SF 3213

as introduced - 85th Legislature (2007 - 2008) Posted on 12/15/2009 12:00am

A bill for an act
relating to human services; making technical changes; amending children's
mental health, health care, and miscellaneous provisions; amending Minnesota
Statutes 2006, sections 254A.035, subdivision 2; 254A.04; 256.0451, subdivision
24; 256.046; 256B.0943, subdivisions 1, 2, 7; 256L.07, subdivision 5; Minnesota
Statutes 2007 Supplement, sections 256.01, subdivisions 2, 2b; 256.476,
subdivisions 4, 5; 256B.057, subdivision 2c; 256B.06, subdivision 4; 256B.0655,
subdivision 12; 256B.0943, subdivisions 6, 9, 12; 256D.03, subdivision 3;
256L.15, subdivision 2; repealing Minnesota Statutes 2006, section 256B.039.

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

ARTICLE 1

CHILDREN'S MENTAL HEALTH

Section 1.

Minnesota Statutes 2006, section 256B.0943, subdivision 1, is amended to
read:

Subdivision 1.

Definitions.

For purposes of this section, the following terms have
the meanings given them.

(a) "Children's therapeutic services and supports" means the flexible package of
mental health services for children who require varying therapeutic and rehabilitative
levels of intervention. The services are time-limited interventions that are delivered using
various treatment modalities and combinations of services designed to reach treatment
outcomes identified in the individual treatment plan.

(b) "Clinical supervision" means the overall responsibility of the mental health
professional for the control and direction of individualized treatment planning, service
delivery, and treatment review for each client. A mental health professional who is an
enrolled Minnesota health care program provider accepts full professional responsibility
for a supervisee's actions and decisions, instructs the supervisee in the supervisee's work,
and oversees or directs the supervisee's work.

(c) "County board" means the county board of commissioners or board established
under sections 402.01 to 402.10 or 471.59.

(d) "Crisis assistance" has the meaning given in section 245.4871, subdivision 9a.

(e) "Culturally competent provider" means a provider who understands and can
utilize to a client's benefit the client's culture when providing services to the client. A
provider may be culturally competent because the provider is of the same cultural or
ethnic group as the client or the provider has developed the knowledge and skills through
training and experience to provide services to culturally diverse clients.

(f) "Day treatment program" for children means a site-based structured program
consisting of group psychotherapy for more than three individuals and other intensive
therapeutic services provided by a multidisciplinary team, under the clinical supervision
of a mental health professional.

(g) "Diagnostic assessment" has the meaning given in section 245.4871, subdivision
11.

(h) "Direct service time" means the time that a mental health professional, mental
health practitioner, or mental health behavioral aide spends face-to-face with a client
and the client's family. Direct service time includes time in which the provider obtains
a client's history or provides service components of children's therapeutic services and
supports. new text begin Notwithstanding Minnesota Rules, part 9505.0323, subpart 1, item M, new text end direct
service time does not include time doing work before and after providing direct services,
including scheduling, maintaining clinical records, consulting with others about the client's
mental health status, preparing reports, receiving clinical supervision deleted text begin directly related to
the client's psychotherapy session deleted text end , and revising the client's individual treatment plan.

(i) "Direction of mental health behavioral aide" means the activities of a mental
health professional or mental health practitioner in guiding the mental health behavioral
aide in providing services to a client. The direction of a mental health behavioral aide
must be based on the client's individualized treatment plan and meet the requirements in
subdivision 6, paragraph (b), clause (5).

(j) "Emotional disturbance" has the meaning given in section 245.4871, subdivision
15. For persons at least age 18 but under age 21, mental illness has the meaning given in
section 245.462, subdivision 20, paragraph (a).

(k) "Individual behavioral plan" means a plan of intervention, treatment, and
services for a child written by a mental health professional or mental health practitioner,
under the clinical supervision of a mental health professional, to guide the work of the
mental health behavioral aide.

(l) "Individual treatment plan" has the meaning given in section 245.4871,
subdivision 21.

(m) "Mental health professional" means an individual as defined in section
245.4871, subdivision 27, clauses (1) to (5), or tribal vendor as defined in section 256B.02,
subdivision 7, paragraph (b).

(n) "Preschool program" means a day program licensed under Minnesota Rules,
parts 9503.0005 to 9503.0175, and enrolled as a children's therapeutic services and
supports provider to provide a structured treatment program to a child who is at least 33
months old but who has not yet attended the first day of kindergarten.

(o) "Skills training" means individual, family, or group training designed to deleted text begin improve
the basic functioning of the child with emotional disturbance and the child's family in the
activities of daily living and community living, and to improve the social functioning of the
child and the child's family in areas important to the child's maintaining or reestablishing
residency in the community. Individual, family, and group skills training must:
deleted text end

deleted text begin (1) consist of activities designed to promote skill development of the child and the
child's family in the use of age-appropriate daily living skills, interpersonal and family
relationships, and leisure and recreational services;
deleted text end

deleted text begin (2) consist of activities that will assist the family's understanding of normal child
development and to use parenting skills that will help the child with emotional disturbance
achieve the goals outlined in the child's individual treatment plan; and
deleted text end

deleted text begin (3) promote family preservation and unification, promote the family's integration
with the community, and reduce the use of unnecessary out-of-home placement or
institutionalization of children with emotional disturbance. deleted text end new text begin provide rehabilitation of
specific skills deficits or maladaptive skills acquired over the course of a psychiatric
illness. Skills training is subject to the following requirements:
new text end

new text begin (1) a mental health professional or a mental health practitioner shall provide skills
training;
new text end

new text begin (2) the child shall always be present during skills training; however, a brief absence
of the child for no more than ten percent of the session unit may be allowed to redirect or
instruct family members;
new text end

new text begin (3) skills training delivered to children or their families shall be targeted to the
specific deficits or maladaptations of the child's mental health disorder and shall be
prescribed in the child's individual treatment plan; and
new text end

new text begin (4) group skills training may be provided to multiple recipients who, because of the
nature of their emotional, behavioral, or social dysfunction, can derive mutual benefit from
interaction in a group setting, which shall be staffed as follows:
new text end

new text begin (i) one mental health professional or one mental health practitioner under supervision
of a licensed mental health professional shall work with a group of four to eight clients; or
new text end

new text begin (ii) two mental health professionals or two mental health practitioners under
supervision of a licensed mental health professional, or one professional plus one
practitioner shall work with a group of nine to 12 clients.
new text end

Sec. 2.

Minnesota Statutes 2006, section 256B.0943, subdivision 2, is amended to read:

Subd. 2.

Covered service components of children's therapeutic services and
supports.

(a) Subject to federal approval, medical assistance covers medically necessary
children's therapeutic services and supports as defined in this section that an eligible
provider entity new text begin certified new text end under deleted text begin subdivisions deleted text end new text begin subdivision new text end 4 deleted text begin and 5 deleted text end provides to a client
eligible under subdivision 3.

(b) The service components of children's therapeutic services and supports are:

(1) individual, family, and group psychotherapy;

(2) individual, family, or group skills training provided by a mental health
professional or mental health practitioner;

(3) crisis assistance;

(4) mental health behavioral aide services; and

(5) direction of a mental health behavioral aide.

(c) Service components new text begin in paragraph (b) new text end may be combined to constitute therapeutic
programs, including day treatment programs and new text begin therapeutic new text end preschool programs.
deleted text begin Although day treatment and preschool programs have specific client and provider
eligibility requirements, medical assistance only pays for the service components listed in
paragraph (b).
deleted text end

Sec. 3.

Minnesota Statutes 2007 Supplement, section 256B.0943, subdivision 6,
is amended to read:

Subd. 6.

Provider entity clinical infrastructure requirements.

(a) To be
an eligible provider entity under this section, a provider entity must have a clinical
infrastructure that utilizes diagnostic assessment, deleted text begin an deleted text end individualized treatment deleted text begin plan deleted text end new text begin plans new text end ,
service delivery, and individual treatment plan review that are culturally competent,
child-centered, and family-driven to achieve maximum benefit for the client. The provider
entity must review and update the clinical policies and procedures every three years and
must distribute the policies and procedures to staff initially and upon each subsequent
update.

(b) The clinical infrastructure written policies and procedures must include policies
and procedures for:

(1) providing or obtaining a client's diagnostic assessment that identifies acute and
chronic clinical disorders, co-occurring medical conditions, sources of psychological and
environmental problems, and a functional assessment. The functional assessment must
clearly summarize the client's individual strengths and needs;

(2) developing an individual treatment plan that deleted text begin is deleted text end :

(i) new text begin is new text end based on the information in the client's diagnostic assessment;

new text begin (ii) identifies goals and objectives of treatment, treatment strategy, a schedule
for accomplishing treatment goals and objectives, and the individuals responsible for
providing treatment services and supports;
new text end

deleted text begin (ii) deleted text end new text begin (iii) is new text end developed deleted text begin no later than the end of the first psychotherapy session after deleted text end
new text begin within 30 days of new text end the completion of the client's diagnostic assessment by deleted text begin the deleted text end new text begin a new text end mental
health professional deleted text begin who provides the client's psychotherapy deleted text end new text begin and before the provision of
children's therapeutic services and supports new text end ;

deleted text begin (iii) deleted text end new text begin (iv) is new text end developed through a child-centered, family-driven new text begin , culturally appropriate new text end
planning process deleted text begin that identifies service needs and individualized, planned, and culturally
appropriate interventions that contain specific treatment goals and objectives for the client
and the client's family or foster family deleted text end ;

deleted text begin (iv) deleted text end new text begin (v) is new text end reviewed at least once every 90 days and revised, if necessary; and

deleted text begin (v) deleted text end new text begin (vi) is new text end signed by new text begin the clinical supervisor and by new text end the client or deleted text begin , if appropriate, by the deleted text end
client's parent or other person authorized by statute to consent to mental health services
for the client;

(3) developing an individual behavior plan that documents deleted text begin services deleted text end new text begin treatment
strategies new text end to be provided by the mental health behavioral aide. The individual behavior
plan must include:

(i) detailed instructions on the deleted text begin service deleted text end new text begin treatment strategies new text end to be provided;

(ii) time allocated to each deleted text begin service deleted text end new text begin treatment strategy new text end ;

(iii) methods of documenting the child's behavior;

(iv) methods of monitoring the child's progress in reaching objectives; and

(v) goals to increase or decrease targeted behavior as identified in the individual
treatment plan;

(4) new text begin providing new text end clinical supervision of the mental health practitioner and mental health
behavioral aide. A mental health professional must document the clinical supervision
the professional provides by cosigning individual treatment plans and making entries in
the client's record on supervisory activities. Clinical supervision does not include the
authority to make or terminate court-ordered placements of the child. A clinical supervisor
must be available for urgent consultation as required by the individual client's needs or
the situation. Clinical supervision may occur individually or in a small group to discuss
treatment and review progress toward goals. The focus of clinical supervision must be the
client's treatment needs and progress and the mental health practitioner's or behavioral
aide's ability to provide services;

(4a) deleted text begin CTSS certified provider entities providing deleted text end new text begin meeting new text end day treatment new text begin and
therapeutic preschool new text end programs deleted text begin must meet the deleted text end conditions in items (i) to (iii):

(i) the supervisor must be present and available on the premises more than 50
percent of the time in a five-working-day period during which the supervisee is providing
a mental health service;

(ii) the diagnosis and the client's individual treatment plan or a change in the
diagnosis or individual treatment plan must be made by or reviewed, approved, and signed
by the supervisor; and

(iii) every 30 days, the supervisor must review and sign the record of the client's care
for all activities in the preceding 30-day period;

(4b) new text begin meeting the clinical supervision standards in items (i) to (iii) new text end for all other
services provided under CTSS deleted text begin , clinical supervision standards provided in items (i) to
(iii) must be used deleted text end :

(i) medical assistance shall reimburse a mental health practitioner new text begin and a mental
health behavioral aide new text end who maintains a consulting relationship with a mental health
professional who accepts full professional responsibility and is present on site for at
least one new text begin clock hour for new text end observation during the first 12 hours in which the mental health
practitioner new text begin or mental health behavioral aide new text end provides deleted text begin the individual, family, or group
skills training to the child or the child's family deleted text end new text begin children's therapeutic services and supports new text end ;

(ii) thereafter, the mental health professional is required to be present on site for
observation as clinically appropriate when the mental health practitioner new text begin or mental health
behavioral aide new text end is providing deleted text begin individual, family, or group skills training to the child or the
child's family deleted text end new text begin CTSS services new text end ; and

(iii) the deleted text begin observation must be a minimum of one clinical unit. The deleted text end on-site presence of
the mental health professional must be documented in the child's record and signed by the
mental health professional who accepts full professional responsibility;

(5) providing direction to a mental health behavioral aide. For entities that employ
mental health behavioral aides, the clinical supervisor must be employed by the provider
entity or other certified children's therapeutic supports and services provider entity to
ensure necessary and appropriate oversight for the client's treatment and continuity
of care. The mental health professional or mental health practitioner giving direction
must begin with the goals on the individualized treatment plan, and instruct the mental
health behavioral aide on how to construct therapeutic activities and interventions that
will lead to goal attainment. The professional or practitioner giving direction must also
instruct the mental health behavioral aide about the client's diagnosis, functional status,
and other characteristics that are likely to affect service delivery. Direction must also
include determining that the mental health behavioral aide has the skills to interact with
the client and the client's family in ways that convey personal and cultural respect and
that the aide actively solicits information relevant to treatment from the family. The aide
must be able to clearly explain the activities the aide is doing with the client and the
activities' relationship to treatment goals. Direction is more didactic than is supervision
and requires the professional or practitioner providing it to continuously evaluate the
mental health behavioral aide's ability to carry out the activities of the individualized
treatment plan and the individualized behavior plan. When providing direction, the
professional or practitioner must:

(i) review progress notes prepared by the mental health behavioral aide for accuracy
and consistency with diagnostic assessment, treatment plan, and behavior goals and the
professional or practitioner must approve and sign the progress notes;

(ii) identify changes in treatment strategies, revise the individual behavior plan,
and communicate treatment instructions and methodologies as appropriate to ensure
that treatment is implemented correctly;

(iii) demonstrate family-friendly behaviors that support healthy collaboration among
the child, the child's family, and providers as treatment is planned and implemented;

(iv) ensure that the mental health behavioral aide is able to effectively communicate
with the child, the child's family, and the provider; and

(v) record the results of any evaluation and corrective actions taken to modify the
work of the mental health behavioral aide;

(6) providing service delivery that implements the individual treatment plan and
meets the requirements under subdivision 9; and

(7) individual treatment plan review. The review must determine the extent to which
the services have met the goals and objectives in the previous treatment plan. The review
must assess the client's progress and ensure that services and treatment goals continue to
be necessary and appropriate to the client and the client's family or foster family. Revision
of the individual treatment plan does not require a new diagnostic assessment unless the
client's mental health status has changed markedly. The updated treatment plan must be
signed new text begin by the clinical supervisor and new text end by the client, if appropriate, and by the client's
parent or other person authorized by statute to give consent to the mental health services
for the child.

Sec. 4.

Minnesota Statutes 2006, section 256B.0943, subdivision 7, is amended to read:

Subd. 7.

Qualifications of individual and team providers.

(a) An individual
or team provider working within the scope of the provider's practice or qualifications
may provide service components of children's therapeutic services and supports that are
identified as medically necessary in a client's individual treatment plan.

(b) An individual provider must be qualified as:

(1) a mental health professional as defined in subdivision 1, paragraph (m); or

(2) a mental health practitioner as defined in section 245.4871, subdivision 26. The
mental health practitioner must work under the clinical supervision of a mental health
professional; or

(3) a mental health behavioral aide working under the deleted text begin direction deleted text end new text begin clinical supervision
new text end of a mental health professional to implement the rehabilitative mental health services
identified in the client's individual treatment plan new text begin and individual behavior plan new text end .

(A) A level I mental health behavioral aide must:

(i) be at least 18 years old;

(ii) have a high school diploma or general equivalency diploma (GED) or two years
of experience as a primary caregiver to a child with severe emotional disturbance within
the previous ten years; and

(iii) meet preservice and continuing education requirements under subdivision 8.

(B) A level II mental health behavioral aide must:

(i) be at least 18 years old;

(ii) have an associate or bachelor's degree or 4,000 hours of experience in delivering
clinical services in the treatment of mental illness concerning children or adolescents; and

(iii) meet preservice and continuing education requirements in subdivision 8.

(c) A preschool program multidisciplinary team must include at least one mental
health professional and one or more of the following individuals under the clinical
supervision of a mental health professional:

(i) a mental health practitioner; or

(ii) a program person, including a teacher, assistant teacher, or aide, who meets the
qualifications and training standards of a level I mental health behavioral aide.

(d) A day treatment multidisciplinary team must include at least one mental health
professional and one mental health practitioner.

Sec. 5.

Minnesota Statutes 2007 Supplement, section 256B.0943, subdivision 9,
is amended to read:

Subd. 9.

Service delivery criteria.

(a) In delivering services under this section, a
certified provider entity must ensure that:

(1) each individual provider's caseload size permits the provider to deliver services
to both clients with severe, complex needs and clients with less intensive needs. The
provider's caseload size should reasonably enable the provider to play an active role in
service planning, monitoring, and delivering services to meet the client's and client's
family's needs, as specified in each client's individual treatment plan;

(2) site-based programs, including day treatment and preschool programs, provide
staffing and facilities to ensure the client's health, safety, and protection of rights, and that
the programs are able to implement each client's individual treatment plan;

(3) a day treatment program is provided to a group of clients by a multidisciplinary
team under the clinical supervision of a mental health professional. The day treatment
program must be provided in and by: (i) an outpatient hospital accredited by the Joint
Commission on Accreditation of Health Organizations and licensed under sections 144.50
to 144.55; (ii) a community mental health center under section 245.62; deleted text begin and deleted text end new text begin or new text end (iii) an
entity that is under contract with the county board to operate a program that meets the
requirements of sections 245.4712, subdivision 2, deleted text begin and deleted text end new text begin or new text end 245.4884, subdivision 2, and
Minnesota Rules, parts 9505.0170 to 9505.0475. The day treatment program must
stabilize the client's mental health status while developing and improving the client's
independent living and socialization skills. The goal of the day treatment program must be
to reduce or relieve the effects of mental illness and provide training to enable the client
to live in the community. The program must be available deleted text begin at least one day a week for a
three-hour time block deleted text end new text begin three hours per day, five days per week, and 12 months of each
calendar year new text end . The three-hour new text begin daily new text end time block must include at least one hour, but no more
than two hours, of individual or group psychotherapy. The remainder of the three-hour
time block may include deleted text begin recreation therapy, socialization therapy, or independent living
skills therapy, deleted text end new text begin individual or group skills training new text end but only if the therapies are included in
the client's individual treatment plan. Day treatment programs are not part of inpatient
or residential treatment services new text begin . A day treatment program may provide fewer than the
minimally required hours for a particular child during the billing period in which the child
is transitioning into, or out of, the program new text end ; and

(4) a new text begin therapeutic new text end preschool program is a structured treatment program offered
to a child who is at least 33 months old, but who has not yet reached the first day of
kindergarten, by a preschool multidisciplinary team in a day program licensed under
Minnesota Rules, parts 9503.0005 to 9503.0175. The program must be available at least
one day a week for a minimum two-hour time block. The structured treatment program
may include individual or group psychotherapy and recreation therapy, socialization
therapy, or independent living skills therapy, if included in the client's individual treatment
plan. new text begin A therapeutic preschool program may provide fewer than the minimally required
hours for a particular child during the billing period in which the child is transitioning
into, or out of, the program.
new text end

(b) A provider entity must deliver the service components of children's therapeutic
services and supports in compliance with the following requirements:

(1) individual, family, and group psychotherapy must be delivered as specified in
Minnesota Rules, part 9505.0323;

(2) individual, family, or group skills training must be provided by a mental health
professional or a mental health practitioner who has a consulting relationship with a
mental health professional who accepts full professional responsibility for the training;

(3) crisis assistance must be time-limited and designed to resolve or stabilize crisis
through arrangements for direct intervention and support services to the child and the
child's family. Crisis assistance must utilize resources designed to address abrupt or
substantial changes in the functioning of the child or the child's family as evidenced by
a sudden change in behavior with negative consequences for well being, a loss of usual
coping mechanisms, or the presentation of danger to self or others;

(4) new text begin mental health behavioral aide services must be new text end medically necessary deleted text begin services
that are provided by a mental health behavioral aide deleted text end new text begin and new text end must be designed to improve
the functioning of the child and support the family in activities of daily and community
living. A mental health behavioral aide must document the delivery of services in written
progress notes. The mental health behavioral aide must implement goals in the treatment
plan for the child's emotional disturbance that allow the child to acquire developmentally
and therapeutically appropriate deleted text begin daily living skills, social skills, and leisure and recreational deleted text end
skills through targeted activities. These activities may include:

deleted text begin (i) assisting a child as needed with skills development in dressing, eating, and
toileting;
deleted text end

deleted text begin (ii) assisting, monitoring, and guiding the child to complete tasks, including
facilitating the child's participation in medical appointments;
deleted text end

deleted text begin (iii) observing the child and deleted text end new text begin (i) new text end intervening to redirect the child's inappropriate
behavior;

deleted text begin (iv) deleted text end new text begin (ii) new text end assisting the child deleted text begin in using deleted text end new text begin to progressively use new text end age-appropriate
self-management skills deleted text begin as related to deleted text end new text begin affected by new text end the child's emotional disorder or mental
illness, deleted text begin including problem solving, decision making, communication, conflict resolution,
anger management, social skills, and recreational skills deleted text end new text begin as identified in the child's
individual treatment plan and individual behavioral plan new text end ; new text begin or
new text end

deleted text begin (v) deleted text end new text begin (iii) new text end implementing deleted text begin deescalation deleted text end new text begin de-escalation new text end techniques as recommended by the
mental health professional; new text begin and
new text end

deleted text begin (vi) implementing any other mental health service that the mental health professional
has approved as being within the scope of the behavioral aide's duties; or
deleted text end

deleted text begin (vii) assisting the parents to develop and use parenting skills that help the child
achieve the goals outlined in the child's individual treatment plan or individual behavioral
plan. Parenting skills must be directed exclusively to the child's treatment; and
deleted text end

(5) direction of a mental health behavioral aide must include the following:

(i) a total of one hour of on-site observation by a mental health professional during
the first 12 hours of service provided to a child;

(ii) ongoing on-site observation by a mental health professional or mental health
practitioner for at least a total of one hour during every 40 hours of service provided
to a child; and

(iii) immediate accessibility of the mental health professional or mental health
practitioner to the mental health behavioral aide during service provision.

Sec. 6.

Minnesota Statutes 2007 Supplement, section 256B.0943, subdivision 12,
is amended to read:

Subd. 12.

Excluded services.

The following services are not eligible for medical
assistance payment as children's therapeutic services and supports:

(1) service components of children's therapeutic services and supports
deleted text begin simultaneously deleted text end provided by more than one provider entity unless prior authorization is
obtained;

new text begin (2) treatment by multiple providers within the same agency at the same clock time;
new text end

deleted text begin (2) deleted text end new text begin (3) new text end children's therapeutic services and supports provided in violation of medical
assistance policy in Minnesota Rules, part 9505.0220;

deleted text begin (3) deleted text end new text begin (4) new text end mental health behavioral aide services provided by a personal care assistant
who is not qualified as a mental health behavioral aide and employed by a certified
children's therapeutic services and supports provider entity new text begin as provided in this section new text end ;

deleted text begin (4) deleted text end new text begin (5) new text end service components of CTSS that are the responsibility of a residential or
program license holder, including foster care providers under the terms of a service
agreement or administrative rules governing licensure;

deleted text begin (5) deleted text end new text begin (6) new text end adjunctive activities that may be offered by a provider entity but are not
otherwise covered by medical assistance, including:

(i) a service that is primarily recreation oriented or that is provided in a setting that
is not medically supervised. This includes sports activities, exercise groups, activities
such as craft hours, leisure time, social hours, meal or snack time, trips to community
activities, and tours;

(ii) a social or educational service that does not have or cannot reasonably be
expected to have a therapeutic outcome related to the client's emotional disturbance;

(iii) consultation with other providers or service agency staff about the care or
progress of a client;

(iv) prevention or education programs provided to the community; and

(v) treatment for clients with primary diagnoses of alcohol or other drug abuse; and

deleted text begin (6) deleted text end new text begin (7) new text end activities that are not direct service time.

ARTICLE 2

HEALTH CARE AND CONTINUING CARE

Section 1.

Minnesota Statutes 2007 Supplement, section 256.01, subdivision 2, is
amended to read:

Subd. 2.

Specific powers.

Subject to the provisions of section 241.021, subdivision
2, the commissioner of human services shall carry out the specific duties in paragraphs (a)
through (cc):

(a) Administer and supervise all forms of public assistance provided for by state law
and other welfare activities or services as are vested in the commissioner. Administration
and supervision of human services activities or services includes, but is not limited to,
assuring timely and accurate distribution of benefits, completeness of service, and quality
program management. In addition to administering and supervising human services
activities vested by law in the department, the commissioner shall have the authority to:

(1) require county agency participation in training and technical assistance programs
to promote compliance with statutes, rules, federal laws, regulations, and policies
governing human services;

(2) monitor, on an ongoing basis, the performance of county agencies in the
operation and administration of human services, enforce compliance with statutes, rules,
federal laws, regulations, and policies governing welfare services and promote excellence
of administration and program operation;

(3) develop a quality control program or other monitoring program to review county
performance and accuracy of benefit determinations;

(4) require county agencies to make an adjustment to the public assistance benefits
issued to any individual consistent with federal law and regulation and state law and rule
and to issue or recover benefits as appropriate;

(5) delay or deny payment of all or part of the state and federal share of benefits and
administrative reimbursement according to the procedures set forth in section 256.017;

(6) make contracts with and grants to public and private agencies and organizations,
both profit and nonprofit, and individuals, using appropriated funds; and

(7) enter into contractual agreements with federally recognized Indian tribes with
a reservation in Minnesota to the extent necessary for the tribe to operate a federally
approved family assistance program or any other program under the supervision of the
commissioner. The commissioner shall consult with the affected county or counties in
the contractual agreement negotiations, if the county or counties wish to be included,
in order to avoid the duplication of county and tribal assistance program services. The
commissioner may establish necessary accounts for the purposes of receiving and
disbursing funds as necessary for the operation of the programs.

(b) Inform county agencies, on a timely basis, of changes in statute, rule, federal law,
regulation, and policy necessary to county agency administration of the programs.

(c) Administer and supervise all child welfare activities; promote the enforcement of
laws protecting disabled, dependent, neglected and delinquent children, and children born
to mothers who were not married to the children's fathers at the times of the conception
nor at the births of the children; license and supervise child-caring and child-placing
agencies and institutions; supervise the care of children in boarding and foster homes or
in private institutions; and generally perform all functions relating to the field of child
welfare now vested in the State Board of Control.

(d) Administer and supervise all noninstitutional service to disabled persons,
including those who are visually impaired, hearing impaired, or physically impaired
or otherwise disabled. The commissioner may provide and contract for the care and
treatment of qualified indigent children in facilities other than those located and available
at state hospitals when it is not feasible to provide the service in state hospitals.

(e) Assist and actively cooperate with other departments, agencies and institutions,
local, state, and federal, by performing services in conformity with the purposes of Laws
1939, chapter 431.

(f) Act as the agent of and cooperate with the federal government in matters of
mutual concern relative to and in conformity with the provisions of Laws 1939, chapter
431, including the administration of any federal funds granted to the state to aid in the
performance of any functions of the commissioner as specified in Laws 1939, chapter 431,
and including the promulgation of rules making uniformly available medical care benefits
to all recipients of public assistance, at such times as the federal government increases its
participation in assistance expenditures for medical care to recipients of public assistance,
the cost thereof to be borne in the same proportion as are grants of aid to said recipients.

(g) Establish and maintain any administrative units reasonably necessary for the
performance of administrative functions common to all divisions of the department.

(h) Act as designated guardian of both the estate and the person of all the wards of
the state of Minnesota, whether by operation of law or by an order of court, without any
further act or proceeding whatever, except as to persons committed as developmentally
disabled. For children under the guardianship of the commissioner or a tribe in Minnesota
recognized by the Secretary of the Interior whose interests would be best served by
adoptive placement, the commissioner may contract with a licensed child-placing agency
or a Minnesota tribal social services agency to provide adoption services. A contract
with a licensed child-placing agency must be designed to supplement existing county
efforts and may not replace existing county programs or tribal social services, unless the
replacement is agreed to by the county board and the appropriate exclusive bargaining
representative, tribal governing body, or the commissioner has evidence that child
placements of the county continue to be substantially below that of other counties. Funds
encumbered and obligated under an agreement for a specific child shall remain available
until the terms of the agreement are fulfilled or the agreement is terminated.

(i) Act as coordinating referral and informational center on requests for service for
newly arrived immigrants coming to Minnesota.

(j) The specific enumeration of powers and duties as hereinabove set forth shall in no
way be construed to be a limitation upon the general transfer of powers herein contained.

(k) Establish county, regional, or statewide schedules of maximum fees and charges
which may be paid by county agencies for medical, dental, surgical, hospital, nursing and
nursing home care and medicine and medical supplies under all programs of medical
care provided by the state and for congregate living care under the income maintenance
programs.

(l) Have the authority to conduct and administer experimental projects to test
methods and procedures of administering assistance and services to recipients or potential
recipients of public welfare. To carry out such experimental projects, it is further provided
that the commissioner of human services is authorized to waive the enforcement of
existing specific statutory program requirements, rules, and standards in one or more
counties. The order establishing the waiver shall provide alternative methods and
procedures of administration, shall not be in conflict with the basic purposes, coverage, or
benefits provided by law, and in no event shall the duration of a project exceed four years.
It is further provided that no order establishing an experimental project as authorized by
the provisions of this section shall become effective until the following conditions have
been met:

(1) the secretary of health and human services of the United States has agreed, for
the same project, to waive state plan requirements relative to statewide uniformity; and

(2) a comprehensive plan, including estimated project costs, shall be approved by
the Legislative Advisory Commission and filed with the commissioner of administration.

(m) According to federal requirements, establish procedures to be followed by
local welfare boards in creating citizen advisory committees, including procedures for
selection of committee members.

(n) Allocate federal fiscal disallowances or sanctions which are based on quality
control error rates for the aid to families with dependent children program formerly
codified in sections 256.72 to 256.87, medical assistance, or food stamp program in the
following manner:

(1) one-half of the total amount of the disallowance shall be borne by the county
boards responsible for administering the programs. For the medical assistance and the
AFDC program formerly codified in sections 256.72 to 256.87, disallowances shall be
shared by each county board in the same proportion as that county's expenditures for the
sanctioned program are to the total of all counties' expenditures for the AFDC program
formerly codified in sections 256.72 to 256.87, and medical assistance programs. For the
food stamp program, sanctions shall be shared by each county board, with 50 percent of
the sanction being distributed to each county in the same proportion as that county's
administrative costs for food stamps are to the total of all food stamp administrative costs
for all counties, and 50 percent of the sanctions being distributed to each county in the
same proportion as that county's value of food stamp benefits issued are to the total of
all benefits issued for all counties. Each county shall pay its share of the disallowance
to the state of Minnesota. When a county fails to pay the amount due hereunder, the
commissioner may deduct the amount from reimbursement otherwise due the county, or
the attorney general, upon the request of the commissioner, may institute civil action
to recover the amount due; and

(2) notwithstanding the provisions of clause (1), if the disallowance results from
knowing noncompliance by one or more counties with a specific program instruction, and
that knowing noncompliance is a matter of official county board record, the commissioner
may require payment or recover from the county or counties, in the manner prescribed in
clause (1), an amount equal to the portion of the total disallowance which resulted from the
noncompliance, and may distribute the balance of the disallowance according to clause (1).

(o) Develop and implement special projects that maximize reimbursements and
result in the recovery of money to the state. For the purpose of recovering state money,
the commissioner may enter into contracts with third parties. Any recoveries that result
from projects or contracts entered into under this paragraph shall be deposited in the
state treasury and credited to a special account until the balance in the account reaches
$1,000,000. When the balance in the account exceeds $1,000,000, the excess shall be
transferred and credited to the general fund. All money in the account is appropriated to
the commissioner for the purposes of this paragraph.

(p) Have the authority to make direct payments to facilities providing shelter
to women and their children according to section 256D.05, subdivision 3. Upon
the written request of a shelter facility that has been denied payments under section
256D.05, subdivision 3, the commissioner shall review all relevant evidence and make
a determination within 30 days of the request for review regarding issuance of direct
payments to the shelter facility. Failure to act within 30 days shall be considered a
determination not to issue direct payments.

(q) Have the authority to establish and enforce the following county reporting
requirements:

(1) the commissioner shall establish fiscal and statistical reporting requirements
necessary to account for the expenditure of funds allocated to counties for human
services programs. When establishing financial and statistical reporting requirements, the
commissioner shall evaluate all reports, in consultation with the counties, to determine if
the reports can be simplified or the number of reports can be reduced;

(2) the county board shall submit monthly or quarterly reports to the department
as required by the commissioner. Monthly reports are due no later than 15 working days
after the end of the month. Quarterly reports are due no later than 30 calendar days after
the end of the quarter, unless the commissioner determines that the deadline must be
shortened to 20 calendar days to avoid jeopardizing compliance with federal deadlines
or risking a loss of federal funding. Only reports that are complete, legible, and in the
required format shall be accepted by the commissioner;

(3) if the required reports are not received by the deadlines established in clause (2),
the commissioner may delay payments and withhold funds from the county board until
the next reporting period. When the report is needed to account for the use of federal
funds and the late report results in a reduction in federal funding, the commissioner shall
withhold from the county boards with late reports an amount equal to the reduction in
federal funding until full federal funding is received;

(4) a county board that submits reports that are late, illegible, incomplete, or not
in the required format for two out of three consecutive reporting periods is considered
noncompliant. When a county board is found to be noncompliant, the commissioner
shall notify the county board of the reason the county board is considered noncompliant
and request that the county board develop a corrective action plan stating how the
county board plans to correct the problem. The corrective action plan must be submitted
to the commissioner within 45 days after the date the county board received notice
of noncompliance;

(5) the final deadline for fiscal reports or amendments to fiscal reports is one year
after the date the report was originally due. If the commissioner does not receive a report
by the final deadline, the county board forfeits the funding associated with the report for
that reporting period and the county board must repay any funds associated with the
report received for that reporting period;

(6) the commissioner may not delay payments, withhold funds, or require repayment
under clause (3) or (5) if the county demonstrates that the commissioner failed to
provide appropriate forms, guidelines, and technical assistance to enable the county to
comply with the requirements. If the county board disagrees with an action taken by the
commissioner under clause (3) or (5), the county board may appeal the action according
to sections 14.57 to 14.69; and

(7) counties subject to withholding of funds under clause (3) or forfeiture or
repayment of funds under clause (5) shall not reduce or withhold benefits or services to
clients to cover costs incurred due to actions taken by the commissioner under clause
(3) or (5).

(r) Allocate federal fiscal disallowances or sanctions for audit exceptions when
federal fiscal disallowances or sanctions are based on a statewide random sample for
the foster care program under title IV-E of the Social Security Act, United States Code,
title 42, in direct proportion to each county's title IV-E foster care maintenance claim
for that period.

(s) new text begin In conjunction with law enforcement and county human services agency officials,
new text end be responsible for deleted text begin ensuring deleted text end the detection, prevention, investigation, and resolution
of fraudulent new text begin and criminal new text end activities or behavior deleted text begin by applicants, recipients, and other
participants in deleted text end new text begin involving new text end the human services programs administered by the department new text begin ,
including programs and in facilities operated by state operated services new text end .

(t) Require county agencies to identify overpayments, establish claims, and utilize
all available and cost-beneficial methodologies to collect and recover these overpayments
in the human services programs administered by the department.

(u) Have the authority to administer a drug rebate program for drugs purchased
pursuant to the prescription drug program established under section 256.955 after the
beneficiary's satisfaction of any deductible established in the program. The commissioner
shall require a rebate agreement from all manufacturers of covered drugs as defined in
section 256B.0625, subdivision 13. Rebate agreements for prescription drugs delivered on
or after July 1, 2002, must include rebates for individuals covered under the prescription
drug program who are under 65 years of age. For each drug, the amount of the rebate shall
be equal to the rebate as defined for purposes of the federal rebate program in United
States Code, title 42, section 1396r-8. The manufacturers must provide full payment
within 30 days of receipt of the state invoice for the rebate within the terms and conditions
used for the federal rebate program established pursuant to section 1927 of title XIX of
the Social Security Act. The manufacturers must provide the commissioner with any
information necessary to verify the rebate determined per drug. The rebate program shall
utilize the terms and conditions used for the federal rebate program established pursuant to
section 1927 of title XIX of the Social Security Act.

(v) Have the authority to administer the federal drug rebate program for drugs
purchased under the medical assistance program as allowed by section 1927 of title XIX
of the Social Security Act and according to the terms and conditions of section 1927.
Rebates shall be collected for all drugs that have been dispensed or administered in an
outpatient setting and that are from manufacturers who have signed a rebate agreement
with the United States Department of Health and Human Services.

(w) Have the authority to administer a supplemental drug rebate program for drugs
purchased under the medical assistance program. The commissioner may enter into
supplemental rebate contracts with pharmaceutical manufacturers and may require prior
authorization for drugs that are from manufacturers that have not signed a supplemental
rebate contract. Prior authorization of drugs shall be subject to the provisions of section
256B.0625, subdivision 13.

(x) Operate the department's communication systems account established in Laws
1993, First Special Session chapter 1, article 1, section 2, subdivision 2, to manage shared
communication costs necessary for the operation of the programs the commissioner
supervises. A communications account may also be established for each regional
treatment center which operates communications systems. Each account must be used
to manage shared communication costs necessary for the operations of the programs the
commissioner supervises. The commissioner may distribute the costs of operating and
maintaining communication systems to participants in a manner that reflects actual usage.
Costs may include acquisition, licensing, insurance, maintenance, repair, staff time and
other costs as determined by the commissioner. Nonprofit organizations and state, county,
and local government agencies involved in the operation of programs the commissioner
supervises may participate in the use of the department's communications technology and
share in the cost of operation. The commissioner may accept on behalf of the state any
gift, bequest, devise or personal property of any kind, or money tendered to the state for
any lawful purpose pertaining to the communication activities of the department. Any
money received for this purpose must be deposited in the department's communication
systems accounts. Money collected by the commissioner for the use of communication
systems must be deposited in the state communication systems account and is appropriated
to the commissioner for purposes of this section.

(y) Receive any federal matching money that is made available through the medical
assistance program for the consumer satisfaction survey. Any federal money received for
the survey is appropriated to the commissioner for this purpose. The commissioner may
expend the federal money received for the consumer satisfaction survey in either year of
the biennium.

(z) Designate community information and referral call centers and incorporate
cost reimbursement claims from the designated community information and referral
call centers into the federal cost reimbursement claiming processes of the department
according to federal law, rule, and regulations. Existing information and referral centers
provided by Greater Twin Cities United Way or existing call centers for which Greater
Twin Cities United Way has legal authority to represent, shall be included in these
designations upon review by the commissioner and assurance that these services are
accredited and in compliance with national standards. Any reimbursement is appropriated
to the commissioner and all designated information and referral centers shall receive
payments according to normal department schedules established by the commissioner
upon final approval of allocation methodologies from the United States Department of
Health and Human Services Division of Cost Allocation or other appropriate authorities.

(aa) Develop recommended standards for foster care homes that address the
components of specialized therapeutic services to be provided by foster care homes with
those services.

(bb) Authorize the method of payment to or from the department as part of the
human services programs administered by the department. This authorization includes the
receipt or disbursement of funds held by the department in a fiduciary capacity as part of
the human services programs administered by the department.

(cc) Have the authority to administer a drug rebate program for drugs purchased for
persons eligible for general assistance medical care under section 256D.03, subdivision 3.
For manufacturers that agree to participate in the general assistance medical care rebate
program, the commissioner shall enter into a rebate agreement for covered drugs as
defined in section 256B.0625, subdivisions 13 and 13d. For each drug, the amount of the
rebate shall be equal to the rebate as defined for purposes of the federal rebate program in
United States Code, title 42, section 1396r-8. The manufacturers must provide payment
within the terms and conditions used for the federal rebate program established under
section 1927 of title XIX of the Social Security Act. The rebate program shall utilize
the terms and conditions used for the federal rebate program established under section
1927 of title XIX of the Social Security Act.

Effective January 1, 2006, drug coverage under general assistance medical care shall
be limited to those prescription drugs that:

(1) are covered under the medical assistance program as described in section
256B.0625, subdivisions 13 and 13d; and

(2) are provided by manufacturers that have fully executed general assistance
medical care rebate agreements with the commissioner and comply with such agreements.
Prescription drug coverage under general assistance medical care shall conform to
coverage under the medical assistance program according to section 256B.0625,
subdivisions 13 to 13g.

The rebate revenues collected under the drug rebate program are deposited in the
general fund.

Sec. 2.

Minnesota Statutes 2007 Supplement, section 256.01, subdivision 2b, is
amended to read:

Subd. 2b.

Performance payments.

(a) The commissioner shall develop and
implement a pay-for-performance system to provide performance payments to eligible
medical groups and clinics that demonstrate optimum care in serving individuals
with chronic diseases who are enrolled in health care programs administered by the
commissioner under chapters 256B, 256D, and 256L. The commissioner may receive any
federal matching money that is made available through the medical assistance program
for managed care oversight contracted through vendors, including consumer surveys,
studies, and external quality reviews as required by the federal Balanced Budget Act of
1997, Code of Federal Regulations, title 42, part 438-managed care, subpart E-external
quality review. Any federal money received for managed care oversight is appropriated
to the commissioner for this purpose. The commissioner may expend the federal money
received in either year of the biennium.

(b) Effective July 1, deleted text begin 2009 deleted text end new text begin 2008 new text end , or upon federal approval, whichever is later, the
commissioner shall develop and implement a patient incentive health program to provide
incentives and rewards to patients who are enrolled in health care programs administered
by the commissioner under chapters 256B, 256D, and 256L, and who have agreed to and
have met personal health goals established with the patients' primary care providers to
manage a chronic disease or condition, including but not limited to diabetes, high blood
pressure, and coronary artery disease.

Sec. 3.

Minnesota Statutes 2006, section 256.046, is amended to read:

256.046 ADMINISTRATIVE FRAUD DISQUALIFICATION HEARINGS.

Subdivision 1.

Hearing authority.

A local agency must initiate an administrative
fraud disqualification hearing for individuals, including child care providers caring for
children receiving child care assistance, accused of wrongfully obtaining assistance or
intentional program violations, in lieu of a criminal action when it has not been pursued, in
the aid to families with dependent children program formerly codified in sections 256.72
to 256.87, MFIP, the diversionary work program, child care assistance programs, general
assistance, family general assistance program formerly codified in section 256D.05,
subdivision 1, clause (15), Minnesota supplemental aid, food stamp programs, general
assistance medical care, MinnesotaCare for adults without children, and upon federal
approval, all categories of medical assistance and remaining categories of MinnesotaCare
except for children through age 18. The Department of Human Services, in lieu of a local
agency, may initiate an administrative fraud disqualification hearing when the state agency
is directly responsible for administration new text begin or investigation new text end of the deleted text begin health care deleted text end program for
which benefits were wrongfully obtained. The hearing is subject to the requirements of
section 256.045 and the requirements in Code of Federal Regulations, title 7, section
273.16 deleted text begin , for the food stamp program and title 45, section 235.112, as of September 30, 1995,
for the cash grant, medical care programs, and child care assistance under chapter 119B deleted text end .

Subd. 2.

Combined hearing.

The referee may combine a fair hearing and
administrative fraud disqualification hearing into a single hearing if the factual issues
arise out of the same, or related, circumstances and the individual receives prior notice
that the hearings will be combined. If the administrative fraud disqualification hearing
and fair hearing are combined, the time frames for administrative fraud disqualification
hearings specified in Code of Federal Regulations, title 7, section 273.16 deleted text begin , and title 45,
section 235.112, as of September 30, 1995, apply deleted text end . If the individual accused of wrongfully
obtaining assistance is charged under section 256.98 for the same act or acts which are
the subject of the hearing, the individual may request that the hearing be delayed until
the criminal charge is decided by the court or withdrawn.

Sec. 4.

Minnesota Statutes 2007 Supplement, section 256.476, subdivision 4, is
amended to read:

Subd. 4.

Support grants; criteria and limitations.

(a) A county board may
choose to participate in the consumer support grant program. If a county has not chosen
to participate by July 1, 2002, the commissioner shall contract with another county or
other entity to provide access to residents of the nonparticipating county who choose
the consumer support grant option. The commissioner shall notify the county board
in a county that has declined to participate of the commissioner's intent to enter into
a contract with another county or other entity at least 30 days in advance of entering
into the contract. The local agency shall establish written procedures and criteria to
determine the amount and use of support grants. These procedures must include, at least,
the availability of respite care, assistance with daily living, and adaptive aids. The local
agency may establish monthly or annual maximum amounts for grants and procedures
where exceptional resources may be required to meet the health and safety needs of the
person on a time-limited basis, however, the total amount awarded to each individual may
not exceed the limits established in subdivision 11.

(b) Support grants to a person, a person's legal representative, or other authorized
representative will be provided through a monthly subsidy payment and be in the form
of cash, voucher, or direct county payment to vendor. Support grant amounts must be
determined by the local agency. Each service and item purchased with a support grant
must meet all of the following criteria:

(1) it must be over and above the normal cost of caring for the person if the person
did not have functional limitations;

(2) it must be directly attributable to the person's functional limitations;

(3) it must enable the person, a person's legal representative, or other authorized
representative to delay or prevent out-of-home placement of the person; and

(4) it must be consistent with the needs identified in the service agreement, when
applicable.

(c) Items and services purchased with support grants must be those for which there
are no other public or private funds available to the person, a person's legal representative,
or other authorized representative. Fees assessed to the person or the person's family for
health and human services are not reimbursable through the grant.

(d) In approving or denying applications, the local agency shall consider the
following factors:

(1) the extent and areas of the person's functional limitations;

(2) the degree of need in the home environment for additional support; and

(3) the potential effectiveness of the grant to maintain and support the person in the
family environment or the person's own home.

(e) At the time of application to the program or screening for other services, the
person, a person's legal representative, or other authorized representative shall be provided
sufficient information to ensure an informed choice of alternatives by the person, the
person's legal representative, or other authorized representative, if any. The application
shall be made to the local agency and shall specify the needs of the person deleted text begin and family deleted text end new text begin or
the person's legal representative or other authorized representative new text end , the form and amount
of grant requested, the items and services to be reimbursed, and evidence of eligibility for
medical assistance.

(f) Upon approval of an application by the local agency and agreement on a
support plan for the person or new text begin the new text end person's deleted text begin family deleted text end new text begin legal representative or other authorized
representative new text end , the local agency shall make grants to the person or the person's deleted text begin family deleted text end new text begin legal
representative or other authorized representative new text end . The grant shall be in an amount for the
direct costs of the services or supports outlined in the service agreement.

(g) Reimbursable costs shall not include costs for resources already available,
such as special education classes, day training and habilitation, case management, other
services to which the person is entitled, medical costs covered by insurance or other health
programs, or other resources usually available at no cost to the person or the person's
deleted text begin family deleted text end new text begin legal representative or other authorized representative new text end .

(h) The state of Minnesota, the county boards participating in the consumer
support grant program, or the agencies acting on behalf of the county boards in the
implementation and administration of the consumer support grant program shall not be
liable for damages, injuries, or liabilities sustained through the purchase of support by
the individual, the individual's family, or the authorized representative under this section
with funds received through the consumer support grant program. Liabilities include but
are not limited to: workers' compensation liability, the Federal Insurance Contributions
Act (FICA), or the Federal Unemployment Tax Act (FUTA). For purposes of this section,
participating county boards and agencies acting on behalf of county boards are exempt
from the provisions of section 268.04.

Sec. 5.

Minnesota Statutes 2007 Supplement, section 256.476, subdivision 5, is
amended to read:

Subd. 5.

Reimbursement, allocations, and reporting.

(a) For the purpose of
transferring persons to the consumer support grant program from the family support
program and personal care assistant services, home health aide services, or private duty
nursing services, the amount of funds transferred by the commissioner between the
family support program account, the medical assistance account, or the consumer support
grant account shall be based on each county's participation in transferring persons to the
consumer support grant program from those programs and services.

(b) At the beginning of each fiscal year, county allocations for consumer support
grants shall be based on:

(1) the number of persons to whom the county board expects to provide consumer
supports grants;

(2) their eligibility for current program and services;

(3) the amount of nonfederal dollars allowed under subdivision 11; and

(4) projected dates when persons will start receiving grants. County allocations shall
be adjusted periodically by the commissioner based on the actual transfer of persons or
service openings, and the nonfederal dollars associated with those persons or service
openings, to the consumer support grant program.

(c) The amount of funds transferred by the commissioner from the medical
assistance account for an individual may be changed if it is determined by the county or its
agent that the individual's need for support has changed.

(d) The authority to utilize funds transferred to the consumer support grant account
for the purposes of implementing and administering the consumer support grant program
will not be limited or constrained by the spending authority provided to the program
of origination.

(e) The commissioner may use up to five percent of each county's allocation, as
adjusted, for payments for administrative expenses, to be paid as a proportionate addition
to reported direct service expenditures.

(f) The county allocation for each deleted text begin individual deleted text end new text begin person new text end or deleted text begin individual's family deleted text end new text begin the
person's legal representative or other authorized representative new text end cannot exceed the amount
allowed under subdivision 11.

(g) The commissioner may recover, suspend, or withhold payments if the county
board, local agency, or grantee does not comply with the requirements of this section.

(h) Grant funds unexpended by consumers shall return to the state once a year. The
annual return of unexpended grant funds shall occur in the quarter following the end of
the state fiscal year.

Sec. 6.

Minnesota Statutes 2007 Supplement, section 256B.057, subdivision 2c,
is amended to read:

Subd. 2c.

Extended coverage for children.

A child receiving medical assistance
under subdivision 2, who becomes ineligible due to excess income, is eligible for two
additional months of medical assistance. Eligibility under this section is effective
following any coverage available under section deleted text begin 256B.0625 deleted text end new text begin 256B.0635 new text end .

A child eligible for extended coverage under this section is deemed automatically
eligible for MinnesotaCare until renewal. MinnesotaCare coverage begins in accordance
with section 256L.05, subdivision 3.

Sec. 7.

Minnesota Statutes 2007 Supplement, section 256B.06, subdivision 4, is
amended to read:

Subd. 4.

Citizenship requirements.

(a) Eligibility for medical assistance is limited
to citizens of the United States, qualified noncitizens as defined in this subdivision, and
other persons residing lawfully in the United States. Citizens or nationals of the United
States must cooperate in obtaining satisfactory documentary evidence of citizenship or
nationality according to the requirements of the federal Deficit Reduction Act of 2005,
Public Law 109-171.

(b) "Qualified noncitizen" means a person who meets one of the following
immigration criteria:

(1) admitted for lawful permanent residence according to United States Code, title 8;

(2) admitted to the United States as a refugee according to United States Code,
title 8, section 1157;

(3) granted asylum according to United States Code, title 8, section 1158;

(4) granted withholding of deportation according to United States Code, title 8,
section 1253(h);

(5) paroled for a period of at least one year according to United States Code, title 8,
section 1182(d)(5);

(6) granted conditional entrant status according to United States Code, title 8,
section 1153(a)(7);

(7) determined to be a battered noncitizen by the United States Attorney General
according to the Illegal Immigration Reform and Immigrant Responsibility Act of 1996,
title V of the Omnibus Consolidated Appropriations Bill, Public Law 104-200;

(8) is a child of a noncitizen determined to be a battered noncitizen by the United
States Attorney General according to the Illegal Immigration Reform and Immigrant
Responsibility Act of 1996, title V, of the Omnibus Consolidated Appropriations Bill,
Public Law 104-200; or

(9) determined to be a Cuban or Haitian entrant as defined in section 501(e) of Public
Law 96-422, the Refugee Education Assistance Act of 1980.

(c) All qualified noncitizens who were residing in the United States before August
22, 1996, who otherwise meet the eligibility requirements of this chapter, are eligible for
medical assistance with federal financial participation.

(d) All qualified noncitizens who entered the United States on or after August 22,
1996, and who otherwise meet the eligibility requirements of this chapter, are eligible for
medical assistance with federal financial participation through November 30, 1996.

Beginning December 1, 1996, qualified noncitizens who entered the United States
on or after August 22, 1996, and who otherwise meet the eligibility requirements of this
chapter are eligible for medical assistance with federal participation for five years if they
meet one of the following criteria:

(i) refugees admitted to the United States according to United States Code, title 8,
section 1157;

(ii) persons granted asylum according to United States Code, title 8, section 1158;

(iii) persons granted withholding of deportation according to United States Code,
title 8, section 1253(h);

(iv) veterans of the United States armed forces with an honorable discharge for
a reason other than noncitizen status, their spouses and unmarried minor dependent
children; or

(v) persons on active duty in the United States armed forces, other than for training,
their spouses and unmarried minor dependent children.

Beginning December 1, 1996, qualified noncitizens who do not meet one of the
criteria in items (i) to (v) are eligible for medical assistance without federal financial
participation as described in paragraph (j).

(e) Noncitizens who are not qualified noncitizens as defined in paragraph (b),
who are lawfully deleted text begin residing deleted text end new text begin present new text end in the United States new text begin , as defined in Code of Federal
Regulations, title 8, section 103.12, new text end and who otherwise meet the eligibility requirements of
this chapter, are eligible for medical assistance under clauses (1) to (3). These individuals
must cooperate with the United States Citizenship and Immigration Services to pursue any
applicable immigration status, including citizenship, that would qualify them for medical
assistance with federal financial participation.

(1) Persons who were medical assistance recipients on August 22, 1996, are eligible
for medical assistance with federal financial participation through December 31, 1996.

(2) Beginning January 1, 1997, persons described in clause (1) are eligible for
medical assistance without federal financial participation as described in paragraph (j).

(3) Beginning December 1, 1996, persons residing in the United States prior to
August 22, 1996, who were not receiving medical assistance and persons who arrived on
or after August 22, 1996, are eligible for medical assistance without federal financial
participation as described in paragraph (j).

(f) Nonimmigrants who otherwise meet the eligibility requirements of this chapter
are eligible for the benefits as provided in paragraphs (g) to (i). For purposes of this
subdivision, a "nonimmigrant" is a person in one of the classes listed in United States
Code, title 8, section 1101(a)(15).

(g) Payment shall also be made for care and services that are furnished to noncitizens,
regardless of immigration status, who otherwise meet the eligibility requirements of
this chapter, if such care and services are necessary for the treatment of an emergency
medical condition, except for organ transplants and related care and services and routine
prenatal care.

(h) For purposes of this subdivision, the term "emergency medical condition" means
a medical condition that meets the requirements of United States Code, title 42, section
1396b(v).

(i) Pregnant noncitizens who are undocumented, nonimmigrants, or eligible for
medical assistance as described in paragraph (j), and who are not covered by a group
health plan or health insurance coverage according to Code of Federal Regulations, title
42, section 457.310, and who otherwise meet the eligibility requirements of this chapter,
are eligible for medical assistance through the period of pregnancy, including labor and
delivery, to the extent federal funds are available under title XXI of the Social Security
Act, and the state children's health insurance program, followed by 60 days postpartum
without federal financial participation.

(j) Qualified noncitizens as described in paragraph (d), and all other noncitizens
lawfully residing in the United States as described in paragraph (e), who are ineligible
for medical assistance with federal financial participation and who otherwise meet the
eligibility requirements of chapter 256B and of this paragraph, are eligible for medical
assistance without federal financial participation. Qualified noncitizens as described
in paragraph (d) are only eligible for medical assistance without federal financial
participation for five years from their date of entry into the United States.

(k) Beginning October 1, 2003, persons who are receiving care and rehabilitation
services from a nonprofit center established to serve victims of torture and are otherwise
ineligible for medical assistance under this chapter are eligible for medical assistance
without federal financial participation. These individuals are eligible only for the period
during which they are receiving services from the center. Individuals eligible under this
paragraph shall not be required to participate in prepaid medical assistance.

Sec. 8.

Minnesota Statutes 2007 Supplement, section 256B.0655, subdivision 12,
is amended to read:

Subd. 12.

Personal care provider; employment prohibition.

A personal care
provider shall not employ a person to provide personal care service for a qualified
recipient if the person:

(1) refuses to provide full disclosure of criminal history records as specified in
deleted text begin subdivision 1g, clause (1) deleted text end new text begin Minnesota Rules, part 9505.0335, subpart 12 new text end ;

(2) has been convicted of a crime that directly relates to the occupation of providing
personal care services to a qualified recipient;

(3) has jeopardized the health or welfare of a vulnerable adult through physical
abuse, sexual abuse, or neglect as defined in section 626.557; or

(4) is misusing or is dependent on mood-altering chemicals, including alcohol, to
the extent that the personal care provider knows or has reason to believe that the use of
chemicals has a negative effect on the person's ability to provide personal care services
or the use of chemicals is apparent during the hours the person is providing personal
care services.

Sec. 9.

Minnesota Statutes 2007 Supplement, section 256D.03, subdivision 3, is
amended to read:

Subd. 3.

General assistance medical care; eligibility.

(a) General assistance
medical care may be paid for any person who is not eligible for medical assistance under
chapter 256B, including eligibility for medical assistance based on a spenddown of excess
income according to section 256B.056, subdivision 5, or MinnesotaCare as defined in
paragraph (b), except as provided in paragraph (c), and:

(1) who is receiving assistance under section 256D.05, except for families with
children who are eligible under Minnesota family investment program (MFIP), or who is
having a payment made on the person's behalf under sections 256I.01 to 256I.06; or

(2) who is a resident of Minnesota; and

(i) who has gross countable income not in excess of 75 percent of the federal poverty
guidelines for the family size, using a six-month budget period and whose equity in assets
is not in excess of $1,000 per assistance unit. General assistance medical care is not
available for applicants or enrollees who are otherwise eligible for medical assistance but
fail to verify their assets. Enrollees who become eligible for medical assistance shall be
terminated and transferred to medical assistance. Exempt assets, the reduction of excess
assets, and the waiver of excess assets must conform to the medical assistance program in
section 256B.056, deleted text begin subdivision deleted text end new text begin subdivisions new text end 3 new text begin and 3d new text end , with the following exception: the
maximum amount of undistributed funds in a trust that could be distributed to or on behalf
of the beneficiary by the trustee, assuming the full exercise of the trustee's discretion under
the terms of the trust, must be applied toward the asset maximum;

(ii) who has gross countable income above 75 percent of the federal poverty
guidelines but not in excess of 175 percent of the federal poverty guidelines for the
family size, using a six-month budget period, whose equity in assets is not in excess
of the limits in section 256B.056, subdivision 3c, and who applies during an inpatient
hospitalization; or

(iii) the commissioner shall adjust the income standards under this section each July
1 by the annual update of the federal poverty guidelines following publication by the
United States Department of Health and Human Services.

(b) Effective for applications and renewals processed on or after September 1, 2006,
general assistance medical care may not be paid for applicants or recipients who are adults
with dependent children under 21 whose gross family income is equal to or less than 275
percent of the federal poverty guidelines who are not described in paragraph (e).

(c) Effective for applications and renewals processed on or after September 1, 2006,
general assistance medical care may be paid for applicants and recipients who meet all
eligibility requirements of paragraph (a), clause (2), item (i), for a temporary period
beginning the date of application. Immediately following approval of general assistance
medical care, enrollees shall be enrolled in MinnesotaCare under section 256L.04,
subdivision 7, with covered services as provided in section 256L.03 for the rest of the
six-month general assistance medical care eligibility period, until their six-month renewal.

(d) To be eligible for general assistance medical care following enrollment in
MinnesotaCare as required by paragraph (c), an individual must complete a new
application.

(e) Applicants and recipients eligible under paragraph (a), clause (1); who have
applied for and are awaiting a determination of blindness or disability by the state medical
review team or a determination of eligibility for Supplemental Security Income or Social
Security Disability Insurance by the Social Security Administration; who fail to meet the
requirements of section 256L.09, subdivision 2; who are homeless as defined by United
States Code, title 42, section 11301, et seq.; who are classified as end-stage renal disease
beneficiaries in the Medicare program; who are enrolled in private health care coverage as
defined in section 256B.02, subdivision 9; who are eligible under paragraph (j); or who
receive treatment funded pursuant to section 254B.02 are exempt from the MinnesotaCare
enrollment requirements of this subdivision.

(f) For applications received on or after October 1, 2003, eligibility may begin no
earlier than the date of application. For individuals eligible under paragraph (a), clause
(2), item (i), a redetermination of eligibility must occur every 12 months. Individuals are
eligible under paragraph (a), clause (2), item (ii), only during inpatient hospitalization but
may reapply if there is a subsequent period of inpatient hospitalization.

(g) Beginning September 1, 2006, Minnesota health care program applications and
renewals completed by recipients and applicants who are persons described in paragraph
(c) and submitted to the county agency shall be determined for MinnesotaCare eligibility
by the county agency. If all other eligibility requirements of this subdivision are met,
eligibility for general assistance medical care shall be available in any month during which
MinnesotaCare enrollment is pending. Upon notification of eligibility for MinnesotaCare,
notice of termination for eligibility for general assistance medical care shall be sent to
an applicant or recipient. If all other eligibility requirements of this subdivision are
met, eligibility for general assistance medical care shall be available until enrollment in
MinnesotaCare subject to the provisions of paragraphs (c), (e), and (f).

(h) The date of an initial Minnesota health care program application necessary to
begin a determination of eligibility shall be the date the applicant has provided a name,
address, and Social Security number, signed and dated, to the county agency or the
Department of Human Services. If the applicant is unable to provide a name, address,
Social Security number, and signature when health care is delivered due to a medical
condition or disability, a health care provider may act on an applicant's behalf to establish
the date of an initial Minnesota health care program application by providing the county
agency or Department of Human Services with provider identification and a temporary
unique identifier for the applicant. The applicant must complete the remainder of the
application and provide necessary verification before eligibility can be determined. The
county agency must assist the applicant in obtaining verification if necessary.

(i) County agencies are authorized to use all automated databases containing
information regarding recipients' or applicants' income in order to determine eligibility for
general assistance medical care or MinnesotaCare. Such use shall be considered sufficient
in order to determine eligibility and premium payments by the county agency.

(j) General assistance medical care is not available for a person in a correctional
facility unless the person is detained by law for less than one year in a county correctional
or detention facility as a person accused or convicted of a crime, or admitted as an
inpatient to a hospital on a criminal hold order, and the person is a recipient of general
assistance medical care at the time the person is detained by law or admitted on a criminal
hold order and as long as the person continues to meet other eligibility requirements
of this subdivision.

(k) General assistance medical care is not available for applicants or recipients who
do not cooperate with the county agency to meet the requirements of medical assistance.

(l) In determining the amount of assets of an individual eligible under paragraph
(a), clause (2), item (i), there shall be included any asset or interest in an asset, including
an asset excluded under paragraph (a), that was given away, sold, or disposed of for
less than fair market value within the 60 months preceding application for general
assistance medical care or during the period of eligibility. Any transfer described in this
paragraph shall be presumed to have been for the purpose of establishing eligibility for
general assistance medical care, unless the individual furnishes convincing evidence to
establish that the transaction was exclusively for another purpose. For purposes of this
paragraph, the value of the asset or interest shall be the fair market value at the time it
was given away, sold, or disposed of, less the amount of compensation received. For any
uncompensated transfer, the number of months of ineligibility, including partial months,
shall be calculated by dividing the uncompensated transfer amount by the average monthly
per person payment made by the medical assistance program to skilled nursing facilities
for the previous calendar year. The individual shall remain ineligible until this fixed period
has expired. The period of ineligibility may exceed 30 months, and a reapplication for
benefits after 30 months from the date of the transfer shall not result in eligibility unless
and until the period of ineligibility has expired. The period of ineligibility begins in the
month the transfer was reported to the county agency, or if the transfer was not reported,
the month in which the county agency discovered the transfer, whichever comes first. For
applicants, the period of ineligibility begins on the date of the first approved application.

(m) When determining eligibility for any state benefits under this subdivision,
the income and resources of all noncitizens shall be deemed to include their sponsor's
income and resources as defined in the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996, title IV, Public Law 104-193, sections 421 and 422, and
subsequently set out in federal rules.

(n) Undocumented noncitizens and nonimmigrants are ineligible for general
assistance medical care. For purposes of this subdivision, a nonimmigrant is an individual
in one or more of the classes listed in United States Code, title 8, section 1101(a)(15), and
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.

(o) Notwithstanding any other provision of law, a noncitizen who is ineligible for
medical assistance due to the deeming of a sponsor's income and resources, is ineligible
for general assistance medical care.

(p) Effective July 1, 2003, general assistance medical care emergency services end.

Sec. 10.

Minnesota Statutes 2006, section 256L.07, subdivision 5, is amended to read:

Subd. 5.

Voluntary disenrollment for members of military.

Notwithstanding
section 256L.05, subdivision 3b, MinnesotaCare enrollees who are members of the
military and their families, who choose to voluntarily disenroll from the program when
one or more family members are called to active duty, may reenroll during or following
that member's tour of active duty. Those individuals and families shall be considered
to have good cause for voluntary termination under section 256L.06, subdivision 3,
paragraph (d). Income and asset increases reported at the time of reenrollment shall be
disregarded. All provisions of sections 256L.01 to 256L.18 shall apply to individuals and
families enrolled under this subdivision upon deleted text begin six-month deleted text end new text begin 12-month new text end renewal.

Sec. 11.

Minnesota Statutes 2007 Supplement, section 256L.15, subdivision 2, is
amended to read:

Subd. 2.

Sliding fee scale; monthly gross individual or family income.

(a) The
commissioner shall establish a sliding fee scale to determine the percentage of monthly
gross individual or family income that households at different income levels must pay
to obtain coverage through the MinnesotaCare program. The sliding fee scale must be
based on the enrollee's monthly gross individual or family income. The sliding fee scale
must contain separate tables based on enrollment of one, two, or three or more persons.
The sliding fee scale begins with a premium of 1.5 percent of monthly gross individual or
family income for individuals or families with incomes below the limits for the medical
assistance program for families and children in effect on January 1, 1999, and proceeds
through the following evenly spaced steps: 1.8, 2.3, 3.1, 3.8, 4.8, 5.9, 7.4, and 8.8 percent.
These percentages are matched to evenly spaced income steps ranging from the medical
assistance income limit for families and children in effect on January 1, 1999, to 275
percent of the federal poverty guidelines for the applicable family size, up to a family size
of five. The sliding fee scale for a family of five must be used for families of more than
five. The sliding fee scale and percentages are not subject to the provisions of chapter
14. If a family or individual reports increased income after enrollment, premiums shall
be adjusted at the time the change in income is reported.

(b) deleted text begin Families deleted text end new text begin Children new text end whose gross income is above 275 percent of the federal
poverty guidelines shall pay the maximum premium. The maximum premium is defined
as a base charge for one, two, or three or more enrollees so that if all MinnesotaCare
cases paid the maximum premium, the total revenue would equal the total cost of
MinnesotaCare medical coverage and administration. In this calculation, administrative
costs shall be assumed to equal ten percent of the total. The costs of medical coverage
for pregnant women and children under age two and the enrollees in these groups shall
be excluded from the total. The maximum premium for two enrollees shall be twice the
maximum premium for one, and the maximum premium for three or more enrollees shall
be three times the maximum premium for one.

ARTICLE 3

MISCELLANEOUS

Section 1.

Minnesota Statutes 2006, section 254A.035, subdivision 2, is amended to
read:

Subd. 2.

Membership terms, compensation, removal and expiration.

The
membership of this council shall be composed of 17 persons who are American Indians
and who are appointed by the commissioner. The commissioner shall appoint one
representative from each of the following groups: Red Lake Band of Chippewa Indians;
Fond du Lac Band, Minnesota Chippewa Tribe; Grand Portage Band, Minnesota
Chippewa Tribe; Leech Lake Band, Minnesota Chippewa Tribe; Mille Lacs Band,
Minnesota Chippewa Tribe; Bois Forte Band, Minnesota Chippewa Tribe; White Earth
Band, Minnesota Chippewa Tribe; Lower Sioux Indian Reservation; Prairie Island Sioux
Indian Reservation; Shakopee Mdewakanton Sioux Indian Reservation; Upper Sioux
Indian Reservation; International Falls Northern Range; Duluth Urban Indian Community;
and two representatives from the Minneapolis Urban Indian Community and two from the
St. Paul Urban Indian Community. The terms, compensation, and removal of American
Indian Advisory Council members shall be as provided in section 15.059. The council
expires June 30, deleted text begin 2008 deleted text end new text begin 2012 new text end .

Sec. 2.

Minnesota Statutes 2006, section 254A.04, is amended to read:

254A.04 CITIZENS ADVISORY COUNCIL.

There is hereby created an Alcohol and Other Drug Abuse Advisory Council to
advise the Department of Human Services concerning the problems of alcohol and
other drug dependency and abuse, composed of ten members. Five members shall be
individuals whose interests or training are in the field of alcohol dependency and abuse;
and five members whose interests or training are in the field of dependency and abuse of
drugs other than alcohol. The terms, compensation and removal of members shall be as
provided in section 15.059. The council expires June 30, deleted text begin 2008 deleted text end new text begin 2012 new text end . The commissioner
of human services shall appoint members whose terms end in even-numbered years. The
commissioner of health shall appoint members whose terms end in odd-numbered years.

Sec. 3.

Minnesota Statutes 2006, section 256.0451, subdivision 24, is amended to read:

Subd. 24.

Reconsideration.

deleted text begin Reconsideration may be requested within 30 days
of the date of the commissioner's final order. If reconsideration is requested, the
other participants in the appeal shall be informed of the request. deleted text end new text begin A party may request
reconsideration by sending a request to the commissioner and copies of the request to the
other parties within 30 days of the date of the commissioner's final order. new text end The deleted text begin person deleted text end
new text begin party new text end seeking reconsideration has the burden to demonstrate why the matter should be
reconsidered. The request for reconsideration may include legal argument and may
include proposed additional evidence supporting the request. The other participants shall
be sent a copy of all material submitted in support of the request for reconsideration
and must be given ten days to respond. new text begin The commissioner shall inform all parties of
any action on the request.
new text end

(a) Findings of fact. When the requesting party raises a question as to the
appropriateness of the findings of fact, the commissioner shall review the entire record.

(b) Conclusions of law. When the requesting party questions the appropriateness
of a conclusion of law, the commissioner shall consider the recommended decision,
the decision under reconsideration, and the material submitted in connection with the
reconsideration. The commissioner shall review the remaining record as necessary to
issue a reconsidered decision.

(c) Written decision. The commissioner shall issue a written decision on
reconsideration in a timely fashion. The decision must clearly inform the parties that this
constitutes the final administrative decision, advise the participants of the right to seek
judicial review, and the deadline for doing so.

Sec. 4. new text begin REPEALER.
new text end

new text begin Minnesota Statutes 2006, section 256B.039, new text end new text begin is repealed.
new text end