 123.24 123.25 123.26 123.27 123.28 123.29 123.30 123.31 123.32 123.33 124.1 124.2 124.3
124.4 124.5 124.6 124.7 124.8 124.9 124.10 124.11 124.12 124.13 124.14 124.15 124.16 124.17 124.18 124.19 124.20 124.21 124.22 124.23 124.24 124.25 124.26 124.27 124.28 124.29 124.30 124.31 124.32 125.1 125.2 125.3 125.4 125.5 125.6 125.7 125.8 125.9 125.10 125.11 125.12 125.13 125.14 125.15 125.16 125.17 125.18 125.19 125.20 125.21 125.22 125.23 125.24 125.25 125.26 125.27 125.28 125.29 125.30 125.31 125.32 125.33 125.34 126.1 126.2 126.3 126.4 126.5 126.6 126.7 126.8 126.9 126.10 126.11 126.12 126.13 126.14 126.15 126.16 126.17 126.18 126.19 126.20 126.21 126.22 126.23 126.24 126.25 126.26 126.27
126.28 126.29 126.30 126.31 126.32 127.1 127.2 127.3 127.4 127.5 127.6 127.7 127.8 127.9 127.10 127.11 127.12 127.13 127.14 127.15 127.16 127.17
127.18 127.19 127.20 127.21 127.22 127.23 127.24 127.25 127.26 127.27 127.28 127.29 127.30 127.31 127.32 128.1 128.2 128.3 128.4 128.5 128.6 128.7 128.8 128.9 128.10 128.11 128.12 128.13 128.14 128.15 128.16 128.17 128.18 128.19 128.20 128.21 128.22 128.23 128.24 128.25 128.26 128.27 128.28 128.29 128.30 128.31 128.32 129.1 129.2 129.3 129.4 129.5 129.6 129.7 129.8 129.9 129.10 129.11 129.12 129.13 129.14 129.15 129.16 129.17 129.18 129.19 129.20 129.21 129.22 129.23 129.24 129.25 129.26 129.27 129.28 129.29 129.30 129.31 129.32 129.33 130.1 130.2 130.3 130.4 130.5 130.6 130.7 130.8 130.9 130.10 130.11 130.12 130.13 130.14 130.15 130.16 130.17 130.18 130.19 130.20 130.21 130.22 130.23 130.24 130.25 130.26 130.27 130.28
130.29 130.30 130.31 130.32 131.1 131.2 131.3 131.4 131.5 131.6 131.7 131.8 131.9 131.10 131.11 131.12 131.13 131.14 131.15 131.16 131.17 131.18 131.19 131.20 131.21 131.22 131.23 131.24
131.25 131.26 131.27 131.28 131.29 131.30 131.31 131.32 132.1 132.2 132.3 132.4 132.5 132.6 132.7 132.8 132.9 132.10 132.11 132.12 132.13 132.14 132.15 132.16 132.17 132.18 132.19 132.20 132.21
132.22 132.23 132.24 132.25 132.26 132.27 132.28 132.29 132.30 132.31 132.32 133.1 133.2 133.3 133.4 133.5 133.6 133.7 133.8 133.9 133.10 133.11 133.12 133.13 133.14 133.15 133.16 133.17 133.18 133.19 133.20 133.21 133.22 133.23 133.24 133.25 133.26 133.27 133.28 133.29 133.30 134.1 134.2 134.3 134.4 134.5 134.6 134.7 134.8 134.9 134.10 134.11 134.12 134.13 134.14 134.15 134.16 134.17 134.18 134.19 134.20 134.21 134.22
134.23 134.24 134.25 134.26 134.27 134.28 134.29 134.30 134.31 135.1 135.2 135.3 135.4 135.5 135.6 135.7 135.8 135.9 135.10 135.11 135.12 135.13 135.14 135.15 135.16 135.17 135.18 135.19 135.20 135.21 135.22 135.23 135.24 135.25 135.26 135.27 135.28 135.29
135.30 135.31 135.32 136.1 136.2 136.3 136.4 136.5 136.6 136.7 136.8 136.9 136.10 136.11 136.12 136.13 136.14 136.15 136.16 136.17 136.18 136.19 136.20 136.21 136.22
136.23 136.24 136.25 136.26 136.27 136.28 136.29 136.30 136.31 136.32 137.1 137.2 137.3 137.4 137.5 137.6 137.7 137.8 137.9 137.10 137.11 137.12 137.13 137.14 137.15 137.16 137.17 137.18 137.19 137.20 137.21 137.22 137.23 137.24 137.25 137.26 137.27
137.28 137.29 137.30 137.31 137.32
138.1 138.2 138.3 138.4 138.5 138.6 138.7 138.8 138.9 138.10 138.11 138.12 138.13 138.14 138.15 138.16 138.17 138.18 138.19 138.20 138.21 138.22 138.23 138.24 138.25 138.26 138.27 138.28 138.29 138.30 138.31 138.32 138.33 138.34 138.35 138.36 139.1 139.2 139.3 139.4 139.5 139.6 139.7 139.8 139.9 139.10 139.11 139.12 139.13 139.14 139.15 139.16 139.17 139.18 139.19 139.20 139.21 139.22 139.23 139.24 139.25 139.26 139.27 139.28 139.29 139.30 139.31 139.32 139.33 139.34 139.35 139.36 140.1 140.2 140.3 140.4 140.5 140.6 140.7 140.8 140.9 140.10 140.11 140.12 140.13 140.14 140.15 140.16 140.17 140.18 140.19 140.20 140.21 140.22
140.23 140.24 140.25 140.26 140.27 140.28 140.29 140.30 140.31 140.32 140.33 141.1 141.2 141.3 141.4 141.5 141.6 141.7 141.8 141.9 141.10 141.11 141.12 141.13 141.14 141.15 141.16 141.17 141.18 141.19 141.20 141.21 141.22 141.23 141.24 141.25 141.26 141.27 141.28 141.29 141.30 142.1 142.2
142.3 142.4 142.5 142.6 142.7 142.8 142.9 142.10 142.11 142.12 142.13 142.14 142.15 142.16 142.17 142.18 142.19 142.20 142.21 142.22 142.23 142.24 142.25 142.26 142.27 142.28 142.29 142.30 143.1 143.2 143.3 143.4 143.5 143.6 143.7 143.8 143.9 143.10 143.11 143.12 143.13 143.14 143.15 143.16 143.17 143.18 143.19 143.20 143.21
143.22 143.23 143.24 143.25 143.26 143.27 143.28 143.29 143.30 143.31 144.1 144.2 144.3 144.4 144.5 144.6 144.7 144.8 144.9 144.10 144.11 144.12 144.13 144.14 144.15 144.16 144.17 144.18 144.19 144.20 144.21 144.22 144.23 144.24 144.25 144.26 144.27 144.28
144.29 144.30 144.31 144.32 144.33 145.1 145.2 145.3 145.4 145.5 145.6 145.7 145.8 145.9 145.10 145.11 145.12 145.13 145.14 145.15 145.16 145.17 145.18
145.19 145.20 145.21 145.22 145.23 145.24 145.25 145.26 145.27 145.28 145.29 145.30 145.31 145.32 145.33 146.1 146.2 146.3 146.4 146.5 146.6 146.7 146.8 146.9 146.10 146.11 146.12 146.13 146.14 146.15 146.16 146.17 146.18 146.19 146.20 146.21 146.22 146.23 146.24 146.25 146.26 146.27 146.28 146.29 146.30 146.31 146.32 146.33 146.34 146.35 147.1 147.2 147.3 147.4
147.5 147.6 147.7 147.8 147.9 147.10 147.11 147.12 147.13 147.14 147.15 147.16 147.17
147.18 147.19 147.20 147.21 147.22 147.23 147.24 147.25 147.26 147.27 147.28 147.29 147.30 147.31 148.1 148.2 148.3 148.4 148.5 148.6 148.7 148.8 148.9 148.10 148.11 148.12 148.13 148.14 148.15 148.16 148.17 148.18 148.19 148.20 148.21 148.22 148.23 148.24 148.25 148.26 148.27 148.28 148.29 148.30 148.31 148.32 148.33 149.1 149.2 149.3 149.4 149.5 149.6 149.7 149.8 149.9 149.10 149.11 149.12 149.13 149.14 149.15 149.16 149.17 149.18 149.19 149.20 149.21 149.22 149.23 149.24 149.25 149.26 149.27 149.28 149.29 149.30 149.31 150.1 150.2 150.3 150.4 150.5 150.6 150.7 150.8 150.9 150.10 150.11 150.12 150.13 150.14 150.15 150.16 150.17 150.18 150.19 150.20
150.21 150.22 150.23 150.24 150.25 150.26 150.27 150.28 150.29 150.30 150.31 150.32 151.1 151.2 151.3 151.4 151.5 151.6 151.7 151.8 151.9 151.10 151.11 151.12 151.13 151.14 151.15 151.16 151.17 151.18 151.19 151.20 151.21 151.22 151.23 151.24 151.25 151.26 151.27 151.28 151.29 151.30 151.31 151.32 152.1 152.2 152.3 152.4 152.5 152.6 152.7 152.8 152.9 152.10 152.11 152.12 152.13 152.14 152.15 152.16 152.17 152.18 152.19 152.20
152.21 152.22 152.23 152.24 152.25 152.26 152.27 152.28 152.29 152.30 152.31 152.32 152.33 152.34 153.1 153.2 153.3 153.4 153.5 153.6 153.7 153.8 153.9 153.10 153.11 153.12 153.13 153.14 153.15 153.16 153.17 153.18 153.19 153.20 153.21 153.22 153.23 153.24 153.25 153.26 153.27 153.28 153.29 153.30 153.31 153.32 153.33 154.1 154.2 154.3 154.4 154.5 154.6 154.7 154.8 154.9 154.10 154.11 154.12 154.13 154.14 154.15 154.16 154.17 154.18 154.19 154.20 154.21 154.22 154.23 154.24 154.25 154.26 154.27 154.28 154.29 154.30 154.31 155.1 155.2 155.3
155.4 155.5 155.6 155.7 155.8 155.9 155.10 155.11 155.12 155.13 155.14 155.15 155.16 155.17 155.18 155.19 155.20 155.21 155.22 155.23 155.24 155.25 155.26 155.27 155.28 155.29 155.30 155.31 156.1 156.2 156.3 156.4 156.5 156.6 156.7 156.8 156.9 156.10 156.11 156.12 156.13 156.14 156.15 156.16 156.17 156.18 156.19 156.20 156.21 156.22 156.23 156.24 156.25 156.26 156.27 156.28 156.29 156.30 156.31 156.32 156.33 157.1 157.2 157.3 157.4 157.5 157.6 157.7 157.8 157.9 157.10 157.11 157.12 157.13 157.14 157.15 157.16 157.17
157.18 157.19 157.20 157.21 157.22 157.23 157.24 157.25 157.26 157.27 157.28 157.29 157.30 157.31 158.1 158.2
158.3 158.4 158.5 158.6 158.7 158.8 158.9 158.10 158.11 158.12 158.13 158.14
158.15
158.16 158.17 158.18 158.19 158.20 158.21 158.22 158.23 158.24 158.25 158.26 158.27 158.28 158.29 158.30
159.1 159.2 159.3 159.4 159.5 159.6 159.7
159.8 159.9 159.10 159.11 159.12 159.13
159.14 159.15 159.16 159.17 159.18
159.19 159.20 159.21 159.22 159.23 159.24
159.25 159.26 159.27 159.28
160.1 160.2 160.3
160.4 160.5 160.6 160.7 160.8
160.9 160.10 160.11 160.12 160.13 160.14
160.15 160.16 160.17 160.18 160.19 160.20
160.21 160.22 160.23 160.24 160.25 160.26
160.27 160.28 160.29 161.1 161.2 161.3 161.4 161.5 161.6 161.7 161.8 161.9 161.10 161.11 161.12 161.13
161.14 161.15 161.16 161.17 161.18 161.19 161.20 161.21 161.22 161.23 161.24 161.25 161.26 161.27 161.28 161.29 161.30 161.31 162.1 162.2 162.3 162.4 162.5 162.6 162.7 162.8 162.9 162.10 162.11 162.12 162.13 162.14 162.15 162.16 162.17 162.18
162.19
162.20 162.21 162.22 162.23 162.24 162.25 162.26 162.27 162.28 162.29 162.30 163.1 163.2 163.3 163.4 163.5 163.6 163.7 163.8 163.9 163.10 163.11 163.12 163.13 163.14 163.15 163.16 163.17 163.18 163.19 163.20 163.21 163.22 163.23 163.24 163.25 163.26 163.27 163.28 163.29 163.30 163.31 163.32
163.33
164.1 164.2 164.3 164.4 164.5 164.6 164.7 164.8 164.9 164.10 164.11 164.12 164.13 164.14 164.15 164.16 164.17 164.18 164.19 164.20 164.21 164.22 164.23 164.24 164.25 164.26 164.27 164.28 164.29 164.30 164.31 164.32 165.1 165.2 165.3 165.4 165.5 165.6 165.7 165.8 165.9 165.10 165.11 165.12 165.13 165.14 165.15 165.16 165.17 165.18 165.19 165.20 165.21 165.22 165.23 165.24 165.25 165.26 165.27 165.28 165.29 165.30 165.31 165.32 165.33 166.1 166.2 166.3 166.4 166.5 166.6 166.7 166.8 166.9 166.10 166.11 166.12 166.13 166.14 166.15 166.16 166.17 166.18 166.19 166.20 166.21 166.22 166.23 166.24 166.25 166.26 166.27 166.28 166.29 166.30 166.31 167.1 167.2 167.3 167.4 167.5 167.6 167.7 167.8 167.9 167.10 167.11 167.12 167.13 167.14 167.15 167.16 167.17 167.18 167.19 167.20 167.21 167.22 167.23 167.24 167.25 167.26 167.27 167.28 167.29 167.30 167.31 167.32 167.33 167.34 168.1 168.2 168.3 168.4 168.5 168.6 168.7 168.8 168.9 168.10 168.11 168.12 168.13 168.14 168.15 168.16 168.17 168.18 168.19 168.20 168.21 168.22 168.23 168.24 168.25 168.26 168.27 168.28 168.29 168.30 168.31 168.32 169.1 169.2 169.3 169.4 169.5 169.6 169.7 169.8 169.9 169.10 169.11 169.12 169.13 169.14 169.15 169.16 169.17 169.18 169.19 169.20 169.21 169.22 169.23 169.24 169.25 169.26 169.27 169.28 169.29 169.30 169.31 169.32 169.33 170.1 170.2 170.3 170.4 170.5 170.6 170.7 170.8 170.9 170.10 170.11 170.12 170.13 170.14 170.15 170.16 170.17
170.18 170.19 170.20 170.21 170.22 170.23 170.24 170.25 170.26 170.27 170.28 170.29 170.30 170.31 170.32 171.1 171.2 171.3 171.4 171.5 171.6 171.7 171.8 171.9 171.10 171.11 171.12 171.13 171.14 171.15 171.16 171.17 171.18 171.19 171.20 171.21 171.22 171.23 171.24 171.25 171.26 171.27 171.28 171.29 171.30 171.31 171.32 171.33 172.1 172.2 172.3 172.4 172.5 172.6 172.7 172.8 172.9 172.10 172.11 172.12 172.13 172.14 172.15 172.16 172.17 172.18 172.19 172.20 172.21 172.22 172.23 172.24 172.25 172.26 172.27 172.28 172.29 172.30 172.31 172.32 173.1 173.2 173.3 173.4 173.5 173.6 173.7
173.8
173.9 173.10 173.11 173.12 173.13 173.14 173.15 173.16 173.17 173.18 173.19 173.20 173.21 173.22 173.23
173.24
173.25 173.26 173.27 173.28 173.29 173.30 174.1 174.2
174.3
174.4 174.5 174.6 174.7 174.8 174.9 174.10 174.11 174.12 174.13 174.14 174.15 174.16 174.17 174.18 174.19 174.20 174.21 174.22 174.23 174.24 174.25 174.26 174.27 174.28 174.29 174.30 175.1 175.2 175.3 175.4 175.5 175.6 175.7 175.8 175.9 175.10 175.11 175.12 175.13 175.14 175.15 175.16 175.17 175.18 175.19 175.20 175.21 175.22 175.23 175.24 175.25 175.26 175.27 175.28 175.29 175.30 175.31 176.1 176.2 176.3 176.4 176.5 176.6 176.7 176.8 176.9 176.10 176.11 176.12 176.13 176.14 176.15 176.16 176.17 176.18 176.19 176.20 176.21 176.22 176.23 176.24 176.25 176.26 176.27 176.28 176.29 177.1 177.2 177.3 177.4 177.5 177.6 177.7 177.8 177.9 177.10 177.11 177.12 177.13 177.14 177.15 177.16 177.17 177.18 177.19 177.20 177.21 177.22 177.23 177.24 177.25 177.26 177.27 177.28 177.29 177.30 177.31 177.32 178.1 178.2 178.3 178.4 178.5 178.6 178.7 178.8 178.9 178.10 178.11 178.12 178.13 178.14 178.15 178.16 178.17 178.18 178.19 178.20 178.21 178.22 178.23 178.24 178.25 178.26 178.27 178.28 178.29 178.30 178.31 179.1 179.2 179.3 179.4 179.5 179.6 179.7 179.8 179.9 179.10 179.11 179.12 179.13 179.14 179.15 179.16 179.17 179.18 179.19 179.20 179.21 179.22 179.23 179.24 179.25 179.26 179.27 179.28 179.29 179.30 179.31 180.1 180.2 180.3 180.4 180.5 180.6 180.7 180.8 180.9 180.10 180.11 180.12 180.13 180.14 180.15 180.16 180.17 180.18 180.19 180.20 180.21 180.22 180.23 180.24 180.25 180.26 180.27
180.28 180.29 180.30 180.31
181.1 181.2 181.3 181.4 181.5 181.6 181.7 181.8 181.9 181.10 181.11 181.12 181.13 181.14 181.15 181.16 181.17 181.18 181.19 181.20 181.21 181.22 181.23 181.24 181.25 181.26 181.27 181.28 181.29 181.30 181.31 182.1 182.2 182.3 182.4 182.5 182.6 182.7 182.8 182.9 182.10 182.11 182.12 182.13 182.14 182.15 182.16 182.17
182.18 182.19 182.20 182.21 182.22 182.23 182.24 182.25 182.26 182.27
182.28
183.1 183.2 183.3 183.4 183.5 183.6 183.7 183.8 183.9 183.10
183.11 183.12 183.13 183.14 183.15 183.16 183.17 183.18
183.19 183.20 183.21 183.22 183.23 183.24 183.25 183.26 183.27 183.28 183.29
183.30
184.1 184.2 184.3 184.4 184.5 184.6 184.7 184.8 184.9 184.10
184.11
184.12 184.13 184.14 184.15 184.16 184.17 184.18 184.19
184.20
184.21 184.22 184.23 184.24 184.25 184.26 184.27 184.28 184.29 184.30 184.31 185.1 185.2 185.3 185.4 185.5 185.6 185.7 185.8 185.9 185.10 185.11 185.12 185.13 185.14
185.15 185.16 185.17 185.18 185.19 185.20 185.21 185.22 185.23 185.24 185.25 185.26 185.27 185.28 185.29 185.30 185.31
185.32
186.1 186.2 186.3 186.4 186.5 186.6 186.7 186.8 186.9 186.10 186.11 186.12 186.13 186.14 186.15 186.16 186.17 186.18 186.19 186.20 186.21 186.22 186.23 186.24 186.25 186.26 186.27 186.28 186.29 186.30 186.31 186.32 187.1 187.2 187.3 187.4 187.5 187.6 187.7 187.8 187.9 187.10 187.11 187.12 187.13 187.14 187.15 187.16 187.17 187.18
187.19
187.20 187.21 187.22 187.23 187.24 187.25 187.26 187.27 187.28 187.29 187.30 187.31 188.1 188.2 188.3 188.4 188.5 188.6 188.7 188.8 188.9 188.10 188.11 188.12 188.13 188.14 188.15 188.16 188.17 188.18 188.19 188.20 188.21 188.22 188.23 188.24 188.25 188.26
188.27
188.28 188.29 188.30 188.31 189.1 189.2 189.3 189.4 189.5 189.6 189.7 189.8 189.9 189.10 189.11 189.12 189.13 189.14 189.15 189.16 189.17 189.18 189.19 189.20 189.21 189.22 189.23 189.24 189.25 189.26 189.27 189.28 189.29 189.30 189.31 190.1 190.2 190.3 190.4 190.5 190.6 190.7 190.8 190.9 190.10 190.11 190.12 190.13 190.14 190.15 190.16 190.17 190.18 190.19 190.20 190.21 190.22 190.23 190.24 190.25 190.26 190.27 190.28 190.29 190.30 190.31 190.32 191.1 191.2 191.3 191.4 191.5 191.6 191.7 191.8 191.9 191.10 191.11 191.12 191.13 191.14 191.15 191.16 191.17 191.18 191.19 191.20 191.21 191.22 191.23 191.24 191.25 191.26 191.27 191.28 191.29 191.30 191.31 192.1 192.2 192.3 192.4 192.5 192.6 192.7 192.8 192.9 192.10 192.11 192.12 192.13 192.14 192.15 192.16 192.17 192.18 192.19 192.20 192.21
192.22
192.23 192.24 192.25 192.26 192.27 192.28 192.29 192.30 192.31 192.32 193.1 193.2 193.3 193.4 193.5 193.6 193.7 193.8 193.9 193.10 193.11 193.12 193.13 193.14 193.15 193.16 193.17 193.18 193.19 193.20 193.21 193.22 193.23 193.24 193.25 193.26 193.27 193.28 193.29 193.30 193.31 193.32 193.33 194.1 194.2 194.3 194.4 194.5 194.6 194.7 194.8 194.9 194.10
194.11
194.12 194.13 194.14 194.15 194.16 194.17 194.18 194.19 194.20 194.21 194.22 194.23 194.24 194.25 194.26 194.27 194.28 194.29 194.30 194.31 195.1 195.2 195.3 195.4 195.5 195.6 195.7 195.8 195.9 195.10 195.11 195.12 195.13 195.14 195.15 195.16 195.17 195.18 195.19 195.20 195.21
195.22
195.23 195.24 195.25 195.26 195.27 195.28 195.29 195.30 195.31 195.32 196.1 196.2 196.3 196.4 196.5 196.6 196.7 196.8 196.9 196.10 196.11 196.12 196.13 196.14 196.15 196.16 196.17
196.18
196.19 196.20 196.21 196.22 196.23 196.24 196.25 196.26 196.27 196.28 197.1 197.2 197.3 197.4 197.5 197.6 197.7 197.8 197.9 197.10 197.11 197.12 197.13 197.14 197.15 197.16 197.17 197.18 197.19 197.20 197.21 197.22
197.23 197.24 197.25 197.26 197.27 197.28 197.29 197.30 197.31 198.1 198.2 198.3 198.4 198.5 198.6 198.7 198.8 198.9 198.10 198.11
198.12
198.13 198.14 198.15 198.16 198.17
198.18 198.19 198.20 198.21 198.22 198.23 198.24 198.25 198.26 198.27 198.28 198.29
199.1 199.2 199.3 199.4 199.5 199.6 199.7 199.8 199.9 199.10 199.11 199.12 199.13 199.14 199.15 199.16 199.17 199.18 199.19
199.20 199.21 199.22 199.23 199.24 199.25 199.26 199.27 199.28 199.29 200.1 200.2 200.3 200.4 200.5 200.6 200.7 200.8 200.9 200.10
200.11 200.12 200.13 200.14 200.15
200.16 200.17 200.18
200.19 200.20 200.21 200.22 200.23 200.24 200.25 200.26 200.27 200.28 200.29 200.30 200.31 201.1 201.2 201.3 201.4 201.5 201.6 201.7 201.8 201.9 201.10 201.11 201.12 201.13 201.14 201.15 201.16 201.17 201.18
201.19 201.20 201.21 201.22 201.23 201.24 201.25 201.26 201.27 201.28
201.29 201.30 201.31 201.32 201.33 202.1 202.2 202.3 202.4 202.5
202.6 202.7 202.8 202.9 202.10 202.11 202.12 202.13 202.14 202.15 202.16 202.17 202.18 202.19 202.20 202.21 202.22 202.23 202.24 202.25 202.26 202.27 202.28 202.29 202.30 202.31 202.32 202.33 202.34 203.1 203.2 203.3 203.4 203.5 203.6 203.7 203.8 203.9 203.10 203.11 203.12 203.13 203.14 203.15 203.16 203.17 203.18 203.19 203.20 203.21 203.22 203.23 203.24 203.25 203.26 203.27 203.28 203.29 203.30
203.31 203.32 203.33 204.1 204.2 204.3 204.4 204.5 204.6 204.7 204.8 204.9 204.10 204.11 204.12 204.13 204.14
204.15 204.16 204.17 204.18 204.19 204.20 204.21 204.22 204.23 204.24 204.25 204.26 204.27 204.28 204.29 204.30 204.31 204.32 205.1 205.2 205.3 205.4 205.5 205.6 205.7 205.8 205.9 205.10 205.11 205.12 205.13 205.14 205.15 205.16 205.17 205.18 205.19 205.20 205.21 205.22 205.23 205.24 205.25 205.26 205.27 205.28 205.29 205.30 205.31 206.1 206.2 206.3 206.4 206.5 206.6
206.7
206.8 206.9 206.10 206.11 206.12 206.13 206.14 206.15 206.16 206.17 206.18 206.19 206.20 206.21 206.22 206.23 206.24 206.25 206.26 206.27 206.28 206.29 206.30 206.31 206.32 207.1 207.2 207.3 207.4 207.5 207.6 207.7 207.8
207.9
207.10 207.11 207.12 207.13 207.14 207.15 207.16 207.17 207.18 207.19 207.20 207.21 207.22 207.23 207.24 207.25 207.26 207.27 207.28 207.29 207.30 207.31 208.1 208.2 208.3 208.4 208.5
208.6 208.7 208.8 208.9 208.10 208.11 208.12
208.13 208.14 208.15 208.16 208.17 208.18 208.19 208.20 208.21 208.22 208.23 208.24 208.25 208.26 208.27 208.28 208.29 208.30 208.31 208.32 208.33 209.1 209.2 209.3 209.4 209.5 209.6 209.7 209.8 209.9 209.10 209.11 209.12 209.13 209.14 209.15
209.16 209.17 209.18 209.19 209.20 209.21 209.22 209.23 209.24 209.25 209.26 209.27 209.28 209.29 209.30 209.31 210.1 210.2 210.3 210.4 210.5 210.6 210.7 210.8
210.9 210.10 210.11 210.12 210.13 210.14 210.15
210.16 210.17 210.18 210.19 210.20 210.21 210.22 210.23 210.24 210.25 210.26 210.27
210.28 210.29 210.30 211.1 211.2 211.3 211.4 211.5
211.6 211.7 211.8
211.9
211.10 211.11 211.12 211.13 211.14
211.15
211.16 211.17 211.18 211.19 211.20 211.21 211.22
211.23
211.24 211.25 211.26 211.27 211.28 212.1 212.2 212.3 212.4 212.5 212.6 212.7 212.8 212.9 212.10 212.11 212.12 212.13 212.14 212.15 212.16 212.17 212.18 212.19 212.20 212.21 212.22 212.23 212.24 212.25 212.26 212.27 212.28 212.29 212.30 213.1 213.2 213.3 213.4 213.5 213.6 213.7 213.8 213.9 213.10 213.11 213.12 213.13 213.14 213.15 213.16 213.17 213.18 213.19 213.20 213.21 213.22 213.23 213.24 213.25 213.26 213.27 213.28 213.29 213.30 213.31 213.32 214.1 214.2 214.3 214.4 214.5 214.6 214.7 214.8 214.9 214.10 214.11 214.12 214.13
214.14 214.15 214.16 214.17 214.18 214.19
214.20 214.21 214.22 214.23 214.24 214.25 214.26 214.27 214.28 214.29 214.30 214.31 215.1 215.2 215.3 215.4 215.5 215.6 215.7 215.8 215.9 215.10 215.11 215.12 215.13 215.14 215.15 215.16 215.17 215.18 215.19 215.20 215.21 215.22 215.23 215.24 215.25 215.26 215.27 215.28 215.29 215.30 215.31 216.1 216.2 216.3 216.4 216.5 216.6 216.7 216.8 216.9 216.10 216.11 216.12 216.13 216.14 216.15 216.16 216.17 216.18 216.19 216.20
216.21 216.22 216.23 216.24 216.25 216.26 216.27 216.28 216.29 216.30 216.31 217.1 217.2 217.3 217.4 217.5 217.6 217.7 217.8 217.9 217.10 217.11 217.12 217.13 217.14
217.15 217.16 217.17 217.18 217.19 217.20 217.21 217.22 217.23 217.24 217.25 217.26 217.27 217.28 217.29 217.30 217.31 217.32 217.33 218.1 218.2 218.3 218.4 218.5 218.6 218.7 218.8 218.9 218.10 218.11 218.12 218.13 218.14 218.15 218.16 218.17 218.18 218.19 218.20 218.21 218.22 218.23 218.24 218.25 218.26 218.27 218.28 218.29 218.30 218.31 218.32 218.33 219.1 219.2 219.3 219.4 219.5 219.6 219.7 219.8 219.9 219.10 219.11 219.12 219.13 219.14 219.15 219.16 219.17 219.18 219.19 219.20 219.21 219.22 219.23 219.24 219.25 219.26 219.27 219.28 219.29 219.30 219.31 219.32 219.33 220.1 220.2 220.3 220.4 220.5 220.6 220.7 220.8 220.9 220.10 220.11 220.12 220.13 220.14 220.15 220.16 220.17 220.18 220.19 220.20 220.21 220.22 220.23 220.24 220.25 220.26 220.27 220.28 220.29 220.30 220.31 221.1 221.2 221.3 221.4 221.5 221.6 221.7 221.8 221.9 221.10 221.11 221.12 221.13 221.14 221.15
221.16 221.17 221.18 221.19 221.20 221.21 221.22 221.23 221.24 221.25 221.26 221.27 221.28 221.29 221.30 221.31 221.32 221.33 222.1 222.2 222.3 222.4 222.5 222.6 222.7 222.8 222.9 222.10 222.11 222.12 222.13 222.14 222.15 222.16 222.17 222.18 222.19 222.20 222.21 222.22 222.23 222.24 222.25 222.26 222.27 222.28 222.29 222.30 223.1 223.2 223.3 223.4 223.5 223.6 223.7 223.8 223.9 223.10 223.11 223.12 223.13 223.14 223.15 223.16 223.17 223.18 223.19 223.20 223.21 223.22 223.23 223.24 223.25 223.26 223.27 223.28 223.29 223.30 223.31 223.32 224.1 224.2 224.3 224.4 224.5 224.6 224.7 224.8 224.9 224.10 224.11 224.12 224.13 224.14 224.15 224.16 224.17 224.18 224.19 224.20 224.21 224.22
224.23 224.24 224.25 224.26 224.27 224.28 224.29 224.30 224.31 224.32 225.1 225.2 225.3
225.4 225.5 225.6 225.7 225.8 225.9 225.10 225.11 225.12 225.13 225.14 225.15 225.16 225.17 225.18 225.19 225.20 225.21 225.22 225.23 225.24 225.25 225.26 225.27 225.28 225.29 225.30 225.31 225.32 226.1 226.2 226.3
226.4 226.5 226.6 226.7 226.8 226.9 226.10 226.11 226.12 226.13 226.14 226.15 226.16 226.17 226.18 226.19 226.20 226.21 226.22 226.23 226.24 226.25 226.26 226.27 226.28 226.29 226.30 227.1 227.2 227.3 227.4 227.5 227.6
227.7 227.8 227.9 227.10 227.11 227.12 227.13 227.14 227.15 227.16 227.17 227.18 227.19 227.20 227.21 227.22 227.23 227.24 227.25 227.26 227.27 227.28 227.29 227.30 227.31 227.32 227.33 228.1 228.2 228.3 228.4 228.5
228.6 228.7 228.8 228.9 228.10 228.11 228.12 228.13 228.14 228.15 228.16 228.17 228.18 228.19 228.20 228.21 228.22
228.23 228.24 228.25 228.26 228.27
228.28 228.29 228.30 228.31 228.32 229.1 229.2 229.3 229.4 229.5 229.6 229.7 229.8 229.9 229.10
229.11 229.12 229.13 229.14 229.15 229.16 229.17 229.18 229.19 229.20 229.21 229.22 229.23 229.24 229.25 229.26 229.27 229.28 229.29 229.30 229.31 230.1 230.2 230.3 230.4 230.5 230.6 230.7 230.8 230.9 230.10 230.11 230.12 230.13 230.14 230.15 230.16 230.17 230.18 230.19 230.20 230.21 230.22 230.23 230.24 230.25 230.26 230.27 230.28 230.29 230.30 230.31 230.32 230.33 230.34 231.1 231.2 231.3 231.4 231.5 231.6 231.7 231.8 231.9 231.10 231.11 231.12 231.13 231.14 231.15 231.16 231.17 231.18 231.19 231.20 231.21 231.22 231.23 231.24 231.25 231.26 231.27 231.28 231.29 231.30 231.31 231.32 232.1 232.2 232.3 232.4 232.5 232.6 232.7 232.8 232.9 232.10 232.11 232.12 232.13 232.14 232.15 232.16 232.17 232.18 232.19 232.20 232.21 232.22 232.23 232.24
232.25
232.26 232.27 232.28 232.29 232.30 232.31 233.1 233.2
233.3 233.4 233.5 233.6 233.7 233.8 233.9
233.10 233.11 233.12 233.13 233.14
233.15 233.16 233.17 233.18 233.19
233.20 233.21 233.22 233.23
233.24 233.25 233.26 233.27 233.28 233.29 234.1 234.2 234.3 234.4 234.5 234.6 234.7 234.8 234.9 234.10 234.11 234.12 234.13
234.14 234.15 234.16 234.17 234.18 234.19 234.20 234.21 234.22 234.23 234.24 234.25 234.26 234.27 234.28 234.29 234.30 234.31 234.32 235.1 235.2 235.3 235.4 235.5 235.6
235.7 235.8 235.9 235.10 235.11 235.12 235.13 235.14 235.15 235.16 235.17 235.18 235.19 235.20 235.21 235.22 235.23 235.24 235.25 235.26 235.27 235.28 235.29 235.30 236.1 236.2 236.3 236.4 236.5 236.6 236.7 236.8 236.9 236.10 236.11 236.12 236.13 236.14 236.15 236.16 236.17 236.18 236.19 236.20 236.21 236.22 236.23 236.24 236.25 236.26 236.27 236.28 236.29 236.30 236.31 236.32 236.33 237.1 237.2 237.3 237.4 237.5 237.6 237.7 237.8 237.9 237.10 237.11 237.12 237.13 237.14 237.15 237.16 237.17 237.18 237.19 237.20 237.21 237.22 237.23
237.24 237.25 237.26 237.27 237.28 237.29 237.30 237.31 238.1 238.2 238.3 238.4 238.5 238.6 238.7 238.8 238.9 238.10 238.11 238.12 238.13 238.14 238.15 238.16 238.17 238.18 238.19 238.20
238.21 238.22 238.23 238.24 238.25 238.26 238.27 238.28 238.29 238.30 238.31 238.32 238.33 239.1 239.2 239.3 239.4 239.5 239.6 239.7 239.8 239.9 239.10 239.11 239.12 239.13
239.14 239.15 239.16 239.17 239.18 239.19 239.20 239.21 239.22 239.23 239.24 239.25 239.26 239.27 239.28 239.29 239.30 239.31 239.32 239.33 240.1 240.2 240.3 240.4 240.5 240.6 240.7 240.8 240.9 240.10 240.11 240.12 240.13 240.14 240.15 240.16 240.17 240.18 240.19 240.20 240.21 240.22 240.23 240.24 240.25 240.26 240.27 240.28 240.29 240.30 240.31 240.32 241.1 241.2 241.3 241.4 241.5 241.6 241.7 241.8 241.9 241.10 241.11 241.12 241.13 241.14 241.15 241.16 241.17 241.18 241.19 241.20 241.21
241.22 241.23 241.24 241.25 241.26 241.27 241.28 241.29 241.30 241.31 242.1 242.2 242.3 242.4 242.5 242.6 242.7 242.8 242.9 242.10 242.11 242.12 242.13 242.14 242.15
242.16 242.17 242.18 242.19 242.20 242.21 242.22 242.23 242.24
242.25 242.26 242.27 242.28 242.29 242.30 242.31
243.1 243.2 243.3 243.4 243.5 243.6 243.7 243.8 243.9 243.10 243.11 243.12 243.13 243.14 243.15
243.16 243.17 243.18 243.19
243.20 243.21 243.22 243.23 243.24 243.25
243.26 243.27 243.28
244.1 244.2 244.3 244.4 244.5
244.6 244.7 244.8 244.9 244.10
244.11 244.12 244.13 244.14 244.15
244.16 244.17 244.18 244.19
244.20 244.21 244.22 244.23 244.24 244.25 244.26 244.27 244.28 244.29 245.1 245.2 245.3 245.4 245.5 245.6 245.7 245.8 245.9 245.10 245.11 245.12
245.13 245.14 245.15 245.16 245.17 245.18 245.19 245.20 245.21 245.22 245.23 245.24 245.25
245.26 245.27 245.28 245.29 245.30 245.31 246.1 246.2 246.3 246.4 246.5 246.6 246.7 246.8 246.9 246.10 246.11 246.12 246.13 246.14 246.15 246.16 246.17 246.18 246.19 246.20 246.21 246.22 246.23 246.24 246.25 246.26
246.27 246.28 246.29 246.30 246.31 247.1 247.2 247.3 247.4 247.5 247.6
247.7 247.8 247.9 247.10
247.11 247.12 247.13 247.14 247.15 247.16 247.17
247.18 247.19 247.20 247.21 247.22 247.23 247.24 247.25 247.26 247.27 247.28 247.29 247.30 247.31 248.1 248.2 248.3 248.4 248.5 248.6 248.7 248.8 248.9 248.10 248.11 248.12
248.13 248.14 248.15 248.16 248.17 248.18 248.19 248.20 248.21 248.22 248.23 248.24 248.25 248.26 248.27 248.28 248.29 248.30 248.31 249.1 249.2 249.3
249.4 249.5 249.6 249.7 249.8 249.9 249.10 249.11 249.12 249.13 249.14 249.15 249.16 249.17
249.18 249.19 249.20 249.21 249.22
249.23 249.24 249.25 249.26 249.27 249.28
250.1 250.2 250.3
250.4 250.5 250.6 250.7 250.8 250.9 250.10 250.11 250.12 250.13
250.14 250.15 250.16 250.17
250.18 250.19 250.20 250.21 250.22 250.23 250.24 250.25 250.26 250.27 250.28 250.29 251.1 251.2 251.3 251.4 251.5 251.6 251.7 251.8 251.9 251.10 251.11 251.12 251.13 251.14 251.15 251.16 251.17 251.18 251.19 251.20 251.21 251.22 251.23 251.24 251.25 251.26 251.27 251.28 251.29 251.30 251.31 251.32 252.1 252.2 252.3 252.4 252.5 252.6 252.7 252.8 252.9 252.10
252.11 252.12 252.13 252.14 252.15 252.16 252.17 252.18 252.19 252.20 252.21 252.22 252.23 252.24 252.25 252.26 252.27 252.28 252.29
253.1 253.2 253.3 253.4 253.5 253.6
253.7 253.8 253.9 253.10 253.11 253.12 253.13 253.14 253.15 253.16 253.17 253.18 253.19 253.20 253.21 253.22 253.23 253.24 253.25 253.26 253.27 253.28 253.29 253.30 254.1 254.2 254.3 254.4
254.5 254.6 254.7 254.8 254.9 254.10 254.11 254.12 254.13 254.14 254.15 254.16 254.17 254.18 254.19 254.20 254.21 254.22 254.23 254.24 254.25 254.26 254.27 254.28
254.29 254.30 254.31 254.32 255.1 255.2 255.3 255.4 255.5 255.6 255.7
255.8 255.9 255.10 255.11 255.12 255.13 255.14 255.15 255.16 255.17 255.18 255.19 255.20 255.21 255.22 255.23 255.24 255.25 255.26 255.27 255.28 255.29 255.30 255.31 255.32 256.1 256.2 256.3 256.4 256.5 256.6 256.7
256.8 256.9 256.10 256.11 256.12 256.13 256.14 256.15 256.16 256.17 256.18 256.19 256.20 256.21 256.22 256.23 256.24 256.25 256.26 256.27 256.28 256.29 256.30 256.31 256.32 256.33 256.34 257.1 257.2 257.3 257.4 257.5 257.6 257.7 257.8 257.9 257.10 257.11 257.12 257.13 257.14 257.15 257.16 257.17 257.18 257.19 257.20 257.21 257.22 257.23 257.24 257.25 257.26 257.27 257.28 257.29 257.30 257.31 257.32 257.33 257.34 258.1 258.2 258.3 258.4 258.5 258.6 258.7 258.8 258.9 258.10 258.11 258.12 258.13 258.14 258.15 258.16 258.17 258.18 258.19 258.20 258.21 258.22 258.23 258.24 258.25 258.26 258.27 258.28 258.29 258.30 258.31 258.32 258.33 258.34 259.1 259.2 259.3 259.4 259.5 259.6 259.7 259.8 259.9 259.10 259.11 259.12 259.13 259.14 259.15 259.16 259.17 259.18 259.19 259.20 259.21 259.22 259.23 259.24 259.25 259.26 259.27 259.28
259.29 259.30 259.31 259.32 259.33 260.1 260.2 260.3 260.4 260.5 260.6 260.7 260.8 260.9 260.10 260.11 260.12 260.13 260.14 260.15 260.16 260.17 260.18 260.19 260.20 260.21 260.22 260.23 260.24 260.25 260.26 260.27 260.28 260.29 260.30 260.31 261.1 261.2 261.3 261.4 261.5 261.6 261.7 261.8 261.9 261.10 261.11 261.12 261.13 261.14 261.15 261.16 261.17 261.18
261.19
261.20 261.21 261.22 261.23 261.24 261.25 261.26 261.27 261.28 261.29 261.30 261.31 261.32 261.33 262.1 262.2 262.3 262.4 262.5 262.6 262.7 262.8 262.9 262.10 262.11 262.12 262.13 262.14 262.15 262.16 262.17 262.18 262.19 262.20 262.21 262.22 262.23 262.24 262.25 262.26 262.27 262.28 262.29 262.30 262.31 262.32 262.33 263.1 263.2 263.3 263.4 263.5 263.6 263.7 263.8 263.9 263.10 263.11 263.12 263.13 263.14 263.15 263.16 263.17 263.18 263.19 263.20 263.21 263.22 263.23 263.24 263.25 263.26 263.27 263.28 263.29 263.30 263.31 263.32 264.1 264.2 264.3 264.4 264.5 264.6 264.7 264.8 264.9 264.10 264.11 264.12 264.13 264.14 264.15 264.16 264.17 264.18 264.19 264.20 264.21 264.22 264.23
264.24
264.25 264.26 264.27 264.28 264.29 264.30 264.31 264.32 265.1 265.2 265.3 265.4 265.5 265.6 265.7 265.8 265.9 265.10 265.11 265.12 265.13
265.14
265.15 265.16 265.17 265.18 265.19 265.20 265.21 265.22 265.23 265.24 265.25 265.26 265.27 265.28 265.29 265.30 266.1 266.2 266.3 266.4 266.5 266.6 266.7 266.8 266.9 266.10 266.11 266.12 266.13 266.14 266.15 266.16 266.17 266.18 266.19 266.20 266.21 266.22 266.23
266.24 266.25 266.26 266.27 266.28 266.29
266.30
267.1 267.2 267.3 267.4 267.5 267.6 267.7 267.8 267.9 267.10 267.11 267.12 267.13 267.14 267.15 267.16 267.17 267.18 267.19 267.20 267.21 267.22 267.23 267.24 267.25 267.26 267.27 267.28 267.29 267.30 267.31 267.32 268.1 268.2
268.3 268.4 268.5 268.6 268.7 268.8 268.9 268.10 268.11 268.12 268.13 268.14 268.15 268.16 268.17 268.18 268.19 268.20 268.21 268.22 268.23 268.24 268.25 268.26 268.27 268.28 268.29 268.30 268.31 268.32 269.1 269.2 269.3 269.4 269.5 269.6 269.7 269.8 269.9 269.10 269.11 269.12 269.13 269.14 269.15 269.16 269.17 269.18 269.19 269.20 269.21 269.22 269.23 269.24 269.25 269.26 269.27 269.28 269.29
269.30 269.31 269.32 270.1 270.2 270.3 270.4 270.5 270.6 270.7 270.8 270.9 270.10 270.11 270.12 270.13 270.14 270.15 270.16 270.17 270.18 270.19 270.20 270.21
270.22 270.23 270.24 270.25 270.26 270.27 270.28 270.29 270.30 271.1 271.2 271.3 271.4 271.5 271.6 271.7 271.8 271.9 271.10 271.11 271.12 271.13 271.14 271.15 271.16 271.17 271.18 271.19 271.20 271.21 271.22 271.23 271.24 271.25 271.26 271.27 271.28
271.29 271.30 271.31 271.32 272.1 272.2 272.3 272.4 272.5 272.6 272.7 272.8 272.9 272.10
272.11
272.12 272.13 272.14 272.15 272.16 272.17 272.18 272.19 272.20 272.21 272.22 272.23
272.24 272.25 272.26 272.27 272.28 272.29 272.30 272.31 273.1 273.2 273.3 273.4 273.5 273.6 273.7 273.8 273.9 273.10 273.11 273.12 273.13 273.14 273.15 273.16 273.17 273.18 273.19 273.20 273.21 273.22 273.23 273.24 273.25 273.26 273.27 273.28 273.29 273.30
274.1 274.2 274.3 274.4 274.5 274.6 274.7 274.8 274.9 274.10 274.11 274.12 274.13 274.14 274.15 274.16 274.17 274.18 274.19 274.20 274.21 274.22 274.23 274.24 274.25 274.26 274.27 274.28 274.29 274.30 274.31 275.1 275.2 275.3 275.4 275.5 275.6 275.7 275.8 275.9 275.10 275.11 275.12 275.13 275.14 275.15 275.16 275.17 275.18 275.19 275.20 275.21 275.22 275.23 275.24 275.25 275.26 275.27 275.28 275.29 275.30 275.31 275.32 275.33 276.1 276.2 276.3 276.4 276.5 276.6 276.7 276.8 276.9 276.10 276.11 276.12 276.13 276.14 276.15 276.16 276.17 276.18 276.19 276.20 276.21 276.22 276.23 276.24 276.25 276.26 276.27 276.28 276.29 276.30 276.31 277.1 277.2 277.3 277.4 277.5 277.6 277.7 277.8 277.9 277.10 277.11 277.12 277.13 277.14 277.15 277.16 277.17 277.18 277.19 277.20 277.21 277.22 277.23 277.24 277.25 277.26 277.27 277.28 277.29 277.30 277.31 277.32 278.1 278.2 278.3 278.4 278.5 278.6 278.7 278.8 278.9 278.10 278.11 278.12 278.13 278.14 278.15 278.16 278.17 278.18 278.19 278.20 278.21 278.22 278.23 278.24 278.25 278.26 278.27 278.28 278.29 278.30 278.31 279.1 279.2 279.3 279.4 279.5
279.6 279.7 279.8 279.9 279.10 279.11 279.12 279.13 279.14 279.15 279.16 279.17 279.18 279.19 279.20 279.21 279.22 279.23 279.24 279.25 279.26 279.27 279.28 279.29 279.30 279.31 280.1 280.2
280.3 280.4 280.5 280.6 280.7 280.8 280.9 280.10 280.11 280.12 280.13 280.14 280.15 280.16 280.17 280.18 280.19
280.20 280.21 280.22 280.23 280.24 280.25 280.26 280.27 280.28 280.29 280.30 280.31 280.32 281.1 281.2 281.3 281.4 281.5 281.6 281.7 281.8 281.9 281.10 281.11 281.12 281.13 281.14 281.15 281.16 281.17 281.18 281.19 281.20 281.21 281.22 281.23 281.24
281.25 281.26 281.27 281.28 281.29
281.30 281.31 281.32 282.1 282.2 282.3 282.4 282.5 282.6 282.7 282.8 282.9 282.10 282.11 282.12 282.13 282.14 282.15 282.16 282.17 282.18 282.19 282.20 282.21 282.22 282.23 282.24 282.25 282.26 282.27 282.28 282.29 283.1 283.2 283.3 283.4 283.5 283.6 283.7 283.8 283.9 283.10 283.11 283.12 283.13 283.14 283.15 283.16 283.17 283.18 283.19 283.20 283.21 283.22 283.23 283.24 283.25 283.26 283.27 283.28 283.29 283.30 283.31 283.32 284.1 284.2 284.3 284.4 284.5 284.6 284.7 284.8 284.9 284.10 284.11 284.12 284.13
284.14 284.15 284.16 284.17 284.18 284.19 284.20 284.21 284.22 284.23 284.24 284.25 284.26 284.27 284.28 284.29 284.30 284.31 284.32 285.1 285.2 285.3 285.4 285.5 285.6 285.7 285.8 285.9 285.10 285.11 285.12 285.13 285.14 285.15 285.16 285.17 285.18 285.19 285.20 285.21 285.22 285.23 285.24 285.25 285.26 285.27 285.28 285.29 285.30 285.31 285.32 286.1 286.2 286.3
286.4 286.5 286.6 286.7 286.8
286.9 286.10
286.11 286.12 286.13 286.14 286.15 286.16 286.17 286.18 286.19 286.20 286.21 286.22 286.23 286.24 286.25 286.26 286.27 286.28 286.29 286.30 286.31 287.1 287.2
287.3 287.4 287.5 287.6 287.7 287.8 287.9 287.10 287.11 287.12 287.13 287.14 287.15 287.16 287.17 287.18 287.19 287.20 287.21
287.22 287.23 287.24 287.25 287.26 287.27 287.28 287.29 287.30 287.31 287.32 288.1 288.2 288.3 288.4 288.5 288.6 288.7 288.8 288.9 288.10 288.11 288.12 288.13 288.14 288.15 288.16 288.17 288.18 288.19 288.20 288.21 288.22 288.23 288.24 288.25 288.26 288.27 288.28 288.29 288.30 288.31 288.32
289.1 289.2 289.3 289.4 289.5 289.6 289.7 289.8 289.9 289.10 289.11 289.12 289.13 289.14 289.15 289.16 289.17 289.18 289.19 289.20 289.21 289.22 289.23 289.24 289.25 289.26 289.27 289.28 289.29 289.30 289.31 289.32 290.1 290.2 290.3 290.4 290.5 290.6 290.7 290.8
290.9 290.10 290.11 290.12 290.13 290.14 290.15 290.16
290.17 290.18 290.19 290.20 290.21 290.22 290.23 290.24 290.25 290.26 290.27 290.28 290.29 290.30 290.31 290.32 291.1 291.2 291.3 291.4 291.5 291.6 291.7 291.8 291.9 291.10 291.11 291.12 291.13 291.14 291.15 291.16 291.17 291.18 291.19 291.20 291.21 291.22 291.23 291.24 291.25 291.26 291.27 291.28 291.29 291.30 291.31 292.1 292.2 292.3 292.4 292.5 292.6 292.7 292.8 292.9 292.10 292.11 292.12 292.13 292.14 292.15 292.16 292.17 292.18 292.19 292.20 292.21 292.22 292.23 292.24 292.25 292.26 292.27 292.28 292.29 292.30 292.31 293.1 293.2 293.3 293.4 293.5 293.6 293.7 293.8 293.9 293.10 293.11 293.12 293.13 293.14 293.15 293.16 293.17 293.18 293.19 293.20 293.21 293.22 293.23 293.24 293.25 293.26 293.27 293.28 293.29 293.30 293.31 293.32 293.33 294.1 294.2 294.3 294.4 294.5 294.6 294.7 294.8 294.9 294.10 294.11 294.12 294.13 294.14 294.15 294.16 294.17 294.18 294.19 294.20 294.21 294.22 294.23 294.24
294.25 294.26 294.27 294.28 294.29 294.30 294.31 295.1 295.2 295.3 295.4 295.5 295.6 295.7 295.8 295.9 295.10 295.11 295.12 295.13 295.14 295.15 295.16 295.17 295.18 295.19 295.20 295.21 295.22 295.23 295.24 295.25 295.26 295.27 295.28 295.29 295.30 295.31 296.1 296.2 296.3 296.4 296.5 296.6 296.7 296.8 296.9 296.10 296.11 296.12 296.13 296.14 296.15 296.16 296.17
296.18 296.19 296.20 296.21 296.22 296.23 296.24 296.25 296.26 296.27 296.28 296.29
297.1 297.2 297.3 297.4 297.5 297.6 297.7 297.8 297.9 297.10 297.11 297.12 297.13 297.14 297.15 297.16 297.17 297.18 297.19 297.20 297.21 297.22 297.23 297.24 297.25 297.26 297.27
297.28 297.29
297.30 297.31 297.32 298.1 298.2 298.3 298.4 298.5 298.6 298.7 298.8 298.9 298.10 298.11 298.12 298.13 298.14 298.15 298.16 298.17 298.18 298.19 298.20 298.21 298.22 298.23 298.24 298.25 298.26 298.27
298.28 298.29 298.30 298.31 298.32 298.33 299.1 299.2 299.3 299.4 299.5 299.6 299.7 299.8 299.9 299.10 299.11 299.12 299.13 299.14 299.15 299.16 299.17 299.18 299.19 299.20 299.21 299.22 299.23 299.24 299.25 299.26 299.27 299.28 299.29 299.30 299.31 299.32 299.33 300.1 300.2 300.3 300.4 300.5 300.6 300.7 300.8
300.9 300.10 300.11 300.12 300.13 300.14 300.15 300.16 300.17 300.18 300.19 300.20 300.21 300.22 300.23 300.24 300.25 300.26 300.27 300.28 300.29 300.30 300.31 300.32 300.33 301.1 301.2 301.3 301.4 301.5 301.6 301.7 301.8 301.9 301.10 301.11 301.12 301.13 301.14 301.15 301.16 301.17 301.18 301.19 301.20 301.21 301.22 301.23 301.24 301.25 301.26 301.27 301.28 301.29 301.30 301.31 301.32 301.33 301.34 301.35 302.1 302.2 302.3 302.4 302.5 302.6 302.7 302.8 302.9 302.10 302.11 302.12
302.13 302.14 302.15 302.16 302.17 302.18 302.19 302.20 302.21 302.22 302.23 302.24 302.25 302.26 302.27 302.28 302.29 302.30 302.31 303.1 303.2 303.3
303.4 303.5 303.6 303.7 303.8 303.9 303.10 303.11
303.12 303.13 303.14 303.15 303.16 303.17 303.18 303.19 303.20 303.21 303.22 303.23 303.24 303.25 303.26 303.27
304.1 304.2 304.3 304.4 304.5 304.6 304.7 304.8 304.9 304.10 304.11 304.12 304.13 304.14 304.15 304.16 304.17 304.18 304.19 304.20 304.21 304.22 304.23 304.24 304.25 304.26 304.27 304.28 304.29 304.30 304.31 304.32 305.1 305.2 305.3 305.4 305.5 305.6 305.7 305.8 305.9 305.10 305.11 305.12 305.13 305.14 305.15 305.16 305.17 305.18 305.19 305.20 305.21 305.22 305.23 305.24 305.25 305.26 305.27 305.28 305.29 305.30 305.31 306.1 306.2 306.3 306.4 306.5 306.6 306.7 306.8 306.9 306.10 306.11 306.12 306.13 306.14 306.15 306.16 306.17 306.18 306.19 306.20 306.21 306.22 306.23 306.24 306.25 306.26 306.27 306.28 306.29 306.30 306.31 306.32 306.33 306.34 306.35 307.1 307.2 307.3 307.4 307.5 307.6 307.7 307.8 307.9 307.10 307.11 307.12 307.13 307.14 307.15 307.16 307.17 307.18 307.19 307.20 307.21 307.22 307.23 307.24 307.25 307.26 307.27 307.28 307.29 307.30
308.1 308.2 308.3 308.4 308.5 308.6 308.7 308.8 308.9 308.10 308.11 308.12 308.13 308.14 308.15 308.16 308.17 308.18 308.19 308.20 308.21 308.22 308.23 308.24 308.25 308.26 308.27 308.28 308.29 308.30 308.31 308.32 308.33 308.34 308.35 309.1 309.2 309.3 309.4 309.5 309.6 309.7 309.8 309.9 309.10 309.11 309.12 309.13 309.14 309.15 309.16 309.17 309.18 309.19 309.20 309.21 309.22 309.23 309.24
309.25 309.26 309.27 309.28 309.29 309.30 309.31 309.32 310.1 310.2 310.3 310.4 310.5 310.6 310.7
310.8 310.9 310.10
310.11 310.12
310.13 310.14 310.15
310.16 310.17 310.18 310.19 310.20 310.21 310.22 310.23 310.24 310.25 310.26
310.27 310.28 310.29 310.30 311.1 311.2 311.3 311.4 311.5 311.6 311.7 311.8 311.9 311.10 311.11 311.12 311.13 311.14 311.15 311.16 311.17 311.18 311.19 311.20 311.21
311.22 311.23 311.24 311.25 311.26 311.27 311.28 311.29 311.30 311.31 312.1 312.2 312.3 312.4 312.5 312.6 312.7 312.8 312.9 312.10 312.11 312.12 312.13 312.14 312.15 312.16 312.17 312.18 312.19 312.20 312.21 312.22 312.23 312.24 312.25 312.26 312.27 312.28 312.29 312.30 312.31 312.32 313.1 313.2 313.3 313.4 313.5 313.6 313.7
313.8 313.9 313.10 313.11 313.12 313.13 313.14 313.15 313.16 313.17 313.18 313.19 313.20 313.21 313.22 313.23 313.24 313.25 313.26 313.27 313.28 313.29
313.30 313.31 313.32 313.33 314.1 314.2 314.3 314.4 314.5 314.6 314.7 314.8 314.9 314.10
314.11 314.12 314.13 314.14 314.15 314.16 314.17 314.18 314.19 314.20 314.21 314.22 314.23 314.24 314.25 314.26
314.27 314.28 314.29 314.30
315.1 315.2 315.3 315.4 315.5 315.6 315.7 315.8 315.9 315.10 315.11 315.12 315.13 315.14 315.15 315.16 315.17 315.18 315.19 315.20 315.21 315.22 315.23 315.24 315.25 315.26 315.27 315.28 315.29 315.30 315.31 315.32 315.33 316.1 316.2 316.3 316.4 316.5 316.6 316.7 316.8 316.9 316.10 316.11 316.12 316.13 316.14 316.15 316.16 316.17 316.18 316.19 316.20 316.21 316.22 316.23 316.24 316.25
316.26 316.27 316.28 316.29 316.30 316.31 316.32 317.1 317.2 317.3 317.4 317.5 317.6 317.7 317.8 317.9 317.10 317.11 317.12 317.13 317.14 317.15 317.16 317.17 317.18 317.19 317.20 317.21 317.22 317.23 317.24 317.25 317.26 317.27 317.28 317.29 317.30 317.31 317.32 317.33 318.1 318.2
318.3 318.4 318.5 318.6 318.7 318.8 318.9 318.10 318.11 318.12 318.13 318.14 318.15 318.16 318.17 318.18 318.19 318.20 318.21 318.22 318.23 318.24 318.25 318.26 318.27 318.28 318.29 318.30 318.31 318.32 318.33 319.1 319.2 319.3 319.4 319.5 319.6 319.7 319.8 319.9 319.10 319.11 319.12 319.13 319.14 319.15 319.16 319.17 319.18 319.19 319.20 319.21 319.22 319.23 319.24 319.25 319.26 319.27 319.28 319.29 319.30 319.31 320.1 320.2 320.3 320.4 320.5 320.6 320.7 320.8
320.9 320.10 320.11 320.12 320.13 320.14 320.15 320.16 320.17 320.18 320.19 320.20 320.21 320.22 320.23 320.24 320.25 320.26 320.27 320.28
321.1 321.2 321.3 321.4 321.5 321.6 321.7 321.8 321.9 321.10 321.11 321.12 321.13 321.14 321.15 321.16 321.17 321.18
321.19 321.20 321.21 321.22 321.23 321.24 321.25 321.26 321.27 321.28 321.29 321.30 321.31 322.1 322.2 322.3 322.4 322.5 322.6 322.7 322.8 322.9
322.10 322.11 322.12 322.13 322.14 322.15 322.16 322.17 322.18 322.19 322.20 322.21 322.22 322.23 322.24 322.25 322.26
322.27 322.28 322.29
323.1 323.2 323.3 323.4 323.5 323.6 323.7 323.8 323.9 323.10 323.11 323.12 323.13 323.14 323.15 323.16 323.17
323.18 323.19 323.20 323.21 323.22 323.23 323.24 323.25 323.26 323.27 323.28 323.29 323.30
324.1 324.2 324.3 324.4 324.5 324.6 324.7 324.8 324.9 324.10 324.11 324.12 324.13 324.14 324.15 324.16 324.17 324.18 324.19 324.20 324.21 324.22 324.23 324.24 324.25 324.26 324.27 324.28 324.29 324.30 324.31 324.32 325.1 325.2 325.3 325.4 325.5 325.6 325.7 325.8 325.9 325.10 325.11 325.12 325.13 325.14 325.15 325.16 325.17 325.18 325.19 325.20 325.21 325.22 325.23 325.24 325.25
325.26 325.27 325.28 325.29 325.30 325.31 325.32 326.1 326.2 326.3 326.4 326.5 326.6 326.7 326.8 326.9 326.10 326.11 326.12 326.13 326.14 326.15 326.16 326.17
326.18 326.19 326.20 326.21
326.22 326.23 326.24 326.25
326.26 326.27 326.28 326.29 326.30 326.31 327.1 327.2 327.3 327.4 327.5 327.6 327.7 327.8 327.9 327.10 327.11 327.12 327.13 327.14 327.15 327.16 327.17 327.18 327.19 327.20 327.21 327.22 327.23 327.24 327.25 327.26 327.27 327.28 327.29 327.30 327.31 327.32 327.33 328.1 328.2 328.3 328.4 328.5 328.6 328.7 328.8 328.9 328.10 328.11 328.12 328.13 328.14 328.15 328.16 328.17 328.18 328.19 328.20 328.21 328.22 328.23 328.24 328.25 328.26 328.27 328.28 328.29 328.30 328.31 328.32 328.33 329.1 329.2 329.3 329.4 329.5 329.6 329.7 329.8 329.9 329.10 329.11 329.12 329.13 329.14 329.15 329.16 329.17 329.18 329.19 329.20 329.21 329.22 329.23 329.24 329.25 329.26 329.27 329.28 329.29 329.30 329.31 330.1 330.2 330.3 330.4 330.5 330.6
330.7 330.8 330.9 330.10 330.11 330.12 330.13 330.14 330.15 330.16 330.17 330.18 330.19 330.20 330.21 330.22 330.23 330.24 330.25 330.26 330.27 330.28 330.29 331.1 331.2
331.3 331.4
331.5 331.6 331.7 331.8 331.9 331.10 331.11 331.12 331.13 331.14 331.15 331.16 331.17 331.18 331.19 331.20 331.21 331.22 331.23 331.24 331.25 331.26 331.27
332.1 332.2 332.3 332.4 332.5 332.6
332.7 332.8 332.9 332.10 332.11 332.12 332.13 332.14 332.15 332.16 332.17 332.18 332.19 332.20 332.21 332.22 332.23
332.24 332.25 332.26 332.27 332.28 332.29 332.30 333.1 333.2 333.3 333.4 333.5 333.6 333.7 333.8 333.9 333.10 333.11 333.12 333.13 333.14 333.15 333.16 333.17 333.18 333.19 333.20 333.21 333.22 333.23 333.24 333.25 333.26 333.27 333.28 333.29 333.30 333.31 334.1 334.2 334.3 334.4 334.5 334.6 334.7 334.8 334.9 334.10 334.11 334.12 334.13 334.14 334.15 334.16 334.17 334.18 334.19 334.20 334.21 334.22 334.23 334.24 334.25 334.26 334.27 334.28 334.29 334.30 334.31 334.32 335.1 335.2 335.3 335.4 335.5 335.6 335.7 335.8 335.9 335.10 335.11 335.12 335.13 335.14 335.15 335.16 335.17 335.18 335.19 335.20 335.21 335.22 335.23 335.24 335.25 335.26 335.27 335.28 335.29 335.30 335.31 335.32 336.1 336.2 336.3 336.4 336.5 336.6 336.7 336.8 336.9 336.10 336.11 336.12 336.13 336.14 336.15 336.16 336.17 336.18 336.19 336.20 336.21 336.22 336.23 336.24 336.25 336.26 336.27 336.28 336.29 336.30 336.31 336.32 337.1 337.2 337.3 337.4 337.5 337.6 337.7 337.8 337.9 337.10 337.11 337.12 337.13 337.14 337.15 337.16 337.17 337.18 337.19 337.20 337.21 337.22 337.23 337.24 337.25 337.26 337.27 337.28 337.29 337.30 337.31 337.32 338.1 338.2 338.3 338.4 338.5 338.6 338.7 338.8 338.9 338.10 338.11 338.12 338.13 338.14 338.15 338.16 338.17 338.18 338.19 338.20 338.21 338.22 338.23 338.24 338.25 338.26 338.27 338.28 338.29 338.30 338.31 338.32 338.33 338.34 339.1 339.2 339.3 339.4 339.5 339.6 339.7 339.8 339.9 339.10 339.11 339.12 339.13 339.14 339.15 339.16 339.17 339.18 339.19 339.20 339.21 339.22 339.23 339.24 339.25 339.26 339.27 339.28 339.29 339.30 339.31 340.1 340.2 340.3 340.4 340.5 340.6 340.7 340.8 340.9 340.10 340.11 340.12 340.13 340.14 340.15 340.16 340.17 340.18 340.19 340.20 340.21 340.22 340.23 340.24 340.25 340.26 340.27 340.28 340.29 340.30 340.31 340.32 341.1 341.2 341.3 341.4 341.5 341.6 341.7 341.8 341.9 341.10 341.11 341.12 341.13 341.14 341.15 341.16 341.17 341.18 341.19 341.20 341.21 341.22 341.23 341.24 341.25 341.26 341.27 341.28 341.29 341.30 341.31 341.32 341.33 342.1 342.2 342.3 342.4 342.5 342.6 342.7 342.8
342.9 342.10 342.11 342.12 342.13 342.14 342.15 342.16 342.17 342.18 342.19 342.20 342.21 342.22
342.23 342.24 342.25 342.26
342.27 342.28 342.29 342.30 342.31 343.1 343.2 343.3 343.4 343.5 343.6 343.7 343.8
343.9 343.10
343.11 343.12
343.13 343.14 343.15 343.16
343.17 343.18 343.19 343.20
343.21 343.22 343.23 343.24 343.25 343.26 343.27 343.28 343.29 343.30 344.1 344.2 344.3 344.4 344.5 344.6 344.7 344.8 344.9
344.10 344.11 344.12 344.13 344.14 344.15 344.16 344.17 344.18 344.19 344.20 344.21 344.22 344.23 344.24 344.25 344.26 344.27 344.28 344.29 344.30 345.1 345.2 345.3 345.4 345.5 345.6 345.7 345.8 345.9 345.10 345.11 345.12 345.13 345.14 345.15 345.16 345.17 345.18 345.19 345.20 345.21 345.22 345.23 345.24 345.25 345.26 345.27 345.28
346.1 346.2 346.3 346.4 346.5 346.6 346.7 346.8 346.9 346.10 346.11 346.12 346.13 346.14 346.15 346.16 346.17 346.18 346.19 346.20 346.21 346.22 346.23 346.24 346.25 346.26 346.27 346.28 346.29 346.30 347.1 347.2 347.3 347.4 347.5 347.6 347.7 347.8 347.9 347.10 347.11 347.12 347.13 347.14 347.15
347.16 347.17 347.18 347.19 347.20 347.21 347.22 347.23 347.24 347.25 347.26 347.27 347.28 347.29 347.30 347.31 348.1 348.2 348.3 348.4 348.5 348.6 348.7 348.8 348.9 348.10 348.11 348.12 348.13 348.14 348.15
348.16 348.17 348.18 348.19 348.20 348.21 348.22 348.23 348.24 348.25 348.26 348.27 348.28 348.29 348.30 348.31 349.1 349.2 349.3 349.4 349.5 349.6 349.7 349.8 349.9 349.10 349.11 349.12
349.13 349.14 349.15 349.16 349.17 349.18 349.19 349.20 349.21 349.22 349.23 349.24 349.25 349.26 349.27 349.28 349.29 349.30 349.31 349.32 350.1 350.2 350.3 350.4 350.5 350.6 350.7 350.8 350.9 350.10 350.11 350.12 350.13 350.14 350.15 350.16 350.17 350.18 350.19 350.20 350.21 350.22 350.23 350.24 350.25 350.26 350.27 350.28 350.29 350.30 350.31 350.32 350.33 350.34 351.1 351.2 351.3 351.4 351.5 351.6 351.7
351.8 351.9 351.10 351.11 351.12 351.13 351.14 351.15
351.16 351.17 351.18 351.19 351.20 351.21
351.22 351.23 351.24 351.25 351.26 351.27 351.28 351.29
352.1 352.2 352.3 352.4 352.5 352.6 352.7
352.8 352.9 352.10 352.11 352.12 352.13 352.14 352.15
352.16 352.17 352.18 352.19 352.20 352.21 352.22
352.23 352.24 352.25 352.26 352.27 352.28
352.29 352.30 352.31 353.1 353.2 353.3 353.4
353.5 353.6 353.7 353.8 353.9 353.10 353.11 353.12 353.13
353.14 353.15 353.16 353.17 353.18 353.19 353.20 353.21
353.22 353.23 353.24 353.25 353.26 353.27 353.28 353.29
354.1 354.2 354.3 354.4 354.5
354.6 354.7 354.8 354.9 354.10 354.11 354.12
354.13 354.14 354.15 354.16 354.17 354.18
354.19 354.20 354.21 354.22 354.23
354.24 354.25 354.26 354.27 354.28 354.29 354.30 354.31 355.1 355.2 355.3 355.4 355.5 355.6 355.7 355.8 355.9
355.10 355.11 355.12 355.13 355.14 355.15
355.16 355.17 355.18 355.19 355.20 355.21 355.22
355.23 355.24 355.25 355.26 355.27 355.28
356.1 356.2 356.3 356.4 356.5
356.6 356.7 356.8 356.9 356.10 356.11 356.12 356.13 356.14
356.15
356.16 356.17 356.18 356.19 356.20 356.21 356.22 356.23 356.24 356.25 356.26 356.27 356.28 356.29 356.30 356.31
357.1 357.2 357.3 357.4 357.5 357.6 357.7 357.8 357.9 357.10 357.11 357.12 357.13 357.14 357.15 357.16 357.17 357.18 357.19 357.20 357.21 357.22 357.23 357.24 357.25 357.26 357.27 357.28 357.29 357.30 357.31 357.32 358.1 358.2 358.3 358.4 358.5 358.6 358.7 358.8 358.9 358.10 358.11 358.12 358.13 358.14 358.15 358.16 358.17 358.18 358.19 358.20 358.21 358.22 358.23 358.24 358.25 358.26 358.27 358.28 358.29 358.30 358.31 358.32 358.33 359.1 359.2 359.3 359.4 359.5 359.6 359.7 359.8 359.9 359.10 359.11 359.12 359.13 359.14 359.15 359.16 359.17 359.18 359.19 359.20 359.21 359.22 359.23 359.24 359.25 359.26 359.27 359.28 359.29 359.30 359.31 359.32 359.33 359.34 359.35 360.1 360.2 360.3 360.4 360.5 360.6 360.7 360.8 360.9 360.10 360.11 360.12 360.13 360.14 360.15 360.16 360.17 360.18 360.19 360.20 360.21 360.22 360.23 360.24 360.25 360.26 360.27 360.28 360.29 360.30 361.1 361.2 361.3 361.4 361.5 361.6 361.7 361.8 361.9 361.10 361.11 361.12 361.13 361.14 361.15 361.16 361.17 361.18 361.19 361.20 361.21 361.22 361.23 361.24 361.25 361.26 361.27 361.28 361.29 361.30
362.1 362.2 362.3
362.4 362.5
362.6 362.7 362.8 362.9 362.10 362.11 362.12 362.13 362.14
362.15 362.16 362.17 362.18 362.19 362.20 362.21 362.22 362.23
362.24 362.25 362.26 362.27 362.28 362.29 362.30 363.1 363.2
363.3 363.4 363.5 363.6 363.7 363.8 363.9 363.10 363.11
363.12 363.13 363.14 363.15 363.16 363.17 363.18 363.19 363.20 363.21 363.22 363.23 363.24 363.25 363.26 363.27 363.28 363.29 363.30 363.31 364.1 364.2 364.3 364.4 364.5 364.6 364.7 364.8 364.9 364.10 364.11 364.12 364.13 364.14 364.15 364.16 364.17 364.18 364.19 364.20
364.21 364.22 364.23 364.24 364.25 364.26 364.27 364.28 364.29 364.30 364.31 364.32 365.1 365.2 365.3 365.4 365.5 365.6 365.7 365.8 365.9 365.10 365.11 365.12 365.13 365.14 365.15 365.16 365.17 365.18 365.19 365.20 365.21 365.22 365.23 365.24 365.25 365.26 365.27 365.28 365.29 365.30 365.31 366.1 366.2 366.3 366.4 366.5 366.6 366.7 366.8 366.9 366.10 366.11 366.12 366.13 366.14 366.15 366.16 366.17 366.18 366.19 366.20 366.21 366.22 366.23 366.24 366.25 366.26 366.27 366.28 366.29 366.30 366.31 366.32 366.33 367.1 367.2 367.3 367.4 367.5 367.6 367.7 367.8 367.9 367.10 367.11 367.12 367.13 367.14 367.15 367.16 367.17 367.18 367.19 367.20 367.21 367.22 367.23 367.24 367.25 367.26 367.27 367.28 367.29 367.30 368.1 368.2 368.3 368.4 368.5 368.6 368.7 368.8 368.9 368.10 368.11 368.12 368.13 368.14 368.15 368.16 368.17 368.18 368.19 368.20 368.21 368.22 368.23 368.24 368.25 368.26 368.27 368.28 368.29 368.30 368.31
368.32 368.33
369.1 369.2 369.3 369.4 369.5 369.6 369.7 369.8 369.9 369.10 369.11 369.12 369.13 369.14
369.15 369.16 369.17 369.18 369.19 369.20 369.21
369.22 369.23 369.24 369.25 369.26 369.27 369.28 369.29 369.30 369.31 370.1 370.2
370.3 370.4 370.5 370.6 370.7 370.8 370.9 370.10 370.11 370.12 370.13
370.14 370.15 370.16
370.17 370.18 370.19 370.20 370.21 370.22 370.23 370.24 370.25 370.26 370.27 370.28 370.29
371.1 371.2 371.3 371.4 371.5 371.6 371.7
371.8 371.9 371.10 371.11 371.12 371.13 371.14 371.15 371.16
371.17 371.18 371.19 371.20 371.21 371.22 371.23 371.24 371.25 371.26 371.27 371.28 371.29 371.30 372.1 372.2 372.3 372.4 372.5 372.6 372.7 372.8 372.9 372.10 372.11 372.12 372.13 372.14 372.15 372.16 372.17 372.18 372.19 372.20 372.21 372.22
372.23 372.24 372.25 372.26 372.27 372.28 372.29 372.30 373.1 373.2 373.3 373.4 373.5 373.6 373.7 373.8 373.9
373.10 373.11 373.12 373.13 373.14 373.15 373.16 373.17 373.18 373.19 373.20 373.21 373.22 373.23 373.24 373.25 373.26 373.27 373.28 373.29 373.30 374.1 374.2 374.3 374.4 374.5
374.6 374.7 374.8 374.9
374.10 374.11 374.12 374.13 374.14 374.15 374.16 374.17 374.18 374.19 374.20 374.21 374.22 374.23 374.24 374.25 374.26 374.27 374.28 374.29 374.30 374.31 374.32 375.1 375.2 375.3 375.4
375.5 375.6
375.7 375.8 375.9 375.10 375.11 375.12 375.13 375.14 375.15 375.16 375.17 375.18 375.19 375.20 375.21 375.22 375.23 375.24 375.25 375.26 375.27 375.28
375.29 375.30 375.31 375.32 376.1 376.2
376.3 376.4 376.5 376.6 376.7 376.8 376.9 376.10 376.11 376.12 376.13 376.14 376.15 376.16 376.17 376.18 376.19 376.20 376.21 376.22 376.23 376.24
376.25 376.26 376.27 376.28 376.29 377.1 377.2 377.3
377.4 377.5 377.6 377.7 377.8 377.9 377.10 377.11 377.12 377.13 377.14 377.15 377.16 377.17 377.18 377.19 377.20 377.21 377.22 377.23 377.24 377.25 377.26 377.27 377.28 377.29 378.1 378.2 378.3 378.4 378.5 378.6 378.7 378.8 378.9 378.10 378.11 378.12 378.13 378.14 378.15 378.16 378.17 378.18 378.19 378.20 378.21 378.22 378.23
378.24 378.25 378.26 378.27 378.28 378.29 379.1 379.2
379.3 379.4 379.5 379.6 379.7 379.8
379.9 379.10 379.11 379.12 379.13 379.14 379.15 379.16 379.17 379.18 379.19 379.20 379.21 379.22 379.23 379.24 379.25 379.26 379.27 379.28 379.29 379.30
380.1 380.2 380.3 380.4 380.5 380.6 380.7 380.8 380.9 380.10 380.11 380.12 380.13 380.14 380.15 380.16 380.17 380.18 380.19 380.20 380.21 380.22 380.23 380.24 380.25 380.26 380.27 380.28 380.29 380.30 380.31 380.32 381.1 381.2 381.3 381.4 381.5 381.6 381.7 381.8 381.9 381.10 381.11 381.12 381.13 381.14 381.15 381.16 381.17 381.18 381.19 381.20 381.21 381.22
381.23 381.24 381.25 381.26 381.27 381.28 381.29 381.30 381.31 381.32 382.1
382.2 382.3 382.4 382.5 382.6 382.7 382.8 382.9 382.10 382.11 382.12 382.13 382.14 382.15 382.16 382.17 382.18 382.19 382.20 382.21 382.22 382.23
382.24 382.25 382.26 382.27 382.28 382.29 383.1 383.2 383.3 383.4 383.5 383.6 383.7 383.8 383.9 383.10 383.11 383.12 383.13 383.14 383.15 383.16 383.17 383.18 383.19 383.20 383.21 383.22 383.23 383.24 383.25 383.26 383.27 383.28 383.29 384.1 384.2 384.3 384.4 384.5 384.6 384.7 384.8 384.9 384.10 384.11 384.12 384.13 384.14 384.15 384.16 384.17 384.18 384.19 384.20 384.21 384.22 384.23 384.24 384.25 384.26 384.27 384.28 384.29 384.30 384.31 384.32 384.33 385.1 385.2 385.3 385.4 385.5
385.6 385.7 385.8 385.9 385.10 385.11 385.12
385.13 385.14 385.15 385.16 385.17 385.18 385.19 385.20 385.21 385.22 385.23 385.24 385.25 385.26 385.27 385.28 385.29 385.30 385.31 386.1 386.2 386.3 386.4 386.5 386.6 386.7 386.8 386.9 386.10 386.11 386.12 386.13 386.14 386.15 386.16 386.17 386.18 386.19 386.20 386.21
386.22 386.23 386.24 386.25 386.26 386.27 386.28 386.29 386.30 386.31 386.32 387.1 387.2 387.3 387.4 387.5 387.6 387.7 387.8 387.9 387.10 387.11
387.12 387.13 387.14 387.15 387.16 387.17 387.18 387.19 387.20 387.21 387.22 387.23 387.24 387.25 387.26 387.27
387.28 387.29 387.30 387.31 388.1 388.2 388.3 388.4 388.5 388.6 388.7 388.8 388.9 388.10 388.11 388.12 388.13
388.14 388.15 388.16 388.17 388.18 388.19 388.20 388.21 388.22 388.23 388.24 388.25 388.26 388.27 388.28 388.29 388.30 388.31
389.1 389.2 389.3 389.4 389.5 389.6 389.7 389.8 389.9 389.10
389.11
389.12 389.13 389.14 389.15 389.16 389.17 389.18 389.19 389.20 389.21 389.22 389.23 389.24 389.25 389.26 389.27 389.28 389.29 389.30 389.31 389.32 390.1 390.2 390.3 390.4 390.5 390.6 390.7 390.8 390.9 390.10 390.11
390.12 390.13
390.14 390.15 390.16 390.17 390.18 390.19 390.20 390.21 390.22 390.23 390.24 390.25 390.26 390.27 390.28 390.29 390.30 391.1 391.2 391.3 391.4 391.5 391.6 391.7 391.8 391.9 391.10 391.11 391.12 391.13 391.14 391.15 391.16 391.17 391.18 391.19 391.20
391.21
391.22 391.23 391.24 391.25 391.26 391.27 391.28 391.29 391.30 392.1 392.2 392.3 392.4
392.5 392.6 392.7 392.8 392.9 392.10 392.11 392.12 392.13 392.14 392.15 392.16 392.17 392.18 392.19 392.20 392.21 392.22 392.23 392.24 392.25 392.26 392.27 392.28 392.29 392.30 392.31
392.32
393.1 393.2 393.3 393.4 393.5 393.6
393.7 393.8
393.9 393.10 393.11 393.12 393.13 393.14
393.15 393.16 393.17 393.18 393.19 393.20 393.21 393.22 393.23 393.24 393.25 393.26 393.27 393.28 393.29 393.30
393.31 393.32
394.1 394.2 394.3 394.4 394.5 394.6 394.7 394.8 394.9 394.10 394.11 394.12 394.13 394.14 394.15 394.16 394.17 394.18 394.19 394.20 394.21 394.22 394.23 394.24 394.25 394.26 394.27 394.28 394.29 394.30 394.31 394.32 395.1 395.2 395.3 395.4 395.5 395.6 395.7 395.8 395.9 395.10 395.11 395.12 395.13 395.14 395.15 395.16 395.17 395.18 395.19 395.20 395.21 395.22 395.23 395.24 395.25 395.26 395.27 395.28 395.29 395.30 395.31 395.32 395.33 396.1 396.2 396.3 396.4 396.5 396.6 396.7 396.8 396.9 396.10 396.11 396.12 396.13 396.14 396.15 396.16 396.17 396.18 396.19 396.20 396.21 396.22 396.23 396.24 396.25 396.26 396.27 396.28 396.29 396.30 396.31 396.32 397.1 397.2 397.3 397.4 397.5 397.6 397.7 397.8 397.9 397.10 397.11 397.12 397.13 397.14 397.15 397.16 397.17 397.18 397.19 397.20 397.21 397.22
397.23 397.24 397.25 397.26 397.27 397.28 397.29 397.30 397.31 398.1 398.2 398.3 398.4 398.5 398.6 398.7 398.8 398.9 398.10 398.11 398.12 398.13 398.14 398.15 398.16 398.17 398.18 398.19 398.20 398.21 398.22 398.23 398.24 398.25 398.26 398.27 398.28 398.29 398.30 398.31 398.32 398.33 399.1 399.2 399.3 399.4 399.5 399.6 399.7 399.8 399.9 399.10 399.11 399.12 399.13 399.14 399.15 399.16 399.17 399.18 399.19 399.20 399.21 399.22 399.23 399.24 399.25 399.26 399.27 399.28 399.29 399.30 399.31 400.1 400.2 400.3 400.4 400.5 400.6 400.7 400.8 400.9 400.10 400.11 400.12 400.13
400.14 400.15 400.16 400.17 400.18 400.19 400.20 400.21 400.22 400.23 400.24 400.25 400.26 400.27 400.28 400.29 400.30 400.31 400.32 400.33 401.1 401.2 401.3 401.4 401.5 401.6 401.7 401.8 401.9 401.10 401.11 401.12 401.13 401.14 401.15
401.16 401.17 401.18 401.19 401.20 401.21 401.22 401.23 401.24 401.25 401.26 401.27 401.28 401.29 401.30 401.31 401.32 401.33 402.1 402.2 402.3 402.4 402.5 402.6 402.7 402.8 402.9 402.10 402.11 402.12 402.13 402.14 402.15 402.16 402.17 402.18 402.19 402.20 402.21 402.22 402.23 402.24 402.25 402.26 402.27 402.28 402.29 402.30 402.31 402.32 402.33 403.1 403.2 403.3 403.4 403.5 403.6 403.7 403.8 403.9 403.10 403.11 403.12 403.13 403.14 403.15 403.16 403.17 403.18 403.19 403.20 403.21 403.22 403.23 403.24 403.25 403.26 403.27 403.28 403.29 403.30 403.31
404.1 404.2 404.3 404.4 404.5 404.6 404.7 404.8 404.9 404.10 404.11 404.12 404.13 404.14 404.15 404.16 404.17 404.18 404.19 404.20 404.21 404.22 404.23 404.24 404.25 404.26 404.27 404.28 404.29 404.30 404.31 405.1 405.2 405.3 405.4 405.5 405.6 405.7
405.8 405.9 405.10 405.11 405.12 405.13 405.14 405.15 405.16 405.17 405.18 405.19 405.20 405.21 405.22 405.23 405.24 405.25 405.26 405.27 405.28 405.29 405.30 406.1 406.2 406.3 406.4 406.5 406.6 406.7 406.8 406.9 406.10 406.11
406.12 406.13 406.14 406.15 406.16 406.17 406.18 406.19 406.20 406.21 406.22 406.23 406.24 406.25 406.26 406.27 406.28 406.29 406.30 407.1 407.2 407.3 407.4 407.5 407.6 407.7 407.8 407.9 407.10 407.11
407.12 407.13 407.14 407.15 407.16 407.17 407.18 407.19 407.20 407.21 407.22 407.23 407.24 407.25 407.26 407.27 407.28 407.29 407.30 407.31 408.1 408.2 408.3 408.4 408.5 408.6 408.7 408.8 408.9 408.10 408.11 408.12 408.13 408.14 408.15 408.16 408.17 408.18 408.19 408.20 408.21 408.22 408.23 408.24 408.25 408.26 408.27 408.28 408.29 408.30 408.31 408.32 408.33 408.34 409.1 409.2 409.3 409.4 409.5 409.6 409.7 409.8 409.9 409.10 409.11 409.12 409.13 409.14 409.15 409.16 409.17 409.18 409.19 409.20 409.21 409.22 409.23 409.24 409.25 409.26 409.27 409.28 409.29 409.30 409.31 409.32 409.33 410.1 410.2 410.3 410.4 410.5 410.6 410.7 410.8 410.9 410.10 410.11 410.12 410.13 410.14 410.15 410.16 410.17 410.18 410.19 410.20
410.21 410.22 410.23
410.24 410.25 410.26 410.27 410.28 410.29 410.30 410.31 410.32 410.33 411.1 411.2 411.3 411.4 411.5 411.6 411.7 411.8 411.9 411.10 411.11 411.12 411.13 411.14 411.15 411.16 411.17 411.18
411.19 411.20 411.21 411.22 411.23 411.24 411.25 411.26
411.27 411.28 411.29 411.30 412.1 412.2
412.3 412.4 412.5 412.6 412.7 412.8 412.9 412.10 412.11 412.12 412.13 412.14 412.15 412.16 412.17 412.18 412.19 412.20 412.21 412.22 412.23
412.24
412.25 412.26 412.27 412.28 412.29
413.1 413.2 413.3 413.4 413.5 413.6 413.7 413.8 413.9 413.10 413.11 413.12 413.13 413.14 413.15 413.16 413.17 413.18 413.19 413.20 413.21 413.22 413.23 413.24 413.25 413.26 413.27 413.28 413.29 413.30 413.31 413.32 413.33 413.34 414.1 414.2 414.3 414.4 414.5 414.6 414.7 414.8 414.9 414.10 414.11 414.12 414.13 414.14 414.15 414.16 414.17 414.18 414.19 414.20 414.21 414.22 414.23 414.24 414.25 414.26 414.27 414.28 414.29 414.30 414.31 414.32 414.33 414.34 415.1 415.2 415.3 415.4 415.5 415.6 415.7 415.8 415.9 415.10 415.11 415.12 415.13 415.14 415.15 415.16 415.17 415.18 415.19 415.20 415.21 415.22 415.23 415.24 415.25 415.26 415.27 415.28 415.29 415.30 415.31 415.32 415.33 415.34 416.1 416.2 416.3 416.4 416.5 416.6 416.7 416.8 416.9 416.10 416.11 416.12 416.13 416.14 416.15 416.16 416.17 416.18 416.19 416.20 416.21 416.22 416.23 416.24 416.25 416.26 416.27 416.28 416.29 416.30 416.31 416.32 416.33 417.1 417.2 417.3 417.4 417.5 417.6 417.7 417.8 417.9 417.10 417.11 417.12 417.13 417.14 417.15 417.16 417.17 417.18
417.19 417.20 417.21 417.22 417.23 417.24 417.25 417.26 417.27 417.28 417.29 417.30 417.31 417.32 417.33 418.1 418.2 418.3 418.4 418.5 418.6 418.7 418.8 418.9 418.10 418.11 418.12 418.13
418.14 418.15 418.16 418.17 418.18 418.19 418.20 418.21 418.22
418.23
418.24 418.25 418.26 418.27
418.28 418.29 418.30
419.1 419.2 419.3 419.4 419.5 419.6 419.7 419.8
419.9
419.10 419.11 419.12 419.13 419.14 419.15 419.16 419.17 419.18
419.19 419.20
419.21 419.22 419.23 419.24 419.25 419.26 419.27 419.28 419.29 419.30 420.1 420.2 420.3 420.4 420.5 420.6 420.7 420.8 420.9 420.10 420.11 420.12 420.13 420.14 420.15 420.16 420.17 420.18
420.19 420.20 420.21 420.22 420.23 420.24 420.25 420.26 420.27 421.1 421.2 421.3 421.4 421.5 421.6 421.7 421.8 421.9 421.10 421.11 421.12 421.13 421.14 421.15
421.16
421.17 421.18 421.19 421.20 421.21 421.22 421.23 421.24 421.25 421.26 421.27 421.28 421.29 421.30 421.31 422.1 422.2 422.3 422.4 422.5 422.6 422.7 422.8 422.9 422.10 422.11 422.12 422.13 422.14 422.15 422.16 422.17 422.18 422.19 422.20 422.21 422.22 422.23 422.24 422.25 422.26 422.27 422.28 422.29 422.30 422.31 423.1 423.2 423.3 423.4 423.5 423.6 423.7 423.8 423.9 423.10 423.11 423.12 423.13 423.14 423.15 423.16 423.17 423.18 423.19 423.20 423.21 423.22 423.23 423.24 423.25 423.26 423.27
423.28
423.29 423.30 423.31 423.32 424.1 424.2 424.3 424.4 424.5 424.6 424.7 424.8 424.9 424.10 424.11 424.12 424.13 424.14
424.15
424.16 424.17 424.18 424.19 424.20 424.21 424.22 424.23 424.24 424.25 424.26 424.27 424.28 424.29 424.30 424.31 424.32 424.33 425.1 425.2 425.3 425.4
425.5
425.6 425.7 425.8 425.9 425.10 425.11 425.12 425.13 425.14 425.15 425.16 425.17 425.18 425.19 425.20 425.21 425.22 425.23 425.24 425.25 425.26 425.27 425.28 425.29
425.30
426.1 426.2 426.3 426.4 426.5 426.6 426.7 426.8 426.9 426.10 426.11 426.12 426.13 426.14 426.15 426.16 426.17 426.18 426.19 426.20 426.21 426.22
426.23
426.24 426.25 426.26 426.27 426.28 426.29 426.30 426.31
427.1
427.2 427.3 427.4 427.5 427.6 427.7 427.8 427.9 427.10 427.11
427.12
427.13 427.14 427.15 427.16 427.17 427.18 427.19 427.20 427.21 427.22
427.23 427.24 427.25 427.26 427.27 427.28 427.29 427.30 428.1 428.2 428.3 428.4 428.5 428.6 428.7 428.8 428.9 428.10 428.11 428.12 428.13 428.14 428.15 428.16 428.17 428.18 428.19 428.20 428.21 428.22 428.23 428.24 428.25 428.26 428.27 428.28 428.29 428.30 428.31 428.32 429.1 429.2 429.3 429.4 429.5 429.6 429.7 429.8 429.9 429.10 429.11 429.12 429.13 429.14 429.15 429.16 429.17 429.18 429.19 429.20 429.21 429.22 429.23 429.24 429.25 429.26 429.27 429.28 429.29 429.30 429.31 429.32 429.33
430.1 430.2 430.3 430.4 430.5 430.6 430.7 430.8 430.9 430.10 430.11 430.12 430.13 430.14 430.15 430.16 430.17 430.18 430.19 430.20 430.21 430.22 430.23
430.24 430.25 430.26 430.27 430.28 430.29 431.1 431.2 431.3 431.4 431.5 431.6 431.7 431.8 431.9 431.10 431.11 431.12 431.13
431.14 431.15 431.16 431.17
431.18 431.19 431.20 431.21 431.22 431.23 431.24 431.25 431.26 431.27 431.28 431.29 431.30 431.31 432.1 432.2 432.3 432.4 432.5 432.6 432.7 432.8 432.9 432.10 432.11 432.12 432.13 432.14 432.15 432.16 432.17 432.18 432.19 432.20 432.21 432.22 432.23
432.24 432.25 432.26 432.27
432.28 432.29 432.30 432.31
433.1 433.2 433.3 433.4 433.5 433.6
433.7 433.8 433.9 433.10 433.11 433.12 433.13 433.14
433.15 433.16 433.17 433.18 433.19 433.20 433.21 433.22 433.23 433.24
433.25 433.26 433.27 433.28 433.29
434.1 434.2 434.3 434.4 434.5 434.6 434.7 434.8 434.9 434.10 434.11 434.12 434.13 434.14 434.15 434.16 434.17 434.18 434.19 434.20 434.21 434.22 434.23 434.24 434.25 434.26 434.27 434.28 434.29 434.30 434.31 435.1 435.2 435.3 435.4 435.5 435.6 435.7 435.8 435.9 435.10 435.11 435.12 435.13 435.14 435.15 435.16 435.17 435.18 435.19
435.20 435.21 435.22 435.23 435.24 435.25 435.26 435.27 435.28 435.29 435.30 435.31 435.32 435.33 435.34 436.1 436.2 436.3
436.4 436.5 436.6 436.7 436.8 436.9
436.10 436.11 436.12 436.13 436.14 436.15 436.16 436.17 436.18 436.19
436.20 436.21 436.22 436.23
436.24 436.25
436.26 436.27
436.28 436.29 436.30 437.1 437.2 437.3 437.4 437.5 437.6 437.7 437.8 437.9 437.10 437.11 437.12 437.13 437.14 437.15 437.16 437.17
437.18 437.19 437.20 437.21 437.22 437.23 437.24 437.25 437.26 437.27 437.28 437.29 437.30 437.31 437.32 438.1 438.2 438.3 438.4 438.5
438.6 438.7 438.8 438.9 438.10 438.11 438.12 438.13 438.14 438.15 438.16 438.17 438.18 438.19 438.20 438.21 438.22 438.23 438.24 438.25 438.26 438.27 438.28 438.29 438.30 438.31 439.1 439.2 439.3 439.4 439.5 439.6 439.7 439.8 439.9 439.10 439.11 439.12 439.13 439.14 439.15
439.16 439.17 439.18 439.19 439.20 439.21 439.22 439.23 439.24 439.25 439.26
439.27 439.28 439.29 439.30 439.31 439.32 440.1 440.2 440.3 440.4 440.5 440.6 440.7 440.8 440.9 440.10 440.11 440.12 440.13 440.14 440.15 440.16 440.17 440.18 440.19 440.20 440.21 440.22 440.23 440.24 440.25 440.26 440.27 440.28 440.29 440.30 440.31 440.32 440.33 440.34 441.1 441.2 441.3 441.4 441.5 441.6 441.7 441.8 441.9 441.10 441.11 441.12 441.13 441.14 441.15 441.16 441.17 441.18 441.19 441.20 441.21 441.22 441.23 441.24 441.25 441.26 441.27 441.28 441.29 441.30 441.31 442.1 442.2 442.3 442.4 442.5 442.6 442.7 442.8 442.9 442.10 442.11 442.12 442.13 442.14 442.15 442.16 442.17 442.18 442.19 442.20 442.21 442.22 442.23 442.24 442.25 442.26 442.27 442.28 442.29 442.30 442.31 443.1 443.2 443.3 443.4 443.5 443.6 443.7 443.8 443.9 443.10 443.11 443.12 443.13 443.14 443.15 443.16
443.17
443.18 443.19 443.20 443.21 443.22 443.23 443.24 443.25 443.26 443.27 443.28 443.29 443.30 444.1 444.2 444.3 444.4 444.5 444.6 444.7 444.8 444.9 444.10 444.11 444.12 444.13 444.14 444.15 444.16 444.17 444.18 444.19 444.20 444.21 444.22 444.23 444.24 444.25 444.26 444.27 444.28 444.29 444.30 444.31 444.32 445.1 445.2 445.3 445.4 445.5 445.6 445.7 445.8 445.9 445.10 445.11 445.12 445.13 445.14 445.15 445.16 445.17 445.18 445.19 445.20 445.21 445.22 445.23
445.24
445.25 445.26 445.27 445.28 445.29 445.30 445.31 445.32 445.33 445.34
446.1
446.2 446.3 446.4 446.5 446.6 446.7 446.8 446.9 446.10 446.11 446.12 446.13 446.14 446.15 446.16 446.17 446.18 446.19 446.20 446.21 446.22 446.23 446.24 446.25 446.26 446.27 446.28 446.29 446.30 446.31 446.32 446.33 446.34 446.35 447.1 447.2 447.3 447.4 447.5 447.6 447.7 447.8 447.9 447.10 447.11 447.12 447.13 447.14 447.15 447.16 447.17 447.18 447.19 447.20 447.21 447.22 447.23 447.24 447.25 447.26 447.27 447.28
447.29 447.30 447.31 447.32 447.33 448.1 448.2 448.3 448.4 448.5 448.6 448.7 448.8 448.9 448.10 448.11 448.12 448.13 448.14 448.15 448.16 448.17 448.18 448.19 448.20 448.21 448.22 448.23 448.24 448.25 448.26 448.27 448.28 448.29 448.30 448.31 448.32 448.33 448.34 449.1 449.2 449.3 449.4 449.5 449.6 449.7 449.8 449.9 449.10 449.11 449.12 449.13 449.14 449.15 449.16 449.17 449.18 449.19 449.20 449.21 449.22 449.23 449.24 449.25 449.26 449.27 449.28 449.29 449.30 449.31 449.32 449.33 450.1 450.2 450.3 450.4 450.5 450.6 450.7 450.8 450.9 450.10 450.11 450.12 450.13 450.14 450.15 450.16 450.17 450.18 450.19
450.20 450.21 450.22 450.23 450.24 450.25 450.26 450.27 450.28 450.29 450.30 450.31 450.32 450.33 450.34 451.1 451.2 451.3 451.4 451.5 451.6 451.7 451.8 451.9 451.10 451.11 451.12
451.13
451.14 451.15 451.16 451.18 451.17 451.19 451.20 451.21 451.22 451.23 451.24 451.25 451.26 451.27 451.28 451.29 451.30 451.31 451.32 451.33 451.34 452.1 452.2 452.3 452.4 452.5 452.6 452.7 452.8 452.9 452.10 452.11 452.12 452.13 452.14 452.15 452.16 452.17 452.18 452.19 452.20 452.21 452.22 452.23 452.24 452.25 452.26 452.27 452.28 452.29 452.30 452.31 452.32 452.33 452.34 452.35 452.36 452.37 452.38 452.39 452.40 452.41 452.42 452.43 452.44 453.1 453.2 453.3 453.4 453.5 453.6 453.7 453.8 453.9 453.10 453.11 453.12 453.13 453.14 453.15 453.16 453.17 453.18 453.19 453.20 453.21 453.22 453.23 453.24 453.25 453.26 453.27 453.28 453.29 453.30 453.31 453.32 453.33 453.34 453.35 453.36 453.37 453.38 454.1 454.2 454.3 454.4 454.5 454.6 454.7 454.8 454.9 454.10 454.11 454.12 454.13 454.14 454.15 454.16 454.17 454.18 454.19 454.20 454.21 454.22 454.23 454.24 454.25 454.26 454.27 454.28 454.29 454.30 454.31 454.32 454.33 454.34 455.1 455.2 455.3 455.4 455.5 455.6 455.7 455.8 455.9 455.10 455.11 455.12 455.13 455.14 455.15 455.16 455.17 455.18 455.19 455.20 455.21 455.22 455.23 455.24 455.25
455.26
455.27 455.28 455.29 455.30 455.31 455.32 455.33 456.1 456.2 456.3 456.4 456.5 456.6 456.7 456.8 456.9 456.10 456.11 456.12 456.13 456.14 456.15 456.16 456.17 456.18 456.19 456.20 456.21 456.22 456.23 456.24 456.25 456.26 456.27 456.28 456.29 456.30 456.31 456.32 457.1 457.2 457.3 457.4 457.5 457.6 457.7 457.8 457.9 457.10 457.11 457.12 457.13 457.14 457.15 457.16 457.17 457.18 457.19 457.20 457.21 457.22 457.23 457.24 457.25 457.26 457.27 457.28
457.29
458.1 458.2 458.3 458.4 458.5 458.6 458.7 458.8 458.9 458.10 458.11 458.12 458.13 458.14 458.15 458.16 458.17 458.18 458.19 458.20 458.21 458.22 458.23 458.24 458.25 458.26 458.27 458.28
458.29 458.30 458.31 459.1 459.2 459.3 459.4 459.5 459.6 459.7 459.8 459.9 459.10 459.11 459.12 459.13 459.14 459.15 459.16 459.17 459.18 459.19 459.20 459.21 459.22 459.23 459.24 459.25 459.26 459.27 459.28 459.29 459.30 459.31 460.1 460.2 460.3 460.4 460.5 460.6
460.7 460.8 460.9
460.10 460.11 460.12 460.13 460.14 460.15 460.16
460.17 460.18 460.19 460.20 460.21 460.22 460.23
460.24 460.25 460.26 460.27 460.28 460.29 461.1 461.2 461.3 461.4 461.5 461.6 461.7 461.8 461.9 461.10 461.11 461.12 461.13 461.14 461.15 461.16 461.17 461.18 461.19 461.20 461.21 461.22 461.23 461.24 461.25 461.26 461.27 461.28 461.29 461.30 461.31 462.1 462.2 462.3 462.4 462.5 462.6 462.7 462.8 462.9
462.10
462.11 462.12 462.13 462.14 462.15 462.16 462.17 462.18
462.19 462.20 462.21 462.22 462.23 462.24 462.25 462.26 462.27 463.1 463.2 463.3 463.4 463.5 463.6 463.7 463.8 463.9
463.10 463.11 463.12 463.13 463.14 463.15
463.16 463.17 463.18 463.19 463.20 463.21 463.22 463.23 463.24 463.25 463.26 463.27 463.28 463.29 463.30 463.31 463.32 463.33 464.1 464.2 464.3 464.4 464.5 464.6 464.7 464.8 464.9 464.10 464.11 464.12 464.13 464.14 464.15 464.16 464.17 464.18 464.19 464.20 464.21 464.22 464.23 464.24 464.25 464.26 464.27 464.28 464.29 464.30 464.31 464.32 464.33 464.34
465.1 465.2 465.3 465.4 465.5 465.6 465.7 465.8 465.9 465.10 465.11 465.12 465.13 465.14 465.15 465.16 465.17
465.18 465.19 465.20 465.21 465.22 465.23 465.24 465.25 465.26 465.27 465.28 465.29 465.30
466.1 466.2 466.3 466.4 466.5 466.6 466.7 466.8 466.9 466.10 466.11 466.12 466.13 466.14 466.15 466.16 466.17 466.18 466.19 466.20 466.21 466.22 466.23 466.24 466.25 466.26 466.27 466.28
467.1 467.2 467.3 467.4
467.5 467.6 467.7 467.8 467.9 467.10 467.11 467.12 467.13 467.14 467.15 467.16 467.17 467.18 467.19 467.20 467.21 467.22 467.23 467.24 467.25 467.26 467.27 467.28 467.29 467.30 468.1 468.2 468.3 468.4 468.5 468.6 468.7 468.8 468.9 468.10 468.11 468.12 468.13 468.14 468.15 468.16 468.17 468.18 468.19 468.20 468.21 468.22 468.23
468.24 468.25 468.26 468.27 468.28 468.29 468.30 468.31
469.1 469.2 469.3 469.4 469.5 469.6 469.7 469.8 469.9 469.10 469.11 469.12
469.13 469.14 469.15 469.16 469.17 469.18 469.19 469.20 469.21 469.22 469.23 469.24 469.25 469.26 469.27 469.28 469.29 469.30
470.1 470.2 470.3 470.4 470.5 470.6 470.7 470.8 470.9 470.10 470.11 470.12
470.13 470.14 470.15 470.16 470.17 470.18 470.19 470.20 470.21 470.22 470.23 470.24 470.25 470.26 470.27 470.28 470.29 470.30 470.31 471.1 471.2 471.3 471.4 471.5 471.6 471.7 471.8 471.9 471.10 471.11
471.12 471.13 471.14 471.15 471.16 471.17 471.18 471.19 471.20 471.21 471.22 471.23 471.24
471.25 471.26 471.27 471.28 471.29 471.30 471.31 471.32 471.33 472.1 472.2 472.3
472.4 472.5 472.6 472.7 472.8 472.9 472.10 472.11 472.12 472.13 472.14 472.15
472.16 472.17 472.18 472.19 472.20 472.21 472.22 472.23 472.24 472.25 472.26 472.27 472.28 472.29 472.30 472.31 472.32 472.33 473.1 473.2 473.3 473.4 473.5 473.6 473.7 473.8 473.9 473.10 473.11
473.12 473.13 473.14 473.15 473.16 473.17 473.18 473.19 473.20 473.21 473.22 473.23 473.24 473.25 473.26 473.27 473.28 473.29 473.30 473.31 473.32 473.33 473.34 474.1 474.2 474.3 474.4 474.5 474.6 474.7 474.8 474.9 474.10 474.11 474.12 474.13 474.14 474.15 474.16 474.17 474.18 474.19 474.20 474.21 474.22 474.23 474.24 474.25 474.26 474.27 474.28 474.29 474.30 474.31 474.32 474.33 474.34 475.1 475.2 475.3 475.4 475.5 475.6 475.7 475.8 475.9 475.10 475.11 475.12 475.13 475.14 475.15 475.16 475.17 475.18 475.19 475.20 475.21 475.22 475.23 475.24 475.25 475.26 475.27 475.28 475.29 475.30 475.31 475.32 476.1 476.2 476.3 476.4 476.5 476.6 476.7 476.8 476.9 476.10 476.11 476.12 476.13 476.14 476.15 476.16 476.17 476.18 476.19 476.20 476.21 476.22 476.23 476.24 476.25 476.26 476.27 476.28 476.29 476.30 476.31 477.1 477.2 477.3 477.4 477.5 477.6 477.7 477.8 477.9 477.10 477.11 477.12 477.13 477.14 477.15 477.16 477.17 477.18 477.19 477.20 477.21 477.22 477.23 477.24 477.25 477.26 477.27 477.28 477.29 477.30 477.31 477.32 477.33 478.1 478.2 478.3 478.4 478.5 478.6 478.7 478.8 478.9 478.10 478.11 478.12 478.13 478.14 478.15 478.16 478.17 478.18 478.19 478.20 478.21 478.22 478.23 478.24 478.25 478.26 478.27 478.28 478.29 478.30 478.31 478.32 479.1 479.2 479.3 479.4 479.5 479.6 479.7 479.8 479.9 479.10 479.11 479.12 479.13 479.14 479.15 479.16 479.17 479.18 479.19
479.20 479.21 479.22 479.23 479.24 479.25 479.26 479.27 479.28 479.29 479.30 479.31 479.32 479.33 479.34 480.1 480.2 480.3 480.4 480.5 480.6 480.7
480.8 480.9 480.10 480.11 480.12 480.13 480.14 480.15 480.16 480.17 480.18 480.19 480.20 480.21 480.22 480.23 480.24 480.25 480.26 480.27 480.28 480.29 480.30 481.1 481.2 481.3 481.4 481.5 481.6 481.7 481.8 481.9 481.10 481.11 481.12 481.13 481.14 481.15 481.16 481.17 481.18 481.19 481.20 481.21 481.22 481.23
481.24 481.25 481.26
481.27 481.28 481.29 481.30 481.31
482.1
482.2 482.3
482.4 482.5 482.6 482.7 482.8 482.9 482.10 482.11 482.12 482.13 482.14 482.15 482.16 482.17 482.18 482.19 482.20 482.21 482.22 482.23 482.24 482.25 482.26 482.27 482.28 482.29 482.30 482.31 482.32 482.33 482.34 483.1 483.2 483.3 483.4 483.5
483.6
483.7 483.8 483.9 483.10 483.11 483.12 483.13 483.14 483.15 483.16 483.17 483.18 483.19 483.20 483.21 483.22 483.23 483.24 483.25 483.26 483.27 483.28 483.29
483.30
484.1 484.2 484.3 484.4 484.5 484.6 484.7 484.8 484.9 484.10 484.11 484.12 484.13 484.14 484.15 484.16 484.17 484.18 484.19 484.20 484.21 484.22 484.23
484.24
484.25 484.26 484.27 484.28 484.29 484.30 484.31 484.32 485.1 485.2 485.3 485.4 485.5 485.6 485.7 485.8 485.9 485.10 485.11 485.12 485.13 485.14 485.15 485.16 485.17 485.18 485.19 485.20 485.21 485.22 485.23 485.24 485.25 485.26 485.27 485.28 485.29 485.30 485.31 485.32 485.33 485.34 486.1 486.2 486.3 486.4 486.5 486.6 486.7 486.8 486.9 486.10 486.11 486.12 486.13 486.14 486.15 486.16 486.17 486.18 486.19 486.20 486.21 486.22 486.23 486.24 486.25 486.26
486.27
486.28 486.29 486.30 486.31 486.32
487.1 487.2 487.3 487.4 487.5 487.6 487.7
487.8 487.9 487.10 487.11 487.12 487.13
487.14 487.15 487.16 487.17 487.18 487.19 487.20 487.21 487.22
487.23 487.24 487.25 487.26 487.27
488.1 488.2 488.3 488.4
488.5 488.6 488.7 488.8 488.9 488.10 488.11 488.12 488.13 488.14 488.15 488.16 488.17 488.18 488.19 488.20 488.21 488.22 488.23 488.24 488.25 488.26 488.27 488.28 488.29 489.1 489.2 489.3 489.4 489.5 489.6 489.7 489.8 489.9 489.10 489.11 489.12
489.13 489.14 489.15 489.16 489.17
489.18
489.19 489.20 489.21 489.22
489.23 489.24 489.25 489.26 489.27 489.28 489.29 489.30 490.1 490.2 490.3 490.4 490.5 490.6 490.7 490.8 490.9 490.10
490.11
490.12 490.13 490.14 490.15 490.16 490.17 490.18 490.19 490.20 490.21 490.22 490.23 490.24 490.25
490.26
491.1 491.2
491.3 491.4 491.5 491.6 491.7 491.8 491.9 491.10 491.11 491.12 491.13 491.14 491.15 491.16 491.17 491.18 491.19 491.20 491.21 491.22 491.23 491.24 491.25 491.26 491.27 491.28 491.29 491.30 491.31 491.32 491.33 491.34
492.1
492.2 492.3 492.4 492.5 492.6 492.7 492.8 492.9 492.10 492.11 492.12 492.13 492.14 492.15 492.16 492.17 492.18 492.19 492.20 492.21 492.22 492.23 492.24 492.25 492.26 492.27 492.28 492.29 492.30 492.31 492.32 492.33 492.34 493.1 493.2
493.3
493.4 493.5 493.6 493.7 493.8 493.9 493.10 493.11 493.12 493.13 493.14 493.15 493.16 493.17 493.18 493.19 493.20 493.21 493.22 493.23 493.24 493.25 493.26 493.27 493.28 493.29 493.30 493.31 493.32 493.33 493.34 494.1 494.2 494.3 494.4 494.5 494.6 494.7 494.8 494.9 494.10 494.11 494.12 494.13 494.14 494.15 494.16 494.17 494.18 494.19 494.20 494.21 494.22 494.23 494.24 494.25 494.26 494.27 494.28 494.29 494.30 494.31 494.32 494.33
495.1 495.2 495.3 495.4 495.5 495.6 495.7 495.8 495.9 495.10 495.11 495.12 495.13 495.14 495.15 495.16 495.17 495.18 495.19 495.20 495.21 495.22 495.23 495.24 495.25 495.26 495.27 495.28 495.29 495.30 495.31 495.32 495.33 495.34 495.35 496.1 496.2 496.3 496.4
496.5
496.6 496.7 496.8 496.9 496.10 496.11 496.12 496.13 496.14 496.15
496.16 496.17 496.18 496.19 496.20 496.21 496.22 496.23 496.24 496.25 496.26 496.27 496.28
496.29 496.30 496.31 497.1 497.2
497.3 497.4 497.5
497.6 497.7
497.8 497.9 497.10 497.11 497.12 497.13 497.14 497.15 497.16 497.17 497.18 497.19 497.20 497.21 497.22 497.23 497.24 497.25 497.26 497.27 497.28 497.29 497.30 497.31 497.32 498.1 498.2 498.3 498.4 498.5 498.6 498.7 498.8 498.9 498.10 498.11 498.12 498.13 498.14 498.15 498.16 498.17 498.18 498.19 498.20 498.21 498.22 498.23 498.24 498.25 498.26 498.27 498.28 498.29 498.30 498.31 498.32 499.1 499.2 499.3 499.4 499.5 499.6 499.7 499.8 499.9 499.10 499.11 499.12 499.13 499.14 499.15 499.16 499.17 499.18 499.19 499.20 499.21 499.22 499.23 499.24 499.25 499.26 499.27 499.28 499.29 499.30 499.31 499.32 500.1 500.2 500.3 500.4 500.5 500.6 500.7 500.8 500.9 500.10 500.11 500.12 500.13 500.14 500.15 500.16 500.17 500.18 500.19 500.20 500.21 500.22 500.23
500.24
500.25 500.26 500.27 500.28 500.29 500.30 500.31 501.1 501.2 501.3 501.4 501.5 501.6 501.7 501.8 501.9 501.10 501.11 501.12 501.13 501.14 501.15 501.16
501.17
501.18 501.19 501.20 501.21 501.22 501.23 501.24 501.25 501.26 501.27 501.28 502.1 502.2 502.3 502.4 502.5 502.6 502.7 502.8 502.9 502.10 502.11 502.12 502.13 502.14 502.15 502.16 502.17 502.18 502.19 502.20 502.21 502.22 502.23 502.24 502.25 502.26 502.27 502.28 502.29 502.30 502.31
502.32
503.1 503.2 503.3 503.4 503.5 503.6 503.7 503.8 503.9 503.10 503.11 503.12 503.13 503.14 503.15 503.16 503.17 503.18
503.19
503.20 503.21 503.22 503.23 503.24 503.25 503.26 503.27 503.28 503.29 503.30 503.31 503.32 504.1 504.2 504.3 504.4 504.5 504.6
504.7
504.8 504.9 504.10 504.11 504.12 504.13 504.14 504.15 504.16 504.17 504.18 504.19 504.20 504.21 504.22 504.23 504.24 504.25 504.26 504.27 504.28 504.29 504.30 505.1 505.2 505.3
505.4
505.5 505.6 505.7 505.8 505.9 505.10 505.11 505.12 505.13 505.14 505.15 505.16 505.17 505.18 505.19 505.20 505.21 505.22 505.23 505.24 505.25 505.26 505.27 505.28 505.29 505.30 505.31 505.32 505.33
505.34
506.1 506.2 506.3 506.4 506.5 506.6 506.7 506.8 506.9 506.10 506.11 506.12 506.13 506.14 506.15 506.16 506.17 506.18 506.19 506.20 506.21 506.22 506.23 506.24 506.25 506.26 506.27 506.28 506.29 506.30 506.31 506.32 506.33 507.1 507.2 507.3 507.4 507.5 507.6 507.7 507.8 507.9 507.10 507.11 507.12 507.13 507.14 507.15 507.16 507.17 507.18 507.19 507.20 507.21 507.22 507.23 507.24 507.25 507.26 507.27 507.28 507.29 507.30 507.31 507.32 507.33 508.1 508.2 508.3 508.4 508.5 508.6 508.7 508.8 508.9 508.10 508.11 508.12 508.13 508.14 508.15 508.16 508.17 508.18 508.19 508.20 508.21 508.22 508.23 508.24 508.25 508.26 508.27 508.28 508.29 508.30 508.31 508.32
508.33
509.1 509.2 509.3 509.4 509.5
509.6
509.7 509.8 509.9 509.10 509.11
509.12 509.13 509.14 509.15 509.16
509.17
509.18 509.19 509.20 509.21 509.22 509.23 509.24
509.25
509.26 509.27 509.28 509.29 509.30 510.1 510.2 510.3 510.4 510.5 510.6
510.7
510.8 510.9 510.10 510.11 510.12 510.13 510.14 510.15 510.16 510.17 510.18 510.19 510.20 510.21
510.22
510.23 510.24 510.25 510.26 510.27 510.28 510.29 510.30 510.31
511.1
511.2 511.3 511.4 511.5 511.6 511.7 511.8 511.9 511.10 511.11 511.12 511.13 511.14 511.15 511.16 511.17 511.18 511.19
511.20
511.21 511.22 511.23 511.24 511.25 511.26 511.27 511.28 511.29 511.30 512.1 512.2 512.3 512.4 512.5 512.6
512.7
512.8 512.9 512.10 512.11 512.12 512.13 512.14 512.15 512.16 512.17 512.18 512.19 512.20 512.21
512.22
512.23 512.24 512.25 512.26 512.27 512.28 512.29 512.30 512.31 513.1 513.2 513.3 513.4 513.5 513.6 513.7 513.8 513.9 513.10 513.11 513.12 513.13 513.14 513.15 513.16 513.17 513.18 513.19 513.20 513.21 513.22 513.23
513.24
513.25 513.26 513.27 513.28 513.29 513.30 513.31 513.32 513.33 514.1 514.2 514.3 514.4 514.5 514.6 514.7 514.8 514.9 514.10 514.11 514.12 514.13 514.14 514.15 514.16 514.17 514.18 514.19 514.20
514.21
514.22 514.23 514.24 514.25 514.26 514.27 514.28 514.29 514.30 514.31 515.1 515.2 515.3 515.4 515.5 515.6 515.7 515.8 515.9 515.10 515.11 515.12 515.13 515.14 515.15 515.16 515.17 515.18 515.19 515.20 515.21 515.22
515.23
515.24 515.25 515.26 515.27 515.28 515.29 515.30 515.31 515.32 515.33 515.34 516.1 516.2 516.3 516.4 516.5 516.6 516.7 516.8 516.9 516.10 516.11 516.12
516.13
516.14 516.15 516.16 516.17 516.18 516.19 516.20 516.21 516.22 516.23 516.24 516.25 516.26 516.27 516.28 516.29 516.30 516.31 516.32
516.33
517.1 517.2 517.3 517.4 517.5 517.6 517.7 517.8 517.9 517.10 517.11 517.12 517.13 517.14 517.15 517.16 517.17 517.18 517.19 517.20 517.21 517.22 517.23 517.24 517.25 517.26 517.27 517.28 517.29 517.30 517.31 517.32 517.33 518.1 518.2 518.3 518.4 518.5 518.6 518.7 518.8 518.9 518.10 518.11 518.12 518.13 518.14 518.15 518.16
518.17 518.18
518.19 518.20 518.21 518.22 518.23 518.24
518.25 518.26
518.27 518.28 518.29 518.30 518.31 519.1 519.2
519.3 519.4
519.5 519.6 519.7 519.8 519.9 519.10 519.11 519.12 519.13 519.14 519.15 519.16 519.17 519.18 519.19 519.20 519.21 519.22 519.23 519.24 519.25 519.26 519.27 519.28 519.29 519.30 519.31 520.1 520.2 520.3 520.4 520.5 520.6 520.7 520.8 520.9 520.10
520.11 520.12
520.13 520.14 520.15 520.16 520.17 520.18 520.19 520.20 520.21 520.22 520.23 520.24 520.25 520.26 520.27 520.28 520.29 520.30 520.31 521.1 521.2 521.3 521.4 521.5 521.6 521.7 521.8 521.9 521.10 521.11
521.12 521.13 521.14 521.15 521.16 521.17 521.18 521.19 521.20 521.21 521.22 521.23 521.24 521.25 521.26 521.27 521.28 521.29 521.30 521.31 522.1 522.2
522.3 522.4
522.5 522.6 522.7 522.8 522.9 522.10 522.11 522.12
522.13 522.14 522.15 522.16 522.17 522.18 522.19 522.20 522.21 522.22 522.23 522.24
522.25 522.26 522.27 522.28 522.29 522.30 522.31 523.1 523.2 523.3 523.4 523.5 523.6 523.7 523.8 523.9 523.10 523.11 523.12 523.13 523.14 523.15 523.16 523.17 523.18 523.19 523.20 523.21 523.22 523.23 523.24 523.25 523.26 523.27 523.28 523.29 523.30
524.1
524.2 524.3 524.4 524.5 524.6 524.7 524.8 524.9 524.10 524.11 524.12 524.13 524.14 524.15 524.16
524.17 524.18 524.19 524.20 524.21 524.22 524.23 524.24 524.25 524.26 524.27 524.28 524.29 524.30 524.31 525.1 525.2 525.3 525.4 525.5 525.6 525.7 525.8 525.9 525.10 525.11 525.12 525.13 525.14 525.15 525.16 525.17 525.18 525.19 525.20 525.21 525.22 525.23 525.24 525.25 525.26 525.27 525.28 525.29 525.30 525.31
526.1 526.2 526.3 526.4 526.5 526.6 526.7 526.8 526.9 526.10 526.11 526.12 526.13 526.14 526.15 526.16 526.17 526.18 526.19 526.20 526.21 526.22 526.23 526.24 526.25 526.26 526.27 526.28 526.29 526.30 526.31 526.32
527.1 527.2 527.3 527.4 527.5 527.6 527.7 527.8 527.9 527.10 527.11 527.12 527.13 527.14
527.15 527.16
527.17 527.18 527.19 527.20 527.21
527.22 527.23 527.24 527.25 527.26 527.27 527.28 527.29 527.30 527.31 528.1 528.2 528.3 528.4 528.5 528.6 528.7 528.8 528.9 528.10 528.11 528.12 528.13 528.14 528.15 528.16 528.17 528.18 528.19 528.20 528.21 528.22 528.23 528.24 528.25 528.26 528.27 528.28 528.29 528.30 528.31 528.32 528.33 528.34 528.35 529.1 529.2 529.3 529.4 529.5 529.6 529.7 529.8 529.9 529.10 529.11 529.12 529.13 529.14 529.15 529.16 529.17 529.18 529.19 529.20 529.21 529.22 529.23 529.24 529.25 529.26 529.27 529.28 529.29 529.30 529.31 529.32 529.33 529.34 529.35 530.1 530.2 530.3 530.4 530.5 530.6 530.7 530.8 530.9 530.10 530.11 530.12 530.13 530.14 530.15 530.16 530.17 530.18 530.19 530.20 530.21 530.22 530.23 530.24 530.25 530.26 530.27 530.28 530.29 530.30 530.31 530.32 530.33 530.34 531.1 531.2 531.3 531.4 531.5 531.6 531.7 531.8 531.9 531.10 531.11 531.12 531.13 531.14 531.15 531.16 531.17 531.18 531.19 531.20 531.21 531.22 531.23 531.24 531.25 531.26 531.27 531.28 531.29 531.30 531.31 531.32 531.33 532.1 532.2
532.3
532.4 532.5 532.6 532.7 532.8 532.9 532.10 532.11 532.12 532.13 532.14 532.15 532.16 532.17
532.18
532.19 532.20 532.21 532.22 532.23 532.24 532.25 532.26 532.27 532.28 532.29 532.30 533.1 533.2 533.3
533.4
533.5 533.6 533.7 533.8 533.9 533.10 533.11 533.12 533.13 533.14 533.15 533.16 533.17 533.18 533.19 533.20 533.21 533.22 533.23 533.24 533.25 533.26 533.27 533.28 533.29
534.1 534.2
534.3 534.4
534.5 534.6 534.7 534.8 534.9 534.10 534.11 534.12 534.13 534.14 534.15 534.16
534.17 534.18 534.19 534.20 534.21 534.22 534.23 534.24 534.25 534.26 534.27 534.28 534.29 534.30 534.31 534.32 534.33 534.34 535.1 535.2 535.3 535.4 535.5 535.6 535.7 535.8 535.9 535.10 535.11 535.12 535.13
535.14 535.15
535.16 535.17
535.18 535.19 535.20 535.21 535.22 535.23 535.24 535.25 535.26 535.27 535.28 535.29
536.1 536.2 536.3 536.4 536.5 536.6 536.7 536.8 536.9 536.10 536.11 536.12 536.13 536.14 536.15 536.16 536.17 536.18 536.19 536.20 536.21 536.22 536.23 536.24 536.25 536.26 536.27 536.28 536.29 536.30 536.31 536.32 536.33 536.34 537.1 537.2 537.3 537.4 537.5 537.6 537.7 537.8 537.9 537.10 537.11 537.12 537.13 537.14 537.15 537.16 537.17 537.18 537.19 537.20 537.21 537.22 537.23 537.24 537.25 537.26 537.27 537.28 537.29 537.30 537.31 537.32 537.33 538.1 538.2 538.3 538.4 538.5 538.6 538.7 538.8 538.9 538.10 538.11 538.12 538.13 538.14 538.15 538.16 538.17 538.18 538.19 538.20 538.21 538.22 538.23 538.24 538.25 538.26 538.27 538.28 538.29 538.30 538.31 538.32 538.33 538.34 539.1 539.2 539.3 539.4 539.5 539.6 539.7 539.8 539.9 539.10 539.11 539.12 539.13 539.14 539.15 539.16 539.17 539.18 539.19 539.20 539.21 539.22 539.23 539.24 539.25 539.26 539.27 539.28 539.29 539.30 539.31 539.32 539.33 539.34 539.35 540.1 540.2 540.3 540.4 540.5 540.6 540.7 540.8 540.9 540.10 540.11 540.12 540.13 540.14 540.15 540.16 540.17 540.18 540.19 540.20 540.21 540.22 540.23 540.24 540.25 540.26 540.27 540.28 540.29 540.30 540.31 540.32 540.33 541.1 541.2 541.3 541.4 541.5 541.6 541.7 541.8 541.9 541.10 541.11 541.12 541.13 541.14 541.15 541.16 541.17 541.18 541.19 541.20 541.21 541.22 541.23 541.24 541.25 541.26 541.27 541.28 541.29 541.30 541.31 541.32 541.33 541.34 542.1 542.2 542.3 542.4 542.5 542.6 542.7 542.8 542.9 542.10 542.11 542.12 542.13 542.14 542.15 542.16 542.17 542.18 542.19 542.20 542.21 542.22 542.23 542.24 542.25 542.26 542.27 542.28 542.29 542.30 542.31 542.32 542.33 542.34 542.35 543.1 543.2 543.3 543.4 543.5 543.6 543.7 543.8 543.9 543.10 543.11 543.12 543.13 543.14 543.15 543.16 543.17 543.18 543.19 543.20 543.21 543.22 543.23 543.24 543.25 543.26 543.27 543.28 543.29 543.30 543.31 543.32 543.33 543.34 544.1 544.2 544.3 544.4 544.5 544.6 544.7 544.8 544.9 544.10 544.11 544.12 544.13 544.14 544.15 544.16 544.17 544.18 544.19 544.20 544.21 544.22 544.23 544.24 544.25 544.26 544.27 544.28 544.29 544.30 544.31 544.32 544.33 544.34 545.1 545.2 545.3 545.4 545.5 545.6 545.7 545.8 545.9 545.10 545.11 545.12 545.13 545.14 545.15 545.16 545.17 545.18 545.19 545.20 545.21 545.22 545.23 545.24 545.25 545.26 545.27 545.28 545.29 545.30 545.31 545.32 545.33 545.34 546.1 546.2 546.3 546.4 546.5 546.6 546.7 546.8 546.9 546.10 546.11 546.12 546.13 546.14 546.15 546.16 546.17 546.18 546.19 546.20 546.21 546.22 546.23 546.24 546.25 546.26
546.27 546.28 546.29 546.30 546.31 546.32 546.33 547.1 547.2 547.3 547.4 547.5 547.6 547.7 547.8 547.9 547.10 547.11 547.12 547.13 547.14 547.15 547.16 547.17 547.18 547.19 547.20 547.21 547.22 547.23 547.24 547.25 547.26 547.27 547.28 547.29 547.30 547.31 547.32 547.33 547.34 547.35 548.1 548.2 548.3 548.4 548.5 548.6 548.7 548.8 548.9 548.10 548.11 548.12 548.13 548.14 548.15 548.16 548.17 548.18 548.19 548.20 548.21 548.22 548.23 548.24 548.25 548.26 548.27 548.28 548.29 548.30 548.31 548.32 548.33 548.34 549.1 549.2 549.3 549.4 549.5 549.6 549.7 549.8 549.9 549.10 549.11 549.12 549.13 549.14 549.15 549.16 549.17 549.18 549.19 549.20 549.21 549.22 549.23 549.24 549.25 549.26 549.27 549.28 549.29 549.30 549.31 549.32 549.33 549.34 549.35 550.1 550.2 550.3 550.4 550.5 550.6 550.7 550.8 550.9 550.10 550.11 550.12 550.13 550.14 550.15 550.16 550.17 550.18 550.19 550.20 550.21 550.22 550.23 550.24 550.25 550.26 550.27 550.28 550.29 550.30 550.31 550.32 551.1 551.2 551.3 551.4 551.5 551.6 551.7 551.8 551.9 551.10 551.11 551.12 551.13 551.14 551.15 551.16 551.17 551.18 551.19 551.20 551.21 551.22 551.23 551.24 551.25 551.26 551.27 551.28 551.29 551.30 551.31 551.32 551.33 551.34 552.1 552.2 552.3 552.4 552.5 552.6 552.7 552.8 552.9 552.10 552.11 552.12 552.13 552.14 552.15 552.16 552.17 552.18 552.19 552.20 552.21 552.22 552.23 552.24 552.25 552.26 552.27 552.28 552.29 552.30 552.31 552.32 552.33 552.34 552.35 553.1 553.2 553.3 553.4 553.5 553.6 553.7 553.8 553.9 553.10 553.11 553.12 553.13 553.14 553.15 553.16 553.17 553.18 553.19 553.20 553.21 553.22 553.23 553.24 553.25 553.26 553.27 553.28 553.29 553.30 553.31 553.32 553.33 553.34 554.1 554.2 554.3 554.4 554.5 554.6 554.7 554.8 554.9 554.10 554.11 554.12 554.13 554.14 554.15 554.16 554.17 554.18 554.19 554.20 554.21 554.22 554.23 554.24 554.25 554.26 554.27 554.28 554.29 554.30 554.31 554.32 554.33 554.34 555.1 555.2 555.3 555.4 555.5 555.6 555.7 555.8 555.9 555.10 555.11 555.12 555.13 555.14 555.15 555.16 555.17 555.18 555.19 555.20 555.21 555.22 555.23 555.24 555.25 555.26 555.27 555.28 555.29 555.30 555.31 555.32 555.33 555.34 555.35 556.1 556.2 556.3 556.4 556.5 556.6 556.7 556.8 556.9 556.10 556.11 556.12 556.13 556.14 556.15 556.16 556.17 556.18 556.19 556.20 556.21 556.22 556.23 556.24 556.25 556.26 556.27 556.28 556.29 556.30 556.31 556.32 556.33 557.1 557.2 557.3 557.4 557.5 557.6 557.7 557.8 557.9 557.10 557.11 557.12 557.13 557.14 557.15 557.16 557.17 557.18 557.19 557.20 557.21 557.22 557.23 557.24 557.25 557.26 557.27 557.28 557.29 557.30 557.31 557.32 557.33 557.34 558.1 558.2 558.3 558.4 558.5 558.6 558.7 558.8 558.9 558.10 558.11 558.12 558.13 558.14 558.15 558.16 558.17 558.18 558.19 558.20 558.21 558.22 558.23 558.24 558.25 558.26 558.27 558.28 558.29 558.30 558.31 558.32 558.33 558.34 559.1 559.2 559.3 559.4 559.5 559.6 559.7 559.8 559.9 559.10 559.11 559.12 559.13 559.14 559.15 559.16 559.17 559.18 559.19 559.20 559.21 559.22 559.23 559.24 559.25 559.26 559.27 559.28 559.29 559.30 559.31 559.32 559.33 559.34 559.35 560.1 560.2 560.3 560.4 560.5 560.6 560.7 560.8 560.9 560.10 560.11 560.12 560.13 560.14 560.15 560.16 560.17 560.18 560.19 560.20 560.21 560.22 560.23 560.24 560.25 560.26 560.27 560.28 560.29 560.30 560.31 560.32 560.33 560.34 561.1 561.2 561.3 561.4 561.5 561.6 561.7 561.8 561.9 561.10 561.11 561.12 561.13 561.14 561.15
561.16 561.17 561.18 561.19 561.20 561.21 561.22 561.23 561.24 561.25 561.26 561.27 561.28 561.29 561.30 561.31 561.32 561.33 562.1 562.2 562.3 562.4 562.5 562.6 562.7 562.8 562.9 562.10 562.11 562.12 562.13 562.14 562.15 562.16 562.17 562.18 562.19 562.20 562.21 562.22 562.23 562.24 562.25 562.26 562.27 562.28 562.29 562.30 562.31 562.32 562.33 562.34 562.35 563.1 563.2 563.3 563.4 563.5 563.6 563.7 563.8 563.9 563.10 563.11 563.12 563.13 563.14 563.15 563.16 563.17 563.18 563.19 563.20 563.21 563.22 563.23 563.24 563.25 563.26 563.27 563.28 563.29 563.30 563.31 563.32 563.33 563.34 563.35 564.1 564.2 564.3 564.4 564.5 564.6 564.7 564.8 564.9 564.10 564.11 564.12 564.13 564.14 564.15 564.16 564.17 564.18 564.19
564.20 564.21 564.22 564.23 564.24 564.25 564.26 564.27 564.28 564.29 564.30 564.31 564.32 564.33 565.1 565.2 565.3 565.4 565.5 565.6 565.7 565.8 565.9 565.10 565.11 565.12 565.13 565.14 565.15 565.16 565.17 565.18 565.19 565.20 565.21 565.22 565.23 565.24 565.25 565.26 565.27 565.28 565.29 565.30 565.31 565.32 565.33 565.34
566.1 566.2 566.3 566.4 566.5 566.6 566.7 566.8 566.9 566.10 566.11 566.12
566.13 566.14
566.15 566.16 566.17 566.18 566.19 566.20 566.21 566.22 566.23 566.24 566.25 566.26 566.27 566.28 566.29 566.30 566.31 566.32 566.33
567.1 567.2 567.3 567.4
567.5 567.6 567.7 567.8 567.9 567.10 567.11 567.12 567.13 567.14 567.15 567.16 567.17 567.18 567.19 567.20 567.21
567.22 567.23 567.24 567.25 567.26 567.27
567.28 567.29 567.30
568.1 568.2 568.3
568.4 568.5 568.6 568.7 568.8 568.9 568.10 568.11 568.12 568.13 568.14 568.15 568.16 568.17 568.18 568.19 568.20 568.21 568.22 568.23 568.24 568.25 568.26 568.27 568.28 568.29 568.30 568.31 568.32 568.33 569.1 569.2 569.3 569.4 569.5 569.6 569.7 569.8 569.9 569.10 569.11 569.12 569.13 569.14 569.15 569.16 569.17
569.18 569.19 569.20
A bill for an act
relating to state government; modifying provisions on health care administration
and affordability, the Minnesota Department of Health, health-related licensing
boards, human services background studies, behavioral health, Department of
Human Services operations and policy, economic assistance, and housing supports;
requiring reports; making forecast adjustments; appropriating money; amending
Minnesota Statutes 2022, sections 12A.08, subdivision 3; 13.3805, subdivision 1;
16A.151, subdivision 2; 62A.045; 62A.30, by adding subdivisions; 62A.673,
subdivision 2; 62J.17, subdivision 5a; 62J.692, subdivisions 1, 3, 4, 5, 8; 62J.84,
subdivisions 2, 3, 4, 6, 7, 8, 9, by adding subdivisions; 62K.10, subdivision 4;
62Q.01, by adding a subdivision; 62Q.021, by adding a subdivision; 62Q.096;
62Q.55, subdivision 5; 62Q.556; 62Q.56, subdivision 2; 62Q.73, subdivisions 1,
7; 62U.04, subdivisions 4, 5, 5a, 11, by adding subdivisions; 62V.05, subdivision
4a, by adding a subdivision; 121A.28; 121A.335; 122A.18, subdivision 8; 144.122;
144.1481, subdivision 1; 144.1501, subdivisions 1, 2, 3, 4, 5; 144.1505; 144.2151;
144.222; 144.226, subdivisions 3, 4; 144.382, by adding subdivisions; 144.55,
subdivision 3; 144.566; 144.608, subdivision 1; 144.615, subdivision 7; 144.651,
by adding a subdivision; 144.653, subdivision 5; 144.6535, subdivisions 1, 2, 4;
144.69; 144.7055; 144.7067, subdivision 1; 144.9501, subdivisions 9, 17, 26a,
26b, by adding subdivisions; 144.9505, subdivisions 1, 1g, 1h; 144.9508,
subdivision 2; 144A.06, subdivision 2; 144A.071, subdivision 2; 144A.073,
subdivision 3b; 144A.474, subdivisions 3, 9, 12; 144A.4791, subdivision 10;
144E.001, subdivision 1, by adding a subdivision; 144E.101, subdivisions 6, 7,
12; 144E.103, subdivision 1; 144E.35; 144G.16, subdivision 7; 144G.18; 144G.57,
subdivision 8; 145.411, subdivisions 1, 5; 145.423, subdivision 1; 145.87,
subdivision 4; 145.924; 145.925; 145A.131, subdivisions 1, 5; 145A.14, by adding
a subdivision; 147.02, subdivision 1; 147.03, subdivision 1; 147.037, subdivision
1; 147.141; 147A.08; 147A.16; 147B.02, subdivisions 4, 7; 148.261, subdivision
1; 148.512, subdivisions 10a, 10b, by adding subdivisions; 148.513, by adding a
subdivision; 148.515, subdivision 6; 148.5175; 148.5195, subdivision 3; 148.5196,
subdivision 1; 148.5197; 148.5198; 148B.392, subdivision 2; 148F.11, by adding
a subdivision; 150A.08, subdivisions 1, 5; 150A.091, by adding a subdivision;
150A.13, subdivision 10; 151.01, subdivision 27, by adding a subdivision; 151.065,
subdivisions 1, 2, 3, 4, 6; 151.37, subdivision 12; 151.40, subdivisions 1, 2;
151.555; 151.74, subdivisions 3, 4; 152.01, subdivision 18; 152.205; 153A.13,
subdivisions 3, 4, 5, 6, 7, 9, 10, 11, by adding subdivisions; 153A.14, subdivisions
1, 2, 2h, 2i, 2j, 4, 4a, 4b, 4c, 4e, 6, 9, 11, by adding a subdivision; 153A.15,
subdivisions 1, 2, 4; 153A.17; 153A.175; 153A.18; 153A.20; 245.4661, subdivision
9; 245.4663, subdivisions 1, 4; 245.469, subdivision 3; 245.4901, subdivision 4,
by adding a subdivision; 245.735, subdivisions 3, 5, 6, by adding subdivisions;
245A.02, subdivisions 5a, 10b; 245A.04, subdivisions 1, 7, 7a; 245A.041, by
adding a subdivision; 245A.05; 245A.055, subdivision 2; 245A.06, subdivisions
1, 2, 4; 245A.07, subdivisions 2a, 3; 245A.10, subdivisions 3, 4; 245A.16,
subdivision 1, by adding a subdivision; 245C.02, subdivisions 6a, 11c, 13e, by
adding subdivisions; 245C.03, subdivisions 1, 1a, 4, 5, 5a; 245C.031, subdivisions
1, 4; 245C.05, subdivisions 1, 4, by adding a subdivision; 245C.07; 245C.08,
subdivision 1; 245C.10, subdivisions 1d, 2, 2a, 3, 4, 5, 6, 8, 9, 9a, 10, 11, 12, 13,
14, 15, 16, 17, 20, 21, by adding a subdivision; 245C.31, subdivision 1; 245C.32,
subdivision 2; 245C.33, subdivision 4; 245G.01, by adding a subdivision; 245G.11,
subdivision 10; 245H.01, subdivision 3, by adding a subdivision; 245H.03,
subdivisions 2, 3, 4; 245H.06, subdivisions 1, 2; 245H.07, subdivisions 1, 2;
245H.13, subdivision 9; 245I.04, subdivisions 14, 16; 245I.05, subdivision 3;
245I.08, subdivisions 2, 3, 4; 245I.10, subdivisions 2, 3, 5, 6, 7, 8; 245I.11,
subdivisions 3, 4; 245I.20, subdivisions 5, 6, 10, 13, 14, 16; 254B.02, subdivision
5; 254B.05, subdivisions 1, 1a; 256.01, by adding a subdivision; 256.0471,
subdivision 1; 256.478, subdivisions 1, 2, by adding subdivisions; 256.9685,
subdivisions 1a, 1b; 256.9686, by adding a subdivision; 256.969, subdivisions 2b,
9, 25, by adding a subdivision; 256B.04, subdivisions 14, 15; 256B.055, subdivision
17; 256B.056, subdivision 7, by adding a subdivision; 256B.0616, subdivisions
3, 4, 5; 256B.0622, subdivisions 7a, 7b, 7c, 8; 256B.0623, subdivision 4;
256B.0624, subdivisions 5, 8; 256B.0625, subdivisions 3a, 5m, 9, 13c, 13e, 16,
22, 28b, 30, 31, 34, by adding subdivisions; 256B.0631, subdivisions 1, 3;
256B.064; 256B.0757, subdivision 4c; 256B.0941, subdivision 2a, by adding
subdivisions; 256B.0946, subdivision 6; 256B.0947, subdivision 7a, by adding a
subdivision; 256B.196, subdivision 2; 256B.27, subdivision 3; 256B.434,
subdivision 4f; 256B.69, subdivisions 4, 5a, 6d, 28, 36; 256B.692, subdivisions
1, 2; 256B.75; 256B.76, subdivisions 1, 2; 256B.764; 256D.01, subdivision 1a;
256D.02, by adding a subdivision; 256D.024, subdivision 1; 256D.06, subdivision
5; 256D.07; 256I.03, subdivisions 7, 15, by adding a subdivision; 256I.04,
subdivisions 1, 2, 3; 256I.05, subdivisions 1a, 2; 256I.06, subdivision 3; 256I.09;
256J.08, subdivision 21; 256J.09, subdivision 3; 256J.26, subdivision 1; 256J.95,
subdivision 5; 256L.03, subdivisions 1, 5; 256L.04, subdivisions 1c, 7a, 10, by
adding a subdivision; 256L.07, subdivision 1; 256L.15, subdivision 2; 256P.01,
by adding subdivisions; 256P.02, subdivisions 1a, 2, by adding subdivisions;
256P.04, by adding a subdivision; 256P.06, subdivision 3, by adding subdivisions;
260C.007, subdivision 26d; 260E.09; 270B.14, subdivision 1; 297F.10, subdivision
1; 518A.39, subdivision 2; 524.5-118; 609B.425, subdivision 2; 609B.435,
subdivision 2; Laws 2017, First Special Session chapter 6, article 5, section 11, as
amended; Laws 2021, First Special Session chapter 7, article 6, section 26; article
16, section 2, subdivision 32, as amended; Laws 2022, chapter 99, article 1, section
46; article 3, section 9; proposing coding for new law in Minnesota Statutes,
chapters 62J; 62Q; 115; 144; 144E; 145; 148; 245; 245A; 245C; 256; repealing
Minnesota Statutes 2022, sections 62J.692, subdivisions 4a, 7, 7a; 62J.84,
subdivision 5; 62Q.145; 62U.10, subdivisions 6, 7, 8; 137.38, subdivision 1;
144.059, subdivision 10; 144.9505, subdivision 3; 145.1621; 145.411, subdivisions
2, 4; 145.412; 145.413, subdivisions 2, 3; 145.4131; 145.4132; 145.4133; 145.4134;
145.4135; 145.4136; 145.415; 145.416; 145.423, subdivisions 2, 3, 4, 5, 6, 7, 8,
9; 145.4235; 145.4241; 145.4242; 145.4243; 145.4244; 145.4245; 145.4246;
145.4247; 145.4248; 145.4249; 152.092; 153A.14, subdivision 5; 245A.22;
245C.02, subdivisions 9, 14b; 245C.031, subdivisions 5, 6, 7; 245C.032; 245C.30,
subdivision 1a; 245C.301; 256.9685, subdivisions 1c, 1d; 256B.011; 256B.40;
256B.69, subdivision 5c; 256I.03, subdivision 6; 261.28; 393.07, subdivision 11;
Minnesota Rules, parts 4615.3600; 4640.1500; 4640.1600; 4640.1700; 4640.1800;
4640.1900; 4640.2000; 4640.2100; 4640.2200; 4640.2300; 4640.2400; 4640.2500;
4640.2600; 4640.2700; 4640.2800; 4640.2900; 4640.3000; 4640.3100; 4640.3200;
4640.3300; 4640.3400; 4640.3500; 4640.3600; 4640.3700; 4640.3800; 4640.3900;
4640.4000; 4640.4100; 4640.4200; 4640.4300; 4640.6100; 4640.6200; 4640.6300;
4640.6400; 4645.0300; 4645.0400; 4645.0500; 4645.0600; 4645.0700; 4645.0800;
4645.0900; 4645.1000; 4645.1100; 4645.1200; 4645.1300; 4645.1400; 4645.1500;
4645.1600; 4645.1700; 4645.1800; 4645.1900; 4645.2000; 4645.2100; 4645.2200;
4645.2300; 4645.2400; 4645.2500; 4645.2600; 4645.2700; 4645.2800; 4645.2900;
4645.3000; 4645.3100; 4645.3200; 4645.3300; 4645.3400; 4645.3500; 4645.3600;
4645.3700; 4645.3800; 4645.3805; 4645.3900; 4645.4000; 4645.4100; 4645.4200;
4645.4300; 4645.4400; 4645.4500; 4645.4600; 4645.4700; 4645.4800; 4645.4900;
4645.5100; 4645.5200; 4700.1900; 4700.2000; 4700.2100; 4700.2210; 4700.2300,
subparts 1, 3, 4, 4a, 5; 4700.2410; 4700.2420; 4700.2500; 5610.0100; 5610.0200;
5610.0300; 9505.0235; 9505.0505, subpart 18; 9505.0520, subpart 9b.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
ARTICLE 1
DEPARTMENT OF HUMAN SERVICES HEALTH CARE
Section 1.
Minnesota Statutes 2022, section 62A.045, is amended to read:
62A.045 PAYMENTS ON BEHALF OF ENROLLEES IN GOVERNMENT
HEALTH PROGRAMS.
(a) As a condition of doing business in Minnesota or providing coverage to residents of
Minnesota covered by this section, each health insurer shall comply with the requirements
deleted text begin ofdeleted text end new text begin for health insurers undernew text end the federal Deficit Reduction Act of 2005, Public Law 109-171new text begin
and the federal Consolidated Appropriations Act of 2022, Public Law 117-103new text end , including
any federal regulations adopted under deleted text begin that actdeleted text end new text begin those actsnew text end , to the extent that deleted text begin it imposesdeleted text end new text begin they
imposenew text end a requirement that applies in this state and that is not also required by the laws of
this state. This section does not require compliance with any provision of the federal deleted text begin actdeleted text end new text begin
actsnew text end prior to the effective deleted text begin datedeleted text end new text begin datesnew text end provided for deleted text begin that provisiondeleted text end new text begin those provisionsnew text end in the
federal deleted text begin actdeleted text end new text begin actsnew text end . The commissioner shall enforce this section.
For the purpose of this section, "health insurer" includes self-insured plans, group health
plans (as defined in section 607(1) of the Employee Retirement Income Security Act of
1974), service benefit plans, managed care organizations, pharmacy benefit managers, or
other parties that are by contract legally responsible to pay a claim for a health-care item
or service for an individual receiving benefits under paragraph (b).
(b) No plan offered by a health insurer issued or renewed to provide coverage to a
Minnesota resident shall contain any provision denying or reducing benefits because services
are rendered to a person who is eligible for or receiving medical benefits pursuant to title
XIX of the Social Security Act (Medicaid) in this or any other state; chapter 256 or 256B;
or services pursuant to section 252.27; 256L.01 to 256L.10; 260B.331, subdivision 2;
260C.331, subdivision 2; or 393.07, subdivision 1 or 2. No health insurer providing benefits
under plans covered by this section shall use eligibility for medical programs named in this
section as an underwriting guideline or reason for nonacceptance of the risk.
(c) If payment for covered expenses has been made under state medical programs for
health care items or services provided to an individual, and a third party has a legal liability
to make payments, the rights of payment and appeal of an adverse coverage decision for
the individual, or in the case of a child their responsible relative or caretaker, will be
subrogated to the state agency. The state agency may assert its rights under this section
within three years of the date the service was rendered. For purposes of this section, "state
agency" includes prepaid health plans under contract with the commissioner according to
sections 256B.69 and 256L.12; children's mental health collaboratives under section 245.493;
demonstration projects for persons with disabilities under section 256B.77; nursing homes
under the alternative payment demonstration project under section 256B.434; and
county-based purchasing entities under section 256B.692.
(d) Notwithstanding any law to the contrary, when a person covered by a plan offered
by a health insurer receives medical benefits according to any statute listed in this section,
payment for covered services or notice of denial for services billed by the provider must be
issued directly to the provider. If a person was receiving medical benefits through the
Department of Human Services at the time a service was provided, the provider must indicate
this benefit coverage on any claim forms submitted by the provider to the health insurer for
those services. If the commissioner of human services notifies the health insurer that the
commissioner has made payments to the provider, payment for benefits or notices of denials
issued by the health insurer must be issued directly to the commissioner. Submission by the
department to the health insurer of the claim on a Department of Human Services claim
form is proper notice and shall be considered proof of payment of the claim to the provider
and supersedes any contract requirements of the health insurer relating to the form of
submission. Liability to the insured for coverage is satisfied to the extent that payments for
those benefits are made by the health insurer to the provider or the commissioner as required
by this section.
(e) When a state agency has acquired the rights of an individual eligible for medical
programs named in this section and has health benefits coverage through a health insurer,
the health insurer shall not impose requirements that are different from requirements
applicable to an agent or assignee of any other individual covered.
(f) A health insurer must process a clean claim made by a state agency for covered
expenses paid under state medical programs within 90 business days of the claim's
submission. A health insurer must process all other claims made by a state agency for
covered expenses paid under a state medical program within the timeline set forth in Code
of Federal Regulations, title 42, section 447.45(d)(4).
(g) A health insurer may request a refund of a claim paid in error to the Department of
Human Services within two years of the date the payment was made to the department. A
request for a refund shall not be honored by the department if the health insurer makes the
request after the time period has lapsed.
Sec. 2.
Minnesota Statutes 2022, section 62A.673, subdivision 2, is amended to read:
Subd. 2.
Definitions.
(a) For purposes of this section, the terms defined in this subdivision
have the meanings given.
(b) "Distant site" means a site at which a health care provider is located while providing
health care services or consultations by means of telehealth.
(c) "Health care provider" means a health care professional who is licensed or registered
by the state to perform health care services within the provider's scope of practice and in
accordance with state law. A health care provider includes a mental health professional
under section 245I.04, subdivision 2; a mental health practitioner under section 245I.04,
subdivision 4; a clinical trainee under section 245I.04, subdivision 6; a treatment coordinator
under section 245G.11, subdivision 7; an alcohol and drug counselor under section 245G.11,
subdivision 5; and a recovery peer under section 245G.11, subdivision 8.
(d) "Health carrier" has the meaning given in section 62A.011, subdivision 2.
(e) "Health plan" has the meaning given in section 62A.011, subdivision 3. Health plan
includes dental plans as defined in section 62Q.76, subdivision 3, but does not include dental
plans that provide indemnity-based benefits, regardless of expenses incurred, and are designed
to pay benefits directly to the policy holder.
(f) "Originating site" means a site at which a patient is located at the time health care
services are provided to the patient by means of telehealth. For purposes of store-and-forward
technology, the originating site also means the location at which a health care provider
transfers or transmits information to the distant site.
(g) "Store-and-forward technology" means the asynchronous electronic transfer or
transmission of a patient's medical information or data from an originating site to a distant
site for the purposes of diagnostic and therapeutic assistance in the care of a patient.
(h) "Telehealth" means the delivery of health care services or consultations through the
use of real time two-way interactive audio and visual communications to provide or support
health care delivery and facilitate the assessment, diagnosis, consultation, treatment,
education, and care management of a patient's health care. Telehealth includes the application
of secure video conferencing, store-and-forward technology, and synchronous interactions
between a patient located at an originating site and a health care provider located at a distant
site. Until July 1, deleted text begin 2023deleted text end new text begin 2025new text end , telehealth also includes audio-only communication between
a health care provider and a patient in accordance with subdivision 6, paragraph (b).
Telehealth does not include communication between health care providers that consists
solely of a telephone conversation, email, or facsimile transmission. Telehealth does not
include communication between a health care provider and a patient that consists solely of
an email or facsimile transmission. Telehealth does not include telemonitoring services as
defined in paragraph (i).
(i) "Telemonitoring services" means the remote monitoring of clinical data related to
the enrollee's vital signs or biometric data by a monitoring device or equipment that transmits
the data electronically to a health care provider for analysis. Telemonitoring is intended to
collect an enrollee's health-related data for the purpose of assisting a health care provider
in assessing and monitoring the enrollee's medical condition or status.
Sec. 3.
Minnesota Statutes 2022, section 256.01, is amended by adding a subdivision to
read:
new text begin Subd. 43. new text end
new text begin Education on contraceptive options. new text end
new text begin
The commissioner shall require hospitals
and primary care providers serving medical assistance and MinnesotaCare enrollees to
develop and implement protocols to provide enrollees, when appropriate, with comprehensive
and scientifically accurate information on the full range of contraceptive options, in a
medically ethical, culturally competent, and noncoercive manner. The information provided
must be designed to assist enrollees in identifying the contraceptive method that best meets
the enrollees' needs and the needs of the enrollees' families. The protocol must specify the
enrollee categories to which this requirement will be applied, the process to be used, and
the information and resources to be provided. Hospitals and providers must make this
protocol available to the commissioner upon request.
new text end
Sec. 4.
Minnesota Statutes 2022, section 256.0471, subdivision 1, is amended to read:
Subdivision 1.
Qualifying overpayment.
Any overpayment for assistance granted under
deleted text begin chapter 119B,deleted text end the MFIP program formerly codified under sections 256.031 to 256.0361deleted text begin ,deleted text end new text begin ;new text end
deleted text begin anddeleted text end the AFDC program formerly codified under sections 256.72 to 256.871; new text begin for assistance
granted under new text end chapters deleted text begin 256B for state-funded medical assistance,deleted text end new text begin 119B,new text end 256D, 256I, 256J,
new text begin and new text end 256Kdeleted text begin , and 256Ldeleted text end new text begin ; for assistance granted pursuant to section 256.045, subdivision 10,new text end
for new text begin state-funded medical assistance and new text end state-funded MinnesotaCarenew text begin under chapters 256B
and 256Lnew text end ; and new text begin for assistance granted under new text end the Supplemental Nutrition Assistance Program
(SNAP), except agency error claims, become a judgment by operation of law 90 days after
the notice of overpayment is personally served upon the recipient in a manner that is sufficient
under rule 4.03(a) of the Rules of Civil Procedure for district courts, or by certified mail,
return receipt requested. This judgment shall be entitled to full faith and credit in this and
any other state.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2023.
new text end
Sec. 5.
Minnesota Statutes 2022, section 256.969, subdivision 2b, is amended to read:
Subd. 2b.
Hospital payment rates.
(a) For discharges occurring on or after November
1, 2014, hospital inpatient services for hospitals located in Minnesota shall be paid according
to the following:
(1) critical access hospitals as defined by Medicare shall be paid using a cost-based
methodology;
(2) long-term hospitals as defined by Medicare shall be paid on a per diem methodology
under subdivision 25;
(3) rehabilitation hospitals or units of hospitals that are recognized as rehabilitation
distinct parts as defined by Medicare shall be paid according to the methodology under
subdivision 12; and
(4) all other hospitals shall be paid on a diagnosis-related group (DRG) methodology.
(b) For the period beginning January 1, 2011, through October 31, 2014, rates shall not
be rebased, except that a Minnesota long-term hospital shall be rebased effective January
1, 2011, based on its most recent Medicare cost report ending on or before September 1,
2008, with the provisions under subdivisions 9 and 23, based on the rates in effect on
December 31, 2010. For rate setting periods after November 1, 2014, in which the base
years are updated, a Minnesota long-term hospital's base year shall remain within the same
period as other hospitals.
(c) Effective for discharges occurring on and after November 1, 2014, payment rates
for hospital inpatient services provided by hospitals located in Minnesota or the local trade
area, except for the hospitals paid under the methodologies described in paragraph (a),
clauses (2) and (3), shall be rebased, incorporating cost and payment methodologies in a
manner similar to Medicare. The base year or years for the rates effective November 1,
2014, shall be calendar year 2012. The rebasing under this paragraph shall be budget neutral,
ensuring that the total aggregate payments under the rebased system are equal to the total
aggregate payments that were made for the same number and types of services in the base
year. Separate budget neutrality calculations shall be determined for payments made to
critical access hospitals and payments made to hospitals paid under the DRG system. Only
the rate increases or decreases under subdivision 3a or 3c that applied to the hospitals being
rebased during the entire base period shall be incorporated into the budget neutrality
calculation.
(d) For discharges occurring on or after November 1, 2014, through the next rebasing
that occurs, the rebased rates under paragraph (c) that apply to hospitals under paragraph
(a), clause (4), shall include adjustments to the projected rates that result in no greater than
a five percent increase or decrease from the base year payments for any hospital. Any
adjustments to the rates made by the commissioner under this paragraph and paragraph (e)
shall maintain budget neutrality as described in paragraph (c).
(e) For discharges occurring on or after November 1, 2014, the commissioner may make
additional adjustments to the rebased rates, and when evaluating whether additional
adjustments should be made, the commissioner shall consider the impact of the rates on the
following:
(1) pediatric services;
(2) behavioral health services;
(3) trauma services as defined by the National Uniform Billing Committee;
(4) transplant services;
(5) obstetric services, newborn services, and behavioral health services provided by
hospitals outside the seven-county metropolitan area;
(6) outlier admissions;
(7) low-volume providers; and
(8) services provided by small rural hospitals that are not critical access hospitals.
(f) Hospital payment rates established under paragraph (c) must incorporate the following:
(1) for hospitals paid under the DRG methodology, the base year payment rate per
admission is standardized by the applicable Medicare wage index and adjusted by the
hospital's disproportionate population adjustment;
(2) for critical access hospitals, payment rates for discharges between November 1, 2014,
and June 30, 2015, shall be set to the same rate of payment that applied for discharges on
October 31, 2014;
(3) the cost and charge data used to establish hospital payment rates must only reflect
inpatient services covered by medical assistance; and
(4) in determining hospital payment rates for discharges occurring on or after the rate
year beginning January 1, 2011, through December 31, 2012, the hospital payment rate per
discharge shall be based on the cost-finding methods and allowable costs of the Medicare
program in effect during the base year or years. In determining hospital payment rates for
discharges in subsequent base years, the per discharge rates shall be based on the cost-finding
methods and allowable costs of the Medicare program in effect during the base year or
years.
(g) The commissioner shall validate the rates effective November 1, 2014, by applying
the rates established under paragraph (c), and any adjustments made to the rates under
paragraph (d) or (e), to hospital claims paid in calendar year 2013 to determine whether the
total aggregate payments for the same number and types of services under the rebased rates
are equal to the total aggregate payments made during calendar year 2013.
(h) Effective for discharges occurring on or after July 1, 2017, and every two years
thereafter, payment rates under this section shall be rebased to reflect only those changes
in hospital costs between the existing base year or years and the next base year or years. In
any year that inpatient claims volume falls below the threshold required to ensure a
statistically valid sample of claims, the commissioner may combine claims data from two
consecutive years to serve as the base year. Years in which inpatient claims volume is
reduced or altered due to a pandemic or other public health emergency shall not be used as
a base year or part of a base year if the base year includes more than one year. Changes in
costs between base years shall be measured using the lower of the hospital cost index defined
in subdivision 1, paragraph (a), or the percentage change in the case mix adjusted cost per
claim. The commissioner shall establish the base year for each rebasing period considering
the most recent year or years for which filed Medicare cost reports are availablenew text begin , except
that the base years for the rebasing effective July 1, 2023, are calendar years 2018 and 2019new text end .
The estimated change in the average payment per hospital discharge resulting from a
scheduled rebasing must be calculated and made available to the legislature by January 15
of each year in which rebasing is scheduled to occur, and must include by hospital the
differential in payment rates compared to the individual hospital's costs.
(i) Effective for discharges occurring on or after July 1, 2015, inpatient payment rates
for critical access hospitals located in Minnesota or the local trade area shall be determined
using a new cost-based methodology. The commissioner shall establish within the
methodology tiers of payment designed to promote efficiency and cost-effectiveness.
Payment rates for hospitals under this paragraph shall be set at a level that does not exceed
the total cost for critical access hospitals as reflected in base year cost reports. Until the
next rebasing that occurs, the new methodology shall result in no greater than a five percent
decrease from the base year payments for any hospital, except a hospital that had payments
that were greater than 100 percent of the hospital's costs in the base year shall have their
rate set equal to 100 percent of costs in the base year. The rates paid for discharges on and
after July 1, 2016, covered under this paragraph shall be increased by the inflation factor
in subdivision 1, paragraph (a). The new cost-based rate shall be the final rate and shall not
be settled to actual incurred costs. Hospitals shall be assigned a payment tier based on the
following criteria:
(1) hospitals that had payments at or below 80 percent of their costs in the base year
shall have a rate set that equals 85 percent of their base year costs;
(2) hospitals that had payments that were above 80 percent, up to and including 90
percent of their costs in the base year shall have a rate set that equals 95 percent of their
base year costs; and
(3) hospitals that had payments that were above 90 percent of their costs in the base year
shall have a rate set that equals 100 percent of their base year costs.
(j) The commissioner may refine the payment tiers and criteria for critical access hospitals
to coincide with the next rebasing under paragraph (h). The factors used to develop the new
methodology may include, but are not limited to:
(1) the ratio between the hospital's costs for treating medical assistance patients and the
hospital's charges to the medical assistance program;
(2) the ratio between the hospital's costs for treating medical assistance patients and the
hospital's payments received from the medical assistance program for the care of medical
assistance patients;
(3) the ratio between the hospital's charges to the medical assistance program and the
hospital's payments received from the medical assistance program for the care of medical
assistance patients;
(4) the statewide average increases in the ratios identified in clauses (1), (2), and (3);
(5) the proportion of that hospital's costs that are administrative and trends in
administrative costs; and
(6) geographic location.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2023.
new text end
Sec. 6.
Minnesota Statutes 2022, section 256.969, subdivision 9, is amended to read:
Subd. 9.
Disproportionate numbers of low-income patients served.
(a) For admissions
occurring on or after July 1, 1993, the medical assistance disproportionate population
adjustment shall comply with federal law and shall be paid to a hospital, excluding regional
treatment centers and facilities of the federal Indian Health Service, with a medical assistance
inpatient utilization rate in excess of the arithmetic mean. The adjustment must be determined
as follows:
(1) for a hospital with a medical assistance inpatient utilization rate above the arithmetic
mean for all hospitals excluding regional treatment centers and facilities of the federal Indian
Health Service but less than or equal to one standard deviation above the mean, the
adjustment must be determined by multiplying the total of the operating and property
payment rates by the difference between the hospital's actual medical assistance inpatient
utilization rate and the arithmetic mean for all hospitals excluding regional treatment centers
and facilities of the federal Indian Health Service; and
(2) for a hospital with a medical assistance inpatient utilization rate above one standard
deviation above the mean, the adjustment must be determined by multiplying the adjustment
that would be determined under clause (1) for that hospital by 1.1. The commissioner shall
report annually on the number of hospitals likely to receive the adjustment authorized by
this paragraph. The commissioner shall specifically report on the adjustments received by
public hospitals and public hospital corporations located in cities of the first class.
(b) Certified public expenditures made by Hennepin County Medical Center shall be
considered Medicaid disproportionate share hospital payments. Hennepin County and
Hennepin County Medical Center shall report by June 15, 2007, on payments made beginning
July 1, 2005, or another date specified by the commissioner, that may qualify for
reimbursement under federal law. Based on these reports, the commissioner shall apply for
federal matching funds.
(c) Upon federal approval of the related state plan amendment, paragraph (b) is effective
retroactively from July 1, 2005, or the earliest effective date approved by the Centers for
Medicare and Medicaid Services.
(d) Effective July 1, 2015, disproportionate share hospital (DSH) payments shall be paid
in accordance with a new methodology using 2012 as the base year. Annual payments made
under this paragraph shall equal the total amount of payments made for 2012. A licensed
children's hospital shall receive only a single DSH factor for children's hospitals. Other
DSH factors may be combined to arrive at a single factor for each hospital that is eligible
for DSH payments. The new methodology shall make payments only to hospitals located
in Minnesota and include the following factors:
(1) a licensed children's hospital with at least 1,000 fee-for-service discharges in the
base year shall receive a factor of 0.868. A licensed children's hospital with less than 1,000
fee-for-service discharges in the base year shall receive a factor of 0.7880;
(2) a hospital that has in effect for the initial rate year a contract with the commissioner
to provide extended psychiatric inpatient services under section 256.9693 shall receive a
factor of 0.0160;
(3) a hospital that has received medical assistance payment for at least 20 transplant
services in the base year shall receive a factor of 0.0435;
(4) a hospital that has a medical assistance utilization rate in the base year between 20
percent up to one standard deviation above the statewide mean utilization rate shall receive
a factor of 0.0468;
(5) a hospital that has a medical assistance utilization rate in the base year that is at least
one standard deviation above the statewide mean utilization rate but is less than two and
one-half standard deviations above the mean shall receive a factor of 0.2300; and
(6) a hospital that is a level one trauma center and that has a medical assistance utilization
rate in the base year that is at least two and deleted text begin one-halfdeleted text end new text begin one-quarternew text end standard deviations above
the statewide mean utilization rate shall receive a factor of 0.3711.
(e) For the purposes of determining eligibility for the disproportionate share hospital
factors in paragraph (d), clauses (1) to (6), the medical assistance utilization rate and
discharge thresholds shall be measured using only one year when a two-year base period
is used.
(f) Any payments or portion of payments made to a hospital under this subdivision that
are subsequently returned to the commissioner because the payments are found to exceed
the hospital-specific DSH limit for that hospital shall be redistributed, proportionate to the
number of fee-for-service discharges, to other DSH-eligible non-children's hospitals that
have a medical assistance utilization rate that is at least one standard deviation above the
mean.
(g) An additional payment adjustment shall be established by the commissioner under
this subdivision for a hospital that provides high levels of administering high-cost drugs to
enrollees in fee-for-service medical assistance. The commissioner shall consider factors
including fee-for-service medical assistance utilization rates and payments made for drugs
purchased through the 340B drug purchasing program and administered to fee-for-service
enrollees. If any part of this adjustment exceeds a hospital's hospital-specific disproportionate
share hospital limit, the commissioner shall make a payment to the hospital that equals the
nonfederal share of the amount that exceeds the limit. The total nonfederal share of the
amount of the payment adjustment under this paragraph shall not exceed $1,500,000.
Sec. 7.
Minnesota Statutes 2022, section 256.969, subdivision 25, is amended to read:
Subd. 25.
Long-term hospital rates.
(a) Long-term hospitals shall be paid on a per diem
basis.
(b) For admissions occurring on or after April 1, 1995, a long-term hospital as designated
by Medicare that does not have admissions in the base year shall have inpatient rates
established at the average of other hospitals with the same designation. For subsequent
rate-setting periods in which base years are updated, the hospital's base year shall be the
first Medicare cost report filed with the long-term hospital designation and shall remain in
effect until it falls within the same period as other hospitals.
new text begin
(c) For admissions occurring on or after July 1, 2023, long-term hospitals must be paid
the higher of a per diem amount computed using the methodology described in subdivision
2b, paragraph (i), or the per diem rate as of July 1, 2021.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2023.
new text end
Sec. 8.
Minnesota Statutes 2022, section 256.969, is amended by adding a subdivision to
read:
new text begin Subd. 31. new text end
new text begin Long-acting reversible contraceptives. new text end
new text begin
(a) The commissioner must provide
separate reimbursement to hospitals for long-acting reversible contraceptives provided
immediately postpartum in the inpatient hospital setting. This payment must be in addition
to the diagnostic-related group reimbursement for labor and delivery and shall be made
consistent with section 256B.0625, subdivision 13e, paragraph (e).
new text end
new text begin
(b) The commissioner must require managed care and county-based purchasing plans
to comply with this subdivision when providing services to medical assistance enrollees.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024.
new text end
Sec. 9.
Minnesota Statutes 2022, section 256B.04, subdivision 14, is amended to read:
Subd. 14.
Competitive bidding.
(a) When determined to be effective, economical, and
feasible, the commissioner may utilize volume purchase through competitive bidding and
negotiation under the provisions of chapter 16C, to provide items under the medical assistance
program including but not limited to the following:
(1) eyeglasses;
(2) oxygen. The commissioner shall provide for oxygen needed in an emergency situation
on a short-term basis, until the vendor can obtain the necessary supply from the contract
dealer;
(3) hearing aids and supplies;
(4) durable medical equipment, including but not limited to:
(i) hospital beds;
(ii) commodes;
(iii) glide-about chairs;
(iv) patient lift apparatus;
(v) wheelchairs and accessories;
(vi) oxygen administration equipment;
(vii) respiratory therapy equipment;
(viii) electronic diagnostic, therapeutic and life-support systems; and
(ix) allergen-reducing products as described in section 256B.0625, subdivision 67,
paragraph (c) or (d);
(5) nonemergency medical transportation level of need determinations, disbursement of
public transportation passes and tokens, and volunteer and recipient mileage and parking
reimbursements; deleted text begin and
deleted text end
(6) drugsdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(7) quitline services as described in section 256B.0625, subdivision 68, paragraph (c).
new text end
(b) Rate changes and recipient cost-sharing under this chapter and chapter 256L do not
affect contract payments under this subdivision unless specifically identified.
(c) The commissioner may not utilize volume purchase through competitive bidding
and negotiation under the provisions of chapter 16C for special transportation services or
incontinence products and related supplies.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024.
new text end
Sec. 10.
Minnesota Statutes 2022, section 256B.055, subdivision 17, is amended to read:
Subd. 17.
Adults who were in foster care at the age of 18.
new text begin (a) new text end Medical assistance may
be paid for a person under 26 years of age who was in foster care under the commissioner's
responsibility on the date of attaining 18 years of age, and who was enrolled in medical
assistance under the state plan or a waiver of the plan while in foster care, in accordance
with section 2004 of the Affordable Care Act.
new text begin
(b) Beginning July 1, 2023, medical assistance may be paid for a person under 26 years
of age who was in foster care on the date of attaining 18 years of age and enrolled in another
state's Medicaid program while in foster care in accordance with the Substance Use-Disorder
Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities
Act of 2018. Public Law 115-271, section 1002.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 11.
Minnesota Statutes 2022, section 256B.0625, subdivision 3a, is amended to read:
Subd. 3a.
deleted text begin Sex reassignment surgerydeleted text end new text begin Gender-affirming servicesnew text end .
deleted text begin
Sex reassignment
surgery is not covered.
deleted text end
new text begin
Medical assistance covers gender-affirming services.
new text end
Sec. 12.
Minnesota Statutes 2022, section 256B.0625, subdivision 9, is amended to read:
Subd. 9.
Dental services.
(a) Medical assistance covers new text begin medically necessary new text end dental
services.
deleted text begin
(b) Medical assistance dental coverage for nonpregnant adults is limited to the following
services:
deleted text end
deleted text begin
(1) comprehensive exams, limited to once every five years;
deleted text end
deleted text begin
(2) periodic exams, limited to one per year;
deleted text end
deleted text begin
(3) limited exams;
deleted text end
deleted text begin
(4) bitewing x-rays, limited to one per year;
deleted text end
deleted text begin
(5) periapical x-rays;
deleted text end
deleted text begin
(6) panoramic x-rays, limited to one every five years except (1) when medically necessary
for the diagnosis and follow-up of oral and maxillofacial pathology and trauma or (2) once
every two years for patients who cannot cooperate for intraoral film due to a developmental
disability or medical condition that does not allow for intraoral film placement;
deleted text end
deleted text begin
(7) prophylaxis, limited to one per year;
deleted text end
deleted text begin
(8) application of fluoride varnish, limited to one per year;
deleted text end
deleted text begin
(9) posterior fillings, all at the amalgam rate;
deleted text end
deleted text begin
(10) anterior fillings;
deleted text end
deleted text begin
(11) endodontics, limited to root canals on the anterior and premolars only;
deleted text end
deleted text begin
(12) removable prostheses, each dental arch limited to one every six years;
deleted text end
deleted text begin
(13) oral surgery, limited to extractions, biopsies, and incision and drainage of abscesses;
deleted text end
deleted text begin
(14) palliative treatment and sedative fillings for relief of pain;
deleted text end
deleted text begin
(15) full-mouth debridement, limited to one every five years; and
deleted text end
deleted text begin
(16) nonsurgical treatment for periodontal disease, including scaling and root planing
once every two years for each quadrant, and routine periodontal maintenance procedures.
deleted text end
deleted text begin
(c) In addition to the services specified in paragraph (b), medical assistance covers the
following services for adults, if provided in an outpatient hospital setting or freestanding
ambulatory surgical center as part of outpatient dental surgery:
deleted text end
deleted text begin
(1) periodontics, limited to periodontal scaling and root planing once every two years;
deleted text end
deleted text begin
(2) general anesthesia; and
deleted text end
deleted text begin
(3) full-mouth survey once every five years.
deleted text end
deleted text begin (d) Medical assistance covers medically necessary dental services for children and
pregnant women.deleted text end The following guidelines apply:
(1) posterior fillings are paid at the amalgam rate;
(2) application of sealants are covered once every five years per permanent molar deleted text begin for
children onlydeleted text end ;
(3) application of fluoride varnish is covered once every six months; and
(4) orthodontia is eligible for coverage for children only.
deleted text begin (e)deleted text end new text begin (b) new text end In addition to the services specified in deleted text begin paragraphs (b) and (c)deleted text end new text begin paragraph (a)new text end ,
medical assistance covers the following services deleted text begin for adultsdeleted text end :
(1) house calls or extended care facility calls for on-site delivery of covered services;
(2) behavioral management when additional staff time is required to accommodate
behavioral challenges and sedation is not used;
(3) oral or IV sedation, if the covered dental service cannot be performed safely without
it or would otherwise require the service to be performed under general anesthesia in a
hospital or surgical center; and
(4) prophylaxis, in accordance with an appropriate individualized treatment plan, but
no more than four times per year.
deleted text begin (f)deleted text end new text begin (c) new text end The commissioner shall not require prior authorization for the services included
in paragraph deleted text begin (e)deleted text end new text begin (b)new text end , clauses (1) to (3), and shall prohibit managed care and county-based
purchasing plans from requiring prior authorization for the services included in paragraph
deleted text begin (e)deleted text end new text begin (b)new text end , clauses (1) to (3), when provided under sections 256B.69, 256B.692, and 256L.12.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024, or upon federal approval,
whichever is later.
new text end
Sec. 13.
Minnesota Statutes 2022, section 256B.0625, subdivision 13c, is amended to
read:
Subd. 13c.
Formulary Committee.
The commissioner, after receiving recommendations
from professional medical associations and professional pharmacy associations, and consumer
groups shall designate a Formulary Committee to carry out duties as described in subdivisions
13 to 13g. The Formulary Committee shall be comprised of deleted text begin fourdeleted text end new text begin at least fivenew text end licensed
physicians actively engaged in the practice of medicine in Minnesota, one of whom deleted text begin must
be actively engaged in the treatment of persons with mental illnessdeleted text end new text begin is an actively practicing
psychiatrist, one of whom specializes in the diagnosis and treatment of rare diseases, one
of whom specializes in pediatrics, and one of whom actively treats persons with disabilitiesnew text end ;
at least three licensed pharmacists actively engaged in the practice of pharmacy in Minnesotanew text begin ,
one of whom practices outside the metropolitan counties listed in section 473.121, subdivision
4, one of whom practices in the metropolitan counties listed in section 473.121, subdivision
4, and one of whom is a practicing hospital pharmacistnew text end ; deleted text begin and onedeleted text end new text begin at least fournew text end consumer
deleted text begin representativedeleted text end new text begin representatives, all of whom must have a personal or professional connection
to medical assistancenew text end ; new text begin and one representative designated by the Minnesota Rare Disease
Advisory Council established under section 256.4835; new text end the remainder to be made up of health
care professionals who are licensed in their field and have recognized knowledge in the
clinically appropriate prescribing, dispensing, and monitoring of covered outpatient drugs.
Members of the Formulary Committee shall not be employed by the Department of Human
Services, but the committee shall be staffed by an employee of the department who shall
serve as an ex officio, nonvoting member of the committee. The department's medical
director shall also serve as an ex officio, nonvoting member for the committee. Committee
members shall serve three-year terms and may be reappointed by the commissioner. The
Formulary Committee shall meet at least deleted text begin twicedeleted text end new text begin oncenew text end per year. The commissioner may require
more frequent Formulary Committee meetings as needed. An honorarium of $100 per
meeting and reimbursement for mileage shall be paid to each committee member in
attendance. new text begin Notwithstanding section 15.059, subdivision 6, new text end the Formulary Committee deleted text begin expires
June 30, 2023deleted text end new text begin does not expirenew text end .
Sec. 14.
Minnesota Statutes 2022, section 256B.0625, subdivision 13e, is amended to
read:
Subd. 13e.
Payment rates.
(a) The basis for determining the amount of payment shall
be the lower of the ingredient costs of the drugs plus the professional dispensing fee; or the
usual and customary price charged to the public. The usual and customary price means the
lowest price charged by the provider to a patient who pays for the prescription by cash,
check, or charge account and includes prices the pharmacy charges to a patient enrolled in
a prescription savings club or prescription discount club administered by the pharmacy or
pharmacy chain. The amount of payment basis must be reduced to reflect all discount
amounts applied to the charge by any third-party provider/insurer agreement or contract for
submitted charges to medical assistance programs. The net submitted charge may not be
greater than the patient liability for the service. The professional dispensing fee shall be
$10.77 for prescriptions filled with legend drugs meeting the definition of "covered outpatient
drugs" according to United States Code, title 42, section 1396r-8(k)(2). The dispensing fee
for intravenous solutions that must be compounded by the pharmacist shall be $10.77 per
claim. The professional dispensing fee for prescriptions filled with over-the-counter drugs
meeting the definition of covered outpatient drugs shall be $10.77 for dispensed quantities
equal to or greater than the number of units contained in the manufacturer's original package.
The professional dispensing fee shall be prorated based on the percentage of the package
dispensed when the pharmacy dispenses a quantity less than the number of units contained
in the manufacturer's original package. The pharmacy dispensing fee for prescribed
over-the-counter drugs not meeting the definition of covered outpatient drugs shall be $3.65
for quantities equal to or greater than the number of units contained in the manufacturer's
original package and shall be prorated based on the percentage of the package dispensed
when the pharmacy dispenses a quantity less than the number of units contained in the
manufacturer's original package. The National Average Drug Acquisition Cost (NADAC)
shall be used to determine the ingredient cost of a drug. For drugs for which a NADAC is
not reported, the commissioner shall estimate the ingredient cost at the wholesale acquisition
cost minus two percent. The ingredient cost of a drug for a provider participating in the
federal 340B Drug Pricing Program shall be either the 340B Drug Pricing Program ceiling
price established by the Health Resources and Services Administration or NADAC,
whichever is lower. Wholesale acquisition cost is defined as the manufacturer's list price
for a drug or biological to wholesalers or direct purchasers in the United States, not including
prompt pay or other discounts, rebates, or reductions in price, for the most recent month for
which information is available, as reported in wholesale price guides or other publications
of drug or biological pricing data. The maximum allowable cost of a multisource drug may
be set by the commissioner and it shall be comparable to the actual acquisition cost of the
drug product and no higher than the NADAC of the generic product. Establishment of the
amount of payment for drugs shall not be subject to the requirements of the Administrative
Procedure Act.
(b) Pharmacies dispensing prescriptions to residents of long-term care facilities using
an automated drug distribution system meeting the requirements of section 151.58, or a
packaging system meeting the packaging standards set forth in Minnesota Rules, part
6800.2700, that govern the return of unused drugs to the pharmacy for reuse, may employ
retrospective billing for prescription drugs dispensed to long-term care facility residents. A
retrospectively billing pharmacy must submit a claim only for the quantity of medication
used by the enrolled recipient during the defined billing period. A retrospectively billing
pharmacy must use a billing period not less than one calendar month or 30 days.
(c) A pharmacy provider using packaging that meets the standards set forth in Minnesota
Rules, part 6800.2700, is required to credit the department for the actual acquisition cost
of all unused drugs that are eligible for reuse, unless the pharmacy is using retrospective
billing. The commissioner may permit the drug clozapine to be dispensed in a quantity that
is less than a 30-day supply.
(d) If a pharmacy dispenses a multisource drug, the ingredient cost shall be the NADAC
of the generic product or the maximum allowable cost established by the commissioner
unless prior authorization for the brand name product has been granted according to the
criteria established by the Drug Formulary Committee as required by subdivision 13f,
paragraph (a), and the prescriber has indicated "dispense as written" on the prescription in
a manner consistent with section 151.21, subdivision 2.
(e) The basis for determining the amount of payment for drugs administered in an
outpatient setting shall be the lower of the usual and customary cost submitted by the
provider, 106 percent of the average sales price as determined by the United States
Department of Health and Human Services pursuant to title XVIII, section 1847a of the
federal Social Security Act, the specialty pharmacy rate, or the maximum allowable cost
set by the commissioner. If average sales price is unavailable, the amount of payment must
be lower of the usual and customary cost submitted by the provider, the wholesale acquisition
cost, the specialty pharmacy rate, or the maximum allowable cost set by the commissioner.
The commissioner shall discount the payment rate for drugs obtained through the federal
340B Drug Pricing Program by 28.6 percent. The payment for drugs administered in an
outpatient setting shall be made to the administering facility or practitioner. A retail or
specialty pharmacy dispensing a drug for administration in an outpatient setting is not
eligible for direct reimbursement.
(f) The commissioner may establish maximum allowable cost rates for specialty pharmacy
products that are lower than the ingredient cost formulas specified in paragraph (a). The
commissioner may require individuals enrolled in the health care programs administered
by the department to obtain specialty pharmacy products from providers with whom the
commissioner has negotiated lower reimbursement rates. Specialty pharmacy products are
defined as those used by a small number of recipients or recipients with complex and chronic
diseases that require expensive and challenging drug regimens. Examples of these conditions
include, but are not limited to: multiple sclerosis, HIV/AIDS, transplantation, hepatitis C,
growth hormone deficiency, Crohn's Disease, rheumatoid arthritis, and certain forms of
cancer. Specialty pharmaceutical products include injectable and infusion therapies,
biotechnology drugs, antihemophilic factor products, high-cost therapies, and therapies that
require complex care. The commissioner shall consult with the Formulary Committee to
develop a list of specialty pharmacy products subject to maximum allowable cost
reimbursement. In consulting with the Formulary Committee in developing this list, the
commissioner shall take into consideration the population served by specialty pharmacy
products, the current delivery system and standard of care in the state, and access to care
issues. The commissioner shall have the discretion to adjust the maximum allowable cost
to prevent access to care issues.
(g) Home infusion therapy services provided by home infusion therapy pharmacies must
be paid at rates according to subdivision 8d.
(h) The commissioner shall contract with a vendor to conduct a cost of dispensing survey
for all pharmacies that are physically located in the state of Minnesota that dispense outpatient
drugs under medical assistance. The commissioner shall ensure that the vendor has prior
experience in conducting cost of dispensing surveys. Each pharmacy enrolled with the
department to dispense outpatient prescription drugs to fee-for-service members must
respond to the cost of dispensing survey. The commissioner may sanction a pharmacy under
section 256B.064 for failure to respond. The commissioner shall require the vendor to
measure a single statewide cost of dispensing for specialty prescription drugs and a single
statewide cost of dispensing for nonspecialty prescription drugs for all responding pharmacies
to measure the mean, mean weighted by total prescription volume, mean weighted by
medical assistance prescription volume, median, median weighted by total prescription
volume, and median weighted by total medical assistance prescription volume. The
commissioner shall post a copy of the final cost of dispensing survey report on the
department's website. The initial survey must be completed no later than January 1, 2021,
and repeated every three years. The commissioner shall provide a summary of the results
of each cost of dispensing survey and provide recommendations for any changes to the
dispensing fee to the chairs and ranking members of the legislative committees with
jurisdiction over medical assistance pharmacy reimbursement.new text begin Notwithstanding section
256.01, subdivision 42, this paragraph does not expire.
new text end
(i) The commissioner shall increase the ingredient cost reimbursement calculated in
paragraphs (a) and (f) by 1.8 percent for prescription and nonprescription drugs subject to
the wholesale drug distributor tax under section 295.52.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 15.
Minnesota Statutes 2022, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 13k. new text end
new text begin Value-based purchasing arrangements. new text end
new text begin
(a) The commissioner may enter
into a value-based purchasing arrangement under medical assistance or MinnesotaCare, by
written arrangement with a drug manufacturer based on agreed-upon metrics. The
commissioner may contract with a vendor to implement and administer the value-based
purchasing arrangement. A value-based purchasing arrangement may include but is not
limited to rebates, discounts, price reductions, risk sharing, reimbursements, guarantees,
shared savings payments, withholds, or bonuses. A value-based purchasing arrangement
must provide at least the same value or discount in the aggregate as would claiming the
mandatory federal drug rebate under the Federal Social Security Act, section 1927.
new text end
new text begin
(b) Nothing in this section shall be interpreted as requiring a drug manufacturer or the
commissioner to enter into an arrangement as described in paragraph (a).
new text end
new text begin
(c) Nothing in this section shall be interpreted as altering or modifying medical assistance
coverage requirements under the federal Social Security Act, section 1927.
new text end
new text begin
(d) If the commissioner determines that a state plan amendment is necessary for
implementation before implementing a value-based purchasing arrangement, the
commissioner shall request the amendment and may delay implementing this provision
until the amendment is approved.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2023.
new text end
Sec. 16.
Minnesota Statutes 2022, section 256B.0625, subdivision 16, is amended to read:
Subd. 16.
Abortion services.
Medical assistance covers abortion servicesdeleted text begin , but only if
one of the following conditions is met:deleted text end new text begin determined to be medically necessary by the treating
provider and delivered in accordance with all applicable Minnesota laws.
new text end
deleted text begin
(a) The abortion is a medical necessity. "Medical necessity" means (1) the signed written
statement of two physicians indicating the abortion is medically necessary to prevent the
death of the mother, and (2) the patient has given her consent to the abortion in writing
unless the patient is physically or legally incapable of providing informed consent to the
procedure, in which case consent will be given as otherwise provided by law;
deleted text end
deleted text begin
(b) The pregnancy is the result of criminal sexual conduct as defined in section 609.342,
subdivision 1, clauses (a), (b), (c)(i) and (ii), and (e), and subdivision 1a, clauses (a), (b),
(c)(i) and (ii), and (d), and the incident is reported within 48 hours after the incident occurs
to a valid law enforcement agency for investigation, unless the victim is physically unable
to report the criminal sexual conduct, in which case the report shall be made within 48 hours
after the victim becomes physically able to report the criminal sexual conduct; or
deleted text end
deleted text begin
(c) The pregnancy is the result of incest, but only if the incident and relative are reported
to a valid law enforcement agency for investigation prior to the abortion.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 17.
Minnesota Statutes 2022, section 256B.0625, subdivision 22, is amended to read:
Subd. 22.
Hospice care.
Medical assistance covers hospice care services under Public
Law 99-272, section 9505, to the extent authorized by rule, except that a recipient age 21
or under who elects to receive hospice services does not waive coverage for services that
are related to the treatment of the condition for which a diagnosis of terminal illness has
been made.new text begin Hospice respite and end-of-life care under subdivision 22a are not hospice care
services under this subdivision.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024.
new text end
Sec. 18.
Minnesota Statutes 2022, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 22a. new text end
new text begin
Residential hospice facility; hospice respite and end-of-life care for
children.
new text end
new text begin
(a) Medical assistance covers hospice respite and end-of-life care if the care is
for recipients age 21 or under who elect to receive hospice care delivered in a facility that
is licensed under sections 144A.75 to 144A.755 and that is a residential hospice facility
under section 144A.75, subdivision 13, paragraph (a). Hospice care services under
subdivision 22 are not hospice respite or end-of-life care under this subdivision.
new text end
new text begin
(b) The payment rates for coverage under this subdivision must be 100 percent of the
Medicare rate for continuous home care hospice services as published in the Centers for
Medicare and Medicaid Services annual final rule updating payments and policies for hospice
care. The commissioner must seek to obtain federal financial participation for payment for
hospice respite and end-of-life care under this subdivision. Payment must be made using
state-only money, if federal financial participation is not obtained. Payment for hospice
respite and end-of-life care must be paid to the residential hospice facility and are not
included in any limit or cap amount applicable to hospice services payments to the elected
hospice services provider.
new text end
new text begin
(c) Certification of the residential hospice facility by the federal Medicare program must
not be a requirement of medical assistance payment for hospice respite and end-of-life care
under this subdivision.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024.
new text end
Sec. 19.
Minnesota Statutes 2022, section 256B.0625, subdivision 28b, is amended to
read:
Subd. 28b.
Doula services.
Medical assistance covers doula services provided by a
certified doula as defined in section 148.995, subdivision 2, of the mother's choice. For
purposes of this section, "doula services" means childbirth education and support services,
including emotional and physical support provided during pregnancy, labor, birth, and
postpartum.new text begin The commissioner shall enroll doula agencies and individual treating doulas
to provide direct reimbursement.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 20.
Minnesota Statutes 2022, section 256B.0625, subdivision 30, is amended to read:
Subd. 30.
Other clinic services.
(a) Medical assistance covers rural health clinic services,
federally qualified health center services, nonprofit community health clinic services, and
public health clinic services. Rural health clinic services and federally qualified health center
services mean services defined in United States Code, title 42, section 1396d(a)(2)(B) and
(C). Payment for rural health clinic and federally qualified health center services shall be
made according to applicable federal law and regulation.
(b) A federally qualified health center (FQHC) that is beginning initial operation shall
submit an estimate of budgeted costs and visits for the initial reporting period in the form
and detail required by the commissioner. An FQHC that is already in operation shall submit
an initial report using actual costs and visits for the initial reporting period. Within 90 days
of the end of its reporting period, an FQHC shall submit, in the form and detail required by
the commissioner, a report of its operations, including allowable costs actually incurred for
the period and the actual number of visits for services furnished during the period, and other
information required by the commissioner. FQHCs that file Medicare cost reports shall
provide the commissioner with a copy of the most recent Medicare cost report filed with
the Medicare program intermediary for the reporting year which support the costs claimed
on their cost report to the state.
(c) In order to continue cost-based payment under the medical assistance program
according to paragraphs (a) and (b), an FQHC or rural health clinic must apply for designation
as an essential community provider within six months of final adoption of rules by the
Department of Health according to section 62Q.19, subdivision 7. For those FQHCs and
rural health clinics that have applied for essential community provider status within the
six-month time prescribed, medical assistance payments will continue to be made according
to paragraphs (a) and (b) for the first three years after application. For FQHCs and rural
health clinics that either do not apply within the time specified above or who have had
essential community provider status for three years, medical assistance payments for health
services provided by these entities shall be according to the same rates and conditions
applicable to the same service provided by health care providers that are not FQHCs or rural
health clinics.
(d) Effective July 1, 1999, the provisions of paragraph (c) requiring an FQHC or a rural
health clinic to make application for an essential community provider designation in order
to have cost-based payments made according to paragraphs (a) and (b) no longer apply.
(e) Effective January 1, 2000, payments made according to paragraphs (a) and (b) shall
be limited to the cost phase-out schedule of the Balanced Budget Act of 1997.
(f) Effective January 1, 2001, through December 31, 2020, each FQHC and rural health
clinic may elect to be paid either under the prospective payment system established in United
States Code, title 42, section 1396a(aa), or under an alternative payment methodology
consistent with the requirements of United States Code, title 42, section 1396a(aa), and
approved by the Centers for Medicare and Medicaid Services. The alternative payment
methodology shall be 100 percent of cost as determined according to Medicare cost
principles.
(g) Effective for services provided on or after January 1, 2021, all claims for payment
of clinic services provided by FQHCs and rural health clinics shall be paid by the
commissioner, according to an annual election by the FQHC or rural health clinic, under
the current prospective payment system described in paragraph (f) or the alternative payment
methodology described in paragraph (l)new text begin , or, upon federal approval, for FQHCs that are also
urban Indian organizations under Title V of the federal Indian Health Improvement Act, as
provided under paragraph (k)new text end .
(h) For purposes of this section, "nonprofit community clinic" is a clinic that:
(1) has nonprofit status as specified in chapter 317A;
(2) has tax exempt status as provided in Internal Revenue Code, section 501(c)(3);
(3) is established to provide health services to low-income population groups, uninsured,
high-risk and special needs populations, underserved and other special needs populations;
(4) employs professional staff at least one-half of which are familiar with the cultural
background of their clients;
(5) charges for services on a sliding fee scale designed to provide assistance to
low-income clients based on current poverty income guidelines and family size; and
(6) does not restrict access or services because of a client's financial limitations or public
assistance status and provides no-cost care as needed.
(i) Effective for services provided on or after January 1, 2015, all claims for payment
of clinic services provided by FQHCs and rural health clinics shall be paid by the
commissioner. the commissioner shall determine the most feasible method for paying claims
from the following options:
(1) FQHCs and rural health clinics submit claims directly to the commissioner for
payment, and the commissioner provides claims information for recipients enrolled in a
managed care or county-based purchasing plan to the plan, on a regular basis; or
(2) FQHCs and rural health clinics submit claims for recipients enrolled in a managed
care or county-based purchasing plan to the plan, and those claims are submitted by the
plan to the commissioner for payment to the clinic.
(j) For clinic services provided prior to January 1, 2015, the commissioner shall calculate
and pay monthly the proposed managed care supplemental payments to clinics, and clinics
shall conduct a timely review of the payment calculation data in order to finalize all
supplemental payments in accordance with federal law. Any issues arising from a clinic's
review must be reported to the commissioner by January 1, 2017. Upon final agreement
between the commissioner and a clinic on issues identified under this subdivision, and in
accordance with United States Code, title 42, section 1396a(bb), no supplemental payments
for managed care plan or county-based purchasing plan claims for services provided prior
to January 1, 2015, shall be made after June 30, 2017. If the commissioner and clinics are
unable to resolve issues under this subdivision, the parties shall submit the dispute to the
arbitration process under section 14.57.
deleted text begin
(k) The commissioner shall seek a federal waiver, authorized under section 1115 of the
deleted text end
deleted text begin
Social Security Act, to obtain federal financial participation at the 100 percent federal
deleted text end
deleted text begin
matching percentage available to facilities of the Indian Health Service or tribal organization
deleted text end
deleted text begin
in accordance with section 1905(b) of the Social Security Act for expenditures made to
deleted text end
deleted text begin
organizations dually certified under Title V of the Indian Health Care Improvement Act,
deleted text end
deleted text begin
Public Law 94-437, and as a federally qualified health center under paragraph (a) that
deleted text end
deleted text begin
provides services to American Indian and Alaskan Native individuals eligible for services
deleted text end
deleted text begin
under this subdivision.
deleted text end
new text begin
(k) The commissioner shall establish an encounter payment rate that is equivalent to the
all inclusive rate (AIR) payment established by the Indian Health Service and published in
the Federal Register. The encounter rate must be updated annually and must reflect the
changes in the AIR established by the Indian Health Service each calendar year. FQHCs
that are also urban Indian organizations under Title V of the federal Indian Health
Improvement Act may elect to be paid: (1) at the encounter rate established under this
paragraph; (2) under the alternative payment methodology described in paragraph (l); or
(3) under the federally required prospective payment system described in paragraph (f).
FQHCs that elect to be paid at the encounter rate established under this paragraph must
continue to meet all state and federal requirements related to FQHCs and urban Indian
organizations and must maintain their statuses as FQHCs and urban Indian organizations.
new text end
(l) All claims for payment of clinic services provided by FQHCs and rural health clinics,
that have elected to be paid under this paragraph, shall be paid by the commissioner according
to the following requirements:
(1) the commissioner shall establish a single medical and single dental organization
encounter rate for each FQHC and rural health clinic when applicable;
(2) each FQHC and rural health clinic is eligible for same day reimbursement of one
medical and one dental organization encounter rate if eligible medical and dental visits are
provided on the same day;
(3) the commissioner shall reimburse FQHCs and rural health clinics, in accordance
with current applicable Medicare cost principles, their allowable costs, including direct
patient care costs and patient-related support services. Nonallowable costs include, but are
not limited to:
(i) general social services and administrative costs;
(ii) retail pharmacy;
(iii) patient incentives, food, housing assistance, and utility assistance;
(iv) external lab and x-ray;
(v) navigation services;
(vi) health care taxes;
(vii) advertising, public relations, and marketing;
(viii) office entertainment costs, food, alcohol, and gifts;
(ix) contributions and donations;
(x) bad debts or losses on awards or contracts;
(xi) fines, penalties, damages, or other settlements;
(xii) fundraising, investment management, and associated administrative costs;
(xiii) research and associated administrative costs;
(xiv) nonpaid workers;
(xv) lobbying;
(xvi) scholarships and student aid; and
(xvii) nonmedical assistance covered services;
(4) the commissioner shall review the list of nonallowable costs in the years between
the rebasing process established in clause (5), in consultation with the Minnesota Association
of Community Health Centers, FQHCs, and rural health clinics. The commissioner shall
publish the list and any updates in the Minnesota health care programs provider manual;
(5) the initial applicable base year organization encounter rates for FQHCs and rural
health clinics shall be computed for services delivered on or after January 1, 2021, and:
(i) must be determined using each FQHC's and rural health clinic's Medicare cost reports
from 2017 and 2018;
(ii) must be according to current applicable Medicare cost principles as applicable to
FQHCs and rural health clinics without the application of productivity screens and upper
payment limits or the Medicare prospective payment system FQHC aggregate mean upper
payment limit;
(iii) must be subsequently rebased every two years thereafter using the Medicare cost
reports that are three and four years prior to the rebasing year. Years in which organizational
cost or claims volume is reduced or altered due to a pandemic, disease, or other public health
emergency shall not be used as part of a base year when the base year includes more than
one year. The commissioner may use the Medicare cost reports of a year unaffected by a
pandemic, disease, or other public health emergency, or previous two consecutive years,
inflated to the base year as established under item (iv);
(iv) must be inflated to the base year using the inflation factor described in clause (6);
and
(v) the commissioner must provide for a 60-day appeals process under section 14.57;
(6) the commissioner shall annually inflate the applicable organization encounter rates
for FQHCs and rural health clinics from the base year payment rate to the effective date by
using the CMS FQHC Market Basket inflator established under United States Code, title
42, section 1395m(o), less productivity;
(7) FQHCs and rural health clinics that have elected the alternative payment methodology
under this paragraph shall submit all necessary documentation required by the commissioner
to compute the rebased organization encounter rates no later than six months following the
date the applicable Medicare cost reports are due to the Centers for Medicare and Medicaid
Services;
(8) the commissioner shall reimburse FQHCs and rural health clinics an additional
amount relative to their medical and dental organization encounter rates that is attributable
to the tax required to be paid according to section 295.52, if applicable;
(9) FQHCs and rural health clinics may submit change of scope requests to the
commissioner if the change of scope would result in an increase or decrease of 2.5 percent
or higher in the medical or dental organization encounter rate currently received by the
FQHC or rural health clinic;
(10) for FQHCs and rural health clinics seeking a change in scope with the commissioner
under clause (9) that requires the approval of the scope change by the federal Health
Resources Services Administration:
(i) FQHCs and rural health clinics shall submit the change of scope request, including
the start date of services, to the commissioner within seven business days of submission of
the scope change to the federal Health Resources Services Administration;
(ii) the commissioner shall establish the effective date of the payment change as the
federal Health Resources Services Administration date of approval of the FQHC's or rural
health clinic's scope change request, or the effective start date of services, whichever is
later; and
(iii) within 45 days of one year after the effective date established in item (ii), the
commissioner shall conduct a retroactive review to determine if the actual costs established
under clause (3) or encounters result in an increase or decrease of 2.5 percent or higher in
the medical or dental organization encounter rate, and if this is the case, the commissioner
shall revise the rate accordingly and shall adjust payments retrospectively to the effective
date established in item (ii);
(11) for change of scope requests that do not require federal Health Resources Services
Administration approval, the FQHC and rural health clinic shall submit the request to the
commissioner before implementing the change, and the effective date of the change is the
date the commissioner received the FQHC's or rural health clinic's request, or the effective
start date of the service, whichever is later. The commissioner shall provide a response to
the FQHC's or rural health clinic's request within 45 days of submission and provide a final
approval within 120 days of submission. This timeline may be waived at the mutual
agreement of the commissioner and the FQHC or rural health clinic if more information is
needed to evaluate the request;
(12) the commissioner, when establishing organization encounter rates for new FQHCs
and rural health clinics, shall consider the patient caseload of existing FQHCs and rural
health clinics in a 60-mile radius for organizations established outside of the seven-county
metropolitan area, and in a 30-mile radius for organizations in the seven-county metropolitan
area. If this information is not available, the commissioner may use Medicare cost reports
or audited financial statements to establish base rates;
(13) the commissioner shall establish a quality measures workgroup that includes
representatives from the Minnesota Association of Community Health Centers, FQHCs,
and rural health clinics, to evaluate clinical and nonclinical measures; and
(14) the commissioner shall not disallow or reduce costs that are related to an FQHC's
or rural health clinic's participation in health care educational programs to the extent that
the costs are not accounted for in the alternative payment methodology encounter rate
established in this paragraph.
new text begin
(m) Effective July 1, 2023, an enrolled Indian health service facility or a Tribal health
center operating under a 638 contract or compact may elect to also enroll as a Tribal FQHC.
Requirements that otherwise apply to an FQHC covered in this subdivision do not apply to
a Tribal FQHC enrolled under this paragraph, except that any requirements necessary to
comply with federal regulations do apply to a Tribal FQHC. The commissioner shall establish
an alternative payment method for a Tribal FQHC enrolled under this paragraph that uses
the same method and rates applicable to a Tribal facility or health center that does not enroll
as a Tribal FQHC.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2026, or upon federal approval,
whichever is later, except that paragraph (m) is effective July 1, 2023. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end
Sec. 21.
Minnesota Statutes 2022, section 256B.0625, subdivision 31, is amended to read:
Subd. 31.
Medical supplies and equipment.
(a) Medical assistance covers medical
supplies and equipment. Separate payment outside of the facility's payment rate shall be
made for wheelchairs and wheelchair accessories for recipients who are residents of
intermediate care facilities for the developmentally disabled. Reimbursement for wheelchairs
and wheelchair accessories for ICF/DD recipients shall be subject to the same conditions
and limitations as coverage for recipients who do not reside in institutions. A wheelchair
purchased outside of the facility's payment rate is the property of the recipient.
(b) Vendors of durable medical equipment, prosthetics, orthotics, or medical supplies
must enroll as a Medicare provider.
(c) When necessary to ensure access to durable medical equipment, prosthetics, orthotics,
or medical supplies, the commissioner may exempt a vendor from the Medicare enrollment
requirement if:
(1) the vendor supplies only one type of durable medical equipment, prosthetic, orthotic,
or medical supply;
(2) the vendor serves ten or fewer medical assistance recipients per year;
(3) the commissioner finds that other vendors are not available to provide same or similar
durable medical equipment, prosthetics, orthotics, or medical supplies; and
(4) the vendor complies with all screening requirements in this chapter and Code of
Federal Regulations, title 42, part 455. The commissioner may also exempt a vendor from
the Medicare enrollment requirement if the vendor is accredited by a Centers for Medicare
and Medicaid Services approved national accreditation organization as complying with the
Medicare program's supplier and quality standards and the vendor serves primarily pediatric
patients.
(d) Durable medical equipment means a device or equipment that:
(1) can withstand repeated use;
(2) is generally not useful in the absence of an illness, injury, or disability; and
(3) is provided to correct or accommodate a physiological disorder or physical condition
or is generally used primarily for a medical purpose.
(e) Electronic tablets may be considered durable medical equipment if the electronic
tablet will be used as an augmentative and alternative communication system as defined
under subdivision 31a, paragraph (a). To be covered by medical assistance, the device must
be locked in order to prevent use not related to communication.
(f) Notwithstanding the requirement in paragraph (e) that an electronic tablet must be
locked to prevent use not as an augmentative communication device, a recipient of waiver
services may use an electronic tablet for a use not related to communication when the
recipient has been authorized under the waiver to receive one or more additional applications
that can be loaded onto the electronic tablet, such that allowing the additional use prevents
the purchase of a separate electronic tablet with waiver funds.
(g) An order or prescription for medical supplies, equipment, or appliances must meet
the requirements in Code of Federal Regulations, title 42, part 440.70.
(h) Allergen-reducing products provided according to subdivision 67, paragraph (c) or
(d), shall be considered durable medical equipment.
new text begin
(i) Seizure detection devices are covered as durable medical equipment under this
subdivision if:
new text end
new text begin
(1) the seizure detection device is medically appropriate based on the recipient's medical
condition or status; and
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new text begin
(2) the recipient's health care provider has identified that a seizure detection device
would:
new text end
new text begin
(i) likely assist in reducing bodily harm to or death of the recipient as a result of the
recipient experiencing a seizure; or
new text end
new text begin
(ii) provide data to the health care provider necessary to appropriately diagnose or treat
a health condition of the recipient that causes the seizure activity.
new text end
new text begin
(j) For the purposes of paragraph (i), "seizure detection device" means a United States
Food and Drug Administration-approved monitoring device and related service or
subscription supporting the prescribed use of the device, including technology that provides
ongoing patient monitoring and alert services that detect seizure activity and transmit
notification of the seizure activity to a caregiver for appropriate medical response or collects
data of the seizure activity of the recipient that can be used by a health care provider to
diagnose or appropriately treat a health care condition that causes the seizure activity. The
medical assistance reimbursement rate for a subscription supporting the prescribed use of
a seizure detection device is 60 percent of the rate for monthly remote monitoring under
the medical assistance telemonitoring benefit.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 22.
Minnesota Statutes 2022, section 256B.0625, subdivision 34, is amended to read:
Subd. 34.
Indian health services facilities.
deleted text begin (a)deleted text end Medical assistance payments and
MinnesotaCare payments to facilities of the Indian health service and facilities operated by
a tribe or tribal organization under funding authorized by United States Code, title 25,
sections 450f to 450n, or title III of the Indian Self-Determination and Education Assistance
Act, Public Law 93-638, for enrollees who are eligible for federal financial participation,
shall be at the option of the facility in accordance with the rate published by the United
States Assistant Secretary for Health under the authority of United States Code, title 42,
sections 248(a) and 249(b). MinnesotaCare payments for enrollees who are not eligible for
federal financial participation at facilities of the Indian health service and facilities operated
by a tribe or tribal organization for the provision of outpatient medical services must be in
accordance with the medical assistance rates paid for the same services when provided in
a facility other than a facility of the Indian health service or a facility operated by a tribe or
tribal organization.
deleted text begin
(b) Effective upon federal approval, the medical assistance payments to a dually certified
facility as defined in subdivision 30, paragraph (j), shall be the encounter rate described in
paragraph (a) or a rate that is substantially equivalent for services provided to American
Indians and Alaskan Native populations. The rate established under this paragraph for dually
certified facilities shall not apply to MinnesotaCare payments.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2026, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 23.
Minnesota Statutes 2022, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 68. new text end
new text begin Tobacco and nicotine cessation. new text end
new text begin
(a) Medical assistance covers tobacco and
nicotine cessation services, drugs to treat tobacco and nicotine addiction or dependence,
and drugs to help individuals discontinue use of tobacco and nicotine products. Medical
assistance must cover services and drugs as provided in this subdivision consistent with
evidence-based or evidence-informed best practices.
new text end
new text begin
(b) Medical assistance must cover in-person individual and group tobacco and nicotine
cessation education and counseling services if provided by a health care practitioner whose
scope of practice encompasses tobacco and nicotine cessation education and counseling.
Service providers include but are not limited to the following:
new text end
new text begin
(1) mental health practitioners under section 245.462, subdivision 17;
new text end
new text begin
(2) mental health professionals under section 245.462, subdivision 18;
new text end
new text begin
(3) mental health certified peer specialists under section 256B.0615;
new text end
new text begin
(4) alcohol and drug counselors licensed under chapter 148F;
new text end
new text begin
(5) recovery peers as defined in section 245F.02, subdivision 21;
new text end
new text begin
(6) certified tobacco treatment specialists;
new text end
new text begin
(7) community health workers;
new text end
new text begin
(8) physicians;
new text end
new text begin
(9) physician assistants;
new text end
new text begin
(10) advanced practice registered nurses; or
new text end
new text begin
(11) other licensed or nonlicensed professionals or paraprofessionals with training in
providing tobacco and nicotine cessation education and counseling services.
new text end
new text begin
(c) Medical assistance covers telephone cessation counseling services provided through
a quitline. Notwithstanding section 256B.0625, subdivision 3b, quitline services may be
provided through audio-only communications. The commissioner of human services may
utilize volume purchasing for quitline services consistent with section 256B.04, subdivision
14.
new text end
new text begin
(d) Medical assistance must cover all prescription and over-the-counter pharmacotherapy
drugs approved by the United States Food and Drug Administration for cessation of tobacco
and nicotine use or treatment of tobacco and nicotine dependence, and that are subject to a
Medicaid drug rebate agreement.
new text end
new text begin
(e) Services covered under this subdivision may be provided by telemedicine.
new text end
new text begin
(f) The commissioner must not:
new text end
new text begin
(1) restrict or limit the type, duration, or frequency of tobacco and nicotine cessation
services;
new text end
new text begin
(2) prohibit the simultaneous use of multiple cessation services, including but not limited
to simultaneous use of counseling and drugs;
new text end
new text begin
(3) require counseling before receiving drugs or as a condition of receiving drugs;
new text end
new text begin
(4) limit pharmacotherapy drug dosage amounts for a dosing regimen for treatment of
a medically accepted indication as defined in United States Code, title 14, section
1396r-8(K)(6); limit dosing frequency; or impose duration limits;
new text end
new text begin
(5) prohibit simultaneous use of multiple drugs, including prescription and
over-the-counter drugs;
new text end
new text begin
(6) require or authorize step therapy; or
new text end
new text begin
(7) require or utilize prior authorization for any tobacco and nicotine cessation services
and drugs covered under this subdivision.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024.
new text end
Sec. 24.
Minnesota Statutes 2022, section 256B.0625, is amended by adding a subdivision
to read:
new text begin Subd. 69. new text end
new text begin Recuperative care services. new text end
new text begin
(a) Medical assistance covers recuperative care
services provided in a setting that meets the requirements in paragraph (b) for recipients
who meet the eligibility requirements in paragraph (c). For purposes of this subdivision,
"recuperative care" means a model of care that prevents hospitalization or that provides
postacute medical care and support services for recipients experiencing homelessness who
are too ill or frail to recover from a physical illness or injury while living in a shelter or are
otherwise unhoused but who are not sick enough to be hospitalized, or remain hospitalized,
or to need other levels of care.
new text end
new text begin
(b) Recuperative care may be provided in any setting, including but not limited to
homeless shelters, congregate care settings, single-room occupancy settings, or supportive
housing, so long as the provider of recuperative care or provider of housing is able to provide
to the recipient within the designated setting, at a minimum:
new text end
new text begin
(1) 24-hour access to a bed and bathroom;
new text end
new text begin
(2) access to three meals a day;
new text end
new text begin
(3) availability to environmental services;
new text end
new text begin
(4) access to a telephone;
new text end
new text begin
(5) a secure place to store belongings; and
new text end
new text begin
(6) staff available within the setting to provide a wellness check as needed, but at a
minimum at least once every 24 hours.
new text end
new text begin
(c) To be eligible for this covered service, a recipient must:
new text end
new text begin
(1) be 21 years of age or older;
new text end
new text begin
(2) be experiencing homelessness;
new text end
new text begin
(3) be in need of short-term acute medical care for a period of no more than 60 days;
new text end
new text begin
(4) meet clinical criteria, as established by the commissioner, that indicates that the
recipient is in need of recuperative care; and
new text end
new text begin
(5) not have behavioral health needs that are greater than what can be managed by the
provider within the setting.
new text end
new text begin
(d) Payment for recuperative care shall consist of two components. The first component
must be for the services provided to the member and is a bundled daily per diem payment
of at least $300 per day. The second component must be for the facility costs and must be
paid using state funds equivalent to the amount paid as the medical assistance room and
board rate and annual adjustments. The eligibility standards in chapter 256I shall not apply.
The second component is only paid when the first component is paid to a provider. Providers
may opt to only be reimbursed for the first component. A provider under this subdivision
means a recuperative care provider and is defined by the standards established by the National
Institute for Medical Respite Care. Services provided within the bundled payment may
include but are not limited to:
new text end
new text begin
(1) basic nursing care, including:
new text end
new text begin
(i) monitoring a patient's physical health and pain level;
new text end
new text begin
(ii) providing wound care;
new text end
new text begin
(iii) medication support;
new text end
new text begin
(iv) patient education;
new text end
new text begin
(v) immunization review and update; and
new text end
new text begin
(vi) establishing clinical goals for the recuperative care period and discharge plan;
new text end
new text begin
(2) care coordination, including:
new text end
new text begin
(i) initial assessment of medical, behavioral, and social needs;
new text end
new text begin
(ii) development of a care plan;
new text end
new text begin
(iii) support and referral assistance for legal services, housing, community social services,
case management, health care benefits, health and other eligible benefits, and transportation
needs and services; and
new text end
new text begin
(iv) monitoring and follow-up to ensure that the care plan is effectively implemented to
address the medical, behavioral, and social needs;
new text end
new text begin
(3) basic behavioral needs, including counseling and peer support, that can be provided
in this recuperative care setting; and
new text end
new text begin
(4) services provided by a community health worker as defined under subdivision 49.
new text end
new text begin
(e) Before a recipient is discharged from a recuperative care setting, the provider must
ensure that the recipient's acute medical condition is stabilized or that the recipient is being
discharged to a setting that is able to meet that recipient's needs.
new text end
new text begin
(f) If a recipient is temporarily absent due to an admission at a residential behavioral
health facility, inpatient hospital, or nursing facility for a period of time exceeding the limits
described in paragraph (d), the agency may request in a format prescribed by the
commissioner an absence day limit exception to continue payments until the recipient is
discharged.
new text end
new text begin
(g) The commissioner shall submit an initial report to the chairs and ranking minority
members of the legislative committees with jurisdiction over health and human services
finance and policy by February 1, 2025, and a final report by February 1, 2027, on coverage
of recuperative care services. The reports must include but are not limited to:
new text end
new text begin
(1) a list of the recuperative care services in Minnesota and the number of recipients;
new text end
new text begin
(2) the estimated return on investment, including health care savings due to reduced
hospitalizations;
new text end
new text begin
(3) follow-up information, if available, on whether recipients' hospital visits decreased
since recuperative care services were provided compared to before the services were
provided; and
new text end
new text begin
(4) any other information that can be used to determine the effectiveness of the program
and its funding, including recommendations for improvements to the program.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024.
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Sec. 25.
Minnesota Statutes 2022, section 256B.196, subdivision 2, is amended to read:
Subd. 2.
Commissioner's duties.
(a) For the purposes of this subdivision and subdivision
3, the commissioner shall determine the fee-for-service outpatient hospital services upper
payment limit for nonstate government hospitals. The commissioner shall then determine
the amount of a supplemental payment to Hennepin County Medical Center and Regions
Hospital for these services that would increase medical assistance spending in this category
to the aggregate upper payment limit for all nonstate government hospitals in Minnesota.
In making this determination, the commissioner shall allot the available increases between
Hennepin County Medical Center and Regions Hospital based on the ratio of medical
assistance fee-for-service outpatient hospital payments to the two facilities. The commissioner
shall adjust this allotment as necessary based on federal approvals, the amount of
intergovernmental transfers received from Hennepin and Ramsey Counties, and other factors,
in order to maximize the additional total payments. The commissioner shall inform Hennepin
County and Ramsey County of the periodic intergovernmental transfers necessary to match
federal Medicaid payments available under this subdivision in order to make supplementary
medical assistance payments to Hennepin County Medical Center and Regions Hospital
equal to an amount that when combined with existing medical assistance payments to
nonstate governmental hospitals would increase total payments to hospitals in this category
for outpatient services to the aggregate upper payment limit for all hospitals in this category
in Minnesota. Upon receipt of these periodic transfers, the commissioner shall make
supplementary payments to Hennepin County Medical Center and Regions Hospital.
(b) For the purposes of this subdivision and subdivision 3, the commissioner shall
determine an upper payment limit for physicians and other billing professionals affiliated
with Hennepin County Medical Center and with Regions Hospital. The upper payment limit
shall be based on the average commercial rate or be determined using another method
acceptable to the Centers for Medicare and Medicaid Services. The commissioner shall
inform Hennepin County and Ramsey County of the periodic intergovernmental transfers
necessary to match the federal Medicaid payments available under this subdivision in order
to make supplementary payments to physicians and other billing professionals affiliated
with Hennepin County Medical Center and to make supplementary payments to physicians
and other billing professionals affiliated with Regions Hospital through HealthPartners
Medical Group equal to the difference between the established medical assistance payment
for physician and other billing professional services and the upper payment limit. Upon
receipt of these periodic transfers, the commissioner shall make supplementary payments
to physicians and other billing professionals affiliated with Hennepin County Medical Center
and shall make supplementary payments to physicians and other billing professionals
affiliated with Regions Hospital through HealthPartners Medical Group.
(c) Beginning January 1, 2010, Ramsey County may make monthly voluntary
intergovernmental transfers to the commissioner in amounts not to exceed $6,000,000 per
year. The commissioner shall increase the medical assistance capitation payments to any
licensed health plan under contract with the medical assistance program that agrees to make
enhanced payments to Regions Hospital. The increase shall be in an amount equal to the
annual value of the monthly transfers plus federal financial participation, with each health
plan receiving its pro rata share of the increase based on the pro rata share of medical
assistance admissions to Regions Hospital by those plans. For the purposes of this paragraph,
"the base amount" means the total annual value of increased medical assistance capitation
payments, including the voluntary intergovernmental transfers, under this paragraph in
calendar year 2017. For managed care contracts beginning on or after January 1, 2018, the
commissioner shall reduce the total annual value of increased medical assistance capitation
payments under this paragraph by an amount equal to ten percent of the base amount, and
by an additional ten percent of the base amount for each subsequent contract year until
December 31, 2025. Upon the request of the commissioner, health plans shall submit
individual-level cost data for verification purposes. The commissioner may ratably reduce
these payments on a pro rata basis in order to satisfy federal requirements for actuarial
soundness. If payments are reduced, transfers shall be reduced accordingly. Any licensed
health plan that receives increased medical assistance capitation payments under the
intergovernmental transfer described in this paragraph shall increase its medical assistance
payments to Regions Hospital by the same amount as the increased payments received in
the capitation payment described in this paragraph. This paragraph expires January 1, 2026.
(d) For the purposes of this subdivision and subdivision 3, the commissioner shall
determine an upper payment limit for ambulance services affiliated with Hennepin County
Medical Center and the city of St. Paul, and ambulance services owned and operated by
another governmental entity that chooses to participate by requesting the commissioner to
determine an upper payment limit. The upper payment limit shall be based on the average
commercial rate or be determined using another method acceptable to the Centers for
Medicare and Medicaid Services. The commissioner shall inform Hennepin County, the
city of St. Paul, and other participating governmental entities of the periodic
intergovernmental transfers necessary to match the federal Medicaid payments available
under this subdivision in order to make supplementary payments to Hennepin County
Medical Center, the city of St. Paul, and other participating governmental entities equal to
the difference between the established medical assistance payment for ambulance services
and the upper payment limit. Upon receipt of these periodic transfers, the commissioner
shall make supplementary payments to Hennepin County Medical Center, the city of St.
Paul, and other participating governmental entities. A tribal government that owns and
operates an ambulance service is not eligible to participate under this subdivision.
(e) For the purposes of this subdivision and subdivision 3, the commissioner shall
determine an upper payment limit for physicians, dentists, and other billing professionals
affiliated with the University of Minnesota and University of Minnesota Physicians. The
upper payment limit shall be based on the average commercial rate or be determined using
another method acceptable to the Centers for Medicare and Medicaid Services. The
commissioner shall inform the University of Minnesota Medical School and University of
Minnesota School of Dentistry of the periodic intergovernmental transfers necessary to
match the federal Medicaid payments available under this subdivision in order to make
supplementary payments to physicians, dentists, and other billing professionals affiliated
with the University of Minnesota and the University of Minnesota Physicians equal to the
difference between the established medical assistance payment for physician, dentist, and
other billing professional services and the upper payment limit. Upon receipt of these periodic
transfers, the commissioner shall make supplementary payments to physicians, dentists,
and other billing professionals affiliated with the University of Minnesota and the University
of Minnesota Physicians.
(f) The commissioner shall inform the transferring governmental entities on an ongoing
basis of the need for any changes needed in the intergovernmental transfers in order to
continue the payments under paragraphs (a) to (e), at their maximum level, including
increases in upper payment limits, changes in the federal Medicaid match, and other factors.
(g) The payments in paragraphs (a) to (e) shall be implemented independently of each
other, subject to federal approval and to the receipt of transfers under subdivision 3.
(h) All of the data and funding transactions related to the payments in paragraphs (a) to
(e) shall be between the commissioner and the governmental entities.new text begin The commissioner
shall not make payments to governmental entities eligible to receive payments described
in paragraphs (a) to (e) that fail to submit the data needed to compute the payments within
24 months of the initial request from the commissioner.
new text end
(i) For purposes of this subdivision, billing professionals are limited to physicians, nurse
practitioners, nurse midwives, clinical nurse specialists, physician assistants,
anesthesiologists, certified registered nurse anesthetists, dentists, dental hygienists, and
dental therapists.
new text begin EFFECTIVE DATE. new text end
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This section is effective July 1, 2023.
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Sec. 26.
Minnesota Statutes 2022, section 256B.69, subdivision 5a, is amended to read:
Subd. 5a.
Managed care contracts.
(a) Managed care contracts under this section and
section 256L.12 shall be entered into or renewed on a calendar year basis. The commissioner
may issue separate contracts with requirements specific to services to medical assistance
recipients age 65 and older.
(b) A prepaid health plan providing covered health services for eligible persons pursuant
to chapters 256B and 256L is responsible for complying with the terms of its contract with
the commissioner. Requirements applicable to managed care programs under chapters 256B
and 256L established after the effective date of a contract with the commissioner take effect
when the contract is next issued or renewed.
(c) The commissioner shall withhold five percent of managed care plan payments under
this section and county-based purchasing plan payments under section 256B.692 for the
prepaid medical assistance program pending completion of performance targets. Each
performance target must be quantifiable, objective, measurable, and reasonably attainable,
except in the case of a performance target based on a federal or state law or rule. Criteria
for assessment of each performance target must be outlined in writing prior to the contract
effective date. Clinical or utilization performance targets and their related criteria must
consider evidence-based research and reasonable interventions when available or applicable
to the populations served, and must be developed with input from external clinical experts
and stakeholders, including managed care plans, county-based purchasing plans, and
providers. The managed care or county-based purchasing plan must demonstrate, to the
commissioner's satisfaction, that the data submitted regarding attainment of the performance
target is accurate. The commissioner shall periodically change the administrative measures
used as performance targets in order to improve plan performance across a broader range
of administrative services. The performance targets must include measurement of plan
efforts to contain spending on health care services and administrative activities. The
commissioner may adopt plan-specific performance targets that take into account factors
affecting only one plan, including characteristics of the plan's enrollee population. The
withheld funds must be returned no sooner than July of the following year if performance
targets in the contract are achieved. The commissioner may exclude special demonstration
projects under subdivision 23.
(d) The commissioner shall require that managed care plans:
(1) use the assessment and authorization processes, forms, timelines, standards,
documentation, and data reporting requirements, protocols, billing processes, and policies
consistent with medical assistance fee-for-service or the Department of Human Services
contract requirements for all personal care assistance services under section 256B.0659 and
community first services and supports under section 256B.85; and
(2) by January 30 of each year that follows a rate increase for any aspect of services
under section 256B.0659 or 256B.85, inform the commissioner and the chairs and ranking
minority members of the legislative committees with jurisdiction over rates determined
under section 256B.851 of the amount of the rate increase that is paid to each personal care
assistance provider agency with which the plan has a contract.
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(e) Effective for services rendered on or after January 1, 2012, the commissioner shall
include as part of the performance targets described in paragraph (c) a reduction in the health
plan's emergency department utilization rate for medical assistance and MinnesotaCare
enrollees, as determined by the commissioner. For 2012, the reduction shall be based on
the health plan's utilization in 2009. To earn the return of the withhold each subsequent
year, the managed care plan or county-based purchasing plan must achieve a qualifying
reduction of no less than ten percent of the plan's emergency department utilization rate for
medical assistance and MinnesotaCare enrollees, excluding enrollees in programs described
in subdivisions 23 and 28, compared to the previous measurement year until the final
performance target is reached. When measuring performance, the commissioner must
consider the difference in health risk in a managed care or county-based purchasing plan's
membership in the baseline year compared to the measurement year, and work with the
managed care or county-based purchasing plan to account for differences that they agree
are significant.
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The withheld funds must be returned no sooner than July 1 and no later than July 31 of
the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that a reduction in the utilization rate
was achieved. The commissioner shall structure the withhold so that the commissioner
returns a portion of the withheld funds in amounts commensurate with achieved reductions
in utilization less than the targeted amount.
deleted text end
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The withhold described in this paragraph shall continue for each consecutive contract
period until the plan's emergency room utilization rate for state health care program enrollees
is reduced by 25 percent of the plan's emergency room utilization rate for medical assistance
and MinnesotaCare enrollees for calendar year 2009. Hospitals shall cooperate with the
health plans in meeting this performance target and shall accept payment withholds that
may be returned to the hospitals if the performance target is achieved.
deleted text end
deleted text begin
(f) Effective for services rendered on or after January 1, 2012, the commissioner shall
include as part of the performance targets described in paragraph (c) a reduction in the plan's
hospitalization admission rate for medical assistance and MinnesotaCare enrollees, as
determined by the commissioner. To earn the return of the withhold each year, the managed
care plan or county-based purchasing plan must achieve a qualifying reduction of no less
than five percent of the plan's hospital admission rate for medical assistance and
MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and
28, compared to the previous calendar year until the final performance target is reached.
When measuring performance, the commissioner must consider the difference in health risk
in a managed care or county-based purchasing plan's membership in the baseline year
compared to the measurement year, and work with the managed care or county-based
purchasing plan to account for differences that they agree are significant.
deleted text end
deleted text begin
The withheld funds must be returned no sooner than July 1 and no later than July 31 of
the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that this reduction in the hospitalization
rate was achieved. The commissioner shall structure the withhold so that the commissioner
returns a portion of the withheld funds in amounts commensurate with achieved reductions
in utilization less than the targeted amount.
deleted text end
deleted text begin
The withhold described in this paragraph shall continue until there is a 25 percent
reduction in the hospital admission rate compared to the hospital admission rates in calendar
year 2011, as determined by the commissioner. The hospital admissions in this performance
target do not include the admissions applicable to the subsequent hospital admission
performance target under paragraph (g). Hospitals shall cooperate with the plans in meeting
this performance target and shall accept payment withholds that may be returned to the
hospitals if the performance target is achieved.
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deleted text begin
(g) Effective for services rendered on or after January 1, 2012, the commissioner shall
include as part of the performance targets described in paragraph (c) a reduction in the plan's
hospitalization admission rates for subsequent hospitalizations within 30 days of a previous
hospitalization of a patient regardless of the reason, for medical assistance and MinnesotaCare
enrollees, as determined by the commissioner. To earn the return of the withhold each year,
the managed care plan or county-based purchasing plan must achieve a qualifying reduction
of the subsequent hospitalization rate for medical assistance and MinnesotaCare enrollees,
excluding enrollees in programs described in subdivisions 23 and 28, of no less than five
percent compared to the previous calendar year until the final performance target is reached.
deleted text end
deleted text begin
The withheld funds must be returned no sooner than July 1 and no later than July 31 of
the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that a qualifying reduction in the
subsequent hospitalization rate was achieved. The commissioner shall structure the withhold
so that the commissioner returns a portion of the withheld funds in amounts commensurate
with achieved reductions in utilization less than the targeted amount.
deleted text end
deleted text begin
The withhold described in this paragraph must continue for each consecutive contract
period until the plan's subsequent hospitalization rate for medical assistance and
MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and
28, is reduced by 25 percent of the plan's subsequent hospitalization rate for calendar year
2011. Hospitals shall cooperate with the plans in meeting this performance target and shall
accept payment withholds that must be returned to the hospitals if the performance target
is achieved.
deleted text end
deleted text begin (h)deleted text end new text begin (e)new text end Effective for services rendered on or after January 1, 2013, through December
31, 2013, the commissioner shall withhold 4.5 percent of managed care plan payments under
this section and county-based purchasing plan payments under section 256B.692 for the
prepaid medical assistance program. The withheld funds must be returned no sooner than
July 1 and no later than July 31 of the following year. The commissioner may exclude
special demonstration projects under subdivision 23.
deleted text begin (i)deleted text end new text begin (f) new text end Effective for services rendered on or after January 1, 2014, the commissioner shall
withhold three percent of managed care plan payments under this section and county-based
purchasing plan payments under section 256B.692 for the prepaid medical assistance
program. The withheld funds must be returned no sooner than July 1 and no later than July
31 of the following year. The commissioner may exclude special demonstration projects
under subdivision 23.
deleted text begin (j)deleted text end new text begin (g)new text end A managed care plan or a county-based purchasing plan under section 256B.692
may include as admitted assets under section 62D.044 any amount withheld under this
section that is reasonably expected to be returned.
deleted text begin (k)deleted text end new text begin (h)new text end Contracts between the commissioner and a prepaid health plan are exempt from
the set-aside and preference provisions of section 16C.16, subdivisions 6, paragraph (a),
and 7.
deleted text begin (l)deleted text end new text begin (i)new text end The return of the withhold under paragraphs (h) and (i) is not subject to the
requirements of paragraph (c).
deleted text begin (m)deleted text end new text begin (j)new text end Managed care plans and county-based purchasing plans shall maintain current
and fully executed agreements for all subcontractors, including bargaining groups, for
administrative services that are expensed to the state's public health care programs.
Subcontractor agreements determined to be material, as defined by the commissioner after
taking into account state contracting and relevant statutory requirements, must be in the
form of a written instrument or electronic document containing the elements of offer,
acceptance, consideration, payment terms, scope, duration of the contract, and how the
subcontractor services relate to state public health care programs. Upon request, the
commissioner shall have access to all subcontractor documentation under this paragraph.
Nothing in this paragraph shall allow release of information that is nonpublic data pursuant
to section 13.02.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024.
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Sec. 27.
Minnesota Statutes 2022, section 256B.76, subdivision 1, is amended to read:
Subdivision 1.
Physician reimbursement.
(a) Effective for services rendered on or after
October 1, 1992, the commissioner shall make payments for physician services as follows:
(1) payment for level one Centers for Medicare and Medicaid Services' common
procedural coding system codes titled "office and other outpatient services," "preventive
medicine new and established patient," "delivery, antepartum, and postpartum care," "critical
care," cesarean delivery and pharmacologic management provided to psychiatric patients,
and level three codes for enhanced services for prenatal high risk, shall be paid at the lower
of (i) submitted charges, or (ii) 25 percent above the rate in effect on June 30, 1992;
(2) payments for all other services shall be paid at the lower of (i) submitted charges,
or (ii) 15.4 percent above the rate in effect on June 30, 1992; and
(3) all physician rates shall be converted from the 50th percentile of 1982 to the 50th
percentile of 1989, less the percent in aggregate necessary to equal the above increases
except that payment rates for home health agency services shall be the rates in effect on
September 30, 1992.
(b) Effective for services rendered on or after January 1, 2000, payment rates for physician
and professional services shall be increased by three percent over the rates in effect on
December 31, 1999, except for home health agency and family planning agency services.
The increases in this paragraph shall be implemented January 1, 2000, for managed care.
(c) Effective for services rendered on or after July 1, 2009, payment rates for physician
and professional services shall be reduced by five percent, except that for the period July
1, 2009, through June 30, 2010, payment rates shall be reduced by 6.5 percent for the medical
assistance and general assistance medical care programs, over the rates in effect on June
30, 2009. This reduction and the reductions in paragraph (d) do not apply to office or other
outpatient visits, preventive medicine visits and family planning visits billed by physicians,
advanced practice nurses, or physician assistants in a family planning agency or in one of
the following primary care practices: general practice, general internal medicine, general
pediatrics, general geriatrics, and family medicine. This reduction and the reductions in
paragraph (d) do not apply to federally qualified health centers, rural health centers, and
Indian health services. Effective October 1, 2009, payments made to managed care plans
and county-based purchasing plans under sections 256B.69, 256B.692, and 256L.12 shall
reflect the payment reduction described in this paragraph.
(d) Effective for services rendered on or after July 1, 2010, payment rates for physician
and professional services shall be reduced an additional seven percent over the five percent
reduction in rates described in paragraph (c). This additional reduction does not apply to
physical therapy services, occupational therapy services, and speech pathology and related
services provided on or after July 1, 2010. This additional reduction does not apply to
physician services billed by a psychiatrist or an advanced practice nurse with a specialty in
mental health. Effective October 1, 2010, payments made to managed care plans and
county-based purchasing plans under sections 256B.69, 256B.692, and 256L.12 shall reflect
the payment reduction described in this paragraph.
(e) Effective for services rendered on or after September 1, 2011, through June 30, 2013,
payment rates for physician and professional services shall be reduced three percent from
the rates in effect on August 31, 2011. This reduction does not apply to physical therapy
services, occupational therapy services, and speech pathology and related services.
(f) Effective for services rendered on or after September 1, 2014, payment rates for
physician and professional services, including physical therapy, occupational therapy, speech
pathology, and mental health services shall be increased by five percent from the rates in
effect on August 31, 2014. In calculating this rate increase, the commissioner shall not
include in the base rate for August 31, 2014, the rate increase provided under section
256B.76, subdivision 7. This increase does not apply to federally qualified health centers,
rural health centers, and Indian health services. Payments made to managed care plans and
county-based purchasing plans shall not be adjusted to reflect payments under this paragraph.
(g) Effective for services rendered on or after July 1, 2015, payment rates for physical
therapy, occupational therapy, and speech pathology and related services provided by a
hospital meeting the criteria specified in section 62Q.19, subdivision 1, paragraph (a), clause
(4), shall be increased by 90 percent from the rates in effect on June 30, 2015. Payments
made to managed care plans and county-based purchasing plans shall not be adjusted to
reflect payments under this paragraph.
(h) Any ratables effective before July 1, 2015, do not apply to early intensive
developmental and behavioral intervention (EIDBI) benefits described in section 256B.0949.
new text begin
(i) The commissioner may reimburse the cost incurred to pay the Department of Health
for metabolic disorder testing of newborns who are medical assistance recipients when the
sample is collected outside of an inpatient hospital setting or freestanding birth center setting
because the newborn was born outside of a hospital setting or freestanding birth center
setting or because it is not medically appropriate to collect the sample during the inpatient
stay for the birth.
new text end
Sec. 28.
Minnesota Statutes 2022, section 256B.76, subdivision 2, is amended to read:
Subd. 2.
Dental reimbursement.
(a) Effective for services rendered deleted text begin on or afterdeleted text end new text begin fromnew text end
October 1, 1992,new text begin to December 31, 2023,new text end the commissioner shall make payments for dental
services as follows:
(1) dental services shall be paid at the lower of (i) submitted charges, or (ii) 25 percent
above the rate in effect on June 30, 1992; and
(2) dental rates shall be converted from the 50th percentile of 1982 to the 50th percentile
of 1989, less the percent in aggregate necessary to equal the above increases.
(b) deleted text begin Beginningdeleted text end new text begin Fromnew text end October 1, 1999,new text begin to December 31, 2023,new text end the payment for tooth
sealants and fluoride treatments shall be the lower of (1) submitted charge, or (2) 80 percent
of median 1997 charges.
(c) Effective for services rendered deleted text begin on or afterdeleted text end new text begin fromnew text end January 1, 2000,new text begin to December 31,
2023,new text end payment rates for dental services shall be increased by three percent over the rates in
effect on December 31, 1999.
(d) Effective for services provided deleted text begin on or afterdeleted text end new text begin fromnew text end January 1, 2002,new text begin to December 31,
2023,new text end payment for diagnostic examinations and dental x-rays provided to children under
age 21 shall be the lower of (1) the submitted charge, or (2) 85 percent of median 1999
charges.
(e) The increases listed in paragraphs (b) and (c) shall be implemented January 1, 2000,
for managed care.
(f) Effective for dental services rendered on or after October 1, 2010, by a state-operated
dental clinic, payment shall be paid on a reasonable cost basis that is based on the Medicare
principles of reimbursement. This payment shall be effective for services rendered on or
after January 1, 2011, to recipients enrolled in managed care plans or county-based
purchasing plans.
(g) Beginning in fiscal year 2011, if the payments to state-operated dental clinics in
paragraph (f), including state and federal shares, are less than $1,850,000 per fiscal year, a
supplemental state payment equal to the difference between the total payments in paragraph
(f) and $1,850,000 shall be paid from the general fund to state-operated services for the
operation of the dental clinics.
deleted text begin
(h) Effective for services rendered on or after January 1, 2014, through December 31,
2021, payment rates for dental services shall be increased by five percent from the rates in
effect on December 31, 2013. This increase does not apply to state-operated dental clinics
in paragraph (f), federally qualified health centers, rural health centers, and Indian health
services. Effective January 1, 2014, payments made to managed care plans and county-based
purchasing plans under sections 256B.69, 256B.692, and 256L.12 shall reflect the payment
increase described in this paragraph.
deleted text end
deleted text begin
(i) Effective for services provided on or after January 1, 2017, through December 31,
2021, the commissioner shall increase payment rates by 9.65 percent for dental services
provided outside of the seven-county metropolitan area. This increase does not apply to
state-operated dental clinics in paragraph (f), federally qualified health centers, rural health
centers, or Indian health services. Effective January 1, 2017, payments to managed care
plans and county-based purchasing plans under sections 256B.69 and 256B.692 shall reflect
the payment increase described in this paragraph.
deleted text end
deleted text begin
(j) Effective for services provided on or after July 1, 2017, through December 31, 2021,
the commissioner shall increase payment rates by 23.8 percent for dental services provided
to enrollees under the age of 21. This rate increase does not apply to state-operated dental
clinics in paragraph (f), federally qualified health centers, rural health centers, or Indian
health centers. This rate increase does not apply to managed care plans and county-based
purchasing plans.
deleted text end
deleted text begin (k)deleted text end new text begin (h)new text end Effective for services provided on or after January 1, 2022, the commissioner
shall exclude from medical assistance and MinnesotaCare payments for dental services to
public health and community health clinics the 20 percent increase authorized under Laws
1989, chapter 327, section 5, subdivision 2, paragraph (b).
deleted text begin (l)deleted text end new text begin (i)new text end Effective for services provided deleted text begin on or afterdeleted text end new text begin fromnew text end January 1, 2022,new text begin to December 31,
2023,new text end the commissioner shall increase payment rates by 98 percent for all dental services.
This rate increase does not apply to state-operated dental clinics, federally qualified health
centers, rural health centers, or Indian health services.
deleted text begin (m)deleted text end new text begin (j)new text end Managed care plans and county-based purchasing plans shall reimburse providers
at a level that is at least equal to the rate paid under fee-for-service for dental services. If,
for any coverage year, federal approval is not received for this paragraph, the commissioner
must adjust the capitation rates paid to managed care plans and county-based purchasing
plans for that contract year to reflect the removal of this provision. Contracts between
managed care plans and county-based purchasing plans and providers to whom this paragraph
applies must allow recovery of payments from those providers if capitation rates are adjusted
in accordance with this paragraph. Payment recoveries must not exceed an amount equal
to any increase in rates that results from this provision. If, for any coverage year, federal
approval is not received for this paragraph, the commissioner shall not implement this
paragraph for subsequent coverage years.
new text begin
(k) Effective for services provided on or after January 1, 2024, payment for dental
services must be the lower of submitted charges or the percentile of 2018-submitted charges
from claims paid by the commissioner so that the total aggregate expenditures does not
exceed the total spend as outlined in the applicable paragraphs (a) to (k). This paragraph
does not apply to federally qualified health centers, rural health centers, state-operated dental
clinics, or Indian health centers.
new text end
new text begin
(l) Beginning January 1, 2028, and every three years thereafter, the commissioner shall
rebase payment rates for dental services to a percentile of submitted charges for the applicable
base year using charge data from claims paid by the commissioner so that the total aggregate
expenditures does not exceed the total spend as outlined in paragraph (k) plus the change
in the Medicare Economic Index (MEI). In 2028, the change in the MEI must be measured
from midyear of 2025 and 2027. For each subsequent rebasing, the change in the MEI must
be measured between the years that are one year after the rebasing years. The base year
used for each rebasing must be the calendar year that is two years prior to the effective date
of the rebasing. This paragraph does not apply to federally qualified health centers, rural
health centers, state-operated dental clinics, or Indian health centers.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 29.
Minnesota Statutes 2022, section 256B.764, is amended to read:
256B.764 REIMBURSEMENT FOR FAMILY PLANNING SERVICES.
(a) Effective for services rendered on or after July 1, 2007, payment rates for family
planning services shall be increased by 25 percent over the rates in effect June 30, 2007,
when these services are provided by a community clinic as defined in section 145.9268,
subdivision 1.
(b) Effective for services rendered on or after July 1, 2013, payment rates for family
planning services shall be increased by 20 percent over the rates in effect June 30, 2013,
when these services are provided by a community clinic as defined in section 145.9268,
subdivision 1. The commissioner shall adjust capitation rates to managed care and
county-based purchasing plans to reflect this increase, and shall require plans to pass on the
full amount of the rate increase to eligible community clinics, in the form of higher payment
rates for family planning services.
new text begin
(c) Effective for services provided on or after January 1, 2024, payment rates for family
planning and abortion services shall be increased by 20 percent. This increase does not
apply to federally qualified health centers, rural health centers, or Indian health services.
new text end
Sec. 30.
Minnesota Statutes 2022, section 256L.03, subdivision 1, is amended to read:
Subdivision 1.
Covered health services.
(a) "Covered health services" means the health
services reimbursed under chapter 256B, with the exception of special education services,
home care nursing services, adult dental care services other than services covered under
section 256B.0625, subdivision 9, orthodontic services, nonemergency medical transportation
services, personal care assistance and case management services, community first services
and supports under section 256B.85, behavioral health home services under section
256B.0757, housing stabilization services under section 256B.051, and nursing home or
intermediate care facilities services.
deleted text begin
(b) No public funds shall be used for coverage of abortion under MinnesotaCare except
where the life of the female would be endangered or substantial and irreversible impairment
of a major bodily function would result if the fetus were carried to term; or where the
pregnancy is the result of rape or incest.
deleted text end
deleted text begin (c)deleted text end new text begin (b)new text end Covered health services shall be expanded as provided in this section.
deleted text begin (d)deleted text end new text begin (c)new text end For the purposes of covered health services under this section, "child" means an
individual younger than 19 years of age.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 31.
Minnesota Statutes 2022, section 256L.03, subdivision 5, is amended to read:
Subd. 5.
Cost-sharing.
(a) Co-payments, coinsurance, and deductibles do not apply to
children under the age of 21 and to American Indians as defined in Code of Federal
Regulations, title 42, section 600.5.
(b) The commissioner deleted text begin shalldeleted text end new text begin mustnew text end adjust co-payments, coinsurance, and deductibles for
covered services in a manner sufficient to maintain the actuarial value of the benefit to 94
percent. The cost-sharing changes described in this paragraph do not apply to eligible
recipients or services exempt from cost-sharing under state law. The cost-sharing changes
described in this paragraph shall not be implemented prior to January 1, 2016.
(c) The cost-sharing changes authorized under paragraph (b) must satisfy the requirements
for cost-sharing under the Basic Health Program as set forth in Code of Federal Regulations,
title 42, sections 600.510 and 600.520.
new text begin
(d) Cost-sharing must not apply to drugs used for tobacco and nicotine cessation or to
tobacco and nicotine cessation services covered under section 256B.0625, subdivision 68.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024.
new text end
Sec. 32.
Laws 2021, First Special Session chapter 7, article 6, section 26, is amended to
read:
Sec. 26. COMMISSIONER OF HUMAN SERVICES; EXTENSION OF COVID-19
HUMAN SERVICES PROGRAM MODIFICATIONS.
Notwithstanding Laws 2020, First Special Session chapter 7, section 1, subdivision 2,
as amended by Laws 2020, Third Special Session chapter 1, section 3, when the peacetime
emergency declared by the governor in response to the COVID-19 outbreak expires, is
terminated, or is rescinded by the proper authority, the following modifications issued by
the commissioner of human services pursuant to Executive Orders 20-11 and 20-12, and
including any amendments to the modification issued before the peacetime emergency
expires, shall remain in effect until July 1, deleted text begin 2023deleted text end new text begin 2025new text end :
(1) CV16: expanding access to telemedicine services for Children's Health Insurance
Program, Medical Assistance, and MinnesotaCare enrollees; and
(2) CV21: allowing telemedicine alternative for school-linked mental health services
and intermediate school district mental health services.
Sec. 33. new text begin REPEALER.
new text end
new text begin
Minnesota Rules, part 9505.0235,
new text end
new text begin
is repealed the day following final enactment.
new text end
ARTICLE 2
HEALTH CARE AFFORDABILITY AND DELIVERY
Section 1.
new text begin
[62J.0411] HEALTH CARE AFFORDABILITY COMMISSION.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of sections 62J.0411 to 62J.0415, the
following terms have the meanings given.
new text end
new text begin
(b) "Commission" means the Health Care Affordability Commission.
new text end
new text begin
(c) "Commissioner" means the commissioner of health.
new text end
new text begin
(d) "Health care entity" includes but is not limited to clinics, hospitals, ambulatory
surgical centers, physician organizations, accountable care organizations, integrated provider
and plan systems, county-based purchasing plans, and health plan companies.
new text end
new text begin
(e) "Health care provider" or "provider" means a health care professional who is licensed
or registered by the state to perform health care services within the provider's scope of
practice and in accordance with state law.
new text end
new text begin
(f) "Health plan" means a health plan as defined in section 62A.011, subdivision 3.
new text end
new text begin
(g) "Health plan company" means a health carrier as defined under section 62A.011,
subdivision 2.
new text end
new text begin
(h) "Hospital" means an entity licensed under sections 144.50 to 144.58.
new text end
new text begin Subd. 2. new text end
new text begin Commission membership. new text end
new text begin
(a) The commissioner of health shall establish a
health care affordability commission that shall consist of the following 15 members:
new text end
new text begin
(1) two members with expertise and experience in advocating on behalf of patients;
new text end
new text begin
(2) two Minnesota residents who are health care consumers, one residing in greater
Minnesota and one residing in a metropolitan area, one of whom represents an underserved
community;
new text end
new text begin
(3) one member representing Indian Tribes;
new text end
new text begin
(4) two members of the business community who purchase health insurance for their
employees, one of whom purchases coverage in the small group market;
new text end
new text begin
(5) two members representing public purchasers of health insurance for their employees;
new text end
new text begin
(6) one licensed and certified health care provider employed at a federally qualified
health center;
new text end
new text begin
(7) one member representing a health care entity or urban hospitals;
new text end
new text begin
(8) one member representing rural hospitals;
new text end
new text begin
(9) one member representing health plans;
new text end
new text begin
(10) one member who is an expert in health care financing and administration; and
new text end
new text begin
(11) one member who is an expert in health economics.
new text end
new text begin
(b) All members appointed must have the knowledge and demonstrated expertise in one
of the following areas of expertise, and each area of expertise must be met by at least one
member of the commission:
new text end
new text begin
(1) health care finance, health economics, and health care management or administration
at a senior level;
new text end
new text begin
(2) health care consumer advocacy;
new text end
new text begin
(3) representing the health care workforce as a leader in a labor organization;
new text end
new text begin
(4) purchasing health insurance representing business management or health benefits
administration;
new text end
new text begin
(5) delivering primary care, health plan administration, or public or population health;
or
new text end
new text begin
(6) addressing health disparities and structural inequities.
new text end
new text begin
(c) No member may participate in commission proceedings involving an individual
provider, purchaser, or patient or a specific activity or transaction if the member has direct
financial interest in the outcome of the commission's proceedings other than as an individual
consumer of health care services.
new text end
new text begin Subd. 3. new text end
new text begin Terms. new text end
new text begin
(a) The commissioners of health, human services, and commerce shall
make recommendations for commission membership. Commission members shall be
appointed by the governor. The initial appointments to the commission shall be made by
September 1, 2023. The initial appointed commission members shall serve staggered terms
of three or four years determined by lot by the secretary of state. Following the initial
appointments, the commission members shall serve four-year terms. Members may not
serve more than two consecutive terms.
new text end
new text begin
(b) The commission is governed by section 15.0575, except as otherwise provided in
this section.
new text end
new text begin
(c) A commission member may resign at any time by giving written notice to the
commission.
new text end
new text begin Subd. 4. new text end
new text begin Chair; other officers. new text end
new text begin
(a) The governor shall annually designate a member to
serve as chair of the commission. The chair shall serve for one year. If there is a vacancy
for any cause, the governor shall make an appointment for that category of membership and
expertise, to become immediately effective.
new text end
new text begin
(b) The commission shall elect a vice-chair and other officers from its membership as
it deems necessary.
new text end
new text begin Subd. 5. new text end
new text begin Compensation. new text end
new text begin
Commission members may be compensated according to
section 15.0575.
new text end
new text begin Subd. 6. new text end
new text begin Meetings. new text end
new text begin
(a) Meetings of the commission, including any public hearings, are
subject to chapter 13D.
new text end
new text begin
(b) The commission must meet publicly on at least a monthly basis until the initial growth
targets are established.
new text end
new text begin
(c) After the initial growth targets are established, the commission shall meet at least
quarterly to consider summary data presented by the commissioner, draft report findings,
consider updates to the health care spending growth target program and growth target levels,
discuss findings with health care providers and payers, and identify additional analyses and
strategies to limit health care spending growth.
new text end
new text begin Subd. 7. new text end
new text begin Hearings. new text end
new text begin
At least annually, the commission shall hold public hearings to
present findings from spending growth target monitoring. The commission shall also regularly
hold public hearings to take testimony from stakeholders on health care spending growth,
setting and revising health care spending growth targets, and the impact of spending growth
and growth targets on health care access and quality and as needed to perform assigned
duties.
new text end
new text begin Subd. 8. new text end
new text begin Staff; technical assistance; contracting. new text end
new text begin
(a) The commission shall hire a
full-time executive director and administrative staff who shall serve in the unclassified
service. The executive director must have significant knowledge and expertise in health
economics and demonstrated experience in health policy.
new text end
new text begin
(b) The attorney general shall provide legal services to the commission.
new text end
new text begin
(c) The commissioner of health shall provide technical assistance to the commission
related to collecting data, analyzing health care trends and costs, and setting health care
spending growth targets.
new text end
new text begin Subd. 9. new text end
new text begin Administration. new text end
new text begin
The commissioner of health shall provide office space,
equipment and supplies, and analytic staff support to the commission and the Health Care
Affordability Advisory Council.
new text end
new text begin Subd. 10. new text end
new text begin Duties of the commissioner. new text end
new text begin
(a) The commissioner, in consultation with the
commissioners of commerce and human services, shall provide staff support to the
commission, including performing and procuring consulting and analytic services. The
commissioner shall:
new text end
new text begin
(1) establish the form and manner of data reporting, including reporting methods and
dates, consistent with program design and timelines formalized by the commission;
new text end
new text begin
(2) under the authority in chapter 62J, collect data identified by the commission for use
in the program in a form and manner that ensures the collection of high-quality, transparent
data;
new text end
new text begin
(3) provide analytical support, including by conducting background research or
environmental scans, evaluating the suitability of available data, performing needed analysis
and data modeling, calculating performance under the spending trends, and researching
drivers of spending growth trends;
new text end
new text begin
(4) assist health care entities subject to the targets with reporting of data, internal analysis
of spending growth trends, and, as necessary, methodological issues;
new text end
new text begin
(5) synthesize information and report to the commission; and
new text end
new text begin
(6) make appointments and staff the Health Care Affordability Advisory Council under
section 62J.0414.
new text end
new text begin
(b) In carrying out the duties required by this section, the commissioner may contract
with entities with expertise in health economic, health finance, and actuarial science.
new text end
new text begin Subd. 11. new text end
new text begin Access to information. new text end
new text begin
(a) The commission or commissioner may request
that a state agency provide the commission with data as defined in sections 62J.04 and
295.52 in a usable format as requested by the commission, at no cost to the commission.
new text end
new text begin
(b) The commission may request from a state agency unique or custom data sets, and
the agency may charge the commission for providing the data at the same rate the agency
would charge any other public or private entity. The commission may grant the commissioner
access to this data.
new text end
new text begin
(c) Any information provided to the commission or commissioner by a state agency
must be de-identified. For purposes of this subdivision, "de-identified" means the process
used to prevent the identity of a person from being connected with information and ensuring
all identifiable information has been removed.
new text end
new text begin
(d) Any data submitted to the commission or the commissioner shall retain their original
classification under the Minnesota Data Practices Act in chapter 13.
new text end
new text begin
(e) The commissioner, under the authority of chapter 62J, may collect data necessary
for the performance of its duties, and shall collect this data in a form and manner that ensures
the collection of high-quality, transparent data.
new text end
Sec. 2.
new text begin
[62J.0412] DUTIES OF THE COMMISSION; GENERAL.
new text end
new text begin Subdivision 1. new text end
new text begin Health care delivery and payment. new text end
new text begin
(a) The commission shall monitor
the administration and reform of the health care delivery and payment systems in the state.
The commission shall:
new text end
new text begin
(1) set health care spending growth targets for the state;
new text end
new text begin
(2) enhance the transparency of provider organizations;
new text end
new text begin
(3) monitor the adoption and effectiveness of alternative payment methodologies;
new text end
new text begin
(4) foster innovative health care delivery and payment models that lower health care
cost growth while improving the quality of patient care;
new text end
new text begin
(5) monitor and review the impact of changes within the health care marketplace; and
new text end
new text begin
(6) monitor patient access to necessary health care services.
new text end
new text begin
(b) The commission shall establish goals to reduce health care disparities in racial and
ethnic communities and to ensure access to quality care for persons with disabilities or with
chronic or complex health conditions.
new text end
new text begin Subd. 2. new text end
new text begin Duties of the commission; market trends. new text end
new text begin
The commission shall monitor
efforts to reform the health care delivery and payment system in Minnesota to understand
emerging trends in the commercial health insurance market, including large self-insured
employers and the state's public health care programs, in order to identify opportunities for
state action to achieve:
new text end
new text begin
(1) improved patient experience of care, including quality, access to care, and satisfaction;
new text end
new text begin
(2) improved health of all populations, including a reduction in health disparities; and
new text end
new text begin
(3) a reduction in the growth of health care costs.
new text end
new text begin Subd. 3. new text end
new text begin Duties of the commission; recommendations for reform. new text end
new text begin
The commission
shall make periodic recommendations for legislative policy, market, or any other reforms
to:
new text end
new text begin
(1) lower the rate of growth in commercial health care costs and public health care
program spending in the state;
new text end
new text begin
(2) positively impact the state's rankings in the areas listed in this subdivision and
subdivision 2; and
new text end
new text begin
(3) improve the quality and value of care for all Minnesotans, and for specific populations
adversely affected by health disparities.
new text end
Sec. 3.
new text begin
[62J.0413] DUTIES OF THE COMMISSION; GROWTH TARGETS.
new text end
new text begin Subdivision 1. new text end
new text begin Growth target program. new text end
new text begin
The commission is responsible for the
development, establishment, and operation of the health care spending growth target program,
determining the health care entities subject to health care spending growth targets, and
reporting on progress toward targets to the legislature and the public.
new text end
new text begin Subd. 2. new text end
new text begin Methodologies for growth targets. new text end
new text begin
(a) The commission shall develop and
maintain the health care spending growth target program, and report to the legislature and
the public on progress toward achieving growth targets. The commission shall conduct all
activities necessary for the successful implementation of the program, in order to limit health
care spending growth. The commission shall:
new text end
new text begin
(1) establish a statement of purpose;
new text end
new text begin
(2) develop a methodology to establish health care spending growth targets and the
economic indicators to be used in establishing the initial and subsequent target levels;
new text end
new text begin
(3) establish health care spending growth targets that:
new text end
new text begin
(i) use a clear and operational definition of total state health care spending;
new text end
new text begin
(ii) promote a predictable and sustainable rate of growth for total health care spending,
as measured by an established economic indicator, such as the rate of increase in the state
economy, the personal income of state residents, or a combination;
new text end
new text begin
(iii) apply to all health care providers and all health plan companies in the state's health
care system; and
new text end
new text begin
(iv) are measurable on a per capita basis, statewide basis, health plan basis, and health
care provider basis; and
new text end
new text begin
(4) establish a methodology for calculating health care cost growth that:
new text end
new text begin
(i) allows measurement statewide and for each health care provider and health plan
company, and at the discretion of the commission allows accounting for variability by age
and sex;
new text end
new text begin
(ii) takes into consideration the need for variability in targets across public and private
payers;
new text end
new text begin
(iii) incorporates health equity considerations; and
new text end
new text begin
(iv) considers the impact of targets on health care access and disparities.
new text end
new text begin
(b) The commission, when developing this methodology, shall determine which health
care entities are subject to targets, and at what level of aggregation.
new text end
new text begin Subd. 3. new text end
new text begin Data on performance. new text end
new text begin
The commission shall identify the data to be used for
tracking performance toward achieving health care spending growth targets, and adopt
methods of data collection. In identifying data and methods, the commission shall:
new text end
new text begin
(1) consider the availability, timeliness, quality, and usefulness of existing data;
new text end
new text begin
(2) assess the need for additional investments in data collection, data validation, or
analysis capacity to support efficient collection and aggregation of data to support the
commission's activities;
new text end
new text begin
(3) limit the reporting burden to the greatest extent possible; and
new text end
new text begin
(4) identify and define the health care entities that are required to report to the
commissioner.
new text end
new text begin Subd. 4. new text end
new text begin Reporting requirements. new text end
new text begin
The commission shall establish requirements for
health care providers and health plan companies to report data and other information
necessary to calculate health care cost growth. Health care providers and health plans must
report data in the form and manner established by the commission.
new text end
new text begin Subd. 5. new text end
new text begin Establishment of growth targets. new text end
new text begin
(a) The commission, by June 15, 2024, shall
establish annual health care spending growth targets consistent with the methodology in
subdivision 2 for each of the next five calendar years, with the goal of limiting health care
spending growth. The commission may continue to establish annual health care spending
growth targets for subsequent years.
new text end
new text begin
(b) The commission shall regularly review all components of the program methodology,
including economic indicators and other factors, and, as appropriate, revise established
health care spending growth target levels. Any changes to health care spending growth
target levels require a two-thirds majority vote of the commission.
new text end
new text begin Subd. 6. new text end
new text begin Additional criteria for growth targets. new text end
new text begin
(a) In developing the health care
spending growth target program, the commission may:
new text end
new text begin
(1) evaluate and ensure that the program does not place a disproportionate burden on
communities most impacted by health disparities, the providers who primarily serve
communities most impacted by health disparities, or individuals who reside in rural areas
or have high health care needs;
new text end
new text begin
(2) consider payment models that help ensure financial sustainability of rural health care
delivery systems and the ability to provide population health;
new text end
new text begin
(3) consider the addition of quality of care performance measures or minimum primary
care spending goals;
new text end
new text begin
(4) allow setting growth targets that encourage an individual health care entity to serve
populations with greater health care risks by incorporating:
new text end
new text begin
(i) a risk factor adjustment reflecting the health status of the entity's patient mix; and
new text end
new text begin
(ii) an equity adjustment accounting for the social determinants of health and other
factors related to health equity for the entity's patient mix;
new text end
new text begin
(5) ensure that growth targets:
new text end
new text begin
(i) encourage the growth of the Minnesota health care workforce, including the need to
provide competitive wages and benefits;
new text end
new text begin
(ii) do not limit the use of collective bargaining or place a floor or ceiling on health care
workforce compensation; and
new text end
new text begin
(iii) promote workforce stability and maintain high-quality health care jobs; and
new text end
new text begin
(6) consult with stakeholders representing patients, health care providers, payers of
health care services, and others.
new text end
new text begin
(b) Based on an analysis of drivers of health care spending by the commissioner and
evidence from public testimony, the commission shall explore strategies, new policies, and
future legislative proposals that can contribute to achieving health care spending growth
targets or limiting health care spending growth without increasing disparities in access to
health care, including the establishment of accountability mechanisms for health care entities.
new text end
new text begin Subd. 7. new text end
new text begin Reports. new text end
new text begin
(a) The commission shall submit the reports specified in this section
to the chairs and ranking minority members of the legislative committees with primary
jurisdiction over health care. These reports must be made available to the public.
new text end
new text begin
(b) The commission shall submit written progress updates about the development and
implementation of the health care growth target program by February 15, 2024, and February
15, 2025. The updates must include reporting on commission membership and activities,
program design decisions, planned timelines for implementation of the program, progress
of implementation, and comprehensive methodological details underlying program design
decisions.
new text end
new text begin
(c) The commission shall submit by March 31, 2026, and by March 31 annually thereafter,
reports on health care spending trends related to the health care growth targets. The
commission may delegate preparation of the reports to the commissioner and any contractors
the commissioner determines are necessary. The reports must include:
new text end
new text begin
(1) aggregate spending growth for entities subject to health care growth targets relative
to established target levels;
new text end
new text begin
(2) findings from the analyses of cost drivers of health care spending growth;
new text end
new text begin
(3) estimates of the impact of health care spending growth on Minnesota residents,
including for those communities most impacted by health disparities, including an analysis
of Minnesota residents' access to insurance and care, the value of health care, and the state's
ability to pursue other spending priorities;
new text end
new text begin
(4) the potential and observed impact of the health care growth targets on the financial
viability of the rural health care delivery system;
new text end
new text begin
(5) changes in the health care spending growth methodology under consideration;
new text end
new text begin
(6) recommended policy changes that may affect health care spending growth trends,
including broader and more transparent adoption of value-based payment arrangements;
and
new text end
new text begin
(7) an overview of health care entities subject to health care growth targets that have
implemented or completed a performance improvement plan.
new text end
Sec. 4.
new text begin
[62J.0414] HEALTH CARE AFFORDABILITY ADVISORY COUNCIL.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following definitions
have the meanings given.
new text end
new text begin
(b) "Council" means the Health Care Affordability Advisory Council.
new text end
new text begin
(c) "Commission" means the Health Care Affordability Commission.
new text end
new text begin Subd. 2. new text end
new text begin Establishment; administration. new text end
new text begin
(a) The commissioner of health shall appoint
a 15-member advisory council to provide technical assistance to the commission. Members
shall be appointed based on their knowledge and demonstrated expertise in one or more of
the following areas:
new text end
new text begin
(1) health care spending trends and drivers;
new text end
new text begin
(2) equitable access to health care services;
new text end
new text begin
(3) health insurance operation and finance;
new text end
new text begin
(4) actuarial science;
new text end
new text begin
(5) the practice of medicine;
new text end
new text begin
(6) patient perspectives;
new text end
new text begin
(7) clinical and health services research; and
new text end
new text begin
(8) the health care marketplace.
new text end
new text begin
(b) The commissioner shall provide administrative and staff support to the advisory
council.
new text end
new text begin Subd. 3. new text end
new text begin Membership. new text end
new text begin
The council's membership shall consist of:
new text end
new text begin
(1) three members representing patients and health care consumers, at least one of whom
must have experience working with communities most impacted by health disparities and
one of whom must have experience working with persons in the disability community;
new text end
new text begin
(2) the commissioner of health or a designee;
new text end
new text begin
(3) the commissioner of human services or a designee;
new text end
new text begin
(4) one member who is a health services researcher at the University of Minnesota;
new text end
new text begin
(5) two members who represent nonprofit group purchasers;
new text end
new text begin
(6) one member who represents for-profit group purchasers;
new text end
new text begin
(7) two members who represent health care entities;
new text end
new text begin
(8) one member who represents independent health care providers;
new text end
new text begin
(9) two members who represent employee benefit plans, with one representing a public
employer; and
new text end
new text begin
(10) one member who represents the Rare Disease Advisory Council.
new text end
new text begin Subd. 4. new text end
new text begin Terms. new text end
new text begin
(a) The initial appointments to the council shall be made by September
30, 2023. The council members shall serve staggered terms of three or four years determined
by lot by the secretary of state. Following the initial appointments, the council members
shall serve four-year terms. Members may not serve more than two consecutive terms.
new text end
new text begin
(b) Removal and vacancies of council members are governed by section 15.059.
new text end
new text begin Subd. 5. new text end
new text begin Meetings. new text end
new text begin
The council must meet publicly on at least a monthly basis until the
initial growth targets are established. After the initial growth targets are established, the
council shall meet at least quarterly.
new text end
new text begin Subd. 6. new text end
new text begin Duties. new text end
new text begin
The council shall:
new text end
new text begin
(1) provide technical advice to the commission on the development and implementation
of the health care spending growth targets, drivers of health care spending, and other items
related to the commission duties;
new text end
new text begin
(2) provide technical input on data sources for measuring health care spending; and
new text end
new text begin
(3) advise the commission on methods to measure the impact of health care spending
growth targets on:
new text end
new text begin
(i) communities most impacted by health disparities;
new text end
new text begin
(ii) the providers who primarily serve communities most impacted by health disparities;
new text end
new text begin
(iii) individuals with disabilities;
new text end
new text begin
(iv) individuals with health coverage through medical assistance or MinnesotaCare;
new text end
new text begin
(v) individuals who reside in rural areas; and
new text end
new text begin
(vi) individuals with rare diseases.
new text end
new text begin Subd. 7. new text end
new text begin Expiration. new text end
new text begin
Notwithstanding section 15.059, subdivision 6, the council does
not expire.
new text end
Sec. 5.
new text begin
[62J.0415] NOTICE TO HEALTH CARE ENTITIES.
new text end
new text begin Subdivision 1. new text end
new text begin Notice. new text end
new text begin
The commission shall provide notice to all health care entities
that have been identified by the commission as exceeding the health care spending growth
target for a specified period as determined by the commission.
new text end
new text begin Subd. 2. new text end
new text begin Performance improvement plans. new text end
new text begin
(a) The commission shall establish and
implement procedures to assist health care entities to improve efficiency and reduce cost
growth by requiring some or all health care entities provided notice under subdivision 1 to
file and implement a performance improvement plan. The commission shall provide written
notice of this requirement to health care entities and describe the form and manner in which
these plans must be prepared and submitted.
new text end
new text begin
(b) Within 45 days of receiving a notice of the requirement to file a performance
improvement plan, a health care entity shall:
new text end
new text begin
(1) file a performance improvement plan as specified in paragraph (d); or
new text end
new text begin
(2) file a request for a waiver or extension as specified in paragraph (c).
new text end
new text begin
(c) The health care entity may file any documentation or supporting evidence with the
commission to support the health care entity's application to waive or extend the timeline
to file a performance improvement plan. The commission shall require the health care entity
to submit any other relevant information it deems necessary in considering the waiver or
extension application, provided that this information shall be made public at the discretion
of the commission. The commission may waive or delay the requirement for a health care
entity to file a performance improvement plan in response to a waiver or extension request
in light of all information received from the health care entity, based on a consideration of
the following factors:
new text end
new text begin
(1) the costs, price, and utilization trends of the health care entity over time, and any
demonstrated improvement in reducing per capita medical expenses adjusted by health
status;
new text end
new text begin
(2) any ongoing strategies or investments that the health care entity is implementing to
improve future long-term efficiency and reduce cost growth;
new text end
new text begin
(3) whether the factors that led to increased costs for the health care entity can reasonably
be considered to be unanticipated and outside of the control of the entity. These factors may
include but shall not be limited to age and other health status adjusted factors of the patients
served by the health care entity and other cost inputs such as pharmaceutical expenses and
medical device expenses;
new text end
new text begin
(4) the overall financial condition of the health care entity; and
new text end
new text begin
(5) any other factors the commission considers relevant.
new text end
new text begin
If the commission declines to waive or extend the requirement for the health care entity to
file a performance improvement plan, the commission shall provide written notice to the
health care entity that its application for a waiver or extension was denied and the health
care entity shall file a performance improvement plan.
new text end
new text begin
(d) The performance improvement plan shall identify the causes of the entity's cost
growth and shall include but not be limited to specific strategies, adjustments, and action
steps the entity proposes to implement to improve cost performance. The proposed
performance improvement plan shall include specific identifiable and measurable expected
outcomes and a timetable for implementation. The commission may request additional
information as needed, in order to approve a proposed performance improvement plan. The
timetable for a performance improvement plan must not exceed 18 months.
new text end
new text begin
(e) The commission shall approve any performance improvement plan that it determines
is reasonably likely to address the underlying cause of the entity's cost growth and has a
reasonable expectation for successful implementation. If the commission determines that
the performance improvement plan is unacceptable or incomplete, the commission may
provide consultation on the criteria that have not been met and may allow an additional time
period of up to 30 calendar days for resubmission. Upon approval of the proposed
performance improvement plan, the commission shall notify the health care entity to begin
immediate implementation of the performance improvement plan. Public notice shall be
provided by the commission on its website, identifying that the health care entity is
implementing a performance improvement plan. All health care entities implementing an
approved performance improvement plan shall be subject to additional reporting requirements
and compliance monitoring, as determined by the commission. The commission may request
the commissioner to assist in the review of performance improvement plans. The commission
shall provide assistance to the health care entity in the successful implementation of the
performance improvement plan.
new text end
new text begin
(f) All health care entities shall in good faith work to implement the performance
improvement plan. At any point during the implementation of the performance improvement
plan, the health care entity may file amendments to the performance improvement plan,
subject to approval of the commission. At the conclusion of the timetable established in the
performance improvement plan, the health care entity shall report to the commission
regarding the outcome of the performance improvement plan. If the commission determines
the performance improvement plan was not implemented successfully, the commission
shall:
new text end
new text begin
(1) extend the implementation timetable of the existing performance improvement plan;
new text end
new text begin
(2) approve amendments to the performance improvement plan as proposed by the health
care entity;
new text end
new text begin
(3) require the health care entity to submit a new performance improvement plan; or
new text end
new text begin
(4) waive or delay the requirement to file any additional performance improvement
plans.
new text end
new text begin
Upon the successful completion of the performance improvement plan, the commission
shall remove the identity of the health care entity from the commission's website.
new text end
new text begin
(g) If the commission determines that a health care entity has:
new text end
new text begin
(1) willfully neglected to file a performance improvement plan with the commission
within 45 days or as required;
new text end
new text begin
(2) failed to file an acceptable performance improvement plan in good faith with the
commission;
new text end
new text begin
(3) failed to implement the performance improvement plan in good faith; or
new text end
new text begin
(4) knowingly failed to provide information required by this subdivision to the
commission or knowingly provided false information, the commission may assess a civil
penalty to the health care entity of not more than $500,000. The commission shall only
impose a civil penalty as a last resort.
new text end
Sec. 6.
new text begin
[62J.0416] IDENTIFY STRATEGIES FOR REDUCTION OF
ADMINISTRATIVE SPENDING AND LOW-VALUE CARE.
new text end
new text begin
(a) The commissioner of health shall develop recommendations for strategies to reduce
the volume and growth of administrative spending by health care organizations and group
purchasers, and the magnitude of low-value care delivered to Minnesota residents. The
commissioner shall:
new text end
new text begin
(1) review the availability of data and identify gaps in the data infrastructure to estimate
aggregated and disaggregated administrative spending and low-value care;
new text end
new text begin
(2) based on available data, estimate the volume and change over time of administrative
spending and low-value care in Minnesota;
new text end
new text begin
(3) conduct an environmental scan and key informant interviews with experts in health
care finance, health economics, health care management or administration, and the
administration of health insurance benefits to determine drivers of spending growth for
spending on administrative services or the provision of low-value care; and
new text end
new text begin
(4) convene a clinical learning community and an employer task force to review the
evidence from clauses (1) to (3) and develop a set of actionable strategies to address
administrative spending volume and growth and the magnitude of the volume of low-value
care.
new text end
new text begin
(b) By March 31, 2025, the commissioner shall deliver the recommendations to the
chairs and ranking minority members of house and senate committees with jurisdiction over
health and human services finance and policy.
new text end
Sec. 7.
new text begin
[62J.0417] PAYMENT MECHANISMS IN RURAL HEALTH CARE.
new text end
new text begin
(a) The commissioner shall develop a plan to assess readiness of rural communities and
rural health care providers to adopt value based, global budgeting or alternative payment
systems and recommend steps needed to implement them. The commissioner may use the
development of case studies and modeling of alternate payment systems to demonstrate
value-based payment systems that ensure a baseline level of essential community or regional
health services and address population health needs.
new text end
new text begin
(b) The commissioner shall develop recommendations for pilot projects with the aim of
ensuring financial viability of rural health care entities in the context of spending growth
targets. The commissioner shall share findings with the health care affordability commission.
new text end
Sec. 8.
Minnesota Statutes 2022, section 62U.04, subdivision 11, is amended to read:
Subd. 11.
Restricted uses of the all-payer claims data.
(a) Notwithstanding subdivision
4, paragraph (b), and subdivision 5, paragraph (b), the commissioner or the commissioner's
designee shall only use the data submitted under subdivisions 4 and 5 for the following
purposes:
(1) to evaluate the performance of the health care home program as authorized under
section 62U.03, subdivision 7;
(2) to study, in collaboration with the reducing avoidable readmissions effectively
(RARE) campaign, hospital readmission trends and rates;
(3) to analyze variations in health care costs, quality, utilization, and illness burden based
on geographical areas or populations;
(4) to evaluate the state innovation model (SIM) testing grant received by the Departments
of Health and Human Services, including the analysis of health care cost, quality, and
utilization baseline and trend information for targeted populations and communities; deleted text begin and
deleted text end
(5) to compile one or more public use files of summary data or tables that must:
(i) be available to the public for no or minimal cost by March 1, 2016, and available by
web-based electronic data download by June 30, 2019;
(ii) not identify individual patients, payers, or providers;
(iii) be updated by the commissioner, at least annually, with the most current data
available;
(iv) contain clear and conspicuous explanations of the characteristics of the data, such
as the dates of the data contained in the files, the absence of costs of care for uninsured
patients or nonresidents, and other disclaimers that provide appropriate context; and
(v) not lead to the collection of additional data elements beyond what is authorized under
this section as of June 30, 2015deleted text begin .deleted text end new text begin ; and
new text end
new text begin
(6) to provide technical assistance to the Health Care Affordability Commission to
implement sections 62J.0411 to 62J.0415.
new text end
(b) The commissioner may publish the results of the authorized uses identified in
paragraph (a) so long as the data released publicly do not contain information or descriptions
in which the identity of individual hospitals, clinics, or other providers may be discerned.
(c) Nothing in this subdivision shall be construed to prohibit the commissioner from
using the data collected under subdivision 4 to complete the state-based risk adjustment
system assessment due to the legislature on October 1, 2015.
(d) The commissioner or the commissioner's designee may use the data submitted under
subdivisions 4 and 5 for the purpose described in paragraph (a), clause (3), until July 1,
2023.
(e) The commissioner shall consult with the all-payer claims database work group
established under subdivision 12 regarding the technical considerations necessary to create
the public use files of summary data described in paragraph (a), clause (5).
Sec. 9.
Minnesota Statutes 2022, section 62V.05, is amended by adding a subdivision to
read:
new text begin Subd. 13. new text end
new text begin Transitional cost-sharing reductions. new text end
new text begin
(a) The board shall develop and
implement, for the 2025 and 2026 plan years only, a system to support eligible individuals
who choose to enroll in gold level health plans through MNsure.
new text end
new text begin
(b) For purposes of this section, an "eligible individual" is an individual who:
new text end
new text begin
(1) is a resident of Minnesota;
new text end
new text begin
(2) has a household income that does not exceed 400 percent of the federal poverty
guidelines; and
new text end
new text begin
(3) is enrolled in a gold level health plan offered in the enrollee's county of residence.
new text end
new text begin
(c) Under the system established in this subdivision, the monthly transitional cost-sharing
reduction subsidy for an eligible individual is $75.
new text end
new text begin
(d) The board shall establish procedures for determining an individual's eligibility for
the subsidy and providing payments to a health carrier for any eligible individuals enrolled
in the carrier's gold level health plans.
new text end
Sec. 10.
new text begin
[256.9631] DIRECT PAYMENT SYSTEM FOR MEDICAL ASSISTANCE
AND MINNESOTACARE.
new text end
new text begin Subdivision 1. new text end
new text begin Direct payment system established. new text end
new text begin
(a) The commissioner shall establish
a direct payment system to deliver services to eligible individuals, in order to achieve better
health outcomes and reduce the cost of health care for the state. Under this system, eligible
individuals shall receive services through the medical assistance fee-for-service system,
county-based purchasing plans, or county-owned health maintenance organizations. The
commissioner shall implement the direct payment system beginning January 1, 2027.
new text end
new text begin
(b) Persons who do not meet the definition of eligible individual shall continue to receive
services from managed care and county-based purchasing plans under sections 256B.69
and 256B.692, subject to the opt-out provision under section 256B.69, subdivision 28,
paragraph (c), for persons who are certified as blind or having a disability, and the exemptions
from managed care enrollment listed in section 256B.69, subdivision 4, paragraph (b).
new text end
new text begin Subd. 2. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following definitions apply.
new text end
new text begin
(b) "Eligible individuals" means: (1) qualified medical assistance enrollees, defined as
persons eligible for medical assistance as families and children and adults without children
eligible under section 256B.055, subdivision 15; and (2) all MinnesotaCare enrollees.
new text end
new text begin
(c) "Qualified hospital provider" means a nonstate government teaching hospital with
high medical assistance utilization and a level 1 trauma center, and all of the hospital's
owned or affiliated health care professionals, ambulance services, sites, and clinics.
new text end
new text begin Subd. 3. new text end
new text begin Managed care service delivery. new text end
new text begin
(a) In counties that choose to operate a
county-based purchasing plan under section 256B.692, the commissioner shall permit those
counties, in a timely manner, to establish a new county-based purchasing plan or participate
in an existing county-based purchasing plan.
new text end
new text begin
(b) In counties that choose to operate a county-owned health maintenance organization
under section 256B.69, the commissioner shall permit those counties to establish a new
county-owned and operated health maintenance organization or continue serving enrollees
through an existing county-owned and operated health maintenance organization.
new text end
new text begin
(c) County-based purchasing plans and county-owned health maintenance organizations
shall be reimbursed at the capitation rate determined under sections 256B.69 and 256B.692.
new text end
new text begin
(d) The commissioner shall allow eligible individuals the opportunity to opt out of
enrollment in a county-based purchasing plan or county-owned health maintenance
organization.
new text end
new text begin Subd. 4. new text end
new text begin Fee-for-service reimbursement. new text end
new text begin
(a) The commissioner shall reimburse health
care providers directly for all medical assistance and MinnesotaCare covered services
provided to eligible individuals, using the fee-for-service payment methods specified in
chapters 256, 256B, 256R, and 256S.
new text end
new text begin
(b) The commissioner shall ensure that payments under this section to a qualified hospital
provider are equivalent to the payments that would have been received based on managed
care direct payment arrangements. If necessary, a qualified hospital provider may use a
county-owned health maintenance organization to receive direct payments as described in
section 256B.1973.
new text end
new text begin Subd. 5. new text end
new text begin Termination of managed care contracts. new text end
new text begin
The commissioner shall terminate
managed care contracts for eligible individuals under sections 256B.69, 256L.12, and
256L.121 by December 31, 2026, except that the commissioner shall continue to contract
with county-based purchasing plans and county-owned health maintenance organizations,
as provided under this section.
new text end
new text begin Subd. 6. new text end
new text begin System development and administration. new text end
new text begin
(a) The commissioner, under the
direct payment system, shall:
new text end
new text begin
(1) provide benefits management, claims processing, and enrollee support services;
new text end
new text begin
(2) coordinate operation of the direct payment system with county agencies and MNsure,
and with service delivery to medical assistance enrollees who are age 65 or older, blind, or
have disabilities, or who are exempt from managed care enrollment under section 256B.69,
subdivision 4, paragraph (b);
new text end
new text begin
(3) establish and maintain provider payment rates at levels sufficient to ensure
high-quality care and enrollee access to covered health care services;
new text end
new text begin
(4) develop and monitor quality measures for health care service delivery; and
new text end
new text begin
(5) develop and implement provider incentives and innovative methods of health care
delivery, to ensure the efficient provision of high-quality care and reduce health care
disparities.
new text end
new text begin
(b) This section does not prohibit the commissioner from seeking legislative and federal
approval for demonstration projects to ensure access to care or improve health care quality.
new text end
new text begin
(c) The commissioner may contract with an administrator to administer the direct payment
system.
new text end
new text begin Subd. 7. new text end
new text begin Implementation plan. new text end
new text begin
(a) The commissioner shall present an implementation
plan for the direct payment system to the chairs and ranking minority members of the
legislative committees with jurisdiction over health care policy and finance by January 15,
2025. The commissioner may contract for technical assistance in developing the
implementation plan and conducting related studies and analysis.
new text end
new text begin
(b) The implementation plan must include:
new text end
new text begin
(1) a timeline for the development and implementation of the direct payment system;
new text end
new text begin
(2) the procedures to be used to ensure continuity of care for enrollees who transition
from managed care to fee-for-service;
new text end
new text begin
(3) any changes to fee-for-service payment rates that the commissioner determines are
necessary to ensure provider access and high-quality care, and reduce health disparities;
new text end
new text begin
(4) recommendations on ensuring effective care coordination under the direct payment
system, especially for enrollees with complex medical conditions, who face socioeconomic
barriers to receiving care, or who are from underserved populations that experience health
disparities;
new text end
new text begin
(5) recommendations on whether the direct payment system should provide supplemental
payments for care coordination, including:
new text end
new text begin
(i) the provider types eligible for supplemental payments and funding for outreach;
new text end
new text begin
(ii) procedures to coordinate supplemental payments with existing supplemental or
cost-based payment methods or to replace these existing methods; and
new text end
new text begin
(iii) procedures to align care coordination initiatives funded through supplemental
payments under this section with existing care coordination initiatives;
new text end
new text begin
(6) recommendations on whether the direct payment system should include funding to
providers for outreach initiatives to patients who, because of mental illness, homelessness,
or other circumstances, are unlikely to obtain needed care and treatment;
new text end
new text begin
(7) recommendations on whether and how the direct payment system should be expanded
to deliver services and care coordination to persons who are age 65 or older, are blind, or
have a disability;
new text end
new text begin
(8) procedures to compensate providers for any loss of savings from the federal 340B
Drug Pricing Program; and
new text end
new text begin
(9) recommendations for statutory changes necessary to implement the direct payment
system.
new text end
new text begin
(c) In developing the implementation plan, the commissioner shall:
new text end
new text begin
(1) calculate the projected cost of a direct payment system relative to the cost of the
current system;
new text end
new text begin
(2) assess gaps in care coordination under the current medical assistance and
MinnesotaCare programs;
new text end
new text begin
(3) evaluate the effectiveness of approaches other states have taken to coordinate care
under a fee-for-service system, including the coordination of care provided to persons who
are blind or have disabilities;
new text end
new text begin
(4) estimate the loss in provider revenues and cost savings under the federal 340B Drug
Pricing Program that would result from the elimination of managed care plan contracts
under medical assistance and MinnesotaCare, and develop a method to reimburse providers
for these potential losses;
new text end
new text begin
(5) estimate the loss of revenues and cost savings from other payment enhancements
based on managed care plan pass-throughs;
new text end
new text begin
(6) consult with the commissioner of health and the contractor or contractors analyzing
the Minnesota Health Plan and other reform models on plan design and assumptions; and
new text end
new text begin
(7) conduct other analyses necessary to develop the implementation plan.
new text end
Sec. 11.
Minnesota Statutes 2022, section 256.969, subdivision 9, is amended to read:
Subd. 9.
Disproportionate numbers of low-income patients served.
(a) For admissions
occurring on or after July 1, 1993, the medical assistance disproportionate population
adjustment shall comply with federal law and shall be paid to a hospital, excluding regional
treatment centers and facilities of the federal Indian Health Service, with a medical assistance
inpatient utilization rate in excess of the arithmetic mean. The adjustment must be determined
as follows:
(1) for a hospital with a medical assistance inpatient utilization rate above the arithmetic
mean for all hospitals excluding regional treatment centers and facilities of the federal Indian
Health Service but less than or equal to one standard deviation above the mean, the
adjustment must be determined by multiplying the total of the operating and property
payment rates by the difference between the hospital's actual medical assistance inpatient
utilization rate and the arithmetic mean for all hospitals excluding regional treatment centers
and facilities of the federal Indian Health Service; and
(2) for a hospital with a medical assistance inpatient utilization rate above one standard
deviation above the mean, the adjustment must be determined by multiplying the adjustment
that would be determined under clause (1) for that hospital by 1.1. The commissioner shall
report annually on the number of hospitals likely to receive the adjustment authorized by
this paragraph. The commissioner shall specifically report on the adjustments received by
public hospitals and public hospital corporations located in cities of the first class.
(b) Certified public expenditures made by Hennepin County Medical Center shall be
considered Medicaid disproportionate share hospital payments. Hennepin County and
Hennepin County Medical Center shall report by June 15, 2007, on payments made beginning
July 1, 2005, or another date specified by the commissioner, that may qualify for
reimbursement under federal law. Based on these reports, the commissioner shall apply for
federal matching funds.
(c) Upon federal approval of the related state plan amendment, paragraph (b) is effective
retroactively from July 1, 2005, or the earliest effective date approved by the Centers for
Medicare and Medicaid Services.
(d) Effective July 1, 2015, disproportionate share hospital (DSH) payments shall be paid
in accordance with a new methodology using 2012 as the base year. Annual payments made
under this paragraph shall equal the total amount of payments made for 2012. A licensed
children's hospital shall receive only a single DSH factor for children's hospitals. Other
DSH factors may be combined to arrive at a single factor for each hospital that is eligible
for DSH payments. The new methodology shall make payments only to hospitals located
in Minnesota and include the following factors:
(1) a licensed children's hospital with at least 1,000 fee-for-service discharges in the
base year shall receive a factor of 0.868. A licensed children's hospital with less than 1,000
fee-for-service discharges in the base year shall receive a factor of 0.7880;
(2) a hospital that has in effect for the initial rate year a contract with the commissioner
to provide extended psychiatric inpatient services under section 256.9693 shall receive a
factor of 0.0160;
(3) a hospital that has received medical assistance payment for at least 20 transplant
services in the base year shall receive a factor of 0.0435;
(4) a hospital that has a medical assistance utilization rate in the base year between 20
percent up to one standard deviation above the statewide mean utilization rate shall receive
a factor of 0.0468;
(5) a hospital that has a medical assistance utilization rate in the base year that is at least
one standard deviation above the statewide mean utilization rate but is less than two and
one-half standard deviations above the mean shall receive a factor of 0.2300; and
(6) a hospital that is a level one trauma center and that has a medical assistance utilization
rate in the base year that is at least two and one-half standard deviations above the statewide
mean utilization rate shall receive a factor of 0.3711.
(e) For the purposes of determining eligibility for the disproportionate share hospital
factors in paragraph (d), clauses (1) to (6), the medical assistance utilization rate and
discharge thresholds shall be measured using only one year when a two-year base period
is used.
(f) Any payments or portion of payments made to a hospital under this subdivision that
are subsequently returned to the commissioner because the payments are found to exceed
the hospital-specific DSH limit for that hospital shall be redistributed, proportionate to the
number of fee-for-service discharges, to other DSH-eligible non-children's hospitals that
have a medical assistance utilization rate that is at least one standard deviation above the
mean.
(g) An additional payment adjustment shall be established by the commissioner under
this subdivision for a hospital that provides high levels of administering high-cost drugs to
enrollees in fee-for-service medical assistance. The commissioner shall consider factors
including fee-for-service medical assistance utilization rates and payments made for drugs
purchased through the 340B drug purchasing program and administered to fee-for-service
enrollees. If any part of this adjustment exceeds a hospital's hospital-specific disproportionate
share hospital limit,new text begin or if the hospital qualifies for the alternative payment rate described in
subdivision 2e,new text end the commissioner shall make a payment to the hospital that equals the
nonfederal share of the amount that exceeds the limit. The total nonfederal share of the
amount of the payment adjustment under this paragraph shall not exceed deleted text begin $1,500,000deleted text end new text begin
$10,000,000. The commissioner shall calculate the aggregate difference in payments for
outpatient pharmacy claims for medical assistance enrollees receiving services from a
managed care or county-based purchasing plan, when reimbursed at the 340B rate as
compared to the non-340B rate, as specified in section 256B.0625, subdivision 13e. By
February 1, 2026, the commissioner shall report the results of this calculation for the prior
fiscal year to the chairs and ranking members of the legislative committees with jurisdiction
over health care finance and policynew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2026, or the January 1
following certification of the modernized pharmacy claims processing system, whichever
is later. The commissioner of human services shall notify the revisor of statutes when
certification of the modernized pharmacy claims processing system occurs.
new text end
Sec. 12.
Minnesota Statutes 2022, section 256B.056, subdivision 7, is amended to read:
Subd. 7.
Period of eligibility.
(a) Eligibility is available for the month of application
and for three months prior to application if the person was eligible in those prior months.
A redetermination of eligibility must occur every 12 months.
new text begin
(b) Notwithstanding any other law to the contrary:
new text end
new text begin
(1) a child under 19 years of age who is determined eligible for medical assistance must
remain eligible for a period of 12 months;
new text end
new text begin
(2) a child 19 years of age and older but under 21 years of age who is determined eligible
for medical assistance must remain eligible for a period of 12 months; and
new text end
new text begin
(3) a child under six years of age who is determined eligible for medical assistance must
remain eligible through the month in which the child reaches six years of age.
new text end
new text begin
(c) A child's eligibility under paragraph (b) may be terminated earlier if:
new text end
new text begin
(1) the child or the child's representative requests voluntary termination of eligibility;
new text end
new text begin
(2) the child ceases to be a resident of this state;
new text end
new text begin
(3) the child dies; or
new text end
new text begin
(4) the agency determines eligibility was erroneously granted at the most recent eligibility
determination due to agency error or fraud, abuse, or perjury attributed to the child or the
child's representative.
new text end
deleted text begin (b)deleted text end new text begin (d)new text end For a person eligible for an insurance affordability program as defined in section
256B.02, subdivision 19, who reports a change that makes the person eligible for medical
assistance, eligibility is available for the month the change was reported and for three months
prior to the month the change was reported, if the person was eligible in those prior months.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025, or upon federal approval,
whichever is later, except that paragraph (b), clause (1), is effective January 1, 2024. The
commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.
new text end
Sec. 13.
Minnesota Statutes 2022, section 256B.0631, subdivision 1, is amended to read:
Subdivision 1.
Cost-sharing.
(a) Except as provided in subdivision 2, the medical
assistance benefit plan shall include the following cost-sharing for all recipients, effective
for services provided deleted text begin on or afterdeleted text end new text begin fromnew text end September 1, 2011new text begin , to December 31, 2023new text end :
(1) $3 per nonpreventive visit, except as provided in paragraph (b). For purposes of this
subdivision, a visit means an episode of service which is required because of a recipient's
symptoms, diagnosis, or established illness, and which is delivered in an ambulatory setting
by a physician or physician assistant, chiropractor, podiatrist, nurse midwife, advanced
practice nurse, audiologist, optician, or optometrist;
(2) $3.50 for nonemergency visits to a hospital-based emergency room, except that this
co-payment shall be increased to $20 upon federal approval;
(3) $3 per brand-name drug prescription, $1 per generic drug prescription, and $1 per
prescription for a brand-name multisource drug listed in preferred status on the preferred
drug list, subject to a $12 per month maximum for prescription drug co-payments. No
co-payments shall apply to antipsychotic drugs when used for the treatment of mental illness;
(4) a family deductible equal to $2.75 per month per family and adjusted annually by
the percentage increase in the medical care component of the CPI-U for the period of
September to September of the preceding calendar year, rounded to the next higher five-cent
increment; and
(5) total monthly cost-sharing must not exceed five percent of family income. For
purposes of this paragraph, family income is the total earned and unearned income of the
individual and the individual's spouse, if the spouse is enrolled in medical assistance and
also subject to the five percent limit on cost-sharing. This paragraph does not apply to
premiums charged to individuals described under section 256B.057, subdivision 9.
(b) Recipients of medical assistance are responsible for all co-payments and deductibles
in this subdivision.
(c) Notwithstanding paragraph (b), the commissioner, through the contracting process
under sections 256B.69 and 256B.692, may allow managed care plans and county-based
purchasing plans to waive the family deductible under paragraph (a), clause (4). The value
of the family deductible shall not be included in the capitation payment to managed care
plans and county-based purchasing plans. Managed care plans and county-based purchasing
plans shall certify annually to the commissioner the dollar value of the family deductible.
(d) Notwithstanding paragraph (b), the commissioner may waive the collection of the
family deductible described under paragraph (a), clause (4), from individuals and allow
long-term care and waivered service providers to assume responsibility for payment.
(e) Notwithstanding paragraph (b), the commissioner, through the contracting process
under section 256B.0756 shall allow the pilot program in Hennepin County to waive
co-payments. The value of the co-payments shall not be included in the capitation payment
amount to the integrated health care delivery networks under the pilot program.
new text begin
(f) For services provided on or after January 1, 2024, the medical assistance benefit plan
must not include cost-sharing or deductibles for any medical assistance recipient or benefit.
new text end
Sec. 14.
Minnesota Statutes 2022, section 256B.0631, subdivision 3, is amended to read:
Subd. 3.
Collection.
(a) The medical assistance reimbursement to the provider shall be
reduced by the amount of the co-payment or deductible, except that reimbursements shall
not be reduced:
(1) once a recipient has reached the $12 per month maximum for prescription drug
co-payments; or
(2) for a recipient who has met their monthly five percent cost-sharing limit.
(b) The provider collects the co-payment or deductible from the recipient. Providers
may not deny services to recipients who are unable to pay the co-payment or deductible.
deleted text begin
(c) Medical assistance reimbursement to fee-for-service providers and payments to
managed care plans shall not be increased as a result of the removal of co-payments or
deductibles effective on or after January 1, 2009.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024.
new text end
Sec. 15.
Minnesota Statutes 2022, section 256B.69, subdivision 4, is amended to read:
Subd. 4.
Limitation of choicenew text begin ; opportunity to opt outnew text end .
(a) The commissioner shall
develop criteria to determine when limitation of choice may be implemented in the
experimental countiesnew text begin , but shall provide all eligible individuals the opportunity to opt out
of enrollment in managed care under this sectionnew text end . The criteria shall ensure that all eligible
individuals in the county have continuing access to the full range of medical assistance
services as specified in subdivision 6.
(b) The commissioner shall exempt the following persons from participation in the
project, in addition to those who do not meet the criteria for limitation of choice:
(1) persons eligible for medical assistance according to section 256B.055, subdivision
1;
(2) persons eligible for medical assistance due to blindness or disability as determined
by the Social Security Administration or the state medical review team, unless:
(i) they are 65 years of age or older; or
(ii) they reside in Itasca County or they reside in a county in which the commissioner
conducts a pilot project under a waiver granted pursuant to section 1115 of the Social
Security Act;
(3) recipients who currently have private coverage through a health maintenance
organization;
(4) recipients who are eligible for medical assistance by spending down excess income
for medical expenses other than the nursing facility per diem expense;
(5) recipients who receive benefits under the Refugee Assistance Program, established
under United States Code, title 8, section 1522(e);
(6) children who are both determined to be severely emotionally disturbed and receiving
case management services according to section 256B.0625, subdivision 20, except children
who are eligible for and who decline enrollment in an approved preferred integrated network
under section 245.4682;
(7) adults who are both determined to be seriously and persistently mentally ill and
received case management services according to section 256B.0625, subdivision 20;
(8) persons eligible for medical assistance according to section 256B.057, subdivision
10;
(9) persons with access to cost-effective employer-sponsored private health insurance
or persons enrolled in a non-Medicare individual health plan determined to be cost-effective
according to section 256B.0625, subdivision 15; and
(10) persons who are absent from the state for more than 30 consecutive days but still
deemed a resident of Minnesota, identified in accordance with section 256B.056, subdivision
1, paragraph (b).
Children under age 21 who are in foster placement may enroll in the project on an elective
basis. Individuals excluded under clauses (1), (6), and (7) may choose to enroll on an elective
basis. The commissioner may enroll recipients in the prepaid medical assistance program
for seniors who are (1) age 65 and over, and (2) eligible for medical assistance by spending
down excess income.
(c) The commissioner may allow persons with a one-month spenddown who are otherwise
eligible to enroll to voluntarily enroll or remain enrolled, if they elect to prepay their monthly
spenddown to the state.
(d) The commissioner may requirenew text begin , subject to the opt-out provision under paragraph (a),new text end
those individuals to enroll in the prepaid medical assistance program who otherwise would
have been excluded under paragraph (b), clauses (1), (3), and (8), and under Minnesota
Rules, part 9500.1452, subpart 2, items H, K, and L.
(e) Before limitation of choice is implemented, eligible individuals shall be notified and
new text begin given the opportunity to opt out of managed care enrollment. new text end After notification, new text begin those
individuals who choose not to opt out new text end shall be allowed to choose only among demonstration
providers. The commissioner may assign an individual with private coverage through a
health maintenance organization, to the same health maintenance organization for medical
assistance coverage, if the health maintenance organization is under contract for medical
assistance in the individual's county of residence. After initially choosing a provider, the
recipient is allowed to change that choice only at specified times as allowed by the
commissioner. If a demonstration provider ends participation in the project for any reason,
a recipient enrolled with that provider must select a new provider but may change providers
without cause once more within the first 60 days after enrollment with the second provider.
(f) An infant born to a woman who is eligible for and receiving medical assistance and
who is enrolled in the prepaid medical assistance program shall be retroactively enrolled to
the month of birth in the same managed care plan as the mother once the child is enrolled
in medical assistance unless the child is determined to be excluded from enrollment in a
prepaid plan under this section.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024.
new text end
Sec. 16.
Minnesota Statutes 2022, section 256B.69, subdivision 6d, is amended to read:
Subd. 6d.
Prescription drugs.
The commissioner deleted text begin maydeleted text end new text begin shallnew text end exclude or modify coverage
for new text begin outpatient new text end prescription drugs new text begin dispensed by a pharmacy to a medical assistance or
MinnesotaCare enrollee new text end from the prepaid managed care contracts entered into under this
deleted text begin section in order to increase savings to the state by collecting additional prescription drug
rebates. The contracts must maintain incentives for the managed care plan to manage drug
costs and utilization and may require that the managed care plans maintain an open drug
formulary. In order to manage drug costs and utilization, the contracts may authorize the
managed care plans to use preferred drug lists and prior authorization. This subdivision is
contingent on federal approval of the managed care contract changes and the collection of
additional prescription drug rebatesdeleted text end new text begin chapter and chapter 256Lnew text end .new text begin The commissioner may
include, exclude, or modify coverage for prescription drugs administered to a medical
assistance or MinnesotaCare enrollee from the prepaid managed care contracts entered into
under this chapter and chapter 256L.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2026, or the January 1
following certification of the modernized pharmacy claims processing system, whichever
is later. The commissioner of human services shall notify the revisor of statutes when
certification of the modernized pharmacy claims processing system occurs.
new text end
Sec. 17.
Minnesota Statutes 2022, section 256B.69, subdivision 28, is amended to read:
Subd. 28.
Medicare special needs plans; medical assistance basic health care.
(a)
The commissioner may contract with demonstration providers and current or former sponsors
of qualified Medicare-approved special needs plans, to provide medical assistance basic
health care services to persons with disabilities, including those with developmental
disabilities. Basic health care services include:
(1) those services covered by the medical assistance state plan except for ICF/DD services,
home and community-based waiver services, case management for persons with
developmental disabilities under section 256B.0625, subdivision 20a, and personal care and
certain home care services defined by the commissioner in consultation with the stakeholder
group established under paragraph (d); and
(2) basic health care services may also include risk for up to 100 days of nursing facility
services for persons who reside in a noninstitutional setting and home health services related
to rehabilitation as defined by the commissioner after consultation with the stakeholder
group.
The commissioner may exclude other medical assistance services from the basic health
care benefit set. Enrollees in these plans can access any excluded services on the same basis
as other medical assistance recipients who have not enrolled.
(b) The commissioner may contract with demonstration providers and current and former
sponsors of qualified Medicare special needs plans, to provide basic health care services
under medical assistance to persons who are dually eligible for both Medicare and Medicaid
and those Social Security beneficiaries eligible for Medicaid but in the waiting period for
Medicare. The commissioner shall consult with the stakeholder group under paragraph (d)
in developing program specifications for these services. Payment for Medicaid services
provided under this subdivision for the months of May and June will be made no earlier
than July 1 of the same calendar year.
(c) deleted text begin Notwithstanding subdivision 4, beginning January 1, 2012,deleted text end The commissioner shall
enroll persons with disabilities in managed care under this section, unless the individual
chooses to opt out of enrollment. The commissioner shall establish enrollment and opt out
procedures consistent with applicable enrollment procedures under this section.
(d) The commissioner shall establish a state-level stakeholder group to provide advice
on managed care programs for persons with disabilities, including both MnDHO and contracts
with special needs plans that provide basic health care services as described in paragraphs
(a) and (b). The stakeholder group shall provide advice on program expansions under this
subdivision and subdivision 23, including:
(1) implementation efforts;
(2) consumer protections; and
(3) program specifications such as quality assurance measures, data collection and
reporting, and evaluation of costs, quality, and results.
(e) Each plan under contract to provide medical assistance basic health care services
shall establish a local or regional stakeholder group, including representatives of the counties
covered by the plan, members, consumer advocates, and providers, for advice on issues that
arise in the local or regional area.
(f) The commissioner is prohibited from providing the names of potential enrollees to
health plans for marketing purposes. The commissioner shall mail no more than two sets
of marketing materials per contract year to potential enrollees on behalf of health plans, at
the health plan's request. The marketing materials shall be mailed by the commissioner
within 30 days of receipt of these materials from the health plan. The health plans shall
cover any costs incurred by the commissioner for mailing marketing materials.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024.
new text end
Sec. 18.
Minnesota Statutes 2022, section 256B.69, subdivision 36, is amended to read:
Subd. 36.
Enrollee support system.
(a) The commissioner shall establish an enrollee
support system that provides support to an enrollee before and during enrollment in a
managed care plan.
(b) The enrollee support system must:
(1) provide access to counseling for each potential enrollee on choosing a managed care
plannew text begin or opting out of managed carenew text end ;
(2) assist an enrollee in understanding enrollment in a managed care plan;
(3) provide an access point for complaints regarding enrollment, covered services, and
other related matters;
(4) provide information on an enrollee's grievance and appeal rights within the managed
care organization and the state's fair hearing process, including an enrollee's rights and
responsibilities; and
(5) provide assistance to an enrollee, upon request, in navigating the grievance and
appeals process within the managed care organization and in appealing adverse benefit
determinations made by the managed care organization to the state's fair hearing process
after the managed care organization's internal appeals process has been exhausted. Assistance
does not include providing representation to an enrollee at the state's fair hearing, but may
include a referral to appropriate legal representation sources.
(c) Outreach to enrollees through the support system must be accessible to an enrollee
through multiple formats, including telephone, Internet, in-person, and, if requested, through
auxiliary aids and services.
(d) The commissioner may designate enrollment brokers to assist enrollees on selecting
a managed care organization and providing necessary enrollment information. For purposes
of this subdivision, "enrollment broker" means an individual or entity that performs choice
counseling or enrollment activities in accordance with Code of Federal Regulations, part
42, section 438.810, or both.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024.
new text end
Sec. 19.
Minnesota Statutes 2022, section 256B.692, subdivision 1, is amended to read:
Subdivision 1.
In general.
County boards or groups of county boards may elect to
purchase or provide health care services on behalf of persons eligible for medical assistance
who would otherwise be required to or may elect to participate in the prepaid medical
assistance program according to section 256B.69new text begin , subject to the opt-out provision of section
256B.69, subdivision 4, paragraph (a)new text end . Counties that elect to purchase or provide health
care under this section must provide all services included in prepaid managed care programs
according to section 256B.69, subdivisions 1 to 22. County-based purchasing under this
section is governed by section 256B.69, unless otherwise provided for under this section.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024.
new text end
Sec. 20.
Minnesota Statutes 2022, section 256B.75, is amended to read:
256B.75 HOSPITAL OUTPATIENT REIMBURSEMENT.
(a) For outpatient hospital facility fee payments for services rendered on or after October
1, 1992, the commissioner of human services shall pay the lower of (1) submitted charge,
or (2) 32 percent above the rate in effect on June 30, 1992, except for those services for
which there is a federal maximum allowable payment. Effective for services rendered on
or after January 1, 2000, payment rates for nonsurgical outpatient hospital facility fees and
emergency room facility fees shall be increased by eight percent over the rates in effect on
December 31, 1999, except for those services for which there is a federal maximum allowable
payment. Services for which there is a federal maximum allowable payment shall be paid
at the lower of (1) submitted charge, or (2) the federal maximum allowable payment. Total
aggregate payment for outpatient hospital facility fee services shall not exceed the Medicare
upper limit. If it is determined that a provision of this section conflicts with existing or
future requirements of the United States government with respect to federal financial
participation in medical assistance, the federal requirements prevail. The commissioner
may, in the aggregate, prospectively reduce payment rates to avoid reduced federal financial
participation resulting from rates that are in excess of the Medicare upper limitations.
(b)new text begin (1)new text end Notwithstanding paragraph (a), payment for outpatient, emergency, and ambulatory
surgery hospital facility fee services for critical access hospitals designated under section
144.1483, clause (9), shall be paid on a cost-based payment system that is based on the
cost-finding methods and allowable costs of the Medicare program. Effective for services
provided on or after July 1, 2015, rates established for critical access hospitals under this
paragraph for the applicable payment year shall be the final payment and shall not be settled
to actual costs. Effective for services delivered on or after the first day of the hospital's fiscal
year ending in 2017, the rate for outpatient hospital services shall be computed using
information from each hospital's Medicare cost report as filed with Medicare for the year
that is two years before the year that the rate is being computed. Rates shall be computed
using information from Worksheet C series until the department finalizes the medical
assistance cost reporting process for critical access hospitals. After the cost reporting process
is finalized, rates shall be computed using information from Title XIX Worksheet D series.
The outpatient rate shall be equal to ancillary cost plus outpatient cost, excluding costs
related to rural health clinics and federally qualified health clinics, divided by ancillary
charges plus outpatient charges, excluding charges related to rural health clinics and federally
qualified health clinics.
new text begin
(2) The rate described in clause (1) must be increased for hospitals providing high levels
of 340B drugs. The rate adjustment must be based on four percent of each hospital's share
of the total reimbursement for 340B drugs to all critical access hospitals, but must not exceed
$3,000,000.
new text end
(c) Effective for services provided on or after July 1, 2003, rates that are based on the
Medicare outpatient prospective payment system shall be replaced by a budget neutral
prospective payment system that is derived using medical assistance data. The commissioner
shall provide a proposal to the 2003 legislature to define and implement this provision.
When implementing prospective payment methodologies, the commissioner shall use general
methods and rate calculation parameters similar to the applicable Medicare prospective
payment systems for services delivered in outpatient hospital and ambulatory surgical center
settings unless other payment methodologies for these services are specified in this chapter.
(d) For fee-for-service services provided on or after July 1, 2002, the total payment,
before third-party liability and spenddown, made to hospitals for outpatient hospital facility
services is reduced by .5 percent from the current statutory rate.
(e) In addition to the reduction in paragraph (d), the total payment for fee-for-service
services provided on or after July 1, 2003, made to hospitals for outpatient hospital facility
services before third-party liability and spenddown, is reduced five percent from the current
statutory rates. Facilities defined under section 256.969, subdivision 16, are excluded from
this paragraph.
(f) In addition to the reductions in paragraphs (d) and (e), the total payment for
fee-for-service services provided on or after July 1, 2008, made to hospitals for outpatient
hospital facility services before third-party liability and spenddown, is reduced three percent
from the current statutory rates. Mental health services and facilities defined under section
256.969, subdivision 16, are excluded from this paragraph.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2026, or the January 1
following certification of the modernized pharmacy claims processing system, whichever
is later. The commissioner of human services shall notify the revisor of statutes when
certification of the modernized pharmacy claims processing system occurs.
new text end
Sec. 21.
Minnesota Statutes 2022, section 256L.04, subdivision 1c, is amended to read:
Subd. 1c.
General requirements.
To be eligible for MinnesotaCare, a person must meet
the eligibility requirements of this section. A person eligible for MinnesotaCare deleted text begin shalldeleted text end new text begin with
a family income of less than or equal to 200 percent of the federal poverty guidelines mustnew text end
not be considered a qualified individual under section 1312 of the Affordable Care Act, and
is not eligible for enrollment in a qualified health plan offered through MNsure under chapter
62V.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2027, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 22.
Minnesota Statutes 2022, section 256L.04, subdivision 7a, is amended to read:
Subd. 7a.
Ineligibility.
Adults whose income is greater than the limits established under
this section may not enroll in the MinnesotaCare programnew text begin , except as provided in subdivision
15new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2027, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 23.
Minnesota Statutes 2022, section 256L.04, subdivision 10, is amended to read:
Subd. 10.
Citizenship requirements.
(a) Eligibility for MinnesotaCare is deleted text begin limiteddeleted text end new text begin
availablenew text end to citizens or nationals of the United States deleted text begin anddeleted text end new text begin ;new text end lawfully present noncitizens as
defined in Code of Federal Regulations, title 8, section 103.12deleted text begin .deleted text end new text begin ; andnew text end undocumented
noncitizens deleted text begin are ineligible for MinnesotaCaredeleted text end . For purposes of this subdivision, an
undocumented noncitizen is an individual who resides in the United States without the
approval or acquiescence of the United States Citizenship and Immigration Services. Families
with children who are citizens or nationals of the United States must cooperate in obtaining
satisfactory documentary evidence of citizenship or nationality according to the requirements
of the federal Deficit Reduction Act of 2005, Public Law 109-171.
(b) Notwithstanding subdivisions 1 and 7, eligible persons include families and
individuals who are deleted text begin lawfully present anddeleted text end ineligible for medical assistance by reason of
immigration status and who have incomes equal to or less than 200 percent of federal poverty
guidelinesnew text begin , except that these persons may be eligible for emergency medical assistance
under section 256B.06, subdivision 4new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025.
new text end
Sec. 24.
Minnesota Statutes 2022, section 256L.04, is amended by adding a subdivision
to read:
new text begin Subd. 15. new text end
new text begin Persons eligible for public option. new text end
new text begin
(a) Families and individuals with income
above the maximum income eligibility limit specified in subdivision 1 or 7 but who meet
all other MinnesotaCare eligibility requirements are eligible for MinnesotaCare. All other
provisions of this chapter apply unless otherwise specified.
new text end
new text begin
(b) Families and individuals may enroll in MinnesotaCare under this subdivision only
during an annual open enrollment period or special enrollment period, as designated by
MNsure in compliance with Code of Federal Regulations, title 45, parts 155.410 and 155.420.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2027, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 25.
Minnesota Statutes 2022, section 256L.07, subdivision 1, is amended to read:
Subdivision 1.
General requirements.
Individuals enrolled in MinnesotaCare under
section 256L.04, subdivision 1, and individuals enrolled in MinnesotaCare under section
256L.04, subdivision 7, whose income increases above 200 percent of the federal poverty
guidelinesdeleted text begin ,deleted text end are no longer eligible for the program and deleted text begin shalldeleted text end new text begin mustnew text end be disenrolled by the
commissionernew text begin , unless the individuals continue MinnesotaCare enrollment through the public
option under section 256L.04, subdivision 15new text end . For persons disenrolled under this subdivision,
MinnesotaCare coverage terminates the last day of the calendar month in which the
commissioner sends advance notice according to Code of Federal Regulations, title 42,
section 431.211, that indicates the income of a family or individual exceeds program income
limits.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2027, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 26.
Minnesota Statutes 2022, section 256L.15, subdivision 2, is amended to read:
Subd. 2.
Sliding fee scale; monthly individual or family income.
(a) The commissioner
shall establish a sliding fee scale to determine the percentage of monthly individual or family
income that households at different income levels must pay to obtain coverage through the
MinnesotaCare program. The sliding fee scale must be based on the enrollee's monthly
individual or family income.
deleted text begin
(b) Beginning January 1, 2014, MinnesotaCare enrollees shall pay premiums according
to the premium scale specified in paragraph (d).
deleted text end
deleted text begin (c)deleted text end new text begin (b)new text end Paragraph deleted text begin (b)deleted text end new text begin (a)new text end does not apply todeleted text begin :
deleted text end
deleted text begin (1)deleted text end children 20 years of age or youngerdeleted text begin ; and
deleted text end
deleted text begin (2) individuals with household incomes below 35 percent of the federal povertydeleted text end
deleted text begin guidelinesdeleted text end .
deleted text begin
(d) The following premium scale is established for each individual in the household who
is 21 years of age or older and enrolled in MinnesotaCare:
deleted text end
|
deleted text begin
Federal Poverty Guideline deleted text end deleted text begin Greater than or Equal to deleted text end |
deleted text begin
Less than deleted text end |
deleted text begin
Individual Premium deleted text end deleted text begin Amount deleted text end |
|
deleted text begin
35% deleted text end |
deleted text begin
55% deleted text end |
deleted text begin
$4 deleted text end |
|
deleted text begin
55% deleted text end |
deleted text begin
80% deleted text end |
deleted text begin
$6 deleted text end |
|
deleted text begin
80% deleted text end |
deleted text begin
90% deleted text end |
deleted text begin
$8 deleted text end |
|
deleted text begin
90% deleted text end |
deleted text begin
100% deleted text end |
deleted text begin
$10 deleted text end |
|
deleted text begin
100% deleted text end |
deleted text begin
110% deleted text end |
deleted text begin
$12 deleted text end |
|
deleted text begin
110% deleted text end |
deleted text begin
120% deleted text end |
deleted text begin
$14 deleted text end |
|
deleted text begin
120% deleted text end |
deleted text begin
130% deleted text end |
deleted text begin
$15 deleted text end |
|
deleted text begin
130% deleted text end |
deleted text begin
140% deleted text end |
deleted text begin
$16 deleted text end |
|
deleted text begin
140% deleted text end |
deleted text begin
150% deleted text end |
deleted text begin
$25 deleted text end |
|
deleted text begin
150% deleted text end |
deleted text begin
160% deleted text end |
deleted text begin
$37 deleted text end |
|
deleted text begin
160% deleted text end |
deleted text begin
170% deleted text end |
deleted text begin
$44 deleted text end |
|
deleted text begin
170% deleted text end |
deleted text begin
180% deleted text end |
deleted text begin
$52 deleted text end |
|
deleted text begin
180% deleted text end |
deleted text begin
190% deleted text end |
deleted text begin
$61 deleted text end |
|
deleted text begin
190% deleted text end |
deleted text begin
200% deleted text end |
deleted text begin
$71 deleted text end |
|
deleted text begin
200% deleted text end |
deleted text begin
$80 deleted text end |
deleted text begin (e)deleted text end new text begin (c)new text end Beginning January 1, deleted text begin 2021deleted text end new text begin 2024new text end , new text begin the commissioner shall continue to charge
premiums in accordance with the simplified premium scale established to comply with the
American Rescue Plan Act of 2021, in effect from January 1, 2021, through December 31,
2025, for families and individuals eligible under section 256L.04, subdivisions 1 and 7. new text end The
commissioner shall adjust the premium scale deleted text begin established under paragraph (d)deleted text end new text begin as needednew text end to
ensure that premiums do not exceed the amount that an individual would have been required
to pay if the individual was enrolled in an applicable benchmark plan in accordance with
the Code of Federal Regulations, title 42, section 600.505 (a)(1).
new text begin
(d) The commissioner shall establish a sliding premium scale for persons eligible through
the public option under section 256L.04, subdivision 15. Beginning January 1, 2027, persons
eligible through the public option shall pay premiums according to this premium scale.
Persons eligible through the public option who are 20 years of age or younger are exempt
from paying premiums.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024, except that paragraph
(d) is effective January 1, 2027, or upon federal approval, whichever is later. The
commissioner of human services shall notify the revisor of statutes when federal approval
is obtained.
new text end
Sec. 27. new text begin TRANSITION TO MINNESOTACARE PUBLIC OPTION.
new text end
new text begin
(a) The commissioner of human services shall continue to administer MinnesotaCare
as a basic health program in accordance with Minnesota Statutes, section 256L.02,
subdivision 5.
new text end
new text begin
(b) The commissioner shall present an implementation plan for the MinnesotaCare public
option under Minnesota Statutes, section 256L.04, subdivision 15, to the chairs and ranking
minority members of the legislative committees with jurisdiction over health care policy
and finance by January 15, 2025. The plan must include:
new text end
new text begin
(1) recommendations for any changes to the MinnesotaCare public option necessary to
continue federal basic health program funding or to receive other federal funding;
new text end
new text begin
(2) recommendations for ensuring sufficient provider participation in MinnesotaCare;
new text end
new text begin
(3) estimates of state costs related to the MinnesotaCare public option;
new text end
new text begin
(4) a description of the proposed premium scale for persons eligible through the public
option, including an analysis of the extent to which the proposed premium scale:
new text end
new text begin
(i) ensures affordable premiums for persons across the income spectrum enrolled under
the public option; and
new text end
new text begin
(ii) avoids premium cliffs for persons transitioning to and enrolled under the public
option; and
new text end
new text begin
(5) draft legislation that includes any additional policy and conforming changes necessary
to implement the MinnesotaCare public option and the implementation plan
recommendations.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 28. new text begin REQUEST FOR FEDERAL APPROVAL.
new text end
new text begin
(a) The commissioner of human services shall seek any federal waivers, approvals, and
law changes necessary to implement the MinnesotaCare public option under Minnesota
Statutes, section 256L.04, subdivision 15, including but not limited to those waivers,
approvals, and law changes necessary to allow the state to:
new text end
new text begin
(1) continue receiving federal basic health program payments for basic health
program-eligible MinnesotaCare enrollees and to receive other federal funding for the
MinnesotaCare public option;
new text end
new text begin
(2) receive federal payments equal to the value of premium tax credits and cost-sharing
reductions that MinnesotaCare enrollees with household incomes greater than 200 percent
of the federal poverty guidelines would otherwise have received; and
new text end
new text begin
(3) receive federal payments equal to the value of emergency medical assistance that
would otherwise have been paid to the state for covered services provided to eligible
enrollees.
new text end
new text begin
(b) In implementing this section, the commissioner of human services shall consult with
the commissioner of commerce and the Board of Directors of MNsure and may contract
for technical and actuarial assistance.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 29. new text begin ANALYSIS OF BENEFITS AND COSTS OF UNIVERSAL HEALTH CARE
SYSTEM REFORM MODELS.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have
the meanings given.
new text end
new text begin
(b) "All necessary care" means the full range of services listed in the proposed Minnesota
Health Plan legislation, including medical, dental, vision and hearing, mental health, chemical
dependency treatment, reproductive and sexual health, prescription drugs, medical equipment
and supplies, long-term care, home care, and coordination of care.
new text end
new text begin
(c) "Direct payment system" means the health care delivery system authorized by
Minnesota Statutes, section 256.9631.
new text end
new text begin
(d) "MinnesotaCare public option" means the MinnesotaCare expansion to cover
individuals eligible under Minnesota Statutes, section 256L.04, subdivision 15.
new text end
new text begin
(e) "Other reform models" means alternative models of health care reform, which may
include changes to health system administration, payments, or benefits, and may be
comprehensive or specific to selected market segments or populations.
new text end
new text begin
(f) "Total public and private health care spending" means:
new text end
new text begin
(1) spending on all medical care including but not limited to dental, vision and hearing,
mental health, chemical dependency treatment, prescription drugs, medical equipment and
supplies, long-term care, and home care, whether paid through premiums, co-pays and
deductibles, other out-of-pocket payments, or other funding from government, employers,
or other sources; and
new text end
new text begin
(2) the costs associated with administering, delivering, and paying for the care. The costs
of administering, delivering, and paying for the care includes all expenses by insurers,
providers, employers, individuals, and the government to select, negotiate, purchase, and
administer insurance and care including but not limited to coverage for health care, dental,
long-term care, prescription drugs, and the medical expense portions of workers compensation
and automobile insurance, and the cost of administering and paying for all health care
products and services that are not covered by insurance.
new text end
new text begin Subd. 2. new text end
new text begin Initial assumptions. new text end
new text begin
(a) When calculating administrative savings under the
universal health proposal, the analysts shall recognize that simple, direct payment of medical
services avoids the need for provider networks, eliminates prior authorization requirements,
and eliminates administrative complexity of other payment schemes along with the need
for creating risk adjustment mechanisms, and measuring, tracking, and paying under those
risk adjusted or nonrisk adjusted payment schemes by both providers and payors.
new text end
new text begin
(b) The analysts shall assume that, under the universal health proposal, while gross
provider payments may be reduced to reflect reduced administrative costs, net provider
income would remain similar to the current system. However, they shall not assume that
payment rate negotiations will track current Medicaid, Medicare, or market payment rates
or a combination of those rates, because provider compensation, after adjusting for reduced
administrative costs, would not be universally raised or lowered but would be negotiated
based on market needs, so provider compensation might be raised in an underserved area
such as mental health but lowered in other areas.
new text end
new text begin Subd. 3. new text end
new text begin Contract for analysis of proposals; analytic tool. new text end
new text begin
(a) The commissioner of
health shall contract with one or more independent entities to:
new text end
new text begin
(1) conduct an analysis of the benefits and costs of a legislative proposal for a universal
health care financing system, based on the legislative proposal known as the Minnesota
Health Plan (Regular Session 2023, Senate File No. 2740/House File No. 2798) and a similar
analysis of the current health care financing system to assist the state in comparing the
proposal to the current system; and
new text end
new text begin
(2) conduct an analysis of the MinnesotaCare public option, the direct payment system,
and other reform models, and a similar analysis of the current health care financing system
to assist the state in comparing the models to the current system.
new text end
new text begin
(b) In conducting these analyses, the contractor or contractors shall develop and use an
analytic tool that meets the requirements in subdivision 4, and shall also make this analytic
tool available for use by the commissioner.
new text end
new text begin
(c) The commissioner shall issue a request for information. Based on responses to the
request for information, the commissioner shall issue a request for proposals that specifies
requirements for the design, analysis, and deliverables, and shall select one or more
contractors based on responses to the request for proposals. The commissioner shall consult
with the chief authors of this act in implementing this paragraph.
new text end
new text begin Subd. 4. new text end
new text begin Requirements for analytic tool. new text end
new text begin
(a) The analytic tool must be able to assess
and model the impact of the Minnesota Health Plan, the direct payment system, the
MinnesotaCare public option, and other reform models on the following:
new text end
new text begin
(1) coverage: the number of people who are uninsured versus the number of people who
are insured;
new text end
new text begin
(2) benefit completeness: adequacy of coverage measured by the completeness of the
coverage and the number of people lacking coverage for key necessary care elements such
as dental, long-term care, medical equipment or supplies, vision and hearing, or other health
services that are not covered, if any. The analysis must take into account the vast variety of
benefit designs in the commercial market and report the extent of coverage in each area;
new text end
new text begin
(3) underinsurance: whether people with coverage can afford the care they need or
whether cost prevents them from accessing care. This includes affordability in terms of
premiums, deductibles, and out-of-pocket expenses;
new text end
new text begin
(4) system capacity: the timeliness and appropriateness of the care received and whether
people turn to inappropriate care such as emergency rooms because of a lack of proper care
in accordance with clinical guidelines; and
new text end
new text begin
(5) health care spending: total public and private health care spending in Minnesota,
including all spending by individuals, businesses, and government. Where relevant, the
analysis shall be broken out by key necessary care areas, such as medical, dental, and mental
health. The analysis of total health care spending shall examine whether there are savings
or additional costs under the legislative proposal compared to the existing system due to:
new text end
new text begin
(i) changes in cost of insurance, billing, underwriting, marketing, evaluation, and other
administrative functions for all entities involved in the health care system, including savings
from global budgeting for hospitals and institutional care instead of billing for individual
services provided;
new text end
new text begin
(ii) changed prices on medical services and products, including pharmaceuticals, due to
price negotiations under the proposal;
new text end
new text begin
(iii) impact on utilization, health outcomes, and workplace absenteeism due to prevention,
early intervention, and health-promoting activities;
new text end
new text begin
(iv) shortages or excess capacity of medical facilities, equipment, and personnel, including
caregivers and staff, under either the current system or the proposal, including capacity of
clinics, hospitals, and other appropriate care sites versus inappropriate emergency room
usage. The analysis shall break down capacity by geographic differences such as rural versus
metro, and disparate access by population group;
new text end
new text begin
(v) the impact on state, local, and federal government non-health-care expenditures.
This may include areas such as reduced crime and out-of-home placement costs due to
mental health or chemical dependency coverage. Additional definition may further develop
hypotheses for other impacts that warrant analysis;
new text end
new text begin
(vi) job losses or gains within the health care system, specifically, in health care delivery,
health billing, and insurance administration;
new text end
new text begin
(vii) job losses or gains elsewhere in the economy under the proposal due to
implementation of the resulting reduction of insurance and administrative burdens on
businesses; and
new text end
new text begin
(viii) impacts on disparities in health care access and outcomes.
new text end
new text begin
(b) The analytic tool must:
new text end
new text begin
(1) have the capacity to conduct interactive microsimulations;
new text end
new text begin
(2) allow comparisons between the Minnesota Health Plan, the direct payment system,
the MinnesotaCare public option, the current delivery system, and other reform models, on
the relative impact of these delivery approaches on the variables described in paragraph (a);
and
new text end
new text begin
(3) allow comparisons based on differing assumptions about the characteristics and
operation of the delivery approaches.
new text end
new text begin Subd. 5. new text end
new text begin Analyses by the commissioner. new text end
new text begin
The commissioner, in cooperation with the
commissioners of human services and commerce and the legislature, may use the analytic
tool to assist in the development, design, and analysis of reform models under consideration
by the legislature and state agencies, and to supplement the analyses of the Minnesota Health
Plan, the MinnesotaCare public option, and the direct payment system conducted by the
contractor or contractors under this section.
new text end
new text begin Subd. 6. new text end
new text begin Report and delivery of analytic tool. new text end
new text begin
(a) The contractor or contractors, by
January 15, 2026, shall report findings and recommendations to the commissioner, and to
the chairs and ranking minority members of the legislative committees with jurisdiction
over health care and commerce, on the design and implementation of the Minnesota Health
Plan, the MinnesotaCare public option, and the direct payment system. The findings and
recommendations must address the feasibility and affordability of the proposals, and the
projected impact of the proposals on the variables listed in subdivision 4.
new text end
new text begin
(b) The contractor or contractors shall make the analytic tool available to the
commissioner by January 15, 2026.
new text end
ARTICLE 3
DEPARTMENT OF HEALTH
Section 1.
Minnesota Statutes 2022, section 12A.08, subdivision 3, is amended to read:
Subd. 3.
Implementation.
To implement the requirements of this section, the
commissioner may cooperate with private health care providers and facilitiesnew text begin , Tribal nations,new text end
and community health boards as defined in section 145A.02deleted text begin ,deleted text end new text begin ;new text end provide grants to assist
community health boardsdeleted text begin ,deleted text end new text begin and Tribal nations;new text end use volunteer services of individuals qualified
to provide public health servicesdeleted text begin ,deleted text end new text begin ;new text end and enter into cooperative or mutual aid agreements to
provide public health services.
Sec. 2.
Minnesota Statutes 2022, section 13.3805, subdivision 1, is amended to read:
Subdivision 1.
Health data generally.
(a) Definitions. As used in this subdivision:
(1) "Commissioner" means the commissioner of health.
(2) "Health data" are data on individuals created, collected, received, or maintained by
the Department of Health, political subdivisions, or statewide systems relating to the
identification, description, prevention, and control of disease or as part of an epidemiologic
investigation the commissioner designates as necessary to analyze, describe, or protect the
public health.
(b) Data on individuals. (1) Health data are private data on individuals. Notwithstanding
section 13.05, subdivision 9, health data may not be disclosed except as provided in this
subdivision and section 13.04.
(2) The commissioner or a community health board as defined in section 145A.02,
subdivision 5, may disclose health data to the data subject's physician as necessary to locate
or identify a case, carrier, or suspect case, to establish a diagnosis, to provide treatment, to
identify persons at risk of illness, or to conduct an epidemiologic investigation.
(3) With the approval of the commissioner, health data may be disclosed to the extent
necessary to assist the commissioner to locate or identify a case, carrier, or suspect case, to
alert persons who may be threatened by illness as evidenced by epidemiologic data, to
control or prevent the spread of serious disease, or to diminish an imminent threat to the
public health.
deleted text begin
(c) Health summary data. Summary data derived from data collected under section
145.413 may be provided under section 13.05, subdivision 7.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 3.
Minnesota Statutes 2022, section 16A.151, subdivision 2, is amended to read:
Subd. 2.
Exceptions.
(a) If a state official litigates or settles a matter on behalf of specific
injured persons or entities, this section does not prohibit distribution of money to the specific
injured persons or entities on whose behalf the litigation or settlement efforts were initiated.
If money recovered on behalf of injured persons or entities cannot reasonably be distributed
to those persons or entities because they cannot readily be located or identified or because
the cost of distributing the money would outweigh the benefit to the persons or entities, the
money must be paid into the general fund.
(b) Money recovered on behalf of a fund in the state treasury other than the general fund
may be deposited in that fund.
(c) This section does not prohibit a state official from distributing money to a person or
entity other than the state in litigation or potential litigation in which the state is a defendant
or potential defendant.
(d) State agencies may accept funds as directed by a federal court for any restitution or
monetary penalty under United States Code, title 18, section 3663(a)(3), or United States
Code, title 18, section 3663A(a)(3). Funds received must be deposited in a special revenue
account and are appropriated to the commissioner of the agency for the purpose as directed
by the federal court.
(e) Tobacco settlement revenues as defined in section 16A.98, subdivision 1, paragraph
(t), may be deposited as provided in section 16A.98, subdivision 12.
(f) Any money received by the state resulting from a settlement agreement or an assurance
of discontinuance entered into by the attorney general of the state, or a court order in litigation
brought by the attorney general of the state, on behalf of the state or a state agency, related
to alleged violations of consumer fraud laws in the marketing, sale, or distribution of opioids
in this state or other alleged illegal actions that contributed to the excessive use of opioids,
must be deposited in the settlement account established in the opiate epidemic response
fund under section 256.043, subdivision 1. This paragraph does not apply to attorney fees
and costs awarded to the state or the Attorney General's Office, to contract attorneys hired
by the state or Attorney General's Office, or to other state agency attorneys.
(g) Notwithstanding paragraph (f), if money is received from a settlement agreement or
an assurance of discontinuance entered into by the attorney general of the state or a court
order in litigation brought by the attorney general of the state on behalf of the state or a state
agency against a consulting firm working for an opioid manufacturer or opioid wholesale
drug distributor, the commissioner shall deposit any money received into the settlement
account established within the opiate epidemic response fund under section 256.042,
subdivision 1. Notwithstanding section 256.043, subdivision 3a, paragraph (a), any amount
deposited into the settlement account in accordance with this paragraph shall be appropriated
to the commissioner of human services to award as grants as specified by the opiate epidemic
response advisory council in accordance with section 256.043, subdivision 3a, paragraph
(d).
new text begin
(h) Any money received by the state resulting from a settlement agreement or an assurance
of discontinuance entered into by the attorney general of the state, or a court order in litigation
brought by the attorney general of the state on behalf of the state or a state agency related
to alleged violations of consumer fraud laws in the marketing, sale, or distribution of
electronic nicotine delivery systems in this state or other alleged illegal actions that
contributed to the exacerbation of youth nicotine use, must be deposited in the tobacco use
prevention account under section 144.398. This paragraph does not apply to: (1) attorney
fees and costs awarded or paid to the state or the Attorney General's Office; (2) contract
attorneys hired by the state or Attorney General's Office; or (3) other state agency attorneys.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 4.
Minnesota Statutes 2022, section 62J.17, subdivision 5a, is amended to read:
Subd. 5a.
Retrospective review.
(a) The commissioner shall retrospectively review
each major spending commitment and deleted text begin notify the provider of the results of the review. The
commissioner shalldeleted text end determine whether the major spending commitment was appropriate.
In making the determination, the commissioner may consider the following criteria: the
major spending commitment's impact on the cost, access, and quality of health care; the
clinical effectiveness and cost-effectiveness of the major spending commitment; and the
alternatives available to the provider.new text begin If the major expenditure is determined not to be
appropriate, the commissioner shall notify the provider.
new text end
(b) The commissioner may not prevent or prohibit a major spending commitment subject
to retrospective review. However, if the provider fails the retrospective review, any major
spending commitments by that provider for the five-year period following the commissioner's
decision are subject to prospective review under subdivision 6a.
Sec. 5.
new text begin
[62J.811] PROVIDER BALANCE BILLING REQUIREMENTS.
new text end
new text begin Subdivision 1. new text end
new text begin Billing requirements. new text end
new text begin
(a) Each health care provider and health facility
shall comply with Consolidated Appropriations Act, 2021, Division BB also known as the
"No Surprises Act," including any federal regulations adopted under that act.
new text end
new text begin
(b) For the purposes of this section, "provider" or "facility" means any health care
provider or facility pursuant to section 62A.63, subdivision 2, or 62J.03, subdivision 8, that
is subject to relevant provisions of the No Surprises Act.
new text end
new text begin Subd. 2. new text end
new text begin Compliance. new text end
new text begin
The commissioner shall, to the extent practicable, seek the
cooperation of health care providers and facilities and may provide any support and assistance
as available, in obtaining compliance with this section.
new text end
Sec. 6.
new text begin
[62J.826] MEDICAL AND DENTAL PRACTICES; CURRENT STANDARD
CHARGES.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) The definitions in this subdivision apply to this section.
new text end
new text begin
(b) "CDT code" means a code value drawn from the Code on Dental Procedures and
Nomenclature published by the American Dental Association.
new text end
new text begin
(c) "Chargemaster" means the list of all individual items and services maintained by a
medical or dental practice for which the medical or dental practice has established a charge.
new text end
new text begin
(d) "Commissioner" means the commissioner of health.
new text end
new text begin
(e) "CPT code" means a code value drawn from the Current Procedural Terminology
published by the American Medical Association.
new text end
new text begin
(f) "Dental service" means a service charged using a CDT code.
new text end
new text begin
(g) "Diagnostic laboratory testing" means a service charged using a CPT code within
the CPT code range of 80047 to 89398.
new text end
new text begin
(h) "Diagnostic radiology service" means a service charged using a CPT code within
the CPT code range of 70010 to 79999 and includes the provision of x-rays, computed
tomography scans, positron emission tomography scans, magnetic resonance imaging scans,
and mammographies.
new text end
new text begin
(i) "Hospital" means an acute care institution licensed under sections 144.50 to 144.58,
but does not include a health care institution conducted for those who rely primarily upon
treatment by prayer or spiritual means in accordance with the creed or tenets of any church
or denomination.
new text end
new text begin
(j) "Medical or dental practice" means a business that:
new text end
new text begin
(1) earns revenue by providing medical care or dental services to the public;
new text end
new text begin
(2) issues payment claims to health plan companies and other payers; and
new text end
new text begin
(3) may be identified by its federal tax identification number.
new text end
new text begin
(k) "Outpatient surgical center" means a health care facility other than a hospital offering
elective outpatient surgery under a license issued under sections 144.50 to 144.58.
new text end
new text begin
(l) "Standard charge" means the regular rate established by the medical or dental practice
for an item or service provided to a specific group of paying patients. This includes all of
the following:
new text end
new text begin
(1) the charge for an individual item or service that is reflected on a medical or dental
practice's chargemaster, absent any discounts;
new text end
new text begin
(2) the charge that a medical or dental practice has negotiated with a third-party payer
for an item or service;
new text end
new text begin
(3) the lowest charge that a medical or dental practice has negotiated with all third-party
payers for an item or service;
new text end
new text begin
(4) the highest charge that a medical or dental practice has negotiated with all third-party
payers for an item or service; and
new text end
new text begin
(5) the charge that applies to an individual who pays cash, or cash equivalent, for an
item or service.
new text end
new text begin Subd. 2. new text end
new text begin Requirement; current standard charges. new text end
new text begin
The following medical or dental
practices must make available to the public a list of their current standard charges, as reflected
in the medical or dental practice's chargemaster, for all items and services provided by the
medical or dental practice:
new text end
new text begin
(1) hospitals;
new text end
new text begin
(2) outpatient surgical centers; and
new text end
new text begin
(3) any other medical or dental practice that has revenue of greater than $50,000,000
per year and that derives the majority of its revenue by providing one or more of the following
services:
new text end
new text begin
(i) diagnostic radiology services;
new text end
new text begin
(ii) diagnostic laboratory testing;
new text end
new text begin
(iii) orthopedic surgical procedures, including joint arthroplasty procedures within the
CPT code range of 26990 to 27899;
new text end
new text begin
(iv) ophthalmologic surgical procedures, including cataract surgery coded using CPT
code 66982 or 66984, or refractive correction surgery to improve visual acuity;
new text end
new text begin
(v) anesthesia services commonly provided as an ancillary to services provided at a
hospital, outpatient surgical center, or medical practice that provides orthopedic surgical
procedures or ophthalmologic surgical procedures;
new text end
new text begin
(vi) oncology services, including radiation oncology treatments within the CPT code
range of 77261 to 77799 and drug infusions; or
new text end
new text begin
(vii) dental services.
new text end
new text begin Subd. 3. new text end
new text begin Required file format and content. new text end
new text begin
(a) A medical or dental practice that is
subject to this section must make available to the public, and must report to the commissioner,
current standard charges using the format and data elements specified in the currently
effective version of the Hospital Price Transparency Sample Format (Tall) (CSV) and related
data dictionary recommended for hospitals by the Centers for Medicare and Medicaid
Services (CMS). If CMS modifies or replaces the specifications for this format, the form
of this file must be modified or replaced to conform with the new CMS specifications by
the date specified by CMS for compliance with its new specifications. All prices included
in the file must be expressed as dollar amounts. The data must be in the form of a
comma-separated-values file that can be directly imported without further editing or
remediation into a relational database table that has been designed to receive these files.
The medical or dental practice must make the file available to the public in a manner specified
by the commissioner and must report the file to the commissioner in a manner and frequency
specified by the commissioner.
new text end
new text begin
(b) A medical or dental practice must test its file for compliance with paragraph (a)
before making the file available to the public and reporting the file to the commissioner.
new text end
new text begin
(c) A hospital must comply with this section no later than January 1, 2024. A medical
or dental practice that meets the requirements in subdivision 2, clause (3), or an outpatient
surgical center must comply with this section no later than January 1, 2025.
new text end
Sec. 7.
Minnesota Statutes 2022, section 62J.84, subdivision 2, is amended to read:
Subd. 2.
Definitions.
(a) For purposes of this section, the terms defined in this subdivision
have the meanings given.
(b) "Biosimilar" means a drug that is produced or distributed pursuant to a biologics
license application approved under United States Code, title 42, section 262(K)(3).
(c) "Brand name drug" means a drug that is produced or distributed pursuant to:
(1) deleted text begin an original,deleted text end new text begin anew text end new drug application approved under United States Code, title 21,
section 355(c), except for a generic drug as defined under Code of Federal Regulations,
title 42, section 447.502; or
(2) a biologics license application approved under United States Code, title deleted text begin 45deleted text end new text begin 42new text end , section
262(a)(c).
(d) "Commissioner" means the commissioner of health.
(e) "Generic drug" means a drug that is marketed or distributed pursuant to:
(1) an abbreviated new drug application approved under United States Code, title 21,
section 355(j);
(2) an authorized generic as defined under Code of Federal Regulations, title deleted text begin 45deleted text end new text begin 42new text end ,
section 447.502; or
(3) a drug that entered the market the year before 1962 and was not originally marketed
under a new drug application.
(f) "Manufacturer" means a drug manufacturer licensed under section 151.252.
(g) "New prescription drug" or "new drug" means a prescription drug approved for
marketing by the United States Food and Drug Administration new text begin (FDA) new text end for which no previous
wholesale acquisition cost has been established for comparison.
(h) "Patient assistance program" means a program that a manufacturer offers to the public
in which a consumer may reduce the consumer's out-of-pocket costs for prescription drugs
by using coupons, discount cards, prepaid gift cards, manufacturer debit cards, or by other
means.
(i) "Prescription drug" or "drug" has the meaning provided in section 151.441, subdivision
8.
(j) "Price" means the wholesale acquisition cost as defined in United States Code, title
42, section 1395w-3a(c)(6)(B).
new text begin
(k) "30-day supply" means the total daily dosage units of a prescription drug
recommended by the prescribing label approved by the FDA for 30 days. If the
FDA-approved prescribing label includes more than one recommended daily dosage, the
30-day supply is based on the maximum recommended daily dosage on the FDA-approved
prescribing label.
new text end
new text begin
(l) "Course of treatment" means the total dosage of a single prescription for a prescription
drug recommended by the FDA-approved prescribing label. If the FDA-approved prescribing
label includes more than one recommended dosage for a single course of treatment, the
course of treatment is the maximum recommended dosage on the FDA-approved prescribing
label.
new text end
new text begin
(m) "Drug product family" means a group of one or more prescription drugs that share
a unique generic drug description or nontrade name and dosage form.
new text end
new text begin
(n) "National drug code" means the three-segment code maintained by the federal Food
and Drug Administration that includes a labeler code, a product code, and a package code
for a drug product and that has been converted to an 11-digit format consisting of five digits
in the first segment, four digits in the second segment, and two digits in the third segment.
A three-segment code shall be considered converted to an 11-digit format when, as necessary,
at least one "0" has been added to the front of each segment containing less than the specified
number of digits such that each segment contains the specified number of digits.
new text end
new text begin
(o) "Pharmacy" or "pharmacy provider" means a place of business licensed by the Board
of Pharmacy under section 151.19 in which prescription drugs are prepared, compounded,
or dispensed under the supervision of a pharmacist.
new text end
new text begin
(p) "Pharmacy benefit manager" or "PBM" means an entity licensed to act as a pharmacy
benefit manager under section 62W.03.
new text end
new text begin
(q) "Pricing unit" means the smallest dispensable amount of a prescription drug product
that could be dispensed.
new text end
new text begin
(r) "Reporting entity" means any manufacturer, pharmacy, pharmacy benefit manager,
wholesale drug distributor, or any other entity required to submit data under this section.
new text end
new text begin
(s) "Wholesale drug distributor" or "wholesaler" means an entity that:
new text end
new text begin
(1) is licensed to act as a wholesale drug distributor under section 151.47; and
new text end
new text begin
(2) distributes prescription drugs, of which it is not the manufacturer, to persons or
entities, or both, other than a consumer or patient in the state.
new text end
Sec. 8.
Minnesota Statutes 2022, section 62J.84, subdivision 3, is amended to read:
Subd. 3.
Prescription drug price increases reporting.
(a) Beginning January 1, 2022,
a drug manufacturer must submit to the commissioner the information described in paragraph
(b) for each prescription drug for which the price was $100 or greater for a 30-day supply
or for a course of treatment lasting less than 30 days and:
(1) for brand name drugs where there is an increase of ten percent or greater in the price
over the previous 12-month period or an increase of 16 percent or greater in the price over
the previous 24-month period; and
(2) for generic new text begin or biosimilar new text end drugs where there is an increase of 50 percent or greater in
the price over the previous 12-month period.
(b) For each of the drugs described in paragraph (a), the manufacturer shall submit to
the commissioner no later than 60 days after the price increase goes into effect, in the form
and manner prescribed by the commissioner, the following information, if applicable:
(1) the deleted text begin namedeleted text end new text begin descriptionnew text end and price of the drug and the net increase, expressed as a
percentagedeleted text begin ;deleted text end new text begin , with the following listed separately:
new text end
new text begin
(i) the national drug code;
new text end
new text begin
(ii) the product name;
new text end
new text begin
(iii) the dosage form;
new text end
new text begin
(iv) the strength; and
new text end
new text begin
(v) the package size;
new text end
(2) the factors that contributed to the price increase;
(3) the name of any generic version of the prescription drug available on the market;
(4) the introductory price of the prescription drug when it was deleted text begin approved for marketing
by the Food and Drug Administration and the net yearly increase, by calendar year, in the
price of the prescription drug during the previous five yearsdeleted text end new text begin introduced for sale in the United
States and the price of the drug on the last day of each of the five calendar years preceding
the price increasenew text end ;
(5) the direct costs incurred new text begin during the previous 12-month period new text end by the manufacturer
that are associated with the prescription drug, listed separately:
(i) to manufacture the prescription drug;
(ii) to market the prescription drug, including advertising costs; and
(iii) to distribute the prescription drug;
(6) the total sales revenue for the prescription drug during the previous 12-month period;
(7) the manufacturer's net profit attributable to the prescription drug during the previous
12-month period;
(8) the total amount of financial assistance the manufacturer has provided through patient
prescription assistance programsnew text begin during the previous 12-month periodnew text end , if applicable;
(9) any agreement between a manufacturer and another entity contingent upon any delay
in offering to market a generic version of the prescription drug;
(10) the patent expiration date of the prescription drug if it is under patent;
(11) the name and location of the company that manufactured the drug; deleted text begin and
deleted text end
(12) if a brand name prescription drug, the deleted text begin tendeleted text end highest deleted text begin pricesdeleted text end new text begin pricenew text end paid for the
prescription drug during the previous calendar year in deleted text begin any country other thandeleted text end new text begin the ten
countries, excludingnew text end the United Statesdeleted text begin .deleted text end new text begin , that charged the highest single price for the
prescription drug; and
new text end
new text begin
(13) if the prescription drug was acquired by the manufacturer during the previous
12-month period, all of the following information:
new text end
new text begin
(i) price at acquisition;
new text end
new text begin
(ii) price in the calendar year prior to acquisition;
new text end
new text begin
(iii) name of the company from which the drug was acquired;
new text end
new text begin
(iv) date of acquisition; and
new text end
new text begin
(v) acquisition price.
new text end
(c) The manufacturer may submit any documentation necessary to support the information
reported under this subdivision.
Sec. 9.
Minnesota Statutes 2022, section 62J.84, subdivision 4, is amended to read:
Subd. 4.
New prescription drug price reporting.
(a) Beginning January 1, 2022, no
later than 60 days after a manufacturer introduces a new prescription drug for sale in the
United States that is a new brand name drug with a price that is greater than the tier threshold
established by the Centers for Medicare and Medicaid Services for specialty drugs in the
Medicare Part D program for a 30-day supply new text begin or for a course of treatment lasting fewer than
30 days new text end or a new generic or biosimilar drug with a price that is greater than the tier threshold
established by the Centers for Medicare and Medicaid Services for specialty drugs in the
Medicare Part D program for a 30-day supply new text begin or for a course of treatment lasting fewer than
30 days new text end and is not at least 15 percent lower than the referenced brand name drug when the
generic or biosimilar drug is launched, the manufacturer must submit to the commissioner,
in the form and manner prescribed by the commissioner, the following information, if
applicable:
new text begin
(1) the description of the drug, with the following listed separately:
new text end
new text begin
(i) the national drug code;
new text end
new text begin
(ii) the product name;
new text end
new text begin
(iii) the dosage form;
new text end
new text begin
(iv) the strength; and
new text end
new text begin
(v) the package size;
new text end
deleted text begin (1)deleted text end new text begin (2)new text end the price of the prescription drug;
deleted text begin (2)deleted text end new text begin (3)new text end whether the Food and Drug Administration granted the new prescription drug a
breakthrough therapy designation or a priority review;
deleted text begin (3)deleted text end new text begin (4)new text end the direct costs incurred by the manufacturer that are associated with the
prescription drug, listed separately:
(i) to manufacture the prescription drug;
(ii) to market the prescription drug, including advertising costs; and
(iii) to distribute the prescription drug; and
deleted text begin (4)deleted text end new text begin (5)new text end the patent expiration date of the drug if it is under patent.
(b) The manufacturer may submit documentation necessary to support the information
reported under this subdivision.
Sec. 10.
Minnesota Statutes 2022, section 62J.84, subdivision 6, is amended to read:
Subd. 6.
Public posting of prescription drug price information.
(a) The commissioner
shall post on the department's website, or may contract with a private entity or consortium
that satisfies the standards of section 62U.04, subdivision 6, to meet this requirement, the
following information:
(1) a list of the prescription drugs reported under subdivisions 3, 4, and deleted text begin 5,deleted text end new text begin 11 to 14new text end and
the manufacturers of those prescription drugs; and
(2) information reported to the commissioner under subdivisions 3, 4, and deleted text begin 5deleted text end new text begin 11 to 14new text end .
(b) The information must be published in an easy-to-read format and in a manner that
identifies the information that is disclosed on a per-drug basis and must not be aggregated
in a manner that prevents the identification of the prescription drug.
(c) The commissioner shall not post to the department's website or a private entity
contracting with the commissioner shall not post any information described in this section
if the information is not public data under section 13.02, subdivision 8a; or is trade secret
information under section 13.37, subdivision 1, paragraph (b); or is trade secret information
pursuant to the Defend Trade Secrets Act of 2016, United States Code, title 18, section
1836, as amended. If a manufacturer believes information should be withheld from public
disclosure pursuant to this paragraph, the manufacturer must clearly and specifically identify
that information and describe the legal basis in writing when the manufacturer submits the
information under this section. If the commissioner disagrees with the manufacturer's request
to withhold information from public disclosure, the commissioner shall provide the
manufacturer written notice that the information will be publicly posted 30 days after the
date of the notice.
(d) If the commissioner withholds any information from public disclosure pursuant to
this subdivision, the commissioner shall post to the department's website a report describing
the nature of the information and the commissioner's basis for withholding the information
from disclosure.
(e) To the extent the information required to be posted under this subdivision is collected
and made available to the public by another state, by the University of Minnesota, or through
an online drug pricing reference and analytical tool, the commissioner may reference the
availability of this drug price data from another source including, within existing
appropriations, creating the ability of the public to access the data from the source for
purposes of meeting the reporting requirements of this subdivision.
Sec. 11.
Minnesota Statutes 2022, section 62J.84, subdivision 7, is amended to read:
Subd. 7.
Consultation.
(a) The commissioner may consult with a private entity or
consortium that satisfies the standards of section 62U.04, subdivision 6, the University of
Minnesota, or the commissioner of commerce, as appropriate, in issuing the form and format
of the information reported under this section; in posting information pursuant to subdivision
6; and in taking any other action for the purpose of implementing this section.
(b) The commissioner may consult with representatives of the deleted text begin manufacturersdeleted text end new text begin reporting
entitiesnew text end to establish a standard format for reporting information under this section and may
use existing reporting methodologies to establish a standard format to minimize
administrative burdens to the state and deleted text begin manufacturersdeleted text end new text begin reporting entitiesnew text end .
Sec. 12.
Minnesota Statutes 2022, section 62J.84, subdivision 8, is amended to read:
Subd. 8.
Enforcement and penalties.
(a) A deleted text begin manufacturerdeleted text end new text begin reporting entitynew text end may be subject
to a civil penalty, as provided in paragraph (b), for:
new text begin
(1) failing to register under subdivision 15;
new text end
deleted text begin (1)deleted text end new text begin (2)new text end failing to submit timely reports or notices as required by this section;
deleted text begin (2)deleted text end new text begin (3)new text end failing to provide information required under this section; or
deleted text begin (3)deleted text end new text begin (4)new text end providing inaccurate or incomplete information under this section.
(b) The commissioner shall adopt a schedule of civil penalties, not to exceed $10,000
per day of violation, based on the severity of each violation.
(c) The commissioner shall impose civil penalties under this section as provided in
section 144.99, subdivision 4.
(d) The commissioner may remit or mitigate civil penalties under this section upon terms
and conditions the commissioner considers proper and consistent with public health and
safety.
(e) Civil penalties collected under this section shall be deposited in the health care access
fund.
Sec. 13.
Minnesota Statutes 2022, section 62J.84, subdivision 9, is amended to read:
Subd. 9.
Legislative report.
(a) No later than May 15, 2022, and by January 15 of each
year thereafter, the commissioner shall report to the chairs and ranking minority members
of the legislative committees with jurisdiction over commerce and health and human services
policy and finance on the implementation of this section, including but not limited to the
effectiveness in addressing the following goals:
(1) promoting transparency in pharmaceutical pricing for the state and other payers;
(2) enhancing the understanding on pharmaceutical spending trends; and
(3) assisting the state and other payers in the management of pharmaceutical costs.
(b) The report must include a summary of the information submitted to the commissioner
under subdivisions 3, 4, and deleted text begin 5deleted text end new text begin 11 to 14new text end .
Sec. 14.
Minnesota Statutes 2022, section 62J.84, is amended by adding a subdivision to
read:
new text begin Subd. 10. new text end
new text begin Notice of prescription drugs of substantial public interest. new text end
new text begin
(a) No later than
January 31, 2024, and quarterly thereafter, the commissioner shall produce and post on the
department's website a list of prescription drugs that the department determines to represent
a substantial public interest and for which the department intends to request data under
subdivisions 11 to 14, subject to paragraph (c). The department shall base its inclusion of
prescription drugs on any information the department determines is relevant to providing
greater consumer awareness of the factors contributing to the cost of prescription drugs in
the state, and the department shall consider drug product families that include prescription
drugs:
new text end
new text begin
(1) that triggered reporting under subdivision 3 or 4 during the previous calendar quarter;
new text end
new text begin
(2) for which average claims paid amounts exceeded 125 percent of the price as of the
claim incurred date during the most recent calendar quarter for which claims paid amounts
are available; or
new text end
new text begin
(3) that are identified by members of the public during a public comment process.
new text end
new text begin
(b) Not sooner than 30 days after publicly posting the list of prescription drugs under
paragraph (a), the department shall notify, via email, reporting entities registered with the
department of the requirement to report under subdivisions 11 to 14.
new text end
new text begin
(c) No more than 500 prescription drugs may be designated as having a substantial public
interest in any one notice.
new text end
Sec. 15.
Minnesota Statutes 2022, section 62J.84, is amended by adding a subdivision to
read:
new text begin Subd. 11. new text end
new text begin Manufacturer prescription drug substantial public interest reporting. new text end
new text begin
(a)
Beginning January 1, 2024, a manufacturer must submit to the commissioner the information
described in paragraph (b) for any prescription drug:
new text end
new text begin
(1) included in a notification to report issued to the manufacturer by the department
under subdivision 10;
new text end
new text begin
(2) which the manufacturer manufactures or repackages;
new text end
new text begin
(3) for which the manufacturer sets the wholesale acquisition cost; and
new text end
new text begin
(4) for which the manufacturer has not submitted data under subdivision 3 during the
120-day period prior to the date of the notification to report.
new text end
new text begin
(b) For each of the drugs described in paragraph (a), the manufacturer shall submit to
the commissioner no later than 60 days after the date of the notification to report, in the
form and manner prescribed by the commissioner, the following information, if applicable:
new text end
new text begin
(1) a description of the drug with the following listed separately:
new text end
new text begin
(i) the national drug code;
new text end
new text begin
(ii) the product name;
new text end
new text begin
(iii) the dosage form;
new text end
new text begin
(iv) the strength; and
new text end
new text begin
(v) the package size;
new text end
new text begin
(2) the price of the drug product on the later of:
new text end
new text begin
(i) the day one year prior to the date of the notification to report;
new text end
new text begin
(ii) the introduced to market date; or
new text end
new text begin
(iii) the acquisition date;
new text end
new text begin
(3) the price of the drug product on the date of the notification to report;
new text end
new text begin
(4) the introductory price of the prescription drug when it was introduced for sale in the
United States and the price of the drug on the last day of each of the five calendar years
preceding the date of the notification to report;
new text end
new text begin
(5) the direct costs incurred during the 12-month period prior to the date of the notification
to report by the manufacturers that are associated with the prescription drug, listed separately:
new text end
new text begin
(i) to manufacture the prescription drug;
new text end
new text begin
(ii) to market the prescription drug, including advertising costs; and
new text end
new text begin
(iii) to distribute the prescription drug;
new text end
new text begin
(6) the number of units of the prescription drug sold during the 12-month period prior
to the date of the notification to report;
new text end
new text begin
(7) the total sales revenue for the prescription drug during the 12-month period prior to
the date of the notification to report;
new text end
new text begin
(8) the total rebate payable amount accrued for the prescription drug during the 12-month
period prior to the date of the notification to report;
new text end
new text begin
(9) the manufacturer's net profit attributable to the prescription drug during the 12-month
period prior to the date of the notification to report;
new text end
new text begin
(10) the total amount of financial assistance the manufacturer has provided through
patient prescription assistance programs during the 12-month period prior to the date of the
notification to report, if applicable;
new text end
new text begin
(11) any agreement between a manufacturer and another entity contingent upon any
delay in offering to market a generic version of the prescription drug;
new text end
new text begin
(12) the patent expiration date of the prescription drug if the prescription drug is under
patent;
new text end
new text begin
(13) the name and location of the company that manufactured the drug;
new text end
new text begin
(14) if the prescription drug is a brand name prescription drug, the ten countries other
than the United States that paid the highest prices for the prescription drug during the
previous calendar year and their prices; and
new text end
new text begin
(15) if the prescription drug was acquired by the manufacturer within a 12-month period
prior to the date of the notification to report, all of the following information:
new text end
new text begin
(i) the price at acquisition;
new text end
new text begin
(ii) the price in the calendar year prior to acquisition;
new text end
new text begin
(iii) the name of the company from which the drug was acquired;
new text end
new text begin
(iv) the date of acquisition; and
new text end
new text begin
(v) the acquisition price.
new text end
new text begin
(c) The manufacturer may submit any documentation necessary to support the information
reported under this subdivision.
new text end
Sec. 16.
Minnesota Statutes 2022, section 62J.84, is amended by adding a subdivision to
read:
new text begin Subd. 12. new text end
new text begin Pharmacy prescription drug substantial public interest reporting. new text end
new text begin
(a)
Beginning January 1, 2024, a pharmacy must submit to the commissioner the information
described in paragraph (b) for any prescription drug included in a notification to report
issued to the pharmacy by the department under subdivision 10.
new text end
new text begin
(b) For each of the drugs described in paragraph (a), the pharmacy shall submit to the
commissioner no later than 60 days after the date of the notification to report, in the form
and manner prescribed by the commissioner, the following information, if applicable:
new text end
new text begin
(1) a description of the drug with the following listed separately:
new text end
new text begin
(i) the national drug code;
new text end
new text begin
(ii) the product name;
new text end
new text begin
(iii) the dosage form;
new text end
new text begin
(iv) the strength; and
new text end
new text begin
(v) the package size;
new text end
new text begin
(2) the number of units of the drug acquired during the 12-month period prior to the date
of the notification to report;
new text end
new text begin
(3) the total spent before rebates by the pharmacy to acquire the drug during the 12-month
period prior to the date of the notification to report;
new text end
new text begin
(4) the total rebate receivable amount accrued by the pharmacy for the drug during the
12-month period prior to the date of the notification to report;
new text end
new text begin
(5) the number of pricing units of the drug dispensed by the pharmacy during the
12-month period prior to the date of the notification to report;
new text end
new text begin
(6) the total payment receivable by the pharmacy for dispensing the drug including
ingredient cost, dispensing fee, and administrative fees during the 12-month period prior
to the date of the notification to report;
new text end
new text begin
(7) the total rebate payable amount accrued by the pharmacy for the drug during the
12-month period prior to the date of the notification to report; and
new text end
new text begin
(8) the average cash price paid by consumers per pricing unit for prescriptions dispensed
where no claim was submitted to a health care service plan or health insurer during the
12-month period prior to the date of the notification to report.
new text end
new text begin
(c) The pharmacy may submit any documentation necessary to support the information
reported under this subdivision.
new text end
Sec. 17.
Minnesota Statutes 2022, section 62J.84, is amended by adding a subdivision to
read:
new text begin Subd. 13. new text end
new text begin PBM prescription drug substantial public interest reporting. new text end
new text begin
(a) Beginning
January 1, 2024, a PBM must submit to the commissioner the information described in
paragraph (b) for any prescription drug included in a notification to report issued to the
PBM by the department under subdivision 10.
new text end
new text begin
(b) For each of the drugs described in paragraph (a), the PBM shall submit to the
commissioner no later than 60 days after the date of the notification to report, in the form
and manner prescribed by the commissioner, the following information, if applicable:
new text end
new text begin
(1) a description of the drug with the following listed separately:
new text end
new text begin
(i) the national drug code;
new text end
new text begin
(ii) the product name;
new text end
new text begin
(iii) the dosage form;
new text end
new text begin
(iv) the strength; and
new text end
new text begin
(v) the package size;
new text end
new text begin
(2) the number of pricing units of the drug product filled for which the PBM administered
claims during the 12-month period prior to the date of the notification to report;
new text end
new text begin
(3) the total reimbursement amount accrued and payable to pharmacies for pricing units
of the drug product filled for which the PBM administered claims during the 12-month
period prior to the date of the notification to report;
new text end
new text begin
(4) the total reimbursement or administrative fee amount, or both, accrued and receivable
from payers for pricing units of the drug product filled for which the PBM administered
claims during the 12-month period prior to the date of the notification to report;
new text end
new text begin
(5) the total rebate receivable amount accrued by the PBM for the drug product during
the 12-month period prior to the date of the notification to report; and
new text end
new text begin
(6) the total rebate payable amount accrued by the PBM for the drug product during the
12-month period prior to the date of the notification to report.
new text end
new text begin
(c) The PBM may submit any documentation necessary to support the information
reported under this subdivision.
new text end
Sec. 18.
Minnesota Statutes 2022, section 62J.84, is amended by adding a subdivision to
read:
new text begin Subd. 14. new text end
new text begin
Wholesale drug distributor prescription drug substantial public interest
reporting.
new text end
new text begin
(a) Beginning January 1, 2024, a wholesale drug distributor must submit to the
commissioner the information described in paragraph (b) for any prescription drug included
in a notification to report issued to the wholesale drug distributor by the department under
subdivision 10.
new text end
new text begin
(b) For each of the drugs described in paragraph (a), the wholesale drug distributor shall
submit to the commissioner no later than 60 days after the date of the notification to report,
in the form and manner prescribed by the commissioner, the following information, if
applicable:
new text end
new text begin
(1) a description of the drug with the following listed separately:
new text end
new text begin
(i) the national drug code;
new text end
new text begin
(ii) the product name;
new text end
new text begin
(iii) the dosage form;
new text end
new text begin
(iv) the strength; and
new text end
new text begin
(v) the package size;
new text end
new text begin
(2) the number of units of the drug product acquired by the wholesale drug distributor
during the 12-month period prior to the date of the notification to report;
new text end
new text begin
(3) the total spent before rebates by the wholesale drug distributor to acquire the drug
product during the 12-month period prior to the date of the notification to report;
new text end
new text begin
(4) the total rebate receivable amount accrued by the wholesale drug distributor for the
drug product during the 12-month period prior to the date of the notification to report;
new text end
new text begin
(5) the number of units of the drug product sold by the wholesale drug distributor during
the 12-month period prior to the date of the notification to report;
new text end
new text begin
(6) gross revenue from sales in the United States generated by the wholesale drug
distributor for this drug product during the 12-month period prior to the date of the
notification to report; and
new text end
new text begin
(7) total rebate payable amount accrued by the wholesale drug distributor for the drug
product during the 12-month period prior to the date of the notification to report.
new text end
new text begin
(c) The wholesale drug distributor may submit any documentation necessary to support
the information reported under this subdivision.
new text end
Sec. 19.
Minnesota Statutes 2022, section 62J.84, is amended by adding a subdivision to
read:
new text begin Subd. 15. new text end
new text begin Registration requirements. new text end
new text begin
Beginning January 1, 2024, a reporting entity
subject to this chapter shall register with the department in a form and manner prescribed
by the commissioner.
new text end
Sec. 20.
Minnesota Statutes 2022, section 62J.84, is amended by adding a subdivision to
read:
new text begin Subd. 16. new text end
new text begin Rulemaking. new text end
new text begin
For the purposes of this section, the commissioner may use the
expedited rulemaking process under section 14.389.
new text end
Sec. 21.
Minnesota Statutes 2022, section 62Q.01, is amended by adding a subdivision to
read:
new text begin Subd. 6b. new text end
new text begin No Surprises Act. new text end
new text begin
"No Surprises Act" means Division BB of the Consolidated
Appropriations Act, 2021, which amended Title XXVII of the Public Health Service Act,
Public Law 116-260, and any amendments to and any federal guidance or regulations issued
under this act.
new text end
Sec. 22.
Minnesota Statutes 2022, section 62Q.021, is amended by adding a subdivision
to read:
new text begin Subd. 3. new text end
new text begin Compliance with 2021 federal law. new text end
new text begin
Each health plan company, health provider,
and health facility shall comply with the No Surprises Act, including any federal regulations
adopted under the act, to the extent that the act imposes requirements that apply in this state
but are not required under the laws of this state. This subdivision does not require compliance
with any provision of the No Surprises Act before the effective date provided for that
provision in the No Surprises Act. The commissioner shall enforce this subdivision.
new text end
Sec. 23.
Minnesota Statutes 2022, section 62Q.55, subdivision 5, is amended to read:
Subd. 5.
Coverage restrictions or limitations.
If emergency services are provided by
a nonparticipating provider, with or without prior authorization, the health plan company
shall not impose coverage restrictions or limitations that are more restrictive than apply to
emergency services received from a participating provider. Cost-sharing requirements that
apply to emergency services received out-of-network must be the same as the cost-sharing
requirements that apply to services received in-networknew text begin and shall count toward the in-network
deductible. All coverage and charges for emergency services must comply with the No
Surprises Actnew text end .
Sec. 24.
Minnesota Statutes 2022, section 62Q.556, is amended to read:
62Q.556 deleted text begin UNAUTHORIZED PROVIDER SERVICESdeleted text end new text begin CONSUMER
PROTECTIONS AGAINST BALANCE BILLINGnew text end .
Subdivision 1.
deleted text begin Unauthorized provider servicesdeleted text end new text begin Nonparticipating provider balance
billing prohibitionnew text end .
(a) Except as provided in paragraph deleted text begin (c), unauthorized provider services
occurdeleted text end new text begin (b), balance billing is prohibitednew text end when an enrollee receives servicesnew text begin fromnew text end :
(1) deleted text begin fromdeleted text end a nonparticipating provider at a participating hospital or ambulatory surgical
center, deleted text begin when the services are rendered:deleted text end new text begin as described by the No Surprises Act, including any
federal regulations adopted under that act;
new text end
deleted text begin
(i) due to the unavailability of a participating provider;
deleted text end
deleted text begin
(ii) by a nonparticipating provider without the enrollee's knowledge; or
deleted text end
deleted text begin
(iii) due to the need for unforeseen services arising at the time the services are being
rendered; or
deleted text end
(2) deleted text begin fromdeleted text end a participating provider that sends a specimen taken from the enrollee in the
participating provider's practice setting to a nonparticipating laboratory, pathologist, or other
medical testing facilitydeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(3) a nonparticipating provider or facility providing emergency services as defined in
section 62Q.55, subdivision 3, and other services as described in the requirements of the
No Surprises Act.
new text end
deleted text begin
(b) Unauthorized provider services do not include emergency services as defined in
section 62Q.55, subdivision 3.
deleted text end
deleted text begin (c)deleted text end new text begin (b)new text end The services described in paragraph (a), deleted text begin clause (2)deleted text end new text begin clauses (1), (2), and (3), as
defined in the No Surprises Act, and any federal regulations adopted under that actnew text end , are deleted text begin not
unauthorized provider servicesdeleted text end new text begin subject to balance billingnew text end if the enrollee deleted text begin gives advance writtendeleted text end new text begin
provides informednew text end consent deleted text begin todeleted text end new text begin prior to receiving services fromnew text end thenew text begin nonparticipatingnew text end provider
acknowledging that the use of a provider, or the services to be rendered, may result in costs
not covered by the health plan.new text begin The informed consent must comply with all requirements
of the No Surprises Act, including any federal regulations adopted under that act.
new text end
Subd. 2.
deleted text begin Prohibitiondeleted text end new text begin Cost-sharing requirements and independent dispute
resolutionnew text end .
(a) An enrollee's financial responsibility for the deleted text begin unauthorizeddeleted text end new text begin nonparticipatingnew text end
provider servicesnew text begin described in subdivision 1, paragraph (a),new text end shall be the same cost-sharing
requirements, including co-payments, deductibles, coinsurance, coverage restrictions, and
coverage limitations, as those applicable to services received by the enrollee from a
participating provider. A health plan company must apply any enrollee cost sharing
requirements, including co-payments, deductibles, and coinsurance, for deleted text begin unauthorizeddeleted text end new text begin
nonparticipatingnew text end provider services to the enrollee's annual out-of-pocket limit to the same
extent payments to a participating provider would be applied.
(b) A health plan company must attempt to negotiate the reimbursement, less any
applicable enrollee cost sharing under paragraph (a), for the deleted text begin unauthorizeddeleted text end new text begin nonparticipatingnew text end
provider services with the nonparticipating provider. If deleted text begin a health plan company's and
nonparticipating provider's attemptsdeleted text end new text begin the attemptnew text end to negotiate reimbursement for the deleted text begin health
caredeleted text end new text begin nonparticipating providernew text end services deleted text begin dodeleted text end new text begin doesnew text end not result in a resolution, deleted text begin the health plan
company or provider may elect to refer the matter for binding arbitration, chosen in
accordance with paragraph (c). A nondisclosure agreement must be executed by both parties
prior to engaging an arbitrator in accordance with this section. The cost of arbitration must
be shared equally between the parties.deleted text end new text begin either party may initiate the federal independent
dispute resolution process pursuant to the No Surprises Act, including any federal regulations
adopted under that act.
new text end
deleted text begin
(c) The commissioner of health, in consultation with the commissioner of the Bureau
of Mediation Services, must develop a list of professionals qualified in arbitration, for the
purpose of resolving disputes between a health plan company and nonparticipating provider
arising from the payment for unauthorized provider services. The commissioner of health
shall publish the list on the Department of Health website, and update the list as appropriate.
deleted text end
deleted text begin
(d) The arbitrator must consider relevant information, including the health plan company's
payments to other nonparticipating providers for the same services, the circumstances and
complexity of the particular case, and the usual and customary rate for the service based on
information available in a database in a national, independent, not-for-profit corporation,
and similar fees received by the provider for the same services from other health plans in
which the provider is nonparticipating, in reaching a decision.
deleted text end
new text begin Subd. 3. new text end
new text begin Annual data reporting. new text end
new text begin
(a) Beginning April 1, 2024, a health plan company
must report annually to the commissioner of health:
new text end
new text begin
(1) the total number of claims and total billed and paid amounts for nonparticipating
provider services, by service and provider type, submitted to the health plan in the prior
calendar year; and
new text end
new text begin
(2) the total number of enrollee complaints received regarding the rights and protections
established by the No Surprises Act in the prior calendar year.
new text end
new text begin
(b) The commissioners of commerce and health shall develop the form and manner for
health plan companies to comply with paragraph (a).
new text end
new text begin Subd. 4. new text end
new text begin Enforcement. new text end
new text begin
(a) Any provider or facility, including a health care provider or
facility pursuant to section 62A.63, subdivision 2, or 62J.03, subdivision 8, that is subject
to the relevant provisions of the No Surprises Act is subject to the requirements of this
section and section 62J.811.
new text end
new text begin
(b) The commissioner of commerce or health shall enforce this section.
new text end
new text begin
(c) If a health-related licensing board has cause to believe that a provider has violated
this section, it may further investigate and enforce the provisions of this section pursuant
to chapter 214.
new text end
Sec. 25.
Minnesota Statutes 2022, section 62Q.56, subdivision 2, is amended to read:
Subd. 2.
Change in health plans.
(a) If an enrollee is subject to a change in health plans,
the enrollee's new health plan company must provide, upon request, authorization to receive
services that are otherwise covered under the terms of the new health plan through the
enrollee's current provider:
(1) for up to 120 days if the enrollee is engaged in a current course of treatment for one
or more of the following conditions:
(i) an acute condition;
(ii) a life-threatening mental or physical illness;
(iii) pregnancy deleted text begin beyond the first trimester of pregnancydeleted text end ;
(iv) a physical or mental disability defined as an inability to engage in one or more major
life activities, provided that the disability has lasted or can be expected to last for at least
one year, or can be expected to result in death; or
(v) a disabling or chronic condition that is in an acute phase; or
(2) for the rest of the enrollee's life if a physician certifies that the enrollee has an expected
lifetime of 180 days or less.
For all requests for authorization under this paragraph, the health plan company must grant
the request for authorization unless the enrollee does not meet the criteria provided in this
paragraph.
(b) The health plan company shall prepare a written plan that provides a process for
coverage determinations regarding continuity of care of up to 120 days for new enrollees
who request continuity of care with their former provider, if the new enrollee:
(1) is receiving culturally appropriate services and the health plan company does not
have a provider in its preferred provider network with special expertise in the delivery of
those culturally appropriate services within the time and distance requirements of section
62D.124, subdivision 1; or
(2) does not speak English and the health plan company does not have a provider in its
preferred provider network who can communicate with the enrollee, either directly or through
an interpreter, within the time and distance requirements of section 62D.124, subdivision
1.
The written plan must explain the criteria that will be used to determine whether a need for
continuity of care exists and how it will be provided.
(c) This subdivision applies only to group coverage and continuation and conversion
coverage, and applies only to changes in health plans made by the employer.
Sec. 26.
Minnesota Statutes 2022, section 62Q.73, subdivision 1, is amended to read:
Subdivision 1.
Definition.
For purposes of this section, "adverse determination" means:
(1) for individual health plans, a complaint decision relating to a health care service or
claim that is partially or wholly adverse to the complainant;
(2) an individual health plan that is grandfathered plan coverage may instead apply the
definition of adverse determination for group coverage in clause (3);
(3) for group health plans, a complaint decision relating to a health care service or claim
that has been appealed in accordance with section 62Q.70 and the appeal decision is partially
or wholly adverse to the complainant;
(4) any adverse determination, as defined in section 62M.02, subdivision 1a, that has
been appealed in accordance with section 62M.06 and the appeal did not reverse the adverse
determination;
(5) a decision relating to a health care service made by a health plan company licensed
under chapter 60A that denies the service on the basis that the service was not medically
necessary; deleted text begin or
deleted text end
(6) the enrollee has met the requirements of subdivision 6, paragraph (e)deleted text begin .deleted text end new text begin ; or
new text end
new text begin
(7) a decision relating to a health plan's coverage of nonparticipating provider services
as described in and subject to section 62Q.556, subdivision 1, paragraph (a).
new text end
An adverse determination does not include complaints relating to fraudulent marketing
practices or agent misrepresentation.
Sec. 27.
Minnesota Statutes 2022, section 62Q.73, subdivision 7, is amended to read:
Subd. 7.
Standards of review.
(a) For an external review of any issue in an adverse
determination that does not require a medical necessity determination, the external review
must be based on whether the adverse determination was in compliance with the enrollee's
health benefit plannew text begin or section 62Q.556, subdivision 1, paragraph (a)new text end .
(b) For an external review of any issue in an adverse determination by a health plan
company licensed under chapter 62D that requires a medical necessity determination, the
external review must determine whether the adverse determination was consistent with the
definition of medically necessary care in Minnesota Rules, part 4685.0100, subpart 9b.
(c) For an external review of any issue in an adverse determination by a health plan
company, other than a health plan company licensed under chapter 62D, that requires a
medical necessity determination, the external review must determine whether the adverse
determination was consistent with the definition of medically necessary care in section
62Q.53, subdivision 2.
(d) For an external review of an adverse determination involving experimental or
investigational treatment, the external review entity must base its decision on all documents
submitted by the health plan company and enrollee, including:
(1) medical records;
(2) the recommendation of the attending physician, advanced practice registered nurse,
physician assistant, or health care professional;
(3) consulting reports from health care professionals;
(4) the terms of coverage;
(5) federal Food and Drug Administration approval; and
(6) medical or scientific evidence or evidence-based standards.
Sec. 28.
Minnesota Statutes 2022, section 62U.04, subdivision 4, is amended to read:
Subd. 4.
Encounter data.
(a) All health plan companiesnew text begin , dental plan companies,new text end and
third-party administrators shall submit encounter data on a monthly basis to a private entity
designated by the commissioner of health. The data shall be submitted in a form and manner
specified by the commissioner subject to the following requirements:
(1) the data must be de-identified data as described under the Code of Federal Regulations,
title 45, section 164.514;
(2) the data for each encounter must include an identifier for the patient's health care
home if the patient has selected a health care homenew text begin , data on contractual value-based payments,new text end
anddeleted text begin , for claims incurred on or after January 1, 2019,deleted text end data deemed necessary by the
commissioner to uniquely identify claims in the individual health insurance market; deleted text begin and
deleted text end
new text begin
(3) the data must include enrollee race and ethnicity, to the extent available; and
new text end
deleted text begin (3)deleted text end new text begin (4)new text end except for the deleted text begin identifierdeleted text end new text begin datanew text end described in deleted text begin clausedeleted text end new text begin clausesnew text end (2)new text begin and (3)new text end , the data must
not include information that is not included in a health care claimnew text begin , dental care claim,new text end or
equivalent encounter information transaction that is required under section 62J.536.
(b) The commissioner or the commissioner's designee shall only use the data submitted
under paragraph (a) to carry out the commissioner's responsibilities in this section, including
supplying the data to providers so they can verify their results of the peer grouping process
consistent with the recommendations developed pursuant to subdivision 3c, paragraph (d),
and adopted by the commissioner and, if necessary, submit comments to the commissioner
or initiate an appeal.
(c) Data on providers collected under this subdivision are private data on individuals or
nonpublic data, as defined in section 13.02. deleted text begin Notwithstanding the definition of summary data
in section 13.02, subdivision 19, summary data prepared under this subdivision may be
derived from nonpublic data.deleted text end new text begin Notwithstanding the data classifications in this paragraph,
data on providers collected under this subdivision may be released or published as authorized
in subdivision 11.new text end The commissioner or the commissioner's designee shall establish
procedures and safeguards to protect the integrity and confidentiality of any data that it
maintains.
(d) The commissioner or the commissioner's designee shall not publish analyses or
reports that identify, or could potentially identify, individual patients.
(e) The commissioner shall compile summary information on the data submitted under
this subdivision. The commissioner shall work with its vendors to assess the data submitted
in terms of compliance with the data submission requirements and the completeness of the
data submitted by comparing the data with summary information compiled by the
commissioner and with established and emerging data quality standards to ensure data
quality.
new text begin EFFECTIVE DATE. new text end
new text begin
Paragraph (a), clause (3), is effective retroactively from January
1, 2023, and applies to claims incurred on or after that date.
new text end
Sec. 29.
Minnesota Statutes 2022, section 62U.04, subdivision 5, is amended to read:
Subd. 5.
Pricing data.
(a) All health plan companiesnew text begin , dental plan companies,new text end and
third-party administrators shall submit, on a monthly basis, data on their contracted prices
with health care providersnew text begin and dental care providersnew text end to a private entity designated by the
commissioner of health for the purposes of performing the analyses required under this
subdivision. new text begin Data on contracted prices submitted under this paragraph must include data on
supplemental contractual value-based payments paid to health care providers. new text end The data shall
be submitted in the form and manner specified by the commissioner of health.
(b) The commissioner or the commissioner's designee shall only use the data submitted
under this subdivision to carry out the commissioner's responsibilities under this section,
including supplying the data to providers so they can verify their results of the peer grouping
process consistent with the recommendations developed pursuant to subdivision 3c, paragraph
(d), and adopted by the commissioner and, if necessary, submit comments to the
commissioner or initiate an appeal.
(c) Data collected under this subdivision are nonpublic data as defined in section 13.02.
Notwithstanding the definition of summary data in section 13.02, subdivision 19, summary
data prepared under this section may be derived from nonpublic data. new text begin Notwithstanding the
data classifications in this paragraph, data on providers collected under this subdivision
may be released or published as authorized in subdivision 11. new text end The commissioner shall
establish procedures and safeguards to protect the integrity and confidentiality of any data
that it maintains.
Sec. 30.
Minnesota Statutes 2022, section 62U.04, subdivision 5a, is amended to read:
Subd. 5a.
Self-insurers.
new text begin (a) new text end The commissioner shall not require a self-insurer governed
by the federal Employee Retirement Income Security Act of 1974 (ERISA) to comply with
this section.
new text begin
(b) A third-party administrator must annually notify the self-insurers whose health plans
are administered by the third-party administrator that the self-insurer may elect to have the
third-party administrator submit encounter data and data on contracted prices under
subdivisions 4 and 5 from the self-insurer's health plan for the upcoming plan year. This
notice must be provided in a form and manner specified by the commissioner. After receiving
responses from self-insurers, a third-party administrator must, in a form and manner specified
by the commissioner, report to the commissioner:
new text end
new text begin
(1) the self-insurers that elected to have the third-party administrator submit encounter
data and data on contracted prices from the self-insurer's health plan for the upcoming plan
year;
new text end
new text begin
(2) the self-insurers that declined to have the third-party administrator submit encounter
data and data on contracted prices from the self-insurer's health plan for the upcoming plan
year; and
new text end
new text begin
(3) data deemed necessary by the commissioner to identify and track the status of
reporting of data from self-insured health plans.
new text end
Sec. 31.
Minnesota Statutes 2022, section 62U.04, is amended by adding a subdivision to
read:
new text begin Subd. 5b. new text end
new text begin Nonclaims-based payments. new text end
new text begin
(a) Beginning January 1, 2025, all health plan
companies and third-party administrators shall submit to a private entity designated by the
commissioner of health all nonclaims-based payments made to health care providers. The
data shall be submitted in a form, manner, and frequency specified by the commissioner.
Nonclaims-based payments are payments to health care providers designed to pay for value
of health care services over volume of health care services and include alternative payment
models or incentives, payments for infrastructure expenditures or investments, and payments
for workforce expenditures or investments. Nonclaims-based payments submitted under
this subdivision must, to the extent possible, be attributed to a health care provider in the
same manner in which claims-based data are attributed to a health care provider and, where
appropriate, must be combined with data collected under subdivisions 4 and 5 in analyses
of health care spending.
new text end
new text begin
(b) Data collected under this subdivision are nonpublic data as defined in section 13.02.
Notwithstanding the definition of summary data in section 13.02, subdivision 19, summary
data prepared under this subdivision may be derived from nonpublic data. The commissioner
shall establish procedures and safeguards to protect the integrity and confidentiality of any
data maintained by the commissioner.
new text end
new text begin
(c) The commissioner shall consult with health plan companies, hospitals, health care
providers, and the commissioner of human services in developing the data reported under
this subdivision and standardized reporting forms.
new text end
Sec. 32.
Minnesota Statutes 2022, section 62U.04, subdivision 11, is amended to read:
Subd. 11.
Restricted uses of the all-payer claims data.
(a) Notwithstanding subdivision
4, paragraph (b), and subdivision 5, paragraph (b), the commissioner or the commissioner's
designee shall only use the data submitted under subdivisions 4 deleted text begin anddeleted text end new text begin ,new text end 5new text begin , 5a, and 5bnew text end for the
deleted text begin followingdeleted text end purposesnew text begin authorized in this subdivision and in subdivision 13new text end :
(1) to evaluate the performance of the health care home program as authorized under
section 62U.03, subdivision 7;
(2) to study, in collaboration with the reducing avoidable readmissions effectively
(RARE) campaign, hospital readmission trends and rates;
(3) to analyze variations in health care costs, quality, utilization, and illness burden based
on geographical areas or populations;
(4) to evaluate the state innovation model (SIM) testing grant received by the Departments
of Health and Human Services, including the analysis of health care cost, quality, and
utilization baseline and trend information for targeted populations and communities; deleted text begin and
deleted text end
(5) to compile one or more public use files of summary data or tables that must:
(i) be available to the public for no or minimal cost by March 1, 2016, and available by
web-based electronic data download by June 30, 2019;
(ii) not identify individual patientsdeleted text begin , payers, or providersdeleted text end new text begin but that may identify the
rendering or billing hospital, clinic, or medical practice so long as no individual health
professionals are identified and the commissioner finds the data to be accurate, valid, and
suitable for publication for such usenew text end ;
(iii) be updated by the commissioner, at least annually, with the most current data
available;new text begin and
new text end
(iv) contain clear and conspicuous explanations of the characteristics of the data, such
as the dates of the data contained in the files, the absence of costs of care for uninsured
patients or nonresidents, and other disclaimers that provide appropriate context; and
deleted text begin
(v) not lead to the collection of additional data elements beyond what is authorized under
this section as of June 30, 2015.
deleted text end
new text begin
(6) to conduct analyses of the impact of health care transactions on health care costs,
market consolidation, and quality under section 144.593, subdivision 6.
new text end
(b) The commissioner may publish the results of the authorized uses identified in
paragraph (a) deleted text begin so long as the data released publicly do not contain information or descriptions
in which the identity of individual hospitals, clinics, or other providers may be discerneddeleted text end .new text begin
The data published under this paragraph may identify hospitals, clinics, and medical practices
so long as no individual health professionals are identified and the commissioner finds the
data to be accurate, valid, and suitable for publication for such use.
new text end
deleted text begin
(c) Nothing in this subdivision shall be construed to prohibit the commissioner from
using the data collected under subdivision 4 to complete the state-based risk adjustment
system assessment due to the legislature on October 1, 2015.
deleted text end
deleted text begin
(d) The commissioner or the commissioner's designee may use the data submitted under
subdivisions 4 and 5 for the purpose described in paragraph (a), clause (3), until July 1,
2023.
deleted text end
deleted text begin
(e) The commissioner shall consult with the all-payer claims database work group
established under subdivision 12 regarding the technical considerations necessary to create
the public use files of summary data described in paragraph (a), clause (5).
deleted text end
Sec. 33.
Minnesota Statutes 2022, section 62U.04, is amended by adding a subdivision to
read:
new text begin Subd. 13. new text end
new text begin Expanded access to and use of the all-payer claims data. new text end
new text begin
(a) The
commissioner or the commissioner's designee shall make the data submitted under
subdivisions 4, 5, 5a, and 5b available to individuals and organizations engaged in research
on, or efforts to effect transformation in, health care outcomes, access, quality, disparities,
or spending, provided the use of the data serves a public benefit. Data made available under
this subdivision may not be used to:
new text end
new text begin
(1) create an unfair market advantage for any participant in the health care market in
Minnesota, including health plan companies, payers, and providers;
new text end
new text begin
(2) reidentify or attempt to reidentify an individual in the data; or
new text end
new text begin
(3) publicly report contract details between a health plan company and provider and
derived from the data.
new text end
new text begin
(b) To implement paragraph (a), the commissioner shall:
new text end
new text begin
(1) establish detailed requirements for data access; a process for data users to apply to
access and use the data; legally enforceable data use agreements to which data users must
consent; a clear and robust oversight process for data access and use, including a data
management plan, that ensures compliance with state and federal data privacy laws;
agreements for state agencies and the University of Minnesota to ensure proper and efficient
use and security of data; and technical assistance for users of the data and for stakeholders;
new text end
new text begin
(2) develop a fee schedule to support the cost of expanded access to and use of the data,
provided the fees charged under the schedule do not create a barrier to access or use for
those most affected by disparities; and
new text end
new text begin
(3) create a research advisory group to advise the commissioner on applications for data
use under this subdivision, including an examination of the rigor of the research approach,
the technical capabilities of the proposed user, and the ability of the proposed user to
successfully safeguard the data.
new text end
Sec. 34.
new text begin
[115.7411] ADVISORY COUNCIL ON WATER SUPPLY SYSTEMS AND
WASTEWATER TREATMENT FACILITIES.
new text end
new text begin Subdivision 1. new text end
new text begin Purpose; membership. new text end
new text begin
The Advisory Council on Water Supply Systems
and Wastewater Treatment Facilities shall advise the commissioners of health and the
Pollution Control Agency regarding classification of water supply systems and wastewater
treatment facilities, qualifications and competency evaluation of water supply system
operators and wastewater treatment facility operators, and additional laws, rules, and
procedures that may be desirable for regulating the operation of water supply systems and
of wastewater treatment facilities. The advisory council is composed of 11 voting members,
of whom:
new text end
new text begin
(1) one member must be from the Department of Health, Division of Environmental
Health, appointed by the commissioner of health;
new text end
new text begin
(2) one member must be from the Pollution Control Agency appointed by the
commissioner of the Pollution Control Agency;
new text end
new text begin
(3) three members must be certified water supply system operators, appointed by the
commissioner of health, one of whom must represent a nonmunicipal community or
nontransient noncommunity water supply system;
new text end
new text begin
(4) three members must be certified wastewater treatment facility operators, appointed
by the commissioner of the Pollution Control Agency;
new text end
new text begin
(5) one member must be a representative from an organization representing municipalities,
appointed by the commissioner of health with the concurrence of the commissioner of the
Pollution Control Agency; and
new text end
new text begin
(6) two members must be members of the public who are not associated with water
supply systems or wastewater treatment facilities. One must be appointed by the
commissioner of health and the other by the commissioner of the Pollution Control Agency.
Consideration should be given to one of these members being a representative of academia
knowledgeable in water or wastewater matters.
new text end
new text begin Subd. 2. new text end
new text begin Geographic representation. new text end
new text begin
At least one of the water supply system operators
and at least one of the wastewater treatment facility operators must be from outside the
seven-county metropolitan area and one wastewater treatment facility operator must be
from the Metropolitan Council.
new text end
new text begin Subd. 3. new text end
new text begin Terms; compensation. new text end
new text begin
The terms of the appointed members and the
compensation and removal of all members are governed by section 15.059.
new text end
new text begin Subd. 4. new text end
new text begin Officers. new text end
new text begin
When new members are appointed to the council, a chair must be
elected at the next council meeting. The Department of Health representative shall serve as
secretary of the council.
new text end
Sec. 35.
Minnesota Statutes 2022, section 121A.335, is amended to read:
121A.335 LEAD IN SCHOOL DRINKING WATER.
Subdivision 1.
Model plan.
The commissioners of health and education shall jointly
develop a model plan to require school districts to accurately and efficiently test for the
presence of lead in water in public school buildings serving students in kindergarten through
grade 12. To the extent possible, the commissioners shall base the plan on the standards
established by the United States Environmental Protection Agency. The plan may be based
on the technical guidance in the Department of Health's document, "Reducing Lead in
Drinking Water: A Technical Guidance for Minnesota's School and Child Care Facilities."new text begin
The plan must include recommendations for remediation efforts when testing reveals the
presence of lead at or above five parts per billion.
new text end
Subd. 2.
School plans.
new text begin (a) new text end By July 1, 2018, the board of each school district or charter
school must adopt the commissioners' model plan or develop and adopt an alternative plan
to accurately and efficiently test for the presence of lead in water in school buildings serving
prekindergarten students and students in kindergarten through grade 12.
new text begin
(b) By July 1, 2024, a school district or charter school must revise its plan to include its
policies and procedures for ensuring consistent water quality throughout the district's or
charter school's facilities. The plan must document the routine water management strategies
and procedures used in each building or facility to maintain water quality and reduce exposure
to lead. A district or charter school must base the plan on the United States Environmental
Protection Agency's "Ensuring Drinking Water Quality in Schools During and After Extended
Closures" fact sheet and the United States Environmental Protection Agency's "3Ts Toolkit
for Reducing Lead in Drinking Water in Schools and Child Care Facilities" manual. A
district or charter school's plan must be publicly available upon request.
new text end
Subd. 3.
Frequency of testing.
(a) The plan under subdivision 2 must include a testing
schedule for every building serving prekindergarten through grade 12 students. The schedule
must require that each building be tested at least once every five years. A school district or
charter school must begin testing school buildings by July 1, 2018, and complete testing of
all buildings that serve students within five years.
(b) A school district or charter school that finds lead at a specific location providing
cooking or drinking water within a facility must formulate, make publicly available, and
implement a plan that is consistent with established guidelines and recommendations to
ensure that student exposure to lead is deleted text begin minimizeddeleted text end new text begin reduced to below five parts per billion as
verified by a retestnew text end . This includes, when a school district or charter school finds the presence
of lead deleted text begin at a level where action should be taken as set by the guidancedeleted text end new text begin at or above five parts
per billionnew text end in any water deleted text begin sourcedeleted text end new text begin fixturenew text end that can provide cooking or drinking water,
immediately shutting off the water deleted text begin sourcedeleted text end new text begin fixturenew text end or making it unavailable until the hazard
has been deleted text begin minimizeddeleted text end new text begin remediated as verified by a retestnew text end .
new text begin
(c) A school district or charter school must test for the presence of lead after completing
remediation activities required under this section to confirm that the water contains lead at
a level below five parts per billion.
new text end
Subd. 4.
Ten-year facilities plan.
A school district may include lead testing and
remediation as a part of its ten-year facilities plan under section 123B.595.
Subd. 5.
Reporting.
new text begin (a) new text end A school district or charter school deleted text begin that has tested its buildings
for the presence of lead shall make the results of the testing available to the public for review
and must notify parents of the availability of the information. School districts and charter
schools must follow the actions outlined in guidance from the commissioners of health and
education.deleted text end new text begin must send parents an annual notice that includes the district's or charter school's
annual testing and remediation plan, information about how to find test results, and a
description of remediation efforts on the district website. The district or charter school must
update the lead testing and remediation information on its website at least annually. In
addition to the annual notice, the district or charter school must include in an official school
handbook or official school policy guide information on how parents may find the test
results and a description of remediation efforts on the district or charter school website and
how often this information is updated.
new text end
new text begin (b)new text end If a test conducted under subdivision 3, paragraph (a), reveals the presence of lead
new text begin at ornew text end above deleted text begin a level where action should be taken as set by the guidancedeleted text end new text begin five parts per billionnew text end ,
the school district or charter school must, within 30 days of receiving the test result, either
remediate the presence of lead to below deleted text begin the level set in guidancedeleted text end new text begin five parts per billionnew text end ,
verified by retest, or directly notify parents of the test result. deleted text begin The school district or charter
school must make the water source unavailable until the hazard has been minimized.
deleted text end
new text begin
(c) Starting July 1, 2024, school districts and charter schools must report their test results
and remediation activities to the commissioner of health in the form and manner determined
by the commissioner in consultation with school districts and charter schools, by July 1 of
each year. The commissioner of health must post and annually update the test results and
remediation efforts on the department website by school site.
new text end
new text begin
(d) A district or charter school must maintain a record of lead testing results and
remediation activities for at least 15 years.
new text end
new text begin Subd. 6. new text end
new text begin Public water systems. new text end
new text begin
(a) A district or charter school is not financially
responsible for remediation of documented elevated lead levels in drinking water caused
by the presence of lead infrastructure owned by a public water supply utility providing water
to the school facility, such as lead service lines, meters, galvanized service lines downstream
of lead, or lead connectors. The district or charter school must communicate with the public
water system regarding its documented significant contribution to lead contamination in
school drinking water and request from the public water system a plan for reducing the lead
contamination.
new text end
new text begin
(b) If the infrastructure is jointly owned by a district or charter school and a public water
supply utility, the district or charter school must attempt to coordinate any needed
replacements of lead service lines with the public water supply utility.
new text end
new text begin
(c) A district or charter school may defer its remediation activities under this section
until after the elevated lead level in the public water system's infrastructure is remediated
and postremediation testing does not detect an elevated lead level in the drinking water that
passes through that infrastructure. A district or charter school may also defer its remediation
activities if the public water supply exceeds the federal Safe Drinking Water Act lead action
level or is in violation of the Safe Drinking Water Act Lead and Copper Rule.
new text end
new text begin Subd. 7. new text end
new text begin Commissioner recommendations. new text end
new text begin
By January 1, 2026, and every five years
thereafter, the commissioner of health must report to the legislative committees having
jurisdiction over health and kindergarten through grade 12 education any recommended
changes to this section. The recommendations must be based on currently available scientific
evidence regarding the effects of lead in drinking water.
new text end
Sec. 36.
new text begin
[144.0526] MINNESOTA ONE HEALTH ANTIMICROBIAL
STEWARDSHIP COLLABORATIVE.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The commissioner of health shall establish the Minnesota
One Health Antimicrobial Stewardship Collaborative. The commissioner shall appoint a
director to execute operations, conduct health education, and provide technical assistance.
new text end
new text begin Subd. 2. new text end
new text begin Commissioner's duties. new text end
new text begin
The commissioner of health shall oversee a program
to:
new text end
new text begin
(1) maintain the position of director of One Health Antimicrobial Stewardship to lead
state antimicrobial stewardship initiatives across human, animal, and environmental health;
new text end
new text begin
(2) communicate to professionals and the public the interconnectedness of human, animal,
and environmental health, especially related to preserving the efficacy of antibiotic
medications, which are a shared resource;
new text end
new text begin
(3) leverage new and existing partnerships. The commissioner of health shall consult
and collaborate with academic institutions, industry and community organizations, and
organizations and agencies in fields including but not limited to health care, veterinary
medicine, and animal agriculture to inform strategies for education, practice improvement,
and research in all settings where antimicrobial products are used;
new text end
new text begin
(4) ensure that veterinary settings have education and strategies needed to practice
appropriate antibiotic prescribing, implement clinical antimicrobial stewardship programs,
and prevent transmission of antimicrobial-resistant microbes; and
new text end
new text begin
(5) support collaborative research and programmatic initiatives to improve the
understanding of the impact of antimicrobial use and resistance in the natural environment.
new text end
Sec. 37.
new text begin
[144.0528] COMPREHENSIVE DRUG OVERDOSE AND MORBIDITY
PREVENTION ACT.
new text end
new text begin Subdivision 1. new text end
new text begin Definition. new text end
new text begin
For the purpose of this section, "drug overdose and morbidity"
means health problems that people experience after inhaling, ingesting, or injecting medicines
in quantities that exceed prescription status; medicines taken that are prescribed to a different
person; medicines that have been adulterated or adjusted by contaminants intentionally or
unintentionally; or nonprescription drugs in amounts that result in morbidity or mortality.
new text end
new text begin Subd. 2. new text end
new text begin Establishment. new text end
new text begin
The commissioner of health shall establish a comprehensive
drug overdose and morbidity program to conduct comprehensive drug overdose and morbidity
prevention activities, epidemiologic investigations and surveillance, and evaluation to
monitor, address, and prevent drug overdoses statewide through integrated strategies that
include the following:
new text end
new text begin
(1) advance access to evidence-based nonnarcotic pain management services;
new text end
new text begin
(2) implement culturally specific interventions and prevention programs with population
and community groups in greatest need, including those who are pregnant and their infants;
new text end
new text begin
(3) enhance overdose prevention and supportive services for people experiencing
homelessness. This strategy includes funding for emergency and short-term housing subsidies
through the homeless overdose prevention hub and expanding support for syringe services
programs serving people experiencing homelessness statewide;
new text end
new text begin
(4) equip employers to promote health and well-being of employees by addressing
substance misuse and drug overdose;
new text end
new text begin
(5) improve outbreak detection and identification of substances involved in overdoses
through the expansion of the Minnesota Drug Overdose and Substance Use Surveillance
Activity (MNDOSA);
new text end
new text begin
(6) implement Tackling Overdose With Networks (TOWN) community prevention
programs;
new text end
new text begin
(7) identify, address, and respond to drug overdose and morbidity in those who are
pregnant or have just given birth through multitiered approaches that may:
new text end
new text begin
(i) promote medication-assisted treatment options;
new text end
new text begin
(ii) support programs that provide services in accord with evidence-based care models
for mental health and substance abuse disorder;
new text end
new text begin
(iii) collaborate with interdisciplinary and professional organizations that focus on quality
improvement initiatives related to substance use disorder; and
new text end
new text begin
(iv) implement substance use disorder-related recommendations from the maternal
mortality review committee, as appropriate; and
new text end
new text begin
(8) design a system to assess, address, and prevent the impacts of drug overdose and
morbidity on those who are pregnant, their infants, and children. Specifically, the
commissioner of health may:
new text end
new text begin
(i) inform health care providers and the public of the prevalence, risks, conditions, and
treatments associated with substance use disorders involving or affecting pregnancies,
infants, and children; and
new text end
new text begin
(ii) identify communities, families, infants, and children affected by substance use
disorder in order to recommend focused interventions, prevention, and services.
new text end
new text begin Subd. 3. new text end
new text begin Partnerships. new text end
new text begin
The commissioner of health may consult with sovereign Tribal
nations, the Minnesota Departments of Human Services, Corrections, Public Safety, and
Education, local public health agencies, care providers and insurers, community organizations
that focus on substance abuse risks and recovery, individuals affected by substance use
disorders, and any other individuals, entities, and organizations as necessary to carry out
the goals of this section.
new text end
new text begin Subd. 4. new text end
new text begin Grants authorized. new text end
new text begin
(a) The commissioner of health may award grants, as
funding allows, to entities and organizations focused on addressing and preventing the
negative impacts of drug overdose and morbidity. Examples of activities the commissioner
may consider for these grant awards include:
new text end
new text begin
(1) developing, implementing, or promoting drug overdose and morbidity prevention
programs and activities;
new text end
new text begin
(2) community outreach and other efforts addressing the root causes of drug overdose
and morbidity;
new text end
new text begin
(3) identifying risk and protective factors relating to drug overdose and morbidity that
contribute to identification, development, or improvement of prevention strategies and
community outreach;
new text end
new text begin
(4) developing or providing trauma-informed drug overdose and morbidity prevention
and services;
new text end
new text begin
(5) developing or providing culturally and linguistically appropriate drug overdose and
morbidity prevention and services, and programs that target and serve historically underserved
communities;
new text end
new text begin
(6) working collaboratively with educational institutions, including school districts, to
implement drug overdose and morbidity prevention strategies for students, teachers, and
administrators;
new text end
new text begin
(7) working collaboratively with sovereign Tribal nations, care providers, nonprofit
organizations, for-profit organizations, government entities, community-based organizations,
and other entities to implement substance misuse and drug overdose prevention strategies
within their communities; and
new text end
new text begin
(8) creating or implementing quality improvement initiatives to improve drug overdose
and morbidity treatment and outcomes.
new text end
new text begin
(b) Any organization or government entity receiving grant money under this section
must collect and make available to the commissioner of health aggregate data related to the
activity funded by the program under this section. The commissioner of health shall use the
information and data from the program evaluation to inform the administration of existing
Department of Health programming and the development of Department of Health policies,
programs, and procedures.
new text end
new text begin Subd. 5. new text end
new text begin Promotion; administration. new text end
new text begin
In fiscal years 2026 and beyond, the commissioner
may spend up to 25 percent of the total funding appropriated to the comprehensive drug
overdose and morbidity program in each fiscal year to promote, administer, support, and
evaluate the programs authorized under this section and to provide technical assistance to
program grantees.
new text end
new text begin Subd. 6. new text end
new text begin External contributions. new text end
new text begin
The commissioner may accept contributions from
governmental and nongovernmental sources and may apply for grants to supplement state
appropriations for the programs authorized under this section. Contributions and grants
received from the sources identified in this subdivision to advance the purpose of this section
are appropriated to the commissioner for the comprehensive drug overdose and morbidity
program.
new text end
new text begin Subd. 7. new text end
new text begin Program evaluation. new text end
new text begin
Beginning February 28, 2024, the commissioner of health
shall report every even-numbered year to the legislative committees with jurisdiction over
health detailing the expenditures of funds authorized under this section. The commissioner
shall use the data to evaluate the effectiveness of the program. The commissioner must
include in the report:
new text end
new text begin
(1) the number of organizations receiving grant money under this section;
new text end
new text begin
(2) the number of individuals served by the grant programs;
new text end
new text begin
(3) a description and analysis of the practices implemented by program grantees; and
new text end
new text begin
(4) best practices recommendations to prevent drug overdose and morbidity, including
culturally relevant best practices and recommendations focused on historically underserved
communities.
new text end
new text begin Subd. 8. new text end
new text begin Measurement. new text end
new text begin
Notwithstanding any law to the contrary, the commissioner of
health shall assess and evaluate grants and contracts awarded using available data sources,
including but not limited to the Minnesota All Payer Claims Database (MN APCD), the
Minnesota Behavioral Risk Factor Surveillance System (BRFSS), the Minnesota Student
Survey, vital records, hospitalization data, syndromic surveillance, and the Minnesota
Electronic Health Record Consortium.
new text end
Sec. 38.
new text begin
[144.0752] CULTURAL COMMUNICATIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The commissioner of health shall establish:
new text end
new text begin
(1) a cultural communications program that advances culturally and linguistically
appropriate communication services for communities most impacted by health disparities
which includes limited English proficient (LEP) populations, African American populations,
LGBTQ+ populations, and people with disabilities; and
new text end
new text begin
(2) a position that works with department and division leadership to ensure that the
department follows the National Standards for Culturally and Linguistically Appropriate
Services (CLAS) Standards.
new text end
new text begin Subd. 2. new text end
new text begin Commissioner's duties. new text end
new text begin
The commissioner of health shall oversee a program
to:
new text end
new text begin
(1) align the department services, policies, procedures, and governance with the National
CLAS Standards, establish culturally and linguistically appropriate goals, policies, and
management accountability, and apply them throughout the organization's planning and
operations;
new text end
new text begin
(2) ensure the department services respond to the cultural and linguistic diversity of
Minnesotans and that the department partners with the community to design, implement,
and evaluate policies, practices, and services that are aligned with the national cultural and
linguistic appropriateness standard; and
new text end
new text begin
(3) ensure the department leadership, workforce, and partners embed culturally and
linguistically appropriate policies and practices into leadership and public health program
planning, intervention, evaluation, and dissemination.
new text end
new text begin Subd. 3. new text end
new text begin Eligible contractors. new text end
new text begin
The commissioner may enter into contracts to implement
this section. Organizations eligible to receive contract funding under this section include:
new text end
new text begin
(1) master contractors that are selected through the state to provide language and
communication services; and
new text end
new text begin
(2) organizations that are able to provide services for languages that master contractors
are unable to cover.
new text end
Sec. 39.
new text begin
[144.0754] OFFICE OF AFRICAN AMERICAN HEALTH; DUTIES.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The commissioner shall establish the Office of African
American Health to address the unique public health needs of African American Minnesotans
and work to develop solutions and systems to address identified health disparities of African
American Minnesotans arising from a context of cumulative and historical discrimination
and disadvantages in multiple systems, including but not limited to housing, education,
employment, gun violence, incarceration, environmental factors, and health care
discrimination.
new text end
new text begin Subd. 2. new text end
new text begin Duties of the office. new text end
new text begin
The office shall:
new text end
new text begin
(1) convene the African American Health State Advisory Council (AAHSAC) under
section 144.0755 to advise the commissioner on issues and to develop specific, targeted
policy solutions to improve the health of African American Minnesotans, with a focus on
United States-born African Americans;
new text end
new text begin
(2) based upon input from and collaboration with the AAHSAC, health indicators, and
identified disparities, conduct analysis and develop policy and program recommendations
and solutions targeted at improving African American health outcomes;
new text end
new text begin
(3) coordinate and conduct community engagement across multiple systems, sectors,
and communities to address racial disparities in labor force participation, educational
achievement, and involvement with the criminal justice system that impact African American
health and well-being;
new text end
new text begin
(4) conduct data analysis and research to support policy goals and solutions;
new text end
new text begin
(5) award and administer African American health special emphasis grants to health and
community-based organizations to plan and develop programs targeted at improving African
American health outcomes, based upon needs identified by the council, health indicators,
and identified disparities and addressing historical trauma and systems of United States-born
African American Minnesotans; and
new text end
new text begin
(6) develop and administer Department of Health immersion experiences for students
in secondary education and community colleges to improve diversity of the public health
workforce and introduce career pathways that contribute to reducing health disparities.
new text end
Sec. 40.
new text begin
[144.0755] AFRICAN AMERICAN HEALTH STATE ADVISORY
COUNCIL.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment; purpose. new text end
new text begin
The commissioner of health shall establish
and administer the African American Health State Advisory Council to advise the
commissioner on implementing specific strategies to reduce health inequities and disparities
that particularly affect African Americans in Minnesota.
new text end
new text begin Subd. 2. new text end
new text begin Members. new text end
new text begin
(a) The council shall include no fewer than 12 or more than 20
members from any of the following groups:
new text end
new text begin
(1) representatives of community-based organizations serving or advocating for African
American citizens;
new text end
new text begin
(2) at-large community leaders or elders, as nominated by other council members;
new text end
new text begin
(3) African American individuals who provide and receive health care services;
new text end
new text begin
(4) African American secondary or college students;
new text end
new text begin
(5) health or human service professionals serving African American communities or
clients;
new text end
new text begin
(6) representatives with research or academic expertise in racial equity; and
new text end
new text begin
(7) other members that the commissioner deems appropriate to facilitate the goals and
duties of the council.
new text end
new text begin
(b) The commissioner shall make recommendations for council membership and, after
considering recommendations from the council, shall appoint a chair or chairs of the council.
Council members shall be appointed by the governor.
new text end
new text begin Subd. 3. new text end
new text begin Terms. new text end
new text begin
A term shall be for two years and appointees may be reappointed to
serve two additional terms. The commissioner shall recommend appointments to replace
members vacating their positions in a timely manner, no more than three months after the
council reviews panel recommendations.
new text end
new text begin Subd. 4. new text end
new text begin Duties of commissioner. new text end
new text begin
The commissioner or commissioner's designee shall:
new text end
new text begin
(1) maintain and actively engage with the council established in this section;
new text end
new text begin
(2) based on recommendations of the council, review identified department or other
related policies or practices that maintain health inequities and disparities that particularly
affect African Americans in Minnesota;
new text end
new text begin
(3) in partnership with the council, recommend or implement action plans and resources
necessary to address identified disparities and advance African American health equity;
new text end
new text begin
(4) support interagency collaboration to advance African American health equity; and
new text end
new text begin
(5) support member participation in the council, including participation in educational
and community engagement events across Minnesota that specifically address African
American health equity.
new text end
new text begin Subd. 5. new text end
new text begin Duties of council. new text end
new text begin
The council shall:
new text end
new text begin
(1) identify health disparities found in African American communities and contributing
factors;
new text end
new text begin
(2) recommend to the commissioner for review any statutes, rules, or administrative
policies or practices that would address African American health disparities;
new text end
new text begin
(3) recommend policies and strategies to the commissioner of health to address disparities
specifically affecting African American health;
new text end
new text begin
(4) form work groups of council members who are persons who provide and receive
services and representatives of advocacy groups;
new text end
new text begin
(5) provide the work groups with clear guidelines, standardized parameters, and tasks
for the work groups to accomplish; and
new text end
new text begin
(6) annually submit to the commissioner a report that summarizes the activities of the
council, identifies disparities specially affecting the health of African American Minnesotans,
and makes recommendations to address identified disparities.
new text end
new text begin Subd. 6. new text end
new text begin Duties of council members. new text end
new text begin
The members of the council shall:
new text end
new text begin
(1) attend scheduled meetings with no more than three absences per year, participate in
scheduled meetings, and prepare for meetings by reviewing meeting notes;
new text end
new text begin
(2) maintain open communication channels with respective constituencies;
new text end
new text begin
(3) identify and communicate issues and risks that may impact the timely completion
of tasks;
new text end
new text begin
(4) participate in any activities the council or commissioner deems appropriate and
necessary to facilitate the goals and duties of the council; and
new text end
new text begin
(5) participate in work groups to carry out council duties.
new text end
new text begin Subd. 7. new text end
new text begin Staffing; office space; equipment. new text end
new text begin
The commissioner shall provide the advisory
council with staff support, office space, and access to office equipment and services.
new text end
new text begin Subd. 8. new text end
new text begin Reimbursement. new text end
new text begin
Compensation and reimbursement for travel and expenses
incurred for council activities are governed by section 15.059, subdivision 3.
new text end
Sec. 41.
new text begin
[144.0756] AFRICAN AMERICAN HEALTH SPECIAL EMPHASIS GRANT
PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The commissioner of health shall establish the African
American health special emphasis grant program administered by the Office of African
American Health. The purposes of the program are to:
new text end
new text begin
(1) identify disparities impacting African American health arising from cumulative and
historical discrimination and disadvantages in multiple systems, including but not limited
to housing, education, employment, gun violence, incarceration, environmental factors, and
health care discrimination; and
new text end
new text begin
(2) develop community-based solutions that incorporate a multisector approach to
addressing identified disparities impacting African American health.
new text end
new text begin Subd. 2. new text end
new text begin Requests for proposals; accountability; data collection. new text end
new text begin
As directed by the
commissioner of health, the Office of African American Health shall:
new text end
new text begin
(1) develop a request for proposals for an African American health special emphasis
grant program in consultation with community stakeholders;
new text end
new text begin
(2) provide outreach, technical assistance, and program development guidance to potential
qualifying organizations or entities;
new text end
new text begin
(3) review responses to requests for proposals in consultation with community
stakeholders and award grants under this section;
new text end
new text begin
(4) establish a transparent and objective accountability process in consultation with
community stakeholders, focused on outcomes that grantees agree to achieve;
new text end
new text begin
(5) provide grantees with access to summary and other public data to assist grantees in
establishing and implementing effective community-led solutions; and
new text end
new text begin
(6) collect and maintain data on outcomes reported by grantees.
new text end
new text begin Subd. 3. new text end
new text begin Eligible grantees. new text end
new text begin
Organizations eligible to receive grant funding under this
section include nonprofit organizations or entities that work with African American
communities or are focused on addressing disparities impacting the health of African
American communities.
new text end
new text begin Subd. 4. new text end
new text begin Strategic consideration and priority of proposals; grant awards. new text end
new text begin
In
developing the requests for proposals and awarding the grants, the commissioner and the
Office of African American Health shall consider building upon the existing capacity of
communities and on developing capacity where it is lacking. Proposals shall focus on
addressing health equity issues specific to United States-born African American communities;
addressing the health impact of historical trauma; reducing health disparities experienced
by United States-born African American communities; and incorporating a multisector
approach to addressing identified disparities.
new text end
new text begin Subd. 5. new text end
new text begin Report. new text end
new text begin
Grantees must report grant program outcomes to the commissioner on
the forms and according to timelines established by the commissioner.
new text end
Sec. 42.
new text begin
[144.0757] OFFICE OF AMERICAN INDIAN HEALTH.
new text end
new text begin Subdivision 1. new text end
new text begin Duties. new text end
new text begin
The Office of American Indian Health is established to address
unique public health needs of American Indian Tribal communities in Minnesota, and shall:
new text end
new text begin
(1) coordinate with Minnesota's Tribal Nations and urban American Indian
community-based organizations to identify underlying causes of health disparities, address
unique health needs of Minnesota's Tribal communities, and develop public health approaches
to achieve health equity;
new text end
new text begin
(2) strengthen capacity of American Indian and community-based organizations and
Tribal Nations to address identified health disparities and needs;
new text end
new text begin
(3) administer state and federal grant funding opportunities targeted to improve the
health of American Indians;
new text end
new text begin
(4) provide overall leadership for targeted development of holistic health and wellness
strategies to improve health and to support Tribal and urban American Indian public health
leadership and self-sufficiency;
new text end
new text begin
(5) provide technical assistance to Tribal and American Indian urban community leaders
to develop culturally appropriate activities to address public health emergencies;
new text end
new text begin
(6) develop and administer the department immersion experiences for American Indian
students in secondary education and community colleges to improve diversity of the public
health workforce and introduce career pathways that contribute to reducing health disparities;
and
new text end
new text begin
(7) identify and promote workforce development strategies for Department of Health
staff to work with the American Indian population and Tribal Nations more effectively in
Minnesota.
new text end
new text begin Subd. 2. new text end
new text begin Grants and contracts. new text end
new text begin
To carry out these duties, the office may contract with
or provide grants to qualifying entities.
new text end
Sec. 43.
new text begin
[144.0758] AMERICAN INDIAN HEALTH SPECIAL EMPHASIS GRANTS.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The commissioner of health shall establish the American
Indian health special emphasis grant program. The purposes of the program are to:
new text end
new text begin
(1) plan and develop programs targeted to address continuing and persistent health
disparities of Minnesota's American Indian population and improve American Indian health
outcomes based upon needs identified by health indicators and identified disparities;
new text end
new text begin
(2) identify disparities in American Indian health arising from cumulative and historical
discrimination; and
new text end
new text begin
(3) plan and develop community-based solutions with a multisector approach to
addressing identified disparities in American Indian health.
new text end
new text begin Subd. 2. new text end
new text begin Commissioner's duties. new text end
new text begin
The commissioner of health shall:
new text end
new text begin
(1) develop a request for proposals for an American Indian health special emphasis grant
program in consultation with Minnesota's Tribal Nations and urban American Indian
community-based organizations based upon needs identified by the community, health
indicators, and identified disparities;
new text end
new text begin
(2) provide outreach, technical assistance, and program development guidance to potential
qualifying organizations or entities;
new text end
new text begin
(3) review responses to requests for proposals in consultation with community
stakeholders and award grants under this section;
new text end
new text begin
(4) establish a transparent and objective accountability process in consultation with
community stakeholders focused on outcomes that grantees agree to achieve;
new text end
new text begin
(5) provide grantees with access to data to assist grantees in establishing and
implementing effective community-led solutions; and
new text end
new text begin
(6) collect and maintain data on outcomes reported by grantees.
new text end
new text begin Subd. 3. new text end
new text begin Eligible grantees. new text end
new text begin
Organizations eligible to receive grant funding under this
section are Minnesota's Tribal Nations and urban American Indian community-based
organizations.
new text end
new text begin Subd. 4. new text end
new text begin Strategic consideration and priority of proposals; grant awards. new text end
new text begin
In
developing the proposals and awarding the grants, the commissioner shall consider building
upon the existing capacity of Minnesota's Tribal Nations and urban American Indian
community-based organizations and on developing capacity where it is lacking. Proposals
may focus on addressing health equity issues specific to Tribal and urban American Indian
communities; addressing the health impact of historical trauma; reducing health disparities
experienced by American Indian communities; and incorporating a multisector approach
to addressing identified disparities.
new text end
new text begin Subd. 5. new text end
new text begin Report. new text end
new text begin
Grantees must report grant program outcomes to the commissioner on
the forms and according to the timelines established by the commissioner.
new text end
Sec. 44.
new text begin
[144.0759] PUBLIC HEALTH AMERICORPS.
new text end
new text begin
The commissioner may award a grant to a statewide, nonprofit organization to support
Public Health AmeriCorps members. The organization awarded the grant shall provide the
commissioner with any information needed by the commissioner to evaluate the program
in the form and according to timelines specified by the commissioner.
new text end
Sec. 45.
Minnesota Statutes 2022, section 144.122, is amended to read:
144.122 LICENSE, PERMIT, AND SURVEY FEES.
(a) The state commissioner of health, by rule, may prescribe procedures and fees for
filing with the commissioner as prescribed by statute and for the issuance of original and
renewal permits, licenses, registrations, and certifications issued under authority of the
commissioner. The expiration dates of the various licenses, permits, registrations, and
certifications as prescribed by the rules shall be plainly marked thereon. Fees may include
application and examination fees and a penalty fee for renewal applications submitted after
the expiration date of the previously issued permit, license, registration, and certification.
The commissioner may also prescribe, by rule, reduced fees for permits, licenses,
registrations, and certifications when the application therefor is submitted during the last
three months of the permit, license, registration, or certification period. Fees proposed to
be prescribed in the rules shall be first approved by the Department of Management and
Budget. All fees proposed to be prescribed in rules shall be reasonable. The fees shall be
in an amount so that the total fees collected by the commissioner will, where practical,
approximate the cost to the commissioner in administering the program. All fees collected
shall be deposited in the state treasury and credited to the state government special revenue
fund unless otherwise specifically appropriated by law for specific purposes.
(b) The commissioner may charge a fee for voluntary certification of medical laboratories
and environmental laboratories, and for environmental and medical laboratory services
provided by the department, without complying with paragraph (a) or chapter 14. Fees
charged for environment and medical laboratory services provided by the department must
be approximately equal to the costs of providing the services.
(c) The commissioner may develop a schedule of fees for diagnostic evaluations
conducted at clinics held by the services for children with disabilities program. All receipts
generated by the program are annually appropriated to the commissioner for use in the
maternal and child health program.
(d) The commissioner shall set license fees for hospitals and nursing homes that are not
boarding care homes at the following levels:
| Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and American Osteopathic Association (AOA) hospitals |
$7,655 plus $16 per bed |
| Non-JCAHO and non-AOA hospitals |
$5,280 plus $250 per bed |
| Nursing home |
$183 plus $91 per bed until June 30, 2018. $183 plus $100 per bed between July 1, 2018, and June 30, 2020. $183 plus $105 per bed beginning July 1, 2020. |
The commissioner shall set license fees for outpatient surgical centers, boarding care
homes, supervised living facilities, assisted living facilities, and assisted living facilities
with dementia care at the following levels:
| Outpatient surgical centers |
$3,712 |
| Boarding care homes |
$183 plus $91 per bed |
| Supervised living facilities |
$183 plus $91 per bed. |
| Assisted living facilities with dementia care |
$3,000 plus $100 per resident. |
| Assisted living facilities |
$2,000 plus $75 per resident. |
Fees collected under this paragraph are nonrefundable. The fees are nonrefundable even if
received before July 1, 2017, for licenses or registrations being issued effective July 1, 2017,
or later.
(e) Unless prohibited by federal law, the commissioner of health shall charge applicants
the following fees to cover the cost of any initial certification surveys required to determine
a provider's eligibility to participate in the Medicare or Medicaid program:
| Prospective payment surveys for hospitals |
$ |
900 |
| Swing bed surveys for nursing homes |
$ |
1,200 |
| Psychiatric hospitals |
$ |
1,400 |
| Rural health facilities |
$ |
1,100 |
| Portable x-ray providers |
$ |
500 |
| Home health agencies |
$ |
1,800 |
| Outpatient therapy agencies |
$ |
800 |
| End stage renal dialysis providers |
$ |
2,100 |
| Independent therapists |
$ |
800 |
| Comprehensive rehabilitation outpatient facilities |
$ |
1,200 |
| Hospice providers |
$ |
1,700 |
| Ambulatory surgical providers |
$ |
1,800 |
| Hospitals |
$ |
4,200 |
| Other provider categories or additional resurveys required to complete initial certification |
Actual surveyor costs: average surveyor cost x number of hours for the survey process. |
|
These fees shall be submitted at the time of the application for federal certification and
shall not be refunded. All fees collected after the date that the imposition of fees is not
prohibited by federal law shall be deposited in the state treasury and credited to the state
government special revenue fund.
(f) Notwithstanding section 16A.1283, the commissioner may adjust the fees assessed
on assisted living facilities and assisted living facilities with dementia care under paragraph
(d), in a revenue-neutral manner in accordance with the requirements of this paragraph:
(1) a facility seeking to renew a license shall pay a renewal fee in an amount that is up
to ten percent lower than the applicable fee in paragraph (d) if residents who receive home
and community-based waiver services under chapter 256S and section 256B.49 comprise
more than 50 percent of the facility's capacity in the calendar year prior to the year in which
the renewal application is submitted; and
(2) a facility seeking to renew a license shall pay a renewal fee in an amount that is up
to ten percent higher than the applicable fee in paragraph (d) if residents who receive home
and community-based waiver services under chapter 256S and section 256B.49 comprise
less than 50 percent of the facility's capacity during the calendar year prior to the year in
which the renewal application is submitted.
The commissioner may annually adjust the percentages in clauses (1) and (2), to ensure this
paragraph is implemented in a revenue-neutral manner. The commissioner shall develop a
method for determining capacity thresholds in this paragraph in consultation with the
commissioner of human services and must coordinate the administration of this paragraph
with the commissioner of human services for purposes of verification.
new text begin
(g) The commissioner shall charge hospitals an annual licensing base fee of $1,826 per
hospital, plus an additional $23 per licensed bed or bassinet fee. Revenue shall be deposited
to the state government special revenue fund and credited toward trauma hospital designations
under sections 144.605 and 144.6071.
new text end
Sec. 46.
Minnesota Statutes 2022, section 144.1481, subdivision 1, is amended to read:
Subdivision 1.
Establishment; membership.
The commissioner of health shall establish
a deleted text begin 16-memberdeleted text end Rural Health Advisory Committee. The committee shall consist of the following
new text begin 22new text end members, all of whom must reside outside the seven-county metropolitan area, as defined
in section 473.121, subdivision 2:
(1) two members from the house of representatives of the state of Minnesota, one from
the majority party and one from the minority party;
(2) two members from the senate of the state of Minnesota, one from the majority party
and one from the minority party;
(3) a volunteer member of an ambulance service based outside the seven-county
metropolitan area;
(4) a representative of a hospital located outside the seven-county metropolitan area;
(5) a representative of a nursing home located outside the seven-county metropolitan
area;
(6) a medical doctor or doctor of osteopathic medicine licensed under chapter 147;
(7) a dentist licensed under chapter 150A;
new text begin
(8) an allied dental personnel as defined in Minnesota Rules, part 3100.0100, subpart
5;
new text end
deleted text begin
(8) a midlevel practitioner;
deleted text end
new text begin
(9) an advanced practice professional;
new text end
deleted text begin (9)deleted text end new text begin (10)new text end a registered nurse or licensed practical nurse;
deleted text begin (10)deleted text end new text begin (11)new text end a licensed health care professional from an occupation not otherwise represented
on the committee;
deleted text begin (11)deleted text end new text begin (12)new text end a representative of an institution of higher education located outside the
seven-county metropolitan area that provides training for rural health care providers; deleted text begin and
deleted text end
new text begin
(13) a member of a Tribal Nation;
new text end
new text begin
(14) a representative of a local public health agency or community health board;
new text end
new text begin
(15) a health professional or advocate with experience working with people with mental
illness;
new text end
new text begin
(16) a representative of a community organization that works with individuals
experiencing health disparities;
new text end
new text begin
(17) an individual with expertise in economic development, or an employer working
outside the seven-county metropolitan area;
new text end
deleted text begin (12) threedeleted text end new text begin (18) twonew text end consumers, at least one of whom must be deleted text begin an advocate for persons
who are mentally ill or developmentally disabled.deleted text end new text begin from a community experiencing health
disparities; and
new text end
new text begin
(19) one consumer who is an advocate for persons who are developmentally disabled.
new text end
The commissioner will make recommendations for committee membership. Committee
members will be appointed by the governor. In making appointments, the governor shall
ensure that appointments provide geographic balance among those areas of the state outside
the seven-county metropolitan area. The chair of the committee shall be elected by the
members. The advisory committee is governed by section 15.059, except that the members
do not receive per diem compensation.
Sec. 47.
Minnesota Statutes 2022, section 144.1501, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
(a) For purposes of this section, the following definitions
apply.
(b) "Advanced dental therapist" means an individual who is licensed as a dental therapist
under section 150A.06, and who is certified as an advanced dental therapist under section
150A.106.
(c) "Alcohol and drug counselor" means an individual who is licensed as an alcohol and
drug counselor under chapter 148F.
(d) "Dental therapist" means an individual who is licensed as a dental therapist under
section 150A.06.
(e) "Dentist" means an individual who is licensed to practice dentistry.
(f) "Designated rural area" means a statutory and home rule charter city or township that
is outside the seven-county metropolitan area as defined in section 473.121, subdivision 2,
excluding the cities of Duluth, Mankato, Moorhead, Rochester, and St. Cloud.
(g) "Emergency circumstances" means those conditions that make it impossible for the
participant to fulfill the service commitment, including death, total and permanent disability,
or temporary disability lasting more than two years.
(h) new text begin "Hospital nurse" means an individual who is licensed as a registered nurse and who
is providing direct patient care in a nonprofit hospital setting.
new text end
new text begin (i) new text end "Mental health professional" means an individual providing clinical services in the
treatment of mental illness who is qualified in at least one of the ways specified in section
245.462, subdivision 18.
deleted text begin (i)deleted text end new text begin (j)new text end "Medical resident" means an individual participating in a medical residency in
family practice, internal medicine, obstetrics and gynecology, pediatrics, or psychiatry.
deleted text begin (j)deleted text end new text begin (k)new text end "Midlevel practitioner" means a nurse practitioner, nurse-midwife, nurse
anesthetist, advanced clinical nurse specialist, or physician assistant.
deleted text begin (k)deleted text end new text begin (l)new text end "Nurse" means an individual who has completed training and received all licensing
or certification necessary to perform duties as a licensed practical nurse or registered nurse.
deleted text begin (l)deleted text end new text begin (m)new text end "Nurse-midwife" means a registered nurse who has graduated from a program
of study designed to prepare registered nurses for advanced practice as nurse-midwives.
deleted text begin (m)deleted text end new text begin (n)new text end "Nurse practitioner" means a registered nurse who has graduated from a program
of study designed to prepare registered nurses for advanced practice as nurse practitioners.
deleted text begin (n)deleted text end new text begin (o)new text end "Pharmacist" means an individual with a valid license issued under chapter 151.
deleted text begin (o)deleted text end new text begin (p)new text end "Physician" means an individual who is licensed to practice medicine in the areas
of family practice, internal medicine, obstetrics and gynecology, pediatrics, or psychiatry.
deleted text begin (p)deleted text end new text begin (q)new text end "Physician assistant" means a person licensed under chapter 147A.
new text begin
(r) "PSLF program" means the federal Public Service Loan Forgiveness program
established under Code of Federal Regulations, title 34, section 685.219.
new text end
deleted text begin (q)deleted text end new text begin (s)new text end "Public health nurse" means a registered nurse licensed in Minnesota who has
obtained a registration certificate as a public health nurse from the Board of Nursing in
accordance with Minnesota Rules, chapter 6316.
deleted text begin (r)deleted text end new text begin (t)new text end "Qualified educational loan" means a government, commercial, or foundation loan
for actual costs paid for tuition, reasonable education expenses, and reasonable living
expenses related to the graduate or undergraduate education of a health care professional.
deleted text begin (s)deleted text end new text begin (u)new text end "Underserved urban community" means a Minnesota urban area or population
included in the list of designated primary medical care health professional shortage areas
(HPSAs), medically underserved areas (MUAs), or medically underserved populations
(MUPs) maintained and updated by the United States Department of Health and Human
Services.
Sec. 48.
Minnesota Statutes 2022, section 144.1501, subdivision 2, is amended to read:
Subd. 2.
Creation of account.
(a) A health professional education loan forgiveness
program account is established. The commissioner of health shall use money from the
account to establish a loan forgiveness program:
(1) for medical residents, mental health professionals, and alcohol and drug counselors
agreeing to practice in designated rural areas or underserved urban communities or
specializing in the area of deleted text begin pediatricdeleted text end psychiatry;
(2) for midlevel practitioners agreeing to practice in designated rural areas or to teach
at least 12 credit hours, or 720 hours per year in the nursing field in a postsecondary program
at the undergraduate level or the equivalent at the graduate level;
(3) for nurses who agree to practice in a Minnesota nursing home; new text begin innew text end an intermediate
care facility for persons with developmental disability; new text begin innew text end a hospital if the hospital owns
and operates a Minnesota nursing home and a minimum of 50 percent of the hours worked
by the nurse is in the nursing home; deleted text begin a housing with services establishment as defined in
section 144D.01, deleted text end deleted text begin subdivision 4deleted text end new text begin in an assisted living facility as defined in section 144G.08,
subdivision 7new text end ; or for a home care provider as defined in section 144A.43, subdivision 4; or
agree to teach at least 12 credit hours, or 720 hours per year in the nursing field in a
postsecondary program at the undergraduate level or the equivalent at the graduate level;
(4) for other health care technicians agreeing to teach at least 12 credit hours, or 720
hours per year in their designated field in a postsecondary program at the undergraduate
level or the equivalent at the graduate level. The commissioner, in consultation with the
Healthcare Education-Industry Partnership, shall determine the health care fields where the
need is the greatest, including, but not limited to, respiratory therapy, clinical laboratory
technology, radiologic technology, and surgical technology;
(5) for pharmacists, advanced dental therapists, dental therapists, and public health nurses
who agree to practice in designated rural areas; deleted text begin and
deleted text end
(6) for dentists agreeing to deliver at least 25 percent of the dentist's yearly patient
encounters to state public program enrollees or patients receiving sliding fee schedule
discounts through a formal sliding fee schedule meeting the standards established by the
United States Department of Health and Human Services under Code of Federal Regulations,
title 42, section deleted text begin 51, chapter 303.deleted text end new text begin 51c.303; and
new text end
new text begin
(7) for nurses who are enrolled in the PSLF program, employed as a hospital nurse by
a nonprofit hospital that is an eligible employer under the PSLF program, and providing
direct care to patients at the nonprofit hospital.
new text end
(b) Appropriations made to the account do not cancel and are available until expended,
except that at the end of each biennium, any remaining balance in the account that is not
committed by contract and not needed to fulfill existing commitments shall cancel to the
fund.
Sec. 49.
Minnesota Statutes 2022, section 144.1501, subdivision 3, is amended to read:
Subd. 3.
Eligibility.
(a) To be eligible to participate in the loan forgiveness program, an
individual must:
(1) be a medical or dental resident; new text begin benew text end a licensed pharmacist; or be enrolled in a training
or education program new text begin or obtaining required supervision hoursnew text end to become a dentist, dental
therapist, advanced dental therapist, mental health professional, alcohol and drug counselor,
pharmacist, public health nurse, midlevel practitioner, registered nurse, or a licensed practical
nurse. The commissioner may also consider applications submitted by graduates in eligible
professions who are licensed and in practice; and
(2) submit an application to the commissioner of health.new text begin Nurses applying under
subdivision 2, paragraph (a), clause (7), must also include proof that the applicant is enrolled
in the PSLF program and confirmation that the applicant is employed as a hospital nurse.
new text end
(b) An applicant selected to participate must sign a contract to agree to serve a minimum
three-year full-time service obligation according to subdivision 2, which shall begin no later
than March 31 following completion of required training, with the exception ofnew text begin :
new text end
new text begin (1) new text end a nurse, who must agree to serve a minimum two-year full-time service obligation
according to subdivision 2, which shall begin no later than March 31 following completion
of required trainingdeleted text begin .deleted text end new text begin ;
new text end
new text begin
(2) a nurse selected under subdivision 2, paragraph (a), clause (7), who must agree to
continue as a hospital nurse for the repayment period of the participant's eligible loan under
the PSLF program; and
new text end
new text begin
(3) a nurse who agrees to teach according to subdivision 2, paragraph (a), clause (3),
who must sign a contract to agree to teach for a minimum of two years.
new text end
Sec. 50.
Minnesota Statutes 2022, section 144.1501, subdivision 4, is amended to read:
Subd. 4.
Loan forgiveness.
new text begin (a) new text end The commissioner of health may select applicants each
year for participation in the loan forgiveness program, within the limits of available funding.
In considering applications, the commissioner shall give preference to applicants who
document diverse cultural competencies. The commissioner shall distribute available funds
for loan forgiveness proportionally among the eligible professions according to the vacancy
rate for each profession in the required geographic area, facility type, teaching area, patient
group, or specialty type specified in subdivision 2new text begin , except for hospital nursesnew text end . The
commissioner shall allocate funds for physician loan forgiveness so that 75 percent of the
funds available are used for rural physician loan forgiveness and 25 percent of the funds
available are used for underserved urban communities and pediatric psychiatry loan
forgiveness. If the commissioner does not receive enough qualified applicants each year to
use the entire allocation of funds for any eligible profession, the remaining funds may be
allocated proportionally among the other eligible professions according to the vacancy rate
for each profession in the required geographic area, patient group, or facility type specified
in subdivision 2. Applicants are responsible for securing their own qualified educational
loans. The commissioner shall select participants based on their suitability for practice
serving the required geographic area or facility type specified in subdivision 2, as indicated
by experience or training. The commissioner shall give preference to applicants closest to
completing their training. new text begin Except as specified in paragraphs (b) and (c), new text end for each year that
a participant meets the service obligation required under subdivision 3, up to a maximum
of four years, the commissioner shall make annual disbursements directly to the participant
equivalent to 15 percent of the average educational debt for indebted graduates in their
profession in the year closest to the applicant's selection for which information is available,
not to exceed the balance of the participant's qualifying educational loans. Before receiving
loan repayment disbursements and as requested, the participant must complete and return
to the commissioner a confirmation of practice form provided by the commissioner verifying
that the participant is practicing as required under subdivisions 2 and 3. The participant
must provide the commissioner with verification that the full amount of loan repayment
disbursement received by the participant has been applied toward the designated loans.
After each disbursement, verification must be received by the commissioner and approved
before the next loan repayment disbursement is made. Participants who move their practice
remain eligible for loan repayment as long as they practice as required under subdivision
2.
new text begin
(b) For hospital nurses, the commissioner of health shall select applicants each year for
participation in the hospital nursing education loan forgiveness program, within limits of
available funding for hospital nurses. Applicants are responsible for applying for and
maintaining eligibility for the PSLF program. For each year that a participant meets the
eligibility requirements described in subdivision 3, the commissioner shall make an annual
disbursement directly to the participant in an amount equal to the minimum loan payments
required to be paid by the participant under the participant's repayment plan established for
the participant under the PSLF program for the previous loan year. Before receiving the
annual loan repayment disbursement, the participant must complete and return to the
commissioner a confirmation of practice form provided by the commissioner, verifying that
the participant continues to meet the eligibility requirements under subdivision 3. The
participant must provide the commissioner with verification that the full amount of loan
repayment disbursement received by the participant has been applied toward the loan for
which forgiveness is sought under the PSLF program.
new text end
new text begin
(c) For each year that a participant who is a nurse and who has agreed to teach according
to subdivision 2 meets the teaching obligation required in subdivision 3, the commissioner
shall make annual disbursements directly to the participant equivalent to 15 percent of the
average annual educational debt for indebted graduates in the nursing profession in the year
closest to the participant's selection for which information is available, not to exceed the
balance of the participant's qualifying educational loans.
new text end
Sec. 51.
Minnesota Statutes 2022, section 144.1501, subdivision 5, is amended to read:
Subd. 5.
Penalty for nonfulfillment.
If a participant does not fulfill the required
minimum commitment of service according to subdivision 3,new text begin or for hospital nurses, if the
secretary of education determines that the participant does not meet eligibility requirements
for the PSLF,new text end the commissioner of health shall collect from the participant the total amount
paid to the participant under the loan forgiveness program plus interest at a rate established
according to section 270C.40. The commissioner shall deposit the money collected in the
health care access fund to be credited to the health professional education loan forgiveness
program account established in subdivision 2. The commissioner shall allow waivers of all
or part of the money owed the commissioner as a result of a nonfulfillment penalty if
emergency circumstances prevented fulfillment of the minimum service commitmentnew text begin , or
for hospital nurses, if the PSLF program is discontinued before the participant's service
commitment is fulfillednew text end .
Sec. 52.
Minnesota Statutes 2022, section 144.1505, is amended to read:
144.1505 HEALTH PROFESSIONALS CLINICAL TRAINING EXPANSION
new text begin AND RURAL AND UNDERSERVED CLINICAL ROTATIONS new text end GRANT deleted text begin PROGRAMdeleted text end new text begin
PROGRAMSnew text end .
Subdivision 1.
Definitions.
For purposes of this section, the following definitions apply:
(1) "eligible advanced practice registered nurse program" means a program that is located
in Minnesota and is currently accredited as a master's, doctoral, or postgraduate level
advanced practice registered nurse program by the Commission on Collegiate Nursing
Education or by the Accreditation Commission for Education in Nursing, or is a candidate
for accreditation;
(2) "eligible dental therapy program" means a dental therapy education program or
advanced dental therapy education program that is located in Minnesota and is either:
(i) approved by the Board of Dentistry; or
(ii) currently accredited by the Commission on Dental Accreditation;
(3) "eligible mental health professional program" means a program that is located in
Minnesota and is listed as a mental health professional program by the appropriate accrediting
body for clinical social work, psychology, marriage and family therapy, or licensed
professional clinical counseling, or is a candidate for accreditation;
(4) "eligible pharmacy program" means a program that is located in Minnesota and is
currently accredited as a doctor of pharmacy program by the Accreditation Council on
Pharmacy Education;
(5) "eligible physician assistant program" means a program that is located in Minnesota
and is currently accredited as a physician assistant program by the Accreditation Review
Commission on Education for the Physician Assistant, or is a candidate for accreditation;
(6) "mental health professional" means an individual providing clinical services in the
treatment of mental illness who meets one of the qualifications under section 245.462,
subdivision 18; deleted text begin and
deleted text end
new text begin
(7) "eligible physician training program" means a physician residency training program
located in Minnesota and that is currently accredited by the accrediting body or has presented
a credible plan as a candidate for accreditation;
new text end
new text begin
(8) "eligible dental program" means a dental education program or a dental residency
training program located in Minnesota and that is currently accredited by the accrediting
body or has presented a credible plan as a candidate for accreditation; and
new text end
deleted text begin (7)deleted text end new text begin (9)new text end "project" means a project to establish or expand clinical training for physician
assistants, advanced practice registered nurses, pharmacists, dental therapists, advanced
dental therapists, or mental health professionals in Minnesota.
Subd. 2.
deleted text begin Programdeleted text end new text begin Programsnew text end .
(a) new text begin For advanced practice provider clinical training
expansion grants, new text end the commissioner of health shall award health professional training site
grants to eligible physician assistant, advanced practice registered nurse, pharmacy, dental
therapy, and mental health professional programs to plan and implement expanded clinical
training. A planning grant shall not exceed $75,000, and a training grant shall not exceed
$150,000 for the first year, $100,000 for the second year, and $50,000 for the third year per
program.
new text begin
(b) For health professional rural and underserved clinical rotations grants, the
commissioner of health shall award health professional training site grants to eligible
physician, physician assistant, advanced practice registered nurse, pharmacy, dentistry,
dental therapy, and mental health professional programs to augment existing clinical training
programs to add rural and underserved rotations or clinical training experiences, such as
credential or certificate rural tracks or other specialized training. For physician and dentist
training, the expanded training must include rotations in primary care settings such as
community clinics, hospitals, health maintenance organizations, or practices in rural
communities.
new text end
deleted text begin (b)deleted text end new text begin (c)new text end Funds may be used for:
(1) establishing or expanding new text begin rotations and new text end clinical training deleted text begin for physician assistants,
advanced practice registered nurses, pharmacists, dental therapists, advanced dental therapists,
and mental health professionals in Minnesotadeleted text end ;
(2) recruitment, training, and retention of students and faculty;
(3) connecting students with appropriate clinical training sites, internships, practicums,
or externship activities;
(4) travel and lodging for students;
(5) faculty, student, and preceptor salaries, incentives, or other financial support;
(6) development and implementation of cultural competency training;
(7) evaluations;
(8) training site improvements, fees, equipment, and supplies required to establish,
maintain, or expand deleted text begin a physician assistant, advanced practice registered nurse, pharmacy,
dental therapy, or mental health professionaldeleted text end training program; and
(9) supporting clinical education in which trainees are part of a primary care team model.
Subd. 3.
Applications.
Eligible physician assistant, advanced practice registered nurse,
pharmacy, dental therapy, new text begin dental, physician,new text end and mental health professional programs seeking
a grant shall apply to the commissioner. Applications must include a description of the
number of additional students who will be trained using grant funds; attestation that funding
will be used to support an increase in the number of clinical training slots; a description of
the problem that the proposed project will address; a description of the project, including
all costs associated with the project, sources of funds for the project, detailed uses of all
funds for the project, and the results expected; and a plan to maintain or operate any
component included in the project after the grant period. The applicant must describe
achievable objectives, a timetable, and roles and capabilities of responsible individuals in
the organization.new text begin Applicants applying under subdivision 2, paragraph (b), must include
information about length of training and training site settings, geographic location of rural
sites, and rural populations expected to be served.
new text end
Subd. 4.
Consideration of applications.
The commissioner shall review each application
to determine whether or not the application is complete and whether the program and the
project are eligible for a grant. In evaluating applications, the commissioner shall score each
application based on factors including, but not limited to, the applicant's clarity and
thoroughness in describing the project and the problems to be addressed, the extent to which
the applicant has demonstrated that the applicant has made adequate provisions to ensure
proper and efficient operation of the training program once the grant project is completed,
the extent to which the proposed project is consistent with the goal of increasing access to
primary care and mental health services for rural and underserved urban communities, the
extent to which the proposed project incorporates team-based primary care, and project
costs and use of funds.
Subd. 5.
Program oversight.
The commissioner shall determine the amount of a grant
to be given to an eligible program based on the relative score of each eligible program's
applicationnew text begin , including rural locations as applicable under subdivision 2, paragraph (b)new text end , other
relevant factors discussed during the review, and the funds available to the commissioner.
Appropriations made to the program do not cancel and are available until expended. During
the grant period, the commissioner may require and collect from programs receiving grants
any information necessary to evaluate the program.
Sec. 53.
new text begin
[144.1507] PRIMARY CARE RESIDENCY TRAINING GRANT
PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have
the meanings given.
new text end
new text begin
(b) "Eligible program" means a program that meets the following criteria:
new text end
new text begin
(1) is located in Minnesota;
new text end
new text begin
(2) trains medical residents in the specialties of family medicine, general internal
medicine, general pediatrics, psychiatry, geriatrics, or general surgery in rural residency
training programs or in community-based ambulatory care centers that primarily serve the
underserved; and
new text end
new text begin
(3) is accredited by the Accreditation Council for Graduate Medical Education or presents
a credible plan to obtain accreditation.
new text end
new text begin
(c) "Rural residency training program" means a residency program that provides an
initial year of training in an accredited residency program in Minnesota. The subsequent
years of the residency program are based in rural communities, utilizing local clinics and
community hospitals, with specialty rotations in nearby regional medical centers.
new text end
new text begin
(d) "Community-based ambulatory care centers" means federally qualified health centers,
community mental health centers, rural health clinics, health centers operated by the Indian
Health Service, an Indian Tribe or Tribal organization, or an urban American Indian
organization or an entity receiving funds under Title X of the Public Health Service Act.
new text end
new text begin
(e) "Eligible project" means a project to establish and maintain a rural residency training
program.
new text end
new text begin Subd. 2. new text end
new text begin Rural residency training program. new text end
new text begin
(a) The commissioner of health shall
award rural residency training program grants to eligible programs to plan, implement, and
sustain rural residency training programs. A rural residency training program grant shall
not exceed $250,000 per year for up to three years for planning and development, and
$225,000 per resident per year for each year thereafter to sustain the program.
new text end
new text begin
(b) Funds may be spent to cover the costs of:
new text end
new text begin
(1) planning related to establishing accredited rural residency training programs;
new text end
new text begin
(2) obtaining accreditation by the Accreditation Council for Graduate Medical Education
or another national body that accredits rural residency training programs;
new text end
new text begin
(3) establishing new rural residency training programs;
new text end
new text begin
(4) recruitment, training, and retention of new residents and faculty related to the new
rural residency training program;
new text end
new text begin
(5) travel and lodging for new residents;
new text end
new text begin
(6) faculty, new resident, and preceptor salaries related to new rural residency training
programs;
new text end
new text begin
(7) training site improvements, fees, equipment, and supplies required for new rural
residency training programs; and
new text end
new text begin
(8) supporting clinical education in which trainees are part of a primary care team model.
new text end
new text begin Subd. 3. new text end
new text begin Applications for rural residency training program grants. new text end
new text begin
Eligible programs
seeking a grant shall apply to the commissioner. Applications must include the number of
new primary care rural residency training program slots planned, under development or
under contract; a description of the training program, including location of the established
residency program and rural training sites; a description of the project, including all costs
associated with the project; all sources of funds for the project; detailed uses of all funds
for the project; the results expected; proof of eligibility for federal graduate medical education
funding, if applicable; and a plan to seek the funding. The applicant must describe achievable
objectives, a timetable, and the roles and capabilities of responsible individuals in the
organization.
new text end
new text begin Subd. 4. new text end
new text begin Consideration of grant applications. new text end
new text begin
The commissioner shall review each
application to determine if the residency program application is complete, if the proposed
rural residency program and residency slots are eligible for a grant, and if the program is
eligible for federal graduate medical education funding, and when the funding is available.
If eligible programs are not eligible for federal graduate medical education funding, the
commissioner may award continuation funding to the eligible program beyond the initial
grant period. The commissioner shall award grants to support training programs in family
medicine, general internal medicine, general pediatrics, psychiatry, geriatrics, general
surgery, and other primary care focus areas.
new text end
new text begin Subd. 5. new text end
new text begin Program oversight. new text end
new text begin
During the grant period, the commissioner may require
and collect from grantees any information necessary to evaluate the program. Notwithstanding
section 16A.28, subdivision 6, encumbrances for grants under this section issued by June
30 of each year may be certified for a period of up to three years beyond the year in which
the funds were originally appropriated.
new text end
Sec. 54.
new text begin
[144.1508] CLINICAL HEALTH CARE TRAINING.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have
the meanings given.
new text end
new text begin
(b) "Accredited clinical training" means the clinical training provided by a medical
education program that is accredited through an organization recognized by the Department
of Education, the Centers for Medicare and Medicaid Services, or another national body
that reviews the accrediting organizations for multiple disciplines and whose standards for
recognizing accrediting organizations are reviewed and approved by the commissioner of
health.
new text end
new text begin
(c) "Clinical medical education program" means the accredited clinical training of
physicians, medical students, residents, doctors of pharmacy practitioners, doctors of
chiropractic, dentists, advanced practice nurses, clinical nurse specialists, certified registered
nurse anesthetists, nurse practitioners, certified nurse midwives, physician assistants, dental
therapists and advanced dental therapists, psychologists, clinical social workers, community
paramedics, community health workers, and other medical professions as determined by
the commissioner.
new text end
new text begin
(d) "Commissioner" means the commissioner of health.
new text end
new text begin
(e) "Eligible entity" means an organization that is located in Minnesota, provides a
clinical medical education experience, and hosts students, residents, or other trainee types
as determined by the commissioner, and is from an accredited Minnesota teaching program
and institution.
new text end
new text begin
(f) "Eligible trainee FTEs" means the number of trainees, as measured by full-time
equivalent counts, that are training in Minnesota at an entity with either currently active
medical assistance enrollment status and a National Provider Identification (NPI) number
or documentation that they provide sliding fee services. Training may occur in an inpatient
or ambulatory patient care setting or alternative setting as determined by the commissioner.
Training that occurs in nursing facility settings is not eligible for funding under this section.
new text end
new text begin
(g) "Teaching institution" means a hospital, medical center, clinic, or other organization
that conducts a clinical medical education program in Minnesota that is accountable to the
accrediting body.
new text end
new text begin
(h) "Trainee" means a student, resident, fellow, or other postgraduate involved in a
clinical medical education program from an accredited Minnesota teaching program and
institution.
new text end
new text begin Subd. 2. new text end
new text begin Application process. new text end
new text begin
(a) An eligible entity hosting clinical trainees from a
clinical medical education program and teaching institution is eligible for funds under
subdivision 3, if the entity:
new text end
new text begin
(1) is funded in part by sliding fee scale services or enrolled in the Minnesota health
care program;
new text end
new text begin
(2) faces increased financial pressure as a result of competition with nonteaching patient
care entities; and
new text end
new text begin
(3) emphasizes primary care or specialties that are in undersupply in rural or underserved
areas of Minnesota.
new text end
new text begin
(b) An entity hosting a clinical medical education program for advanced practice nursing
is eligible for funds under subdivision 3, if the program meets the eligibility requirements
in paragraph (a), clauses (1) to (3), and is sponsored by the University of Minnesota
Academic Health Center, the Mayo Foundation, or an institution that is part of the Minnesota
State Colleges and Universities system or members of the Minnesota Private College Council.
new text end
new text begin
(c) An application must be submitted to the commissioner by an eligible entity through
the teaching institution and contain the following information:
new text end
new text begin
(1) the official name and address and the site addresses of the clinical medical education
programs where eligible trainees are hosted;
new text end
new text begin
(2) the name, title, and business address of those persons responsible for administering
the funds;
new text end
new text begin
(3) for each applicant, the type and specialty orientation of trainees in the program; the
name, entity address, medical assistance provider number, and national provider identification
number of each training site used in the program, as appropriate; the federal tax identification
number of each training site, where available; the total number of eligible trainee FTEs at
each site; and
new text end
new text begin
(4) other supporting information the commissioner deems necessary.
new text end
new text begin
(d) An applicant that does not provide information requested by the commissioner shall
not be eligible for funds for the current funding cycle.
new text end
new text begin Subd. 3. new text end
new text begin Distribution of funds. new text end
new text begin
(a) The commissioner may distribute funds for clinical
training in areas of Minnesota and for the professions listed in subdivision 1, paragraph (c),
determined by the commissioner as a high need area and profession shortage area. The
commissioner shall annually distribute medical education funds to qualifying applicants
under this section based on the costs to train, service level needs, and profession or training
site shortages. Use of funds is limited to related clinical training costs for eligible programs.
new text end
new text begin
(b) To ensure the quality of clinical training, eligible entities must demonstrate that they
hold contracts in good standing with eligible educational institutions that specify the terms,
expectations, and outcomes of the clinical training conducted at sites. Funds shall be
distributed in an administrative process determined by the commissioner to be efficient.
new text end
new text begin Subd. 4. new text end
new text begin Report. new text end
new text begin
(a) Teaching institutions receiving funds under this section must sign
and submit a medical education grant verification report (GVR) to verify funding was
distributed as specified in the GVR. If the teaching institution fails to submit the GVR by
the stated deadline, the teaching institution is required to return the full amount of funds
received to the commissioner within 30 days of receiving notice from the commissioner.
The commissioner shall distribute returned funds to the appropriate training sites in
accordance with the commissioner's approval letter.
new text end
new text begin
(b) Teaching institutions receiving funds under this section must provide any other
information the commissioner deems appropriate to evaluate the effectiveness of the use of
funds for medical education.
new text end
Sec. 55.
Minnesota Statutes 2022, section 144.2151, is amended to read:
144.2151 new text begin FETAL DEATH new text end RECORDnew text begin AND CERTIFICATEnew text end OF BIRTH
RESULTING IN STILLBIRTH.
Subdivision 1.
deleted text begin Filingdeleted text end new text begin Registrationnew text end .
A new text begin fetal death new text end record deleted text begin of birth for each birth resulting
in a stillbirth in this state, on or after August 1, 2005,deleted text end new text begin must be establishednew text end for deleted text begin which adeleted text end new text begin eachnew text end
fetal death deleted text begin report is requireddeleted text end new text begin reported and registerednew text end under section 144.222, subdivision 1deleted text begin ,
shall be filed with the state registrar within five days after the birth if the parent or parents
of the stillbirth request to have a record of birth resulting in stillbirth prepareddeleted text end .
Subd. 2.
Information to parents.
The party responsible for filing a fetal death report
under section 144.222, subdivision 1, shall advise the parent or parents of a stillbirth:
deleted text begin
(1) that they may request preparation of a record of birth resulting in stillbirth;
deleted text end
deleted text begin
(2) that preparation of the record is optional; and
deleted text end
deleted text begin
(3) how to obtain a certified copy of the record if one is requested and prepared.
deleted text end
new text begin
(1) that the parent or parents may choose to provide a full name or provide only a last
name for the record;
new text end
new text begin
(2) that the parent or parents may request a certificate of birth resulting in stillbirth after
the fetal death record is established;
new text end
new text begin
(3) that the parent who gave birth may request an informational copy of the fetal death
record; and
new text end
new text begin
(4) that the parent or parents named on the fetal death record and the party responsible
for reporting the fetal death may correct or amend the record to protect the integrity and
accuracy of vital records.
new text end
Subd. 3.
deleted text begin Preparationdeleted text end new text begin Responsibilities of the state registrarnew text end .
deleted text begin
(a) Within five days after
delivery of a stillbirth, the parent or parents of the stillbirth may prepare and file the record
with the state registrar if the parent or parents of the stillbirth, after being advised as provided
in subdivision 2, request to have a record of birth resulting in stillbirth prepared.
deleted text end
deleted text begin
(b) If the parent or parents of the stillbirth do not choose to provide a full name for the
stillbirth, the parent or parents may choose to file only a last name.
deleted text end
deleted text begin
(c) Either parent of the stillbirth or, if neither parent is available, another person with
knowledge of the facts of the stillbirth shall attest to the accuracy of the personal data entered
on the record in time to permit the filing of the record within five days after delivery.
deleted text end
new text begin
The state registrar shall:
new text end
new text begin
(1) prescribe the process to:
new text end
new text begin
(i) register a fetal death;
new text end
new text begin
(ii) request the certificate of birth resulting in stillbirth; and
new text end
new text begin
(iii) request the informational copy of a fetal death record;
new text end
new text begin
(2) prescribe a standardized format for the certificate of birth resulting in stillbirth, which
shall integrate security features and be as similar as possible to a birth certificate;
new text end
new text begin
(3) issue a certificate of birth resulting in stillbirth or a statement of no vital record found
to the parent or parents named on the fetal death record upon the parent's proper completion
of an attestation provided by the commissioner and payment of the required fee;
new text end
new text begin
(4) correct or amend the fetal death record upon a request from the parent who gave
birth, parents, or the person who registered the fetal death or filed the report; and
new text end
new text begin
(5) refuse to amend or correct the fetal death record when an applicant does not submit
the minimum documentation required to amend the record or when the state registrar has
cause to question the validity or completeness of the applicant's statements or any
documentary evidence and the deficiencies are not corrected. The state registrar shall advise
the applicant of the reason for this action and shall further advise the applicant of the right
of appeal to a court with competent jurisdiction over the Department of Health.
new text end
Subd. 4.
deleted text begin Retroactive applicationdeleted text end new text begin Delayed registrationnew text end .
deleted text begin Notwithstanding subdivisions
1 to 3,deleted text end If a deleted text begin birth thatdeleted text end new text begin fetal deathnew text end occurred in this state at any time deleted text begin resulted in a stillbirthdeleted text end for
which a fetal death report was required under section 144.222, subdivision 1, but a deleted text begin record
of birth resulting in stillbirth was not prepared under subdivision 3, a parent of the stillbirth
may submit to the state registrar, on or after August 1, 2005, a written request for preparation
of a record of birth resulting in stillbirth and evidence of the facts of the stillbirth in the
form and manner specified by the state registrar. The state registrar shall prepare and file
the record of birth resulting in stillbirth within 30 days after receiving satisfactory evidence
of the facts of the stillbirth.deleted text end new text begin fetal death was not registered and a record was not established,
a person responsible for registering the fetal death, the medical examiner or coroner with
jurisdiction, or a parent may submit to the state registrar a written request to register the
fetal death and submit the evidence to support the request.
new text end
deleted text begin Subd. 5. deleted text end
deleted text begin Responsibilities of state registrar. deleted text end
deleted text begin
The state registrar shall:
deleted text end
deleted text begin
(1) prescribe the form of and information to be included on a record of birth resulting
in stillbirth, which shall be as similar as possible to the form of and information included
on a record of birth;
deleted text end
deleted text begin
(2) prescribe the form of and information to be provided by the parent of a stillbirth
requesting a record of birth resulting in stillbirth under subdivisions 3 and 4 and make this
form available on the Department of Health's website;
deleted text end
deleted text begin
(3) issue a certified copy of a record of birth resulting in stillbirth to a parent of the
stillbirth that is the subject of the record if:
deleted text end
deleted text begin
(i) a record of birth resulting in stillbirth has been prepared and filed under subdivision
3 or 4; and
deleted text end
deleted text begin
(ii) the parent requesting a certified copy of the record submits the request in writing;
and
deleted text end
deleted text begin
(4) create and implement a process for entering, preparing, and handling stillbirth records
identical or as close as possible to the processes for birth and fetal death records when
feasible, but no later than the date on which the next reprogramming of the Department of
Health's database for vital records is completed.
deleted text end
Sec. 56.
Minnesota Statutes 2022, section 144.222, is amended to read:
144.222 new text begin FETAL DEATH new text end REPORTS deleted text begin OF FETAL OR INFANT DEATHdeleted text end new text begin AND
REGISTRATIONnew text end .
Subdivision 1.
Fetal death report required.
A fetal death deleted text begin reportdeleted text end must be deleted text begin fileddeleted text end new text begin registered
or reportednew text end within five days of the death of a fetus for whom 20 or more weeks of gestation
have elapsed, except for abortions defined under section 145.4241. A fetal death deleted text begin report must
be prepareddeleted text end new text begin must be registered or reportednew text end in a format prescribed by the state registrar and
filed in accordance with Minnesota Rules, parts 4601.0100 to 4601.2600 by:
(1) a person in charge of an institution or that person's authorized designee if a fetus is
delivered in the institution or en route to the institution;
(2) a physician, certified nurse midwife, or other licensed medical personnel in attendance
at or immediately after the delivery if a fetus is delivered outside an institution; or
(3) a parent or other person in charge of the disposition of the remains if a fetal death
occurred without medical attendance at or immediately after the delivery.
deleted text begin Subd. 2. deleted text end
deleted text begin Sudden infant death. deleted text end
deleted text begin
Each infant death which is diagnosed as sudden infant
death syndrome shall be reported within five days to the state registrar.
deleted text end
Sec. 57.
Minnesota Statutes 2022, section 144.222, subdivision 1, is amended to read:
Subdivision 1.
Fetal death report required.
A fetal death report must be filed within
five days of the death of a fetus for whom 20 or more weeks of gestation have elapsed,
except for abortions defined under section deleted text begin 145.4241deleted text end new text begin 145.411, subdivision 5new text end . A fetal death
report must be prepared in a format prescribed by the state registrar and filed in accordance
with Minnesota Rules, parts 4601.0100 to 4601.2600 by:
(1) a person in charge of an institution or that person's authorized designee if a fetus is
delivered in the institution or en route to the institution;
(2) a physician, certified nurse midwife, or other licensed medical personnel in attendance
at or immediately after the delivery if a fetus is delivered outside an institution; or
(3) a parent or other person in charge of the disposition of the remains if a fetal death
occurred without medical attendance at or immediately after the delivery.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 58.
Minnesota Statutes 2022, section 144.226, subdivision 3, is amended to read:
Subd. 3.
Birth record surcharge.
(a) In addition to any fee prescribed under subdivision
1, there shall be a nonrefundable surcharge of $3 for each certified birth or stillbirth record
and for a certification that the vital record cannot be found. The state registrar or local
issuance office shall forward this amount to the commissioner of management and budget
new text begin each month following the collection of the surcharge new text end for deposit into the account for the
children's trust fund for the prevention of child abuse established under section 256E.22.
This surcharge shall not be charged under those circumstances in which no fee for a certified
birth or stillbirth record is permitted under subdivision 1, paragraph (b). Upon certification
by the commissioner of management and budget that the assets in that fund exceed
$20,000,000, this surcharge shall be discontinued.
(b) In addition to any fee prescribed under subdivision 1, there shall be a nonrefundable
surcharge of $10 for each certified birth record. The state registrar or local issuance office
shall forward this amount to the commissioner of management and budget new text begin each month
following the collection of the surcharge new text end for deposit in the general fund.
Sec. 59.
Minnesota Statutes 2022, section 144.226, subdivision 4, is amended to read:
Subd. 4.
Vital records surcharge.
In addition to any fee prescribed under subdivision
1, there is a nonrefundable surcharge of $4 for each certified and noncertified birth, stillbirth,
or death record, and for a certification that the record cannot be found. The local issuance
office or state registrar shall forward this amount to the commissioner of management and
budget new text begin each month following the collection of the surcharge new text end to be deposited into the state
government special revenue fund.
Sec. 60.
new text begin
[144.3431] NONRESIDENTIAL MENTAL HEALTH SERVICES.
new text end
new text begin
A minor who is age 16 or older may give effective consent for nonresidential mental
health services, and the consent of no other person is required. For purposes of this section,
"nonresidential mental health services" means outpatient services as defined in section
245.4871, subdivision 29, provided to a minor who is not residing in a hospital, inpatient
unit, or licensed residential treatment facility or program.
new text end
Sec. 61.
Minnesota Statutes 2022, section 144.382, is amended by adding a subdivision
to read:
new text begin Subd. 2a. new text end
new text begin Connector. new text end
new text begin
"Connector" means gooseneck, pigtail, and other service line
connectors. A connector is typically a short section of piping not exceeding two feet that
can be bent and used for connections between rigid service piping.
new text end
Sec. 62.
Minnesota Statutes 2022, section 144.382, is amended by adding a subdivision
to read:
new text begin Subd. 3a. new text end
new text begin Galvanized requiring replacement. new text end
new text begin
"Galvanized requiring replacement"
means a galvanized service line that is or was at any time connected to a lead service line
or lead status unknown service line, or is currently or was previously affixed to a lead
connector. The majority of galvanized service lines fall under this category.
new text end
Sec. 63.
Minnesota Statutes 2022, section 144.382, is amended by adding a subdivision
to read:
new text begin Subd. 3b. new text end
new text begin Galvanized service line. new text end
new text begin
"Galvanized service line" means a service line made
of iron or piping that has been dipped in zinc to prevent corrosion and rusting.
new text end
Sec. 64.
Minnesota Statutes 2022, section 144.382, is amended by adding a subdivision
to read:
new text begin Subd. 3c. new text end
new text begin Lead connector. new text end
new text begin
"Lead connector" means a connector made of lead.
new text end
Sec. 65.
Minnesota Statutes 2022, section 144.382, is amended by adding a subdivision
to read:
new text begin Subd. 3d. new text end
new text begin Lead service line. new text end
new text begin
"Lead service line" means a portion of pipe that is made
of lead, which connects the water main to the building inlet. A lead service line may be
owned by the water system, by the property owner, or both.
new text end
Sec. 66.
Minnesota Statutes 2022, section 144.382, is amended by adding a subdivision
to read:
new text begin Subd. 3e. new text end
new text begin Lead status unknown service line or unknown service line. new text end
new text begin
"Lead status
unknown service line" or "unknown service line" means a service line that has not been
demonstrated to meet or does not meet the definition of lead free in section 1417 of the Safe
Drinking Water Act.
new text end
Sec. 67.
Minnesota Statutes 2022, section 144.382, is amended by adding a subdivision
to read:
new text begin Subd. 3f. new text end
new text begin Nonlead service line. new text end
new text begin
"Nonlead service line" means a service line determined
through an evidence-based record, method, or technique not to be a lead service line or
galvanized service line requiring replacement. Most nonlead service lines are made of copper
or plastic.
new text end
Sec. 68.
Minnesota Statutes 2022, section 144.382, is amended by adding a subdivision
to read:
new text begin Subd. 4a. new text end
new text begin Service line. new text end
new text begin
"Service line" means a portion of pipe that connects the water
main to the building inlet. A service line may be owned by the water system, by the property
owner, or both. A service line may be made of many materials, such as lead, copper,
galvanized steel, or plastic.
new text end
Sec. 69.
new text begin
[144.3853] CLASSIFICATION OF SERVICE LINES.
new text end
new text begin Subdivision 1. new text end
new text begin Classification of lead status of service line. new text end
new text begin
(a) A water system may
classify the actual material of a service line, such as copper or plastic, as an alternative to
classifying the service line as a nonlead service line, for the purpose of the lead service line
inventory.
new text end
new text begin
(b) It is not necessary to physically verify the material composition, such as copper or
plastic, of a service line for its lead status to be identified. For example, if records demonstrate
the service line was installed after a municipal, state, or federal ban on the installation of
lead service lines, the service line may be classified as a nonlead service line.
new text end
new text begin Subd. 2. new text end
new text begin Lead connector. new text end
new text begin
For the purposes of the lead service line inventory and lead
service line replacement plan, if a service line has a lead connector, the service line shall
be classified as a lead service line or a galvanized service line requiring replacement.
new text end
new text begin Subd. 3. new text end
new text begin Galvanized service line. new text end
new text begin
A galvanized service line may only be classified as
a nonlead service line if there is documentation verifying it was never connected to a lead
service line or lead connector. Rarely will a galvanized service line be considered a nonlead
service line.
new text end
Sec. 70.
new text begin
[144.398] TOBACCO USE PREVENTION ACCOUNT; ESTABLISHMENT
AND USES.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) As used in this section, the terms in this subdivision have
the meanings given.
new text end
new text begin
(b) "Electronic delivery device" has the meaning given in section 609.685, subdivision
1, paragraph (c).
new text end
new text begin
(c) "Nicotine delivery product" has the meaning given in section 609.6855, subdivision
1, paragraph (c).
new text end
new text begin
(d) "Tobacco" has the meaning given in section 609.685, subdivision 1, paragraph (a).
new text end
new text begin
(e) "Tobacco-related devices" has the meaning given in section 609.685, subdivision 1,
paragraph (b).
new text end
new text begin Subd. 2. new text end
new text begin Account created. new text end
new text begin
A tobacco use prevention account is created in the special
revenue fund. Pursuant to section 16A.151, subdivision 2, paragraph (h), the commissioner
of management and budget shall deposit into the account any money received by the state
resulting from a settlement agreement or an assurance of discontinuance entered into by the
attorney general of the state, or a court order in litigation brought by the attorney general
of the state on behalf of the state or a state agency related to alleged violations of consumer
fraud laws in the marketing, sale, or distribution of electronic nicotine delivery systems in
this state or other alleged illegal actions that contributed to the exacerbation of youth nicotine
use.
new text end
new text begin Subd. 3. new text end
new text begin Appropriations from tobacco use prevention account. new text end
new text begin
(a) Each fiscal year,
the amount of money in the tobacco use prevention account is appropriated to the
commissioner of health for:
new text end
new text begin
(1) tobacco and electronic delivery device use prevention and cessation projects consistent
with the duties specified in section 144.392;
new text end
new text begin
(2) a public information program under section 144.393;
new text end
new text begin
(3) the development of health promotion and health education materials about tobacco
and electronic delivery device use prevention and cessation;
new text end
new text begin
(4) tobacco and electronic delivery device use prevention activities under section 144.396;
and
new text end
new text begin
(5) statewide tobacco cessation services under section 144.397.
new text end
new text begin
(b) In activities funded under this subdivision, the commissioner of health must:
new text end
new text begin
(1) prioritize preventing persons under the age of 21 from using commercial tobacco,
electronic delivery devices, tobacco-related devices, and nicotine delivery products;
new text end
new text begin
(2) promote racial and health equity; and
new text end
new text begin
(3) use strategies that are evidence-based or based on promising practices.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 71.
Minnesota Statutes 2022, section 144.55, subdivision 3, is amended to read:
Subd. 3.
Standards for licensure.
(a) Notwithstanding the provisions of section 144.56,
for the purpose of hospital licensure, the commissioner of health shall use as minimum
standards the hospital certification regulations promulgated pursuant to title XVIII of the
Social Security Act, United States Code, title 42, section 1395, et seq. The commissioner
may use as minimum standards changes in the federal hospital certification regulations
promulgated after May 7, 1981, if the commissioner finds that such changes are reasonably
necessary to protect public health and safety. deleted text begin The commissioner shall also promulgate in
rules additional minimum standards for new construction.
deleted text end
new text begin
(b) Hospitals must meet the applicable provisions of the 2022 edition of the Facility
Guidelines Institute Guidelines for Design and Construction of Hospitals. This minimum
design standard must be met for all new licenses, new construction, change of use, or change
of occupancy for which plan review packages are received on or after January 1, 2024.
new text end
new text begin
(c) If the commissioner decides to update the edition of the guidelines specified in
paragraph (b) for purposes of this subdivision, the commissioner must notify the chairs and
ranking minority members of the legislative committees with jurisdiction over health care
and public safety of the planned update by January 15 of the year in which the new edition
will become effective. Following notice from the commissioner, the new edition shall
become effective for hospitals beginning August 1 of that year, unless otherwise provided
in law. The commissioner shall, by publication in the State Register, specify a date by which
hospitals must comply with the updated edition. The date by which hospitals must comply
shall not be sooner than 12 months after publication of the commissioner's notice in the
State Register and shall apply only to plan review packages received on or after that date.
new text end
new text begin
(d) Hospitals shall be in compliance with all applicable state and local governing laws,
regulations, standards, ordinances, and codes for fire safety, building, and zoning
requirements.
new text end
deleted text begin (b)deleted text end new text begin (e)new text end Each hospital and outpatient surgical center shall establish policies and procedures
to prevent the transmission of human immunodeficiency virus and hepatitis B virus to
patients and within the health care setting. The policies and procedures shall be developed
in conformance with the most recent recommendations issued by the United States
Department of Health and Human Services, Public Health Service, Centers for Disease
Control. The commissioner of health shall evaluate a hospital's compliance with the policies
and procedures according to subdivision 4.
deleted text begin (c)deleted text end new text begin (f)new text end An outpatient surgical center must establish and maintain a comprehensive
tuberculosis infection control program according to the most current tuberculosis infection
control guidelines issued by the United States Centers for Disease Control and Prevention
(CDC), Division of Tuberculosis Elimination, as published in CDC's Morbidity and Mortality
Weekly Report (MMWR). This program must include a tuberculosis infection control plan
that covers all paid and unpaid employees, contractors, students, and volunteers. The
Department of Health shall provide technical assistance regarding implementation of the
guidelines.
deleted text begin (d)deleted text end new text begin (g)new text end Written compliance with this subdivision must be maintained by the outpatient
surgical center.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024.
new text end
Sec. 72.
Minnesota Statutes 2022, section 144.566, is amended to read:
144.566 VIOLENCE AGAINST HEALTH CARE WORKERS.
Subdivision 1.
Definitions.
(a) The following definitions apply to this section and have
the meanings given.
(b) "Act of violence" means an act by a patient or visitor against a health care worker
that includes kicking, scratching, urinating, sexually harassing, or any act defined in sections
609.221 to 609.2241.
(c) "Commissioner" means the commissioner of health.
(d) "Health care worker" means any person, whether licensed or unlicensed, employed
by, volunteering in, or under contract with a hospital, who has direct contact with a patient
of the hospital for purposes of either medical care or emergency response to situations
potentially involving violence.
(e) "Hospital" means any facility licensed as a hospital under section 144.55.
(f) "Incident response" means the actions taken by hospital administration and health
care workers during and following an act of violence.
(g) "Interfere" means to prevent, impede, discourage, or delay a health care worker's
ability to report acts of violence, including by retaliating or threatening to retaliate against
a health care worker.
(h) "Preparedness" means the actions taken by hospital administration and health care
workers to prevent a single act of violence or acts of violence generally.
(i) "Retaliate" means to discharge, discipline, threaten, otherwise discriminate against,
or penalize a health care worker regarding the health care worker's compensation, terms,
conditions, location, or privileges of employment.
new text begin
(j) "Workplace violence hazards" means locations and situations where violent incidents
are more likely to occur, including, as applicable, but not limited to locations isolated from
other health care workers; health care workers working alone; health care workers working
in remote locations; health care workers working late night or early morning hours; locations
where an assailant could prevent entry of responders or other health care workers into a
work area; locations with poor illumination; locations with poor visibility; lack of physical
barriers between health care workers and persons at risk of committing workplace violence;
lack of effective escape routes; obstacles and impediments to accessing alarm systems;
locations within the facility where alarm systems are not operational; entryways where
unauthorized entrance may occur, such as doors designated for staff entrance or emergency
exits; presence, in the areas where patient contact activities are performed, of furnishings
or objects that could be used as weapons; and locations where high-value items, currency,
or pharmaceuticals are stored.
new text end
Subd. 2.
deleted text begin Hospital dutiesdeleted text end new text begin Action plans and action plan reviews requirednew text end .
deleted text begin (a)deleted text end All
hospitals must design and implement preparedness and incident response action plans to
acts of violence by January 15, 2016, and reviewnew text begin and updatenew text end the plan at least annually
thereafter.new text begin The plan must be in writing; specific to the workplace violence hazards and
corrective measures for the units, services, or operations of the hospital; and available to
health care workers at all times.
new text end
new text begin Subd. 3. new text end
new text begin Action plan committees. new text end
deleted text begin (b)deleted text end A hospital shall designate a committee of
representatives of health care workers employed by the hospital, including nonmanagerial
health care workers, nonclinical staff, administrators, patient safety experts, and other
appropriate personnel to develop preparedness and incident response action plans to acts
of violence. The hospital shall, in consultation with the designated committee, implement
the plans under deleted text begin paragraph (a)deleted text end new text begin subdivision 2new text end . Nothing in this deleted text begin paragraphdeleted text end new text begin subdivisionnew text end shall
require the establishment of a separate committee solely for the purpose required by this
subdivision.
new text begin Subd. 4. new text end
new text begin Required elements of action plans; generally. new text end
new text begin
The preparedness and incident
response action plans to acts of violence must include:
new text end
new text begin
(1) effective procedures to obtain the active involvement of health care workers and
their representatives in developing, implementing, and reviewing the plan, including their
participation in identifying, evaluating, and correcting workplace violence hazards, designing
and implementing training, and reporting and investigating incidents of workplace violence;
new text end
new text begin
(2) names or job titles of the persons responsible for implementing the plan; and
new text end
new text begin
(3) effective procedures to ensure that supervisory and nonsupervisory health care
workers comply with the plan.
new text end
new text begin Subd. 5. new text end
new text begin Required elements of action plans; evaluation of risk factors. new text end
new text begin
(a) The
preparedness and incident response action plans to acts of violence must include assessment
procedures to identify and evaluate workplace violence hazards for each facility, unit,
service, or operation, including community-based risk factors and areas surrounding the
facility, such as employee parking areas and other outdoor areas. Procedures shall specify
the frequency with which such environmental assessments will take place.
new text end
new text begin
(b) The preparedness and incident response action plans to acts of violence must include
assessment tools, environmental checklists, or other effective means to identify workplace
violence hazards.
new text end
new text begin Subd. 6. new text end
new text begin
Required elements of action plans; review of workplace violence
incidents.
new text end
new text begin
The preparedness and incident response action plans to acts of violence must
include procedures for reviewing all workplace violence incidents that occurred in the
facility, unit, service, or operation within the previous year, whether or not an injury occurred.
new text end
new text begin Subd. 7. new text end
new text begin Required elements of action plans; reporting workplace violence. new text end
new text begin
The
preparedness and incident response action plans to acts of violence must include:
new text end
new text begin
(1) effective procedures for health care workers to document information regarding
conditions that may increase the potential for workplace violence incidents and communicate
that information without fear of reprisal to other health care workers, shifts, or units;
new text end
new text begin
(2) effective procedures for health care workers to report a violent incident, threat, or
other workplace violence concern without fear of reprisal;
new text end
new text begin
(3) effective procedures for the hospital to accept and respond to reports of workplace
violence and to prohibit retaliation against a health care worker who makes such a report;
new text end
new text begin
(4) a policy statement stating the hospital will not prevent a health care worker from
reporting workplace violence or take punitive or retaliatory action against a health care
worker for doing so;
new text end
new text begin
(5) effective procedures for investigating health care worker concerns regarding workplace
violence or workplace violence hazards;
new text end
new text begin
(6) procedures for informing health care workers of the results of the investigation arising
from a report of workplace violence or from a concern about a workplace violence hazard
and of any corrective actions taken;
new text end
new text begin
(7) effective procedures for obtaining assistance from the appropriate law enforcement
agency or social service agency during all work shifts. The procedure may establish a central
coordination procedure; and
new text end
new text begin
(8) a policy statement stating the hospital will not prevent a health care worker from
seeking assistance and intervention from local emergency services or law enforcement when
a violent incident occurs or take punitive or retaliatory action against a health care worker
for doing so.
new text end
new text begin Subd. 8. new text end
new text begin Required elements of action plans; coordination with other employers. new text end
new text begin
The
preparedness and incident response action plans to acts of violence must include methods
the hospital will use to coordinate implementation of the plan with other employers whose
employees work in the same health care facility, unit, service, or operation and to ensure
that those employers and their employees understand their respective roles as provided in
the plan. These methods must ensure that all employees working in the facility, unit, service,
or operation are provided the training required by subdivision 11 and that workplace violence
incidents involving any employee are reported, investigated, and recorded.
new text end
new text begin Subd. 9. new text end
new text begin
Required elements of action plans; white supremacist affiliation and support
prohibited.
new text end
new text begin
(a) The preparedness and incident response action plans to acts of violence
must include a policy statement stating that security personnel employed by the hospital or
assigned to the hospital by a contractor are prohibited from affiliating with, supporting, or
advocating for white supremacist groups, causes, or ideologies or participating in, or actively
promoting, an international or domestic extremist group that the Federal Bureau of
Investigation has determined supports or encourages illegal, violent conduct.
new text end
new text begin
(b) For purposes of this subdivision, white supremacist groups, causes, or ideologies
include organizations and associations and ideologies that promote white supremacy and
the idea that white people are superior to Black, Indigenous, and people of color (BIPOC);
promote religious and racial bigotry; seek to exacerbate racial and ethnic tensions between
BIPOC and non-BIPOC; or engage in patently hateful and inflammatory speech, intimidation,
and violence against BIPOC as means of promoting white supremacy.
new text end
new text begin Subd. 10. new text end
new text begin Required elements of action plans; training. new text end
new text begin
(a) The preparedness and
incident response action plans to acts of violence must include:
new text end
new text begin
(1) procedures for developing and providing the training required in subdivision 11 that
permits health care workers and their representatives to participate in developing the training;
and
new text end
new text begin
(2) a requirement for cultural competency training and equity, diversity, and inclusion
training.
new text end
new text begin
(b) The preparedness and incident response action plans to acts of violence must include
procedures to communicate with health care workers regarding workplace violence matters,
including:
new text end
new text begin
(1) how health care workers will document and communicate to other health care workers
and between shifts and units information regarding conditions that may increase the potential
for workplace violence incidents;
new text end
new text begin
(2) how health care workers can report a violent incident, threat, or other workplace
violence concern;
new text end
new text begin
(3) how health care workers can communicate workplace violence concerns without
fear of reprisal; and
new text end
new text begin
(4) how health care worker concerns will be investigated, and how health care workers
will be informed of the results of the investigation and any corrective actions to be taken.
new text end
new text begin Subd. 11. new text end
new text begin Training required. new text end
deleted text begin (c)deleted text end A hospital deleted text begin shalldeleted text end new text begin mustnew text end provide training to all health
care workers employed or contracted with the hospital on safety during acts of violence.
Each health care worker must receive safety training deleted text begin annually and upon hiredeleted text end new text begin during the
health care worker's orientation and before the health care worker completes a shift
independently, and annually thereafternew text end . Training must, at a minimum, include:
(1) safety guidelines for response to and de-escalation of an act of violence;
(2) ways to identify potentially violent or abusive situationsnew text begin , including aggression and
violence predicting factorsnew text end ; deleted text begin and
deleted text end
(3) the hospital's deleted text begin incident response reaction plan and violence prevention plandeleted text end new text begin
preparedness and incident response action plans for acts of violence, including how the
health care worker may report concerns about workplace violence within each hospital's
reporting structure without fear of reprisal, how the hospital will address workplace violence
incidents, and how the health care worker can participate in reviewing and revising the plan;
and
new text end
new text begin (4) any resources available to health care workers for coping with incidents of violence,
including but not limited to critical incident stress debriefing or employee assistance
programsnew text end .
new text begin Subd. 12. new text end
new text begin Annual review and update of action plans. new text end
deleted text begin (d)deleted text end new text begin (a)new text end As part of its annual
reviewnew text begin of preparedness and incident response action plansnew text end required under deleted text begin paragraph (a)deleted text end new text begin
subdivision 2new text end , the hospital must review with the designated committee:
(1) the effectiveness of its preparedness and incident response action plansnew text begin , including
the sufficiency of security systems, alarms, emergency responses, and security personnel
availabilitynew text end ;
(2) new text begin security risks associated with specific units, areas of the facility with uncontrolled
access, late night shifts, early morning shifts, and areas surrounding the facility such as
employee parking areas and other outdoor areas;
new text end
new text begin (3) new text end the most recent gap analysis as provided by the commissioner; deleted text begin and
deleted text end
deleted text begin (3)deleted text end new text begin (4)new text end the number of acts of violence that occurred in the hospital during the previous
year, including injuries sustained, if any, and the unit in which the incident occurreddeleted text begin .deleted text end new text begin ;
new text end
new text begin
(5) evaluations of staffing, including staffing patterns and patient classification systems
that contribute to, or are insufficient to address, the risk of violence; and
new text end
new text begin
(6) any reports of discrimination or abuse that arise from security resources, including
from the behavior of security personnel.
new text end
new text begin
(b) As part of the annual update of preparedness and incident response action plans
required under subdivision 2, the hospital must incorporate corrective actions into the action
plan to address workplace violence hazards identified during the annual action plan review,
reports of workplace violence, reports of workplace violence hazards, and reports of
discrimination or abuse that arise from the security resources.
new text end
new text begin Subd. 13. new text end
new text begin Action plan updates. new text end
new text begin
Following the annual review of the action plan, a hospital
must update the action plans to reflect the corrective actions the hospital will implement to
mitigate the hazards and vulnerabilities identified during the annual review.
new text end
new text begin Subd. 14. new text end
new text begin Requests for additional staffing. new text end
new text begin
A hospital shall create and implement a
procedure for a health care worker to officially request of hospital supervisors or
administration that additional staffing be provided. The hospital must document all requests
for additional staffing made because of a health care worker's concern over a risk of an act
of violence. If the request for additional staffing to reduce the risk of violence is denied,
the hospital must provide the health care worker who made the request a written reason for
the denial and must maintain documentation of that communication with the documentation
of requests for additional staffing. A hospital must make documentation regarding staffing
requests available to the commissioner for inspection at the commissioner's request. The
commissioner may use documentation regarding staffing requests to inform the
commissioner's determination on whether the hospital is providing adequate staffing and
security to address acts of violence, and may use documentation regarding staffing requests
if the commissioner imposes a penalty under subdivision 18.
new text end
new text begin Subd. 15. new text end
new text begin Disclosure of action plans. new text end
deleted text begin (e)deleted text end new text begin (a)new text end A hospital deleted text begin shalldeleted text end new text begin mustnew text end make itsnew text begin most recentnew text end
action plans and deleted text begin the information listed in paragraph (d)deleted text end new text begin most recent action plan reviewsnew text end
available to deleted text begin local law enforcementdeleted text end new text begin all direct care staffnew text end and, if any of its workers are
represented by a collective bargaining unit, to the exclusive bargaining representatives of
those collective bargaining units.
new text begin
(b) A hospital must also annually submit to the commissioner its most recent action plan
and the results of the most recent annual review conducted under subdivision 12.
new text end
new text begin Subd. 16. new text end
new text begin Legislative report required. new text end
new text begin
(a) The commissioner must compile the
information into a single annual report and submit the report to the chairs and ranking
minority members of the legislative committees with jurisdiction over health care by January
15 of each year.
new text end
new text begin
(b) This subdivision does not expire.
new text end
new text begin Subd. 17. new text end
new text begin Interference prohibited. new text end
deleted text begin (f)deleted text end A hospital, including any individual, partner,
association, or any person or group of persons acting directly or indirectly in the interest of
the hospital, deleted text begin shalldeleted text end new text begin mustnew text end not interfere with or discourage a health care worker if the health
care worker wishes to contact law enforcement or the commissioner regarding an act of
violence.
new text begin Subd. 18. new text end
new text begin Penalties. new text end
deleted text begin (g)deleted text end new text begin Notwithstanding section 144.653, subdivision 6,new text end the
commissioner may impose deleted text begin an administrativedeleted text end new text begin anew text end fine of up to deleted text begin $250deleted text end new text begin $10,000new text end for failure to
comply with the requirements of this deleted text begin subdivisiondeleted text end new text begin sectionnew text end . new text begin The commissioner must allow
the hospital at least 30 calendar days to correct a violation of this section before assessing
a fine.
new text end
Sec. 73.
new text begin
[144.587] REQUIREMENTS FOR SCREENING FOR ELIGIBILITY FOR
HEALTH COVERAGE OR ASSISTANCE.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) The terms defined in this subdivision apply to this section
and sections 144.588 to 144.589.
new text end
new text begin
(b) "Charity care" means the provision of free or discounted care to a patient according
to a hospital's financial assistance policies.
new text end
new text begin
(c) "Hospital" means a private, nonprofit, or municipal hospital licensed under sections
144.50 to 144.56.
new text end
new text begin
(d) "Minnesota attorney general/hospital agreement" means the agreement between the
attorney general and certain Minnesota hospitals that is filed in Ramsey County District
Court and that establishes requirements for hospital litigation practices, garnishments, use
of collection agencies, central billing office practices, and practices for billing uninsured
patients.
new text end
new text begin
(e) "Most favored insurer" means the nongovernmental third-party payor that provided
the most revenue to the provider during the previous calendar year.
new text end
new text begin
(f) "Navigator" has the meaning given in section 62V.02, subdivision 9.
new text end
new text begin
(g) "Premium tax credit" means a tax credit or premium subsidy under the federal Patient
Protection and Affordable Care Act, Public Law 111-148, as amended, including the federal
Health Care and Education Reconciliation Act of 2010, Public Law 111-152, and any
amendments to and federal guidance and regulations issued under these acts.
new text end
new text begin
(h) "Presumptive eligibility" has the meaning given in section 256B.057, subdivision
12.
new text end
new text begin
(i) "Revenue recapture" means the use of the procedures in chapter 270A to collect debt.
new text end
new text begin
(j) "Uninsured service or treatment" means any service or treatment that is not covered
by: (1) a health plan, contract, or policy that provides health coverage to a patient; or (2)
any other type of insurance coverage, including but not limited to no-fault automobile
coverage, workers' compensation coverage, or liability coverage.
new text end
new text begin
(k) "Unreasonable burden" includes requiring a patient to apply for enrollment in a state
or federal program for which the patient is obviously or categorically ineligible or has been
found to be ineligible in the previous 12 months.
new text end
new text begin Subd. 2. new text end
new text begin Screening. new text end
new text begin
A hospital must screen a patient who is uninsured or whose insurance
coverage status is not known by the hospital for: eligibility for charity care from the hospital;
eligibility for state or federal public health care programs using presumptive eligibility or
another similar process; and eligibility for a premium tax credit. The hospital must attempt
to complete this screening process in person or by telephone within 30 days after the patient
receives services at the hospital or at the emergency department associated with the hospital.
new text end
new text begin Subd. 3. new text end
new text begin Charity care. new text end
new text begin
(a) Upon completion of the screening process in subdivision 2,
the hospital must either assist the patient with applying for charity care and refer the patient
to the appropriate department in the hospital for follow-up or make a determination that the
patient is ineligible for charity care. A hospital may initiate one or more of the following
steps only after the hospital determines that the patient is ineligible for charity care and may
not initiate any of the following steps while the patient's application for charity care is
pending:
new text end
new text begin
(1) offering to enroll or enrolling the patient in a payment plan;
new text end
new text begin
(2) changing the terms of a patient's payment plan;
new text end
new text begin
(3) offering the patient a loan or line of credit, application materials for a loan or line of
credit, or assistance with applying for a loan or line of credit, for the payment of medical
debt;
new text end
new text begin
(4) referring a patient's debt for collections, including in-house collections, third-party
collections, revenue recapture, or any other process for the collection of debt;
new text end
new text begin
(5) denying health care services to the patient or any member of the patient's household
because of outstanding medical debt, regardless of whether the services are deemed necessary
or may be available from another provider; or
new text end
new text begin
(6) accepting a credit card payment of over $500 for the medical debt owed to the hospital.
new text end
new text begin
(b) A hospital may not impose application procedures for charity care that place an
unreasonable burden on the individual patient, taking into account the individual patient's
physical, mental, intellectual, or sensory deficiencies or language barriers that may hinder
the patient's ability to comply with application procedures.
new text end
new text begin
(c) When a hospital evaluates a patient's eligibility for charity care, hospital requests to
the responsible party for verification of assets or income shall be limited to:
new text end
new text begin
(1) information that is reasonably necessary and readily available to determine eligibility;
and
new text end
new text begin
(2) facts that are relevant to determine eligibility.
new text end
new text begin
A hospital must not demand duplicate forms of verification of assets.
new text end
new text begin Subd. 4. new text end
new text begin Public health care program; premium tax credit. new text end
new text begin
(a) If a patient is
presumptively eligible for a public health care program, the hospital must assist the patient
in completing an insurance affordability program application, help the patient schedule an
appointment with a navigator organization, or provide the patient with contact information
for the nearest available navigator or certified application counselor services.
new text end
new text begin
(b) If a patient is eligible for a premium tax credit, the hospital may schedule an
appointment for the patient with a navigator or a MNsure-certified insurance broker
organization or provide the patient with contact information for the nearest available navigator
services or a MNsure-certified insurance broker.
new text end
new text begin Subd. 5. new text end
new text begin Patient may decline services. new text end
new text begin
A patient may decline to participate in the
screening process, to apply for charity care, to complete an insurance affordability program
application, to schedule an appointment with a navigator organization, or to accept
information about navigator services.
new text end
new text begin Subd. 6. new text end
new text begin Notice. new text end
new text begin
(a) A hospital must post notice of the availability of charity care from
the hospital in at least the following locations: (1) areas of the hospital where patients are
admitted or registered; (2) emergency departments; and (3) the portion of the hospital's
financial services or billing department that is accessible to patients. The posted notice must
be in all languages spoken by more than five percent of the population in the hospital's
service area.
new text end
new text begin
(b) A hospital must make available on the hospital's website, the current version of the
hospital's charity care policy, a plain-language summary of the policy, and the hospital's
charity care application form. The summary and application form must be available in all
languages spoken by more than five percent of the population in the hospital's service area.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective November 1, 2023.
new text end
Sec. 74.
new text begin
[144.588] CERTIFICATION OF EXPERT REVIEW.
new text end
new text begin Subdivision 1. new text end
new text begin Requirement; referral to third-party debt collection agency. new text end
new text begin
(a) In
order to refer a patient's account to a third-party debt collection agency, a hospital must
complete an affidavit of expert review certifying that the hospital:
new text end
new text begin
(1) confirmed the information required of the hospital in the most recent version of the
Minnesota attorney general/hospital agreement for referral of a specific patient's account
to a third-party debt collection agency; and
new text end
new text begin
(2) unless the patient declined to participate, complied with the requirements in section
144.587 to conduct a patient screening and, as applicable, assist the patient in applying for
charity care, assist the patient with completing an insurance affordability program application,
or refer the patient to a navigator organization.
new text end
new text begin
(b) The affidavit of expert review must be completed by a designated employee of the
hospital seeking to refer the patient's account to a third-party debt collection agency.
new text end
new text begin Subd. 2. new text end
new text begin Penalty for noncompliance. new text end
new text begin
Failure to comply with subdivision 1 shall subject
a hospital to a fine assessed by the commissioner of health.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective November 1, 2023.
new text end
Sec. 75.
new text begin
[144.589] BILLING OF UNINSURED PATIENTS.
new text end
new text begin
A hospital shall not charge a patient whose annual household income is less than $125,000
for any uninsured service or treatment in an amount that exceeds the total amount the
provider would be reimbursed for that service or treatment from its most favored insurer.
The total amount the provider would be reimbursed for that service or treatment from its
most favored insurer includes both the amount the provider would be reimbursed directly
from its most favored insurer, and the amount the provider would be reimbursed from the
insured's policyholder under any applicable co-payments, deductibles, and coinsurance.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective November 1, 2023.
new text end
Sec. 76.
new text begin
[144.593] REQUIREMENTS FOR CERTAIN HEALTH CARE ENTITY
TRANSACTIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have
the meaning given.
new text end
new text begin
(b) "Captive professional entity" means a professional corporation, limited liability
company, or other entity formed to render professional services in which a beneficial owner
is a health care provider employed by, controlled by, or subject to the direction of a hospital
or hospital system.
new text end
new text begin
(c) "Commissioner" means the commissioner of health.
new text end
new text begin
(d) "Health care entity" means:
new text end
new text begin
(1) a hospital;
new text end
new text begin
(2) a hospital system;
new text end
new text begin
(3) a captive professional entity;
new text end
new text begin
(4) a medical foundation;
new text end
new text begin
(5) a health care provider group practice;
new text end
new text begin
(6) an entity organized or controlled by an entity listed in clauses (1) to (5); or
new text end
new text begin
(7) an entity that owns or exercised substantial control over an entity listed in clauses
(1) to (5).
new text end
new text begin
(e) "Health care provider" means a physician licensed under chapter 147, a physician
assistant licensed under chapter 147A, or an advanced practice registered nurse as defined
in section 148.171, subdivision 3, who provides health care services, including but not
limited to medical care, consultation, diagnosis, or treatment.
new text end
new text begin
(f) "Health care provider group practice" means two or more health care providers legally
organized in a partnership, professional corporation, limited liability company, medical
foundation, nonprofit corporation, faculty practice plan, or other similar entity:
new text end
new text begin
(1) in which each health care provider who is a member of the group provides
substantially the full range of services that a health care provider routinely provides, including
but not limited to medical care, consultation, diagnosis, and treatment, through the joint use
of shared office space, facilities, equipment, or personnel;
new text end
new text begin
(2) for which substantially all services of the health care providers who are group
members are provided through the group and are billed in the name of the group practice
and amounts so received are treated as receipts of the group; or
new text end
new text begin
(3) in which the overhead expenses of, and the income from, the group are distributed
in accordance with methods previously determined by members of the group.
new text end
new text begin
An entity that otherwise meets the definition of health care provider group practice in this
paragraph shall be considered a health care provider group practice even if its shareholders,
partners, or owners include single-health care provider professional corporations, limited
liability companies formed to render professional services, or other entities in which
beneficial owners are individual health care providers.
new text end
new text begin
(g) "Hospital" means a health care facility licensed as a hospital under sections 144.50
to 144.56.
new text end
new text begin
(h) "Medical foundation" means a nonprofit legal entity through which physicians or
other health care providers perform research or provide medical services.
new text end
new text begin
(i) "Transaction" means a single action, or a series of actions within a five-year period,
that constitutes:
new text end
new text begin
(1) a merger or exchange of a health care entity with another entity;
new text end
new text begin
(2) the sale, lease, or transfer of 30 percent or more of the assets of a health care entity
to another entity;
new text end
new text begin
(3) the granting of a security interest of 30 percent or more of the property and assets
of a health care entity to another entity;
new text end
new text begin
(4) the transfer of 30 percent or more of the shares or other ownership of the health care
entity to another entity;
new text end
new text begin
(5) an addition or substitution of one or more members of the health care entity's
governing body that effectively transfers control, responsibility for, or governance of the
health care entity to another entity;
new text end
new text begin
(6) the creation of a new health care entity; or
new text end
new text begin
(7) substantial investment of 30 percent or more in a health care entity that results in
sharing of revenues without a change in ownership or voting shares.
new text end
new text begin Subd. 2. new text end
new text begin Notice required. new text end
new text begin
(a) This subdivision applies to all transactions where:
new text end
new text begin
(1) the health care entity involved in the transaction has average revenue of at least
$10,000,000 per year; or
new text end
new text begin
(2) an entity created by the transaction is projected to have average revenue of at least
$10,000,000 per year once the entity is operating at full capacity.
new text end
new text begin
(b) A health care entity must provide notice to the attorney general and the commissioner
and comply with this subdivision before entering into a transaction. Notice must be provided
at least 180 days before the proposed completion date for the transaction.
new text end
new text begin
(c) As part of the notice required under this subdivision, at least 180 days before the
proposed completion date of the transaction, a health care entity must affirmatively disclose
the following to the attorney general and the commissioner:
new text end
new text begin
(1) the entities involved in the transaction;
new text end
new text begin
(2) the leadership of the entities involved in the transaction, including all directors, board
members, and officers;
new text end
new text begin
(3) the services provided by each entity and the attributed revenue for each entity by
location;
new text end
new text begin
(4) the primary service area for each location;
new text end
new text begin
(5) the proposed service area for each location;
new text end
new text begin
(6) the current relationships between the entities and the health care providers and
practices affected, the locations of affected health care providers and practices, the services
provided by affected health care providers and practices, and the proposed relationships
between the entities and the health care providers and practices affected;
new text end
new text begin
(7) the terms of the transaction agreement or agreements;
new text end
new text begin
(8) the acquisition price;
new text end
new text begin
(9) markets in which the entities expect postmerger synergies to produce a competitive
advantage;
new text end
new text begin
(10) potential areas of expansion, whether in existing markets or new markets;
new text end
new text begin
(11) plans to close facilities, reduce workforce, or reduce or eliminate services;
new text end
new text begin
(12) the experts and consultants used to evaluate the transaction;
new text end
new text begin
(13) the number of full-time equivalent positions at each location before and after the
transaction by job category, including administrative and contract positions; and
new text end
new text begin
(14) any other information requested by the attorney general or commissioner.
new text end
new text begin
(d) As part of the notice required under this subdivision, at least 180 days before the
proposed completion date of the transaction, a health care entity must affirmatively produce
the following to the attorney general and the commissioner:
new text end
new text begin
(1) the current governing documents for all entities involved in the transaction and any
amendments to these documents;
new text end
new text begin
(2) the transaction agreement or agreements and all related agreements;
new text end
new text begin
(3) any collateral agreements related to the principal transaction, including leases,
management contracts, and service contracts;
new text end
new text begin
(4) all expert or consultant reports or valuations conducted in evaluating the transaction,
including any valuation of the assets that are subject to the transaction prepared within three
years preceding the anticipated transaction completion date and any reports of financial or
economic analysis conducted in anticipation of the transaction;
new text end
new text begin
(5) the results of any projections or modeling of health care utilization or financial
impacts related to the transaction, including but not limited to copies of reports by appraisers,
accountants, investment bankers, actuaries, and other experts;
new text end
new text begin
(6) a financial and economic analysis and report prepared by an independent expert or
consultant on the effects of the transaction;
new text end
new text begin
(7) an impact analysis report prepared by an independent expert or consultant on the
effects of the transaction on communities and the workforce, including any changes in
availability or accessibility of services;
new text end
new text begin
(8) all documents reflecting the purposes of or restrictions on any related nonprofit
entity's charitable assets;
new text end
new text begin
(9) copies of all filings submitted to federal regulators, including any Hart-Scott-Rodino
filing the entities submitted to the Federal Trade Commission in connection with the
transaction;
new text end
new text begin
(10) a certification sworn under oath by each board member and chief executive officer
for any nonprofit entity involved in the transaction containing the following: an explanation
of how the completed transaction is in the public interest, addressing the factors in subdivision
5, paragraph (a); a disclosure of each declarant's compensation and benefits relating to the
transaction for the three years following the transaction's anticipated completion date; and
a disclosure of any conflicts of interest;
new text end
new text begin
(11) audited and unaudited financial statements from all entities involved in the
transaction and tax filings for all entities involved in the transaction covering the preceding
five fiscal years; and
new text end
new text begin
(12) any other information or documents requested by the attorney general or
commissioner.
new text end
new text begin
(e) The commissioner may adopt rules to implement this section, and may alter, amend,
suspend, or repeal any of such rules. The requirements of section 14.125 do not apply to
the adoption of rules under this paragraph.
new text end
new text begin
(f) The attorney general may extend the notice and waiting period required under
paragraph (b) for an additional 90 days by notifying the health care entity in writing of the
extension.
new text end
new text begin
(g) The attorney general may waive all or any part of the notice and waiting period
required under paragraph (b).
new text end
new text begin
(h) The attorney general or the commissioner may hold public listening sessions or
forums to obtain input on the transaction from providers or community members who may
be impacted by the transaction.
new text end
new text begin
(i) The attorney general or the commissioner may bring an action in district court to
compel compliance with the notice requirements in this subdivision.
new text end
new text begin Subd. 3. new text end
new text begin Prohibited transactions. new text end
new text begin
No health care entity may enter into a transaction
that will:
new text end
new text begin
(1) substantially lessen competition; or
new text end
new text begin
(2) tend to create a monopoly or monopsony.
new text end
new text begin Subd. 4. new text end
new text begin Additional requirements for nonprofit health care entities. new text end
new text begin
A health care
entity that is incorporated under chapter 317A or organized under section 322C.1101, or
that is a subsidiary of any such entity, must, before entering into a transaction, ensure that:
new text end
new text begin
(1) the transaction complies with chapters 317A and 501B and other applicable laws;
new text end
new text begin
(2) the transaction does not involve or constitute a breach of charitable trust;
new text end
new text begin
(3) the nonprofit health care entity will receive full and fair value for its public benefit
assets;
new text end
new text begin
(4) the value of the public benefit assets to be transferred has not been manipulated in
a manner that causes or has caused the value of the assets to decrease;
new text end
new text begin
(5) the proceeds of the transaction will be used in a manner consistent with the public
benefit for which the assets are held by the nonprofit health care entity;
new text end
new text begin
(6) the transaction will not result in a breach of fiduciary duty; and
new text end
new text begin
(7) there are procedures and policies in place to prohibit any officer, director, trustee,
or other executive of the nonprofit health care entity from directly or indirectly benefiting
from the transaction.
new text end
new text begin Subd. 5. new text end
new text begin Attorney general enforcement and supplemental authority. new text end
new text begin
(a) The attorney
general may bring an action in district court to enjoin or unwind a transaction or seek other
equitable relief necessary to protect the public interest if a health care entity or transaction
violates this section, if the transaction is contrary to the public interest, or if both a health
care entity or transaction violates this section and the transaction is contrary to the public
interest. Factors informing whether a transaction is contrary to the public interest include
but are not limited to whether the transaction:
new text end
new text begin
(1) will harm public health;
new text end
new text begin
(2) will reduce the affected community's continued access to affordable and quality care
and to the range of services historically provided by the entities or will prevent members
in the affected community from receiving a comparable or better patient experience;
new text end
new text begin
(3) will have a detrimental impact on competing health care options within primary and
dispersed service areas;
new text end
new text begin
(4) will reduce delivery of health care to disadvantaged, uninsured, underinsured, and
underserved populations and to populations enrolled in public health care programs;
new text end
new text begin
(5) will have a substantial negative impact on medical education and teaching programs,
health care workforce training, or medical research;
new text end
new text begin
(6) will have a negative impact on the market for health care services, health insurance
services, or skilled health care workers;
new text end
new text begin
(7) will increase health care costs for patients; or
new text end
new text begin
(8) will adversely impact provider cost trends and containment of total health care
spending.
new text end
new text begin
(b) The attorney general may enforce this section under section 8.31.
new text end
new text begin
(c) Failure of the entities involved in a transaction to provide timely information as
required by the attorney general or the commissioner shall be an independent and sufficient
ground for a court to enjoin the transaction or provide other equitable relief, provided the
attorney general notified the entities of the inadequacy of the information provided and
provided the entities with a reasonable opportunity to remedy the inadequacy.
new text end
new text begin
(d) The attorney general shall consult with the commissioner to determine whether a
transaction is contrary to the public interest. Any information exchanged between the attorney
general and the commissioner according to this subdivision is confidential data on individuals
as defined in section 13.02, subdivision 3, or protected nonpublic data as defined in section
13.02, subdivision 13. The commissioner may share with the attorney general, according
to section 13.05, subdivision 9, any not public data, as defined in section 13.02, subdivision
8a, held by the Department of Health to aid in the investigation and review of the transaction,
and the attorney general must maintain this data with the same classification according to
section 13.03, subdivision 4, paragraph (d).
new text end
new text begin Subd. 6. new text end
new text begin Supplemental authority of commissioner. new text end
new text begin
(a) Notwithstanding any law to
the contrary, the commissioner may use data or information submitted under this section,
section 62U.04, and sections 144.695 to 144.705 to conduct analyses of the aggregate impact
of health care transactions on access to or the cost of health care services, health care market
consolidation, and health care quality.
new text end
new text begin
(b) The commissioner shall issue periodic public reports on the number and types of
transactions subject to this section and on the aggregate impact of transactions on health
care cost, quality, and competition in Minnesota.
new text end
new text begin Subd. 7. new text end
new text begin Relation to other law. new text end
new text begin
(a) The powers and authority under this section are in
addition to, and do not affect or limit, all other rights, powers, and authority of the attorney
general or the commissioner under chapter 8, 309, 317A, 325D, 501B, or other law.
new text end
new text begin
(b) Nothing in this section shall suspend any obligation imposed under chapter 8, 309,
317A, 325D, 501B, or other law on the entities involved in a transaction.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment and
applies to transactions completed on or after that date. In determining whether a transaction
was completed on or after the effective date, any actions or series of actions necessary to
the completion of the transaction that occurred prior to the effective date must be considered.
new text end
Sec. 77.
Minnesota Statutes 2022, section 144.608, subdivision 1, is amended to read:
Subdivision 1.
Trauma Advisory Council established.
(a) A Trauma Advisory Council
is established to advise, consult with, and make recommendations to the commissioner on
the development, maintenance, and improvement of a statewide trauma system.
(b) The council shall consist of the following members:
(1) a trauma surgeon certified by the American Board of Surgery or the American
Osteopathic Board of Surgery who practices in a level I or II trauma hospital;
(2) a general surgeon certified by the American Board of Surgery or the American
Osteopathic Board of Surgery whose practice includes trauma and who practices in a
designated rural area as defined under section 144.1501, subdivision 1deleted text begin , paragraph (e)deleted text end ;
(3) a neurosurgeon certified by the American Board of Neurological Surgery who
practices in a level I or II trauma hospital;
(4) a trauma program nurse manager or coordinator practicing in a level I or II trauma
hospital;
(5) an emergency physician certified by the American Board of Emergency Medicine
or the American Osteopathic Board of Emergency Medicine whose practice includes
emergency room care in a level I, II, III, or IV trauma hospital;
(6) a trauma program manager or coordinator who practices in a level III or IV trauma
hospital;
(7) a physician certified by the American Board of Family Medicine or the American
Osteopathic Board of Family Practice whose practice includes emergency department care
in a level III or IV trauma hospital located in a designated rural area as defined under section
144.1501, subdivision 1deleted text begin , paragraph (e)deleted text end ;
(8) a nurse practitioner, as defined under section 144.1501, subdivision 1deleted text begin , paragraph (l)deleted text end ,
or a physician assistant, as defined under section 144.1501, subdivision 1deleted text begin , paragraph (o)deleted text end ,
whose practice includes emergency room care in a level IV trauma hospital located in a
designated rural area as defined under section 144.1501, subdivision 1deleted text begin , paragraph (e)deleted text end ;
(9) a physician certified in pediatric emergency medicine by the American Board of
Pediatrics or certified in pediatric emergency medicine by the American Board of Emergency
Medicine or certified by the American Osteopathic Board of Pediatrics whose practice
primarily includes emergency department medical care in a level I, II, III, or IV trauma
hospital, or a surgeon certified in pediatric surgery by the American Board of Surgery whose
practice involves the care of pediatric trauma patients in a trauma hospital;
(10) an orthopedic surgeon certified by the American Board of Orthopaedic Surgery or
the American Osteopathic Board of Orthopedic Surgery whose practice includes trauma
and who practices in a level I, II, or III trauma hospital;
(11) the state emergency medical services medical director appointed by the Emergency
Medical Services Regulatory Board;
(12) a hospital administrator of a level III or IV trauma hospital located in a designated
rural area as defined under section 144.1501, subdivision 1deleted text begin , paragraph (e)deleted text end ;
(13) a rehabilitation specialist whose practice includes rehabilitation of patients with
major trauma injuries or traumatic brain injuries and spinal cord injuries as defined under
section 144.661;
(14) an attendant or ambulance director who is an EMT, deleted text begin EMT-I, or EMT-Pdeleted text end new text begin AEMT, or
paramedicnew text end within the meaning of section 144E.001 and who actively practices with a licensed
ambulance service in a primary service area located in a designated rural area as defined
under section 144.1501, subdivision 1deleted text begin , paragraph (e)deleted text end ; and
(15) the commissioner of public safety or the commissioner's designee.
Sec. 78.
Minnesota Statutes 2022, section 144.615, subdivision 7, is amended to read:
Subd. 7.
Limitations of services.
(a) The following limitations apply to the services
performed at a birth center:
(1) surgical procedures must be limited to those normally accomplished during an
uncomplicated birth, including episiotomy and repair;new text begin and
new text end
deleted text begin
(2) no abortions may be administered; and
deleted text end
deleted text begin (3)deleted text end new text begin (2)new text end no general or regional anesthesia may be administered.
(b) Notwithstanding paragraph (a), local anesthesia may be administered at a birth center
if the administration of the anesthetic is performed within the scope of practice of a health
care professional.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 79.
Minnesota Statutes 2022, section 144.651, is amended by adding a subdivision
to read:
new text begin Subd. 10a. new text end
new text begin Designated support person for pregnant patient. new text end
new text begin
(a) A health care provider
and a health care facility must allow, at a minimum, one designated support person of a
pregnant patient's choosing to be physically present while the patient is receiving health
care services including during a hospital stay.
new text end
new text begin
(b) For purposes of this subdivision, "designated support person" means any person
necessary to provide comfort to the patient including but not limited to the patient's spouse,
partner, family member, or another person related by affinity. Certified doulas and traditional
midwives may not be counted toward the limit of one designated support person.
new text end
Sec. 80.
Minnesota Statutes 2022, section 144.653, subdivision 5, is amended to read:
Subd. 5.
Correction orders.
Whenever a duly authorized representative of the state
commissioner of health finds upon inspection of a facility required to be licensed under the
provisions of sections 144.50 to 144.58 that the licensee of such facility is not in compliance
with sections 144.411 to 144.417, 144.50 to 144.58, 144.651,new text begin 144.7051 to 144.7058,new text end or
626.557, or the applicable rules promulgated under those sections, a correction order shall
be issued to the licensee. The correction order shall state the deficiency, cite the specific
rule violated, and specify the time allowed for correction.
Sec. 81.
Minnesota Statutes 2022, section 144.6535, subdivision 1, is amended to read:
Subdivision 1.
Request for variance or waiver.
A hospital may request that the
commissioner grant a variance or waiver from the provisions of deleted text begin Minnesota Rules, chapter
4640 or 4645deleted text end new text begin section 144.55, subdivision 3, paragraph (b)new text end . A request for a variance or waiver
must be submitted to the commissioner in writing. Each request must contain:
(1) the specific deleted text begin rule or rulesdeleted text end new text begin requirementnew text end for which the variance or waiver is requested;
(2) the reasons for the request;
(3) the alternative measures that will be taken if a variance or waiver is granted;
(4) the length of time for which the variance or waiver is requested; and
(5) other relevant information deemed necessary by the commissioner to properly evaluate
the request for the variance or waiver.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024.
new text end
Sec. 82.
Minnesota Statutes 2022, section 144.6535, subdivision 2, is amended to read:
Subd. 2.
Criteria for evaluation.
The decision to grant or deny a variance or waiver
must be based on the commissioner's evaluation of the following criteria:
(1) whether the variance or waiver will adversely affect the health, treatment, comfort,
safety, or well-being of a patient;
(2) whether the alternative measures to be taken, if any, are equivalent to or superior to
those prescribed in deleted text begin Minnesota Rules, chapter 4640 or 4645deleted text end new text begin section 144.55, subdivision 3,
paragraph (b)new text end ; and
(3) whether compliance with the deleted text begin rule or rulesdeleted text end new text begin requirementsnew text end would impose an undue
burden upon the applicant.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024.
new text end
Sec. 83.
Minnesota Statutes 2022, section 144.6535, subdivision 4, is amended to read:
Subd. 4.
Effect of alternative measures or conditions.
(a) Alternative measures or
conditions attached to a variance or waiver have the same force and effect as the deleted text begin rulesdeleted text end new text begin
requirementnew text end under deleted text begin Minnesota Rules, chapter 4640 or 4645deleted text end new text begin section 144.55, subdivision 3,
paragraph (b)new text end , and are subject to the issuance of correction orders and penalty assessments
in accordance with section 144.55.
(b) Fines for a violation of this section shall be in the same amount as that specified for
the particular deleted text begin ruledeleted text end new text begin requirementnew text end for which the variance or waiver was requested.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024.
new text end
Sec. 84.
Minnesota Statutes 2022, section 144.69, is amended to read:
144.69 CLASSIFICATION OF DATA ON INDIVIDUALS.
new text begin Subdivision 1. new text end
new text begin Data collected by the cancer reporting system. new text end
Notwithstanding any
law to the contrary, including section 13.05, subdivision 9, data collected on individuals by
the cancer deleted text begin surveillancedeleted text end new text begin reportingnew text end system, including the names and personal identifiers of
persons required in section 144.68 to report, shall be private and may only be used for the
purposes set forth in this section and sections 144.671, 144.672, and 144.68. Any disclosure
other than is provided for in this section and sections 144.671, 144.672, and 144.68, is
declared to be a misdemeanor and punishable as such. Except as provided by rule, and as
part of an epidemiologic investigation, an officer or employee of the commissioner of health
may interview patients named in any such report, or relatives of any such patient, only after
deleted text begin the consent ofdeleted text end new text begin notifyingnew text end the attending physician, advanced practice registered nurse, physician
assistant, or surgeon deleted text begin is obtaineddeleted text end .new text begin Research protections for patients must be consistent with
section 13.04, subdivision 2, and Code of Federal Regulations, title 45, part 46.
new text end
new text begin Subd. 2. new text end
new text begin
Transfers of information to state cancer registries and federal government
agencies.
new text end
new text begin
(a) Information containing personal identifiers of a non-Minnesota resident
collected by the cancer reporting system may be provided to the statewide cancer registry
of the nonresident's home state solely for the purposes consistent with this section and
sections 144.671, 144.672, and 144.68, provided that the other state agrees to maintain the
classification of the information as provided under subdivision 1.
new text end
new text begin
(b) Information, excluding direct identifiers such as name, Social Security number,
telephone number, and street address, collected by the cancer reporting system may be
provided to the Centers for Disease Control and Prevention's National Program of Cancer
Registries and the National Cancer Institute's Surveillance, Epidemiology, and End Results
Program registry.
new text end
Sec. 85.
new text begin
[144.7051] DEFINITIONS.
new text end
new text begin Subdivision 1. new text end
new text begin Applicability. new text end
new text begin
For the purposes of sections 144.7051 to 144.7058, the
terms defined in this section have the meanings given.
new text end
new text begin Subd. 2. new text end
new text begin Concern for safe staffing form. new text end
new text begin
"Concern for safe staffing form" means a
standard uniform form developed by the commissioner that may be used by any individual
to report unsafe staffing situations while maintaining the privacy of patients.
new text end
new text begin Subd. 3. new text end
new text begin Commissioner. new text end
new text begin
"Commissioner" means the commissioner of health.
new text end
new text begin Subd. 4. new text end
new text begin Daily staffing schedule. new text end
new text begin
"Daily staffing schedule" means the actual number
of full-time equivalent nonmanagerial care staff assigned to an inpatient care unit and
providing care in that unit during a 24-hour period and the actual number of patients assigned
to each direct care registered nurse present and providing care in the unit.
new text end
new text begin Subd. 5. new text end
new text begin Direct care registered nurse. new text end
new text begin
"Direct care registered nurse" means a registered
nurse, as defined in section 148.171, subdivision 20, who is nonsupervisory and
nonmanagerial and who directly provides nursing care to patients more than 60 percent of
the time.
new text end
new text begin Subd. 6. new text end
new text begin Hospital. new text end
new text begin
"Hospital" means any setting that is licensed under this chapter as a
hospital.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2025.
new text end
Sec. 86.
new text begin
[144.7053] HOSPITAL NURSE STAFFING COMMITTEE.
new text end
new text begin Subdivision 1. new text end
new text begin Hospital nurse staffing committee required. new text end
new text begin
(a) Each hospital must
establish and maintain a functioning hospital nurse staffing committee. A hospital may
assign the functions and duties of a hospital nurse staffing committee to an existing committee
provided the existing committee meets the membership requirements applicable to a hospital
nurse staffing committee.
new text end
new text begin
(b) The commissioner is not required to verify compliance with this section by an on-site
visit.
new text end
new text begin Subd. 2. new text end
new text begin Staffing committee membership. new text end
new text begin
(a) At least 35 percent of the hospital nurse
staffing committee's membership must be direct care registered nurses typically assigned
to a specific unit for an entire shift and at least 15 percent of the committee's membership
must be other direct care workers typically assigned to a specific unit for an entire shift.
Direct care registered nurses and other direct care workers who are members of a collective
bargaining unit shall be appointed or elected to the committee according to the guidelines
of the applicable collective bargaining agreement. If there is no collective bargaining
agreement, direct care registered nurses shall be elected to the committee by direct care
registered nurses employed by the hospital and other direct care workers shall be elected
to the committee by other direct care workers employed by the hospital.
new text end
new text begin
(b) The hospital shall appoint 50 percent of the hospital nurse staffing committee's
membership.
new text end
new text begin Subd. 3. new text end
new text begin Staffing committee compensation. new text end
new text begin
A hospital must treat participation in the
hospital nurse staffing committee meetings by any hospital employee as scheduled work
time and compensate each committee member at the employee's existing rate of pay. A
hospital must relieve all direct care registered nurse members of the hospital nurse staffing
committee of other work duties during the times when the committee meets.
new text end
new text begin Subd. 4. new text end
new text begin Staffing committee meeting frequency. new text end
new text begin
Each hospital nurse staffing committee
must meet at least quarterly.
new text end
new text begin Subd. 5. new text end
new text begin Staffing committee duties. new text end
new text begin
(a) Each hospital nurse staffing committee shall
create, implement, continuously evaluate, and update as needed evidence-based written
core staffing plans to guide the creation of daily staffing schedules for each inpatient care
unit of the hospital.
new text end
new text begin
(b) Each hospital nurse staffing committee must:
new text end
new text begin
(1) establish a secure, uniform, and easily accessible method for any hospital employee,
patient, or patient family member to submit directly to the committee a concern for safe
staffing form;
new text end
new text begin
(2) review each concern for safe staffing form;
new text end
new text begin
(3) forward a copy of all concern for safe staffing forms to the relevant hospital nurse
workload committee;
new text end
new text begin
(4) review the documentation of compliance maintained by the hospital under section
144.7056, subdivision 10;
new text end
new text begin
(5) conduct a trend analysis of the data related to all reported concerns regarding safe
staffing;
new text end
new text begin
(6) develop a mechanism for tracking and analyzing staffing trends within the hospital;
new text end
new text begin
(7) submit a nurse staffing report to the commissioner;
new text end
new text begin
(8) assist the commissioner in compiling data for the Nursing Workforce Report by
encouraging participation in the commissioner's independent study on reasons licensed
registered nurses are leaving the profession; and
new text end
new text begin
(9) record in the committee minutes for each meeting a summary of the discussions and
recommendations of the committee. Each committee must maintain the minutes, records,
and distributed materials for five years.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2025.
new text end
Sec. 87.
new text begin
[144.7054] HOSPITAL NURSE WORKLOAD COMMITTEE.
new text end
new text begin Subdivision 1. new text end
new text begin Hospital nurse workload committee required. new text end
new text begin
(a) Each hospital must
establish and maintain functioning hospital nurse workload committees for each unit.
new text end
new text begin
(b) The commissioner is not required to verify compliance with this section by an on-site
visit.
new text end
new text begin Subd. 2. new text end
new text begin Workload committee membership. new text end
new text begin
(a) At least 35 percent of each workload
committee's membership must be direct care registered nurses typically assigned to the unit
for an entire shift and at least 15 percent of the committee's membership must be other direct
care workers typically assigned to the unit for an entire shift. Direct care registered nurses
and other direct care workers who are members of a collective bargaining unit shall be
appointed or elected to the committee according to the guidelines of the applicable collective
bargaining agreement. If there is no collective bargaining agreement, direct care registered
nurses shall be elected to the committee by direct care registered nurses typically assigned
to the unit for an entire shift and other direct care workers shall be elected to the committee
by other direct care workers typically assigned to the unit for an entire shift.
new text end
new text begin
(b) The hospital shall appoint 50 percent of each unit's nurse workload committee's
membership.
new text end
new text begin
(c) Notwithstanding paragraphs (a) and (b), if a hospital has established a staffing
committee through collective bargaining, then the composition of that committee prevails.
new text end
new text begin Subd. 3. new text end
new text begin Workload committee compensation. new text end
new text begin
A hospital must treat participation in a
hospital nurse workload committee meeting by any hospital employee as scheduled work
time and compensate each committee member at the employee's existing rate of pay. A
hospital must relieve all direct care registered nurse members of a hospital nurse workload
committee of other work duties during the times when the committee meets.
new text end
new text begin Subd. 4. new text end
new text begin Workload committee meeting frequency. new text end
new text begin
Each hospital nurse workload
committee must meet at least monthly whenever the committee is in receipt of an unresolved
concern for safe staffing form.
new text end
new text begin Subd. 5. new text end
new text begin Workload committee duties. new text end
new text begin
(a) Each hospital nurse workload committee
must create, implement, and maintain dispute resolution procedures to guide the committee's
development and implementation of solutions to the staffing concerns raised in concern for
safe staffing forms that have been forwarded to the committee. The dispute resolution
procedures must include an expedited arbitration process with an arbitrator who has expertise
in patient care. The committee must use the expedited arbitration process for any complaint
that remains unresolved 30 days after the submission of the concern for safe staffing form
that gave rise to the complaint.
new text end
new text begin
(b) Each hospital nurse workload committee must attempt to expeditiously resolve
staffing issues the committee determines arise from a violation of the hospital's core staffing
plan.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2025.
new text end
Sec. 88.
Minnesota Statutes 2022, section 144.7055, is amended to read:
144.7055 new text begin HOSPITAL CORE new text end STAFFING PLAN deleted text begin REPORTSdeleted text end .
Subdivision 1.
Definitions.
(a) For the purposes of deleted text begin this sectiondeleted text end new text begin sections 144.7051 to
144.7058new text end , the following terms have the meanings given.
(b) "Core staffing plan" means deleted text begin the projected number of full-time equivalent
nonmanagerial care staff that will be assigned in a 24-hour period to an inpatient care unitdeleted text end new text begin
a plan described in subdivision 2new text end .
(c) "Nonmanagerial care staff" means registered nurses, licensed practical nurses, and
other health care workers, which may include but is not limited to nursing assistants, nursing
aides, patient care technicians, and patient care assistants, who perform nonmanagerial
direct patient care functions for more than 50 percent of their scheduled hours on a given
patient care unit.
(d) "Inpatient care unit"new text begin or "unit"new text end means a designated inpatient area for assigning patients
and staff for which a deleted text begin distinct staffing plandeleted text end new text begin daily staffing schedulenew text end exists and that operates
24 hours per day, seven days per week in a hospital setting. Inpatient care unit does not
include any hospital-based clinic, long-term care facility, or outpatient hospital department.
(e) "Staffing hours per patient day" means the number of full-time equivalent
nonmanagerial care staff who will ordinarily be assigned to provide direct patient care
divided by the expected average number of patients upon which such assignments are based.
deleted text begin
(f) "Patient acuity tool" means a system for measuring an individual patient's need for
nursing care. This includes utilizing a professional registered nursing assessment of patient
condition to assess staffing need.
deleted text end
Subd. 2.
Hospitalnew text begin corenew text end staffing deleted text begin reportdeleted text end new text begin plansnew text end .
(a) The deleted text begin chief nursing executive or nursing
designeedeleted text end new text begin hospital nurse staffing committeenew text end of every deleted text begin reportingdeleted text end hospital deleted text begin in Minnesota under
section 144.50 willdeleted text end new text begin mustnew text end develop a core staffing plan for each deleted text begin patientdeleted text end new text begin inpatientnew text end care unit.
new text begin
(b) The commissioner is not required to verify compliance with this section by an on-site
visit.
new text end
deleted text begin (b)deleted text end new text begin (c)new text end Core staffing plans deleted text begin shalldeleted text end new text begin mustnew text end specifynew text begin all of the following:
new text end
new text begin (1) new text end thenew text begin projected number ofnew text end full-time equivalent deleted text begin fordeleted text end new text begin nonmanagerial care staff that will
be assigned in a 24-hour period tonew text end each deleted text begin patientdeleted text end new text begin inpatientnew text end care unit deleted text begin for each 24-hour period.deleted text end new text begin ;
new text end
new text begin
(2) the maximum number of patients on each inpatient care unit for whom a direct care
nurse can typically safely care;
new text end
new text begin
(3) criteria for determining when circumstances exist on each inpatient care unit such
that a direct care nurse cannot safely care for the typical number of patients and when
assigning a lower number of patients to each nurse on the inpatient unit would be appropriate;
new text end
new text begin
(4) a procedure for each inpatient care unit to make shift-to-shift adjustments in staffing
levels when such adjustments are required by patient acuity and nursing intensity in the
unit;
new text end
new text begin
(5) a contingency plan for each inpatient unit to safely address circumstances in which
patient care needs unexpectedly exceed the staffing resources provided for in a daily staffing
schedule. A contingency plan must include a method to quickly identify, for each daily
staffing schedule, additional direct care registered nurses who are available to provide direct
care on the inpatient care unit;
new text end
new text begin
(6) strategies to enable direct care registered nurses to take breaks they are entitled to
under law or under an applicable collective bargaining agreement; and
new text end
new text begin
(7) strategies to eliminate patient boarding in emergency departments that do not rely
on requiring direct care registered nurses to work additional hours to provide care.
new text end
deleted text begin (c)deleted text end new text begin (d) Core staffing plans must ensure that:
new text end
new text begin
(1) the person creating a daily staffing schedule has sufficiently detailed information to
create a daily staffing schedule that meets the requirements of the plan;
new text end
new text begin
(2) daily staffing schedules do not rely on assigning individual nonmanagerial care staff
to work overtime hours in excess of 16 hours in a 24-hour period or to work consecutive
24-hour periods requiring 16 or more hours;
new text end
new text begin
(3) a direct care registered nurse is not required or expected to perform functions outside
the nurse's professional license;
new text end
new text begin
(4) a light duty direct care registered nurse is given appropriate assignments;
new text end
new text begin
(5) a charge nurse does not have patient assignments; and
new text end
new text begin
(6) daily staffing schedules do not interfere with applicable collective bargaining
agreements.
new text end
new text begin Subd. 2a. new text end
new text begin Development of hospital core staffing plans. new text end
new text begin (a) new text end Prior to deleted text begin submittingdeleted text end new text begin
completing or updatingnew text end the core staffing plan, deleted text begin as required in subdivision 3, hospitals shalldeleted text end new text begin
a hospital nurse staffing committee mustnew text end consult with representatives of the hospital medical
staff, managerial and nonmanagerial care staff, and other relevant hospital personnel about
the core staffing plan and the expected average number of patients upon which thenew text begin corenew text end
staffing plan is based.
new text begin
(b) When developing a core staffing plan, a hospital nurse staffing committee must
consider all of the following:
new text end
new text begin
(1) the individual needs and expected census of each inpatient care unit;
new text end
new text begin
(2) unit-specific patient acuity, including fall risk and behaviors requiring intervention,
such as physical aggression toward self or others or destruction of property;
new text end
new text begin
(3) unit-specific demands on direct care registered nurses' time, including: frequency of
admissions, discharges, and transfers; frequency and complexity of patient evaluations and
assessments; frequency and complexity of nursing care planning; planning for patient
discharge; assessing for patient referral; patient education; and implementing infectious
disease protocols;
new text end
new text begin
(4) the architecture and geography of the inpatient care unit, including the placement of
patient rooms, treatment areas, nursing stations, medication preparation areas, and equipment;
new text end
new text begin
(5) mechanisms and procedures to provide for one-to-one patient observation for patients
on psychiatric or other units;
new text end
new text begin
(6) the stress that direct care nurses experience when required to work extreme amounts
of overtime, such as shifts in excess of 12 hours or multiple consecutive double shifts;
new text end
new text begin
(7) the need for specialized equipment and technology on the unit;
new text end
new text begin
(8) other special characteristics of the unit or community patient population, including
age, cultural and linguistic diversity and needs, functional ability, communication skills,
and other relevant social and socioeconomic factors;
new text end
new text begin
(9) the skill mix of personnel other than direct care registered nurses providing or
supporting direct patient care on the unit;
new text end
new text begin
(10) mechanisms and procedures for identifying additional registered nurses who are
available for direct patient care when patients' unexpected needs exceed the planned workload
for direct care staff; and
new text end
new text begin
(11) demands on direct care registered nurses' time not directly related to providing
direct care on a unit, such as involvement in quality improvement activities, professional
development, service to the hospital, including serving on the hospital nurse staffing
committee or the hospital nurse workload committee, and service to the profession.
new text end
new text begin Subd. 2b. new text end
new text begin Failure to develop hospital core staffing plans. new text end
new text begin
If a hospital nurse staffing
committee cannot approve a hospital core staffing plan by a majority vote, the members of
the nurse staffing committee must enter an expedited arbitration process with an arbitrator
who understands patient care needs.
new text end
new text begin Subd. 2c. new text end
new text begin Objections to hospital core staffing plans. new text end
new text begin
(a) If hospital management objects
to a core staffing plan approved by a majority vote of the hospital nurse staffing committee,
the hospital may elect to attempt to amend the core staffing plan through arbitration.
new text end
new text begin
(b) During an ongoing dispute resolution process, a hospital must continue to implement
the core staffing plan as written and approved by the hospital nurse staffing committee.
new text end
new text begin
(c) If the dispute resolution process results in an amendment to the core staffing plan,
the hospital must implement the amended core staffing plan.
new text end
new text begin Subd. 2d. new text end
new text begin Mandatory submission of core staffing plan to commissioner. new text end
new text begin
Each hospital
must submit to the commissioner the core staffing plans approved by the hospital's nurse
staffing committee. A hospital must submit any substantial updates to any previously
approved plan, including any amendments to the plan resulting from arbitration, within 30
calendar days of approval of the update by the committee or the conclusion of arbitration.
new text end
Subd. 3.
Standard electronic reporting developed.
deleted text begin
(a) Hospitals must submit the core
staffing plans to the Minnesota Hospital Association by January 1, 2014. The Minnesota
Hospital Association shall include each reporting hospital's core staffing plan on the
Minnesota Hospital Association's Minnesota Hospital Quality Report website by April 1,
2014. any substantial changes to the core staffing plan shall be updated within 30 days.
deleted text end
deleted text begin (b)deleted text end The Minnesota Hospital Association shall include on its website for each reporting
hospital on a quarterly basis the actual direct patient care hours per patient and per unit.
Hospitals must submit the direct patient care report to the Minnesota Hospital Association
by July 1, 2014, and quarterly thereafter.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2025.
new text end
Sec. 89.
new text begin
[144.7056] IMPLEMENTATION OF HOSPITAL CORE STAFFING PLANS.
new text end
new text begin Subdivision 1. new text end
new text begin Plan implementation required. new text end
new text begin
(a) A hospital must implement the core
staffing plans approved by a majority vote of its hospital nurse staffing committee.
new text end
new text begin
(b) The commissioner is not required to verify compliance with this section by on-site
visits during routine hospital surveys.
new text end
new text begin Subd. 2. new text end
new text begin Public posting of core staffing plans. new text end
new text begin
A hospital must post its core staffing
plan for each inpatient care unit in a public area on the relevant unit.
new text end
new text begin Subd. 3. new text end
new text begin Public posting of compliance with plan. new text end
new text begin
For each publicly posted core staffing
plan, a hospital must post a notice stating whether the current staffing on the unit complies
with the hospital's core staffing plan for that unit. The public notice of compliance must
include a list of the number of nonmanagerial care staff working on the unit during the
current shift and the number of patients assigned to each direct care registered nurse working
on the unit during the current shift. The list must enumerate the nonmanagerial care staff
by health care worker type. The public notice of compliance must be posted immediately
adjacent to the publicly posted core staffing plan.
new text end
new text begin Subd. 4. new text end
new text begin Posting of compliance in patient rooms. new text end
new text begin
A hospital must post on a whiteboard
in a patient's room or make available through a television in a patient's room both the number
of patients a nurse on the patient's unit should be assigned under the relevant core staffing
plan and the number of patients actually assigned to a nurse during the current shift.
new text end
new text begin Subd. 5. new text end
new text begin Deviations from core staffing plans. new text end
new text begin
(a) Before hospital management lowers
the staffing level of any unit, management must consult with and receive agreement from
at least 50 percent of the direct care registered nurses staffing the unit.
new text end
new text begin
(b) Deviation from a core staffing plan with the agreement of at least 50 percent of the
direct care registered nurses staffing the unit does not constitute compliance with the core
staffing plan.
new text end
new text begin Subd. 6. new text end
new text begin Public posting of emergency department wait times. new text end
new text begin
A hospital must maintain
on its website and publicly display in its emergency department the approximate wait time
for patients who are not in critical need of emergency care. The approximate wait time must
be updated at least hourly.
new text end
new text begin Subd. 7. new text end
new text begin Disclosure of staffing plan upon admission. new text end
new text begin
A hospital must provide an
explanation of its core staffing plan to each patient upon admission.
new text end
new text begin Subd. 8. new text end
new text begin Public distribution of core staffing plan and notice of compliance. new text end
new text begin
(a) A
hospital must include with the posted materials described in subdivisions 2 and 3 a statement
that individual copies of the posted materials are available upon request to any patient on
the unit or to any visitor of a patient on the unit. The statement must include specific
instructions for obtaining copies of the posted materials.
new text end
new text begin
(b) A hospital must, within four hours after the request, provide individual copies of all
the posted materials described in subdivisions 2 and 3 to any patient on the unit or to any
visitor of a patient on the unit who requests the materials.
new text end
new text begin Subd. 9. new text end
new text begin Reporting noncompliance. new text end
new text begin
(a) Any hospital employee, patient, or patient
family member may submit a concern for safe staffing form to report an instance of
noncompliance with a hospital's core staffing plan, to object to the contents of a core staffing
plan, or to challenge the process of the hospital nurse staffing committee.
new text end
new text begin
(b) A hospital must not interfere with or retaliate against a hospital employee for
submitting a concern for safe staffing form.
new text end
new text begin
(c) The commissioner of labor and industry may investigate any report of retaliation
against a hospital employee for submitting a concern for safe staffing form. The commissioner
of labor and industry may fine a hospital up to $250,000 for each instance of substantiated
retaliation against a hospital employee for submitting a concern for safe staffing form.
new text end
new text begin Subd. 10. new text end
new text begin Documentation of compliance. new text end
new text begin
Each hospital must document compliance
with its core nursing plans and maintain records demonstrating compliance for each inpatient
care unit for five years. Each hospital must provide to its nurse staffing committee access
to all documentation required under this subdivision.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective October 1, 2025.
new text end
Sec. 90.
new text begin
[144.7057] HOSPITAL NURSE STAFFING REPORTS.
new text end
new text begin Subdivision 1. new text end
new text begin Nurse staffing report required. new text end
new text begin
Each hospital nurse staffing committee
must submit quarterly nurse staffing reports to the commissioner. Reports must be submitted
within 60 days of the end of the quarter.
new text end
new text begin Subd. 2. new text end
new text begin Nurse staffing report. new text end
new text begin
Nurse staffing reports submitted to the commissioner
by a hospital nurse staffing committee must:
new text end
new text begin
(1) identify any suspected incidents of the hospital failing during the reporting quarter
to meet the standards of one of its core staffing plans;
new text end
new text begin
(2) identify each occurrence of the hospital accepting an elective surgery at a time when
the unit performing the surgery is out of compliance with its core staffing plan;
new text end
new text begin
(3) identify problems of insufficient staffing, including but not limited to:
new text end
new text begin
(i) inappropriate number of direct care registered nurses scheduled in a unit;
new text end
new text begin
(ii) inappropriate number of direct care registered nurses present and delivering care in
a unit;
new text end
new text begin
(iii) inappropriately experienced direct care registered nurses scheduled for a particular
unit;
new text end
new text begin
(iv) inappropriately experienced direct care registered nurses present and delivering care
in a unit;
new text end
new text begin
(v) inability for nurse supervisors to adjust daily nursing schedules for increased patient
acuity or nursing intensity in a unit; and
new text end
new text begin
(vi) chronically unfilled direct care positions within the hospital;
new text end
new text begin
(4) identify any units that pose a risk to patient safety due to inadequate staffing;
new text end
new text begin
(5) propose solutions to solve insufficient staffing;
new text end
new text begin
(6) propose solutions to reduce risks to patient safety in inadequately staffed units; and
new text end
new text begin
(7) describe staffing trends within the hospital.
new text end
new text begin Subd. 3. new text end
new text begin Public posting of nurse staffing reports. new text end
new text begin
The commissioner must include on
its website each quarterly nurse staffing report submitted to the commissioner under
subdivision 1.
new text end
new text begin Subd. 4. new text end
new text begin Standardized reporting. new text end
new text begin
The commissioner shall develop and provide to each
hospital nurse staffing committee a uniform format or standard form the committee must
use to comply with the nurse staffing reporting requirements under this section. The format
or form developed by the commissioner must present the reported information in a manner
allowing patients and the public to clearly understand and compare staffing patterns and
actual levels of staffing across reporting hospitals. The commissioner must include, in the
uniform format or on the standardized form, space to allow the reporting hospital to include
a description of additional resources available to support unit-level patient care and a
description of the hospital.
new text end
new text begin Subd. 5. new text end
new text begin Penalties. new text end
new text begin
Notwithstanding section 144.653, subdivisions 5 and 6, the
commissioner may impose an immediate fine of up to $5,000 for each instance of a failure
to report an elective surgery requiring reporting under subdivision 2, clause (2). The facility
may request a hearing on the immediate fine under section 144.653, subdivision 8.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective October 1, 2025.
new text end
Sec. 91.
new text begin
[144.7058] GRADING OF COMPLIANCE WITH CORE STAFFING PLANS.
new text end
new text begin Subdivision 1. new text end
new text begin Grading compliance with core staffing plans. new text end
new text begin
By January 1, 2026, the
commissioner must develop a uniform annual grading system that evaluates each hospital's
compliance with its own core staffing plan. The commissioner must assign each hospital a
compliance grade based on a review of the hospital's nurse staffing report submitted under
section 144.7057. The commissioner must assign a failing compliance grade to any hospital
that has not been in compliance with its staffing plan for six or more months during the
reporting year.
new text end
new text begin Subd. 2. new text end
new text begin Grading factors. new text end
new text begin
When grading a hospital's compliance with its core staffing
plan, the commissioner must consider at least the following factors:
new text end
new text begin
(1) the number of assaults and injuries occurring in the hospital involving patients;
new text end
new text begin
(2) the prevalence of infections, pressure ulcers, and falls among patients;
new text end
new text begin
(3) emergency department wait times;
new text end
new text begin
(4) readmissions;
new text end
new text begin
(5) use of restraints and other behavior interventions;
new text end
new text begin
(6) employment turnover rates among direct care registered nurses and other direct care
health care workers;
new text end
new text begin
(7) prevalence of overtime among direct care registered nurses and other direct care
health care workers;
new text end
new text begin
(8) prevalence of missed shift breaks among direct care registered nurses and other direct
care health care workers;
new text end
new text begin
(9) frequency of incidents of being out of compliance with a core staffing plan; and
new text end
new text begin
(10) the extent of noncompliance with a core staffing plan.
new text end
new text begin Subd. 3. new text end
new text begin Public disclosure of compliance grades. new text end
new text begin
Beginning January 1, 2027, the
commissioner must publish a compliance grade for each hospital on the department website
with a link to the hospital's core staffing plan, the hospital's nurse staffing reports, and an
accessible and easily understandable explanation of what the compliance grade means.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2026.
new text end
Sec. 92.
new text begin
[144.7059] RETALIATION AGAINST NURSES PROHIBITED.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have
the meanings given.
new text end
new text begin
(b) "Emergency" means a period when replacement staff are not able to report for duty
for the next shift, or a period of increased patient need, because of unusual, unpredictable,
or unforeseen circumstances, including but not limited to an act of terrorism, a disease
outbreak, adverse weather conditions, or a natural disaster, that impacts continuity of patient
care.
new text end
new text begin
(c) "Nurse" has the meaning given in section 148.171, subdivision 9, and includes nurses
employed by the state.
new text end
new text begin
(d) "Taking action against" means discharging, disciplining, threatening, reporting to
the Board of Nursing, discriminating against, or penalizing regarding compensation, terms,
conditions, location, or privileges of employment.
new text end
new text begin Subd. 2. new text end
new text begin Prohibited actions. new text end
new text begin
Except as provided in subdivision 5, a hospital or other
entity licensed under sections 144.50 to 144.58, and its agent, or other health care facility
licensed by the commissioner of health, and the facility's agent, is prohibited from taking
action against a nurse solely on the ground that the nurse fails to accept an assignment of
one or more additional patients because the nurse determines that accepting an additional
patient assignment, in the nurse's judgment, may create an unnecessary danger to a patient's
life, health, or safety or may otherwise constitute a ground for disciplinary action under
section 148.261. This subdivision does not apply to a nursing facility, an intermediate care
facility for persons with developmental disabilities, or a licensed boarding care home.
new text end
new text begin Subd. 3. new text end
new text begin State nurses. new text end
new text begin
Subdivision 2 applies to nurses employed by the state regardless
of the type of facility where the nurse is employed and regardless of the facility's license,
if the nurse is involved in resident or patient care.
new text end
new text begin Subd. 4. new text end
new text begin Collective bargaining rights. new text end
new text begin
This section does not diminish or impair the
rights of a person under any collective bargaining agreement.
new text end
new text begin Subd. 5. new text end
new text begin Emergency. new text end
new text begin
A nurse may be required to accept an additional patient assignment
in an emergency.
new text end
new text begin Subd. 6. new text end
new text begin Enforcement. new text end
new text begin
The commissioner of labor and industry shall enforce this section.
The commissioner of labor and industry may assess a fine of up to $5,000 for each violation
of this section.
new text end
Sec. 93.
Minnesota Statutes 2022, section 144.7067, subdivision 1, is amended to read:
Subdivision 1.
Establishment of reporting system.
(a) The commissioner shall establish
an adverse health event reporting system designed to facilitate quality improvement in the
health care system. The reporting system shall not be designed to punish errors by health
care practitioners or health care facility employees.
(b) The reporting system shall consist of:
(1) mandatory reporting by facilities of 27 adverse health care events;
(2) new text begin mandatory reporting by facilities of whether the unit where an adverse event occurred
was in compliance with the core staffing plan for the unit at the time of the adverse event;
new text end
new text begin (3) new text end mandatory completion of a root cause analysis and a corrective action plan by the
facility and reporting of the findings of the analysis and the plan to the commissioner or
reporting of reasons for not taking corrective action;
deleted text begin (3)deleted text end new text begin (4)new text end analysis of reported information by the commissioner to determine patterns of
systemic failure in the health care system and successful methods to correct these failures;
deleted text begin (4)deleted text end new text begin (5)new text end sanctions against facilities for failure to comply with reporting system
requirements; and
deleted text begin (5)deleted text end new text begin (6)new text end communication from the commissioner to facilities, health care purchasers, and
the public to maximize the use of the reporting system to improve health care quality.
(c) The commissioner is not authorized to select from or between competing alternate
acceptable medical practices.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective October 1, 2025.
new text end
Sec. 94.
Minnesota Statutes 2022, section 144.9501, subdivision 9, is amended to read:
Subd. 9.
Elevated blood lead level.
"Elevated blood lead level" means a diagnostic
blood lead test with a result that is equal to or greater than deleted text begin tendeleted text end new text begin 3.5new text end micrograms of lead per
deciliter of whole blood in any person, unless the commissioner finds that a lower
concentration is necessary to protect public health.
Sec. 95.
Minnesota Statutes 2022, section 144.9501, subdivision 17, is amended to read:
Subd. 17.
Lead hazard reduction.
new text begin (a) new text end "Lead hazard reduction" means abatementnew text begin , swab
team services,new text end or interim controls undertaken to make a residence, child care facility, school,
playground, or other location where lead hazards are identified lead-safe by complying with
the lead standards and methods adopted under section 144.9508.
new text begin
(b) Lead hazard reduction does not include renovation activity that is primarily intended
to remodel, repair, or restore a given structure or dwelling rather than abate or control
lead-based paint hazards.
new text end
new text begin
(c) Lead hazard reduction does not include activities that disturb painted surfaces that
total:
new text end
new text begin
(1) less than 20 square feet (two square meters) on exterior surfaces; or
new text end
new text begin
(2) less than two square feet (0.2 square meters) in an interior room.
new text end
Sec. 96.
Minnesota Statutes 2022, section 144.9501, subdivision 26a, is amended to read:
Subd. 26a.
Regulated lead work.
deleted text begin (a)deleted text end "Regulated lead work" means:
(1) abatement;
(2) interim controls;
(3) a clearance inspection;
(4) a lead hazard screen;
(5) a lead inspection;
(6) a lead risk assessment;
(7) lead project designer services;
(8) lead sampling technician services;
(9) swab team services;
(10) renovation activities; deleted text begin or
deleted text end
new text begin
(11) lead hazard reduction; or
new text end
deleted text begin (11)deleted text end new text begin (12)new text end activities performed to comply with lead orders issued by deleted text begin a community health
boarddeleted text end new text begin an assessing agencynew text end .
deleted text begin
(b) Regulated lead work does not include abatement, interim controls, swab team services,
or renovation activities that disturb painted surfaces that total no more than:
deleted text end
deleted text begin
(1) 20 square feet (two square meters) on exterior surfaces; or
deleted text end
deleted text begin
(2) six square feet (0.6 square meters) in an interior room.
deleted text end
Sec. 97.
Minnesota Statutes 2022, section 144.9501, subdivision 26b, is amended to read:
Subd. 26b.
Renovation.
new text begin (a) new text end "Renovation" means the modification of any pre-1978
affected property new text begin for compensation new text end that results in the disturbance of known or presumed
lead-containing painted surfaces defined under section 144.9508, unless that activity is
performed as lead hazard reduction. A renovation performed for the purpose of converting
a building or part of a building into an affected property is a renovation under this
subdivision.
new text begin
(b) Renovation does not include minor repair and maintenance activities described in
this paragraph. All activities that disturb painted surfaces and are performed within 30 days
of other activities that disturb painted surfaces in the same room must be considered a single
project when applying the criteria below. Unless the activity involves window replacement
or demolition of a painted surface, building component, or portion of a structure, for purposes
of this paragraph, "minor repair and maintenance" means activities that disturb painted
surfaces totaling:
new text end
new text begin
(1) less than 20 square feet (two square meters) on exterior surfaces; or
new text end
new text begin
(2) less than six square feet (0.6 square meters) in an interior room.
new text end
new text begin
(c) Renovation does not include total demolition of a freestanding structure. For purposes
of this paragraph, "total demolition" means demolition and disposal of all interior and
exterior painted surfaces, including windows. Unpainted foundation building components
remaining after total demolition may be reused.
new text end
Sec. 98.
Minnesota Statutes 2022, section 144.9501, is amended by adding a subdivision
to read:
new text begin Subd. 33. new text end
new text begin Compensation. new text end
new text begin
"Compensation" means money or other mutually agreed upon
form of payment given or received for regulated lead work, including rental payments,
rental income, or salaries derived from rental payments.
new text end
Sec. 99.
Minnesota Statutes 2022, section 144.9501, is amended by adding a subdivision
to read:
new text begin Subd. 34. new text end
new text begin Individual. new text end
new text begin
"Individual" means a natural person.
new text end
Sec. 100.
Minnesota Statutes 2022, section 144.9505, subdivision 1, is amended to read:
Subdivision 1.
Licensing, certification, and permitting.
(a) Fees collected under this
section shall be deposited into the state treasury and credited to the state government special
revenue fund.
(b) Persons shall not advertise or otherwise present themselves as lead supervisors, lead
workers, lead inspectors, lead risk assessors, lead sampling technicians, lead project designers,
renovation firms, or lead firms unless they have licenses or certificates issued by the
commissioner under this section.
(c) The fees required in this section for inspectors, risk assessors, and certified lead firms
are waived for state or local government employees performing services for or as an assessing
agency.
(d) deleted text begin An individual who is the owner of property on which regulated lead work is to be
performed or an adult individual who is related to the property owner, as defined under
section 245A.02, subdivision 13, is exempt from the requirements to obtain a license and
pay a fee according to this section.deleted text end new text begin Individual residential property owners who perform
regulated lead work on their own residence are exempt from the licensure and firm
certification requirements of this section. Notwithstanding the provisions of paragraphs (a)
to (c), this exemption does not apply when the regulated lead work is a renovation performed
for compensation, when a child with an elevated blood level has been identified in the
residence or the building in which the residence is located, or when the residence is occupied
by one or more individuals who are not related to the property owner, as defined under
section 245A.02, subdivision 13.
new text end
deleted text begin
(e) A person that employs individuals to perform regulated lead work outside of the
person's property must obtain certification as a certified lead firm. An individual who
performs lead hazard reduction, lead hazard screens, lead inspections, lead risk assessments,
clearance inspections, lead project designer services, lead sampling technician services,
swab team services, and activities performed to comply with lead orders must be employed
by a certified lead firm, unless the individual is a sole proprietor and does not employ any
other individuals, the individual is employed by a person that does not perform regulated
lead work outside of the person's property, or the individual is employed by an assessing
agency.
deleted text end
Sec. 101.
Minnesota Statutes 2022, section 144.9505, subdivision 1g, is amended to read:
Subd. 1g.
Certified lead firm.
A person whonew text begin performs ornew text end employs individuals to perform
regulated lead work, with the exception of renovation, deleted text begin outside of the person's propertydeleted text end must
obtain certification as a lead firm. The certificate must be in writing, contain an expiration
date, be signed by the commissioner, and give the name and address of the person to whom
it is issued. A lead firm certificate is valid for one year. The certification fee is $100, is
nonrefundable, and must be submitted with each application. The lead firm certificate or a
copy of the certificate must be readily available at the worksite for review by the contracting
entity, the commissioner, and other public health officials charged with the health, safety,
and welfare of the state's citizens.
Sec. 102.
Minnesota Statutes 2022, section 144.9505, subdivision 1h, is amended to read:
Subd. 1h.
Certified renovation firm.
A person who new text begin performs or new text end employs individuals
to perform renovation deleted text begin activities outside of the person's propertydeleted text end new text begin for compensationnew text end must
obtain certification as a renovation firm. The certificate must be in writing, contain an
expiration date, be signed by the commissioner, and give the name and address of the person
to whom it is issued. A renovation firm certificate is valid for two years. The certification
fee is $100, is nonrefundable, and must be submitted with each application. The renovation
firm certificate or a copy of the certificate must be readily available at the worksite for
review by the contracting entity, the commissioner, and other public health officials charged
with the health, safety, and welfare of the state's citizens.
Sec. 103.
Minnesota Statutes 2022, section 144.9508, subdivision 2, is amended to read:
Subd. 2.
Regulated lead work standards and methods.
(a) The commissioner shall
adopt rules establishing regulated lead work standards and methods in accordance with the
provisions of this section, for lead in paint, dust, drinking water, and soil in a manner that
protects public health and the environment for all residences, including residences also used
for a commercial purpose, child care facilities, playgrounds, and schools.
(b) In the rules required by this section, the commissioner shall require lead hazard
reduction of intact paint only if the commissioner finds that the intact paint is on a chewable
or lead-dust producing surface that is a known source of actual lead exposure to a specific
individual. The commissioner shall prohibit methods that disperse lead dust into the air that
could accumulate to a level that would exceed the lead dust standard specified under this
section. The commissioner shall work cooperatively with the commissioner of administration
to determine which lead hazard reduction methods adopted under this section may be used
for lead-safe practices including prohibited practices, preparation, disposal, and cleanup.
The commissioner shall work cooperatively with the commissioner of the Pollution Control
Agency to develop disposal procedures. In adopting rules under this section, the
commissioner shall require the best available technology for regulated lead work methods,
paint stabilization, and repainting.
(c) The commissioner of health shall adopt regulated lead work standards and methods
for lead in bare soil in a manner to protect public health and the environment. The
commissioner shall adopt a maximum standard of 100 parts of lead per million in bare soil.
The commissioner shall set a soil replacement standard not to exceed 25 parts of lead per
million. Soil lead hazard reduction methods shall focus on erosion control and covering of
bare soil.
(d) The commissioner shall adopt regulated lead work standards and methods for lead
in dust in a manner to protect the public health and environment. Dust standards shall use
a weight of lead per area measure and include dust on the floor, on the window sills, and
on window wells. Lead hazard reduction methods for dust shall focus on dust removal and
other practices which minimize the formation of lead dust from paint, soil, or other sources.
(e) The commissioner shall adopt lead hazard reduction standards and methods for lead
in drinking water both at the tap and public water supply system or private well in a manner
to protect the public health and the environment. The commissioner may adopt the rules
for controlling lead in drinking water as contained in Code of Federal Regulations, title 40,
part 141. Drinking water lead hazard reduction methods may include an educational approach
of minimizing lead exposure from lead in drinking water.
(f) The commissioner of the Pollution Control Agency shall adopt rules to ensure that
removal of exterior lead-based coatings from residences and steel structures by abrasive
blasting methods is conducted in a manner that protects health and the environment.
(g) All regulated lead work standards shall provide reasonable margins of safety that
are consistent with more than a summary review of scientific evidence and an emphasis on
overprotection rather than underprotection when the scientific evidence is ambiguous.
(h) No unit of local government shall have an ordinance or regulation governing regulated
lead work standards or methods for lead in paint, dust, drinking water, or soil that require
a different regulated lead work standard or method than the standards or methods established
under this section.
(i) Notwithstanding paragraph (h), the commissioner may approve the use by a unit of
local government of an innovative lead hazard reduction method which is consistent in
approach with methods established under this section.
(j) The commissioner shall adopt rules for issuing lead orders required under section
144.9504, rules for notification of abatement or interim control activities requirements, and
other rules necessary to implement sections 144.9501 to 144.9512.
(k) The commissioner shall adopt rules consistent with section 402(c)(3) of the Toxic
Substances Control Act new text begin and all regulations adopted thereunder new text end to ensure that renovation in
a pre-1978 affected property deleted text begin where a child or pregnant female residesdeleted text end is conducted in a
manner that protects health and the environment. Notwithstanding sections 14.125 and
14.128, the authority to adopt these rules does not expire.
(l) The commissioner shall adopt rules consistent with sections 406(a) and 406(b) of the
Toxic Substances Control Act. Notwithstanding sections 14.125 and 14.128, the authority
to adopt these rules does not expire.
Sec. 104.
Minnesota Statutes 2022, section 144A.06, subdivision 2, is amended to read:
Subd. 2.
New license required; change of ownership.
(a) The commissioner of health
by rule shall prescribe procedures for licensure under this section.
(b) A new license is required and the prospective licensee must apply for a license prior
to operating a currently licensed nursing home. The licensee must change whenever one of
the following events occur:
(1) the form of the licensee's legal entity structure is converted or changed to a different
type of legal entity structure;
(2) the licensee dissolves, consolidates, or merges with another legal organization and
the licensee's legal organization does not survive;
(3) within the previous 24 months, 50 percent or more of the licensee's ownership interest
is transferred, whether by a single transaction or multiple transactions to:
(i) a different personnew text begin or multiple different personsnew text end ; or
(ii) a person new text begin or multiple persons new text end who had less than a five percent ownership interest in
the facility at the time of the first transaction; or
(4) any other event or combination of events that results in a substitution, elimination,
or withdrawal of the licensee's responsibility for the facility.
Sec. 105.
Minnesota Statutes 2022, section 144A.071, subdivision 2, is amended to read:
Subd. 2.
Moratorium.
new text begin (a) new text end The commissioner of health, in coordination with the
commissioner of human services, shall deny each request for new licensed or certified
nursing home or certified boarding care beds except as provided in subdivision 3 or 4a, or
section 144A.073. "Certified bed" means a nursing home bed or a boarding care bed certified
by the commissioner of health for the purposes of the medical assistance program, under
United States Code, title 42, sections 1396 et seq. Certified beds in facilities which do not
allow medical assistance intake shall be deemed to be decertified for purposes of this section
only.
new text begin (b) new text end The commissioner of human services, in coordination with the commissioner of
health, shall deny any request to issue a license under section 252.28 and chapter 245A to
a nursing home or boarding care home, if that license would result in an increase in the
medical assistance reimbursement amount.
new text begin (c) new text end In addition, the commissioner of health must not approve any construction project
whose cost exceeds $1,000,000, unless:
deleted text begin (a)deleted text end new text begin (1)new text end any construction costs exceeding $1,000,000 are not added to the facility's
appraised value and are not included in the facility's payment rate for reimbursement under
the medical assistance program; or
deleted text begin (b)deleted text end new text begin (2)new text end the project:
deleted text begin (1)deleted text end new text begin (i)new text end has been approved through the process described in section 144A.073;
deleted text begin (2)deleted text end new text begin (ii)new text end meets an exception in subdivision 3 or 4a;
deleted text begin (3)deleted text end new text begin (iii)new text end is necessary to correct violations of state or federal law issued by the
commissioner of health;
deleted text begin (4)deleted text end new text begin (iv)new text end is necessary to repair or replace a portion of the facility that was damaged by
fire, lightning, ground shifts, or other such hazards, including environmental hazards,
provided that the provisions of subdivision 4a, clause (a), are met; or
deleted text begin (5)deleted text end new text begin (v)new text end is being proposed by a licensed nursing facility that is not certified to participate
in the medical assistance program and will not result in new licensed or certified beds.
new text begin (d) new text end Prior to the final plan approval of any construction project, the commissioners of
health and human services shall be provided with an itemized cost estimate for the project
construction costs. If a construction project is anticipated to be completed in phases, the
total estimated cost of all phases of the project shall be submitted to the commissioners and
shall be considered as one construction project. Once the construction project is completed
and prior to the final clearance by the commissioners, the total project construction costs
for the construction project shall be submitted to the commissioners. If the final project
construction cost exceeds the dollar threshold in this subdivision, the commissioner of
human services shall not recognize any of the project construction costs or the related
financing costs in excess of this threshold in establishing the facility's property-related
payment rate.
new text begin (e) new text end The dollar thresholds for construction projects are as follows: for construction projects
other than those authorized in deleted text begin clauses (1) to (6)deleted text end new text begin paragraph (c), clause (2), items (i) to (v)new text end ,
the dollar threshold is $1,000,000. For projects authorized after July 1, 1993, under deleted text begin clause
(1)deleted text end new text begin paragraph (c), clause (2), item (i)new text end , the dollar threshold is the cost estimate submitted
with a proposal for an exception under section 144A.073, plus inflation as calculated
according to section 256B.431, subdivision 3f, paragraph (a). For projects authorized under
deleted text begin clauses (2) to (4)deleted text end new text begin paragraph (c), clause (2), items (ii) to (iv)new text end , the dollar threshold is the
itemized estimate project construction costs submitted to the commissioner of health at the
time of final plan approval, plus inflation as calculated according to section 256B.431,
subdivision 3f, paragraph (a).
new text begin (f) new text end The commissioner of health shall adopt rules to implement this section or to amend
the emergency rules for granting exceptions to the moratorium on nursing homes under
section 144A.073.
new text begin
(g) All construction projects approved through section 144A.073, subdivision 3, after
March 1, 2020, are subject to the fair rental value property rate as described in section
256R.26.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective retroactively from March 1, 2020.
new text end
Sec. 106.
Minnesota Statutes 2022, section 144A.073, subdivision 3b, is amended to read:
Subd. 3b.
Amendments to approved projects.
(a) Nursing facilities that have received
approval deleted text begin on or after July 1, 1993,deleted text end for exceptions to the moratorium on nursing homes through
the process described in this section may request amendments to the designs of the projects
by writing the commissioner within 15 months of receiving approval. Applicants shall
submit supporting materials that demonstrate how the amended projects meet the criteria
described in paragraph (b).
(b) The commissioner shall approve requests for amendments for projects approved deleted text begin on
or after July 1, 1993,deleted text end according to the following criteria:
(1) the amended project designs must provide solutions to all of the problems addressed
by the original application that are at least as effective as the original solutions;
(2) the amended project designs may not reduce the space in each resident's living area
or in the total amount of common space devoted to resident and family uses by more than
five percent;
(3) the costs deleted text begin recognized for reimbursementdeleted text end of amended project designs shall be deleted text begin the
threshold amount of the original proposal as identified according to section 144A.071,
subdivision 2deleted text end new text begin the cost estimate associated with the project as originally approvednew text end , except
under conditions described in clause (4); and
(4) total costs deleted text begin up to ten percent greater than the cost identified in clause (3) may be
recognized for reimbursement ifdeleted text end new text begin of the amendment are no greater than ten percent of the
cost estimate associated with the project as initially approved ifnew text end the proposer can document
that one of the following circumstances is true:
(i) changes are needed due to a natural disaster;
(ii) conditions that affect the safety or durability of the project that could not have
reasonably been known prior to approval are discovered;
(iii) state or federal law require changes in project design; or
(iv) documentable circumstances occur that are beyond the control of the owner and
require changes in the design.
(c) Approval of a request for an amendment does not alter the expiration of approval of
the project according to subdivision 3.
new text begin
(d) Reimbursement for amendments to approved projects is independent of the actual
construction costs and based on the allowable appraised value of the completed project. An
approved project may not be amended to reduce the scope of an approved project.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective retroactively from March 1, 2020.
new text end
Sec. 107.
Minnesota Statutes 2022, section 144A.474, subdivision 3, is amended to read:
Subd. 3.
Survey process.
The survey process for core surveys shall include the following
as applicable to the particular licensee and setting surveyed:
(1) presurvey review of pertinent documents and notification to the ombudsman for
long-term care;
(2) an entrance conference with available staff;
(3) communication with managerial officials or the registered nurse in charge, if available,
and ongoing communication with key staff throughout the survey regarding information
needed by the surveyor, clarifications regarding home care requirements, and applicable
standards of practice;
(4) presentation of written contact information to the provider about the survey staff
conducting the survey, the supervisor, and the process for requesting a reconsideration of
the survey results;
(5) a brief tour of deleted text begin a sample ofdeleted text end the deleted text begin housing with services establishmentsdeleted text end new text begin establishmentnew text end
in which the provider is providing home care services;
(6) a sample selection of home care clients;
(7) information-gathering through client and staff observations, client and staff interviews,
and reviews of records, policies, procedures, practices, and other agency information;
(8) interviews of clients' family members, if available, with clients' consent when the
client can legally give consent;
(9) except for complaint surveys conducted by the Office of Health Facilities Complaints,
an deleted text begin on-sitedeleted text end exit conferencedeleted text begin ,deleted text end with preliminary findings deleted text begin shared anddeleted text end discussed with the providernew text begin
within one business day after completion of survey activitiesnew text end , deleted text begin documentation that an exit
conference occurred,deleted text end and new text begin with new text end written information provided on the process for requesting
a reconsideration of the survey results; and
(10) postsurvey analysis of findings and formulation of survey results, including
correction orders when applicable.
Sec. 108.
Minnesota Statutes 2022, section 144A.474, subdivision 9, is amended to read:
Subd. 9.
Follow-up surveys.
For providers that have Level 3 or Level 4 violations under
subdivision 11, deleted text begin or any violations determined to be widespread,deleted text end the department shall conduct
a follow-up survey within 90 calendar days of the survey. When conducting a follow-up
survey, the surveyor will focus on whether the previous violations have been corrected and
may also address any new violations that are observed while evaluating the corrections that
have been made.
Sec. 109.
Minnesota Statutes 2022, section 144A.474, subdivision 12, is amended to read:
Subd. 12.
Reconsideration.
(a) The commissioner shall make available to home care
providers a correction order reconsideration process. This process may be used to challenge
the correction order issued, including the level and scope described in subdivision 11, and
any fine assessed. During the correction order reconsideration request, the issuance for the
correction orders under reconsideration are not stayed, but the department shall post
information on the website with the correction order that the licensee has requested a
reconsideration and that the review is pending.
(b) A licensed home care provider may request from the commissioner, in writing, a
correction order reconsideration regarding any correction order issued to the provider. The
written request for reconsideration must be received by the commissioner within 15 deleted text begin calendardeleted text end new text begin
businessnew text end days of the correction order receipt date. The correction order reconsideration shall
not be reviewed by any surveyor, investigator, or supervisor that participated in the writing
or reviewing of the correction order being disputed. The correction order reconsiderations
may be conducted in person, by telephone, by another electronic form, or in writing, as
determined by the commissioner. The commissioner shall respond in writing to the request
from a home care provider for a correction order reconsideration within 60 days of the date
the provider requests a reconsideration. The commissioner's response shall identify the
commissioner's decision regarding each citation challenged by the home care provider.
(c) The findings of a correction order reconsideration process shall be one or more of
the following:
(1) supported in full, the correction order is supported in full, with no deletion of findings
to the citation;
(2) supported in substance, the correction order is supported, but one or more findings
are deleted or modified without any change in the citation;
(3) correction order cited an incorrect home care licensing requirement, the correction
order is amended by changing the correction order to the appropriate statutory reference;
(4) correction order was issued under an incorrect citation, the correction order is amended
to be issued under the more appropriate correction order citation;
(5) the correction order is rescinded;
(6) fine is amended, it is determined that the fine assigned to the correction order was
applied incorrectly; or
(7) the level or scope of the citation is modified based on the reconsideration.
(d) If the correction order findings are changed by the commissioner, the commissioner
shall update the correction order website.
(e) This subdivision does not apply to temporary licensees.
Sec. 110.
Minnesota Statutes 2022, section 144A.4791, subdivision 10, is amended to
read:
Subd. 10.
Termination of service plan.
(a) If a home care provider terminates a service
plan with a client, and the client continues to need home care services, the home care provider
shall provide the client and the client's representative, if any, with a written notice of
termination which includes the following information:
(1) the effective date of termination;
(2) the reason for termination;
new text begin
(3) a statement that the client may contact the Office of Ombudsman for Long-Term
Care to request an advocate to assist regarding the termination and contact information for
the office, including the office's central telephone number;
new text end
deleted text begin (3)deleted text end new text begin (4)new text end a list of known licensed home care providers in the client's immediate geographic
area;
deleted text begin (4)deleted text end new text begin (5)new text end a statement that the home care provider will participate in a coordinated transfer
of care of the client to another home care provider, health care provider, or caregiver, as
required by the home care bill of rights, section 144A.44, subdivision 1, clause (17);
deleted text begin (5)deleted text end new text begin (6)new text end the name and contact information of a person employed by the home care provider
with whom the client may discuss the notice of termination; and
deleted text begin (6)deleted text end new text begin (7)new text end if applicable, a statement that the notice of termination of home care services
does not constitute notice of termination of deleted text begin the housing with services contract with a housing
with services establishmentdeleted text end new text begin any housing contractnew text end .
(b) When the home care provider voluntarily discontinues services to all clients, the
home care provider must notify the commissioner, lead agencies, and ombudsman for
long-term care about its clients and comply with the requirements in this subdivision.
Sec. 111.
Minnesota Statutes 2022, section 144G.16, subdivision 7, is amended to read:
Subd. 7.
Finesnew text begin and penaltiesnew text end .
new text begin (a) new text end The deleted text begin feedeleted text end new text begin finenew text end for failure to comply with the notification
requirements in section 144G.52, subdivision 7, is $1,000.
new text begin
(b) Fines and penalties collected under this section shall be deposited in a dedicated
special revenue account. On an annual basis, the balance in the special revenue account
shall be appropriated to the commissioner to implement the recommendations of the advisory
council established in section 144A.4799.
new text end
Sec. 112.
Minnesota Statutes 2022, section 144G.18, is amended to read:
144G.18 NOTIFICATION OF CHANGES IN INFORMATION.
new text begin Subdivision 1. new text end
new text begin Notification. new text end
A provisional licensee or licensee shall notify the
commissioner in writing prior to a change in the manager or authorized agent and within
60 calendar days after any change in the information required in section 144G.12, subdivision
1, clause (1), (3), (4), (17), or (18).
new text begin Subd. 2. new text end
new text begin Fines and penalties. new text end
new text begin
(a) The fine for failure to comply with the notification
requirements of this section is $1,000.
new text end
new text begin
(b) Fines and penalties collected under this subdivision shall be deposited in a dedicated
special revenue account. On an annual basis, the balance in the special revenue account
shall be appropriated to the commissioner to implement the recommendations of the advisory
council established in section 144A.4799.
new text end
Sec. 113.
Minnesota Statutes 2022, section 144G.57, subdivision 8, is amended to read:
Subd. 8.
deleted text begin Finedeleted text end new text begin Fines and penaltiesnew text end .
new text begin (a) new text end The commissioner may impose a fine for failure
to follow the requirements of this section.
new text begin
(b) The fine for failure to comply with this section is $1,000.
new text end
new text begin
(c) Fines and penalties collected under this section shall be deposited in a dedicated
special revenue account. On an annual basis, the balance in the special revenue account
shall be appropriated to the commissioner to implement the recommendations of the advisory
council established in section 144A.4799.
new text end
Sec. 114.
Minnesota Statutes 2022, section 145.411, subdivision 1, is amended to read:
Subdivision 1.
Terms.
As used in sections 145.411 to deleted text begin 145.416deleted text end new text begin 145.414new text end , the terms defined
in this section have the meanings given to them.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 115.
Minnesota Statutes 2022, section 145.411, subdivision 5, is amended to read:
Subd. 5.
Abortion.
"Abortion" includes an act, procedure or use of any instrument,
medicine or drug which is supplied or prescribed for or administered to deleted text begin a pregnant womandeleted text end new text begin
an individual with the intention of terminating, andnew text end which results in the termination ofnew text begin ,new text end
pregnancy.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 116.
Minnesota Statutes 2022, section 145.423, subdivision 1, is amended to read:
Subdivision 1.
Recognition; deleted text begin medicaldeleted text end care.
deleted text begin A born alivedeleted text end new text begin Annew text end infant deleted text begin as a result of an
abortiondeleted text end new text begin who is born alivenew text end shall be fully recognized as a human person, and accorded
immediate protection under the law. All reasonable measures consistent with good medical
practice, including the compilation of appropriate medical records, shall be taken by the
responsible medical personnel to deleted text begin preserve the life and health of the born alive infantdeleted text end new text begin care
for the infant who is born alivenew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 117.
new text begin
[145.561] 988 SUICIDE AND CRISIS LIFELINE.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For the purposes of this section, the following have the
meanings given.
new text end
new text begin
(b) "Commissioner" means the commissioner of health.
new text end
new text begin
(c) "Department" means the Department of Health.
new text end
new text begin
(d) "988" means the universal telephone number designated as the universal telephone
number within the United States for the purpose of the national suicide prevention and
mental health crisis hotline system operating through the 988 Suicide and Crisis Lifeline,
or its successor, maintained by the Assistant Secretary for Mental Health and Substance
Use under section 520E-3 of the Public Health Service Act (United States Code, title 42,
sections 290bb-36c).
new text end
new text begin
(e) "988 administrator" means the administrator of the national 988 Suicide and Crisis
Lifeline maintained by the Assistant Secretary for Mental Health and Substance Use under
section 520E-3 of the Public Health Service Act.
new text end
new text begin
(f) "988 contact" means a communication with the 988 Suicide and Crisis Lifeline system
within the United States via modalities offered including call, chat, or text.
new text end
new text begin
(g) "988 Lifeline Center" means a state-identified center that is a member of the Suicide
and Crisis Lifeline network that responds to statewide or regional 988 contacts.
new text end
new text begin
(h) "988 Suicide and Crisis Lifeline" or "988 Lifeline" means the national suicide
prevention and mental health crisis hotline system maintained by the Assistant Secretary
for Mental Health and Substance Use under section 520E-3 of the Public Health Service
Act (United States Code, title 42, sections 290bb-36c).
new text end
new text begin
(i) "Veterans Crisis Line" means the Veterans Crisis Line maintained by the Secretary
of Veterans Affairs under United States Code, title 38, section 170F(h).
new text end
new text begin Subd. 2. new text end
new text begin 988 Lifeline. new text end
new text begin
(a) The commissioner shall administer the designation of and
oversight for a 988 Lifeline center or a network of 988 Lifeline centers to answer contacts
from individuals accessing the Suicide and Crisis Lifeline from any jurisdiction within the
state 24 hours per day, seven days per week.
new text end
new text begin
(b) The designated 988 Lifeline Center must:
new text end
new text begin
(1) have an active agreement with the 988 Suicide and Crisis Lifeline program for
participation in the network and the department;
new text end
new text begin
(2) meet the 988 Lifeline program requirements and best practice guidelines for
operational and clinical standards;
new text end
new text begin
(3) provide data and reports, and participate in evaluations and related quality
improvement activities as required by the 988 Lifeline program and the department;
new text end
new text begin
(4) identify or adapt technology that is demonstrated to be interoperable across mobile
crisis and public safety answering points used in the state for the purpose of crisis care
coordination;
new text end
new text begin
(5) facilitate crisis and outgoing services, including mobile crisis teams in accordance
with guidelines established by the 988 Lifeline program and the department;
new text end
new text begin
(6) actively collaborate and coordinate service linkages with mental health and substance
use disorder treatment providers, local community mental health centers including certified
community behavioral health clinics and community behavioral health centers, mobile crisis
teams, and community based and hospital emergency departments;
new text end
new text begin
(7) offer follow-up services to individuals accessing the 988 Lifeline Center that are
consistent with guidance established by the 988 Lifeline program and the department; and
new text end
new text begin
(8) meet the requirements set by the 988 Lifeline program and the department for serving
at-risk and specialized populations.
new text end
new text begin
(c) The commissioner shall adopt rules to allow appropriate information sharing and
communication between and across crisis and emergency response systems.
new text end
new text begin
(d) The department, having primary oversight of suicide prevention, shall work with the
988 Lifeline program, veterans crisis line, and other SAMHSA-approved networks for the
purpose of ensuring consistency of public messaging about 988 services.
new text end
new text begin
(e) The department shall work with representatives from 988 Lifeline Centers and public
safety answering points, other public safety agencies, and the commissioner of public safety
to facilitate the development of protocols and procedures for interactions between 988 and
911 services across Minnesota. Protocols and procedures shall be developed following
available national standards and guidelines.
new text end
new text begin
(f) The commissioner shall provide an annual public report on 988 Lifeline usage,
including data on answer rates, abandoned calls, and referrals to 911 emergency response.
new text end
new text begin Subd. 3. new text end
new text begin Activities to support the 988 system. new text end
new text begin
The commissioner shall use money
appropriated for the 988 system to fund:
new text end
new text begin
(1) implementing, maintaining, and improving the 988 Suicide and Crisis Lifeline to
ensure the efficient and effective routing and handing of calls, chats, and texts made to the
988 Lifeline Centers, including staffing and technological infrastructure enhancements
necessary to achieve operational standards and best practices set by the 988 Lifeline and
the department;
new text end
new text begin
(2) personnel for 988 Lifeline Centers;
new text end
new text begin
(3) the provision of acute mental health and crisis outreach services to persons who
contact a 988 Lifeline Center;
new text end
new text begin
(4) publicizing and raising awareness of 988 services, or providing grants to organizations
to publicize and raise awareness of 988 services;
new text end
new text begin
(5) data collection, reporting, participation in evaluations, public promotion, and related
quality improvement activities as required by the 988 administrator and the department;
and
new text end
new text begin
(6) administration, oversight, and evaluation.
new text end
new text begin Subd. 4. new text end
new text begin 988 Lifeline operating budget; report on data to legislature. new text end
new text begin
The
commissioner shall provide to the legislature a biennial report for maintaining the 988
system. The report must include data on direct and indirect expenditures to maintain the
988 system.
new text end
Sec. 118.
Minnesota Statutes 2022, section 145.87, subdivision 4, is amended to read:
Subd. 4.
deleted text begin Administrative costsdeleted text end new text begin Administrationnew text end .
The commissioner may deleted text begin use up to seven
percent of the annual appropriation under this section todeleted text end provide training and technical
assistance and deleted text begin todeleted text end administer and evaluate the program. The commissioner may contract for
training, capacity-building support for grantees or potential grantees, technical assistance,
and evaluation support.
Sec. 119.
new text begin
[145.903] SCHOOL-BASED HEALTH CENTERS.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have
the meanings given.
new text end
new text begin
(b) "School-based health center" or "comprehensive school-based health center" means
a safety net health care delivery model that is located in or near a school facility and that
offers comprehensive health care, including preventive and behavioral health services,
provided by licensed and qualified health professionals in accordance with federal, state,
and local law. When not located on school property, the school-based health center must
have an established relationship with one or more schools in the community and operate to
primarily serve those student groups.
new text end
new text begin
(c) "Sponsoring organization" means any of the following that operate a school-based
health center:
new text end
new text begin
(1) health care providers;
new text end
new text begin
(2) community clinics;
new text end
new text begin
(3) hospitals;
new text end
new text begin
(4) federally qualified health centers and look-alikes as defined in section 145.9269;
new text end
new text begin
(5) health care foundations or nonprofit organizations;
new text end
new text begin
(6) higher education institutions; or
new text end
new text begin
(7) local health departments.
new text end
new text begin Subd. 2. new text end
new text begin Expansion of Minnesota school-based health centers. new text end
new text begin
(a) The commissioner
of health shall administer a program to provide grants to school districts and school-based
health centers to support existing centers and facilitate the growth of school-based health
centers in Minnesota.
new text end
new text begin
(b) Grant funds distributed under this subdivision shall be used to support new or existing
school-based health centers that:
new text end
new text begin
(1) operate in partnership with a school or school district and with the permission of the
school or school district board;
new text end
new text begin
(2) provide health services through a sponsoring organization; and
new text end
new text begin
(3) provide health services to all students and youth within a school or school district,
regardless of ability to pay, insurance coverage, or immigration status, and in accordance
with federal, state, and local law.
new text end
new text begin
(c) The commissioner of health shall administer a grant to a nonprofit organization to
facilitate a community of practice among school-based health centers to improve quality,
equity, and sustainability of care delivered through school-based health centers; encourage
cross-sharing among school-based health centers; support existing clinics; and expand
school-based health centers in new communities in Minnesota.
new text end
new text begin
(d) Grant recipients shall report their activities and annual performance measures as
defined by the commissioner in a format and time specified by the commissioner.
new text end
new text begin
(e) The commissioners of health and of education shall coordinate the projects and
initiatives funded under this section with other efforts at the local, state, or national level
to avoid duplication and promote coordinated efforts.
new text end
new text begin Subd. 3. new text end
new text begin School-based health center services. new text end
new text begin
Services provided by a school-based
health center may include but are not limited to:
new text end
new text begin
(1) preventive health care;
new text end
new text begin
(2) chronic medical condition management, including diabetes and asthma care;
new text end
new text begin
(3) mental health care and crisis management;
new text end
new text begin
(4) acute care for illness and injury;
new text end
new text begin
(5) oral health care;
new text end
new text begin
(6) vision care;
new text end
new text begin
(7) nutritional counseling;
new text end
new text begin
(8) substance abuse counseling;
new text end
new text begin
(9) referral to a specialist, medical home, or hospital for care;
new text end
new text begin
(10) additional services that address social determinants of health; and
new text end
new text begin
(11) emerging services such as mobile health and telehealth.
new text end
new text begin Subd. 4. new text end
new text begin Sponsoring organizations. new text end
new text begin
A sponsoring organization that agrees to operate
a school-based health center must enter into a memorandum of agreement with the school
or school district. The memorandum of agreement must require the sponsoring organization
to be financially responsible for the operation of school-based health centers in the school
or school district and must identify the costs that are the responsibility of the school or
school district, such as Internet access, custodial services, utilities, and facility maintenance.
To the greatest extent possible, a sponsoring organization must bill private insurers, medical
assistance, and other public programs for services provided in the school-based health
centers in order to maintain the financial sustainability of school-based health centers.
new text end
Sec. 120.
Minnesota Statutes 2022, section 145.924, is amended to read:
145.924 deleted text begin AIDSdeleted text end new text begin HIVnew text end PREVENTION GRANTS.
(a) The commissioner may award grants to community health boards as defined in section
145A.02, subdivision 5, state agencies, state councils, or nonprofit corporations to provide
evaluation and counseling services to populations at risk for acquiring human
immunodeficiency virus infection, including, but not limited to, deleted text begin minoritiesdeleted text end new text begin communities of
colornew text end , adolescents, deleted text begin intravenous drug usersdeleted text end new text begin women, people who inject drugsnew text end , and deleted text begin homosexual
mendeleted text end new text begin gay, bisexual, and transgender individualsnew text end .
(b) The commissioner may award grants to agencies experienced in providing services
to communities of color, for the design of innovative outreach and education programs for
targeted groups within the community who may be at risk of acquiring the human
immunodeficiency virus infection, including deleted text begin intravenous drug usersdeleted text end new text begin people who inject drugsnew text end
and their partners, adolescents, new text begin women, and new text end gay deleted text begin anddeleted text end new text begin ,new text end bisexualnew text begin , and transgendernew text end individuals
deleted text begin and womendeleted text end . Grants shall be awarded on a request for proposal basis and shall include funds
for administrative costs. Priority for grants shall be given to agencies or organizations that
have experience in providing service to the particular community which the grantee proposes
to serve; that have policy makers representative of the targeted population; that have
experience in dealing with issues relating to HIV/AIDS; and that have the capacity to deal
effectively with persons of differing sexual orientations. For purposes of this paragraph,
the "communities of color" are: the American-Indian community; the Hispanic community;
the African-American community; and the Asian-Pacific new text begin Islander new text end community.
(c) All state grants awarded under this section for programs targeted to adolescents shall
include the promotion of abstinence from sexual activity and drug use.
new text begin
(d) The commissioner shall administer a grant program to provide funds to organizations,
including Tribal health agencies, to assist with HIV/AIDS outbreaks.
new text end
Sec. 121.
Minnesota Statutes 2022, section 145.925, is amended to read:
145.925 deleted text begin FAMILY PLANNINGdeleted text end new text begin SEXUAL AND REPRODUCTIVE HEALTH
SERVICESnew text end GRANTS.
Subdivision 1.
deleted text begin Eligible organizations; purposedeleted text end new text begin Goal and establishmentnew text end .
deleted text begin
The
commissioner of health may make special grants to cities, counties, groups of cities or
counties, or nonprofit corporations to provide prepregnancy family planning services.
deleted text end
new text begin
(a)
It is the goal of the state to increase access to sexual and reproductive health services for
people who experience barriers, whether geographic, cultural, financial, or other, in access
to such services. The commissioner of health shall administer grants to facilitate access to
sexual and reproductive health services for people of reproductive age, particularly those
from populations that experience barriers to these services.
new text end
new text begin
(b) The commissioner of health shall coordinate with other efforts at the local, state, or
national level to avoid duplication and promote complementary efforts in sexual and
reproductive health service promotion among people of reproductive age.
new text end
deleted text begin Subd. 1a. deleted text end
deleted text begin Family planning services; defined. deleted text end
deleted text begin
"Family planning services" means
counseling by trained personnel regarding family planning; distribution of information
relating to family planning, referral to licensed physicians or local health agencies for
consultation, examination, medical treatment, genetic counseling, and prescriptions for the
purpose of family planning; and the distribution of family planning products, such as charts,
thermometers, drugs, medical preparations, and contraceptive devices. For purposes of
sections 145A.01 to 145A.14, family planning shall mean voluntary action by individuals
to prevent or aid conception but does not include the performance, or make referrals for
encouragement of voluntary termination of pregnancy.
deleted text end
deleted text begin Subd. 2. deleted text end
deleted text begin Prohibition. deleted text end
deleted text begin
The commissioner shall not make special grants pursuant to this
section to any nonprofit corporation which performs abortions. No state funds shall be used
under contract from a grantee to any nonprofit corporation which performs abortions. This
provision shall not apply to hospitals licensed pursuant to sections 144.50 to 144.56, or
health maintenance organizations certified pursuant to chapter 62D.
deleted text end
new text begin Subd. 2a. new text end
new text begin Sexual and reproductive health services defined. new text end
new text begin
For purposes of this section,
"sexual and reproductive health services" means services that promote a state of complete
physical, mental, and social well-being in relation to sexuality, reproduction, and the
reproductive system and its functions and processes, and not merely the absence of disease
or infirmity. These services must be provided in accord with nationally recognized standards
and include but are not limited to sexual and reproductive health counseling, voluntary and
informed decision-making on sexual and reproductive health, information on and provision
of contraceptive methods, sexual and reproductive health screenings and treatment, pregnancy
testing and counseling, and other preconception services.
new text end
Subd. 3.
deleted text begin Minorsdeleted text end new text begin Grants authorizednew text end .
deleted text begin
No funds provided by grants made pursuant to
this section shall be used to support any family planning services for any unemancipated
minor in any elementary or secondary school building.
deleted text end
new text begin
(a) The commissioner of health shall
award grants to eligible community organizations, including nonprofit organizations,
community health boards, and Tribal communities in rural and metropolitan areas of the
state to support, sustain, expand, or implement reproductive and sexual health programs for
people of reproductive age to increase access to and availability of medically accurate sexual
and reproductive health services.
new text end
new text begin
(b) The commissioner of health shall establish application scoring criteria to use in the
evaluation of applications submitted for award under this section. These criteria shall include
but are not limited to the degree to which applicants' programming responds to demographic
factors relevant to subdivision 1, paragraph (a), and paragraph (f).
new text end
new text begin
(c) When determining whether to award a grant or the amount of a grant under this
section, the commissioner of health may identify and stratify geographic regions based on
the region's need for sexual and reproductive health services. In this stratification, the
commissioner may consider data on the prevalence of poverty and other factors relevant to
a geographic region's need for sexual and reproductive health services.
new text end
new text begin
(d) The commissioner of health may consider geographic and Tribal communities'
representation in the award of grants.
new text end
new text begin
(e) Current recipients of funding under this section shall not be afforded priority over
new applicants.
new text end
new text begin
(f) Grant funds shall be used to support new or existing sexual and reproductive health
programs that provide person-centered, accessible services; that are culturally and
linguistically appropriate, inclusive of all people, and trauma-informed; that protect the
dignity of the individual; and that ensure equitable, quality services consistent with nationally
recognized standards of care. These services shall include:
new text end
new text begin
(1) education and outreach on medically accurate sexual and reproductive health
information;
new text end
new text begin
(2) contraceptive counseling, provision of contraceptive methods, and follow-up;
new text end
new text begin
(3) screening, testing, and treatment of sexually transmitted infections and other sexual
or reproductive concerns; and
new text end
new text begin
(4) referral and follow-up for medical, financial, mental health, and other services in
accord with a service recipient's needs.
new text end
deleted text begin Subd. 4. deleted text end
deleted text begin Parental notification. deleted text end
deleted text begin
Except as provided in sections 144.341 and 144.342,
any person employed to provide family planning services who is paid in whole or in part
from funds provided under this section who advises an abortion or sterilization to any
unemancipated minor shall, following such a recommendation, so notify the parent or
guardian of the reasons for such an action.
deleted text end
deleted text begin Subd. 5. deleted text end
deleted text begin Rules. deleted text end
deleted text begin
The commissioner of health shall promulgate rules for approval of plans
and budgets of prospective grant recipients, for the submission of annual financial and
statistical reports, and the maintenance of statements of source and application of funds by
grant recipients. The commissioner of health may not require that any home rule charter or
statutory city or county apply for or receive grants under this subdivision as a condition for
the receipt of any state or federal funds unrelated to family planning services.
deleted text end
Subd. 6.
Public services; individual deleted text begin and employeedeleted text end rights.
The request of any person
for deleted text begin family planningdeleted text end new text begin sexual and reproductive healthnew text end services or the refusal to accept any
service shall in no way affect the right of the person to receive public assistance, public
health services, or any other public service. Nothing in this section shall abridge the right
of the deleted text begin individualdeleted text end new text begin personnew text end to make decisions concerning deleted text begin family planningdeleted text end new text begin sexual and
reproductive healthnew text end , nor shall any deleted text begin individualdeleted text end new text begin personnew text end be required to state a reason for refusing
any offer of deleted text begin family planningdeleted text end new text begin sexual and reproductive healthnew text end services.
deleted text begin
Any employee of the agencies engaged in the administration of the provisions of this
section may refuse to accept the duty of offering family planning services to the extent that
the duty is contrary to personal beliefs. A refusal shall not be grounds for dismissal,
suspension, demotion, or any other discrimination in employment. The directors or
supervisors of the agencies shall reassign the duties of employees in order to carry out the
provisions of this section.
deleted text end
All information gathered by any agency, entity, or individual conducting programs in
deleted text begin family planningdeleted text end new text begin sexual and reproductive healthnew text end is private data on individuals within the
meaning of section 13.02, subdivision 12.new text begin For any person or entity meeting the definition
of a "provider" under section 144.291, subdivision 2, paragraph (i), all sexual and
reproductive health services information provided to, gathered about, or received from a
person under this section is also subject to the Minnesota Health Records Act, in sections
144.291 to 144.298.
new text end
deleted text begin Subd. 7. deleted text end
deleted text begin Family planning services; information required. deleted text end
deleted text begin
A grant recipient shall
inform any person requesting counseling on family planning methods or procedures of:
deleted text end
deleted text begin
(1) Any methods or procedures which may be followed, including identification of any
which are experimental or any which may pose a health hazard to the person;
deleted text end
deleted text begin
(2) A description of any attendant discomforts or risks which might reasonably be
expected;
deleted text end
deleted text begin
(3) A fair explanation of the likely results, should a method fail;
deleted text end
deleted text begin
(4) A description of any benefits which might reasonably be expected of any method;
deleted text end
deleted text begin
(5) A disclosure of appropriate alternative methods or procedures;
deleted text end
deleted text begin
(6) An offer to answer any inquiries concerning methods of procedures; and
deleted text end
deleted text begin
(7) An instruction that the person is free either to decline commencement of any method
or procedure or to withdraw consent to a method or procedure at any reasonable time.
deleted text end
deleted text begin Subd. 8. deleted text end
deleted text begin Coercion; penalty. deleted text end
deleted text begin
Any person who receives compensation for services under
any program receiving financial assistance under this section, who coerces or endeavors to
coerce any person to undergo an abortion or sterilization procedure by threatening the person
with the loss of or disqualification for the receipt of any benefit or service under a program
receiving state or federal financial assistance shall be guilty of a misdemeanor.
deleted text end
deleted text begin Subd. 9. deleted text end
deleted text begin Amount of grant; rules. deleted text end
deleted text begin
Notwithstanding any rules to the contrary, including
rules proposed in the State Register on April 1, 1991, the commissioner, in allocating grant
funds for family planning special projects, shall not limit the total amount of funds that can
be allocated to an organization. The commissioner shall allocate to an organization receiving
grant funds on July 1, 1997, at least the same amount of grant funds for the 1998 to 1999
grant cycle as the organization received for the 1996 to 1997 grant cycle, provided the
organization submits an application that meets grant funding criteria. This subdivision does
not affect any procedure established in rule for allocating special project money to the
different regions. The commissioner shall revise the rules for family planning special project
grants so that they conform to the requirements of this subdivision. In adopting these
revisions, the commissioner is not subject to the rulemaking provisions of chapter 14, but
is bound by section 14.386, paragraph (a), clauses (1) and (3). Section 14.386, paragraph
(b), does not apply to these rules.
deleted text end
Sec. 122.
new text begin
[145.9257] COMMUNITY SOLUTIONS FOR HEALTHY CHILD
DEVELOPMENT GRANT PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The commissioner of health shall establish a grant
program to improve child development outcomes and the well-being of children of color
and American Indian children from prenatal to grade 3 and their families. The purposes of
the program are to:
new text end
new text begin
(1) improve child development outcomes related to the well-being of children of color
and American Indian children from prenatal to grade 3 and their families, including but not
limited to the goals outlined by the Department of Human Services' early childhood systems
reform effort: early learning; health and well-being; economic security; and safe, stable,
nurturing relationships and environments by funding community-based solutions for
challenges that are identified by the affected community;
new text end
new text begin
(2) reduce racial disparities in children's health and development from prenatal to grade
3; and
new text end
new text begin
(3) promote racial and geographic equity.
new text end
new text begin Subd. 2. new text end
new text begin Commissioner's duties. new text end
new text begin
The commissioner of health shall:
new text end
new text begin
(1) develop a request for proposals for the community solutions for healthy child
development grant program in consultation with the community solutions advisory council;
new text end
new text begin
(2) provide outreach, technical assistance, and program development support to increase
capacity for new and existing service providers in order to better meet statewide needs,
particularly in greater Minnesota and areas where services to reduce health disparities have
not been established;
new text end
new text begin
(3) review responses to requests for proposals, in consultation with the community
solutions advisory council, and award grants under this section;
new text end
new text begin
(4) ensure communication with the ethnic councils, Minnesota Indian Affairs Council,
and the State Advisory Council on Early Childhood Education and Care on the request for
proposal process;
new text end
new text begin
(5) establish a transparent and objective accountability process, in consultation with the
community solutions advisory council, focused on outcomes that grantees agree to achieve;
new text end
new text begin
(6) provide grantees with access to data to assist grantees in establishing and
implementing effective community-led solutions;
new text end
new text begin
(7) maintain data on outcomes reported by grantees; and
new text end
new text begin
(8) contract with an independent third-party entity to evaluate the success of the grant
program and to build the evidence base for effective community solutions in reducing health
disparities of children of color and American Indian children from prenatal to grade 3.
new text end
new text begin Subd. 3. new text end
new text begin
Community solutions advisory council; establishment; duties;
compensation.
new text end
new text begin
(a) No later than October 1, 2023, the commissioner shall have convened
a 12-member community solutions advisory council as follows:
new text end
new text begin
(1) two members representing the African Heritage community;
new text end
new text begin
(2) two members representing the Latino community;
new text end
new text begin
(3) two members representing the Asian-Pacific Islander community;
new text end
new text begin
(4) two members representing the American Indian community;
new text end
new text begin
(5) two parents of children who are under nine years of age and are Black, nonwhite
people of color, or American Indian;
new text end
new text begin
(6) one member with research or academic expertise in racial equity and healthy child
development; and
new text end
new text begin
(7) one member representing an organization that advocates on behalf of communities
of color or American Indians.
new text end
new text begin
(b) At least three of the 12 members of the advisory council must come from outside
the seven-county metropolitan area.
new text end
new text begin
(c) The community solutions advisory council shall:
new text end
new text begin
(1) advise the commissioner on the development of the request for proposals for
community solutions for healthy child development grants. In advising the commissioner,
the council must consider how to build on the capacity of communities to promote child
and family well-being and address social determinants of healthy child development;
new text end
new text begin
(2) review responses to requests for proposals and advise the commissioner on the
selection of grantees and grant awards;
new text end
new text begin
(3) advise the commissioner on the establishment of a transparent and objective
accountability process focused on outcomes the grantees agree to achieve;
new text end
new text begin
(4) advise the commissioner on ongoing oversight and necessary support in the
implementation of the program; and
new text end
new text begin
(5) support the commissioner on other racial equity and early childhood grant efforts.
new text end
new text begin
(d) Each advisory council member shall be compensated in accordance with section
15.059, subdivision 3.
new text end
new text begin Subd. 4. new text end
new text begin Eligible grantees. new text end
new text begin
Organizations eligible to receive grant funding under this
section include:
new text end
new text begin
(1) organizations or entities that work with Black communities, nonwhite communities
of color, and American Indian communities;
new text end
new text begin
(2) Tribal nations and Tribal organizations as defined in section 658P of the Child Care
and Development Block Grant Act of 1990; and
new text end
new text begin
(3) organizations or entities focused on supporting healthy child development.
new text end
new text begin Subd. 5. new text end
new text begin
Strategic consideration and priority of proposals; eligible populations;
grant awards.
new text end
new text begin
(a) The commissioner, in consultation with the community solutions advisory
council, shall develop a request for proposals for healthy child development grants. In
developing the proposals and awarding the grants, the commissioner shall consider building
on the capacity of communities to promote child and family well-being and address social
determinants of healthy child development. Proposals must focus on increasing racial equity
and healthy child development and reducing health disparities experienced by children who
are Black, nonwhite people of color, or American Indian from prenatal to grade 3 and their
families.
new text end
new text begin
(b) In awarding the grants, the commissioner shall provide strategic consideration and
give priority to proposals from:
new text end
new text begin
(1) organizations or entities led by Black and other nonwhite people of color and serving
Black and nonwhite communities of color;
new text end
new text begin
(2) organizations or entities led by American Indians and serving American Indians,
including Tribal nations and Tribal organizations;
new text end
new text begin
(3) organizations or entities with proposals focused on healthy development from prenatal
to grade three;
new text end
new text begin
(4) organizations or entities with proposals focusing on multigenerational solutions;
new text end
new text begin
(5) organizations or entities located in or with proposals to serve communities located
in counties that are moderate to high risk according to the Wilder Research Risk and Reach
Report; and
new text end
new text begin
(6) community-based organizations that have historically served communities of color
and American Indians and have not traditionally had access to state grant funding.
new text end
new text begin
The advisory council may recommend additional strategic considerations and priorities
to the commissioner.
new text end
new text begin Subd. 6. new text end
new text begin Geographic distribution of grants. new text end
new text begin
The commissioner and the advisory council
shall ensure that grant funds are prioritized and awarded to organizations and entities that
are within counties that have a higher proportion of Black, nonwhite communities of color,
and American Indians than the state average, to the extent possible.
new text end
new text begin Subd. 7. new text end
new text begin Report. new text end
new text begin
Grantees must report grant program outcomes to the commissioner on
the forms and according to the timelines established by the commissioner.
new text end
Sec. 123.
new text begin
[145.9272] LEAD REMEDIATION IN SCHOOL AND CHILD CARE
SETTINGS GRANT PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment; purpose. new text end
new text begin
The commissioner of health shall develop a
grant program for the purpose of remediating identified sources of lead in drinking water
in schools and licensed child care settings.
new text end
new text begin Subd. 2. new text end
new text begin Grants authorized. new text end
new text begin
The commissioner shall award grants through a request
for proposals process to schools and licensed child care settings. Priority shall be given to
schools and licensed child care settings with higher levels of lead detected in water samples,
evidence of lead service lines, or lead plumbing materials and school districts that serve
disadvantaged communities.
new text end
new text begin Subd. 3. new text end
new text begin Grant allocation. new text end
new text begin
Grantees must use the funds to address sources of lead
contamination in their facilities including but not limited to service connections and premise
plumbing, and to implement best practices for water management within the building.
new text end
Sec. 124.
new text begin
[145.9273] TESTING FOR LEAD IN DRINKING WATER IN CHILD
CARE SETTINGS.
new text end
new text begin Subdivision 1. new text end
new text begin Requirement to test. new text end
new text begin
(a) By July 1, 2024, licensed or certified child care
providers must develop a plan to accurately and efficiently test for the presence of lead in
drinking water in child care facilities following either the Department of Health's document
"Reducing Lead in Drinking Water: A Technical Guidance for Minnesota's School and
Child Care Facilities" or the Environmental Protection Agency's "3Ts: Training, Testing,
Taking Action" guidance materials.
new text end
new text begin
(b) For purposes of this section, "licensed or certified child care provider" means a child
care center licensed under Minnesota Rules, chapter 9503, or a certified license-exempt
child care center under chapter 245H.
new text end
new text begin Subd. 2. new text end
new text begin Scope and frequency of testing. new text end
new text begin
The plan under subdivision 1 must include
testing every building serving children and all water fixtures used for consumption of water,
including water used in food preparation. All taps must be tested at least once every five
years. A licensed or certified child care provider must begin testing in buildings by July 1,
2024, and complete testing in all buildings that serve students within five years.
new text end
new text begin Subd. 3. new text end
new text begin Remediation of lead in drinking water. new text end
new text begin
The plan under subdivision 1 must
include steps to remediate if lead is present in drinking water. A licensed or certified child
care provider that finds lead at concentrations at or exceeding five parts per billion at a
specific location providing water to children within its facilities must take action to reduce
lead exposure following guidance and verify the success of remediation by retesting the
location for lead. Remediation actions are actions that reduce lead levels from the drinking
water fixture as demonstrated by testing. This includes using certified filters, implementing
and documenting a building-wide flushing program, and replacing or removing fixtures
with elevated lead levels.
new text end
new text begin Subd. 4. new text end
new text begin Reporting results. new text end
new text begin
(a) A licensed or certified child care provider that tested its
buildings for the presence of lead shall make the results of the testing and any remediation
steps taken available to parents and staff and notify them of the availability of results.
Reporting shall occur no later than 30 days from receipt of results and annually thereafter.
new text end
new text begin
(b) Beginning July 1, 2024, a licensed or certified child care provider must report the
provider's test results and remediation activities to the commissioner of health annually on
or before July 1 of each year.
new text end
Sec. 125.
new text begin
[145.987] HEALTH EQUITY ADVISORY AND LEADERSHIP (HEAL)
COUNCIL.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment; composition of advisory council. new text end
new text begin
The commissioner
shall establish and appoint a health equity advisory and leadership (HEAL) council to
provide guidance to the commissioner of health regarding strengthening and improving the
health of communities most impacted by health inequities across the state. The council shall
consist of 18 members who will provide representation from the following groups:
new text end
new text begin
(1) African American and African heritage communities;
new text end
new text begin
(2) Asian American and Pacific Islander communities;
new text end
new text begin
(3) Latina/o/x communities;
new text end
new text begin
(4) American Indian communities and Tribal governments and nations;
new text end
new text begin
(5) disability communities;
new text end
new text begin
(6) lesbian, gay, bisexual, transgender, and queer (LGBTQ) communities; and
new text end
new text begin
(7) representatives who reside outside the seven-county metropolitan area.
new text end
new text begin Subd. 2. new text end
new text begin Organization and meetings. new text end
new text begin
The advisory council shall be organized and
administered under section 15.059. Meetings shall be held at least quarterly and hosted by
the department. Subcommittees may be convened as necessary. Advisory council meetings
are subject to the open meeting law under chapter 13D.
new text end
new text begin Subd. 3. new text end
new text begin Duties. new text end
new text begin
The advisory council shall:
new text end
new text begin
(1) advise the commissioner on health equity issues and the health equity priorities and
concerns of the populations specified in subdivision 1;
new text end
new text begin
(2) assist the agency in efforts to advance health equity, including consulting on specific
agency policies and programs, providing ideas and input about potential budget and policy
proposals, and recommending review of agency policies, standards, or procedures that may
create or perpetuate health inequities; and
new text end
new text begin
(3) assist the agency in developing and monitoring meaningful performance measures
related to advancing health equity.
new text end
new text begin Subd. 4. new text end
new text begin Expiration. new text end
new text begin
The advisory council shall remain in existence until health inequities
in the state are eliminated. Health inequities will be considered eliminated when race,
ethnicity, income, gender, gender identity, geographic location, or other identity or social
marker will no longer be predictors of health outcomes in the state. Section 145.928 describes
nine health disparities that must be considered when determining whether health inequities
have been eliminated in the state.
new text end
Sec. 126.
Minnesota Statutes 2022, section 145A.131, subdivision 1, is amended to read:
Subdivision 1.
Funding formula for community health boards.
(a) Base funding for
each community health board eligible for a local public health grant under section 145A.03,
subdivision 7, shall be determined by each community health board's fiscal year 2003
allocations, prior to unallotment, for the following grant programs: community health
services subsidy; state and federal maternal and child health special projects grants; family
home visiting grants; TANF MN ENABL grants; TANF youth risk behavior grants; and
available women, infants, and children grant funds in fiscal year 2003, prior to unallotment,
distributed based on the proportion of WIC participants served in fiscal year 2003 within
the CHS service area.
(b) Base funding for a community health board eligible for a local public health grant
under section 145A.03, subdivision 7, as determined in paragraph (a), shall be adjusted by
the percentage difference between the base, as calculated in paragraph (a), and the funding
available for the local public health grant.
(c) Multicounty or multicity community health boards shall receive a local partnership
base of up to $5,000 per year for each county or city in the case of a multicity community
health board included in the community health board.
(d) The State Community Health new text begin Servicesnew text end Advisory Committee may recommend a
formula to the commissioner to use in distributing funds to community health boards.
(e) Notwithstanding any adjustment in paragraph (b), community health boards, all or
a portion of which are located outside of the counties of Anoka, Chisago, Carver, Dakota,
Hennepin, Isanti, Ramsey, Scott, Sherburne, Washington, and Wright, are eligible to receive
an increase equal to ten percent of the grant award to the community health board under
paragraph (a) starting July 1, 2015. The increase in calendar year 2015 shall be prorated for
the last six months of the year. For calendar years beginning on or after January 1, 2016,
the amount distributed under this paragraph shall be adjusted each year based on available
funding and the number of eligible community health boards.
new text begin
(f) Funding for foundational public health responsibilities must be distributed based on
a formula determined by the commissioner in consultation with the State Community Health
Services Advisory Committee. A portion of these funds may be used to fund new
organizational models, including multijurisdictional and regional partnerships. These funds
shall be used in accordance with subdivision 5.
new text end
Sec. 127.
Minnesota Statutes 2022, section 145A.131, subdivision 5, is amended to read:
Subd. 5.
Use of funds.
new text begin (a) new text end Community health boards may use new text begin the base funding of new text end their
local public health grant funds new text begin as outlined in subdivision 1, paragraphs (a) to (e), new text end to address
the areas of public health responsibility and local priorities developed through the community
health assessment and community health improvement planning process.
new text begin
(b) Funding for foundational public health responsibilities as outlined in subdivision 1,
paragraph (f), must be used to fulfill foundational public health responsibilities as defined
by the commissioner in consultation with the State Community Health Services Advisory
Committee unless a community health board demonstrates fulfillment of foundational public
health responsibilities. If a community health board demonstrates foundational public health
responsibilities are fulfilled, funds may be used for local priorities developed through the
community health assessment and community health improvement planning process.
new text end
new text begin
(c) By July 1, 2028, all local public health grant funds must be used first to fulfill
foundational public health responsibilities. Once a community health board demonstrates
foundational public health responsibilities are fulfilled, funds may be used for local priorities
developed through the community health assessment and community health improvement
planning process.
new text end
Sec. 128.
Minnesota Statutes 2022, section 145A.14, is amended by adding a subdivision
to read:
new text begin Subd. 2b. new text end
new text begin Grants to Tribes. new text end
new text begin
The commissioner shall distribute grants to Tribal
governments for foundational public health responsibilities as defined by each Tribal
government.
new text end
Sec. 129.
Minnesota Statutes 2022, section 147A.08, is amended to read:
147A.08 EXEMPTIONS.
(a) This chapter does not apply to, control, prevent, or restrict the practice, service, or
activities of persons listed in section 147.09, clauses (1) to (6) and (8) to (13)deleted text begin ,deleted text end new text begin ;new text end persons
regulated under section 214.01, subdivision 2deleted text begin ,deleted text end new text begin ;new text end or deleted text begin personsdeleted text end new text begin midlevel practitioners, nurses,
or nurse-midwives asnew text end defined in section 144.1501, subdivision 1deleted text begin , paragraphs (i), (k), and
(l)deleted text end .
(b) Nothing in this chapter shall be construed to require licensure of:
(1) a physician assistant student enrolled in a physician assistant educational program
accredited by the Accreditation Review Commission on Education for the Physician Assistant
or by its successor agency approved by the board;
(2) a physician assistant employed in the service of the federal government while
performing duties incident to that employment; or
(3) technicians, other assistants, or employees of physicians who perform delegated
tasks in the office of a physician but who do not identify themselves as a physician assistant.
Sec. 130.
Minnesota Statutes 2022, section 148.261, subdivision 1, is amended to read:
Subdivision 1.
Grounds listed.
The board may deny, revoke, suspend, limit, or condition
the license and registration of any person to practice advanced practice, professional, or
practical nursing under sections 148.171 to 148.285, or to otherwise discipline a licensee
or applicant as described in section 148.262. The following are grounds for disciplinary
action:
(1) Failure to demonstrate the qualifications or satisfy the requirements for a license
contained in sections 148.171 to 148.285 or rules of the board. In the case of a person
applying for a license, the burden of proof is upon the applicant to demonstrate the
qualifications or satisfaction of the requirements.
(2) Employing fraud or deceit in procuring or attempting to procure a permit, license,
or registration certificate to practice advanced practice, professional, or practical nursing
or attempting to subvert the licensing examination process. Conduct that subverts or attempts
to subvert the licensing examination process includes, but is not limited to:
(i) conduct that violates the security of the examination materials, such as removing
examination materials from the examination room or having unauthorized possession of
any portion of a future, current, or previously administered licensing examination;
(ii) conduct that violates the standard of test administration, such as communicating with
another examinee during administration of the examination, copying another examinee's
answers, permitting another examinee to copy one's answers, or possessing unauthorized
materials; or
(iii) impersonating an examinee or permitting an impersonator to take the examination
on one's own behalf.
(3) Conviction of a felony or gross misdemeanor reasonably related to the practice of
professional, advanced practice registered, or practical nursing. Conviction as used in this
subdivision includes a conviction of an offense that if committed in this state would be
considered a felony or gross misdemeanor without regard to its designation elsewhere, or
a criminal proceeding where a finding or verdict of guilt is made or returned but the
adjudication of guilt is either withheld or not entered.
(4) Revocation, suspension, limitation, conditioning, or other disciplinary action against
the person's professional or practical nursing license or advanced practice registered nursing
credential, in another state, territory, or country; failure to report to the board that charges
regarding the person's nursing license or other credential are pending in another state,
territory, or country; or having been refused a license or other credential by another state,
territory, or country.
(5) Failure to or inability to perform professional or practical nursing as defined in section
148.171, subdivision 14 or 15, with reasonable skill and safety, including failure of a
registered nurse to supervise or a licensed practical nurse to monitor adequately the
performance of acts by any person working at the nurse's direction.
(6) Engaging in unprofessional conduct, including, but not limited to, a departure from
or failure to conform to board rules of professional or practical nursing practice that interpret
the statutory definition of professional or practical nursing as well as provide criteria for
violations of the statutes, or, if no rule exists, to the minimal standards of acceptable and
prevailing professional or practical nursing practice, or any nursing practice that may create
unnecessary danger to a patient's life, health, or safety. Actual injury to a patient need not
be established under this clause.
(7) Failure of an advanced practice registered nurse to practice with reasonable skill and
safety or departure from or failure to conform to standards of acceptable and prevailing
advanced practice registered nursing.
(8) Delegating or accepting the delegation of a nursing function or a prescribed health
care function when the delegation or acceptance could reasonably be expected to result in
unsafe or ineffective patient care.
(9) Actual or potential inability to practice nursing with reasonable skill and safety to
patients by reason of illness, use of alcohol, drugs, chemicals, or any other material, or as
a result of any mental or physical condition.
(10) Adjudication as mentally incompetent, mentally ill, a chemically dependent person,
or a person dangerous to the public by a court of competent jurisdiction, within or without
this state.
(11) Engaging in any unethical conduct, including, but not limited to, conduct likely to
deceive, defraud, or harm the public, or demonstrating a willful or careless disregard for
the health, welfare, or safety of a patient. Actual injury need not be established under this
clause.
(12) Engaging in conduct with a patient that is sexual or may reasonably be interpreted
by the patient as sexual, or in any verbal behavior that is seductive or sexually demeaning
to a patient, or engaging in sexual exploitation of a patient or former patient.
(13) Obtaining money, property, or services from a patient, other than reasonable fees
for services provided to the patient, through the use of undue influence, harassment, duress,
deception, or fraud.
(14) Revealing a privileged communication from or relating to a patient except when
otherwise required or permitted by law.
(15) Engaging in abusive or fraudulent billing practices, including violations of federal
Medicare and Medicaid laws or state medical assistance laws.
(16) Improper management of patient records, including failure to maintain adequate
patient records, to comply with a patient's request made pursuant to sections 144.291 to
144.298, or to furnish a patient record or report required by law.
(17) Knowingly aiding, assisting, advising, or allowing an unlicensed person to engage
in the unlawful practice of advanced practice, professional, or practical nursing.
(18) Violating a rule adopted by the board, an order of the board, or a state or federal
law relating to the practice of advanced practice, professional, or practical nursing, or a
state or federal narcotics or controlled substance law.
(19) Knowingly providing false or misleading information that is directly related to the
care of that patient unless done for an accepted therapeutic purpose such as the administration
of a placebo.
(20) Aiding suicide or aiding attempted suicide in violation of section 609.215 as
established by any of the following:
(i) a copy of the record of criminal conviction or plea of guilty for a felony in violation
of section 609.215, subdivision 1 or 2;
(ii) a copy of the record of a judgment of contempt of court for violating an injunction
issued under section 609.215, subdivision 4;
(iii) a copy of the record of a judgment assessing damages under section 609.215,
subdivision 5; or
(iv) a finding by the board that the person violated section 609.215, subdivision 1 or 2.
The board shall investigate any complaint of a violation of section 609.215, subdivision 1
or 2.
(21) Practicing outside the scope of practice authorized by section 148.171, subdivision
5, 10, 11, 13, 14, 15, or 21.
(22) Making a false statement or knowingly providing false information to the board,
failing to make reports as required by section 148.263, or failing to cooperate with an
investigation of the board as required by section 148.265.
(23) Engaging in false, fraudulent, deceptive, or misleading advertising.
(24) Failure to inform the board of the person's certification or recertification status as
a certified registered nurse anesthetist, certified nurse-midwife, certified nurse practitioner,
or certified clinical nurse specialist.
(25) Engaging in clinical nurse specialist practice, nurse-midwife practice, nurse
practitioner practice, or registered nurse anesthetist practice without a license and current
certification or recertification by a national nurse certification organization acceptable to
the board.
deleted text begin
(26) Engaging in conduct that is prohibited under section 145.412.
deleted text end
deleted text begin (27)deleted text end new text begin (26)new text end Failing to report employment to the board as required by section 148.211,
subdivision 2a, or knowingly aiding, assisting, advising, or allowing a person to fail to report
as required by section 148.211, subdivision 2a.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 131.
Minnesota Statutes 2022, section 148.512, subdivision 10a, is amended to read:
Subd. 10a.
Hearing aid.
"Hearing aid" means deleted text begin an instrumentdeleted text end new text begin a prescribed aidnew text end , or any of
its parts, worn in the ear canal and designed to or represented as being able to aid deleted text begin or enhancedeleted text end
human hearing. "Hearing aid" includes the aid's parts, attachments, or accessories, including,
but not limited to, ear molds and behind the ear (BTE) devices with or without an ear mold.
Batteries and cords are not parts, attachments, or accessories of a hearing aid. Surgically
implanted hearing aids, and assistive listening devices not worn within the ear canal, are
not hearing aids.
Sec. 132.
Minnesota Statutes 2022, section 148.512, subdivision 10b, is amended to read:
Subd. 10b.
Hearing aid dispensing.
"Hearing aid dispensing" means making ear mold
impressions, prescribingdeleted text begin , or recommendingdeleted text end a hearing aid, assisting the consumer in
new text begin prescription new text end aid selectiondeleted text begin , selling hearing aids at retaildeleted text end , or testing human hearing in connection
with these activities regardless of whether the person conducting these activities has a
monetary interest in the dispensing of new text begin prescription new text end hearing aids to the consumer.new text begin Hearing
aid dispensing does not include selling over-the-counter hearing aids.
new text end
Sec. 133.
Minnesota Statutes 2022, section 148.512, is amended by adding a subdivision
to read:
new text begin Subd. 10c. new text end
new text begin Over-the-counter hearing aid or OTC hearing aid. new text end
new text begin
"Over-the-counter
hearing aid" or "OTC hearing aid" has the meaning given to that term in Code of Federal
Regulations, title 21, section 800.30(b).
new text end
Sec. 134.
Minnesota Statutes 2022, section 148.512, is amended by adding a subdivision
to read:
new text begin Subd. 13a. new text end
new text begin Prescription hearing aid. new text end
new text begin
"Prescription hearing aid" means a hearing aid
requiring a prescription from a certified hearing aid dispenser or licensed audiologist that
is not an OTC hearing aid.
new text end
Sec. 135.
Minnesota Statutes 2022, section 148.513, is amended by adding a subdivision
to read:
new text begin Subd. 4. new text end
new text begin Over-the-counter hearing aids. new text end
new text begin
Nothing in sections 148.511 to 148.5198 shall
preclude licensed audiologists from dispensing or selling over-the-counter hearing aids.
new text end
Sec. 136.
Minnesota Statutes 2022, section 148.515, subdivision 6, is amended to read:
Subd. 6.
Dispensing audiologist examination requirements.
(a) Audiologists are
exempt from the written examination requirement in section 153A.14, subdivision 2h,
paragraph (a), clause (1).
(b) After July 31, 2005, all applicants for audiologist licensure under sections 148.512
to 148.5198 must achieve a passing score on the practical tests of proficiency described in
section 153A.14, subdivision 2h, paragraph (a), clause (2), within the time period described
in section 153A.14, subdivision 2h, paragraph (c).
(c) In order to dispense new text begin prescription new text end hearing aids as a sole proprietor, member of a
partnership, or for a limited liability company, corporation, or any other entity organized
for profit, a licensee who obtained audiologist licensure under sections 148.512 to 148.5198,
before August 1, 2005, and who is not certified to dispense new text begin prescription new text end hearing aids under
chapter 153A, must achieve a passing score on the practical tests of proficiency described
in section 153A.14, subdivision 2h, paragraph (a), clause (2), within the time period described
in section 153A.14, subdivision 2h, paragraph (c). All other audiologist licensees who
obtained licensure before August 1, 2005, are exempt from the practical tests.
(d) An applicant for an audiology license who obtains a temporary license under section
148.5175 may dispense new text begin prescription new text end hearing aids only under supervision of a licensed
audiologist who dispenses new text begin prescription new text end hearing aids.
Sec. 137.
Minnesota Statutes 2022, section 148.5175, is amended to read:
148.5175 TEMPORARY LICENSURE.
(a) The commissioner shall issue temporary licensure as a speech-language pathologist,
an audiologist, or both, to an applicant who:
(1) submits a signed and dated affidavit stating that the applicant is not the subject of a
disciplinary action or past disciplinary action in this or another jurisdiction and is not
disqualified on the basis of section 148.5195, subdivision 3; and
(2) either:
(i) provides a copy of a current credential as a speech-language pathologist, an audiologist,
or both, held in the District of Columbia or a state or territory of the United States; or
(ii) provides a copy of a current certificate of clinical competence issued by the American
Speech-Language-Hearing Association or board certification in audiology by the American
Board of Audiology.
(b) A temporary license issued to a person under this subdivision expires 90 days after
it is issued or on the date the commissioner grants or denies licensure, whichever occurs
first.
(c) Upon application, a temporary license shall be renewed twice to a person who is able
to demonstrate good cause for failure to meet the requirements for licensure within the
initial temporary licensure period and who is not the subject of a disciplinary action or
disqualified on the basis of section 148.5195, subdivision 3. Good cause includes but is not
limited to inability to take and complete the required practical exam for dispensing
new text begin prescription new text end hearing deleted text begin instrumentsdeleted text end new text begin aidsnew text end .
(d) Upon application, a temporary license shall be issued to a person who meets the
requirements of section 148.515, subdivisions 2a and 4, but has not completed the
requirement in section 148.515, subdivision 6.
Sec. 138.
Minnesota Statutes 2022, section 148.5195, subdivision 3, is amended to read:
Subd. 3.
Grounds for disciplinary action by commissioner.
The commissioner may
take any of the disciplinary actions listed in subdivision 4 on proof that the individual has:
(1) intentionally submitted false or misleading information to the commissioner or the
advisory council;
(2) failed, within 30 days, to provide information in response to a written request by the
commissioner or advisory council;
(3) performed services of a speech-language pathologist or audiologist in an incompetent
or negligent manner;
(4) violated sections 148.511 to 148.5198;
(5) failed to perform services with reasonable judgment, skill, or safety due to the use
of alcohol or drugs, or other physical or mental impairment;
(6) violated any state or federal law, rule, or regulation, and the violation is a felony or
misdemeanor, an essential element of which is dishonesty, or which relates directly or
indirectly to the practice of speech-language pathology or audiology. Conviction for violating
any state or federal law which relates to speech-language pathology or audiology is
necessarily considered to constitute a violation, except as provided in chapter 364;
(7) aided or abetted another person in violating any provision of sections 148.511 to
148.5198;
(8) been or is being disciplined by another jurisdiction, if any of the grounds for the
discipline is the same or substantially equivalent to those under sections 148.511 to 148.5198;
(9) not cooperated with the commissioner or advisory council in an investigation
conducted according to subdivision 1;
(10) advertised in a manner that is false or misleading;
(11) engaged in conduct likely to deceive, defraud, or harm the public; or demonstrated
a willful or careless disregard for the health, welfare, or safety of a client;
(12) failed to disclose to the consumer any fee splitting or any promise to pay a portion
of a fee to any other professional other than a fee for services rendered by the other
professional to the client;
(13) engaged in abusive or fraudulent billing practices, including violations of federal
Medicare and Medicaid laws, Food and Drug Administration regulations, or state medical
assistance laws;
(14) obtained money, property, or services from a consumer through the use of undue
influence, high pressure sales tactics, harassment, duress, deception, or fraud;
(15) performed services for a client who had no possibility of benefiting from the services;
(16) failed to refer a client for medical evaluation or to other health care professionals
when appropriate or when a client indicated symptoms associated with diseases that could
be medically or surgically treated;
(17) had the certification required by chapter 153A denied, suspended, or revoked
according to chapter 153A;
(18) used the term doctor of audiology, doctor of speech-language pathology, AuD, or
SLPD without having obtained the degree from an institution accredited by the North Central
Association of Colleges and Secondary Schools, the Council on Academic Accreditation
in Audiology and Speech-Language Pathology, the United States Department of Education,
or an equivalent;
(19) failed to comply with the requirements of section 148.5192 regarding supervision
of speech-language pathology assistants; or
(20) if the individual is an audiologist or certified hearing deleted text begin instrumentdeleted text end new text begin aidnew text end dispenser:
(i) prescribed deleted text begin or otherwise recommendeddeleted text end to a consumer or potential consumer the use
of a new text begin prescription new text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end , unless the prescription from a physician deleted text begin or
recommendation fromdeleted text end new text begin ,new text end an audiologistnew text begin ,new text end or new text begin a new text end certified dispenser is in writing, is based on an
audiogram that is delivered to the consumer or potential consumer when the prescription
deleted text begin or recommendationdeleted text end is made, and bears the following information in all capital letters of
12-point or larger boldface type: "THIS PRESCRIPTION deleted text begin OR RECOMMENDATIONdeleted text end
MAY BE FILLED BY, AND new text begin PRESCRIPTION new text end HEARING deleted text begin INSTRUMENTSdeleted text end new text begin AIDSnew text end MAY
BE PURCHASED FROM, THE LICENSED AUDIOLOGIST OR CERTIFIED DISPENSER
OF YOUR CHOICE";
(ii) failed to give a copy of the audiogram, upon which the prescription deleted text begin or
recommendationdeleted text end is based, to the consumer when the consumer requests a copy;
(iii) failed to provide the consumer rights brochure required by section 148.5197,
subdivision 3;
(iv) failed to comply with restrictions on sales of new text begin prescription new text end hearing deleted text begin instrumentsdeleted text end new text begin aidsnew text end
in sections 148.5197, subdivision 3, and 148.5198;
(v) failed to return a consumer's new text begin prescription new text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end used as a trade-in
or for a discount in the price of a newnew text begin prescriptionnew text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end when requested
by the consumer upon cancellation of the purchase agreement;
(vi) failed to follow Food and Drug Administration or Federal Trade Commission
regulations relating to dispensingnew text begin prescriptionnew text end hearing deleted text begin instrumentsdeleted text end new text begin aidsnew text end ;
(vii) failed to dispense a new text begin prescription new text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end in a competent manner or
without appropriate training;
(viii) delegated new text begin prescription new text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end dispensing authority to a person not
authorized to dispense a new text begin prescription new text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end under this chapter or chapter
153A;
(ix) failed to comply with the requirements of an employer or supervisor of a hearing
deleted text begin instrumentdeleted text end new text begin aidnew text end dispenser trainee;
(x) violated a state or federal court order or judgment, including a conciliation court
judgment, relating to the activities of the individual's new text begin prescription new text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end
dispensing; or
(xi) failed to include on the audiogram the practitioner's printed name, credential type,
credential number, signature, and date.
Sec. 139.
Minnesota Statutes 2022, section 148.5196, subdivision 1, is amended to read:
Subdivision 1.
Membership.
The commissioner shall appoint 12 persons to a
Speech-Language Pathologist and Audiologist Advisory Council. The 12 persons must
include:
(1) three public members, as defined in section 214.02. Two of the public members shall
be either persons receiving services of a speech-language pathologist or audiologist, or
family members of or caregivers to such persons, and at least one of the public members
shall be either a hearing deleted text begin instrumentdeleted text end new text begin aidnew text end user or an advocate of one;
(2) three speech-language pathologists licensed under sections 148.511 to 148.5198,
one of whom is currently and has been, for the five years immediately preceding the
appointment, engaged in the practice of speech-language pathology in Minnesota and each
of whom is employed in a different employment setting including, but not limited to, private
practice, hospitals, rehabilitation settings, educational settings, and government agencies;
(3) one speech-language pathologist licensed under sections 148.511 to 148.5198, who
is currently and has been, for the five years immediately preceding the appointment,
employed by a Minnesota public school district or a Minnesota public school district
consortium that is authorized by Minnesota Statutes and who is licensed in speech-language
pathology by the Professional Educator Licensing and Standards Board;
(4) three audiologists licensed under sections 148.511 to 148.5198, two of whom are
currently and have been, for the five years immediately preceding the appointment, engaged
in the practice of audiology and the dispensing of new text begin prescription new text end hearing deleted text begin instrumentsdeleted text end new text begin aidsnew text end in
Minnesota and each of whom is employed in a different employment setting including, but
not limited to, private practice, hospitals, rehabilitation settings, educational settings, industry,
and government agencies;
(5) one nonaudiologist hearing deleted text begin instrumentdeleted text end new text begin aidnew text end dispenser recommended by a professional
association representing hearing deleted text begin instrumentdeleted text end new text begin aidnew text end dispensers; and
(6) one physician licensed under chapter 147 and certified by the American Board of
Otolaryngology, Head and Neck Surgery.
Sec. 140.
Minnesota Statutes 2022, section 148.5197, is amended to read:
148.5197 HEARING AID DISPENSING.
Subdivision 1.
Content of contracts.
Oral statements made by an audiologist or certified
dispenser regarding the provision of warranties, refunds, and service on the new text begin prescription
new text end hearing aid or aids dispensed must be written on, and become part of, the contract of sale,
specify the item or items covered, and indicate the person or business entity obligated to
provide the warranty, refund, or service.
Subd. 2.
Required use of license number.
The audiologist's license number or certified
dispenser's certificate number must appear on all contracts, bills of sale, and receipts used
in the sale of new text begin prescription new text end hearing aids.
Subd. 3.
Consumer rights information.
An audiologist or certified dispenser shall, at
the time of the deleted text begin recommendation ordeleted text end prescription, give a consumer rights brochure, prepared
by the commissioner and containing information about legal requirements pertaining to
dispensing of new text begin prescription new text end hearing aids, to each potential consumer of a new text begin prescription new text end hearing
aid. The brochure must contain information about the consumer information center described
in section 153A.18. A contract for a new text begin prescription new text end hearing aid must note the receipt of the
brochure by the consumer, along with the consumer's signature or initials.
Subd. 4.
Liability for contracts.
Owners of entities in the business of dispensing
new text begin prescription new text end hearing aids, employers of audiologists or persons who dispense new text begin prescription
new text end hearing aids, supervisors of trainees or audiology students, and hearing aid dispensers
conducting the transaction at issue are liable for satisfying all terms of contracts, written or
oral, made by their agents, employees, assignees, affiliates, or trainees, including terms
relating to products, repairs, warranties, service, and refunds. The commissioner may enforce
the terms of new text begin prescription new text end hearing aid contracts against the principal, employer, supervisor,
or dispenser who conducted the transaction and may impose any remedy provided for in
this chapter.
Sec. 141.
Minnesota Statutes 2022, section 148.5198, is amended to read:
148.5198 RESTRICTION ON SALE OF new text begin PRESCRIPTION new text end HEARING AIDS.
Subdivision 1.
45-calendar-day guarantee and buyer right to cancel.
(a) An audiologist
or certified dispenser dispensing a new text begin prescription new text end hearing aid in this state must comply with
paragraphs (b) and (c).
(b) The audiologist or certified dispenser must provide the buyer with a 45-calendar-day
written money-back guarantee. The guarantee must permit the buyer to cancel the purchase
for any reason within 45 calendar days after receiving the new text begin prescription new text end hearing aid by giving
or mailing written notice of cancellation to the audiologist or certified dispenser. If the buyer
mails the notice of cancellation, the 45-calendar-day period is counted using the postmark
date, to the date of receipt by the audiologist or certified dispenser. If the new text begin prescription new text end hearing
aid must be repaired, remade, or adjusted during the 45-calendar-day money-back guarantee
period, the running of the 45-calendar-day period is suspended one day for each 24-hour
period that the new text begin prescription new text end hearing aid is not in the buyer's possession. A repaired, remade,
or adjusted new text begin prescription new text end hearing aid must be claimed by the buyer within three business
days after notification of availability, after which time the running of the 45-calendar-day
period resumes. The guarantee must entitle the buyer, upon cancellation, to receive a refund
of payment within 30 days of return of the new text begin prescription new text end hearing aid to the audiologist or
certified dispenser. The audiologist or certified dispenser may retain as a cancellation fee
no more than $250 of the buyer's total purchase price of the new text begin prescription new text end hearing aid.
(c) The audiologist or certified dispenser shall provide the buyer with a contract written
in plain English, that contains uniform language and provisions that meet the requirements
under the Plain Language Contract Act, sections 325G.29 to 325G.36. The contract must
include, but is not limited to, the following: in immediate proximity to the space reserved
for the signature of the buyer, or on the first page if there is no space reserved for the
signature of the buyer, a clear and conspicuous disclosure of the following specific statement
in all capital letters of no less than 12-point boldface type: "MINNESOTA STATE LAW
GIVES THE BUYER THE RIGHT TO CANCEL THIS PURCHASE FOR ANY REASON
AT ANY TIME PRIOR TO MIDNIGHT OF THE 45TH CALENDAR DAY AFTER
RECEIPT OF THE new text begin PRESCRIPTION new text end HEARING AID(S). THIS CANCELLATION MUST
BE IN WRITING AND MUST BE GIVEN OR MAILED TO THE AUDIOLOGIST OR
CERTIFIED DISPENSER. IF THE BUYER DECIDES TO RETURN THE new text begin PRESCRIPTION
new text end HEARING AID(S) WITHIN THIS 45-CALENDAR-DAY PERIOD, THE BUYER WILL
RECEIVE A REFUND OF THE TOTAL PURCHASE PRICE OF THE AID(S) FROM
WHICH THE AUDIOLOGIST OR CERTIFIED DISPENSER MAY RETAIN AS A
CANCELLATION FEE NO MORE THAN $250."
Subd. 2.
Itemized repair bill.
Any audiologist, certified dispenser, or company who
agrees to repair a new text begin prescription new text end hearing aid must provide the owner of the new text begin prescription new text end hearing
aid, or the owner's representative, with a bill that describes the repair and services rendered.
The bill must also include the repairing audiologist's, certified dispenser's, or company's
name, address, and telephone number.
This subdivision does not apply to an audiologist, certified dispenser, or company that
repairs a new text begin prescription new text end hearing aid pursuant to an express warranty covering the entire
new text begin prescription new text end hearing aid and the warranty covers the entire cost, both parts and labor, of the
repair.
Subd. 3.
Repair warranty.
Any guarantee of new text begin prescription new text end hearing aid repairs must be
in writing and delivered to the owner of the new text begin prescription new text end hearing aid, or the owner's
representative, stating the repairing audiologist's, certified dispenser's, or company's name,
address, telephone number, length of guarantee, model, and serial number of the new text begin prescription
new text end hearing aid and all other terms and conditions of the guarantee.
Subd. 4.
Misdemeanor.
A person found to have violated this section is guilty of a
misdemeanor.
Subd. 5.
Additional.
In addition to the penalty provided in subdivision 4, a person found
to have violated this section is subject to the penalties and remedies provided in section
325F.69, subdivision 1.
Subd. 6.
Estimates.
Upon the request of the owner of a new text begin prescription new text end hearing aid or the
owner's representative for a written estimate and prior to the commencement of repairs, a
repairing audiologist, certified dispenser, or company shall provide the customer with a
written estimate of the price of repairs. If a repairing audiologist, certified dispenser, or
company provides a written estimate of the price of repairs, it must not charge more than
the total price stated in the estimate for the repairs. If the repairing audiologist, certified
dispenser, or company after commencing repairs determines that additional work is necessary
to accomplish repairs that are the subject of a written estimate and if the repairing audiologist,
certified dispenser, or company did not unreasonably fail to disclose the possible need for
the additional work when the estimate was made, the repairing audiologist, certified
dispenser, or company may charge more than the estimate for the repairs if the repairing
audiologist, certified dispenser, or company immediately provides the owner or owner's
representative a revised written estimate pursuant to this section and receives authorization
to continue with the repairs. If continuation of the repairs is not authorized, the repairing
audiologist, certified dispenser, or company shall return the new text begin prescription new text end hearing aid as close
as possible to its former condition and shall release the new text begin prescription new text end hearing aid to the owner
or owner's representative upon payment of charges for repairs actually performed and not
in excess of the original estimate.
Sec. 142.
Minnesota Statutes 2022, section 151.37, subdivision 12, is amended to read:
Subd. 12.
Administration of opiate antagonists for drug overdose.
(a) A licensed
physician, a licensed advanced practice registered nurse authorized to prescribe drugs
pursuant to section 148.235, or a licensed physician assistant may authorize the following
individuals to administer opiate antagonists, as defined in section 604A.04, subdivision 1:
(1) an emergency medical responder registered pursuant to section 144E.27;
(2) a peace officer as defined in section 626.84, subdivision 1, paragraphs (c) and (d);
(3) correctional employees of a state or local political subdivision;
(4) staff of community-based health disease prevention or social service programs;
(5) a volunteer firefighter; and
(6) a deleted text begin licensed schooldeleted text end nurse or deleted text begin certified public health nursedeleted text end new text begin any other personnelnew text end employed
by, or under contract with, a deleted text begin school board under section 121A.21deleted text end new text begin charter, public, or private
schoolnew text end .
(b) For the purposes of this subdivision, opiate antagonists may be administered by one
of these individuals only if:
(1) the licensed physician, licensed physician assistant, or licensed advanced practice
registered nurse has issued a standing order to, or entered into a protocol with, the individual;
and
(2) the individual has training in the recognition of signs of opiate overdose and the use
of opiate antagonists as part of the emergency response to opiate overdose.
(c) Nothing in this section prohibits the possession and administration of naloxone
pursuant to section 604A.04.
new text begin
(d) Notwithstanding section 148.235, subdivisions 8 and 9, a licensed practical nurse is
authorized to possess and administer according to this subdivision an opiate antagonist in
a school setting.
new text end
Sec. 143.
Minnesota Statutes 2022, section 153A.13, subdivision 3, is amended to read:
Subd. 3.
Hearing deleted text begin instrumentdeleted text end new text begin aidnew text end .
"Hearing deleted text begin instrumentdeleted text end new text begin aidnew text end " means an instrumentdeleted text begin , or
any of its parts, worn in the ear canal and designed to or represented as being able to aid or
enhance human hearing. "Hearing instrument" includes the instrument's parts, attachments,
or accessories, including, but not limited to, ear molds and behind the ear (BTE) devices
with or without an ear mold. Batteries and cords are not parts, attachments, or accessories
of a hearing instrument. Surgically implanted hearing instruments, and assistive listening
devices not worn within the ear canal, are not hearing instruments.deleted text end new text begin as defined in section
148.512, subdivision 10a.
new text end
Sec. 144.
Minnesota Statutes 2022, section 153A.13, subdivision 4, is amended to read:
Subd. 4.
Hearing deleted text begin instrumentdeleted text end new text begin aidnew text end dispensing.
"Hearing deleted text begin instrumentdeleted text end new text begin aidnew text end dispensing"
deleted text begin means making ear mold impressions, prescribing, or recommending a hearing instrument,
assisting the consumer in instrument selection, selling hearing instruments at retail, or testing
human hearing in connection with these activities regardless of whether the person conducting
these activities has a monetary interest in the sale of hearing instruments to the consumer.deleted text end new text begin
has the meaning given in section 148.512, subdivision 10b.
new text end
Sec. 145.
Minnesota Statutes 2022, section 153A.13, subdivision 5, is amended to read:
Subd. 5.
Dispenser of hearing deleted text begin instrumentsdeleted text end new text begin aidsnew text end .
"Dispenser of hearing deleted text begin instrumentsdeleted text end new text begin
aidsnew text end " means a natural person who engages in new text begin prescription new text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end dispensingnew text begin ,new text end
whether or not certified by the commissioner of health or licensed by an existing
health-related board, except that a person described as follows is not a dispenser of hearing
deleted text begin instrumentsdeleted text end new text begin aidsnew text end :
(1) a student participating in supervised field work that is necessary to meet requirements
of an accredited educational program if the student is designated by a title which clearly
indicates the student's status as a student trainee; or
(2) a person who helps a dispenser of hearing deleted text begin instrumentsdeleted text end new text begin aidsnew text end in an administrative or
clerical manner and does not engage in new text begin prescription new text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end dispensing.
A person who offers to dispense a new text begin prescription new text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end , or a person who
advertises, holds out to the public, or otherwise represents that the person is authorized to
dispense new text begin prescription new text end hearing deleted text begin instrumentsdeleted text end new text begin aids,new text end must be certified by the commissioner except
when the person is an audiologist as defined in section 148.512.
Sec. 146.
Minnesota Statutes 2022, section 153A.13, subdivision 6, is amended to read:
Subd. 6.
Advisory council.
"Advisory council" means the Minnesota Hearing deleted text begin Instrumentdeleted text end new text begin
Aidnew text end Dispenser Advisory Council, or a committee of deleted text begin itdeleted text end new text begin the councilnew text end , established under section
153A.20.
Sec. 147.
Minnesota Statutes 2022, section 153A.13, subdivision 7, is amended to read:
Subd. 7.
ANSI.
"ANSI" means deleted text begin ANSI S3.6-1989,deleted text end American National Standard
Specification for Audiometers deleted text begin from the American National Standards Institute. This
document is available through the Minitex interlibrary loan systemdeleted text end new text begin as defined in the United
States Food and Drug Administration, Code of Federal Regulations, title 21, section
874.1050new text end .
Sec. 148.
Minnesota Statutes 2022, section 153A.13, subdivision 9, is amended to read:
Subd. 9.
Supervision.
"Supervision" means monitoring activities of, and accepting
responsibility for, the new text begin prescription new text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end dispensing activities of a trainee.
Sec. 149.
Minnesota Statutes 2022, section 153A.13, subdivision 10, is amended to read:
Subd. 10.
Direct supervision or directly supervised.
"Direct supervision" or "directly
supervised" means the on-site and contemporaneous location of a supervisor and trainee,
when the supervisor observes the trainee engaging in new text begin prescription new text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end
dispensing with a consumer.
Sec. 150.
Minnesota Statutes 2022, section 153A.13, subdivision 11, is amended to read:
Subd. 11.
Indirect supervision or indirectly supervised.
"Indirect supervision" or
"indirectly supervised" means the remote and independent performance of new text begin prescription
new text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end dispensing by a trainee when authorized under section 153A.14,
subdivision 4a, paragraph (b).
Sec. 151.
Minnesota Statutes 2022, section 153A.13, is amended by adding a subdivision
to read:
new text begin Subd. 12. new text end
new text begin Over-the-counter hearing aid or OTC hearing aid. new text end
new text begin
"Over-the-counter
hearing aid" or "OTC hearing aid" has the meaning given in section 148.512, subdivision
10c.
new text end
Sec. 152.
Minnesota Statutes 2022, section 153A.13, is amended by adding a subdivision
to read:
new text begin Subd. 13. new text end
new text begin Prescription hearing aid. new text end
new text begin
"Prescription hearing aid" has the meaning given
in section 148.512, subdivision 13a.
new text end
Sec. 153.
Minnesota Statutes 2022, section 153A.14, subdivision 1, is amended to read:
Subdivision 1.
Application for certificate.
An applicant must:
(1) be 21 years of age or older;
(2) apply to the commissioner for a certificate to dispense new text begin prescription new text end hearing deleted text begin instrumentsdeleted text end new text begin
aidsnew text end on application forms provided by the commissioner;
(3) at a minimum, provide the applicant's name, Social Security number, business address
and phone number, employer, and information about the applicant's education, training,
and experience in testing human hearing and fitting new text begin prescription new text end hearing deleted text begin instrumentsdeleted text end new text begin aidsnew text end ;
(4) include with the application a statement that the statements in the application are
true and correct to the best of the applicant's knowledge and belief;
(5) include with the application a written and signed authorization that authorizes the
commissioner to make inquiries to appropriate regulatory agencies in this or any other state
where the applicant has sold new text begin prescription new text end hearing deleted text begin instrumentsdeleted text end new text begin aidsnew text end ;
(6) submit certification to the commissioner that the applicant's audiometric equipment
has been calibrated to meet current ANSI standards within 12 months of the date of the
application;
(7) submit evidence of continuing education credits, if required;
(8) submit all fees as required under section 153A.17; and
(9) consent to a fingerprint-based criminal history records check required under section
144.0572, pay all required fees, and cooperate with all requests for information. An applicant
must complete a new criminal background check if more than one year has elapsed since
the applicant last applied for a license.
Sec. 154.
Minnesota Statutes 2022, section 153A.14, subdivision 2, is amended to read:
Subd. 2.
Issuance of certificate.
(a) The commissioner shall issue a certificate to each
dispenser of hearing deleted text begin instrumentsdeleted text end new text begin aidsnew text end who applies under subdivision 1 if the commissioner
determines that the applicant is in compliance with this chapter, has passed an examination
administered by the commissioner, has met the continuing education requirements, if
required, and has paid the fee set by the commissioner. The commissioner may reject or
deny an application for a certificate if there is evidence of a violation or failure to comply
with this chapter.
(b) The commissioner shall not issue a certificate to an applicant who refuses to consent
to a criminal history background check as required by section 144.0572 within 90 days after
submission of an application or fails to submit fingerprints to the Department of Human
Services. Any fees paid by the applicant to the Department of Health shall be forfeited if
the applicant refuses to consent to the background study.
Sec. 155.
Minnesota Statutes 2022, section 153A.14, subdivision 2h, is amended to read:
Subd. 2h.
Certification by examination.
An applicant must achieve a passing score,
as determined by the commissioner, on an examination according to paragraphs (a) to (c).
(a) The examination must include, but is not limited to:
(1) A written examination approved by the commissioner covering the following areas
as they pertain to new text begin prescription new text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end selling:
(i) basic physics of sound;
(ii) the anatomy and physiology of the ear;
(iii) the function of new text begin prescription new text end hearing deleted text begin instrumentsdeleted text end new text begin aidsnew text end ; and
(iv) the principles of new text begin prescription new text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end selection.
(2) Practical tests of proficiency in the following techniques as they pertain to new text begin prescription
new text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end selling:
(i) pure tone audiometry, including air conduction testing and bone conduction testing;
(ii) live voice or recorded voice speech audiometry including speech recognition
(discrimination) testing, most comfortable loudness level, and uncomfortable loudness
measurements of tolerance thresholds;
(iii) masking when indicated;
(iv) recording and evaluation of audiograms and speech audiometry to determine proper
selection and fitting of a new text begin prescription new text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end ;
(v) taking ear mold impressions;
(vi) using an otoscope for the visual observation of the entire ear canal; and
(vii) state and federal laws, rules, and regulations.
(b) The practical examination shall be administered by the commissioner at least twice
a year.
(c) An applicant must achieve a passing score on all portions of the examination within
a two-year period. An applicant who does not achieve a passing score on all portions of the
examination within a two-year period must retake the entire examination and achieve a
passing score on each portion of the examination. An applicant who does not apply for
certification within one year of successful completion of the examination must retake the
examination and achieve a passing score on each portion of the examination. An applicant
may not take any part of the practical examination more than three times in a two-year
period.
Sec. 156.
Minnesota Statutes 2022, section 153A.14, subdivision 2i, is amended to read:
Subd. 2i.
Continuing education requirement.
On forms provided by the commissioner,
each certified dispenser must submit with the application for renewal of certification evidence
of completion of ten course hours of continuing education earned within the 12-month
period of November 1 to October 31, between the effective and expiration dates of
certification. Continuing education courses must be directly related tonew text begin prescriptionnew text end hearing
deleted text begin instrumentdeleted text end new text begin aidnew text end dispensing and approved by the International Hearing Society, the American
Speech-Language-Hearing Association, or the American Academy of Audiology. Evidence
of completion of the ten course hours of continuing education must be submitted by
December 1 of each year. This requirement does not apply to dispensers certified for less
than one year.
Sec. 157.
Minnesota Statutes 2022, section 153A.14, subdivision 2j, is amended to read:
Subd. 2j.
Required use of certification number.
The certification holder must use the
certification number on all contracts, bills of sale, and receipts used in the sale of new text begin prescription
new text end hearing deleted text begin instrumentsdeleted text end new text begin aidsnew text end .
Sec. 158.
Minnesota Statutes 2022, section 153A.14, subdivision 4, is amended to read:
Subd. 4.
Dispensing of new text begin prescription new text end hearing deleted text begin instrumentsdeleted text end new text begin aidsnew text end without
certificate.
Except as provided in subdivisions 4a and 4c, and in sections 148.512 to
148.5198, it is unlawful for any person not holding a valid certificate to dispense a
new text begin prescription new text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end as defined in section 153A.13, subdivision 3. A person
who dispenses a new text begin prescription new text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end without the certificate required by this
section is guilty of a gross misdemeanor.
Sec. 159.
Minnesota Statutes 2022, section 153A.14, subdivision 4a, is amended to read:
Subd. 4a.
Trainees.
(a) A person who is not certified under this section may dispense
new text begin prescription new text end hearing deleted text begin instrumentsdeleted text end new text begin aidsnew text end as a trainee for a period not to exceed 12 months if
the person:
(1) submits an application on forms provided by the commissioner;
(2) is under the supervision of a certified dispenser meeting the requirements of this
subdivision;
(3) meets all requirements for certification except passage of the examination required
by this section; and
(4) uses the title "dispenser trainee" in contacts with the patients, clients, or consumers.
(b) A certified hearing deleted text begin instrumentdeleted text end new text begin aidnew text end dispenser may not supervise more than two trainees
at the same time and may not directly supervise more than one trainee at a time. The certified
dispenser is responsible for all actions or omissions of a trainee in connection with the
dispensing of new text begin prescription new text end hearing deleted text begin instrumentsdeleted text end new text begin aidsnew text end . A certified dispenser may not supervise
a trainee if there are any commissioner, court, or other orders, currently in effect or issued
within the last five years, that were issued with respect to an action or omission of a certified
dispenser or a trainee under the certified dispenser's supervision.
Until taking and passing the practical examination testing the techniques described in
subdivision 2h, paragraph (a), clause (2), trainees must be directly supervised in all areas
described in subdivision 4b, and the activities tested by the practical examination. Thereafter,
trainees may dispense new text begin prescription new text end hearing deleted text begin instrumentsdeleted text end new text begin aidsnew text end under indirect supervision until
expiration of the trainee period. Under indirect supervision, the trainee must complete two
monitored activities a week. Monitored activities may be executed by correspondence,
telephone, or other telephonic devices, and include, but are not limited to, evaluation of
audiograms, written reports, and contracts. The time spent in supervision must be recorded
and the record retained by the supervisor.
Sec. 160.
Minnesota Statutes 2022, section 153A.14, subdivision 4b, is amended to read:
Subd. 4b.
new text begin Prescription new text end hearing testing protocol.
A dispenser when conducting a hearing
test for the purpose of new text begin prescription new text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end dispensing must:
(1) comply with the United States Food and Drug Administration warning regarding
potential medical conditions required by Code of Federal Regulations, title 21, section
deleted text begin 801.420deleted text end new text begin 801.422new text end ;
(2) complete a case history of the client's hearing;
(3) inspect the client's ears with an otoscope; and
(4) conduct the following tests on both ears of the client and document the results, and
if for any reason one of the following tests cannot be performed pursuant to the United
States Food and Drug Administration guidelines, an audiologist shall evaluate the hearing
and the need for a new text begin prescription new text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end :
(i) air conduction at 250, 500, 1,000, 2,000, 4,000, and 8,000 Hertz. When a difference
of 20 dB or more occurs between adjacent octave frequencies the interoctave frequency
must be tested;
(ii) bone conduction at 500, 1,000, 2,000, and 4,000 Hertz for any frequency where the
air conduction threshold is greater than 15 dB HL;
(iii) monaural word recognition (discrimination), with a minimum of 25 words presented
for each ear; and
(iv) loudness discomfort level, monaural, for setting a new text begin prescription new text end hearing deleted text begin instrument'sdeleted text end new text begin
aid'snew text end maximum power output; and
(5) include masking in all tests whenever necessary to ensure accurate results.
Sec. 161.
Minnesota Statutes 2022, section 153A.14, subdivision 4c, is amended to read:
Subd. 4c.
Reciprocity.
(a) A person who has dispensed new text begin prescription new text end hearing deleted text begin instrumentsdeleted text end new text begin
aidsnew text end in another jurisdiction may dispensenew text begin prescriptionnew text end hearing deleted text begin instrumentsdeleted text end new text begin aidsnew text end as a trainee
under indirect supervision if the person:
(1) satisfies the provisions of subdivision 4a, paragraph (a);
(2) submits a signed and dated affidavit stating that the applicant is not the subject of a
disciplinary action or past disciplinary action in this or another jurisdiction and is not
disqualified on the basis of section 153A.15, subdivision 1; and
(3) provides a copy of a current credential as a hearing deleted text begin instrumentdeleted text end new text begin aidnew text end dispenser held in
the District of Columbia or a state or territory of the United States.
(b) A person becoming a trainee under this subdivision who fails to take and pass the
practical examination described in subdivision 2h, paragraph (a), clause (2), when next
offered must cease dispensing new text begin prescription new text end hearing deleted text begin instrumentsdeleted text end new text begin aidsnew text end unless under direct
supervision.
Sec. 162.
Minnesota Statutes 2022, section 153A.14, subdivision 4e, is amended to read:
Subd. 4e.
new text begin Prescription new text end hearing aids; enforcement.
Costs incurred by the Minnesota
Department of Health for conducting investigations of unlicensed new text begin prescription new text end hearing aid
deleted text begin dispensersdeleted text end new text begin dispensingnew text end shall be apportioned between all licensed or credentialed professions
that dispense new text begin prescription new text end hearing aids.
Sec. 163.
Minnesota Statutes 2022, section 153A.14, subdivision 6, is amended to read:
Subd. 6.
new text begin Prescription new text end hearing deleted text begin instrumentsdeleted text end new text begin aidsnew text end to comply with federal and state
requirements.
The commissioner shall ensure that new text begin prescription new text end hearing deleted text begin instrumentsdeleted text end new text begin aidsnew text end
are dispensed in compliance with state requirements and the requirements of the United
States Food and Drug Administration. Failure to comply with state or federal regulations
may be grounds for enforcement actions under section 153A.15, subdivision 2.
Sec. 164.
Minnesota Statutes 2022, section 153A.14, subdivision 9, is amended to read:
Subd. 9.
Consumer rights.
A hearing deleted text begin instrumentdeleted text end new text begin aidnew text end dispenser shall comply with the
requirements of sections 148.5195, subdivision 3, clause (20); 148.5197; and 148.5198.
Sec. 165.
Minnesota Statutes 2022, section 153A.14, subdivision 11, is amended to read:
Subd. 11.
Requirement to maintain current information.
A dispenser must notify the
commissioner in writing within 30 days of the occurrence of any of the following:
(1) a change of name, address, home or business telephone number, or business name;
(2) the occurrence of conduct prohibited by section 153A.15;
(3) a settlement, conciliation court judgment, or award based on negligence, intentional
acts, or contractual violations committed in the dispensing of new text begin prescription new text end hearing deleted text begin instrumentsdeleted text end new text begin
aidsnew text end by the dispenser; and
(4) the cessation of new text begin prescription new text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end dispensing activities as an
individual or a business.
Sec. 166.
Minnesota Statutes 2022, section 153A.14, is amended by adding a subdivision
to read:
new text begin Subd. 12. new text end
new text begin Over-the-counter hearing aids. new text end
new text begin
Nothing in this chapter shall preclude certified
hearing aid dispensers from dispensing or selling over-the-counter hearing aids.
new text end
Sec. 167.
Minnesota Statutes 2022, section 153A.15, subdivision 1, is amended to read:
Subdivision 1.
Prohibited acts.
The commissioner may take enforcement action as
provided under subdivision 2 against a dispenser of new text begin prescription new text end hearing deleted text begin instrumentsdeleted text end new text begin aidsnew text end
for the following acts and conduct:
(1) dispensing a new text begin prescription new text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end to a minor person 18 years or younger
unless evaluated by an audiologist for hearing evaluation and new text begin prescription new text end hearing aid
evaluation;
(2) being disciplined through a revocation, suspension, restriction, or limitation by
another state for conduct subject to action under this chapter;
(3) presenting advertising that is false or misleading;
(4) providing the commissioner with false or misleading statements of credentials,
training, or experience;
(5) engaging in conduct likely to deceive, defraud, or harm the public; or demonstrating
a willful or careless disregard for the health, welfare, or safety of a consumer;
(6) splitting fees or promising to pay a portion of a fee to any other professional other
than a fee for services rendered by the other professional to the client;
(7) engaging in abusive or fraudulent billing practices, including violations of federal
Medicare and Medicaid laws, Food and Drug Administration regulations, or state medical
assistance laws;
(8) obtaining money, property, or services from a consumer through the use of undue
influence, high pressure sales tactics, harassment, duress, deception, or fraud;
(9) performing the services of a certified hearing deleted text begin instrumentdeleted text end new text begin aidnew text end dispenser in an
incompetent or negligent manner;
(10) failing to comply with the requirements of this chapter as an employer, supervisor,
or trainee;
(11) failing to provide information in a timely manner in response to a request by the
commissioner, commissioner's designee, or the advisory council;
(12) being convicted within the past five years of violating any laws of the United States,
or any state or territory of the United States, and the violation is a felony, gross misdemeanor,
or misdemeanor, an essential element of which relates to new text begin prescription new text end hearing deleted text begin instrumentdeleted text end new text begin
aidnew text end dispensing, except as provided in chapter 364;
(13) failing to cooperate with the commissioner, the commissioner's designee, or the
advisory council in any investigation;
(14) failing to perform new text begin prescription new text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end dispensing with reasonable
judgment, skill, or safety due to the use of alcohol or drugs, or other physical or mental
impairment;
(15) failing to fully disclose actions taken against the applicant or the applicant's legal
authorization to dispense new text begin prescription new text end hearing deleted text begin instrumentsdeleted text end new text begin aidsnew text end in this or another state;
(16) violating a state or federal court order or judgment, including a conciliation court
judgment, relating to the activities of the applicant in new text begin prescription new text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end
dispensing;
(17) having been or being disciplined by the commissioner of the Department of Health,
or other authority, in this or another jurisdiction, if any of the grounds for the discipline are
the same or substantially equivalent to those in sections 153A.13 to 153A.18;
(18) misrepresenting the purpose of hearing tests, or in any way communicating that the
hearing test or hearing test protocol required by section 153A.14, subdivision 4b, is a medical
evaluation, a diagnostic hearing evaluation conducted by an audiologist, or is other than a
test to select a new text begin prescription new text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end , except that the hearing deleted text begin instrumentdeleted text end new text begin aidnew text end
dispenser can determine the need for or recommend the consumer obtain a medical evaluation
consistent with requirements of the United States Food and Drug Administration;
(19) violating any of the provisions of sections 148.5195, subdivision 3, clause (20);
148.5197; 148.5198; and 153A.13 to 153A.18; and
(20) aiding or abetting another person in violating any of the provisions of sections
148.5195, subdivision 3, clause (20); 148.5197; 148.5198; and 153A.13 to 153A.18.
Sec. 168.
Minnesota Statutes 2022, section 153A.15, subdivision 2, is amended to read:
Subd. 2.
Enforcement actions.
When the commissioner finds that a dispenser of
new text begin prescription new text end hearing deleted text begin instrumentsdeleted text end new text begin aidsnew text end has violated one or more provisions of this chapter,
the commissioner may do one or more of the following:
(1) deny or reject the application for a certificate;
(2) revoke the certificate;
(3) suspend the certificate;
(4) impose, for each violation, a civil penalty that deprives the dispenser of any economic
advantage gained by the violation and that reimburses the Department of Health for costs
of the investigation and proceeding resulting in disciplinary action, including the amount
paid for services of the Office of Administrative Hearings, the amount paid for services of
the Office of the Attorney General, attorney fees, court reporters, witnesses, reproduction
of records, advisory council members' per diem compensation, department staff time, and
expenses incurred by advisory council members and department staff;
(5) censure or reprimand the dispenser;
(6) revoke or suspend the right to supervise trainees;
(7) revoke or suspend the right to be a trainee;
(8) impose a civil penalty not to exceed $10,000 for each separate violation; or
(9) any other action reasonably justified by the individual case.
Sec. 169.
Minnesota Statutes 2022, section 153A.15, subdivision 4, is amended to read:
Subd. 4.
Penalties.
Except as provided in section 153A.14, subdivision 4, a person
violating this chapter is guilty of a misdemeanor. The commissioner may impose an automatic
civil penalty equal to one-fourth the renewal fee on each hearing deleted text begin instrument sellerdeleted text end new text begin aid
dispensernew text end who fails to renew the certificate required in section 153A.14 by the renewal
deadline.
Sec. 170.
Minnesota Statutes 2022, section 153A.17, is amended to read:
153A.17 EXPENSES; FEES.
(a) The expenses for administering the certification requirements, including the complaint
handling system for hearing aid dispensers in sections 153A.14 and 153A.15, and the
Consumer Information Center under section 153A.18, must be paid from initial application
and examination fees, renewal fees, penalties, and fines. The commissioner shall only use
fees collected under this section for the purposes of administering this chapter. The legislature
must not transfer money generated by these fees from the state government special revenue
fund to the general fund. deleted text begin Surcharges collected by the commissioner of health under section
16E.22 are not subject to this paragraph.
deleted text end
(b) The fees are as follows:
(1) the initial certification application fee is $772.50;
(2) the annual renewal certification application fee is $750;
(3) the initial examination fee for the practical portion is $1,200, and $600 for each time
it is taken, thereafter; for individuals meeting the requirements of section 148.515, subdivision
2, the fee for the practical portion of the new text begin prescription new text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end dispensing
examination is $600 each time it is taken;
(4) the trainee application fee is $230;
(5) the penalty fee for late submission of a renewal application is $260; and
(6) the fee for verification of certification to other jurisdictions or entities is $25.
(c) The commissioner may prorate the certification fee for new applicants based on the
number of quarters remaining in the annual certification period.
(d) All fees are nonrefundable. All fees, penalties, and fines received must be deposited
in the state government special revenue fund.
(e) Hearing instrument dispensers who were certified before January 1, 2018, shall pay
a onetime surcharge of $22.50 to renew their certification when it expires after October 31,
2020. The surcharge shall cover the commissioner's costs associated with criminal
background checks.
Sec. 171.
Minnesota Statutes 2022, section 153A.175, is amended to read:
153A.175 PENALTY FEES.
(a) The penalty fee for holding oneself out as a hearing deleted text begin instrumentdeleted text end new text begin aidnew text end dispenser without
a current certificate after the credential has expired and before it is renewed is one-half the
amount of the certificate renewal fee for any part of the first day, plus one-half the certificate
renewal fee for any part of any subsequent days up to 30 days.
(b) The penalty fee for applicants who hold themselves out as hearing deleted text begin instrumentdeleted text end new text begin aidnew text end
dispensers after expiration of the trainee period and before being issued a certificate is
one-half the amount of the certificate application fee for any part of the first day, plus
one-half the certificate application fee for any part of any subsequent days up to 30 days.
This paragraph does not apply to applicants not qualifying for a certificate who hold
themselves out as hearing deleted text begin instrumentdeleted text end new text begin aidnew text end dispensers.
(c) The penalty fee for practicing new text begin prescription new text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end dispensing and
failing to submit a continuing education report by the due date with the correct number or
type of hours in the correct time period is $200 plus $200 for each missing clock hour.
"Missing" means not obtained between the effective and expiration dates of the certificate,
the one-month period following the certificate expiration date, or the 30 days following
notice of a penalty fee for failing to report all continuing education hours. The certificate
holder must obtain the missing number of continuing education hours by the next reporting
due date.
(d) Civil penalties and discipline incurred by certificate holders prior to August 1, 2005,
for conduct described in paragraph (a), (b), or (c) shall be recorded as nondisciplinary penalty
fees. Payment of a penalty fee does not preclude any disciplinary action reasonably justified
by the individual case.
Sec. 172.
Minnesota Statutes 2022, section 153A.18, is amended to read:
153A.18 CONSUMER INFORMATION CENTER.
The commissioner shall establish a Consumer Information Center to assist actual and
potential purchasers of new text begin prescription new text end hearing aids by providing them with information
regarding new text begin prescription new text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end sales. The Consumer Information Center shall
disseminate information about consumers' legal rights related to new text begin prescription new text end hearing
deleted text begin instrumentdeleted text end new text begin aidnew text end sales, provide information relating to complaints about dispensers of
new text begin prescription new text end hearing deleted text begin instrumentsdeleted text end new text begin aidsnew text end , and provide information about outreach and advocacy
services for consumers of new text begin prescription new text end hearing deleted text begin instrumentsdeleted text end new text begin aidsnew text end . In establishing the center
and developing the information, the commissioner shall consult with representatives of
hearing deleted text begin instrumentdeleted text end new text begin aidnew text end dispensers, audiologists, physicians, and consumers.
Sec. 173.
Minnesota Statutes 2022, section 153A.20, is amended to read:
153A.20 HEARING deleted text begin INSTRUMENTdeleted text end new text begin AIDnew text end DISPENSER ADVISORY COUNCIL.
Subdivision 1.
Membership.
(a) The commissioner shall appoint seven persons to a
Hearing deleted text begin Instrumentdeleted text end new text begin Aidnew text end Dispenser Advisory Council.
(b) The seven persons must include:
(1) three public members, as defined in section 214.02. At least one of the public members
shall be a new text begin prescription new text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end user and one of the public members shall be
either a new text begin prescription new text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end user or an advocate of one;
(2) three hearing deleted text begin instrumentdeleted text end new text begin aidnew text end dispensers certified under sections 153A.14 to 153A.20,
each of whom is currently, and has been for the five years immediately preceding their
appointment, engaged in new text begin prescription new text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end dispensing in Minnesota and
who represent the occupation of new text begin prescription new text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end dispensing and who
are not audiologists; and
(3) one audiologist licensed as an audiologist under chapter 148 who dispenses
new text begin prescription new text end hearing deleted text begin instrumentsdeleted text end new text begin aidsnew text end , recommended by a professional association
representing audiologists and speech-language pathologists.
(c) The factors the commissioner may consider when appointing advisory council
members include, but are not limited to, professional affiliation, geographical location, and
type of practice.
(d) No two members of the advisory council shall be employees of, or have binding
contracts requiring sales exclusively for, the same new text begin prescription new text end hearing deleted text begin instrumentdeleted text end new text begin aidnew text end
manufacturer or the same employer.
Subd. 2.
Organization.
The advisory council shall be organized and administered
according to section 15.059. The council may form committees to carry out its duties.
Subd. 3.
Duties.
At the commissioner's request, the advisory council shall:
(1) advise the commissioner regarding hearing deleted text begin instrumentdeleted text end new text begin aidnew text end dispenser certification
standards;
(2) provide for distribution of information regarding hearing deleted text begin instrumentdeleted text end new text begin aidnew text end dispenser
certification standards;
(3) review investigation summaries of competency violations and make recommendations
to the commissioner as to whether the allegations of incompetency are substantiated; and
(4) perform other duties as directed by the commissioner.
Sec. 174.
Minnesota Statutes 2022, section 256B.434, subdivision 4f, is amended to read:
Subd. 4f.
Construction project rate adjustments effective October 1, 2006.
(a)
Effective October 1, 2006, facilities reimbursed under this section may receive a property
rate adjustment for construction projects exceeding the threshold in section 256B.431,
subdivision 16, and below the threshold in section 144A.071, subdivision 2, deleted text begin clause (a)deleted text end new text begin
paragraph (c), clause (1)new text end . For these projects, capital assets purchased shall be counted as
construction project costs for a rate adjustment request made by a facility if they are: (1)
purchased within 24 months of the completion of the construction project; (2) purchased
after the completion date of any prior construction project; and (3) are not purchased prior
to July 14, 2005. Except as otherwise provided in this subdivision, the definitions, rate
calculation methods, and principles in sections 144A.071 and 256B.431 and Minnesota
Rules, parts 9549.0010 to 9549.0080, shall be used to calculate rate adjustments for allowable
construction projects under this subdivision and section 144A.073. Facilities completing
construction projects between October 1, 2005, and October 1, 2006, are eligible to have a
property rate adjustment effective October 1, 2006. Facilities completing projects after
October 1, 2006, are eligible for a property rate adjustment effective on the first day of the
month following the completion date. Facilities completing projects after January 1, 2018,
are eligible for a property rate adjustment effective on the first day of the month of January
or July, whichever occurs immediately following the completion date.
(b) Notwithstanding subdivision 18, as of July 14, 2005, facilities with rates set under
section 256B.431 and Minnesota Rules, parts 9549.0010 to 9549.0080, that commenced a
construction project on or after October 1, 2004, and do not have a contract under subdivision
3 by September 30, 2006, are eligible to request a rate adjustment under section 256B.431,
subdivision 10, through September 30, 2006. If the request results in the commissioner
determining a rate adjustment is allowable, the rate adjustment is effective on the first of
the month following project completion. These facilities shall be allowed to accumulate
construction project costs for the period October 1, 2004, to September 30, 2006.
(c) Facilities shall be allowed construction project rate adjustments no sooner than 12
months after completing a previous construction project. Facilities must request the rate
adjustment according to section 256B.431, subdivision 10.
(d) Capacity days shall be computed according to Minnesota Rules, part 9549.0060,
subpart 11. For rate calculations under this section, the number of licensed beds in the
nursing facility shall be the number existing after the construction project is completed and
the number of days in the nursing facility's reporting period shall be 365.
(e) The value of assets to be recognized for a total replacement project as defined in
section 256B.431, subdivision 17d, shall be computed as described in clause (1). The value
of assets to be recognized for all other projects shall be computed as described in clause
(2).
(1) Replacement-cost-new limits under section 256B.431, subdivision 17e, and the
number of beds allowed under subdivision 3a, paragraph (c), shall be used to compute the
maximum amount of assets allowable in a facility's property rate calculation. If a facility's
current request for a rate adjustment results from the completion of a construction project
that was previously approved under section 144A.073, the assets to be used in the rate
calculation cannot exceed the lesser of the amount determined under sections 144A.071,
subdivision 2, and 144A.073, subdivision 3b, or the actual allowable costs of the construction
project. A current request that is not the result of a project under section 144A.073 cannot
exceed the limit under section 144A.071, subdivision 2, paragraph deleted text begin (a)deleted text end new text begin (c), clause (1)new text end .
Applicable credits must be deducted from the cost of the construction project.
(2)(i) Replacement-cost-new limits under section 256B.431, subdivision 17e, and the
number of beds allowed under section 256B.431, subdivision 3a, paragraph (c), shall be
used to compute the maximum amount of assets allowable in a facility's property rate
calculation.
(ii) The value of a facility's assets to be compared to the amount in item (i) begins with
the total appraised value from the last rate notice a facility received when its rates were set
under section 256B.431 and Minnesota Rules, parts 9549.0010 to 9549.0080. This value
shall be indexed by the factor in section 256B.431, subdivision 3f, paragraph (a), for each
rate year the facility received an inflation factor on its property-related rate when its rates
were set under this section. The value of assets listed as previous capital additions, capital
additions, and special projects on the facility's base year rate notice and the value of assets
related to a construction project for which the facility received a rate adjustment when its
rates were determined under this section shall be added to the indexed appraised value.
(iii) The maximum amount of assets to be recognized in computing a facility's rate
adjustment after a project is completed is the lesser of the aggregate replacement-cost-new
limit computed in (i) minus the assets recognized in (ii) or the actual allowable costs of the
construction project.
(iv) If a facility's current request for a rate adjustment results from the completion of a
construction project that was previously approved under section 144A.073, the assets to be
added to the rate calculation cannot exceed the lesser of the amount determined under
sections 144A.071, subdivision 2, and 144A.073, subdivision 3b, or the actual allowable
costs of the construction project. A current request that is not the result of a project under
section 144A.073 cannot exceed the limit stated in section 144A.071, subdivision 2,
paragraph deleted text begin (a)deleted text end new text begin (c), clause (1)new text end . Assets disposed of as a result of a construction project and
applicable credits must be deducted from the cost of the construction project.
(f) For construction projects approved under section 144A.073, allowable debt may
never exceed the lesser of the cost of the assets purchased, the threshold limit in section
144A.071, subdivision 2, or the replacement-cost-new limit less previously existing capital
debt.
(g) For construction projects that were not approved under section 144A.073, allowable
debt is limited to the lesser of the threshold in section 144A.071, subdivision 2, for such
construction projects or the applicable limit in paragraph (e), clause (1) or (2), less previously
existing capital debt. Amounts of debt taken out that exceed the costs of a construction
project shall not be allowed regardless of the use of the funds.
For all construction projects being recognized, interest expense and average debt shall
be computed based on the first 12 months following project completion. "Previously existing
capital debt" means capital debt recognized on the last rate determined under section
256B.431 and Minnesota Rules, parts 9549.0010 to 9549.0080, and the amount of debt
recognized for a construction project for which the facility received a rate adjustment when
its rates were determined under this section.
For a total replacement project as defined in section 256B.431, subdivision 17d, the
value of previously existing capital debt shall be zero.
(h) In addition to the interest expense allowed from the application of paragraph (f), the
amounts allowed under section 256B.431, subdivision 17a, paragraph (a), clauses (2) and
(3), will be added to interest expense.
(i) The equity portion of the construction project shall be computed as the allowable
assets in paragraph (e), less the average debt in paragraph (f). The equity portion must be
multiplied by 5.66 percent and the allowable interest expense in paragraph (f) must be added.
This sum must be divided by 95 percent of capacity days to compute the construction project
rate adjustment.
(j) For projects that are not a total replacement of a nursing facility, the amount in
paragraph (i) is adjusted for nonreimbursable areas and then added to the current property
payment rate of the facility.
(k) For projects that are a total replacement of a nursing facility, the amount in paragraph
(i) becomes the new property payment rate after being adjusted for nonreimbursable areas.
Any amounts existing in a facility's rate before the effective date of the construction project
for equity incentives under section 256B.431, subdivision 16; capital repairs and replacements
under section 256B.431, subdivision 15; or refinancing incentives under section 256B.431,
subdivision 19, shall be removed from the facility's rates.
(l) No additional equipment allowance is allowed under Minnesota Rules, part 9549.0060,
subpart 10, as the result of construction projects under this section. Allowable equipment
shall be included in the construction project costs.
(m) Capital assets purchased after the completion date of a construction project shall be
counted as construction project costs for any future rate adjustment request made by a facility
under section 144A.071, subdivision 2, deleted text begin clause (a)deleted text end new text begin paragraph (c), clause (1)new text end , if they are
purchased within 24 months of the completion of the future construction project.
(n) In subsequent rate years, the property payment rate for a facility that results from
the application of this subdivision shall be the amount inflated in subdivision 4.
(o) Construction projects are eligible for an equity incentive under section 256B.431,
subdivision 16. When computing the equity incentive for a construction project under this
subdivision, only the allowable costs and allowable debt related to the construction project
shall be used. The equity incentive shall not be a part of the property payment rate and not
inflated under subdivision 4. Effective October 1, 2006, all equity incentives for nursing
facilities reimbursed under this section shall be allowed for a duration determined under
section 256B.431, subdivision 16, paragraph (c).
Sec. 175.
Minnesota Statutes 2022, section 256B.692, subdivision 2, is amended to read:
Subd. 2.
Duties of commissioner of health.
(a) Notwithstanding chapters 62D and 62N,
a county that elects to purchase medical assistance in return for a fixed sum without regard
to the frequency or extent of services furnished to any particular enrollee is not required to
obtain a certificate of authority under chapter 62D or 62N. The county board of
commissioners is the governing body of a county-based purchasing program. In a multicounty
arrangement, the governing body is a joint powers board established under section 471.59.
(b) A county that elects to purchase medical assistance services under this section must
satisfy the commissioner of health that the requirements for assurance of consumer protection,
provider protection, and fiscal solvency of chapter 62D, applicable to health maintenance
organizations will be met according to the following schedule:
(1) for a county-based purchasing plan approved on or before June 30, 2008, the plan
must have in reserve:
(i) at least 50 percent of the minimum amount required under chapter 62D as of January
1, 2010;
(ii) at least 75 percent of the minimum amount required under chapter 62D as of January
1, 2011;
(iii) at least 87.5 percent of the minimum amount required under chapter 62D as of
January 1, 2012; and
(iv) at least 100 percent of the minimum amount required under chapter 62D as of January
1, 2013; and
(2) for a county-based purchasing plan first approved after June 30, 2008, the plan must
have in reserve:
(i) at least 50 percent of the minimum amount required under chapter 62D at the time
the plan begins enrolling enrollees;
(ii) at least 75 percent of the minimum amount required under chapter 62D after the first
full calendar year;
(iii) at least 87.5 percent of the minimum amount required under chapter 62D after the
second full calendar year; and
(iv) at least 100 percent of the minimum amount required under chapter 62D after the
third full calendar year.
(c) Until a plan is required to have reserves equaling at least 100 percent of the minimum
amount required under chapter 62D, the plan may demonstrate its ability to cover any losses
by satisfying the requirements of chapter 62N. A county-based purchasing plan must also
assure the commissioner of health that the requirements of sections 62J.041; 62J.48; 62J.71
to 62J.73; all applicable provisions of chapter 62Q, including sections 62Q.075; 62Q.1055;
62Q.106; 62Q.12; 62Q.135; 62Q.14; deleted text begin 62Q.145;deleted text end 62Q.19; 62Q.23, paragraph (c); 62Q.43;
62Q.47; 62Q.50; 62Q.52 to 62Q.56; 62Q.58; 62Q.68 to 62Q.72; and 72A.201 will be met.
(d) All enforcement and rulemaking powers available under chapters 62D, 62J, 62N,
and 62Q are hereby granted to the commissioner of health with respect to counties that
purchase medical assistance services under this section.
(e) The commissioner, in consultation with county government, shall develop
administrative and financial reporting requirements for county-based purchasing programs
relating to sections 62D.041, 62D.042, 62D.045, 62D.08, 62N.28, 62N.29, and 62N.31,
and other sections as necessary, that are specific to county administrative, accounting, and
reporting systems and consistent with other statutory requirements of counties.
(f) The commissioner shall collect from a county-based purchasing plan under this
section the following fees:
(1) fees attributable to the costs of audits and other examinations of plan financial
operations. These fees are subject to the provisions of Minnesota Rules, part 4685.2800,
subpart 1, item F; and
(2) an annual fee of $21,500, to be paid by June 15 of each calendar year.
All fees collected under this paragraph shall be deposited in the state government special
revenue fund.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 176.
Minnesota Statutes 2022, section 518A.39, subdivision 2, is amended to read:
Subd. 2.
Modification.
(a) The terms of an order respecting maintenance or support
may be modified upon a showing of one or more of the following, any of which makes the
terms unreasonable and unfair: (1) substantially increased or decreased gross income of an
obligor or obligee; (2) substantially increased or decreased need of an obligor or obligee or
the child or children that are the subject of these proceedings; (3) receipt of assistance under
the AFDC program formerly codified under sections 256.72 to 256.87 or 256B.01 to deleted text begin 256B.40deleted text end new text begin
256B.39new text end , or chapter 256J or 256K; (4) a change in the cost of living for either party as
measured by the federal Bureau of Labor Statistics; (5) extraordinary medical expenses of
the child not provided for under section 518A.41; (6) a change in the availability of
appropriate health care coverage or a substantial increase or decrease in health care coverage
costs; (7) the addition of work-related or education-related child care expenses of the obligee
or a substantial increase or decrease in existing work-related or education-related child care
expenses; or (8) upon the emancipation of the child, as provided in subdivision 5.
(b) It is presumed that there has been a substantial change in circumstances under
paragraph (a) and the terms of a current support order shall be rebuttably presumed to be
unreasonable and unfair if:
(1) the application of the child support guidelines in section 518A.35, to the current
circumstances of the parties results in a calculated court order that is at least 20 percent and
at least $75 per month higher or lower than the current support order or, if the current support
order is less than $75, it results in a calculated court order that is at least 20 percent per
month higher or lower;
(2) the medical support provisions of the order established under section 518A.41 are
not enforceable by the public authority or the obligee;
(3) health coverage ordered under section 518A.41 is not available to the child for whom
the order is established by the parent ordered to provide;
(4) the existing support obligation is in the form of a statement of percentage and not a
specific dollar amount;
(5) the gross income of an obligor or obligee has decreased by at least 20 percent through
no fault or choice of the party; or
(6) a deviation was granted based on the factor in section 518A.43, subdivision 1, clause
(4), and the child no longer resides in a foreign country or the factor is otherwise no longer
applicable.
(c) A child support order is not presumptively modifiable solely because an obligor or
obligee becomes responsible for the support of an additional nonjoint child, which is born
after an existing order. Section 518A.33 shall be considered if other grounds are alleged
which allow a modification of support.
(d) If child support was established by applying a parenting expense adjustment or
presumed equal parenting time calculation under previously existing child support guidelines
and there is no parenting plan or order from which overnights or overnight equivalents can
be determined, there is a rebuttable presumption that the established adjustment or calculation
will continue after modification so long as the modification is not based on a change in
parenting time. In determining an obligation under previously existing child support
guidelines, it is presumed that the court shall:
(1) if a 12 percent parenting expense adjustment was applied, multiply the obligor's
share of the combined basic support obligation calculated under section 518A.34, paragraph
(b), clause (5), by 0.88; or
(2) if the parenting time was presumed equal but the parents' parental incomes for
determining child support were not equal:
(i) multiply the combined basic support obligation under section 518A.34, paragraph
(b), clause (5), by 0.75;
(ii) prorate the amount under item (i) between the parents based on each parent's
proportionate share of the combined PICS; and
(iii) subtract the lower amount from the higher amount.
(e) On a motion for modification of maintenance, including a motion for the extension
of the duration of a maintenance award, the court shall apply, in addition to all other relevant
factors, the factors for an award of maintenance under section 518.552 that exist at the time
of the motion. On a motion for modification of support, the court:
(1) shall apply section 518A.35, and shall not consider the financial circumstances of
each party's spouse, if any; and
(2) shall not consider compensation received by a party for employment in excess of a
40-hour work week, provided that the party demonstrates, and the court finds, that:
(i) the excess employment began after entry of the existing support order;
(ii) the excess employment is voluntary and not a condition of employment;
(iii) the excess employment is in the nature of additional, part-time employment, or
overtime employment compensable by the hour or fractions of an hour;
(iv) the party's compensation structure has not been changed for the purpose of affecting
a support or maintenance obligation;
(v) in the case of an obligor, current child support payments are at least equal to the
guidelines amount based on income not excluded under this clause; and
(vi) in the case of an obligor who is in arrears in child support payments to the obligee,
any net income from excess employment must be used to pay the arrearages until the
arrearages are paid in full.
(f) A modification of support or maintenance, including interest that accrued pursuant
to section 548.091, may be made retroactive only with respect to any period during which
the petitioning party has pending a motion for modification but only from the date of service
of notice of the motion on the responding party and on the public authority if public assistance
is being furnished or the county attorney is the attorney of record, unless the court adopts
an alternative effective date under paragraph (l). The court's adoption of an alternative
effective date under paragraph (l) shall not be considered a retroactive modification of
maintenance or support.
(g) Except for an award of the right of occupancy of the homestead, provided in section
518.63, all divisions of real and personal property provided by section 518.58 shall be final,
and may be revoked or modified only where the court finds the existence of conditions that
justify reopening a judgment under the laws of this state, including motions under section
518.145, subdivision 2. The court may impose a lien or charge on the divided property at
any time while the property, or subsequently acquired property, is owned by the parties or
either of them, for the payment of maintenance or support money, or may sequester the
property as is provided by section 518A.71.
(h) The court need not hold an evidentiary hearing on a motion for modification of
maintenance or support.
(i) Sections 518.14 and 518A.735 shall govern the award of attorney fees for motions
brought under this subdivision.
(j) An enactment, amendment, or repeal of law constitutes a substantial change in the
circumstances for purposes of modifying a child support order when it meets the standards
for modification in this section.
(k) On the first modification following implementation of amended child support
guidelines, the modification of basic support may be limited if the amount of the full variance
would create hardship for either the obligor or the obligee. Hardship includes, but is not
limited to, eligibility for assistance under chapter 256J.
(l) The court may select an alternative effective date for a maintenance or support order
if the parties enter into a binding agreement for an alternative effective date.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 177.
Laws 2017, First Special Session chapter 6, article 5, section 11, as amended
by Laws 2019, First Special Session chapter 9, article 8, section 20, is amended to read:
Sec. 11. MORATORIUM ON CONVERSION TRANSACTIONS.
(a) Notwithstanding Laws 2017, chapter 2, article 2, a nonprofit deleted text begin healthdeleted text end service plan
corporation operating under Minnesota Statutes, chapter 62C, or a nonprofit health
maintenance organization operating under Minnesota Statutes, chapter 62D, as of January
1, 2017, may only merge or consolidate with; convert; or transfer, as part of a single
transaction or a series of transactions within a 24-month period, all or a material amount of
its assets to an entity that is a corporation organized under Minnesota Statutes, chapter
317A; or to a Minnesota nonprofit hospital within the same integrated health system as the
health maintenance organization. For purposes of this section, "material amount" means
the lesser of ten percent of such an entity's total admitted net assets as of December 31 of
the previous year, or $50,000,000.
(b) Paragraph (a) does not apply if the nonprofit service plan corporation or nonprofit
health maintenance organization files an intent to dissolve due to insolvency of the
corporation in accordance with Minnesota Statutes, chapter 317A, or insolvency proceedings
are commenced under Minnesota Statutes, chapter 60B.
(c) Nothing in this section shall be construed to authorize a nonprofit health maintenance
organization or a nonprofit service plan corporation to engage in any transaction or activities
not otherwise permitted under state law.
(d) This section expires July 1, deleted text begin 2023deleted text end new text begin 2026new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 178.
Laws 2022, chapter 99, article 1, section 46, is amended to read:
Sec. 46.
MENTAL HEALTH GRANTS FOR HEALTH CARE PROFESSIONALS.
Subdivision 1.
Grants authorized.
(a) The commissioner of health shall develop a grant
program to award grants to health care entities, including but not limited to health care
systems, hospitals, nursing facilities, community health clinics or consortium of clinics,
federally qualified health centers, rural health clinics, or health professional associations
for the purpose of establishing or expanding programs focused on improving the mental
health of health care professionals.
(b) Grants shall be awarded for programs that are evidenced-based or evidenced-informed
and are focused on addressing the mental health of health care professionals by:
(1) identifying and addressing the barriers to and stigma among health care professionals
associated with seeking self-care, including mental health and substance use disorder services;
(2) encouraging health care professionals to seek support and care for mental health and
substance use disorder concerns;
(3) identifying risk factors associated with suicide and other mental health conditions;
deleted text begin or
deleted text end
(4) developing and making available resources to support health care professionals with
self-care and resiliencydeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(5) identifying and modifying structural barriers in health care delivery that create
unnecessary stress in the workplace.
new text end
Subd. 2.
Allocation of grants.
(a) To receive a grant, a health care entity must submit
an application to the commissioner by the deadline established by the commissioner. An
application must be on a form and contain information as specified by the commissioner
and at a minimum must contain:
(1) a description of the purpose of the program for which the grant funds will be used;
(2) a description of the achievable objectives of the program and how these objectives
will be met; and
(3) a process for documenting and evaluating the results of the program.
(b) The commissioner shall give priority to programs that involve peer-to-peer support.
new text begin Subd. 2a. new text end
new text begin Grant term. new text end
new text begin
Notwithstanding Minnesota Statutes, section 16A.28, subdivision
6, encumbrances for grants under this section issued by June 30 of each year may be certified
for a period of up to three years beyond the year in which the funds were originally
appropriated.
new text end
Subd. 3.
Evaluation.
The commissioner shall evaluate the overall effectiveness of the
grant program by conducting a periodic evaluation of the impact and outcomes of the grant
program on health care professional burnout and retention. The commissioner shall submit
the results of the evaluation and any recommendations for improving the grant program to
the chairs and ranking minority members of the legislative committees with jurisdiction
over health care policy and finance by October 15, 2024.
Sec. 179.
Laws 2022, chapter 99, article 3, section 9, is amended to read:
Sec. 9. APPROPRIATION; MENTAL HEALTH GRANTS FOR HEALTH CARE
PROFESSIONALS.
$1,000,000 in fiscal year 2023 is appropriated from the general fund to the commissioner
of health for the health care professionals mental health grant program. This is a onetime
appropriationnew text begin and is available until June 30, 2027new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 180.
new text begin
ADOLESCENT MENTAL HEALTH PROMOTION; GRANTS
AUTHORIZED.
new text end
new text begin Subdivision 1. new text end
new text begin Goal and establishment. new text end
new text begin
(a) It is the goal of the state to increase protective
factors for mental well-being and decrease disparities in rates of mental health issues among
adolescent populations. The commissioner of health shall administer grants to
community-based organizations to facilitate mental health promotion programs for
adolescents, particularly those from populations that report higher rates of specific mental
health needs.
new text end
new text begin
(b) The commissioner of health shall coordinate with other efforts at the local, state, or
national level to avoid duplication and promote complementary efforts in mental health
promotion among adolescents.
new text end
new text begin Subd. 2. new text end
new text begin Grants authorized. new text end
new text begin
(a) The commissioner of health shall award grants to
eligible community organizations, including nonprofit organizations, community health
boards, and Tribal public health entities, to implement community-based mental health
promotion programs for adolescents in community settings to improve adolescent mental
health and reduce disparities between adolescent populations in reported rates of mental
health needs.
new text end
new text begin
(b) The commissioner of health, in collaboration with community and professional
stakeholders, shall establish criteria for review of applications received under this subdivision
to ensure funded programs operate using best practices such as trauma-informed care and
positive youth development principles.
new text end
new text begin
(c) Grant funds distributed under this subdivision shall be used to support new or existing
community-based mental health promotion programs that include but are not limited to:
new text end
new text begin
(1) training community-based members to facilitate discussions or courses on adolescent
mental health promotion skills;
new text end
new text begin
(2) training trusted community members to model positive mental health skills and
practices in their existing roles;
new text end
new text begin
(3) training and supporting adolescents to provide peer support; and
new text end
new text begin
(4) supporting community dialogue on mental health promotion and collective stress or
trauma.
new text end
new text begin Subd. 3. new text end
new text begin Evaluation. new text end
new text begin
The commissioner shall conduct an evaluation of the
community-based grant programs funded under this section. Grant recipients shall cooperate
with the commissioner in the evaluation, and at the direction of the commissioner, shall
provide the commissioner with the information needed to conduct the evaluation.
new text end
Sec. 181.
new text begin
ADVANCING HEALTH EQUITY THROUGH CAPACITY BUILDING
AND RESOURCE ALLOCATION.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment of grant program. new text end
new text begin
The commissioner of health shall:
new text end
new text begin
(1) establish an annual grant program to award infrastructure capacity building grants
to help metro and rural community and faith-based organizations serving populations of
color, American Indians, LGBTQIA+ communities, and those with disabilities in Minnesota
who have been disproportionately impacted by health and other inequities to be better
equipped and prepared for success in procuring grants and contracts at the department and
addressing inequities; and
new text end
new text begin
(2) create a framework at the department to maintain equitable practices in grantmaking
to ensure that internal grantmaking and procurement policies and practices prioritize equity,
transparency, and accessibility to include:
new text end
new text begin
(i) a tracking system for the department to better monitor and evaluate equitable
procurement and grantmaking processes and their impacts; and
new text end
new text begin
(ii) technical assistance and coaching to department leadership in grantmaking and
procurement processes and programs and providing tools and guidance to ensure equitable
and transparent competitive grantmaking processes and award distribution across
communities most impacted by inequities and develop measures to track progress over time.
new text end
new text begin Subd. 2. new text end
new text begin Commissioner's duties. new text end
new text begin
The commissioner of health shall:
new text end
new text begin
(1) in consultation with community stakeholders, community health boards, and Tribal
nations, develop a request for proposals for an infrastructure capacity building grant program
to help community-based organizations, including faith-based organizations, to be better
equipped and prepared for success in procuring grants and contracts at the department and
beyond;
new text end
new text begin
(2) provide outreach, technical assistance, and program development support to increase
capacity for new and existing community-based organizations and other service providers
in order to better meet statewide needs particularly in greater Minnesota and areas where
services to reduce health disparities have not been established;
new text end
new text begin
(3) in consultation with community stakeholders, review responses to requests for
proposals and award grants under this section;
new text end
new text begin
(4) ensure communication with the ethnic councils; Minnesota Indian Affairs Council;
Minnesota Council on Disability; Minnesota Commission of the Deaf, Deafblind, and Hard
of Hearing; and the governor's office on the request for proposal process;
new text end
new text begin
(5) in consultation with community stakeholders, establish a transparent and objective
accountability process focused on outcomes that grantees agree to achieve;
new text end
new text begin
(6) maintain data on outcomes reported by grantees; and
new text end
new text begin
(7) establish a process or mechanism to evaluate the success of the capacity building
grant program and to build the evidence base for effective community-based organizational
capacity building in reducing disparities.
new text end
new text begin Subd. 3. new text end
new text begin Eligible grantees. new text end
new text begin
Organizations eligible to receive grant funding under this
section include: organizations or entities that work with diverse communities such as
populations of color, American Indians, LGBTQIA+ communities, and those with disabilities
in metro and rural communities.
new text end
new text begin Subd. 4. new text end
new text begin
Strategic consideration and priority of proposals; eligible populations;
grant awards.
new text end
new text begin
(a) The commissioner, in consultation with community stakeholders, shall
develop a request for proposals for equity in procurement and grantmaking capacity building
grant program to help community-based organizations, including faith-based organizations
to be better equipped and prepared for success in procuring grants and contracts at the
department and addressing inequities.
new text end
new text begin
(b) In awarding the grants, the commissioner shall provide strategic consideration and
give priority to proposals from organizations or entities led by populations of color or
American Indians, and those serving communities of color, American Indians, LGBTQIA+
communities, and disability communities.
new text end
new text begin Subd. 5. new text end
new text begin Geographic distribution of grants. new text end
new text begin
The commissioner shall ensure that grant
funds are prioritized and awarded to organizations and entities that are within counties that
have a higher proportion of Black or African American, nonwhite Latino(a), LGBTQIA+,
and disability communities to the extent possible.
new text end
new text begin Subd. 6. new text end
new text begin Report. new text end
new text begin
Grantees must report grant program outcomes to the commissioner on
the forms and according to the timelines established by the commissioner.
new text end
Sec. 182.
new text begin
CLIMATE RESILIENCY.
new text end
new text begin Subdivision 1. new text end
new text begin Climate resiliency program. new text end
new text begin
The commissioner of health shall implement
a climate resiliency program to:
new text end
new text begin
(1) increase awareness of climate change;
new text end
new text begin
(2) track the public health impacts of climate change and extreme weather events;
new text end
new text begin
(3) provide technical assistance and tools that support climate resiliency to local public
health departments, Tribal health departments, soil and water conservation districts, and
other local governmental and nongovernmental organizations; and
new text end
new text begin
(4) coordinate with the commissioners of the Pollution Control Agency, natural resources,
and agriculture and other state agencies in climate resiliency related planning and
implementation.
new text end
new text begin Subd. 2. new text end
new text begin Grants authorized; allocation. new text end
new text begin
(a) The commissioner of health shall manage
a grant program for the purpose of climate resiliency planning. The commissioner shall
award grants through a request for proposals process to local public health departments,
Tribal health departments, soil and water conservation districts, or other local organizations
for planning for the health impacts of extreme weather events and developing adaptation
actions. Priority shall be given to organizations that serve communities that are
disproportionately impacted by climate change.
new text end
new text begin
(b) Grantees must use the funds to develop a plan or implement strategies that will reduce
the risk of health impacts from extreme weather events. The grant application must include:
new text end
new text begin
(1) a description of the plan or project for which the grant funds will be used;
new text end
new text begin
(2) a description of the pathway between the plan or project and its impacts on health;
new text end
new text begin
(3) a description of the objectives, a work plan, and a timeline for implementation; and
new text end
new text begin
(4) the community or group on which the grant proposes to focus.
new text end
Sec. 183. new text begin CRITICAL ACCESS DENTAL INFRASTRUCTURE PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have
the meanings given.
new text end
new text begin
(b) "Commissioner" means the commissioner of health.
new text end
new text begin
(c) "Critical access dental provider" means a critical access dental provider as defined
in Minnesota Statutes, section 256B.76, subdivision 4.
new text end
new text begin
(d) "Dental infrastructure" means:
new text end
new text begin
(1) physical infrastructure of a dental setting, including but not limited to the operations
and clinical spaces in a dental clinic; associated heating, ventilation, and air conditioning
infrastructure and other mechanical infrastructure; and dental equipment needed to operate
a dental clinic; or
new text end
new text begin
(2) mobile dental equipment or other equipment needed to provide dental services via
a hub-and-spoke service delivery model or via teledentistry.
new text end
new text begin Subd. 2. new text end
new text begin Grant and loan program established. new text end
new text begin
The commissioner shall make grants
and forgivable loans to critical access dental providers for eligible dental infrastructure
projects.
new text end
new text begin Subd. 3. new text end
new text begin Eligible projects. new text end
new text begin
In order to be eligible for a grant or forgivable loan under
this section, a dental infrastructure project must be proposed by a critical access dental
provider and must allow the provider to maintain or expand the provider's capacity to serve
Minnesota health care program enrollees.
new text end
new text begin Subd. 4. new text end
new text begin Application. new text end
new text begin
(a) The commissioner must develop forms and procedures for
soliciting and reviewing applications for grants and forgivable loans under this section and
for awarding grants and forgivable loans. Critical access dental providers seeking a grant
or forgivable loan under this section must apply to the commissioner in a time and manner
specified by the commissioner. In evaluating applications for grants or forgivable loans for
eligible projects, the commissioner must review applications for completeness and must
determine the extent to which:
new text end
new text begin
(1) the project would ensure that the critical access dental provider is able to continue
to serve Minnesota health care program enrollees in a manner that would not be possible
but for the project; or
new text end
new text begin
(2) the project would increase the number of Minnesota health care program enrollees
served by the provider or the clinical complexity of the Minnesota health care program
enrollees served by the provider.
new text end
new text begin
(b) The commissioner must award grants and forgivable loans based on the information
provided in the grant application.
new text end
new text begin Subd. 5. new text end
new text begin Program oversight. new text end
new text begin
The commissioner may require and collect from grant and
loan recipients any information needed to evaluate the program.
new text end
Sec. 184. new text begin DIRECTION TO COMMISSIONER OF HEALTH; DEVELOPMENT
OF ANALYTICAL TOOLS.
new text end
new text begin
(a) The commissioner of health, in consultation with the Minnesota Nurses Association
and other professional nursing organizations, must develop a means of analyzing available
adverse event data, available staffing data, and available data from concern for safe staffing
forms to examine potential causal links between adverse events and understaffing.
new text end
new text begin
(b) The commissioner must develop an initial means of conducting the analysis described
in paragraph (a) by January 1, 2025, and publish a public report on the commissioner's
initial findings by January 1, 2026.
new text end
new text begin
(c) By January 1, 2024, the commissioner must submit to the chairs and ranking minority
members of the house and senate committees with jurisdiction over the regulation of hospitals
a report on the available data, potential sources of additional useful data, and any additional
statutory authority the commissioner requires to collect additional useful information from
hospitals.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2023.
new text end
Sec. 185. new text begin DIRECTION TO COMMISSIONER OF HEALTH; NURSING
WORKFORCE REPORT.
new text end
new text begin
(a) The commissioner of health must publish a public report on the current status of the
state's nursing workforce employed by hospitals. In preparing the report, the commissioner
shall utilize information collected in collaboration with the Board of Nursing as directed
under Minnesota Statutes, sections 144.051 and 144.052, on Minnesota's supply of active
licensed nurses and reasons licensed nurses are leaving direct care positions at hospitals;
information collected and shared by the Minnesota Hospital Association on retention by
hospitals of licensed nurses; information collected through an independent study on reasons
licensed nurses are choosing not to renew their licenses and leaving the profession; and
other publicly available data the commissioner deems useful.
new text end
new text begin
(b) The commissioner must publish the report by January 1, 2026.
new text end
Sec. 186. new text begin EMMETT LOUIS TILL VICTIMS RECOVERY PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Short title. new text end
new text begin
This section shall be known as the Emmett Louis Till Victims
Recovery Program.
new text end
new text begin Subd. 2. new text end
new text begin Program established; grants. new text end
new text begin
(a) The commissioner of health shall establish
the Emmett Louis Till Victims Recovery Program to address the health and wellness needs
of:
new text end
new text begin
(1) victims who experienced trauma, including historical trauma, resulting from events
such as assault or another violent physical act, intimidation, false accusations, wrongful
conviction, a hate crime, the violent death of a family member, or experiences of
discrimination or oppression based on the victim's race, ethnicity, or national origin; and
new text end
new text begin
(2) the families and heirs of victims described in clause (1), who experienced trauma,
including historical trauma, because of their proximity or connection to the victim.
new text end
new text begin
(b) The commissioner, in consultation with victims, families, and heirs described in
paragraph (a), shall award competitive grants to applicants for projects to provide the
following services to victims, families, and heirs described in paragraph (a):
new text end
new text begin
(1) health and wellness services, which may include services and support to address
physical health, mental health, and cultural needs;
new text end
new text begin
(2) remembrance and legacy preservation activities;
new text end
new text begin
(3) cultural awareness services; and
new text end
new text begin
(4) community resources and services to promote healing for victims, families, and heirs
described in paragraph (a).
new text end
new text begin
(c) In awarding grants under this section, the commissioner must prioritize grant awards
to community-based organizations experienced in providing support and services to victims,
families, and heirs described in paragraph (a).
new text end
new text begin Subd. 3. new text end
new text begin Evaluation. new text end
new text begin
Grant recipients must provide the commissioner with information
required by the commissioner to evaluate the grant program, in a time and manner specified
by the commissioner.
new text end
new text begin Subd. 4. new text end
new text begin Reports. new text end
new text begin
The commissioner must submit a status report by January 15, 2024,
and an additional report by January 15, 2025, on the operation and results of the grant
program, to the extent available. These reports must be submitted to the chairs and ranking
minority members of the legislative committees with jurisdiction over health care. The
report due January 15, 2024, must include information on grant program activities to date
and an assessment of the need to continue to offer services provided by grant recipients to
victims, families, and heirs who experienced trauma resulting from government-sponsored
activities. The report due January 15, 2025, must include a summary of the services offered
by grant recipients; an assessment of the need to continue to offer services provided by
grant recipients to victims, families, and heirs described in subdivision 2, paragraph (a);
and an evaluation of the grant program's goals and outcomes.
new text end
Sec. 187.
new text begin
HEALTHY BEGINNINGS, HEALTHY FAMILIES ACT.
new text end
new text begin Subdivision 1. new text end
new text begin Purpose. new text end
new text begin
The purpose of the Healthy Beginnings, Healthy Families Act
is to build equitable, inclusive, and culturally and linguistically responsive systems that
ensure the health and well-being of young children and their families by supporting the
Minnesota perinatal quality collaborative, establishing the Minnesota partnership to prevent
infant mortality, increasing access to culturally relevant developmental and social-emotional
screening with follow-up, and sustaining and expanding the model jail practices for children
of incarcerated parents in Minnesota jails.
new text end
new text begin Subd. 2. new text end
new text begin Minnesota perinatal quality collaborative. new text end
new text begin
The Minnesota perinatal quality
collaborative is established to improve pregnancy outcomes for pregnant people and
newborns through efforts to:
new text end
new text begin
(1) advance evidence-based and evidence-informed clinics and other health service
practices and processes through quality care review, chart audits, and continuous quality
improvement initiatives that enable equitable outcomes;
new text end
new text begin
(2) review current data, trends, and research on best practices to inform and prioritize
quality improvement initiatives;
new text end
new text begin
(3) identify methods that incorporate antiracism into individual practice and organizational
guidelines in the delivery of perinatal health services;
new text end
new text begin
(4) support quality improvement initiatives to address substance use disorders in pregnant
people and infants with neonatal abstinence syndrome or other effects of substance use;
new text end
new text begin
(5) provide a forum to discuss state-specific system and policy issues to guide quality
improvement efforts that improve population-level perinatal outcomes;
new text end
new text begin
(6) reach providers and institutions in a multidisciplinary, collaborative, and coordinated
effort across system organizations to reinforce a continuum of care model; and
new text end
new text begin
(7) support health care facilities in monitoring interventions through rapid data collection
and applying system changes to provide improved care in perinatal health.
new text end
new text begin Subd. 3. new text end
new text begin Eligible organizations. new text end
new text begin
The commissioner of health shall make a grant to a
nonprofit organization to create or sustain a multidisciplinary network of representatives
of health care systems, health care providers, academic institutions, local and state agencies,
and community partners that will collaboratively improve pregnancy and infant outcomes
through evidence-based, population-level quality improvement initiatives.
new text end
new text begin Subd. 4. new text end
new text begin Grants authorized. new text end
new text begin
The commissioner shall award one grant to a nonprofit
organization to support efforts that improve maternal and infant health outcomes aligned
with the purpose outlined in subdivision 2. The commissioner shall give preference to a
nonprofit organization that has the ability to provide these services throughout the state.
The commissioner shall provide content expertise to the grant recipient to further the
accomplishment of the purpose.
new text end
new text begin Subd. 5. new text end
new text begin Minnesota partnership to prevent infant mortality program. new text end
new text begin
(a) The
commissioner of health shall establish the Minnesota partnership to prevent infant mortality
program that is a statewide partnership program to engage communities, exchange best
practices, share summary data on infant health, and promote policies to improve birth
outcomes and eliminate preventable infant mortality.
new text end
new text begin
(b) The goals of the Minnesota partnership to prevent infant mortality program are to:
new text end
new text begin
(1) build a statewide multisectoral partnership including the state government, local
public health agencies, Tribes, private sector, and community nonprofit organizations with
the shared goal of decreasing infant mortality rates among populations with significant
disparities, including among Black, American Indian, and other nonwhite communities,
and rural populations;
new text end
new text begin
(2) address the leading causes of poor infant health outcomes such as premature birth,
infant sleep-related deaths, and congenital anomalies through strategies to change social
and environmental determinants of health; and
new text end
new text begin
(3) promote the development, availability, and use of data-informed, community-driven
strategies to improve infant health outcomes.
new text end
new text begin Subd. 5a. new text end
new text begin Grants authorized. new text end
new text begin
(a) The commissioner of health shall award grants to
eligible applicants to convene, coordinate, and implement data-driven strategies and culturally
relevant activities to improve infant health by reducing preterm births, sleep-related infant
deaths, and congenital malformations and address social and environmental determinants
of health. Grants shall be awarded to support community nonprofit organizations, Tribal
governments, and community health boards. In accordance with available funding, grants
shall be noncompetitively awarded to the eleven sovereign Tribal governments if their
respective proposals demonstrate the ability to implement programs designed to achieve
the purposes in subdivision 5 and meet other requirements of this section. An eligible
applicant must submit a complete application to the commissioner of health by the deadline
established by the commissioner. The commissioner shall award all other grants competitively
to eligible applicants in metropolitan and rural areas of the state and may consider geographic
representation in grant awards.
new text end
new text begin
(b) Grantee activities shall:
new text end
new text begin
(1) address the leading cause or causes of infant mortality;
new text end
new text begin
(2) be based on community input;
new text end
new text begin
(3) focus on policy, systems, and environmental changes that support infant health; and
new text end
new text begin
(4) address the health disparities and inequities that are experienced in the grantee's
community.
new text end
new text begin
(c) The commissioner shall review each application to determine whether the application
is complete and whether the applicant and the project are eligible for a grant. In evaluating
applications according to subdivision 5, the commissioner shall establish criteria including
but not limited to: the eligibility of the applicant's project under this section; the applicant's
thoroughness and clarity in describing the infant health issues grant funds are intended to
address; a description of the applicant's proposed project; the project's likelihood to achieve
the grant's purposes as described in this section; a description of the population demographics
and service area of the proposed project; and evidence of efficiencies and effectiveness
gained through collaborative efforts.
new text end
new text begin
(d) Grant recipients shall report their activities to the commissioner in a format and at
a time specified by the commissioner.
new text end
new text begin Subd. 5b. new text end
new text begin Technical assistance. new text end
new text begin
(a) The commissioner shall provide content expertise,
technical expertise, training to grant recipients, and advice on data-driven strategies.
new text end
new text begin
(b) For the purposes of carrying out the grant program under subdivision 5a, including
for administrative purposes, the commissioner shall award contracts to appropriate entities
to assist in training and provide technical assistance to grantees.
new text end
new text begin
(c) Contracts awarded under paragraph (b) may be used to provide technical assistance
and training in the areas of:
new text end
new text begin
(1) partnership development and capacity building;
new text end
new text begin
(2) Tribal support;
new text end
new text begin
(3) implementation support for specific infant health strategies;
new text end
new text begin
(4) communications by convening and sharing lessons learned; and
new text end
new text begin
(5) health equity.
new text end
new text begin Subd. 6. new text end
new text begin Developmental and social-emotional screening with follow-up. new text end
new text begin
The goal of
the developmental and social-emotional screening is to identify young children at risk for
developmental and behavioral concerns and provide follow-up services to connect families
and young children to appropriate community-based resources and programs. The
commissioner of health shall work with the commissioners of human services and education
to implement this section and promote interagency coordination with other early childhood
programs including those that provide screening and assessment.
new text end
new text begin Subd. 6a. new text end
new text begin Duties. new text end
new text begin
The commissioner shall:
new text end
new text begin
(1) increase the awareness of developmental and social-emotional screening with
follow-up in coordination with community and state partners;
new text end
new text begin
(2) expand existing electronic screening systems to administer developmental and
social-emotional screening to children from birth to kindergarten entrance;
new text end
new text begin
(3) provide screening for developmental and social-emotional delays based on current
recommended best practices;
new text end
new text begin
(4) review and share the results of the screening with the parent or guardian and support
families in their role as caregivers by providing anticipatory guidance around typical growth
and development;
new text end
new text begin
(5) ensure children and families are referred to and linked with appropriate
community-based services and resources when any developmental or social-emotional
concerns are identified through screening; and
new text end
new text begin
(6) establish performance measures and collect, analyze, and share program data regarding
population-level outcomes of developmental and social-emotional screening, referrals to
community-based services, and follow-up services.
new text end
new text begin Subd. 6b. new text end
new text begin Grants authorized. new text end
new text begin
The commissioner shall award grants to community-based
organizations, community health boards, and Tribal nations to support follow-up services
for children with developmental or social-emotional concerns identified through screening
in order to link children and their families to appropriate community-based services and
resources. Grants shall also be awarded to community-based organizations to train and
utilize cultural liaisons to help families navigate the screening and follow-up process in a
culturally and linguistically responsive manner. The commissioner shall provide technical
assistance, content expertise, and training to grant recipients to ensure that follow-up services
are effectively provided.
new text end
new text begin Subd. 7. new text end
new text begin Model jail practices for incarcerated parents. new text end
new text begin
(a) The commissioner of health
may make special grants to counties and groups of counties to implement model jail practices
and to county governments, Tribal governments, or nonprofit organizations in corresponding
geographic areas to build partnerships with county jails to support children of incarcerated
parents and their caregivers.
new text end
new text begin
(b) "Model jail practices" means a set of practices that correctional administrators can
implement, without compromising the safety or security of the correctional facility, to
remove barriers that may prevent children from cultivating or maintaining relationships
with their incarcerated parents during and immediately after incarceration.
new text end
new text begin Subd. 7a. new text end
new text begin Grants authorized; model jail practices. new text end
new text begin
(a) The commissioner of health
shall award grants to eligible county jails to implement model jail practices and separate
grants to county governments, Tribal governments, or nonprofit organizations in
corresponding geographic areas to build partnerships with county jails to support children
of incarcerated parents and their caregivers.
new text end
new text begin
(b) Grantee activities include but are not limited to:
new text end
new text begin
(1) parenting classes or groups;
new text end
new text begin
(2) family-centered intake and assessment of inmate programs;
new text end
new text begin
(3) family notification, information, and communication strategies;
new text end
new text begin
(4) correctional staff training;
new text end
new text begin
(5) policies and practices for family visits; and
new text end
new text begin
(6) family-focused reentry planning.
new text end
new text begin
(c) Grant recipients shall report their activities to the commissioner in a format and at a
time specified by the commissioner.
new text end
new text begin Subd. 7b. new text end
new text begin Technical assistance and oversight; model jail practices. new text end
new text begin
(a) The
commissioner shall provide content expertise, training to grant recipients, and advice on
evidence-based strategies, including evidence-based training to support incarcerated parents.
new text end
new text begin
(b) For the purposes of carrying out the grant program under subdivision 7a, including
for administrative purposes, the commissioner shall award contracts to appropriate entities
to assist in training and provide technical assistance to grantees.
new text end
new text begin
(c) Contracts awarded under paragraph (b) may be used to provide technical assistance
and training in the areas of:
new text end
new text begin
(1) evidence-based training for incarcerated parents;
new text end
new text begin
(2) partnership building and community engagement;
new text end
new text begin
(3) evaluation of process and outcomes of model jail practices; and
new text end
new text begin
(4) expert guidance on reducing the harm caused to children of incarcerated parents and
application of model jail practices.
new text end
Sec. 188.
new text begin
HELP ME CONNECT RESOURCE AND REFERRAL SYSTEM FOR
CHILDREN.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment; purpose. new text end
new text begin
The commissioner shall establish the Help Me
Connect resource and referral system for children as a comprehensive, collaborative resource
and referral system for children from the prenatal stage through age eight, and their families.
The commissioner of health shall work collaboratively with the commissioners of human
services and education to implement this section.
new text end
new text begin Subd. 2. new text end
new text begin Duties. new text end
new text begin
(a) The Help Me Connect system shall facilitate collaboration across
sectors, including child health, early learning and education, child welfare, and family
supports by:
new text end
new text begin
(1) providing early childhood provider outreach to support knowledge of and access to
local resources that provide early detection and intervention services;
new text end
new text begin
(2) identifying and providing access to early childhood and family support navigation
specialists that can support families and their children's needs; and
new text end
new text begin
(3) linking children and families to appropriate community-based services.
new text end
new text begin
(b) The Help Me Connect system shall provide community outreach that includes support
for, and participation in, the Help Me Connect system, including disseminating information
on the system and compiling and maintaining a current resource directory that includes but
is not limited to primary and specialty medical care providers, early childhood education
and child care programs, developmental disabilities assessment and intervention programs,
mental health services, family and social support programs, child advocacy and legal services,
public health services and resources, and other appropriate early childhood information.
new text end
new text begin
(c) The Help Me Connect system shall maintain a centralized access point for parents
and professionals to obtain information, resources, and other support services.
new text end
new text begin
(d) The Help Me Connect system shall collect data to increase understanding of the
current and ongoing system of support and resources for expectant families and children
through age eight and their families, including identification of gaps in service, barriers to
finding and receiving appropriate services, and lack of resources.
new text end
Sec. 189. new text begin INITIAL IMPLEMENTATION OF THE KEEPING NURSES AT THE
BEDSIDE ACT.
new text end
new text begin
(a) By October 1, 2024, each hospital must establish and convene a hospital nurse staffing
committee as described under Minnesota Statutes, section 144.7053, and a hospital nurse
workload committee as described under Minnesota Statutes, section 144.7054.
new text end
new text begin
(b) By October 1, 2025, each hospital must implement core staffing plans developed by
its hospital nurse staffing committee and satisfy the plan posting requirements under
Minnesota Statutes, section 144.7056.
new text end
new text begin
(c) By October 1, 2025, each hospital must submit to the commissioner of health core
staffing plans meeting the requirements of Minnesota Statutes, section 144.7055.
new text end
new text begin
(d) By October 1, 2025, the commissioner of health must develop a standard concern
for safe staffing form and provide an electronic means of submitting the form to the relevant
hospital nurse staffing committee. The commissioner must base the form on the existing
concern for safe staffing form maintained by the Minnesota Nurses' Association.
new text end
new text begin
(e) By January 1, 2026, the commissioner of health must provide electronic access to
the uniform format or standard form for nurse staffing reporting described under Minnesota
Statutes, section 144.7057, subdivision 4.
new text end
Sec. 190.
new text begin
LONG COVID.
new text end
new text begin Subdivision 1. new text end
new text begin Definition. new text end
new text begin
For the purpose of this section, "long COVID" means health
problems that people experience four or more weeks after being infected with SARS-CoV-2,
the virus that causes COVID-19. Long COVID is also called post COVID conditions,
long-haul COVID, chronic COVID, post-acute COVID, or post-acute sequelae of COVID-19
(PASC).
new text end
new text begin Subd. 2. new text end
new text begin Establishment. new text end
new text begin
The commissioner of health shall establish a program to conduct
community assessments and epidemiologic investigations to monitor and address impacts
of long COVID. The purposes of these activities are to:
new text end
new text begin
(1) monitor trends in: incidence, prevalence, mortality, and health outcomes; care
management and costs; changes in disability status, employment, and quality of life; and
service needs of individuals with long COVID and to detect potential public health problems,
predict risks, and assist in investigating long COVID health inequities;
new text end
new text begin
(2) more accurately target information and resources for communities and patients and
their families;
new text end
new text begin
(3) inform health professionals and citizens about risks and early detection of long
COVID known to be elevated in their communities; and
new text end
new text begin
(4) promote evidence-based practices around long COVID prevention and management
and to address public concerns and questions about long COVID.
new text end
new text begin Subd. 3. new text end
new text begin Partnerships. new text end
new text begin
The commissioner of health shall, in consultation with health
care professionals, the Department of Human Services, local public health, health insurers,
employers, schools, long COVID survivors, and community organizations serving people
at high risk of long COVID, identify priority actions and activities to address the needs for
communication, services, resources, tools, strategies, and policies to support long COVID
survivors and their families.
new text end
new text begin Subd. 4. new text end
new text begin Grants and contracts. new text end
new text begin
The commissioner of health shall coordinate and
collaborate with community and organizational partners to implement evidence-informed
priority actions through community-based grants and contracts. The commissioner of health
shall award contracts and grants to organizations that serve communities disproportionately
impacted by COVID-19 and long COVID, including but not limited to rural and low-income
areas, Black and African Americans, African immigrants, American Indians, Asian
American-Pacific Islanders, Latino(a) communities, LGBTQ+ communities, and persons
with disabilities. Organizations may also address intersectionality within the groups. The
commissioner shall award grants and contracts to eligible organizations to plan, construct,
and disseminate resources and information to support survivors of long COVID, including
caregivers, health care providers, ancillary health care workers, workplaces, schools,
communities, and local and Tribal public health.
new text end
Sec. 191. new text begin MEMBERSHIP TERMS; PALLIATIVE CARE ADVISORY COUNCIL.
new text end
new text begin
Notwithstanding the terms of office specified to the members upon their appointment,
the terms for members appointed to the Palliative Care Advisory Council under Minnesota
Statutes, section 144.059, on or after February 1, 2022, shall be three years, as provided in
Minnesota Statutes, section 144.059, subdivision 3.
new text end
Sec. 192. new text begin PSYCHEDELIC MEDICINE TASK FORCE.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment; purpose. new text end
new text begin
The Psychedelic Medicine Task Force is
established to advise the legislature on the legal, medical, and policy issues associated with
the legalization of psychedelic medicine in the state. For purposes of this section,
"psychedelic medicine" means 3,4-methylenedioxymethamphetamine (MDMA), psilocybin,
and LSD.
new text end
new text begin Subd. 2. new text end
new text begin Membership; compensation. new text end
new text begin
(a) The Psychedelic Medicine Task Force shall
consist of:
new text end
new text begin
(1) the governor or a designee;
new text end
new text begin
(2) two members of the house of representatives, one appointed by the speaker of the
house and one appointed by the minority leader of the house of representatives, and two
members of the senate, one appointed by the senate majority leader and one appointed by
the senate minority leader;
new text end
new text begin
(3) the commissioner of health or a designee;
new text end
new text begin
(4) the commissioner of public safety or a designee;
new text end
new text begin
(5) the commissioner of human services or a designee;
new text end
new text begin
(6) the attorney general or a designee;
new text end
new text begin
(7) the executive director of the Board of Pharmacy or a designee;
new text end
new text begin
(8) the commissioner of commerce or a designee; and
new text end
new text begin
(9) members of the public, appointed by the governor, who have relevant knowledge
and expertise, including:
new text end
new text begin
(i) two members representing Indian Tribes within the boundaries of Minnesota, one
representing the Ojibwe Tribes and one representing the Dakota Tribes;
new text end
new text begin
(ii) one member with expertise in the treatment of substance use disorders;
new text end
new text begin
(iii) one member with experience working in public health policy;
new text end
new text begin
(iv) two veterans with treatment-resistant mental health conditions;
new text end
new text begin
(v) two patients with treatment-resistant mental health conditions;
new text end
new text begin
(vi) one psychiatrist with experience treating treatment-resistant mental health conditions,
including post-traumatic stress disorder;
new text end
new text begin
(vii) one health care practitioner with experience in integrative medicine;
new text end
new text begin
(viii) one psychologist with experience treating treatment-resistant mental health
conditions, including post-traumatic stress disorder; and
new text end
new text begin
(ix) one member with demonstrable experience in the medical use of psychedelic
medicine.
new text end
new text begin
(b) Members listed in paragraph (a), clauses (1) and (3) to (8), and members appointed
under paragraph (a), clause (9), may be reimbursed for expenses under Minnesota Statutes,
section 15.059, subdivision 6. Members appointed under paragraph (a), clause (2), may
receive per diem compensation from their respective bodies according to the rules of their
respective bodies.
new text end
new text begin
(c) Members shall be designated or appointed to the task force by July 15, 2023.
new text end
new text begin Subd. 3. new text end
new text begin Organization. new text end
new text begin
(a) The commissioner of health or the commissioner's designee
shall convene the first meeting of the task force.
new text end
new text begin
(b) At the first meeting, the members of the task force shall elect a chairperson and other
officers as the members deem necessary.
new text end
new text begin
(c) The first meeting of the task force shall occur by August 1, 2023. The task force shall
meet monthly or as determined by the chairperson.
new text end
new text begin Subd. 4. new text end
new text begin Staff. new text end
new text begin
The commissioner of health shall provide support staff, office and meeting
space, and administrative services for the task force.
new text end
new text begin Subd. 5. new text end
new text begin Duties. new text end
new text begin
The task force shall:
new text end
new text begin
(1) survey existing studies in the scientific literature on the therapeutic efficacy of
psychedelic medicine in the treatment of mental health conditions, including depression,
anxiety, post-traumatic stress disorder, bipolar disorder, and any other mental health
conditions and medical conditions for which a psychedelic medicine may provide an effective
treatment option;
new text end
new text begin
(2) compare the efficacy of psychedelic medicine in treating the conditions described
in clause (1) with the efficacy of treatments currently used for these conditions; and
new text end
new text begin
(3) develop a comprehensive plan that covers:
new text end
new text begin
(i) statutory changes necessary for the legalization of psychedelic medicine;
new text end
new text begin
(ii) state and local regulation of psychedelic medicine;
new text end
new text begin
(iii) federal law, policy, and regulation of psychedelic medicine, with a focus on retaining
state autonomy to act without conflicting with federal law, including methods to resolve
conflicts such as seeking an administrative exemption to the federal Controlled Substances
Act under United States Code, title 21, section 822(d), and Code of Federal Regulations,
title 21, part 1307.03; seeking a judicially created exemption to the federal Controlled
Substances Act; petitioning the United States Attorney General to establish a research
program under United States Code, title 21, section 872(e); using the Food and Drug
Administration's expanded access program; and using authority under the federal Right to
Try Act; and
new text end
new text begin
(iv) education of the public on recommendations made to the legislature and others about
necessary and appropriate actions related to the legalization of psychedelic medicine in the
state.
new text end
new text begin Subd. 6. new text end
new text begin Reports. new text end
new text begin
The task force shall submit two reports to the chairs and ranking
minority members of the legislative committees with jurisdiction over health and human
services that detail the task force's findings regarding the legalization of psychedelic medicine
in the state, including the comprehensive plan developed under subdivision 5. The first
report must be submitted by February 1, 2024, and the second report must be submitted by
January 1, 2025.
new text end
Sec. 193. new text begin REPORT ON TRANSPARENCY OF HEALTH CARE PAYMENTS.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) The terms defined in this subdivision apply to this section.
new text end
new text begin
(b) "Commissioner" means the commissioner of health.
new text end
new text begin
(c) "Nonclaims-based payments" means payments to health care providers designed to
support and reward value of health care services over volume of health care services and
includes alternative payment models or incentives, payments for infrastructure expenditures
or investments, and payments for workforce expenditures or investments.
new text end
new text begin
(d) "Nonpublic data" has the meaning given in Minnesota Statutes, section 13.02,
subdivision 9.
new text end
new text begin
(e) "Primary care services" means integrated, accessible health care services provided
by clinicians who are accountable for addressing a large majority of personal health care
needs, developing a sustained partnership with patients, and practicing in the context of
family and community. Primary care services include but are not limited to preventive
services, office visits, administration of vaccines, annual physicals, pre-operative physicals,
assessments, care coordination, development of treatment plans, management of chronic
conditions, and diagnostic tests.
new text end
new text begin Subd. 2. new text end
new text begin Report. new text end
new text begin
(a) To provide the legislature with information needed to meet the
evolving health care needs of Minnesotans, the commissioner shall report to the legislature
by February 15, 2024, on the volume and distribution of health care spending across payment
models used by health plan companies and third-party administrators, with a particular focus
on value-based care models and primary care spending.
new text end
new text begin
(b) The report must include specific health plan and third-party administrator estimates
of health care spending for claims-based payments and nonclaims-based payments for the
most recent available year, reported separately for Minnesotans enrolled in state health care
programs, Medicare Advantage, and commercial health insurance. The report must also
include recommendations on changes needed to gather better data from health plan companies
and third-party administrators on the use of value-based payments that pay for value of
health care services provided over volume of services provided, promote the health of all
Minnesotans, reduce health disparities, and support the provision of primary care services
and preventive services.
new text end
new text begin
(c) In preparing the report, the commissioner shall:
new text end
new text begin
(1) describe the form, manner, and timeline for submission of data by health plan
companies and third-party administrators to produce estimates as specified in paragraph
(b);
new text end
new text begin
(2) collect summary data that permits the computation of:
new text end
new text begin
(i) the percentage of total payments that are nonclaims-based payments; and
new text end
new text begin
(ii) the percentage of payments in item (i) that are for primary care services;
new text end
new text begin
(3) where data was not directly derived, specify the methods used to estimate data
elements;
new text end
new text begin
(4) notwithstanding Minnesota Statutes, section 62U.04, subdivision 11, conduct analyses
of the magnitude of primary care payments using data collected by the commissioner under
Minnesota Statutes, section 62U.04; and
new text end
new text begin
(5) conduct interviews with health plan companies and third-party administrators to
better understand the types of nonclaims-based payments and models in use, the purposes
or goals of each, the criteria for health care providers to qualify for these payments, and the
timing and structure of health plan companies or third-party administrators making these
payments to health care provider organizations.
new text end
new text begin
(d) Health plan companies and third-party administrators must comply with data requests
from the commissioner under this section within 60 days after receiving the request.
new text end
new text begin
(e) Data collected under this section is nonpublic data. Notwithstanding the definition
of summary data in Minnesota Statutes, section 13.02, subdivision 19, summary data prepared
under this section may be derived from nonpublic data. The commissioner shall establish
procedures and safeguards to protect the integrity and confidentiality of any data maintained
by the commissioner.
new text end
Sec. 194. new text begin RETURN OF CHARITABLE ASSETS.
new text end
new text begin
If a health system that is organized as a charitable organization, and that includes M
Health Fairview University of Minnesota Medical Center, sells or transfers control to an
out-of-state nonprofit entity or to any for-profit entity, the health system must return to the
general fund any charitable assets the health system received from the state.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment and
applies to transactions completed on or after that date.
new text end
Sec. 195. new text begin SKIN-LIGHTENING PRODUCTS PUBLIC AWARENESS AND
EDUCATION GRANT.
new text end
new text begin
An organization receiving a grant from the commissioner of health for public awareness
and education activities to address issues of colorism, skin-lightening products, and chemical
exposure from skin-lightening products must use the grant funds for activities that are
culturally specific and community-based and that focus on:
new text end
new text begin
(1) increasing public awareness and providing education on the health dangers associated
with using skin-lightening creams and products that contain mercury and hydroquinone and
are manufactured in other countries, brought into this country, and sold illegally online or
in stores; the dangers of exposure to mercury through dermal absorption, inhalation,
hand-to-mouth contact, and contact with individuals who have used skin-lightening products;
the health effects of mercury poisoning, including the permanent effects on the central
nervous system and kidneys; and the dangers to mothers and infants of using these products
or being exposed to these products during pregnancy and while breastfeeding;
new text end
new text begin
(2) identifying products that contain mercury and hydroquinone by testing skin-lightening
products;
new text end
new text begin
(3) developing a train the trainer curriculum to increase community knowledge and
influence behavior changes by training community leaders, cultural brokers, community
health workers, and educators;
new text end
new text begin
(4) continuing to build the self-esteem and overall wellness of young people who are
using skin-lightening products or are at risk of starting the practice of skin lightening; and
new text end
new text begin
(5) building the capacity of community-based organizations to continue to combat
skin-lightening practices and chemical exposures from skin-lightening products.
new text end
Sec. 196. new text begin STATEWIDE HEALTH CARE PROVIDER DIRECTORY.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have
the meanings given.
new text end
new text begin
(b) "Health care provider" means a practicing provider that accepts reimbursement from
a group purchaser.
new text end
new text begin
(c) "Health care provider directory" means an electronic catalog and index that supports
the management of health care provider information, both individual and organizational, in
a directory structure for public use to find available providers and networks and support
state agency responsibilities.
new text end
new text begin
(d) "Group purchaser" has the meaning given in Minnesota Statutes, section 62J.03,
subdivision 6.
new text end
new text begin Subd. 2. new text end
new text begin Health care provider directory. new text end
new text begin
The commissioner shall assess the feasibility
and stakeholder commitment to develop, manage, and maintain a statewide electronic
directory of health care providers. The assessment must take into consideration consumer
information needs, state agency applications, stakeholder needs, technical requirements,
alignment with national standards, governance, operations, legal and policy considerations,
and existing directories. The commissioner shall conduct this assessment in consultation
with stakeholders, including but not limited to consumers, group purchasers, health care
providers, community health boards, and state agencies.
new text end
Sec. 197. new text begin STUDY AND RECOMMENDATIONS; NONPROFIT HEALTH
MAINTENANCE ORGANIZATION CONVERSIONS AND OTHER
TRANSACTIONS.
new text end
new text begin
(a) The commissioner of health shall study and develop recommendations on the
regulation of conversions, mergers, transfers of assets, and other transactions affecting
Minnesota-domiciled nonprofit health maintenance organizations and for-profit health
maintenance organizations. The recommendations must at least address:
new text end
new text begin
(1) monitoring and regulation of Minnesota-domiciled for-profit health maintenance
organizations;
new text end
new text begin
(2) issues related to public benefit assets held by a nonprofit health maintenance
organization, including identifying the portion of the organization's assets that are considered
public benefit assets to be protected, establishing a fair and independent process to value
to the assets, and how public benefit assets should be stewarded for the public good;
new text end
new text begin
(3) designating a state agency or executive branch office with authority to review and
approve or disapprove a nonprofit health maintenance organization's plan to convert to a
for-profit organization; and
new text end
new text begin
(4) establishing a process for the public to learn about and provide input on a nonprofit
health maintenance organization's proposed conversion to a for-profit organization.
new text end
new text begin
(b) To fulfill the requirements under this section, the commissioner:
new text end
new text begin
(1) may consult with the commissioners of human services and commerce;
new text end
new text begin
(2) may enter into one or more contracts for professional or technical services;
new text end
new text begin
(3) notwithstanding any law to the contrary, may use data submitted under Minnesota
Statutes, sections 62U.04 and 144.695 to 144.705, and other data held by the commissioner
for purposes of regulating health maintenance organizations or already submitted to the
commissioner by health carriers; and
new text end
new text begin
(4) may collect from health maintenance organizations and their parent or affiliated
companies, financial data and other information, including nonpublic data and trade secret
data, that are deemed necessary by the commissioner to conduct the study and develop the
recommendations under this section. Health maintenance organizations must provide the
commissioner with any information requested by the commissioner under this clause, in
the form and manner specified by the commissioner. Any data collected by the commissioner
under this clause is classified as confidential data as defined in Minnesota Statutes, section
13.02, subdivision 3 or protected nonpublic data as defined in Minnesota Statutes, section
13.02, subdivision 13.
new text end
new text begin
(c) No later than October 1, 2023, the commissioner must seek public comments on the
regulation of conversion transactions involving nonprofit health maintenance organizations.
new text end
new text begin
(d) The commissioner may use the enforcement authority in Minnesota Statutes, section
62D.17, if a health maintenance organization fails to comply with a request for information
under paragraph (b), clause (4).
new text end
new text begin
(e) The commissioner shall submit preliminary findings from this study to the chairs of
the legislative committees with jurisdiction over health and human services by January 15,
2024, and shall submit a final report and recommendations to the legislature by June 30,
2024.
new text end
Sec. 198. new text begin STUDY OF THE DEVELOPMENT OF A STATEWIDE REGISTRY FOR
PROVIDER ORDERS FOR LIFE-SUSTAINING TREATMENT.
new text end
new text begin Subdivision 1. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following terms have
the meanings given.
new text end
new text begin
(b) "Commissioner" means the commissioner of health.
new text end
new text begin
(c) "Life-sustaining treatment" means any medical procedure, pharmaceutical drug,
medical device, or medical intervention that maintains life by sustaining, restoring, or
supplanting a vital function. Life-sustaining treatment does not include routine care necessary
to sustain patient cleanliness and comfort.
new text end
new text begin
(d) "POLST" means a provider order for life-sustaining treatment, signed by a physician,
advanced practice registered nurse, or physician assistant, to ensure that the medical treatment
preferences of a patient with an advanced serious illness who is nearing the end of life are
honored.
new text end
new text begin
(e) "POLST form" means a portable medical form used to communicate a physician's,
advanced practice registered nurse's, or physician assistant's order to help ensure that a
patient's medical treatment preferences are conveyed to emergency medical service personnel
and other health care providers.
new text end
new text begin Subd. 2. new text end
new text begin Establishment. new text end
new text begin
(a) The commissioner, in consultation with the advisory
committee established in paragraph (c), shall develop recommendations for a statewide
registry of POLST forms to ensure that a patient's medical treatment preferences are followed
by all health care providers. The registry must allow for the submission of completed POLST
forms and for the forms to be accessed by health care providers and emergency medical
service personnel in a timely manner for the provision of care or services.
new text end
new text begin
(b) The commissioner shall develop recommendations on the following:
new text end
new text begin
(1) electronic capture, storage, and security of information in the registry;
new text end
new text begin
(2) procedures to protect the accuracy and confidentiality of information submitted to
the registry;
new text end
new text begin
(3) limits as to who can access the registry;
new text end
new text begin
(4) where the registry should be housed;
new text end
new text begin
(5) ongoing funding models for the registry; and
new text end
new text begin
(6) any other action needed to ensure that patients' rights are protected and that their
health care decisions are followed.
new text end
new text begin
(c) The commissioner shall create an advisory committee with members representing
physicians, physician assistants, advanced practice registered nurses, nursing homes,
emergency medical system providers, hospice and palliative care providers, the disability
community, attorneys, medical ethicists, and the religious community.
new text end
new text begin Subd. 3. new text end
new text begin Report. new text end
new text begin
The commissioner shall submit recommendations on establishing a
statewide registry of POLST forms to the chairs and ranking minority members of the
legislative committees with jurisdiction over health and human services policy and finance
by February 1, 2024, and implement the registry no later than December 1, 2024.
new text end
Sec. 199.
new text begin
VACCINES FOR UNINSURED AND UNDERINSURED ADULTS.
new text end
new text begin
The commissioner of health shall administer a program to provide vaccines to uninsured
and underinsured adults. The commissioner shall determine adult eligibility for free or
low-cost vaccines under this program and shall enroll clinics to participate in the program
and administer vaccines recommended by the Centers for Disease Control and Prevention.
In administering the program, the commissioner shall address racial and ethnic disparities
in vaccine coverage rates. State money appropriated for purposes of this section shall be
used to supplement, but not supplant, available federal funding for purposes of this section.
new text end
Sec. 200. new text begin WORKPLACE SAFETY GRANTS; HEALTH CARE ENTITIES AND
HUMAN SERVICES PROVIDERS.
new text end
new text begin Subdivision 1. new text end
new text begin Grant program established. new text end
new text begin
The commissioner of health shall administer
a program to award workplace safety grants to health care entities and human services
providers to increase safety measures at health care settings and at human services workplaces
providing behavioral health care; services for children, families, and vulnerable adults;
services for older adults and people with disabilities; and other social services or related
care.
new text end
new text begin Subd. 2. new text end
new text begin Eligible applicants; application. new text end
new text begin
(a) Entities eligible for a grant under this
section shall include health systems, hospitals, medical clinics, dental clinics, ambulance
services, community health clinics, county human services agencies, Tribal human services
agencies, and other human services provider organizations.
new text end
new text begin
(b) An entity seeking a grant under this section must submit an application to the
commissioner in a form and manner prescribed by the commissioner. An application must
include information about:
new text end
new text begin
(1) the type of entity or organization seeking grant funding;
new text end
new text begin
(2) the specific safety measures or activities for which the applicant will use the grant
funding;
new text end
new text begin
(3) the specific policies that will be implemented or upheld to ensure that individuals'
rights to privacy and data protection are protected during the use of safety equipment obtained
or operated through grant funding;
new text end
new text begin
(4) a proposed budget for each of the specific activities for which the applicant will use
the grant funding;
new text end
new text begin
(5) an outline of efforts to enhance or improve existing safety measures or proposed
new measures to improve the safety of staff at the entity, agency, or organization;
new text end
new text begin
(6) sample consent forms for any safety equipment that has capacity to record, store, or
share audio or video that will be collected from patients or clients prior to implementation
of grant-funded safety measures, excluding equipment located in public spaces in
provider-controlled, licensed settings;
new text end
new text begin
(7) how the grant-funded measures will lead to long-term improvements in safety and
stability for staff and for patients and clients accessing health care or services from the
applicant; and
new text end
new text begin
(8) methods the applicant will use to evaluate effectiveness of the safety measures and
changes that will be made if the measures are deemed ineffective.
new text end
new text begin Subd. 3. new text end
new text begin Grant awards. new text end
new text begin
Grants must be awarded to eligible applicants that meet
application requirements on a first-come, first-served basis. Forty percent of grant funds
must be awarded to eligible applicants located outside of the seven-county metropolitan
area. Each grant award must be for at least $5,000, but no more than $100,000.
new text end
new text begin Subd. 4. new text end
new text begin Allowable uses of grant funds. new text end
new text begin
(a) Grant funds may be used for one or more
of the following:
new text end
new text begin
(1) the procurement and installation of safety equipment, including but not limited to
cellular telephones; personal radios; wearable tracking devices for staff to share their location
with supervisors, subject to the federal Health Insurance Portability and Accountability Act
of 1996 (HIPAA) data privacy requirements outlined in Code of Federal Regulations, title
45, parts 160 and 164, subparts A and E; security systems and cameras in public spaces of
provider-controlled, licensed settings or of health care settings; and panic buttons;
new text end
new text begin
(2) training for staff, which may include:
new text end
new text begin
(i) sessions and exercises for crisis management, strategies for de-escalating conflict
situations, safety planning, and self-defense in accordance with positive support strategies
under Minnesota Rules, chapter 9544, and person-centered planning and service delivery
according to Minnesota Statutes, section 245D.07, subdivision 1a;
new text end
new text begin
(ii) training in culturally informed and culturally affirming practices, including linguistic
training;
new text end
new text begin
(iii) training in trauma-informed social, emotional, and behavioral support; and
new text end
new text begin
(iv) other training topics, sessions, and exercises the commissioner determines to be
appropriate;
new text end
new text begin
(3) facility safety improvements, including but not limited to a threat and vulnerability
review and barrier protection;
new text end
new text begin
(4) support services, counseling, and additional resources for staff who have experienced
safety concerns or trauma-related incidents in the workplace;
new text end
new text begin
(5) installation and implementation of an internal data incident tracking system to track
and prevent workplace safety incidents; and
new text end
new text begin
(6) other prevention and mitigation measures and safety training, resources, and support
services the commissioner determines to be appropriate.
new text end
new text begin
(b) The following restrictions apply to the eligible uses of grant funds under paragraph
(a):
new text end
new text begin
(1) safety equipment must not include:
new text end
new text begin
(i) tools or devices that facilitate physical or chemical restraint;
new text end
new text begin
(ii) barriers, environmental modifications, or other tools or devices that facilitate
individual seclusion, except plexiglass barriers in office settings are allowed;
new text end
new text begin
(iii) wearable body cameras; or
new text end
new text begin
(iv) wearable tracking devices that have the capacity to store location data;
new text end
new text begin
(2) security cameras must only be used in staff spaces and entry points of buildings and
may not be used in common areas, bedrooms, and bathrooms;
new text end
new text begin
(3) in settings that are required to comply with the positive supports rule, all safety
equipment or measures must comply with Minnesota Rules, chapter 9544;
new text end
new text begin
(4) settings licensed under Minnesota Statutes, section 245D, must follow person-centered
practices according to Minnesota Statutes, section 245D.07;
new text end
new text begin
(5) any safety equipment purchased with grant funding that has electronic monitoring
capacity must be used according to Minnesota Statutes, section 144.6502, or the brain injury,
community alternative care, community access for disability inclusion, and developmental
disabilities federal waiver plan language that outlines monitoring technology use;
new text end
new text begin
(6) prior to the use of safety equipment that has capacity to record, store, and share audio,
video, or a combination thereof, the grant recipient must:
new text end
new text begin
(i) provide patients or clients with information about electronic monitoring in a way that
is most accessible to the patients or clients, including the definition of electronic monitoring,
the type of device that will be in use, how the footage captured will be used, with whom
the footage captured will be shared, and a statement that a patient or client has the right to
decline use of safety equipment that has capacity to record, store, and share audio, video,
or a combination thereof;
new text end
new text begin
(ii) provide notice every time electronic monitoring devices are in use; and
new text end
new text begin
(iii) obtain written consent from anyone whose audio or video may be recorded during
the time the device is in use and, if applicable, from guardians of individuals whose audio
or video may be recorded during the time the device is in use; and
new text end
new text begin
(7) in settings that provide home and community-based services, if at any point a client
or their guardian declines the use of safety equipment that has capacity to record, store, or
share audio, video, or a combination thereof or revokes prior consent to such use, the provider
must cease using the safety equipment immediately and indefinitely. A provider may not
deny or delay the provision of services as a result of an individual's decision to decline the
use of safety equipment that has capacity to record, store, or share audio, video, or a
combination thereof.
new text end
new text begin
(c) All video, audio, or other personally identifiable information collected through safety
equipment paid for by grant funds under this section must:
new text end
new text begin
(1) be treated consistently with the federal Health Insurance Portability and Accountability
Act of 1996 (HIPAA) requirements outlined in Code of Federal Regulations, title 45, parts
160 and 164, subparts A and E;
new text end
new text begin
(2) be subject to applicable rules of evidence and procedure if admitted into evidence
in a civil, criminal, or administrative proceeding; and
new text end
new text begin
(3) not result in the denial or delay of services provided to an individual.
new text end
new text begin Subd. 5. new text end
new text begin Report. new text end
new text begin
Within two years after receiving grant funds under this section, each
grant recipient must submit a report to the commissioner. The commissioner must submit
a compilation of the reports to the chairs and ranking minority members of the legislative
committees with jurisdiction over health and human services, the Office of Ombudsman
for Long-Term Care, and Office of Ombudsman for Mental Health and Developmental
Disabilities. Grant recipient reports to the commissioner must include:
new text end
new text begin
(1) the number of workplace safety incidents that occurred over the course of the grant
period;
new text end
new text begin
(2) the number and type of safety measures funded by the grants, and how those safety
measures helped alleviate or de-escalate workplace safety incidents;
new text end
new text begin
(3) the number of staff benefiting from safety measures implemented through grant
funding;
new text end
new text begin
(4) the number of patients or clients benefiting from safety measures implemented
through grant funding;
new text end
new text begin
(5) practices implemented concurrently with the use of safety equipment that ensured
that the rights of patients or clients served were upheld;
new text end
new text begin
(6) the number of patients or clients who declined to consent to the use of any safety
equipment that had capacity to record, store, or share audio, video, or a combination thereof;
new text end
new text begin
(7) an evaluation of the effectiveness of the safety measures, including assessment of
whether and how the grant funding has led or will lead to improved safety and service
provisions for staff, patients, and clients; and
new text end
new text begin
(8) changes to policy or practice that were made if safety measures implemented using
grant funds were deemed ineffective.
new text end
new text begin Subd. 6. new text end
new text begin Technical assistance. new text end
new text begin
The commissioner must provide technical assistance to
grant applicants throughout the application process and to applicants and grant recipients
regarding grant distribution and required grant recipient reporting
new text end
Sec. 201. new text begin TASK FORCE ON PREGNANCY HEALTH AND SUBSTANCE USE
DISORDERS.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The Task Force on Pregnancy Health and Substance Use
Disorders is established to recommend protocols for when physicians, advanced practice
registered nurses, and physician assistants should administer a toxicology test and
requirements for reporting for prenatal exposure to a controlled substance.
new text end
new text begin Subd. 2. new text end
new text begin Membership. new text end
new text begin
(a) The task force shall consist of the following members:
new text end
new text begin
(1) a physician licensed in Minnesota to practice obstetrics and gynecology who provides
care primarily to medical assistance enrollees during pregnancy appointed by the American
College of Obstetricians and Gynecologists;
new text end
new text begin
(2) a physician licensed in Minnesota to practice pediatrics or family medicine who
provides care primarily to medical assistance enrollees with substance use disorders or who
provides addiction medicine care during pregnancy appointed by the Minnesota Medical
Association;
new text end
new text begin
(3) a certified nurse-midwife licensed as an advanced practice registered nurse in
Minnesota who provides care primarily to medical assistance enrollees with substance use
disorders or provides addiction medicine care during pregnancy appointed by the Minnesota
Advanced Practice Registered Nurses Coalition;
new text end
new text begin
(4) two representatives of county social services agencies, one from a county outside
the seven-county metropolitan area and one from a county within the seven-county
metropolitan area, appointed by the Minnesota Association of County Social Service
Administrators;
new text end
new text begin
(5) one representative from the Board of Social Work;
new text end
new text begin
(6) two Tribal representatives appointed by the Minnesota Indian Affairs Council;
new text end
new text begin
(7) two members who identify as Black or African American and who have lived
experience with the child welfare system and substance use disorders appointed by the
Cultural and Ethnic Communities Leadership Council;
new text end
new text begin
(8) two members who are licensed substance use disorder treatment providers appointed
by the Minnesota Association of Resources for Recovery and Chemical Health;
new text end
new text begin
(9) one member representing hospitals appointed by the Minnesota Hospital Association;
new text end
new text begin
(10) one designee of the commissioner of health with expertise in substance use disorders
and treatment;
new text end
new text begin
(11) two members who identify as Native American or American Indian and who have
lived experience with the child welfare system and substance use disorders appointed by
the Minnesota Indian Affairs Council;
new text end
new text begin
(12) two members from the Council for Minnesotans of African Heritage; and
new text end
new text begin
(13) one member of the Minnesota Perinatal Quality Collaborative.
new text end
new text begin
(b) Appointments to the task force must be made by October 1, 2023.
new text end
new text begin Subd. 3. new text end
new text begin Chairs; meetings. new text end
new text begin
(a) The task force shall elect a chair and cochair at the first
meeting, which shall be convened no later than October 15, 2023.
new text end
new text begin
(b) Task force meetings are subject to the Minnesota Open Meeting Law under Minnesota
Statutes, chapter 13D.
new text end
new text begin Subd. 4. new text end
new text begin Administrative support. new text end
new text begin
The Department of Health must provide administrative
support and meeting space for the task force.
new text end
new text begin Subd. 5. new text end
new text begin Duties; reports. new text end
new text begin
(a) The task force shall develop recommended protocols for
when a toxicology test for prenatal exposure to a controlled substance should be administered
to a birthing parent and a newborn infant. The task force must also recommend protocols
for providing notice or reporting of prenatal exposure to a controlled substance to local
welfare agencies under Minnesota Statutes, chapter 260E.
new text end
new text begin
(b) No later than December 1, 2024, the task force must submit a written report to the
chairs and ranking minority members of the legislative committees and divisions with
jurisdiction over health and human services on the task force's activities and recommendations
on the protocols developed under paragraph (a).
new text end
new text begin Subd. 6. new text end
new text begin Expiration. new text end
new text begin
The task force shall expire upon submission of the report required
under subdivision 5, paragraph (b), or December 1, 2024, whichever is later.
new text end
Sec. 202. new text begin REVISOR INSTRUCTION.
new text end
new text begin
(a) The revisor of statutes shall change the term "cancer surveillance system" to "cancer
reporting system" wherever it appears in the next edition of Minnesota Statutes and Minnesota
Rules and in the online publication.
new text end
new text begin
(b) The revisor of statutes shall amend the headnote for Minnesota Statutes, section
145.423, to read "RECOGNITION OF INFANT WHO IS BORN ALIVE."
new text end
new text begin
(c) In Minnesota Statutes, section 144.7055, the revisor shall renumber paragraphs (b)
to (e) alphabetically as individual subdivisions under Minnesota Statutes, section 144.7051.
The revisor shall make any necessary changes to sentence structure for this renumbering
while preserving the meaning of the text. The revisor shall also make necessary
cross-reference changes in Minnesota Statutes and Minnesota Rules consistent with the
renumbering.
new text end
Sec. 203. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Rules, parts 4640.1500; 4640.1600; 4640.1700; 4640.1800; 4640.1900;
4640.2000; 4640.2100; 4640.2200; 4640.2300; 4640.2400; 4640.2500; 4640.2600;
4640.2700; 4640.2800; 4640.2900; 4640.3000; 4640.3100; 4640.3200; 4640.3300;
4640.3400; 4640.3500; 4640.3600; 4640.3700; 4640.3800; 4640.3900; 4640.4000;
4640.4100; 4640.4200; 4640.4300; 4640.6100; 4640.6200; 4640.6300; 4640.6400;
4645.0300; 4645.0400; 4645.0500; 4645.0600; 4645.0700; 4645.0800; 4645.0900;
4645.1000; 4645.1100; 4645.1200; 4645.1300; 4645.1400; 4645.1500; 4645.1600;
4645.1700; 4645.1800; 4645.1900; 4645.2000; 4645.2100; 4645.2200; 4645.2300;
4645.2400; 4645.2500; 4645.2600; 4645.2700; 4645.2800; 4645.2900; 4645.3000;
4645.3100; 4645.3200; 4645.3300; 4645.3400; 4645.3500; 4645.3600; 4645.3700;
4645.3800; 4645.3805; 4645.3900; 4645.4000; 4645.4100; 4645.4200; 4645.4300;
4645.4400; 4645.4500; 4645.4600; 4645.4700; 4645.4800; 4645.4900; 4645.5100; and
4645.5200,
new text end
new text begin
are repealed effective January 1, 2024.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Statutes 2022, sections 62J.84, subdivision 5; 62U.10, subdivisions 6, 7,
and 8; 144.059, subdivision 10; 144.9505, subdivision 3; 145.4235; and 153A.14, subdivision
5,
new text end
new text begin
are repealed.
new text end
new text begin
(c)
new text end
new text begin
Minnesota Rules, part 4615.3600,
new text end
new text begin
is repealed effective the day following final
enactment.
new text end
new text begin
(d)
new text end
new text begin
Minnesota Rules, parts 4700.1900; 4700.2000; 4700.2100; 4700.2210; 4700.2300,
subparts 1, 3, 4, 4a, and 5; 4700.2410; 4700.2420; and 4700.2500,
new text end
new text begin
are repealed.
new text end
new text begin
(e)
new text end
new text begin
Minnesota Statutes 2022, sections 62Q.145; 145.1621; 145.411, subdivisions 2 and
4; 145.412; 145.413, subdivisions 2 and 3; 145.4131; 145.4132; 145.4133; 145.4134;
145.4135; 145.4136; 145.415; 145.416; 145.423, subdivisions 2, 3, 4, 5, 6, 7, 8, and 9;
145.4241; 145.4242; 145.4243; 145.4244; 145.4245; 145.4246; 145.4247; 145.4248;
145.4249; 256B.011; 256B.40; 261.28; and 393.07, subdivision 11,
new text end
new text begin
are repealed effective
the day following final enactment.
new text end
ARTICLE 4
MEDICAL EDUCATION AND RESEARCH COSTS
Section 1.
Minnesota Statutes 2022, section 62J.692, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
(a) For purposes of this section, the following definitions
apply:
(b) "Accredited clinical training" means the clinical training provided by a medical
education program that is accredited through an organization recognized by the Department
of Education, the Centers for Medicare and Medicaid Services, or another national body
who reviews the accrediting organizations for multiple disciplines and whose standards for
recognizing accrediting organizations are reviewed and approved by the commissioner of
health.
(c) "Commissioner" means the commissioner of health.
(d) "Clinical medical education program" means the accredited clinical training of
physicians (medical students and residents), doctor of pharmacy practitionersnew text begin (pharmacy
students and residents)new text end , doctors of chiropractic, dentistsnew text begin (dental students and residents)new text end ,
advanced practice registered nurses (clinical nurse specialists, certified registered nurse
anesthetists, nurse practitioners, and certified nurse midwives), physician assistants, dental
therapists and advanced dental therapists, psychologists, clinical social workers, community
paramedics, and community health workers.
(e) "Sponsoring institution" means a hospital, school, or consortium located in Minnesota
that sponsors and maintains primary organizational and financial responsibility for a clinical
medical education program in Minnesota and which is accountable to the accrediting body.
(f) "Teaching institution" means a hospital, medical center, clinic, or other organization
that conducts a clinical medical education program in Minnesota.
(g) "Trainee" means a student or resident involved in a clinical medical education
program.
(h) "Eligible trainee FTE's" means the number of trainees, as measured by full-time
equivalent counts, that are at training sites located in Minnesota with currently active medical
assistance enrollment status and a National Provider Identification (NPI) number where
training occurs in either an inpatient or ambulatory patient care setting and where the training
is funded, in part, by patient care revenues. Training that occurs in nursing facility settings
is not eligible for funding under this section.
Sec. 2.
Minnesota Statutes 2022, section 62J.692, subdivision 3, is amended to read:
Subd. 3.
Application process.
(a) A clinical medical education program conducted in
Minnesota by a teaching institution to train physicians, doctor of pharmacy practitioners,
dentists, chiropractors, physician assistants, dental therapists and advanced dental therapists,
psychologists, clinical social workers, community paramedics, or community health workers
is eligible for funds under subdivision 4 if the program:
(1) is funded, in part, by patient care revenues;
(2) occurs in patient care settings that face increased financial pressure as a result of
competition with nonteaching patient care entities; and
(3) emphasizes primary care or specialties that are in undersupply in Minnesota.
(b) A clinical medical education program for advanced practice nursing is eligible for
funds under subdivision 4 if the program meets the eligibility requirements in paragraph
(a), clauses (1) to (3), and is sponsored by the University of Minnesota Academic Health
Center, the Mayo Foundation, or institutions that are part of the Minnesota State Colleges
and Universities system or members of the Minnesota Private College Council.
(c) Applications must be submitted to the commissioner by a sponsoring institution on
behalf of an eligible clinical medical education program deleted text begin and must be received by October
31 of each year for distribution in the following yeardeleted text end new text begin on a timeline determined by the
commissionernew text end . An application for funds must contain deleted text begin the following information:deleted text end new text begin information
the commissioner deems necessary to determine program eligibility based on the criteria
in paragraphs (a) and (b) and to ensure the equitable distribution of funds.
new text end
deleted text begin
(1) the official name and address of the sponsoring institution and the official name and
site address of the clinical medical education programs on whose behalf the sponsoring
institution is applying;
deleted text end
deleted text begin
(2) the name, title, and business address of those persons responsible for administering
the funds;
deleted text end
deleted text begin
(3) for each clinical medical education program for which funds are being sought; the
type and specialty orientation of trainees in the program; the name, site address, and medical
assistance provider number and national provider identification number of each training
site used in the program; the federal tax identification number of each training site used in
the program, where available; the total number of trainees at each training site; and the total
number of eligible trainee FTEs at each site; and
deleted text end
deleted text begin
(4) other supporting information the commissioner deems necessary to determine program
eligibility based on the criteria in paragraphs (a) and (b) and to ensure the equitable
distribution of funds.
deleted text end
deleted text begin
(d) An application must include the information specified in clauses (1) to (3) for each
clinical medical education program on an annual basis for three consecutive years. After
that time, an application must include the information specified in clauses (1) to (3) when
requested, at the discretion of the commissioner:
deleted text end
deleted text begin
(1) audited clinical training costs per trainee for each clinical medical education program
when available or estimates of clinical training costs based on audited financial data;
deleted text end
deleted text begin
(2) a description of current sources of funding for clinical medical education costs,
including a description and dollar amount of all state and federal financial support, including
Medicare direct and indirect payments; and
deleted text end
deleted text begin
(3) other revenue received for the purposes of clinical training.
deleted text end
deleted text begin (e)deleted text end new text begin (d)new text end An applicant that does not provide information requested by the commissioner
shall not be eligible for funds for the deleted text begin currentdeleted text end new text begin applicablenew text end funding cycle.
Sec. 3.
Minnesota Statutes 2022, section 62J.692, subdivision 4, is amended to read:
Subd. 4.
Distribution of funds.
(a) The commissioner shall annually distribute deleted text begin the
available medical education fundsdeleted text end new text begin revenue credited or money transferred to the medical
education and research costs account under subdivision 8 and section 297F.10, subdivision
1, clause (2), new text end to all qualifying applicants based on a public program volume factor, which
is determined by the total volume of public program revenue received by each training site
as a percentage of all public program revenue received by all training sites in the fund pool.
Public program revenue for the distribution formula includes revenue from medical
assistance and prepaid medical assistance. Training sites that receive no public program
revenue are ineligible for funds available under this subdivision. deleted text begin For purposes of determining
training-site level grants to be distributed under this paragraph, total statewide average costs
per trainee for medical residents is based on audited clinical training costs per trainee in
primary care clinical medical education programs for medical residents. Total statewide
average costs per trainee for dental residents is based on audited clinical training costs per
trainee in clinical medical education programs for dental students. Total statewide average
costs per trainee for pharmacy residents is based on audited clinical training costs per trainee
in clinical medical education programs for pharmacy students.
deleted text end
Training sites whose training site level grant is less than $5,000, based on the deleted text begin formuladeleted text end new text begin
formulasnew text end described in this deleted text begin paragraphdeleted text end new text begin subdivisionnew text end , or that train fewer than 0.1 FTE eligible
trainees, are ineligible for funds available under this subdivision. No training sites shall
receive a grant per FTE trainee that is in excess of the 95th percentile grant per FTE across
all eligible training sites; grants in excess of this amount will be redistributed to other eligible
sites based on the deleted text begin formuladeleted text end new text begin formulasnew text end described in this deleted text begin paragraphdeleted text end new text begin subdivisionnew text end .
(b) deleted text begin For funds distributed in fiscal years 2014 and 2015, the distribution formula shall
include a supplemental public program volume factor, which is determined by providing a
supplemental payment to training sites whose public program revenue accounted for at least
0.98 percent of the total public program revenue received by all eligible training sites. The
supplemental public program volume factor shall be equal to ten percent of each training
site's grant for funds distributed in fiscal year 2014 and for funds distributed in fiscal year
2015. Grants to training sites whose public program revenue accounted for less than 0.98
percent of the total public program revenue received by all eligible training sites shall be
reduced by an amount equal to the total value of the supplemental payment. For fiscal year
2016 and beyond, the distribution of funds shall be based solely on the public program
volume factor as described in paragraph (a).deleted text end new text begin Money appropriated through the state general
fund, the health care access fund, and any additional fund for the purpose of funding medical
education and research costs and that does not require federal approval must be awarded
only to eligible training sites that do not qualify for a medical education and research cost
rate factor under sections 256.969, subdivision 2b, paragraph (k), or 256B.75, paragraph
(b). The commissioner shall distribute the available medical education money appropriated
to eligible training sites that do not qualify for a medical education and research cost rate
factor based on a distribution formula determined by the commissioner. The distribution
formula under this paragraph must consider clinical training costs, public program revenues,
and other factors identified by the commissioner that address the objective of supporting
clinical training.
new text end
(c) Funds distributed shall not be used to displace current funding appropriations from
federal or state sources.
(d) Funds shall be distributed to the sponsoring institutions indicating the amount to be
distributed to each of the sponsor's clinical medical education programs based on the criteria
in this subdivision and in accordance with the commissioner's approval letter. Each clinical
medical education program must distribute funds allocated under paragraphs (a) and (b) to
the training sites as specified in the commissioner's approval letter. Sponsoring institutions,
which are accredited through an organization recognized by the Department of Education
or the Centers for Medicare and Medicaid Services, may contract directly with training sites
to provide clinical training. To ensure the quality of clinical training, those accredited
sponsoring institutions must:
(1) develop contracts specifying the terms, expectations, and outcomes of the clinical
training conducted at sites; and
(2) take necessary action if the contract requirements are not met. Action may include
deleted text begin the withholding of paymentsdeleted text end new text begin disqualifying the training sitenew text end under this section or the removal
of students from the site.
(e) Use of funds is limited to expenses related to new text begin eligible new text end clinical training deleted text begin programdeleted text end costs
deleted text begin for eligible programsdeleted text end new text begin . The commissioner shall develop a methodology for determining
eligible costsnew text end .
(f) Any funds deleted text begin notdeleted text end new text begin that cannot benew text end distributed in accordance with the commissioner's
approval letter must be returned to the medical education and research fund within 30 days
of receiving notice from the commissioner. deleted text begin The commissioner shall distribute returned
funds to the appropriate training sites in accordance with the commissioner's approval letter.deleted text end new text begin
When appropriate, the commissioner shall include the undistributed money in the subsequent
distribution cycle using the applicable methodology described in this subdivision.
new text end
deleted text begin
(g) A maximum of $150,000 of the funds dedicated to the commissioner under section
297F.10, subdivision 1, clause (2), may be used by the commissioner for administrative
expenses associated with implementing this section.
deleted text end
Sec. 4.
Minnesota Statutes 2022, section 62J.692, subdivision 5, is amended to read:
Subd. 5.
Report.
(a) Sponsoring institutions receiving funds under this section must
deleted text begin sign anddeleted text end submit a medical education grant verification report (GVR) to verify that the correct
grant amount was forwarded to each eligible training site. deleted text begin If the sponsoring institution fails
to submit the GVR by the stated deadline, or to request and meet the deadline for an
extension, the sponsoring institution is required to return the full amount of funds received
to the commissioner within 30 days of receiving notice from the commissioner. The
commissioner shall distribute returned funds to the appropriate training sites in accordance
with the commissioner's approval letter.
deleted text end
(b) The reports must provide verification of the distribution of the funds and must include:
deleted text begin
(1) the total number of eligible trainee FTEs in each clinical medical education program;
deleted text end
deleted text begin
(2) the name of each funded program and, for each program, the dollar amount distributed
to each training site and a training site expenditure report;
deleted text end
deleted text begin (3)deleted text end new text begin (1)new text end documentation of any discrepancies between the deleted text begin initialdeleted text end grant distribution notice
included in the commissioner's approval letter and the actual distribution;
deleted text begin (4)deleted text end new text begin (2)new text end a statement by the sponsoring institution stating that the completed grant
verification report is valid and accurate; and
deleted text begin (5)deleted text end new text begin (3)new text end other information the commissioner deems appropriate to evaluate the effectiveness
of the use of funds for medical education.
deleted text begin
(c) Each year, the commissioner shall provide an annual summary report to the legislature
on the implementation of this section. This report is exempt from section 144.05, subdivision
7.
deleted text end
Sec. 5.
Minnesota Statutes 2022, section 62J.692, subdivision 8, is amended to read:
Subd. 8.
Federal financial participation.
The commissioner of human services shall
seek deleted text begin to maximizedeleted text end federal financial participation deleted text begin in paymentsdeleted text end new text begin for the dedicated revenuenew text end for
medical education and research costsnew text begin provided under section 297F.10, subdivision 1, clause
(2)new text end .
deleted text begin
The commissioner shall use physician clinic rates where possible to maximize federal
financial participation. Any additional funds that become available must be distributed under
subdivision 4, paragraph (a).
deleted text end
Sec. 6.
new text begin
[144.1913] CLINICAL DENTAL EDUCATION INNOVATION GRANTS.
new text end
new text begin
(a) The commissioner shall award clinical dental education innovation grants to teaching
institutions and clinical training sites for projects that increase dental access for underserved
populations and promote innovative clinical training of dental professionals. In awarding
the grants, the commissioner shall consider the following:
new text end
new text begin
(1) the potential to successfully increase access to dental services for an underserved
population;
new text end
new text begin
(2) the long-term viability of the project to improve access to dental services beyond
the period of initial funding;
new text end
new text begin
(3) the evidence of collaboration between the applicant and local communities;
new text end
new text begin
(4) the efficiency in the use of grant funding; and
new text end
new text begin
(5) the priority level of the project in relation to state education, access, and workforce
goals.
new text end
new text begin
(b) The commissioner shall periodically evaluate the priorities in awarding innovations
grants under this section to ensure that the priorities meet the changing workforce needs of
the state.
new text end
Sec. 7.
Minnesota Statutes 2022, section 256.969, subdivision 2b, is amended to read:
Subd. 2b.
Hospital payment rates.
(a) For discharges occurring on or after November
1, 2014, hospital inpatient services for hospitals located in Minnesota shall be paid according
to the following:
(1) critical access hospitals as defined by Medicare shall be paid using a cost-based
methodology;
(2) long-term hospitals as defined by Medicare shall be paid on a per diem methodology
under subdivision 25;
(3) rehabilitation hospitals or units of hospitals that are recognized as rehabilitation
distinct parts as defined by Medicare shall be paid according to the methodology under
subdivision 12; and
(4) all other hospitals shall be paid on a diagnosis-related group (DRG) methodology.
(b) For the period beginning January 1, 2011, through October 31, 2014, rates shall not
be rebased, except that a Minnesota long-term hospital shall be rebased effective January
1, 2011, based on its most recent Medicare cost report ending on or before September 1,
2008, with the provisions under subdivisions 9 and 23, based on the rates in effect on
December 31, 2010. For rate setting periods after November 1, 2014, in which the base
years are updated, a Minnesota long-term hospital's base year shall remain within the same
period as other hospitals.
(c) Effective for discharges occurring on and after November 1, 2014, payment rates
for hospital inpatient services provided by hospitals located in Minnesota or the local trade
area, except for the hospitals paid under the methodologies described in paragraph (a),
clauses (2) and (3), shall be rebased, incorporating cost and payment methodologies in a
manner similar to Medicare. The base year or years for the rates effective November 1,
2014, shall be calendar year 2012. The rebasing under this paragraph shall be budget neutral,
ensuring that the total aggregate payments under the rebased system are equal to the total
aggregate payments that were made for the same number and types of services in the base
year. Separate budget neutrality calculations shall be determined for payments made to
critical access hospitals and payments made to hospitals paid under the DRG system. Only
the rate increases or decreases under subdivision 3a or 3c that applied to the hospitals being
rebased during the entire base period shall be incorporated into the budget neutrality
calculation.
(d) For discharges occurring on or after November 1, 2014, through the next rebasing
that occurs, the rebased rates under paragraph (c) that apply to hospitals under paragraph
(a), clause (4), shall include adjustments to the projected rates that result in no greater than
a five percent increase or decrease from the base year payments for any hospital. Any
adjustments to the rates made by the commissioner under this paragraph and paragraph (e)
shall maintain budget neutrality as described in paragraph (c).
(e) For discharges occurring on or after November 1, 2014, the commissioner may make
additional adjustments to the rebased rates, and when evaluating whether additional
adjustments should be made, the commissioner shall consider the impact of the rates on the
following:
(1) pediatric services;
(2) behavioral health services;
(3) trauma services as defined by the National Uniform Billing Committee;
(4) transplant services;
(5) obstetric services, newborn services, and behavioral health services provided by
hospitals outside the seven-county metropolitan area;
(6) outlier admissions;
(7) low-volume providers; and
(8) services provided by small rural hospitals that are not critical access hospitals.
(f) Hospital payment rates established under paragraph (c) must incorporate the following:
(1) for hospitals paid under the DRG methodology, the base year payment rate per
admission is standardized by the applicable Medicare wage index and adjusted by the
hospital's disproportionate population adjustment;
(2) for critical access hospitals, payment rates for discharges between November 1, 2014,
and June 30, 2015, shall be set to the same rate of payment that applied for discharges on
October 31, 2014;
(3) the cost and charge data used to establish hospital payment rates must only reflect
inpatient services covered by medical assistance; and
(4) in determining hospital payment rates for discharges occurring on or after the rate
year beginning January 1, 2011, through December 31, 2012, the hospital payment rate per
discharge shall be based on the cost-finding methods and allowable costs of the Medicare
program in effect during the base year or years. In determining hospital payment rates for
discharges in subsequent base years, the per discharge rates shall be based on the cost-finding
methods and allowable costs of the Medicare program in effect during the base year or
years.
(g) The commissioner shall validate the rates effective November 1, 2014, by applying
the rates established under paragraph (c), and any adjustments made to the rates under
paragraph (d) or (e), to hospital claims paid in calendar year 2013 to determine whether the
total aggregate payments for the same number and types of services under the rebased rates
are equal to the total aggregate payments made during calendar year 2013.
(h) Effective for discharges occurring on or after July 1, 2017, and every two years
thereafter, payment rates under this section shall be rebased to reflect only those changes
in hospital costs between the existing base year or years and the next base year or years. In
any year that inpatient claims volume falls below the threshold required to ensure a
statistically valid sample of claims, the commissioner may combine claims data from two
consecutive years to serve as the base year. Years in which inpatient claims volume is
reduced or altered due to a pandemic or other public health emergency shall not be used as
a base year or part of a base year if the base year includes more than one year. Changes in
costs between base years shall be measured using the lower of the hospital cost index defined
in subdivision 1, paragraph (a), or the percentage change in the case mix adjusted cost per
claim. The commissioner shall establish the base year for each rebasing period considering
the most recent year or years for which filed Medicare cost reports are available. The
estimated change in the average payment per hospital discharge resulting from a scheduled
rebasing must be calculated and made available to the legislature by January 15 of each
year in which rebasing is scheduled to occur, and must include by hospital the differential
in payment rates compared to the individual hospital's costs.
(i) Effective for discharges occurring on or after July 1, 2015, inpatient payment rates
for critical access hospitals located in Minnesota or the local trade area shall be determined
using a new cost-based methodology. The commissioner shall establish within the
methodology tiers of payment designed to promote efficiency and cost-effectiveness.
Payment rates for hospitals under this paragraph shall be set at a level that does not exceed
the total cost for critical access hospitals as reflected in base year cost reports. Until the
next rebasing that occurs, the new methodology shall result in no greater than a five percent
decrease from the base year payments for any hospital, except a hospital that had payments
that were greater than 100 percent of the hospital's costs in the base year shall have their
rate set equal to 100 percent of costs in the base year. The rates paid for discharges on and
after July 1, 2016, covered under this paragraph shall be increased by the inflation factor
in subdivision 1, paragraph (a). The new cost-based rate shall be the final rate and shall not
be settled to actual incurred costs. Hospitals shall be assigned a payment tier based on the
following criteria:
(1) hospitals that had payments at or below 80 percent of their costs in the base year
shall have a rate set that equals 85 percent of their base year costs;
(2) hospitals that had payments that were above 80 percent, up to and including 90
percent of their costs in the base year shall have a rate set that equals 95 percent of their
base year costs; and
(3) hospitals that had payments that were above 90 percent of their costs in the base year
shall have a rate set that equals 100 percent of their base year costs.
(j) The commissioner may refine the payment tiers and criteria for critical access hospitals
to coincide with the next rebasing under paragraph (h). The factors used to develop the new
methodology may include, but are not limited to:
(1) the ratio between the hospital's costs for treating medical assistance patients and the
hospital's charges to the medical assistance program;
(2) the ratio between the hospital's costs for treating medical assistance patients and the
hospital's payments received from the medical assistance program for the care of medical
assistance patients;
(3) the ratio between the hospital's charges to the medical assistance program and the
hospital's payments received from the medical assistance program for the care of medical
assistance patients;
(4) the statewide average increases in the ratios identified in clauses (1), (2), and (3);
(5) the proportion of that hospital's costs that are administrative and trends in
administrative costs; and
(6) geographic location.
new text begin
(k) Effective for discharges occurring on or after January 1, 2024, the rates paid to
hospitals described in paragraph (a), clauses (2) to (4), must include a rate factor specific
to each hospital that qualifies for a medical education and research cost distribution under
section 62J.692 subdivision 4, paragraph (a).
new text end
Sec. 8.
Minnesota Statutes 2022, section 256B.75, is amended to read:
256B.75 HOSPITAL OUTPATIENT REIMBURSEMENT.
(a) For outpatient hospital facility fee payments for services rendered on or after October
1, 1992, the commissioner of human services shall pay the lower of (1) submitted charge,
or (2) 32 percent above the rate in effect on June 30, 1992, except for those services for
which there is a federal maximum allowable payment. Effective for services rendered on
or after January 1, 2000, payment rates for nonsurgical outpatient hospital facility fees and
emergency room facility fees shall be increased by eight percent over the rates in effect on
December 31, 1999, except for those services for which there is a federal maximum allowable
payment. Services for which there is a federal maximum allowable payment shall be paid
at the lower of (1) submitted charge, or (2) the federal maximum allowable payment. Total
aggregate payment for outpatient hospital facility fee services shall not exceed the Medicare
upper limit. If it is determined that a provision of this section conflicts with existing or
future requirements of the United States government with respect to federal financial
participation in medical assistance, the federal requirements prevail. The commissioner
may, in the aggregate, prospectively reduce payment rates to avoid reduced federal financial
participation resulting from rates that are in excess of the Medicare upper limitations.
(b) Notwithstanding paragraph (a), payment for outpatient, emergency, and ambulatory
surgery hospital facility fee services for critical access hospitals designated under section
144.1483, clause (9), shall be paid on a cost-based payment system that is based on the
cost-finding methods and allowable costs of the Medicare program. Effective for services
provided on or after July 1, 2015, rates established for critical access hospitals under this
paragraph for the applicable payment year shall be the final payment and shall not be settled
to actual costs. Effective for services delivered on or after the first day of the hospital's fiscal
year ending in 2017, the rate for outpatient hospital services shall be computed using
information from each hospital's Medicare cost report as filed with Medicare for the year
that is two years before the year that the rate is being computed. Rates shall be computed
using information from Worksheet C series until the department finalizes the medical
assistance cost reporting process for critical access hospitals. After the cost reporting process
is finalized, rates shall be computed using information from Title XIX Worksheet D series.
The outpatient rate shall be equal to ancillary cost plus outpatient cost, excluding costs
related to rural health clinics and federally qualified health clinics, divided by ancillary
charges plus outpatient charges, excluding charges related to rural health clinics and federally
qualified health clinics.new text begin Effective for services delivered on or after January 1, 2024, the
rates paid to critical access hospitals under this section must be adjusted to include the
amount of any distributions under section 62J.692, subdivision 4, paragraph (a), that were
not included in the rate adjustment described under section 256.969, subdivision 2b,
paragraph (k).
new text end
(c) Effective for services provided on or after July 1, 2003, rates that are based on the
Medicare outpatient prospective payment system shall be replaced by a budget neutral
prospective payment system that is derived using medical assistance data. The commissioner
shall provide a proposal to the 2003 legislature to define and implement this provision.
When implementing prospective payment methodologies, the commissioner shall use general
methods and rate calculation parameters similar to the applicable Medicare prospective
payment systems for services delivered in outpatient hospital and ambulatory surgical center
settings unless other payment methodologies for these services are specified in this chapter.
(d) For fee-for-service services provided on or after July 1, 2002, the total payment,
before third-party liability and spenddown, made to hospitals for outpatient hospital facility
services is reduced by .5 percent from the current statutory rate.
(e) In addition to the reduction in paragraph (d), the total payment for fee-for-service
services provided on or after July 1, 2003, made to hospitals for outpatient hospital facility
services before third-party liability and spenddown, is reduced five percent from the current
statutory rates. Facilities defined under section 256.969, subdivision 16, are excluded from
this paragraph.
(f) In addition to the reductions in paragraphs (d) and (e), the total payment for
fee-for-service services provided on or after July 1, 2008, made to hospitals for outpatient
hospital facility services before third-party liability and spenddown, is reduced three percent
from the current statutory rates. Mental health services and facilities defined under section
256.969, subdivision 16, are excluded from this paragraph.
Sec. 9.
Minnesota Statutes 2022, section 297F.10, subdivision 1, is amended to read:
Subdivision 1.
Tax and use tax on cigarettes.
Revenue received from cigarette taxes,
as well as related penalties, interest, license fees, and miscellaneous sources of revenue
shall be deposited by the commissioner in the state treasury and credited as follows:
(1) $22,250,000 each year must be credited to the Academic Health Center special
revenue fund hereby created and is annually appropriated to the Board of Regents at the
University of Minnesota for Academic Health Center funding at the University of Minnesota;
and
(2) deleted text begin $3,937,000deleted text end new text begin $3,788,000new text end each year must be credited to the medical education and
research costs account hereby created in the special revenue fund and is annually appropriated
to the commissioner of health for distribution under section 62J.692, subdivision 4new text begin , paragraph
(a)new text end ; and
(3) the balance of the revenues derived from taxes, penalties, and interest (under this
chapter) and from license fees and miscellaneous sources of revenue shall be credited to
the general fund.
Sec. 10. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2022, sections 62J.692, subdivisions 4a, 7, and 7a; 137.38, subdivision
1; and 256B.69, subdivision 5c,
new text end
new text begin
are repealed.
new text end
ARTICLE 5
HEALTH-RELATED LICENSING BOARDS
Section 1.
Minnesota Statutes 2022, section 144E.001, subdivision 1, is amended to read:
Sec. 2.
Minnesota Statutes 2022, section 144E.001, is amended by adding a subdivision
to read:
new text begin Subd. 8b. new text end
new text begin Medical resource communication center. new text end
new text begin
"Medical resource communication
center" means an entity that:
new text end
new text begin
(1) facilitates hospital-to-ambulance communications for ambulance services, the regional
emergency medical services systems, and the board by coordinating patient care and
transportation for ground and air operations;
new text end
new text begin
(2) is integrated with the state's Allied Radio Matrix for Emergency Response (ARMER)
radio system; and
new text end
new text begin
(3) is the point of contact and a communication resource for statewide public safety
entities, hospitals, and communities.
new text end
Sec. 3.
Minnesota Statutes 2022, section 144E.101, subdivision 6, is amended to read:
Subd. 6.
Basic life support.
(a) Except as provided in paragraph (e), a basic life-support
ambulance shall be staffed by at least two EMTs, one of whom must accompany the patient
and provide a level of care so as to ensure that:
(1) life-threatening situations and potentially serious injuries are recognized;
(2) patients are protected from additional hazards;
(3) basic treatment to reduce the seriousness of emergency situations is administered;
and
(4) patients are transported to an appropriate medical facility for treatment.
(b) A basic life-support service shall provide basic airway management.
(c) A basic life-support service shall provide automatic defibrillation.
(d) A basic life-support service licensee's medical director may authorize ambulance
service personnel to perform intravenous infusion and use equipment that is within the
licensure level of the ambulance servicedeleted text begin , includingdeleted text end new text begin . A basic life-support licensee's medical
director must authorize ambulance service personnel to performnew text end administration of an opiate
antagonist. Ambulance service personnel must be properly trained. Documentation of
authorization for use, guidelines for use, continuing education, and skill verification must
be maintained in the licensee's files.
(e) For emergency ambulance calls and interfacility transfers, an ambulance service may
staff its basic life-support ambulances with one EMT, who must accompany the patient,
and one registered emergency medical responder driver. For purposes of this paragraph,
"ambulance service" means either an ambulance service whose primary service area is
mainly located outside the metropolitan counties listed in section 473.121, subdivision 4,
and outside the cities of Duluth, Mankato, Moorhead, Rochester, and St. Cloud; or an
ambulance service based in a community with a population of less than 2,500.
Sec. 4.
Minnesota Statutes 2022, section 144E.101, subdivision 7, is amended to read:
Subd. 7.
Advanced life support.
(a) Except as provided in paragraphs (f) and (g), an
advanced life-support ambulance shall be staffed by at least:
(1) one EMT or one AEMT and one paramedic;
(2) one EMT or one AEMT and one registered nurse who is an EMT or an AEMT, is
currently practicing nursing, and has passed a paramedic practical skills test approved by
the board and administered by an education program; or
(3) one EMT or one AEMT and one physician assistant who is an EMT or an AEMT,
is currently practicing as a physician assistant, and has passed a paramedic practical skills
test approved by the board and administered by an education program.
(b) An advanced life-support service shall provide basic life support, as specified under
subdivision 6, paragraph (a), advanced airway management, manual defibrillation, deleted text begin anddeleted text end
administration of intravenous fluids and pharmaceuticalsnew text begin , and administration of opiate
antagonistsnew text end .
(c) In addition to providing advanced life support, an advanced life-support service may
staff additional ambulances to provide basic life support according to subdivision 6 and
section 144E.103, subdivision 1.
(d) An ambulance service providing advanced life support shall have a written agreement
with its medical director to ensure medical control for patient care 24 hours a day, seven
days a week. The terms of the agreement shall include a written policy on the administration
of medical control for the service. The policy shall address the following issues:
(1) two-way communication for physician direction of ambulance service personnel;
(2) patient triage, treatment, and transport;
(3) use of standing orders; and
(4) the means by which medical control will be provided 24 hours a day.
The agreement shall be signed by the licensee's medical director and the licensee or the
licensee's designee and maintained in the files of the licensee.
(e) When an ambulance service provides advanced life support, the authority of a
paramedic, Minnesota registered nurse-EMT, or Minnesota registered physician
assistant-EMT to determine the delivery of patient care prevails over the authority of an
EMT.
(f) Upon application from an ambulance service that includes evidence demonstrating
hardship, the board may grant a variance from the staff requirements in paragraph (a), clause
(1), and may authorize an advanced life-support ambulance to be staffed by a registered
emergency medical responder driver with a paramedic for all emergency calls and interfacility
transfers. The variance shall apply to advanced life-support ambulance services until the
ambulance service renews its license. When the variance expires, an ambulance service
may apply for a new variance under this paragraph. This paragraph applies only to an
ambulance service whose primary service area is mainly located outside the metropolitan
counties listed in section 473.121, subdivision 4, and outside the cities of Duluth, Mankato,
Moorhead, Rochester, and St. Cloud, or an ambulance based in a community with a
population of less than 1,000 persons.
(g) After an initial emergency ambulance call, each subsequent emergency ambulance
response, until the initial ambulance is again available, and interfacility transfers, may be
staffed by one registered emergency medical responder driver and an EMT or paramedic.
This paragraph applies only to an ambulance service whose primary service area is mainly
located outside the metropolitan counties listed in section 473.121, subdivision 4, and outside
the cities of Duluth, Mankato, Moorhead, Rochester, and St. Cloud, or an ambulance based
in a community with a population of less than 1,000 persons.
Sec. 5.
Minnesota Statutes 2022, section 144E.101, subdivision 12, is amended to read:
Subd. 12.
Mutual aid agreement.
(a) A licensee shall have a written agreement with
at least one neighboring licensed ambulance service for the preplanned and organized
response of emergency medical services, and other emergency personnel and equipment,
to a request for assistance in an emergency when local ambulance transport resources have
been expended. The response is predicated upon formal agreements among participating
ambulance services. A copy of each mutual aid agreement shall be maintained in the files
of the licenseenew text begin and shall be filed with the board for informational purposes onlynew text end .
(b) A licensee may have a written agreement with a neighboring licensed ambulance
service, including a licensed ambulance service from a neighboring state if that service is
currently and remains in compliance with its home state licensing requirements, to provide
deleted text begin part-timedeleted text end support to the primary service area of the licensee upon the licensee's request. The
agreement may allow the licensee to suspend ambulance services in its primary service area
during the times the neighboring licensed ambulance service has agreed to provide all
emergency services to the licensee's primary service area. The agreement may deleted text begin notdeleted text end permit
the neighboring licensed ambulance service to serve the licensee's primary service area fordeleted text begin
more than 12deleted text end new text begin up to 24new text end hours per daynew text begin , provided service by the neighboring licensed ambulance
does not exceed 108 hours per calendar weeknew text end . This paragraph applies only to an ambulance
service whose primary service area is mainly located outside the metropolitan counties listed
in section 473.121, subdivision 4, and outside the cities of Duluth, Mankato, Moorhead,
Rochester, and St. Cloud, or an ambulance based in a community with a population of less
than 2,500 persons.
Sec. 6.
Minnesota Statutes 2022, section 144E.103, subdivision 1, is amended to read:
Subdivision 1.
General requirements.
Every ambulance in service for patient care shall
carry, at a minimum:
(1) oxygen;
(2) airway maintenance equipment in various sizes to accommodate all age groups;
(3) splinting equipment in various sizes to accommodate all age groups;
(4) dressings, bandages, commercially manufactured tourniquets, and bandaging
equipment;
(5) an emergency obstetric kit;
(6) equipment to determine vital signs in various sizes to accommodate all age groups;
(7) a stretcher;
(8) a defibrillator; deleted text begin and
deleted text end
(9) a fire extinguisherdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(10) opiate antagonists.
new text end
Sec. 7.
Minnesota Statutes 2022, section 144E.35, is amended to read:
144E.35 REIMBURSEMENT TO deleted text begin NONPROFITdeleted text end AMBULANCE SERVICESnew text begin FOR
VOLUNTEER EDUCATION COSTSnew text end .
Subdivision 1.
Repayment for volunteer education.
A licensed ambulance service
shall be reimbursed by the board for the necessary expense of the initial education of a
volunteer ambulance attendant upon successful completion by the attendant of an EMT
education course, or a continuing education course for EMT care, or both, which has been
approved by the board, pursuant to section 144E.285. Reimbursement may include tuition,
transportation, food, lodging, hourly payment for the time spent in the education course,
and other necessary expenditures, except that in no instance shall a volunteer ambulance
attendant be reimbursed more than deleted text begin $600deleted text end new text begin $900new text end for successful completion of an initial
education course, and deleted text begin $275deleted text end new text begin $375new text end for successful completion of a continuing education course.
Subd. 2.
Reimbursement provisions.
Reimbursement deleted text begin willdeleted text end new text begin mustnew text end be paid under provisions
of this section when documentation is provided new text begin to new text end the board that the individual has served
for one year from the date of the final certification exam as an active member of a Minnesota
licensed ambulance service.
Sec. 8.
new text begin
[144E.53] MEDICAL RESOURCE COMMUNICATION CENTER GRANTS.
new text end
new text begin
The board shall distribute medical resource communication center grants annually to
the two medical resource communication centers that were in operation in the state prior to
January 1, 2000.
new text end
Sec. 9.
Minnesota Statutes 2022, section 147.02, subdivision 1, is amended to read:
Subdivision 1.
United States or Canadian medical school graduates.
The board shall
issue a license to practice medicine to a person not currently licensed in another state or
Canada and who meets the requirements in paragraphs (a) to (i).
(a) An applicant for a license shall file a written application on forms provided by the
board, showing to the board's satisfaction that the applicant is of good moral character and
satisfies the requirements of this section.
(b) The applicant shall present evidence satisfactory to the board of being a graduate of
a medical or osteopathic medical school located in the United States, its territories or Canada,
and approved by the board based upon its faculty, curriculum, facilities, accreditation by a
recognized national accrediting organization approved by the board, and other relevant data,
or is currently enrolled in the final year of study at the school.
(c) The applicant must have passed an examination as described in clause (1) or (2).
(1) The applicant must have passed a comprehensive examination for initial licensure
prepared and graded by the National Board of Medical Examiners, the Federation of State
Medical Boards, the Medical Council of Canada, the National Board of Osteopathic
Examiners, or the appropriate state board that the board determines acceptable. The board
shall by rule determine what constitutes a passing score in the examination.
(2) The applicant taking the United States Medical Licensing Examination (USMLE)
or Comprehensive Osteopathic Medical Licensing Examination (COMLEX-USA) must
have passed steps or levels one, two, and three. Step or level three must be passed within
five years of passing step or level two, or before the end of residency training. The applicant
must pass each of steps or levels one, two, and three with passing scores as recommended
by the USMLE program or National Board of Osteopathic Medical Examiners within three
attempts. The applicant taking combinations of Federation of State Medical Boards, National
Board of Medical Examiners, and USMLE may be accepted only if the combination is
approved by the board as comparable to existing comparable examination sequences and
all examinations are completed prior to the year 2000.
(d) The applicant shall present evidence satisfactory to the board of the completion of
one year of graduate, clinical medical training in a program accredited by a national
accrediting organization approved by the board deleted text begin or other graduate training approved in
advance by the board as meeting standards similar to those of a national accrediting
organizationdeleted text end .
(e) The applicant may make arrangements with the executive director to appear in person
before the board or its designated representative to show that the applicant satisfies the
requirements of this section. The board may establish as internal operating procedures the
procedures or requirements for the applicant's personal presentation.
(f) The applicant shall pay a nonrefundable fee established by the board. Upon application
or notice of license renewal, the board must provide notice to the applicant and to the person
whose license is scheduled to be issued or renewed of any additional fees, surcharges, or
other costs which the person is obligated to pay as a condition of licensure. The notice must:
(1) state the dollar amount of the additional costs; and
(2) clearly identify to the applicant the payment schedule of additional costs.
(g) The applicant must not be under license suspension or revocation by the licensing
board of the state or jurisdiction in which the conduct that caused the suspension or revocation
occurred.
(h) The applicant must not have engaged in conduct warranting disciplinary action
against a licensee, or have been subject to disciplinary action other than as specified in
paragraph (g). If the applicant does not satisfy the requirements stated in this paragraph,
the board may issue a license only on the applicant's showing that the public will be protected
through issuance of a license with conditions and limitations the board considers appropriate.
(i) If the examination in paragraph (c) was passed more than ten years ago, the applicant
must either:
(1) pass the special purpose examination of the Federation of State Medical Boards with
a score of 75 or better within three attempts; or
(2) have a current certification by a specialty board of the American Board of Medical
Specialties, of the American Osteopathic Association, the Royal College of Physicians and
Surgeons of Canada, or of the College of Family Physicians of Canada.
Sec. 10.
Minnesota Statutes 2022, section 147.03, subdivision 1, is amended to read:
Subdivision 1.
Endorsement; reciprocity.
(a) The board may issue a license to practice
medicine to any person who satisfies the requirements in paragraphs (b) to (e).
(b) The applicant shall satisfy all the requirements established in section 147.02,
subdivision 1, paragraphs (a), (b), (d), (e), and (f), or section 147.037, subdivision 1,
paragraphs (a) to (e).
(c) The applicant shall:
(1) have passed an examination prepared and graded by the Federation of State Medical
Boards, the National Board of Medical Examiners, or the United States Medical Licensing
Examination (USMLE) program in accordance with section 147.02, subdivision 1, paragraph
(c), clause (2); the National Board of Osteopathic Medical Examiners; or the Medical Council
of Canada; and
(2) have a current license from the equivalent licensing agency in another state or Canada
and, if the examination in clause (1) was passed more than ten years ago, either:
(i) pass the Special Purpose Examination of the Federation of State Medical Boards deleted text begin with
a score of 75 or betterdeleted text end new text begin (SPEX) new text end within three attempts; or
(ii) have a current certification by a specialty board of the American Board of Medical
Specialties, of the American Osteopathic Association, the Royal College of Physicians and
Surgeons of Canada, or of the College of Family Physicians of Canada; or
(3) if the applicant fails to meet the requirement established in section 147.02, subdivision
1, paragraph (c), clause (2), because the applicant failed to pass new text begin within the permitted three
attempts new text end each of steps new text begin or levels new text end one, two, and three of the USMLE deleted text begin within the required three
attemptsdeleted text end new text begin or the Comprehensive Osteopathic Medical Licensing Examination
(COMLEX-USA)new text end , the applicant may be granted a license provided the applicant:
(i) has passed each of steps new text begin or levels new text end one, two, and three new text begin within no more than four attempts
for any of the three steps or levels new text end with passing scores as recommended by the USMLE new text begin or
COMLEX-USA new text end program deleted text begin within no more than four attempts for any of the three stepsdeleted text end ;
(ii) is currently licensed in another state; and
(iii) has current certification by a specialty board of the American Board of Medical
Specialties, the American Osteopathic Association deleted text begin Bureau of Professional Educationdeleted text end , the
Royal College of Physicians and Surgeons of Canada, or the College of Family Physicians
of Canada.
(d) The applicant must not be under license suspension or revocation by the licensing
board of the state or jurisdiction in which the conduct that caused the suspension or revocation
occurred.
(e) The applicant must not have engaged in conduct warranting disciplinary action against
a licensee, or have been subject to disciplinary action other than as specified in paragraph
(d). If an applicant does not satisfy the requirements stated in this paragraph, the board may
issue a license only on the applicant's showing that the public will be protected through
issuance of a license with conditions or limitations the board considers appropriate.
(f) Upon the request of an applicant, the board may conduct the final interview of the
applicant by teleconference.
Sec. 11.
Minnesota Statutes 2022, section 147.037, subdivision 1, is amended to read:
Subdivision 1.
Requirements.
The board shall issue a license to practice medicine to
any person who satisfies the requirements in paragraphs (a) to (g).
(a) The applicant shall satisfy all the requirements established in section 147.02,
subdivision 1, paragraphs (a), (e), (f), (g), and (h).
(b) The applicant shall present evidence satisfactory to the board that the applicant is a
graduate of a medical or osteopathic school approved by the board as equivalent to accredited
United States or Canadian schools based upon its faculty, curriculum, facilities, accreditation,
or other relevant data. If the applicant is a graduate of a medical or osteopathic program
that is not accredited by the Liaison Committee for Medical Education or the American
Osteopathic Association, the applicant may use the Federation of State Medical Boards'
Federation Credentials Verification Service (FCVS) or its successor. If the applicant uses
this service as allowed under this paragraph, the physician application fee may be less than
$200 but must not exceed the cost of administering this paragraph.
(c) The applicant shall present evidence satisfactory to the board that the applicant has
been awarded a certificate by the Educational Council for Foreign Medical Graduates, and
the applicant has a working ability in the English language sufficient to communicate with
patients and physicians and to engage in the practice of medicine.
(d) The applicant shall present evidence satisfactory to the board of the completion of
one year of graduate, clinical medical training in a program accredited by a national
accrediting organization approved by the board deleted text begin or other graduate training approved in
advance by the board as meeting standards similar to those of a national accrediting
organizationdeleted text end . This requirement does not applynew text begin to an applicant who is admitted pursuant to
the rules of the United States Department of Labor andnew text end :
(1) deleted text begin to an applicantdeleted text end who deleted text begin isdeleted text end new text begin wasnew text end admitted as a permanent immigrant to the United States
on or before October 1, 1991, as a person of exceptional ability in the sciences according
to Code of Federal Regulations, title 20, section 656.22(d); or
(2) deleted text begin to an applicant holdingdeleted text end new text begin who holdsnew text end a valid license to practice medicine in another
country and new text begin was new text end issued a permanent immigrant visa after October 1, 1991, as a person of
extraordinary ability in the field of science or as an outstanding professor or researcher
according to Code of Federal Regulations, title 8, section 204.5(h) and (i), or a temporary
nonimmigrant visa as a person of extraordinary ability in the field of science according to
Code of Federal Regulations, title 8, section 214.2(o)deleted text begin ,deleted text end new text begin .
new text end
deleted text begin
provided that a person under clause (1) or (2) is admitted pursuant to rules of the United
States Department of Labor.
deleted text end
(e) The applicant must:
(1) have passed an examination prepared and graded by the Federation of State Medical
Boards, the United States Medical Licensing Examinationnew text begin (USMLE)new text end program in accordance
with section 147.02, subdivision 1, paragraph (c), clause (2), or the Medical Council of
Canada; and
(2) if the examination in clause (1) was passed more than ten years ago, either:
(i) pass the Special Purpose Examination of the Federation of State Medical Boards deleted text begin with
a score of 75 or better within three attemptsdeleted text end new text begin (SPEX) or the Comprehensive Osteopathic
Medical Variable-Purpose Examination of the National Board of Osteopathic Medical
Examiners (COMVEX). The applicant must pass the SPEX or COMVEX within no more
than three attempts of taking the SPEX, COMVEX, or a combination of the SPEX and
COMVEXnew text end ; or
(ii) have a current certification by a specialty board of the American Board of Medical
Specialties, deleted text begin ofdeleted text end the American Osteopathic Association, deleted text begin ofdeleted text end the Royal College of Physicians
and Surgeons of Canada, or deleted text begin ofdeleted text end the College of Family Physicians of Canada; or
(3) if the applicant fails to meet the requirement established in section 147.02, subdivision
1, paragraph (c), clause (2), because the applicant failed to pass new text begin within the permitted three
attempts new text end each of steps new text begin or levels new text end one, two, and three of the USMLE deleted text begin within the required three
attemptsdeleted text end new text begin or the Comprehensive Osteopathic Medical Licensing Examination
(COMLEX-USA)new text end , the applicant may be granted a license provided the applicant:
(i) has passed each of steps new text begin or levels new text end one, two, and three new text begin within no more than four attempts
for any of the three steps or levels new text end with passing scores as recommended by the USMLE new text begin or
COMLEX-USA new text end program deleted text begin within no more than four attempts for any of the three stepsdeleted text end ;
(ii) is currently licensed in another state; and
(iii) has current certification by a specialty board of the American Board of Medical
Specialties, the American Osteopathic Association, the Royal College of Physicians and
Surgeons of Canada, or the College of Family Physicians of Canada.
(f) The applicant must not be under license suspension or revocation by the licensing
board of the state or jurisdiction in which the conduct that caused the suspension or revocation
occurred.
(g) The applicant must not have engaged in conduct warranting disciplinary action
against a licenseedeleted text begin ,deleted text end or have been subject to disciplinary action other than as specified in
paragraph (f). If an applicant does not satisfy the requirements stated in this paragraph, the
board may issue a license only on the applicant's showing that the public will be protected
through issuance of a license with conditions or limitations the board considers appropriate.
Sec. 12.
Minnesota Statutes 2022, section 147.141, is amended to read:
147.141 FORMS OF DISCIPLINARY ACTION.
When the board finds that a licensed physician or a physician registered under section
147.032 has violated a provision or provisions of sections 147.01 to 147.22, it may do one
or more of the following:
(1) revoke the license;
(2) suspend the license;
(3) revoke or suspend registration to perform interstate telehealth;
(4) impose limitations or conditions on the physician's practice of medicine, including
new text begin limiting new text end the deleted text begin limitation ofdeleted text end scope of practice to designated field specialties; deleted text begin the imposition ofdeleted text end new text begin
imposingnew text end retraining or rehabilitation requirements; deleted text begin the requirement ofdeleted text end new text begin requiringnew text end practice
under supervision; or deleted text begin thedeleted text end conditioning deleted text begin ofdeleted text end continued practice on demonstration of knowledge
or skills by appropriate examination or other review of skill and competence;
(5) impose a civil penalty not exceeding $10,000 for each separate violation, the amount
of the civil penalty to be fixed deleted text begin so asdeleted text end to deprive the physician of any economic advantage
gained by reason of the violation charged or to reimburse the board for the cost of the
investigation and proceeding;
(6) order the physician to provide unremunerated professional service under supervision
at a designated public hospital, clinic, or other health care institution; or
(7) censure or reprimand the licensed physician.
Sec. 13.
Minnesota Statutes 2022, section 147A.16, is amended to read:
147A.16 FORMS OF DISCIPLINARY ACTION.
new text begin (a) new text end When the board finds that a licensed physician assistant has violated a provision of
this chapter, it may do one or more of the following:
(1) revoke the license;
(2) suspend the license;
(3) impose limitations or conditions on the physician assistant's practice, including
limiting the scope of practice to designated field specialties; imposing retraining or
rehabilitation requirements; or limiting practice until demonstration of knowledge or skills
by appropriate examination or other review of skill and competence;
(4) impose a civil penalty not exceeding $10,000 for each separate violation, the amount
of the civil penalty to be fixed deleted text begin so asdeleted text end to deprive the physician assistant of any economic
advantage gained by reason of the violation charged or to reimburse the board for the cost
of the investigation and proceeding; or
(5) censure or reprimand the licensed physician assistant.
new text begin (b) new text end Upon judicial review of any board disciplinary action taken under this chapter, the
reviewing court shall seal the administrative record, except for the board's final decision,
and shall not make the administrative record available to the public.
Sec. 14.
Minnesota Statutes 2022, section 147B.02, subdivision 4, is amended to read:
Subd. 4.
Exceptions.
(a) The following persons may practice acupuncture within the
scope of their practice without an acupuncture license:
(1) a physician licensed under chapter 147;
(2) an osteopathic physician licensed under chapter 147;
(3) a chiropractor licensed under chapter 148;
deleted text begin
(4) a person who is studying in a formal course of study or tutorial intern program
approved by the acupuncture advisory council established in section 147B.05 so long as
the person's acupuncture practice is supervised by a licensed acupuncturist or a person who
is exempt under clause (5);
deleted text end
new text begin
(4) a person who is studying in a formal course of study so long as the person's
acupuncture practice is supervised by a licensed acupuncturist or a person who is exempt
under clause (5);
new text end
(5) a visiting acupuncturist practicing acupuncture within an instructional setting for the
sole purpose of teaching at a school registered with the Minnesota Office of Higher
Education, who may practice without a license for a period of one year, with two one-year
extensions permitted; and
(6) a visiting acupuncturist who is in the state for the sole purpose of providing a tutorial
or workshop not to exceed 30 days in one calendar year.
(b) This chapter does not prohibit a person who does not have an acupuncturist license
from practicing specific noninvasive techniques, such as acupressure, that are within the
scope of practice as set forth in section 147B.06, subdivision 4.
Sec. 15.
Minnesota Statutes 2022, section 147B.02, subdivision 7, is amended to read:
Subd. 7.
Licensure requirements.
(a) deleted text begin After June 30, 1997,deleted text end An applicant for licensure
must:
(1) submit a completed application for licensure on forms provided by the board, which
must include the applicant's name and address of record, which shall be public;
(2) unless licensed under subdivision 5 or 6, submit deleted text begin a notarized copy of adeleted text end new text begin evidence
satisfactory to the board ofnew text end current NCCAOM certification;
(3) sign a statement that the information in the application is true and correct to the best
of the applicant's knowledge and belief;
(4) submit with the application all fees required; and
(5) sign a waiver authorizing the board to obtain access to the applicant's records in this
state or any state in which the applicant has engaged in the practice of acupuncture.
(b) The board may ask the applicant to provide any additional information necessary to
ensure that the applicant is able to practice with reasonable skill and safety to the public.
(c) The board may investigate information provided by an applicant to determine whether
the information is accurate and complete. The board shall notify an applicant of action taken
on the application and the reasons for denying licensure if licensure is denied.
Sec. 16.
new text begin
[148.635] FEE.
new text end
new text begin Subdivision 1. new text end
new text begin Nonrefundable fee. new text end
new text begin
The fee in this section is nonrefundable.
new text end
new text begin Subd. 2. new text end
new text begin Licensure verification fee. new text end
new text begin
The fee for verification of licensure is $20.
new text end
Sec. 17.
Minnesota Statutes 2022, section 148B.392, subdivision 2, is amended to read:
Subd. 2.
Licensure and application fees.
Licensure and application fees established
by the board shall not exceed the following amounts:
(1) application fee for national examination is deleted text begin $110deleted text end new text begin $150new text end ;
(2) application fee for Licensed Marriage and Family Therapist (LMFT) state examination
is deleted text begin $110deleted text end new text begin $150new text end ;
(3) initial LMFT license fee is prorated, but cannot exceed deleted text begin $125deleted text end new text begin $225new text end ;
(4) annual renewal fee for LMFT license is deleted text begin $125deleted text end new text begin $225new text end ;
(5) late fee for LMFT license renewal is deleted text begin $50deleted text end new text begin $100new text end ;
(6) application fee for LMFT licensure by reciprocity is deleted text begin $220deleted text end new text begin $300new text end ;
(7) fee for initial Licensed Associate Marriage and Family Therapist (LAMFT) license
is deleted text begin $75deleted text end new text begin $100new text end ;
(8) annual renewal fee for LAMFT license is deleted text begin $75deleted text end new text begin $100new text end ;
(9) late fee for LAMFT renewal is deleted text begin $25deleted text end new text begin $50new text end ;
(10) fee for reinstatement of license is $150;
(11) fee for emeritus status is deleted text begin $125deleted text end new text begin $225new text end ; and
(12) fee for temporary license for members of the military is $100.
Sec. 18.
Minnesota Statutes 2022, section 148F.11, is amended by adding a subdivision
to read:
new text begin Subd. 2a. new text end
new text begin Former students. new text end
new text begin
(a) A former student may practice alcohol and drug
counseling for 90 days from the former student's degree conferral date from an accredited
school or educational program or from the last date the former student received credit for
an alcohol and drug counseling course from an accredited school or educational program.
The former student's practice must be supervised by an alcohol and drug counselor or an
alcohol and drug counselor supervisor, as defined in section 245G.11. The former student's
practice is limited to the site where the student completed their internship or practicum. A
former student must be paid for work performed during the 90-day period.
new text end
new text begin
(b) The former student's right to practice automatically expires after 90 days from the
former student's degree conferral date or date of last course credit for an alcohol and drug
counseling course, whichever occurs last.
new text end
Sec. 19.
Minnesota Statutes 2022, section 150A.08, subdivision 1, is amended to read:
Subdivision 1.
Grounds.
The board may refuse or by order suspend or revoke, limit or
modify by imposing conditions it deems necessary, the license of a dentist, dental therapist,
dental hygienist, or dental deleted text begin assistingdeleted text end new text begin assistantnew text end upon any of the following grounds:
(1) fraud or deception in connection with the practice of dentistry or the securing of a
license certificate;
(2) conviction, including a finding or verdict of guilt, an admission of guilt, or a no
contest plea, in any court of a felony or gross misdemeanor reasonably related to the practice
of dentistry as evidenced by a certified copy of the conviction;
(3) conviction, including a finding or verdict of guilt, an admission of guilt, or a no
contest plea, in any court of an offense involving moral turpitude as evidenced by a certified
copy of the conviction;
(4) habitual overindulgence in the use of intoxicating liquors;
(5) improper or unauthorized prescription, dispensing, administering, or personal or
other use of any legend drug as defined in chapter 151, of any chemical as defined in chapter
151, or of any controlled substance as defined in chapter 152;
(6) conduct unbecoming a person licensed to practice dentistry, dental therapy, dental
hygiene, or dental assisting, or conduct contrary to the best interest of the public, as such
conduct is defined by the rules of the board;
(7) gross immorality;
(8) any physical, mental, emotional, or other disability which adversely affects a dentist's,
dental therapist's, dental hygienist's, or dental assistant's ability to perform the service for
which the person is licensed;
(9) revocation or suspension of a license or equivalent authority to practice, or other
disciplinary action or denial of a license application taken by a licensing or credentialing
authority of another state, territory, or country as evidenced by a certified copy of the
licensing authority's order, if the disciplinary action or application denial was based on facts
that would provide a basis for disciplinary action under this chapter and if the action was
taken only after affording the credentialed person or applicant notice and opportunity to
refute the allegations or pursuant to stipulation or other agreement;
(10) failure to maintain adequate safety and sanitary conditions for a dental office in
accordance with the standards established by the rules of the board;
(11) employing, assisting, or enabling in any manner an unlicensed person to practice
dentistry;
(12) failure or refusal to attend, testify, and produce records as directed by the board
under subdivision 7;
(13) violation of, or failure to comply with, any other provisions of sections 150A.01 to
150A.12, the rules of the Board of Dentistry, or any disciplinary order issued by the board,
sections 144.291 to 144.298 or 595.02, subdivision 1, paragraph (d), or for any other just
cause related to the practice of dentistry. Suspension, revocation, modification or limitation
of any license shall not be based upon any judgment as to therapeutic or monetary value of
any individual drug prescribed or any individual treatment rendered, but only upon a repeated
pattern of conduct;
(14) knowingly providing false or misleading information that is directly related to the
care of that patient unless done for an accepted therapeutic purpose such as the administration
of a placebo; or
(15) aiding suicide or aiding attempted suicide in violation of section 609.215 as
established by any of the following:
(i) a copy of the record of criminal conviction or plea of guilty for a felony in violation
of section 609.215, subdivision 1 or 2;
(ii) a copy of the record of a judgment of contempt of court for violating an injunction
issued under section 609.215, subdivision 4;
(iii) a copy of the record of a judgment assessing damages under section 609.215,
subdivision 5; or
(iv) a finding by the board that the person violated section 609.215, subdivision 1 or 2.
The board shall investigate any complaint of a violation of section 609.215, subdivision 1
or 2.
Sec. 20.
Minnesota Statutes 2022, section 150A.08, subdivision 5, is amended to read:
Subd. 5.
Medical examinations.
If the board has probable cause to believe that a dentist,
dental therapist, dental hygienist, dental assistant, or applicant engages in acts described in
subdivision 1, clause (4) or (5), or has a condition described in subdivision 1, clause (8), it
shall direct the dentist, dental therapist, dental hygienist, new text begin dental new text end assistant, or applicant to
submit to a mental or physical examination or a substance use disorder assessment. For the
purpose of this subdivision, every dentist, dental therapist, dental hygienist, or dental assistant
licensed under this chapter or person submitting an application for a license is deemed to
have given consent to submit to a mental or physical examination when directed in writing
by the board and to have waived all objections in any proceeding under this section to the
admissibility of the examining physician's testimony or examination reports on the ground
that they constitute a privileged communication. Failure to submit to an examination without
just cause may result in an application being denied or a default and final order being entered
without the taking of testimony or presentation of evidence, other than evidence which may
be submitted by affidavit, that the licensee or applicant did not submit to the examination.
A dentist, dental therapist, dental hygienist, dental assistant, or applicant affected under this
section shall at reasonable intervals be afforded an opportunity to demonstrate ability to
start or resume the competent practice of dentistry or perform the duties of a dental therapist,
dental hygienist, or dental assistant with reasonable skill and safety to patients. In any
proceeding under this subdivision, neither the record of proceedings nor the orders entered
by the board is admissible, is subject to subpoena, or may be used against the dentist, dental
therapist, dental hygienist, dental assistant, or applicant in any proceeding not commenced
by the board. Information obtained under this subdivision shall be classified as private
pursuant to the Minnesota Government Data Practices Act.
Sec. 21.
Minnesota Statutes 2022, section 150A.091, is amended by adding a subdivision
to read:
new text begin Subd. 23. new text end
new text begin Mailing list services. new text end
new text begin
Each licensee must submit a nonrefundable $5 fee to
request a mailing address list.
new text end
Sec. 22.
Minnesota Statutes 2022, section 150A.13, subdivision 10, is amended to read:
Subd. 10.
Failure to report.
deleted text begin On or after August 1, 2012,deleted text end Any person, institution, insurer,
or organization that fails to report as required under subdivisions 2 to 6 shall be subject to
civil penalties for failing to report as required by law.
Sec. 23.
Minnesota Statutes 2022, section 151.01, subdivision 27, is amended to read:
Subd. 27.
Practice of pharmacy.
new text begin (a) new text end "Practice of pharmacy" means:
(1) interpretation and evaluation of prescription drug orders;
(2) compounding, labeling, and dispensing drugs and devices (except labeling by a
manufacturer or packager of nonprescription drugs or commercially packaged legend drugs
and devices);
(3) participation in clinical interpretations and monitoring of drug therapy for assurance
of safe and effective use of drugs, including the performance of laboratory tests that are
waived under the federal Clinical Laboratory Improvement Act of 1988, United States Code,
title 42, section 263a et seq., provided that a pharmacist may interpret the results of laboratory
tests but may modify drug therapy only pursuant to a protocol or collaborative practice
agreement;
(4) participation in drug and therapeutic device selection; drug administration for first
dosage and medical emergencies; intramuscular and subcutaneous drug administration under
a prescription drug order; drug regimen reviews; and drug or drug-related research;
(5) drug administration, through intramuscular and subcutaneous administration used
to treat mental illnesses as permitted under the following conditions:
(i) upon the order of a prescriber and the prescriber is notified after administration is
complete; or
(ii) pursuant to a protocol or collaborative practice agreement as defined by section
151.01, subdivisions 27b and 27c, and participation in the initiation, management,
modification, administration, and discontinuation of drug therapy is according to the protocol
or collaborative practice agreement between the pharmacist and a dentist, optometrist,
physician, physician assistant, podiatrist, or veterinarian, or an advanced practice registered
nurse authorized to prescribe, dispense, and administer under section 148.235. Any changes
in drug therapy or medication administration made pursuant to a protocol or collaborative
practice agreement must be documented by the pharmacist in the patient's medical record
or reported by the pharmacist to a practitioner responsible for the patient's care;
(6) participation in administration of influenza vaccines and vaccines new text begin authorized or
new text end approved by the United States Food and Drug Administration related to COVID-19 or
SARS-CoV-2 to all eligible individuals six years of age and older and all other vaccines to
patients 13 years of age and older by written protocol with a physician licensed under chapter
147, a physician assistant authorized to prescribe drugs under chapter 147A, or an advanced
practice registered nurse authorized to prescribe drugs under section 148.235, provided that:
(i) the protocol includes, at a minimum:
(A) the name, dose, and route of each vaccine that may be given;
(B) the patient population for whom the vaccine may be given;
(C) contraindications and precautions to the vaccine;
(D) the procedure for handling an adverse reaction;
(E) the name, signature, and address of the physician, physician assistant, or advanced
practice registered nurse;
(F) a telephone number at which the physician, physician assistant, or advanced practice
registered nurse can be contacted; and
(G) the date and time period for which the protocol is valid;
(ii) the pharmacist has successfully completed a program approved by the Accreditation
Council for Pharmacy Education new text begin (ACPE) new text end specifically for the administration of immunizations
or a program approved by the board;
(iii) the pharmacist utilizes the Minnesota Immunization Information Connection to
assess the immunization status of individuals prior to the administration of vaccines, except
when administering influenza vaccines to individuals age nine and older;
(iv) the pharmacist reports the administration of the immunization to the Minnesota
Immunization Information Connection; deleted text begin and
deleted text end
(v) the pharmacist complies with guidelines for vaccines and immunizations established
by the federal Advisory Committee on Immunization Practices, except that a pharmacist
does not need to comply with those portions of the guidelines that establish immunization
schedules when administering a vaccine pursuant to a valid, patient-specific order issued
by a physician licensed under chapter 147, a physician assistant authorized to prescribe
drugs under chapter 147A, or an advanced practice registered nurse authorized to prescribe
drugs under section 148.235, provided that the order is consistent with the United States
Food and Drug Administration approved labeling of the vaccine;new text begin and
new text end
new text begin
(vi) the pharmacist has a current certificate in cardiopulmonary resuscitation;
new text end
(7) participation in the initiation, management, modification, and discontinuation of
drug therapy according to a written protocol or collaborative practice agreement between:
(i) one or more pharmacists and one or more dentists, optometrists, physicians, physician
assistants, podiatrists, or veterinarians; or (ii) one or more pharmacists and one or more
physician assistants authorized to prescribe, dispense, and administer under chapter 147A,
or advanced practice registered nurses authorized to prescribe, dispense, and administer
under section 148.235. Any changes in drug therapy made pursuant to a protocol or
collaborative practice agreement must be documented by the pharmacist in the patient's
medical record or reported by the pharmacist to a practitioner responsible for the patient's
care;
(8) participation in the storage of drugs and the maintenance of records;
(9) patient counseling on therapeutic values, content, hazards, and uses of drugs and
devices;
(10) offering or performing those acts, services, operations, or transactions necessary
in the conduct, operation, management, and control of a pharmacy;
(11) participation in the initiation, management, modification, and discontinuation of
therapy with opiate antagonists, as defined in section 604A.04, subdivision 1, pursuant to:
(i) a written protocol as allowed under clause (7); or
(ii) a written protocol with a community health board medical consultant or a practitioner
designated by the commissioner of health, as allowed under section 151.37, subdivision 13;
(12) prescribing self-administered hormonal contraceptives; nicotine replacement
medications; and opiate antagonists for the treatment of an acute opiate overdose pursuant
to section 151.37, subdivision 14, 15, or 16; and
(13) participation in the placement of drug monitoring devices according to a prescription,
protocol, or collaborative practice agreement.
new text begin
(b) A pharmacist may delegate the authority to administer vaccines under paragraph (a),
clause (6), to a pharmacy technician or pharmacist intern who has completed training in
vaccine administration if:
new text end
new text begin
(1) the pharmacy technician or pharmacist intern has successfully completed a program
approved by the ACPE specifically for the administration of immunizations or a program
approved by the board;
new text end
new text begin
(2) the pharmacy technician or pharmacist intern has a current certificate in
cardiopulmonary resuscitation;
new text end
new text begin
(3) the pharmacist intern has the ability, under the direct supervision of a pharmacist,
to utilize the Minnesota Immunization Information Connection to assess the immunization
status of individuals prior to the administration of vaccines, except when administering
influenza vaccines to individuals age nine and older;
new text end
new text begin
(4) the pharmacy technician has completed a minimum of two hours of ACPE-approved,
immunization-related continuing pharmacy education as part of the pharmacy technician's
two-year continuing education schedule;
new text end
new text begin
(5) the pharmacy technician has completed one of the training programs listed under
Minnesota Rules, part 6800.3850, subpart 1h, item B; and
new text end
new text begin
(6) the pharmacy technician or pharmacist intern administering vaccinations is supervised
by a licensed pharmacist according to the following requirements:
new text end
new text begin
(i) the supervising pharmacist is readily and immediately available to the immunizing
pharmacy technician or pharmacist intern; and
new text end
new text begin
(ii) direct supervision under this clause is provided in person and not through telehealth,
as defined under section 62A.673, subdivision 2.
new text end
Sec. 24.
Minnesota Statutes 2022, section 151.065, subdivision 1, is amended to read:
Subdivision 1.
Application fees.
Application fees for licensure and registration are as
follows:
(1) pharmacist licensed by examination, deleted text begin $175deleted text end new text begin $210new text end ;
(2) pharmacist licensed by reciprocity, deleted text begin $275deleted text end new text begin $300new text end ;
(3) pharmacy intern, deleted text begin $50deleted text end new text begin $75new text end ;
(4) pharmacy technician, deleted text begin $50deleted text end new text begin $60new text end ;
(5) pharmacy, deleted text begin $260deleted text end new text begin $300new text end ;
(6) drug wholesaler, legend drugs only, deleted text begin $5,260deleted text end new text begin $5,300new text end ;
(7) drug wholesaler, legend and nonlegend drugs, deleted text begin $5,260deleted text end new text begin $5,300new text end ;
(8) drug wholesaler, nonlegend drugs, veterinary legend drugs, or both, deleted text begin $5,260deleted text end new text begin $5,300new text end ;
(9) drug wholesaler, medical gases, deleted text begin $5,260deleted text end new text begin $5,300new text end for the first facility and deleted text begin $260deleted text end new text begin $300new text end
for each additional facility;
(10) third-party logistics provider, deleted text begin $260deleted text end new text begin $300new text end ;
(11) drug manufacturer, nonopiate legend drugs only, deleted text begin $5,260deleted text end new text begin $5,300new text end ;
(12) drug manufacturer, nonopiate legend and nonlegend drugs, deleted text begin $5,260deleted text end new text begin $5,300new text end ;
(13) drug manufacturer, nonlegend or veterinary legend drugs, deleted text begin $5,260deleted text end new text begin $5,300new text end ;
(14) drug manufacturer, medical gases, deleted text begin $5,260deleted text end new text begin $5,300new text end for the first facility and deleted text begin $260deleted text end new text begin
$300new text end for each additional facility;
(15) drug manufacturer, also licensed as a pharmacy in Minnesota, deleted text begin $5,260deleted text end new text begin $5,300new text end ;
(16) drug manufacturer of opiate-containing controlled substances listed in section
152.02, subdivisions 3 to 5, deleted text begin $55,260deleted text end new text begin $55,300new text end ;
(17) medical gas dispenser, $260;
(18) controlled substance researcher, deleted text begin $75deleted text end new text begin $150new text end ; and
(19) pharmacy professional corporation, $150.
Sec. 25.
Minnesota Statutes 2022, section 151.065, subdivision 2, is amended to read:
Subd. 2.
Original license fee.
The pharmacist original licensure fee, deleted text begin $175deleted text end new text begin $210new text end .
Sec. 26.
Minnesota Statutes 2022, section 151.065, subdivision 3, is amended to read:
Subd. 3.
Annual renewal fees.
Annual licensure and registration renewal fees are as
follows:
(1) pharmacist, deleted text begin $175deleted text end new text begin $210new text end ;
(2) pharmacy technician, deleted text begin $50deleted text end new text begin $60new text end ;
(3) pharmacy, deleted text begin $260deleted text end new text begin $300new text end ;
(4) drug wholesaler, legend drugs only, deleted text begin $5,260deleted text end new text begin $5,300new text end ;
(5) drug wholesaler, legend and nonlegend drugs, deleted text begin $5,260deleted text end new text begin $5,300new text end ;
(6) drug wholesaler, nonlegend drugs, veterinary legend drugs, or both, deleted text begin $5,260deleted text end new text begin $5,300new text end ;
(7) drug wholesaler, medical gases, deleted text begin $5,260deleted text end new text begin $5,300new text end for the first facility and deleted text begin $260deleted text end new text begin $300new text end
for each additional facility;
(8) third-party logistics provider, deleted text begin $260deleted text end new text begin $300new text end ;
(9) drug manufacturer, nonopiate legend drugs only, deleted text begin $5,260deleted text end new text begin $5,300new text end ;
(10) drug manufacturer, nonopiate legend and nonlegend drugs, deleted text begin $5,260deleted text end new text begin $5,300new text end ;
(11) drug manufacturer, nonlegend, veterinary legend drugs, or both, deleted text begin $5,260deleted text end new text begin $5,300new text end ;
(12) drug manufacturer, medical gases, deleted text begin $5,260deleted text end new text begin $5,300new text end for the first facility and deleted text begin $260deleted text end new text begin
$300new text end for each additional facility;
(13) drug manufacturer, also licensed as a pharmacy in Minnesota, deleted text begin $5,260deleted text end new text begin $5,300new text end ;
(14) drug manufacturer of opiate-containing controlled substances listed in section
152.02, subdivisions 3 to 5, deleted text begin $55,260deleted text end new text begin $55,300new text end ;
(15) medical gas dispenser, $260;
(16) controlled substance researcher, deleted text begin $75deleted text end new text begin $150new text end ; and
(17) pharmacy professional corporation, deleted text begin $100deleted text end new text begin $150new text end .
Sec. 27.
Minnesota Statutes 2022, section 151.065, subdivision 4, is amended to read:
Subd. 4.
Miscellaneous fees.
Fees for issuance of affidavits and duplicate licenses and
certificates are as follows:
(1) intern affidavit, deleted text begin $20deleted text end new text begin $30new text end ;
(2) duplicate small license, deleted text begin $20deleted text end new text begin $30new text end ; and
(3) duplicate large certificate, $30.
Sec. 28.
Minnesota Statutes 2022, section 151.065, subdivision 6, is amended to read:
Subd. 6.
Reinstatement fees.
(a) A pharmacist who has allowed the pharmacist's license
to lapse may reinstate the license with board approval and upon payment of any fees and
late fees in arrears, up to a maximum of $1,000.
(b) A pharmacy technician who has allowed the technician's registration to lapse may
reinstate the registration with board approval and upon payment of any fees and late fees
in arrears, up to a maximum of deleted text begin $90deleted text end new text begin $250new text end .
(c) An owner of a pharmacy, a drug wholesaler, a drug manufacturer, third-party logistics
provider, or a medical gas dispenser who has allowed the license of the establishment to
lapse may reinstate the license with board approval and upon payment of any fees and late
fees in arrears.
(d) A controlled substance researcher who has allowed the researcher's registration to
lapse may reinstate the registration with board approval and upon payment of any fees and
late fees in arrears.
(e) A pharmacist owner of a professional corporation who has allowed the corporation's
registration to lapse may reinstate the registration with board approval and upon payment
of any fees and late fees in arrears.
Sec. 29.
Minnesota Statutes 2022, section 151.555, is amended to read:
151.555 deleted text begin PRESCRIPTION DRUGdeleted text end new text begin MEDICATIONnew text end REPOSITORY PROGRAM.
Subdivision 1.
Definitions.
(a) For the purposes of this section, the terms defined in this
subdivision have the meanings given.
(b) "Central repository" means a wholesale distributor that meets the requirements under
subdivision 3 and enters into a contract with the Board of Pharmacy in accordance with this
section.
(c) "Distribute" means to deliver, other than by administering or dispensing.
(d) "Donor" means:
(1) a health care facility as defined in this subdivision;
(2) a skilled nursing facility licensed under chapter 144A;
(3) an assisted living facility licensed under chapter 144G;
(4) a pharmacy licensed under section 151.19, and located either in the state or outside
the state;
(5) a drug wholesaler licensed under section 151.47;
(6) a drug manufacturer licensed under section 151.252; or
(7) an individual at least 18 years of age, provided that the drug or medical supply that
is donated was obtained legally and meets the requirements of this section for donation.
(e) "Drug" means any prescription drug that has been approved for medical use in the
United States, is listed in the United States Pharmacopoeia or National Formulary, and
meets the criteria established under this section for donation; or any over-the-counter
medication that meets the criteria established under this section for donation. This definition
includes cancer drugs and antirejection drugs, but does not include controlled substances,
as defined in section 152.01, subdivision 4, or a prescription drug that can only be dispensed
to a patient registered with the drug's manufacturer in accordance with federal Food and
Drug Administration requirements.
(f) "Health care facility" means:
(1) a physician's office or health care clinic where licensed practitioners provide health
care to patients;
(2) a hospital licensed under section 144.50;
(3) a pharmacy licensed under section 151.19 and located in Minnesota; or
(4) a nonprofit community clinic, including a federally qualified health center; a rural
health clinic; public health clinic; or other community clinic that provides health care utilizing
a sliding fee scale to patients who are low-income, uninsured, or underinsured.
(g) "Local repository" means a health care facility that elects to accept donated drugs
and medical supplies and meets the requirements of subdivision 4.
(h) "Medical supplies" or "supplies" means any prescription deleted text begin anddeleted text end new text begin ornew text end nonprescription
medical supplies needed to administer a deleted text begin prescriptiondeleted text end drug.
(i) "Original, sealed, unopened, tamper-evident packaging" means packaging that is
sealed, unopened, and tamper-evident, including a manufacturer's original unit dose or
unit-of-use container, a repackager's original unit dose or unit-of-use container, or unit-dose
packaging prepared by a licensed pharmacy according to the standards of Minnesota Rules,
part 6800.3750.
(j) "Practitioner" has the meaning given in section 151.01, subdivision 23, except that
it does not include a veterinarian.
Subd. 2.
Establishmentnew text begin ; contract and oversightnew text end .
deleted text begin By January 1, 2020,deleted text end new text begin (a) new text end The Board
of Pharmacy shall establish a deleted text begin drugdeleted text end new text begin medicationnew text end repository program, through which donors
may donate a drug or medical supply for use by an individual who meets the eligibility
criteria specified under subdivision 5.
new text begin (b)new text end The board shall contract with a central repository that meets the requirements of
subdivision 3 to implement and administer the deleted text begin prescription drugdeleted text end new text begin medicationnew text end repository
program.new text begin The contract must:
new text end
new text begin
(1) require the board to transfer to the central repository any money appropriated by the
legislature for the purpose of operating the medication repository program and require the
central repository to spend any money transferred only for purposes specified in the contract;
new text end
new text begin
(2) require the central repository to report the following performance measures to the
board:
new text end
new text begin
(i) the number of individuals served and the types of medications these individuals
received;
new text end
new text begin
(ii) the number of clinics, pharmacies, and long-term care facilities with which the central
repository partnered;
new text end
new text begin
(iii) the number and cost of medications accepted for inventory, disposed of, and
dispensed to individuals in need; and
new text end
new text begin
(iv) locations within the state to which medications were shipped or delivered; and
new text end
new text begin
(3) require the board to annually audit the expenditure by the central repository of any
money appropriated by the legislature and transferred by the board to ensure that this money
is used only for purposes specified in the contract.
new text end
Subd. 3.
Central repository requirements.
(a) The board may publish a request for
proposal for participants who meet the requirements of this subdivision and are interested
in acting as the central repository for the deleted text begin drugdeleted text end new text begin medicationnew text end repository program. If the board
publishes a request for proposal, it shall follow all applicable state procurement procedures
in the selection process. The board may also work directly with the University of Minnesota
to establish a central repository.
(b) To be eligible to act as the central repository, the participant must be a wholesale
drug distributor located in Minnesota, licensed pursuant to section 151.47, and in compliance
with all applicable federal and state statutes, rules, and regulations.
(c) The central repository shall be subject to inspection by the board pursuant to section
151.06, subdivision 1.
(d) The central repository shall comply with all applicable federal and state laws, rules,
and regulations pertaining to the deleted text begin drugdeleted text end new text begin medicationnew text end repository program, drug storage, and
dispensing. The facility must maintain in good standing any state license or registration that
applies to the facility.
Subd. 4.
Local repository requirements.
(a) To be eligible for participation in the deleted text begin drugdeleted text end new text begin
medicationnew text end repository program, a health care facility must agree to comply with all applicable
federal and state laws, rules, and regulations pertaining to the deleted text begin drugdeleted text end new text begin medicationnew text end repository
program, drug storage, and dispensing. The facility must also agree to maintain in good
standing any required state license or registration that may apply to the facility.
(b) A local repository may elect to participate in the program by submitting the following
information to the central repository on a form developed by the board and made available
on the board's website:
(1) the name, street address, and telephone number of the health care facility and any
state-issued license or registration number issued to the facility, including the issuing state
agency;
(2) the name and telephone number of a responsible pharmacist or practitioner who is
employed by or under contract with the health care facility; and
(3) a statement signed and dated by the responsible pharmacist or practitioner indicating
that the health care facility meets the eligibility requirements under this section and agrees
to comply with this section.
(c) Participation in the deleted text begin drugdeleted text end new text begin medicationnew text end repository program is voluntary. A local
repository may withdraw from participation in the deleted text begin drugdeleted text end new text begin medicationnew text end repository program at
any time by providing written notice to the central repository on a form developed by the
board and made available on the board's website. The central repository shall provide the
board with a copy of the withdrawal notice within ten business days from the date of receipt
of the withdrawal notice.
Subd. 5.
Individual eligibility and application requirements.
(a) To be eligible for
the deleted text begin drugdeleted text end new text begin medicationnew text end repository program, an individual must submit to a local repository an
intake application form that is signed by the individual and attests that the individual:
(1) is a resident of Minnesota;
(2) is uninsured and is not enrolled in the medical assistance program under chapter
256B or the MinnesotaCare program under chapter 256L, has no prescription drug coverage,
or is underinsured;
(3) acknowledges that the drugs or medical supplies to be received through the program
may have been donated; and
(4) consents to a waiver of the child-resistant packaging requirements of the federal
Poison Prevention Packaging Act.
(b) Upon determining that an individual is eligible for the program, the local repository
shall furnish the individual with an identification card. The card shall be valid for one year
from the date of issuance and may be used at any local repository. A new identification card
may be issued upon expiration once the individual submits a new application form.
(c) The local repository shall send a copy of the intake application form to the central
repository by regular mail, facsimile, or secured email within ten days from the date the
application is approved by the local repository.
(d) The board shall develop and make available on the board's website an application
form and the format for the identification card.
Subd. 6.
Standards and procedures for accepting donations of drugs and supplies.
(a)
A donor may donate deleted text begin prescriptiondeleted text end drugs or medical supplies to the central repository or a
local repository if the drug or supply meets the requirements of this section as determined
by a pharmacist or practitioner who is employed by or under contract with the central
repository or a local repository.
(b) A deleted text begin prescriptiondeleted text end drug is eligible for donation under the deleted text begin drugdeleted text end new text begin medicationnew text end repository
program if the following requirements are met:
(1) the donation is accompanied by a deleted text begin drugdeleted text end new text begin medicationnew text end repository donor form described
under paragraph (d) that is signed by an individual who is authorized by the donor to attest
to the donor's knowledge in accordance with paragraph (d);
(2) the drug's expiration date is at least six months after the date the drug was donated.
If a donated drug bears an expiration date that is less than six months from the donation
date, the drug may be accepted and distributed if the drug is in high demand and can be
dispensed for use by a patient before the drug's expiration date;
(3) the drug is in its original, sealed, unopened, tamper-evident packaging that includes
the expiration date. Single-unit-dose drugs may be accepted if the single-unit-dose packaging
is unopened;
(4) the drug or the packaging does not have any physical signs of tampering, misbranding,
deterioration, compromised integrity, or adulteration;
(5) the drug does not require storage temperatures other than normal room temperature
as specified by the manufacturer or United States Pharmacopoeia, unless the drug is being
donated directly by its manufacturer, a wholesale drug distributor, or a pharmacy located
in Minnesota; and
(6) the deleted text begin prescriptiondeleted text end drug is not a controlled substance.
(c) A medical supply is eligible for donation under the deleted text begin drugdeleted text end new text begin medicationnew text end repository
program if the following requirements are met:
(1) the supply has no physical signs of tampering, misbranding, or alteration and there
is no reason to believe it has been adulterated, tampered with, or misbranded;
(2) the supply is in its original, unopened, sealed packaging;
(3) the donation is accompanied by a deleted text begin drugdeleted text end new text begin medicationnew text end repository donor form described
under paragraph (d) that is signed by an individual who is authorized by the donor to attest
to the donor's knowledge in accordance with paragraph (d); and
(4) if the supply bears an expiration date, the date is at least six months later than the
date the supply was donated. If the donated supply bears an expiration date that is less than
six months from the date the supply was donated, the supply may be accepted and distributed
if the supply is in high demand and can be dispensed for use by a patient before the supply's
expiration date.
(d) The board shall develop the deleted text begin drugdeleted text end new text begin medicationnew text end repository donor form and make it
available on the board's website. The form must state that to the best of the donor's knowledge
the donated drug or supply has been properly stored under appropriate temperature and
humidity conditions and that the drug or supply has never been opened, used, tampered
with, adulterated, or misbranded.
(e) Donated drugs and supplies may be shipped or delivered to the premises of the central
repository or a local repository, and shall be inspected by a pharmacist or an authorized
practitioner who is employed by or under contract with the repository and who has been
designated by the repository to accept donations. A drop box must not be used to deliver
or accept donations.
(f) The central repository and local repository shall inventory all drugs and supplies
donated to the repository. For each drug, the inventory must include the drug's name, strength,
quantity, manufacturer, expiration date, and the date the drug was donated. For each medical
supply, the inventory must include a description of the supply, its manufacturer, the date
the supply was donated, and, if applicable, the supply's brand name and expiration date.
Subd. 7.
Standards and procedures for inspecting and storing donated deleted text begin prescriptiondeleted text end
drugs and supplies.
(a) A pharmacist or authorized practitioner who is employed by or
under contract with the central repository or a local repository shall inspect all donated
deleted text begin prescriptiondeleted text end drugs and supplies before the drug or supply is dispensed to determine, to the
extent reasonably possible in the professional judgment of the pharmacist or practitioner,
that the drug or supply is not adulterated or misbranded, has not been tampered with, is safe
and suitable for dispensing, has not been subject to a recall, and meets the requirements for
donation. The pharmacist or practitioner who inspects the drugs or supplies shall sign an
inspection record stating that the requirements for donation have been met. If a local
repository receives drugs and supplies from the central repository, the local repository does
not need to reinspect the drugs and supplies.
(b) The central repository and local repositories shall store donated drugs and supplies
in a secure storage area under environmental conditions appropriate for the drug or supply
being stored. Donated drugs and supplies may not be stored with nondonated inventory.
(c) The central repository and local repositories shall dispose of all deleted text begin prescriptiondeleted text end drugs
and medical supplies that are not suitable for donation in compliance with applicable federal
and state statutes, regulations, and rules concerning hazardous waste.
(d) In the event that controlled substances or deleted text begin prescriptiondeleted text end drugs that can only be dispensed
to a patient registered with the drug's manufacturer are shipped or delivered to a central or
local repository for donation, the shipment delivery must be documented by the repository
and returned immediately to the donor or the donor's representative that provided the drugs.
(e) Each repository must develop drug and medical supply recall policies and procedures.
If a repository receives a recall notification, the repository shall destroy all of the drug or
medical supply in its inventory that is the subject of the recall and complete a record of
destruction form in accordance with paragraph (f). If a drug or medical supply that is the
subject of a Class I or Class II recall has been dispensed, the repository shall immediately
notify the recipient of the recalled drug or medical supply. A drug that potentially is subject
to a recall need not be destroyed if its packaging bears a lot number and that lot of the drug
is not subject to the recall. If no lot number is on the drug's packaging, it must be destroyed.
(f) A record of destruction of donated drugs and supplies that are not dispensed under
subdivision 8, are subject to a recall under paragraph (e), or are not suitable for donation
shall be maintained by the repository for at least two years. For each drug or supply destroyed,
the record shall include the following information:
(1) the date of destruction;
(2) the name, strength, and quantity of the drug destroyed; and
(3) the name of the person or firm that destroyed the drug.
Subd. 8.
Dispensing requirements.
(a) Donated drugs and supplies may be dispensed
if the drugs or supplies are prescribed by a practitioner for use by an eligible individual and
are dispensed by a pharmacist or practitioner. A repository shall dispense drugs and supplies
to eligible individuals in the following priority order: (1) individuals who are uninsured;
(2) individuals with no prescription drug coverage; and (3) individuals who are underinsured.
A repository shall dispense donated deleted text begin prescriptiondeleted text end drugs in compliance with applicable federal
and state laws and regulations for dispensing deleted text begin prescriptiondeleted text end drugs, including all requirements
relating to packaging, labeling, record keeping, drug utilization review, and patient
counseling.
(b) Before dispensing or administering a drug or supply, the pharmacist or practitioner
shall visually inspect the drug or supply for adulteration, misbranding, tampering, and date
of expiration. Drugs or supplies that have expired or appear upon visual inspection to be
adulterated, misbranded, or tampered with in any way must not be dispensed or administered.
(c) Before a drug or supply is dispensed or administered to an individual, the individual
must sign a drug repository recipient form acknowledging that the individual understands
the information stated on the form. The board shall develop the form and make it available
on the board's website. The form must include the following information:
(1) that the drug or supply being dispensed or administered has been donated and may
have been previously dispensed;
(2) that a visual inspection has been conducted by the pharmacist or practitioner to ensure
that the drug or supply has not expired, has not been adulterated or misbranded, and is in
its original, unopened packaging; and
(3) that the dispensing pharmacist, the dispensing or administering practitioner, the
central repository or local repository, the Board of Pharmacy, and any other participant of
the deleted text begin drugdeleted text end new text begin medicationnew text end repository program cannot guarantee the safety of the drug or medical
supply being dispensed or administered and that the pharmacist or practitioner has determined
that the drug or supply is safe to dispense or administer based on the accuracy of the donor's
form submitted with the donated drug or medical supply and the visual inspection required
to be performed by the pharmacist or practitioner before dispensing or administering.
Subd. 9.
Handling fees.
(a) The central or local repository may charge the individual
receiving a drug or supply a handling fee of no more than 250 percent of the medical
assistance program dispensing fee for each drug or medical supply dispensed or administered
by that repository.
(b) A repository that dispenses or administers a drug or medical supply through the deleted text begin drugdeleted text end new text begin
medicationnew text end repository program shall not receive reimbursement under the medical assistance
program or the MinnesotaCare program for that dispensed or administered drug or supply.
Subd. 10.
Distribution of donated drugs and supplies.
(a) The central repository and
local repositories may distribute drugs and supplies donated under the deleted text begin drugdeleted text end new text begin medicationnew text end
repository program to other participating repositories for use pursuant to this program.
(b) A local repository that elects not to dispense donated drugs or supplies must transfer
all donated drugs and supplies to the central repository. A copy of the donor form that was
completed by the original donor under subdivision 6 must be provided to the central
repository at the time of transfer.
Subd. 11.
Forms and record-keeping requirements.
(a) The following forms developed
for the administration of this program shall be utilized by the participants of the program
and shall be available on the board's website:
(1) intake application form described under subdivision 5;
(2) local repository participation form described under subdivision 4;
(3) local repository withdrawal form described under subdivision 4;
(4) deleted text begin drugdeleted text end new text begin medicationnew text end repository donor form described under subdivision 6;
(5) record of destruction form described under subdivision 7; and
(6) deleted text begin drugdeleted text end new text begin medicationnew text end repository recipient form described under subdivision 8.
(b) All records, including drug inventory, inspection, and disposal of donated deleted text begin prescriptiondeleted text end
drugs and medical supplies, must be maintained by a repository for a minimum of two years.
Records required as part of this program must be maintained pursuant to all applicable
practice acts.
(c) Data collected by the deleted text begin drugdeleted text end new text begin medicationnew text end repository program from all local repositories
shall be submitted quarterly or upon request to the central repository. Data collected may
consist of the information, records, and forms required to be collected under this section.
(d) The central repository shall submit reports to the board as required by the contract
or upon request of the board.
Subd. 12.
Liability.
(a) The manufacturer of a drug or supply is not subject to criminal
or civil liability for injury, death, or loss to a person or to property for causes of action
described in clauses (1) and (2). A manufacturer is not liable for:
(1) the intentional or unintentional alteration of the drug or supply by a party not under
the control of the manufacturer; or
(2) the failure of a party not under the control of the manufacturer to transfer or
communicate product or consumer information or the expiration date of the donated drug
or supply.
(b) A health care facility participating in the program, a pharmacist dispensing a drug
or supply pursuant to the program, a practitioner dispensing or administering a drug or
supply pursuant to the program, or a donor of a drug or medical supply is immune from
civil liability for an act or omission that causes injury to or the death of an individual to
whom the drug or supply is dispensed and no disciplinary action by a health-related licensing
board shall be taken against a pharmacist or practitioner so long as the drug or supply is
donated, accepted, distributed, and dispensed according to the requirements of this section.
This immunity does not apply if the act or omission involves reckless, wanton, or intentional
misconduct, or malpractice unrelated to the quality of the drug or medical supply.
Subd. 13.
Drug returned for credit.
Nothing in this section allows a long-term care
facility to donate a drug to a central or local repository when federal or state law requires
the drug to be returned to the pharmacy that initially dispensed it, so that the pharmacy can
credit the payer for the amount of the drug returned.
Subd. 14.
Cooperation.
The central repository, as approved by the Board of Pharmacy,
may enter into an agreement with another state that has an established drug repository or
drug donation program if the other state's program includes regulations to ensure the purity,
integrity, and safety of the drugs and supplies donated, to permit the central repository to
offer to another state program inventory that is not needed by a Minnesota resident and to
accept inventory from another state program to be distributed to local repositories and
dispensed to Minnesota residents in accordance with this program.
new text begin Subd. 15. new text end
new text begin Funding. new text end
new text begin
The central repository may seek grants and other money from
nonprofit charitable organizations, the federal government, and other sources to fund the
ongoing operations of the medication repository program.
new text end
Sec. 30.
new text begin
[245A.245] CHILDREN'S RESIDENTIAL FACILITY SUBSTANCE USE
DISORDER TREATMENT PROGRAMS.
new text end
new text begin Subdivision 1. new text end
new text begin Applicability. new text end
new text begin
A license holder of a children's residential facility substance
use disorder treatment program license issued under this chapter and Minnesota Rules, parts
2960.0010 to 2960.0220 and 2960.0430 to 2960.0490, must comply with this section.
new text end
new text begin Subd. 2. new text end
new text begin Former students. new text end
new text begin
(a) "Alcohol and drug counselor" means an individual
qualified according to Minnesota Rules, part 2960.0460, subpart 5.
new text end
new text begin
(b) "Former student" means an individual that meets the requirements in section 148F.11,
subdivision 2a, to practice as a former student.
new text end
new text begin
(c) An alcohol and drug counselor must supervise and be responsible for a treatment
service performed by a former student and must review and sign each assessment, individual
treatment plan, progress note, and treatment plan review prepared by a former student.
new text end
new text begin
(d) A former student must receive the orientation and training required for permanent
staff members.
new text end
Sec. 31.
Minnesota Statutes 2022, section 245G.01, is amended by adding a subdivision
to read:
new text begin Subd. 13c. new text end
new text begin Former student. new text end
new text begin
"Former student" means a staff person that meets the
requirements in section 148F.11, subdivision 2a, to practice as a former student.
new text end
Sec. 32.
Minnesota Statutes 2022, section 245G.11, subdivision 10, is amended to read:
Subd. 10.
Student internsnew text begin and former studentsnew text end .
new text begin (a) new text end A qualified staff member must
supervise and be responsible for a treatment service performed by a student intern and must
review and sign each assessment, individual treatment plan, and treatment plan review
prepared by a student intern.
new text begin
(b) An alcohol and drug counselor must supervise and be responsible for a treatment
service performed by a former student and must review and sign each assessment, individual
treatment plan, and treatment plan review prepared by the former student.
new text end
new text begin (c)new text end A student intern new text begin or former student new text end must receive the orientation and training required
in section 245G.13, subdivisions 1, clause (7), and 2. No more than 50 percent of the
treatment staff may be studentsnew text begin , former students,new text end or licensing candidates with time
documented to be directly related to the provision of treatment services for which the staff
are authorized.
Sec. 33. new text begin REPEALER.
new text end
new text begin
Minnesota Rules, parts 5610.0100; 5610.0200; and 5610.0300,
new text end
new text begin
are repealed.
new text end
ARTICLE 6
BACKGROUND STUDIES
Section 1.
Minnesota Statutes 2022, section 245C.02, is amended by adding a subdivision
to read:
new text begin Subd. 7a. new text end
new text begin Conservator. new text end
new text begin
"Conservator" has the meaning given under section 524.1-201,
clause (10), and includes proposed and current conservators.
new text end
Sec. 2.
Minnesota Statutes 2022, section 245C.02, is amended by adding a subdivision to
read:
new text begin Subd. 11f. new text end
new text begin Guardian. new text end
new text begin
"Guardian" has the meaning given under section 524.1-201, clause
(27), and includes proposed and current guardians.
new text end
Sec. 3.
Minnesota Statutes 2022, section 245C.02, subdivision 13e, is amended to read:
Subd. 13e.
NETStudy 2.0.
"NETStudy 2.0" means the commissioner's system that
replaces both NETStudy and the department's internal background study processing system.
NETStudy 2.0 is designed to enhance protection of children and vulnerable adults by
improving the accuracy of background studies through fingerprint-based criminal record
checks and expanding the background studies to include a review of information from the
Minnesota Court Information System and the national crime information database. NETStudy
2.0 is also designed to increase efficiencies in and the speed of the hiring process by:
(1) providing access to and updates from public web-based data related to employment
eligibility;
(2) decreasing the need for repeat studies through electronic updates of background
study subjects' criminal records;
(3) supporting identity verification using subjects' Social Security numbers and
photographs;
(4) using electronic employer notifications; deleted text begin and
deleted text end
(5) issuing immediate verification of subjects' eligibility to provide services as more
studies are completed under the NETStudy 2.0 systemdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(6) providing electronic access to certain notices for entities and background study
subjects.
new text end
Sec. 4.
Minnesota Statutes 2022, section 245C.03, subdivision 1, is amended to read:
Subdivision 1.
Licensed programs.
(a) The commissioner shall conduct a background
study on:
(1) the person or persons applying for a license;
(2) an individual age 13 and over living in the household where the licensed program
will be provided who is not receiving licensed services from the program;
(3) current or prospective employees or contractors of the applicant who will have direct
contact with persons served by the facility, agency, or program;
(4) volunteers or student volunteers who will have direct contact with persons served
by the program to provide program services if the contact is not under the continuous, direct
supervision by an individual listed in clause (1) or (3);
(5) an individual age ten to 12 living in the household where the licensed services will
be provided when the commissioner has reasonable cause as defined in section 245C.02,
subdivision 15;
(6) an individual who, without providing direct contact services at a licensed program,
may have unsupervised access to children or vulnerable adults receiving services from a
program, when the commissioner has reasonable cause as defined in section 245C.02,
subdivision 15;
(7) all controlling individuals as defined in section 245A.02, subdivision 5a;
(8) notwithstanding the other requirements in this subdivision, child care background
study subjects as defined in section 245C.02, subdivision 6a; and
(9) notwithstanding clause (3), for children's residential facilities and foster residence
settings, any adult working in the facility, whether or not the individual will have direct
contact with persons served by the facility.
(b) For child foster care when the license holder resides in the home where foster care
services are provided, a short-term substitute caregiver providing direct contact services for
a child for less than 72 hours of continuous care is not required to receive a background
study under this chapter.
(c) This subdivision applies to the following programs that must be licensed under
chapter 245A:
(1) adult foster care;
(2) child foster care;
(3) children's residential facilities;
(4) family child care;
(5) licensed child care centers;
(6) licensed home and community-based services under chapter 245D;
(7) residential mental health programs for adults;
(8) substance use disorder treatment programs under chapter 245G;
(9) withdrawal management programs under chapter 245F;
(10) adult day care centers;
(11) family adult day services;
(12) independent living assistance for youth;
(13) detoxification programs;
(14) community residential settings; deleted text begin and
deleted text end
(15) intensive residential treatment services and residential crisis stabilization under
chapter 245Ideleted text begin .deleted text end new text begin ; and
new text end
new text begin
(16) treatment programs for persons with sexual psychopathic personality or sexually
dangerous persons, licensed under chapter 245A and according to Minnesota Rules, parts
9515.3000 to 9515.3110.
new text end
Sec. 5.
new text begin
[245C.033] GUARDIANS AND CONSERVATORS; MALTREATMENT
AND STATE LICENSING AGENCY CHECKS.
new text end
new text begin Subdivision 1. new text end
new text begin Maltreatment data. new text end
new text begin
Requests for maltreatment data submitted pursuant
to section 524.5-118 must include information regarding whether the guardian or conservator
has been a perpetrator of substantiated maltreatment of a vulnerable adult under section
626.557 or a minor under chapter 260E. If the guardian or conservator has been the
perpetrator of substantiated maltreatment of a vulnerable adult or a minor, the commissioner
must include a copy of any available public portion of the investigation memorandum under
section 626.557, subdivision 12b, or any available public portion of the investigation
memorandum under section 260E.30.
new text end
new text begin Subd. 2. new text end
new text begin State licensing agency data. new text end
new text begin
(a) Requests for state licensing agency data
submitted pursuant to section 524.5-118 shall include information from a check of state
licensing agency records.
new text end
new text begin
(b) The commissioner shall provide the court with licensing agency data for licenses
directly related to the responsibilities of a guardian or conservator if the guardian or
conservator has a current or prior affiliation with the:
new text end
new text begin
(1) Lawyers Responsibility Board;
new text end
new text begin
(2) State Board of Accountancy;
new text end
new text begin
(3) Board of Social Work;
new text end
new text begin
(4) Board of Psychology;
new text end
new text begin
(5) Board of Nursing;
new text end
new text begin
(6) Board of Medical Practice;
new text end
new text begin
(7) Department of Education;
new text end
new text begin
(8) Department of Commerce;
new text end
new text begin
(9) Board of Chiropractic Examiners;
new text end
new text begin
(10) Board of Dentistry;
new text end
new text begin
(11) Board of Marriage and Family Therapy;
new text end
new text begin
(12) Department of Human Services;
new text end
new text begin
(13) Peace Officer Standards and Training (POST) Board; or
new text end
new text begin
(14) Professional Educator Licensing and Standards Board.
new text end
new text begin
(c) The commissioner shall provide to the court the electronically available data
maintained in the agency's database, including whether the guardian or conservator is or
has been licensed by the agency and whether a disciplinary action or a sanction against the
individual's license, including a condition, suspension, revocation, or cancellation, is in the
licensing agency's database.
new text end
new text begin Subd. 3. new text end
new text begin Procedure; maltreatment and state licensing agency data. new text end
new text begin
Requests for
maltreatment and state licensing agency data checks must be submitted by the guardian or
conservator to the commissioner on the form or in the manner prescribed by the
commissioner. Upon receipt of a signed informed consent and payment under section
245C.10, the commissioner shall complete the maltreatment and state licensing agency
checks. Upon completion of the checks, the commissioner shall provide the requested
information to the courts on the form or in the manner prescribed by the commissioner.
new text end
new text begin Subd. 4. new text end
new text begin
Classification of maltreatment and state licensing agency data; access to
information.
new text end
new text begin
All data obtained by the commissioner for maltreatment and state licensing
agency checks completed under this section are classified as private data.
new text end
Sec. 6.
Minnesota Statutes 2022, section 245C.05, subdivision 1, is amended to read:
Subdivision 1.
Individual studied.
(a) The individual who is the subject of the
background study must provide the applicant, license holder, or other entity under section
245C.04 with sufficient information to ensure an accurate study, including:
(1) the individual's first, middle, and last name and all other names by which the
individual has been known;
(2) current home address, city, and state of residence;
(3) current zip code;
(4) sex;
(5) date of birth;
(6) driver's license number or state identification number; and
(7) upon implementation of NETStudy 2.0, the home address, city, county, and state of
residence for the past five years.
(b) Every subject of a background study conducted or initiated by counties or private
agencies under this chapter must also provide the home address, city, county, and state of
residence for the past five years.
(c) Every subject of a background study related to private agency adoptions or related
to child foster care licensed through a private agency, who is 18 years of age or older, shall
also provide the commissioner a signed consent for the release of any information received
from national crime information databases to the private agency that initiated the background
study.
(d) The subject of a background study shall provide fingerprints and a photograph as
required in subdivision 5.
(e) The subject of a background study shall submit a completed criminal and maltreatment
history records check consent form for applicable national and state level record checks.
new text begin
(f) A background study subject who has access to the NETStudy 2.0 applicant portal
must provide updated contact information to the commissioner via NETStudy 2.0 any time
their personal information changes for as long as they remain affiliated on any roster.
new text end
new text begin
(g) An entity must update contact information in NETStudy 2.0 for a background study
subject on the entity's roster any time the entity receives new contact information from the
study subject.
new text end
Sec. 7.
Minnesota Statutes 2022, section 245C.05, subdivision 4, is amended to read:
Subd. 4.
Electronic transmission.
(a) For background studies conducted by the
Department of Human Services, the commissioner shall implement a secure system for the
electronic transmission of:
(1) background study information to the commissioner;
(2) background study results to the license holder;
(3) background study information obtained under this section and section 245C.08 to
counties and private agencies for background studies conducted by the commissioner for
child foster care, including a summary of nondisqualifying results, except as prohibited by
law; and
(4) background study results to county agencies for background studies conducted by
the commissioner for adult foster care and family adult day services and, upon
implementation of NETStudy 2.0, family child care and legal nonlicensed child care
authorized under chapter 119B.
(b) Unless the commissioner has granted a hardship variance under paragraph (c), a
license holder or an applicant must use the electronic transmission system known as
NETStudy or NETStudy 2.0 to submit all requests for background studies to the
commissioner as required by this chapter.
(c) A license holder or applicant whose program is located in an area in which high-speed
Internet is inaccessible may request the commissioner to grant a variance to the electronic
transmission requirement.
(d) Section 245C.08, subdivision 3, paragraph (c), applies to results transmitted under
this subdivision.
new text begin
(e) The background study subject shall access background study-related documents
electronically in the applicant portal. A background study subject may request the
commissioner to grant a variance to the requirement to access documents electronically in
the NETStudy 2.0 applicant portal, and maintains the ability to request paper documentation
of their background studies.
new text end
Sec. 8.
Minnesota Statutes 2022, section 245C.08, subdivision 1, is amended to read:
Subdivision 1.
Background studies conducted by Department of Human Services.
(a)
For a background study conducted by the Department of Human Services, the commissioner
shall review:
(1) information related to names of substantiated perpetrators of maltreatment of
vulnerable adults that has been received by the commissioner as required under section
626.557, subdivision 9c, paragraph (j);
(2) the commissioner's records relating to the maltreatment of minors in licensed
programs, and from findings of maltreatment of minors as indicated through the social
service information system;
(3) information from juvenile courts as required in subdivision 4 for individuals listed
in section 245C.03, subdivision 1, paragraph (a), when there is reasonable cause;
(4) information from the Bureau of Criminal Apprehension, including information
regarding a background study subject's registration in Minnesota as a predatory offender
under section 243.166;
(5) except as provided in clause (6), information received as a result of submission of
fingerprints for a national criminal history record check, as defined in section 245C.02,
subdivision 13c, when the commissioner has reasonable cause for a national criminal history
record check as defined under section 245C.02, subdivision 15a, or as required under section
144.057, subdivision 1, clause (2);
(6) for a background study related to a child foster family setting application for licensure,
foster residence settings, children's residential facilities, a transfer of permanent legal and
physical custody of a child under sections 260C.503 to 260C.515, or adoptions, and for a
background study required for family child care, certified license-exempt child care, child
care centers, and legal nonlicensed child care authorized under chapter 119B, the
commissioner shall also review:
(i) information from the child abuse and neglect registry for any state in which the
background study subject has resided for the past five years;
(ii) when the background study subject is 18 years of age or older, or a minor under
section 245C.05, subdivision 5a, paragraph (c), information received following submission
of fingerprints for a national criminal history record check; and
(iii) when the background study subject is 18 years of age or older or a minor under
section 245C.05, subdivision 5a, paragraph (d), for licensed family child care, certified
license-exempt child care, licensed child care centers, and legal nonlicensed child care
authorized under chapter 119B, information obtained using non-fingerprint-based data
including information from the criminal and sex offender registries for any state in which
the background study subject resided for the past five years and information from the national
crime information database and the national sex offender registry; and
(7) for a background study required for family child care, certified license-exempt child
care centers, licensed child care centers, and legal nonlicensed child care authorized under
chapter 119B, the background study shall also include, to the extent practicable, a name
and date-of-birth search of the National Sex Offender Public website.
(b) Notwithstanding expungement by a court, the commissioner may consider information
obtained under paragraph (a), clauses (3) and (4), unless the commissioner received notice
of the petition for expungement and the court order for expungement is directed specifically
to the commissioner.
(c) The commissioner shall also review criminal case information received according
to section 245C.04, subdivision 4a, from the Minnesota court information system that relates
to individuals who have already been studied under this chapter and who remain affiliated
with the agency that initiated the background study.
(d) When the commissioner has reasonable cause to believe that the identity of a
background study subject is uncertain, the commissioner may require the subject to provide
a set of classifiable fingerprints for purposes of completing a fingerprint-based record check
with the Bureau of Criminal Apprehension. Fingerprints collected under this paragraph
shall not be saved by the commissioner after they have been used to verify the identity of
the background study subject against the particular criminal record in question.
(e) The commissioner may inform the entity that initiated a background study under
NETStudy 2.0 of the status of processing of the subject's fingerprints.
new text begin
(f) For a background study required for treatment programs for sexual psychopathic
personality or sexually dangerous persons, the background study shall only include a review
of the information required under paragraph (a), clauses (1), (2), (3), and (4).
new text end
Sec. 9.
Minnesota Statutes 2022, section 245C.10, subdivision 1d, is amended to read:
Subd. 1d.
new text begin State; new text end national criminal history record check fees.
The commissioner may
increase background study fees as necessary, commensurate with an increase in new text begin state Bureau
of Criminal Apprehension or new text end the national criminal history record check deleted text begin feedeleted text end new text begin feesnew text end . deleted text begin Thedeleted text end
deleted text begin commissioner shall report any fee increase under this subdivision to the legislature during
deleted text end deleted text begin the legislative session following the fee increase, so that the legislature may consider adoption
deleted text end deleted text begin of the fee increase into statute. By July 1 of every year, background study fees shall be set
deleted text end deleted text begin at the amount adopted by the legislature under this section.
deleted text end
Sec. 10.
Minnesota Statutes 2022, section 245C.10, subdivision 2, is amended to read:
Subd. 2.
Supplemental nursing services agencies.
The commissioner shall recover the
cost of the background studies initiated by supplemental nursing services agencies registered
under section 144A.71, subdivision 1, through a fee of no more than deleted text begin $42deleted text end new text begin $44new text end per study
charged to the agency. The fees collected under this subdivision are appropriated to the
commissioner for the purpose of conducting background studies.
Sec. 11.
Minnesota Statutes 2022, section 245C.10, subdivision 2a, is amended to read:
Subd. 2a.
Occupations regulated by commissioner of health.
The commissioner shall
set fees to recover the cost of combined background studies and criminal background checks
initiated by applicants, licensees, and certified practitioners regulated under sections 148.511
to 148.5198 and chapter 153Anew text begin through a fee of no more than $44 per study charged to the
entitynew text end . The fees collected under this subdivision shall be deposited in the special revenue
fund and are appropriated to the commissioner for the purpose of conducting background
studies and criminal background checks.
Sec. 12.
Minnesota Statutes 2022, section 245C.10, subdivision 3, is amended to read:
Subd. 3.
Personal care provider organizations.
The commissioner shall recover the
cost of background studies initiated by a personal care provider organization under sections
256B.0651 to 256B.0654 and 256B.0659 through a fee of no more than deleted text begin $42deleted text end new text begin $44new text end per study
charged to the organization responsible for submitting the background study form. The fees
collected under this subdivision are appropriated to the commissioner for the purpose of
conducting background studies.
Sec. 13.
Minnesota Statutes 2022, section 245C.10, subdivision 4, is amended to read:
Subd. 4.
Temporary personnel agencies, educational programs, and professional
services agencies.
The commissioner shall recover the cost of the background studies
initiated by temporary personnel agencies, educational programs, and professional services
agencies that initiate background studies under section 245C.03, subdivision 4, through a
fee of no more than deleted text begin $42deleted text end new text begin $44new text end per study charged to the agency. The fees collected under this
subdivision are appropriated to the commissioner for the purpose of conducting background
studies.
Sec. 14.
Minnesota Statutes 2022, section 245C.10, subdivision 5, is amended to read:
Subd. 5.
Adult foster care and family adult day services.
The commissioner shall
recover the cost of background studies required under section 245C.03, subdivision 1, for
the purposes of adult foster care and family adult day services licensing, through a fee of
no more than deleted text begin $42deleted text end new text begin $44new text end per study charged to the license holder. The fees collected under this
subdivision are appropriated to the commissioner for the purpose of conducting background
studies.
Sec. 15.
Minnesota Statutes 2022, section 245C.10, subdivision 6, is amended to read:
Subd. 6.
Unlicensed home and community-based waiver providers of service to
seniors and individuals with disabilities.
The commissioner shall recover the cost of
background studies initiated by unlicensed home and community-based waiver providers
of service to seniors and individuals with disabilities under section 256B.4912 through a
fee of no more than deleted text begin $42deleted text end new text begin $44new text end per study.
Sec. 16.
Minnesota Statutes 2022, section 245C.10, subdivision 8, is amended to read:
Subd. 8.
Children's therapeutic services and supports providers.
The commissioner
shall recover the cost of background studies required under section 245C.03, subdivision
7, for the purposes of children's therapeutic services and supports under section 256B.0943,
through a fee of no more than deleted text begin $42deleted text end new text begin $44new text end per study charged to the license holder. The fees
collected under this subdivision are appropriated to the commissioner for the purpose of
conducting background studies.
Sec. 17.
Minnesota Statutes 2022, section 245C.10, subdivision 9, is amended to read:
Subd. 9.
Human services licensed programs.
The commissioner shall recover the cost
of background studies required under section 245C.03, subdivision 1, for all programs that
are licensed by the commissioner, except child foster care when the applicant or license
holder resides in the home where child foster care services are provided, family child care,
child care centers, certified license-exempt child care centers, and legal nonlicensed child
care authorized under chapter 119B, through a fee of no more than deleted text begin $42deleted text end new text begin $44new text end per study charged
to the license holder. The fees collected under this subdivision are appropriated to the
commissioner for the purpose of conducting background studies.
Sec. 18.
Minnesota Statutes 2022, section 245C.10, subdivision 9a, is amended to read:
Subd. 9a.
Child care programs.
The commissioner shall recover the cost of a background
study required for family child care, certified license-exempt child care centers, licensed
child care centers, and legal nonlicensed child care providers authorized under chapter 119B
through a fee of no more than deleted text begin $40deleted text end new text begin $44new text end per study charged to the license holder. A fee of no
more than deleted text begin $42deleted text end new text begin $44new text end per study shall be charged for studies conducted under section 245C.05,
subdivision 5a, paragraph (a). The fees collected under this subdivision are appropriated to
the commissioner to conduct background studies.
Sec. 19.
Minnesota Statutes 2022, section 245C.10, subdivision 10, is amended to read:
Subd. 10.
Community first services and supports organizations.
The commissioner
shall recover the cost of background studies initiated by an agency-provider delivering
services under section 256B.85, subdivision 11, or a financial management services provider
providing service functions under section 256B.85, subdivision 13, through a fee of no more
than deleted text begin $42deleted text end new text begin $44new text end per study, charged to the organization responsible for submitting the background
study form. The fees collected under this subdivision are appropriated to the commissioner
for the purpose of conducting background studies.
Sec. 20.
Minnesota Statutes 2022, section 245C.10, subdivision 11, is amended to read:
Subd. 11.
Providers of housing support.
The commissioner shall recover the cost of
background studies initiated by providers of housing support under section 256I.04 through
a fee of no more than deleted text begin $42deleted text end new text begin $44new text end per study. The fees collected under this subdivision are
appropriated to the commissioner for the purpose of conducting background studies.
Sec. 21.
Minnesota Statutes 2022, section 245C.10, subdivision 12, is amended to read:
Subd. 12.
Child protection workers or social services staff having responsibility for
child protective duties.
The commissioner shall recover the cost of background studies
initiated by county social services agencies and local welfare agencies for individuals who
are required to have a background study under section 260E.36, subdivision 3, through a
fee of no more than deleted text begin $42deleted text end new text begin $44new text end per study. The fees collected under this subdivision are
appropriated to the commissioner for the purpose of conducting background studies.
Sec. 22.
Minnesota Statutes 2022, section 245C.10, subdivision 13, is amended to read:
Subd. 13.
Providers of special transportation service.
The commissioner shall recover
the cost of background studies initiated by providers of special transportation service under
section 174.30 through a fee of no more than deleted text begin $42deleted text end new text begin $44new text end per study. The fees collected under
this subdivision are appropriated to the commissioner for the purpose of conducting
background studies.
Sec. 23.
Minnesota Statutes 2022, section 245C.10, subdivision 14, is amended to read:
Subd. 14.
Children's residential facilities.
The commissioner shall recover the cost of
background studies initiated by a licensed children's residential facility through a fee of no
more than deleted text begin $51deleted text end new text begin $53new text end per study. Fees collected under this subdivision are appropriated to the
commissioner for purposes of conducting background studies.
Sec. 24.
Minnesota Statutes 2022, section 245C.10, subdivision 15, is amended to read:
Subd. 15.
Guardians and conservators.
The commissioner shall recover the cost of
conducting deleted text begin background studiesdeleted text end new text begin maltreatment and state licensing agency checksnew text end for guardians
and conservators under section deleted text begin 524.5-118deleted text end new text begin 245C.033 new text end through a fee of no more than deleted text begin $110
per studydeleted text end new text begin $50new text end . The fees collected under this subdivision are appropriated to the commissioner
for the purpose of conducting deleted text begin background studiesdeleted text end new text begin maltreatment and state licensing agency
checksnew text end . The fee deleted text begin for conducting an alternative background study for appointment of a
professional guardian or conservator must be paid by the guardian or conservator. In other
cases, the fee must be paid as follows:deleted text end new text begin must be paid directly to and in the manner prescribed
by the commissioner before any maltreatment and state licensing agency checks under
section 245C.033 may be conducted.
new text end
deleted text begin
(1) if the matter is proceeding in forma pauperis, the fee must be paid as an expense for
purposes of section 524.5-502, paragraph (a);
deleted text end
deleted text begin
(2) if there is an estate of the ward or protected person, the fee must be paid from the
estate; or
deleted text end
deleted text begin
(3) in the case of a guardianship or conservatorship of a person that is not proceeding
in forma pauperis, the fee must be paid by the guardian, conservator, or the court.
deleted text end
Sec. 25.
Minnesota Statutes 2022, section 245C.10, subdivision 16, is amended to read:
Subd. 16.
Providers of housing support services.
The commissioner shall recover the
cost of background studies initiated by providers of housing support services under section
256B.051 through a fee of no more than deleted text begin $42deleted text end new text begin $44new text end per study. The fees collected under this
subdivision are appropriated to the commissioner for the purpose of conducting background
studies.
Sec. 26.
Minnesota Statutes 2022, section 245C.10, subdivision 17, is amended to read:
Subd. 17.
Early intensive developmental and behavioral intervention providers.
The
commissioner shall recover the cost of background studies required under section 245C.03,
subdivision 15, for the purposes of early intensive developmental and behavioral intervention
under section 256B.0949, through a fee of no more than deleted text begin $42deleted text end new text begin $44new text end per study charged to the
enrolled agency. The fees collected under this subdivision are appropriated to the
commissioner for the purpose of conducting background studies.
Sec. 27.
Minnesota Statutes 2022, section 245C.10, subdivision 20, is amended to read:
Subd. 20.
Professional Educators Licensing Standards Board.
The commissioner
shall recover the cost of background studies initiated by the Professional Educators Licensing
Standards Board through a fee of no more than deleted text begin $51deleted text end new text begin $53new text end per study. Fees collected under this
subdivision are appropriated to the commissioner for purposes of conducting background
studies.
Sec. 28.
Minnesota Statutes 2022, section 245C.10, subdivision 21, is amended to read:
Subd. 21.
Board of School Administrators.
The commissioner shall recover the cost
of background studies initiated by the Board of School Administrators through a fee of no
more than deleted text begin $51deleted text end new text begin $53new text end per study. Fees collected under this subdivision are appropriated to the
commissioner for purposes of conducting background studies.
Sec. 29.
Minnesota Statutes 2022, section 245C.10, is amended by adding a subdivision
to read:
new text begin Subd. 22. new text end
new text begin Tribal organizations. new text end
new text begin
The commissioner shall recover the cost of background
studies initiated by Tribal organizations under section 245C.34 for adoption and child foster
care. The fee amount shall be established through interagency agreements between the
commissioner and Tribal organizations or their designees. The fees collected under this
subdivision shall be deposited in the special revenue fund and are appropriated to the
commissioner for the purpose of conducting background studies and criminal background
checks.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2024.
new text end
Sec. 30.
Minnesota Statutes 2022, section 245C.32, subdivision 2, is amended to read:
Subd. 2.
Use.
(a) The commissioner may also use these systems and records to obtain
and provide criminal history data from the Bureau of Criminal Apprehension, criminal
history data held by the commissioner, and data about substantiated maltreatment under
section 626.557 or chapter 260E, for other purposes, provided that:
(1) the background study is specifically authorized in statute; or
(2) the request is made with the informed consent of the subject of the study as provided
in section 13.05, subdivision 4.
(b) An individual making a request under paragraph (a), clause (2), must agree in writing
not to disclose the data to any other individual without the consent of the subject of the data.
new text begin
(c) The commissioner may use these systems to share background study documentation
electronically with entities and individuals who are the subject of a background study.
new text end
deleted text begin (c)deleted text end new text begin (d)new text end The commissioner may recover the cost of obtaining and providing background
study data by charging the individual or entity requesting the study a fee deleted text begin of no more than
$42 per studydeleted text end new text begin as described in section 245C.10new text end . The fees collected under this paragraph are
appropriated to the commissioner for the purpose of conducting background studies.
Sec. 31.
Minnesota Statutes 2022, section 524.5-118, is amended to read:
524.5-118 deleted text begin BACKGROUND STUDYdeleted text end new text begin MALTREATMENT AND STATE LICENSING
AGENCY CHECKS; CRIMINAL HISTORY CHECKnew text end .
Subdivision 1.
When required; exception.
(a) The court shall require deleted text begin a background
studydeleted text end new text begin maltreatment and state licensing agency checks and a criminal history checknew text end under
this section:
(1) before the appointment of a guardian or conservator, unless deleted text begin a background study hasdeleted text end new text begin
maltreatment and state licensing agency checks and a criminal history check havenew text end been
done on the person under this section within the previous five years; and
(2) once every five years after the appointment, if the person continues to serve as a
guardian or conservator.
(b) Thedeleted text begin background studydeleted text end new text begin maltreatment and state licensing agency checks and criminal
history check under this sectionnew text end must include:
(1) criminal history data from the Bureau of Criminal Apprehensiondeleted text begin , other criminal
history data held by the commissioner of human services, and data regarding whether the
person has been a perpetrator of substantiated maltreatment of a vulnerable adult or minordeleted text end ;
(2) criminal history data from a national criminal history record check deleted text begin as defined in
section 245C.02, subdivision 13cdeleted text end ; deleted text begin and
deleted text end
(3) state licensing agency data if a search of the database or databases of the agencies
listed in subdivision 2a shows that the proposed guardian or conservator has ever held a
professional license directly related to the responsibilities of a professional fiduciary from
an agency listed in subdivision 2a that was conditioned, suspended, revoked, or canceleddeleted text begin .deleted text end new text begin ;
and
new text end
new text begin
(4) data regarding whether the person has been a perpetrator of substantiated maltreatment
of a vulnerable adult or minor.
new text end
(c) If the guardian or conservator is not an individual, the deleted text begin background studydeleted text end new text begin maltreatment
and state licensing agency checks and criminal history checknew text end must be done on all individuals
currently employed by the proposed guardian or conservator who will be responsible for
exercising powers and duties under the guardianship or conservatorship.
(d) new text begin Notwithstanding paragraph (a), new text end if the court determines that it would be in the best
interests of the person subject to guardianship or conservatorship to appoint a guardian or
conservator before the deleted text begin background studydeleted text end new text begin maltreatment and state licensing agency checks
and criminal history checknew text end can be completed, the court may make the appointment pending
the results of the deleted text begin studydeleted text end new text begin checksnew text end , however, the deleted text begin background studydeleted text end new text begin maltreatment and state
licensing agency checks and criminal history checknew text end must then be completed as soon as
reasonably possible after appointmentdeleted text begin , no later than 30 days after appointmentdeleted text end .
(e) The deleted text begin feedeleted text end new text begin feesnew text end for deleted text begin background studiesdeleted text end new text begin the maltreatment and state licensing agency
checks and the criminal history checknew text end conducted under this section deleted text begin isdeleted text end new text begin arenew text end specified in deleted text begin sectiondeleted text end new text begin
sectionsnew text end 245C.10, subdivision deleted text begin 14deleted text end new text begin 15, and 299C.10, subdivisions 4 and 5new text end . The deleted text begin feedeleted text end new text begin feesnew text end for
conducting deleted text begin a background studydeleted text end new text begin the checksnew text end for appointment of a professional guardian or
conservator must be paid by the guardian or conservator. In other cases, the fee must be
paid as follows:
(1) if the matter is proceeding in forma pauperis, the fee is an expense for purposes of
section 524.5-502, paragraph (a);
(2) if there is an estate of the person subject to guardianship or conservatorship, the fee
must be paid from the estate; or
(3) in the case of a guardianship or conservatorship of the person that is not proceeding
in forma pauperis, the court may order that the fee be paid by the guardian or conservator
or by the court.
(f) The requirements of this subdivision do not apply if the guardian or conservator is:
(1) a state agency or county;
(2) a parent or guardian of a person proposed to be subject to guardianship or
conservatorship who has a developmental disability, if the parent or guardian has raised the
person proposed to be subject to guardianship or conservatorship in the family home until
the time the petition is filed, unless counsel appointed for the person proposed to be subject
to guardianship or conservatorship under section 524.5-205, paragraph (e); 524.5-304,
paragraph (b); 524.5-405, paragraph (a); or 524.5-406, paragraph (b), recommends a
background deleted text begin studydeleted text end new text begin checknew text end ; or
(3) a bank with trust powers, bank and trust company, or trust company, organized under
the laws of any state or of the United States and which is regulated by the commissioner of
commerce or a federal regulator.
Subd. 2.
Procedure; new text begin maltreatment and state licensing agency checks and new text end criminal
history deleted text begin and maltreatment records backgrounddeleted text end check.
(a) The deleted text begin courtdeleted text end new text begin guardian or
conservatornew text end shall request new text begin thatnew text end the deleted text begin commissioner of human services todeleted text end new text begin Bureau of Criminal
Apprehensionnew text end complete a deleted text begin background study under section 245C.32deleted text end new text begin criminal history checknew text end .
The request must be accompanied by the applicable fee and acknowledgment that the deleted text begin study
subjectdeleted text end new text begin guardian or conservatornew text end received a privacy notice deleted text begin required under subdivision 3deleted text end . The
deleted text begin commissioner of human servicesdeleted text end new text begin Bureau of Criminal Apprehensionnew text end shall conduct a national
criminal history record check. The deleted text begin study subjectdeleted text end new text begin guardian or conservatornew text end shall submit a set
of classifiable fingerprints. The fingerprints must be recorded on a fingerprint card provided
by the deleted text begin commissioner of human servicesdeleted text end new text begin Bureau of Criminal Apprehensionnew text end .
(b) The deleted text begin commissioner of human servicesdeleted text end new text begin Bureau of Criminal Apprehensionnew text end shall provide
the court with criminal history data as defined in section 13.87 from the Bureau of Criminal
Apprehension in the Department of Public Safetydeleted text begin , other criminal history data held by the
commissioner of human services, data regarding substantiated maltreatment of vulnerable
adults under section 626.557, and substantiated maltreatment of minors under chapter deleted text end deleted text begin 260Edeleted text end deleted text begin ,deleted text end
and criminal history information from other states or jurisdictions as indicated from a national
criminal history record check within 20 working days of receipt of a request. new text begin In accordance
with section 245C.033, the commissioner of human services shall provide the court with
data regarding substantiated maltreatment of vulnerable adults under section 626.557, and
substantiated maltreatment of minors under chapter 260E within 25 working days of receipt
of a request. new text end If the deleted text begin subject of the studydeleted text end new text begin guardian or conservatornew text end has been the perpetrator of
substantiated maltreatment of a vulnerable adult or minor, the response must include a copy
of deleted text begin thedeleted text end new text begin any availablenew text end public portion of the investigation memorandum under section 626.557,
subdivision 12b, or deleted text begin thedeleted text end new text begin any availablenew text end public portion of the investigation memorandum under
section 260E.30. deleted text begin The commissioner shall provide the court with information from a review
of information according to subdivision 2a if the study subject provided information
indicating current or prior affiliation with a state licensing agency.
deleted text end
(c) Notwithstanding section 260E.30 or 626.557, subdivision 12b, if the commissioner
of human services or a county lead agency or lead investigative agency has information that
a person deleted text begin on whom a background study was previously donedeleted text end under this section has been
determined to be a perpetrator of maltreatment of a vulnerable adult or minor, the
commissioner or the county may provide this information to the court that deleted text begin requested the
background studydeleted text end new text begin is determining eligibility for the guardian or conservatornew text end . deleted text begin The commissioner
may also provide the court with additional criminal history or substantiated maltreatment
information that becomes available after the background study is done.
deleted text end
Subd. 2a.
Procedure; state licensing agency data.
(a) new text begin In response to a request submitted
under section 245C.033, new text end the deleted text begin court shall request thedeleted text end commissioner of human services deleted text begin todeleted text end new text begin shallnew text end
provide deleted text begin the court within 25 working days of receipt of the request withdeleted text end licensing agency
data for licenses directly related to the responsibilities of a professional fiduciary if the deleted text begin study
subject indicatesdeleted text end new text begin guardian or conservator has anew text end current or prior affiliation deleted text begin fromdeleted text end new text begin with any ofnew text end
the following agencies in Minnesota:
(1) Lawyers Responsibility Board;
(2) State Board of Accountancy;
(3) Board of Social Work;
(4) Board of Psychology;
(5) Board of Nursing;
(6) Board of Medical Practice;
(7) Department of Education;
(8) Department of Commerce;
(9) Board of Chiropractic Examiners;
(10) Board of Dentistry;
(11) Board of Marriage and Family Therapy;
(12) Department of Human Services;
(13) Peace Officer Standards and Training (POST) Board; and
(14) Professional Educator Licensing and Standards Board.
deleted text begin
(b) The commissioner shall enter into agreements with these agencies to provide the
commissioner with electronic access to the relevant licensing data, and to provide the
commissioner with a quarterly list of new sanctions issued by the agency.
deleted text end
deleted text begin (c)deleted text end new text begin (b)new text end The commissioner shall providenew text begin informationnew text end to the court deleted text begin the electronically
available data maintained in the agency's database, including whether the proposed guardian
or conservator is or has been licensed by the agency, and if the licensing agency database
indicates a disciplinary action or a sanction against the individual's license, including a
condition, suspension, revocation, or cancellationdeleted text end new text begin in accordance with section 245C.033new text end .
deleted text begin
(d) If the proposed guardian or conservator has resided in a state other than Minnesota
in the previous ten years, licensing agency data under this section shall also include the
licensing agency data from any other state where the proposed guardian or conservator
reported to have resided during the previous ten years if the study subject indicates current
or prior affiliation. If the proposed guardian or conservator has or has had a professional
license in another state that is directly related to the responsibilities of a professional fiduciary
from one of the agencies listed under paragraph (a), state licensing agency data shall also
include data from the relevant licensing agency of that state.
deleted text end
deleted text begin
(e) The commissioner is not required to repeat a search for Minnesota or out-of-state
licensing data on an individual if the commissioner has provided this information to the
court within the prior five years.
deleted text end
deleted text begin
(f) The commissioner shall review the information in paragraph (c) at least once every
four months to determine if an individual who has been studied within the previous five
years:
deleted text end
deleted text begin
(1) has new disciplinary action or sanction against the individual's license; or
deleted text end
deleted text begin
(2) did not disclose a prior or current affiliation with a Minnesota licensing agency.
deleted text end
deleted text begin
(g) If the commissioner's review in paragraph (f) identifies new information, the
commissioner shall provide any new information to the court.
deleted text end
Subd. 3.
Forms and systems.
deleted text begin The courtdeleted text end new text begin In accordance with section 245C.033, subdivision
3, the commissioner of human servicesnew text end must provide the deleted text begin study subjectdeleted text end new text begin guardian or conservator
new text end with a privacy noticenew text begin for the maltreatment and state licensing agency checksnew text end that complies
with section deleted text begin 245C.05, subdivision 2cdeleted text end new text begin 13.04, subdivision 2new text end . deleted text begin The commissioner of human
services shall use the NETStudy 2.0 system to conduct a background study under this section.deleted text end new text begin
The Bureau of Criminal Apprehension must provide the guardian or conservator with a
privacy notice for the criminal history check.
new text end
Subd. 4.
Rights.
The court shall notify the deleted text begin subject of a background studydeleted text end new text begin guardian or
conservatornew text end that deleted text begin the subject hasdeleted text end new text begin they havenew text end the following rights:
(1) the right to be informed that the court will request deleted text begin a background study on the subjectdeleted text end new text begin
maltreatment and state licensing agency checks and a criminal history check on the guardian
or conservatornew text end for the purpose of determining whether the person's appointment or continued
appointment is in the best interests of the person subject to guardianship or conservatorship;
(2) the right to be informed of the results of the deleted text begin studydeleted text end new text begin checksnew text end and to obtain from the
court a copy of the results; and
(3) the right to challenge the accuracy and completeness of information contained in the
results under section 13.04, subdivision 4, except to the extent precluded by section 256.045,
subdivision 3.
Sec. 32. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2022, sections 245C.02, subdivision 14b; 245C.031, subdivisions
5, 6, and 7; 245C.032; and 245C.30, subdivision 1a,
new text end
new text begin
are repealed.
new text end
ARTICLE 7
BEHAVIORAL HEALTH
Section 1.
Minnesota Statutes 2022, section 245.4663, subdivision 1, is amended to read:
Subdivision 1.
Grant program established.
The commissioner shall award grants to
licensed or certified mental health providers that meet the criteria in subdivision 2 to fund
supervision of new text begin or preceptorships for students, new text end internsnew text begin ,new text end and clinical trainees who are working
toward becoming mental health professionals deleted text begin anddeleted text end new text begin ;new text end to subsidize the costs of licensing
applications and examination fees for clinical traineesnew text begin ; and to fund training for workers to
become supervisorsnew text end . For purposes of this section, an intern may include an individual who
is working toward an undergraduate degree in the behavioral sciences or related field at an
accredited educational institution.
Sec. 2.
Minnesota Statutes 2022, section 245.4663, subdivision 4, is amended to read:
Subd. 4.
Allowable uses of grant funds.
A mental health provider must use grant funds
received under this section for one or more of the following:
(1) to pay for direct supervision hours new text begin or preceptorships new text end for new text begin students, new text end internsnew text begin ,new text end and clinical
trainees, in an amount up to $7,500 per new text begin student, new text end internnew text begin ,new text end or clinical trainee;
(2) to establish a program to provide supervision to multiple new text begin students, new text end internsnew text begin ,new text end or clinical
trainees; deleted text begin or
deleted text end
(3) to pay licensing application and examination fees for clinical traineesdeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(4) to provide a weekend training program for workers to become supervisors.
new text end
Sec. 3.
Minnesota Statutes 2022, section 245.4901, subdivision 4, is amended to read:
Subd. 4.
Data collection and outcome measurement.
Grantees shall provide data to
the commissioner for the purpose of evaluating the effectiveness of the school-linked
behavioral health grant programnew text begin , no more frequently than twice per year. Data provided by
grantees shall include the number of clients served, client demographics, payment
information, duration and frequency of services and client-related clinic ancillary services
including hours of direct client services, and hours of ancillary direct and indirect support
services. Qualitative data may also be collected to demonstrate impact from client and school
personnel perspectivesnew text end .
Sec. 4.
Minnesota Statutes 2022, section 245.4901, is amended by adding a subdivision
to read:
new text begin Subd. 5. new text end
new text begin Consultation; grant awards. new text end
new text begin
In administering the grant program, the
commissioner shall consult with school districts that have not received grants under this
section but that wish to collaborate with a community mental health provider. The
commissioner shall also work with culturally specific providers to allow these providers to
serve students from their community in multiple schools. When awarding grants, the
commissioner shall consider the need to have consistency of providers over time among
schools and students.
new text end
Sec. 5.
Minnesota Statutes 2022, section 245.735, is amended by adding a subdivision to
read:
new text begin Subd. 1a. new text end
new text begin Definitions. new text end
new text begin
(a) For the purposes of this section, the terms in this subdivision
have the meanings given.
new text end
new text begin
(b) "Alcohol and drug counselor" has the meaning given in section 245G.11, subdivision
5.
new text end
new text begin
(c) "Care coordination" means the activities required to coordinate care across settings
and providers for a person served to ensure seamless transitions across the full spectrum of
health services. Care coordination includes outreach and engagement; documenting a plan
of care for medical, behavioral health, and social services and supports in the integrated
treatment plan; assisting with obtaining appointments; confirming appointments are kept;
developing a crisis plan; tracking medication; and implementing care coordination agreements
with external providers. Care coordination may include psychiatric consultation with primary
care practitioners and with mental health clinical care practitioners.
new text end
new text begin
(d) "Community needs assessment" means an assessment to identify community needs
and determine the community behavioral health clinic's capacity to address the needs of the
population being served.
new text end
new text begin
(e) "Comprehensive evaluation" means a person-centered, family-centered, and
trauma-informed evaluation meeting the requirements of subdivision 4b completed for the
purposes of diagnosis and treatment planning.
new text end
new text begin
(f) "Designated collaborating organization" means an entity meeting the requirements
of subdivision 3a with a formal agreement with a CCBHC to furnish CCBHC services.
new text end
new text begin
(g) "Functional assessment" means an assessment of a client's current level of functioning
relative to functioning that is appropriate for someone the client's age and that meets the
requirements of subdivision 4a.
new text end
new text begin
(h) "Initial evaluation" means an evaluation completed by a mental health professional
that gathers and documents information necessary to formulate a preliminary diagnosis and
begin client services.
new text end
new text begin
(i) "Integrated treatment plan" means a documented plan of care meeting the requirements
of subdivision 4d that guides treatment and interventions addressing all services required,
including but not limited to recovery supports, with provisions for monitoring progress
toward the client's goals.
new text end
new text begin
(j) "Medical director" means a physician who is responsible for overseeing the medical
components of the CCBHC services.
new text end
new text begin
(k) "Mental health professional" has the meaning given in section 245I.04, subdivision
2.
new text end
new text begin
(l) "Mobile crisis services" has the meaning given in section 256B.0624, subdivision 2.
new text end
new text begin
(m) "Preliminary screening and risk assessment" means a mandatory screening and risk
assessment that is completed at the first contact with the prospective CCBHC service
recipient and determines the acuity of client need.
new text end
Sec. 6.
Minnesota Statutes 2022, section 245.735, subdivision 3, is amended to read:
Subd. 3.
Certified community behavioral health clinics.
(a) The commissioner shall
establish deleted text begin adeleted text end state certification deleted text begin processdeleted text end new text begin and recertification processesnew text end for certified community
behavioral health clinics (CCBHCs) that satisfy all federal requirements necessary for
CCBHCs certified under this section to be eligible for reimbursement under medical
assistance, without service area limits based on geographic area or region. The commissioner
shall consult with CCBHC stakeholders before establishing and implementing changes in
the certification new text begin or recertification new text end process and requirements. deleted text begin Entities that choose to be
CCBHCs must:deleted text end new text begin Any changes to the certification or recertification process or requirements
must be consistent with the most recently issued Certified Community Behavioral Health
Clinic Certification Criteria published by the Substance Abuse and Mental Health Services
Administration. The commissioner must allow a transition period for CCBHCs to meet the
revised criteria prior to July 1, 2024. The commissioner is authorized to amend the state's
Medicaid state plan or the terms of the demonstration to comply with federal requirements.
new text end
new text begin
(b) As part of the state CCBHC certification and recertification processes, the
commissioner shall provide to entities applying for certification or requesting recertification
the standard requirements of the community needs assessment and the staffing plan that are
consistent with the most recently issued Certified Community Behavioral Health Clinic
Certification Criteria published by the Substance Abuse and Mental Health Services
Administration.
new text end
new text begin
(c) The commissioner shall schedule a certification review that includes a site visit within
90 calendar days of receipt of an application for certification or recertification.
new text end
new text begin
(d) Entities that choose to be CCBHCs must:
new text end
new text begin
(1) complete a community needs assessment and complete a staffing plan that is
responsive to the needs identified in the community needs assessment and update both the
community needs assessment and the staffing plan no less frequently than every 36 months;
new text end
deleted text begin (1)deleted text end new text begin (2)new text end comply with state licensing requirements and other requirements issued by the
commissioner;
new text begin
(3) employ or contract with a medical director. A medical director must be a physician
licensed under chapter 147 and either certified by the American Board of Psychiatry and
Neurology, certified by the American Osteopathic Board of Neurology and Psychiatry, or
eligible for board certification in psychiatry. A registered nurse who is licensed under
sections 148.171 to 148.285 and is certified as a nurse practitioner in adult or family
psychiatric and mental health nursing by a national nurse certification organization may
serve as the medical director when a CCBHC is unable to employ or contract a qualified
physician;
new text end
deleted text begin (2)deleted text end new text begin (4)new text end employ or contract for clinic staff who have backgrounds in diverse disciplines,
including licensed mental health professionals and licensed alcohol and drug counselors,
and staff who are culturally and linguistically trained to meet the needs of the population
the clinic serves;
deleted text begin (3)deleted text end new text begin (5)new text end ensure that clinic services are available and accessible to individuals and families
of all ages and genders new text begin with access on evenings and weekends new text end and that crisis management
services are available 24 hours per day;
deleted text begin (4)deleted text end new text begin (6)new text end establish fees for clinic services for individuals who are not enrolled in medical
assistance using a sliding fee scale that ensures that services to patients are not denied or
limited due to an individual's inability to pay for services;
deleted text begin (5)deleted text end new text begin (7)new text end comply with quality assurance reporting requirements and other reporting
requirementsdeleted text begin , including any required reporting of encounter data, clinical outcomes data,
and quality datadeleted text end new text begin included in the most recently issued Certified Community Behavioral
Health Clinic Certification Criteria published by the Substance Abuse and Mental Health
Services Administrationnew text end ;
deleted text begin (6)deleted text end new text begin (8)new text end provide crisis mental health and substance use services, withdrawal management
services, emergency crisis intervention services, and stabilization services through existing
mobile crisis services; screening, assessment, and diagnosis services, including risk
assessments and level of care determinations; person- and family-centered treatment planning;
outpatient mental health and substance use services; targeted case management; psychiatric
rehabilitation services; peer support and counselor services and family support services;
and intensive community-based mental health services, including mental health services
for members of the armed forces and veterans. CCBHCs must directly provide the majority
of these services to enrollees, but may coordinate some services with another entity through
a collaboration or agreement, pursuant to deleted text begin paragraph (b)deleted text end new text begin subdivision 3anew text end ;
deleted text begin (7)deleted text end new text begin (9)new text end provide coordination of care across settings and providers to ensure seamless
transitions for individuals being served across the full spectrum of health services, including
acute, chronic, and behavioral needsdeleted text begin . Care coordination may be accomplished through
partnerships or formal contracts with:deleted text end new text begin ;
new text end
deleted text begin
(i) counties, health plans, pharmacists, pharmacies, rural health clinics, federally qualified
health centers, inpatient psychiatric facilities, substance use and detoxification facilities, or
community-based mental health providers; and
deleted text end
deleted text begin
(ii) other community services, supports, and providers, including schools, child welfare
agencies, juvenile and criminal justice agencies, Indian health services clinics, tribally
licensed health care and mental health facilities, urban Indian health clinics, Department of
Veterans Affairs medical centers, outpatient clinics, drop-in centers, acute care hospitals,
and hospital outpatient clinics;
deleted text end
deleted text begin (8)deleted text end new text begin (10)new text end be certified as a mental health clinic under section 245I.20;
deleted text begin (9)deleted text end new text begin (11)new text end comply with standards established by the commissioner relating to CCBHC
screenings, assessments, and evaluationsnew text begin that are consistent with this sectionnew text end ;
deleted text begin (10)deleted text end new text begin (12)new text end be licensed to provide substance use disorder treatment under chapter 245G;
deleted text begin (11)deleted text end new text begin (13)new text end be certified to provide children's therapeutic services and supports under section
256B.0943;
deleted text begin (12)deleted text end new text begin (14)new text end be certified to provide adult rehabilitative mental health services under section
256B.0623;
deleted text begin (13)deleted text end new text begin (15)new text end be enrolled to provide mental health crisis response services under section
256B.0624;
deleted text begin (14)deleted text end new text begin (16)new text end be enrolled to provide mental health targeted case management under section
256B.0625, subdivision 20;
deleted text begin
(15) comply with standards relating to mental health case management in Minnesota
Rules, parts 9520.0900 to 9520.0926;
deleted text end
deleted text begin (16)deleted text end new text begin (17)new text end provide services that comply with the evidence-based practices described in
deleted text begin paragraph (e)deleted text end new text begin subdivision 3dnew text end ; deleted text begin and
deleted text end
deleted text begin (17) comply with standards relating todeleted text end new text begin (18) providenew text end peer services deleted text begin underdeleted text end new text begin as defined innew text end
sections 256B.0615, 256B.0616, and 245G.07, subdivision 2, clause (8), as applicable when
peer services are provideddeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(19) inform all clients upon initiation of care of the full array of services available under
the CCBHC model.
new text end
deleted text begin
(b) If a certified CCBHC is unable to provide one or more of the services listed in
paragraph (a), clauses (6) to (17), the CCBHC may contract with another entity that has the
required authority to provide that service and that meets the following criteria as a designated
collaborating organization:
deleted text end
deleted text begin
(1) the entity has a formal agreement with the CCBHC to furnish one or more of the
services under paragraph (a), clause (6);
deleted text end
deleted text begin
(2) the entity provides assurances that it will provide services according to CCBHC
service standards and provider requirements;
deleted text end
deleted text begin
(3) the entity agrees that the CCBHC is responsible for coordinating care and has clinical
and financial responsibility for the services that the entity provides under the agreement;
and
deleted text end
deleted text begin
(4) the entity meets any additional requirements issued by the commissioner.
deleted text end
deleted text begin
(c) Notwithstanding any other law that requires a county contract or other form of county
approval for certain services listed in paragraph (a), clause (6), a clinic that otherwise meets
CCBHC requirements may receive the prospective payment under section 256B.0625,
subdivision 5m, for those services without a county contract or county approval. As part of
the certification process in paragraph (a), the commissioner shall require a letter of support
from the CCBHC's host county confirming that the CCBHC and the county or counties it
serves have an ongoing relationship to facilitate access and continuity of care, especially
for individuals who are uninsured or who may go on and off medical assistance.
deleted text end
deleted text begin
(d) When the standards listed in paragraph (a) or other applicable standards conflict or
address similar issues in duplicative or incompatible ways, the commissioner may grant
variances to state requirements if the variances do not conflict with federal requirements
for services reimbursed under medical assistance. If standards overlap, the commissioner
may substitute all or a part of a licensure or certification that is substantially the same as
another licensure or certification. The commissioner shall consult with stakeholders, as
described in subdivision 4, before granting variances under this provision. For the CCBHC
that is certified but not approved for prospective payment under section 256B.0625,
subdivision 5m, the commissioner may grant a variance under this paragraph if the variance
does not increase the state share of costs.
deleted text end
deleted text begin
(e) The commissioner shall issue a list of required evidence-based practices to be
delivered by CCBHCs, and may also provide a list of recommended evidence-based practices.
The commissioner may update the list to reflect advances in outcomes research and medical
services for persons living with mental illnesses or substance use disorders. The commissioner
shall take into consideration the adequacy of evidence to support the efficacy of the practice,
the quality of workforce available, and the current availability of the practice in the state.
At least 30 days before issuing the initial list and any revisions, the commissioner shall
provide stakeholders with an opportunity to comment.
deleted text end
deleted text begin
(f) The commissioner shall recertify CCBHCs at least every three years. The
commissioner shall establish a process for decertification and shall require corrective action,
medical assistance repayment, or decertification of a CCBHC that no longer meets the
requirements in this section or that fails to meet the standards provided by the commissioner
in the application and certification process.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective upon federal approval. The commissioner
of human services must notify the revisor of statutes when federal approval is obtained.
new text end
Sec. 7.
Minnesota Statutes 2022, section 245.735, is amended by adding a subdivision to
read:
new text begin Subd. 3a. new text end
new text begin Designated collaborating organizations. new text end
new text begin
If a certified CCBHC is unable to
provide one or more of the services listed in subdivision 3, paragraph (d), clauses (8) to
(19), the CCBHC may contract with another entity that has the required authority to provide
that service and that meets the following criteria as a designated collaborating organization:
new text end
new text begin
(1) the entity has a formal agreement with the CCBHC to furnish one or more of the
services under subdivision 3, paragraph (d), clause (8);
new text end
new text begin
(2) the entity provides assurances that it will provide services according to CCBHC
service standards and provider requirements;
new text end
new text begin
(3) the entity agrees that the CCBHC is responsible for coordinating care and has clinical
and financial responsibility for the services that the entity provides under the agreement;
and
new text end
new text begin
(4) the entity meets any additional requirements issued by the commissioner.
new text end
Sec. 8.
Minnesota Statutes 2022, section 245.735, is amended by adding a subdivision to
read:
new text begin Subd. 3b. new text end
new text begin Exemptions to host county approval. new text end
new text begin
Notwithstanding any other law that
requires a county contract or other form of county approval for a service listed in subdivision
3, paragraph (d), clause (8), a CCBHC that meets the requirements of this section may
receive the prospective payment under section 256B.0625, subdivision 5m, for that service
without a county contract or county approval.
new text end
Sec. 9.
Minnesota Statutes 2022, section 245.735, is amended by adding a subdivision to
read:
new text begin Subd. 3c. new text end
new text begin Variances. new text end
new text begin
When the standards listed in this section or other applicable
standards conflict or address similar issues in duplicative or incompatible ways, the
commissioner may grant variances to state requirements if the variances do not conflict
with federal requirements for services reimbursed under medical assistance. If standards
overlap, the commissioner may substitute all or a part of a licensure or certification that is
substantially the same as another licensure or certification. The commissioner shall consult
with stakeholders before granting variances under this provision. For a CCBHC that is
certified but not approved for prospective payment under section 256B.0625, subdivision
5m, the commissioner may grant a variance under this paragraph if the variance does not
increase the state share of costs.
new text end
Sec. 10.
Minnesota Statutes 2022, section 245.735, is amended by adding a subdivision
to read:
new text begin Subd. 3d. new text end
new text begin Evidence-based practices. new text end
new text begin
The commissioner shall issue a list of required
evidence-based practices to be delivered by CCBHCs and may also provide a list of
recommended evidence-based practices. The commissioner may update the list to reflect
advances in outcomes research and medical services for persons living with mental illnesses
or substance use disorders. The commissioner shall take into consideration the adequacy
of evidence to support the efficacy of the practice across cultures and ages, the workforce
available, and the current availability of the practice in the state. At least 30 days before
issuing the initial list or issuing any revisions, the commissioner shall provide stakeholders
with an opportunity to comment.
new text end
Sec. 11.
Minnesota Statutes 2022, section 245.735, is amended by adding a subdivision
to read:
new text begin Subd. 3e. new text end
new text begin Recertification. new text end
new text begin
A CCBHC must apply for recertification every 36 months.
new text end
Sec. 12.
Minnesota Statutes 2022, section 245.735, is amended by adding a subdivision
to read:
new text begin Subd. 3f. new text end
new text begin Opportunity to cure. new text end
new text begin
(a) The commissioner shall provide a formal written
notice to an applicant for CCBHC certification outlining the determination of the application
and process for applicable and necessary corrective action required of the applicant signed
by the commissioner or appropriate division director to applicant entities within 30 calendar
days of the site visit.
new text end
new text begin
(b) The commissioner may reject an application if the applicant entity does not take all
corrective actions specified in the notice and notify the commissioner that the applicant
entity has done so within 60 calendar days.
new text end
new text begin
(c) The commissioner must send the applicant entity a final decision on the corrected
application within 30 calendar days of the applicant entity's notice to the commissioner that
the applicant has taken the required corrective actions.
new text end
Sec. 13.
Minnesota Statutes 2022, section 245.735, is amended by adding a subdivision
to read:
new text begin Subd. 3g. new text end
new text begin Decertification process. new text end
new text begin
The commissioner must establish a process for
decertification. The commissioner must require corrective action, medical assistance
repayment, or decertification of a CCBHC that no longer meets the requirements in this
section or that fails to meet the standards provided by the commissioner in the application,
certification, or recertification process.
new text end
Sec. 14.
Minnesota Statutes 2022, section 245.735, is amended by adding a subdivision
to read:
new text begin Subd. 4a. new text end
new text begin Functional assessment requirements. new text end
new text begin
(a) For adults, a functional assessment
may be completed using a Daily Living Activities-20 tool.
new text end
new text begin
(b) Notwithstanding any law to the contrary, a functional assessment performed by a
CCBHC that meets the requirements of this subdivision satisfies the requirements in:
new text end
new text begin
(1) section 256B.0623, subdivision 9;
new text end
new text begin
(2) section 245.4711, subdivision 3; and
new text end
new text begin
(3) Minnesota Rules, part 9520.0914, subpart 2.
new text end
Sec. 15.
Minnesota Statutes 2022, section 245.735, is amended by adding a subdivision
to read:
new text begin Subd. 4b. new text end
new text begin Requirements for comprehensive evaluations. new text end
new text begin
(a) A comprehensive
evaluation must be completed for all new clients within 60 calendar days following the
preliminary screening and risk assessment.
new text end
new text begin
(b) Only a mental health professional may complete a comprehensive evaluation. The
mental health professional must consult with an alcohol and drug counselor when substance
use disorder services are deemed clinically appropriate.
new text end
new text begin
(c) The comprehensive evaluation must consist of the synthesis of existing information
including but not limited to an external diagnostic assessment, crisis assessment, preliminary
screening and risk assessment, initial evaluation, and primary care screenings.
new text end
new text begin
(d) A comprehensive evaluation must be completed in the cultural context of the client
and updated to reflect changes in the client's conditions and at the client's request or when
the client's condition no longer meets the existing diagnosis.
new text end
new text begin
(e) The psychiatric evaluation and management service fulfills requirements for the
comprehensive evaluation when a client of a CCBHC is receiving exclusively psychiatric
evaluation and management services. The CCBHC shall complete the comprehensive
evaluation within 60 calendar days of a client's referral for additional CCBHC services.
new text end
new text begin
(f) For clients engaging exclusively in substance use disorder services at the CCBHC,
a substance use disorder comprehensive assessment as defined in section 245G.05,
subdivision 2, that is completed within 60 calendar days of service initiation shall fulfill
requirements of the comprehensive evaluation.
new text end
new text begin
(g) Notwithstanding any law to the contrary, a comprehensive evaluation performed by
a CCBHC that meets the requirements of this subdivision satisfies the requirements in:
new text end
new text begin
(1) section 245.462, subdivision 20, paragraph (c);
new text end
new text begin
(2) section 245.4711, subdivision 2, paragraph (b);
new text end
new text begin
(3) section 245.4871, subdivision 6;
new text end
new text begin
(4) section 245.4881, subdivision 2, paragraph (c);
new text end
new text begin
(5) section 245G.04, subdivision 1;
new text end
new text begin
(6) section 245G.05, subdivision 1;
new text end
new text begin
(7) section 245I.10, subdivisions 4 to 6;
new text end
new text begin
(8) section 256B.0623, subdivisions 3, clause (4), 8, and 10;
new text end
new text begin
(9) section 256B.0943, subdivisions 3 and 6, paragraph (b), clause (1);
new text end
new text begin
(10) Minnesota Rules, part 9520.0909, subpart 1;
new text end
new text begin
(11) Minnesota Rules, part 9520.0910, subparts 1 and 2; and
new text end
new text begin
(12) Minnesota Rules, part 9520.0914, subpart 2.
new text end
Sec. 16.
Minnesota Statutes 2022, section 245.735, is amended by adding a subdivision
to read:
new text begin Subd. 4c. new text end
new text begin Requirements for initial evaluations. new text end
new text begin
(a) A CCBHC must complete either
an initial evaluation or a comprehensive evaluation within ten business days of the
preliminary screening and risk assessment.
new text end
new text begin
(b) Notwithstanding any law to the contrary, an initial evaluation performed by a CCBHC
that meets the requirements of this subdivision satisfies the requirements in:
new text end
new text begin
(1) section 245.4711, subdivision 4;
new text end
new text begin
(2) section 245.4881, subdivisions 3 and 4;
new text end
new text begin
(3) section 245I.10, subdivision 5;
new text end
new text begin
(4) section 256B.0623, subdivisions 3, clause (4), 8, and 10;
new text end
new text begin
(5) section 256B.0943, subdivisions 3 and 6, paragraph (b), clauses (1) and (2);
new text end
new text begin
(6) Minnesota Rules, part 9520.0909, subpart 1;
new text end
new text begin
(7) Minnesota Rules, part 9520.0910, subpart 1;
new text end
new text begin
(8) Minnesota Rules, part 9520.0914, subpart 2;
new text end
new text begin
(9) Minnesota Rules, part 9520.0918, subparts 1 and 2; and
new text end
new text begin
(10) Minnesota Rules, part 9520.0919, subpart 2.
new text end
Sec. 17.
Minnesota Statutes 2022, section 245.735, is amended by adding a subdivision
to read:
new text begin Subd. 4d. new text end
new text begin Requirements for integrated treatment plans. new text end
new text begin
(a) An integrated treatment
plan must be completed within 60 calendar days following the preliminary screening and
risk assessment and updated no less frequently than every six months or when the client's
circumstances change.
new text end
new text begin
(b) Only a mental health professional may complete an integrated treatment plan. The
mental health professional must consult with an alcohol and drug counselor when substance
use disorder services are deemed clinically appropriate. An alcohol and drug counselor may
approve the integrated treatment plan. The integrated treatment plan must be developed
through a shared decision-making process with the client, the client's support system if the
client chooses, or, for children, with the family or caregivers.
new text end
new text begin
(c) The integrated treatment plan must:
new text end
new text begin
(1) use the ASAM 6 dimensional framework; and
new text end
new text begin
(2) incorporate prevention, medical and behavioral health needs, and service delivery.
new text end
new text begin
(d) The psychiatric evaluation and management service fulfills requirements for the
integrated treatment plan when a client of a CCBHC is receiving exclusively psychiatric
evaluation and management services. The CCBHC must complete an integrated treatment
plan within 60 calendar days of a client's referral for additional CCBHC services.
new text end
new text begin
(e) Notwithstanding any law to the contrary, an integrated treatment plan developed by
a CCBHC that meets the requirements of this subdivision satisfies the requirements in:
new text end
new text begin
(1) section 245G.06, subdivision 1;
new text end
new text begin
(2) section 245G.09, subdivision 3, clause (6);
new text end
new text begin
(3) section 245I.10, subdivisions 7 and 8;
new text end
new text begin
(4) section 256B.0623, subdivision 10; and
new text end
new text begin
(5) section 256B.0943, subdivision 6, paragraph (b), clause (2).
new text end
Sec. 18.
Minnesota Statutes 2022, section 245.735, subdivision 5, is amended to read:
Subd. 5.
Information systems support.
The commissioner and the state chief information
officer shall provide information systems support to the projects as necessary to comply
with state and federal requirementsnew text begin , including data reporting requirementsnew text end .
Sec. 19.
Minnesota Statutes 2022, section 245.735, subdivision 6, is amended to read:
Subd. 6.
deleted text begin Demonstrationdeleted text end new text begin Section 223 of the Protecting Access to Medicare Actnew text end
entities.
new text begin (a) new text end The commissioner deleted text begin may operatedeleted text end new text begin must request federal approval to participate innew text end
the demonstration program established by section 223 of the Protecting Access to Medicare
Actnew text begin and,new text end if new text begin approved, to continue to participate in the demonstration program as long as
new text end federal funding for the demonstration program remains available from the United States
Department of Health and Human Services. To the extent practicable, the commissioner
shall align the requirements of the demonstration program with the requirements under this
section for CCBHCs receiving medical assistance reimbursementnew text begin under the authority of the
state's Medicaid state plannew text end . A CCBHC may not apply to participate as a billing provider in
both the CCBHC federal demonstration and the benefit for CCBHCs under the medical
assistance program.
new text begin
(b) The commissioner must follow federal payment guidance, including payment of the
CCBHC daily bundled rate for services rendered by CCBHCs to individuals who are dually
eligible for Medicare and medical assistance when Medicare is the primary payer for the
service. An entity that receives a CCBHC daily bundled rate that overlaps with another
federal Medicaid methodology is not eligible for the CCBHC rate. Services provided by a
CCBHC operating under the authority of the state's Medicaid state plan will not receive the
prospective payment system rate for services rendered by CCBHCs to individuals who are
dually eligible for Medicare and medical assistance when Medicare is the primary payer
for the service.
new text end
new text begin
(c) Payment for services rendered by CCBHCs to individuals who have commercial
insurance as the primary payer and medical assistance as secondary payer is subject to the
requirements under section 256B.37. Services provided by a CCBHC operating under the
authority of the 223 demonstration or the state's Medicaid state plan will not receive the
prospective payment system rate for services rendered by CCBHCs to individuals who have
commercial insurance as the primary payer and medical assistance as the secondary payer.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective upon federal approval. The commissioner
of human services must notify the revisor of statutes when federal approval is obtained.
new text end
Sec. 20.
Minnesota Statutes 2022, section 245.735, is amended by adding a subdivision
to read:
new text begin Subd. 7. new text end
new text begin Addition of CCBHCs to section 223 state demonstration programs. new text end
new text begin
(a) If
the commissioner's request under subdivision 6 to reenter the demonstration program
established by section 223 of the Protecting Access to Medicare Act is approved, upon
reentry the commissioner must follow all federal guidance on the addition of CCBHCs to
section 223 state demonstration programs.
new text end
new text begin
(b) Prior to participating in the demonstration, a CCBHC must meet the demonstration
certification criteria and prospective payment system guidance in effect at that time and be
certified as a CCBHC by the state. The Substance Abuse and Mental Health Services
Administration attestation process for CCBHC expansion grants is not sufficient to constitute
state certification. CCBHCs newly added to the demonstration must participate in all aspects
of the state demonstration program, including but not limited to quality measurement and
reporting, evaluation activities, and state CCBHC demonstration program requirements,
such as use of state-specified evidence-based practices. A newly added CCBHC must report
on quality measures before its first full demonstration year if it joined the demonstration
program in calendar year 2023 out of alignment with the state's demonstration year cycle.
A CCBHC may provide services in multiple locations and in community-based settings
subject to federal rules of the 223 demonstration authority or Medicaid state plan authority.
new text end
new text begin
(c) If a CCBHC meets the definition of a satellite facility, as defined by the Substance
Abuse and Mental Health Services Administration, and was established after April 1, 2014,
the CCBHC cannot receive payment as a part of the demonstration program.
new text end
Sec. 21.
Minnesota Statutes 2022, section 245.735, is amended by adding a subdivision
to read:
new text begin Subd. 8. new text end
new text begin Grievance procedures required. new text end
new text begin
CCBHCs and designated collaborating
organizations must allow all service recipients access to grievance procedures, which must
satisfy the minimum requirements of medical assistance and other grievance requirements
such as those that may be mandated by relevant accrediting entities.
new text end
Sec. 22.
Minnesota Statutes 2022, section 245I.04, subdivision 14, is amended to read:
Subd. 14.
Mental health rehabilitation worker qualifications.
(a) A mental health
rehabilitation worker must:
(1) have a high school diploma or equivalent; deleted text begin and
deleted text end
new text begin
(2) have the training required under section 245I.05, subdivision 3, paragraph (c); and
new text end
deleted text begin (2)deleted text end new text begin (3)new text end meet one of the following qualification requirements:
(i) be fluent in the non-English language or competent in the culture of the ethnic group
to which at least 20 percent of the mental health rehabilitation worker's clients belong;
(ii) have an associate of arts degree;
(iii) have two years of full-time postsecondary education or a total of 15 semester hours
or 23 quarter hours in behavioral sciences or related fields;
(iv) be a registered nurse;
(v) have, within the previous ten years, three years of personal life experience with
mental illness;
(vi) have, within the previous ten years, three years of life experience as a primary
caregiver to an adult with a mental illness, traumatic brain injury, substance use disorder,
or developmental disability; or
(vii) have, within the previous ten years, 2,000 hours of work experience providing
health and human services to individuals.
(b) A mental health rehabilitation worker who is new text begin exclusively new text end scheduled as an overnight
staff person deleted text begin and works alonedeleted text end is exempt from the additional qualification requirements in
paragraph (a), clause deleted text begin (2)deleted text end new text begin (3)new text end .
Sec. 23.
Minnesota Statutes 2022, section 245I.04, subdivision 16, is amended to read:
Subd. 16.
Mental health behavioral aide qualifications.
(a) A level 1 mental health
behavioral aide must havenew text begin the training required under section 245I.05, subdivision 3,
paragraph (c), andnew text end : (1) a high school diploma or equivalent; or (2) two years of experience
as a primary caregiver to a child with mental illness within the previous ten years.
(b) A level 2 mental health behavioral aide mustdeleted text begin : (1)deleted text end havenew text begin the training required under
section 245I.05, subdivision 3, paragraph (c), andnew text end an associate or bachelor's degreedeleted text begin ; or (2)
be certified by a program under section 256B.0943, subdivision 8adeleted text end .
Sec. 24.
Minnesota Statutes 2022, section 245I.05, subdivision 3, is amended to read:
Subd. 3.
Initial training.
(a) A staff person must receive training about:
(1) vulnerable adult maltreatment under section 245A.65, subdivision 3; and
(2) the maltreatment of minor reporting requirements and definitions in chapter 260E
within 72 hours of first providing direct contact services to a client.
(b) Before providing direct contact services to a client, a staff person must receive training
about:
(1) client rights and protections under section 245I.12;
(2) the Minnesota Health Records Act, including client confidentiality, family engagement
under section 144.294, and client privacy;
(3) emergency procedures that the staff person must follow when responding to a fire,
inclement weather, a report of a missing person, and a behavioral or medical emergency;
(4) specific activities and job functions for which the staff person is responsible, including
the license holder's program policies and procedures applicable to the staff person's position;
(5) professional boundaries that the staff person must maintain; and
(6) specific needs of each client to whom the staff person will be providing direct contact
services, including each client's developmental status, cognitive functioning, and physical
and mental abilities.
(c) Before providing direct contact services to a client, a mental health rehabilitation
worker, mental health behavioral aide, or mental health practitioner required to receive the
training according to section 245I.04, subdivision 4, must receive 30 hours of training about:
(1) mental illnesses;
(2) client recovery and resiliency;
(3) mental health de-escalation techniques;
(4) co-occurring mental illness and substance use disorders; and
(5) psychotropic medications and medication side effects.
(d) Within 90 days of first providing direct contact services to an adult client, deleted text begin a clinical
trainee,deleted text end mental health practitioner, mental health certified peer specialist, or mental health
rehabilitation worker must receive training about:
(1) trauma-informed care and secondary trauma;
(2) person-centered individual treatment plans, including seeking partnerships with
family and other natural supports;
(3) co-occurring substance use disorders; and
(4) culturally responsive treatment practices.
(e) Within 90 days of first providing direct contact services to a child client, deleted text begin a clinical
trainee,deleted text end mental health practitioner, mental health certified family peer specialist, mental
health certified peer specialist, or mental health behavioral aide must receive training about
the topics in clauses (1) to (5). This training must address the developmental characteristics
of each child served by the license holder and address the needs of each child in the context
of the child's family, support system, and culture. Training topics must include:
(1) trauma-informed care and secondary trauma, including adverse childhood experiences
(ACEs);
(2) family-centered treatment plan development, including seeking partnership with a
child client's family and other natural supports;
(3) mental illness and co-occurring substance use disorders in family systems;
(4) culturally responsive treatment practices; and
(5) child development, including cognitive functioning, and physical and mental abilities.
(f) For a mental health behavioral aide, the training under paragraph (e) must include
parent team training using a curriculum approved by the commissioner.
Sec. 25.
Minnesota Statutes 2022, section 245I.08, subdivision 2, is amended to read:
Subd. 2.
Documentation standards.
A license holder must ensure that all documentation
required by this chapter:
(1) is legible;
(2) identifies the applicable client new text begin name on each page of the client file new text end and staff personnew text begin
namenew text end on each pagenew text begin of the personnel filenew text end ; and
(3) is signed and dated by the staff persons who provided services to the client or
completed the documentation, including the staff persons' credentials.
Sec. 26.
Minnesota Statutes 2022, section 245I.08, subdivision 3, is amended to read:
Subd. 3.
Documenting approval.
A license holder must ensure that all diagnostic
assessments, functional assessments, level of care assessments, and treatment plans completed
by a clinical trainee or mental health practitioner contain documentation of approval by a
treatment supervisor within deleted text begin fivedeleted text end new text begin 30new text end business days of initial completion by the staff person
under treatment supervision.
Sec. 27.
Minnesota Statutes 2022, section 245I.08, subdivision 4, is amended to read:
Subd. 4.
Progress notes.
A license holder must use a progress note to document each
occurrence of a mental health service that a staff person provides to a client. A progress
note must include the following:
(1) the type of service;
(2) the date of service;
(3) the start and stop time of the service unless the license holder is licensed as a
residential program;
(4) the location of the service;
(5) the scope of the service, including: (i) the targeted goal and objective; (ii) the
intervention that the staff person provided to the client and the methods that the staff person
used; (iii) the client's response to the intervention;new text begin andnew text end (iv) the staff person's plan to take
future actions, including changes in treatment that the staff person will implement if the
intervention was ineffective; deleted text begin and (v) the service modality;
deleted text end
(6) the signature and credentials of the staff person who provided the service to the
client;
(7) the mental health provider travel documentation required by section 256B.0625, if
applicable; and
(8) significant observations by the staff person, if applicable, including: (i) the client's
current risk factors; (ii) emergency interventions by staff persons; (iii) consultations with
or referrals to other professionals, family, or significant others; and (iv) changes in the
client's mental or physical symptoms.
Sec. 28.
Minnesota Statutes 2022, section 245I.10, subdivision 2, is amended to read:
Subd. 2.
Generally.
(a) A license holder must use a client's diagnostic assessment or
crisis assessment to determine a client's eligibility for mental health services, except as
provided in this section.
(b) Prior to completing a client's initial diagnostic assessment, a license holder may
provide a client with the following services:
(1) an explanation of findings;
(2) neuropsychological testing, neuropsychological assessment, and psychological
testing;
(3) any combination of psychotherapy sessions, family psychotherapy sessions, and
family psychoeducation sessions not to exceed three sessions;
(4) crisis assessment services according to section 256B.0624; and
(5) ten days of intensive residential treatment services according to the assessment and
treatment planning standards in section 245I.23, subdivision 7.
(c) Based on the client's needs that a crisis assessment identifies under section 256B.0624,
a license holder may provide a client with the following services:
(1) crisis intervention and stabilization services under section 245I.23 or 256B.0624;
and
(2) any combination of psychotherapy sessions, group psychotherapy sessions, family
psychotherapy sessions, and family psychoeducation sessions not to exceed ten sessions
within a 12-month period without prior authorization.
(d) Based on the client's needs in the client's brief diagnostic assessment, a license holder
may provide a client with any combination of psychotherapy sessions, group psychotherapy
sessions, family psychotherapy sessions, and family psychoeducation sessions not to exceed
ten sessions within a 12-month period without prior authorization for any new client or for
an existing client who the license holder projects will need fewer than ten sessions during
the next 12 months.
(e) Based on the client's needs that a hospital's medical history and presentation
examination identifies, a license holder may provide a client with:
(1) any combination of psychotherapy sessions, group psychotherapy sessions, family
psychotherapy sessions, and family psychoeducation sessions not to exceed ten sessions
within a 12-month period without prior authorization for any new client or for an existing
client who the license holder projects will need fewer than ten sessions during the next 12
months; and
(2) up to five days of day treatment services or partial hospitalization.
(f) A license holder must complete a new standard diagnostic assessment of a clientnew text begin or
an update to an assessment as permitted under paragraph (g)new text end :
(1) when the client requires services of a greater number or intensity than the services
that paragraphs (b) to (e) describe;
(2) deleted text begin at least annually following the client's initial diagnostic assessmentdeleted text end if the client needs
additional mental health services and the client does not meet the criteria for a brief
assessment;
(3) when the client's mental health condition has changed markedly since the client's
most recent diagnostic assessment; deleted text begin or
deleted text end
(4) when the client's current mental health condition does not meet the criteria of the
client's current diagnosisdeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(5) upon the client's request.
new text end
(g) For deleted text begin an existingdeleted text end new text begin a new text end clientnew text begin who is already engaged in services and has a prior assessmentnew text end ,
the license holder must deleted text begin ensure that a new standard diagnostic assessment includesdeleted text end new text begin completenew text end
a written update containing all significant new or changed information about the client,new text begin
removal of outdated or inaccurate information,new text end and an update regarding what information
has not significantly changed, including a discussion with the client about changes in the
client's life situation, functioning, presenting problems, and progress with achieving treatment
goals since the client's last diagnostic assessment was completed.
Sec. 29.
Minnesota Statutes 2022, section 245I.10, subdivision 3, is amended to read:
Subd. 3.
Continuity of services.
(a) For any client with a diagnostic assessment
completed under Minnesota Rules, parts 9505.0370 to 9505.0372, before July 1, 2022, or
upon federal approval, whichever is later, the diagnostic assessment is valid for authorizing
the client's treatment and billing for one calendar year after the date that the assessment was
completed.
(b) For any client with an individual treatment plan completed under section 256B.0622,
256B.0623, 256B.0943, 256B.0946, or 256B.0947 or Minnesota Rules, parts 9505.0370 to
9505.0372, the client's treatment plan is valid for authorizing treatment and billing until the
treatment plan's expiration date.
(c) This subdivision expires deleted text begin July 1deleted text end new text begin October 17new text end , 2023.
Sec. 30.
Minnesota Statutes 2022, section 245I.10, subdivision 5, is amended to read:
Subd. 5.
Brief diagnostic assessment; required elements.
(a) Only a mental health
professional or clinical trainee may complete a brief diagnostic assessment of a client. deleted text begin A
license holder may only use a brief diagnostic assessment for a client who is six years of
age or older.
deleted text end
(b) When conducting a brief diagnostic assessment of a client, the assessor must complete
a face-to-face interview with the client and a written evaluation of the client. The assessor
must gather and document initial components of the client's standard diagnostic assessment,
including the client's:
(1) age;
(2) description of symptoms, including the reason for the client's referral;
(3) history of mental health treatment;
(4) cultural influences on the client; and
(5) mental status examination.
(c) Based on the initial components of the assessment, the assessor must develop a
provisional diagnostic formulation about the client. The assessor may use the client's
provisional diagnostic formulation to address the client's immediate needs and presenting
problems.
(d) A mental health professional or clinical trainee may use treatment sessions with the
client authorized by a brief diagnostic assessment to gather additional information about
the client to complete the client's standard diagnostic assessment if the number of sessions
will exceed the coverage limits in subdivision 2.
Sec. 31.
Minnesota Statutes 2022, section 245I.10, subdivision 6, is amended to read:
Subd. 6.
Standard diagnostic assessment; required elements.
(a) Only a mental health
professional or a clinical trainee may complete a standard diagnostic assessment of a client.
A standard diagnostic assessment of a client must include a face-to-face interview with a
client and a written evaluation of the client. The assessor must complete a client's standard
diagnostic assessment within the client's cultural context.
(b) When completing a standard diagnostic assessment of a client, the assessor must
gather and document information about the client's current life situation, including the
following information:
(1) the client's age;
(2) the client's current living situation, including the client's housing status and household
members;
(3) the status of the client's basic needs;
(4) the client's education level and employment status;
(5) the client's current medications;
(6) any immediate risks to the client's health and safety;
(7) the client's perceptions of the client's condition;
(8) the client's description of the client's symptoms, including the reason for the client's
referral;
(9) the client's history of mental health treatment; and
(10) cultural influences on the client.
(c) If the assessor cannot obtain the information that this paragraph requires without
retraumatizing the client or harming the client's willingness to engage in treatment, the
assessor must identify which topics will require further assessment during the course of the
client's treatment. The assessor must gather and document information related to the following
topics:
(1) the client's relationship with the client's family and other significant personal
relationships, including the client's evaluation of the quality of each relationship;
(2) the client's strengths and resources, including the extent and quality of the client's
social networks;
(3) important developmental incidents in the client's life;
(4) maltreatment, trauma, potential brain injuries, and abuse that the client has suffered;
(5) the client's history of or exposure to alcohol and drug usage and treatment; and
(6) the client's health history and the client's family health history, including the client's
physical, chemical, and mental health history.
(d) When completing a standard diagnostic assessment of a client, an assessor must use
a recognized diagnostic framework.
(1) When completing a standard diagnostic assessment of a client who is five years of
age or younger, the assessor must use the current edition of the DC: 0-5 Diagnostic
Classification of Mental Health and Development Disorders of Infancy and Early Childhood
published by Zero to Three.
(2) When completing a standard diagnostic assessment of a client who is six years of
age or older, the assessor must use the current edition of the Diagnostic and Statistical
Manual of Mental Disorders published by the American Psychiatric Association.
deleted text begin
(3) When completing a standard diagnostic assessment of a client who is five years of
deleted text end
deleted text begin
age or younger, an assessor must administer the Early Childhood Service Intensity Instrument
deleted text end
deleted text begin
(ECSII) to the client and include the results in the client's assessment.
deleted text end
deleted text begin
(4) When completing a standard diagnostic assessment of a client who is six to 17 years
deleted text end
deleted text begin
of age, an assessor must administer the Child and Adolescent Service Intensity Instrument
deleted text end
deleted text begin
(CASII) to the client and include the results in the client's assessment.
deleted text end
deleted text begin (5)deleted text end new text begin (3)new text end When completing a standard diagnostic assessment of a client who is 18 years
of age or older, an assessor must use either (i) the CAGE-AID Questionnaire or (ii) the
criteria in the most recent edition of the Diagnostic and Statistical Manual of Mental
Disorders published by the American Psychiatric Association to screen and assess the client
for a substance use disorder.
(e) When completing a standard diagnostic assessment of a client, the assessor must
include and document the following components of the assessment:
(1) the client's mental status examination;
(2) the client's baseline measurements; symptoms; behavior; skills; abilities; resources;
vulnerabilities; safety needs, including client information that supports the assessor's findings
after applying a recognized diagnostic framework from paragraph (d); and any differential
diagnosis of the client;
(3) an explanation of: (i) how the assessor diagnosed the client using the information
from the client's interview, assessment, psychological testing, and collateral information
about the client; (ii) the client's needs; (iii) the client's risk factors; (iv) the client's strengths;
and (v) the client's responsivity factors.
(f) When completing a standard diagnostic assessment of a client, the assessor must
consult the client and the client's family about which services that the client and the family
prefer to treat the client. The assessor must make referrals for the client as to services required
by law.
new text begin
(g) Information from other providers and prior assessments may be used to complete
the diagnostic assessment if the source of the information is documented in the diagnostic
assessment.
new text end
Sec. 32.
Minnesota Statutes 2022, section 245I.10, subdivision 7, is amended to read:
Subd. 7.
Individual treatment plan.
A license holder must follow each client's written
individual treatment plan when providing services to the client with the following exceptions:
(1) services that do not require that a license holder completes a standard diagnostic
assessment of a client before providing services to the client;
(2) when developing a new text begin treatment or new text end service plan; and
(3) when a client re-engages in services under subdivision 8, paragraph (b).
Sec. 33.
Minnesota Statutes 2022, section 245I.10, subdivision 8, is amended to read:
Subd. 8.
Individual treatment plan; required elements.
(a) After completing a client's
diagnostic assessment new text begin or reviewing a client's diagnostic assessment received from a different
provider new text end and before providing services to the clientnew text begin beyond those permitted under subdivision
7new text end , the license holder must complete the client's individual treatment plan. The license holder
must:
(1) base the client's individual treatment plan on the client's diagnostic assessment and
baseline measurements;
(2) for a child client, use a child-centered, family-driven, and culturally appropriate
planning process that allows the child's parents and guardians to observe and participate in
the child's individual and family treatment services, assessments, and treatment planning;
(3) for an adult client, use a person-centered, culturally appropriate planning process
that allows the client's family and other natural supports to observe and participate in the
client's treatment services, assessments, and treatment planning;
(4) identify the client's treatment goals, measureable treatment objectives, a schedule
for accomplishing the client's treatment goals and objectives, a treatment strategy, and the
individuals responsible for providing treatment services and supports to the client. The
license holder must have a treatment strategy to engage the client in treatment if the client:
(i) has a history of not engaging in treatment; and
(ii) is ordered by a court to participate in treatment services or to take neuroleptic
medications;
(5) identify the participants involved in the client's treatment planning. The client must
be a participant in the client's treatment planning. If applicable, the license holder must
document the reasons that the license holder did not involve the client's family or other
natural supports in the client's treatment planning;
(6) review the client's individual treatment plan every 180 days and update the client's
individual treatment plan with the client's treatment progress, new treatment objectives and
goals or, if the client has not made treatment progress, changes in the license holder's
approach to treatment; and
(7) ensure that the client approves of the client's individual treatment plan unless a court
orders the client's treatment plan under chapter 253B.
(b) If the client disagrees with the client's treatment plan, the license holder must
document in the client file the reasons why the client does not agree with the treatment plan.
If the license holder cannot obtain the client's approval of the treatment plan, a mental health
professional must make efforts to obtain approval from a person who is authorized to consent
on the client's behalf within 30 days after the client's previous individual treatment plan
expired. A license holder may not deny a client service during this time period solely because
the license holder could not obtain the client's approval of the client's individual treatment
plan. A license holder may continue to bill for the client's otherwise eligible services when
the client re-engages in services.
Sec. 34.
Minnesota Statutes 2022, section 245I.11, subdivision 3, is amended to read:
Subd. 3.
Storing and accounting for medications.
(a) If a license holder stores client
medications, the license holder must:
(1) store client medications in original containers in a locked location;
(2) store refrigerated client medications in special trays or containers that are separate
from food;
(3) store client medications marked "for external use only" in a compartment that is
separate from other client medications;
(4) store Schedule II deleted text begin to IVdeleted text end drugs listed in section 152.02, deleted text begin subdivisionsdeleted text end new text begin subdivision new text end 3 deleted text begin to
5deleted text end , in a compartment that is locked separately from other medications;
(5) ensure that only authorized staff persons have access to stored client medications;
(6) follow a documentation procedure deleted text begin on each shiftdeleted text end to account for all deleted text begin scheduleddeleted text end new text begin Schedule
II to Vnew text end drugsnew text begin listed in section 152.02, subdivisions 3 to 6new text end ; and
(7) record each incident when a staff person accepts a supply of client medications and
destroy discontinued, outdated, or deteriorated client medications.
(b) If a license holder is licensed as a residential program, the license holder must allow
clients who self-administer medications to keep a private medication supply. The license
holder must ensure that the client stores all private medication in a locked container in the
client's private living area, unless the private medication supply poses a health and safety
risk to any clients. A client must not maintain a private medication supply of a prescription
medication without a written medication order from a licensed prescriber and a prescription
label that includes the client's name.
Sec. 35.
Minnesota Statutes 2022, section 245I.11, subdivision 4, is amended to read:
Subd. 4.
Medication orders.
(a) If a license holder stores, prescribes, or administers
medications or observes a client self-administer medications, the license holder must:
(1) ensure that a licensed prescriber writes all orders to accept, administer, or discontinue
client medications;
(2) accept nonwritten orders to administer client medications in emergency circumstances
only;
(3) establish a timeline and process for obtaining a written order with the licensed
prescriber's signature when the license holder accepts a nonwritten order to administer client
medications;new text begin and
new text end
deleted text begin
(4) obtain prescription medication renewals from a licensed prescriber for each client
every 90 days for psychotropic medications and annually for all other medications; and
deleted text end
deleted text begin (5)deleted text end new text begin (4)new text end maintain the client's right to privacy and dignity.
(b) If a license holder employs a licensed prescriber, the license holder must inform the
client about potential medication effects and side effects and obtain and document the client's
informed consent before the licensed prescriber prescribes a medication.
Sec. 36.
Minnesota Statutes 2022, section 245I.20, subdivision 5, is amended to read:
Subd. 5.
Treatment supervision specified.
deleted text begin (a)deleted text end A mental health professional must remain
responsible for each client's case. The certification holder must document the name of the
mental health professional responsible for each case and the dates that the mental health
professional is responsible for the client's case from beginning date to end date. The
certification holder must assign each client's case for assessment, diagnosis, and treatment
services to a treatment team member who is competent in the assigned clinical service, the
recommended treatment strategy, and in treating the client's characteristics.
deleted text begin
(b) Treatment supervision of mental health practitioners and clinical trainees required
by section 245I.06 must include case reviews as described in this paragraph. Every two
months, a mental health professional must complete and document a case review of each
client assigned to the mental health professional when the client is receiving clinical services
from a mental health practitioner or clinical trainee. The case review must include a
consultation process that thoroughly examines the client's condition and treatment, including:
(1) a review of the client's reason for seeking treatment, diagnoses and assessments, and
the individual treatment plan; (2) a review of the appropriateness, duration, and outcome
of treatment provided to the client; and (3) treatment recommendations.
deleted text end
Sec. 37.
Minnesota Statutes 2022, section 245I.20, subdivision 6, is amended to read:
Subd. 6.
Additional policy and procedure requirements.
(a) In addition to the policies
and procedures required by section 245I.03, the certification holder must establish, enforce,
and maintain the policies and procedures required by this subdivision.
(b) The certification holder must have a clinical evaluation procedure to identify and
document each treatment team member's areas of competence.
(c) The certification holder must have policies and procedures for client intake and case
assignment that:
(1) outline the client intake process;
(2) describe how the mental health clinic determines the appropriateness of accepting a
client into treatment by reviewing the client's condition and need for treatment, the clinical
services that the mental health clinic offers to clients, and other available resources; and
(3) contain a process for assigning a client's case to a mental health professional who is
responsible for the client's case and other treatment team members.
new text begin
(d) Notwithstanding the requirements under section 245I.10, subdivisions 5 to 9, for the
required elements of a diagnostic assessment and a treatment plan, psychiatry billed as
evaluation and management services must be documented in accordance with the most
recent current procedural terminology as published by the American Medical Association.
new text end
Sec. 38.
Minnesota Statutes 2022, section 254B.02, subdivision 5, is amended to read:
Subd. 5.
deleted text begin Administrative adjustmentdeleted text end new text begin Local agency allocationnew text end .
The commissioner may
make payments to local agencies from money allocated under this section to support
deleted text begin administrative activities under sections 254B.03 and 254B.04deleted text end new text begin individuals with substance
use disordersnew text end . The deleted text begin administrativedeleted text end payment must not deleted text begin exceed the lesser of: (1) five percent
of the first $50,000, four percent of the next $50,000, and three percent of the remaining
payments for services from the special revenue account according to subdivision 1; or (2)deleted text end new text begin
be less than 133 percent ofnew text end the local agency deleted text begin administrativedeleted text end payment for the fiscal year ending
June 30, 2009, adjusted in proportion to the statewide change in the appropriation for this
chapter.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 39.
Minnesota Statutes 2022, section 254B.05, subdivision 1, is amended to read:
Subdivision 1.
Licensure required.
(a) Programs licensed by the commissioner are
eligible vendors. Hospitals may apply for and receive licenses to be eligible vendors,
notwithstanding the provisions of section 245A.03. American Indian programs that provide
substance use disorder treatment, extended care, transitional residence, or outpatient treatment
services, and are licensed by tribal government are eligible vendors.
(b) A licensed professional in private practice as defined in section 245G.01, subdivision
17, who meets the requirements of section 245G.11, subdivisions 1 and 4, is an eligible
vendor of a comprehensive assessment and assessment summary provided according to
section 245G.05, and treatment services provided according to sections 245G.06 and
245G.07, subdivision 1, paragraphs (a), clauses (1) to (5), and (b); and subdivision 2, clauses
(1) to (6).
(c) A county is an eligible vendor for a comprehensive assessment and assessment
summary when provided by an individual who meets the staffing credentials of section
245G.11, subdivisions 1 and 5, and completed according to the requirements of section
245G.05. A county is an eligible vendor of care coordination services when provided by an
individual who meets the staffing credentials of section 245G.11, subdivisions 1 and 7, and
provided according to the requirements of section 245G.07, subdivision 1, paragraph (a),
clause (5).
(d) A recovery community organization that meets certification requirements identified
by the commissioner is an eligible vendor of peer support services.
(e) Detoxification programs licensed under Minnesota Rules, parts 9530.6510 to
9530.6590, are not eligible vendors. Programs that are not licensed as a residential or
nonresidential substance use disorder treatment or withdrawal management program by the
commissioner or by tribal government or do not meet the requirements of subdivisions 1a
and 1b are not eligible vendors.
new text begin
(f) Hospitals, federally qualified health centers, and rural health clinics are eligible
vendors of a comprehensive assessment when the comprehensive assessment is completed
according to section 245G.05 and by an individual who meets the criteria of an alcohol and
drug counselor according to section 245G.11, subdivision 5. The alcohol and drug counselor
must be individually enrolled with the commissioner and reported on the claim as the
individual who provided the service.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective upon federal approval. The commissioner
of human services shall notify the revisor of statutes when federal approval is obtained.
new text end
Sec. 40.
Minnesota Statutes 2022, section 254B.05, subdivision 1a, is amended to read:
Subd. 1a.
Room and board provider requirements.
(a) deleted text begin Effective January 1, 2000,deleted text end
Vendors of room and board are eligible for behavioral health fund payment if the vendor:
(1) has rules prohibiting residents bringing chemicals into the facility or using chemicals
while residing in the facility and provide consequences for infractions of those rules;
(2) is determined to meet applicable health and safety requirements;
(3) is not a jail or prison;
(4) is not concurrently receiving funds under chapter 256I for the recipient;
(5) admits individuals who are 18 years of age or older;
(6) is registered as a board and lodging or lodging establishment according to section
157.17;
(7) has awake staff on site 24 hours per day;
(8) has staff who are at least 18 years of age and meet the requirements of section
245G.11, subdivision 1, paragraph (b);
(9) has emergency behavioral procedures that meet the requirements of section 245G.16;
(10) meets the requirements of section 245G.08, subdivision 5, if administering
medications to clients;
(11) meets the abuse prevention requirements of section 245A.65, including a policy on
fraternization and the mandatory reporting requirements of section 626.557;
(12) documents coordination with the treatment provider to ensure compliance with
section 254B.03, subdivision 2;
(13) protects client funds and ensures freedom from exploitation by meeting the
provisions of section 245A.04, subdivision 13;
(14) has a grievance procedure that meets the requirements of section 245G.15,
subdivision 2; and
(15) has sleeping and bathroom facilities for men and women separated by a door that
is locked, has an alarm, or is supervised by awake staff.
(b) Programs licensed according to Minnesota Rules, chapter 2960, are exempt from
paragraph (a), clauses (5) to (15).
(c) Programs providing children's mental health crisis admissions and stabilization under
section 245.4882, subdivision 6, are eligible vendors of room and board.
new text begin
(d) Programs providing children's residential services under section 245.4882, except
services for individuals who have a placement under chapter 260C or 260D, are eligible
vendors of room and board.
new text end
deleted text begin (d)deleted text end new text begin (e)new text end Licensed programs providing intensive residential treatment services or residential
crisis stabilization services pursuant to section 256B.0622 or 256B.0624 are eligible vendors
of room and board and are exempt from paragraph (a), clauses (6) to (15).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2023.
new text end
Sec. 41.
Minnesota Statutes 2022, section 256.478, subdivision 1, is amended to read:
Subdivision 1.
Purpose.
(a) The commissioner shall establish the transition to community
initiative to award grants to serve deleted text begin individualsdeleted text end new text begin children and adultsnew text end for whom supports and
services not covered by medical assistance would allow them to:
(1) live in the least restrictive setting and as independently as possible;
new text begin
(2) access services that support short- and long-term needs for developmental growth
or individualized treatment needs;
new text end
deleted text begin (2)deleted text end new text begin (3)new text end build or maintain relationships with family and friends; and
deleted text begin (3)deleted text end new text begin (4)new text end participate in community life.
(b) Grantees must ensure that deleted text begin individualsdeleted text end new text begin the individual or the child and familynew text end are
engaged in a process that involves person-centered planning and informed choice
decision-making. The informed choice decision-making process must provide accessible
written information and be experiential whenever possible.
Sec. 42.
Minnesota Statutes 2022, section 256.478, subdivision 2, is amended to read:
Subd. 2.
Eligibility.
deleted text begin An individualdeleted text end new text begin A child or adultnew text end is eligible for the transition to
community initiative if thedeleted text begin individual does not meet eligibility criteria for the medical
assistance program under deleted text end deleted text begin section deleted text end deleted text begin or deleted text end deleted text begin , but whodeleted text end new text begin child or adult can
demonstrate that current services are not capable of meeting individual treatment and service
needs that can be met in the community with support, and the child or adultnew text end meets at least
one of the following criteria:
(1) the person otherwise meets the criteria under section 256B.092, subdivision 13, or
256B.49, subdivision 24;
(2) the person has met treatment objectives and no longer requires a hospital-level care
or a secure treatment setting, but the person's discharge from the Anoka Metro Regional
Treatment Center, the Minnesota deleted text begin Security Hospitaldeleted text end new text begin Forensic Mental Health Program, the
Child and Adolescent Behavioral Health Hospital program, a psychiatric residential treatment
facility under section 256B.0941, intensive residential treatment services under section
256B.0622, children's residential services under section 245.4882new text end , new text begin juvenile detention facility,
county supervised building, new text end or a deleted text begin community behavioral healthdeleted text end hospital would be substantially
delayed without additional resources available through the transitions to community initiative;
deleted text begin
(3) the person is in a community hospital, but alternative community living options
would be appropriate for the person, and the person has received approval from the
commissioner; or
deleted text end
deleted text begin (4)(i)deleted text end new text begin (3)new text end the person new text begin (i) new text end is receiving customized living services reimbursed under section
256B.4914, 24-hour customized living services reimbursed under section 256B.4914, or
community residential services reimbursed under section 256B.4914; (ii) deleted text begin the persondeleted text end expresses
a desire to move; and (iii) deleted text begin the persondeleted text end has received approval from the commissionerdeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(4) the person can demonstrate that the person's needs are beyond the scope of current
service designs and grant funding can support the inclusion of additional supports for the
person to access appropriate treatment and services in the least restrictive environment.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2023.
new text end
Sec. 43.
Minnesota Statutes 2022, section 256B.0616, subdivision 3, is amended to read:
Subd. 3.
Eligibility.
Family peer support services deleted text begin maydeleted text end new text begin shallnew text end be provided to recipients
deleted text begin of inpatient hospitalization, partial hospitalization, residential treatment, children's intensive
behavioral health services, day treatment, children's therapeutic services and supports, or
crisis servicesdeleted text end new text begin eligible under medical assistance, upon a determination by a licensed mental
health providernew text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024, or upon federal approval,
whichever is later.
new text end
Sec. 44.
Minnesota Statutes 2022, section 256B.0616, subdivision 4, is amended to read:
Subd. 4.
Peer support specialist program providers.
The commissioner shall develop
a process to certify family new text begin and youthnew text end peer support specialist programsnew text begin and associated training
supportnew text end , in accordance with the federal guidelinesdeleted text begin ,deleted text end in order for the program to bill for
reimbursable services. Family new text begin and youthnew text end peer support programs must operate within an
existing mental health community provider or center.
Sec. 45.
Minnesota Statutes 2022, section 256B.0616, subdivision 5, is amended to read:
Subd. 5.
Certified family new text begin and youth new text end peer specialist training and certification.
The
commissioner shall develop deleted text begin adeleted text end new text begin or approve the use of an existingnew text end training and certification
process for certified familynew text begin and youthnew text end peer specialists. deleted text begin Thedeleted text end new text begin Family peernew text end candidates must
have raised or be currently raising a child with a mental illness, have had experience
navigating the children's mental health system, and deleted text begin mustdeleted text end demonstrate leadership and advocacy
skills and a strong dedication to family-driven and family-focused services. new text begin Youth peer
candidates must have demonstrated lived experience in children's mental health or related
adverse experiences in adolescence, a high school degree, and leadership and advocacy
skills with a focus on supporting client voice. new text end The training curriculum must teach participating
family new text begin and youth new text end peer specialists specific skills relevant to providing peer support to other
parentsnew text begin or to youth in mental health treatmentnew text end . In addition to initial training and certification,
the commissioner shall develop ongoing continuing educational workshops on pertinent
issues related to family new text begin and youth new text end peer support counseling.new text begin Training for family and youth
peer support specialists may be delivered by the commissioner or by organizations approved
by the commissioner.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024, or upon federal approval,
whichever is later.
new text end
Sec. 46.
Minnesota Statutes 2022, section 256B.0622, subdivision 7a, is amended to read:
Subd. 7a.
Assertive community treatment team staff requirements and roles.
(a)
The required treatment staff qualifications and roles for an ACT team are:
(1) the team leader:
(i) shall be a mental health professional. Individuals who are not licensed but who are
eligible for licensure and are otherwise qualified may also fulfill this role deleted text begin but must obtain
full licensure within 24 months of assuming the role of team leaderdeleted text end ;
(ii) must be an active member of the ACT team and provide some direct services to
clients;
(iii) must be a single full-time staff member, dedicated to the ACT team, who is
responsible for overseeing the administrative operations of the teamdeleted text begin , providing treatment
supervision of services in conjunction with the psychiatrist or psychiatric care provider,deleted text end and
supervising team members to ensure delivery of best and ethical practices; and
(iv) must be available to provide overall treatment supervision to the ACT team after
regular business hours and on weekends and holidays. The team leader maynew text begin at any timenew text end
delegate this duty to another qualified deleted text begin member of the ACT teamdeleted text end new text begin licensed professionalnew text end ;
(2) the psychiatric care provider:
(i) must be a mental health professional permitted to prescribe psychiatric medications
as part of the mental health professional's scope of practice. The psychiatric care provider
must have demonstrated clinical experience working with individuals with serious and
persistent mental illness;
(ii) shall collaborate with the team leader in sharing overall clinical responsibility for
screening and admitting clients; monitoring clients' treatment and team member service
delivery; educating staff on psychiatric and nonpsychiatric medications, their side effects,
and health-related conditions; actively collaborating with nurses; and helping provide
treatment supervision to the team;
(iii) shall fulfill the following functions for assertive community treatment clients:
provide assessment and treatment of clients' symptoms and response to medications, including
side effects; provide brief therapy to clients; provide diagnostic and medication education
to clients, with medication decisions based on shared decision making; monitor clients'
nonpsychiatric medical conditions and nonpsychiatric medications; and conduct home and
community visits;
(iv) shall serve as the point of contact for psychiatric treatment if a client is hospitalized
for mental health treatment and shall communicate directly with the client's inpatient
psychiatric care providers to ensure continuity of care;
(v) shall have a minimum full-time equivalency that is prorated at a rate of 16 hours per
50 clients. Part-time psychiatric care providers shall have designated hours to work on the
team, with sufficient blocks of time on consistent days to carry out the provider's clinical,
supervisory, and administrative responsibilities. No more than two psychiatric care providers
may share this role; and
(vi) shall provide psychiatric backup to the program after regular business hours and on
weekends and holidays. The psychiatric care provider may delegate this duty to another
qualified psychiatric provider;
(3) the nursing staff:
(i) shall consist of one to three registered nurses or advanced practice registered nurses,
of whom at least one has a minimum of one-year experience working with adults with
serious mental illness and a working knowledge of psychiatric medications. No more than
two individuals can share a full-time equivalent position;
(ii) are responsible for managing medication, administering and documenting medication
treatment, and managing a secure medication room; and
(iii) shall develop strategies, in collaboration with clients, to maximize taking medications
as prescribed; screen and monitor clients' mental and physical health conditions and
medication side effects; engage in health promotion, prevention, and education activities;
communicate and coordinate services with other medical providers; facilitate the development
of the individual treatment plan for clients assigned; and educate the ACT team in monitoring
psychiatric and physical health symptoms and medication side effects;
(4) the co-occurring disorder specialist:
(i) shall be a full-time equivalent co-occurring disorder specialist who has received
specific training on co-occurring disorders that is consistent with national evidence-based
practices. The training must include practical knowledge of common substances and how
they affect mental illnesses, the ability to assess substance use disorders and the client's
stage of treatment, motivational interviewing, and skills necessary to provide counseling to
clients at all different stages of change and treatment. The co-occurring disorder specialist
may also be an individual who is a licensed alcohol and drug counselor as described in
section 148F.01, subdivision 5, or a counselor who otherwise meets the training, experience,
and other requirements in section 245G.11, subdivision 5. No more than two co-occurring
disorder specialists may occupy this role; and
(ii) shall provide or facilitate the provision of co-occurring disorder treatment to clients.
The co-occurring disorder specialist shall serve as a consultant and educator to fellow ACT
team members on co-occurring disorders;
(5) the vocational specialist:
(i) shall be a full-time vocational specialist who has at least one-year experience providing
employment services or advanced education that involved field training in vocational services
to individuals with mental illness. An individual who does not meet these qualifications
may also serve as the vocational specialist upon completing a training plan approved by the
commissioner;
(ii) shall provide or facilitate the provision of vocational services to clients. The vocational
specialist serves as a consultant and educator to fellow ACT team members on these services;
and
(iii) must not refer individuals to receive any type of vocational services or linkage by
providers outside of the ACT team;
(6) the mental health certified peer specialist:
(i) shall be a full-time equivalent. No more than two individuals can share this position.
The mental health certified peer specialist is a fully integrated team member who provides
highly individualized services in the community and promotes the self-determination and
shared decision-making abilities of clients. This requirement may be waived due to workforce
shortages upon approval of the commissioner;
(ii) must provide coaching, mentoring, and consultation to the clients to promote recovery,
self-advocacy, and self-direction, promote wellness management strategies, and assist clients
in developing advance directives; and
(iii) must model recovery values, attitudes, beliefs, and personal action to encourage
wellness and resilience, provide consultation to team members, promote a culture where
the clients' points of view and preferences are recognized, understood, respected, and
integrated into treatment, and serve in a manner equivalent to other team members;
(7) the program administrative assistant shall be a full-time office-based program
administrative assistant position assigned to solely work with the ACT team, providing a
range of supports to the team, clients, and families; and
(8) additional staff:
(i) shall be based on team size. Additional treatment team staff may include mental
health professionals; clinical trainees; certified rehabilitation specialists; mental health
practitioners; or mental health rehabilitation workers. These individuals shall have the
knowledge, skills, and abilities required by the population served to carry out rehabilitation
and support functions; and
(ii) shall be selected based on specific program needs or the population served.
(b) Each ACT team must clearly document schedules for all ACT team members.
(c) Each ACT team member must serve as a primary team member for clients assigned
by the team leader and are responsible for facilitating the individual treatment plan process
for those clients. The primary team member for a client is the responsible team member
knowledgeable about the client's life and circumstances and writes the individual treatment
plan. The primary team member provides individual supportive therapy or counseling, and
provides primary support and education to the client's family and support system.
(d) Members of the ACT team must have strong clinical skills, professional qualifications,
experience, and competency to provide a full breadth of rehabilitation services. Each staff
member shall be proficient in their respective discipline and be able to work collaboratively
as a member of a multidisciplinary team to deliver the majority of the treatment,
rehabilitation, and support services clients require to fully benefit from receiving assertive
community treatment.
(e) Each ACT team member must fulfill training requirements established by the
commissioner.
Sec. 47.
Minnesota Statutes 2022, section 256B.0622, subdivision 7b, is amended to read:
Subd. 7b.
Assertive community treatment program size and opportunities.
(a) Each
ACT team shall maintain an annual average caseload that does not exceed 100 clients.
Staff-to-client ratios shall be based on team size as follows:
(1) a small ACT team must:
(i) employ at least six but no more than seven full-time treatment team staff, excluding
the program assistant and the psychiatric care provider;
(ii) serve an annual average maximum of no more than 50 clients;
(iii) ensure at least one full-time equivalent position for every eight clients served;
(iv) schedule ACT team staff deleted text begin for at least eight-hour shift coveragedeleted text end on weekdays and
on-call duty to provide crisis services and deliver services after hours when staff are not
working;
(v) provide crisis services during business hours if the small ACT team does not have
sufficient staff numbers to operate an after-hours on-call system. During all other hours,
the ACT team may arrange for coverage for crisis assessment and intervention services
through a reliable crisis-intervention provider as long as there is a mechanism by which the
ACT team communicates routinely with the crisis-intervention provider and the on-call
ACT team staff are available to see clients face-to-face when necessary or if requested by
the crisis-intervention services provider;
(vi) adjust schedules and provide staff to carry out the needed service activities in the
evenings or on weekend days or holidays, when necessary;
(vii) arrange for and provide psychiatric backup during all hours the psychiatric care
provider is not regularly scheduled to work. If availability of the ACT team's psychiatric
care provider during all hours is not feasible, alternative psychiatric prescriber backup must
be arranged and a mechanism of timely communication and coordination established in
writing; and
(viii) be composed of, at minimum, one full-time team leader, at least 16 hours each
week per 50 clients of psychiatric provider time, or equivalent if fewer clients, one full-time
equivalent nursing, one full-time co-occurring disorder specialist, one full-time equivalent
mental health certified peer specialist, one full-time vocational specialist, one full-time
program assistant, and at least one additional full-time ACT team member who has mental
health professional, certified rehabilitation specialist, clinical trainee, or mental health
practitioner status; and
(2) a midsize ACT team shall:
(i) be composed of, at minimum, one full-time team leader, at least 16 hours of psychiatry
time for 51 clients, with an additional two hours for every six clients added to the team, 1.5
to two full-time equivalent nursing staff, one full-time co-occurring disorder specialist, one
full-time equivalent mental health certified peer specialist, one full-time vocational specialist,
one full-time program assistant, and at least 1.5 to two additional full-time equivalent ACT
members, with at least one dedicated full-time staff member with mental health professional
status. Remaining team members may have mental health professional, certified rehabilitation
specialist, clinical trainee, or mental health practitioner status;
(ii) employ seven or more treatment team full-time equivalents, excluding the program
assistant and the psychiatric care provider;
(iii) serve an annual average maximum caseload of 51 to 74 clients;
(iv) ensure at least one full-time equivalent position for every nine clients served;
(v) schedule ACT team staff for a minimum of ten-hour shift coverage on weekdays
and six- to eight-hour shift coverage on weekends and holidays. In addition to these minimum
specifications, staff are regularly scheduled to provide the necessary services on a
client-by-client basis in the evenings and on weekends and holidays;
(vi) schedule ACT team staff on-call duty to provide crisis services and deliver services
when staff are not working;
(vii) have the authority to arrange for coverage for crisis assessment and intervention
services through a reliable crisis-intervention provider as long as there is a mechanism by
which the ACT team communicates routinely with the crisis-intervention provider and the
on-call ACT team staff are available to see clients face-to-face when necessary or if requested
by the crisis-intervention services provider; and
(viii) arrange for and provide psychiatric backup during all hours the psychiatric care
provider is not regularly scheduled to work. If availability of the psychiatric care provider
during all hours is not feasible, alternative psychiatric prescriber backup must be arranged
and a mechanism of timely communication and coordination established in writing;
(3) a large ACT team must:
(i) be composed of, at minimum, one full-time team leader, at least 32 hours each week
per 100 clients, or equivalent of psychiatry time, three full-time equivalent nursing staff,
one full-time co-occurring disorder specialist, one full-time equivalent mental health certified
peer specialist, one full-time vocational specialist, one full-time program assistant, and at
least two additional full-time equivalent ACT team members, with at least one dedicated
full-time staff member with mental health professional status. Remaining team members
may have mental health professional or mental health practitioner status;
(ii) employ nine or more treatment team full-time equivalents, excluding the program
assistant and psychiatric care provider;
(iii) serve an annual average maximum caseload of 75 to 100 clients;
(iv) ensure at least one full-time equivalent position for every nine individuals served;
(v) schedule staff to work two eight-hour shifts, with a minimum of two staff on the
second shift providing services at least 12 hours per day weekdays. For weekends and
holidays, the team must operate and schedule ACT team staff to work one eight-hour shift,
with a minimum of two staff each weekend day and every holiday;
(vi) schedule ACT team staff on-call duty to provide crisis services and deliver services
when staff are not working; and
(vii) arrange for and provide psychiatric backup during all hours the psychiatric care
provider is not regularly scheduled to work. If availability of the ACT team psychiatric care
provider during all hours is not feasible, alternative psychiatric backup must be arranged
and a mechanism of timely communication and coordination established in writing.
(b) An ACT team of any size may have a staff-to-client ratio that is lower than the
requirements described in paragraph (a) upon approval by the commissioner, but may not
exceed a one-to-ten staff-to-client ratio.
Sec. 48.
Minnesota Statutes 2022, section 256B.0622, subdivision 7c, is amended to read:
Subd. 7c.
Assertive community treatment program organization and communication
requirements.
(a) An ACT team shall provide at least 75 percent of all services in the
community in non-office-based or non-facility-based settings.
(b) ACT team members must know all clients receiving services, and interventions must
be carried out with consistency and follow empirically supported practice.
(c) Each ACT team client shall be assigned an individual treatment team that is
determined by a variety of factors, including team members' expertise and skills, rapport,
and other factors specific to the individual's preferences. The majority of clients shall see
at least three ACT team members in a given month.
(d) The ACT team shall have the capacity to rapidly increase service intensity to a client
when the client's status requires it, regardless of geography, new text begin and new text end provide flexible service in
an individualized mannerdeleted text begin , and see clients on average three times per week for at least 120
minutes per weekdeleted text end new text begin at a frequency that meets the client's needsnew text end . Services must be available
at times that meet client needs.
(e) ACT teams shall make deliberate efforts to assertively engage clients in services.
Input of family members, natural supports, and previous and subsequent treatment providers
is required in developing engagement strategies. ACT teams shall include the client, identified
family, and other support persons in the admission, initial assessment, and planning process
as primary stakeholders, meet with the client in the client's environment at times of the day
and week that honor the client's preferences, and meet clients at home and in jails or prisons,
streets, homeless shelters, or hospitals.
(f) ACT teams shall ensure that a process is in place for identifying individuals in need
of more or less assertive engagement. Interventions are monitored to determine the success
of these techniques and the need to adapt the techniques or approach accordingly.
(g) ACT teams shall conduct daily team meetings to systematically update clinically
relevant information, briefly discuss the status of assertive community treatment clients
over the past 24 hours, problem solve emerging issues, plan approaches to address and
prevent crises, and plan the service contacts for the following 24-hour period or weekend.
All team members scheduled to work shall attend this meeting.
(h) ACT teams shall maintain a clinical log that succinctly documents important clinical
information and develop a daily team schedule for the day's contacts based on a central file
of the clients' weekly or monthly schedules, which are derived from interventions specified
within the individual treatment plan. The team leader must have a record to ensure that all
assigned contacts are completed.
Sec. 49.
Minnesota Statutes 2022, section 256B.0622, subdivision 8, is amended to read:
Subd. 8.
Medical assistance payment for assertive community treatment and
intensive residential treatment services.
(a) Payment for intensive residential treatment
services and assertive community treatment in this section shall be based on one daily rate
per provider inclusive of the following services received by an eligible client in a given
calendar day: all rehabilitative services under this section, staff travel time to provide
rehabilitative services under this section, and nonresidential crisis stabilization services
under section 256B.0624.
(b) Except as indicated in paragraph (c), payment will not be made to more than one
entity for each client for services provided under this section on a given day. If services
under this section are provided by a team that includes staff from more than one entity, the
team must determine how to distribute the payment among the members.
(c) The commissioner shall determine one rate for each provider that will bill medical
assistance for residential services under this section and one rate for each assertive community
treatment provider. If a single entity provides both services, one rate is established for the
entity's residential services and another rate for the entity's nonresidential services under
this section. A provider is not eligible for payment under this section without authorization
from the commissioner. The commissioner shall develop rates using the following criteria:
(1) the provider's cost for services shall include direct services costs, other program
costs, and other costs determined as follows:
(i) the direct services costs must be determined using actual costs of salaries, benefits,
payroll taxes, and training of direct service staff and service-related transportation;
(ii) other program costs not included in item (i) must be determined as a specified
percentage of the direct services costs as determined by item (i). The percentage used shall
be determined by the commissioner based upon the average of percentages that represent
the relationship of other program costs to direct services costs among the entities that provide
similar services;
(iii) physical plant costs calculated based on the percentage of space within the program
that is entirely devoted to treatment and programming. This does not include administrative
or residential space;
(iv) assertive community treatment physical plant costs must be reimbursed as part of
the costs described in item (ii); deleted text begin and
deleted text end
(v) subject to federal approval, up to an additional five percent of the total rate may be
added to the program rate as a quality incentive based upon the entity meeting performance
criteria specified by the commissioner;
new text begin
(vi) for assertive community treatment, intensive residential treatment services, and
residential crisis services, providers may include in their prospective cost-based rate-setting
methodology a line item reflecting estimated additional staffing compensation costs.
Estimated additional staffing compensation costs are subject to review by the commissioner;
and
new text end
new text begin
(vii) for intensive residential treatment services and residential crisis services, providers
may include in their prospective cost-based rate-setting methodology a line item reflecting
estimated new capital costs. Estimated new capital costs are subject to review by the
commissioner;
new text end
(2) actual cost is defined as costs which are allowable, allocable, and reasonable, and
consistent with federal reimbursement requirements under Code of Federal Regulations,
title 48, chapter 1, part 31, relating to for-profit entities, and Office of Management and
Budget Circular Number A-122, relating to nonprofit entities;
(3) the number of service units;
(4) the degree to which clients will receive services other than services under this section;
and
(5) the costs of other services that will be separately reimbursed.
(d) The rate for intensive residential treatment services and assertive community treatment
must exclude room and board, as defined in section 256I.03, subdivision 6, and services
not covered under this section, such as partial hospitalization, home care, and inpatient
services.
(e) Physician services that are not separately billed may be included in the rate to the
extent that a psychiatrist, or other health care professional providing physician services
within their scope of practice, is a member of the intensive residential treatment services
treatment team. Physician services, whether billed separately or included in the rate, may
be delivered by telehealth. For purposes of this paragraph, "telehealth" has the meaning
given to "mental health telehealth" in section 256B.0625, subdivision 46, when telehealth
is used to provide intensive residential treatment services.
(f) When services under this section are provided by an assertive community treatment
provider, case management functions must be an integral part of the team.
(g) The rate for a provider must not exceed the rate charged by that provider for the
same service to other payors.
(h) The rates for existing programs must be established prospectively based upon the
expenditures and utilization over a prior 12-month period using the criteria established in
paragraph (c). The rates for new programs must be established based upon estimated
expenditures and estimated utilization using the criteria established in paragraph (c).
(i) Entities who discontinue providing services must be subject to a settle-up process
whereby actual costs and reimbursement for the previous 12 months are compared. In the
event that the entity was paid more than the entity's actual costs plus any applicable
performance-related funding due the provider, the excess payment must be reimbursed to
the department. If a provider's revenue is less than actual allowed costs due to lower
utilization than projected, the commissioner may reimburse the provider to recover its actual
allowable costs. The resulting adjustments by the commissioner must be proportional to the
percent of total units of service reimbursed by the commissioner and must reflect a difference
of greater than five percent.
(j) A provider may request of the commissioner a review of any rate-setting decision
made under this subdivision.
Sec. 50.
Minnesota Statutes 2022, section 256B.0623, subdivision 4, is amended to read:
Subd. 4.
Provider entity standards.
(a) The provider entity must be certified by the
state following the certification process and procedures developed by the commissioner.
(b) The certification process is a determination as to whether the entity meets the standards
in this section and chapter 245I, as required in section 245I.011, subdivision 5. The
certification must specify which adult rehabilitative mental health services the entity is
qualified to provide.
deleted text begin
(c) A noncounty provider entity must obtain additional certification from each county
in which it will provide services. The additional certification must be based on the adequacy
of the entity's knowledge of that county's local health and human service system, and the
ability of the entity to coordinate its services with the other services available in that county.
A county-operated entity must obtain this additional certification from any other county in
which it will provide services.
deleted text end
deleted text begin (d)deleted text end new text begin (c)new text end State-level recertification must occur at least every three years.
deleted text begin (e)deleted text end new text begin (d)new text end The commissioner may intervene at any time and decertify providers with cause.
The decertification is subject to appeal to the state. A county board may recommend that
the state decertify a provider for cause.
deleted text begin (f)deleted text end new text begin (e) new text end The adult rehabilitative mental health services provider entity must meet the
following standards:
(1) have capacity to recruit, hire, manage, and train qualified staff;
(2) have adequate administrative ability to ensure availability of services;
(3) ensure that staff are skilled in the delivery of the specific adult rehabilitative mental
health services provided to the individual eligible recipient;
(4) ensure enough flexibility in service delivery to respond to the changing and
intermittent care needs of a recipient as identified by the recipient and the individual treatment
plan;
(5) assist the recipient in arranging needed crisis assessment, intervention, and
stabilization services;
(6) ensure that services are coordinated with other recipient mental health services
providers and the county mental health authority and the federally recognized American
Indian authority and necessary others after obtaining the consent of the recipient. Services
must also be coordinated with the recipient's case manager or care coordinator if the recipient
is receiving case management or care coordination services;
(7) keep all necessary records required by law;
(8) deliver services as required by section 245.461;
(9) be an enrolled Medicaid provider; and
(10) maintain a quality assurance plan to determine specific service outcomes and the
recipient's satisfaction with services.
Sec. 51.
Minnesota Statutes 2022, section 256B.0624, subdivision 5, is amended to read:
Subd. 5.
Crisis assessment and intervention staff qualifications.
(a) Qualified
individual staff of a qualified provider entity must provide crisis assessment and intervention
services to a recipient. A staff member providing crisis assessment and intervention services
to a recipient must be qualified as a:
(1) mental health professional;
(2) clinical trainee;
(3) mental health practitioner;
(4) mental health certified family peer specialist; or
(5) mental health certified peer specialist.
(b) When crisis assessment and intervention services are provided to a recipient in the
community, a mental health professional, clinical trainee, or mental health practitioner must
lead the response.
(c) The 30 hours of ongoing training required by section 245I.05, subdivision 4, paragraph
(b), must be specific to providing crisis services to children and adults and include training
about evidence-based practices identified by the commissioner of health to reduce the
recipient's risk of suicide and self-injurious behavior.
new text begin
(d) At least six hours of the ongoing training under paragraph (c) must be specific to
working with families and providing crisis stabilization services to children and include the
following topics:
new text end
new text begin
(1) developmental tasks of childhood and adolescence;
new text end
new text begin
(2) family relationships;
new text end
new text begin
(3) child and youth engagement and motivation, including motivational interviewing;
new text end
new text begin
(4) culturally responsive care, including care for lesbian, gay, bisexual, transgender, and
queer youth;
new text end
new text begin
(5) positive behavior support;
new text end
new text begin
(6) crisis intervention for youth with developmental disabilities;
new text end
new text begin
(7) child traumatic stress, trauma-informed care, and trauma-focused cognitive behavioral
therapy; and
new text end
new text begin
(8) youth substance use.
new text end
deleted text begin (d)deleted text end new text begin (e)new text end Team members must be experienced in crisis assessment, crisis intervention
techniques, treatment engagement strategies, working with families, and clinical
decision-making under emergency conditions and have knowledge of local services and
resources.
Sec. 52.
Minnesota Statutes 2022, section 256B.0624, subdivision 8, is amended to read:
Subd. 8.
Crisis stabilization staff qualifications.
(a) Mental health crisis stabilization
services must be provided by qualified individual staff of a qualified provider entity. A staff
member providing crisis stabilization services to a recipient must be qualified as a:
(1) mental health professional;
(2) certified rehabilitation specialist;
(3) clinical trainee;
(4) mental health practitioner;
(5) mental health certified family peer specialist;
(6) mental health certified peer specialist; or
(7) mental health rehabilitation worker.
(b) The 30 hours of ongoing training required in section 245I.05, subdivision 4, paragraph
(b), must be specific to providing crisis services to children and adults and include training
about evidence-based practices identified by the commissioner of health to reduce a recipient's
risk of suicide and self-injurious behavior.
new text begin
(c) For providers who deliver care to children 21 years of age and younger, at least six
hours of the ongoing training under this subdivision must be specific to working with families
and providing crisis stabilization services to children and include the following topics:
new text end
new text begin
(1) developmental tasks of childhood and adolescence;
new text end
new text begin
(2) family relationships;
new text end
new text begin
(3) child and youth engagement and motivation, including motivational interviewing;
new text end
new text begin
(4) culturally responsive care, including care for lesbian, gay, bisexual, transgender, and
queer youth;
new text end
new text begin
(5) positive behavior support;
new text end
new text begin
(6) crisis intervention for youth with developmental disabilities;
new text end
new text begin
(7) child traumatic stress, trauma-informed care, and trauma-focused cognitive behavioral
therapy; and
new text end
new text begin
(8) youth substance use.
new text end
new text begin
This paragraph does not apply to adult residential crisis stabilization service providers
licensed according to section 245I.23.
new text end
Sec. 53.
Minnesota Statutes 2022, section 256B.0625, subdivision 5m, is amended to read:
Subd. 5m.
Certified community behavioral health clinic services.
(a) Medical
assistance covers services provided by a not-for-profit certified community behavioral health
clinic (CCBHC) that meets the requirements of section 245.735, subdivision 3.
(b) The commissioner shall reimburse CCBHCs on a per-day basis for each day that an
eligible service is delivered using the CCBHC daily bundled rate system for medical
assistance payments as described in paragraph (c). The commissioner shall include a quality
incentive payment in the CCBHC daily bundled rate system as described in paragraph (e).
There is no county share for medical assistance services when reimbursed through the
CCBHC daily bundled rate system.
(c) The commissioner shall ensure that the CCBHC daily bundled rate system for CCBHC
payments under medical assistance meets the following requirements:
(1) the CCBHC daily bundled rate shall be a provider-specific rate calculated for each
CCBHC, based on the daily cost of providing CCBHC services and the total annual allowable
CCBHC costs divided by the total annual number of CCBHC visits. For calculating the
payment rate, total annual visits include visits covered by medical assistance and visits not
covered by medical assistance. Allowable costs include but are not limited to the salaries
and benefits of medical assistance providers; the cost of CCBHC services provided under
section 245.735, subdivision 3, paragraph (a), clauses (6) and (7); and other costs such as
insurance or supplies needed to provide CCBHC services;
(2) payment shall be limited to one payment per day per medical assistance enrollee
when an eligible CCBHC service is provided. A CCBHC visit is eligible for reimbursement
if at least one of the CCBHC services listed under section 245.735, subdivision 3, paragraph
(a), clause (6), is furnished to a medical assistance enrollee by a health care practitioner or
licensed agency employed by or under contract with a CCBHC;
(3) initial CCBHC daily bundled rates for newly certified CCBHCs under section 245.735,
subdivision 3, shall be established by the commissioner using a provider-specific rate based
on the newly certified CCBHC's audited historical cost report data adjusted for the expected
cost of delivering CCBHC services. Estimates are subject to review by the commissioner
and must include the expected cost of providing the full scope of CCBHC services and the
expected number of visits for the rate period;
(4) the commissioner shall rebase CCBHC rates once every deleted text begin threedeleted text end new text begin twonew text end years following
the last rebasing and no less than 12 months following an initial rate or a rate change due
to a change in the scope of services;
(5) the commissioner shall provide for a 60-day appeals process after notice of the results
of the rebasing;
(6) deleted text begin the CCBHC daily bundled rate under this section does not apply to services rendered
by CCBHCs to individuals who are dually eligible for Medicare and medical assistance
when Medicare is the primary payer for the service. An entity that receives a CCBHC daily
bundled rate system that overlaps with the CCBHC rate is not eligible for the CCBHC ratedeleted text end new text begin
if the commissioner has not reentered the CCBHC demonstration program by July 1, 2023,
CCBHCs shall be paid the daily bundled rate under this section for services rendered to
individuals who are duly eligible for Medicare and medical assistancenew text end ;
(7) payments for CCBHC services to individuals enrolled in managed care shall be
coordinated with the state's phase-out of CCBHC wrap payments. The commissioner shall
complete the phase-out of CCBHC wrap payments within 60 days of the implementation
of the CCBHC daily bundled rate system in the Medicaid Management Information System
(MMIS), for CCBHCs reimbursed under this chapter, with a final settlement of payments
due made payable to CCBHCs no later than 18 months thereafter;
(8) the CCBHC daily bundled rate for each CCBHC shall be updated by trending each
provider-specific rate by the Medicare Economic Index for primary care services. This
update shall occur each year in between rebasing periods determined by the commissioner
in accordance with clause (4). CCBHCs must provide data on costs and visits to the state
annually using the CCBHC cost report established by the commissioner; and
(9) a CCBHC may request a rate adjustment for changes in the CCBHC's scope of
services when such changes are expected to result in an adjustment to the CCBHC payment
rate by 2.5 percent or more. The CCBHC must provide the commissioner with information
regarding the changes in the scope of services, including the estimated cost of providing
the new or modified services and any projected increase or decrease in the number of visits
resulting from the change. Estimated costs are subject to review by the commissioner. Rate
adjustments for changes in scope shall occur no more than once per year in between rebasing
periods per CCBHC and are effective on the date of the annual CCBHC rate update.
(d) Managed care plans and county-based purchasing plans shall reimburse CCBHC
providers at the CCBHC daily bundled rate. The commissioner shall monitor the effect of
this requirement on the rate of access to the services delivered by CCBHC providers. If, for
any contract year, federal approval is not received for this paragraph, the commissioner
must adjust the capitation rates paid to managed care plans and county-based purchasing
plans for that contract year to reflect the removal of this provision. Contracts between
managed care plans and county-based purchasing plans and providers to whom this paragraph
applies must allow recovery of payments from those providers if capitation rates are adjusted
in accordance with this paragraph. Payment recoveries must not exceed the amount equal
to any increase in rates that results from this provision. This paragraph expires if federal
approval is not received for this paragraph at any time.
(e) The commissioner shall implement a quality incentive payment program for CCBHCs
that meets the following requirements:
(1) a CCBHC shall receive a quality incentive payment upon meeting specific numeric
thresholds for performance metrics established by the commissioner, in addition to payments
for which the CCBHC is eligible under the CCBHC daily bundled rate system described in
paragraph (c);
(2) a CCBHC must be certified and enrolled as a CCBHC for the entire measurement
year to be eligible for incentive payments;
(3) each CCBHC shall receive written notice of the criteria that must be met in order to
receive quality incentive payments at least 90 days prior to the measurement year; and
(4) a CCBHC must provide the commissioner with data needed to determine incentive
payment eligibility within six months following the measurement year. The commissioner
shall notify CCBHC providers of their performance on the required measures and the
incentive payment amount within 12 months following the measurement year.
(f) All claims to managed care plans for CCBHC services as provided under this section
shall be submitted directly to, and paid by, the commissioner on the dates specified no later
than January 1 of the following calendar year, if:
(1) one or more managed care plans does not comply with the federal requirement for
payment of clean claims to CCBHCs, as defined in Code of Federal Regulations, title 42,
section 447.45(b), and the managed care plan does not resolve the payment issue within 30
days of noncompliance; and
(2) the total amount of clean claims not paid in accordance with federal requirements
by one or more managed care plans is 50 percent of, or greater than, the total CCBHC claims
eligible for payment by managed care plans.
If the conditions in this paragraph are met between January 1 and June 30 of a calendar
year, claims shall be submitted to and paid by the commissioner beginning on January 1 of
the following year. If the conditions in this paragraph are met between July 1 and December
31 of a calendar year, claims shall be submitted to and paid by the commissioner beginning
on July 1 of the following year.
new text begin
(g) Peer services provided by a CCBHC certified under section 245.735 are a covered
service under medical assistance when a licensed mental health professional or alcohol and
drug counselor determines that peer services are medically necessary. Eligibility under this
subdivision for peer services provided by a CCBHC supersede eligibility standards under
sections 256B.0615, 256B.0616, and 245G.07, subdivision 2, clause (8).
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2023, or upon federal approval,
whichever is later. The commissioner of human services shall inform the revisor of statutes
when federal approval is obtained.
new text end
Sec. 54.
Minnesota Statutes 2022, section 256B.0757, subdivision 4c, is amended to read:
Subd. 4c.
Behavioral health home services staff qualifications.
(a) A behavioral health
home services provider must maintain staff with required professional qualifications
appropriate to the setting.
(b) If behavioral health home services are offered in a mental health setting, the
integration specialist must be a deleted text begin registereddeleted text end new text begin licensednew text end nurse deleted text begin licensed under the Minnesota Nurse
Practice Act, sections 148.171 to 148.285deleted text end new text begin , as defined in section 148.171, subdivision 9new text end .
(c) If behavioral health home services are offered in a primary care setting, the integration
specialist must be a mental health professional who is qualified according to section 245I.04,
subdivision 2.
(d) If behavioral health home services are offered in either a primary care setting or
mental health setting, the systems navigator must be a mental health practitioner who is
qualified according to section 245I.04, subdivision 4, or a community health worker as
defined in section 256B.0625, subdivision 49.
(e) If behavioral health home services are offered in either a primary care setting or
mental health setting, the qualified health home specialist must be one of the following:
(1) a mental health certified peer specialist who is qualified according to section 245I.04,
subdivision 10;
(2) a mental health certified family peer specialist who is qualified according to section
245I.04, subdivision 12;
(3) a case management associate as defined in section 245.462, subdivision 4, paragraph
(g), or 245.4871, subdivision 4, paragraph (j);
(4) a mental health rehabilitation worker who is qualified according to section 245I.04,
subdivision 14;
(5) a community paramedic as defined in section 144E.28, subdivision 9;
(6) a peer recovery specialist as defined in section 245G.07, subdivision 1, clause (5);
or
(7) a community health worker as defined in section 256B.0625, subdivision 49.
Sec. 55.
Minnesota Statutes 2022, section 256B.0941, subdivision 2a, is amended to read:
Subd. 2a.
Sleeping hours.
During normal sleeping hours, a psychiatric residential
treatment facility provider must provide at least one staff person for every six residents
present within a living unit. A provider must adjust sleeping-hour staffing levels based on
the clinical needs of the residents in the facility.new text begin Sleeping hours must include at least one
staff trained and certified to provide emergency medical response. During normal sleeping
hours, a registered nurse must be available on call to assess a child's needs and must be
available within 60 minutes.
new text end
Sec. 56.
Minnesota Statutes 2022, section 256B.0941, is amended by adding a subdivision
to read:
new text begin Subd. 2b. new text end
new text begin Shared site. new text end
new text begin
Related services that have a bright-line separation from psychiatric
residential treatment facility service operations may be delivered in the same facility,
including under the same structural roof. In shared site settings, staff must provide services
only to programs they are affiliated to through NETStudy 2.0.
new text end
Sec. 57.
Minnesota Statutes 2022, section 256B.0941, is amended by adding a subdivision
to read:
new text begin Subd. 5. new text end
new text begin Start-up and capacity-building grants. new text end
new text begin
(a) The commissioner shall establish
start-up and capacity-building grants for psychiatric residential treatment facility sites.
Start-up grants to prospective psychiatric residential treatment facility sites may be used
for:
new text end
new text begin
(1) administrative expenses;
new text end
new text begin
(2) consulting services;
new text end
new text begin
(3) Health Insurance Portability and Accountability Act of 1996 compliance;
new text end
new text begin
(4) therapeutic resources, including evidence-based, culturally appropriate curriculums
and training programs for staff and clients;
new text end
new text begin
(5) allowable physical renovations to the property; and
new text end
new text begin
(6) emergency workforce shortage uses, as determined by the commissioner.
new text end
new text begin
(b) Start-up and capacity-building grants to prospective and current psychiatric residential
treatment facilities may be used to support providers who treat and accept individuals with
complex support needs, including but not limited to:
new text end
new text begin
(1) neurocognitive disorders;
new text end
new text begin
(2) co-occurring intellectual developmental disabilities;
new text end
new text begin
(3) schizophrenia spectrum disorders;
new text end
new text begin
(4) manifested or labeled aggressive behaviors; and
new text end
new text begin
(5) manifested sexually inappropriate behaviors.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2023.
new text end
Sec. 58.
Minnesota Statutes 2022, section 256B.0947, is amended by adding a subdivision
to read:
new text begin Subd. 10. new text end
new text begin Young adult continuity of care. new text end
new text begin
A client who received services under this
section or section 256B.0946 and aged out of eligibility may continue to receive services
from the same providers under this section until the client is 27 years old.
new text end
Sec. 59.
Minnesota Statutes 2022, section 256B.69, subdivision 5a, is amended to read:
Subd. 5a.
Managed care contracts.
(a) Managed care contracts under this section and
section 256L.12 shall be entered into or renewed on a calendar year basis. The commissioner
may issue separate contracts with requirements specific to services to medical assistance
recipients age 65 and older.
(b) A prepaid health plan providing covered health services for eligible persons pursuant
to chapters 256B and 256L is responsible for complying with the terms of its contract with
the commissioner. Requirements applicable to managed care programs under chapters 256B
and 256L established after the effective date of a contract with the commissioner take effect
when the contract is next issued or renewed.
(c) The commissioner shall withhold five percent of managed care plan payments under
this section and county-based purchasing plan payments under section 256B.692 for the
prepaid medical assistance program pending completion of performance targets. Each
performance target must be quantifiable, objective, measurable, and reasonably attainable,
except in the case of a performance target based on a federal or state law or rule. Criteria
for assessment of each performance target must be outlined in writing prior to the contract
effective date. Clinical or utilization performance targets and their related criteria must
consider evidence-based research and reasonable interventions when available or applicable
to the populations served, and must be developed with input from external clinical experts
and stakeholders, including managed care plans, county-based purchasing plans, and
providers. The managed care or county-based purchasing plan must demonstrate, to the
commissioner's satisfaction, that the data submitted regarding attainment of the performance
target is accurate. The commissioner shall periodically change the administrative measures
used as performance targets in order to improve plan performance across a broader range
of administrative services. The performance targets must include measurement of plan
efforts to contain spending on health care services and administrative activities. The
commissioner may adopt plan-specific performance targets that take into account factors
affecting only one plan, including characteristics of the plan's enrollee population. The
withheld funds must be returned no sooner than July of the following year if performance
targets in the contract are achieved. The commissioner may exclude special demonstration
projects under subdivision 23.
(d) The commissioner shall require that managed care plans:
(1) use the assessment and authorization processes, forms, timelines, standards,
documentation, and data reporting requirements, protocols, billing processes, and policies
consistent with medical assistance fee-for-service or the Department of Human Services
contract requirements for all personal care assistance services under section 256B.0659 and
community first services and supports under section 256B.85; and
(2) by January 30 of each year that follows a rate increase for any aspect of services
under section 256B.0659 or 256B.85, inform the commissioner and the chairs and ranking
minority members of the legislative committees with jurisdiction over rates determined
under section 256B.851 of the amount of the rate increase that is paid to each personal care
assistance provider agency with which the plan has a contract.
(e) Effective for services rendered on or after January 1, 2012, the commissioner shall
include as part of the performance targets described in paragraph (c) a reduction in the health
plan's emergency department utilization rate for medical assistance and MinnesotaCare
enrollees, as determined by the commissioner. For 2012, the reduction shall be based on
the health plan's utilization in 2009. To earn the return of the withhold each subsequent
year, the managed care plan or county-based purchasing plan must achieve a qualifying
reduction of no less than ten percent of the plan's emergency department utilization rate for
medical assistance and MinnesotaCare enrollees, excluding enrollees in programs described
in subdivisions 23 and 28, compared to the previous measurement year until the final
performance target is reached. When measuring performance, the commissioner must
consider the difference in health risk in a managed care or county-based purchasing plan's
membership in the baseline year compared to the measurement year, and work with the
managed care or county-based purchasing plan to account for differences that they agree
are significant.
The withheld funds must be returned no sooner than July 1 and no later than July 31 of
the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that a reduction in the utilization rate
was achieved. The commissioner shall structure the withhold so that the commissioner
returns a portion of the withheld funds in amounts commensurate with achieved reductions
in utilization less than the targeted amount.
The withhold described in this paragraph shall continue for each consecutive contract
period until the plan's emergency room utilization rate for state health care program enrollees
is reduced by 25 percent of the plan's emergency room utilization rate for medical assistance
and MinnesotaCare enrollees for calendar year 2009. Hospitals shall cooperate with the
health plans in meeting this performance target and shall accept payment withholds that
may be returned to the hospitals if the performance target is achieved.
(f) Effective for services rendered on or after January 1, 2012, the commissioner shall
include as part of the performance targets described in paragraph (c) a reduction in the plan's
hospitalization admission rate for medical assistance and MinnesotaCare enrollees, as
determined by the commissioner. To earn the return of the withhold each year, the managed
care plan or county-based purchasing plan must achieve a qualifying reduction of no less
than five percent of the plan's hospital admission rate for medical assistance and
MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and
28, compared to the previous calendar year until the final performance target is reached.
When measuring performance, the commissioner must consider the difference in health risk
in a managed care or county-based purchasing plan's membership in the baseline year
compared to the measurement year, and work with the managed care or county-based
purchasing plan to account for differences that they agree are significant.
The withheld funds must be returned no sooner than July 1 and no later than July 31 of
the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that this reduction in the hospitalization
rate was achieved. The commissioner shall structure the withhold so that the commissioner
returns a portion of the withheld funds in amounts commensurate with achieved reductions
in utilization less than the targeted amount.
The withhold described in this paragraph shall continue until there is a 25 percent
reduction in the hospital admission rate compared to the hospital admission rates in calendar
year 2011, as determined by the commissioner. The hospital admissions in this performance
target do not include the admissions applicable to the subsequent hospital admission
performance target under paragraph (g). Hospitals shall cooperate with the plans in meeting
this performance target and shall accept payment withholds that may be returned to the
hospitals if the performance target is achieved.
(g) Effective for services rendered on or after January 1, 2012, the commissioner shall
include as part of the performance targets described in paragraph (c) a reduction in the plan's
hospitalization admission rates for subsequent hospitalizations within 30 days of a previous
hospitalization of a patient regardless of the reason, for medical assistance and MinnesotaCare
enrollees, as determined by the commissioner. To earn the return of the withhold each year,
the managed care plan or county-based purchasing plan must achieve a qualifying reduction
of the subsequent hospitalization rate for medical assistance and MinnesotaCare enrollees,
excluding enrollees in programs described in subdivisions 23 and 28, of no less than five
percent compared to the previous calendar year until the final performance target is reached.
The withheld funds must be returned no sooner than July 1 and no later than July 31 of
the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that a qualifying reduction in the
subsequent hospitalization rate was achieved. The commissioner shall structure the withhold
so that the commissioner returns a portion of the withheld funds in amounts commensurate
with achieved reductions in utilization less than the targeted amount.
The withhold described in this paragraph must continue for each consecutive contract
period until the plan's subsequent hospitalization rate for medical assistance and
MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and
28, is reduced by 25 percent of the plan's subsequent hospitalization rate for calendar year
2011. Hospitals shall cooperate with the plans in meeting this performance target and shall
accept payment withholds that must be returned to the hospitals if the performance target
is achieved.
(h) Effective for services rendered on or after January 1, 2013, through December 31,
2013, the commissioner shall withhold 4.5 percent of managed care plan payments under
this section and county-based purchasing plan payments under section 256B.692 for the
prepaid medical assistance program. The withheld funds must be returned no sooner than
July 1 and no later than July 31 of the following year. The commissioner may exclude
special demonstration projects under subdivision 23.
(i) Effective for services rendered on or after January 1, 2014, the commissioner shall
withhold three percent of managed care plan payments under this section and county-based
purchasing plan payments under section 256B.692 for the prepaid medical assistance
program. The withheld funds must be returned no sooner than July 1 and no later than July
31 of the following year. The commissioner may exclude special demonstration projects
under subdivision 23.
(j) A managed care plan or a county-based purchasing plan under section 256B.692 may
include as admitted assets under section 62D.044 any amount withheld under this section
that is reasonably expected to be returned.
(k) Contracts between the commissioner and a prepaid health plan are exempt from the
set-aside and preference provisions of section 16C.16, subdivisions 6, paragraph (a), and
7.
(l) The return of the withhold under paragraphs (h) and (i) is not subject to the
requirements of paragraph (c).
(m) Managed care plans and county-based purchasing plans shall maintain current and
fully executed agreements for all subcontractors, including bargaining groups, for
administrative services that are expensed to the state's public health care programs.
Subcontractor agreements determined to be material, as defined by the commissioner after
taking into account state contracting and relevant statutory requirements, must be in the
form of a written instrument or electronic document containing the elements of offer,
acceptance, consideration, payment terms, scope, duration of the contract, and how the
subcontractor services relate to state public health care programs. Upon request, the
commissioner shall have access to all subcontractor documentation under this paragraph.
Nothing in this paragraph shall allow release of information that is nonpublic data pursuant
to section 13.02.
new text begin
(n) Effective for services rendered on or after January 1, 2024, the commissioner shall
require, as part of a contract, that all managed care plans use timely claim filing timelines
of 12 months and use remittance advice and prior authorizations timelines consistent with
those used under medical assistance fee-for-service for mental health and substance use
disorder treatment services. A managed care plan under this section may not take back funds
the managed care plan paid to a mental health and substance use disorder treatment provider
once six months have elapsed from the date the funds were paid.
new text end
Sec. 60.
Minnesota Statutes 2022, section 260C.007, subdivision 26d, is amended to read:
Subd. 26d.
Qualified residential treatment program.
"Qualified residential treatment
program" means a children's residential treatment program licensed under chapter 245A or
licensed or approved by a tribe that is approved to receive foster care maintenance payments
under section 256.82 that:
(1) has a trauma-informed treatment model designed to address the needs of children
with serious emotional or behavioral disorders or disturbances;
(2) has registered or licensed nursing staff and other licensed clinical staff who:
(i) provide care within the scope of their practice; and
(ii) are available 24 hours per day and seven days per week;
(3) is accredited by any of the following independent, nonprofit organizations: the
Commission on Accreditation of Rehabilitation Facilities (CARF), the Joint Commission
on Accreditation of Healthcare Organizations (JCAHO), and the Council on Accreditation
(COA), or any other nonprofit accrediting organization approved by the United States
Department of Health and Human Services;
(4) if it is in the child's best interests, facilitates participation of the child's family members
in the child's treatment programming consistent with the child's out-of-home placement
plan under sections 260C.212, subdivision 1, and 260C.708;
(5) facilitates outreach to family members of the child, including siblings;
(6) documents how the facility facilitates outreach to the child's parents and relatives,
as well as documents the child's parents' and other relatives' contact information;
(7) documents how the facility includes family members in the child's treatment process,
including after the child's discharge, and how the facility maintains the child's sibling
connections; and
(8) provides the child and child's family with discharge planning and family-based
aftercare support for at least six months after the child's discharge.new text begin Aftercare support may
include mental health certified family and youth peer specialist services, as defined under
section 256B.0616.
new text end
Sec. 61. new text begin LOCAL AGENCY SUBSTANCE USE DISORDER ALLOCATION.
new text end
new text begin
The commissioner of human services shall evaluate the ongoing need for local agency
substance use disorder allocations under Minnesota Statutes, section 254B.02. The evaluation
must include recommendations on whether local agency allocations should continue, and
if so, the commissioner must recommend what the purpose of the allocations should be and
propose an updated allocation methodology that aligns with the purpose and person-centered
outcomes for people experiencing substance use disorders and behavioral health conditions.
The commissioner may contract with a vendor to support this evaluation through research
and actuarial analysis.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 62. new text begin RATE INCREASE FOR MENTAL HEALTH ADULT DAY TREATMENT.
new text end
new text begin
The commissioner of human services must increase the reimbursement rate for adult
day treatment under Minnesota Statutes, section 256B.0671, subdivision 3, by 50 percent
over the reimbursement rate in effect as of June 30, 2023.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner of human services shall notify the revisor of statutes
when federal approval is obtained.
new text end
Sec. 63. new text begin ROOM AND BOARD COSTS IN CHILDREN'S RESIDENTIAL
FACILITIES.
new text end
new text begin
The commissioner of human services must update the behavioral health fund room and
board rate schedule to include services provided under Minnesota Statutes, section 245.4882,
for individuals who do not have a placement under Minnesota Statutes, chapter 260C or
260D. The commissioner must establish room and board rates commensurate with current
room and board rates for adolescent programs licensed under Minnesota Statutes, section
245G.18.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective July 1, 2023.
new text end
Sec. 64. new text begin DIRECTION TO THE COMMISSIONER; EARLY INTERVENTION AND
PREVENTION SERVICES.
new text end
new text begin
The commissioner of human services must make the International Classification of
Diseases, Tenth Revision V and Z codes available to medical assistance and MinnesotaCare
enrolled professionals to provide early intervention and prevention services. Services must
be delivered under the supervision of a mental health professional, as defined in Minnesota
Statutes, section 245I.02, subdivision 27, and must only be provided for a period of up to
six months after the first contact with a client who is enrolled in medical assistance or
MinnesotaCare.
new text end
ARTICLE 8
DEPARTMENT OF HUMAN SERVICES POLICY
Section 1.
Minnesota Statutes 2022, section 245.4661, subdivision 9, is amended to read:
Subd. 9.
Services and programs.
(a) The following three distinct grant programs are
funded under this section:
(1) mental health crisis services;
(2) housing with supports for adults with serious mental illness; and
(3) projects for assistance in transitioning from homelessness (PATH program).
(b) In addition, the following are eligible for grant funds:
(1) community education and prevention;
(2) client outreach;
(3) early identification and intervention;
(4) adult outpatient diagnostic assessment and psychological testing;
(5) peer support services;
(6) community support program services (CSP);
(7) adult residential crisis stabilization;
(8) supported employment;
(9) assertive community treatment (ACT);
(10) housing subsidies;
(11) basic living, social skills, and community intervention;
(12) emergency response services;
(13) adult outpatient psychotherapy;
(14) adult outpatient medication management;
(15) adult mobile crisis services;
(16) adult day treatment;
(17) partial hospitalization;
(18) adult residential treatment;
(19) adult mental health targeted case management;new text begin and
new text end
deleted text begin
(20) intensive community rehabilitative services (ICRS); and
deleted text end
deleted text begin (21)deleted text end new text begin (20)new text end transportation.
Sec. 2.
Minnesota Statutes 2022, section 245.469, subdivision 3, is amended to read:
Subd. 3.
Mental health crisis services.
The commissioner of human services shall
increase access to mental health crisis services for children and adults. In order to increase
access, the commissioner must:
(1) develop a central phone number where calls can be routed to the appropriate crisis
services;
(2) provide telephone consultation 24 hours a day to mobile crisis teams who are serving
people with traumatic brain injury or intellectual disabilities who are experiencing a mental
health crisis;
(3) expand crisis services across the state, including rural areas of the state and examining
access per population;
(4) establish and implement state standardsnew text begin and requirementsnew text end for crisis servicesnew text begin as outlined
in section 256B.0624new text end ; and
(5) provide grants to adult mental health initiatives, counties, tribes, or community mental
health providers to establish new mental health crisis residential service capacity.
Priority will be given to regions that do not have a mental health crisis residential services
program, do not have an inpatient psychiatric unit within the region, do not have an inpatient
psychiatric unit within 90 miles, or have a demonstrated need based on the number of crisis
residential or intensive residential treatment beds available to meet the needs of the residents
in the region. At least 50 percent of the funds must be distributed to programs in rural
Minnesota. Grant funds may be used for start-up costs, including but not limited to
renovations, furnishings, and staff training. Grant applications shall provide details on how
the intended service will address identified needs and shall demonstrate collaboration with
crisis teams, other mental health providers, hospitals, and police.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 3.
new text begin
[245.4903] CULTURAL AND ETHNIC MINORITY INFRASTRUCTURE
GRANT PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The commissioner of human services shall establish a
cultural and ethnic minority infrastructure grant program to ensure that mental health and
substance use disorder treatment supports and services are culturally specific and culturally
responsive to meet the cultural needs of the communities served.
new text end
new text begin Subd. 2. new text end
new text begin Eligible applicants. new text end
new text begin
An eligible applicant is a licensed entity or provider from
a cultural or ethnic minority population who:
new text end
new text begin
(1) provides mental health or substance use disorder treatment services and supports to
individuals from cultural and ethnic minority populations, including individuals who are
lesbian, gay, bisexual, transgender, or queer and from cultural and ethnic minority
populations;
new text end
new text begin
(2) provides or is qualified and has the capacity to provide clinical supervision and
support to members of culturally diverse and ethnic minority communities to qualify as
mental health and substance use disorder treatment providers; or
new text end
new text begin
(3) has the capacity and experience to provide training for mental health and substance
use disorder treatment providers on cultural competency and cultural humility.
new text end
new text begin Subd. 3. new text end
new text begin Allowable grant activities. new text end
new text begin
(a) The cultural and ethnic minority infrastructure
grant program grantees must engage in activities and provide supportive services to ensure
and increase equitable access to culturally specific and responsive care and to build
organizational and professional capacity for licensure and certification for the communities
served. Allowable grant activities include but are not limited to:
new text end
new text begin
(1) workforce development activities focused on recruiting, supporting, training, and
supervision activities for mental health and substance use disorder practitioners and
professionals from diverse racial, cultural, and ethnic communities;
new text end
new text begin
(2) supporting members of culturally diverse and ethnic minority communities to qualify
as mental health and substance use disorder professionals, practitioners, clinical supervisors,
recovery peer specialists, mental health certified peer specialists, and mental health certified
family peer specialists;
new text end
new text begin
(3) culturally specific outreach, early intervention, trauma-informed services, and recovery
support in mental health and substance use disorder services;
new text end
new text begin
(4) provision of trauma-informed, culturally responsive mental health and substance use
disorder supports and services for children and families, youth, or adults who are from
cultural and ethnic minority backgrounds and are uninsured or underinsured;
new text end
new text begin
(5) mental health and substance use disorder service expansion and infrastructure
improvement activities, particularly in greater Minnesota;
new text end
new text begin
(6) training for mental health and substance use disorder treatment providers on cultural
competency and cultural humility;
new text end
new text begin
(7) activities to increase the availability of culturally responsive mental health and
substance use disorder services for children and families, youth, or adults or to increase the
availability of substance use disorder services for individuals from cultural and ethnic
minorities in the state;
new text end
new text begin
(8) providing interpreter services at intensive residential treatment facilities, children's
residential treatment centers, or psychiatric residential treatment facilities in order for
children or adults with limited English proficiency or children or adults who are fluent in
another language to be able to access treatment; and
new text end
new text begin
(9) paying for case-specific consultation between a mental health professional and the
appropriate diverse mental health professional in order to facilitate the provision of services
that are culturally appropriate to a client's needs.
new text end
new text begin
(b) The commissioner must assist grantees with meeting third-party credentialing
requirements, and grantees must obtain all available third-party reimbursement sources as
a condition of receiving grant funds. Grantees must serve individuals from cultural and
ethnic minority communities regardless of health coverage status or ability to pay.
new text end
new text begin Subd. 4. new text end
new text begin Data collection and outcomes. new text end
new text begin
Grantees must provide regular data summaries
to the commissioner for purposes of evaluating the effectiveness of the cultural and ethnic
minority infrastructure grant program. The commissioner must use identified culturally
appropriate outcome measures instruments to evaluate outcomes and must evaluate program
activities by analyzing whether the program:
new text end
new text begin
(1) increased access to culturally specific services for individuals from cultural and
ethnic minority communities across the state;
new text end
new text begin
(2) increased the number of individuals from cultural and ethnic minority communities
served by grantees;
new text end
new text begin
(3) increased cultural responsiveness and cultural competency of mental health and
substance use disorder treatment providers;
new text end
new text begin
(4) increased the number of mental health and substance use disorder treatment providers
and clinical supervisors from cultural and ethnic minority communities;
new text end
new text begin
(5) increased the number of mental health and substance use disorder treatment
organizations owned, managed, or led by individuals who are Black, Indigenous, or people
of color;
new text end
new text begin
(6) reduced health disparities through improved clinical and functional outcomes for
those accessing services; and
new text end
new text begin
(7) led to an overall increase in culturally specific mental health and substance use
disorder service availability.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 4.
new text begin
[245.4906] MENTAL HEALTH CERTIFIED PEER SPECIALIST GRANT
PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The mental health certified peer specialist grant program
is established in the Department of Human Services to provide funding for training for
mental health certified peer specialists who provide services to support individuals with
lived experience of mental illness under section 256B.0615. Certified peer specialists provide
services to individuals who are receiving assertive community treatment or intensive
residential treatment services under section 256B.0622, adult rehabilitative mental health
services under section 256B.0623, or crisis response services under section 256B.0624.
Mental health certified peer specialist qualifications are defined in section 245I.04,
subdivision 10, and mental health certified peer specialists' scope of practice is defined in
section 245I.04, subdivision 11.
new text end
new text begin Subd. 2. new text end
new text begin Activities. new text end
new text begin
Grant funding may be used to provide training for mental health
certified peer specialists as specified in section 256B.0615, subdivision 5.
new text end
new text begin Subd. 3. new text end
new text begin Outcomes. new text end
new text begin
Evaluation includes the extent to which individuals receiving peer
services:
new text end
new text begin
(1) experience progress on achieving treatment goals; and
new text end
new text begin
(2) experience a reduction in hospital admissions.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 5.
new text begin
[245.4907] MENTAL HEALTH CERTIFIED FAMILY PEER SPECIALIST
GRANT PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The mental health certified peer family specialist grant
program is established in the Department of Human Services to provide funding for training
for mental health certified peer family specialists who provide services to support individuals
with lived experience of mental illness under section 256B.0616. Certified family peer
specialists provide services to families who have a child with an emotional disturbance or
severe emotional disturbance under chapter 245. Certified family peer specialists provide
services to families whose children are receiving inpatient hospitalization under section
256B.0625, subdivision 1; partial hospitalization under Minnesota Rules, parts 9505.0370,
subpart 24, and 9505.0372, subpart 9; residential treatment under section 245.4882; children's
intensive behavioral health services under section 256B.0946; and day treatment, children's
therapeutic services and supports, or crisis response services under section 256B.0624.
Mental health certified family peer specialist qualifications are defined in section 245I.04,
subdivision 12, and mental health certified family peer specialists' scope of practice is
defined in section 245I.04, subdivision 13.
new text end
new text begin Subd. 2. new text end
new text begin Activities. new text end
new text begin
Grant funding may be used to provide training for mental health
certified family peer specialists as specified in section 256B.0616, subdivision 5.
new text end
new text begin Subd. 3. new text end
new text begin Outcomes. new text end
new text begin
Evaluation includes the extent to which individuals receiving family
peer services
new text end
new text begin
:
new text end
new text begin
(1) progress on achieving treatment goals; and
new text end
new text begin
(2) experience a reduction in hospital admissions.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 6.
new text begin
[245.991] PROJECTS FOR ASSISTANCE IN TRANSITION FROM
HOMELESSNESS PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Establishment. new text end
new text begin
The projects for assistance in transition from homelessness
program is established in the Department of Human Services to prevent or end homelessness
for people with serious mental illness or co-occurring substance use disorder and ensure
the commissioner may achieve the goals of the housing mission statement in section 245.461,
subdivision 4.
new text end
new text begin Subd. 2. new text end
new text begin Activities. new text end
new text begin
All projects for assistance in transition from homelessness must
provide homeless outreach and case management services. Projects may provide clinical
assessment, habilitation and rehabilitation services, community mental health services,
substance use disorder treatment, housing transition and sustaining services, direct assistance
funding, and other activities as determined by the commissioner.
new text end
new text begin Subd. 3. new text end
new text begin Eligibility. new text end
new text begin
Program activities must be provided to people with serious mental
illness, or with co-occurring substance use disorder, who meet homeless criteria determined
by the commissioner. People receiving homeless outreach may be presumed eligible until
serious mental illness can be verified.
new text end
new text begin Subd. 4. new text end
new text begin Outcomes. new text end
new text begin
Evaluation of each project includes the extent to which:
new text end
new text begin
(1) grantees contact individuals through homeless outreach services;
new text end
new text begin
(2) grantees enroll individuals in case management services;
new text end
new text begin
(3) individuals access behavioral health services; and
new text end
new text begin
(4) individuals transition from homelessness to housing.
new text end
new text begin Subd. 5. new text end
new text begin Federal aid or grants. new text end
new text begin
The commissioner of human services must comply with
all conditions and requirements necessary to receive federal aid or grants with respect to
homeless services or programs as specified in section 245.70.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 7.
new text begin
[245.992] HOUSING WITH SUPPORT FOR ADULTS WITH SERIOUS
MENTAL ILLNESS PROGRAM.
new text end
new text begin Subdivision 1. new text end
new text begin Creation. new text end
new text begin
The housing with support for adults with serious mental illness
program is established in the Department of Human Services to prevent or end homelessness
for people with serious mental illness, increase the availability of housing with support, and
ensure the commissioner may achieve the goals of the housing mission statement in section
245.461, subdivision 4.
new text end
new text begin Subd. 2. new text end
new text begin Activities. new text end
new text begin
The housing with support for adults with serious mental illness
program may provide a range of activities and supportive services to assure that people
obtain and retain permanent supportive housing. Program activities may include case
management, site-based housing services, housing transition and sustaining services, outreach
services, community support services, direct assistance funding, and other activities as
determined by the commissioner.
new text end
new text begin Subd. 3. new text end
new text begin Eligibility. new text end
new text begin
Program activities must be provided to people with serious mental
illness, or with co-occurring substance use disorder, who meet homeless criteria determined
by the commissioner.
new text end
new text begin Subd. 4. new text end
new text begin Outcomes. new text end
new text begin
Evaluation of program activities must utilize evidence-based
practices and must include the extent to which:
new text end
new text begin
(1) grantees' housing and activities utilize evidence-based practices;
new text end
new text begin
(2) individuals transition from homelessness to housing;
new text end
new text begin
(3) individuals retain housing; and
new text end
new text begin
(4) individuals are satisfied with their housing.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 8.
Minnesota Statutes 2022, section 256.478, is amended by adding a subdivision to
read:
new text begin Subd. 3. new text end
new text begin Authorized uses of grant funds. new text end
new text begin
Grant funds may be used for but are not
limited to the following:
new text end
new text begin
(1) increasing access to home and community-based services for an individual;
new text end
new text begin
(2) improving caregiver-child relationships and aiding progress toward treatment goals;
and
new text end
new text begin
(3) reducing emergency department visits.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 9.
Minnesota Statutes 2022, section 256.478, is amended by adding a subdivision to
read:
new text begin Subd. 4. new text end
new text begin Outcomes. new text end
new text begin
Program evaluation is based on but not limited to the following
criteria:
new text end
new text begin
(1) expediting discharges for individuals who no longer need hospital level of care;
new text end
new text begin
(2) individuals obtaining and retaining housing;
new text end
new text begin
(3) individuals maintaining community living by diverting admission to Anoka Metro
Regional Treatment Center and Forensic Mental Health Program;
new text end
new text begin
(4) reducing recidivism rates of individuals returning to state institutions; and
new text end
new text begin
(5) individuals' ability to live in the least restrictive community setting.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 10.
Minnesota Statutes 2022, section 256B.056, is amended by adding a subdivision
to read:
new text begin Subd. 5d. new text end
new text begin Medical assistance room and board rate. new text end
new text begin
"Medical assistance room and
board rate" means an amount equal to 81 percent of the federal poverty guideline for a single
individual living alone in the community less the medical assistance personal needs allowance
under section 256B.35. The amount of the room and board rate, as defined in section 256I.03,
subdivision 2, that exceeds the medical assistance room and board rate is considered a
remedial care cost. A remedial care cost may be used to meet a spenddown obligation under
this section. The medical assistance room and board rate is to be adjusted on January 1 of
each year.
new text end
Sec. 11.
Minnesota Statutes 2022, section 256B.0622, subdivision 8, is amended to read:
Subd. 8.
Medical assistance payment for assertive community treatment and
intensive residential treatment services.
(a) Payment for intensive residential treatment
services and assertive community treatment in this section shall be based on one daily rate
per provider inclusive of the following services received by an eligible client in a given
calendar day: all rehabilitative services under this section, staff travel time to provide
rehabilitative services under this section, and nonresidential crisis stabilization services
under section 256B.0624.
(b) Except as indicated in paragraph (c), payment will not be made to more than one
entity for each client for services provided under this section on a given day. If services
under this section are provided by a team that includes staff from more than one entity, the
team must determine how to distribute the payment among the members.
(c) The commissioner shall determine one rate for each provider that will bill medical
assistance for residential services under this section and one rate for each assertive community
treatment provider. If a single entity provides both services, one rate is established for the
entity's residential services and another rate for the entity's nonresidential services under
this section. A provider is not eligible for payment under this section without authorization
from the commissioner. The commissioner shall develop rates using the following criteria:
(1) the provider's cost for services shall include direct services costs, other program
costs, and other costs determined as follows:
(i) the direct services costs must be determined using actual costs of salaries, benefits,
payroll taxes, and training of direct service staff and service-related transportation;
(ii) other program costs not included in item (i) must be determined as a specified
percentage of the direct services costs as determined by item (i). The percentage used shall
be determined by the commissioner based upon the average of percentages that represent
the relationship of other program costs to direct services costs among the entities that provide
similar services;
(iii) physical plant costs calculated based on the percentage of space within the program
that is entirely devoted to treatment and programming. This does not include administrative
or residential space;
(iv) assertive community treatment physical plant costs must be reimbursed as part of
the costs described in item (ii); and
(v) subject to federal approval, up to an additional five percent of the total rate may be
added to the program rate as a quality incentive based upon the entity meeting performance
criteria specified by the commissioner;
(2) actual cost is defined as costs which are allowable, allocable, and reasonable, and
consistent with federal reimbursement requirements under Code of Federal Regulations,
title 48, chapter 1, part 31, relating to for-profit entities, and Office of Management and
Budget Circular Number A-122, relating to nonprofit entities;
(3) the number of service units;
(4) the degree to which clients will receive services other than services under this section;
and
(5) the costs of other services that will be separately reimbursed.
(d) The rate for intensive residential treatment services and assertive community treatment
must excludenew text begin the medical assistancenew text end room and boardnew text begin ratenew text end , as defined in section deleted text begin 256I.03,
subdivision 6deleted text end new text begin 256B.056, subdivision 5dnew text end , and services not covered under this section, such
as partial hospitalization, home care, and inpatient services.
(e) Physician services that are not separately billed may be included in the rate to the
extent that a psychiatrist, or other health care professional providing physician services
within their scope of practice, is a member of the intensive residential treatment services
treatment team. Physician services, whether billed separately or included in the rate, may
be delivered by telehealth. For purposes of this paragraph, "telehealth" has the meaning
given to "mental health telehealth" in section 256B.0625, subdivision 46, when telehealth
is used to provide intensive residential treatment services.
(f) When services under this section are provided by an assertive community treatment
provider, case management functions must be an integral part of the team.
(g) The rate for a provider must not exceed the rate charged by that provider for the
same service to other payors.
(h) The rates for existing programs must be established prospectively based upon the
expenditures and utilization over a prior 12-month period using the criteria established in
paragraph (c). The rates for new programs must be established based upon estimated
expenditures and estimated utilization using the criteria established in paragraph (c).
(i) Entities who discontinue providing services must be subject to a settle-up process
whereby actual costs and reimbursement for the previous 12 months are compared. In the
event that the entity was paid more than the entity's actual costs plus any applicable
performance-related funding due the provider, the excess payment must be reimbursed to
the department. If a provider's revenue is less than actual allowed costs due to lower
utilization than projected, the commissioner may reimburse the provider to recover its actual
allowable costs. The resulting adjustments by the commissioner must be proportional to the
percent of total units of service reimbursed by the commissioner and must reflect a difference
of greater than five percent.
(j) A provider may request of the commissioner a review of any rate-setting decision
made under this subdivision.
Sec. 12.
Minnesota Statutes 2022, section 256B.0946, subdivision 6, is amended to read:
Subd. 6.
Excluded services.
(a) Services in clauses (1) to (7) are not covered under this
section and are not eligible for medical assistance payment as components of children's
intensive behavioral health services, but may be billed separately:
(1) inpatient psychiatric hospital treatment;
(2) mental health targeted case management;
(3) partial hospitalization;
(4) medication management;
(5) children's mental health day treatment services;
(6) crisis response services under section 256B.0624;
(7) transportation; and
(8) mental health certified family peer specialist services under section 256B.0616.
(b) Children receiving intensive behavioral health services are not eligible for medical
assistance reimbursement for the following services while receiving children's intensive
behavioral health services:
(1) psychotherapy and skills training components of children's therapeutic services and
supports under section 256B.0943;
(2) mental health behavioral aide services as defined in section 256B.0943, subdivision
1, paragraph (l);
(3) home and community-based waiver services;
(4) mental health residential treatment; and
(5)new text begin medical assistancenew text end room and board deleted text begin costsdeleted text end new text begin rate,new text end as defined in section deleted text begin 256I.03,
subdivision 6deleted text end new text begin 256B.056, subdivision 5dnew text end .
Sec. 13.
Minnesota Statutes 2022, section 256B.0947, subdivision 7a, is amended to read:
Subd. 7a.
Noncovered services.
(a) The rate for intensive rehabilitative mental health
services does not include medical assistance payment for services in clauses (1) to (7).
Services not covered under this paragraph may be billed separately:
(1) inpatient psychiatric hospital treatment;
(2) partial hospitalization;
(3) children's mental health day treatment services;
(4) physician services outside of care provided by a psychiatrist serving as a member of
the treatment team;
(5)new text begin medical assistancenew text end room and board deleted text begin costsdeleted text end new text begin ratenew text end , as defined in section deleted text begin 256I.03,
subdivision 6deleted text end new text begin 256B.056, subdivision 5dnew text end ;
(6) home and community-based waiver services; and
(7) other mental health services identified in the child's individualized education program.
(b) The following services are not covered under this section and are not eligible for
medical assistance payment while youth are receiving intensive rehabilitative mental health
services:
(1) mental health residential treatment; and
(2) mental health behavioral aide services, as defined in section 256B.0943, subdivision
1, paragraph (l).
Sec. 14.
Minnesota Statutes 2022, section 256D.02, is amended by adding a subdivision
to read:
new text begin Subd. 20. new text end
new text begin Date of application. new text end
new text begin
"Date of application" has the meaning given in section
256P.01, subdivision 2b.
new text end
Sec. 15.
Minnesota Statutes 2022, section 256D.07, is amended to read:
256D.07 TIME OF PAYMENT OF ASSISTANCE.
An applicant for general assistance shall be deemed eligible if the application and the
verification of the statement on that application demonstrate that the applicant is within the
eligibility criteria established by sections 256D.01 to 256D.21 and any applicable rules of
the commissioner. Any person requesting general assistance shall be permitted by the county
agency to make an application for assistance as soon as administratively possible and in no
event later than the fourth day following the date on which assistance is first requested, and
no county agency shall require that a person requesting assistance appear at the offices of
the county agency more than once prior to the date on which the person is permitted to make
the application. deleted text begin The application shall be in writing in the manner and upon the form
prescribed by the commissioner and attested to by the oath of the applicant or in lieu thereof
shall contain the following declaration which shall be signed by the applicant: "I declare
that this application has been examined by me and to the best of my knowledge and belief
is a true and correct statement of every material point."deleted text end new text begin Applications must be submitted
according to section 256P.04, subdivision 1a.new text end On the date that general assistance is first
requested, the county agency shall inquire and determine whether the person requesting
assistance is in immediate need of food, shelter, clothing, assistance for necessary
transportation, or other emergency assistance pursuant to section 256D.06, subdivision 2.
A person in need of emergency assistance shall be granted emergency assistance immediately,
and necessary emergency assistance shall continue for up to 30 days following the date of
application. A determination of an applicant's eligibility for general assistance shall be made
by the county agency as soon as the required verifications are received by the county agency
and in no event later than 30 days following the date that the application is made. Any
verifications required of the applicant shall be reasonable, and the commissioner shall by
rule establish reasonable verifications. General assistance shall be granted to an eligible
applicant without the necessity of first securing action by the board of the county agency.
The first month's grant must be computed to cover the time period starting with the date deleted text begin a
signed application form is received by the county agencydeleted text end new text begin of application, as defined by
section 256P.01, subdivision 2b,new text end or from the date that the applicant meets all eligibility
factors, whichever occurs later.
If upon verification and due investigation it appears that the applicant provided false
information and the false information materially affected the applicant's eligibility for general
assistance or the amount of the applicant's general assistance grant, the county agency may
refer the matter to the county attorney. The county attorney may commence a criminal
prosecution or a civil action for the recovery of any general assistance wrongfully received,
or both.
Sec. 16.
Minnesota Statutes 2022, section 256I.03, subdivision 15, is amended to read:
Subd. 15.
Supportive housing.
"Supportive housing" means housing that is not
time-limited deleted text begin anddeleted text end new text begin ,new text end provides or coordinates services necessary for a resident to maintain
housing stabilitynew text begin , and is not licensed as an assisted living facility under chapter 144Gnew text end .
Sec. 17.
Minnesota Statutes 2022, section 256I.03, is amended by adding a subdivision
to read:
new text begin Subd. 16. new text end
new text begin Date of application. new text end
new text begin
"Date of application" has the meaning given in section
256P.01, subdivision 2b.
new text end
Sec. 18.
Minnesota Statutes 2022, section 256I.04, subdivision 2, is amended to read:
Subd. 2.
Date of eligibility.
An individual who has met the eligibility requirements of
subdivision 1, shall have a housing support payment made on the individual's behalf from
the first day of the month deleted text begin in which a signeddeleted text end new text begin of the date ofnew text end application deleted text begin form is received by
a county agencydeleted text end ,new text begin as defined by section 256P.01, subdivision 2b,new text end or the first day of the month
in which all eligibility factors have been met, whichever is later.
Sec. 19.
Minnesota Statutes 2022, section 256I.06, subdivision 3, is amended to read:
Subd. 3.
Filing of application.
deleted text begin The county agency must immediately provide an
application form to any person requesting housing support. Application for housing support
must be in writing on a form prescribed by the commissioner.deleted text end new text begin Applications must be submitted
according to section 256P.04, subdivision 1a.new text end The county agency must determine an
applicant's eligibility for housing support as soon as the required verifications are received
by the county agency and within 30 days after a signed application is received by the county
agency for the aged or blind or within 60 days for people with a disability.
Sec. 20.
Minnesota Statutes 2022, section 256I.09, is amended to read:
256I.09 COMMUNITY LIVING INFRASTRUCTURE.
The commissioner shall award grants to agenciesnew text begin and multi-Tribal collaborativesnew text end through
an annual competitive process. Grants awarded under this section may be used for: (1)
outreach to locate and engage people who are homeless or residing in segregated settings
to screen for basic needs and assist with referral to community living resources; (2) building
capacity to provide technical assistance and consultation on housing and related support
service resources for persons with both disabilities and low income; or (3) streamlining the
administration and monitoring activities related to housing support funds. Agencies may
collaborate and submit a joint application for funding under this section.
Sec. 21.
Minnesota Statutes 2022, section 256J.08, subdivision 21, is amended to read:
Subd. 21.
Date of application.
"Date of application" deleted text begin means the date on which the county
agency receives an applicant's application as a signed written application, an application
submitted by telephone, or an application submitted through Internet telepresencedeleted text end new text begin has the
meaning given in section 256P.01, subdivision 2bnew text end .
Sec. 22.
Minnesota Statutes 2022, section 256J.09, subdivision 3, is amended to read:
Subd. 3.
Submitting application form.
(a) A county agency must offer, in person or
by mail, the application forms prescribed by the commissioner as soon as a person makes
a written or oral inquiry. At that time, the county agency must:
(1) inform the person that assistance begins on the date deleted text begin that thedeleted text end new text begin ofnew text end application deleted text begin is received
by the county agency either as a signed written application; an application submitted by
telephone; or an application submitted through Internet telepresence;deleted text end new text begin , as defined in section
256P.01, subdivision 2b,new text end or on the date that all eligibility criteria are met, whichever is later;
(2) inform a person that the person may submit the application by telephone or through
Internet telepresence;
(3) inform a person deleted text begin that when the person submits the application by telephone or through
Internet telepresence, the county agency must receive a signed written application within
30 days of the date that the person submitted the application by telephone or through Internet
telepresencedeleted text end new text begin of the application submission requirements in section 256P.04, subdivision
1anew text end ;
(4) inform the person that any delay in submitting the application will reduce the amount
of assistance paid for the month of application;
(5) inform a person that the person may submit the application before an interview;
(6) explain the information that will be verified during the application process by the
county agency as provided in section 256J.32;
(7) inform a person about the county agency's average application processing time and
explain how the application will be processed under subdivision 5;
(8) explain how to contact the county agency if a person's application information changes
and how to withdraw the application;
(9) inform a person that the next step in the application process is an interview and what
a person must do if the application is approved including, but not limited to, attending
orientation under section 256J.45 and complying with employment and training services
requirements in sections 256J.515 to 256J.57;
(10) inform the person that an interview must be conducted. The interview may be
conducted face-to-face in the county office or at a location mutually agreed upon, through
Internet telepresence, or by telephone;
(11) explain the child care and transportation services that are available under paragraph
(c) to enable caregivers to attend the interview, screening, and orientation; and
(12) identify any language barriers and arrange for translation assistance during
appointments, including, but not limited to, screening under subdivision 3a, orientation
under section 256J.45, and assessment under section 256J.521.
(b) Upon receipt of a signed application, the county agency must stamp the date of receipt
on the face of the application. The county agency must process the application within the
time period required under subdivision 5. An applicant may withdraw the application at
any time by giving written or oral notice to the county agency. The county agency must
issue a written notice confirming the withdrawal. The notice must inform the applicant of
the county agency's understanding that the applicant has withdrawn the application and no
longer wants to pursue it. When, within ten days of the date of the agency's notice, an
applicant informs a county agency, in writing, that the applicant does not wish to withdraw
the application, the county agency must reinstate the application and finish processing the
application.
(c) Upon a participant's request, the county agency must arrange for transportation and
child care or reimburse the participant for transportation and child care expenses necessary
to enable participants to attend the screening under subdivision 3a and orientation under
section 256J.45.
Sec. 23.
Minnesota Statutes 2022, section 256J.95, subdivision 5, is amended to read:
Subd. 5.
Submitting application form.
The eligibility date for the diversionary work
program begins on the date deleted text begin that the combineddeleted text end new text begin ofnew text end application deleted text begin form (CAF) is received by the
county agency either as a signed written application; an application submitted by telephone;
or an application submitted through Internet telepresence;deleted text end new text begin , as defined in section 256P.01,
subdivision 2b,new text end or on the date that diversionary work program eligibility criteria are met,
whichever is later. The county agency must inform an applicant deleted text begin that when the applicant
submits the application by telephone or through Internet telepresence, the county agency
must receive a signed written application within 30 days of the date that the applicant
submitted the application by telephone or through Internet telepresencedeleted text end new text begin of the application
submission requirements in section 256P.04, subdivision 1anew text end . The county agency must inform
the applicant that any delay in submitting the application will reduce the benefits paid for
the month of application. The county agency must inform a person that an application may
be submitted before the person has an interview appointment. Upon receipt of a signed
application, the county agency must stamp the date of receipt on the face of the application.
The applicant may withdraw the application at any time prior to approval by giving written
or oral notice to the county agency. The county agency must follow the notice requirements
in section 256J.09, subdivision 3, when issuing a notice confirming the withdrawal.
Sec. 24.
Minnesota Statutes 2022, section 256P.01, is amended by adding a subdivision
to read:
new text begin Subd. 2b. new text end
new text begin Date of application. new text end
new text begin
"Date of application" means the date on which the agency
receives an applicant's application as a signed written application, an application submitted
by telephone, or an application submitted through Internet telepresence. The child care
assistance program under chapter 119B is exempt from this definition.
new text end
Sec. 25.
Minnesota Statutes 2022, section 256P.04, is amended by adding a subdivision
to read:
new text begin Subd. 1a. new text end
new text begin Application submission. new text end
new text begin
An agency must offer, in person or by mail, the
application forms prescribed by the commissioner as soon as a person makes a written or
oral inquiry about assistance. Applications must be received by the agency as a signed
written application, an application submitted by telephone, or an application submitted
through Internet telepresence. When a person submits an application by telephone or through
Internet telepresence, the agency must receive a signed written application within 30 days
of the date that the person submitted the application by telephone or through Internet
telepresence.
new text end
Sec. 26. new text begin REVISOR INSTRUCTION.
new text end
new text begin
The revisor of statutes shall renumber the subdivisions in Minnesota Statutes, sections
256D.02 and 256I.03, in alphabetical order, excluding the first subdivision in each section,
and correct any cross-reference changes that result.
new text end
Sec. 27. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2022, section 256I.03, subdivision 6,
new text end
new text begin
is repealed.
new text end
ARTICLE 9
DEPARTMENT OF HUMAN SERVICES OPERATIONS POLICY
Section 1.
Minnesota Statutes 2022, section 62V.05, subdivision 4a, is amended to read:
Subd. 4a.
Background study required.
(a) The board must initiate background studies
under section 245C.031 of:
(1) each navigator;
(2) each in-person assister; and
(3) each certified application counselor.
(b) The board may initiate the background studies required by paragraph (a) using the
online NETStudy 2.0 system operated by the commissioner of human services.
(c) The board shall not permit any individual to provide any service or function listed
in paragraph (a) until deleted text begin the board has received notification from the commissioner of human
services indicating that the individualdeleted text end :
(1)new text begin the board has evaluated any notification received from the commissioner of human
services indicating the individual's potential disqualifications and has determined that the
individualnew text end is not disqualified under chapter 245C; or
(2)new text begin the board has determined that the individualnew text end is disqualifieddeleted text begin ,deleted text end but has deleted text begin receiveddeleted text end new text begin grantednew text end
a set aside deleted text begin from the boarddeleted text end of that disqualification according to sections 245C.22 and 245C.23.
(d) The board or its delegate shall review a reconsideration request of an individual in
paragraph (a), including granting a set aside, according to the procedures and criteria in
chapter 245C. The board shall notify the individual and the Department of Human Services
of the board's decision.
Sec. 2.
Minnesota Statutes 2022, section 122A.18, subdivision 8, is amended to read:
Subd. 8.
Background studies.
(a) The Professional Educator Licensing and Standards
Board and the Board of School Administrators must initiate criminal history background
studies of all first-time applicants for educator new text begin and administrator new text end licenses under their
jurisdiction. Applicants must include with their licensure applications:
(1) an executed criminal history consent form, including fingerprints; and
(2) payment to conduct the background study. The Professional Educator Licensing and
Standards Board must deposit payments received under this subdivision in an account in
the special revenue fund. Amounts in the account are annually appropriated to the
Professional Educator Licensing and Standards Board to pay for the costs of background
studies on applicants for licensure.
(b) The background study for all first-time deleted text begin teachingdeleted text end applicants fornew text begin educatornew text end licenses
must include a review of information from the Bureau of Criminal Apprehension, including
criminal history data as defined in section 13.87, and must also include a review of the
national criminal records repository. The superintendent of the Bureau of Criminal
Apprehension is authorized to exchange fingerprints with the Federal Bureau of Investigation
for purposes of the criminal history check.
(c) The Professional Educator Licensing and Standards Board may initiate criminal
history background studies through the commissioner of human services according to section
245C.031 to obtain background study data required under this chapter.
Sec. 3.
Minnesota Statutes 2022, section 245A.02, subdivision 5a, is amended to read:
Subd. 5a.
Controlling individual.
(a) "Controlling individual" means an owner of a
program or service provider licensed under this chapter and the following individuals, if
applicable:
(1) each officer of the organization, including the chief executive officer and chief
financial officer;
(2) the individual designated as the authorized agent under section 245A.04, subdivision
1, paragraph (b);
(3) the individual designated as the compliance officer under section 256B.04, subdivision
21, paragraph (g);
(4) each managerial official whose responsibilities include the direction of the
management or policies of a program; deleted text begin and
deleted text end
(5) the individual designated as the primary provider of care for a special family child
care program under section 245A.14, subdivision 4, paragraph (i)deleted text begin .deleted text end new text begin ; and
new text end
new text begin
(6) the president and treasurer of the board of directors of a nonprofit corporation.
new text end
(b) Controlling individual does not include:
(1) a bank, savings bank, trust company, savings association, credit union, industrial
loan and thrift company, investment banking firm, or insurance company unless the entity
operates a program directly or through a subsidiary;
(2) an individual who is a state or federal official, or state or federal employee, or a
member or employee of the governing body of a political subdivision of the state or federal
government that operates one or more programs, unless the individual is also an officer,
owner, or managerial official of the program, receives remuneration from the program, or
owns any of the beneficial interests not excluded in this subdivision;
(3) an individual who owns less than five percent of the outstanding common shares of
a corporation:
(i) whose securities are exempt under section 80A.45, clause (6); or
(ii) whose transactions are exempt under section 80A.46, clause (2);
(4) an individual who is a member of an organization exempt from taxation under section
290.05, unless the individual is also an officer, owner, or managerial official of the program
or owns any of the beneficial interests not excluded in this subdivision. This clause does
not exclude from the definition of controlling individual an organization that is exempt from
taxation; or
(5) an employee stock ownership plan trust, or a participant or board member of an
employee stock ownership plan, unless the participant or board member is a controlling
individual according to paragraph (a).
(c) For purposes of this subdivision, "managerial official" means an individual who has
the decision-making authority related to the operation of the program, and the responsibility
for the ongoing management of or direction of the policies, services, or employees of the
program. A site director who has no ownership interest in the program is not considered to
be a managerial official for purposes of this definition.
Sec. 4.
Minnesota Statutes 2022, section 245A.02, subdivision 10b, is amended to read:
Subd. 10b.
Owner.
"Owner" means an individual or organization that has a direct or
indirect ownership interest of five percent or more in a program licensed under this chapter.
For purposes of this subdivision, "direct ownership interest" means the possession of equity
in capital, stock, or profits of an organization, and "indirect ownership interest" means a
direct ownership interest in an entity that has a direct or indirect ownership interest in a
licensed program. For purposes of this chapter, "owner of deleted text begin a nonprofit corporation" means
the president and treasurer of the board of directors or, for an entity owned bydeleted text end an employee
stock ownership plandeleted text begin ,deleted text end new text begin "new text end means the president and treasurer of the entity. A government entitynew text begin
or nonprofit corporationnew text end that is issued a license under this chapter shall be designated the
owner.
Sec. 5.
Minnesota Statutes 2022, section 245A.04, subdivision 1, is amended to read:
Subdivision 1.
Application for licensure.
(a) An individual, organization, or government
entity that is subject to licensure under section 245A.03 must apply for a license. The
application must be made on the forms and in the manner prescribed by the commissioner.
The commissioner shall provide the applicant with instruction in completing the application
and provide information about the rules and requirements of other state agencies that affect
the applicant. An applicant seeking licensure in Minnesota with headquarters outside of
Minnesota must have a program office located within 30 miles of the Minnesota border.
An applicant who intends to buy or otherwise acquire a program or services licensed under
this chapter that is owned by another license holder must apply for a license under this
chapter and comply with the application procedures in this section and section deleted text begin 245A.03deleted text end new text begin
245A.043new text end .
The commissioner shall act on the application within 90 working days after a complete
application and any required reports have been received from other state agencies or
departments, counties, municipalities, or other political subdivisions. The commissioner
shall not consider an application to be complete until the commissioner receives all of the
required information.
When the commissioner receives an application for initial licensure that is incomplete
because the applicant failed to submit required documents or that is substantially deficient
because the documents submitted do not meet licensing requirements, the commissioner
shall provide the applicant written notice that the application is incomplete or substantially
deficient. In the written notice to the applicant the commissioner shall identify documents
that are missing or deficient and give the applicant 45 days to resubmit a second application
that is substantially complete. An applicant's failure to submit a substantially complete
application after receiving notice from the commissioner is a basis for license denial under
section 245A.05.
(b) An application for licensure must identify all controlling individuals as defined in
section 245A.02, subdivision 5a, and must designate one individual to be the authorized
agent. The application must be signed by the authorized agent and must include the authorized
agent's first, middle, and last name; mailing address; and email address. By submitting an
application for licensure, the authorized agent consents to electronic communication with
the commissioner throughout the application process. The authorized agent must be
authorized to accept service on behalf of all of the controlling individuals. A government
entity that holds multiple licenses under this chapter may designate one authorized agent
for all licenses issued under this chapter or may designate a different authorized agent for
each license. Service on the authorized agent is service on all of the controlling individuals.
It is not a defense to any action arising under this chapter that service was not made on each
controlling individual. The designation of a controlling individual as the authorized agent
under this paragraph does not affect the legal responsibility of any other controlling individual
under this chapter.
(c) An applicant or license holder must have a policy that prohibits license holders,
employees, subcontractors, and volunteers, when directly responsible for persons served
by the program, from abusing prescription medication or being in any manner under the
influence of a chemical that impairs the individual's ability to provide services or care. The
license holder must train employees, subcontractors, and volunteers about the program's
drug and alcohol policy.
(d) An applicant and license holder must have a program grievance procedure that permits
persons served by the program and their authorized representatives to bring a grievance to
the highest level of authority in the program.
(e) The commissioner may limit communication during the application process to the
authorized agent or the controlling individuals identified on the license application and for
whom a background study was initiated under chapter 245C. The commissioner may require
the applicant, except for child foster care, to demonstrate competence in the applicable
licensing requirements by successfully completing a written examination. The commissioner
may develop a prescribed written examination format.
(f) When an applicant is an individual, the applicant must provide:
(1) the applicant's taxpayer identification numbers including the Social Security number
or Minnesota tax identification number, and federal employer identification number if the
applicant has employees;
(2) at the request of the commissioner, a copy of the most recent filing with the secretary
of state that includes the complete business name, if any;
(3) if doing business under a different name, the doing business as (DBA) name, as
registered with the secretary of state;
(4) if applicable, the applicant's National Provider Identifier (NPI) number and Unique
Minnesota Provider Identifier (UMPI) number; and
(5) at the request of the commissioner, the notarized signature of the applicant or
authorized agentdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(6) except for family foster care providers, an email address that will be made public
subject to the requirements under section 13.46, subdivision 4, paragraph (b), clause (1),
item (i).
new text end
(g) When an applicant is an organization, the applicant must provide:
(1) the applicant's taxpayer identification numbers including the Minnesota tax
identification number and federal employer identification number;
(2) at the request of the commissioner, a copy of the most recent filing with the secretary
of state that includes the complete business name, and if doing business under a different
name, the doing business as (DBA) name, as registered with the secretary of state;
(3) the first, middle, and last name, and address for all individuals who will be controlling
individuals, including all officers, owners, and managerial officials as defined in section
245A.02, subdivision 5a, and the date that the background study was initiated by the applicant
for each controlling individual;
(4) if applicable, the applicant's NPI number and UMPI number;
(5) the documents that created the organization and that determine the organization's
internal governance and the relations among the persons that own the organization, have
an interest in the organization, or are members of the organization, in each case as provided
or authorized by the organization's governing statute, which may include a partnership
agreement, bylaws, articles of organization, organizational chart, and operating agreement,
or comparable documents as provided in the organization's governing statute; deleted text begin and
deleted text end
(6) the notarized signature of the applicant or authorized agentdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(7) an email address that will be made public subject to the requirements under section
13.46, subdivision 4, paragraph (b), clause (1), item (i).
new text end
(h) When the applicant is a government entity, the applicant must provide:
(1) the name of the government agency, political subdivision, or other unit of government
seeking the license and the name of the program or services that will be licensed;
(2) the applicant's taxpayer identification numbers including the Minnesota tax
identification number and federal employer identification number;
(3) a letter signed by the manager, administrator, or other executive of the government
entity authorizing the submission of the license application; and
(4) if applicable, the applicant's NPI number and UMPI numberdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(5) an email address that will be made public subject to the requirements under section
13.46, subdivision 4, paragraph (b), clause (1), item (i).
new text end
(i) At the time of application for licensure or renewal of a license under this chapter, the
applicant or license holder must acknowledge on the form provided by the commissioner
if the applicant or license holder elects to receive any public funding reimbursement from
the commissioner for services provided under the license that:
(1) the applicant's or license holder's compliance with the provider enrollment agreement
or registration requirements for receipt of public funding may be monitored by the
commissioner as part of a licensing investigation or licensing inspection; and
(2) noncompliance with the provider enrollment agreement or registration requirements
for receipt of public funding that is identified through a licensing investigation or licensing
inspection, or noncompliance with a licensing requirement that is a basis of enrollment for
reimbursement for a service, may result in:
(i) a correction order or a conditional license under section 245A.06, or sanctions under
section 245A.07;
(ii) nonpayment of claims submitted by the license holder for public program
reimbursement;
(iii) recovery of payments made for the service;
(iv) disenrollment in the public payment program; or
(v) other administrative, civil, or criminal penalties as provided by law.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 6.
Minnesota Statutes 2022, section 245A.04, subdivision 7, is amended to read:
Subd. 7.
Grant of license; license extension.
(a) If the commissioner determines that
the program complies with all applicable rules and laws, the commissioner shall issue a
license consistent with this section or, if applicable, a temporary change of ownership license
under section 245A.043. At minimum, the license shall state:
(1) the name of the license holder;
(2) the address of the program;
(3) the effective date and expiration date of the license;
(4) the type of license;
(5) the maximum number and ages of persons that may receive services from the program;
deleted text begin and
deleted text end
(6) any special conditions of licensuredeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(7) the public email address of the program.
new text end
(b) The commissioner may issue a license for a period not to exceed two years if:
(1) the commissioner is unable to conduct the deleted text begin evaluation ordeleted text end observation required by
subdivision 4, paragraph (a), clause deleted text begin (4)deleted text end new text begin (3)new text end , because the program is not yet operational;
(2) certain records and documents are not available because persons are not yet receiving
services from the program; and
(3) the applicant complies with applicable laws and rules in all other respects.
(c) A decision by the commissioner to issue a license does not guarantee that any person
or persons will be placed or cared for in the licensed program.
(d) Except as provided in paragraphs (f) and (g), the commissioner shall not issue or
reissue a license if the applicant, license holder, or controlling individual has:
(1) been disqualified and the disqualification was not set aside and no variance has been
granted;
(2) been denied a license under this chapter, within the past two years;
(3) had a license issued under this chapter revoked within the past five years;
(4) an outstanding debt related to a license fee, licensing fine, or settlement agreement
for which payment is delinquent; or
(5) failed to submit the information required of an applicant under subdivision 1,
paragraph (f) deleted text begin ordeleted text end new text begin ,new text end (g),new text begin or (h),new text end after being requested by the commissioner.
When a license issued under this chapter is revoked under clause (1) or (3), the license
holder and controlling individual may not hold any license under chapter 245A for five
years following the revocation, and other licenses held by the applicant, license holder, or
controlling individual shall also be revoked.
(e) The commissioner shall not issue or reissue a license under this chapter if an individual
living in the household where the services will be provided as specified under section
245C.03, subdivision 1, has been disqualified and the disqualification has not been set aside
and no variance has been granted.
(f) Pursuant to section 245A.07, subdivision 1, paragraph (b), when a license issued
under this chapter has been suspended or revoked and the suspension or revocation is under
appeal, the program may continue to operate pending a final order from the commissioner.
If the license under suspension or revocation will expire before a final order is issued, a
temporary provisional license may be issued provided any applicable license fee is paid
before the temporary provisional license is issued.
(g) Notwithstanding paragraph (f), when a revocation is based on the disqualification
of a controlling individual or license holder, and the controlling individual or license holder
is ordered under section 245C.17 to be immediately removed from direct contact with
persons receiving services or is ordered to be under continuous, direct supervision when
providing direct contact services, the program may continue to operate only if the program
complies with the order and submits documentation demonstrating compliance with the
order. If the disqualified individual fails to submit a timely request for reconsideration, or
if the disqualification is not set aside and no variance is granted, the order to immediately
remove the individual from direct contact or to be under continuous, direct supervision
remains in effect pending the outcome of a hearing and final order from the commissioner.
(h) For purposes of reimbursement for meals only, under the Child and Adult Care Food
Program, Code of Federal Regulations, title 7, subtitle B, chapter II, subchapter A, part 226,
relocation within the same county by a licensed family day care provider, shall be considered
an extension of the license for a period of no more than 30 calendar days or until the new
license is issued, whichever occurs first, provided the county agency has determined the
family day care provider meets licensure requirements at the new location.
(i) Unless otherwise specified by statute, all licenses issued under this chapter expire at
12:01 a.m. on the day after the expiration date stated on the license. A license holder must
apply for and be granted a new license to operate the program or the program must not be
operated after the expiration date.
(j) The commissioner shall not issue or reissue a license under this chapter if it has been
determined that a tribal licensing authority has established jurisdiction to license the program
or service.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 7.
Minnesota Statutes 2022, section 245A.041, is amended by adding a subdivision
to read:
new text begin Subd. 6. new text end
new text begin First date of direct contact; documentation requirements. new text end
new text begin
Except for family
child care, family foster care for children, and family adult day services that the license
holder provides in the license holder's residence, license holders must document the first
date that a background study subject has direct contact, as defined in section 245C.02,
subdivision 11, with a person served by the license holder's program. Unless this chapter
otherwise requires, if the license holder does not maintain the documentation required by
this subdivision in the license holder's personnel files, the license holder must provide the
documentation to the commissioner upon the commissioner's request.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024.
new text end
Sec. 8.
Minnesota Statutes 2022, section 245A.07, subdivision 2a, is amended to read:
Subd. 2a.
Immediate suspension expedited hearing.
(a) Within five working days of
receipt of the license holder's timely appeal, the commissioner shall request assignment of
an administrative law judge. The request must include a proposed date, time, and place of
a hearing. A hearing must be conducted by an administrative law judge within 30 calendar
days of the request for assignment, unless an extension is requested by either party and
granted by the administrative law judge for good cause. The commissioner shall issue a
notice of hearing by certified mail or personal service at least ten working days before the
hearing. The scope of the hearing shall be limited solely to the issue of whether the temporary
immediate suspension should remain in effect pending the commissioner's final order under
section 245A.08, regarding a licensing sanction issued under subdivision 3 following the
immediate suspension. For suspensions under subdivision 2, paragraph (a), clause (1), the
burden of proof in expedited hearings under this subdivision shall be limited to the
commissioner's demonstration that reasonable cause exists to believe that the license holder's
actions or failure to comply with applicable law or rule poses, or the actions of other
individuals or conditions in the program poses an imminent risk of harm to the health, safety,
or rights of persons served by the program. "Reasonable cause" means there exist specific
articulable facts or circumstances which provide the commissioner with a reasonable
suspicion that there is an imminent risk of harm to the health, safety, or rights of persons
served by the program. When the commissioner has determined there is reasonable cause
to order the temporary immediate suspension of a license based on a violation of safe sleep
requirements, as defined in section 245A.1435, the commissioner is not required to
demonstrate that an infant died or was injured as a result of the safe sleep violations. For
suspensions under subdivision 2, paragraph (a), clause (2), the burden of proof in expedited
hearings under this subdivision shall be limited to the commissioner's demonstration by a
preponderance of the evidence that, since the license was revoked, the license holder
committed additional violations of law or rule which may adversely affect the health or
safety of persons served by the program.
(b) The administrative law judge shall issue findings of fact, conclusions, and a
recommendation within ten working days from the date of hearing. The parties shall have
ten calendar days to submit exceptions to the administrative law judge's report. The record
shall close at the end of the ten-day period for submission of exceptions. The commissioner's
final order shall be issued within ten working days from the close of the record. When an
appeal of a temporary immediate suspension is withdrawn or dismissed, the commissioner
shall issue a final order affirming the temporary immediate suspension within ten calendar
days of the commissioner's receipt of the withdrawal or dismissal. Within 90 calendar days
after new text begin an immediate suspension has been issued and the license holder has not submitted a
timely appeal under subdivision 2, paragraph (b), or within 90 calendar days after new text end a final
order affirming an immediate suspension, the commissioner shall deleted text begin make a determination
regardingdeleted text end new text begin determine:
new text end
new text begin (1)new text end whether a final licensing sanction shall be issued under subdivision 3new text begin , paragraph (a),
clauses (1) to (5)new text end . The license holder shall continue to be prohibited from operation of the
program during this 90-day perioddeleted text begin .deleted text end new text begin ; or
new text end
new text begin
(2) whether the outcome of related, ongoing investigations or judicial proceedings are
necessary to determine if a final licensing sanction under subdivision 3, paragraph (a),
clauses (1) to (5), will be issued, and persons served by the program remain at an imminent
risk of harm during the investigation period or proceedings. If so, the commissioner shall
issue a suspension order under subdivision 3, paragraph (a), clause (6).
new text end
(c) When the final order under paragraph (b) affirms an immediate suspensionnew text begin or the
license holder does not submit a timely appeal of the immediate suspensionnew text end , and a final
licensing sanction is issued under subdivision 3 and the license holder appeals that sanction,
the license holder continues to be prohibited from operation of the program pending a final
commissioner's order under section 245A.08, subdivision 5, regarding the final licensing
sanction.
new text begin
(d) The license holder shall continue to be prohibited from operation of the program
while a suspension order issued under paragraph (b), clause (2), remains in effect.
new text end
deleted text begin (d)deleted text end new text begin (e)new text end For suspensions under subdivision 2, paragraph (a), clause (3), the burden of
proof in expedited hearings under this subdivision shall be limited to the commissioner's
demonstration by a preponderance of the evidence that a criminal complaint and warrant
or summons was issued for the license holder that was not dismissed, and that the criminal
charge is an offense that involves fraud or theft against a program administered by the
commissioner.
Sec. 9.
Minnesota Statutes 2022, section 245A.07, subdivision 3, is amended to read:
Subd. 3.
License suspension, revocation, or fine.
(a) The commissioner may suspend
or revoke a license, or impose a fine if:
(1) a license holder fails to comply fully with applicable laws or rules including but not
limited to the requirements of this chapter and chapter 245C;
(2) a license holder, a controlling individual, or an individual living in the household
where the licensed services are provided or is otherwise subject to a background study has
been disqualified and the disqualification was not set aside and no variance has been granted;
(3) a license holder knowingly withholds relevant information from or gives false or
misleading information to the commissioner in connection with an application for a license,
in connection with the background study status of an individual, during an investigation,
or regarding compliance with applicable laws or rules;
(4) a license holder is excluded from any program administered by the commissioner
under section 245.095; deleted text begin or
deleted text end
(5) revocation is required under section 245A.04, subdivision 7, paragraph (d)deleted text begin .deleted text end new text begin ; or
new text end
new text begin
(6) suspension is necessary under subdivision 2a, paragraph (b), clause (2).
new text end
A license holder who has had a license issued under this chapter suspended, revoked,
or has been ordered to pay a fine must be given notice of the action by certified mail or
personal service. If mailed, the notice must be mailed to the address shown on the application
or the last known address of the license holder. The notice must state in plain language the
reasons the license was suspended or revoked, or a fine was ordered.
(b) If the license was suspended or revoked, the notice must inform the license holder
of the right to a contested case hearing under chapter 14 and Minnesota Rules, parts
1400.8505 to 1400.8612. The license holder may appeal an order suspending or revoking
a license. The appeal of an order suspending or revoking a license must be made in writing
by certified mail or personal service. If mailed, the appeal must be postmarked and sent to
the commissioner within ten calendar days after the license holder receives notice that the
license has been suspended or revoked. If a request is made by personal service, it must be
received by the commissioner within ten calendar days after the license holder received the
order. Except as provided in subdivision 2a, paragraph (c), if a license holder submits a
timely appeal of an order suspending or revoking a license, the license holder may continue
to operate the program as provided in section 245A.04, subdivision 7, paragraphs (f) and
(g), until the commissioner issues a final order on the suspension or revocation.
(c)(1) If the license holder was ordered to pay a fine, the notice must inform the license
holder of the responsibility for payment of fines and the right to a contested case hearing
under chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. The appeal of an
order to pay a fine must be made in writing by certified mail or personal service. If mailed,
the appeal must be postmarked and sent to the commissioner within ten calendar days after
the license holder receives notice that the fine has been ordered. If a request is made by
personal service, it must be received by the commissioner within ten calendar days after
the license holder received the order.
(2) The license holder shall pay the fines assessed on or before the payment date specified.
If the license holder fails to fully comply with the order, the commissioner may issue a
second fine or suspend the license until the license holder complies. If the license holder
receives state funds, the state, county, or municipal agencies or departments responsible for
administering the funds shall withhold payments and recover any payments made while the
license is suspended for failure to pay a fine. A timely appeal shall stay payment of the fine
until the commissioner issues a final order.
(3) A license holder shall promptly notify the commissioner of human services, in writing,
when a violation specified in the order to forfeit a fine is corrected. If upon reinspection the
commissioner determines that a violation has not been corrected as indicated by the order
to forfeit a fine, the commissioner may issue a second fine. The commissioner shall notify
the license holder by certified mail or personal service that a second fine has been assessed.
The license holder may appeal the second fine as provided under this subdivision.
(4) Fines shall be assessed as follows:
(i) the license holder shall forfeit $1,000 for each determination of maltreatment of a
child under chapter 260E or the maltreatment of a vulnerable adult under section 626.557
for which the license holder is determined responsible for the maltreatment under section
260E.30, subdivision 4, paragraphs (a) and (b), or 626.557, subdivision 9c, paragraph (c);
(ii) if the commissioner determines that a determination of maltreatment for which the
license holder is responsible is the result of maltreatment that meets the definition of serious
maltreatment as defined in section 245C.02, subdivision 18, the license holder shall forfeit
$5,000;
(iii) for a program that operates out of the license holder's home and a program licensed
under Minnesota Rules, parts 9502.0300 to 9502.0445, the fine assessed against the license
holder shall not exceed $1,000 for each determination of maltreatment;
(iv) the license holder shall forfeit $200 for each occurrence of a violation of law or rule
governing matters of health, safety, or supervision, including but not limited to the provision
of adequate staff-to-child or adult ratios, and failure to comply with background study
requirements under chapter 245C; and
(v) the license holder shall forfeit $100 for each occurrence of a violation of law or rule
other than those subject to a $5,000, $1,000, or $200 fine in items (i) to (iv).
For purposes of this section, "occurrence" means each violation identified in the
commissioner's fine order. Fines assessed against a license holder that holds a license to
provide home and community-based services, as identified in section 245D.03, subdivision
1, and a community residential setting or day services facility license under chapter 245D
where the services are provided, may be assessed against both licenses for the same
occurrence, but the combined amount of the fines shall not exceed the amount specified in
this clause for that occurrence.
(5) When a fine has been assessed, the license holder may not avoid payment by closing,
selling, or otherwise transferring the licensed program to a third party. In such an event, the
license holder will be personally liable for payment. In the case of a corporation, each
controlling individual is personally and jointly liable for payment.
(d) Except for background study violations involving the failure to comply with an order
to immediately remove an individual or an order to provide continuous, direct supervision,
the commissioner shall not issue a fine under paragraph (c) relating to a background study
violation to a license holder who self-corrects a background study violation before the
commissioner discovers the violation. A license holder who has previously exercised the
provisions of this paragraph to avoid a fine for a background study violation may not avoid
a fine for a subsequent background study violation unless at least 365 days have passed
since the license holder self-corrected the earlier background study violation.
Sec. 10.
Minnesota Statutes 2022, section 245A.10, subdivision 3, is amended to read:
Subd. 3.
Application fee for initial license or certification.
(a) For fees required under
subdivision 1, an applicant for an initial license or certification issued by the commissioner
shall submit a $500 application fee with each new application required under this subdivision.
An applicant for an initial day services facility license under chapter 245D shall submit a
$250 application fee with each new application. The application fee shall not be prorated,
is nonrefundable, and is in lieu of the annual license or certification fee that expires on
December 31. The commissioner shall not process an application until the application fee
is paid.
(b) Except as provided in clauses (1) deleted text begin to (3)deleted text end new text begin and (2)new text end , an applicant shall apply for a license
to provide services at a specific location.
(1) For a license to provide home and community-based services to persons with
disabilities or age 65 and older under chapter 245D, an applicant shall submit an application
to provide services statewide. Notwithstanding paragraph (a), applications received by the
commissioner between July 1, 2013, and December 31, 2013, for licensure of services
provided under chapter 245D must include an application fee that is equal to the annual
license renewal fee under subdivision 4, paragraph (b), or $500, whichever is less.
Applications received by the commissioner after January 1, 2014, must include the application
fee required under paragraph (a). Applicants who meet the modified application criteria
identified in section 245A.042, subdivision 2, are exempt from paying an application fee.
deleted text begin
(2) For a license to provide independent living assistance for youth under section 245A.22,
an applicant shall submit a single application to provide services statewide.
deleted text end
deleted text begin (3)deleted text end new text begin (2)new text end For a license for a private agency to provide foster care or adoption services under
Minnesota Rules, parts 9545.0755 to 9545.0845, an applicant shall submit a single application
to provide services statewide.
(c) The initial application fee charged under this subdivision does not include the
temporary license surcharge under section 16E.22.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 11.
Minnesota Statutes 2022, section 245A.10, subdivision 4, is amended to read:
Subd. 4.
License or certification fee for certain programs.
(a) Child care centers shall
pay an annual nonrefundable license fee based on the following schedule:
| Licensed Capacity |
Child Care Center License Fee |
|
| 1 to 24 persons |
$200 |
|
| 25 to 49 persons |
$300 |
|
| 50 to 74 persons |
$400 |
|
| 75 to 99 persons |
$500 |
|
| 100 to 124 persons |
$600 |
|
| 125 to 149 persons |
$700 |
|
| 150 to 174 persons |
$800 |
|
| 175 to 199 persons |
$900 |
|
| 200 to 224 persons |
$1,000 |
|
| 225 or more persons |
$1,100 |
(b)(1) A program licensed to provide one or more of the home and community-based
services and supports identified under chapter 245D to persons with disabilities or age 65
and older, shall pay an annual nonrefundable license fee based on revenues derived from
the provision of services that would require licensure under chapter 245D during the calendar
year immediately preceding the year in which the license fee is paid, according to the
following schedule:
| License Holder Annual Revenue |
License Fee |
|
| less than or equal to $10,000 |
$200 |
|
| greater than $10,000 but less than or equal to $25,000 |
$300 |
|
| greater than $25,000 but less than or equal to $50,000 |
$400 |
|
| greater than $50,000 but less than or equal to $100,000 |
$500 |
|
| greater than $100,000 but less than or equal to $150,000 |
$600 |
|
| greater than $150,000 but less than or equal to $200,000 |
$800 |
|
| greater than $200,000 but less than or equal to $250,000 |
$1,000 |
|
| greater than $250,000 but less than or equal to $300,000 |
$1,200 |
|
| greater than $300,000 but less than or equal to $350,000 |
$1,400 |
|
| greater than $350,000 but less than or equal to $400,000 |
$1,600 |
|
| greater than $400,000 but less than or equal to $450,000 |
$1,800 |
|
| greater than $450,000 but less than or equal to $500,000 |
$2,000 |
|
| greater than $500,000 but less than or equal to $600,000 |
$2,250 |
|
| greater than $600,000 but less than or equal to $700,000 |
$2,500 |
|
| greater than $700,000 but less than or equal to $800,000 |
$2,750 |
|
| greater than $800,000 but less than or equal to $900,000 |
$3,000 |
|
| greater than $900,000 but less than or equal to $1,000,000 |
$3,250 |
|
| greater than $1,000,000 but less than or equal to $1,250,000 |
$3,500 |
|
| greater than $1,250,000 but less than or equal to $1,500,000 |
$3,750 |
|
| greater than $1,500,000 but less than or equal to $1,750,000 |
$4,000 |
|
| greater than $1,750,000 but less than or equal to $2,000,000 |
$4,250 |
|
| greater than $2,000,000 but less than or equal to $2,500,000 |
$4,500 |
|
| greater than $2,500,000 but less than or equal to $3,000,000 |
$4,750 |
|
| greater than $3,000,000 but less than or equal to $3,500,000 |
$5,000 |
|
| greater than $3,500,000 but less than or equal to $4,000,000 |
$5,500 |
|
| greater than $4,000,000 but less than or equal to $4,500,000 |
$6,000 |
|
| greater than $4,500,000 but less than or equal to $5,000,000 |
$6,500 |
|
| greater than $5,000,000 but less than or equal to $7,500,000 |
$7,000 |
|
| greater than $7,500,000 but less than or equal to $10,000,000 |
$8,500 |
|
| greater than $10,000,000 but less than or equal to $12,500,000 |
$10,000 |
|
| greater than $12,500,000 but less than or equal to $15,000,000 |
$14,000 |
|
| greater than $15,000,000 |
$18,000 |
(2) If requested, the license holder shall provide the commissioner information to verify
the license holder's annual revenues or other information as needed, including copies of
documents submitted to the Department of Revenue.
(3) At each annual renewal, a license holder may elect to pay the highest renewal fee,
and not provide annual revenue information to the commissioner.
(4) A license holder that knowingly provides the commissioner incorrect revenue amounts
for the purpose of paying a lower license fee shall be subject to a civil penalty in the amount
of double the fee the provider should have paid.
(5) Notwithstanding clause (1), a license holder providing services under one or more
licenses under chapter 245B that are in effect on May 15, 2013, shall pay an annual license
fee for calendar years 2014, 2015, and 2016, equal to the total license fees paid by the license
holder for all licenses held under chapter 245B for calendar year 2013. For calendar year
2017 and thereafter, the license holder shall pay an annual license fee according to clause
(1).
(c) A substance use disorder treatment program licensed under chapter 245G, to provide
substance use disorder treatment shall pay an annual nonrefundable license fee based on
the following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$600 |
|
| 25 to 49 persons |
$800 |
|
| 50 to 74 persons |
$1,000 |
|
| 75 to 99 persons |
$1,200 |
|
| 100 or more persons |
$1,400 |
(d) A detoxification program licensed under Minnesota Rules, parts 9530.6510 to
9530.6590, or a withdrawal management program licensed under chapter 245F shall pay
an annual nonrefundable license fee based on the following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$760 |
|
| 25 to 49 persons |
$960 |
|
| 50 or more persons |
$1,160 |
A detoxification program that also operates a withdrawal management program at the same
location shall only pay one fee based upon the licensed capacity of the program with the
higher overall capacity.
(e) Except for child foster care, a residential facility licensed under Minnesota Rules,
chapter 2960, to serve children shall pay an annual nonrefundable license fee based on the
following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$1,000 |
|
| 25 to 49 persons |
$1,100 |
|
| 50 to 74 persons |
$1,200 |
|
| 75 to 99 persons |
$1,300 |
|
| 100 or more persons |
$1,400 |
(f) A residential facility licensed under section 245I.23 or Minnesota Rules, parts
9520.0500 to 9520.0670, to serve persons with mental illness shall pay an annual
nonrefundable license fee based on the following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$2,525 |
|
| 25 or more persons |
$2,725 |
(g) A residential facility licensed under Minnesota Rules, parts 9570.2000 to 9570.3400,
to serve persons with physical disabilities shall pay an annual nonrefundable license fee
based on the following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$450 |
|
| 25 to 49 persons |
$650 |
|
| 50 to 74 persons |
$850 |
|
| 75 to 99 persons |
$1,050 |
|
| 100 or more persons |
$1,250 |
deleted text begin
(h) A program licensed to provide independent living assistance for youth under section
245A.22 shall pay an annual nonrefundable license fee of $1,500.
deleted text end
deleted text begin (i)deleted text end new text begin (h)new text end A private agency licensed to provide foster care and adoption services under
Minnesota Rules, parts 9545.0755 to 9545.0845, shall pay an annual nonrefundable license
fee of $875.
deleted text begin (j)deleted text end new text begin (i)new text end A program licensed as an adult day care center licensed under Minnesota Rules,
parts 9555.9600 to 9555.9730, shall pay an annual nonrefundable license fee based on the
following schedule:
| Licensed Capacity |
License Fee |
|
| 1 to 24 persons |
$500 |
|
| 25 to 49 persons |
$700 |
|
| 50 to 74 persons |
$900 |
|
| 75 to 99 persons |
$1,100 |
|
| 100 or more persons |
$1,300 |
deleted text begin (k)deleted text end new text begin (j)new text end A program licensed to provide treatment services to persons with sexual
psychopathic personalities or sexually dangerous persons under Minnesota Rules, parts
9515.3000 to 9515.3110, shall pay an annual nonrefundable license fee of $20,000.
deleted text begin (l)deleted text end new text begin (k)new text end A mental health clinic certified under section 245I.20 shall pay an annual
nonrefundable certification fee of $1,550. If the mental health clinic provides services at a
primary location with satellite facilities, the satellite facilities shall be certified with the
primary location without an additional charge.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 12.
Minnesota Statutes 2022, section 245A.16, subdivision 1, is amended to read:
Subdivision 1.
Delegation of authority to agencies.
(a) County agencies and private
agencies that have been designated or licensed by the commissioner to perform licensing
functions and activities under section 245A.04 deleted text begin and background studies for family child care
under chapter deleted text end deleted text begin 245Cdeleted text end ; to recommend denial of applicants under section 245A.05; to issue
correction orders, to issue variances, and recommend a conditional license under section
245A.06; or to recommend suspending or revoking a license or issuing a fine under section
245A.07, shall comply with rules and directives of the commissioner governing those
functions and with this section. The following variances are excluded from the delegation
of variance authority and may be issued only by the commissioner:
(1) dual licensure of family child care and child foster care, dual licensure of child and
adult foster care, and adult foster care and family child care;
(2) adult foster care maximum capacity;
(3) adult foster care minimum age requirement;
(4) child foster care maximum age requirement;
(5) variances regarding disqualified individuals deleted text begin except that, before the implementation
of NETStudy 2.0, county agencies may issue variances under section 245C.30 regarding
disqualified individuals when the county is responsible for conducting a consolidated
reconsideration according to sections 245C.25 and 245C.27, subdivision 2, clauses (a) and
(b), of a county maltreatment determination and a disqualification based on serious or
recurring maltreatmentdeleted text end ;
(6) the required presence of a caregiver in the adult foster care residence during normal
sleeping hours;
(7) variances to requirements relating to chemical use problems of a license holder or a
household member of a license holder; and
(8) variances to section 245A.53 for a time-limited period. If the commissioner grants
a variance under this clause, the license holder must provide notice of the variance to all
parents and guardians of the children in care.
Except as provided in section 245A.14, subdivision 4, paragraph (e), a county agency must
not grant a license holder a variance to exceed the maximum allowable family child care
license capacity of 14 children.
(b) A county agency that has been designated by the commissioner to issue family child
care variances must:
(1) publish the county agency's policies and criteria for issuing variances on the county's
public website and update the policies as necessary; and
(2) annually distribute the county agency's policies and criteria for issuing variances to
all family child care license holders in the county.
deleted text begin
(c) Before the implementation of NETStudy 2.0, county agencies must report information
about disqualification reconsiderations under sections 245C.25 and 245C.27, subdivision
2, paragraphs (a) and (b), and variances granted under paragraph (a), clause (5), to the
commissioner at least monthly in a format prescribed by the commissioner.
deleted text end
deleted text begin (d)deleted text end new text begin (c)new text end For family child care programs, the commissioner shall require a county agency
to conduct one unannounced licensing review at least annually.
deleted text begin (e)deleted text end new text begin (d)new text end For family adult day services programs, the commissioner may authorize licensing
reviews every two years after a licensee has had at least one annual review.
deleted text begin (f)deleted text end new text begin (e)new text end A license issued under this section may be issued for up to two years.
deleted text begin (g)deleted text end new text begin (f)new text end During implementation of chapter 245D, the commissioner shall consider:
(1) the role of counties in quality assurance;
(2) the duties of county licensing staff; and
(3) the possible use of joint powers agreements, according to section 471.59, with counties
through which some licensing duties under chapter 245D may be delegated by the
commissioner to the counties.
Any consideration related to this paragraph must meet all of the requirements of the corrective
action plan ordered by the federal Centers for Medicare and Medicaid Services.
deleted text begin (h)deleted text end new text begin (g)new text end Licensing authority specific to section 245D.06, subdivisions 5, 6, 7, and 8, or
successor provisions; and section 245D.061 or successor provisions, for family child foster
care programs providing out-of-home respite, as identified in section 245D.03, subdivision
1, paragraph (b), clause (1), is excluded from the delegation of authority to county and
private agencies.
deleted text begin (i)deleted text end new text begin (h)new text end A county agency shall report to the commissioner, in a manner prescribed by the
commissioner, the following information for a licensed family child care program:
(1) the results of each licensing review completed, including the date of the review, and
any licensing correction order issued;
(2) any death, serious injury, or determination of substantiated maltreatment; and
(3) any fires that require the service of a fire department within 48 hours of the fire. The
information under this clause must also be reported to the state fire marshal within two
business days of receiving notice from a licensed family child care provider.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 13.
new text begin
[245A.211] PRONE RESTRAINT PROHIBITION.
new text end
new text begin Subdivision 1. new text end
new text begin Applicability. new text end
new text begin
This section applies to all programs licensed or certified
under this chapter, chapters 245D, 245F, 245G, 245H, and sections 245I.20 and 245I.23.
The requirements in this section are in addition to any applicable requirements for the use
of holds or restraints for each license or certification type.
new text end
new text begin Subd. 2. new text end
new text begin Definitions. new text end
new text begin
(a) "Mechanical restraint" means a restraint device that limits the
voluntary movement of a person or the person's limbs.
new text end
new text begin
(b) "Prone restraint" means a restraint that places a person in a face-down position with
the person's chest in contact with the floor or other surface.
new text end
new text begin
(c) "Restraint" means a physical hold, physical restraint, manual restraint, restraint
equipment, or mechanical restraint that holds a person immobile or limits the voluntary
movement of a person or the person's limbs.
new text end
new text begin Subd. 3. new text end
new text begin Prone restraint prohibition. new text end
new text begin
(a) A license or certification holder must not use
a prone restraint on any person receiving services in a program, except in the instances
allowed by paragraphs (b) to (d).
new text end
new text begin
(b) If a person rolls into a prone position during the use of a restraint, the person must
be restored to a nonprone position as quickly as possible.
new text end
new text begin
(c) If the applicable licensing requirements allow a program to use mechanical restraints,
a person may be briefly held in a prone restraint for the purpose of applying mechanical
restraints if the person is restored to a nonprone position as quickly as possible.
new text end
new text begin
(d) If the applicable licensing requirements allow a program to use seclusion, a person
may be briefly held in a prone restraint to allow staff to safely exit a seclusion room.
new text end
new text begin Subd. 4. new text end
new text begin Contraindicated physical restraints. new text end
new text begin
A license or certification holder must
not implement a restraint on a person receiving services in a program in a way that is
contraindicated for any of the person's known medical or psychological conditions. Prior
to using restraints on a person, the license or certification holder must assess and document
a determination of any medical or psychological conditions that restraints are contraindicated
for and the type of restraints that will not be used on the person based on this determination.
new text end
Sec. 14.
Minnesota Statutes 2022, section 245C.02, subdivision 6a, is amended to read:
Subd. 6a.
Child care background study subject.
(a) "Child care background study
subject" means an individual who is affiliated with a licensed child care center, certified
license-exempt child care center, licensed family child care program, or legal nonlicensed
child care provider authorized under chapter 119B, and who is:
(1) employed by a child care provider for compensation;
(2) assisting in the care of a child for a child care provider;
(3) a person applying for licensure, certification, or enrollment;
(4) a controlling individual as defined in section 245A.02, subdivision 5a;
(5) an individual 13 years of age or older who lives in the household where the licensed
program will be provided and who is not receiving licensed services from the program;
(6) an individual ten to 12 years of age who lives in the household where the licensed
services will be provided when the commissioner has reasonable cause as defined in section
245C.02, subdivision 15;
(7) an individual who, without providing direct contact services at a licensed program,
certified program, or program authorized under chapter 119B, may have unsupervised access
to a child receiving services from a program when the commissioner has reasonable cause
as defined in section 245C.02, subdivision 15; or
(8) a volunteer, contractornew text begin providing services for hire in the programnew text end , prospective
employee, or other individual who has unsupervised physical access to a child served by a
program and who is not under supervision by an individual listed in clause (1) or (5),
regardless of whether the individual provides program services.
(b) Notwithstanding paragraph (a), an individual who is providing services that are not
part of the child care program is not required to have a background study if:
(1) the child receiving services is signed out of the child care program for the duration
that the services are provided;
(2) the licensed child care center, certified license-exempt child care center, licensed
family child care program, or legal nonlicensed child care provider authorized under chapter
119B has obtained advanced written permission from the parent authorizing the child to
receive the services, which is maintained in the child's record;
(3) the licensed child care center, certified license-exempt child care center, licensed
family child care program, or legal nonlicensed child care provider authorized under chapter
119B maintains documentation on site that identifies the individual service provider and
the services being provided; and
(4) the licensed child care center, certified license-exempt child care center, licensed
family child care program, or legal nonlicensed child care provider authorized under chapter
119B ensures that the service provider does not have unsupervised access to a child not
receiving the provider's services.
new text begin
(c) The definition of employee under subdivision 11f and the definition of volunteer
under subdivision 22 do not apply for child care background study subjects.
new text end
Sec. 15.
Minnesota Statutes 2022, section 245C.02, subdivision 11c, is amended to read:
Subd. 11c.
Entity.
"Entity" means any program, organization,new text begin license holder,new text end or agency
deleted text begin initiatingdeleted text end new text begin required to initiate or submitnew text end a background study.
Sec. 16.
Minnesota Statutes 2022, section 245C.02, is amended by adding a subdivision
to read:
new text begin Subd. 11f. new text end
new text begin Employee. new text end
new text begin
"Employee" means an individual who provides services or seeks
to provide services for or through the entity with which they are required to be affiliated in
NETStudy 2.0 and who is subject to oversight by the entity, which includes but is not limited
to continuous, direct supervision by the entity and being subject to immediate removal from
providing direct contact services by the entity when required.
new text end
Sec. 17.
Minnesota Statutes 2022, section 245C.02, is amended by adding a subdivision
to read:
new text begin Subd. 22. new text end
new text begin Volunteer. new text end
new text begin
"Volunteer" means an individual who provides or seeks to provide
services for or through an entity without direct compensation for services provided, is
required to be affiliated in NETStudy 2.0 and is subject to oversight by the entity, including
but not limited to continuous, direct supervision and immediate removal from providing
direct contact services when required.
new text end
Sec. 18.
Minnesota Statutes 2022, section 245C.03, subdivision 1, is amended to read:
Subdivision 1.
Licensed programs.
(a) The commissioner shall conduct a background
study on:
(1) the person or persons applying for a license;
(2) an individual age 13 and over living in the household where the licensed program
will be provided who is not receiving licensed services from the program;
(3) current or prospective employees deleted text begin or contractorsdeleted text end of the applicant new text begin or license holdernew text end
who will have direct contact with persons served by the facility, agency, or program;
(4) volunteers or student volunteers who will have direct contact with persons served
by the program to provide program services if the contact is not under the continuous, direct
supervision by an individual listed in clause (1) or (3);
(5) an individual age ten to 12 living in the household where the licensed services will
be provided when the commissioner has reasonable cause as defined in section 245C.02,
subdivision 15;
(6) an individual who, without providing direct contact services at a licensed program,
may have unsupervised access to children or vulnerable adults receiving services from a
program, when the commissioner has reasonable cause as defined in section 245C.02,
subdivision 15;
(7) all controlling individuals as defined in section 245A.02, subdivision 5a;
(8) notwithstanding the other requirements in this subdivision, child care background
study subjects as defined in section 245C.02, subdivision 6a; and
(9) notwithstanding clause (3), for children's residential facilities and foster residence
settings, any adult working in the facility, whether or not the individual will have direct
contact with persons served by the facility.
(b) For child foster care when the license holder resides in the home where foster care
services are provided, a short-term substitute caregiver providing direct contact services for
a child for less than 72 hours of continuous care is not required to receive a background
study under this chapter.
(c) This subdivision applies to the following programs that must be licensed under
chapter 245A:
(1) adult foster care;
(2) child foster care;
(3) children's residential facilities;
(4) family child care;
(5) licensed child care centers;
(6) licensed home and community-based services under chapter 245D;
(7) residential mental health programs for adults;
(8) substance use disorder treatment programs under chapter 245G;
(9) withdrawal management programs under chapter 245F;
(10) adult day care centers;
(11) family adult day services;
deleted text begin
(12) independent living assistance for youth;
deleted text end
deleted text begin (13)deleted text end new text begin (12)new text end detoxification programs;
deleted text begin (14)deleted text end new text begin (13)new text end community residential settings; and
deleted text begin (15)deleted text end new text begin (14)new text end intensive residential treatment services and residential crisis stabilization under
chapter 245I.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 19.
Minnesota Statutes 2022, section 245C.03, subdivision 1a, is amended to read:
Subd. 1a.
Procedure.
(a) Individuals and organizations that are required under this
section to have or initiate background studies shall comply with the requirements of this
chapter.
(b) All studies conducted under this section shall be conducted according to sections
299C.60 to 299C.64new text begin , including the consent and self-disclosure required in section 299C.62,
subdivision 2new text end . This requirement does not apply to subdivisions 1, paragraph (c), clauses (2)
to (5), and 6a.
Sec. 20.
Minnesota Statutes 2022, section 245C.03, subdivision 4, is amended to read:
Subd. 4.
Personnel new text begin pool new text end agencies; new text begin temporary personnel agencies; new text end educational
programs; professional services agencies.
new text begin (a) new text end The commissioner also may conduct studies
on individuals specified in subdivision 1, paragraph (a), clauses (3) and (4), when the studies
are initiated by:
(1) personnel pool agencies;
(2) temporary personnel agencies;
(3) educational programs that train individuals by providing direct contact services in
licensed programs; and
(4) professional services agencies that are not licensed and deleted text begin which contractdeleted text end new text begin that worknew text end
with licensed programs to provide direct contact services or individuals who provide direct
contact services.
new text begin
(b) Personnel pool agencies, temporary personnel agencies, and professional services
agencies must employ the individuals providing direct care services for children, people
with disabilities, or the elderly. Individuals must be affiliated in NETStudy 2.0 and subject
to oversight by the entity, which includes but is not limited to continuous, direct supervision
by the entity and being subject to immediate removal from providing direct care services
when required.
new text end
Sec. 21.
Minnesota Statutes 2022, section 245C.03, subdivision 5, is amended to read:
Subd. 5.
Other state agencies.
The commissioner shall conduct background studies on
applicants and license holders under the jurisdiction of other state agencies who are required
in other statutory sections to initiate background studies under this chapter, including the
applicant's or license holder's employeesdeleted text begin , contractors,deleted text end and volunteers when required under
other statutory sections.
Sec. 22.
Minnesota Statutes 2022, section 245C.03, subdivision 5a, is amended to read:
Subd. 5a.
Facilities serving children or adults licensed or regulated by the
Department of Health.
(a) Except as specified in paragraph (b), the commissioner shall
conduct background studies of:
(1) individuals providing services who have direct contact, as defined under section
245C.02, subdivision 11, with patients and residents in hospitals, boarding care homes,
outpatient surgical centers licensed under sections 144.50 to 144.58; nursing homes and
home care agencies licensed under chapter 144A; assisted living facilities and assisted living
facilities with dementia care licensed under chapter 144G; and board and lodging
establishments that are registered to provide supportive or health supervision services under
section 157.17;
(2) individuals specified in subdivision 2 who provide direct contact services in a nursing
home or a home care agency licensed under chapter 144A; an assisted living facility or
assisted living facility with dementia care licensed under chapter 144G; or a boarding care
home licensed under sections 144.50 to 144.58. If the individual undergoing a study resides
outside of Minnesota, the study must include a check for substantiated findings of
maltreatment of adults and children in the individual's state of residence when the state
makes the information available;
(3) all other employees in assisted living facilities or assisted living facilities with
dementia care licensed under chapter 144G, nursing homes licensed under chapter 144A,
and boarding care homes licensed under sections 144.50 to 144.58. A disqualification of
an individual in this section shall disqualify the individual from positions allowing direct
contact with or access to patients or residents receiving services. "Access" means physical
access to a client or the client's personal property without continuous, direct supervision as
defined in section 245C.02, subdivision 8, when the employee's employment responsibilities
do not include providing direct contact services;
(4) individuals employed by a supplemental nursing services agency, as defined under
section 144A.70, who are providing services in health care facilities;
(5) controlling persons of a supplemental nursing services agency, as defined by section
144A.70; and
(6) license applicants, owners, managerial officials, and controlling individuals who are
required under section 144A.476, subdivision 1, or 144G.13, subdivision 1, to undergo a
background study under this chapter, regardless of the licensure status of the license applicant,
owner, managerial official, or controlling individual.
(b) deleted text begin The commissioner of human services shall not conductdeleted text end new text begin An entity shall not initiatenew text end a
background study on any individual identified in paragraph (a), clauses (1) to (5), if the
individual has a valid license issued by a health-related licensing board as defined in section
214.01, subdivision 2, and has completed the criminal background check as required in
section 214.075. An entity that is affiliated with individuals who meet the requirements of
this paragraph must separate those individuals from the entity's roster for NETStudy 2.0.new text begin
The Department of Human Services is not liable for conducting background studies that
have been submitted or not removed from the roster in violation of this provision.
new text end
(c) If a facility or program is licensed by the Department of Human Services and the
Department of Health and is subject to the background study provisions of this chapter, the
Department of Human Services is solely responsible for the background studies of individuals
in the jointly licensed program.
(d) The commissioner of health shall review and make decisions regarding reconsideration
requests, including whether to grant variances, according to the procedures and criteria in
this chapter. The commissioner of health shall inform the requesting individual and the
Department of Human Services of the commissioner of health's decision regarding the
reconsideration. The commissioner of health's decision to grant or deny a reconsideration
of a disqualification is a final administrative agency action.
Sec. 23.
Minnesota Statutes 2022, section 245C.031, subdivision 1, is amended to read:
Subdivision 1.
Alternative background studies.
(a) The commissioner shall conduct
an alternative background study of individuals listed in this section.
(b) Notwithstanding other sections of this chapter, all alternative background studies
except subdivision 12 shall be conducted according to this section and with sections 299C.60
to 299C.64new text begin , including the consent and self-disclosure required in section 299C.62, subdivision
2new text end .
(c) All terms in this section shall have the definitions provided in section 245C.02.
(d) The entity that submits an alternative background study request under this section
shall submit the request to the commissioner according to section 245C.05.
(e) The commissioner shall comply with the destruction requirements in section 245C.051.
(f) Background studies conducted under this section are subject to the provisions of
section 245C.32.
(g) The commissioner shall forward all information that the commissioner receives under
section 245C.08 to the entity that submitted the alternative background study request under
subdivision 2. The commissioner shall not make any eligibility determinations regarding
background studies conducted under this section.
Sec. 24.
Minnesota Statutes 2022, section 245C.031, subdivision 4, is amended to read:
Subd. 4.
Applicants, licensees, and other occupations regulated by the commissioner
of health.
The commissioner shall conduct an alternative background study, including a
check of state data, and a national criminal history records check of the following individuals.
For studies under this section, the following persons shall complete a consent formnew text begin and
criminal history disclosure formnew text end :
(1) An applicant for initial licensure, temporary licensure, or relicensure after a lapse in
licensure as an audiologist or speech-language pathologist or an applicant for initial
certification as a hearing instrument dispenser who must submit to a background study
under section 144.0572.
(2) An applicant for a renewal license or certificate as an audiologist, speech-language
pathologist, or hearing instrument dispenser who was licensed or obtained a certificate
before January 1, 2018.
Sec. 25.
Minnesota Statutes 2022, section 245C.05, subdivision 1, is amended to read:
Subdivision 1.
Individual studied.
(a) The individual who is the subject of the
background study must provide the applicant, license holder, or other entity under section
245C.04 with sufficient information to ensure an accurate study, including:
(1) the individual's first, middle, and last name and all other names by which the
individual has been known;
(2) current home address, city, and state of residence;
(3) current zip code;
(4) sex;
(5) date of birth;
(6) driver's license number or state identification numbernew text begin or, for those without a driver's
license or state identification card, an acceptable form of identification as determined by
the commissionernew text end ; and
(7) upon implementation of NETStudy 2.0, the home address, city, county, and state of
residence for the past five years.
(b) Every subject of a background study conducted or initiated by counties or private
agencies under this chapter must also provide the home address, city, county, and state of
residence for the past five years.
(c) Every subject of a background study related to private agency adoptions or related
to child foster care licensed through a private agency, who is 18 years of age or older, shall
also provide the commissioner a signed consent for the release of any information received
from national crime information databases to the private agency that initiated the background
study.
(d) The subject of a background study shall provide fingerprints and a photograph as
required in subdivision 5.
(e) The subject of a background study shall submit a completed criminal and maltreatment
history records check consent form new text begin and criminal history disclosure form new text end for applicable
national and state level record checks.
Sec. 26.
Minnesota Statutes 2022, section 245C.05, is amended by adding a subdivision
to read:
new text begin Subd. 8. new text end
new text begin Study submitted. new text end
new text begin
The entity with which the background study subject is seeking
affiliation shall initiate the background study in the NETStudy 2.0 system.
new text end
Sec. 27.
Minnesota Statutes 2022, section 245C.07, is amended to read:
245C.07 STUDY SUBJECT AFFILIATED WITH MULTIPLE FACILITIES.
(a) Subject to the conditions in paragraph (d), when a license holder, applicant, or other
entity owns multiple programs or services that are licensed by the Department of Human
Services, Department of Health, or Department of Corrections, only one background study
is required for an individual who provides direct contact services in one or more of the
licensed programs or services if:
(1) the license holder designates one individual with one address and telephone number
as the person to receive sensitive background study information for the multiple licensed
programs or services that depend on the same background study; and
(2) the individual designated to receive the sensitive background study information is
capable of determining, upon request of the department, whether a background study subject
is providing direct contact services in one or more of the license holder's programs or services
and, if so, at which location or locations.
(b) When a license holder maintains background study compliance for multiple licensed
programs according to paragraph (a), and one or more of the licensed programs closes, the
license holder shall immediately notify the commissioner which staff must be transferred
to an active license so that the background studies can be electronically paired with the
license holder's active program.
(c) When a background study is being initiated by a licensed program or service or a
foster care provider that is also licensed under chapter 144G, a study subject affiliated with
multiple licensed programs or services may attach to the background study form a cover
letter indicating the additional names of the programs or services, addresses, and background
study identification numbers.
When the commissioner receives a notice, the commissioner shall notify each program
or service identified by the background study subject of the study results.
The background study notice the commissioner sends to the subsequent agencies shall
satisfy those programs' or services' responsibilities for initiating a background study on that
individual.
(d) If a background study was conducted on an individual related to child foster care
and the requirements under paragraph (a) are met, the background study is transferable
across all licensed programs. If a background study was conducted on an individual under
a license other than child foster care and the requirements under paragraph (a) are met, the
background study is transferable to all licensed programs except child foster care.
(e) The provisions of this section that allow a single background study in one or more
licensed programs or services do not apply to background studies submitted by adoption
agencies, supplemental nursing services agencies, personnel new text begin pool new text end agencies, educational
programs, professional services agencies, new text begin temporary personnel agencies, new text end and unlicensed
personal care provider organizations.
(f) For an entity operating under NETStudy 2.0, the entity's active roster must be the
system used to document when a background study subject is affiliated with multiple entities.
For a background study to be transferable:
(1) the background study subject must be on and moving to a roster for which the person
designated to receive sensitive background study information is the same; and
(2) the same entity must own or legally control both the roster from which the transfer
is occurring and the roster to which the transfer is occurring. For an entity that holds or
controls multiple licenses, or unlicensed personal care provider organizations, there must
be a common highest level entity that has a legally identifiable structure that can be verified
through records available from the secretary of state.
Sec. 28.
Minnesota Statutes 2022, section 245C.10, subdivision 4, is amended to read:
Subd. 4.
Temporary personnel agencies, new text begin personnel pool agencies, new text end educational
programs, and professional services agencies.
The commissioner shall recover the cost
of the background studies initiated by temporary personnel agencies,new text begin personnel pool agencies,new text end
educational programs, and professional services agencies that initiate background studies
under section 245C.03, subdivision 4, through a fee of no more than $42 per study charged
to the agency. The fees collected under this subdivision are appropriated to the commissioner
for the purpose of conducting background studies.
Sec. 29.
Minnesota Statutes 2022, section 245C.31, subdivision 1, is amended to read:
Subdivision 1.
Board determines disciplinary or corrective action.
deleted text begin (a)deleted text end The
commissioner shall notify a health-related licensing board as defined in section 214.01,
subdivision 2, if the commissioner determines that an individual who is licensed by the
health-related licensing board and who is included on the board's roster list provided in
accordance with subdivision 3a is responsible for substantiated maltreatment under section
626.557 or chapter 260E, in accordance with subdivision 2. Upon receiving notification,
the health-related licensing board shall make a determination as to whether to impose
disciplinary or corrective action under chapter 214.
deleted text begin
(b) This section does not apply to a background study of an individual regulated by a
health-related licensing board if the individual's study is related to child foster care, adult
foster care, or family child care licensure.
deleted text end
Sec. 30.
Minnesota Statutes 2022, section 245C.33, subdivision 4, is amended to read:
Subd. 4.
Information commissioner reviews.
(a) The commissioner shall review the
following information regarding the background study subject:
(1) the information under section 245C.08, subdivisions 1, 3, and 4;
(2) information from the child abuse and neglect registry for any state in which the
subject has resided for the past five years; and
(3) information from national crime information databases, when required under section
245C.08.
(b) The commissioner shall provide any information collected under this subdivision to
the county or private agency that initiated the background study. The commissioner shall
also provide the agencydeleted text begin :
deleted text end
deleted text begin (1)deleted text end new text begin with anew text end notice whether the information collected shows that the subject of the
background study has a conviction listed in United States Code, title 42, section
671(a)(20)(A)deleted text begin ; anddeleted text end new text begin .
new text end
deleted text begin
(2) for background studies conducted under subdivision 1, paragraph (a), the date of all
adoption-related background studies completed on the subject by the commissioner after
June 30, 2007, and the name of the county or private agency that initiated the adoption-related
background study.
deleted text end
Sec. 31.
Minnesota Statutes 2022, section 245H.13, subdivision 9, is amended to read:
Subd. 9.
Behavior guidance.
The certified center must ensure that staff and volunteers
use positive behavior guidance and do not subject children to:
(1) corporal punishment, including but not limited to rough handling, shoving, hair
pulling, ear pulling, shaking, slapping, kicking, biting, pinching, hitting, and spanking;
(2) humiliation;
(3) abusive language;
(4) the use of mechanical restraints, including tying;
(5) the use of physical restraints other than to physically hold a child when containment
is necessary to protect a child or others from harm; deleted text begin or
deleted text end
new text begin
(6) prone restraints, as prohibited by section 245A.211; or
new text end
deleted text begin (6)deleted text end new text begin (7)new text end the withholding or forcing of food and other basic needs.
Sec. 32.
Minnesota Statutes 2022, section 245I.20, subdivision 10, is amended to read:
Subd. 10.
Application procedures.
(a) The applicant for certification must submit any
documents that the commissioner requires on forms approved by the commissioner.
(b) Upon submitting an application for certification, an applicant must pay the application
fee required by section 245A.10, subdivision 3.
(c) The commissioner must act on an application within 90 working days of receiving
a completed application.
(d) When the commissioner receives an application for initial certification that is
incomplete because the applicant failed to submit required documents or is deficient because
the submitted documents do not meet certification requirements, the commissioner must
provide the applicant with written notice that the application is incomplete or deficient. In
the notice, the commissioner must identify the particular documents that are missing or
deficient and give the applicant 45 days to submit a second application that is complete. An
applicant's failure to submit a complete application within 45 days after receiving notice
from the commissioner is a basis for certification denial.
(e) The commissioner must give notice of a denial to an applicant when the commissioner
has made the decision to deny the certification application. In the notice of denial, the
commissioner must state the reasons for the denial in plain language. The commissioner
must send or deliver the notice of denial to an applicant by certified mail or personal service.
In the notice of denial, the commissioner must state the reasons that the commissioner denied
the application and must inform the applicant of the applicant's right to request a contested
case hearing under chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. The
applicant may appeal the denial by notifying the commissioner in writing by certified mail
or personal service. If mailed, the appeal must be postmarked and sent to the commissioner
within 20 calendar days after the applicant received the notice of denial. If an applicant
delivers an appeal by personal service, the commissioner must receive the appeal within 20
calendar days after the applicant received the notice of denial.
new text begin
(f) The commissioner may require the applicant or certification holder to provide an
email address for the certification holder that will be made public subject to the requirements
under section 13.46, subdivision 4, paragraph (b), clause (1), item (i).
new text end
Sec. 33.
Minnesota Statutes 2022, section 256.9685, subdivision 1a, is amended to read:
Subd. 1a.
Administrative reconsideration.
Notwithstanding section 256B.04,
subdivision 15, the commissioner shall establish an administrative reconsideration process
for appeals of inpatient hospital services determined to be medically unnecessary. A
physician, advanced practice registered nurse, physician assistant, or hospital may request
a reconsideration of the decision that inpatient hospital services are not medically necessary
by submitting a written request for review to the commissioner within deleted text begin 30deleted text end new text begin 45 calendar new text end days
after deleted text begin receivingdeleted text end new text begin the date of thenew text end notice of the decisionnew text begin was mailednew text end . Thenew text begin request fornew text end
reconsideration deleted text begin processdeleted text end shall deleted text begin take place prior to the procedures of subdivision 1b and shall
be conducteddeleted text end new text begin be reviewednew text end by deleted text begin thedeleted text end new text begin at least onenew text end medical review agent that is independent of
the case under reconsideration.new text begin The medical review agent shall make a recommendation to
the commissioner. The commissioner's decision on reconsideration is final and not subject
to appeal under chapter 14.
new text end
Sec. 34.
Minnesota Statutes 2022, section 256.9685, subdivision 1b, is amended to read:
Subd. 1b.
Appeal of reconsideration.
deleted text begin
Notwithstanding section 256B.72, the
commissioner may recover inpatient hospital payments for services that have been determined
to be medically unnecessary after the reconsideration and determinations. A physician,
advanced practice registered nurse, physician assistant, or hospital may appeal the result of
the reconsideration process by submitting a written request for review to the commissioner
within 30 days after receiving notice of the action. The commissioner shall review the
medical record and information submitted during the reconsideration process and the medical
review agent's basis for the determination that the services were not medically necessary
for inpatient hospital services. The commissioner shall issue an order upholding or reversing
the decision of the reconsideration process based on the review.
deleted text end
new text begin
The commissioner's decision
under subdivision 1a is appealable by petition for writ of certiorari under chapter 606.
new text end
Sec. 35.
Minnesota Statutes 2022, section 256.9686, is amended by adding a subdivision
to read:
new text begin Subd. 7a. new text end
new text begin Medical review agent. new text end
new text begin
"Medical review agent" means the representative of
the commissioner who is authorized by the commissioner to administer medical record
reviews; conduct administrative reconsiderations as defined by section 256.9685, subdivision
1a; and perform other functions as stipulated in the terms of the agent's contract with the
department. Medical records reviews and administrative reconsiderations will be performed
by medical professionals within their scope of expertise, including but not limited to
physicians, physician assistants, advanced practice registered nurses, and registered nurses.
The medical professional performing the review or reconsideration must be on staff with
the medical review agent, in good standing, and licensed to practice in the state where the
medical professional resides.
new text end
Sec. 36.
Minnesota Statutes 2022, section 256B.04, subdivision 15, is amended to read:
Subd. 15.
Utilization review.
(a) Establish on a statewide basis a new program to
safeguard against unnecessary or inappropriate use of medical assistance services, against
excess payments, against unnecessary or inappropriate hospital admissions or lengths of
stay, and against underutilization of services in prepaid health plans, long-term care facilities
or any health care delivery system subject to fixed rate reimbursement. In implementing
the program, the state agency shall utilize both prepayment and postpayment review systems
to determine if utilization is reasonable and necessary. The determination of whether services
are reasonable and necessary shall be made by the commissioner in consultation with a
professional services advisory group or health care consultant appointed by the commissioner.
(b) Contracts entered into for purposes of meeting the requirements of this subdivision
shall not be subject to the set-aside provisions of chapter 16C.
(c) A recipient aggrieved by the commissioner's termination of services or denial of
future services may appeal pursuant to section 256.045. new text begin Unless otherwise provided by law,
new text end a vendor aggrieved by the commissioner's determination that services provided were not
reasonable or necessary may appeal pursuant to the contested case procedures of chapter
14. To appeal, the vendor shall notify the commissioner in writing within 30 days of receiving
the commissioner's notice. The appeal request shall specify each disputed item, the reason
for the dispute, an estimate of the dollar amount involved for each disputed item, the
computation that the vendor believes is correct, the authority in statute or rule upon which
the vendor relies for each disputed item, the name and address of the person or firm with
whom contacts may be made regarding the appeal, and other information required by the
commissioner.
(d) The commissioner may select providers to provide case management services to
recipients who use health care services inappropriately or to recipients who are eligible for
other managed care projects. The providers shall be selected based upon criteria that may
include a comparison with a peer group of providers related to the quality, quantity, or cost
of health care services delivered or a review of sanctions previously imposed by health care
services programs or the provider's professional licensing board.
Sec. 37.
Minnesota Statutes 2022, section 256B.064, is amended to read:
256B.064 SANCTIONS; MONETARY RECOVERY.
Subdivision 1.
Terminating payments to ineligible deleted text begin vendorsdeleted text end new text begin individuals or entitiesnew text end .
The
commissioner may terminate payments under this chapter to any person or facility that,
under applicable federal law or regulation, has been determined to be ineligible for payments
under title XIX of the Social Security Act.
Subd. 1a.
Grounds for sanctions deleted text begin against vendorsdeleted text end .
(a) The commissioner may impose
sanctions against deleted text begin a vendor of medical caredeleted text end new text begin any individual or entity that receives payments
from medical assistance or provides goods or services for which payment is made from
medical assistancenew text end for any of the following: (1) fraud, theft, or abuse in connection with the
provision of deleted text begin medical caredeleted text end new text begin goods and servicesnew text end to recipients of public assistancenew text begin for which
payment is made from medical assistancenew text end ; (2) a pattern of presentment of false or duplicate
claims or claims for services not medically necessary; (3) a pattern of making false statements
of material facts for the purpose of obtaining greater compensation than that to which the
deleted text begin vendordeleted text end new text begin individual or entitynew text end is legally entitled; (4) suspension or termination as a Medicare
vendor; (5) refusal to grant the state agency access during regular business hours to examine
all records necessary to disclose the extent of services provided to program recipients and
appropriateness of claims for payment; (6) failure to repay an overpayment or a fine finally
established under this section; (7) failure to correct errors in the maintenance of health
service or financial records for which a fine was imposed or after issuance of a warning by
the commissioner; and (8) any reason for which deleted text begin a vendordeleted text end new text begin an individual or entitynew text end could be
excluded from participation in the Medicare program under section 1128, 1128A, or
1866(b)(2) of the Social Security Act.new text begin For the purposes of this section, goods or services
for which payment is made from medical assistance includes but is not limited to care and
services identified in section 256B.0625 or provided pursuant to any federally approved
waiver.
new text end
(b) The commissioner may impose sanctions against a pharmacy provider for failure to
respond to a cost of dispensing survey under section 256B.0625, subdivision 13e, paragraph
(h).
Subd. 1b.
Sanctions available.
The commissioner may impose the following sanctions
for the conduct described in subdivision 1a: suspension or withholding of payments to deleted text begin a
vendordeleted text end new text begin an individual or entitynew text end and suspending or terminating participation in the program,
or imposition of a fine under subdivision 2, paragraph (f). When imposing sanctions under
this section, the commissioner shall consider the nature, chronicity, or severity of the conduct
and the effect of the conduct on the health and safety of persons served by the deleted text begin vendordeleted text end new text begin
individual or entitynew text end . The commissioner shall suspend deleted text begin a vendor'sdeleted text end new text begin an individual's or entity'snew text end
participation in the program for a minimum of five years if the deleted text begin vendordeleted text end new text begin individual or entitynew text end
is convicted of a crime, received a stay of adjudication, or entered a court-ordered diversion
program for an offense related to a provision of a health service under medical assistancenew text begin ,
including a federally approved waiver,new text end or health care fraud. Regardless of imposition of
sanctions, the commissioner may make a referral to the appropriate state licensing board.
Subd. 1c.
Grounds for and methods of monetary recovery.
(a) The commissioner
may obtain monetary recovery from deleted text begin a vendor whodeleted text end new text begin an individual or entity thatnew text end has been
improperly paid new text begin by the department new text end either as a result of conduct described in subdivision 1a
or as a result of deleted text begin a vendor or departmentdeleted text end new text begin annew text end errornew text begin by the individual or entity submitting the
claim or by the departmentnew text end , regardless of whether the error was intentional. Patterns need
not be proven as a precondition to monetary recovery of erroneous or false claims, duplicate
claims, claims for services not medically necessary, or claims based on false statements.
(b) The commissioner may obtain monetary recovery using methods including but not
limited to the following: assessing and recovering money improperly paid and debiting from
future payments any money improperly paid. The commissioner shall charge interest on
money to be recovered if the recovery is to be made by installment payments or debits,
except when the monetary recovery is of an overpayment that resulted from a department
error. The interest charged shall be the rate established by the commissioner of revenue
under section 270C.40.
Subd. 1d.
Investigative costs.
The commissioner may seek recovery of investigative
costs from any deleted text begin vendor of medical care or services whodeleted text end new text begin individual or entity thatnew text end willfully
submits a claim for reimbursement for services that the deleted text begin vendordeleted text end new text begin individual or entitynew text end knows,
or reasonably should have known, is a false representation and that results in the payment
of public funds for which the deleted text begin vendordeleted text end new text begin individual or entitynew text end is ineligible. Billing errors that
result in unintentional overcharges shall not be grounds for investigative cost recoupment.
Subd. 2.
Imposition of monetary recovery and sanctions.
(a) The commissioner shall
determine any monetary amounts to be recovered and sanctions to be imposed upon deleted text begin a vendor
of medical caredeleted text end new text begin an individual or entitynew text end under this section. Except as provided in paragraphs
(b) and (d), neither a monetary recovery nor a sanction will be imposed by the commissioner
without prior notice and an opportunity for a hearing, according to chapter 14, on the
commissioner's proposed action, provided that the commissioner may suspend or reduce
payment to deleted text begin a vendor of medical caredeleted text end new text begin an individual or entitynew text end , except a nursing home or
convalescent care facility, after notice and prior to the hearing if in the commissioner's
opinion that action is necessary to protect the public welfare and the interests of the program.
(b) Except when the commissioner finds good cause not to suspend payments under
Code of Federal Regulations, title 42, section 455.23 (e) or (f), the commissioner shall
withhold or reduce payments to deleted text begin a vendor of medical caredeleted text end new text begin an individual or entitynew text end without
providing advance notice of such withholding or reduction if either of the following occurs:
(1) the deleted text begin vendordeleted text end new text begin individual or entitynew text end is convicted of a crime involving the conduct described
in subdivision 1a; or
(2) the commissioner determines there is a credible allegation of fraud for which an
investigation is pending under the program. new text begin Allegations are considered credible when they
have an indicium of reliability and the state agency has reviewed all allegations, facts, and
evidence carefully and acts judiciously on a case-by-case basis. new text end A credible allegation of
fraud is an allegation which has been verified by the state, from any source, including but
not limited to:
(i) fraud hotline complaints;
(ii) claims data mining; and
(iii) patterns identified through provider audits, civil false claims cases, and law
enforcement investigations.
deleted text begin
Allegations are considered to be credible when they have an indicia of reliability and
the state agency has reviewed all allegations, facts, and evidence carefully and acts
judiciously on a case-by-case basis.
deleted text end
(c) The commissioner must send notice of the withholding or reduction of payments
under paragraph (b) within five days of taking such action unless requested in writing by a
law enforcement agency to temporarily withhold the notice. The notice must:
(1) state that payments are being withheld according to paragraph (b);
(2) set forth the general allegations as to the nature of the withholding action, but need
not disclose any specific information concerning an ongoing investigation;
(3) except in the case of a conviction for conduct described in subdivision 1a, state that
the withholding is for a temporary period and cite the circumstances under which withholding
will be terminated;
(4) identify the types of claims to which the withholding applies; and
(5) inform the deleted text begin vendordeleted text end new text begin individual or entitynew text end of the right to submit written evidence for
consideration by the commissioner.
new text begin (d) new text end The withholding or reduction of payments will not continue after the commissioner
determines there is insufficient evidence of fraud by the deleted text begin vendordeleted text end new text begin individual or entitynew text end , or after
legal proceedings relating to the alleged fraud are completed, unless the commissioner has
sent notice of intention to impose monetary recovery or sanctions under paragraph (a). Upon
conviction for a crime related to the provision, management, or administration of a health
service under medical assistance, a payment held pursuant to this section by the commissioner
or a managed care organization that contracts with the commissioner under section 256B.035
is forfeited to the commissioner or managed care organization, regardless of the amount
charged in the criminal complaint or the amount of criminal restitution ordered.
deleted text begin (d)deleted text end new text begin (e)new text end The commissioner shall suspend or terminate deleted text begin a vendor'sdeleted text end new text begin an individual's or entity'snew text end
participation in the program without providing advance notice and an opportunity for a
hearing when the suspension or termination is required because of the deleted text begin vendor'sdeleted text end new text begin individual's
or entity'snew text end exclusion from participation in Medicare. Within five days of taking such action,
the commissioner must send notice of the suspension or termination. The notice must:
(1) state that suspension or termination is the result of the deleted text begin vendor'sdeleted text end new text begin individual's or entity'snew text end
exclusion from Medicare;
(2) identify the effective date of the suspension or termination; and
(3) inform the deleted text begin vendordeleted text end new text begin individual or entitynew text end of the need to be reinstated to Medicare before
reapplying for participation in the program.
deleted text begin (e)deleted text end new text begin (f)new text end Upon receipt of a notice under paragraph (a) that a monetary recovery or sanction
is to be imposed, deleted text begin a vendordeleted text end new text begin an individual or entitynew text end may request a contested case, as defined
in section 14.02, subdivision 3, by filing with the commissioner a written request of appeal.
The appeal request must be received by the commissioner no later than 30 days after the
date the notification of monetary recovery or sanction was mailed to the deleted text begin vendordeleted text end new text begin individual
or entitynew text end . The appeal request must specify:
(1) each disputed item, the reason for the dispute, and an estimate of the dollar amount
involved for each disputed item;
(2) the computation that the deleted text begin vendordeleted text end new text begin individual or entitynew text end believes is correct;
(3) the authority in statute or rule upon which the deleted text begin vendordeleted text end new text begin individual or entitynew text end relies for
each disputed item;
(4) the name and address of the person or entity with whom contacts may be made
regarding the appeal; and
(5) other information required by the commissioner.
deleted text begin (f)deleted text end new text begin (g)new text end The commissioner may order deleted text begin a vendordeleted text end new text begin an individual or entitynew text end to forfeit a fine for
failure to fully document services according to standards in this chapter and Minnesota
Rules, chapter 9505. The commissioner may assess fines if specific required components
of documentation are missing. The fine for incomplete documentation shall equal 20 percent
of the amount paid on the claims for reimbursement submitted by the deleted text begin vendordeleted text end new text begin individual or
entitynew text end , or up to $5,000, whichever is less. If the commissioner determines that deleted text begin a vendordeleted text end new text begin an
individual or entitynew text end repeatedly violated this chapter, chapter 254B or 245G, or Minnesota
Rules, chapter 9505, related to the provision of services to program recipients and the
submission of claims for payment, the commissioner may order deleted text begin a vendordeleted text end new text begin an individual or
entitynew text end to forfeit a fine based on the nature, severity, and chronicity of the violations, in an
amount of up to $5,000 or 20 percent of the value of the claims, whichever is greater.new text begin The
commissioner may issue fines under this paragraph in place of or in addition to full monetary
recovery of the value of the claims submitted under subdivision 1c.
new text end
deleted text begin (g)deleted text end new text begin (h)new text end The deleted text begin vendordeleted text end new text begin individual or entitynew text end shall pay the fine assessed on or before the
payment date specified. If the deleted text begin vendordeleted text end new text begin individual or entitynew text end fails to pay the fine, the
commissioner may withhold or reduce payments and recover the amount of the fine. A
timely appeal shall stay payment of the fine until the commissioner issues a final order.
Subd. 3.
deleted text begin Vendordeleted text end Mandates on prohibited payments.
(a) The commissioner shall
maintain and publish a list of each excluded individual and entity that was convicted of a
crime related to the provision, management, or administration of a medical assistance health
service, or suspended or terminated under subdivision 2. Medical assistance payments cannot
be made by deleted text begin a vendordeleted text end new text begin an individual or entitynew text end for items or services furnished either directly
or indirectly by an excluded individual or entity, or at the direction of excluded individuals
or entities.
(b) The deleted text begin vendordeleted text end new text begin entitynew text end must check the exclusion list on a monthly basis and document
the date and time the exclusion list was checked and the name and title of the person who
checked the exclusion list. The deleted text begin vendordeleted text end new text begin entitynew text end must immediately terminate payments to an
individual or entity on the exclusion list.
(c) deleted text begin A vendor'sdeleted text end new text begin An entity'snew text end requirement to check the exclusion list and to terminate
payments to individuals or entities on the exclusion list applies to each individual or entity
on the exclusion list, even if the named individual or entity is not responsible for direct
patient care or direct submission of a claim to medical assistance.
(d) deleted text begin A vendordeleted text end new text begin An entitynew text end that pays medical assistance program funds to an individual or
entity on the exclusion list must refund any payment related to either items or services
rendered by an individual or entity on the exclusion list from the date the individual or entity
is first paid or the date the individual or entity is placed on the exclusion list, whichever is
later, and deleted text begin a vendordeleted text end new text begin an entitynew text end may be subject to:
(1) sanctions under subdivision 2;
(2) a civil monetary penalty of up to $25,000 for each determination by the department
that the vendor employed or contracted with an individual or entity on the exclusion list;
and
(3) other fines or penalties allowed by law.
Subd. 4.
Notice.
(a) The new text begin department shall serve the new text end notice required under subdivision 2
deleted text begin shall be serveddeleted text end by certified mail at the address submitted to the department by the deleted text begin vendordeleted text end new text begin
individual or entitynew text end . Service is complete upon mailing. deleted text begin The commissioner shall place an
affidavit of the certified mailing in the vendor's file as an indication of the address and the
date of mailing.
deleted text end
(b) The department shall give notice in writing to a recipient placed in the Minnesota
restricted recipient program under section 256B.0646 and Minnesota Rules, part 9505.2200.
The new text begin department shall send the new text end notice deleted text begin shall be sentdeleted text end by first class mail to the recipient's current
address on file with the department. A recipient placed in the Minnesota restricted recipient
program may contest the placement by submitting a written request for a hearing to the
department within 90 days of the notice being mailed.
Subd. 5.
Immunity; good faith reporters.
(a) A person who makes a good faith report
is immune from any civil or criminal liability that might otherwise arise from reporting or
participating in the investigation. Nothing in this subdivision affects deleted text begin a vendor'sdeleted text end new text begin an individual's
or entity'snew text end responsibility for an overpayment established under this subdivision.
(b) A person employed by a lead investigative agency who is conducting or supervising
an investigation or enforcing the law according to the applicable law or rule is immune from
any civil or criminal liability that might otherwise arise from the person's actions, if the
person is acting in good faith and exercising due care.
(c) For purposes of this subdivision, "person" includes a natural person or any form of
a business or legal entity.
(d) After an investigation is complete, the reporter's name must be kept confidential.
The subject of the report may compel disclosure of the reporter's name only with the consent
of the reporter or upon a written finding by a district court that the report was false and there
is evidence that the report was made in bad faith. This subdivision does not alter disclosure
responsibilities or obligations under the Rules of Criminal Procedure, except that when the
identity of the reporter is relevant to a criminal prosecution the district court shall conduct
an in-camera review before determining whether to order disclosure of the reporter's identity.
Sec. 38.
Minnesota Statutes 2022, section 256B.27, subdivision 3, is amended to read:
Subd. 3.
Access to medical records.
The commissioner of human services, with the
written consent of the recipient, on file with the local welfare agency, shall be allowed
access new text begin in the manner and within the time prescribed by the commissioner new text end to all personal
medical records of medical assistance recipients solely for the purposes of investigating
whether or not: (a) a vendor of medical care has submitted a claim for reimbursement, a
cost report or a rate application which is duplicative, erroneous, or false in whole or in part,
or which results in the vendor obtaining greater compensation than the vendor is legally
entitled to; or (b) the medical care was medically necessary. When the commissioner is
investigating a possible overpayment of Medicaid funds, the commissioner must be given
immediate access without prior notice to the vendor's office during regular business hours
and to documentation and records related to services provided and submission of claims
for services provided. The department shall document in writing the need for immediate
access to records related to a specific investigation. Denying the commissioner access to
records is cause for the vendor's immediate suspension of payment or termination according
to section 256B.064. new text begin Any records not provided to the commissioner at the date and time of
the request are inadmissible if offered as evidence by the provider in any proceeding to
contest sanctions against or monetary recovery from the provider. new text end The determination of
provision of services not medically necessary shall be made by the commissioner.
Notwithstanding any other law to the contrary, a vendor of medical care shall not be subject
to any civil or criminal liability for providing access to medical records to the commissioner
of human services pursuant to this section.
Sec. 39.
Minnesota Statutes 2022, section 524.5-118, subdivision 2a, is amended to read:
Subd. 2a.
Procedure; state licensing agency data.
(a) The court shall request the
commissioner of human services to provide the court within 25 working days of receipt of
the request with licensing agency data for licenses directly related to the responsibilities of
a professional fiduciary if the study subject indicates current or prior affiliation from the
following agencies in Minnesota:
(1) Lawyers Responsibility Board;
(2) State Board of Accountancy;
(3) Board of Social Work;
(4) Board of Psychology;
(5) Board of Nursing;
(6) Board of Medical Practice;
deleted text begin
(7) Department of Education;
deleted text end
deleted text begin (8)deleted text end new text begin (7)new text end Department of Commerce;
deleted text begin (9)deleted text end new text begin (8)new text end Board of Chiropractic Examiners;
deleted text begin (10)deleted text end new text begin (9)new text end Board of Dentistry;
deleted text begin (11)deleted text end new text begin (10)new text end Board of Marriage and Family Therapy;
deleted text begin (12)deleted text end new text begin (11)new text end Department of Human Services;
deleted text begin (13)deleted text end new text begin (12)new text end Peace Officer Standards and Training (POST) Board; and
deleted text begin (14)deleted text end new text begin (13)new text end Professional Educator Licensing and Standards Board.
(b) The commissioner shall enter into agreements with these agencies to provide the
commissioner with electronic access to the relevant licensing data, and to provide the
commissioner with a quarterly list of new sanctions issued by the agency.
(c) The commissioner shall provide to the court the electronically available data
maintained in the agency's database, including whether the proposed guardian or conservator
is or has been licensed by the agency, and if the licensing agency database indicates a
disciplinary action or a sanction against the individual's license, including a condition,
suspension, revocation, or cancellation.
(d) If the proposed guardian or conservator has resided in a state other than Minnesota
in the previous ten years, licensing agency data under this section shall also include the
licensing agency data from any other state where the proposed guardian or conservator
reported to have resided during the previous ten years if the study subject indicates current
or prior affiliation. If the proposed guardian or conservator has or has had a professional
license in another state that is directly related to the responsibilities of a professional fiduciary
from one of the agencies listed under paragraph (a), state licensing agency data shall also
include data from the relevant licensing agency of that state.
(e) The commissioner is not required to repeat a search for Minnesota or out-of-state
licensing data on an individual if the commissioner has provided this information to the
court within the prior five years.
(f) The commissioner shall review the information in paragraph (c) at least once every
four months to determine if an individual who has been studied within the previous five
years:
(1) has new disciplinary action or sanction against the individual's license; or
(2) did not disclose a prior or current affiliation with a Minnesota licensing agency.
(g) If the commissioner's review in paragraph (f) identifies new information, the
commissioner shall provide any new information to the court.
Sec. 40. new text begin REVISOR INSTRUCTION.
new text end
new text begin
The revisor of statutes shall renumber the subdivisions in Minnesota Statutes, section
245C.02, in alphabetical order and correct any cross-reference changes that result.
new text end
Sec. 41. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2022, sections 245A.22; 245C.02, subdivision 9; 245C.301; and
256.9685, subdivisions 1c and 1d,
new text end
new text begin
are repealed.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Rules, parts 9505.0505, subpart 18; and 9505.0520, subpart 9b,
new text end
new text begin
are
repealed.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
ARTICLE 10
ECONOMIC ASSISTANCE
Section 1.
Minnesota Statutes 2022, section 256D.01, subdivision 1a, is amended to read:
Subd. 1a.
Standards.
(a) A principal objective in providing general assistance is to
provide for single adults, childless couples, or children as defined in section 256D.02,
subdivision 6, ineligible for federal programs who are unable to provide for themselves.
The minimum standard of assistance determines the total amount of the general assistance
grant without separate standards for shelter, utilities, or other needs.
(b) The deleted text begin commissioner shall set thedeleted text end standard of assistance for an assistance unit consisting
of deleted text begin an adultdeleted text end new text begin anew text end recipient who is childless and unmarried or living apart from children and
spouse and who does not live with a parent or parents or a legal custodiannew text begin is the cash portion
of the MFIP transitional standard for a single adult under section 256J.24, subdivision 5new text end .
deleted text begin When the other standards specified in this subdivision increase, this standard must also be
increased by the same percentage.
deleted text end
(c) For an assistance unit consisting of a single adult who lives with a parent or parents,
the general assistance standard of assistance deleted text begin is the amount that the aid to families with
dependent children standard of assistance, in effect on July 16, 1996, would increase if the
recipient were added as an additional minor child to an assistance unit consisting of the
recipient's parent and all of that parent's family members, except that the standard may not
exceed the standard for a general assistance recipient living alonedeleted text end new text begin is the cash portion of the
MFIP transitional standard for a single adult under section 256J.24, subdivision 5new text end . Benefits
received by a responsible relative of the assistance unit under the Supplemental Security
Income program, a workers' compensation program, the Minnesota supplemental aid program,
or any other program based on the responsible relative's disability, and any benefits received
by a responsible relative of the assistance unit under the Social Security retirement program,
may not be counted in the determination of eligibility or benefit level for the assistance unit.
Except as provided below, the assistance unit is ineligible for general assistance if the
available resources or the countable income of the assistance unit and the parent or parents
with whom the assistance unit lives are such that a family consisting of the assistance unit's
parent or parents, the parent or parents' other family members and the assistance unit as the
only or additional minor child would be financially ineligible for general assistance. For
the purposes of calculating the countable income of the assistance unit's parent or parents,
the calculation methods must follow the provisions under section 256P.06.
(d) For an assistance unit consisting of a childless couple, the standards of assistance
are the same as the first and second adult standards of the aid to families with dependent
children program in effect on July 16, 1996. If one member of the couple is not included in
the general assistance grant, the standard of assistance for the other is the second adult
standard of the aid to families with dependent children program as of July 16, 1996.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective October 1, 2024.
new text end
Sec. 2.
Minnesota Statutes 2022, section 256D.024, subdivision 1, is amended to read:
Subdivision 1.
Person convicted of drug offenses.
(a) deleted text begin Ifdeleted text end An deleted text begin applicant or recipientdeleted text end new text begin
individual whonew text end has been convicted of a new text begin felony-level new text end drug offense deleted text begin after July 1, 1997, the
assistance unit is ineligible for benefits under this chapter until five years after the applicant
has completed terms of the court-ordered sentence, unless the person is participating in a
drug treatment program, has successfully completed a drug treatment program, or has been
assessed by the county and determined not to be in need of a drug treatment program. Persons
subject to the limitations of this subdivision who become eligible for assistance under this
chapter shalldeleted text end new text begin during the previous ten years from the date of application or recertification
maynew text end be subject to random drug testing deleted text begin as a condition of continued eligibility and shall lose
eligibility for benefits for five years beginning the month following:deleted text end new text begin . The county must
provide information about substance use disorder treatment programs to a person who tests
positive for an illegal controlled substance.
new text end
deleted text begin
(1) Any positive test result for an illegal controlled substance; or
deleted text end
deleted text begin
(2) discharge of sentence after conviction for another drug felony.
deleted text end
(b) For the purposes of this subdivision, "drug offense" means a conviction that occurred
deleted text begin after July 1, 1997,deleted text end new text begin during the previous ten years from the date of application or recertificationnew text end
of sections 152.021 to 152.025, 152.0261, 152.0262, or 152.096. Drug offense also means
a conviction in another jurisdiction of the possession, use, or distribution of a controlled
substance, or conspiracy to commit any of these offenses, if the deleted text begin offensedeleted text end new text begin convictionnew text end occurred
deleted text begin after July 1, 1997,deleted text end new text begin during the previous ten years from the date of application or recertificationnew text end
and the conviction is a felony offense in that jurisdiction, or in the case of New Jersey, a
high misdemeanor.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2023.
new text end
Sec. 3.
Minnesota Statutes 2022, section 256D.06, subdivision 5, is amended to read:
Subd. 5.
Eligibility; requirements.
(a) Any applicant, otherwise eligible for general
assistance and possibly eligible for maintenance benefits from any other source shall (1)
make application for those benefits within deleted text begin 30deleted text end new text begin 90new text end days of the general assistance application;
and (2) execute an interim assistance agreement on a form as directed by the commissioner.
(b) The commissioner shall review a denial of an application for other maintenance
benefits and may require a recipient of general assistance to file an appeal of the denial if
appropriate. If found eligible for benefits from other sources, and a payment received from
another source relates to the period during which general assistance was also being received,
the recipient shall be required to reimburse the county agency for the interim assistance
paid. Reimbursement shall not exceed the amount of general assistance paid during the time
period to which the other maintenance benefits apply and shall not exceed the state standard
applicable to that time period.
(c) The commissioner may contract with the county agencies, qualified agencies,
organizations, or persons to provide advocacy and support services to process claims for
federal disability benefits for applicants or recipients of services or benefits supervised by
the commissioner using money retained under this section.
(d) The commissioner may provide methods by which county agencies shall identify,
refer, and assist recipients who may be eligible for benefits under federal programs for
people with a disability.
(e) The total amount of interim assistance recoveries retained under this section for
advocacy, support, and claim processing services shall not exceed 35 percent of the interim
assistance recoveries in the prior fiscal year.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024.
new text end
Sec. 4.
Minnesota Statutes 2022, section 256J.26, subdivision 1, is amended to read:
Subdivision 1.
Person convicted of drug offenses.
(a) An individual who has been
convicted of a felony level drug offense deleted text begin committeddeleted text end during the previous ten years from the
date of application or recertification is subject to the following:
(1) Benefits for the entire assistance unit must be paid in vendor form for shelter and
utilities during any time the applicant is part of the assistance unit.
(2) The convicted applicant or participant deleted text begin shalldeleted text end new text begin maynew text end be subject to random drug testing
deleted text begin as a condition of continued eligibility anddeleted text end new text begin .new text end Following any positive test for an illegal controlled
substance deleted text begin is subject to the following sanctions:deleted text end new text begin , the county must provide information about
substance use disorder treatment programs to the applicant or participant.
new text end
deleted text begin
(i) for failing a drug test the first time, the residual amount of the participant's grant after
making vendor payments for shelter and utility costs, if any, must be reduced by an amount
equal to 30 percent of the MFIP standard of need for an assistance unit of the same size.
When a sanction under this subdivision is in effect, the job counselor must attempt to meet
with the person face-to-face. During the face-to-face meeting, the job counselor must explain
the consequences of a subsequent drug test failure and inform the participant of the right to
appeal the sanction under section 256J.40. If a face-to-face meeting is not possible, the
county agency must send the participant a notice of adverse action as provided in section
256J.31, subdivisions 4 and 5, and must include the information required in the face-to-face
meeting; or
deleted text end
deleted text begin
(ii) for failing a drug test two times, the participant is permanently disqualified from
receiving MFIP assistance, both the cash and food portions. The assistance unit's MFIP
grant must be reduced by the amount which would have otherwise been made available to
the disqualified participant. Disqualification under this item does not make a participant
ineligible for the Supplemental Nutrition Assistance Program (SNAP). Before a
disqualification under this provision is imposed, the job counselor must attempt to meet
with the participant face-to-face. During the face-to-face meeting, the job counselor must
identify other resources that may be available to the participant to meet the needs of the
family and inform the participant of the right to appeal the disqualification under section
256J.40. If a face-to-face meeting is not possible, the county agency must send the participant
a notice of adverse action as provided in section 256J.31, subdivisions 4 and 5, and must
include the information required in the face-to-face meeting.
deleted text end
deleted text begin
(3) A participant who fails a drug test the first time and is under a sanction due to other
MFIP program requirements is considered to have more than one occurrence of
noncompliance and is subject to the applicable level of sanction as specified under section
256J.46, subdivision 1, paragraph (d).
deleted text end
(b) Applicants requesting only SNAP benefits or participants receiving only SNAP
benefits, who have been convicted of a new text begin felony-level new text end drug offense deleted text begin that occurred after July
1, 1997,deleted text end new text begin during the previous ten years from the date of application or recertificationnew text end may,
if otherwise eligible, receive SNAP benefits deleted text begin ifdeleted text end new text begin .new text end The convicted applicant or participant deleted text begin isdeleted text end new text begin
may benew text end subject to random drug testing deleted text begin as a condition of continued eligibilitydeleted text end . Following a
positive test for an illegal controlled substance, the deleted text begin applicant is subject to the following
sanctions:deleted text end new text begin county must provide information about substance use disorder treatment programs
to the applicant or participant.
new text end
deleted text begin
(1) for failing a drug test the first time, SNAP benefits shall be reduced by an amount
equal to 30 percent of the applicable SNAP benefit allotment. When a sanction under this
clause is in effect, a job counselor must attempt to meet with the person face-to-face. During
the face-to-face meeting, a job counselor must explain the consequences of a subsequent
drug test failure and inform the participant of the right to appeal the sanction under section
256J.40. If a face-to-face meeting is not possible, a county agency must send the participant
a notice of adverse action as provided in section 256J.31, subdivisions 4 and 5, and must
include the information required in the face-to-face meeting; and
deleted text end
deleted text begin
(2) for failing a drug test two times, the participant is permanently disqualified from
receiving SNAP benefits. Before a disqualification under this provision is imposed, a job
counselor must attempt to meet with the participant face-to-face. During the face-to-face
meeting, the job counselor must identify other resources that may be available to the
participant to meet the needs of the family and inform the participant of the right to appeal
the disqualification under section 256J.40. If a face-to-face meeting is not possible, a county
agency must send the participant a notice of adverse action as provided in section 256J.31,
subdivisions 4 and 5, and must include the information required in the face-to-face meeting.
deleted text end
(c) For the purposes of this subdivision, "drug offense" means deleted text begin an offensedeleted text end new text begin a convictionnew text end
that occurred during the previous ten years from the date of application or recertification
of sections 152.021 to 152.025, 152.0261, 152.0262, 152.096, or 152.137. Drug offense
also means a conviction in another jurisdiction of the possession, use, or distribution of a
controlled substance, or conspiracy to commit any of these offenses, if the deleted text begin offensedeleted text end new text begin convictionnew text end
occurred during the previous ten years from the date of application or recertification and
the conviction is a felony offense in that jurisdiction, or in the case of New Jersey, a high
misdemeanor.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2023.
new text end
Sec. 5.
Minnesota Statutes 2022, section 256P.01, is amended by adding a subdivision to
read:
new text begin Subd. 2b. new text end
new text begin Census income. new text end
new text begin
"Census income" means income earned working as a census
enumerator or decennial census worker responsible for recording the housing units and
residents in a specific geographic area.
new text end
Sec. 6.
Minnesota Statutes 2022, section 256P.01, is amended by adding a subdivision to
read:
new text begin Subd. 5a. new text end
new text begin Lived-experience engagement. new text end
new text begin
"Lived-experience engagement" means an
intentional engagement of people with lived experience by a federal, Tribal, state, county,
municipal, or nonprofit human services agency funded in part or in whole by federal, state,
local government, Tribal Nation, public, private, or philanthropic funds to gather and share
feedback on the impact of human services programs.
new text end
Sec. 7.
Minnesota Statutes 2022, section 256P.02, subdivision 1a, is amended to read:
Subd. 1a.
Exemption.
Participants who qualify for child care assistance programs under
chapter 119B are exempt from this section, except that the personal property identified in
subdivision 2 is counted toward the asset limit of the child care assistance program under
chapter 119B.new text begin Census income is not counted toward the asset limit of the child care assistance
program under chapter 119B.
new text end
Sec. 8.
Minnesota Statutes 2022, section 256P.02, subdivision 2, is amended to read:
Subd. 2.
Personal property limitations.
The equity value of an assistance unit's personal
property listed in clauses (1) to (5) must not exceed $10,000 for applicants and participants.
For purposes of this subdivision, personal property is limited to:
(1) cashnew text begin not excluded under subdivisions 4 and 5new text end ;
(2) bank accounts;
(3) liquid stocks and bonds that can be readily accessed without a financial penalty;
(4) vehicles not excluded under subdivision 3; and
(5) the full value of business accounts used to pay expenses not related to the business.
Sec. 9.
Minnesota Statutes 2022, section 256P.02, is amended by adding a subdivision to
read:
new text begin Subd. 4. new text end
new text begin Health and human services recipient engagement income. new text end
new text begin
Income received
from lived-experience engagement, as defined in section 256P.01, subdivision 6, shall be
excluded when determining the equity value of personal property.
new text end
Sec. 10.
Minnesota Statutes 2022, section 256P.02, is amended by adding a subdivision
to read:
new text begin Subd. 5. new text end
new text begin Census income. new text end
new text begin
Census income is excluded when determining the equity value
of personal property.
new text end
Sec. 11.
Minnesota Statutes 2022, section 256P.06, subdivision 3, is amended to read:
Subd. 3.
Income inclusions.
The following must be included in determining the income
of an assistance unit:
(1) earned income; and
(2) unearned income, which includes:
(i) interest and dividends from investments and savings;
(ii) capital gains as defined by the Internal Revenue Service from any sale of real property;
(iii) proceeds from rent and contract for deed payments in excess of the principal and
interest portion owed on property;
(iv) income from trusts, excluding special needs and supplemental needs trusts;
(v) interest income from loans made by the participant or household;
(vi) cash prizes and winnings;
(vii) unemployment insurance income that is received by an adult member of the
assistance unit unless the individual receiving unemployment insurance income is:
(A) 18 years of age and enrolled in a secondary school; or
(B) 18 or 19 years of age, a caregiver, and is enrolled in school at least half-time;
(viii) retirement, survivors, and disability insurance payments;
(ix) nonrecurring income over $60 per quarter unless the nonrecurring income is: (A)
from tax refunds, tax rebates, or tax credits; (B) a reimbursement, rebate, award, grant, or
refund of personal or real property or costs or losses incurred when these payments are
made by: a public agency; a court; solicitations through public appeal; a federal, state, or
local unit of government; or a disaster assistance organization; (C) provided as an in-kind
benefit; or (D) earmarked and used for the purpose for which it was intended, subject to
verification requirements under section 256P.04;
(x) retirement benefits;
(xi) cash assistance benefits, as defined by each program in chapters 119B, 256D, 256I,
and 256J;
deleted text begin
(xii) Tribal per capita payments unless excluded by federal and state law;
deleted text end
deleted text begin (xiii)deleted text end new text begin (xii)new text end income from members of the United States armed forces unless excluded
from income taxes according to federal or state law;
deleted text begin (xiv)deleted text end new text begin (xiii)new text end all child support payments for programs under chapters 119B, 256D, and
256I;
deleted text begin (xv)deleted text end new text begin (xiv)new text end the amount of child support received that exceeds $100 for assistance units
with one child and $200 for assistance units with two or more children for programs under
chapter 256J;
deleted text begin (xvi)deleted text end new text begin (xv)new text end spousal support; and
deleted text begin (xvii)deleted text end new text begin (xvi)new text end workers' compensation.
Sec. 12.
Minnesota Statutes 2022, section 256P.06, is amended by adding a subdivision
to read:
new text begin Subd. 4. new text end
new text begin Recipient engagement income. new text end
new text begin
Income received from lived-experience
engagement, as defined in section 256P.01, subdivision 5a, must not be counted as income
for purposes of determining or redetermining eligibility or benefits.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2024.
new text end
Sec. 13.
Minnesota Statutes 2022, section 256P.06, is amended by adding a subdivision
to read:
new text begin Subd. 5. new text end
new text begin Census income. new text end
new text begin
Census income does not count as income for purposes of
determining or redetermining eligibility or benefits.
new text end
Sec. 14.
Minnesota Statutes 2022, section 609B.425, subdivision 2, is amended to read:
Subd. 2.
Benefit eligibility.
(a) new text begin For general assistance benefits and Minnesota
supplemental aid under chapter 256D, new text end a person convicted of a new text begin felony-level new text end drug offense
deleted text begin after July 1, 1997, is ineligible for general assistance benefits and Supplemental Security
Income under chapter 256D until:deleted text end new text begin during the previous ten years from the date of application
or recertification may be subject to random drug testing. The county must provide information
about substance use disorder treatment programs to a person who tests positive for an illegal
controlled substance.
new text end
deleted text begin
(1) five years after completing the terms of a court-ordered sentence; or
deleted text end
deleted text begin
(2) unless the person is participating in a drug treatment program, has successfully
completed a program, or has been determined not to be in need of a drug treatment program.
deleted text end
deleted text begin
(b) A person who becomes eligible for assistance under chapter 256D is subject to
random drug testing and shall lose eligibility for benefits for five years beginning the month
following:
deleted text end
deleted text begin
(1) any positive test for an illegal controlled substance; or
deleted text end
deleted text begin
(2) discharge of sentence for conviction of another drug felony.
deleted text end
deleted text begin (c)deleted text end new text begin (b)new text end Parole violators and fleeing felons are ineligible for benefits and persons
fraudulently misrepresenting eligibility are also ineligible to receive benefits for ten years.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2023.
new text end
Sec. 15.
Minnesota Statutes 2022, section 609B.435, subdivision 2, is amended to read:
Subd. 2.
Drug offenders; random testing; sanctions.
A person who is an applicant for
benefits from the Minnesota family investment program or MFIP, the vehicle for temporary
assistance for needy families or TANF, and who has been convicted of a new text begin felony-level new text end drug
offense deleted text begin shalldeleted text end new text begin maynew text end be subject to deleted text begin certain conditions, includingdeleted text end random drug testingdeleted text begin , in order
to receive MFIP benefitsdeleted text end . Following any positive test for a controlled substance, the deleted text begin convicted
applicant or participant is subject to the following sanctions:deleted text end new text begin county must provide information
about substance use disorder treatment programs to the applicant or participant.
new text end
deleted text begin
(1) a first time drug test failure results in a reduction of benefits in an amount equal to
30 percent of the MFIP standard of need; and
deleted text end
deleted text begin
(2) a second time drug test failure results in permanent disqualification from receiving
MFIP assistance.
deleted text end
deleted text begin
A similar disqualification sequence occurs if the applicant is receiving Supplemental Nutrition
Assistance Program (SNAP) benefits.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2023.
new text end
ARTICLE 11
HOUSING SUPPORTS
Section 1.
Minnesota Statutes 2022, section 256I.03, subdivision 7, is amended to read:
Subd. 7.
Countable income.
new text begin (a) new text end "Countable income" means all income received by an
applicant or recipient as described under section 256P.06, less any applicable exclusions or
disregards. deleted text begin For a recipient of any cash benefit from the SSI program, countable income
means the SSI benefit limit in effect at the time the person is a recipient of housing support,
less the medical assistance personal needs allowance under section 256B.35. If the SSI limit
or benefit is reduced for a person due to events other than receipt of additional income,
countable income means actual income less any applicable exclusions and disregards.
deleted text end
new text begin
(b) For a recipient of any cash benefit from the SSI program who does not live in a
setting described in section 256I.04, subdivision 2a, paragraph (b), clause (2), countable
income equals the SSI benefit limit in effect at the time the person is a recipient of housing
support, less the personal needs allowance under section 256B.35. If the SSI limit or benefit
is reduced for a person due to events other than receipt of additional income, countable
income equals actual income less any applicable exclusions and disregards.
new text end
new text begin
(c) For a recipient of any cash benefit from the SSI program who lives in a setting as
described in section 256I.04, subdivision 2a, paragraph (b), clause (2), countable income
equals 30 percent of the SSI benefit limit in effect at the time a person is a recipient of
housing support. If the SSI limit or benefit is reduced for a person due to events other than
receipt of additional income, countable income equals 30 percent of the actual income less
any applicable exclusions and disregards. For recipients under this paragraph, the personal
needs allowance described in section 256B.35 does not apply.
new text end
new text begin
(d) Notwithstanding the earned income disregard described in section 256P.03, for a
recipient of unearned income as defined in section 256P.06, subdivision 3, clause (2), other
than SSI and the general assistance personal needs allowance who lives in a setting described
in section 256I.04, subdivision 2a, paragraph (b), clause (2), countable income equals 30
percent of the recipient's total income after applicable exclusions and disregards. Total
income includes any unearned income as defined in section 256P.06 and any earned income
in the month the person is a recipient of housing support. For recipients under this paragraph,
the personal needs allowance described in section 256B.35 does not apply.
new text end
new text begin
(e) For a recipient who lives in a setting as described in section 256I.04, subdivision 2a,
paragraph (b), clause (2), and receives general assistance, the personal needs allowance
described in section 256B.35 is not countable unearned income.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective October 1, 2024.
new text end
Sec. 2.
Minnesota Statutes 2022, section 256I.04, subdivision 1, is amended to read:
Subdivision 1.
Individual eligibility requirements.
An individual is eligible for and
entitled to a housing support payment to be made on the individual's behalf if the agency
has approved the setting where the individual will receive housing support and the individual
meets the requirements in paragraph (a), (b), deleted text begin ordeleted text end (c)new text begin , or (d)new text end .
(a) The individual is aged, blind, or is over 18 years of age with a disability as determined
under the criteria used by the title II program of the Social Security Act, and meets the
resource restrictions and standards of section 256P.02, and the individual's countable income
after deducting the (1) exclusions and disregards of the SSI program, (2) the medical
assistance personal needs allowance under section 256B.35, and (3) an amount equal to the
income actually made available to a community spouse by an elderly waiver participant
under the provisions of sections 256B.0575, paragraph (a), clause (4), and 256B.058,
subdivision 2, is less than the monthly rate specified in the agency's agreement with the
provider of housing support in which the individual resides.
(b) The individual meets a category of eligibility under section 256D.05, subdivision 1,
paragraph (a), clauses (1), (3), (4) to (8), and (13), and paragraph (b), if applicable, and the
individual's resources are less than the standards specified by section 256P.02, and the
individual's countable income as determined under section 256P.06, less the medical
assistance personal needs allowance under section 256B.35 is less than the monthly rate
specified in the agency's agreement with the provider of housing support in which the
individual resides.
(c) The individual lacks a fixed, adequate, nighttime residence upon discharge from a
residential behavioral health treatment program, as determined by treatment staff from the
residential behavioral health treatment program. An individual is eligible under this paragraph
for up to three months, including a full or partial month from the individual's move-in date
at a setting approved for housing support following discharge from treatment, plus two full
months.
new text begin
(d) The individual meets the criteria related to establishing a certified disability or
disabling condition in paragraph (a) or (b) and lacks a fixed, adequate, nighttime residence
upon discharge from a correctional facility, as determined by an authorized representative
from a Minnesota-based correctional facility. An individual is eligible under this paragraph
for up to three months, including a full or partial month from the individual's move-in date
at a setting approved for housing support following release, plus two full months. People
who meet the disabling condition criteria established in paragraph (a) or (b) will not have
any countable income for the duration of eligibility under this paragraph.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective November 1, 2024.
new text end
Sec. 3.
Minnesota Statutes 2022, section 256I.04, subdivision 3, is amended to read:
Subd. 3.
Moratorium on development of housing support beds.
(a) Agencies shall
not enter into agreements for new housing support beds with total rates in excess of the
MSA equivalent rate except:
(1) for establishments licensed under chapter 245D provided the facility is needed to
meet the census reduction targets for persons with developmental disabilities at regional
treatment centers;
(2) up to 80 beds in a single, specialized facility located in Hennepin County that will
provide housing for chronic inebriates who are repetitive users of detoxification centers and
are refused placement in emergency shelters because of their state of intoxication, and
planning for the specialized facility must have been initiated before July 1, 1991, in
anticipation of receiving a grant from the Housing Finance Agency under section 462A.05,
subdivision 20a, paragraph (b);
(3) notwithstanding the provisions of subdivision 2a, for up to 226 supportive housing
units in Anoka, new text begin Carver, new text end Dakota, Hennepin, deleted text begin ordeleted text end Ramseynew text begin , Scott, or Washingtonnew text end County for
homeless adults with a mental illness, a history of substance abuse, or human
immunodeficiency virus or acquired immunodeficiency syndrome. For purposes of this
section, "homeless adult" means a person who is living on the street or in a shelter or
discharged from a regional treatment center, community hospital, or residential treatment
program and has no appropriate housing available and lacks the resources and support
necessary to access appropriate housing. At least 70 percent of the supportive housing units
must serve homeless adults with mental illness, substance abuse problems, or human
immunodeficiency virus or acquired immunodeficiency syndrome who are about to be or,
within the previous six months, have been discharged from a regional treatment center, or
a state-contracted psychiatric bed in a community hospital, or a residential mental health
or substance use disorder treatment program. If a person meets the requirements of
subdivision 1, paragraph (a), and receives a federal or state housing subsidy, the housing
support rate for that person is limited to the supplementary rate under section 256I.05,
subdivision 1a, and is determined by subtracting the amount of the person's countable income
that exceeds the MSA equivalent rate from the housing support supplementary service rate.
A resident in a demonstration project site who no longer participates in the demonstration
program shall retain eligibility for a housing support payment in an amount determined
under section 256I.06, subdivision 8, using the MSA equivalent rate. Service funding under
section 256I.05, subdivision 1a, will end June 30, 1997, if federal matching funds are
available and the services can be provided through a managed care entity. If federal matching
funds are not available, then service funding will continue under section 256I.05, subdivision
1a;
(4) for an additional two beds, resulting in a total of 32 beds, for a facility located in
Hennepin County providing services for men with and recovering from substance use
disorder that has had a housing support contract with the county and has been licensed as
a board and lodge facility with special services since 1980;
(5) for a housing support provider located in the city of St. Cloud, or a county contiguous
to the city of St. Cloud, that operates a 40-bed facility, that received financing through the
Minnesota Housing Finance Agency Ending Long-Term Homelessness Initiative and serves
clientele with substance use disorder, providing 24-hour-a-day supervision;
(6) for a new 65-bed facility in Crow Wing County that will serve persons with substance
use disorder, operated by a housing support provider that currently operates a 304-bed
facility in Minneapolis, and a 44-bed facility in Duluth;
(7) for a housing support provider that operates two ten-bed facilities, one located in
Hennepin County and one located in Ramsey County, that provide community support and
24-hour-a-day supervision to serve the mental health needs of individuals who have
chronically lived unsheltered; and
(8) for a facility authorized for recipients of housing support in Hennepin County with
a capacity of up to 48 beds that has been licensed since 1978 as a board and lodging facility
and that until August 1, 2007, operated as a licensed substance use disorder treatment
program.
(b) An agency may enter into a housing support agreement for beds with rates in excess
of the MSA equivalent rate in addition to those currently covered under a housing support
agreement if the additional beds are only a replacement of beds with rates in excess of the
MSA equivalent rate which have been made available due to closure of a setting, a change
of licensure or certification which removes the beds from housing support payment, or as
a result of the downsizing of a setting authorized for recipients of housing support. The
transfer of available beds from one agency to another can only occur by the agreement of
both agencies.
Sec. 4.
Minnesota Statutes 2022, section 256I.05, subdivision 1a, is amended to read:
Subd. 1a.
Supplementary service rates.
(a) Subject to the provisions of section 256I.04,
subdivision 3, the agency may negotiate a payment not to exceed deleted text begin $426.37deleted text end new text begin $531.12new text end for other
services necessary to provide room and board if the residence is licensed by or registered
by the Department of Health, or licensed by the Department of Human Services to provide
services in addition to room and board, and if the provider of services is not also concurrently
receiving funding for services for a recipientnew text begin in the residencenew text end under deleted text begin adeleted text end new text begin the following programs
or funding sources: (1)new text end home and community-based waivernew text begin servicesnew text end under deleted text begin title XIX of the
federal Social Security Actdeleted text end new text begin chapter 256S or section 256B.0913, 256B.092, or 256B.49new text end ; deleted text begin or
funding from the medical assistance programdeleted text end new text begin (2) personal care assistancenew text end under section
256B.0659deleted text begin , for personal care services for residents in the settingdeleted text end ; deleted text begin or residing in a setting
which receives funding underdeleted text end new text begin (3) community first services and supports under section
256B.85; or (4) services for adults with mental illness grants undernew text end section 245.73. If funding
is available for other necessary services through a home and community-based waiverdeleted text begin , ordeleted text end new text begin
under chapter 256S, or section 256B.0913, 256B.092, or 256B.49;new text end personal care new text begin assistance
new text end services under section 256B.0659deleted text begin ,deleted text end new text begin ; community first services and supports under section
256B.85; or services for adults with mental illness grants under section 245.73,new text end then the
housing support rate is limited to the rate set in subdivision 1. Unless otherwise provided
in law, in no case may the supplementary service rate exceed deleted text begin $426.37deleted text end new text begin $531.12new text end . The
registration and licensure requirement does not apply to establishments which are exempt
from state licensure because they are located on Indian reservations and for which the tribe
has prescribed health and safety requirements. Service payments under this section may be
prohibited under rules to prevent the supplanting of federal funds with state funds. deleted text begin The
commissioner shall pursue the feasibility of obtaining the approval of the Secretary of Health
and Human Services to provide home and community-based waiver services under title
XIX of the federal Social Security Act for residents who are not eligible for an existing
home and community-based waiver due to a primary diagnosis of mental illness or substance
use disorder and shall apply for a waiver if it is determined to be cost-effective.
deleted text end
(b) The commissioner is authorized to make cost-neutral transfers from the housing
support fund for beds under this section to other funding programs administered by the
department after consultation with the agency in which the affected beds are located. The
commissioner may also make cost-neutral transfers from the housing support fund to agencies
for beds permanently removed from the housing support census under a plan submitted by
the agency and approved by the commissioner. The commissioner shall report the amount
of any transfers under this provision annually to the legislature.
(c) Agencies must not negotiate supplementary service rates with providers of housing
support that are licensed as board and lodging with special services and that do not encourage
a policy of sobriety on their premises and make referrals to available community services
for volunteer and employment opportunities for residents.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024.
new text end
Sec. 5.
Minnesota Statutes 2022, section 256I.05, subdivision 2, is amended to read:
Subd. 2.
Monthly rates; exemptions.
This subdivision applies to a residence that on
August 1, 1984, was licensed by the commissioner of health only as a boarding care home,
certified by the commissioner of health as an intermediate care facility, and licensed by the
commissioner of human services under Minnesota Rules, parts 9520.0500 to 9520.0670.
Notwithstanding the provisions of subdivision 1c, the rate paid to a facility reimbursed
under this subdivision shall be determined under chapter 256R, if the facility is accepted
by the commissioner for participation in the alternative payment demonstration project. The
rate paid to this facility shall also include adjustments to the room and board rate according
to subdivision 1deleted text begin , and any adjustments applicable to supplemental service rates statewidedeleted text end .
Sec. 6. new text begin HOUSING SUPPORT SUPPLEMENTARY SERVICE RATE STUDY.
new text end
new text begin
(a) The commissioner of human services, in consultation with residents of housing
support settings, providers, and lead agencies, must analyze housing support supplementary
service rates under Minnesota Statutes, section 256I.05, to recommend a rate setting
methodology that is person-centered, equitable, and adequately covers the cost to provide
services. The analysis must include but is not limited to:
new text end
new text begin
(1) a review of current supplemental rates;
new text end
new text begin
(2) recommendations to avoid duplication of services, while ensuring informed choice;
and
new text end
new text begin
(3) recommendations on an updated rate setting methodology.
new text end
new text begin
(b) By January 15, 2026, the commissioner must submit a report, including
recommendations and draft legislative language, to the chairs and ranking minority members
of the legislative committees with jurisdiction over human services policy and finance.
new text end
Sec. 7. new text begin HOUSING STABILIZATION SERVICES INFLATIONARY ADJUSTMENT.
new text end
new text begin
The commissioner of human services shall seek federal approval to apply biennial
inflationary updates to housing stabilization services rates based on the consumer price
index. Beginning January 1, 2024, the commissioner must update rates using the most
recently available data from the consumer price index.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024, or upon federal approval,
whichever is later. The commissioner shall notify the revisor of statutes when federal
approval is obtained.
new text end
ARTICLE 12
LICENSING
Section 1.
Minnesota Statutes 2022, section 245A.04, subdivision 1, is amended to read:
Subdivision 1.
Application for licensure.
(a) An individual, organization, or government
entity that is subject to licensure under section 245A.03 must apply for a license. The
application must be made on the forms and in the manner prescribed by the commissioner.
The commissioner shall provide the applicant with instruction in completing the application
and provide information about the rules and requirements of other state agencies that affect
the applicant. An applicant seeking licensure in Minnesota with headquarters outside of
Minnesota must have a program office located within 30 miles of the Minnesota border.
An applicant who intends to buy or otherwise acquire a program or services licensed under
this chapter that is owned by another license holder must apply for a license under this
chapter and comply with the application procedures in this section and section 245A.03.
The commissioner shall act on the application within 90 working days after a complete
application and any required reports have been received from other state agencies or
departments, counties, municipalities, or other political subdivisions. The commissioner
shall not consider an application to be complete until the commissioner receives all of the
required information.
When the commissioner receives an application for initial licensure that is incomplete
because the applicant failed to submit required documents or that is substantially deficient
because the documents submitted do not meet licensing requirements, the commissioner
shall provide the applicant written notice that the application is incomplete or substantially
deficient. In the written notice to the applicant the commissioner shall identify documents
that are missing or deficient and give the applicant 45 days to resubmit a second application
that is substantially complete. An applicant's failure to submit a substantially complete
application after receiving notice from the commissioner is a basis for license denial under
section 245A.05.
(b) An application for licensure must identify all controlling individuals as defined in
section 245A.02, subdivision 5a, and must designate one individual to be the authorized
agent. The application must be signed by the authorized agent and must include the authorized
agent's first, middle, and last name; mailing address; and email address. By submitting an
application for licensure, the authorized agent consents to electronic communication with
the commissioner throughout the application process. The authorized agent must be
authorized to accept service on behalf of all of the controlling individuals. A government
entity that holds multiple licenses under this chapter may designate one authorized agent
for all licenses issued under this chapter or may designate a different authorized agent for
each license. Service on the authorized agent is service on all of the controlling individuals.
It is not a defense to any action arising under this chapter that service was not made on each
controlling individual. The designation of a controlling individual as the authorized agent
under this paragraph does not affect the legal responsibility of any other controlling individual
under this chapter.
(c) An applicant or license holder must have a policy that prohibits license holders,
employees, subcontractors, and volunteers, when directly responsible for persons served
by the program, from abusing prescription medication or being in any manner under the
influence of a chemical that impairs the individual's ability to provide services or care. The
license holder must train employees, subcontractors, and volunteers about the program's
drug and alcohol policy.
(d) An applicant and license holder must have a program grievance procedure that permits
persons served by the program and their authorized representatives to bring a grievance to
the highest level of authority in the program.
(e) The commissioner may limit communication during the application process to the
authorized agent or the controlling individuals identified on the license application and for
whom a background study was initiated under chapter 245C.new text begin Upon implementation of the
provider licensing and reporting hub, applicants and license holders must use the hub in the
manner prescribed by the commissioner.new text end The commissioner may require the applicant,
except for child foster care, to demonstrate competence in the applicable licensing
requirements by successfully completing a written examination. The commissioner may
develop a prescribed written examination format.
(f) When an applicant is an individual, the applicant must provide:
(1) the applicant's taxpayer identification numbers including the Social Security number
or Minnesota tax identification number, and federal employer identification number if the
applicant has employees;
(2) at the request of the commissioner, a copy of the most recent filing with the secretary
of state that includes the complete business name, if any;
(3) if doing business under a different name, the doing business as (DBA) name, as
registered with the secretary of state;
(4) if applicable, the applicant's National Provider Identifier (NPI) number and Unique
Minnesota Provider Identifier (UMPI) number; and
(5) at the request of the commissioner, the notarized signature of the applicant or
authorized agent.
(g) When an applicant is an organization, the applicant must provide:
(1) the applicant's taxpayer identification numbers including the Minnesota tax
identification number and federal employer identification number;
(2) at the request of the commissioner, a copy of the most recent filing with the secretary
of state that includes the complete business name, and if doing business under a different
name, the doing business as (DBA) name, as registered with the secretary of state;
(3) the first, middle, and last name, and address for all individuals who will be controlling
individuals, including all officers, owners, and managerial officials as defined in section
245A.02, subdivision 5a, and the date that the background study was initiated by the applicant
for each controlling individual;
(4) if applicable, the applicant's NPI number and UMPI number;
(5) the documents that created the organization and that determine the organization's
internal governance and the relations among the persons that own the organization, have
an interest in the organization, or are members of the organization, in each case as provided
or authorized by the organization's governing statute, which may include a partnership
agreement, bylaws, articles of organization, organizational chart, and operating agreement,
or comparable documents as provided in the organization's governing statute; and
(6) the notarized signature of the applicant or authorized agent.
(h) When the applicant is a government entity, the applicant must provide:
(1) the name of the government agency, political subdivision, or other unit of government
seeking the license and the name of the program or services that will be licensed;
(2) the applicant's taxpayer identification numbers including the Minnesota tax
identification number and federal employer identification number;
(3) a letter signed by the manager, administrator, or other executive of the government
entity authorizing the submission of the license application; and
(4) if applicable, the applicant's NPI number and UMPI number.
(i) At the time of application for licensure or renewal of a license under this chapter, the
applicant or license holder must acknowledge on the form provided by the commissioner
if the applicant or license holder elects to receive any public funding reimbursement from
the commissioner for services provided under the license that:
(1) the applicant's or license holder's compliance with the provider enrollment agreement
or registration requirements for receipt of public funding may be monitored by the
commissioner as part of a licensing investigation or licensing inspection; and
(2) noncompliance with the provider enrollment agreement or registration requirements
for receipt of public funding that is identified through a licensing investigation or licensing
inspection, or noncompliance with a licensing requirement that is a basis of enrollment for
reimbursement for a service, may result in:
(i) a correction order or a conditional license under section 245A.06, or sanctions under
section 245A.07;
(ii) nonpayment of claims submitted by the license holder for public program
reimbursement;
(iii) recovery of payments made for the service;
(iv) disenrollment in the public payment program; or
(v) other administrative, civil, or criminal penalties as provided by law.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 2.
Minnesota Statutes 2022, section 245A.04, subdivision 7a, is amended to read:
Subd. 7a.
Notification required.
(a) A license holder must notify the commissioner, in
a manner prescribed by the commissioner, and obtain the commissioner's approval before
making any change that would alter the license information listed under subdivision 7,
paragraph (a).
(b) A license holder must also notify the commissioner, in a manner prescribed by the
commissioner, before making any change:
(1) to the license holder's authorized agent as defined in section 245A.02, subdivision
3b;
(2) to the license holder's controlling individual as defined in section 245A.02, subdivision
5a;
(3) to the license holder information on file with the secretary of state;
(4) in the location of the program or service licensed under this chapter; and
(5) to the federal or state tax identification number associated with the license holder.
(c) When, for reasons beyond the license holder's control, a license holder cannot provide
the commissioner with prior notice of the changes in paragraph (b), clauses (1) to (3), the
license holder must notify the commissioner by the tenth business day after the change and
must provide any additional information requested by the commissioner.
(d) When a license holder notifies the commissioner of a change to the license holder
information on file with the secretary of state, the license holder must provide amended
articles of incorporation and other documentation of the change.
new text begin
(e) Upon implementation of the provider licensing and reporting hub, license holders
must enter and update information in the hub in a manner prescribed by the commissioner.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 3.
Minnesota Statutes 2022, section 245A.05, is amended to read:
245A.05 DENIAL OF APPLICATION.
(a) The commissioner may deny a license if an applicant or controlling individual:
(1) fails to submit a substantially complete application after receiving notice from the
commissioner under section 245A.04, subdivision 1;
(2) fails to comply with applicable laws or rules;
(3) knowingly withholds relevant information from or gives false or misleading
information to the commissioner in connection with an application for a license or during
an investigation;
(4) has a disqualification that has not been set aside under section 245C.22 and no
variance has been granted;
(5) has an individual living in the household who received a background study under
section 245C.03, subdivision 1, paragraph (a), clause (2), who has a disqualification that
has not been set aside under section 245C.22, and no variance has been granted;
(6) is associated with an individual who received a background study under section
245C.03, subdivision 1, paragraph (a), clause (6), who may have unsupervised access to
children or vulnerable adults, and who has a disqualification that has not been set aside
under section 245C.22, and no variance has been granted;
(7) fails to comply with section 245A.04, subdivision 1, paragraph (f) or (g);
(8) fails to demonstrate competent knowledge as required by section 245A.04, subdivision
6;
(9) has a history of noncompliance as a license holder or controlling individual with
applicable laws or rules, including but not limited to this chapter and chapters 119B and
245C;
(10) is prohibited from holding a license according to section 245.095; or
(11) for a family foster setting, has nondisqualifying background study information, as
described in section 245C.05, subdivision 4, that reflects on the individual's ability to safely
provide care to foster children.
(b) An applicant whose application has been denied by the commissioner must be given
notice of the denial, which must state the reasons for the denial in plain language. Notice
must be given by certified mail deleted text begin ordeleted text end new text begin , bynew text end personal servicenew text begin , or through the provider licensing
and reporting hubnew text end . The notice must state the reasons the application was denied and must
inform the applicant of the right to a contested case hearing under chapter 14 and Minnesota
Rules, parts 1400.8505 to 1400.8612. The applicant may appeal the denial by notifying the
commissioner in writing by certified mail deleted text begin ordeleted text end new text begin , bynew text end personal servicenew text begin , or through the provider
licensing and reporting hubnew text end . If mailed, the appeal must be postmarked and sent to the
commissioner within 20 calendar days after the applicant received the notice of denial. If
an appeal request is made by personal service, it must be received by the commissioner
within 20 calendar days after the applicant received the notice of denial. new text begin If the order is issued
through the provider hub, the appeal must be received by the commissioner within 20
calendar days from the date the commissioner issued the order through the hub.new text end Section
245A.08 applies to hearings held to appeal the commissioner's denial of an application.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 4.
Minnesota Statutes 2022, section 245A.055, subdivision 2, is amended to read:
Subd. 2.
Reconsideration of closure.
If a license is closed, the commissioner must
notify the license holder of closure by certified mail deleted text begin ordeleted text end new text begin , bynew text end personal servicenew text begin , or through the
provider licensing and reporting hubnew text end . If mailed, the notice of closure must be mailed to the
last known address of the license holder and must inform the license holder why the license
was closed and that the license holder has the right to request reconsideration of the closure.
If the license holder believes that the license was closed in error, the license holder may ask
the commissioner to reconsider the closure. The license holder's request for reconsideration
must be made in writing and must include documentation that the licensed program has
served a client in the previous 12 months. The request for reconsideration must be postmarked
and sent to the commissioner new text begin or submitted through the provider licensing and reporting hub
new text end within 20 calendar days after the license holder receives the notice of closure. new text begin Upon
implementation of the provider licensing and reporting hub, the provider must use the hub
to request reconsideration. If the order is issued through the provider hub, the reconsideration
must be received by the commissioner within 20 calendar days from the date the
commissioner issued the order through the hub. new text end A timely request for reconsideration stays
imposition of the license closure until the commissioner issues a decision on the request for
reconsideration.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 5.
Minnesota Statutes 2022, section 245A.06, subdivision 1, is amended to read:
Subdivision 1.
Contents of correction orders and conditional licenses.
(a) If the
commissioner finds that the applicant or license holder has failed to comply with an
applicable law or rule and this failure does not imminently endanger the health, safety, or
rights of the persons served by the program, the commissioner may issue a correction order
and an order of conditional license to the applicant or license holder. When issuing a
conditional license, the commissioner shall consider the nature, chronicity, or severity of
the violation of law or rule and the effect of the violation on the health, safety, or rights of
persons served by the program. The correction order or conditional license must state the
following in plain language:
(1) the conditions that constitute a violation of the law or rule;
(2) the specific law or rule violated;
(3) the time allowed to correct each violation; and
(4) if a license is made conditional, the length and terms of the conditional license, and
the reasons for making the license conditional.
(b) Nothing in this section prohibits the commissioner from proposing a sanction as
specified in section 245A.07, prior to issuing a correction order or conditional license.
new text begin
(c) The commissioner may issue a correction order and an order of conditional license
to the applicant or license holder through the provider licensing and reporting hub.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 6.
Minnesota Statutes 2022, section 245A.06, subdivision 2, is amended to read:
Subd. 2.
Reconsideration of correction orders.
(a) If the applicant or license holder
believes that the contents of the commissioner's correction order are in error, the applicant
or license holder may ask the Department of Human Services to reconsider the parts of the
correction order that are alleged to be in error. The request for reconsideration must be made
in writing and must be postmarked and sent to the commissioner within 20 calendar days
after receipt of the correction order by the applicant or license holdernew text begin or submitted in the
provider licensing and reporting hub within 20 calendar days from the date the commissioner
issued the order through the hubnew text end , and:
(1) specify the parts of the correction order that are alleged to be in error;
(2) explain why they are in error; and
(3) include documentation to support the allegation of error.
new text begin Upon implementation of the provider licensing and reporting hub, the provider must use
the hub to request reconsideration. new text end A request for reconsideration does not stay any provisions
or requirements of the correction order. The commissioner's disposition of a request for
reconsideration is final and not subject to appeal under chapter 14.
(b) This paragraph applies only to licensed family child care providers. A licensed family
child care provider who requests reconsideration of a correction order under paragraph (a)
may also request, on a form and in the manner prescribed by the commissioner, that the
commissioner expedite the review if:
(1) the provider is challenging a violation and provides a description of how complying
with the corrective action for that violation would require the substantial expenditure of
funds or a significant change to their program; and
(2) describes what actions the provider will take in lieu of the corrective action ordered
to ensure the health and safety of children in care pending the commissioner's review of the
correction order.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 7.
Minnesota Statutes 2022, section 245A.06, subdivision 4, is amended to read:
Subd. 4.
Notice of conditional license; reconsideration of conditional license.
new text begin (a) new text end If
a license is made conditional, the license holder must be notified of the order by certified
mail deleted text begin ordeleted text end new text begin , bynew text end personal servicenew text begin , or through the provider licensing and reporting hubnew text end . If mailed,
the notice must be mailed to the address shown on the application or the last known address
of the license holder. The notice must state the reasons the conditional license was ordered
and must inform the license holder of the right to request reconsideration of the conditional
license by the commissioner. The license holder may request reconsideration of the order
of conditional license by notifying the commissioner by certified mail deleted text begin ordeleted text end new text begin , bynew text end personal servicenew text begin ,
or through the provider licensing and reporting hubnew text end . The request must be made in writing.
If sent by certified mail, the request must be postmarked and sent to the commissioner within
ten calendar days after the license holder received the order. If a request is made by personal
service, it must be received by the commissioner within ten calendar days after the license
holder received the order. new text begin If the order is issued through the provider hub, the request must
be received by the commissioner within ten calendar days from the date the commissioner
issued the order through the hub.new text end The license holder may submit with the request for
reconsideration written argument or evidence in support of the request for reconsideration.
A timely request for reconsideration shall stay imposition of the terms of the conditional
license until the commissioner issues a decision on the request for reconsideration. If the
commissioner issues a dual order of conditional license under this section and an order to
pay a fine under section 245A.07, subdivision 3, the license holder has a right to a contested
case hearing under chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. The
scope of the contested case hearing shall include the fine and the conditional license. In this
case, a reconsideration of the conditional license will not be conducted under this section.
If the license holder does not appeal the fine, the license holder does not have a right to a
contested case hearing and a reconsideration of the conditional license must be conducted
under this subdivision.
new text begin (b) new text end The commissioner's disposition of a request for reconsideration is final and not
subject to appeal under chapter 14.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 8.
Minnesota Statutes 2022, section 245A.07, subdivision 3, is amended to read:
Subd. 3.
License suspension, revocation, or fine.
(a) The commissioner may suspend
or revoke a license, or impose a fine if:
(1) a license holder fails to comply fully with applicable laws or rules including but not
limited to the requirements of this chapter and chapter 245C;
(2) a license holder, a controlling individual, or an individual living in the household
where the licensed services are provided or is otherwise subject to a background study has
been disqualified and the disqualification was not set aside and no variance has been granted;
(3) a license holder knowingly withholds relevant information from or gives false or
misleading information to the commissioner in connection with an application for a license,
in connection with the background study status of an individual, during an investigation,
or regarding compliance with applicable laws or rules;
(4) a license holder is excluded from any program administered by the commissioner
under section 245.095; or
(5) revocation is required under section 245A.04, subdivision 7, paragraph (d).
A license holder who has had a license issued under this chapter suspended, revoked,
or has been ordered to pay a fine must be given notice of the action by certified mail deleted text begin ordeleted text end new text begin , bynew text end
personal servicenew text begin , or through the provider licensing and reporting hubnew text end . If mailed, the notice
must be mailed to the address shown on the application or the last known address of the
license holder. The notice must state in plain language the reasons the license was suspended
or revoked, or a fine was ordered.
(b) If the license was suspended or revoked, the notice must inform the license holder
of the right to a contested case hearing under chapter 14 and Minnesota Rules, parts
1400.8505 to 1400.8612. The license holder may appeal an order suspending or revoking
a license. The appeal of an order suspending or revoking a license must be made in writing
by certified mail deleted text begin ordeleted text end new text begin , bynew text end personal servicenew text begin , or through the provider licensing and reporting
hubnew text end . If mailed, the appeal must be postmarked and sent to the commissioner within ten
calendar days after the license holder receives notice that the license has been suspended
or revoked. If a request is made by personal service, it must be received by the commissioner
within ten calendar days after the license holder received the order. new text begin If the order is issued
through the provider hub, the appeal must be received by the commissioner within ten
calendar days from the date the commissioner issued the order through the hub.new text end Except as
provided in subdivision 2a, paragraph (c), if a license holder submits a timely appeal of an
order suspending or revoking a license, the license holder may continue to operate the
program as provided in section 245A.04, subdivision 7, paragraphs (f) and (g), until the
commissioner issues a final order on the suspension or revocation.
(c)(1) If the license holder was ordered to pay a fine, the notice must inform the license
holder of the responsibility for payment of fines and the right to a contested case hearing
under chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. The appeal of an
order to pay a fine must be made in writing by certified mail deleted text begin ordeleted text end new text begin , bynew text end personal servicenew text begin , or
through the provider licensing and reporting hubnew text end . If mailed, the appeal must be postmarked
and sent to the commissioner within ten calendar days after the license holder receives
notice that the fine has been ordered. If a request is made by personal service, it must be
received by the commissioner within ten calendar days after the license holder received the
order.new text begin If the order is issued through the provider hub, the appeal must be received by the
commissioner within ten calendar days from the date the commissioner issued the order
through the hub.
new text end
(2) The license holder shall pay the fines assessed on or before the payment date specified.
If the license holder fails to fully comply with the order, the commissioner may issue a
second fine or suspend the license until the license holder complies. If the license holder
receives state funds, the state, county, or municipal agencies or departments responsible for
administering the funds shall withhold payments and recover any payments made while the
license is suspended for failure to pay a fine. A timely appeal shall stay payment of the fine
until the commissioner issues a final order.
(3) A license holder shall promptly notify the commissioner of human services, in writing,
when a violation specified in the order to forfeit a fine is corrected. If upon reinspection the
commissioner determines that a violation has not been corrected as indicated by the order
to forfeit a fine, the commissioner may issue a second fine. The commissioner shall notify
the license holder by certified mail deleted text begin ordeleted text end new text begin , bynew text end personal servicenew text begin , or through the provider licensing
and reporting hubnew text end that a second fine has been assessed. The license holder may appeal the
second fine as provided under this subdivision.
(4) Fines shall be assessed as follows:
(i) the license holder shall forfeit $1,000 for each determination of maltreatment of a
child under chapter 260E or the maltreatment of a vulnerable adult under section 626.557
for which the license holder is determined responsible for the maltreatment under section
260E.30, subdivision 4, paragraphs (a) and (b), or 626.557, subdivision 9c, paragraph (c);
(ii) if the commissioner determines that a determination of maltreatment for which the
license holder is responsible is the result of maltreatment that meets the definition of serious
maltreatment as defined in section 245C.02, subdivision 18, the license holder shall forfeit
$5,000;
(iii) for a program that operates out of the license holder's home and a program licensed
under Minnesota Rules, parts 9502.0300 to 9502.0445, the fine assessed against the license
holder shall not exceed $1,000 for each determination of maltreatment;
(iv) the license holder shall forfeit $200 for each occurrence of a violation of law or rule
governing matters of health, safety, or supervision, including but not limited to the provision
of adequate staff-to-child or adult ratios, and failure to comply with background study
requirements under chapter 245C; and
(v) the license holder shall forfeit $100 for each occurrence of a violation of law or rule
other than those subject to a $5,000, $1,000, or $200 fine in items (i) to (iv).
For purposes of this section, "occurrence" means each violation identified in the
commissioner's fine order. Fines assessed against a license holder that holds a license to
provide home and community-based services, as identified in section 245D.03, subdivision
1, and a community residential setting or day services facility license under chapter 245D
where the services are provided, may be assessed against both licenses for the same
occurrence, but the combined amount of the fines shall not exceed the amount specified in
this clause for that occurrence.
(5) When a fine has been assessed, the license holder may not avoid payment by closing,
selling, or otherwise transferring the licensed program to a third party. In such an event, the
license holder will be personally liable for payment. In the case of a corporation, each
controlling individual is personally and jointly liable for payment.
(d) Except for background study violations involving the failure to comply with an order
to immediately remove an individual or an order to provide continuous, direct supervision,
the commissioner shall not issue a fine under paragraph (c) relating to a background study
violation to a license holder who self-corrects a background study violation before the
commissioner discovers the violation. A license holder who has previously exercised the
provisions of this paragraph to avoid a fine for a background study violation may not avoid
a fine for a subsequent background study violation unless at least 365 days have passed
since the license holder self-corrected the earlier background study violation.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 9.
Minnesota Statutes 2022, section 245A.16, is amended by adding a subdivision to
read:
new text begin Subd. 10. new text end
new text begin Licensing and reporting hub. new text end
new text begin
Upon implementation of the provider licensing
and reporting hub, county staff who perform licensing functions must use the hub in the
manner prescribed by the commissioner.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 10.
Minnesota Statutes 2022, section 245H.01, subdivision 3, is amended to read:
Subd. 3.
Center operator or program operator.
"Center operator" or "program operator"
means the person exercising supervision or control over the center's or program's operations,
planning, and functioning. deleted text begin There may be more than one designated center operator or
program operator.
deleted text end
Sec. 11.
Minnesota Statutes 2022, section 245H.01, is amended by adding a subdivision
to read:
new text begin Subd. 4a. new text end
new text begin Authorized agent. new text end
new text begin
"Authorized agent" means the individual designated by
the certification holder that is responsible for communicating with the commissioner
regarding all items pursuant to this chapter.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 12.
Minnesota Statutes 2022, section 245H.03, subdivision 2, is amended to read:
Subd. 2.
Application submission.
The commissioner shall provide application
instructions and information about the rules and requirements of other state agencies that
affect the applicant. The certification application must be submitted in a manner prescribed
by the commissioner. new text begin Upon implementation of the provider licensing and reporting hub,
applicants must use the hub in the manner prescribed by the commissioner. new text end The commissioner
shall act on the application within 90 working days of receiving a completed application.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 13.
Minnesota Statutes 2022, section 245H.03, subdivision 3, is amended to read:
Subd. 3.
Incomplete applications.
When the commissioner receives an application for
initial certification that is incomplete because the applicant failed to submit required
documents or is deficient because the documents submitted do not meet certification
requirements, the commissioner shall provide the applicant written notice that the application
is incomplete or deficient. In the notice, the commissioner shall identify documents that are
missing or deficient and give the applicant 45 days to resubmit a second application that is
complete. An applicant's failure to submit a complete application after receiving notice from
the commissioner is basis for certification denial. new text begin For purposes of this section, when a denial
order is issued through the provider licensing and reporting hub, the applicant is deemed to
have received the order upon the date of issuance through the hub.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 14.
Minnesota Statutes 2022, section 245H.03, subdivision 4, is amended to read:
Subd. 4.
Reconsideration of certification denial.
(a) The applicant may request
reconsideration of the denial by notifying the commissioner by certified mail deleted text begin ordeleted text end new text begin , bynew text end personal
servicenew text begin , or through the provider licensing and reporting hubnew text end . The request must be made in
writing. If sent by certified mail, the request must be postmarked and sent to the
commissioner within 20 calendar days after the applicant received the order. If a request is
made by personal service, it must be received by the commissioner within 20 calendar days
after the applicant received the order. new text begin If the order is issued through the provider hub, the
request must be received by the commissioner within 20 calendar days from the date the
commissioner issued the order through the hub.new text end The applicant may submit with the request
for reconsideration a written argument or evidence in support of the request for
reconsideration.
(b) The commissioner's disposition of a request for reconsideration is final and not
subject to appeal under chapter 14.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 15.
Minnesota Statutes 2022, section 245H.06, subdivision 1, is amended to read:
Subdivision 1.
Correction order requirements.
new text begin (a) new text end If the applicant or certification
holder failed to comply with a law or rule, the commissioner may issue a correction order.
The correction order must state:
(1) the condition that constitutes a violation of the law or rule;
(2) the specific law or rule violated; and
(3) the time allowed to correct each violation.
new text begin
(b) The commissioner may issue a correction order to the applicant or certification holder
through the provider licensing and reporting hub.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 16.
Minnesota Statutes 2022, section 245H.06, subdivision 2, is amended to read:
Subd. 2.
Reconsideration request.
(a) If the applicant or certification holder believes
that the commissioner's correction order is erroneous, the applicant or certification holder
may ask the commissioner to reconsider the part of the correction order that is allegedly
erroneous. A request for reconsideration must be made in writingdeleted text begin ,deleted text end new text begin andnew text end postmarkeddeleted text begin ,deleted text end new text begin or
submitted through the provider licensing and reporting hubnew text end and sent to the commissioner
within 20 calendar days after the applicant or certification holder received the correction
order, and must:
(1) specify the part of the correction order that is allegedly erroneous;
(2) explain why the specified part is erroneous; and
(3) include documentation to support the allegation of error.
(b) A request for reconsideration does not stay any provision or requirement of the
correction order. The commissioner's disposition of a request for reconsideration is final
and not subject to appeal.
new text begin
(c) Upon implementation of the provider licensing and reporting hub, the provider must
use the hub to request reconsideration. If the order is issued through the provider hub, the
request must be received by the commissioner within 20 calendar days from the date the
commissioner issued the order through the hub.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 17.
Minnesota Statutes 2022, section 245H.07, subdivision 1, is amended to read:
Subdivision 1.
Generally.
(a) The commissioner may decertify a center if a certification
holder:
(1) failed to comply with an applicable law or rule;
(2) knowingly withheld relevant information from or gave false or misleading information
to the commissioner in connection with an application for certification, in connection with
the background study status of an individual, during an investigation, or regarding compliance
with applicable laws or rules; or
(3) has authorization to receive child care assistance payments revoked pursuant to
chapter 119B.
(b) When considering decertification, the commissioner shall consider the nature,
chronicity, or severity of the violation of law or rule.
(c) When a center is decertified, the center is ineligible to receive a child care assistance
payment under chapter 119B.
new text begin
(d) The commissioner may issue a decertification order to a certification holder through
the provider licensing and reporting hub.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 18.
Minnesota Statutes 2022, section 245H.07, subdivision 2, is amended to read:
Subd. 2.
Reconsideration of decertification.
(a) The certification holder may request
reconsideration of the decertification by notifying the commissioner by certified mail deleted text begin ordeleted text end new text begin ,
bynew text end personal servicenew text begin , or through the provider licensing and reporting hubnew text end . The request must
be made in writing. If sent by certified mail, the request must be postmarked and sent to the
commissioner within 20 calendar days after the certification holder received the order. If a
request is made by personal service, it must be received by the commissioner within 20
calendar days after the certification holder received the order. new text begin If the order is issued through
the provider hub, the request must be received by the commissioner within 20 calendar days
from the date the commissioner issued the order through the hub.new text end With the request for
reconsideration, the certification holder may submit a written argument or evidence in
support of the request for reconsideration.
(b) The commissioner's disposition of a request for reconsideration is final and not
subject to appeal under chapter 14.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 19.
Minnesota Statutes 2022, section 245I.20, subdivision 10, is amended to read:
Subd. 10.
Application procedures.
(a) The applicant for certification must submit any
documents that the commissioner requires on forms approved by the commissioner.new text begin Upon
implementation of the provider licensing and reporting hub, applicants must use the hub in
the manner prescribed by the commissioner.
new text end
(b) Upon submitting an application for certification, an applicant must pay the application
fee required by section 245A.10, subdivision 3.
(c) The commissioner must act on an application within 90 working days of receiving
a completed application.
(d) When the commissioner receives an application for initial certification that is
incomplete because the applicant failed to submit required documents or is deficient because
the submitted documents do not meet certification requirements, the commissioner must
provide the applicant with written notice that the application is incomplete or deficient. In
the notice, the commissioner must identify the particular documents that are missing or
deficient and give the applicant 45 days to submit a second application that is complete. An
applicant's failure to submit a complete application within 45 days after receiving notice
from the commissioner is a basis for certification denial.
(e) The commissioner must give notice of a denial to an applicant when the commissioner
has made the decision to deny the certification application. In the notice of denial, the
commissioner must state the reasons for the denial in plain language. The commissioner
must send or deliver the notice of denial to an applicant by certified mail deleted text begin ordeleted text end new text begin , bynew text end personal
service. In the notice of denial, the commissioner must state the reasons that the commissioner
denied the application and must inform the applicant of the applicant's right to request a
contested case hearing under chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612.
The applicant may appeal the denial by notifying the commissioner in writing by certified
mail deleted text begin ordeleted text end new text begin , bynew text end personal servicenew text begin , or through the provider licensing and reporting hubnew text end . If mailed,
the appeal must be postmarked and sent to the commissioner within 20 calendar days after
the applicant received the notice of denial. If an applicant delivers an appeal by personal
service, the commissioner must receive the appeal within 20 calendar days after the applicant
received the notice of denial. new text begin If the order is issued through the provider hub, the request
must be received by the commissioner within 20 calendar days from the date the
commissioner issued the order through the hub.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 20.
Minnesota Statutes 2022, section 245I.20, subdivision 13, is amended to read:
Subd. 13.
Correction orders.
(a) If the applicant or certification holder fails to comply
with a law or rule, the commissioner may issue a correction order. The correction order
must state:
(1) the condition that constitutes a violation of the law or rule;
(2) the specific law or rule that the applicant or certification holder has violated; and
(3) the time that the applicant or certification holder is allowed to correct each violation.
(b) If the applicant or certification holder believes that the commissioner's correction
order is erroneous, the applicant or certification holder may ask the commissioner to
reconsider the part of the correction order that is allegedly erroneous. An applicant or
certification holder must make a request for reconsideration in writing. The request must
be postmarked and sent to the commissioner new text begin or submitted in the provider licensing and
reporting hub new text end within 20 calendar days after the applicant or certification holder received
the correction order; and the request must:
(1) specify the part of the correction order that is allegedly erroneous;
(2) explain why the specified part is erroneous; and
(3) include documentation to support the allegation of error.
(c) A request for reconsideration does not stay any provision or requirement of the
correction order. The commissioner's disposition of a request for reconsideration is final
and not subject to appeal.
(d) If the commissioner finds that the applicant or certification holder failed to correct
the violation specified in the correction order, the commissioner may decertify the certified
mental health clinic according to subdivision 14.
(e) Nothing in this subdivision prohibits the commissioner from decertifying a mental
health clinic according to subdivision 14.
new text begin
(f) The commissioner may issue a correction order to the applicant or certification holder
through the provider licensing and reporting hub. If the order is issued through the provider
hub, the request must be received by the commissioner within 20 calendar days from the
date the commissioner issued the order through the hub.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 21.
Minnesota Statutes 2022, section 245I.20, subdivision 14, is amended to read:
Subd. 14.
Decertification.
(a) The commissioner may decertify a mental health clinic
if a certification holder:
(1) failed to comply with an applicable law or rule; or
(2) knowingly withheld relevant information from or gave false or misleading information
to the commissioner in connection with an application for certification, during an
investigation, or regarding compliance with applicable laws or rules.
(b) When considering decertification of a mental health clinic, the commissioner must
consider the nature, chronicity, or severity of the violation of law or rule and the effect of
the violation on the health, safety, or rights of clients.
(c) If the commissioner decertifies a mental health clinic, the order of decertification
must inform the certification holder of the right to have a contested case hearing under
chapter 14 and Minnesota Rules, parts 1400.8505 to 1400.8612. new text begin The commissioner may
issue the order through the provider licensing and reporting hub. new text end The certification holder
may appeal the decertification. The certification holder must appeal a decertification in
writing and send or deliver the appeal to the commissioner by certified mail deleted text begin ordeleted text end new text begin , bynew text end personal
servicenew text begin , or through the provider licensing and reporting hubnew text end . If the certification holder mails
the appeal, the appeal must be postmarked and sent to the commissioner within ten calendar
days after the certification holder receives the order of decertification. If the certification
holder delivers an appeal by personal service, the commissioner must receive the appeal
within ten calendar days after the certification holder received the order. new text begin If the order is
issued through the provider hub, the request must be received by the commissioner within
20 calendar days from the date the commissioner issued the order through the hub.new text end If a
certification holder submits a timely appeal of an order of decertification, the certification
holder may continue to operate the program until the commissioner issues a final order on
the decertification.
(d) If the commissioner decertifies a mental health clinic pursuant to paragraph (a),
clause (1), based on a determination that the mental health clinic was responsible for
maltreatment, and if the certification holder appeals the decertification according to paragraph
(c), and appeals the maltreatment determination under section 260E.33, the final
decertification determination is stayed until the commissioner issues a final decision regarding
the maltreatment appeal.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 22.
Minnesota Statutes 2022, section 245I.20, subdivision 16, is amended to read:
Subd. 16.
Notifications required and noncompliance.
(a) A certification holder must
notify the commissioner, in a manner prescribed by the commissioner, and obtain the
commissioner's approval before making any change to the name of the certification holder
or the location of the mental health clinic.new text begin Upon implementation of the provider licensing
and reporting hub, certification holders must enter and update information in the hub in a
manner prescribed by the commissioner.
new text end
(b) Changes in mental health clinic organization, staffing, treatment, or quality assurance
procedures that affect the ability of the certification holder to comply with the minimum
standards of this section must be reported in writing by the certification holder to the
commissioner within 15 days of the occurrence. Review of the change must be conducted
by the commissioner. A certification holder with changes resulting in noncompliance in
minimum standards must receive written notice and may have up to 180 days to correct the
areas of noncompliance before being decertified. Interim procedures to resolve the
noncompliance on a temporary basis must be developed and submitted in writing to the
commissioner for approval within 30 days of the commissioner's determination of the
noncompliance. Not reporting an occurrence of a change that results in noncompliance
within 15 days, failure to develop an approved interim procedure within 30 days of the
determination of the noncompliance, or nonresolution of the noncompliance within 180
days will result in immediate decertification.
(c) The mental health clinic may be required to submit written information to the
department to document that the mental health clinic has maintained compliance with this
section and mental health clinic procedures.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 23.
Minnesota Statutes 2022, section 260E.09, is amended to read:
260E.09 REPORTING REQUIREMENTS.
(a) An oral report shall be made immediately by telephone or otherwise. An oral report
made by a person required under section 260E.06, subdivision 1, to report shall be followed
within 72 hours, exclusive of weekends and holidays, by a report in writing to the appropriate
police department, the county sheriff, the agency responsible for assessing or investigating
the report, or the local welfare agency.
(b) Any report shall be of sufficient content to identify the child, any person believed
to be responsible for the maltreatment of the child if the person is known, the nature and
extent of the maltreatment, and the name and address of the reporter. The local welfare
agency or agency responsible for assessing or investigating the report shall accept a report
made under section 260E.06 notwithstanding refusal by a reporter to provide the reporter's
name or address as long as the report is otherwise sufficient under this paragraph.
new text begin
(c) Notwithstanding paragraph (a), upon implementation of the provider licensing and
reporting hub, an individual who has an account with the provider licensing and reporting
hub and is required to report suspected maltreatment as a licensed program under section
260E.06, subdivision 1, may submit a written report in the hub in a manner prescribed by
the commissioner and is not required to make an oral report. A report submitted through
the provider licensing and reporting hub must be made immediately.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 24.
Minnesota Statutes 2022, section 270B.14, subdivision 1, is amended to read:
Subdivision 1.
Disclosure to commissioner of human services.
(a) On the request of
the commissioner of human services, the commissioner shall disclose return information
regarding taxes imposed by chapter 290, and claims for refunds under chapter 290A, to the
extent provided in paragraph (b) and for the purposes set forth in paragraph (c).
(b) Data that may be disclosed are limited to data relating to the identity, whereabouts,
employment, income, and property of a person owing or alleged to be owing an obligation
of child support.
(c) The commissioner of human services may request data only for the purposes of
carrying out the child support enforcement program and to assist in the location of parents
who have, or appear to have, deserted their children. Data received may be used only as set
forth in section 256.978.
(d) The commissioner shall provide the records and information necessary to administer
the supplemental housing allowance to the commissioner of human services.
(e) At the request of the commissioner of human services, the commissioner of revenue
shall electronically match the Social Security numbers and names of participants in the
telephone assistance plan operated under sections 237.69 to 237.71, with those of property
tax refund filers, and determine whether each participant's household income is within the
eligibility standards for the telephone assistance plan.
(f) The commissioner may provide records and information collected under sections
295.50 to 295.59 to the commissioner of human services for purposes of the Medicaid
Voluntary Contribution and Provider-Specific Tax Amendments of 1991, Public Law
102-234. Upon the written agreement by the United States Department of Health and Human
Services to maintain the confidentiality of the data, the commissioner may provide records
and information collected under sections 295.50 to 295.59 to the Centers for Medicare and
Medicaid Services section of the United States Department of Health and Human Services
for purposes of meeting federal reporting requirements.
(g) The commissioner may provide records and information to the commissioner of
human services as necessary to administer the early refund of refundable tax credits.
(h) The commissioner may disclose information to the commissioner of human services
as necessary for income verification for eligibility and premium payment under the
MinnesotaCare program, under section 256L.05, subdivision 2, as well as the medical
assistance program under chapter 256B.
(i) The commissioner may disclose information to the commissioner of human services
necessary to verify whether applicants or recipients for the Minnesota family investment
program, general assistance, the Supplemental Nutrition Assistance Program (SNAP),
Minnesota supplemental aid program, and child care assistance have claimed refundable
tax credits under chapter 290 and the property tax refund under chapter 290A, and the
amounts of the credits.
(j) The commissioner may disclose information to the commissioner of human services
necessary to verify income for purposes of calculating parental contribution amounts under
section 252.27, subdivision 2a.
new text begin
(k) The commissioner shall disclose information to the commissioner of human services
to verify the income and tax identification information of:
new text end
new text begin
(1) an applicant under section 245A.04, subdivision 1;
new text end
new text begin
(2) an applicant under section 245H.03;
new text end
new text begin
(3) an applicant under section 245I.20;
new text end
new text begin
(4) a license holder; or
new text end
new text begin
(5) a certification holder.
new text end
ARTICLE 13
MISCELLANEOUS
Section 1.
Minnesota Statutes 2022, section 62A.30, is amended by adding a subdivision
to read:
new text begin Subd. 5. new text end
new text begin Mammogram; diagnostic services and testing. new text end
new text begin
If a health care provider
determines an enrollee requires additional diagnostic services or testing after a mammogram,
a health plan must provide coverage for the additional diagnostic services or testing with
no cost-sharing, including co-pay, deductible, or coinsurance.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024, and applies to health
plans offered, issued, or sold on or after that date.
new text end
Sec. 2.
Minnesota Statutes 2022, section 62A.30, is amended by adding a subdivision to
read:
new text begin Subd. 6. new text end
new text begin Application. new text end
new text begin
If the application of subdivision 5 before an enrollee has met their
health plan's deductible would result in: (1) health savings account ineligibility under United
States Code, title 26, section 223; or (2) catastrophic health plan ineligibility under United
States Code, title 42, section 18022(e), then subdivision 5 shall apply to diagnostic services
or testing only after the enrollee has met their health plan's deductible.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024, and applies to health
plans offered, issued, or sold on or after that date.
new text end
Sec. 3.
Minnesota Statutes 2022, section 62K.10, subdivision 4, is amended to read:
Subd. 4.
Network adequacy.
new text begin (a) new text end Each designated provider network must include a
sufficient number and type of providers, including providers that specialize in mental health
and substance use disorder services, to ensure that covered services are available to all
enrollees without unreasonable delay. In determining network adequacy, the commissioner
of health shall consider availability of services, including the following:
(1) primary care physician services are available and accessible 24 hours per day, seven
days per week, within the network area;
(2) a sufficient number of primary care physicians have hospital admitting privileges at
one or more participating hospitals within the network area so that necessary admissions
are made on a timely basis consistent with generally accepted practice parameters;
(3) specialty physician service is available through the network or contract arrangement;
(4) mental health and substance use disorder treatment providers are available and
accessible through the network or contract arrangement;
(5) to the extent that primary care services are provided through primary care providers
other than physicians, and to the extent permitted under applicable scope of practice in state
law for a given provider, these services shall be available and accessible; and
(6) the network has available, either directly or through arrangements, appropriate and
sufficient personnel, physical resources, and equipment to meet the projected needs of
enrollees for covered health care services.
new text begin
(b) The commissioner must determine network sufficiency in a manner that is consistent
with the requirements of this section and may establish network sufficiency by referencing
any reasonable criteria, which may include but is not limited to:
new text end
new text begin
(1) provider to covered person ratios by specialty;
new text end
new text begin
(2) primary care provider to covered person ratios;
new text end
new text begin
(3) geographic accessibility of providers;
new text end
new text begin
(4) geographic variation and population dispersion;
new text end
new text begin
(5) waiting times for an appointment with a participating provider;
new text end
new text begin
(6) hours of operation;
new text end
new text begin
(7) the ability of the network to meet the needs of covered persons, which may include:
(i) low-income persons; (ii) children and adults with serious, chronic, or complex health
conditions, physical disabilities, or mental illness; or (iii) persons with limited English
proficiency and persons from underserved communities;
new text end
new text begin
(8) other health care service delivery system options, including telehealth, mobile clinics,
and centers of excellence; and
new text end
new text begin
(9) the availability of technological and specialty care services to meet the needs of
covered persons requiring technologically advanced or specialty care services.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2025, and applies to health
plans offered, issued, or renewed on or after that date.
new text end
Sec. 4.
Minnesota Statutes 2022, section 62Q.096, is amended to read:
62Q.096 CREDENTIALING OF PROVIDERS.
new text begin (a) new text end If a health plan company has initially credentialed, as providers in its provider network,
individual providers employed by or under contract with an entity that:
(1) is authorized to bill under section 256B.0625, subdivision 5;
(2) is a mental health clinic certified under section 245I.20;
(3) is designated an essential community provider under section 62Q.19; and
(4) is under contract with the health plan company to provide mental health services,
the health plan company must continue to credential at least the same number of providers
from that entity, as long as those providers meet the health plan company's credentialing
standards.
new text begin
(b) In order to ensure timely access by patients to mental health services, between July
1, 2023, and June 30, 2025, a health plan company must credential and enter into a contract
for mental health services with any provider of mental health services that:
new text end
new text begin
(1) meets the health plan company's credential requirements. For purposes of credentialing
under this paragraph, a health plan company may waive credentialing requirements that are
not directly related to quality of care in order to ensure patient access to providers from
underserved communities or to providers in rural areas;
new text end
new text begin
(2) seeks a credential from the health plan company;
new text end
new text begin
(3) agrees to the health plan company's contract terms. The contract shall include payment
rates that are usual and customary for the services provided;
new text end
new text begin
(4) is accepting new patients; and
new text end
new text begin
(5) is not already under a contract with the health plan company under a separate tax
identification number or, if already under a contract with the health plan company, has
provided notice to the health plan company of termination of the existing contract.
new text end
new text begin (c) new text end A health plan company shall not refuse to credential these providers on the grounds
that their provider network hasnew text begin :
new text end
new text begin (1) new text end a sufficient number of providers of that typenew text begin , including but not limited to the provider
types identified in paragraph (a); or
new text end
new text begin (2) a sufficient number of providers of mental health services in the aggregatenew text end .
Sec. 5.
new text begin
[62Q.481] COST-SHARING FOR PRESCRIPTION DRUGS AND RELATED
MEDICAL SUPPLIES TO TREAT CHRONIC DISEASE.
new text end
new text begin Subdivision 1. new text end
new text begin Cost-sharing limits. new text end
new text begin
(a) A health plan must limit the amount of any
enrollee cost-sharing for prescription drugs prescribed to treat a chronic disease to no more
than $25 per one-month supply for each prescription drug regardless of the amount or type
of medication required to fill the prescription and to no more than $50 per month in total
for all related medical supplies. The cost-sharing limit for related medical supplies does not
increase with the number of chronic diseases for which an enrollee is treated. Coverage
under this section shall not be subject to any deductible.
new text end
new text begin
(b) If application of this section before an enrollee has met their plan's deductible would
result in: (1) health savings account ineligibility under United States Code, title 26, section
223; or (2) catastrophic health plan ineligibility under United States Code, title 42, section
18022(e), then this section shall apply to that specific prescription drug or related medical
supply only after the enrollee has met their plan's deductible.
new text end
new text begin Subd. 2. new text end
new text begin Definitions. new text end
new text begin
(a) For purposes of this section, the following definitions apply.
new text end
new text begin
(b) "Chronic disease" means diabetes, asthma, and allergies requiring the use of
epinephrine auto-injectors.
new text end
new text begin
(c) "Cost-sharing" means co-payments and coinsurance.
new text end
new text begin
(d) "Related medical supplies" means syringes, insulin pens, insulin pumps, test strips,
glucometers, continuous glucose monitors, epinephrine auto-injectors, asthma inhalers, and
other medical supply items necessary to effectively and appropriately treat a chronic disease
or administer a prescription drug prescribed to treat a chronic disease.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024, and applies to health
plans offered, issued, or renewed on or after that date.
new text end
Sec. 6.
Minnesota Statutes 2022, section 121A.28, is amended to read:
121A.28 LAW ENFORCEMENT RECORDS.
A law enforcement agency shall provide notice of any drug incident occurring within
the agency's jurisdiction, in which the agency has probable cause to believe a student violated
section 152.021, 152.022, 152.023, 152.024, 152.025, 152.0262, 152.027, deleted text begin 152.092,deleted text end 152.097,
or 340A.503, subdivision 1, 2, or 3. The notice shall be in writing and shall be provided,
within two weeks after an incident occurs, to the chemical abuse preassessment team in the
school where the student is enrolled.
Sec. 7.
Minnesota Statutes 2022, section 151.01, is amended by adding a subdivision to
read:
new text begin Subd. 43. new text end
new text begin Syringe services provider. new text end
new text begin
"Syringe services provider" means a
community-based public health program that offers cost-free comprehensive harm reduction
services which may include: providing sterile needles, syringes, and other injection
equipment; making safe disposal containers for needles and syringes available; educating
participants and others about overdose prevention, safer injection practices, and infectious
disease prevention; providing blood-borne pathogen testing or referrals to blood-borne
pathogen testing; offering referrals to substance use disorder treatment, including substance
use disorder treatment with medications for opioid use disorder; and providing referrals to
medical treatment and services, mental health programs and services, and other social
services.
new text end
Sec. 8.
Minnesota Statutes 2022, section 151.40, subdivision 1, is amended to read:
Subdivision 1.
Generally.
It is unlawful for any person to deleted text begin possess, control,deleted text end manufacture,
sell, furnish, dispense, or otherwise dispose of hypodermic syringes or needles or any
instrument or implement which can be adapted for subcutaneous injections, except for:
(1) the following persons when acting in the course of their practice or employment:
(i) licensed practitioners and their employees, agents, or delegates;
(ii) licensed pharmacies and their employees or agents;
(iii) licensed pharmacists;
(iv) registered nurses and licensed practical nurses;
(v) registered medical technologists;
(vi) medical interns and residents;
(vii) licensed drug wholesalers and their employees or agents;
(viii) licensed hospitals;
(ix) bona fide hospitals in which animals are treated;
(x) licensed nursing homes;
(xi) licensed morticians;
(xii) syringe and needle manufacturers and their dealers and agents;
(xiii) persons engaged in animal husbandry;
(xiv) clinical laboratories and their employees;
(xv) persons engaged in bona fide research or education or industrial use of hypodermic
syringes and needles provided such persons cannot use hypodermic syringes and needles
for the administration of drugs to human beings unless such drugs are prescribed, dispensed,
and administered by a person lawfully authorized to do so; deleted text begin and
deleted text end
(xvi) persons who administer drugs pursuant to an order or direction of a licensed
practitioner;new text begin and
new text end
new text begin
(xvii) syringe services providers and their employees and agents;
new text end
(2) a person who self-administers drugs pursuant to either the prescription or the direction
of a practitioner, or a family member, caregiver, or other individual who is designated by
such person to assist the person in obtaining and using needles and syringes for the
administration of such drugs;
(3) a person who is disposing of hypodermic syringes and needles through an activity
or program developed under section 325F.785; deleted text begin or
deleted text end
(4) a person who sellsdeleted text begin , possesses,deleted text end or handles hypodermic syringes and needles pursuant
to subdivision 2deleted text begin .deleted text end new text begin ; or
new text end
new text begin
(5) a participant receiving services from a syringe services provider who accesses or
receives new syringes or needles from a syringe services provider or returns used syringes
or needles to a syringe services provider.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2023.
new text end
Sec. 9.
Minnesota Statutes 2022, section 151.40, subdivision 2, is amended to read:
Subd. 2.
Sales deleted text begin of limited quantitiesdeleted text end of clean needles and syringes.
(a) A registered
pharmacy or a licensed pharmacist may sell, without the prescription or direction of a
practitioner, unused hypodermic needles and syringes deleted text begin in quantities of ten or fewer,deleted text end provided
the pharmacy or pharmacist complies with all of the requirements of this subdivision.
(b) At any location where hypodermic needles and syringes are kept for retail sale under
this subdivision, the needles and syringes shall be stored in a manner that makes them
available only to authorized personnel and not openly available to customers.
(c) A registered pharmacy or licensed pharmacist that sells hypodermic needles or
syringes under this subdivision may give the purchaser the materials developed by the
commissioner of health under section 325F.785.
(d) A registered pharmacy or licensed pharmacist that sells hypodermic needles or
syringes under this subdivision must certify to the commissioner of health participation in
an activity, including but not limited to those developed under section 325F.785, that supports
proper disposal of used hypodermic needles or syringes.
Sec. 10.
Minnesota Statutes 2022, section 151.74, subdivision 3, is amended to read:
Subd. 3.
Access to urgent-need insulin.
(a) MNsure shall develop an application form
to be used by an individual who is in urgent need of insulin. The application must ask the
individual to attest to the eligibility requirements described in subdivision 2. The form shall
be accessible through MNsure's website. MNsure shall also make the form available to
pharmacies and health care providers who prescribe or dispense insulin, hospital emergency
departments, urgent care clinics, and community health clinics. By submitting a completed,
signed, and dated application to a pharmacy, the individual attests that the information
contained in the application is correct.
(b) If the individual is in urgent need of insulin, the individual may present a completed,
signed, and dated application form to a pharmacy. The individual must also:
(1) have a valid insulin prescription; and
(2) present the pharmacist with identification indicating Minnesota residency in the form
of a valid Minnesota identification card, driver's license or permit, new text begin individual taxpayer
identification number, new text end or Tribal identification card as defined in section 171.072, paragraph
(b). If the individual in urgent need of insulin is under the age of 18, the individual's parent
or legal guardian must provide the pharmacist with proof of residency.
(c) Upon receipt of a completed and signed application, the pharmacist shall dispense
the prescribed insulin in an amount that will provide the individual with a 30-day supply.
The pharmacy must notify the health care practitioner who issued the prescription order no
later than 72 hours after the insulin is dispensed.
(d) The pharmacy may submit to the manufacturer of the dispensed insulin product or
to the manufacturer's vendor a claim for payment that is in accordance with the National
Council for Prescription Drug Program standards for electronic claims processing, unless
the manufacturer agrees to send to the pharmacy a replacement supply of the same insulin
as dispensed in the amount dispensed. If the pharmacy submits an electronic claim to the
manufacturer or the manufacturer's vendor, the manufacturer or vendor shall reimburse the
pharmacy in an amount that covers the pharmacy's acquisition cost.
(e) The pharmacy may collect an insulin co-payment from the individual to cover the
pharmacy's costs of processing and dispensing in an amount not to exceed $35 for the 30-day
supply of insulin dispensed.
(f) The pharmacy shall also provide each eligible individual with the information sheet
described in subdivision 7 and a list of trained navigators provided by the Board of Pharmacy
for the individual to contact if the individual is in need of accessing ongoing insulin coverage
options, including assistance in:
(1) applying for medical assistance or MinnesotaCare;
(2) applying for a qualified health plan offered through MNsure, subject to open and
special enrollment periods;
(3) accessing information on providers who participate in prescription drug discount
programs, including providers who are authorized to participate in the 340B program under
section 340b of the federal Public Health Services Act, United States Code, title 42, section
256b; and
(4) accessing insulin manufacturers' patient assistance programs, co-payment assistance
programs, and other foundation-based programs.
(g) The pharmacist shall retain a copy of the application form submitted by the individual
to the pharmacy for reporting and auditing purposes.
Sec. 11.
Minnesota Statutes 2022, section 151.74, subdivision 4, is amended to read:
Subd. 4.
Continuing safety net program; general.
(a) Each manufacturer shall make
a patient assistance program available to any individual who meets the requirements of this
subdivision. Each manufacturer's patient assistance programs must meet the requirements
of this section. Each manufacturer shall provide the Board of Pharmacy with information
regarding the manufacturer's patient assistance program, including contact information for
individuals to call for assistance in accessing their patient assistance program.
(b) To be eligible to participate in a manufacturer's patient assistance program, the
individual must:
(1) be a Minnesota resident with a valid Minnesota identification card that indicates
Minnesota residency in the form of a Minnesota identification card, driver's license or
permit, new text begin individual taxpayer identification number, new text end or Tribal identification card as defined
in section 171.072, paragraph (b). If the individual is under the age of 18, the individual's
parent or legal guardian must provide proof of residency;
(2) have a family income that is equal to or less than 400 percent of the federal poverty
guidelines;
(3) not be enrolled in medical assistance or MinnesotaCare;
(4) not be eligible to receive health care through a federally funded program or receive
prescription drug benefits through the Department of Veterans Affairs; and
(5) not be enrolled in prescription drug coverage through an individual or group health
plan that limits the total amount of cost-sharing that an enrollee is required to pay for a
30-day supply of insulin, including co-payments, deductibles, or coinsurance to $75 or less,
regardless of the type or amount of insulin needed.
(c) Notwithstanding the requirement in paragraph (b), clause (4), an individual who is
enrolled in Medicare Part D is eligible for a manufacturer's patient assistance program if
the individual has spent $1,000 on prescription drugs in the current calendar year and meets
the eligibility requirements in paragraph (b), clauses (1) to (3).
(d) An individual who is interested in participating in a manufacturer's patient assistance
program may apply directly to the manufacturer; apply through the individual's health care
practitioner, if the practitioner participates; or contact a trained navigator for assistance in
finding a long-term insulin supply solution, including assistance in applying to a
manufacturer's patient assistance program.
Sec. 12.
Minnesota Statutes 2022, section 152.01, subdivision 18, is amended to read:
Subd. 18.
Drug paraphernalia.
(a) Except as otherwise provided in paragraph (b), "drug
paraphernalia" means all equipment, products, and materials of any kind, except those items
used in conjunction with permitted uses of controlled substances under this chapter or the
Uniform Controlled Substances Act, which are knowingly or intentionally used primarily
in (1) manufacturing a controlled substance, (2) injecting, ingesting, inhaling, or otherwise
introducing into the human body a controlled substance, new text begin or new text end (3) deleted text begin testing the strength,
effectiveness, or purity of a controlled substance, or (4)deleted text end enhancing the effect of a controlled
substance.
(b) "Drug paraphernalia" does not include the possession, manufacture, delivery, or sale
of: (1) deleted text begin hypodermic needles or syringes in accordance with section 151.40, subdivision 2deleted text end new text begin
hypodermic syringes or needles or any instrument or implement that can be adapted for
subcutaneous injectionsnew text end ; or (2) products that detect the presence of fentanyl or a fentanyl
analog in a controlled substance.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective August 1, 2023, and applies to crimes
committed on or after that date.
new text end
Sec. 13.
Minnesota Statutes 2022, section 152.205, is amended to read:
152.205 LOCAL REGULATIONS.
Sections 152.01, subdivision 18, and deleted text begin 152.092deleted text end new text begin 152.093new text end to 152.095 do not preempt
enforcement or preclude adoption of municipal or county ordinances prohibiting or otherwise
regulating the manufacture, delivery, possession, or advertisement of drug paraphernalia.
Sec. 14.
Minnesota Statutes 2022, section 256B.69, subdivision 5a, is amended to read:
Subd. 5a.
Managed care contracts.
(a) Managed care contracts under this section and
section 256L.12 shall be entered into or renewed on a calendar year basis. The commissioner
may issue separate contracts with requirements specific to services to medical assistance
recipients age 65 and older.
(b) A prepaid health plan providing covered health services for eligible persons pursuant
to chapters 256B and 256L is responsible for complying with the terms of its contract with
the commissioner. Requirements applicable to managed care programs under chapters 256B
and 256L established after the effective date of a contract with the commissioner take effect
when the contract is next issued or renewed.
(c) The commissioner shall withhold five percent of managed care plan payments under
this section and county-based purchasing plan payments under section 256B.692 for the
prepaid medical assistance program pending completion of performance targets. Each
performance target must be quantifiable, objective, measurable, and reasonably attainable,
except in the case of a performance target based on a federal or state law or rule. Criteria
for assessment of each performance target must be outlined in writing prior to the contract
effective date. Clinical or utilization performance targets and their related criteria must
consider evidence-based research and reasonable interventions when available or applicable
to the populations served, and must be developed with input from external clinical experts
and stakeholders, including managed care plans, county-based purchasing plans, and
providers. The managed care or county-based purchasing plan must demonstrate, to the
commissioner's satisfaction, that the data submitted regarding attainment of the performance
target is accurate. The commissioner shall periodically change the administrative measures
used as performance targets in order to improve plan performance across a broader range
of administrative services. The performance targets must include measurement of plan
efforts to contain spending on health care services and administrative activities. The
commissioner may adopt plan-specific performance targets that take into account factors
affecting only one plan, including characteristics of the plan's enrollee population. The
withheld funds must be returned no sooner than July of the following year if performance
targets in the contract are achieved. The commissioner may exclude special demonstration
projects under subdivision 23.
(d) The commissioner shall require that managed care plans:
(1) use the assessment and authorization processes, forms, timelines, standards,
documentation, and data reporting requirements, protocols, billing processes, and policies
consistent with medical assistance fee-for-service or the Department of Human Services
contract requirements for all personal care assistance services under section 256B.0659 and
community first services and supports under section 256B.85; deleted text begin and
deleted text end
(2) by January 30 of each year that follows a rate increase for any aspect of services
under section 256B.0659 or 256B.85, inform the commissioner and the chairs and ranking
minority members of the legislative committees with jurisdiction over rates determined
under section 256B.851 of the amount of the rate increase that is paid to each personal care
assistance provider agency with which the plan has a contractdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(3) use a six-month timely filing standard and provide an exemption to the timely filing
timelines for the resubmission of claims where there has been a denial, request for more
information, or system issue.
new text end
(e) Effective for services rendered on or after January 1, 2012, the commissioner shall
include as part of the performance targets described in paragraph (c) a reduction in the health
plan's emergency department utilization rate for medical assistance and MinnesotaCare
enrollees, as determined by the commissioner. For 2012, the reduction shall be based on
the health plan's utilization in 2009. To earn the return of the withhold each subsequent
year, the managed care plan or county-based purchasing plan must achieve a qualifying
reduction of no less than ten percent of the plan's emergency department utilization rate for
medical assistance and MinnesotaCare enrollees, excluding enrollees in programs described
in subdivisions 23 and 28, compared to the previous measurement year until the final
performance target is reached. When measuring performance, the commissioner must
consider the difference in health risk in a managed care or county-based purchasing plan's
membership in the baseline year compared to the measurement year, and work with the
managed care or county-based purchasing plan to account for differences that they agree
are significant.
The withheld funds must be returned no sooner than July 1 and no later than July 31 of
the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that a reduction in the utilization rate
was achieved. The commissioner shall structure the withhold so that the commissioner
returns a portion of the withheld funds in amounts commensurate with achieved reductions
in utilization less than the targeted amount.
The withhold described in this paragraph shall continue for each consecutive contract
period until the plan's emergency room utilization rate for state health care program enrollees
is reduced by 25 percent of the plan's emergency room utilization rate for medical assistance
and MinnesotaCare enrollees for calendar year 2009. Hospitals shall cooperate with the
health plans in meeting this performance target and shall accept payment withholds that
may be returned to the hospitals if the performance target is achieved.
(f) Effective for services rendered on or after January 1, 2012, the commissioner shall
include as part of the performance targets described in paragraph (c) a reduction in the plan's
hospitalization admission rate for medical assistance and MinnesotaCare enrollees, as
determined by the commissioner. To earn the return of the withhold each year, the managed
care plan or county-based purchasing plan must achieve a qualifying reduction of no less
than five percent of the plan's hospital admission rate for medical assistance and
MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and
28, compared to the previous calendar year until the final performance target is reached.
When measuring performance, the commissioner must consider the difference in health risk
in a managed care or county-based purchasing plan's membership in the baseline year
compared to the measurement year, and work with the managed care or county-based
purchasing plan to account for differences that they agree are significant.
The withheld funds must be returned no sooner than July 1 and no later than July 31 of
the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that this reduction in the hospitalization
rate was achieved. The commissioner shall structure the withhold so that the commissioner
returns a portion of the withheld funds in amounts commensurate with achieved reductions
in utilization less than the targeted amount.
The withhold described in this paragraph shall continue until there is a 25 percent
reduction in the hospital admission rate compared to the hospital admission rates in calendar
year 2011, as determined by the commissioner. The hospital admissions in this performance
target do not include the admissions applicable to the subsequent hospital admission
performance target under paragraph (g). Hospitals shall cooperate with the plans in meeting
this performance target and shall accept payment withholds that may be returned to the
hospitals if the performance target is achieved.
(g) Effective for services rendered on or after January 1, 2012, the commissioner shall
include as part of the performance targets described in paragraph (c) a reduction in the plan's
hospitalization admission rates for subsequent hospitalizations within 30 days of a previous
hospitalization of a patient regardless of the reason, for medical assistance and MinnesotaCare
enrollees, as determined by the commissioner. To earn the return of the withhold each year,
the managed care plan or county-based purchasing plan must achieve a qualifying reduction
of the subsequent hospitalization rate for medical assistance and MinnesotaCare enrollees,
excluding enrollees in programs described in subdivisions 23 and 28, of no less than five
percent compared to the previous calendar year until the final performance target is reached.
The withheld funds must be returned no sooner than July 1 and no later than July 31 of
the following calendar year if the managed care plan or county-based purchasing plan
demonstrates to the satisfaction of the commissioner that a qualifying reduction in the
subsequent hospitalization rate was achieved. The commissioner shall structure the withhold
so that the commissioner returns a portion of the withheld funds in amounts commensurate
with achieved reductions in utilization less than the targeted amount.
The withhold described in this paragraph must continue for each consecutive contract
period until the plan's subsequent hospitalization rate for medical assistance and
MinnesotaCare enrollees, excluding enrollees in programs described in subdivisions 23 and
28, is reduced by 25 percent of the plan's subsequent hospitalization rate for calendar year
2011. Hospitals shall cooperate with the plans in meeting this performance target and shall
accept payment withholds that must be returned to the hospitals if the performance target
is achieved.
(h) Effective for services rendered on or after January 1, 2013, through December 31,
2013, the commissioner shall withhold 4.5 percent of managed care plan payments under
this section and county-based purchasing plan payments under section 256B.692 for the
prepaid medical assistance program. The withheld funds must be returned no sooner than
July 1 and no later than July 31 of the following year. The commissioner may exclude
special demonstration projects under subdivision 23.
(i) Effective for services rendered on or after January 1, 2014, the commissioner shall
withhold three percent of managed care plan payments under this section and county-based
purchasing plan payments under section 256B.692 for the prepaid medical assistance
program. The withheld funds must be returned no sooner than July 1 and no later than July
31 of the following year. The commissioner may exclude special demonstration projects
under subdivision 23.
(j) A managed care plan or a county-based purchasing plan under section 256B.692 may
include as admitted assets under section 62D.044 any amount withheld under this section
that is reasonably expected to be returned.
(k) Contracts between the commissioner and a prepaid health plan are exempt from the
set-aside and preference provisions of section 16C.16, subdivisions 6, paragraph (a), and
7.
(l) The return of the withhold under paragraphs (h) and (i) is not subject to the
requirements of paragraph (c).
(m) Managed care plans and county-based purchasing plans shall maintain current and
fully executed agreements for all subcontractors, including bargaining groups, for
administrative services that are expensed to the state's public health care programs.
Subcontractor agreements determined to be material, as defined by the commissioner after
taking into account state contracting and relevant statutory requirements, must be in the
form of a written instrument or electronic document containing the elements of offer,
acceptance, consideration, payment terms, scope, duration of the contract, and how the
subcontractor services relate to state public health care programs. Upon request, the
commissioner shall have access to all subcontractor documentation under this paragraph.
Nothing in this paragraph shall allow release of information that is nonpublic data pursuant
to section 13.02.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024.
new text end
Sec. 15.
Minnesota Statutes 2022, section 256L.03, subdivision 5, is amended to read:
Subd. 5.
Cost-sharing.
(a) Co-payments, coinsurance, and deductibles do not apply to
children under the age of 21 and to American Indians as defined in Code of Federal
Regulations, title 42, section 600.5.
(b) The commissioner shall adjust co-payments, coinsurance, and deductibles for covered
services in a manner sufficient to maintain the actuarial value of the benefit to 94 percent.
The cost-sharing changes described in this paragraph do not apply to eligible recipients or
services exempt from cost-sharing under state law. The cost-sharing changes described in
this paragraph shall not be implemented prior to January 1, 2016.
(c) The cost-sharing changes authorized under paragraph (b) must satisfy the requirements
for cost-sharing under the Basic Health Program as set forth in Code of Federal Regulations,
title 42, sections 600.510 and 600.520.
new text begin
(d) Cost-sharing for prescription drugs and related medical supplies to treat chronic
disease must comply with the requirements of section 62Q.481.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024.
new text end
Sec. 16.
Minnesota Statutes 2022, section 256L.03, subdivision 5, is amended to read:
Subd. 5.
Cost-sharing.
(a) Co-payments, coinsurance, and deductibles do not apply to
children under the age of 21 and to American Indians as defined in Code of Federal
Regulations, title 42, section 600.5.
(b) The commissioner shall adjust co-payments, coinsurance, and deductibles for covered
services in a manner sufficient to maintain the actuarial value of the benefit to 94 percent.
The cost-sharing changes described in this paragraph do not apply to eligible recipients or
services exempt from cost-sharing under state law. The cost-sharing changes described in
this paragraph shall not be implemented prior to January 1, 2016.
(c) The cost-sharing changes authorized under paragraph (b) must satisfy the requirements
for cost-sharing under the Basic Health Program as set forth in Code of Federal Regulations,
title 42, sections 600.510 and 600.520.
new text begin
(d) Co-payments, coinsurance, and deductibles do not apply to additional diagnostic
services or testing that a health care provider determines an enrollee requires after a
mammogram, as specified under section 62A.30, subdivision 5.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective January 1, 2024.
new text end
Sec. 17. new text begin GEOGRAPHIC ACCESSIBILITY AND NETWORK ADEQUACY STUDY.
new text end
new text begin
(a) The commissioner of health, in consultation with the commissioner of commerce
and stakeholders, must study and develop recommendations on additional methods, other
than maximum distance and travel times for enrollees, to determine adequate geographic
accessibility of health care providers and the adequacy of health care provider networks
maintained by health plan companies. The commissioner may examine the effectiveness
and feasibility of using the following methods to determine geographic accessibility and
network adequacy:
new text end
new text begin
(1) establishing ratios of providers to enrollees by provider specialty;
new text end
new text begin
(2) establishing ratios of primary care providers to enrollees; and
new text end
new text begin
(3) establishing maximum waiting times for appointments with participating providers.
new text end
new text begin
(b) The commissioner must examine:
new text end
new text begin
(1) geographic accessibility of providers under current law;
new text end
new text begin
(2) geographic variation and population dispersion;
new text end
new text begin
(3) how provider hours of operations limit access to care;
new text end
new text begin
(4) the ability of existing networks to meet the needs of enrollees, which may include
low-income persons; children and adults with serious, chronic, or complex health conditions,
physical disabilities, or mental illness; or persons with limited English proficiency and
persons from underserved communities;
new text end
new text begin
(5) other health care service delivery options, including telehealth, mobile clinics, and
centers of excellence; and
new text end
new text begin
(6) the availability of services needed to meet the needs of enrollees requiring
technologically advanced or specialty care services.
new text end
new text begin
(c) The commissioner must submit to the legislature a report on the study and
recommendations required by this section no later than January 15, 2024.
new text end
Sec. 18. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2022, section 152.092,
new text end
new text begin
is repealed.
new text end
ARTICLE 14
FORECAST ADJUSTMENTS
Section 1. new text begin DEPARTMENT OF HUMAN SERVICES FORECAST ADJUSTMENT.
|
new text begin
The dollar amounts shown in the columns marked "Appropriations" are added to or, if
shown in parentheses, are subtracted from the appropriations in Laws 2021, First Special
Session chapter 7, article 15, and Laws 2021, First Special Session chapter 7, article 16,
from the general fund, or any other fund named, to the commissioner of human services for
the purposes specified in this article, to be available for the fiscal year indicated for each
purpose. The figure "2023" used in this article means that the appropriations listed are
available for the fiscal year ending June 30, 2023.
new text end
|
new text begin
APPROPRIATIONS new text end |
||||||
|
new text begin
Available for the Year new text end |
||||||
|
new text begin
Ending June 30 new text end |
||||||
|
new text begin
2023 new text end |
||||||
Sec. 2. new text begin COMMISSIONER OF HUMAN
|
||||||
new text begin Subdivision 1. new text end
new text begin
Total Appropriation
|
new text begin
$ new text end |
new text begin
(1,453,441,000) new text end |
||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
2023 new text end |
||
|
new text begin
General new text end |
new text begin
(1,228,684,000) new text end |
|
|
new text begin
Health Care Access new text end |
new text begin
(203,530,000) new text end |
|
|
new text begin
Federal TANF new text end |
new text begin
(21,227,000) new text end |
|
new text begin Subd. 2. new text end
new text begin
Forecasted Programs
|
|||||
|
new text begin
(a) Minnesota Family Investment Program (MFIP)/Diversionary Work Program (DWP) new text end |
|||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
2023 new text end |
||
|
new text begin
General new text end |
new text begin
(99,000) new text end |
|
|
new text begin
Federal TANF new text end |
new text begin
(21,227,000) new text end |
|
|
new text begin
(b) MFIP Child Care Assistance new text end |
new text begin
(36,957,000) new text end |
|||||
|
new text begin
(c) General Assistance new text end |
new text begin
(1,632,000) new text end |
|||||
|
new text begin
(d) Minnesota Supplemental Aid new text end |
new text begin
783,000 new text end |
|||||
|
new text begin
(e) Housing Support new text end |
new text begin
180,000 new text end |
|||||
|
new text begin
(f) Northstar Care for Children new text end |
new text begin
(18,038,000) new text end |
|||||
|
new text begin
(g) MinnesotaCare new text end |
new text begin
(203,530,000) new text end |
|||||
new text begin
This appropriation is from the health care
access fund.
new text end
|
new text begin
(h) Medical Assistance new text end |
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
2023 new text end |
||
|
new text begin
General new text end |
new text begin
(1,172,921,000) new text end |
|
|
new text begin
Health Care Access new text end |
new text begin
0 new text end |
|
|
new text begin
(i) Behavioral Health Fund new text end |
new text begin
(6,404,000) new text end |
|||||
Sec. 3. new text begin EFFECTIVE DATE.
new text end
new text begin
Sections 1 and 2 are effective the day following final enactment.
new text end
ARTICLE 15
APPROPRIATIONS
Section 1. new text begin HEALTH AND HUMAN SERVICES APPROPRIATIONS.
|
new text begin
The sums shown in the columns marked "Appropriations" are appropriated to the agencies
and for the purposes specified in this article. The appropriations are from the general fund,
or another named fund, and are available for the fiscal years indicated for each purpose.
The figures "2024" and "2025" used in this article mean that the appropriations listed under
them are available for the fiscal year ending June 30, 2024, or June 30, 2025, respectively.
"The first year" is fiscal year 2024. "The second year" is fiscal year 2025. "The biennium"
is fiscal years 2024 and 2025.
new text end
|
new text begin
APPROPRIATIONS new text end |
||||||
|
new text begin
Available for the Year new text end |
||||||
|
new text begin
Ending June 30 new text end |
||||||
|
new text begin
2024 new text end |
new text begin
2025 new text end |
|||||
Sec. 2. new text begin COMMISSIONER OF HUMAN
|
||||||
new text begin Subdivision 1. new text end
new text begin
Total Appropriation
|
new text begin
$ new text end |
new text begin
3,093,744,000 new text end |
new text begin
$ new text end |
new text begin
3,094,666,000 new text end |
||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
2024 new text end |
new text begin
2025 new text end |
|
|
new text begin
General new text end |
new text begin
2,001,487,000 new text end |
new text begin
1,677,851,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
4,846,000 new text end |
new text begin
5,294,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
1,010,023,000 new text end |
new text begin
1,336,089,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
75,165,000 new text end |
new text begin
75,269,000 new text end |
new text begin
The amounts that may be spent for each
purpose are specified in the following
subdivisions.
new text end
new text begin Subd. 2. new text end
new text begin
TANF Maintenance of Effort
|
||||||
new text begin
(a) Nonfederal Expenditures. The
commissioner shall ensure that sufficient
qualified nonfederal expenditures are made
each year to meet the state's maintenance of
effort requirements of the TANF block grant
specified under Code of Federal Regulations,
title 45, section 263.1. In order to meet these
basic TANF maintenance of effort
requirements, the commissioner may report
as TANF maintenance of effort expenditures
only nonfederal money expended for allowable
activities listed in the following clauses:
new text end
new text begin
(1) MFIP cash, diversionary work program,
and food assistance benefits under Minnesota
Statutes, chapter 256J;
new text end
new text begin
(2) the child care assistance programs under
Minnesota Statutes, sections 119B.03 and
119B.05, and county child care administrative
costs under Minnesota Statutes, section
119B.15;
new text end
new text begin
(3) state and county MFIP administrative costs
under Minnesota Statutes, chapters 256J and
256K;
new text end
new text begin
(4) state, county, and Tribal MFIP
employment services under Minnesota
Statutes, chapters 256J and 256K;
new text end
new text begin
(5) expenditures made on behalf of legal
noncitizen MFIP recipients who qualify for
the MinnesotaCare program under Minnesota
Statutes, chapter 256L;
new text end
new text begin
(6) qualifying working family credit
expenditures under Minnesota Statutes, section
290.0671;
new text end
new text begin
(7) qualifying Minnesota education credit
expenditures under Minnesota Statutes, section
290.0674; and
new text end
new text begin
(8) qualifying Head Start expenditures under
Minnesota Statutes, section 119A.50.
new text end
new text begin
(b) Nonfederal Expenditures; Reporting.
For the activities listed in paragraph (a),
clauses (2) to (8), the commissioner may
report only expenditures that are excluded
from the definition of assistance under Code
of Federal Regulations, title 45, section
260.31.
new text end
new text begin
(c) Limitations; Exceptions. The
commissioner must not claim an amount of
TANF maintenance of effort in excess of the
75 percent standard in Code of Federal
Regulations, title 45, section 263.1(a)(2),
except:
new text end
new text begin
(1) to the extent necessary to meet the 80
percent standard under Code of Federal
Regulations, title 45, section 263.1(a)(1), if it
is determined by the commissioner that the
state will not meet the TANF work
participation target rate for the current year;
new text end
new text begin
(2) to provide any additional amounts under
Code of Federal Regulations, title 45, section
264.5, that relate to replacement of TANF
funds due to the operation of TANF penalties;
and
new text end
new text begin
(3) to provide any additional amounts that may
contribute to avoiding or reducing TANF work
participation penalties through the operation
of the excess maintenance of effort provisions
of Code of Federal Regulations, title 45,
section 261.43(a)(2).
new text end
new text begin
(d) Supplemental Expenditures. For the
purposes of paragraph (c), the commissioner
may supplement the maintenance of effort
claim with working family credit expenditures
or other qualified expenditures to the extent
such expenditures are otherwise available after
considering the expenditures allowed in this
subdivision.
new text end
new text begin
(e) Reduction of Appropriations; Exception.
The requirement in Minnesota Statutes, section
256.011, subdivision 3, that federal grants or
aids secured or obtained under that subdivision
be used to reduce any direct appropriations
provided by law does not apply if the grants
or aids are federal TANF funds.
new text end
new text begin
(f) IT Appropriations Generally. This
appropriation includes funds for information
technology projects, services, and support.
Notwithstanding Minnesota Statutes, section
16E.0466, funding for information technology
project costs must be incorporated into the
service level agreement and paid to the
Minnesota IT Services by the Department of
Human Services under the rates and
mechanism specified in that agreement.
new text end
new text begin
(g) Receipts for Systems Project.
Appropriations and federal receipts for
information technology systems projects for
MAXIS, PRISM, MMIS, ISDS, METS, and
SSIS must be deposited in the state systems
account authorized in Minnesota Statutes,
section 256.014. Money appropriated for
information technology projects approved by
the commissioner of the Minnesota IT
Services funded by the legislature and
approved by the commissioner of management
and budget may be transferred from one
project to another and from development to
operations as the commissioner of human
services considers necessary. Any unexpended
balance in the appropriation for these projects
does not cancel and is available for ongoing
development and operations.
new text end
new text begin
(h) Federal SNAP Education and Training
Grants. Federal funds available during fiscal
years 2024 and 2025 for Supplemental
Nutrition Assistance Program Education and
Training and SNAP Quality Control
Performance Bonus grants are appropriated
to the commissioner of human services for the
purposes allowable under the terms of the
federal award. This paragraph is effective the
day following final enactment.
new text end
new text begin Subd. 3. new text end
new text begin
Central Office; Operations
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
282,251,000 new text end |
new text begin
245,773,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
4,721,000 new text end |
new text begin
5,169,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
9,347,000 new text end |
new text begin
11,244,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
1,090,000 new text end |
new text begin
1,194,000 new text end |
new text begin
(a) Administrative Recovery; Set-Aside. The
commissioner may invoice local entities
through the SWIFT accounting system as an
alternative means to recover the actual cost of
administering the following provisions:
new text end
new text begin
(1) the statewide data management system
authorized in Minnesota Statutes, section
125A.744, subdivision 3;
new text end
new text begin
(2) repayment of the special revenue
maximization account as provided under
Minnesota Statutes, section 245.495,
paragraph (b);
new text end
new text begin
(3) repayment of the special revenue
maximization account as provided under
Minnesota Statutes, section 256B.0625,
subdivision 20, paragraph (k);
new text end
new text begin
(4) targeted case management under
Minnesota Statutes, section 256B.0924,
subdivision 6, paragraph (g);
new text end
new text begin
(5) residential services for children with severe
emotional disturbance under Minnesota
Statutes, section 256B.0945, subdivision 4,
paragraph (d); and
new text end
new text begin
(6) repayment of the special revenue
maximization account as provided under
Minnesota Statutes, section 256F.10,
subdivision 6, paragraph (b).
new text end
new text begin
(b) Tribal Nations Fraud Prevention
Program Grants. $400,000 in fiscal year
2024 is from the general fund for start-up
grants to the Red Lake Nation, White Earth
Nation, and Mille Lacs Band of Ojibwe to
develop a fraud prevention program. This
appropriation is available until June 30, 2025.
new text end
new text begin
(c) Base Level Adjustment. The general fund
base is $221,687,000 in fiscal year 2026 and
$238,595,000 in fiscal year 2027. The state
government special revenue base is $4,765,000
in fiscal year 2026 and $4,765,000 in fiscal
year 2027.
new text end
new text begin Subd. 4. new text end
new text begin
Central Office; Children and Families
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
18,791,000 new text end |
new text begin
18,797,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
2,582,000 new text end |
new text begin
2,582,000 new text end |
new text begin Subd. 5. new text end
new text begin
Central Office; Health Care
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
36,477,000 new text end |
new text begin
36,291,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
28,168,000 new text end |
new text begin
28,168,000 new text end |
new text begin
(a) Improved Accessibility. $1,350,000 in
fiscal year 2024 is from the general fund to
improve the accessibility of Minnesota health
care programs applications, forms, and other
consumer support resources and services to
enrollees with limited English proficiency.
new text end
new text begin
(b) Improvements to Application,
Enrollment, Service Delivery. $510,000 in
fiscal year 2024 and $1,020,000 in fiscal year
2025 are from the general fund for contracts
with community-based organizations to
facilitate conversations with applicants and
enrollees in Minnesota health care programs
to improve the application, enrollment, and
service delivery experience in medical
assistance and MinnesotaCare.
new text end
new text begin
(c) Base Level Adjustment. The general fund
base is $50,332,000 in fiscal year 2026 and
$64,809,000 in fiscal year 2027.
new text end
new text begin Subd. 6. new text end
new text begin
Central Office; Continuing Care for
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
38,726,000 new text end |
new text begin
34,688,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
125,000 new text end |
new text begin
125,000 new text end |
new text begin Subd. 7. new text end
new text begin
Central Office; Behavioral Health,
|
new text begin
27,980,000 new text end |
new text begin
28,227,000 new text end |
||||
new text begin
(a) Evaluation of Outcomes; PATH Grants.
$150,000 in fiscal year 2025 is for evaluating
outcomes for the additional grant funding for
the expansion of base funding for the PATH
grants. This is a onetime appropriation.
new text end
new text begin
(b) Online Locator. $1,720,000 in fiscal year
2024 and $1,720,000 in fiscal year 2025 are
for an online behavioral health program
locator with continued expansion of the
provider database allowing people to research
and access mental health and substance use
disorder treatment options.
new text end
new text begin
(c) Base Level Adjustment. The general fund
base is $26,472,000 in fiscal year 2026 and
$25,911,000 in fiscal year 2027.
new text end
new text begin Subd. 8. new text end
new text begin
Forecasted Programs; MFIP/DWP
|
new text begin
77,000 new text end |
new text begin
108,000 new text end |
||||
new text begin Subd. 9. new text end
new text begin
Forecasted Programs; General
|
new text begin
52,018,000 new text end |
new text begin
74,455,000 new text end |
||||
new text begin
Emergency General Assistance. The amount
appropriated for emergency general assistance
is limited to no more than $6,729,812 in fiscal
year 2024 and $6,729,812 in fiscal year 2025.
Funds to counties shall be allocated by the
commissioner using the allocation method
under Minnesota Statutes, section 256D.06.
new text end
new text begin Subd. 10. new text end
new text begin
Forecasted Programs; Minnesota
|
new text begin
58,320,000 new text end |
new text begin
59,865,000 new text end |
||||
new text begin Subd. 11. new text end
new text begin
Forecasted Programs; Housing
|
new text begin
213,786,000 new text end |
new text begin
228,244,000 new text end |
||||
new text begin Subd. 12. new text end
new text begin
Forecasted Programs; MinnesotaCare
|
new text begin
88,889,000 new text end |
new text begin
59,513,000 new text end |
||||
new text begin
These appropriations are from the health care
access fund.
new text end
new text begin Subd. 13. new text end
new text begin
Forecasted Programs; Medical
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
1,066,045,000 new text end |
new text begin
748,577,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
880,154,000 new text end |
new text begin
1,233,699,000 new text end |
new text begin
Base Level Adjustment. The health care
access fund base is $591,957,000 in fiscal year
2026, $1,197,599,000 in fiscal year 2027, and
$612,099,000 in fiscal year 2028.
new text end
new text begin Subd. 14. new text end
new text begin
Forecasted Programs; Behavioral
|
new text begin
351,000 new text end |
new text begin
350,000 new text end |
||||
new text begin Subd. 15. new text end
new text begin
Grant Programs; Health Care Grants
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
7,311,000 new text end |
new text begin
7,311,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
3,465,000 new text end |
new text begin
3,465,000 new text end |
new text begin
(a) Indian Health Board. $2,500,000 in fiscal
year 2024 and $2,500,000 in fiscal year 2025
are from the general fund for funding to the
Indian Health Board of Minneapolis to support
continued access to health care coverage
through Minnesota health care programs,
improve access to quality care, and increase
vaccination rates among urban American
Indians. The general fund base for this
appropriation is $2,500,000 in fiscal year 2026
and $0 in fiscal year 2027.
new text end
new text begin
(b) Base Level Adjustment. The general fund
base is $7,311,000 in fiscal year 2026 and
$4,811,000 in fiscal year 2027.
new text end
new text begin Subd. 16. new text end
new text begin
Grant Programs; Disabilities Grants
|
new text begin
500,000 new text end |
new text begin
1,000,000 new text end |
||||
new text begin
(a) Transition to Community Initiative.
$500,000 in fiscal year 2024 and $1,000,000
in fiscal year 2025 are for the transition to
community initiative grant funding under
Laws 2021, First Special Session chapter 7,
article 17, section 6.
new text end
new text begin
(b) Base Level Adjustment. The general fund
base is $1,000,000 in fiscal year 2026 and
$100,000 in fiscal year 2027.
new text end
new text begin Subd. 17. new text end
new text begin
Grant Programs; Housing Support
|
new text begin
19,464,000 new text end |
new text begin
11,464,000 new text end |
||||
new text begin
Heading Home Corps. $1,100,000 in fiscal
year 2024 and $1,100,000 in fiscal year 2025
are for the AmeriCorps Heading Home Corps
program.
new text end
new text begin Subd. 18. new text end
new text begin
Grant Programs; Adult Mental Health
|
new text begin
127,912,000 new text end |
new text begin
137,925,000 new text end |
||||
new text begin
(a) White Earth Nation; Adult Mental
Health Initiative. $300,000 in fiscal year
2024 and $300,000 in fiscal year 2025 are for
adult mental health initiative grants to the
White Earth Nation. This is a onetime
appropriation.
new text end
new text begin
(b) Transition to Community Initiative.
$750,000 in fiscal year 2024 and $750,000 in
fiscal year 2025 are for the transition to
community initiative grant funding under
Laws 2021, First Special Session chapter 7,
article 17, section 6.
new text end
new text begin
(c) Mobile Crisis Grants. $4,000,000 in fiscal
year 2024 and $8,000,000 in fiscal year 2025
are for the mobile crisis grants under Laws
2021, First Special Session chapter 7, article
17, section 11. The base for this appropriation
is $5,000,000 in fiscal year 2026 and
$5,000,000 in fiscal year 2027.
new text end
new text begin
(d) Mobile Crisis Funds to Tribal Nations.
$1,000,000 in fiscal year 2024 and $1,000,000
in fiscal year 2025 are for mobile crisis funds
to Tribal Nations. This is a onetime
appropriation.
new text end
new text begin
(e) Engagement Services Pilot Grants.
$250,000 in fiscal year 2024 is for grants to
counties to establish pilot projects to provide
engagement services under Minnesota
Statutes, section 253B.041. Counties receiving
grants must develop a system to respond to
individual requests for engagement services,
conduct outreach to families and engagement
services providers, and evaluate the impact of
engagement services in decreasing civil
commitments, increasing engagement in
treatment, decreasing police involvement with
individuals exhibiting symptoms of serious
mental illness, and other measures.
new text end
new text begin
(f) Base Level Adjustment. The general fund
base is $132,297,000 in fiscal year 2026 and
$132,297,000 in fiscal year 2027.
new text end
new text begin Subd. 19. new text end
new text begin
Grant Programs; Child Mental Health
|
new text begin
50,128,000 new text end |
new text begin
43,426,000 new text end |
||||
new text begin
(a) School-Linked Behavioral Health
Services. $11,248,000 in fiscal year 2024 and
$8,400,000 in fiscal year 2025 are for
school-linked behavioral health services and
for school-linked behavioral health services
in intermediate school districts. The base for
this appropriation is $2,500,000 in fiscal year
2026 and $2,500,000 in fiscal year 2027.
new text end
new text begin
(b) Psychiatric Residential Treatment
Facility Specialization Grants. $1,050,000
in fiscal year 2024 and $1,050,000 in fiscal
year 2025 are for psychiatric residential
treatment facilities specialization grants for
staffing costs to treat and support behavioral
health conditions and support children and
families.
new text end
new text begin
(c) Base Level Adjustment. The general fund
base is $37,526,000 in fiscal year 2026 and
$37,526,000 in fiscal year 2027.
new text end
new text begin Subd. 20. new text end
new text begin
Grant Programs; Chemical
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
1,350,000 new text end |
new text begin
1,350,000 new text end |
new text begin Subd. 21. new text end
new text begin
Technical Activities
|
new text begin
71,493,000 new text end |
new text begin
71,493,000 new text end |
||||
new text begin
This appropriation is from the federal TANF
fund.
new text end
Sec. 3. new text begin COMMISSIONER OF HEALTH
|
||||||
new text begin Subdivision 1. new text end
new text begin
Total Appropriation
|
new text begin
$ new text end |
new text begin
472,644,000 new text end |
new text begin
$ new text end |
new text begin
436,192,000 new text end |
||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
2024 new text end |
new text begin
2025 new text end |
|
|
new text begin
General new text end |
new text begin
331,125,000 new text end |
new text begin
289,444,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
83,373,000 new text end |
new text begin
85,902,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
38,857,000 new text end |
new text begin
41,557,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
11,713,000 new text end |
new text begin
11,713,000 new text end |
new text begin
The amounts that may be spent for each
purpose are specified in the following
subdivisions.
new text end
new text begin Subd. 2. new text end
new text begin
Health Improvement
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
273,258,000 new text end |
new text begin
235,687,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
12,392,000 new text end |
new text begin
12,682,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
38,857,000 new text end |
new text begin
41,557,000 new text end |
|
new text begin
Federal TANF new text end |
new text begin
11,713,000 new text end |
new text begin
11,713,000 new text end |
new text begin
(a) Telehealth; Payment Parity. Of the
amount appropriated in Laws 2021, First
Special Session chapter 7, article 16, section
3, subdivision 2, $1,200,000 from the general
fund in fiscal year 2023 is for the studies of
telehealth expansion and payment parity and
is available until June 30, 2024.
new text end
new text begin
(b) Adolescent Mental Health Promotion.
$2,790,000 in fiscal year 2024 and $2,790,000
in fiscal year 2025 are from the general fund
for adolescent mental health promotion. Of
this appropriation each year, $2,250,000 is for
grants and $540,000 is for administration. This
is a onetime appropriation.
new text end
new text begin
(c) Advancing Equity Through Capacity
Building and Resource Allocation.
$1,986,000 in fiscal year 2024 and $1,986,000
in fiscal year 2025 are from the general fund
to advance equity in procurement and
grantmaking. Of this appropriation each year,
$1,000,000 is for grants and $986,000 is for
administration. This is a onetime
appropriation.
new text end
new text begin
(d) Community Solutions for Healthy Child
Development Grants. $4,980,000 in fiscal
year 2024 and $5,055,000 in fiscal year 2025
are from the general fund to improve child
development outcomes and well-being of
children of color and American Indian children
and their families under Minnesota Statutes,
section 145.9257. Of this appropriation in
fiscal year 2024, $4,000,000 is for grants and
$980,000 is for administration and in fiscal
year 2025, $4,000,000 is for grants and
$1,055,000 is for administration.
new text end
new text begin
(e) Comprehensive Overdose and Morbidity
Prevention Act. $8,164,000 in fiscal year
2024 and $8,164,000 in fiscal year 2025 are
from the general fund for comprehensive
overdose and morbidity prevention strategies
under Minnesota Statutes, section 144.0528.
Of this appropriation each year, $6,250,000
is for grants and $1,644,000 is for
administration.
new text end
new text begin
(f) Emergency Preparedness and Response.
$12,400,000 in fiscal year 2024 and
$12,400,000 in fiscal year 2025 are from the
general fund for public health emergency
preparedness and response, the sustainability
of the strategic stockpile, and COVID-19
pandemic response transition. Of this
appropriation each year, $8,400,000 is for
grants and $4,000,000 is for administration.
The general fund base for this appropriation
is $11,400,000 in fiscal year 2026, of which
$8,400,000 is for grants and $3,000,000 is for
administration, and $11,400,000 in fiscal year
2027, of which $8,400,000 is for grants and
$3,000,000 is for administration.
new text end
new text begin
(g) Healthy Beginnings, Healthy Families.
$12,052,000 in fiscal year 2024 and
$11,853,000 in fiscal year 2025 are from the
general fund for a comprehensive approach to
ensure healthy outcomes for children and
families. Of this appropriation in fiscal year
2024, $8,750,000 is for grants and $2,339,000
is for administration and in fiscal year 2025,
$8,750,000 is for grants and $1,682,000 is for
administration. This is a onetime
appropriation.
new text end
new text begin
(h) No Surprises Act Enforcement.
$1,210,000 in fiscal year 2024 and $1,090,000
in fiscal year 2025 are from the general fund
for implementation of the federal No Surprises
Act portion of the Consolidated
Appropriations Act, 2021, under Minnesota
Statutes, section 62Q.021, and assessment of
feasibility of a statewide provider directory.
The general fund base for this appropriation
is $855,000 in fiscal year 2026 and $855,000
in fiscal year 2027.
new text end
new text begin
(i) African American Health. $2,182,000 in
fiscal year 2024 and $2,182,000 in fiscal year
2025 are from the general fund to establish an
Office of African American Health at the
Minnesota Department of Health under
Minnesota Statutes, section 144.0755, and for
grants under Minnesota Statutes, section
144.0756. Of this appropriation each year,
$1,000,000 is for grants and $1,182,000 is for
administration. The general fund base for this
appropriation is $2,182,000 in fiscal year
2026, of which $1,000,000 is for grants and
$1,182,000 is for administration, and
$2,117,000 in fiscal year 2027, of which
$1,000,000 is for grants and $1,117,000 is for
administration.
new text end
new text begin
(j) American Indian Health. $2,089,000 in
fiscal year 2024 and $2,089,000 in fiscal year
2025 are from the general fund for the Office
of American Indian Health at the Minnesota
Department of Health under Minnesota
Statutes, section 144.0757. Of this
appropriation each year, $1,000,000 is for
grants and $1,089,000 is for administration.
new text end
new text begin
(k) Public Health System Transformation.
$17,120,000 in fiscal year 2024 and
$17,120,000 in fiscal year 2025 are from the
general fund for public health system
transformation. Of this appropriation each
year:
new text end
new text begin
(1) $15,000,000 is for grants to community
health boards under Minnesota Statutes,
section 145A.131, subdivision 1, paragraph
(f);
new text end
new text begin
(2) $750,000 is for grants to Tribal
governments under Minnesota Statutes, section
145A.14, subdivision 2b;
new text end
new text begin
(3) $500,000 is for a public health AmeriCorps
program grant under Minnesota Statutes,
section 144.0759; and
new text end
new text begin
(4) $870,000 is for oversight and
administration of activities under this
paragraph.
new text end
new text begin
The base for this appropriation is $8,000,000
in fiscal year 2026 and $8,000,000 in fiscal
year 2027.
new text end
new text begin
(l) Health Care Workforce. $5,720,000 in
fiscal year 2024 and $7,000,000 in fiscal year
2025 are from the general fund to revitalize
the Minnesota health care workforce. The
general fund base for this appropriation is
$6,450,000 in fiscal year 2026 and $6,700,000
in fiscal year 2027. Of this appropriation:
new text end
new text begin
(1) $750,000 in fiscal year 2024 and
$2,000,000 in fiscal year 2025 are for rural
training tracks and rural clinicals grants under
Minnesota Statutes, section 144.1508;
new text end
new text begin
(2) $220,000 in fiscal year 2024 and $200,000
in fiscal year 2025 are for immigrant
international medical graduate training grants
under Minnesota Statutes, section 144.1911;
new text end
new text begin
(3) $3,250,000 in fiscal year 2024 and
$3,300,000 in fiscal year 2025 are for
site-based clinical training grants under
Minnesota Statutes, section 144.1505. The
base for this appropriation is $3,000,000 in
fiscal year 2026 and $3,000,000 in fiscal year
2027;
new text end
new text begin
(4) $500,000 in fiscal year 2024 and $500,000
in fiscal year 2025 are for mental health for
health care professionals grants. These
appropriations are available until June 30,
2027, and are onetime appropriations;
new text end
new text begin
(5) $750,000 in fiscal year 2024 and $750,000
in fiscal year 2025 are for administration of
the grant programs and loan forgiveness
programs under this paragraph; and
new text end
new text begin
(6) $250,000 in fiscal year 2024 and $250,000
in fiscal year 2025 are for workforce research
and data on shortages, maldistribution of
health care providers in Minnesota, and
determinants of practicing in rural areas.
new text end
new text begin
(m) School Health. $1,432,000 in fiscal year
2024 and $1,932,000 in fiscal year 2025 are
from the general fund for school-based health
centers under Minnesota Statutes, section
145.903. Of this appropriation each year,
$800,000 is for grants and $632,000 is for
administration. The general fund base for this
appropriation is $2,983,000 in fiscal year
2026, of which $2,300,000 is for grants and
$683,000 is for administration, and $2,983,000
in fiscal year 2027, of which $2,300,000 is for
grants and $683,000 is for administration.
new text end
new text begin
(n) Long COVID. $3,146,000 in fiscal year
2024 and $3,146,000 in fiscal year 2025 are
from the general fund to address long COVID
and post-COVID conditions. Of this
appropriation each year, $900,000 is for grants
and $2,246,000 is for administration. This is
a onetime appropriation.
new text end
new text begin
(o) Home Visiting for Priority Populations.
$2,500,000 in fiscal year 2024 and $2,500,000
in fiscal year 2025 are from the general fund
to expand home visiting for priority
populations under Minnesota Statutes, section
145.87. Of this appropriation each year,
$2,250,000 is for grants to promising practices
home visiting programs as defined in
Minnesota Statutes, section 145.87,
subdivision 1, paragraph (e), and $250,000 is
for administration.
new text end
new text begin
(p) Clinical Dental Education Innovation
Grants. $1,182,000 in fiscal year 2024 and
$1,182,000 in fiscal year 2025 are from the
general fund for clinical dental education
innovation grants under Minnesota Statutes,
section 144.1913. Of this appropriation each
year, $1,122,000 is for grants and $60,000 is
for administration.
new text end
new text begin
(q) Medical Education and Research Costs.
$300,000 in fiscal year 2024 and $300,000 in
fiscal year 2025 are from the general fund for
administration of the medical education and
research costs program under Minnesota
Statutes, section 62J.692.
new text end
new text begin
(r) Health Care Affordability Commission
and Advisory Council. $4,131,000 in fiscal
year 2024 and $4,773,000 in fiscal year 2025
are from the general fund for the costs of the
Health Care Affordability Commission and
the Health Care Affordability Advisory
Council, including the costs to the
commissioner to provide technical and
administrative support. The general fund base
for this appropriation is $4,787,000 in fiscal
year 2026 and $4,784,000 in fiscal year 2027.
new text end
new text begin
(s) Economic Analysis; Analytic Tool.
$4,020,000 in fiscal year 2024 and $580,000
in fiscal year 2025 are from the general fund
to contract for and conduct an economic
analysis of the benefits and costs of universal
health care system reform models and to
develop a related analytic tool. The general
fund base for this appropriation is $580,000
in fiscal year 2026 and $0 in fiscal year 2027.
This appropriation is available until June 30,
2027.
new text end
new text begin
(t) Keeping Nurses at the Bedside Act.
$11,553,000 in fiscal year 2024 and
$11,558,000 in fiscal year 2025 are from the
general fund for the Keeping Nurses at the
Bedside Act. Of these appropriations:
new text end
new text begin
(1) $5,000,000 in fiscal year 2024 and
$5,000,000 in fiscal year 2025 are for mental
health grants for health care professionals
under Laws 2022, chapter 99, article 1, section
46;
new text end
new text begin
(2) notwithstanding the priorities and
distribution requirements under Minnesota
Statutes, section 144.1501, $5,050,000 in
fiscal year 2024 and $5,050,000 in fiscal year
2025 are for the health professional education
loan forgiveness program under Minnesota
Statutes, section 144.1501, of which:
new text end
new text begin
(i) $5,000,000 in fiscal year 2024 and
$5,000,000 in fiscal year 2025 are for
distribution to eligible nurses who have agreed
to work as hospital nurses in accordance with
Minnesota Statutes, section 144.1501,
subdivision 2, paragraph (a), clause (7); and
new text end
new text begin
(ii) $50,000 in fiscal year 2024 and $50,000
in fiscal year 2025 are for distribution to
eligible nurses who have agreed to teach in
accordance with Minnesota Statutes, section
144.1501, subdivision 2, paragraph (a), clause
(3); and
new text end
new text begin
(3) $1,503,000 in fiscal year 2024 and
$1,508,000 in fiscal year 2025 are for the
commissioner of health to administer
Minnesota Statutes, section 144.7057; to
perform the grading duties described in
Minnesota Statutes, section 144.7058; to
continue the prevention of violence in health
care programs and to create violence
prevention resources for hospitals and other
health care providers to use to train their staff
on violence prevention; for work to identify
potential links between adverse events and
understaffing; and for a report on the current
status of the state's nursing workforce
employed by hospitals.
new text end
new text begin
(u) Supporting Healthy Development of
Babies During Pregnancy and Postpartum.
$260,000 in fiscal year 2024 is from the
general fund for a grant to the Amherst H.
Wilder Foundation for the African American
Babies Coalition initiative for
community-driven training and education on
best practices to support healthy development
of babies during pregnancy and postpartum.
The grant must be used to build capacity in,
train, educate, or improve practices among
individuals, from youth to elders, serving
families with members who are Black,
Indigenous, or People of Color during
pregnancy and postpartum. This appropriation
is available until June 30, 2025.
new text end
new text begin
(v) Critical Access Dental Infrastructure
Program. $20,000,000 in fiscal year 2024 is
from the general fund for the critical access
dental infrastructure program. This
appropriation is available until June 30, 2026.
new text end
new text begin
(w) Workplace Safety Grants Program.
$10,000,000 in fiscal year 2024 is from the
general fund for the workplace safety grants
program for health care entities and human
services providers. This appropriation is
available until June 30, 2025.
new text end
new text begin
(x) Analyses and Reports; Health Care
Transactions. $2,000,000 in fiscal year 2024
is from the general fund to conduct analyses
of the impacts of health care transactions on
health care cost, quality, and competition, and
to issue public reports on health care
transactions in Minnesota and their impacts.
This appropriation is available until June 30,
2025.
new text end
new text begin
(y) Provider Orders for Life-sustaining
Treatment Registry. $530,000 in fiscal year
2024 and $1,655,000 in fiscal year 2025 are
from the general fund to study and implement
a statewide registry for provider orders for
life-sustaining treatment. The general fund
base for this appropriation is $658,000 in fiscal
year 2026 and $658,000 in fiscal year 2027.
new text end
new text begin
(z) Emmett Louis Till Victims Recovery
Program. $500,000 in fiscal year 2024 is from
the general fund for the Emmett Louis Till
victims recovery program. This appropriation
is available until June 30, 2025.
new text end
new text begin
(aa) Task Force on Pregnancy Health and
Substance Use Disorders. $199,000 in fiscal
year 2024 and $100,000 in fiscal year 2025
are from the general fund for the Task Force
on Pregnancy Health and Substance Use
Disorders. This is a onetime appropriation and
is available until December 1, 2024.
new text end
new text begin
(bb) Labor Trafficking Services Programs.
$546,000 in fiscal year 2024 and $546,000 in
fiscal year 2025 are from the general fund for
grants for comprehensive, trauma-informed,
and culturally specific services for victims of
labor trafficking or labor exploitation. This is
a onetime appropriation.
new text end
new text begin
(cc) Psychedelic Medicine Task Force.
$338,000 in fiscal year 2024 and $171,000 in
fiscal year 2025 are from the general fund for
the Psychedelic Medicine Task Force. This is
a onetime appropriation.
new text end
new text begin
(dd) Help Me Connect. $463,000 in fiscal
year 2024 and $921,000 in fiscal year 2025
are from the general fund for the Help Me
Connect system. This is a onetime
appropriation.
new text end
new text begin
(ee) 988 Lifeline System. $8,504,000 in fiscal
year 2024 and $8,504,000 in fiscal year 2025
are from the general fund for activities to
support the 988 Lifeline system.
new text end
new text begin
(ff) Network Adequacy. $798,000 in fiscal
year 2024 and $491,000 in fiscal year 2025
are from the general fund for costs related to
reviews of provider networks to determine
network adequacy and a geographic
accessibility and network adequacy study.
new text end
new text begin
(gg) Skin-Lightening Products Public
Awareness and Education Grant. $121,000
in fiscal year 2024 and $121,000 in fiscal year
2025 are from the general fund for a grant to
the Beautywell Project for public awareness
and education activities to address issues of
colorism, skin-lightening products, and
chemical exposures from these products. Of
these appropriations, the commissioner may
use up to $21,000 in fiscal year 2024 and
$21,000 in fiscal year 2025 for administration.
This is a onetime appropriation.
new text end
new text begin
(hh) TANF Appropriations. (1) TANF funds
must be used as follows:
new text end
new text begin
(i) $3,579,000 in fiscal year 2024 and
$3,579,000 in fiscal year 2025 are from the
TANF fund for home visiting and nutritional
services listed under Minnesota Statutes,
section 145.882, subdivision 7, clauses (6) and
(7). Funds must be distributed to community
health boards according to Minnesota Statutes,
section 145A.131, subdivision 1;
new text end
new text begin
(ii) $2,000,000 in fiscal year 2024 and
$2,000,000 in fiscal year 2025 are from the
TANF fund for decreasing racial and ethnic
disparities in infant mortality rates under
Minnesota Statutes, section 145.928,
subdivision 7;
new text end
new text begin
(iii) $4,978,000 in fiscal year 2024 and
$4,978,000 in fiscal year 2025 are from the
TANF fund for the family home visiting grant
program under Minnesota Statutes, section
145A.17. $4,000,000 in each fiscal year must
be distributed to community health boards
under Minnesota Statutes, section 145A.131,
subdivision 1. $978,000 in each fiscal year
must be distributed to Tribal governments
under Minnesota Statutes, section 145A.14,
subdivision 2a;
new text end
new text begin
(iv) $1,156,000 in fiscal year 2024 and
$1,156,000 in fiscal year 2025 are from the
TANF fund for family planning grants under
Minnesota Statutes, section 145.925; and
new text end
new text begin
(v) the commissioner may use up to 6.23
percent of the funds appropriated from the
TANF fund each fiscal year to conduct the
ongoing evaluations required under Minnesota
Statutes, section 145A.17, subdivision 7, and
training and technical assistance as required
under Minnesota Statutes, section 145A.17,
subdivisions 4 and 5.
new text end
new text begin
(2) TANF Carryforward. Any unexpended
balance of the TANF appropriation in the first
year does not cancel but is available in the
second year.
new text end
new text begin
(ii) Base Level Adjustments. The general
fund base is $203,876,000 in fiscal year 2026
and $203,384,000 in fiscal year 2027. The
health care access fund base is $42,157,000
in fiscal year 2026 and $41,557,000 in fiscal
year 2027.
new text end
new text begin Subd. 3. new text end
new text begin
Health Protection
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
39,375,000 new text end |
new text begin
35,352,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
70,981,000 new text end |
new text begin
73,220,000 new text end |
new text begin
(a) Lead Remediation in Schools and Child
Care Settings. $500,000 in fiscal year 2024
and $500,000 in fiscal year 2025 are from the
general fund to reduce lead in drinking water
in schools and child care facilities under
Minnesota Statutes, section 145.9272. Of this
appropriation in fiscal year 2024, $146,000 is
for grants and $354,000 is for administration
and in fiscal year 2025, $239,000 is for grants
and $261,000 is for administration.
new text end
new text begin
(b) Antimicrobial Stewardship. $312,000 in
fiscal year 2024 and $312,000 in fiscal year
2025 are from the general fund for the
Minnesota One Health Antimicrobial
Stewardship Collaborative under Minnesota
Statutes, section 144.0526.
new text end
new text begin
(c) Comprehensive Overdose and Morbidity
Prevention Act; Public Health Laboratory
and Infectious Disease Prevention.
$1,544,000 in fiscal year 2024 and $1,544,000
in fiscal year 2025 are from the general fund
for comprehensive overdose and morbidity
prevention strategies under Minnesota
Statutes, section 144.0528. Of this
appropriation in fiscal year 2024, $960,000 is
for grants and $584,000 is for administration
and in fiscal year 2025, $960,000 is for grants
and $584,000 is for administration.
new text end
new text begin
(d) HIV Prevention Health Equity.
$2,267,000 in fiscal year 2024 and $2,267,000
in fiscal year 2025 are from the general fund
for equity in HIV prevention. Of this
appropriation each year, $1,264,000 is for
grants under Minnesota Statutes, section
145.924, and $1,003,000 is for administration.
This is a onetime appropriation.
new text end
new text begin
(e) Uninsured and Underinsured Adult
Vaccine Program. $1,470,000 in fiscal year
2024 and $1,470,000 in fiscal year 2025 are
from the general fund for the program for
vaccines for uninsured and underinsured
adults. This is a onetime appropriation.
new text end
new text begin
(f) Climate Resiliency. $500,000 in fiscal
year 2024 and $500,000 in fiscal year 2025
are from the general fund for climate resiliency
actions. This is a onetime appropriation.
new text end
new text begin
(g) Transfer to Public Health Response
Contingency Account. The commissioner
shall transfer $4,804,000 in fiscal year 2024
from the general fund to the public health
response contingency account established in
Minnesota Statutes, section 144.4199. This is
a onetime transfer.
new text end
new text begin
(h) Base Level Adjustments. The general
fund base is $31,115,000 in fiscal year 2026
and $31,115,000 in fiscal year 2027.
new text end
new text begin Subd. 4. new text end
new text begin
Health Operations
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General new text end |
new text begin
18,492,000 new text end |
new text begin
18,405,000 new text end |
Sec. 4. new text begin HEALTH-RELATED BOARDS
|
||||||
new text begin Subdivision 1. new text end
new text begin
Total Appropriation
|
new text begin
$ new text end |
new text begin
31,292,000 new text end |
new text begin
$ new text end |
new text begin
32,040,000 new text end |
||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General Fund new text end |
new text begin
468,000 new text end |
new text begin
468,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
30,748,000 new text end |
new text begin
31,534,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
76,000 new text end |
new text begin
38,000 new text end |
new text begin
This appropriation is from the state
government special revenue fund unless
specified otherwise. The amounts that may be
spent for each purpose are specified in the
following subdivisions.
new text end
new text begin Subd. 2. new text end
new text begin
Board of Behavioral Health and
|
new text begin
1,022,000 new text end |
new text begin
1,044,000 new text end |
||||
new text begin Subd. 3. new text end
new text begin
Board of Chiropractic Examiners
|
new text begin
773,000 new text end |
new text begin
790,000 new text end |
||||
new text begin Subd. 4. new text end
new text begin
Board of Dentistry
|
new text begin
4,100,000 new text end |
new text begin
4,163,000 new text end |
||||
new text begin
(a) Administrative Services Unit; Operating
Costs. Of this appropriation, $1,936,000 in
fiscal year 2024 and $1,960,000 in fiscal year
2025 are for operating costs of the
administrative services unit. The
administrative services unit may receive and
expend reimbursements for services it
performs for other agencies.
new text end
new text begin
(b) Administrative Services Unit; Volunteer
Health Care Provider Program. Of this
appropriation, $150,000 in fiscal year 2024
and $150,000 in fiscal year 2025 are to pay
for medical professional liability coverage
required under Minnesota Statutes, section
214.40.
new text end
new text begin
(c) Administrative Services Unit;
Retirement Costs. Of this appropriation,
$237,000 in fiscal year 2024 and $237,000 in
fiscal year 2025 are for the administrative
services unit to pay for the retirement costs of
health-related board employees. This funding
may be transferred to the health board
incurring retirement costs. Any board that has
an unexpended balance for an amount
transferred under this paragraph shall transfer
the unexpended amount to the administrative
services unit. If the amount appropriated in
the first year of the biennium is not sufficient,
the amount from the second year of the
biennium is available.
new text end
new text begin
(d) Administrative Services Unit; Contested
Cases and Other Legal Proceedings. Of this
appropriation, $200,000 in fiscal year 2024
and $200,000 in fiscal year 2025 are for costs
of contested case hearings and other
unanticipated costs of legal proceedings
involving health-related boards funded under
this section. Upon certification by a
health-related board to the administrative
services unit that costs will be incurred and
that there is insufficient money available to
pay for the costs out of money currently
available to that board, the administrative
services unit is authorized to transfer money
from this appropriation to the board for
payment of those costs with the approval of
the commissioner of management and budget.
The commissioner of management and budget
must require any board that has an unexpended
balance for an amount transferred under this
paragraph to transfer the unexpended amount
to the administrative services unit to be
deposited in the state government special
revenue fund.
new text end
new text begin Subd. 5. new text end
new text begin
Board of Dietetics and Nutrition
|
new text begin
213,000 new text end |
new text begin
217,000 new text end |
||||
new text begin Subd. 6. new text end
new text begin
Board of Executives for Long-term
|
new text begin
705,000 new text end |
new text begin
736,000 new text end |
||||
new text begin Subd. 7. new text end
new text begin
Board of Marriage and Family Therapy
|
new text begin
443,000 new text end |
new text begin
456,000 new text end |
||||
new text begin Subd. 8. new text end
new text begin
Board of Medical Practice
|
new text begin
5,779,000 new text end |
new text begin
5,971,000 new text end |
||||
new text begin Subd. 9. new text end
new text begin
Board of Nursing
|
new text begin
6,039,000 new text end |
new text begin
6,275,000 new text end |
||||
new text begin Subd. 10. new text end
new text begin
Board of Occupational Therapy
|
new text begin
468,000 new text end |
new text begin
480,000 new text end |
||||
new text begin Subd. 11. new text end
new text begin
Board of Optometry
|
new text begin
270,000 new text end |
new text begin
280,000 new text end |
||||
new text begin Subd. 12. new text end
new text begin
Board of Pharmacy
|
||||||
|
new text begin
Appropriations by Fund new text end |
||
|
new text begin
General Fund new text end |
new text begin
468,000 new text end |
new text begin
468,000 new text end |
|
new text begin
State Government Special Revenue new text end |
new text begin
5,226,000 new text end |
new text begin
5,206,000 new text end |
|
new text begin
Health Care Access new text end |
new text begin
76,000 new text end |
new text begin
38,000 new text end |
new text begin
(a) Medication Repository Program.
$468,000 in fiscal year 2024 and $468,000 in
fiscal year 2025 are from the general fund for
transfer to the central repository to administer
the medication repository program under
Minnesota Statutes, section 151.555.
new text end
new text begin
(b) Base Level Adjustment. The state
government special revenue fund base is
$5,056,000 in fiscal year 2026 and $5,056,000
in fiscal year 2027. The health care access
fund base is $0 in fiscal year 2026 and $0 in
fiscal year 2027.
new text end
new text begin Subd. 13. new text end
new text begin
Board of Physical Therapy
|
new text begin
678,000 new text end |
new text begin
694,000 new text end |
||||
new text begin Subd. 14. new text end
new text begin
Board of Podiatric Medicine
|
new text begin
253,000 new text end |
new text begin
257,000 new text end |
||||
new text begin Subd. 15. new text end
new text begin
Board of Psychology
|
new text begin
2,618,000 new text end |
new text begin
2,734,000 new text end |
||||
new text begin
Health Professionals Service Program. This
appropriation includes $1,234,000 in fiscal
year 2024 and $1,324,000 in fiscal year 2025
for the health professional services program.
new text end
new text begin Subd. 16. new text end
new text begin
Board of Social Work
|
new text begin
1,779,000 new text end |
new text begin
1,839,000 new text end |
||||
new text begin Subd. 17. new text end
new text begin
Board of Veterinary Medicine
|
new text begin
382,000 new text end |
new text begin
392,000 new text end |
||||
Sec. 5. new text begin EMERGENCY MEDICAL SERVICES
|
new text begin
$ new text end |
new text begin
6,800,000 new text end |
new text begin
$ new text end |
new text begin
6,176,000 new text end |
||
new text begin
(a) Cooper/Sams Volunteer Ambulance
Program. $950,000 in fiscal year 2024 and
$950,000 in fiscal year 2025 are for the
Cooper/Sams volunteer ambulance program
under Minnesota Statutes, section 144E.40.
new text end
new text begin
(1) Of this appropriation, $861,000 in fiscal
year 2024 and $861,000 in fiscal year 2025
are for the ambulance service personnel
longevity award and incentive program under
Minnesota Statutes, section 144E.40.
new text end
new text begin
(2) Of this appropriation, $89,000 in fiscal
year 2024 and $89,000 in fiscal year 2025 are
for operations of the ambulance service
personnel longevity award and incentive
program under Minnesota Statutes, section
144E.40.
new text end
new text begin
(b) EMSRB Operations. $2,421,000 in fiscal
year 2024 and $2,480,000 in fiscal year 2025
are for board operations.
new text end
new text begin
(c) Regional Grants for Continuing
Education. $585,000 in fiscal year 2024 and
$585,000 in fiscal year 2025 are for regional
emergency medical services programs to be
distributed equally to the eight emergency
medical service regions under Minnesota
Statutes, section 144E.52.
new text end
new text begin
(d) Ambulance Training Grants. $361,000
in fiscal year 2024 and $361,000 in fiscal year
2025 are for training grants under Minnesota
Statutes, section 144E.35.
new text end
new text begin
(e) Medical Resource Communication
Center Grants. $1,683,000 in fiscal year 2024
and $1,000,000 in fiscal year 2025 are for
medical resource communication center grants
under Minnesota Statutes, section 144E.53.
This is a onetime appropriation.
new text end
new text begin
(f) Grants to Regional Emergency Medical
Services Program. $800,000 in fiscal year
2024 and $800,000 in fiscal year 2025 are for
grants to regional emergency medical services
programs, to be distributed among the eight
emergency medical services regions according
to Minnesota Statutes, section 144E.50.
new text end
new text begin
(g) Base Level Adjustment. The general fund
base is $5,176,000 in fiscal year 2026 and
$5,176,000 in fiscal year 2027.
new text end
Sec. 6. new text begin MNSURE.
|
new text begin
$ new text end |
new text begin
12,428,000 new text end |
new text begin
$ new text end |
new text begin
19,195,000 new text end |
||
new text begin
(a) Transfer. The general fund appropriations
must be transferred to the enterprise account
established under Minnesota Statutes, section
62V.07, for the purpose of establishing a
single end-to-end IT system with seamless,
real-time interoperability between qualified
health plan eligibility and enrollment services.
new text end
new text begin
(b) Base Level Adjustment. The general fund
base is $3,591,000 in fiscal year 2026,
$3,530,000 in fiscal year 2027, and $7,055,000
in fiscal year 2028.
new text end
Sec. 7. new text begin RARE DISEASE ADVISORY
|
new text begin
$ new text end |
new text begin
314,000 new text end |
new text begin
$ new text end |
new text begin
326,000 new text end |
||
Sec. 8.
Laws 2021, First Special Session chapter 7, article 16, section 2, subdivision 32,
as amended by Laws 2022, chapter 98, article 15, section 7, is amended to read:
Subd. 32.Grant Programs; Child Mental Health
|
30,167,000 |
30,182,000 |
||||
(a) Children's Residential Facilities.
$1,964,000 in fiscal year 2022 and $1,979,000
in fiscal year 2023 are to reimburse counties
and Tribal governments for a portion of the
costs of treatment in children's residential
facilities. The commissioner shall distribute
the appropriation to counties and Tribal
governments proportionally based on a
methodology developed by the commissioner.
The deleted text begin fiscal year 2022 appropriation is available
until June 30, 2023deleted text end new text begin base for this activity is $0
in fiscal year 2025new text end .
(b) Base Level Adjustment. The general fund
base is $29,580,000 in fiscal year 2024 and
deleted text begin $27,705,000deleted text end new text begin $25,726,000new text end in fiscal year 2025.
Sec. 9. new text begin ASSET DISREGARDS.
new text end
new text begin
$351,000 in fiscal year 2023 is appropriated from the general fund to the commissioner
of human services to implement a temporary asset disregard program in the medical
assistance program. This is a onetime appropriation.
new text end
Sec. 10. new text begin TRANSFERS.
new text end
new text begin Subdivision 1. new text end
new text begin Grants. new text end
new text begin
The commissioner of human services, with the approval of the
commissioner of management and budget, may transfer unencumbered appropriation balances
for the biennium ending June 30, 2025, within fiscal years among MFIP; general assistance;
medical assistance; MinnesotaCare; MFIP child care assistance under Minnesota Statutes,
section 119B.05; Minnesota supplemental aid program; housing support program; the
entitlement portion of Northstar Care for Children under Minnesota Statutes, chapter 256N;
and the entitlement portion of the behavioral health fund between fiscal years of the biennium.
The commissioner shall report to the chairs and ranking minority members of the legislative
committees with jurisdiction over health and human services quarterly about transfers made
under this subdivision.
new text end
new text begin Subd. 2. new text end
new text begin Administration. new text end
new text begin
Positions, salary money, and nonsalary administrative money
may be transferred within the Department of Human Services as the commissioners consider
necessary, with the advance approval of the commissioner of management and budget. The
commissioners shall report to the chairs and ranking minority members of the legislative
committees with jurisdiction over health and human services finance quarterly about transfers
made under this section.
new text end
Sec. 11. new text begin TRANSFERS; ADMINISTRATION.
new text end
new text begin
Positions, salary money, and nonsalary administrative money may be transferred within
the Department of Health as the commissioner considers necessary with the advance approval
of the commissioner of management and budget. The commissioner shall report to the chairs
and ranking minority members of the legislative committees with jurisdiction over health
finance quarterly about transfers made under this section.
new text end
Sec. 12. new text begin INDIRECT COSTS NOT TO FUND PROGRAMS.
new text end
new text begin
The commissioner of health shall not use indirect cost allocations to pay for the
operational costs of any program for which they are responsible.
new text end
Sec. 13. new text begin APPROPRIATIONS GIVEN EFFECT ONCE.
new text end
new text begin
If an appropriation or transfer in this article is enacted more than once during the 2023
regular session, the appropriation or transfer must be given effect once.
new text end
Sec. 14. new text begin FINANCIAL REVIEW OF NONPROFIT GRANT RECIPIENTS
REQUIRED.
new text end
new text begin Subdivision 1. new text end
new text begin Financial review required. new text end
new text begin
(a) Before awarding a competitive,
legislatively named, single-source, or sole-source grant to a nonprofit organization under
this act, the grantor must require the applicant to submit financial information sufficient for
the grantor to document and assess the applicant's current financial standing and management.
Items of significant concern must be addressed with the applicant and resolved to the
satisfaction of the grantor before a grant is awarded. The grantor must document the material
requested and reviewed; whether the applicant had a significant operating deficit, a deficit
in unrestricted net assets, or insufficient internal controls; whether and how the applicant
resolved the grantor's concerns; and the grantor's final decision. This documentation must
be maintained in the grantor's files.
new text end
new text begin
(b) At a minimum, the grantor must require each applicant to provide the following
information:
new text end
new text begin
(1) the applicant's most recent Form 990, Form 990-EZ, or Form 990-N filed with the
Internal Revenue Service. If the applicant has not been in existence long enough or is not
required to file Form 990, Form 990-EZ, or Form 990-N, the applicant must demonstrate
to the grantor that the applicant is exempt and must instead submit documentation of internal
controls and the applicant's most recent financial statement prepared in accordance with
generally accepted accounting principles and approved by the applicant's board of directors
or trustees, or if there is no such board, by the applicant's managing group;
new text end
new text begin
(2) evidence of registration and good standing with the secretary of state under Minnesota
Statutes, chapter 317A, or other applicable law;
new text end
new text begin
(3) unless exempt under Minnesota Statutes, section 309.515, evidence of registration
and good standing with the attorney general under Minnesota Statutes, chapter 309; and
new text end
new text begin
(4) if required under Minnesota Statutes, section 309.53, subdivision 3, the applicant's
most recent audited financial statement prepared in accordance with generally accepted
accounting principles.
new text end
new text begin Subd. 2. new text end
new text begin Authority to postpone or forgo; reporting required. new text end
new text begin
(a) Notwithstanding
any contrary provision in this act, a grantor that identifies an area of significant concern
regarding the financial standing or management of a legislatively named applicant may
postpone or forgo awarding the grant.
new text end
new text begin
(b) No later than 30 days after a grantor exercises the authority provided under paragraph
(a), the grantor must report to the chairs and ranking minority members of the legislative
committees with jurisdiction over the grantor's operating budget. The report must identify
the legislatively named applicant and the grantor's reason for postponing or forgoing the
grant.
new text end
new text begin Subd. 3. new text end
new text begin Authority to award subject to additional assistance and oversight. new text end
new text begin
A grantor
that identifies an area of significant concern regarding an applicant's financial standing or
management may award a grant to the applicant if the grantor provides or the grantee
otherwise obtains additional technical assistance, as needed, and the grantor imposes
additional requirements in the grant agreement. Additional requirements may include but
are not limited to enhanced monitoring, additional reporting, or other reasonable requirements
imposed by the grantor to protect the interests of the state.
new text end
new text begin Subd. 4. new text end
new text begin Relation to other law and policy. new text end
new text begin
The requirements in this section are in
addition to any other requirements imposed by law, the commissioner of administration
under Minnesota Statutes, sections 16B.97 and 16B.98, or agency policy.
new text end
Sec. 15. new text begin EXPIRATION OF UNCODIFIED LANGUAGE.
new text end
new text begin
All uncodified language contained in this article expires on June 30, 2025, unless a
different expiration date is explicit.
new text end
APPENDIX
Repealed Minnesota Statutes: UES2995-2
62J.692 MEDICAL EDUCATION.
Subd. 4a.
Alternative distribution.
If federal approval is not received for the formula described in subdivision 4, paragraphs (a) and (b), 100 percent of available medical education and research funds shall be distributed based on a distribution formula that reflects a summation of two factors:
(1) a public program volume factor, that is determined by the total volume of public program revenue received by each training site as a percentage of all public program revenue received by all training sites in the fund pool; and
(2) a supplemental public program volume factor, that is determined by providing a supplemental payment of 20 percent of each training site's grant to training sites whose public program revenue accounted for at least 0.98 percent of the total public program revenue received by all eligible training sites. Grants to training sites whose public program revenue accounted for less than 0.98 percent of the total public program revenue received by all eligible training sites shall be reduced by an amount equal to the total value of the supplemental payment.
Subd. 7.
Transfers from commissioner of human services.
Of the amount transferred according to section 256B.69, subdivision 5c, paragraph (a), clauses (1) to (4), $21,714,000 shall be distributed as follows:
(1) $2,157,000 shall be distributed by the commissioner to the University of Minnesota Board of Regents for the purposes described in sections 137.38 to 137.40;
(2) $1,035,360 shall be distributed by the commissioner to the Hennepin County Medical Center for clinical medical education;
(3) $17,400,000 shall be distributed by the commissioner to the University of Minnesota Board of Regents for purposes of medical education;
(4) $1,121,640 shall be distributed by the commissioner to clinical medical education dental innovation grants in accordance with subdivision 7a; and
(5) the remainder of the amount transferred according to section 256B.69, subdivision 5c, clauses (1) to (4), shall be distributed by the commissioner annually to clinical medical education programs that meet the qualifications of subdivision 3 based on the formula in subdivision 4, paragraph (a).
Subd. 7a.
Clinical medical education innovations grants.
(a) The commissioner shall award grants to teaching institutions and clinical training sites for projects that increase dental access for underserved populations and promote innovative clinical training of dental professionals. In awarding the grants, the commissioner, in consultation with the commissioner of human services, shall consider the following:
(1) potential to successfully increase access to an underserved population;
(2) the long-term viability of the project to improve access beyond the period of initial funding;
(3) evidence of collaboration between the applicant and local communities;
(4) the efficiency in the use of the funding; and
(5) the priority level of the project in relation to state clinical education, access, and workforce goals.
(b) The commissioner shall periodically evaluate the priorities in awarding the innovations grants in order to ensure that the priorities meet the changing workforce needs of the state.
62J.84 PRESCRIPTION DRUG PRICE TRANSPARENCY.
Subd. 5.
Newly acquired prescription drug price reporting.
(a) Beginning January 1, 2022, the acquiring drug manufacturer must submit to the commissioner the information described in paragraph (b) for each newly acquired prescription drug for which the price was $100 or greater for a 30-day supply or for a course of treatment lasting less than 30 days and:
(1) for a newly acquired brand name drug where there is an increase of ten percent or greater in the price over the previous 12-month period or an increase of 16 percent or greater in price over the previous 24-month period; and
(2) for a newly acquired generic drug where there is an increase of 50 percent or greater in the price over the previous 12-month period.
(b) For each of the drugs described in paragraph (a), the acquiring manufacturer shall submit to the commissioner no later than 60 days after the acquiring manufacturer begins to sell the newly acquired drug, in the form and manner prescribed by the commissioner, the following information, if applicable:
(1) the price of the prescription drug at the time of acquisition and in the calendar year prior to acquisition;
(2) the name of the company from which the prescription drug was acquired, the date acquired, and the purchase price;
(3) the year the prescription drug was introduced to market and the price of the prescription drug at the time of introduction;
(4) the price of the prescription drug for the previous five years;
(5) any agreement between a manufacturer and another entity contingent upon any delay in offering to market a generic version of the manufacturer's drug; and
(6) the patent expiration date of the drug if it is under patent.
(c) The manufacturer may submit any documentation necessary to support the information reported under this subdivision.
62Q.145 ABORTION AND SCOPE OF PRACTICE.
Health plan company policies related to scope of practice for allied independent health providers, midlevel practitioners as defined in section 144.1501, subdivision 1, and other nonphysician health care professionals must comply with the requirements governing the performance of abortions in section 145.412, subdivision 1.
62U.10 HEALTH CARE TRANSFER, SAVINGS, AND REPAYMENT.
Subd. 6.
Projected spending baseline.
Beginning February 15, 2016, and each February 15 thereafter, the commissioner of health shall report the projected impact on spending from specified health indicators related to various preventable illnesses and death. The impacts shall be reported over a ten-year time frame using a baseline forecast of private and public health care and long-term care spending for residents of this state, beginning with calendar year 2009 projected estimates of costs, and updated annually for each of the following health indicators:
(1) costs related to rates of obesity, including obesity-related cancers, coronary heart disease, stroke, and arthritis;
(2) costs related to the utilization of tobacco products;
(3) costs related to hypertension;
(4) costs related to diabetes or prediabetes; and
(5) costs related to dementia and chronic disease among an elderly population over 60, including additional long-term care costs.
Subd. 7.
Outcomes reporting; savings determination.
(a) Beginning November 1, 2016, and each November 1 thereafter, the commissioner of health shall determine the actual total private and public health care and long-term care spending for Minnesota residents related to each health indicator projected in subdivision 6 for the most recent calendar year available. The commissioner shall determine the difference between the projected and actual spending for each health indicator and for each year, and determine the savings attributable to changes in these health indicators. The assumptions and research methods used to calculate actual spending must be determined to be appropriate by an independent actuarial consultant. If the actual spending is less than the projected spending, the commissioner, in consultation with the commissioners of human services and management and budget, shall use the proportion of spending for state-administered health care programs to total private and public health care spending for each health indicator for the calendar year two years before the current calendar year to determine the percentage of the calculated aggregate savings amount accruing to state-administered health care programs.
(b) The commissioner may use the data submitted under section 62U.04, subdivisions 4 and 5, to complete the activities required under this section, but may only report publicly on regional data aggregated to granularity of 25,000 lives or greater for this purpose.
Subd. 8.
Transfers.
When accumulated annual savings accruing to state-administered health care programs, as calculated under subdivision 7, meet or exceed $50,000,000 for all health indicators in aggregate statewide, the commissioner of health shall certify that event to the commissioner of management and budget, no later than December 15 of each year. In the next fiscal year following the certification, the commissioner of management and budget shall transfer $50,000,000 from the general fund to the health care access fund. This transfer shall repeat in each fiscal year following subsequent certifications of additional cumulative savings, up to $50,000,000 per year. The amount necessary to make the transfer is appropriated from the general fund to the commissioner of management and budget.
137.38 EDUCATION AND TRAINING OF PRIMARY CARE PHYSICIANS.
Subdivision 1.
Condition.
If the Board of Regents accepts the amount transferred under section 62J.692, subdivision 7, clause (1), to be used for the purposes described in sections 137.38 to 137.40, it shall comply with the duties for which the transfer is made.
144.059 PALLIATIVE CARE ADVISORY COUNCIL.
Subd. 10.
Sunset.
The council shall sunset January 1, 2025.
144.9505 CREDENTIALING OF LEAD FIRMS AND PROFESSIONALS.
Subd. 3.
Licensed building contractor; information.
The commissioner shall provide health and safety information on lead abatement and lead hazard reduction to all residential building contractors licensed under section 326B.805. The information must include the lead-safe practices and any other materials describing ways to protect the health and safety of both employees and residents.
145.1621 DISPOSITION OF ABORTED OR MISCARRIED FETUSES.
Subdivision 1.
Purpose.
The purpose of this section is to protect the public health and welfare by providing for the dignified and sanitary disposition of the remains of aborted or miscarried human fetuses in a uniform manner and to declare violations of this section to be a public nuisance.
Subd. 2.
Definition; remains of a human fetus.
For the purposes of this section, the term "remains of a human fetus" means the remains of the dead offspring of a human being that has reached a stage of development so that there are cartilaginous structures, fetal or skeletal parts after an abortion or miscarriage, whether or not the remains have been obtained by induced, spontaneous, or accidental means.
Subd. 3.
Regulation of disposal.
Remains of a human fetus resulting from an abortion or miscarriage, induced or occurring accidentally or spontaneously at a hospital, clinic, or medical facility must be deposited or disposed of in this state only at the place and in the manner provided by this section or, if not possible, as directed by the commissioner of health.
Subd. 4.
Disposition; tests.
Hospitals, clinics, and medical facilities in which abortions are induced or occur spontaneously or accidentally and laboratories to which the remains of human fetuses are delivered must provide for the disposal of the remains by cremation, interment by burial, or in a manner directed by the commissioner of health. The hospital, clinic, medical facility, or laboratory may complete laboratory tests necessary for the health of the woman or her future offspring or for purposes of a criminal investigation or determination of parentage prior to disposing of the remains.
Subd. 5.
Violation; penalty.
Failure to comply with this section constitutes a public nuisance. A person, firm, or corporation failing to comply with this section is guilty of a misdemeanor.
Subd. 6.
Exclusions.
To comply with this section, a religious service or ceremony is not required as part of the disposition of the remains of a human fetus, and no discussion of the method of disposition is required with the woman obtaining an induced abortion.
145.411 REGULATION OF ABORTIONS; DEFINITIONS.
Subd. 2.
Viable.
"Viable" means able to live outside the womb even though artificial aid may be required. During the second half of its gestation period a fetus shall be considered potentially "viable."
Subd. 4.
Abortion facility.
"Abortion facility" means those places properly recognized and licensed by the state commissioner of health under lawful rules promulgated by the commissioner for the performance of abortions.
145.412 CRIMINAL ACTS.
Subdivision 1.
Requirements.
It shall be unlawful to willfully perform an abortion unless the abortion is performed:
(1) by a physician licensed to practice medicine pursuant to chapter 147, or a physician in training under the supervision of a licensed physician;
(2) in a hospital or abortion facility if the abortion is performed after the first trimester;
(3) in a manner consistent with the lawful rules promulgated by the state commissioner of health; and
(4) with the consent of the woman submitting to the abortion after a full explanation of the procedure and effect of the abortion.
Subd. 2.
Unconsciousness; lifesaving.
It shall be unlawful to perform an abortion upon a woman who is unconscious except if the woman has been rendered unconscious for the purpose of having an abortion or if the abortion is necessary to save the life of the woman.
Subd. 3.
Viability.
It shall be unlawful to perform an abortion when the fetus is potentially viable unless:
(1) the abortion is performed in a hospital;
(2) the attending physician certifies in writing that in the physician's best medical judgment the abortion is necessary to preserve the life or health of the pregnant woman; and
(3) to the extent consistent with sound medical practice the abortion is performed under circumstances which will reasonably assure the live birth and survival of the fetus.
Subd. 4.
Penalty.
A person who performs an abortion in violation of this section is guilty of a felony.
145.413 RECORDING AND REPORTING HEALTH DATA.
Subd. 2.
Death of woman.
If any woman who has had an abortion dies from any cause within 30 days of the abortion or from any cause potentially related to the abortion within 90 days of the abortion, that fact shall be reported to the state commissioner of health.
Subd. 3.
Penalty.
A physician who performs an abortion and who fails to comply with subdivision 1 and transmit the required information to the state commissioner of health within 30 days after the abortion is guilty of a misdemeanor.
145.4131 RECORDING AND REPORTING ABORTION DATA.
Subdivision 1.
Forms.
(a) Within 90 days of July 1, 1998, the commissioner shall prepare a reporting form for use by physicians or facilities performing abortions. A copy of this section shall be attached to the form. A physician or facility performing an abortion shall obtain a form from the commissioner.
(b) The form shall require the following information:
(1) the number of abortions performed by the physician in the previous calendar year, reported by month;
(2) the method used for each abortion;
(3) the approximate gestational age expressed in one of the following increments:
(i) less than nine weeks;
(ii) nine to ten weeks;
(iii) 11 to 12 weeks;
(iv) 13 to 15 weeks;
(v) 16 to 20 weeks;
(vi) 21 to 24 weeks;
(vii) 25 to 30 weeks;
(viii) 31 to 36 weeks; or
(ix) 37 weeks to term;
(4) the age of the woman at the time the abortion was performed;
(5) the specific reason for the abortion, including, but not limited to, the following:
(i) the pregnancy was a result of rape;
(ii) the pregnancy was a result of incest;
(iii) economic reasons;
(iv) the woman does not want children at this time;
(v) the woman's emotional health is at stake;
(vi) the woman's physical health is at stake;
(vii) the woman will suffer substantial and irreversible impairment of a major bodily function if the pregnancy continues;
(viii) the pregnancy resulted in fetal anomalies; or
(ix) unknown or the woman refused to answer;
(6) the number of prior induced abortions;
(7) the number of prior spontaneous abortions;
(8) whether the abortion was paid for by:
(i) private coverage;
(ii) public assistance health coverage; or
(iii) self-pay;
(9) whether coverage was under:
(i) a fee-for-service plan;
(ii) a capitated private plan; or
(iii) other;
(10) complications, if any, for each abortion and for the aftermath of each abortion. Space for a description of any complications shall be available on the form;
(11) the medical specialty of the physician performing the abortion;
(12) if the abortion was performed via telehealth, the facility code for the patient and the facility code for the physician; and
(13) whether the abortion resulted in a born alive infant, as defined in section 145.423, subdivision 4, and:
(i) any medical actions taken to preserve the life of the born alive infant;
(ii) whether the born alive infant survived; and
(iii) the status of the born alive infant, should the infant survive, if known.
Subd. 2.
Submission.
A physician performing an abortion or a facility at which an abortion is performed shall complete and submit the form to the commissioner no later than April 1 for abortions performed in the previous calendar year. The annual report to the commissioner shall include the methods used to dispose of fetal tissue and remains.
Subd. 3.
Additional reporting.
Nothing in this section shall be construed to preclude the voluntary or required submission of other reports or forms regarding abortions.
145.4132 RECORDING AND REPORTING ABORTION COMPLICATION DATA.
Subdivision 1.
Forms.
(a) Within 90 days of July 1, 1998, the commissioner shall prepare an abortion complication reporting form for all physicians licensed and practicing in the state. A copy of this section shall be attached to the form.
(b) The Board of Medical Practice shall ensure that the abortion complication reporting form is distributed:
(1) to all physicians licensed to practice in the state, within 120 days after July 1, 1998, and by December 1 of each subsequent year; and
(2) to a physician who is newly licensed to practice in the state, at the same time as official notification to the physician that the physician is so licensed.
Subd. 2.
Required reporting.
A physician licensed and practicing in the state who knowingly encounters an illness or injury that, in the physician's medical judgment, is related to an induced abortion or the facility where the illness or injury is encountered shall complete and submit an abortion complication reporting form to the commissioner.
Subd. 3.
Submission.
A physician or facility required to submit an abortion complication reporting form to the commissioner shall do so as soon as practicable after the encounter with the abortion-related illness or injury.
Subd. 4.
Additional reporting.
Nothing in this section shall be construed to preclude the voluntary or required submission of other reports or forms regarding abortion complications.
145.4133 REPORTING OUT-OF-STATE ABORTIONS.
The commissioner of human services shall report to the commissioner by April 1 each year the following information regarding abortions paid for with state funds and performed out of state in the previous calendar year:
(1) the total number of abortions performed out of state and partially or fully paid for with state funds through the medical assistance or MinnesotaCare program, or any other program;
(2) the total amount of state funds used to pay for the abortions and expenses incidental to the abortions; and
(3) the gestational age at the time of abortion.
145.4134 COMMISSIONER'S PUBLIC REPORT.
(a) By July 1 of each year, except for 1998 and 1999 information, the commissioner shall issue a public report providing statistics for the previous calendar year compiled from the data submitted under sections 145.4131 to 145.4133 and sections 145.4241 to 145.4249. For 1998 and 1999 information, the report shall be issued October 1, 2000. Each report shall provide the statistics for all previous calendar years, adjusted to reflect any additional information from late or corrected reports. The commissioner shall ensure that none of the information included in the public reports can reasonably lead to identification of an individual having performed or having had an abortion. All data included on the forms under sections 145.4131 to 145.4133 and sections 145.4241 to 145.4249 must be included in the public report, except that the commissioner shall maintain as confidential, data which alone or in combination may constitute information from which an individual having performed or having had an abortion may be identified using epidemiologic principles.
(b) The commissioner may, by rules adopted under chapter 14, alter the submission dates established under sections 145.4131 to 145.4133 for administrative convenience, fiscal savings, or other valid reason, provided that physicians or facilities and the commissioner of human services submit the required information once each year and the commissioner issues a report once each year.
145.4135 ENFORCEMENT; PENALTIES.
(a) If the commissioner finds that a physician or facility has failed to submit the required form under section 145.4131 within 60 days following the due date, the commissioner shall notify the physician or facility that the form is late. A physician or facility who fails to submit the required form under section 145.4131 within 30 days following notification from the commissioner that a report is late is subject to a late fee of $500 for each 30-day period, or portion thereof, that the form is overdue. If a physician or facility required to report under this section does not submit a report, or submits only an incomplete report, more than one year following the due date, the commissioner may take action to fine the physician or facility or may bring an action to require that the physician or facility be directed by a court of competent jurisdiction to submit a complete report within a period stated by court order or be subject to sanctions for civil contempt. Notwithstanding section 13.39 to the contrary, action taken by the commissioner to enforce the provision of this section shall be treated as private if the data related to this action, alone or in combination, may constitute information from which an individual having performed or having had an abortion may be identified using epidemiologic principles.
(b) If the commissioner fails to issue the public report required under section 145.4134 or fails in any way to enforce this section, a group of 100 or more citizens of the state may seek an injunction in a court of competent jurisdiction against the commissioner requiring that a complete report be issued within a period stated by court order or requiring that enforcement action be taken.
(c) A physician or facility reporting in good faith and exercising due care shall have immunity from civil, criminal, or administrative liability that might otherwise result from reporting. A physician who knowingly or recklessly submits a false report under this section is guilty of a misdemeanor.
(d) The commissioner may take reasonable steps to ensure compliance with sections 145.4131 to 145.4133 and to verify data provided, including but not limited to, inspection of places where abortions are performed in accordance with chapter 14.
(e) The commissioner shall develop recommendations on appropriate penalties and methods of enforcement for physicians or facilities who fail to submit the report required under section 145.4132, submit an incomplete report, or submit a late report. The commissioner shall also assess the effectiveness of the enforcement methods and penalties provided in paragraph (a) and shall recommend appropriate changes, if any. These recommendations shall be reported to the chairs of the senate Health and Family Security Committee and the house of representatives Health and Human Services Committee by November 15, 1998.
145.4136 SEVERABILITY.
If any one or more provision, section, subdivision, sentence, clause, phrase, or word in sections 145.4131 to 145.4135, or the application thereof to any person or circumstance is found to be unconstitutional, the same is hereby declared to be severable and the balance of sections 145.4131 to 145.4135 shall remain effective notwithstanding such unconstitutionality. The legislature hereby declares that it would have passed sections 145.4131 to 145.4135, and each provision, section, subdivision, sentence, clause, phrase, or word thereof, irrespective of the fact that any one or more provision, section, subdivision, sentence, clause, phrase, or word be declared unconstitutional.
145.415 LIVE FETUS AFTER ABORTION, TREATMENT.
Subdivision 1.
Recognition.
A potentially viable fetus which is live born following an attempted abortion shall be fully recognized as a human person under the law.
Subd. 2.
Medical care.
If an abortion of a potentially viable fetus results in a live birth, the responsible medical personnel shall take all reasonable measures, in keeping with good medical practice, to preserve the life and health of the live born person.
Subd. 3.
Status.
(1) Unless the abortion is performed to save the life of the woman or child, or, (2) unless one or both of the parents of the unborn child agrees within 30 days of the birth to accept the parental rights and responsibilities for the child if it survives the abortion, whenever an abortion of a potentially viable fetus results in a live birth, the child shall be an abandoned ward of the state and the parents shall have no parental rights or obligations as if the parental rights had been terminated pursuant to section 260C.301. The child shall be provided for pursuant to chapter 256J.
145.416 LICENSING AND REGULATION OF FACILITIES.
The state commissioner of health shall license and promulgate rules for facilities as defined in section 145.411, subdivision 4, which are organized for purposes of delivering abortion services.
145.423 ABORTION; LIVE BIRTHS.
Subd. 2.
Physician required.
When an abortion is performed after the 20th week of pregnancy, a physician, other than the physician performing the abortion, shall be immediately accessible to take all reasonable measures consistent with good medical practice, including the compilation of appropriate medical records, to preserve the life and health of any born alive infant that is the result of the abortion.
Subd. 3.
Death.
If a born alive infant described in subdivision 1 dies after birth, the body shall be disposed of in accordance with the provisions of section 145.1621.
Subd. 4.
Definition of born alive infant.
(a) In determining the meaning of any Minnesota statute, or of any ruling, regulation, or interpretation of the various administrative bureaus and agencies of Minnesota, the words "person," "human being," "child," and "individual" shall include every infant member of the species Homo sapiens who is born alive at any stage of development.
(b) As used in this section, the term "born alive," with respect to a member of the species Homo sapiens, means the complete expulsion or extraction from his or her mother of that member, at any stage of development, who, after such expulsion or extraction, breathes or has a beating heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, regardless of whether the umbilical cord has been cut, and regardless of whether the expulsion or extraction occurs as a result of a natural or induced labor, cesarean section, or induced abortion.
(c) Nothing in this section shall be construed to affirm, deny, expand, or contract any legal status or legal right applicable to any member of the species Homo sapiens at any point prior to being born alive, as defined in this section.
Subd. 5.
Civil and disciplinary actions.
(a) Any person upon whom an abortion has been performed, or the parent or guardian of the mother if the mother is a minor, and the abortion results in the infant having been born alive, may maintain an action for death of or injury to the born alive infant against the person who performed the abortion if the death or injury was a result of simple negligence, gross negligence, wantonness, willfulness, intentional conduct, or another violation of the legal standard of care.
(b) Any responsible medical personnel that does not take all reasonable measures consistent with good medical practice to preserve the life and health of the born alive infant, as required by subdivision 1, may be subject to the suspension or revocation of that person's professional license by the professional board with authority over that person. Any person who has performed an abortion and against whom judgment has been rendered pursuant to paragraph (a) shall be subject to an automatic suspension of the person's professional license for at least one year and said license shall be reinstated only after the person's professional board requires compliance with this section by all board licensees.
(c) Nothing in this subdivision shall be construed to hold the mother of the born alive infant criminally or civilly liable for the actions of a physician, nurse, or other licensed health care provider in violation of this section to which the mother did not give her consent.
Subd. 6.
Protection of privacy in court proceedings.
In every civil action brought under this section, the court shall rule whether the anonymity of any female upon whom an abortion has been performed or attempted shall be preserved from public disclosure if she does not give her consent to such disclosure. The court, upon motion or sua sponte, shall make such a ruling and, upon determining that her anonymity should be preserved, shall issue orders to the parties, witnesses, and counsel and shall direct the sealing of the record and exclusion of individuals from courtrooms or hearing rooms to the extent necessary to safeguard her identity from public disclosure. Each order must be accompanied by specific written findings explaining why the anonymity of the female should be preserved from public disclosure, why the order is essential to that end, how the order is narrowly tailored to serve that interest, and why no reasonable, less restrictive alternative exists. This section may not be construed to conceal the identity of the plaintiff or of witnesses from the defendant.
Subd. 7.
Status of born alive infant.
Unless the abortion is performed to save the life of the woman or fetus, or, unless one or both of the parents of the born alive infant agree within 30 days of the birth to accept the parental rights and responsibilities for the child, the child shall be an abandoned ward of the state and the parents shall have no parental rights or obligations as if the parental rights had been terminated pursuant to section 260C.301. The child shall be provided for pursuant to chapter 256J.
Subd. 8.
Severability.
If any one or more provision, section, subdivision, sentence, clause, phrase, or word of this section or the application of it to any person or circumstance is found to be unconstitutional, it is declared to be severable and the balance of this section shall remain effective notwithstanding such unconstitutionality. The legislature intends that it would have passed this section, and each provision, section, subdivision, sentence, clause, phrase, or word, regardless of the fact that any one provision, section, subdivision, sentence, clause, phrase, or word is declared unconstitutional.
Subd. 9.
Short title.
This section may be cited as the "Born Alive Infants Protection Act."
145.4235 POSITIVE ABORTION ALTERNATIVES.
Subdivision 1.
Definitions.
For purposes of this section, the following terms have the meanings given:
(1) "abortion" means the use of any means to terminate the pregnancy of a woman known to be pregnant with knowledge that the termination with those means will, with reasonable likelihood, cause the death of the unborn child. For purposes of this section, abortion does not include an abortion necessary to prevent the death of the mother;
(2) "nondirective counseling" means providing clients with:
(i) a list of health care providers and social service providers that provide prenatal care, childbirth care, infant care, foster care, adoption services, alternatives to abortion, or abortion services; and
(ii) nondirective, nonmarketing information regarding such providers; and
(3) "unborn child" means a member of the species Homo sapiens from fertilization until birth.
Subd. 2.
Eligibility for grants.
(a) The commissioner shall award grants to eligible applicants under paragraph (c) for the reasonable expenses of alternatives to abortion programs to support, encourage, and assist women in carrying their pregnancies to term and caring for their babies after birth by providing information on, referral to, and assistance with securing necessary services that enable women to carry their pregnancies to term and care for their babies after birth. Necessary services must include, but are not limited to:
(1) medical care;
(2) nutritional services;
(3) housing assistance;
(4) adoption services;
(5) education and employment assistance, including services that support the continuation and completion of high school;
(6) child care assistance; and
(7) parenting education and support services.
An applicant may not provide or assist a woman to obtain adoption services from a provider of adoption services that is not licensed.
(b) In addition to providing information and referral under paragraph (a), an eligible program may provide one or more of the necessary services under paragraph (a) that assists women in carrying their pregnancies to term. To avoid duplication of efforts, grantees may refer to other public or private programs, rather than provide the care directly, if a woman meets eligibility criteria for the other programs.
(c) To be eligible for a grant, an agency or organization must:
(1) be a private, nonprofit organization;
(2) demonstrate that the program is conducted under appropriate supervision;
(3) not charge women for services provided under the program;
(4) provide each pregnant woman counseled with accurate information on the developmental characteristics of babies and of unborn children, including offering the printed information described in section 145.4243;
(5) ensure that its alternatives-to-abortion program's purpose is to assist and encourage women in carrying their pregnancies to term and to maximize their potentials thereafter;
(6) ensure that none of the money provided is used to encourage or affirmatively counsel a woman to have an abortion not necessary to prevent her death, to provide her an abortion, or to directly refer her to an abortion provider for an abortion. The agency or organization may provide nondirective counseling; and
(7) have had the alternatives to abortion program in existence for at least one year as of July 1, 2011; or incorporated an alternative to abortion program that has been in existence for at least one year as of July 1, 2011.
(d) The provisions, words, phrases, and clauses of paragraph (c) are inseverable from this subdivision, and if any provision, word, phrase, or clause of paragraph (c) or its application to any person or circumstance is held invalid, the invalidity applies to all of this subdivision.
(e) An organization that provides abortions, promotes abortions, or directly refers to an abortion provider for an abortion is ineligible to receive a grant under this program. An affiliate of an organization that provides abortions, promotes abortions, or directly refers to an abortion provider for an abortion is ineligible to receive a grant under this section unless the organizations are separately incorporated and independent from each other. To be independent, the organizations may not share any of the following:
(1) the same or a similar name;
(2) medical facilities or nonmedical facilities, including but not limited to, business offices, treatment rooms, consultation rooms, examination rooms, and waiting rooms;
(3) expenses;
(4) employee wages or salaries; or
(5) equipment or supplies, including but not limited to, computers, telephone systems, telecommunications equipment, and office supplies.
(f) An organization that receives a grant under this section and that is affiliated with an organization that provides abortion services must maintain financial records that demonstrate strict compliance with this subdivision and that demonstrate that its independent affiliate that provides abortion services receives no direct or indirect economic or marketing benefit from the grant under this section.
(g) The commissioner shall approve any information provided by a grantee on the health risks associated with abortions to ensure that the information is medically accurate.
Subd. 3.
Privacy protection.
(a) Any program receiving a grant under this section must have a privacy policy and procedures in place to ensure that the name, address, telephone number, or any other information that might identify any woman seeking the services of the program is not made public or shared with any other agency or organization without the written consent of the woman. All communications between the program and the woman must remain confidential. For purposes of any medical care provided by the program, including, but not limited to, pregnancy tests or ultrasonic scanning, the program must adhere to the requirements in sections 144.291 to 144.298 that apply to providers before releasing any information relating to the medical care provided.
(b) Notwithstanding paragraph (a), the commissioner has access to any information necessary to monitor and review a grantee's program as required under subdivision 4.
Subd. 4.
Duties of commissioner.
The commissioner shall make grants under subdivision 2 beginning no later than July 1, 2006. In awarding grants, the commissioner shall consider the program's demonstrated capacity in providing services to assist a pregnant woman in carrying her pregnancy to term. The commissioner shall monitor and review the programs of each grantee to ensure that the grantee carefully adheres to the purposes and requirements of subdivision 2 and shall cease funding a grantee that fails to do so.
Subd. 5.
Severability.
Except as provided in subdivision 2, paragraph (d), if any provision, word, phrase, or clause of this section or its application to any person or circumstance is held invalid, such invalidity shall not affect the provisions, words, phrases, clauses, or applications of this section that can be given effect without the invalid provision, word, phrase, clause, or application and to this end, the provisions, words, phrases, and clauses of this section are severable.
Subd. 6.
Minnesota Supreme Court jurisdiction.
The Minnesota Supreme Court has original jurisdiction over an action challenging the constitutionality of this section and shall expedite the resolution of the action.
145.4241 DEFINITIONS.
Subdivision 1.
Applicability.
As used in sections 145.4241 to 145.4249, the following terms have the meanings given them.
Subd. 2.
Abortion.
"Abortion" means the use or prescription of any instrument, medicine, drug, or any other substance or device to intentionally terminate the pregnancy of a female known to be pregnant, with an intention other than to increase the probability of a live birth, to preserve the life or health of the child after live birth, or to remove a dead fetus.
Subd. 3.
Attempt to perform an abortion.
"Attempt to perform an abortion" means an act, or an omission of a statutorily required act, that, under the circumstances as the actor believes them to be, constitutes a substantial step in a course of conduct planned to culminate in the performance of an abortion in Minnesota in violation of sections 145.4241 to 145.4249.
Subd. 3a.
Fetal anomaly incompatible with life.
"Fetal anomaly incompatible with life" means a fetal anomaly diagnosed before birth that will with reasonable certainty result in death of the unborn child within three months. Fetal anomaly incompatible with life does not include conditions which can be treated.
Subd. 4.
Medical emergency.
"Medical emergency" means any condition that, on the basis of the physician's good faith clinical judgment, so complicates the medical condition of a pregnant female as to necessitate the immediate abortion of her pregnancy to avert her death or for which a delay will create serious risk of substantial and irreversible impairment of a major bodily function.
Subd. 4a.
Perinatal hospice.
(a) "Perinatal hospice" means comprehensive support to the female and her family that includes support from the time of diagnosis through the time of birth and death of the infant and through the postpartum period. Supportive care may include maternal-fetal medical specialists, obstetricians, neonatologists, anesthesia specialists, clergy, social workers, and specialty nurses.
(b) The availability of perinatal hospice provides an alternative to families for whom elective pregnancy termination is not chosen.
Subd. 5.
Physician.
"Physician" means a person licensed as a physician or osteopathic physician under chapter 147.
Subd. 6.
Probable gestational age of the unborn child.
"Probable gestational age of the unborn child" means what will, in the judgment of the physician, with reasonable probability, be the gestational age of the unborn child at the time the abortion is planned to be performed.
Subd. 7.
Stable Internet website.
"Stable Internet website" means a website that, to the extent reasonably practicable, is safeguarded from having its content altered other than by the commissioner of health.
Subd. 8.
Unborn child.
"Unborn child" means a member of the species Homo sapiens from fertilization until birth.
145.4242 INFORMED CONSENT.
(a) No abortion shall be performed in this state except with the voluntary and informed consent of the female upon whom the abortion is to be performed. Except in the case of a medical emergency or if the fetus has an anomaly incompatible with life, and the female has declined perinatal hospice care, consent to an abortion is voluntary and informed only if:
(1) the female is told the following, by telephone or in person, by the physician who is to perform the abortion or by a referring physician, at least 24 hours before the abortion:
(i) the particular medical risks associated with the particular abortion procedure to be employed including, when medically accurate, the risks of infection, hemorrhage, breast cancer, danger to subsequent pregnancies, and infertility;
(ii) the probable gestational age of the unborn child at the time the abortion is to be performed;
(iii) the medical risks associated with carrying her child to term; and
(iv) for abortions after 20 weeks gestational, whether or not an anesthetic or analgesic would eliminate or alleviate organic pain to the unborn child caused by the particular method of abortion to be employed and the particular medical benefits and risks associated with the particular anesthetic or analgesic.
The information required by this clause may be provided by telephone without conducting a physical examination or tests of the patient, in which case the information required to be provided may be based on facts supplied to the physician by the female and whatever other relevant information is reasonably available to the physician. It may not be provided by a tape recording, but must be provided during a consultation in which the physician is able to ask questions of the female and the female is able to ask questions of the physician. If a physical examination, tests, or the availability of other information to the physician subsequently indicate, in the medical judgment of the physician, a revision of the information previously supplied to the patient, that revised information may be communicated to the patient at any time prior to the performance of the abortion. Nothing in this section may be construed to preclude provision of required information in a language understood by the patient through a translator;
(2) the female is informed, by telephone or in person, by the physician who is to perform the abortion, by a referring physician, or by an agent of either physician at least 24 hours before the abortion:
(i) that medical assistance benefits may be available for prenatal care, childbirth, and neonatal care;
(ii) that the father is liable to assist in the support of her child, even in instances when the father has offered to pay for the abortion; and
(iii) that she has the right to review the printed materials described in section 145.4243, that these materials are available on a state-sponsored website, and what the website address is. The physician or the physician's agent shall orally inform the female that the materials have been provided by the state of Minnesota and that they describe the unborn child, list agencies that offer alternatives to abortion, and contain information on fetal pain. If the female chooses to view the materials other than on the website, they shall either be given to her at least 24 hours before the abortion or mailed to her at least 72 hours before the abortion by certified mail, restricted delivery to addressee, which means the postal employee can only deliver the mail to the addressee.
The information required by this clause may be provided by a tape recording if provision is made to record or otherwise register specifically whether the female does or does not choose to have the printed materials given or mailed to her;
(3) the female certifies in writing, prior to the abortion, that the information described in clauses (1) and (2) has been furnished to her and that she has been informed of her opportunity to review the information referred to in clause (2), item (iii); and
(4) prior to the performance of the abortion, the physician who is to perform the abortion or the physician's agent obtains a copy of the written certification prescribed by clause (3) and retains it on file with the female's medical record for at least three years following the date of receipt.
(b) Prior to administering the anesthetic or analgesic as described in paragraph (a), clause (1), item (iv), the physician must disclose to the woman any additional cost of the procedure for the administration of the anesthetic or analgesic. If the woman consents to the administration of the anesthetic or analgesic, the physician shall administer the anesthetic or analgesic or arrange to have the anesthetic or analgesic administered.
(c) A female seeking an abortion of her unborn child diagnosed with fetal anomaly incompatible with life must be informed of available perinatal hospice services and offered this care as an alternative to abortion. If perinatal hospice services are declined, voluntary and informed consent by the female seeking an abortion is given if the female receives the information required in paragraphs (a), clause (1), and (b). The female must comply with the requirements in paragraph (a), clauses (3) and (4).
145.4243 PRINTED INFORMATION.
(a) Within 90 days after July 1, 2003, the commissioner of health shall cause to be published, in English and in each language that is the primary language of two percent or more of the state's population, and shall cause to be available on the state website provided for under section 145.4244 the following printed materials in such a way as to ensure that the information is easily comprehensible:
(1) geographically indexed materials designed to inform the female of public and private agencies and services available to assist a female through pregnancy, upon childbirth, and while the child is dependent, including adoption agencies, which shall include a comprehensive list of the agencies available, a description of the services they offer, and a description of the manner, including telephone numbers, in which they might be contacted or, at the option of the commissioner of health, printed materials including a toll-free, 24-hours-a-day telephone number that may be called to obtain, orally or by a tape recorded message tailored to a zip code entered by the caller, such a list and description of agencies in the locality of the caller and of the services they offer;
(2) materials designed to inform the female of the probable anatomical and physiological characteristics of the unborn child at two-week gestational increments from the time when a female can be known to be pregnant to full term, including any relevant information on the possibility of the unborn child's survival and pictures or drawings representing the development of unborn children at two-week gestational increments, provided that any such pictures or drawings must contain the dimensions of the fetus and must be realistic and appropriate for the stage of pregnancy depicted. The materials shall be objective, nonjudgmental, and designed to convey only accurate scientific information about the unborn child at the various gestational ages. The material shall also contain objective information describing the methods of abortion procedures commonly employed, the medical risks commonly associated with each procedure, the possible detrimental psychological effects of abortion, and the medical risks commonly associated with carrying a child to term; and
(3) materials with the following information concerning an unborn child of 20 weeks gestational age and at two weeks gestational increments thereafter in such a way as to ensure that the information is easily comprehensible:
(i) the development of the nervous system of the unborn child;
(ii) fetal responsiveness to adverse stimuli and other indications of capacity to experience organic pain; and
(iii) the impact on fetal organic pain of each of the methods of abortion procedures commonly employed at this stage of pregnancy.
The material under this clause shall be objective, nonjudgmental, and designed to convey only accurate scientific information.
(b) The materials referred to in this section must be printed in a typeface large enough to be clearly legible. The website provided for under section 145.4244 shall be maintained at a minimum resolution of 70 DPI (dots per inch). All pictures appearing on the website shall be a minimum of 200x300 pixels. All letters on the website shall be a minimum of 11-point font. All information and pictures shall be accessible with an industry standard browser, requiring no additional plug-ins. The materials required under this section must be available at no cost from the commissioner of health upon request and in appropriate number to any person, facility, or hospital.
145.4244 INTERNET WEBSITE.
The commissioner of health shall develop and maintain a stable Internet website to provide the information described under section 145.4243. No information regarding who uses the website shall be collected or maintained. The commissioner of health shall monitor the website on a weekly basis to prevent and correct tampering.
145.4245 PROCEDURE IN CASE OF MEDICAL EMERGENCY.
When a medical emergency compels the performance of an abortion, the physician shall inform the female, prior to the abortion if possible, of the medical indications supporting the physician's judgment that an abortion is necessary to avert her death or that a 24-hour delay will create serious risk of substantial and irreversible impairment of a major bodily function.
145.4246 REPORTING REQUIREMENTS.
Subdivision 1.
Reporting form.
Within 90 days after July 1, 2003, the commissioner of health shall prepare a reporting form for physicians containing a reprint of sections 145.4241 to 145.4249 and listing:
(1) the number of females to whom the physician provided the information described in section 145.4242, clause (1); of that number, the number provided by telephone and the number provided in person; and of each of those numbers, the number provided in the capacity of a referring physician and the number provided in the capacity of a physician who is to perform the abortion;
(2) the number of females to whom the physician or an agent of the physician provided the information described in section 145.4242, clause (2); of that number, the number provided by telephone and the number provided in person; of each of those numbers, the number provided in the capacity of a referring physician and the number provided in the capacity of a physician who is to perform the abortion; and of each of those numbers, the number provided by the physician and the number provided by an agent of the physician;
(3) the number of females who availed themselves of the opportunity to obtain a copy of the printed information described in section 145.4243 other than on the website and the number who did not; and of each of those numbers, the number who, to the best of the reporting physician's information and belief, went on to obtain the abortion; and
(4) the number of abortions performed by the physician in which information otherwise required to be provided at least 24 hours before the abortion was not so provided because an immediate abortion was necessary to avert the female's death and the number of abortions in which such information was not so provided because a delay would create serious risk of substantial and irreversible impairment of a major bodily function.
Subd. 2.
Distribution of forms.
The commissioner of health shall ensure that copies of the reporting forms described in subdivision 1 are provided:
(1) by December 1, 2003, and by December 1 of each subsequent year thereafter to all physicians licensed to practice in this state; and
(2) to each physician who subsequently becomes newly licensed to practice in this state, at the same time as official notification to that physician that the physician is so licensed.
Subd. 3.
Reporting requirement.
By April 1, 2005, and by April 1 of each subsequent year thereafter, each physician who provided, or whose agent provided, information to one or more females in accordance with section 145.4242 during the previous calendar year shall submit to the commissioner of health a copy of the form described in subdivision 1 with the requested data entered accurately and completely.
Subd. 4.
Additional reporting.
Nothing in this section shall be construed to preclude the voluntary or required submission of other reports or forms regarding abortions.
Subd. 5.
Failure to report as required.
Reports that are not submitted by the end of a grace period of 30 days following the due date shall be subject to a late fee of $500 for each additional 30-day period or portion of a 30-day period they are overdue. Any physician required to report according to this section who has not submitted a report, or has submitted only an incomplete report, more than one year following the due date, may, in an action brought by the commissioner of health, be directed by a court of competent jurisdiction to submit a complete report within a period stated by court order or be subject to sanctions for civil contempt.
Subd. 6.
Public statistics.
By July 1, 2005, and by July 1 of each subsequent year thereafter, the commissioner of health shall issue a public report providing statistics for the previous calendar year compiled from all of the reports covering that year submitted according to this section for each of the items listed in subdivision 1. Each report shall also provide the statistics for all previous calendar years, adjusted to reflect any additional information from late or corrected reports. The commissioner of health shall take care to ensure that none of the information included in the public reports could reasonably lead to the identification of any individual providing or provided information according to section 145.4242.
Subd. 7.
Consolidation.
The commissioner of health may consolidate the forms or reports described in this section with other forms or reports to achieve administrative convenience or fiscal savings or to reduce the burden of reporting requirements.
145.4247 REMEDIES.
Subdivision 1.
Civil remedies.
Any person upon whom an abortion has been performed without complying with sections 145.4241 to 145.4249 may maintain an action against the person who performed the abortion in knowing or reckless violation of sections 145.4241 to 145.4249 for actual and punitive damages. Any person upon whom an abortion has been attempted without complying with sections 145.4241 to 145.4249 may maintain an action against the person who attempted to perform the abortion in knowing or reckless violation of sections 145.4241 to 145.4249 for actual and punitive damages. No civil liability may be assessed for failure to comply with section 145.4242, clause (2), item (iii), or that portion of section 145.4242, clause (2), requiring written certification that the female has been informed of her opportunity to review the information referred to in section 145.4242, clause (2), item (iii), unless the commissioner of health has made the printed materials or website address available at the time the physician or the physician's agent is required to inform the female of her right to review them.
Subd. 2.
Suit to compel statistical report.
If the commissioner of health fails to issue the public report required under section 145.4246, subdivision 6, or fails in any way to enforce Laws 2003, chapter 14, any group of ten or more citizens of this state may seek an injunction in a court of competent jurisdiction against the commissioner of health requiring that a complete report be issued within a period stated by court order. Failure to abide by such an injunction shall subject the commissioner to sanctions for civil contempt.
Subd. 3.
Attorney fees.
If judgment is rendered in favor of the plaintiff in any action described in this section, the court shall also render judgment for reasonable attorney fees in favor of the plaintiff against the defendant. If judgment is rendered in favor of the defendant and the court finds that the plaintiff's suit was frivolous and brought in bad faith, the court shall also render judgment for reasonable attorney fees in favor of the defendant against the plaintiff.
Subd. 4.
Protection of privacy in court proceedings.
In every civil action brought under sections 145.4241 to 145.4249, the court shall rule whether the anonymity of any female upon whom an abortion has been performed or attempted shall be preserved from public disclosure if she does not give her consent to such disclosure. The court, upon motion or sua sponte, shall make such a ruling and, upon determining that her anonymity should be preserved, shall issue orders to the parties, witnesses, and counsel and shall direct the sealing of the record and exclusion of individuals from courtrooms or hearing rooms to the extent necessary to safeguard her identity from public disclosure. Each order must be accompanied by specific written findings explaining why the anonymity of the female should be preserved from public disclosure, why the order is essential to that end, how the order is narrowly tailored to serve that interest, and why no reasonable, less restrictive alternative exists. In the absence of written consent of the female upon whom an abortion has been performed or attempted, anyone, other than a public official, who brings an action under subdivision 1, shall do so under a pseudonym. This section may not be construed to conceal the identity of the plaintiff or of witnesses from the defendant.
145.4248 SEVERABILITY.
If any one or more provision, section, subsection, sentence, clause, phrase, or word of sections 145.4241 to 145.4249 or the application thereof to any person or circumstance is found to be unconstitutional, the same is hereby declared to be severable and the balance of sections 145.4241 to 145.4249 shall remain effective notwithstanding such unconstitutionality. The legislature hereby declares that it would have passed sections 145.4241 to 145.4249, and each provision, section, subsection, sentence, clause, phrase, or word thereof, irrespective of the fact that any one or more provision, section, subsection, sentence, clause, phrase, or word be declared unconstitutional.
145.4249 SUPREME COURT JURISDICTION.
The Minnesota Supreme Court has original jurisdiction over an action challenging the constitutionality of sections 145.4241 to 145.4249 and shall expedite the resolution of the action.
152.092 POSSESSION OF DRUG PARAPHERNALIA PROHIBITED.
(a) It is unlawful for any person knowingly or intentionally to use or to possess drug paraphernalia. Any violation of this section is a petty misdemeanor.
(b) A person who violates paragraph (a) and has previously violated paragraph (a) on two or more occasions has committed a crime and may be sentenced to imprisonment for up to 90 days or to payment of a fine up to $1,000, or both.
153A.14 REGULATION.
Subd. 5.
Rulemaking authority.
The commissioner shall adopt rules under chapter 14 to implement this chapter. The rules may include procedures and standards relating to the certification requirement, the scope of authorized practice, fees, supervision required, continuing education, career progression, disciplinary matters, and examination procedures.
245A.22 INDEPENDENT LIVING ASSISTANCE FOR YOUTH.
Subdivision 1.
Independent living assistance for youth.
"Independent living assistance for youth" means a nonresidential program that provides a system of services that includes training, counseling, instruction, supervision, and assistance provided to youth according to the youth's independent living plan, when the placements in the program are made by the county agency. Services may include assistance in locating housing, budgeting, meal preparation, shopping, personal appearance, counseling, and related social support services needed to meet the youth's needs and improve the youth's ability to conduct such tasks independently. Such services shall not extend to youths needing 24-hour per day supervision and services. Youths needing a 24-hour per day program of supervision and services shall not be accepted or retained in an independent living assistance program.
Subd. 2.
Admission.
(a) The license holder shall accept as clients in the independent living assistance program only youth ages 16 to 21 who are in out-of-home placement, leaving out-of-home placement, at risk of becoming homeless, or homeless.
(b) Youth who have current drug or alcohol problems, a recent history of violent behaviors, or a mental health disorder or issue that is not being resolved through counseling or treatment are not eligible to receive the services described in subdivision 1.
(c) Youth who are not employed, participating in employment training, or enrolled in an academic program are not eligible to receive transitional housing or independent living assistance.
(d) The commissioner may grant a variance under section 245A.04, subdivision 9, to requirements in this section.
Subd. 3.
Independent living plan.
(a) Unless an independent living plan has been developed by the local agency, the license holder shall develop a plan based on the client's individual needs that specifies objectives for the client. The services provided shall include those specified in this section. The plan shall identify the persons responsible for implementation of each part of the plan. The plan shall be reviewed as necessary, but at least annually.
(b) The following services, or adequate access to referrals for the following services, must be made available to the targeted youth participating in the programs described in subdivision 1:
(1) counseling services for the youth and their families, if appropriate, on site, to help with problems that contributed to the homelessness or could impede making the transition to independent living;
(2) educational, vocational, or employment services;
(3) health care;
(4) transportation services including, where appropriate, assisting the child in obtaining a driver's license;
(5) money management skills training;
(6) planning for ongoing housing;
(7) social and recreational skills training; and
(8) assistance establishing and maintaining connections with the child's family and community.
Subd. 4.
Records.
(a) The license holder shall maintain a record for each client.
(b) For each client the record maintained by the license holder shall document the following:
(1) admission information;
(2) the independent living plan;
(3) delivery of the services required of the license holder in the independent living plan;
(4) the client's progress toward obtaining the objectives identified in the independent living plan; and
(5) a termination summary after service is terminated.
(c) If the license holder manages the client's money, the record maintained by the license holder shall also include the following:
(1) written permission from the client or the client's legal guardian to manage the client's money;
(2) the reasons the license holder is to manage the client's money; and
(3) a complete record of the use of the client's money and reconciliation of the account.
Subd. 5.
Service termination plan.
The license holder, in conjunction with the county agency, shall establish a service termination plan that specifies how independent living assistance services will be terminated and the actions to be performed by the involved agencies, including necessary referrals for other ongoing services.
Subd. 6.
Place of residence provided by program.
When a client's place of residence is provided by the license holder as part of the independent living assistance program, the place of residence is not subject to separate licensure.
Subd. 7.
General licensing requirements apply.
In addition to the requirements of this section, providers of independent living assistance are subject to general licensing requirements of this chapter.
245C.02 DEFINITIONS.
Subd. 9.
Contractor.
"Contractor" means any individual, regardless of employer, who is providing program services for hire under the control of the provider.
Subd. 14b.
Public law background study.
"Public law background study" means a background study conducted by the commissioner pursuant to section 245C.032.
245C.031 BACKGROUND STUDY; ALTERNATIVE BACKGROUND STUDIES.
Subd. 5.
Guardians and conservators.
(a) The commissioner shall conduct an alternative background study of:
(1) every court-appointed guardian and conservator, unless a background study has been completed of the person under this section within the previous five years. The alternative background study shall be completed prior to the appointment of the guardian or conservator, unless a court determines that it would be in the best interests of the ward or protected person to appoint a guardian or conservator before the alternative background study can be completed. If the court appoints the guardian or conservator while the alternative background study is pending, the alternative background study must be completed as soon as reasonably possible after the guardian or conservator's appointment and no later than 30 days after the guardian or conservator's appointment; and
(2) a guardian and a conservator once every five years after the guardian or conservator's appointment if the person continues to serve as a guardian or conservator.
(b) An alternative background study is not required if the guardian or conservator is:
(1) a state agency or county;
(2) a parent or guardian of a proposed ward or protected person who has a developmental disability if the parent or guardian has raised the proposed ward or protected person in the family home until the time that the petition is filed, unless counsel appointed for the proposed ward or protected person under section 524.5-205, paragraph (d); 524.5-304, paragraph (b); 524.5-405, paragraph (a); or 524.5-406, paragraph (b), recommends a background study; or
(3) a bank with trust powers, a bank and trust company, or a trust company, organized under the laws of any state or of the United States and regulated by the commissioner of commerce or a federal regulator.
Subd. 6.
Guardians and conservators; required checks.
(a) An alternative background study for a guardian or conservator pursuant to subdivision 5 shall include:
(1) criminal history data from the Bureau of Criminal Apprehension and other criminal history data obtained by the commissioner of human services;
(2) data regarding whether the person has been a perpetrator of substantiated maltreatment of a vulnerable adult under section 626.557 or a minor under chapter 260E. If the subject of the study has been the perpetrator of substantiated maltreatment of a vulnerable adult or a minor, the commissioner must include a copy of the public portion of the investigation memorandum under section 626.557, subdivision 12b, or the public portion of the investigation memorandum under section 260E.30. The commissioner shall provide the court with information from a review of information according to subdivision 7 if the study subject provided information that the study subject has a current or prior affiliation with a state licensing agency;
(3) criminal history data from a national criminal history record check as defined in section 245C.02, subdivision 13c; and
(4) state licensing agency data if a search of the database or databases of the agencies listed in subdivision 7 shows that the proposed guardian or conservator has held a professional license directly related to the responsibilities of a professional fiduciary from an agency listed in subdivision 7 that was conditioned, suspended, revoked, or canceled.
(b) If the guardian or conservator is not an individual, the background study must be completed of all individuals who are currently employed by the proposed guardian or conservator who are responsible for exercising powers and duties under the guardianship or conservatorship.
Subd. 7.
Guardians and conservators; state licensing data.
(a) Within 25 working days of receiving the request for an alternative background study of a guardian or conservator, the commissioner shall provide the court with licensing agency data for licenses directly related to the responsibilities of a guardian or conservator if the study subject has a current or prior affiliation with the:
(1) Lawyers Responsibility Board;
(2) State Board of Accountancy;
(3) Board of Social Work;
(4) Board of Psychology;
(5) Board of Nursing;
(6) Board of Medical Practice;
(7) Department of Education;
(8) Department of Commerce;
(9) Board of Chiropractic Examiners;
(10) Board of Dentistry;
(11) Board of Marriage and Family Therapy;
(12) Department of Human Services;
(13) Peace Officer Standards and Training (POST) Board; and
(14) Professional Educator Licensing and Standards Board.
(b) The commissioner and each of the agencies listed above, except for the Department of Human Services, shall enter into a written agreement to provide the commissioner with electronic access to the relevant licensing data and to provide the commissioner with a quarterly list of new sanctions issued by the agency.
(c) The commissioner shall provide to the court the electronically available data maintained in the agency's database, including whether the proposed guardian or conservator is or has been licensed by the agency and whether a disciplinary action or a sanction against the individual's license, including a condition, suspension, revocation, or cancellation, is in the licensing agency's database.
(d) If the proposed guardian or conservator has resided in a state other than Minnesota during the previous ten years, licensing agency data under this section shall also include licensing agency data from any other state where the proposed guardian or conservator reported to have resided during the previous ten years if the study subject has a current or prior affiliation to the licensing agency. If the proposed guardian or conservator has or has had a professional license in another state that is directly related to the responsibilities of a guardian or conservator from one of the agencies listed under paragraph (a), state licensing agency data shall also include data from the relevant licensing agency of the other state.
(e) The commissioner is not required to repeat a search for Minnesota or out-of-state licensing data on an individual if the commissioner has provided this information to the court within the prior five years.
(f) The commissioner shall review the information in paragraph (c) at least once every four months to determine whether an individual who has been studied within the previous five years:
(1) has any new disciplinary action or sanction against the individual's license; or
(2) did not disclose a prior or current affiliation with a Minnesota licensing agency.
(g) If the commissioner's review in paragraph (f) identifies new information, the commissioner shall provide any new information to the court.
245C.032 PUBLIC LAW BACKGROUND STUDIES.
Subdivision 1.
Public law background studies.
(a) Notwithstanding all other sections of chapter 245C, the commissioner shall conduct public law background studies exclusively in accordance with this section. The commissioner shall conduct a public law background study under this section for an individual having direct contact with persons served by a licensed sex offender treatment program under chapters 246B and 253D.
(b) All terms in this section shall have the definitions provided in section 245C.02.
(c) The commissioner shall conduct public law background studies according to the following:
(1) section 245C.04, subdivision 1, paragraphs (a), (b), (d), (g), (h), and (i), subdivision 4a, and subdivision 7;
(2) section 245C.05, subdivision 1, paragraphs (a) and (d), subdivisions 2, 2c, and 2d, subdivision 4, paragraph (a), clauses (1) and (2), subdivision 5, paragraphs (b) to (f), and subdivisions 6 and 7;
(3) section 245C.051;
(4) section 245C.07, paragraphs (a), (b), (d), and (f);
(5) section 245C.08, subdivision 1, paragraph (a), clauses (1) to (5), paragraphs (b), (c), (d), and (e), subdivision 3, and subdivision 4, paragraphs (a), (c), (d), and (e);
(6) section 245C.09, subdivisions 1 and 2;
(7) section 245C.10, subdivision 9;
(8) section 245C.13, subdivision 1, and subdivision 2, paragraph (a), and paragraph (c), clauses (1) to (3);
(9) section 245C.14, subdivisions 1 and 2;
(10) section 245C.15;
(11) section 245C.16, subdivision 1, paragraphs (a), (b), (c), and (f), and subdivision 2, paragraphs (a) and (b);
(12) section 245C.17, subdivision 1, subdivision 2, paragraph (a), clauses (1) to (3), clause (6), item (ii), subdivision 3, paragraphs (a) and (b), paragraph (c), clauses (1) and (2), items (ii) and (iii), paragraph (d), clauses (1) and (2), item (ii), and paragraph (e);
(13) section 245C.18, paragraph (a);
(14) section 245C.19;
(15) section 245C.20;
(16) section 245C.21, subdivision 1, subdivision 1a, paragraph (c), and subdivisions 2, 3, and 4;
(17) section 245C.22, subdivisions 1, 2, and 3, subdivision 4, paragraphs (a) to (c), subdivision 5, paragraphs (a), (b), and (d), and subdivision 6;
(18) section 245C.23, subdivision 1, paragraphs (a) and (b), and subdivision 2, paragraphs (a) to (c);
(19) section 245C.24, subdivision 2, paragraph (a);
(20) section 245C.25;
(21) section 245C.27;
(22) section 245C.28;
(23) section 245C.29, subdivision 1, and subdivision 2, paragraphs (a) and (c);
(24) section 245C.30, subdivision 1, paragraphs (a) and (d), and subdivisions 3 to 5;
(25) section 245C.31; and
(26) section 245C.32.
Subd. 2.
Classification of public law background study data; access to information.
All data obtained by the commissioner for a background study completed under this section shall be classified as private data.
245C.30 VARIANCE FOR A DISQUALIFIED INDIVIDUAL.
Subd. 1a.
Public law background study variances.
For a variance related to a public law background study conducted under section 245C.032, the variance shall state the services that may be provided by the disqualified individual and state the conditions with which the license holder or applicant must comply for the variance to remain in effect. The variance shall not state the reason for the disqualification.
245C.301 NOTIFICATION OF SET-ASIDE OR VARIANCE.
(a) Except as provided under paragraphs (b) and (c), if required by the commissioner, family child care providers and child care centers must provide a written notification to parents considering enrollment of a child or parents of a child attending the family child care or child care center if the program employs or has living in the home any individual who is the subject of either a set-aside or variance.
(b) Notwithstanding paragraph (a), family child care license holders are not required to disclose that the program has an individual living in the home who is the subject of a set-aside or variance if:
(1) the household member resides in the residence where the family child care is provided;
(2) the subject of the set-aside or variance is under the age of 18 years; and
(3) the set-aside or variance relates to a disqualification under section 245C.15, subdivision 4, for a misdemeanor-level theft crime as defined in section 609.52.
(c) The notice specified in paragraph (a) is not required when the period of disqualification in section 245C.15, subdivisions 2 to 4, has been exceeded.
256.9685 ESTABLISHMENT OF INPATIENT HOSPITAL PAYMENT SYSTEM.
Subd. 1c.
Judicial review.
A hospital, physician, advanced practice registered nurse, or physician assistant aggrieved by an order of the commissioner under subdivision 1b may appeal the order to the district court of the county in which the physician, advanced practice registered nurse, physician assistant, or hospital is located by:
(1) serving a written copy of a notice of appeal upon the commissioner within 30 days after the date the commissioner issued the order; and
(2) filing the original notice of appeal and proof of service with the court administrator of the district court. The appeal shall be treated as a dispositive motion under the Minnesota General Rules of Practice, rule 115. The district court scope of review shall be as set forth in section 14.69.
Subd. 1d.
Transmittal of record.
Within 30 days after being served with the notice of appeal, the commissioner shall transmit to the district court the original or certified copy of the entire record considered by the commissioner in making the final agency decision. The district court shall not consider evidence that was not included in the record before the commissioner.
256B.011 POLICY FOR CHILDBIRTH AND ABORTION FUNDING.
Between normal childbirth and abortion it is the policy of the state of Minnesota that normal childbirth is to be given preference, encouragement and support by law and by state action, it being in the best interests of the well being and common good of Minnesota citizens.
256B.40 SUBSIDY FOR ABORTIONS PROHIBITED.
No medical assistance funds of this state or any agency, county, municipality or any other subdivision thereof and no federal funds passing through the state treasury or the state agency shall be authorized or paid pursuant to this chapter to any person or entity for or in connection with any abortion that is not eligible for funding pursuant to sections 256B.02, subdivision 8, and 256B.0625.
256B.69 PREPAID HEALTH PLANS.
Subd. 5c.
Medical education and research fund.
(a) The commissioner of human services shall transfer each year to the medical education and research fund established under section 62J.692, an amount specified in this subdivision. The commissioner shall calculate the following:
(1) an amount equal to the reduction in the prepaid medical assistance payments as specified in this clause. After January 1, 2002, the county medical assistance capitation base rate prior to plan specific adjustments is reduced 6.3 percent for Hennepin County, two percent for the remaining metropolitan counties, and 1.6 percent for nonmetropolitan Minnesota counties. Nursing facility and elderly waiver payments and demonstration project payments operating under subdivision 23 are excluded from this reduction. The amount calculated under this clause shall not be adjusted for periods already paid due to subsequent changes to the capitation payments;
(2) beginning July 1, 2003, $4,314,000 from the capitation rates paid under this section;
(3) beginning July 1, 2002, an additional $12,700,000 from the capitation rates paid under this section; and
(4) beginning July 1, 2003, an additional $4,700,000 from the capitation rates paid under this section.
(b) This subdivision shall be effective upon approval of a federal waiver which allows federal financial participation in the medical education and research fund. The amount specified under paragraph (a), clauses (1) to (4), shall not exceed the total amount transferred for fiscal year 2009. Any excess shall first reduce the amounts specified under paragraph (a), clauses (2) to (4). Any excess following this reduction shall proportionally reduce the amount specified under paragraph (a), clause (1).
(c) Beginning September 1, 2011, of the amount in paragraph (a), the commissioner shall transfer $21,714,000 each fiscal year to the medical education and research fund.
(d) Beginning September 1, 2011, of the amount in paragraph (a), following the transfer under paragraph (c), the commissioner shall transfer to the medical education research fund $23,936,000 in fiscal years 2012 and 2013 and $49,552,000 in fiscal year 2014 and thereafter.
256I.03 DEFINITIONS.
Subd. 6.
Medical assistance room and board rate.
"Medical assistance room and board rate" means an amount equal to 81 percent of the federal poverty guideline for a single individual living alone in the community less the medical assistance personal needs allowance under section 256B.35. For the purposes of this section, the amount of the room and board rate that exceeds the medical assistance room and board rate is considered a remedial care cost. A remedial care cost may be used to meet a spenddown obligation under section 256B.056, subdivision 5. The medical assistance room and board rate is to be adjusted on the first day of January of each year.
261.28 SUBSIDY FOR ABORTIONS PROHIBITED.
No funds of this state or any subdivision thereof administered under this chapter shall be authorized for or in connection with any abortion that is not eligible for funding pursuant to sections 256B.02, subdivision 8, and 256B.0625.
393.07 POWERS AND DUTIES.
Subd. 11.
Abortion services; policy and powers.
In keeping with the public policy of Minnesota to give preference to childbirth over abortion, Minnesota local social services agencies shall not provide any medical assistance grant or reimbursement for any abortion not eligible for funding pursuant to sections 256B.02, subdivision 8, and 256B.0625.
Repealed Minnesota Rule: UES2995-2
4615.3600 REPORTS TO THE COMMISSIONER OF HEALTH.
Subpart 1.
Statistical reports.
Each ambulatory facility shall submit a written compilation of statistical data quarterly to the commissioner of health on such forms and in such manner as the commissioner may prescribe.
Subp. 2.
Reporting terminations.
An ambulatory facility shall report all pregnancy terminations performed by its staff as follows:
A.
By the tenth of each month all pregnancy terminations performed in the ambulatory facility during the preceding month shall be reported on forms prescribed by the commissioner which shall include but not be limited to the following items:
B.
All surgery-related or anesthesia-related complications which result in morbidity or death of a patient shall be reported in writing to the commissioner within 15 days from the notification to the ambulatory facility of the morbidity or death of the patient.
C.
The commissioner shall ensure and maintain confidentiality of all individual pregnancy termination records.
4640.1500 LABORATORY SERVICE.
Subp. 2.
Personnel.
A physician shall have responsibility for the supervision of the laboratory. The laboratory personnel shall be qualified by education, training, and experience for the type of service performed.
It is recommended that this physician be a clinical pathologist.
Subp. 3.
Facilities and equipment.
Facilities and equipment for the performance of routine clinical diagnostic procedures and other laboratory techniques shall be adequate for the services provided.
Subp. 4.
Tissue examination.
Tissue removed at operation or autopsy shall be examined by a competent pathologist and the report of this examination shall be made a part of the patient's record.
4640.1600 X-RAY SERVICE.
Subp. 2.
Personnel.
A physician shall have responsibility for the supervision of the X-ray service. The X-ray personnel shall be qualified by education, training, and experience for the type of service performed.
It is recommended that this physician be a radiologist.
Subp. 3.
Facilities and equipment.
Diagnostic and therapeutic X-ray facilities shall be adequate for the services provided. Protection against radiation hazards shall be provided for the patients, operators, and other personnel.
4640.1700 PATIENT ROOMS.
Subpart 1.
Bedrooms.
All bedrooms used for patients shall be outside rooms, dry, well ventilated, naturally lighted, and otherwise suitable for occupancy. Each bedroom shall have direct access to a corridor. Rooms extending below ground level shall not be used as bedrooms for patients, except that any patient bedroom in use prior to the effective date of these rules may be continued provided it does not extend more than three feet below ground level.
Subp. 2.
Rooms used for patients.
No patient shall at any time be admitted for regular bed care to any room other than one regularly designed as a patient room or ward, except in case of emergency and then only as a temporary measure.
Subp. 3.
Placement of beds.
Patients' beds shall not be placed in corridors nor shall furniture or equipment be kept in corridors except in the process of moving from one room to another. There shall be a space of at least three feet between beds and sufficient space around the bed to facilitate nursing care and to accommodate the necessary equipment for care. Beds shall be located to avoid drafts or other discomforts to patients.
Subp. 4.
Window area.
The window area of each bedroom shall equal at least one-eighth of the total floor area. The minimum floor area shall be at least 100 square feet in single bedrooms and at least 80 square feet per bed in multibed rooms. All hospitals in operation as of the effective date of these rules shall comply with the requirements of this subpart to the extent possible, but nothing contained herein shall be so construed as to require major alterations by such hospitals nor shall a license be suspended or revoked for an inability to comply fully with this subpart.
4640.1800 EQUIPMENT FOR PATIENT ROOMS.
The following items shall be provided for each patient unless clinically contraindicated:
A.
a comfortable, hospital-type bed, a clean mattress, waterproof sheeting or pad, pillows, and necessary covering. Clean bedding, towels, washcloths, bath blankets, and other necessary supplies shall be kept on hand for use at all times;
C.
a locker or closet for storage of clothing. Where one closet is used for two or more persons, provisions shall be made for separation of patients' clothing;
F.
a device for signaling attendants which shall be kept in working order at all times, except in psychiatric and pediatric units where an emergency call should be available in each patient's room for the use of the nurse;
G.
hand-washing facilities located in the room or convenient to the room for the use of patients and personnel. It is recommended that these be equipped with gooseneck spouts and wrist-action controls;
I.
individual bedpans, wash basins, emesis basins, and mouthwash cups shall be provided for each patient confined to bed. Such utensils shall be sterilized before use by any other patient.
4640.1900 NURSES' STATION.
There shall be one nurses' station provided for each nursing unit. Each station shall be conveniently located for patient service and observation of signals. It shall have a locked, well-illuminated medicine cabinet. Where narcotics are kept on the nursing station, a separate, locked, permanently secured cabinet for narcotics shall be provided. Adequate lighting, space for keeping patients' charts, and for personnel to record and chart shall be provided.
4640.2000 UTILITY ROOMS.
There shall be at least one conveniently located, well-illuminated, and ventilated utility room for each nursing unit. Such room shall provide adequate space and facilities for the emptying, cleaning, sterilizing, and storage of equipment. Bathtubs or lavatories or laundry trays shall not be used for these purposes. A segregation of clean and dirty activities shall be maintained.
It is recommended that a separate subutility room be provided for the exclusive use of maternity patients when other patients are housed on the same floor.
4640.2100 LINEN CLOSET.
A linen closet or linen supply cupboard shall be provided convenient to the nurses' station.
4640.2200 SUPPLIES AND EQUIPMENT.
Supplies and equipment for medical and nursing care shall be provided according to the type of patients accepted. Storage areas shall be provided for supplies and equipment. A separate enclosed space shall be provided and identified for the storage of sterile supplies. Sterile supplies and equipment for the administration of blood and intravenous or subcutaneous solutions shall be readily available. Acceptable arrangements shall be made for the provision of whole blood whenever indicated.
4640.2300 ISOLATION FACILITIES.
A room, or rooms, equipped for the isolation of cases or suspected cases of communicable disease shall be provided. Policies and procedures for the care of infectious patients including the handling of linens, utensils, dishes, and other supplies and equipment shall be established.
4640.2400 SURGICAL DEPARTMENT.
Subpart 1.
Areas to be provided.
All hospitals providing for the surgical care of patients shall have an operating room or rooms, scrub-up facilities, it is recommended that these be located just outside the operating room, cleanup facilities, and space for the storage of surgical supplies and instruments. The surgical suite shall be located to prevent routine traffic through it to any other part of the hospital. It is recommended that the surgical and obstetrical suites be entirely separate.
Subp. 2.
Operating room.
The operating room shall be of sufficient size to accommodate the personnel and equipment needed.
Subp. 3.
Illumination.
There shall be satisfactory illumination of the operative field as well as general illumination.
Subp. 4.
Sterilizing facilities.
Adequate work space, sterilizing space, and sterile storage space shall be provided. Sterilizers and autoclaves of the proper type and necessary capacity for the sterilization of utensils, instruments, dressings, water, and other solutions shall be provided and maintained in an operating condition. Special precautions shall be taken so that sterile supplies are readily identifiable as such and are completely separated from unsterile supplies. A central sterilizing and supply room is recommended.
Provision of sterile water in flasks is recommended.
4640.2500 ANESTHESIA.
Subpart 1.
Administration.
Anesthesia shall be administered by a person adequately trained and competent in anesthesia administration, or under the close supervision of a physician.
Subp. 2.
Equipment.
Suitable equipment for the administration of the type of anesthesia used shall be available. Where conductive flooring is installed in anesthetizing areas, all equipment shall have safety features as defined in Part II of Standard No. 56, issued in May 1954, entitled Recommended Safe Practice for Hospital Operating Rooms by the National Fire Protection Association, 60 Batterymarch Street, Boston, Massachusetts, which part of said standard is hereby adopted by the commissioner of health with the same force and effect as if the same were fully set forth in and written as part of this subpart.
4640.2600 OBSTETRICAL DEPARTMENT.
Subpart 1.
Areas to be provided.
Hospitals providing for the obstetrical care of maternity patients shall have a delivery room or rooms, in the ratio of one for each 20 maternity beds, scrub-up facilities, cleanup facilities, and space for the storage of obstetrical supplies and instruments. The obstetrical suite shall be located to prevent routine traffic through it to any other part of the hospital.
It is recommended that these be located just outside the delivery room.
An exception is made for those hospitals, which on the effective date of these rules, provide a single room which is used for both surgery and delivery purposes. Scrub-up facilities, cleanup facilities, and space for the storage of supplies and instruments shall be provided in such hospitals. Precautions shall be taken to avoid cross-infection.
Subp. 2.
Delivery room.
The delivery room shall be of sufficient size to accommodate the personnel and equipment needed.
Subp. 3.
Illumination.
There shall be satisfactory illumination of the delivery field as well as general illumination.
Subp. 4.
Labor beds.
One labor bed for each ten maternity beds or fraction thereof shall be provided in a labor room or rooms adjacent to or in the delivery suite unless the patient's own room is used for labor. It is recommended that the labor room be acoustically treated and provided with a toilet and lavatory.
Subp. 5.
Accommodations.
Maternity patients shall not be placed in rooms with other than maternity patients.
Subp. 6.
Minimum equipment requirements for delivery room.
The following shall be provided in the delivery room:
B.
a source of oxygen with a mechanism for controlling the concentration of oxygen and with a suitable device for administering oxygen to the infant;
C.
a safe and suitable type of suction device for cleaning the infant's upper respiratory tract of mucus and other fluid;
D.
a properly heated bassinet for reception of the newborn infant. This shall include no hazardous electrical equipment;
G.
a device as well as an established procedure for easy and positive identification of the infant before removal from the delivery room. This shall be of a type which cannot be inadvertently removed during routine care of the infant; and
H.
sterile supplies and equipment for the administration of blood and intravenous or subcutaneous solutions shall be readily available. Acceptable arrangements shall be made for the provision of the whole blood whenever indicated.
Subp. 7.
Obstetrical isolation facilities.
Maternity patients with infection, fever, or other conditions or symptoms which may constitute a hazard to other maternity patients shall be isolated immediately in a separate room which is properly equipped for isolation in an area removed from the obstetrical department.
4640.2700 NURSERY DEPARTMENT.
Subpart 1.
Newborn nursery.
Each hospital with a maternity service shall provide at least one newborn nursery for the exclusive use of well infants delivered within the institution. The number of bassinets provided shall be at least equal to the number of maternity beds. Each nursery shall be provided with a lavatory with gooseneck spout and other than hand-operated faucets.
It is recommended that each newborn nursery be limited to 12 bassinets. An exit door from the nursery into the corridor is recommended for emergency use.
Subp. 2.
Nursery space of new hospitals.
In hospitals constructed after the effective date of these rules, the total nursery space, exclusive of the workroom, shall provide a floor area of at least 24 square feet for each bassinet, with a distance of at least two feet between each bassinet and an aisle space of at least three feet.
Subp. 3.
Nursery space of existing hospitals.
Hospitals operating as of the effective date of these rules shall comply with subpart 2, to the extent possible, but no hospital shall have a nursery area which provides less than 18 inches between each bassinet and an aisle space of at least three feet, exclusive of the workroom or work area.
Subp. 4.
Bassinet.
Each bassinet shall be mounted on a single stand and be removable to facilitate cleaning.
Subp. 5.
Observation window.
An observation window shall be installed between the corridor and nursery for the viewing of infants.
Subp. 6.
Incubators.
Each nursery department shall have one or more incubators whereby temperature, humidity, and oxygen can be controlled and measured.
Subp. 7.
Premature nursery.
A separate premature nursery and workroom are recommended for hospitals with 25 or more maternity beds on the basis of 30 square feet per incubator and a maximum of six incubators per nursery.
It is recommended that the oxygen concentration be checked by measurement with an oxygen analyzer at least every eight hours or that an incubator-attached, minus 40 percent oxygen concentration limiting device be used.
Subp. 8.
Examination and workroom.
An adjoining examination and workroom shall be provided for each nursery or between each two nurseries. The workroom shall be of adequate size to provide facilities necessary to prepare personnel for work in the nursery, for the examination and treatment of infants by physicians, for charting, for storage of nursery linen, for disposal of soiled linen, for storage and dispensing of feedings, and for initial rinsing of bottles and nipples. Each workroom shall be provided with a scrub-up sink having foot, knee, or elbow action controls; counter with counter sink having a gooseneck spout and other than hand-operated controls.
Hospitals operating as of the effective date of these rules shall comply with regulation subpart 2, to the extent possible, but if a separate examination and workroom is not provided, there shall be a segregated examination and work area in the nursery. The work area shall be of adequate size and provide the facilities and equipment necessary to prepare personnel for work in the nursery, for the examination and treatment of infants by physicians, for storage of nursery linen, and for the dispensing of feedings.
Subp. 9.
Formula preparation.
Space and equipment for cleanup, preparation, and refrigeration to be used exclusively for infant formulas shall be provided apart from care areas and apart from other food service areas. A registered nurse or a dietitian shall be responsible for the formula preparation. A separate formula room is recommended; terminal sterilization is recommended.
Subp. 10.
Suspect nursery or room.
There shall be a room available for the care of newborn infants suspected of having a communicable disease and for newborn infants admitted from the outside. Where a suspect nursery is available, it shall provide 40 square feet per bassinet with a maximum of six bassinets and have a separate workroom. Isolation technique shall be used in the suspect nursery.
Subp. 11.
Isolation.
Infants found to have an infectious condition shall be transferred promptly to an isolation area elsewhere in the hospital.
4640.2800 PREPARATION AND SERVING OF FOOD.
Subpart 1.
Supervision.
The dietary department shall be under the supervision of a trained dietitian or other person experienced in the handling, preparation, and serving of foods; in the preparation of special diets; and in the supervision and management of food service personnel. This person shall be responsible for compliance with safe practices in food service and sanitation.
Subp. 2.
Kitchen.
There shall be sufficient space and equipment for the proper preparation and serving of food for both patients and personnel. The kitchen shall be used for no other purpose than activities connected with the dietary service and the washing and storage of dishes and utensils. A dining room or rooms shall be provided for personnel.
It is recommended that a separate dishwashing area or room be provided.
Subp. 3.
Food.
Food for patients and employees shall be nutritious, free from contamination, properly prepared, palatable, and easily digestible. A file of the menus served shall be maintained for at least 30 days.
Subp. 4.
The serving and storage of food.
All foods shall be stored and served so as to be protected from dust, flies, rodents, vermin, unnecessary handling, overhead leakage, and other means of contamination. All readily perishable food shall be stored in clean refrigerators at temperatures of 50 degrees Fahrenheit or lower. Each refrigerator shall be equipped with a thermometer.
Subp. 5.
Milk and ice.
All fluid milk shall be procured from suppliers licensed by the commissioner of agriculture or pasteurized in accordance with the requirements prescribed by the commissioner of agriculture. The milk shall be dispensed directly from the container in which it was packaged at the pasteurization plant. Ice used in contact with food or drink shall be obtained from a source acceptable to the commissioner of health, and handled and dispensed in a sanitary manner.
Subp. 6.
Hand-washing facilities.
Hand-washing facilities with hot and cold running water, soap, and individual towels shall be accessible for the use of all food handlers and so located in the kitchen to permit direct observation by the supervisor. No employee shall resume work after using the toilet room without first washing his or her hands.
4640.2900 DISHWASHING FACILITIES AND METHODS.
Subp. 2.
Manual.
A three-compartment sink or equivalent of a size adequate to permit the introduction of long-handled wire baskets of dishes shall be provided. There shall be a sufficient number of baskets to hold the dishes used during the peak load for a period sufficient to permit complete air drying. Water-heating equipment capable of maintaining the temperature of the water in the disinfection compartment at 170 degrees Fahrenheit shall be provided. Drain boards shall be part of the three-compartment sink and adequate space shall be available for drainage. The dishes shall be washed in the first compartment of the sink with warm water containing a suitable detergent; rinsed in clear water in the second compartment; and disinfected by complete immersion in the third compartment for at least two minutes in water at a temperature not lower than 170 degrees Fahrenheit. Temperature readings shall be determined by a thermometer. Dishes and utensils shall be air-dried.
Subp. 3.
Mechanical.
Water pressure in the lines supplying the wash and rinse section of the dishwashing machine shall not be less than 15 pounds per square inch nor more than 30 pounds per square inch. The rinse water shall be at a temperature not lower than 180 degrees Fahrenheit at the machine. The machines shall be equipped with thermometers which will indicate accurately the temperature of the wash water and rinse water. Dishes and utensils shall be air-dried. New dishwashing machines shall conform to sections 1, 2, 3, 4, and 6 on pages 7-28 inclusive, of Standard No. 3 issued in May 1953, entitled Spray-Type Dishwashing Machines by the National Sanitation Foundation, Ann Arbor, Michigan, which sections of such standard are hereby adopted by the commissioner of health with the same force and effect as if the same were fully set forth in and written as part of this subpart.
4640.3000 VENTILATION.
All rooms in which food is stored, prepared, or served or in which utensils are washed shall be well ventilated. The cooking area shall be ventilated to control temperatures, smoke, and odors.
4640.3100 GARBAGE DISPOSAL.
Garbage shall be disposed of in a manner acceptable to the commissioner of health. When stored, it shall be retained in watertight metal cans equipped with tightly fitting metal covers. All containers for the collection of garbage and refuse shall be kept in a sanitary condition.
4640.3200 TOILET AND LAVATORY FACILITIES.
Conveniently located toilet and lavatory facilities shall be provided for employees engaged in food handling. Toilet rooms shall not open directly into any room in which food is prepared or utensils are handled or stored.
4640.3300 WATER FACILITIES.
Subpart 1.
Water supply.
The water supply shall be of safe sanitary quality, suitable for use, and shall be obtained from a water supply system, the location, construction, and operation of which are acceptable to the commissioner of health. Hot water of a temperature required for its specific use shall be available as needed. For the protection of patients and personnel, thermostatically controlled valves shall be installed where indicated.
Subp. 2.
Sewage disposal.
Sewage shall be discharged into a municipal sewerage system where such a system is available; otherwise, the sewage shall be collected, treated, and disposed of in a sewage disposal system which is acceptable to the commissioner of health.
Subp. 3.
Plumbing.
The plumbing and drainage, or other arrangements for the disposal of excreta and wastes, shall be in accordance with the rules of the commissioner of health and with the provisions of the Minnesota Plumbing Code, chapter 4714.
Subp. 4.
Toilets.
Toilets shall be conveniently located and provided in number ample for use according to the number of patients and personnel of both sexes. The minimum requirement is one toilet for each eight patients or fraction thereof. It is recommended that separate toilet and bathing facilities be provided for maternity patients.
Subp. 5.
Hand-washing facilities.
Hand-washing facilities of the proper type in each instance shall be readily available for physicians, nurses, and other personnel. Lavatories shall be provided in the ratio of at least one lavatory for each eight patients or fraction thereof. Lavatories shall be readily accessible to all toilets. Individual towels and soap shall be available at all times. The use of the common towel is prohibited. It is recommended that each patient's room be equipped with a lavatory.
Subp. 6.
Bathing facilities.
A bathtub or shower shall be provided in the ratio of at least one tub or shower for each 30 patients or fraction thereof. It is recommended that separate toilet and bathing facilities be provided for maternity patients.
4640.3400 SCREENS.
Outside openings including doors and windows shall be properly screened or otherwise protected to prevent the entrance of flies, mosquitoes, and other insects.
4640.3500 PHYSICAL PLANT.
Subpart 1.
Safety.
The hospital structure and its equipment shall be kept in good repair and operated at all times with regard for the health, treatment, comfort, safety, and well-being of the patients and personnel. All dangerous areas and equipment shall be provided with proper guards and appropriate devices to prevent accidents. Elevators, dumbwaiters, and machinery shall be so constructed and maintained as to comply with the rules of the Division of Accident Prevention, Minnesota Department of Labor and Industry. All electrical wiring, appliances, fixtures, and equipment shall be installed to comply with the requirements of the Board of Electricity.
Subp. 2.
Fire protection.
Fire protection for the hospital shall be provided in accordance with the requirements of the state fire marshal. Approval by the state fire marshal of the fire protection of a hospital shall be a prerequisite for licensure.
Subp. 3.
Heating.
The heating system shall be capable of maintaining temperatures adequate for the comfort and protection of all patients at all times.
Subp. 4.
Incinerator.
An incinerator shall be provided for the safe disposal of infected dressings, surgical and obstetrical wastes, and other similar materials.
Subp. 5.
Laundry.
The hospital shall make provision for the proper laundering of linen and washable goods. Where linen is sent to an outside laundry, the hospital shall take reasonable precautions to see that contaminated linen is properly handled.
Subp. 7.
Lighting in hazardous areas.
All lighting and electrical fixtures including emergency lighting in operating rooms, delivery rooms, and spaces where explosive gases are used or stored shall comply with Part II of Standard No. 56, issued in May 1954, entitled Recommended Safe Practice for Hospital Operating Rooms, by the National Fire Protection Association, 60 Batterymarch Street, Boston, Massachusetts, which part of said standard is hereby adopted by the commissioner of health with the same force and effect as if the same were fully set forth in and written as part of this subpart.
Subp. 8.
Emergency lighting.
Safe emergency lighting equipment shall be provided and distributed so as to be readily available to personnel on duty in the event of a power failure. There shall be at least a battery operated lamp with vaporproof switch, in readiness at all times for use in the delivery and operating rooms.
It is recommended that an independent source of power be available for emergency lighting of surgical and obstetrical suites, exits, stairways, and corridors.
Subp. 9.
Stairways and ramps.
All stairways and ramps shall be provided with handrails on both sides and with nonskid treads.
Subp. 10.
General storage.
Space shall be provided for the storage of supplies and equipment. Corridors shall not be used as storage areas.
Subp. 11.
Telephones.
Adequate telephone service shall be provided in order to assure efficient service and operation of the institution and to summon help promptly in case of emergency.
Subp. 12.
Ventilation.
Kitchens, laundries, toilet rooms, and utility rooms shall be ventilated by windows or mechanical means to control temperatures and offensive odors. If ventilation is used in operating rooms, delivery rooms, or other anesthetizing areas, the system shall conform to the requirements of part 4645.3200.
Subp. 13.
Walls, floors, and ceilings.
Walls, floors, and ceilings shall be kept clean and in good repair at all times. They shall be of a type to permit good maintenance including frequent washings, cleaning, or painting.
4640.3600 STAFF.
Subpart 1.
Medical director or chief of staff.
There shall be a medical director or chief of staff who shall be a licensed physician with training and experience in psychiatry and who shall assume responsibility for the medical care rendered.
Subp. 2.
Medical and nursing staff.
An adequate medical staff shall be provided to assure optimum care of patients at all times. The director of the nursing service shall be a well-qualified, registered nurse with training and experience in psychiatric nursing. There shall be a sufficient number of nurses, psychiatric aides, and attendants under the director's supervision to assure optimum care of patients at all times.
Subp. 3.
Other staff.
The staff shall include a sufficient number of qualified physical and occupational therapists to provide rehabilitation services for the number of patients accommodated. The hospital shall make provisions in its staff organization for consultations in the specialized fields of medicine.
4640.3700 DENTAL SERVICE.
Provisions shall be made for dental service either within or outside the institution.
4640.3800 PROTECTION OF PATIENTS AND PERSONNEL.
Subpart 1.
Security.
Every reasonable precaution shall be taken for the security of patients and personnel. Drugs, narcotics, sharp instruments, and other potentially hazardous articles shall be inaccessible to patients.
Subp. 2.
Segregation of patients.
Patients with tuberculosis or other communicable disease shall be segregated.
Subp. 3.
Seclusion and restraints.
Patients shall not be placed in seclusion or mechanical restraints without the written order of the physician in charge unless, in the judgment of the supervisor in charge of the service, the safety and protection of the patient, hospital employees, or other patients require such immediate seclusion or restraint. Such seclusion or restraint shall not be continued beyond eight hours except by written or telephone order of the attending physician. Emergency orders given by telephone shall be reduced to writing immediately upon receipt and shall be signed by the staff member within 24 hours after the order is given. Such patient shall be under reasonable observation and care of a nurse or attendant at all times.
4640.3900 FLOOR AREA IN PATIENTS' ROOMS.
The following minimum areas shall be provided:
A.
psychiatric units and wards of general hospitals, and those units and wards of public and private mental hospitals where diagnosis and intensive treatment are provided, such as receiving, medical and surgical, tuberculosis, intensive treatment and rehabilitation, and units and wards for the acutely disturbed patient: parts 4640.1700 to 4640.2200 shall apply; and
B.
continued treatment areas for long-term patients: in hospitals constructed after the effective date of these rules, the minimum floor area shall be at least 80 square feet in single rooms and 60 square feet in multibed rooms; in dormitory areas, this may include the space devoted to aisles. All main traffic aisles shall be five feet in width except in large dormitories where the aisle serves ten or more patients, it shall be six feet in width.
All hospitals in operation as of the effective date of these rules shall comply with the requirements of this part to the extent possible.
Beds shall be placed at least three feet from adjacent beds except where partitions or other barriers separate beds or where two beds are placed foot-to-foot. Beds shall be so located as to avoid drafts and other discomforts to patients.
Whenever the patient's condition permits, each individual patient's area shall be equipped with a chair and a bedside cabinet. Adequate provision shall be made for the storage of patients' clothes and other personal possessions.
4640.4000 DINING ROOM.
A minimum of 12 square feet of dining room space shall be provided for each patient. Arrangements may be made for multiple seatings.
4640.4100 RECREATION AND DAYROOMS.
Space shall be provided for recreation and dayroom areas.
4640.4200 SPECIALIZED TREATMENT FACILITIES.
Space and equipment for physical, occupational, and recreational therapy shall be provided. Storage space for equipment shall be provided.
4640.4300 INSTITUTIONS FOR THE MENTALLY DEFICIENT AND EPILEPTIC.
Hospital sections in institutions for persons with developmental disabilities and eiplepsy shall comply with the applicable portions of the rules for general hospitals contained herein.
Parts 4640.3900, except for item A, 4640.4000, and 4640.4100 shall apply to the sections of these institutions other than the hospital sections. Hospital rules shall not apply to facilities for foster care licensed by the commissioner of human services nor to institutions that do not have hospital units.
4640.6100 STAFF.
Subpart 1.
Licensed physician.
A licensed physician with interest, training, and experience in the medical and physical rehabilitation of the chronically ill shall be responsible for the adequacy of the medical care rendered.
Subp. 2.
Medical and nursing staff.
An adequate medical staff shall be provided to assure optimum care of patients at all times. The director of the nursing service shall be a well-qualified, registered nurse with experience in rehabilitation nursing. There shall be a sufficient number of nurses and attendants under the director's supervision to assure optimum care of patients at all times.
Subp. 3.
Other staff.
The services of at least one qualified physical therapist and one qualified occupational therapist shall be available, preferably on a full-time basis. Additional therapists shall be provided to assure optimum care for the number of patients accommodated. There shall be an adequate number of medical social workers. Educational and vocational educational personnel shall be provided where indicated. The hospital shall make provisions in its staff organization for consultations in the specialized fields of medicine.
4640.6200 DENTAL SERVICE.
Provision shall be made for dental service either within or outside the institution.
4640.6300 DIAGNOSTIC AND TREATMENT FACILITIES AND SERVICES.
Laboratory and X-ray facilities and services as well as basal metabolism and electrocardiograph shall be provided unless available in an adjacent general hospital.
4640.6400 ROOMS IN THE HOSPITAL.
Subpart 1.
Dining room.
Every possible effort shall be made to encourage all patients to eat in a common dining room. A minimum of 15 square feet shall be provided for each ambulatory patient. Arrangements may be made for multiple seatings. Areas in dayrooms and solaria may be utilized for this purpose.
Subp. 2.
Dayroom or solarium.
Every possible effort shall be made to encourage all patients to utilize dayrooms, solaria, recreational and occupational therapy, and similar areas. A minimum of 25 square feet per patient shall be provided.
Subp. 3.
Specialized treatment facilities.
Space and equipment for physical, occupational, and recreational therapy shall be provided. Storage space for equipment shall be provided.
4645.0300 DESIGN AND CONSTRUCTION.
All design and construction shall conform to all applicable portions of parts 4645.0200 to 4645.5200 of these hospital rules.
4645.0400 COMPLIANCE.
All construction including exit lights and fire towers; heating, piping, ventilation, and air-conditioning; plumbing and drainage; electrical installations; elevators and dumbwaiters; refrigeration; kitchen equipment; laundry equipment; and gas piping shall be in strict compliance with all applicable state and local codes, ordinances, and rules not in conflict with the provisions contained in parts 4645.0200 to 4645.5200.
4645.0500 HOSPITALS OF LESS THAN 50 BEDS.
In hospitals of less than 50 beds, the size of the various departments will be generally smaller and will depend upon the requirements of the particular hospital. Some of the functions allotted separate spaces or rooms may be combined in such hospitals provided that the resulting plan will not compromise the best standards of medical and nursing practice. In other respects the rules as set forth herein, including the area requirements, shall apply.
4645.0600 ADMINISTRATION DEPARTMENT.
The administration department shall consist of a business office with information counter, administrator's office, medical record room, staff lounge, lobby, and public toilets for each sex. If over 100 beds, the following additional areas shall be provided: director of nurses' office, admitting office, library, conference, and board room.
It is recommended that the following be provided: a PBX board and night information for all hospitals; director of nurses' office in hospitals under 100 beds; medical social service room, and retiring room in hospitals over 100 beds.
4645.0700 ADJUNCT DIAGNOSTIC AND TREATMENT FACILITIES.
Subpart 1.
Laboratory.
Adequate facilities and equipment for the performance of routine clinical diagnostic procedures and other laboratory techniques in keeping with the services rendered by the hospital shall be provided. Approximately 4-1/2 square feet of floor space per patient bed shall be provided.
Subp. 2.
Basal metabolism and electrocardiography.
One room shall be provided for basal metabolism and electrocardiography in hospitals with 100 beds or more.
Subp. 3.
Recommended facilities.
It is recommended that these facilities, except for morgue and autopsy, be located convenient to both inpatients and outpatients.
It is recommended that space be provided for electrotherapy, hydrotherapy, massage, and exercise in hospitals with 100 beds or more.
Subp. 4.
Radiology.
Radiographic room or rooms with adjoining darkroom, toilet, dressing cubicles, and office shall be provided. Protection against radiation hazards shall be provided for the patients, operators, and other personnel. To assure adequate protection against radiation hazards, X-ray apparatus and protection shall be installed in accordance with the applicable standards prescribed in Handbook 41, issued March 30, 1949, entitled Medical X-ray Protection up to Two Million Volts and Handbook 50, issued May 9, 1952, entitled X-Ray Protection Design by the National Bureau of Standards, U.S. Department of Commerce, Superintendent of Documents, Washington 25, D.C., which standards are hereby adopted by the commissioner of health with the same force and effect as if the same were fully set forth in and written as part of this subpart.
Subp. 6.
Morgue and autopsy room.
A morgue and autopsy room shall be provided in hospitals with 100 beds or more. Where morgue and autopsy rooms are provided, they shall be properly equipped and ventilated and of sufficient size to allow for the performance of satisfactory pathological examinations. Definite arrangements for space and facilities for the performance of autopsies outside the hospital shall be made if the hospital does not have an autopsy room.
4645.0800 NURSING DEPARTMENT.
Subpart 1.
Patients' rooms.
All patients' rooms shall be outside rooms and have direct access to a hall. The window area shall not be less than one-eighth of the total floor area. No bedrooms shall be located below grade. Minimum room areas shall be 80 square feet per bed in rooms having two or more beds and 100 square feet in single rooms. No bedroom shall have more than four beds. Each bedroom or its adjoining toilet or bathroom shall have a lavatory equipped with gooseneck spout and wrist-action controls. A locker shall be provided for each patient.
Subp. 2.
Areas to be provided.
The following areas shall be provided in each nursing unit: nurses' station, utility room divided into dirty and clean areas, bedpan facilities, toilet facilities for each sex in a ratio of one toilet for each eight patients or fraction thereof, bathtubs or showers in a ratio of one tub or shower for each 30 patients or fraction thereof, linen and supply storage, and janitors' closet. Each nursing floor shall have a floor pantry and nurses' toilet room. Separate subutility, toilet, and bathing facilities shall be provided for the maternity section.
It is recommended that a stretcher alcove, treatment room, and solarium be provided.
A psychiatric or quiet room is recommended in general hospitals not providing a psychiatric unit.
Adjustments will be made where patients' rooms are provided with individual toilets.
Subp. 3.
Nurses' station.
Each nurses' station shall be conveniently located for patient service and observation of signals. It shall have a locked, well-illuminated medicine cabinet. Where narcotics are kept on the nursing station, a separate, locked, permanently secured cabinet for narcotics shall be provided. Adequate lighting, hand-washing facilities, space for keeping patients' charts, and for personnel to record and chart shall be provided. Refrigeration storage shall be provided for medications and biologics unless provided elsewhere.
Subp. 4.
Isolation suite.
One isolation suite shall be provided in each hospital unless a contagious disease nursing unit is available in the hospital. The isolation suite shall consist of one or more patients' rooms, each having an adjacent toilet equipped with bedpan lugs and spray attachment. Each suite shall have a subutility room equipped with utensil sterilizer, sink, and storage cabinets.
4645.0900 SURGICAL DEPARTMENT.
Subpart 1.
Location.
The surgical department shall be so located to prevent routine traffic through it to any other part of the hospital and completely separated from the obstetrical department.
Subp. 2.
The operating suite.
The operating suite shall consist of major operating room or rooms, each having an area of not less than 270 square feet with a minimum width of 15 feet; separate scrub-up area adjacent to operating room; cleanup room; storage areas for instruments, sterile supplies, and anesthesia equipment; and a janitors' closet. In hospitals consisting of 50 or more beds, a surgical supervisor's station, doctors' locker room and toilet, and nurses' locker room and toilet shall be provided. In hospitals of less than 50 beds, doctors' and nurses' locker and toilet rooms may be provided in a convenient location outside the operating and delivery suites to serve both units.
A stretcher alcove and a recovery (postanesthesia) room are recommended.
Subp. 3.
Central sterilizing and supply room.
A central sterilizing and supply room shall be provided and divided into work space, sterilizing space, and separate storage areas for sterile and unsterile supplies. Sterilizers and autoclaves for adequate sterilization of supplies and utensils shall be provided.
Provision of sterile water in flasks is recommended.
4645.1000 EMERGENCY ROOM.
An emergency room shall be provided separate from the operating and delivery suites.
4645.1100 OBSTETRICAL DEPARTMENT.
Subpart 1.
Location.
The obstetrical department shall be so located to prevent routine traffic through it to any other part of the hospital and completely separated from the surgical department. A combination classroom-parent teaching room is recommended in the obstetrical departments, outside the delivery suite.
Subp. 2.
The delivery suite.
The delivery suite shall consist of delivery room or rooms, each having an area of not less than 270 square feet with a minimum width of 15 feet; separate scrub-up area adjacent to delivery room; cleanup room; storage areas for instruments and sterile supplies; and a janitors' closet. In hospitals consisting of 50 or more beds, an obstetrical supervisor's station, doctors' locker room and toilet, and nurses' locker room and toilet shall be provided. In hospitals of less than 50 beds, doctors' and nurses' locker and toilet rooms may be provided in a convenient location outside the delivery and operating suites to serve both units. A stretcher alcove is recommended.
Subp. 4.
Labor room.
A labor room with a lavatory and an adjacent toilet shall be provided in a convenient location with respect to the delivery room. One labor bed shall be provided for each 10 maternity beds. The labor room shall be acoustically treated or so located to minimize the possibility of sounds reaching other patients.
4645.1200 NURSERY DEPARTMENT.
Subpart 1.
Size.
Each hospital providing a maternity service shall have a nursery department of sufficient size to accommodate the anticipated load.
Subp. 2.
Newborn nursery.
A minimum floor area of 24 square feet per bassinet shall be provided in each newborn nursery with not more than 12 bassinets in each nursery. A connecting examination and work room shall be provided.
A separate premature nursery and work room are recommended for hospitals with 25 or more maternity beds on the basis of 30 square feet per incubator and a maximum of six incubators per nursery.
Subp. 3.
Suspect nursery.
A suspect nursery with a separate connecting workroom shall be provided in hospitals of 50 beds or more. At least 40 square feet of floor area shall be provided for each bassinet with no more than six bassinets in each suspect nursery.
Subp. 4.
Formula room.
A formula room shall be provided in the nursery area or in the dietary department where adequate supervision can be provided. This room shall be used exclusively for the preparation of infant formulas. The formula room shall contain a lavatory with gooseneck spout and wrist-action controls, a two-compartment sink for washing and rinsing bottles and utensils, and adequate storage and counter space. The work space shall be divided into clean and dirty sections. Equipment shall be provided for sterilization. Refrigerated storage space sufficient for one day's supply of prepared formulas shall be provided in this room or in the nursery workroom. Terminal sterilization is recommended.
4645.1300 SERVICE DEPARTMENT.
Subpart 1.
Dietary facilities.
Dietary facilities shall consist of main kitchen with provision for the protected storage of clean dishes, utensils, and foodstuffs; day storage room; adequate refrigeration; dishwashing facilities; and the necessary space and provisions for the handling and disposal of garbage. A dietitian's office shall be provided in hospitals of 50 or more beds. Hand-washing facilities with hot and cold water, soap, and individual towels shall be accessible for the use of all food-service personnel and so located to permit direct observation by the supervisor. Dining space for personnel, allowing 12 square feet per person, shall be provided. This space may be designed for multiple seatings.
Subp. 2.
Laundry facilities.
Each hospital shall have a laundry of sufficient capacity to process a full seven days' laundry during the work week unless commercial or other laundry facilities are available. It shall include sorting area; processing area; and clean linen and sewing room separate from the laundry. The sewing room may be combined with the clean linen room in hospitals of less than 100 beds. Where no laundry is provided in the hospital, a soiled linen room and a clean linen and sewing room shall be provided.
Subp. 3.
Housekeeper's office.
A housekeeper's office shall be provided. This may be combined with the clean linen room in hospitals of less than 100 beds.
Subp. 4.
Mechanical facilities.
A boiler and pump room with engineers' space and maintenance shop shall be provided. In hospitals of more than 100 beds, separate areas for carpentry, painting, and plumbing shall be provided.
Shower and locker facilities are recommended.
Subp. 5.
Employees facilities.
Locker rooms with lockers, rest rooms, toilets, and showers for nurses and female help; and a locker room with lockers, toilets, and showers for male help shall be provided.
Subp. 6.
Storage.
Inactive record storage shall be provided. General storage of not less than 20 square feet per bed shall be provided. General storage shall be concentrated in one area in so far as possible.
4645.1400 CONTAGIOUS DISEASE NURSING UNIT.
When ten or more beds are provided for contagious disease, they shall be contained in a separate nursing unit. Each patient room shall have a view window from the corridor, a separate toilet, a lavatory in the room, and shall contain no more than two beds. Each nursing unit shall contain a nurses' station, utility room, nurses' work room, treatment room, scrub sinks conveniently located in the corridor, serving pantry with separate dishwashing room adjacent, doctors' locker space and gown room, nurses' locker spare and gown room, janitors' closet, and a storage closet.
Glazed partitions between beds and a stretcher alcove are recommended.
4645.1500 PEDIATRIC NURSING UNIT.
Where there are 16 or more pediatric beds a separate pediatric nursing unit shall be provided. Minimum room areas shall be 100 square feet in single rooms, 80 square feet per bed in rooms having two or more beds, and 40 square feet per bassinet in nurseries. Each nursing unit shall contain a nursery with bassinets in cubicles, isolation suite, treatment room, nurses' station with adjoining toilet room, utility room, floor pantry, play room or solarium, bath and toilet room with raised free-standing tub and 50 percent children's fixtures, bedpan facilities, janitors' closet, and a storage closet.
Glazed cubicles for each bed in multibed rooms, clear glazing between rooms and in corridor partitions, and a wheel chair and stretcher alcove are recommended.
4645.1600 PSYCHIATRIC NURSING UNIT.
Where a psychiatric nursing unit is provided, the principles of psychiatric security and safety shall be followed throughout. Layout and design shall be such that the patient will be under close observation and will not be afforded opportunity for hiding, escape, or suicide. Care shall be taken to avoid sharp projections, exposed pipes, fixtures, or heating elements to prevent injury by accident. Minimum room areas shall be 100 square feet in single rooms, 80 square feet per bed in rooms having two or more beds, and 25 square feet per patient in dayrooms. Each nursing unit shall contain a doctors' office, examination room, nurses' station, dayroom, pantry, dining room, utility room, bedpan facilities, toilet rooms for each sex, shower and bathroom, continuous tub room for disturbed patients, patients' personal laundry for women's wards only, patients' locker room, storage closet for therapy equipment, stretcher closet, linen closet, supply closet, and a janitors' closet.
4645.1700 ADMINISTRATION DEPARTMENT.
Where not available in an adjoining general hospital, the following facilities shall be provided in the administration department: a business office with information counter, telephone switchboard, cashiers' window, administrator's office, medical director's office, medical record room, medical social service office, combination conference room and doctors' lounge, lobby and waiting room, public toilets, and a locker room and toilets for personnel.
For efficiency and economy of operation, a chronic disease hospital is best located as an integral part or unit immediately adjacent to and operated in connection with a large, modern, well-equipped, and completely staffed acute general hospital. Essentially all of the services of the general hospital are necessary for the complete care of the chronic disease patient. The rehabilitation services and facilities of the chronic hospital should be readily available to the acute patient in need of such services and also available on an outpatient basis. The medical and nursing staff of the general hospital can also serve the chronic unit. Some of the basic services (food service, laundry, boiler plant, etc.) can be provided through the general hospital thus making construction and operational costs less expensive.
4645.1800 ADJUNCT DIAGNOSTIC AND TREATMENT FACILITIES.
Where not available in an adjoining general hospital, adjunct diagnostic and treatment facilities shall be provided.
4645.1900 SPECIALIZED TREATMENT FACILITIES.
Subpart 1.
Physical therapy.
Space and equipment shall be provided for electrotherapy, massage, hydrotherapy, and exercise. In the larger unit, an office shall be provided for the physical therapist and a conference room shall be provided near the physical therapy area.
Subp. 2.
Occupational therapy.
Space and equipment shall be provided for diversified occupational therapy work. An exhibit space shall be provided. In the larger unit, an office shall be provided for the occupational therapist.
4645.2000 SPECIAL SERVICE ROOMS.
Where not available in the adjoining general hospital, the following special service rooms shall be provided: eye, ear, nose, and throat room; dental facilities; doctors' office; and a treatment room which may also be used as an emergency operating room. Provision shall also be made for a nurses' office and a patients' waiting room and toilets.
4645.2100 NURSING DEPARTMENT.
A nursing unit shall not exceed 50 beds unless additional services and facilities are provided. No room shall have more than six beds and not more than three beds deep from the outside wall. A quiet room shall be provided. Room locations, areas, and equipment as specified for general hospitals shall apply. In addition to the requirements for the general hospital, the following shall be provided: bathtubs or showers in the ratio of one tub or shower for each 20 patients or fraction thereof; wheelchair parking area; treatment room, one for each two nursing units on a floor; dayrooms or solariums for each nursing floor providing 25 square feet per patient; a dining room with a minimum of 15 square feet for each ambulatory patient, which may be designed for multiple seatings; assembly room, capable of seating the entire ambulant population with ample space for wheelchairs, adjacent wash rooms and toilets adequate in size to accommodate wheelchairs; and projection facilities. Provision shall be made for beauty parlor and barber shop services.
4645.2200 SERVICE DEPARTMENT.
Subpart 1.
Kitchen area for preparation of special diets.
In addition to the requirements for the general hospital, adequate space in the main kitchen shall be provided for the preparation of special diets.
Subp. 2.
Storage.
In addition to the requirements for the general hospital, a patient's clothes storage room shall be provided. Adequate storage space shall be provided for reserve equipment.
4645.2300 SPACE ALLOWANCES FOR WHEELCHAIRS.
Space allowance shall be more generous than in other types of hospitals to allow for wheelchair traffic in such areas as dining rooms, recreation rooms, and toilets. Corridors shall be not less than eight feet wide with handrails on both sides. Water closet enclosures, urinals, showers, and tubs shall be easily accessible and provided with grab bars. Lavatories shall be of sufficient height to allow for use by wheelchair patients. Doorways shall not have raised thresholds. Ten-foot corridors are recommended. It is recommended that walls of corridors, toilet rooms, etc. be constructed of durable material to the level of the hand rails in order to withstand the impact of wheelchairs and heavy equipment. Adjustable height beds are recommended.
4645.2400 DETAILS AND FINISHES, GENERAL REQUIREMENTS FOR ALL HOSPITALS.
Subpart 1.
Ceilings.
The ceilings of the following areas shall have smooth, waterproof painted, glazed, or similar finishes: operating rooms, delivery rooms, sculleries, and kitchens. The ceilings of the following areas shall be acoustically treated: corridors in patient areas, nurses' stations, floor pantries, quiet rooms, and pediatric rooms. The ceiling of the labor room shall be acoustically treated unless it is located apart from the patient areas.
Ceiling heights shall be at least eight feet clear except for storage closets and other minor auxiliary rooms where they may be lower. Ceiling heights for laundry and kitchen shall be at least nine feet clear. Special equipment such as X-ray and surgical lights may require greater ceiling heights. Ceilings of boiler rooms located below occupied spaces shall be insulated or the temperatures otherwise controlled to permit comfortable occupancy of the spaces above.
Subp. 2.
Corridor widths.
Corridor widths shall be not less than seven feet. A greater width shall be provided at elevator entrances and in areas where special equipment is to be used.
Subp. 3.
Door widths.
Door widths shall be not less than three feet eight inches at all bedrooms, treatment rooms, operating rooms, X-ray rooms, delivery rooms, labor rooms, solariums, and physical therapy rooms. No doors shall swing into the corridor except closet doors and exit and stairway doors required to swing in the lane of egress travel. The door-swing requirement does not apply to psychiatric units or mental hospitals.
Subp. 4.
Floors.
The floors of the following areas shall have smooth, water-resistant surfaces: toilets, baths, bedpan rooms, utility rooms, janitors' closets, floor pantries, pharmacies, laboratories, and patients' rooms. The floors of the food preparation and formula rooms shall be water-resistant, grease-resistant, smooth, and resistant to heavy wear. The floors of the operating rooms, delivery rooms, and rooms or spaces where explosive gases are used or stored shall have conductive flooring as defined in Part II of Standard No. 56, issued in May, 1954, entitled Recommended Safe Practice for Hospital Operating Rooms by the National Fire Protection Association, 60 Batterymarch Street, Boston, Massachusetts which part of said standard is hereby adopted by the commissioner of health with the same force and effect as if the same were fully set forth in and written as part of this subpart.
Subp. 5.
Laundry chutes.
Where laundry chutes are used, they shall be not less than two feet in diameter.
Subp. 6.
Stair widths.
Stair widths shall be not less than three feet eight inches. The width shall be measured between handrails where handrails project more than 3-1/2 inches. Platforms and landings shall be large enough to permit stretcher travel in emergencies.
Subp. 7.
Walls.
The walls of the following areas shall have smooth, waterproof painted, glazed, or similar finishes: kitchens, sculleries, utility rooms, baths, showers, dishwashing rooms, janitors' closets, sterilizing room, spaces with sinks or lavatories, operating rooms, and delivery rooms.
4645.2500 DESIGN DATA.
The buildings and all parts thereof shall be of sufficient strength to support all dead, live, and lateral loads without exceeding the working stresses permitted for construction materials in generally accepted good engineering practice. Special provisions shall be made for machines or apparatus loads which would cause a greater load than the specified minimum live load. Consideration shall be given to structural members and connections of structures which may be subject to severe windstorms. Floor areas where partition locations are subject to change shall be designed to support, in addition to all other loads, a uniformly distributed load of 25 pounds per square foot.
4645.2600 LIVE LOADS.
The following unit live loads shall be taken as the minimum distributed live loads for:
A.
bedrooms and all adjoining service rooms which comprise a typical nursing unit, except solariums and corridors, 40 pounds per square foot;
B.
solariums, corridors in nursing units, operating suites, examination and treatment rooms, laboratories, toilet and locker rooms, 60 pounds per square foot;
C.
offices, conference room, library, kitchen, radiographic room, corridors, and other public areas on first floor, 80 pounds per square foot;
D.
stairways, laundry, large rooms used for dining, recreation, or assembly purposes, workshops, 100 pounds per square foot;
H.
wind loads, as required by design conditions, but not less than 15 pounds per square foot for buildings less than 60 feet above ground.
4645.2700 CONSTRUCTION.
Foundations shall rest on natural solid ground and shall be carried to depth of not less than one foot below the estimated frost line or shall rest on leveled rock or load-bearing piles when solid ground is not encountered. Footings, piers, and foundation walls shall be adequately protected against deterioration from the action of groundwater. Reasonable care shall be taken to establish proper soil-bearing values for the soil at the building site. If the bearing capacity of a soil is not definitely known or is in question, a recognized load test shall be used to determine the safe bearing value. Hospitals shall be constructed of incombustible materials, using a structural framework of reinforced concrete or structural steel except that masonry walls and piers may be utilized for buildings up to three stories in height not accounting for penthouses. The various elements of such buildings shall meet the following fire-resistive requirements:
J.
roof panels, including beams and joists in same, two hours.
Stairs and platforms shall be reinforced concrete or structural steel with hard incombustible materials for the finish of risers and treads. Rooms housing furnaces, boilers, combustible storage or other facilities which may provide fire hazards shall be of three-hour fire-resistive construction.
4645.2800 HEATING, PIPING, VENTILATION, AND AIR-CONDITIONING.
The heating system, piping, boilers, ventilation, and air-conditioning shall be furnished and installed to meet the requirements as set forth herein and the requirements of Part II of Standard No. 56, issued in May, 1954, entitled Recommended Safe Practice for Hospital Operating Rooms by the National Fire Protection Association, 60 Batterymarch Street, Boston, Massachusetts, which part of said standard is hereby adopted by the commissioner of health with the same force and effect as if the same were fully set forth in and written as part of this part. It is recommended that ventilating systems be designed for air cooling or for the future addition of air cooling.
4645.2900 BOILERS.
Boilers shall have the necessary capacity to supply the heating, ventilating, and air-conditioning systems and hot water and steam operated equipment, such as sterilizers and laundry and kitchen equipment. Spare boiler capacity shall be provided in a separate unit to replace any boiler which might break down. Standby boiler feed pumps, return pumps, and circulating pumps shall be provided.
4645.3000 HEATING.
Subpart 1.
Heating system.
The building shall be heated by a hot water, steam, or equal type heating system. Each radiator shall be provided with a hand control or automatic temperature control valve. The heating system shall be designed to maintain a minimum temperature of 75 degrees Fahrenheit in nurseries, delivery rooms, operating and recovery rooms, and similar spaces and a minimum temperature of 70 degrees Fahrenheit in all other rooms and occupied spaces. The outside design temperature for the locality shall be based on the information contained in that portion of chapter 12 of the publication, issued in 1954, entitled Heating Ventilating Air Conditioning Guide by the American Society of Heating and Ventilating Engineers, 51 Madison Avenue, New York, New York, starting with Design Outdoor Weather Conditions on page 240 and ending on page 247 which portion of chapter 12 of said guide is hereby adopted by the commissioner of health with the same force and effect as if the same were fully set forth in and written as part of this subpart.
Subp. 2.
Auxiliary heat.
Auxiliary heat supply shall be provided for heating in operating rooms, delivery rooms, and nurseries to supply heat when the main heating system is not in operation. This may be accomplished by proper separate zoning.
4645.3100 PIPING.
Subpart 1.
Pipe used in heating system.
Pipe used in heating and steam systems shall not be smaller in size than that prescribed in that portion of chapter 21 of the publication, issued in 1954, entitled Heating, Ventilating, Air Conditioning Guide, by the American Society of Heating and Ventilating Engineers, 51 Madison Avenue, New York, New York, starting with "Sizing Piping for Steam Heating Systems" on page 491 and continuing through "Sizing Piping for Indirect Heating Units" on page 506, which portion of chapter 21 of said guide is hereby adopted by the commissioner of health with the same force and effect as if the same were fully set forth in and written as part of this subpart. The ends of all steam mains and low points in steam mains shall be dripped.
Subp. 2.
Valves.
Steam return and heating mains shall be controlled separately by a valve at boiler or header. Each steam and return main shall be valved. Each piece of equipment supplied with steam shall be valved on the supply and return ends.
Subp. 3.
Thermostatic control.
The heating system shall be thermostatically controlled using one or more zones.
Subp. 4.
Coverings.
Boilers and smoke breeching shall be insulated with covering having a thermal resistance (1/c) value of not less than 1.96 and one-half inch plastic asbestos finish covered with four ounce canvas. All high-pressure steam and return piping shall be insulated with covering not less than the equivalent of one inch four-ply asbestos covering. Heating supply mains in the boiler room, in unheated spaces, unexcavated spaces, and where concealed, shall be insulated with a covering of asbestos air cell having a thickness of not less than one inch.
4645.3200 VENTILATION.
Sterilizer rooms, sterilizer equipment chambers, bathrooms, hydrotherapy rooms, garbage storage, and can washing rooms shall be provided with forced or suitable exhaust ventilation to change the air at least once every six minutes. A similar ventilating system shall be provided for rooms lacking outside windows such as utility rooms, toilets, and bedpan rooms. Kitchens, morgues, and laundries which are located inside the hospital building shall be ventilated by exhaust systems which will discharge the air above the main roof or at least 50 feet from any window. The ventilation of these spaces shall comply with the state or local codes but if no code governs, the air in the work spaces shall be exhausted at least once every ten minutes with the greater part of the air being taken from the flat work ironer and ranges. All exhaust ducts shall be provided with control dampers. Summertime ventilation rate of laundry, in excess of equipment requirements, may be introduced through doors, windows, or louvers in laundry room walls and be exhausted by exhaust fans located in walls generally opposite from intakes or arranged to provide the best possible circulation within the room. Rooms used for the storage of inflammable material shall be ventilated in accordance with the requirements of the state fire marshal. The operating and delivery rooms shall be provided with a supply ventilating system with heaters and humidifiers which will change the air at least eight times per hour by supplying fresh filtered air humidified to reduce the electrostatic hazard. Humidifiers shall be capable of maintaining a minimum relative humidity of 55 percent at 75 degrees Fahrenheit temperature. No recirculation shall be permitted. The air shall be removed from these rooms by a forced system of exhaust. The sterilizing rooms adjoining these rooms shall be furnished with an exhaust ventilating system. The supply air to operating rooms may be exhausted from operating rooms to adjoining sterilizer or work rooms from where it shall be exhausted. Exhaust systems of ventilation shall be balanced with an approximately equal amount of supply air delivered directly into the rooms or areas being exhausted or to other spaces of the hospital such as corridors. All outdoor supply air shall be tempered and filtered. All outdoor air intake louvers shall be located in areas relatively free from dust, obnoxious fumes, and odors.
4645.3300 INCINERATOR.
An incinerator shall be provided to burn dressings, infectious materials, and amputations. When garbage is incinerated, the incinerator shall be of a design that will burn 50 percent wet garbage completely without objectionable smoke or odor. The incinerator shall be designed with drying hearth, grates, and combustion chamber lined with fire brick. The gases shall be carried to a point above the roof of the hospital. Provisions for air supply to the incinerator room shall be made. Gas- or oil-fired incinerators are desirable.
4645.3400 WATER SUPPLY.
The water supply shall be of safe sanitary quality, suitable for use, and shall be obtained from a water supply system, the location, construction, and operation of which are acceptable to the commissioner of health.
4645.3500 PLUMBING AND DRAINAGE.
Subpart 1.
Problems.
Problems of a special nature applicable to the hospital plumbing system include the following.
Subp. 2.
Vapor vent systems.
Permanently installed pressure sterilizers, other sterilizers which are provided with vent openings, steam kettles, and other fixtures requiring vapor vents shall be connected with a vapor venting system extending up through the roof independent of the plumbing fixture vent system. The vertical riser pipe shall be provided with a drip line which discharges into the drainage system through an air-gap or open fixture. The connection between the fixture and the vertical vent riser pipe shall be made by means of a horizontal offset.
Subp. 3.
Plumbing fixtures.
Water closets in and adjoining patients' areas shall be of a quiet-operating type. Flush valves in rooms adjoining patients' rooms shall be designed for quiet operation with quiet-acting stops. Gooseneck spouts and wrist-action controls shall be used for patients' lavatories, nursery lavatories, and sinks which may be used for filling pitchers. Foot, knee, or elbow-action faucets shall be used for doctors' scrub-up, including nursery work room; utility and clinic sinks; and in treatment rooms. Elbow or wrist-action spade handle controls shall be provided on other lavatories and sinks used by doctors or nurses.
Subp. 4.
Special precautions for mental patients.
Plumbing fixtures which require hot water and which are accessible to mental patients shall be supplied with water which is thermostatically controlled to provide a maximum water temperature of 110 degrees Fahrenheit at the fixture. Special consideration shall be given to piping, controls, and fittings of plumbing fixtures as required by the types of mental patients. No pipes or traps shall be exposed and fixtures shall be substantially bolted through walls. Generally, for disturbed patients, special-type water closets without seats shall be used and shower and bath controls shall not be accessible to patients.
Subp. 5.
Hot water heaters and tanks.
The hot water heating equipment shall have sufficient capacity to supply at least five gallons of water at 150 degrees Fahrenheit per hour per bed for hospital fixtures, and at least eight gallons at 180 degrees Fahrenheit per hour per bed for the laundry and kitchen. The hot water storage tank or tanks shall have a capacity equal to 80 percent of the heater capacity. Where direct-fired hot water heaters are used, they shall be of the high-pressure cast iron type. Submerged steam heating coils shall be of copper. Storage tanks shall be of corrosion-resistant metal or be lined with corrosion-resistant material. Tanks and heaters shall be fitted with vacuum and relief valves, and where the water is heated by coal or gas, they shall have thermostatic relief valves. Heaters shall be thermostatically controlled.
Subp. 6.
Water supply systems.
Cold water and hot water mains and branches from the cold water service and hot water tanks shall be run to supply all plumbing fixtures and equipment which require cold or hot water or both for their operation. Pressure and pipe size shall be adequate to supply water to all fixtures with a minimum pressure of 15 pounds at the top floor fixtures during maximum demand periods. Where booster systems are necessary, water shall be supplied to the booster pump through a receiving tank in which the water level is automatically controlled. The receiving tank shall have a properly constructed and screened opening to the atmosphere and a watertight, overlapping cover. The receiving tank and booster pump shall be situated entirely above the ground level. If a pressure tank is employed in the booster system, it shall also be situated above ground level. Hot water circulating mains and risers shall be run from the hot water storage tank to a point directly below the highest fixture at the end of each branch main. Where the building is higher than three stories, each riser shall be circulated.
Subp. 7.
Roof and area drainage.
Leaders shall be provided to drain the water from roof areas to a point from which it cannot flow into the basement or areas around the building. Courts, yards, and drives which do not have natural drainage from the building shall have catch basins and drains to low ground, storm water system, or dry wells. Where dry wells are used, they shall be located at least 20 feet from the building.
Subp. 8.
Valves.
Each main, branch main, riser, and branch to a group of fixtures of the water systems shall be valved.
Subp. 9.
Insulation.
Hot water tanks and heaters shall be insulated with covering equal to one inch, four-ply air cell. Hot water and circulating pipes shall be insulated with covering equal to canvas jacketed three-ply asbestos air cell. Cold water mains and exposed rain water leaders in occupied spaces and in store rooms shall be insulated with canvas-jacketed felt covering to prevent condensation. All pipes in outside walls shall be insulated to prevent freezing.
Subp. 10.
Tests.
Water pipe shall be hydraulically tested to a pressure equal to twice the working pressure.
4645.3600 STERILIZERS.
Sterilizers and autoclaves of the required types and necessary capacity shall be provided to sterilize instruments, utensils, dressings, water, and other materials and equipment. The flasking system for sterile water supply is recommended. The sterilizers shall be of recognized hospital types with approved controls and safety features.
4645.3700 SEWAGE AND WASTE DISPOSAL.
All building sewage shall be discharged into a municipal sanitary sewer system, if available, otherwise an independent sewage disposal system shall be provided which is constructed in accordance with the requirements of the commissioner of health.
4645.3800 GAS PIPING.
Gas appliances shall bear the stamp of approval of the American Gas Association. Oxygen piping outlets and manifolds where used shall be installed in accordance with publication No. 565, issued in 1951, entitled Standard for Nonflammable Medical Gas Systems by the National Fire Protection Association, 60 Batterymarch Street, Boston, Massachusetts, which standard is hereby adopted by the commissioner of health with the same force and effect as if the same were fully set forth and written as part of this part.
4645.3805 REFRIGERATION.
Subpart 1.
Extent of coverage.
This part shall include portable refrigerators, built-in refrigerators, garbage refrigerators, ice-making and refrigerator equipment, and morgue boxes.
Subp. 2.
Box construction.
Boxes shall be lined with nonabsorbent sanitary material which will withstand the heavy use to which they will be subjected and shall be constructed so as to be easily cleaned. Refrigerators of adequate capacity shall be provided in all kitchens and other preparation centers where perishable foods will be stored. In the main kitchen, a minimum of two separate sections or boxes shall be provided, one for meats and dairy products, and one for general storage.
Subp. 3.
Refrigerator machines.
Toxic, "irritant," or inflammable refrigerants shall not be used in refrigerator machines located in buildings occupied by patients. The compressors and evaporators shall have sufficient capacity to maintain temperatures of 35 degrees Fahrenheit in the meat and dairy boxes, and 40 degrees Fahrenheit in the general storage boxes when the boxes are being used normally. Compressors shall be automatically controlled.
4645.3900 ELECTRICAL SYSTEMS.
Electrical systems shall be furnished and installed to meet the requirements as set forth herein and the requirements of part 2 of the Standard No. 56 issued in May 1954, entitled "Recommended Safe Practice for Hospital Operating Rooms," by the National Fire Protection Association, 60 Batterymarch Street, Boston, Massachusetts, which part of said standard is hereby adopted by the commissioner of health with the same force and effect as if the same were fully set forth and written as part of this part.
4645.4000 FEEDERS AND CIRCUITS.
Separate power and light feeders shall be run from the service to a main switchboard and from there, subfeeders shall be provided to the motors and power and light distributing panels. Where there is only one service feeder, separate power and light feeders from the service entrance to the switchboard will not be required. From the power panels, feeders shall be provided for large motors, and circuits from the light panels shall be run to the lighting outlets. Large heating elements shall be supplied by separate feeders from the local utility and installed as directed. Independent feeders shall be furnished for X-ray equipment.
4645.4100 LIGHT PANELS.
Light panels shall be provided on each floor for the lighting circuits on that floor. Light panels shall be located near the load centers not more than 100 feet from the farthest outlet.
4645.4200 LIGHTING OUTLETS, RECEPTACLES, AND SWITCHES.
All occupied areas shall be adequately lighted as required for the duties performed in the space. Patients' bedrooms shall have as a minimum: general illumination, a bracket or receptacle for each bed, a duplex receptacle for each two beds for doctor's examining light, and a night light. Where ceiling lights are used in patients' rooms, they shall be of a type which does not shine in the patients' eyes. The outlets for night lights shall be independently switched at the door. Receptacles for special equipment shall be of a heavy duty type on separate circuits. Switches in patients' rooms shall be of an approved mercury or equal, quiet-operating type, except for cord operated switches on fixtures. No lighting fixtures, switches, receptacles or electrical equipment shall be accessible to disturbed mental patients. Operating and delivery rooms shall be provided with special lights for the tables, each on an independent circuit, and lights for general illumination. Not less than three explosion-proof receptacles shall be provided in each operating and delivery room except that the explosion-proof type will not be required if the receptacles are above the five-foot level. Each operating room shall have a film-viewing box. All switches, viewing boxes, and equipment controls installed below the five-foot level shall be explosion-proof.
4645.4300 EMERGENCY ELECTRICAL SYSTEM.
Each hospital shall have a source of emergency power which may be an entirely separate outside source from an independent generating plant, a generator operated by a prime mover, or a battery with adequate means for charging. Where the installation consists of a standby generator operated by a prime mover, it shall be of a size sufficient to supply all estimated current demands for required areas. The system shall be so arranged that, in the event of failure of the principal source of current, the emergency system shall be automatically placed in operation. Emergency lighting shall be provided for: stairs; exits; patient corridors; corridors leading to exits; exit signs; operating, delivery, and emergency rooms; telephone switchboard room; nurseries; emergency generator room; boiler room; and all psychiatric patient areas.
It is recommended that emergency power be provided for the operation of at least one boiler.
4645.4400 NURSES' CALL.
Each patient shall be furnished with a nurses' call which will register at the corridor door, at the nurses' station, and in each floor kitchen and utility room of the nursing unit. A duplex unit may be used for two patients. Indicating lights shall be provided at each station where there are more than two beds in a room. Nurses' call stations will not be required for psychiatric occupancies, pediatric rooms, and nurseries where an emergency call shall be available in each room for the use of the nurse. A call station shall be provided in each operating and delivery room.
4645.4500 NUMBER OF CARS.
Any hospital with patients on one or more floors above the first floor or where the operating or delivery rooms are not on the first floor shall have at least one mechanically driven elevator. Hospitals with a bed capacity of from 60 to 200 above the first floor shall have not less than two elevators. Hospitals with a bed capacity of from 200 to 350 above the first floor shall have not less than three elevators, two passenger and one service.
4645.4600 CABS.
Cabs shall be constructed with fireproof material. Passenger cab platforms for the minimum required number of elevators shall be not less than five feet four inches by eight feet with a capacity of at least 3,500 pounds. Cab and shaft doors shall be not less than three feet ten inches clear opening. Service elevators shall be of sufficient size to receive a stretcher with patient.
4645.4700 CONTROLS.
Elevators, for which operators will not be employed, shall have automatic push-button control, signal control, or dual control for use with or without operator. Where two push-button elevators are located together and where one such elevator serves more than three floors and basement, they shall have collective or signal control. Where the car has a speed of more than 100 feet per minute or has a rise of four or more floors, the elevator shall be equipped with automatic self-leveling control which will automatically bring the car platform level with the landing with no load or full load. Multivoltage or variable voltage machines shall be used where speeds are greater than 150 feet per minute. For speeds above 350 feet per minute, the elevators shall be of the gearless type.
4645.4800 DUMBWAITERS.
Dumbwaiter cabs shall be not less than 24 inches by 24 inches by 36 inches of steel with one shelf to operate at a speed of 50 feet to 100 feet per minute when carrying a load of 100 pounds. Dumbwaiters serving basement and four floors shall have a minimum speed of 100 feet per minute.
4645.4900 TESTS.
Elevator machines shall be tested for speed and load with and without loads in both directions and shall be given overspeed tests as required by the Minnesota Department of Labor and Industry.
4645.5100 KITCHEN EQUIPMENT FOR ALL HOSPITALS.
Subpart 1.
Equipment.
The equipment shall be adequate, properly constructed, and so arranged as to enable the storage, preparation, cooking, and serving of food and drink to patients, staff, and employees to be carried out in an efficient and sanitary manner. The equipment shall be selected and arranged in accordance with the types of food service adopted for the hospital. Cabinets or other enclosures shall be provided for the storage or display of food, drink, and utensils and shall be designed as to protect them from contamination by insects, rodents, other vermin, splash, dust, and overhead leakage. All utensils and equipment surfaces with which food or drink comes in contact shall be of smooth, nontoxic, corrosion-resistant material, free of breaks, open seams or cracks, chipped places, and V-type threads. Sufficient separation shall be provided between equipment and the walls or floor to permit easy cleaning or the equipment shall be set tight against the walls or floor and the joint properly sealed.
4645.5200 LAUNDRY FOR ALL HOSPITALS.
Where laundries are provided, they shall be complete with washers, extractors, tumblers, ironers, and presses which shall be provided with all safety appliances and meet all sanitary requirements.
4700.1900 PURPOSE, SCOPE, AND APPLICABILITY.
The purpose and scope of parts 4700.1900 to 4700.2500 is to prescribe requirements applicable to family planning special project grants, to establish minimum standards for family planning services supported in whole or in part by family planning special project grant funds, and to provide criteria for the review of family planning special project grant applications.
Minnesota Statutes, section 145.925, contains a provision prohibiting use of these funds for abortions, and for family planning services to unemancipated minors in an elementary or secondary school building; requiring notice to parents or guardians of unemancipated minors to whom abortion or sterilization is advised, except as provided in Minnesota Statutes, sections 144.341 and 144.342; and prohibiting coercing anyone to undergo an abortion or sterilization.
4700.2000 DEFINITIONS.
Subpart 1.
Scope.
For purposes of parts 4700.1900 to 4700.2500, the following terms have the meanings given them in this part.
Subp. 2.
Approvable application.
"Approvable application" means an application which meets the criteria for award, as specified in part 4700.2300.
Subp. 3.
Community health board.
"Community health board" means a community health board established, operating, and eligible for a subsidy under Minnesota Statutes, sections 145A.09 to 145A.13.
Subp. 4.
Current award.
"Current award" means the amount of family planning special project grant funds received in the year immediately preceding the one for which a new grant of family planning special project funds is requested.
Subp. 5.
Current recipient.
"Current recipient" means an agency receiving family planning special project grant funds in the year immediately preceding the one for which a new grant of family planning special project funds is requested.
Subp. 6.
Family planning.
"Family planning" means voluntary planning and action by individuals to attain or prevent pregnancy.
Subp. 7.
Family planning methods.
"Family planning methods" means agents and devices for the purpose of fertility regulation prescribed by a licensed physician, and other agents and devices for the purpose of fertility regulation including, spermicidal agents, diaphragms, condoms, oral contraceptives, intrauterine devices, natural family planning methods, sterilizations, and the diagnosis and treatment of infertility by a licensed physician, which can be paid for in whole or in part by family planning special project grant funds.
Subp. 8.
Family planning services components.
"Family planning services components" means the public information, outreach, counseling, method, referral, and follow-up categories under which all services provided by family planning service providers must be described. The minimum standards in part 4700.2210 serve to define these components.
Subp. 9.
High risk person.
"High risk person" means an individual whose age, health, prior pregnancy outcome, or socioeconomic status increases her chances of experiencing an unplanned pregnancy or problems during pregnancy. High risk persons include, but are not limited to, women under 18 or over 35; women who have experienced premature labor and delivery; women with existing health problems such as diabetes, anemia, and obesity; and persons whose individual or family income is determined to be at or below 200 percent of the official income poverty line as defined by United States Code, title 42, section 9902, and as published by the Federal Office of Management and Budget and revised annually in the Federal Register. A copy of the most current guideline is available from the Office of Planning and Evaluation, Department of Health and Human Services, Washington, D.C., 20201, (202) 245-6141.
Subp. 10.
Linkages.
"Linkages" means formal or informal arrangements between the applicant and other family planning providers including contracts, reciprocal referral agreements, and committees.
Subp. 11.
New applicant.
"New applicant" means an agency which did not receive family planning special project funds in the year immediately preceding the one for which a grant of family planning special project funds is requested.
Subp. 12.
Provide.
"Provide" means to directly supply or render or to pay for in whole or in part.
Subp. 13.
Publicly subsidized.
"Publicly subsidized" means funded by federal, state, county, or city tax dollars, but does not include title XIX of the Social Security Act medical assistance funds.
Subp. 14.
Region.
"Region" means that group of counties represented by a single person on the executive committee of the State Community Health Advisory Committee. The counties in each region are as follows:
| Northeastern | Northwestern | West Central |
| Aitkin | Becker | Clay |
| Carlton | Beltrami | Douglas |
| Cook | Clearwater | Grant |
| Itasca | Hubbard | Otter Tail |
| Koochiching | Kittson | Pope |
| Lake | Lake of the Woods | Stevens |
| Saint Louis | Mahnomen | Traverse |
| Marshall | Wilkin | |
| Norman | ||
| Pennington | ||
| Polk | ||
| Red Lake | ||
| Roseau | ||
| Central | Metro | South Central |
| Benton | Anoka | Blue Earth |
| Cass | Carver | Brown |
| Chisago | Dakota | Faribault |
| Crow Wing | Hennepin | Le Sueur |
| Isanti | Ramsey | McLeod |
| Kanabec | Scott | Martin |
| Mille Lacs | Washington | Meeker |
| Morrison | Nicollet | |
| Pine | Sibley | |
| Sherburne | Waseca | |
| Stearns | Watonwan | |
| Todd | ||
| Wadena | ||
| Wright |
| Southeastern | Southwestern |
| Dodge | Big Stone |
| Fillmore | Chippewa |
| Freeborn | Cottonwood |
| Goodhue | Jackson |
| Houston | Kandiyohi |
| Mower | Lac Qui Parle |
| Olmsted | Lincoln |
| Rice | Lyon |
| Steele | Murray |
| Wabasha | Nobles |
| Winona | Pipestone |
| Redwood | |
| Renville | |
| Rock | |
| Swift | |
| Yellow Medicine |
4700.2100 CONTENT OF APPLICATION.
The application shall identify the geographic area to be served by the applicant and shall provide the following required information:
A.
An inventory of existing family planning services provider agencies in the geographic area served by the applicant. The inventory shall include, for each provider agency, at least the agency name; addresses of all agency service sites; the target population served, including total number served if available (if unavailable, estimates will be acceptable); and the family planning service components provided.
B.
An assessment of unmet needs of the geographic area to be served by the applicant. The assessment of unmet needs must, at least, identify unavailable family planning service components or unserved or underserved populations. A description of the method used in making the assessment shall be provided by the applicant.
C.
A description of the family planning service components to be provided by the applicant. Each component to be provided with family planning special project funds must meet the standards for that component described in part 4700.2210. The application must include a budget and budget justification and summary of applicable training or experience of persons providing services relevant to these components. Also, for each component provided, the application must describe:
D.
A description of the linkages between the applicant and other family planning services in the geographic area.
E.
A description of fees to be charged individuals for any family planning services. Fees must be charged for services to individuals and must be in accordance with a sliding fee schedule for services and supplies based on the cost of such services or supplies and on the individual's ability to pay as determined by income, family size, and other relevant factors. Services shall not be denied based on ability to pay as specified in item H.
H.
Assurance that services will be provided without regard to age, sex, race, religion, marital status, income level, residence, parity, or presence or degree of disability except as otherwise required by law.
I.
Assurance that arrangements shall be made for communication to take place in a language understood by the family planning service recipient.
4700.2210 MINIMUM STANDARDS FOR FAMILY PLANNING SERVICE COMPONENTS.
An applicant is not required to provide all components to be eligible for funding. However, the applicant must make available the names and addresses of other family planning services provider agencies in the geographic area, if any, who offer components and services not offered by the applicant.
All funded projects must establish linkages to facilitate access to outreach, counseling, and other component services for service recipients.
Procedures for referral and follow-up must be incorporated into all services that are provided by the applicant on a one-to-one basis.
The provision of all service components except public information shall include information on family planning services available from the applicant.
Service components to be provided by the applicant shall be defined by, and shall meet or exceed, the following minimum standards:
A.
Public information must include specific activities designed to inform the general population about family planning and how to obtain information on all family planning service components available in the geographic area.
B.
Outreach must include specific activities designed to inform members of the target population about family planning and all the family planning service components available in the geographic area. Outreach activities shall include one-to-one or small group contacts with the target population.
Outreach must be conducted at times and places convenient to the target population. Persons conducting outreach shall have training or experience in family planning services.
C.
Counseling must include utilization of nondirective techniques in a decision-making format which enables individuals to voluntarily determine their participation in family planning services and their family planning method of choice, if any. "Nondirective techniques" means techniques that employ open-ended questions to enable individuals to consider their feelings, attitudes, and values about alternatives and outcomes. A decision-making format means a format that allows individuals to consider alternatives and outcomes, weigh advantages and disadvantages, and make choices.
When individuals are seeking to prevent pregnancy, counseling shall include the provision and explanation of factual information on all family planning pregnancy prevention methods in a nonjudgmental manner. "Nonjudgmental manner" means a manner in which the counselor's personal values and beliefs do not interfere with the client's choices.
When individuals are seeking to attain pregnancy, counseling shall include the provision and explanation of factual information on infertility diagnosis and treatment and services for pregnant women available in the geographic area.
Counseling shall be available to any individual in the target population and shall be conducted at times and places convenient to the target population.
Counseling shall include documentation that information required in Minnesota Statutes, section 145.925, has been provided. Counseling shall be conducted by persons with training or experience in counseling and family planning services.
D.
Method must include the provision to a service recipient of the recipient's family planning method of choice. Provision of any family planning method must include:
(1)
procedures which document that the service recipient participated in counseling prior to selecting a family planning method to prevent pregnancy;
(3)
information on the advisability of females obtaining a gynecological examination with Pap smear prior to initiating any family planning method;
(4)
education on the use of the selected family planning method, including the risks and benefits of the method; and
(5)
medical/laboratory services prior to the provision of a family planning method when the selected method requires medical intervention for prescription, fitting, insertion, or for surgical or diagnostic procedures. When the selected method does not require medical intervention, as described herein, the applicant shall encourage service recipients to obtain medical/laboratory services, but provision by the applicant is not required. Medical/laboratory services shall include:
(h)
when indicated by history or symptoms, for both male and female as appropriate, diagnosis and curative treatment of venereal disease, diagnosis and treatment of vaginitis, diagnosis of pregnancy, and for females, as appropriate, provision of rubella immunization.
Medical services shall be rendered by licensed physicians, or professional nurses with documentable training in gynecological care conducted under the supervision of a licensed physician, or nurse midwives certified by the American College of Nurse Midwifery, or physician assistants, under the supervision of a licensed physician. Laboratory tests shall be conducted by personnel trained to conduct such tests.
E.
Referral must include the provision, in writing, of information to service recipients which enables them to participate in family planning and other needed health and human services. Documentation of referrals must be maintained.
F.
Follow-up must include specific procedures of continuing care designed to encourage safe and consistent utilization of family planning and other needed health and human services, using protocols based on accepted professional standards of care.
4700.2300 CRITERIA FOR AWARD OF FAMILY PLANNING SPECIAL PROJECT GRANTS.
Subpart 1.
Application criteria.
Applications which meet the requirements of law and parts 4700.1900 to 4700.2500 shall be deemed approvable applications and eligible for award according to the notice of availability and the following criteria.
Subp. 3.
Quality and content.
Applications will be evaluated on the basis of:
A.
the extent the funds will be used to meet unmet needs in the geographic area as identified in the application;
B.
the extent the application proposes an identifiable expansion in the scope of the family planning service system in the geographic area to be served by the applicant;
C.
the extent the application proposes to coordinate family planning services with organizations, agencies, and individual providers in the geographic area to be served;
Subp. 4.
Agency.
When equivalent and competing applications are submitted for a geographic area, award priorities will be in accordance with the following:
Subp. 4a.
Priority.
Current recipients of family planning special project funds will not be accorded any priority over new applicants.
Subp. 5.
Review and comment by community health board.
Before submission to the commissioner, the applicant shall submit the proposal to the community health board responsible for the geographic area in which the applicant proposes to provide its services, for the community health board's review and comment. The community health board's comments shall address the application based on the criteria in subpart 3. Any comments of a community health board shall be submitted to the commissioner within 45 days of the date the proposal was received by the community health board.
4700.2410 ALLOCATION SCHEME.
Subpart 1.
Family planning hotline grant.
Five percent of the total annual funds available or $100,000 per year, whichever is less, must be allocated for a statewide family planning hotline. Applications must contain identifiable plans and budget allocations for both the operation of the hotline and its promotion statewide. If the grant award is not for the full amount of funds allocated under this subpart, the funds remaining must be reallocated for distribution under subpart 2.
Subp. 2.
Family planning services grants.
The portion of the total funds remaining after the distribution made under subpart 1 must be allocated according to this subpart. Except as provided in part 4700.2420, subpart 4, the family planning special project grant funds must be allocated on a regional basis according to the following needs-based distribution formula.
A.
Determine the regional need by totaling the following three factors:
(1)
the number of resident women within the region who are 12 to 18 years of age, determined by using Department of Health data from the most recent year for which it is available;
(2)
the number of resident women within the region 19 to 34 years of age who are on medical assistance as determined by using Department of Human Services data from the most recent year for which it is available; and
(3)
the number of resident women within the region who are 35 to 44 years of age as determined by using Department of Health data from the most recent year for which it is available.
B.
Compute the regional proportion of the total state need for services by totaling the three factors in item A for each region and dividing each regional total by the sum of the three factors for the entire state.
C.
Calculate the amount of family planning special project grant funds available for each region by multiplying its regional proportion by the total amount of money available for family planning special projects under this subpart.
4700.2420 FAMILY PLANNING SERVICES GRANT FUNDING.
Subpart 1.
Funding limit.
An applicant, other than an applicant for a family planning hotline grant, shall be limited to an annual application request of $75,000 per region. Two or more agencies may submit a joint application; each agency that is a party to it shall be limited to an annual application request of $75,000 for each region covered by the joint application.
Subp. 2.
Grant allocations.
The applications, other than those for a family planning hotline grant, must be ranked in order within each region from highest to lowest based on the criteria for award in part 4700.2300. The applications must be funded in rank order from highest to lowest until all available funds for the region are allocated.
Subp. 3.
Funding awards.
If the amount requested by any applicant is more than that reasonably required to provide the proposed services, or if the proposed services are not based on part 4700.2210 or 4700.2300, the commissioner must either deny funding or award less than the amount the applicant requested. When the commissioner decides to award less than requested, the applicant must submit a revised description of the target population, methodologies, budget, or budget justification as required by the commissioner to receive funding.
Subp. 4.
Contingency funding.
If any of the conditions in items A to D exist, the commissioner shall redistribute the funds according to this subpart.
A.
If funds remain available in a region after all approvable applications are funded according to this part, the commissioner shall redistribute the funds to the other regions, proportional to their share of funding need, based upon the process stated in part 4700.2410, subpart 2. The redistributed funds shall be awarded according to subpart 2.
B.
Funds remaining available after all approvable applications are funded at the funding limit in subpart 1, and awarded according to subpart 2, will be proportionally distributed to all applicants with approvable applications. In order to receive additional funds, an applicant with an approvable application must submit a revised description of the target population, objectives, methodologies, budget, and budget justification to the commissioner within 60 days after receiving notice of the availability of additional funds.
C.
If the department funds for family planning special project grants are increased after awards have been made under part 4700.2410, subpart 1, or 4700.2420, subparts 2 to 4, funds must first be allocated to the family planning hotline grant recipient within the funding limits specified in part 4700.2410, subpart 1. Remaining funds must then be distributed to the regions proportional to their share of funding need as determined according to part 4700.2410, subpart 2, and awarded according to part 4700.2420, subparts 2 to 4.
D.
If department funds for family planning special project grants are reduced after awards have been made under this subpart or subpart 2 and part 4700.2410, subpart 1, all awards must be reduced proportionate to the department's reduction in these funds. A grant award recipient must submit a revised description of the target population, objectives, methodologies, budget, and budget justification to the commissioner within 60 days after receiving notice of reduced awards.
4700.2500 USE OF STATE FUNDS AVAILABLE FOR FAMILY PLANNING SPECIAL PROJECT GRANTS.
Family planning special project grant recipients may not replace funds from other sources, such as existing federal, state, or local funds which the recipient uses for family planning information or services and over which the recipient exercises discretion, with family planning special project grant funds. Recipients are not required to match funds available under family planning special project grants.
5610.0100 SWORN STATEMENT TO BOARD.
At the time a professional corporation files with the board the copy of its articles of incorporation as required by Minnesota Statutes, section 319A.08, and annually thereafter when such corporation files with the board its annual report as required by Minnesota Statutes, section 319A.21, it shall file with the board a statement under oath as to each and all of the following:
A.
the address of the registered office of the corporation and the name of its proposed registered agent, if any, for service and process;
B.
the name or names and respective office and residence addresses of the directors and officers of the corporation;
C.
in the case of a corporation organized under Minnesota Statutes, chapter 301, a statement of the aggregate number of issued shares, itemized by classes and the person or persons to whom issued;
D.
in the case of a corporation organized under Minnesota Statutes, chapter 317A, a statement of the names of the members of the corporation if no stock has been issued, or if stock has been issued, a statement of the aggregate number of issued shares, itemized by classes and the person or persons to whom issued;
E.
a description of the nature of the professional services and ancillary services, if any, to be provided by the corporation;
F.
the location or locations of the premises at which the applicant corporation proposes to provide professional services;
G.
a statement listing the name or names of employees, other than members or shareholders of the corporation, who are licensed under Minnesota Statutes, chapter 147, to practice medicine and surgery within the state of Minnesota; and
H.
a statement whether or not all shareholders, members, directors, officers, employees, and agents rendering professional service in Minnesota on behalf of the corporation are licensed to practice medicine and surgery in Minnesota or are otherwise authorized to render the professional service being rendered by the corporation.
5610.0200 SUSPENSION OR REVOCATION OF LICENSE OF SHAREHOLDER, MEMBER, DIRECTOR, OFFICER, EMPLOYEE, OR AGENT.
If the license to practice medicine in Minnesota of any shareholder, member, director, officer, employee, or agent rendering professional service in this state on behalf of the corporation is revoked or suspended by the board, the corporation shall forthwith remove from office and terminate the employment of such shareholder, member, director, officer, employee, or agent, and shall not reinstate in office or reemploy such shareholder, member, director, officer, employee, or agent unless and until the license to practice medicine in Minnesota is restored by the board.
5610.0300 WRITTEN NOTICE REQUIREMENT.
Every professional corporation shall promptly notify the board in writing upon the happening of any of the following events:
A.
the death of any shareholder, member, director, officer, employee, or agent who is licensed to practice medicine in Minnesota;
B.
the revocation or suspension of the license to practice medicine in Minnesota of any shareholder, member, director, officer, employee, or agent;
C.
the amendment of the articles of incorporation or bylaws of the corporation, in which case a copy of such amendment shall be furnished to the board with such notice;
F.
the admission, election, or employment of a new shareholder, member, director, officer, employee, or agent of the corporation;
G.
the termination, replacement, or discharge of a shareholder, member, director, officer, employee, or agent, in which case the professional corporation shall notify the board of the date thereof and reason therefor;
H.
a change in the nature of the professional services and ancillary services, if any, provided by the corporation; or
I.
a change in the location or locations of the premises at which the corporation provides or intends to provide professional services.
9505.0235 ABORTION SERVICES.
Subpart 1.
Definition.
For purposes of this part, "abortion related services" means services provided in connection with an elective abortion except those services which would otherwise be provided in the course of a pregnancy. Examples of abortion related services include hospitalization when the abortion is performed in an inpatient setting, the use of a facility when the abortion is performed in an outpatient setting, counseling about the abortion, general and local anesthesia provided in connection with the abortion, and antibiotics provided directly after the abortion.
Medically necessary services that are not considered to be abortion related include family planning services as defined in part 9505.0280, subpart 1, history and physical examination, tests for pregnancy and venereal disease, blood tests, rubella titer, ultrasound tests, rhoGAM(TM), pap smear, and laboratory examinations for the purpose of detecting fetal abnormalities.
Treatment for infection or other complications of the abortion are covered services.
Subp. 2.
Payment limitation.
Unless otherwise provided by law, an abortion related service provided to a recipient is eligible for medical assistance payment if the abortion meets the conditions in item A, B, or C.
A.
The abortion must be necessary to prevent the death of a pregnant woman who has given her written consent to the abortion. If the pregnant woman is physically or legally incapable of giving her written consent to the procedure, authorization for the abortion must be obtained as specified in Minnesota Statutes, section 144.343. The necessity of the abortion to prevent the death of the pregnant woman must be certified in writing by two physicians before the abortion is performed.
B.
The pregnancy is the result of criminal sexual conduct as defined in Minnesota Statutes, section 609.342, paragraphs (c) to (f). The conduct must be reported to a law enforcement agency within 48 hours after its occurrence. If the victim is physically unable to report the criminal sexual conduct within 48 hours after its occurrence, the report must be made within 48 hours after the victim becomes physically able to report the criminal sexual conduct.
C.
The pregnancy is the result of incest. Before the abortion, the incest and the name of the relative allegedly committing the incest must be reported to a law enforcement agency.
9505.0505 DEFINITIONS.
Subp. 18.
Medical review agent.
"Medical review agent" means the representative of the commissioner who is authorized by the commissioner to administer procedures for admission certifications, medical record reviews and reconsideration, and perform other functions as stipulated in the terms of the agent's contract with the department.
9505.0520 INPATIENT ADMISSION CERTIFICATION.
Subp. 9b.
Reconsideration; physician advisers appointed by medical review agent.
Upon receipt of a request for reconsideration under subpart 9, the medical review agent shall appoint at least three physician advisers who did not take part in the decision to deny or withdraw all or part of the admission certification. Each physician adviser shall determine the medical necessity of the admission or the continued stay or, in the case of a readmission, determine whether the admission and readmission meet the criteria in part 9505.0540. The reconsideration decision must be the majority opinion of the physician advisers. In making the decision, the three physician advisers shall use the criteria of medical necessity set out in part 9505.0530.