Minnesota Legislature
SF 3560
2nd Engrossment - 91st Legislature (2019 - 2020) Posted on 05/18/2020 08:27am
2.31 2.32
2.33 2.34 2.35 2.36 2.37 2.38
2.39 2.40 2.41 2.42 2.43 2.44 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 3.20
3.21 3.22 3.23 3.24
3.25 3.26 3.27 3.28 3.29 3.30
3.31 3.32 3.33 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9 4.10 4.11 4.12 4.13 4.14 4.15 4.16 4.17 4.18 4.19 4.20 4.21 4.22 4.23 4.24 4.25 4.26 4.27 4.28 4.29 4.30 4.31 4.32 4.33 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9 5.10 5.11 5.12 5.13 5.14 5.15 5.16 5.17 5.18 5.19 5.20 5.21 5.22 5.23 5.24 5.25 5.26 5.27 5.28 5.29 5.30 5.31 5.32 6.1 6.2 6.3 6.4 6.5 6.6 6.7
6.8 6.9 6.10 6.11 6.12 6.13 6.14 6.15 6.16 6.17 6.18 6.19 6.20 6.21 6.22 6.23 6.24 6.25 6.26 6.27 6.28 6.29 6.30 6.31 6.32 6.33 7.1 7.2 7.3 7.4 7.5 7.6
7.7 7.8 7.9 7.10 7.11 7.12 7.13 7.14 7.15 7.16 7.17 7.18 7.19 7.20 7.21 7.22 7.23
7.24 7.25 7.26 7.27 7.28 7.29 7.30 7.31 7.32 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 8.9
8.10 8.11 8.12 8.13 8.14 8.15 8.16 8.17 8.18 8.19 8.20 8.21 8.22
8.23 8.24 8.25 8.26 8.27
8.28 8.29 8.30 8.31 8.32 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8
9.9 9.10 9.11 9.12 9.13 9.14 9.15 9.16 9.17 9.18 9.19 9.20 9.21 9.22 9.23 9.24 9.25 9.26 9.27 9.28 9.29 9.30 9.31 9.32 9.33 9.34 10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 10.9 10.10 10.11 10.12 10.13 10.14 10.15 10.16 10.17 10.18 10.19 10.20 10.21 10.22 10.23 10.24 10.25 10.26 10.27 10.28 10.29 10.30 10.31 10.32 10.33 11.1 11.2 11.3 11.4 11.5 11.6 11.7 11.8 11.9 11.10 11.11 11.12 11.13 11.14 11.15 11.16 11.17 11.18 11.19
11.20 11.21 11.22 11.23 11.24 11.25 11.26 11.27 11.28 11.29 11.30 12.1 12.2 12.3 12.4 12.5 12.6 12.7 12.8 12.9 12.10 12.11 12.12 12.13 12.14 12.15 12.16 12.17 12.18
12.19 12.20 12.21 12.22 12.23 12.24 12.25 12.26 12.27 12.28 12.29 12.30 12.31 12.32 13.1 13.2 13.3 13.4 13.5 13.6 13.7 13.8 13.9 13.10 13.11 13.12 13.13 13.14 13.15 13.16 13.17 13.18 13.19 13.20 13.21 13.22 13.23 13.24 13.25 13.26
13.27 13.28
13.29
13.30
14.1 14.2 14.3
14.4 14.5
14.6 14.7 14.8 14.9 14.10 14.11 14.12 14.13 14.14
14.15 14.16 14.17 14.18 14.19 14.20 14.21 14.22 14.23 14.24 14.25
14.26 14.27 14.28 14.29 14.30 14.31
15.1 15.2 15.3 15.4 15.5
15.6 15.7 15.8 15.9 15.10 15.11
15.12 15.13 15.14 15.15 15.16 15.17
15.18 15.19 15.20 15.21 15.22
15.23 15.24 15.25 15.26 15.27 15.28 15.29 16.1 16.2 16.3 16.4 16.5 16.6 16.7 16.8 16.9 16.10 16.11 16.12 16.13 16.14 16.15 16.16 16.17 16.18 16.19 16.20 16.21 16.22 16.23 16.24 16.25 16.26 16.27
16.28 16.29 16.30 16.31 16.32
17.1 17.2 17.3 17.4 17.5 17.6 17.7 17.8 17.9 17.10 17.11 17.12 17.13 17.14 17.15
17.16 17.17 17.18 17.19 17.20 17.21 17.22 17.23 17.24 17.25 17.26 17.27 17.28
17.29 17.30 17.31 17.32 18.1 18.2 18.3 18.4 18.5 18.6 18.7 18.8 18.9 18.10 18.11 18.12 18.13 18.14 18.15 18.16 18.17 18.18 18.19 18.20 18.21 18.22 18.23 18.24 18.25 18.26 18.27 18.28 18.29 18.30 18.31 19.1 19.2 19.3 19.4 19.5 19.6 19.7 19.8 19.9 19.10 19.11 19.12 19.13 19.14 19.15 19.16 19.17 19.18 19.19 19.20 19.21 19.22 19.23 19.24 19.25 19.26 19.27 19.28 19.29 19.30 19.31 19.32 20.1 20.2 20.3 20.4 20.5 20.6 20.7 20.8 20.9 20.10 20.11 20.12 20.13 20.14 20.15 20.16 20.17 20.18 20.19 20.20 20.21
20.22 20.23 20.24 20.25 20.26 20.27 20.28 20.29 20.30 20.31 21.1 21.2 21.3 21.4 21.5 21.6 21.7 21.8 21.9 21.10 21.11 21.12 21.13 21.14 21.15 21.16 21.17 21.18 21.19 21.20 21.21 21.22 21.23 21.24 21.25 21.26 21.27 21.28 21.29 21.30 21.31 21.32 22.1 22.2 22.3 22.4 22.5 22.6 22.7 22.8 22.9 22.10 22.11 22.12 22.13 22.14 22.15 22.16 22.17 22.18 22.19 22.20 22.21 22.22 22.23 22.24 22.25 22.26 22.27 22.28 22.29 22.30 22.31 22.32 23.1 23.2 23.3 23.4 23.5 23.6 23.7 23.8 23.9 23.10 23.11 23.12 23.13 23.14 23.15 23.16 23.17 23.18 23.19 23.20 23.21
23.22 23.23 23.24 23.25 23.26 23.27 23.28 23.29 23.30 23.31 23.32
24.1 24.2 24.3 24.4 24.5 24.6 24.7 24.8 24.9 24.10 24.11 24.12 24.13 24.14 24.15 24.16 24.17 24.18 24.19 24.20 24.21
24.22 24.23 24.24 24.25 24.26 24.27 24.28 24.29 24.30 24.31 25.1 25.2 25.3 25.4 25.5 25.6 25.7 25.8 25.9 25.10 25.11 25.12 25.13 25.14 25.15 25.16 25.17 25.18
25.19 25.20 25.21 25.22 25.23 25.24 25.25 25.26 25.27 25.28 25.29 25.30 26.1 26.2 26.3 26.4 26.5 26.6
26.7 26.8 26.9 26.10 26.11 26.12 26.13 26.14 26.15 26.16 26.17 26.18 26.19 26.20 26.21 26.22
26.23 26.24 26.25 26.26 26.27 26.28 26.29 26.30 26.31 26.32 27.1 27.2 27.3 27.4 27.5
27.6 27.7 27.8 27.9 27.10 27.11 27.12 27.13 27.14 27.15 27.16 27.17 27.18 27.19 27.20 27.21 27.22 27.23 27.24 27.25 27.26 27.27 27.28 27.29 27.30 27.31 27.32 27.33 28.1 28.2 28.3 28.4 28.5 28.6 28.7 28.8 28.9 28.10 28.11 28.12 28.13 28.14 28.15 28.16 28.17 28.18 28.19 28.20 28.21 28.22 28.23 28.24 28.25 28.26 28.27 28.28 28.29 28.30 28.31 28.32 29.1 29.2 29.3 29.4 29.5 29.6 29.7 29.8 29.9 29.10 29.11 29.12 29.13 29.14 29.15 29.16 29.17 29.18 29.19 29.20 29.21 29.22 29.23 29.24 29.25
29.26 29.27 29.28 29.29 29.30 29.31
30.1 30.2 30.3 30.4 30.5 30.6 30.7 30.8 30.9 30.10 30.11 30.12 30.13 30.14 30.15 30.16 30.17 30.18 30.19 30.20 30.21 30.22 30.23 30.24 30.25 30.26 30.27 30.28 30.29 30.30 30.31 30.32 30.33 30.34 30.35 31.1 31.2 31.3 31.4 31.5 31.6 31.7 31.8 31.9 31.10 31.11 31.12 31.13 31.14 31.15 31.16 31.17 31.18 31.19 31.20 31.21 31.22 31.23 31.24 31.25 31.26 31.27 31.28 31.29 31.30 31.31 32.1 32.2 32.3 32.4 32.5 32.6 32.7 32.8 32.9 32.10 32.11 32.12 32.13 32.14 32.15 32.16 32.17 32.18 32.19 32.20 32.21 32.22 32.23 32.24 32.25 32.26 32.27 32.28 32.29
32.30 32.31 32.32 32.33 33.1 33.2 33.3 33.4 33.5 33.6 33.7 33.8 33.9 33.10 33.11 33.12 33.13 33.14 33.15 33.16 33.17 33.18 33.19 33.20 33.21 33.22 33.23 33.24 33.25 33.26 33.27 33.28 33.29 33.30 33.31 33.32 34.1 34.2 34.3 34.4 34.5 34.6 34.7 34.8 34.9 34.10 34.11 34.12 34.13 34.14 34.15 34.16 34.17 34.18 34.19 34.20 34.21 34.22 34.23
34.24 34.25 34.26 34.27 34.28 34.29 34.30 34.31 34.32 34.33 35.1 35.2 35.3 35.4 35.5 35.6 35.7 35.8 35.9 35.10 35.11 35.12 35.13 35.14 35.15 35.16 35.17 35.18 35.19 35.20 35.21 35.22 35.23 35.24 35.25
35.26 35.27 35.28 35.29 35.30 35.31 35.32 35.33 35.34 36.1 36.2 36.3 36.4 36.5 36.6 36.7 36.8 36.9 36.10 36.11 36.12 36.13 36.14 36.15 36.16 36.17 36.18 36.19 36.20 36.21 36.22 36.23 36.24 36.25
36.26 36.27 36.28 36.29 36.30 36.31 36.32 36.33 37.1 37.2 37.3 37.4 37.5 37.6 37.7 37.8 37.9
37.10
37.11 37.12 37.13 37.14 37.15 37.16 37.17 37.18 37.19 37.20 37.21 37.22
37.23 37.24 37.25 37.26 37.27 37.28 37.29 37.30 37.31 37.32 38.1 38.2 38.3 38.4 38.5 38.6 38.7 38.8 38.9 38.10 38.11 38.12 38.13 38.14 38.15 38.16 38.17 38.18 38.19 38.20 38.21 38.22 38.23 38.24 38.25 38.26 38.27 38.28 38.29 38.30 38.31 38.32 38.33 38.34 39.1 39.2 39.3 39.4 39.5 39.6 39.7 39.8 39.9 39.10 39.11 39.12 39.13
39.14 39.15 39.16 39.17 39.18 39.19 39.20 39.21 39.22 39.23 39.24 39.25 39.26 39.27 39.28 39.29 39.30 39.31 39.32 40.1 40.2 40.3 40.4 40.5 40.6 40.7 40.8 40.9 40.10 40.11 40.12 40.13 40.14 40.15 40.16 40.17 40.18 40.19 40.20 40.21 40.22 40.23 40.24 40.25 40.26 40.27 40.28 40.29 40.30 40.31 40.32 40.33 41.1 41.2 41.3 41.4 41.5 41.6 41.7 41.8 41.9
41.10 41.11 41.12 41.13 41.14 41.15 41.16 41.17 41.18 41.19 41.20
41.21
41.22 41.23 41.24 41.25 41.26 41.27 41.28 41.29 41.30 41.31 41.32
42.1
42.2 42.3 42.4 42.5 42.6 42.7 42.8 42.9 42.10 42.11
42.12
42.13 42.14 42.15 42.16 42.17 42.18 42.19 42.20 42.21 42.22 42.23 42.24 42.25 42.26 42.27 42.28 42.29 42.30 43.1 43.2 43.3 43.4 43.5 43.6
43.7
43.8 43.9 43.10
43.11 43.12
43.13 43.14 43.15 43.16 43.17 43.18 43.19 43.20 43.21 43.22 43.23 43.24 43.25 43.26 43.27 43.28 43.29 43.30 43.31 44.1 44.2 44.3 44.4 44.5 44.6 44.7 44.8 44.9 44.10 44.11 44.12 44.13 44.14 44.15 44.16 44.17 44.18 44.19 44.20
44.21
44.22 44.23 44.24 44.25 44.26 44.27 44.28 44.29 44.30 44.31 44.32 44.33 45.1 45.2 45.3 45.4
45.5
45.6 45.7 45.8 45.9 45.10 45.11 45.12 45.13 45.14 45.15 45.16 45.17 45.18 45.19 45.20 45.21 45.22 45.23 45.24 45.25 45.26 45.27 45.28 45.29 45.30 46.1 46.2 46.3 46.4 46.5 46.6 46.7 46.8 46.9 46.10 46.11 46.12
46.13
46.14 46.15 46.16 46.17 46.18 46.19 46.20 46.21 46.22 46.23 46.24 46.25 46.26 46.27 46.28 46.29 46.30 47.1 47.2 47.3 47.4 47.5 47.6 47.7 47.8 47.9
47.10
47.11 47.12 47.13 47.14 47.15 47.16 47.17 47.18 47.19 47.20 47.21 47.22 47.23 47.24 47.25 47.26 47.27 47.28 48.1 48.2 48.3 48.4 48.5 48.6
48.7
48.8 48.9 48.10 48.11 48.12 48.13 48.14 48.15 48.16 48.17 48.18 48.19 48.20 48.21 48.22 48.23 48.24 48.25
48.26
49.1 49.2 49.3 49.4 49.5 49.6 49.7 49.8 49.9 49.10 49.11 49.12
49.13
49.14 49.15 49.16 49.17 49.18 49.19 49.20 49.21 49.22 49.23 49.24 49.25 49.26 49.27 49.28 49.29 49.30 49.31 49.32 49.33 50.1 50.2 50.3 50.4 50.5 50.6 50.7 50.8 50.9 50.10 50.11 50.12 50.13 50.14 50.15 50.16 50.17 50.18 50.19 50.20 50.21 50.22 50.23 50.24 50.25 50.26 50.27 50.28 50.29 50.30 50.31 50.32 50.33 50.34 51.1 51.2 51.3 51.4 51.5 51.6 51.7 51.8 51.9 51.10 51.11 51.12 51.13 51.14 51.15 51.16 51.17 51.18 51.19 51.20 51.21 51.22 51.23 51.24 51.25 51.26 51.27 51.28 51.29 51.30 51.31 51.32 51.33 51.34 52.1 52.2 52.3 52.4 52.5 52.6 52.7 52.8 52.9 52.10 52.11 52.12 52.13 52.14 52.15 52.16 52.17 52.18 52.19 52.20 52.21 52.22 52.23 52.24 52.25 52.26 52.27 52.28 52.29 52.30 52.31 52.32 52.33 53.1 53.2 53.3 53.4 53.5 53.6 53.7 53.8 53.9 53.10 53.11 53.12 53.13 53.14 53.15 53.16 53.17 53.18 53.19 53.20 53.21 53.22 53.23 53.24
53.25
53.26 53.27 53.28 53.29 53.30 53.31 53.32 54.1 54.2 54.3 54.4 54.5 54.6 54.7 54.8
54.9
54.10 54.11 54.12 54.13 54.14 54.15 54.16 54.17 54.18 54.19 54.20 54.21 54.22 54.23 54.24 54.25 54.26 54.27 54.28 54.29 54.30 54.31 54.32 54.33 55.1 55.2 55.3 55.4 55.5 55.6 55.7 55.8 55.9 55.10 55.11 55.12 55.13
55.14
55.15 55.16 55.17 55.18 55.19 55.20 55.21 55.22 55.23 55.24 55.25 55.26 55.27 55.28 55.29 55.30 55.31 55.32 55.33 56.1 56.2 56.3 56.4 56.5 56.6 56.7 56.8 56.9 56.10 56.11 56.12 56.13 56.14 56.15 56.16 56.17 56.18 56.19 56.20 56.21 56.22 56.23 56.24
56.25
56.26 56.27 56.28 56.29 56.30 56.31 56.32 56.33 56.34 57.1 57.2 57.3 57.4 57.5 57.6 57.7 57.8 57.9 57.10 57.11 57.12 57.13 57.14 57.15 57.16 57.17 57.18 57.19 57.20 57.21 57.22 57.23 57.24
57.25
57.26 57.27 57.28 57.29 57.30 57.31 57.32 58.1 58.2 58.3 58.4 58.5 58.6 58.7 58.8 58.9 58.10 58.11 58.12 58.13 58.14 58.15 58.16 58.17 58.18 58.19 58.20 58.21 58.22 58.23 58.24 58.25 58.26 58.27 58.28 58.29 58.30 58.31 59.1 59.2 59.3 59.4 59.5 59.6 59.7 59.8 59.9 59.10 59.11 59.12 59.13 59.14 59.15 59.16 59.17 59.18 59.19 59.20 59.21 59.22 59.23 59.24 59.25
59.26
59.27 59.28 59.29 59.30 59.31 60.1 60.2 60.3 60.4 60.5 60.6 60.7
60.8
60.9 60.10 60.11 60.12 60.13 60.14 60.15 60.16 60.17 60.18 60.19 60.20 60.21 60.22 60.23 60.24 60.25 60.26 60.27 60.28 60.29 60.30 61.1 61.2 61.3 61.4 61.5 61.6 61.7 61.8 61.9 61.10 61.11 61.12 61.13 61.14 61.15 61.16 61.17 61.18 61.19 61.20 61.21 61.22 61.23 61.24 61.25 61.26 61.27 61.28 61.29 61.30 61.31 61.32 61.33 61.34 61.35 62.1 62.2 62.3
62.4
62.5 62.6 62.7 62.8 62.9 62.10 62.11 62.12 62.13 62.14 62.15 62.16 62.17 62.18 62.19 62.20 62.21 62.22 62.23 62.24 62.25 62.26 62.27 62.28 62.29 62.30 62.31 62.32 63.1 63.2 63.3 63.4 63.5 63.6
63.7
63.8 63.9 63.10 63.11 63.12 63.13 63.14 63.15 63.16 63.17 63.18 63.19 63.20 63.21 63.22 63.23 63.24 63.25 63.26 63.27 63.28 63.29 63.30 63.31 63.32 64.1 64.2 64.3 64.4 64.5
64.6
64.7 64.8 64.9 64.10 64.11 64.12 64.13 64.14
64.15
64.16 64.17 64.18 64.19 64.20 64.21 64.22 64.23 64.24 64.25 64.26 64.27 64.28 64.29 64.30 64.31 64.32 65.1 65.2 65.3
65.4
65.5 65.6 65.7 65.8 65.9 65.10 65.11 65.12 65.13 65.14 65.15 65.16 65.17 65.18 65.19 65.20 65.21 65.22 65.23 65.24 65.25 65.26 65.27 65.28 65.29 65.30 65.31 66.1 66.2 66.3
66.4
66.5 66.6 66.7 66.8 66.9 66.10 66.11 66.12 66.13 66.14 66.15 66.16 66.17 66.18 66.19 66.20 66.21 66.22 66.23 66.24 66.25 66.26 66.27 66.28 66.29
66.30
67.1 67.2 67.3 67.4 67.5 67.6 67.7 67.8 67.9 67.10 67.11 67.12 67.13 67.14 67.15 67.16
67.17
67.18 67.19 67.20 67.21 67.22 67.23 67.24 67.25 67.26 67.27 67.28 67.29 67.30 67.31 67.32 68.1 68.2 68.3 68.4 68.5 68.6 68.7 68.8
68.9 68.10 68.11 68.12 68.13 68.14 68.15 68.16 68.17 68.18 68.19 68.20 68.21 68.22 68.23 68.24 68.25 68.26 68.27 68.28 68.29 68.30 68.31 68.32 69.1 69.2 69.3 69.4 69.5 69.6 69.7 69.8 69.9 69.10 69.11 69.12 69.13 69.14 69.15 69.16 69.17 69.18 69.19 69.20 69.21 69.22 69.23 69.24 69.25 69.26 69.27 69.28
70.1 70.2 70.3 70.4 70.5 70.6 70.7 70.8 70.9 70.10 70.11 70.12 70.13 70.14
70.15
70.16 70.17 70.18 70.19 70.20 70.21 70.22 70.23 70.24 70.25 70.26 70.27 70.28 70.29 70.30 70.31 70.32 71.1 71.2 71.3 71.4 71.5 71.6 71.7
71.8
71.9 71.10 71.11 71.12 71.13 71.14
71.15
71.16 71.17 71.18 71.19 71.20 71.21 71.22 71.23 71.24 71.25 71.26 71.27 71.28 71.29 71.30 72.1 72.2 72.3 72.4 72.5 72.6
72.7 72.8 72.9 72.10 72.11 72.12 72.13 72.14 72.15 72.16 72.17 72.18 72.19 72.20 72.21 72.22 72.23 72.24 72.25 72.26 72.27 72.28 72.29 72.30 73.1 73.2 73.3 73.4 73.5 73.6 73.7 73.8 73.9 73.10 73.11 73.12 73.13 73.14 73.15 73.16 73.17 73.18 73.19 73.20 73.21 73.22 73.23 73.24 73.25 73.26 73.27 73.28 73.29 73.30 73.31 73.32 74.1 74.2 74.3 74.4 74.5 74.6 74.7 74.8 74.9 74.10 74.11 74.12 74.13 74.14 74.15 74.16 74.17 74.18 74.19 74.20 74.21 74.22 74.23 74.24 74.25 74.26 74.27 74.28 74.29 74.30 74.31 74.32 74.33 75.1 75.2 75.3 75.4 75.5 75.6 75.7 75.8 75.9 75.10 75.11 75.12 75.13 75.14 75.15 75.16 75.17 75.18 75.19 75.20 75.21 75.22 75.23 75.24 75.25 75.26 75.27 75.28 75.29 75.30 75.31 75.32 75.33 75.34 75.35 76.1 76.2 76.3 76.4 76.5 76.6 76.7 76.8 76.9 76.10 76.11 76.12 76.13 76.14 76.15 76.16
76.17
76.18 76.19 76.20 76.21 76.22 76.23 76.24 76.25 76.26 76.27 76.28 76.29 76.30 76.31 77.1 77.2
77.3
77.4 77.5 77.6 77.7 77.8 77.9 77.10 77.11 77.12 77.13 77.14 77.15 77.16 77.17 77.18 77.19
77.20 77.21 77.22 77.23 77.24 77.25 77.26 77.27 77.28 77.29 77.30 77.31 77.32 77.33 78.1 78.2 78.3 78.4 78.5 78.6 78.7 78.8 78.9 78.10 78.11 78.12 78.13 78.14 78.15 78.16 78.17 78.18 78.19 78.20 78.21 78.22 78.23 78.24 78.25 78.26 78.27 78.28 78.29 78.30 78.31 78.32 78.33 78.34 79.1 79.2 79.3
79.4
79.5 79.6 79.7 79.8 79.9 79.10 79.11 79.12 79.13 79.14 79.15 79.16 79.17 79.18
79.19
79.20 79.21 79.22 79.23 79.24 79.25 79.26 79.27 79.28 79.29 79.30 79.31 80.1 80.2 80.3 80.4 80.5 80.6 80.7 80.8 80.9 80.10 80.11 80.12 80.13 80.14 80.15 80.16 80.17 80.18 80.19 80.20 80.21 80.22
80.23
80.24 80.25 80.26 80.27 80.28 80.29 80.30 80.31 80.32 81.1 81.2 81.3 81.4 81.5 81.6 81.7 81.8 81.9 81.10 81.11 81.12 81.13 81.14 81.15 81.16 81.17 81.18 81.19 81.20 81.21 81.22 81.23 81.24 81.25 81.26 81.27 81.28 81.29 81.30 81.31 81.32 81.33 81.34 82.1 82.2 82.3 82.4 82.5 82.6 82.7 82.8 82.9 82.10 82.11 82.12 82.13 82.14 82.15 82.16 82.17 82.18 82.19 82.20 82.21 82.22 82.23 82.24 82.25 82.26 82.27 82.28 82.29 82.30 82.31 82.32 82.33 82.34 83.1 83.2 83.3 83.4 83.5 83.6 83.7 83.8 83.9 83.10 83.11 83.12 83.13 83.14 83.15 83.16
83.17
83.18 83.19 83.20 83.21
83.22
83.23 83.24 83.25 83.26 83.27 83.28 83.29 83.30 83.31 84.1 84.2 84.3 84.4 84.5 84.6 84.7 84.8 84.9 84.10 84.11 84.12 84.13 84.14 84.15 84.16 84.17 84.18 84.19 84.20 84.21 84.22 84.23 84.24 84.25 84.26 84.27 84.28 84.29 84.30 84.31 84.32 84.33 85.1 85.2 85.3 85.4
85.5 85.6 85.7 85.8 85.9 85.10 85.11 85.12 85.13 85.14 85.15 85.16 85.17 85.18 85.19 85.20 85.21 85.22 85.23 85.24 85.25 85.26 85.27 85.28 85.29 85.30 85.31 86.1 86.2 86.3 86.4 86.5
86.6 86.7 86.8 86.9 86.10 86.11 86.12 86.13 86.14 86.15 86.16 86.17 86.18 86.19 86.20 86.21 86.22 86.23 86.24 86.25
86.26
86.27 86.28 86.29
86.30
87.1 87.2
87.3 87.4 87.5 87.6 87.7 87.8 87.9 87.10 87.11 87.12 87.13 87.14 87.15 87.16 87.17 87.18 87.19 87.20 87.21 87.22 87.23 87.24 87.25 87.26 87.27 87.28 87.29 87.30
88.1 88.2 88.3 88.4 88.5 88.6 88.7 88.8 88.9 88.10 88.11 88.12 88.13 88.14 88.15 88.16 88.17 88.18 88.19 88.20 88.21 88.22 88.23 88.24 88.25 88.26 88.27 88.28 88.29 88.30 89.1 89.2 89.3 89.4 89.5 89.6 89.7 89.8 89.9 89.10 89.11 89.12 89.13 89.14 89.15 89.16 89.17 89.18 89.19 89.20 89.21 89.22 89.23 89.24 89.25 89.26 89.27 89.28 89.29 89.30 89.31 89.32 90.1 90.2 90.3 90.4 90.5 90.6 90.7 90.8 90.9 90.10 90.11 90.12 90.13 90.14 90.15 90.16 90.17 90.18
90.19 90.20 90.21 90.22 90.23 90.24 90.25 90.26 90.27 90.28 90.29 90.30 90.31 90.32 91.1 91.2 91.3 91.4 91.5 91.6 91.7
91.8 91.9 91.10 91.11 91.12 91.13 91.14 91.15 91.16 91.17 91.18 91.19 91.20 91.21 91.22 91.23 91.24 91.25 91.26 91.27 91.28 91.29 91.30 91.31 92.1 92.2 92.3 92.4 92.5 92.6 92.7 92.8 92.9 92.10 92.11 92.12 92.13 92.14 92.15 92.16
92.17 92.18 92.19 92.20 92.21 92.22 92.23 92.24 92.25 92.26 92.27 92.28 92.29 92.30 92.31 93.1 93.2 93.3 93.4 93.5 93.6 93.7 93.8 93.9 93.10 93.11 93.12
93.13 93.14 93.15 93.16 93.17 93.18 93.19 93.20 93.21 93.22 93.23 93.24 93.25 93.26 93.27 93.28 93.29 93.30 93.31 94.1 94.2 94.3
94.4 94.5 94.6 94.7 94.8 94.9 94.10 94.11 94.12 94.13 94.14 94.15 94.16 94.17
94.18 94.19 94.20 94.21 94.22 94.23 94.24 94.25 94.26 94.27 94.28 94.29 94.30 95.1 95.2 95.3 95.4 95.5 95.6 95.7 95.8 95.9 95.10 95.11
95.12 95.13 95.14 95.15 95.16 95.17
95.18 95.19 95.20 95.21 95.22 95.23 95.24 95.25 95.26
95.27 95.28 95.29 95.30 95.31 96.1 96.2 96.3 96.4 96.5 96.6 96.7 96.8
96.9 96.10 96.11 96.12 96.13 96.14 96.15 96.16 96.17 96.18 96.19 96.20
96.21 96.22 96.23 96.24 96.25 96.26 96.27 96.28 96.29 96.30 96.31 97.1 97.2 97.3 97.4 97.5 97.6 97.7 97.8 97.9 97.10
97.11 97.12 97.13 97.14 97.15
97.16 97.17 97.18 97.19 97.20 97.21 97.22 97.23 97.24
97.25 97.26 97.27 97.28 97.29 97.30 97.31 98.1 98.2 98.3 98.4 98.5 98.6 98.7 98.8 98.9 98.10 98.11 98.12 98.13 98.14 98.15 98.16 98.17 98.18 98.19 98.20 98.21 98.22 98.23 98.24 98.25 98.26 98.27 98.28 98.29 98.30 98.31 98.32 99.1 99.2 99.3 99.4 99.5 99.6 99.7 99.8 99.9 99.10 99.11 99.12 99.13 99.14 99.15 99.16 99.17 99.18 99.19 99.20 99.21 99.22 99.23 99.24 99.25 99.26 99.27 99.28 99.29 99.30 99.31 100.1 100.2 100.3 100.4 100.5 100.6 100.7 100.8 100.9 100.10 100.11 100.12 100.13 100.14 100.15 100.16 100.17 100.18 100.19 100.20 100.21 100.22 100.23 100.24 100.25 100.26 100.27 100.28 100.29 100.30 101.1 101.2 101.3 101.4 101.5 101.6 101.7 101.8 101.9 101.10 101.11 101.12 101.13 101.14 101.15 101.16 101.17 101.18 101.19 101.20 101.21 101.22 101.23 101.24 101.25 101.26 101.27 101.28 101.29 101.30 102.1 102.2 102.3 102.4 102.5
102.6 102.7 102.8 102.9 102.10 102.11 102.12 102.13 102.14
102.15 102.16 102.17 102.18 102.19 102.20 102.21 102.22
102.23 102.24 102.25 102.26 102.27 102.28 102.29 102.30 102.31 102.32 103.1 103.2 103.3 103.4 103.5 103.6 103.7 103.8 103.9 103.10 103.11 103.12 103.13 103.14 103.15 103.16
103.17 103.18 103.19 103.20 103.21 103.22 103.23 103.24 103.25 103.26 103.27 103.28 103.29 103.30 103.31 103.32 104.1 104.2 104.3 104.4 104.5 104.6
104.7 104.8 104.9 104.10 104.11 104.12
104.13 104.14 104.15 104.16 104.17 104.18 104.19 104.20 104.21 104.22 104.23 104.24 104.25 104.26 104.27 104.28 104.29 104.30 104.31 104.32 104.33 105.1 105.2 105.3 105.4 105.5 105.6 105.7
105.8 105.9 105.10 105.11 105.12 105.13 105.14 105.15 105.16 105.17 105.18 105.19 105.20 105.21 105.22 105.23 105.24 105.25 105.26 105.27 105.28 105.29 105.30
105.31 105.32 106.1 106.2 106.3 106.4 106.5 106.6 106.7 106.8 106.9
106.10 106.11 106.12 106.13 106.14 106.15 106.16 106.17 106.18 106.19 106.20 106.21 106.22 106.23 106.24 106.25 106.26 106.27 106.28 106.29 106.30
107.1 107.2 107.3 107.4 107.5 107.6 107.7 107.8 107.9 107.10 107.11 107.12 107.13 107.14 107.15
107.16 107.17 107.18 107.19 107.20
107.21 107.22 107.23 107.24 107.25 107.26
107.27 107.28 107.29 107.30 108.1 108.2 108.3 108.4 108.5 108.6 108.7 108.8 108.9 108.10 108.11 108.12 108.13 108.14 108.15 108.16 108.17 108.18 108.19 108.20 108.21 108.22 108.23
108.24 108.25 108.26 108.27 108.28 108.29 108.30 109.1 109.2 109.3 109.4 109.5 109.6 109.7 109.8 109.9 109.10 109.11 109.12 109.13 109.14 109.15 109.16 109.17 109.18 109.19 109.20 109.21 109.22 109.23 109.24 109.25 109.26 109.27
109.28 109.29 109.30 109.31 109.32 109.33
110.1 110.2 110.3 110.4 110.5
110.6 110.7 110.8 110.9 110.10
110.11 110.12 110.13 110.14 110.15 110.16 110.17 110.18 110.19 110.20 110.21 110.22
110.23 110.24 110.25 110.26 110.27 110.28 110.29 110.30 110.31 110.32 111.1 111.2
111.3 111.4 111.5 111.6 111.7 111.8 111.9 111.10 111.11 111.12 111.13 111.14 111.15 111.16 111.17
111.18 111.19 111.20 111.21 111.22 111.23
111.24 111.25 111.26 111.27 111.28 111.29 111.30 111.31
112.1 112.2 112.3 112.4 112.5 112.6 112.7 112.8 112.9 112.10
112.11 112.12 112.13 112.14 112.15 112.16 112.17 112.18 112.19 112.20 112.21 112.22 112.23 112.24 112.25 112.26 112.27 112.28
112.29 112.30 112.31 112.32 112.33 113.1 113.2 113.3 113.4 113.5 113.6 113.7 113.8 113.9 113.10 113.11 113.12 113.13 113.14 113.15 113.16 113.17 113.18 113.19 113.20 113.21 113.22 113.23 113.24 113.25 113.26 113.27 113.28 113.29 113.30 113.31 113.32 113.33 113.34 114.1 114.2 114.3 114.4 114.5 114.6 114.7 114.8 114.9 114.10 114.11
114.12 114.13 114.14 114.15 114.16 114.17 114.18 114.19 114.20
114.21 114.22 114.23 114.24 114.25 114.26 114.27 114.28 114.29 114.30
114.31 114.32 114.33 115.1 115.2 115.3 115.4 115.5 115.6
115.7 115.8 115.9 115.10 115.11 115.12 115.13 115.14 115.15 115.16 115.17 115.18 115.19 115.20 115.21 115.22 115.23 115.24 115.25 115.26 115.27 115.28 115.29 115.30 115.31 115.32 116.1 116.2 116.3 116.4 116.5 116.6 116.7 116.8 116.9 116.10 116.11 116.12 116.13
116.14 116.15 116.16 116.17 116.18 116.19 116.20 116.21 116.22 116.23 116.24 116.25
116.26 116.27 116.28 116.29 116.30 116.31 116.32 116.33 117.1 117.2 117.3 117.4
117.5 117.6 117.7 117.8 117.9 117.10 117.11 117.12 117.13 117.14 117.15 117.16 117.17 117.18 117.19
117.20 117.21 117.22 117.23 117.24 117.25 117.26 117.27 117.28 117.29 117.30 117.31 117.32 118.1 118.2 118.3 118.4 118.5 118.6 118.7 118.8 118.9 118.10 118.11
118.12 118.13 118.14 118.15 118.16 118.17 118.18 118.19 118.20 118.21 118.22 118.23 118.24 118.25 118.26 118.27 118.28 118.29 118.30 118.31 118.32 119.1 119.2 119.3 119.4 119.5 119.6 119.7 119.8 119.9 119.10 119.11 119.12 119.13 119.14 119.15 119.16 119.17 119.18 119.19 119.20 119.21 119.22 119.23 119.24 119.25 119.26
119.27 119.28 119.29 119.30 119.31 119.32 120.1 120.2 120.3 120.4 120.5 120.6 120.7 120.8 120.9 120.10 120.11 120.12 120.13 120.14 120.15 120.16 120.17 120.18 120.19 120.20 120.21 120.22
120.23 120.24 120.25 120.26 120.27 120.28 120.29
120.30 120.31 120.32 121.1 121.2 121.3 121.4 121.5 121.6 121.7 121.8 121.9 121.10
121.11 121.12 121.13 121.14 121.15 121.16 121.17 121.18 121.19 121.20 121.21 121.22 121.23 121.24 121.25 121.26 121.27 121.28 121.29 121.30 122.1 122.2 122.3 122.4
122.5 122.6 122.7 122.8 122.9 122.10 122.11
122.12 122.13 122.14 122.15 122.16 122.17 122.18 122.19 122.20 122.21 122.22 122.23 122.24 122.25 122.26 122.27 122.28 122.29 122.30 122.31 122.32 123.1 123.2 123.3 123.4 123.5 123.6 123.7 123.8 123.9 123.10 123.11 123.12 123.13 123.14 123.15
123.16 123.17 123.18 123.19 123.20 123.21 123.22 123.23 123.24 123.25 123.26 123.27 123.28 123.29 123.30 123.31 123.32 124.1 124.2 124.3 124.4 124.5 124.6 124.7 124.8 124.9 124.10
124.11 124.12 124.13 124.14 124.15 124.16 124.17 124.18 124.19 124.20 124.21 124.22 124.23 124.24 124.25 124.26 124.27 124.28 124.29
125.1 125.2 125.3 125.4 125.5 125.6 125.7
125.8 125.9 125.10 125.11 125.12 125.13 125.14 125.15 125.16 125.17 125.18 125.19 125.20 125.21 125.22 125.23 125.24 125.25 125.26 125.27
125.28 125.29 125.30 125.31 125.32 126.1 126.2
126.3 126.4 126.5 126.6 126.7 126.8 126.9 126.10 126.11 126.12
126.13 126.14 126.15 126.16 126.17 126.18 126.19 126.20 126.21 126.22 126.23 126.24 126.25 126.26 126.27 126.28 126.29 126.30
127.1 127.2 127.3 127.4 127.5 127.6 127.7 127.8 127.9 127.10
127.11 127.12 127.13 127.14
127.15 127.16 127.17 127.18 127.19 127.20 127.21 127.22 127.23 127.24 127.25 127.26 127.27 127.28 127.29 127.30 127.31 127.32
128.1 128.2 128.3 128.4 128.5 128.6 128.7 128.8 128.9 128.10 128.11 128.12 128.13 128.14
128.15 128.16 128.17 128.18 128.19 128.20 128.21 128.22 128.23
128.24 128.25 128.26 128.27 128.28 128.29 129.1 129.2 129.3 129.4 129.5 129.6 129.7 129.8 129.9 129.10 129.11 129.12 129.13 129.14 129.15 129.16 129.17 129.18 129.19 129.20 129.21 129.22 129.23 129.24 129.25 129.26 129.27 129.28 129.29 129.30 129.31 129.32 130.1 130.2 130.3 130.4 130.5 130.6 130.7 130.8 130.9 130.10 130.11 130.12 130.13 130.14 130.15 130.16 130.17 130.18
130.19 130.20 130.21 130.22 130.23 130.24 130.25 130.26 130.27 130.28 130.29 130.30
131.1 131.2 131.3 131.4 131.5 131.6 131.7 131.8 131.9 131.10
131.11 131.12 131.13 131.14 131.15 131.16 131.17 131.18 131.19 131.20 131.21 131.22 131.23 131.24 131.25 131.26 131.27 131.28 131.29 131.30 131.31 132.1 132.2 132.3 132.4 132.5 132.6 132.7 132.8 132.9 132.10 132.11 132.12 132.13 132.14 132.15 132.16 132.17 132.18 132.19 132.20 132.21 132.22 132.23 132.24 132.25 132.26 132.27 132.28 132.29 132.30 133.1 133.2 133.3 133.4 133.5 133.6 133.7 133.8 133.9 133.10 133.11 133.12 133.13 133.14 133.15 133.16 133.17 133.18 133.19 133.20 133.21 133.22 133.23 133.24 133.25 133.26 133.27 133.28 133.29 133.30 133.31 134.1 134.2 134.3 134.4 134.5 134.6 134.7 134.8 134.9 134.10 134.11 134.12 134.13 134.14 134.15 134.16 134.17 134.18 134.19 134.20 134.21 134.22 134.23 134.24 134.25 134.26 134.27 134.28 135.1 135.2 135.3 135.4 135.5 135.6 135.7 135.8 135.9 135.10 135.11 135.12 135.13 135.14 135.15 135.16 135.17 135.18 135.19 135.20 135.21 135.22 135.23 135.24 135.25 135.26 135.27 135.28 136.1 136.2 136.3 136.4 136.5 136.6 136.7 136.8 136.9 136.10 136.11 136.12 136.13 136.14 136.15 136.16 136.17 136.18 136.19 136.20 136.21 136.22 136.23 136.24 136.25 136.26 136.27 136.28 136.29 136.30 137.1 137.2 137.3 137.4 137.5 137.6 137.7 137.8 137.9 137.10 137.11 137.12 137.13 137.14 137.15 137.16 137.17 137.18 137.19 137.20 137.21 137.22 137.23 137.24 137.25 137.26 137.27 137.28 137.29 137.30 137.31 138.1 138.2 138.3 138.4 138.5 138.6 138.7
138.8 138.9 138.10 138.11 138.12 138.13 138.14 138.15 138.16 138.17 138.18 138.19 138.20
138.21 138.22 138.23 138.24 138.25 138.26 138.27 138.28 138.29 138.30 138.31 138.32 139.1 139.2 139.3 139.4 139.5 139.6 139.7 139.8 139.9 139.10 139.11 139.12 139.13 139.14 139.15 139.16 139.17 139.18 139.19 139.20
139.21 139.22 139.23 139.24 139.25 139.26 139.27
139.28 139.29 139.30 139.31 139.32 139.33 140.1 140.2 140.3 140.4 140.5 140.6 140.7 140.8 140.9 140.10 140.11 140.12 140.13 140.14 140.15 140.16 140.17 140.18 140.19 140.20 140.21 140.22 140.23 140.24
140.25 140.26 140.27 140.28 140.29 140.30 140.31
141.1 141.2 141.3 141.4 141.5 141.6 141.7 141.8 141.9 141.10 141.11 141.12 141.13 141.14 141.15 141.16 141.17 141.18 141.19 141.20 141.21 141.22 141.23 141.24 141.25 141.26 141.27 141.28 141.29 141.30 141.31 141.32 141.33 141.34 142.1 142.2 142.3 142.4 142.5
142.6 142.7 142.8 142.9 142.10 142.11 142.12 142.13 142.14 142.15 142.16 142.17 142.18 142.19 142.20 142.21 142.22 142.23 142.24 142.25 142.26 142.27 142.28
142.29 142.30 142.31 142.32 143.1 143.2 143.3 143.4 143.5 143.6 143.7 143.8 143.9 143.10 143.11 143.12 143.13 143.14 143.15 143.16 143.17 143.18 143.19 143.20 143.21 143.22 143.23 143.24 143.25 143.26 143.27 143.28 143.29 143.30 143.31 143.32 143.33 144.1 144.2 144.3 144.4 144.5 144.6 144.7 144.8 144.9 144.10 144.11 144.12 144.13 144.14 144.15 144.16 144.17 144.18 144.19 144.20 144.21 144.22 144.23 144.24 144.25 144.26 144.27 144.28 144.29 144.30 144.31 144.32 145.1 145.2 145.3 145.4 145.5 145.6 145.7 145.8 145.9 145.10 145.11 145.12 145.13 145.14 145.15 145.16 145.17 145.18 145.19 145.20
145.21 145.22 145.23 145.24 145.25 145.26 145.27 145.28 145.29 145.30 145.31 145.32 146.1 146.2 146.3 146.4 146.5 146.6 146.7 146.8 146.9 146.10 146.11 146.12 146.13 146.14 146.15 146.16 146.17
146.18 146.19 146.20 146.21 146.22 146.23 146.24 146.25 146.26 146.27 146.28 146.29 146.30 146.31 147.1 147.2 147.3 147.4 147.5 147.6 147.7 147.8 147.9 147.10 147.11 147.12 147.13 147.14 147.15 147.16 147.17 147.18 147.19 147.20 147.21 147.22 147.23 147.24 147.25 147.26 147.27 147.28 147.29 147.30 147.31 148.1 148.2 148.3 148.4 148.5 148.6 148.7 148.8 148.9 148.10 148.11 148.12 148.13 148.14
148.15 148.16 148.17 148.18 148.19 148.20 148.21 148.22 148.23
148.24 148.25 148.26 148.27 148.28
148.29 148.30 148.31 149.1 149.2 149.3 149.4 149.5
149.6 149.7 149.8 149.9 149.10 149.11 149.12 149.13 149.14
149.15 149.16 149.17 149.18 149.19 149.20 149.21 149.22 149.23 149.24 149.25 149.26 149.27 149.28 149.29 149.30 150.1 150.2 150.3 150.4 150.5 150.6 150.7 150.8 150.9 150.10 150.11 150.12 150.13 150.14 150.15 150.16 150.17 150.18 150.19 150.20 150.21 150.22 150.23 150.24 150.25 150.26 150.27 150.28 150.29
150.30 150.31 150.32 151.1 151.2 151.3 151.4 151.5 151.6 151.7 151.8
151.9 151.10 151.11 151.12 151.13 151.14 151.15 151.16 151.17 151.18 151.19 151.20 151.21 151.22 151.23 151.24 151.25 151.26 151.27 151.28 151.29 151.30 151.31 151.32 152.1 152.2 152.3 152.4
152.5 152.6 152.7 152.8 152.9 152.10 152.11 152.12 152.13 152.14
152.15 152.16 152.17 152.18 152.19 152.20 152.21 152.22 152.23 152.24 152.25
152.26 152.27 152.28 152.29 152.30 153.1 153.2 153.3 153.4 153.5 153.6 153.7 153.8 153.9 153.10 153.11 153.12 153.13 153.14 153.15 153.16
153.17 153.18 153.19 153.20 153.21 153.22 153.23 153.24 153.25 153.26 153.27 153.28 153.29 153.30 153.31 153.32 154.1 154.2 154.3 154.4 154.5 154.6 154.7 154.8 154.9 154.10 154.11 154.12 154.13 154.14 154.15 154.16 154.17 154.18 154.19 154.20 154.21 154.22 154.23
154.24 154.25 154.26 154.27 154.28 154.29 154.30 154.31 154.32 155.1 155.2 155.3 155.4 155.5 155.6 155.7 155.8 155.9 155.10 155.11 155.12 155.13 155.14 155.15 155.16 155.17 155.18 155.19 155.20
155.21 155.22 155.23 155.24 155.25 155.26 155.27
155.28 155.29 155.30 155.31 155.32 156.1 156.2 156.3 156.4 156.5 156.6 156.7 156.8 156.9 156.10 156.11
156.12 156.13 156.14 156.15 156.16 156.17 156.18 156.19 156.20 156.21 156.22 156.23 156.24 156.25 156.26 156.27 156.28 156.29 156.30
157.1 157.2 157.3 157.4 157.5 157.6 157.7 157.8 157.9 157.10
157.11 157.12 157.13 157.14 157.15 157.16 157.17 157.18 157.19 157.20
157.21 157.22 157.23 157.24
157.25 157.26 157.27 157.28 157.29 157.30 157.31 157.32 158.1 158.2 158.3 158.4 158.5 158.6 158.7 158.8 158.9 158.10 158.11 158.12 158.13 158.14 158.15 158.16 158.17 158.18 158.19 158.20 158.21 158.22 158.23 158.24 158.25 158.26 158.27 158.28 158.29 158.30 158.31 158.32 158.33 159.1 159.2 159.3
159.4 159.5 159.6 159.7 159.8 159.9 159.10
159.11 159.12 159.13 159.14 159.15 159.16 159.17 159.18 159.19 159.20
159.21 159.22 159.23 159.24 159.25 159.26 159.27 159.28 159.29 159.30 159.31 159.32 160.1 160.2
160.3 160.4 160.5 160.6 160.7 160.8 160.9 160.10 160.11 160.12
160.13 160.14 160.15 160.16 160.17 160.18 160.19 160.20 160.21 160.22 160.23
160.24 160.25 160.26 160.27 160.28 160.29 160.30 160.31 160.32 161.1 161.2
161.3 161.4 161.5 161.6 161.7 161.8 161.9 161.10 161.11 161.12 161.13 161.14 161.15 161.16 161.17 161.18 161.19 161.20 161.21 161.22 161.23 161.24 161.25 161.26 161.27 161.28 161.29 161.30 161.31 162.1 162.2 162.3 162.4 162.5 162.6 162.7 162.8 162.9 162.10 162.11 162.12 162.13 162.14
162.15 162.16 162.17 162.18 162.19 162.20 162.21 162.22 162.23 162.24 162.25 162.26 162.27 162.28 162.29 162.30 163.1 163.2 163.3 163.4 163.5 163.6 163.7 163.8 163.9 163.10 163.11 163.12 163.13 163.14 163.15 163.16 163.17 163.18 163.19 163.20 163.21 163.22 163.23 163.24 163.25 163.26 163.27 163.28 163.29 163.30 164.1 164.2 164.3 164.4 164.5 164.6 164.7 164.8 164.9 164.10 164.11 164.12
164.13 164.14 164.15 164.16 164.17 164.18 164.19 164.20 164.21 164.22 164.23 164.24 164.25 164.26
164.27 164.28 164.29 164.30 164.31 164.32 165.1 165.2 165.3 165.4 165.5 165.6 165.7 165.8
165.9 165.10 165.11 165.12 165.13 165.14 165.15 165.16 165.17 165.18 165.19 165.20 165.21 165.22 165.23 165.24 165.25 165.26 165.27 165.28 165.29 165.30 165.31 165.32 165.33 165.34 166.1 166.2 166.3 166.4 166.5 166.6 166.7 166.8 166.9 166.10 166.11 166.12 166.13 166.14 166.15 166.16 166.17 166.18 166.19 166.20 166.21 166.22 166.23 166.24 166.25 166.26 166.27 166.28 166.29 166.30 166.31 166.32 166.33 166.34 166.35 167.1 167.2 167.3 167.4 167.5 167.6 167.7 167.8 167.9 167.10 167.11 167.12 167.13 167.14 167.15 167.16 167.17 167.18 167.19 167.20 167.21 167.22 167.23 167.24 167.25 167.26 167.27 167.28 167.29 167.30
168.1 168.2 168.3 168.4 168.5 168.6 168.7 168.8 168.9 168.10 168.11 168.12 168.13 168.14 168.15 168.16 168.17 168.18 168.19 168.20 168.21 168.22 168.23 168.24 168.25 168.26 168.27 168.28 168.29 168.30 168.31 169.1 169.2 169.3 169.4 169.5 169.6 169.7 169.8 169.9 169.10 169.11 169.12 169.13 169.14 169.15 169.16 169.17 169.18 169.19 169.20
169.21 169.22 169.23 169.24 169.25 169.26 169.27 169.28 169.29 169.30 169.31 169.32 169.33 170.1 170.2 170.3 170.4 170.5 170.6 170.7 170.8 170.9 170.10 170.11 170.12 170.13 170.14 170.15 170.16 170.17
170.18 170.19 170.20 170.21 170.22 170.23 170.24
170.25 170.26 170.27 170.28 170.29 170.30 170.31 171.1 171.2 171.3 171.4 171.5 171.6 171.7 171.8 171.9 171.10 171.11 171.12 171.13 171.14 171.15 171.16 171.17 171.18 171.19 171.20 171.21 171.22 171.23 171.24 171.25 171.26 171.27 171.28 171.29 171.30 171.31 171.32 171.33 171.34 172.1 172.2 172.3 172.4 172.5 172.6 172.7 172.8 172.9 172.10 172.11
172.12 172.13 172.14 172.15 172.16 172.17 172.18 172.19 172.20 172.21 172.22 172.23 172.24 172.25 172.26 172.27 172.28 172.29 172.30 172.31 172.32 173.1 173.2 173.3 173.4 173.5 173.6 173.7 173.8 173.9 173.10 173.11 173.12 173.13 173.14 173.15 173.16 173.17 173.18 173.19 173.20 173.21 173.22 173.23 173.24 173.25 173.26 173.27 173.28 173.29 173.30 173.31 173.32 174.1 174.2 174.3 174.4 174.5 174.6 174.7 174.8 174.9 174.10 174.11 174.12 174.13 174.14 174.15 174.16 174.17 174.18 174.19 174.20 174.21 174.22 174.23 174.24 174.25 174.26 174.27 174.28 174.29 174.30 174.31 174.32 174.33 175.1 175.2 175.3 175.4 175.5 175.6 175.7 175.8 175.9 175.10 175.11 175.12 175.13 175.14 175.15 175.16 175.17 175.18 175.19 175.20 175.21 175.22 175.23 175.24 175.25 175.26 175.27 175.28 175.29 175.30 175.31 176.1 176.2 176.3 176.4 176.5 176.6 176.7 176.8 176.9 176.10 176.11 176.12 176.13 176.14 176.15 176.16 176.17 176.18 176.19 176.20 176.21 176.22 176.23 176.24 176.25 176.26 176.27
176.28 176.29 176.30 176.31 177.1 177.2 177.3 177.4 177.5 177.6 177.7 177.8 177.9 177.10 177.11 177.12 177.13 177.14 177.15 177.16 177.17 177.18 177.19 177.20 177.21 177.22 177.23 177.24 177.25 177.26 177.27 177.28 177.29 177.30 177.31 177.32 177.33 177.34 178.1 178.2 178.3 178.4 178.5 178.6 178.7 178.8 178.9 178.10 178.11 178.12 178.13 178.14 178.15 178.16 178.17 178.18 178.19 178.20 178.21 178.22 178.23 178.24 178.25 178.26 178.27 178.28
178.29 178.30 178.31 178.32 178.33 178.34 179.1 179.2 179.3 179.4 179.5 179.6 179.7 179.8
179.9 179.10 179.11 179.12 179.13 179.14 179.15 179.16 179.17 179.18 179.19 179.20 179.21 179.22 179.23 179.24 179.25 179.26 179.27 179.28 179.29 180.1 180.2
180.3 180.4 180.5 180.6 180.7 180.8 180.9 180.10 180.11 180.12 180.13 180.14 180.15 180.16 180.17 180.18 180.19 180.20
180.21 180.22 180.23 180.24 180.25 180.26 180.27 180.28 180.29 180.30 181.1 181.2 181.3
181.4 181.5 181.6 181.7 181.8 181.9 181.10 181.11 181.12 181.13 181.14 181.15 181.16 181.17 181.18 181.19 181.20 181.21 181.22 181.23 181.24 181.25 181.26 181.27 181.28 181.29 181.30 182.1 182.2 182.3 182.4 182.5 182.6 182.7 182.8 182.9 182.10 182.11 182.12 182.13 182.14 182.15 182.16 182.17 182.18 182.19 182.20 182.21 182.22 182.23 182.24 182.25 182.26 182.27 182.28 182.29 182.30 182.31 182.32 183.1 183.2 183.3 183.4 183.5 183.6 183.7 183.8 183.9 183.10 183.11
183.12 183.13 183.14 183.15 183.16 183.17 183.18 183.19 183.20 183.21 183.22 183.23 183.24 183.25 183.26 183.27 183.28 183.29 183.30 184.1 184.2 184.3 184.4 184.5 184.6 184.7 184.8 184.9 184.10 184.11 184.12 184.13 184.14 184.15 184.16 184.17 184.18 184.19 184.20 184.21 184.22 184.23 184.24 184.25 184.26 184.27
184.28 184.29 184.30 184.31 184.32 184.33 185.1 185.2 185.3 185.4 185.5 185.6 185.7 185.8 185.9 185.10 185.11 185.12 185.13 185.14 185.15 185.16 185.17 185.18 185.19 185.20 185.21 185.22 185.23 185.24 185.25 185.26 185.27 185.28 185.29 185.30 185.31 186.1 186.2 186.3 186.4 186.5 186.6 186.7 186.8 186.9 186.10 186.11 186.12 186.13 186.14 186.15 186.16 186.17 186.18 186.19 186.20 186.21 186.22 186.23
186.24 186.25 186.26 186.27 186.28 186.29 186.30 186.31 187.1 187.2 187.3 187.4 187.5 187.6 187.7 187.8 187.9 187.10 187.11 187.12 187.13 187.14 187.15 187.16 187.17 187.18 187.19 187.20 187.21 187.22 187.23 187.24 187.25 187.26 187.27 187.28 187.29 187.30 188.1 188.2 188.3 188.4 188.5 188.6 188.7 188.8 188.9 188.10 188.11 188.12 188.13 188.14 188.15 188.16 188.17 188.18 188.19 188.20 188.21 188.22 188.23 188.24
188.25 188.26 188.27 188.28 188.29 188.30 188.31
189.1 189.2 189.3 189.4 189.5 189.6 189.7 189.8 189.9 189.10 189.11 189.12 189.13 189.14 189.15 189.16 189.17 189.18 189.19 189.20 189.21 189.22 189.23 189.24 189.25 189.26 189.27 189.28 189.29 189.30 189.31 189.32 190.1 190.2 190.3 190.4 190.5 190.6 190.7 190.8 190.9 190.10 190.11 190.12 190.13 190.14 190.15 190.16 190.17 190.18 190.19 190.20 190.21 190.22 190.23 190.24 190.25
190.26 190.27 190.28 190.29 190.30 190.31 190.32 190.33 191.1 191.2 191.3 191.4 191.5 191.6 191.7 191.8 191.9 191.10 191.11 191.12 191.13 191.14 191.15 191.16 191.17 191.18
191.19 191.20 191.21 191.22 191.23 191.24 191.25 191.26 191.27 191.28 191.29 191.30 191.31
192.1 192.2 192.3 192.4 192.5 192.6 192.7 192.8 192.9 192.10 192.11 192.12 192.13 192.14 192.15 192.16 192.17 192.18 192.19 192.20 192.21 192.22 192.23 192.24 192.25 192.26 192.27 192.28 192.29 192.30 192.31 192.32 193.1 193.2 193.3 193.4 193.5 193.6 193.7 193.8 193.9 193.10 193.11 193.12 193.13
193.14 193.15 193.16 193.17 193.18 193.19 193.20 193.21 193.22 193.23 193.24 193.25 193.26 193.27 193.28 193.29 193.30
194.1 194.2 194.3 194.4 194.5 194.6 194.7 194.8 194.9 194.10 194.11 194.12 194.13 194.14 194.15 194.16 194.17 194.18 194.19 194.20 194.21 194.22 194.23 194.24 194.25 194.26 194.27 194.28 194.29 194.30 194.31 194.32 194.33 194.34
195.1 195.2 195.3 195.4 195.5 195.6 195.7 195.8 195.9 195.10 195.11 195.12 195.13 195.14 195.15
195.16 195.17 195.18 195.19
195.20 195.21 195.22 195.23 195.24 195.25 195.26 195.27 195.28 195.29
195.30 195.31 195.32 196.1 196.2
196.3 196.4 196.5 196.6
196.7 196.8 196.9 196.10 196.11 196.12
196.13 196.14
A bill for an act
relating to human services; modifying policy provisions governing health care;
specifying when a provider must furnish requested medical records; modifying
x-ray equipment provisions; requiring an annual unannounced inspection of medical
cannabis manufacturers; modifying eligibility for the reduced patient enrollment
fee for the medical cannabis program; permitting licensed physician assistants to
practice without a delegation agreement; modifying licensed traditional midwifery
scope of practice; modifying the request for proposal for a central drug repository;
authorizing pharmacists to prescribe self-administered hormonal contraceptives,
nicotine replacement medications, and opiate antagonists; allowing telemedicine
examinations to be used to prescribe medications for erectile dysfunction and for
the treatment of substance abuse disorders; changing the terminology and other
technical changes to the opiate epidemic response account and council; adding
advanced practice registered nurses to certain statutes; amending Minnesota Statutes
2018, sections 62A.307, subdivision 2; 62D.09, subdivision 1; 62E.06, subdivision
1; 62J.17, subdivision 4a; 62J.495, subdivision 1a; 62J.52, subdivision 2; 62J.823,
subdivision 3; 62Q.43, subdivisions 1, 2; 62Q.54; 62Q.57, subdivision 1; 62Q.73,
subdivision 7; 62Q.733, subdivision 3; 62Q.74, subdivision 1; 62S.08, subdivision
3; 62S.20, subdivision 5b; 62S.21, subdivision 2; 62S.268, subdivision 1; 62U.03;
62U.04, subdivision 11; 144.121, subdivisions 1, 2, 5, by adding subdivisions;
144.292, subdivisions 2, 5; 144.3345, subdivision 1; 144.3352; 144.34; 144.441,
subdivisions 4, 5; 144.442, subdivision 1; 144.4803, subdivisions 1, 4, 10, by
adding a subdivision; 144.4806; 144.4807, subdivisions 1, 2, 4; 144.50, subdivision
2; 144.55, subdivision 6; 144.6501, subdivision 7; 144.651, subdivisions 7, 8, 9,
10, 12, 14, 31, 33; 144.652, subdivision 2; 144.69; 144.7402, subdivision 2;
144.7406, subdivision 2; 144.7407, subdivision 2; 144.7414, subdivision 2;
144.7415, subdivision 2; 144.9502, subdivision 4; 144.966, subdivisions 3, 6;
144A.135; 144A.161, subdivisions 5, 5a, 5e, 5g; 144A.75, subdivisions 3, 6;
144A.752, subdivision 1; 145.853, subdivision 5; 145.892, subdivision 3; 145.94,
subdivision 2; 145B.13; 145C.02; 145C.06; 145C.07, subdivision 1; 145C.16;
147A.01, subdivisions 3, 21, 26, 27, by adding a subdivision; 147A.02; 147A.03,
by adding a subdivision; 147A.05; 147A.09; 147A.13, subdivision 1; 147A.14,
subdivision 4; 147A.16; 147A.23; 147D.03, subdivision 2; 148.6438, subdivision
1; 151.01, by adding a subdivision; 151.071, subdivision 8; 151.19, subdivision
4; 151.21, subdivision 4a; 151.37, subdivision 2, by adding subdivisions; 152.12,
subdivision 1; 152.32, subdivision 3; 152.35; 245A.143, subdivision 8; 245A.1435;
245C.02, subdivision 18; 245C.04, subdivision 1; 245D.02, subdivision 11;
245D.11, subdivision 2; 245D.22, subdivision 7; 245D.25, subdivision 2; 245G.08,
subdivisions 2, 5; 245G.21, subdivisions 2, 3; 246.711, subdivision 2; 246.715,
subdivision 2; 246.716, subdivision 2; 246.721; 246.722; 251.043, subdivision 1;
252A.02, subdivision 12; 252A.04, subdivision 2; 252A.20, subdivision 1; 253B.03,
subdivisions 4, 6d; 253B.06, subdivision 2; 253B.23, subdivision 4; 254A.08,
subdivision 2; 256.01, subdivision 29; 256.9685, subdivisions 1a, 1b, 1c; 256.975,
subdivisions 7a, 11; 256B.04, subdivision 14a; 256B.043, subdivision 2; 256B.055,
subdivision 12; 256B.056, subdivisions 1a, 4, 7, 10; 256B.0561, subdivision 2;
256B.057, subdivisions 1, 10; 256B.0575, subdivisions 1, 2; 256B.0622, subdivision
2b; 256B.0623, subdivision 2; 256B.0625, subdivisions 1, 12, 13h, 26, 27, 28, 64;
256B.0654, subdivisions 1, 2a, 3, 4; 256B.0659, subdivisions 2, 4, 8; 256B.0751;
256B.0753, subdivision 1; 256B.69, by adding a subdivision; 256B.73, subdivision
5; 256B.75; 256J.08, subdivision 73a; 256L.03, subdivision 1; 256L.15, subdivision
1; 256R.54, subdivisions 1, 2; 257.63, subdivision 3; 257B.01, subdivisions 3, 9,
10; 257B.06, subdivision 7; 446A.081, subdivision 9; Minnesota Statutes 2019
Supplement, sections 16A.151, subdivision 2; 62J.23, subdivision 2; 62Q.184,
subdivision 1; 144.121, subdivisions 1a, 5a; 144.55, subdivision 2; 145C.05,
subdivision 2; 147A.06; 151.01, subdivisions 23, 27; 151.065, subdivisions 1, as
amended, 3, as amended, 6, 7, as amended; 151.071, subdivision 2; 151.19,
subdivision 3; 151.252, subdivision 1; 151.555, subdivision 3; 152.29, subdivision
1; 245G.08, subdivision 3; 245H.11; 256.042, subdivisions 2, 4; 256.043; 256B.056,
subdivision 7a; 256B.0625, subdivisions 13, 17, 60a; 256B.0659, subdivision 11;
256B.0913, subdivision 8; 256R.44; Laws 2019, chapter 63, article 3, sections 1;
2; Laws 2019, First Special Session chapter 9, article 11, section 35; Laws 2020,
chapter 73, section 4, subdivisions 3, 4; proposing coding for new law in Minnesota
Statutes, chapters 62Q; 147A; repealing Minnesota Statutes 2018, sections 62U.15,
subdivision 2; 144.121, subdivisions 3, 5b; 147A.01, subdivisions 4, 11, 16a, 17a,
24, 25; 147A.04; 147A.10; 147A.11; 147A.18, subdivisions 1, 2, 3; 147A.20;
256B.057, subdivision 8; 256B.0752; 256L.04, subdivision 13; Minnesota Rules,
parts 7380.0280; 9505.0365, subpart 3.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA:
ARTICLE 1
DEPARTMENT OF HEALTH
Section 1.
Minnesota Statutes 2018, section 144.121, subdivision 1, is amended to read:
Subdivision 1.
Registration; fees.
The fee for the registration for x-ray deleted text begin machinesdeleted text end new text begin
equipmentnew text end and other sources of ionizing radiation required to be registered under rules
adopted by the state commissioner of health pursuant to section 144.12, shall be in an amount
as described in subdivision 1a pursuant to section 144.122. The registration shall expire and
be renewed as prescribed by the commissioner pursuant to section 144.122.
Sec. 2.
Minnesota Statutes 2019 Supplement, section 144.121, subdivision 1a, is amended
to read:
Subd. 1a.
Fees for ionizing radiation-producing equipment.
(a) A facility with ionizing
radiation-producing equipment new text begin and other sources of ionizing radiation new text end must pay an deleted text begin annualdeleted text end
initial or annual renewal registration fee consisting of a base facility fee of $100 and an
additional fee for each deleted text begin radiation sourcedeleted text end new text begin x-ray tubenew text end , as follows:
| (1) |
medical or veterinary equipment |
$ |
100 |
|
| (2) |
dental x-ray equipment |
$ |
40 |
|
| (3) |
x-ray equipment not used on humans or animals |
$ |
100 |
|
| (4) |
devices with sources of ionizing radiation not used on humans or animals |
$ |
100 |
|
| (5) |
security screening system |
$ |
100 |
(b) A facility with radiation therapy and accelerator equipment must pay an new text begin initial or
new text end annual registration fee of $500. A facility with an industrial accelerator must pay an new text begin initial
or new text end annual registration fee of $150.
(c) Electron microscopy equipment is exempt from the registration fee requirements of
this section.
(d) For purposes of this section, a security screening system means new text begin ionizing
new text end radiation-producing equipment designed and used for security screening of humans who
are in the custody of a correctional or detention facility, and used by the facility to image
and identify contraband items concealed within or on all sides of a human body. For purposes
of this section, a correctional or detention facility is a facility licensed under section 241.021
and operated by a state agency or political subdivision charged with detection, enforcement,
or incarceration in respect to state criminal and traffic laws.
Sec. 3.
Minnesota Statutes 2018, section 144.121, is amended by adding a subdivision to
read:
new text begin Subd. 1d. new text end
new text begin Handheld dental x-ray equipment. new text end
new text begin
A facility that uses handheld dental x-ray
equipment according to section 144.1215 must comply with this section.
new text end
Sec. 4.
Minnesota Statutes 2018, section 144.121, subdivision 2, is amended to read:
Subd. 2.
Inspections.
Periodic radiation safety inspections of the new text begin x-ray equipment and
othernew text end sources of ionizing radiation shall be made by the deleted text begin statedeleted text end commissioner of health. The
frequency of safety inspections shall be prescribed by the commissioner on the basis of the
frequency of use of the new text begin x-ray equipment and other new text end source of ionizing radiationdeleted text begin ;deleted text end new text begin ,new text end provided
that each source shall be inspected at least once every four years.
Sec. 5.
Minnesota Statutes 2018, section 144.121, subdivision 5, is amended to read:
Subd. 5.
Examination for individual operating x-ray deleted text begin equipmentdeleted text end new text begin systemsnew text end .
(a) deleted text begin After
January 1, 2008,deleted text end An individual in a facility with x-ray deleted text begin equipmentdeleted text end new text begin systemsnew text end for use on new text begin living
new text end humans that is registered under subdivision 1 may not operate, nor may the facility allow
the individual to operate, x-ray deleted text begin equipmentdeleted text end new text begin systemsnew text end unless the individual has passed a national
new text begin or state new text end examination deleted text begin for limited x-ray machine operators that meets the requirements of
paragraphs (b) and (c) and is approved by the commissioner of healthdeleted text end .
deleted text begin
(b) The commissioner shall establish criteria for the approval of examinations based on
national standards, such as the examination in radiography from the American Registry of
Radiologic Technologists, the examination for limited scope of practice in radiography from
the American Registry of Radiologic Technologists for limited x-ray machine operators,
and the American Registry of Chiropractic Radiography Technologists for limited
radiography in spines and extremities; or equivalent examinations approved by other states.
Equivalent examinations may be approved by the commissioner, if the examination is
consistent with the standards for educational and psychological testing as recommended by
the American Education Research Association, the American Psychological Association,
the National Council on Measurement in Education, or the National Commission for
Certifying Agencies. The organization proposing the use of an equivalent examination shall
submit a fee to the commissioner of $1,000 per examination to cover the cost of determining
the extent to which the examination meets the examining standards. The collected fee shall
be deposited in the state treasury and credited to the state government special revenue fund.
deleted text end
new text begin
(b) Individuals who may operate x-ray systems include:
new text end
new text begin
(1) an individual who has passed the American Registry of Radiologic Technologists
(ARRT) registry for radiography examination;
new text end
new text begin
(2) an individual who has passed the American Chiropractic Registry of Radiologic
Technologists (ACRRT) registry examination and is limited to radiography of spines and
extremities;
new text end
new text begin
(3) a registered limited scope x-ray operator and a registered bone densitometry equipment
operator who passed the examination requirements in paragraphs (d) and (e) and practices
according to subdivision 5a;
new text end
new text begin
(4) an x-ray operator who has the original certificate or the original letter of passing the
examination that was required before January 1, 2008, under Minnesota Statutes 2008,
section 144.121, subdivision 5a, paragraph (b), clause (1);
new text end
new text begin
(5) an individual who has passed the American Registry of Radiologic Technologists
(ARRT) registry for radiation therapy examination according to subdivision 5e;
new text end
new text begin
(6) a cardiovascular technologist according to subdivision 5c;
new text end
new text begin
(7) a nuclear medicine technologist according to subdivision 5d;
new text end
new text begin
(8) an individual who has passed the examination for a dental hygienist under section
150A.06 and only operates dental x-ray systems;
new text end
new text begin
(9) an individual who has passed the examination for a dental therapist under section
150A.06 and only operates dental x-ray systems;
new text end
new text begin
(10) an individual who has passed the examination for a dental assistant under section
150A.06, and only operates dental x-ray systems;
new text end
new text begin
(11) an individual who has passed the examination under Minnesota Rules, part
3100.8500, subpart 3, and only operates dental x-ray systems; and
new text end
new text begin
(12) a qualified practitioner who is licensed by a health-related licensing board with
active practice authority and is working within the practitioner's scope of practice.
new text end
new text begin
(c) Except for individuals under clauses (3) and (4), an individual who is participating
in a training or educational program in any of the occupations listed in paragraph (b) is
exempt from the examination requirement within the scope and for the duration of the
training or educational program.
new text end
deleted text begin (c)deleted text end new text begin (d)new text end The new text begin Minnesota new text end examination for limitednew text begin scopenew text end x-ray deleted text begin machinedeleted text end operators must
include:
(1) radiation protection, new text begin radiation physics and radiobiology, new text end equipment deleted text begin maintenance anddeleted text end
operationnew text begin and quality assurancenew text end , image deleted text begin productiondeleted text end new text begin acquisitionnew text end and new text begin technical new text end evaluation, and
patient deleted text begin caredeleted text end new text begin interactionsnew text end and management; and
(2) at least one of the following regions of the human anatomy: chest, extremities, skull
and sinus, spine, or deleted text begin ankle and footdeleted text end new text begin podiatrynew text end . The examinations must include the anatomy
of, and deleted text begin positioningdeleted text end new text begin radiographic positions and projectionsnew text end for, the specific regions.
new text begin
(e) The examination for bone densitometry equipment operators must include:
new text end
new text begin
(1) osteoporosis, bone physiology, bone health and patient education, patient preparation,
fundamental principals, biological effects of radiation, units of measurements, radiation
protection in bone densitometry, fundamentals of x-ray production, quality control, measuring
bone mineral testing, determining quality in bone mineral testing, file and database
management; and
new text end
new text begin
(2) dual x-ray absorptiometry scanning of the lumbar spine, proximal femur, and forearm.
The examination must include the anatomy, scan acquisition, and scan analysis for these
three procedures.
new text end
deleted text begin (d)deleted text end new text begin (f)new text end A limited new text begin scope new text end x-ray operatornew text begin , and a bone densitometry equipment operator,new text end
who deleted text begin isdeleted text end new text begin arenew text end required to take an examination under this subdivision must submit to the
commissioner deleted text begin andeleted text end new text begin a registrationnew text end application for the examinationdeleted text begin ,deleted text end new text begin andnew text end a $25 processing feedeleted text begin ,
and the required examination fee set by the national organization offering the examinationdeleted text end .
The processing fee deleted text begin and the examination feedeleted text end shall be deposited in the state treasury and
credited to the state government special revenue fund. deleted text begin The commissioner shall submit the
fee to the national organization providing the examination.
deleted text end
Sec. 6.
Minnesota Statutes 2019 Supplement, section 144.121, subdivision 5a, is amended
to read:
Subd. 5a.
Limited new text begin scope new text end x-ray deleted text begin machinedeleted text end new text begin and bone densitometry equipmentnew text end operator
practice.
deleted text begin (a)deleted text end A new text begin registered new text end limited new text begin scope new text end x-ray operator new text begin and a registered bone densitometry
equipment operator new text end may only practice medical radiography on limited regions of the human
anatomy for which the operator has successfully passed an examination identified in
subdivision 5, deleted text begin unless the operator meets one of the exemptions described in paragraph (b).
The operator may practice using only routine radiographic procedures, for the interpretation
by and under the direction of a qualified practitioner, excludingdeleted text end new text begin paragraphs (d) and (e) and
may not operate new text end computed tomography, new text begin cone beam computed tomography, new text end the use of contrast
media, and the use of fluoroscopic or mammographic deleted text begin equipmentdeleted text end new text begin x-ray systemsnew text end .
deleted text begin
(b) This subdivision does not apply to:
deleted text end
deleted text begin
(1) limited x-ray machine operators who passed the examination that was required before
January 1, 2008;
deleted text end
deleted text begin
(2) certified radiologic technologists, licensed dental hygienists, registered dental
assistants, certified registered nurse anesthetists, and registered physician assistants;
deleted text end
deleted text begin
(3) individuals who are licensed in Minnesota to practice medicine, osteopathic medicine,
chiropractic, podiatry, or dentistry;
deleted text end
deleted text begin
(4) individuals who are participating in a training course in any of the occupations listed
in clause (2), (3), or (5) for the duration and within the scope of the training course; and
deleted text end
deleted text begin
(5) cardiovascular technologists who assist with the operation of fluoroscopy equipment
if they:
deleted text end
deleted text begin
(i) are credentialed by Cardiovascular Credentialing International as a registered
cardiovascular invasive specialist or as a registered cardiac electrophysiology specialist,
are a graduate of an education program accredited by the Commission on Accreditation of
Allied Health Education Programs, which uses the standards and criteria established by the
Joint Review Committee on Education in Cardiovascular Technology, or are designated on
a variance granted by the commissioner, effective July 31, 2019; and
deleted text end
deleted text begin
(ii) are under the personal supervision and in the physical presence of a qualified
practitioner for diagnosing or treating a disease or condition of the cardiovascular system
in fluoroscopically guided interventional procedures. Cardiovascular technologists may not
activate the fluoroscopic system or evaluate quality control tests.
deleted text end
Sec. 7.
Minnesota Statutes 2018, section 144.121, is amended by adding a subdivision to
read:
new text begin Subd. 5c. new text end
new text begin Cardiovascular technologist practice. new text end
new text begin
(a) Cardiovascular technologists may
assist with the operation of fluoroscopy equipment if they:
new text end
new text begin
(1) are credentialed by Cardiovascular Credentialing International as a registered
cardiovascular invasive specialist or as a registered cardiac electrophysiology specialist,
are a graduate of an educational program accredited by the Commission on Accreditation
of Allied Health Education Programs, which uses the standards and criteria established by
the Joint Review Committee on Education in Cardiovascular Technology, or are designated
on a variance granted by the commissioner effective July 31, 2019; and
new text end
new text begin
(2) are under the personal supervision and in the physical presence of a qualified
practitioner for diagnosing or treating a disease or condition of the cardiovascular system
in fluoroscopically guided interventional procedures. Cardiovascular technologists may not
activate the fluoroscopic system or evaluate quality control tests.
new text end
new text begin
(b) A cardiovascular technologist who is participating in a training or educational program
in any of the occupations listed in this subdivision is exempt from the examination
requirement within the scope and for the duration of the training or educational program.
new text end
Sec. 8.
Minnesota Statutes 2018, section 144.121, is amended by adding a subdivision to
read:
new text begin Subd. 5d. new text end
new text begin Nuclear medicine technologist practice. new text end
new text begin
(a) Nuclear medicine technologists
who have passed the primary pathway credential in Nuclear Medicine Technology
Certification Board (NMTCB) for nuclear medicine or the American Registry of Radiologic
Technologists (ARRT) for nuclear medicine technology or the American Society of Clinical
Pathologists (NM) (ASCP) may operate a fusion imaging device or a dual imaging device
that uses radioactive material as a point source in transmission scanning and attenuation
correction.
new text end
new text begin
(b) A nuclear medicine technologist in paragraph (a) may only operate a stand-alone
computed tomography x-ray system if the technologist has passed the Nuclear Medicine
Technology Certification Board for computed tomography (CT) or is credentialed in
computed tomography (CT) from the American Registry of Radiologic Technologists
(ARRT).
new text end
new text begin
(c) A nuclear medicine technologist who meets the requirements under paragraph (a)
and who is participating in a training or educational program to obtain a credential under
paragraph (b) is exempt from the examination requirement within the scope and for the
duration of the training or educational program.
new text end
Sec. 9.
Minnesota Statutes 2018, section 144.121, is amended by adding a subdivision to
read:
new text begin Subd. 5e. new text end
new text begin Radiation therapy technologist practice. new text end
new text begin
(a) A radiation therapy technologist
who has passed the primary pathway credential in radiation therapy may operate radiation
therapy accelerator and simulator x-ray systems.
new text end
new text begin
(b) A radiation therapy technologist in paragraph (a) may only operate a stand-alone
computed tomography x-ray system if the technologist has passed and is credentialed in
computed tomography (CT) from the American Registry of Radiologic Technologists
(ARRT).
new text end
new text begin
(c) A radiation therapy technologist who meets the requirements under paragraph (a)
and who is participating in a training or educational program to obtain a credential under
paragraph (b) is exempt from the examination requirement within the scope and for the
duration of the training or educational program.
new text end
Sec. 10.
Minnesota Statutes 2018, section 144.292, subdivision 2, is amended to read:
Subd. 2.
Patient access.
Upon request, a provider shall supply to a patient new text begin within 30
calendar days of receiving a written request for medical records new text end complete and current
information possessed by that provider concerning any diagnosis, treatment, and prognosis
of the patient in terms and language the patient can reasonably be expected to understand.
Sec. 11.
Minnesota Statutes 2018, section 144.292, subdivision 5, is amended to read:
Subd. 5.
Copies of health records to patients.
Except as provided in section 144.296,
upon a patient's written request, a provider, at a reasonable cost to the patient, shall deleted text begin promptlydeleted text end
furnish to the patientnew text begin within 30 calendar days of receiving a written request for medical
recordsnew text end :
(1) copies of the patient's health record, including but not limited to laboratory reports,
x-rays, prescriptions, and other technical information used in assessing the patient's health
conditions; or
(2) the pertinent portion of the record relating to a condition specified by the patient.
With the consent of the patient, the provider may instead furnish only a summary of the
record. The provider may exclude from the health record written speculations about the
patient's health condition, except that all information necessary for the patient's informed
consent must be provided.
Sec. 12.
Minnesota Statutes 2019 Supplement, section 152.29, subdivision 1, is amended
to read:
Subdivision 1.
Manufacturer; requirements.
(a) A manufacturer deleted text begin shalldeleted text end new text begin maynew text end operate
eight distribution facilities, which may include the manufacturer's single location for
cultivation, harvesting, manufacturing, packaging, and processing but is not required to
include that location. The commissioner shall designate the geographical service areas to
be served by each manufacturer based on geographical need throughout the state to improve
patient access. A manufacturer shall not have more than two distribution facilities in each
geographical service area assigned to the manufacturer by the commissioner. A manufacturer
shall operate only one location where all cultivation, harvesting, manufacturing, packaging,
and processing of medical cannabis shall be conducted. This location may be one of the
manufacturer's distribution facility sites. The additional distribution facilities may dispense
medical cannabis and medical cannabis products but may not contain any medical cannabis
in a form other than those forms allowed under section 152.22, subdivision 6, and the
manufacturer shall not conduct any cultivation, harvesting, manufacturing, packaging, or
processing at the other distribution facility sites. Any distribution facility operated by the
manufacturer is subject to all of the requirements applying to the manufacturer under sections
152.22 to 152.37, including, but not limited to, security and distribution requirements.
(b) A manufacturer may acquire hemp grown in this state from a hemp grower. A
manufacturer may manufacture or process hemp into an allowable form of medical cannabis
under section 152.22, subdivision 6. Hemp acquired by a manufacturer under this paragraph
is subject to the same quality control program, security and testing requirements, and other
requirements that apply to medical cannabis under sections 152.22 to 152.37 and Minnesota
Rules, chapter 4770.
(c) A medical cannabis manufacturer shall contract with a laboratory approved by the
commissioner, subject to any additional requirements set by the commissioner, for purposes
of testing medical cannabis manufactured or hemp acquired by the medical cannabis
manufacturer as to content, contamination, and consistency to verify the medical cannabis
meets the requirements of section 152.22, subdivision 6. The cost of laboratory testing shall
be paid by the manufacturer.
(d) The operating documents of a manufacturer must include:
(1) procedures for the oversight of the manufacturer and procedures to ensure accurate
record keeping;
(2) procedures for the implementation of appropriate security measures to deter and
prevent the theft of medical cannabis and unauthorized entrance into areas containing medical
cannabis; and
(3) procedures for the delivery and transportation of hemp between hemp growers and
manufacturers.
(e) A manufacturer shall implement security requirements, including requirements for
the delivery and transportation of hemp, protection of each location by a fully operational
security alarm system, facility access controls, perimeter intrusion detection systems, and
a personnel identification system.
(f) A manufacturer shall not share office space with, refer patients to a health care
practitioner, or have any financial relationship with a health care practitioner.
(g) A manufacturer shall not permit any person to consume medical cannabis on the
property of the manufacturer.
(h) A manufacturer is subject to reasonable inspection by the commissioner.
(i) For purposes of sections 152.22 to 152.37, a medical cannabis manufacturer is not
subject to the Board of Pharmacy licensure or regulatory requirements under chapter 151.
(j) A medical cannabis manufacturer may not employ any person who is under 21 years
of age or who has been convicted of a disqualifying felony offense. An employee of a
medical cannabis manufacturer must submit a completed criminal history records check
consent form, a full set of classifiable fingerprints, and the required fees for submission to
the Bureau of Criminal Apprehension before an employee may begin working with the
manufacturer. The bureau must conduct a Minnesota criminal history records check and
the superintendent is authorized to exchange the fingerprints with the Federal Bureau of
Investigation to obtain the applicant's national criminal history record information. The
bureau shall return the results of the Minnesota and federal criminal history records checks
to the commissioner.
(k) A manufacturer may not operate in any location, whether for distribution or
cultivation, harvesting, manufacturing, packaging, or processing, within 1,000 feet of a
public or private school existing before the date of the manufacturer's registration with the
commissioner.
(l) A manufacturer shall comply with reasonable restrictions set by the commissioner
relating to signage, marketing, display, and advertising of medical cannabis.
(m) Before a manufacturer acquires hemp from a hemp grower, the manufacturer must
verify that the hemp grower has a valid license issued by the commissioner of agriculture
under chapter 18K.
new text begin
(n) Until a state-centralized, seed-to-sale system is implemented that can track a specific
medical cannabis plant from cultivation through testing and point of sale, the commissioner
shall conduct at least one unannounced inspection per year of each manufacturer that includes
inspection of:
new text end
new text begin
(1) business operations;
new text end
new text begin
(2) physical locations of the manufacturer's manufacturing facility and distribution
facilities;
new text end
new text begin
(3) financial information and inventory documentation, including laboratory testing
results; and
new text end
new text begin
(4) physical and electronic security alarm systems.
new text end
Sec. 13.
Minnesota Statutes 2018, section 152.35, is amended to read:
152.35 FEES; DEPOSIT OF REVENUE.
(a) The commissioner shall collect an enrollment fee of $200 from patients enrolled
under this section. If the patient deleted text begin attests todeleted text end new text begin provides evidence ofnew text end receiving Social Security
disabilitynew text begin insurance (SSDI)new text end , Supplemental Security deleted text begin Insurancedeleted text end new text begin Income (SSI), veterans
disability, or railroad disabilitynew text end payments, or being enrolled in medical assistance or
MinnesotaCare, then the fee shall be $50. new text begin For purposes of this section:
new text end
new text begin
(1) a patient is considered to receive SSDI if the patient was receiving SSDI at the time
the patient was transitioned to retirement benefits by the United States Social Security
Administration; and
new text end
new text begin
(2) veterans disability payments include VA dependency and indemnity compensation.
new text end
new text begin Unless a patient provides evidence of receiving payments from or participating in one of
the programs specifically listed in this paragraph, the commissioner of health must collect
the $200 enrollment fee from a patient to enroll the patient in the registry program. new text end The fees
shall be payable annually and are due on the anniversary date of the patient's enrollment.
The fee amount shall be deposited in the state treasury and credited to the state government
special revenue fund.
(b) The commissioner shall collect an application fee of $20,000 from each entity
submitting an application for registration as a medical cannabis manufacturer. Revenue
from the fee shall be deposited in the state treasury and credited to the state government
special revenue fund.
(c) The commissioner shall establish and collect an annual fee from a medical cannabis
manufacturer equal to the cost of regulating and inspecting the manufacturer in that year.
Revenue from the fee amount shall be deposited in the state treasury and credited to the
state government special revenue fund.
(d) A medical cannabis manufacturer may charge patients enrolled in the registry program
a reasonable fee for costs associated with the operations of the manufacturer. The
manufacturer may establish a sliding scale of patient fees based upon a patient's household
income and may accept private donations to reduce patient fees.
Sec. 14.
Minnesota Statutes 2018, section 446A.081, subdivision 9, is amended to read:
Subd. 9.
Other uses of fund.
(a) The drinking water revolving loan fund may be used
as provided in the act, including the following uses:
(1) to buy or refinance the debt obligations, at or below market rates, of public water
systems for drinking water systems, where the debt was incurred after the date of enactment
of the act, for the purposes of construction of the necessary improvements to comply with
the national primary drinking water regulations under the federal Safe Drinking Water Act;
(2) to purchase or guarantee insurance for local obligations to improve credit market
access or reduce interest rates;
(3) to provide a source of revenue or security for the payment of principal and interest
on revenue or general obligation bonds issued by the authority if the bond proceeds are
deposited in the fund;
(4) to provide loans or loan guarantees for similar revolving funds established by a
governmental unit or state agency;
(5) to earn interest on fund accounts;
(6) to pay the reasonable costs incurred by the authority, the Department of Employment
and Economic Development, and the Department of Health for conducting activities as
authorized and required under the act up to the limits authorized under the act;
(7) to develop and administer programs for water system supervision, source water
protection, and related programs required under the act;
(8) deleted text begin notwithstanding Minnesota Rules, part 7380.0280,deleted text end to provide principal forgiveness
or grants to the extent permitted under the federal Safe Drinking Water Act and other federal
law, based on the criteria and requirements established for drinking water projects under
the water infrastructure funding program under section 446A.072;
(9) to provide loans, principal forgiveness or grants to the extent permitted under the
federal Safe Drinking Water Act and other federal law to address green infrastructure, water
or energy efficiency improvements, or other environmentally innovative activities; deleted text begin and
deleted text end
(10) to provide principal forgiveness, or grants for deleted text begin 50deleted text end new text begin 80new text end percent of deleted text begin thedeleted text end project deleted text begin costdeleted text end new text begin costsnew text end
up to a maximum of deleted text begin $10,000deleted text end new text begin $100,000new text end for projects needed to comply with national primary
drinking water standards for an existingnew text begin nonmunicipalnew text end community deleted text begin or noncommunitydeleted text end public
water systemdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(11) to provide principal forgiveness or grants to the extent permitted under the federal
Safe Drinking Water Act and other federal laws for 50 percent of the project costs up to a
maximum of $250,000 for projects to replace the privately owned portion of drinking water
lead service lines.
new text end
(b) Principal forgiveness or grants provided under paragraph (a), clause (9), may not
exceed 25 percent of the eligible project costs as determined by the Department of Health
for project components directly related to green infrastructure, water or energy efficiency
improvements, or other environmentally innovative activities, up to a maximum of
$1,000,000.
Sec. 15.
Laws 2019, First Special Session chapter 9, article 11, section 35, the effective
date, is amended to read:
EFFECTIVE DATE.
This section is effective deleted text begin August 1, 2020deleted text end new text begin January 1, 2021new text end .
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 16. new text begin REPEALER.
new text end
new text begin
(a)
new text end
new text begin
Minnesota Statutes 2018, section 144.121, subdivisions 3 and 5b,
new text end
new text begin
are repealed.
new text end
new text begin
(b)
new text end
new text begin
Minnesota Rules, part 7380.0280,
new text end
new text begin
is repealed.
new text end
ARTICLE 2
HEALTH-RELATED LICENSING BOARDS
Section 1.
Minnesota Statutes 2018, section 62A.307, subdivision 2, is amended to read:
Subd. 2.
Requirement.
Coverage described in subdivision 1 that covers prescription
drugs must provide the same coverage for a prescription written by a health care provider
authorized to prescribe the particular drug covered by the health coverage described in
subdivision 1, regardless of the type of health care provider that wrote the prescription. This
section is intended to prohibit denial of coverage based on the prescription having been
written by an advanced practice nurse under section 148.235, a physician assistant under
section deleted text begin 147A.18deleted text end new text begin 147A.185new text end , or any other nonphysician health care provider authorized to
prescribe the particular drug.
Sec. 2.
new text begin
[62Q.529] COVERAGE FOR DRUGS PRESCRIBED AND DISPENSED BY
PHARMACIES.
new text end
new text begin
(a) A health plan that provides prescription coverage must provide coverage for
self-administered hormonal contraceptives, nicotine replacement medications, and opiate
antagonists for the treatment of an acute opiate overdose prescribed and dispensed by a
licensed pharmacist in accordance with section 151.37, subdivision 14, 15, or 16, under the
same terms of coverage that would apply had the prescription drug been prescribed by a
licensed physician, physician assistant, or advanced practice nurse practitioner.
new text end
new text begin
(b) A health plan is not required to cover the drug if dispensed by an out-of-network
pharmacy, unless the health plan covers prescription drugs dispensed by out-of-network
pharmacies.
new text end
Sec. 3.
Minnesota Statutes 2018, section 147A.01, subdivision 3, is amended to read:
Subd. 3.
Administer.
"Administer" means the delivery by a physician assistant deleted text begin authorized
to prescribe legend drugs, a single dosedeleted text end of a legend drugdeleted text begin , including controlled substances,deleted text end
to a patient by injection, inhalation, ingestion, or by any other immediate meansdeleted text begin , and the
delivery by a physician assistant ordered by a physician a single dose of a legend drug by
injection, inhalation, ingestion, or by any other immediate meansdeleted text end .
Sec. 4.
Minnesota Statutes 2018, section 147A.01, is amended by adding a subdivision to
read:
new text begin Subd. 6a. new text end
new text begin Collaborating physician. new text end
new text begin
"Collaborating physician" means a Minnesota
licensed physician who oversees the performance, practice, and activities of a physician
assistant under a collaborative agreement as described in section 147A.02, paragraph (c).
new text end
Sec. 5.
Minnesota Statutes 2018, section 147A.01, subdivision 21, is amended to read:
Subd. 21.
Prescription.
"Prescription" means a signed written order, an oral order
reduced to writing, or an electronic order meeting current and prevailing standards given
by a physician assistant deleted text begin authorized to prescribe drugsdeleted text end for patients in the course of the
physician assistant's practicedeleted text begin ,deleted text end new text begin andnew text end issued for an individual patient deleted text begin and containing the
information required in the physician-physician assistant delegation agreementdeleted text end .
Sec. 6.
Minnesota Statutes 2018, section 147A.01, subdivision 26, is amended to read:
Subd. 26.
Therapeutic order.
"Therapeutic order" means deleted text begin andeleted text end new text begin a written or verbalnew text end order
given to another for the purpose of treating or curing a patient in the course of a physician
assistant's practice. deleted text begin Therapeutic orders may be written or verbal, but do not include the
prescribing of legend drugs or medical devices unless prescribing authority has been
delegated within the physician-physician assistant delegation agreement.
deleted text end
Sec. 7.
Minnesota Statutes 2018, section 147A.01, subdivision 27, is amended to read:
Subd. 27.
Verbal order.
"Verbal order" means an oral order given to another for the
purpose of treating or curing a patient in the course of a physician assistant's practice. deleted text begin Verbal
orders do not include the prescribing of legend drugs unless prescribing authority has been
delegated within the physician-physician assistant delegation agreement.
deleted text end
Sec. 8.
Minnesota Statutes 2018, section 147A.02, is amended to read:
147A.02 QUALIFICATIONS FOR LICENSURE.
deleted text begin
Except as otherwise provided in this chapter, an individual shall be licensed by the board
before the individual may practice as a physician assistant.
deleted text end
new text begin (a) new text end The board may grant a license as a physician assistant to an applicant who:
(1) submits an application on forms approved by the board;
(2) pays the appropriate fee as determined by the board;
(3) has current certification from the National Commission on Certification of Physician
Assistants, or its successor agency as approved by the board;
(4) certifies that the applicant is mentally and physically able to engage safely in practice
as a physician assistant;
(5) has no licensure, certification, or registration as a physician assistant under current
discipline, revocation, suspension, or probation for cause resulting from the applicant's
practice as a physician assistant, unless the board considers the condition and agrees to
licensure;
(6) submits any other information the board deems necessary to evaluate the applicant's
qualifications; and
(7) has been approved by the board.
new text begin (b) new text end All persons registered as physician assistants as of June 30, 1995, are eligible for
continuing license renewal. All persons applying for licensure after that date shall be licensed
according to this chapter.
new text begin
(c) A physician assistant who qualifies for licensure must practice for at least 2,080
hours, within the context of a collaborative agreement, within a hospital or integrated clinical
setting where physician assistants and physicians work together to provide patient care. The
physician assistant shall submit written evidence to the board with the application, or upon
completion of the required collaborative practice experience. For purposes of this paragraph,
a collaborative agreement is a mutually agreed upon plan for the overall working relationship
and collaborative arrangement between a physician assistant, and one or more physicians
licensed under chapter 147, that designates the scope of services that can be provided to
manage the care of patients. The physician assistant and one of the collaborative physicians
must have experience in providing care to patients with the same or similar medical
conditions. The collaborating physician is not required to be physically present so long as
the collaborating physician and physician assistant are or can be easily in contact with each
other by radio, telephone, or other telecommunication device.
new text end
Sec. 9.
Minnesota Statutes 2018, section 147A.03, is amended by adding a subdivision to
read:
new text begin Subd. 1a. new text end
new text begin Licensure required. new text end
new text begin
Except as provided under subdivision 2, it is unlawful
for any person to practice as a physician assistant without being issued a valid license
according to this chapter.
new text end
Sec. 10.
Minnesota Statutes 2018, section 147A.05, is amended to read:
147A.05 INACTIVE LICENSE.
new text begin (a) new text end Physician assistants who notify the board in writing may elect to place their license
on an inactive status. Physician assistants with an inactive license shall be excused from
payment of renewal fees and shall not practice as physician assistants. Persons who engage
in practice while their license is lapsed or on inactive status shall be considered to be
practicing without a license, which shall be grounds for discipline under section 147A.13.
Physician assistants who provide care under the provisions of section 147A.23 shall not be
considered practicing without a license or subject to disciplinary action. Physician assistants
who notify the board of their intent to resume active practice shall be required to pay the
current renewal fees and all unpaid back fees and shall be required to meet the criteria for
renewal specified in section 147A.07.
new text begin
(b) Notwithstanding section 147A.03, subdivision 1, a person with an inactive license
may continue to use the protected titles specified in section 147A.03, subdivision 1, so long
as the person does not practice as a physician assistant.
new text end
Sec. 11.
Minnesota Statutes 2019 Supplement, section 147A.06, is amended to read:
147A.06 CANCELLATION OF LICENSE FOR NONRENEWAL.
Subdivision 1.
Cancellation of license.
The board shall not renew, reissue, reinstate, or
restore a license that has lapsed deleted text begin on or after July 1, 1996,deleted text end and has not been renewed within
two annual renewal cycles deleted text begin starting July 1, 1997deleted text end . A licensee whose license is canceled for
nonrenewal must obtain a new license by applying for licensure and fulfilling all requirements
then in existence for an initial license to practice as a physician assistant.
Subd. 2.
Licensure following lapse of licensed status; transition.
(a) A licensee whose
license has lapsed under subdivision 1 before January 1, 2020, and who seeks to regain
licensed status after January 1, 2020, shall be treated as a first-time licensee only for purposes
of establishing a license renewal schedule, and shall not be subject to the license cycle
conversion provisions in section 147A.29.
(b) This subdivision expires July 1, 2022.
Sec. 12.
Minnesota Statutes 2018, section 147A.09, is amended to read:
147A.09 SCOPE OF PRACTICEdeleted text begin , DELEGATIONdeleted text end .
Subdivision 1.
Scope of practice.
Physician assistants shall practice medicine only deleted text begin with
physician supervision. Physician assistants may perform those duties and responsibilities
as delegated in the physician-physician assistant delegation agreement and delegation forms
maintained at the address of record by the supervising physician and physician assistant,
including the prescribing, administering, and dispensing of drugs, controlled substances,
and medical devices, excluding anesthetics, other than local anesthetics, injected in
connection with an operating room procedure, inhaled anesthesia and spinal anesthesiadeleted text end new text begin
under an established practice agreementnew text end .
deleted text begin Patient service must be limited todeleted text end new text begin A physician assistant's scope of practice includesnew text end :
(1) services within the training and experience of the physician assistant;
(2) new text begin patient new text end services customary to the practice of the deleted text begin supervising physician or alternate
supervising physiciandeleted text end new text begin physician assistant and the practice agreementnew text end ;new text begin and
new text end
(3) deleted text begin services delegated by the supervising physician or alternate supervising physician
under the physician-physician assistant delegation agreement; and
deleted text end
deleted text begin (4)deleted text end services within the parameters of the laws, rules, and standards of the facilities in
which the physician assistant practices.
deleted text begin
Nothing in this chapter authorizes physician assistants to perform duties regulated by
the boards listed in section 214.01, subdivision 2, other than the Board of Medical Practice,
and except as provided in this section.
deleted text end
Subd. 2.
deleted text begin Delegationdeleted text end new text begin Patient servicesnew text end .
Patient services may include, but are not limited
to, the followingdeleted text begin , as delegated by the supervising physician and authorized in the delegation
agreementdeleted text end :
(1) taking patient histories and developing medical status reports;
(2) performing physical examinations;
(3) interpreting and evaluating patient data;
(4) ordering deleted text begin ordeleted text end new text begin ,new text end performingnew text begin , or reviewingnew text end diagnostic procedures, including the use of
radiographic imaging systems in compliance with Minnesota Rules 2007, chapter 4732new text begin , but
excluding interpreting computed tomography scans, magnetic resonance imaging scans,
positron emission tomography scans, nuclear scans, and mammographynew text end ;
(5) ordering or performing therapeutic procedures including the use of ionizing radiation
in compliance with Minnesota Rules 2007, chapter 4732;
(6) providing instructions regarding patient care, disease prevention, and health
promotion;
(7) deleted text begin assisting the supervising physician indeleted text end new text begin providingnew text end patient care in the home and in health
care facilities;
(8) creating and maintaining appropriate patient records;
(9) transmitting or executing specific orders deleted text begin at the direction of the supervising physiciandeleted text end ;
(10) prescribing, administering, and dispensing drugs, controlled substances, and medical
devices deleted text begin if this function has been delegated by the supervising physician pursuant to and
subject to the limitations of section 147A.18 and chapter 151. For physician assistants who
have been delegated the authority to prescribe controlled substances, such delegation shall
be included in the physician-physician assistant delegation agreement, and all schedules of
controlled substances the physician assistant has the authority to prescribe shall be specifieddeleted text end new text begin ,
including administering local anesthetics, but excluding anesthetics injected in connection
with an operating room procedure, inhaled anesthesia, and spinal anesthesianew text end ;
(11) deleted text begin for physician assistants not delegated prescribing authority, administering legend
drugs and medical devices following prospective review for each patient by and upon
direction of the supervising physician;
deleted text end
deleted text begin (12)deleted text end functioning as an emergency medical technician with permission of the ambulance
service and in compliance with section 144E.127, and ambulance service rules adopted by
the commissioner of health;
deleted text begin (13)deleted text end new text begin (12)new text end initiating evaluation and treatment procedures essential to providing an
appropriate response to emergency situations;
deleted text begin (14)deleted text end new text begin (13)new text end certifying a patient's eligibility for a disability parking certificate under section
169.345, subdivision 2;
deleted text begin (15)deleted text end new text begin (14)new text end assisting at surgery; and
deleted text begin (16)deleted text end new text begin (15)new text end providing medical authorization for admission for emergency care and treatment
of a patient under section 253B.05, subdivision 2.
deleted text begin
Orders of physician assistants shall be considered the orders of their supervising
physicians in all practice-related activities, including, but not limited to, the ordering of
diagnostic, therapeutic, and other medical services.
deleted text end
new text begin Subd. 3. new text end
new text begin Practice agreement review. new text end
new text begin
A physician assistant shall have a practice
agreement at the practice level that describes the practice of the physician assistant. The
practice agreement must be reviewed on an annual basis by a licensed physician within the
same clinic, hospital, health system, or other facility as the physician assistant and has
knowledge of the physician assistant's practice to ensure that the physician assistant's medical
practice is consistent with the practice agreement. A document stating that the review
occurred must be maintained at the practice level and made available to the board, upon
request.
new text end
new text begin Subd. 4. new text end
new text begin
Scope of practice limitations; spinal injections for acute and chronic
pain.
new text end
new text begin
Notwithstanding subdivision 1, a physician assistant may only perform spinal injections
to address acute and chronic pain symptoms upon referral and in collaboration with a
physician licensed under chapter 147. For purposes of performing spinal injections for acute
or chronic pain symptoms, the physician assistant and one or more physicians licensed under
chapter 147 must have a mutually agreed upon plan that designates the scope of collaboration
necessary for treating patients with acute and chronic pain.
new text end
new text begin Subd. 5. new text end
new text begin
Scope of practice limitations; psychiatric care for children with emotional
disturbance or adults with serious mental illness.
new text end
new text begin
Notwithstanding subdivision 1, a
physician assistant may only provide ongoing psychiatric treatment for children with
emotional disturbance, as defined in section 245.4871, subdivision 15, or adults with serious
mental illness in collaboration with a physician licensed under chapter 147. For purposes
of providing ongoing psychiatric treatment for children with emotional disturbance or adults
with serious mental illness, the practice agreement between the physician assistant and one
or more physicians licensed under chapter 147 must define the collaboration between the
physician assistant and the collaborating physician, including appropriate consultation or
referral to psychiatry.
new text end
Sec. 13.
Minnesota Statutes 2018, section 147A.13, subdivision 1, is amended to read:
Subdivision 1.
Grounds listed.
The board may refuse to grant licensure or may impose
disciplinary action as described in this subdivision against any physician assistant. The
following conduct is prohibited and is grounds for disciplinary action:
(1) failure to demonstrate the qualifications or satisfy the requirements for licensure
contained in this chapter or rules of the board. The burden of proof shall be upon the applicant
to demonstrate such qualifications or satisfaction of such requirements;
(2) obtaining a license by fraud or cheating, or attempting to subvert the examination
process. Conduct which subverts or attempts to subvert the examination process includes,
but is not limited to:
(i) conduct which violates the security of the examination materials, such as removing
examination materials from the examination room or having unauthorized possession of
any portion of a future, current, or previously administered licensing examination;
(ii) conduct which violates the standard of test administration, such as communicating
with another examinee during administration of the examination, copying another examinee's
answers, permitting another examinee to copy one's answers, or possessing unauthorized
materials; and
(iii) impersonating an examinee or permitting an impersonator to take the examination
on one's own behalf;
(3) conviction, during the previous five years, of a felony reasonably related to the
practice of physician assistant. Conviction as used in this subdivision includes a conviction
of an offense which if committed in this state would be deemed a felony without regard to
its designation elsewhere, or a criminal proceeding where a finding or verdict of guilt is
made or returned but the adjudication of guilt is either withheld or not entered;
(4) revocation, suspension, restriction, limitation, or other disciplinary action against
the person's physician assistant credentials in another state or jurisdiction, failure to report
to the board that charges regarding the person's credentials have been brought in another
state or jurisdiction, or having been refused licensure by any other state or jurisdiction;
(5) advertising which is false or misleading, violates any rule of the board, or claims
without substantiation the positive cure of any disease or professional superiority to or
greater skill than that possessed by another physician assistant;
(6) violating a rule adopted by the board or an order of the board, a state, or federal law
which relates to the practice of a physician assistant, or in part regulates the practice of a
physician assistant, including without limitation sections 604.201, 609.344, and 609.345,
or a state or federal narcotics or controlled substance law;
(7) engaging in any unethical conduct; conduct likely to deceive, defraud, or harm the
public, or demonstrating a willful or careless disregard for the health, welfare, or safety of
a patient; or practice which is professionally incompetent, in that it may create unnecessary
danger to any patient's life, health, or safety, in any of which cases, proof of actual injury
need not be established;
deleted text begin
(8) failure to adhere to the provisions of the physician-physician assistant delegation
agreement;
deleted text end
deleted text begin (9)deleted text end new text begin (8)new text end engaging in the practice of medicine beyond deleted text begin thatdeleted text end new text begin what isnew text end allowed deleted text begin by the
physician-physician assistant delegation agreementdeleted text end new text begin under this chapternew text end , or aiding or abetting
an unlicensed person in the practice of medicine;
deleted text begin (10)deleted text end new text begin (9) new text end adjudication as mentally incompetent, mentally ill or developmentally disabled,
or as a chemically dependent person, a person dangerous to the public, a sexually dangerous
person, or a person who has a sexual psychopathic personality by a court of competent
jurisdiction, within or without this state. Such adjudication shall automatically suspend a
license for its duration unless the board orders otherwise;
deleted text begin (11)deleted text end new text begin (10)new text end engaging in unprofessional conduct. Unprofessional conduct includes any
departure from or the failure to conform to the minimal standards of acceptable and prevailing
practice in which proceeding actual injury to a patient need not be established;
deleted text begin (12)deleted text end new text begin (11)new text end inability to practice with reasonable skill and safety to patients by reason of
illness, drunkenness, use of drugs, narcotics, chemicals, or any other type of material, or as
a result of any mental or physical condition, including deterioration through the aging
process or loss of motor skills;
deleted text begin (13)deleted text end new text begin (12)new text end revealing a privileged communication from or relating to a patient except when
otherwise required or permitted by law;
deleted text begin (14)deleted text end new text begin (13)new text end any identification of a physician assistant by the title "Physiciandeleted text begin ,deleted text end " deleted text begin "Doctor,"
or "Dr."deleted text end in a patient care setting or in a communication directed to the general public;
deleted text begin (15)deleted text end new text begin (14)new text end improper management of medical records, including failure to maintain adequate
medical records, to comply with a patient's request made pursuant to sections 144.291 to
144.298, or to furnish a medical record or report required by law;
deleted text begin (16)deleted text end new text begin (15)new text end engaging in abusive or fraudulent billing practices, including violations of the
federal Medicare and Medicaid laws or state medical assistance laws;
deleted text begin (17)deleted text end new text begin (16)new text end becoming addicted or habituated to a drug or intoxicant;
deleted text begin (18)deleted text end new text begin (17)new text end prescribing a drug or device for other than medically accepted therapeutic,
experimental, or investigative purposes authorized by a state or federal agency or referring
a patient to any health care provider as defined in sections 144.291 to 144.298 for services
or tests not medically indicated at the time of referral;
deleted text begin (19)deleted text end new text begin (18)new text end engaging in conduct with a patient which is sexual or may reasonably be
interpreted by the patient as sexual, or in any verbal behavior which is seductive or sexually
demeaning to a patient;
deleted text begin (20)deleted text end new text begin (19)new text end failure to make reports as required by section 147A.14 or to cooperate with an
investigation of the board as required by section 147A.15, subdivision 3;
deleted text begin (21)deleted text end new text begin (20)new text end knowingly providing false or misleading information that is directly related
to the care of that patient unless done for an accepted therapeutic purpose such as the
administration of a placebo;
deleted text begin (22)deleted text end new text begin (21)new text end aiding suicide or aiding attempted suicide in violation of section 609.215 as
established by any of the following:
(i) a copy of the record of criminal conviction or plea of guilty for a felony in violation
of section 609.215, subdivision 1 or 2;
(ii) a copy of the record of a judgment of contempt of court for violating an injunction
issued under section 609.215, subdivision 4;
(iii) a copy of the record of a judgment assessing damages under section 609.215,
subdivision 5; or
(iv) a finding by the board that the person violated section 609.215, subdivision 1 or 2.
The board shall investigate any complaint of a violation of section 609.215, subdivision 1
or 2; or
deleted text begin (23)deleted text end new text begin (22)new text end deleted text begin failure to maintain annually reviewed and updated physician-physician assistant
delegation agreements for each physician-physician assistant practice relationship, or failure
to provide copies of such documents upon request by the boarddeleted text end new text begin failure to maintain the proof
of review document as required under section 147A.09, subdivision 3, or to provide a copy
of the document upon request of the boardnew text end .
Sec. 14.
Minnesota Statutes 2018, section 147A.14, subdivision 4, is amended to read:
Subd. 4.
Licensed professionals.
Licensed health professionals and persons holding
residency permits under section 147.0391, shall report to the board personal knowledge of
any conduct which the person reasonably believes constitutes grounds for disciplinary action
under this chapter by a physician assistant, including any conduct indicating that the person
may be incompetent, or may have engaged in unprofessional conduct or may be medically
or physically unable to engage safely in practice as a physician assistant. No report shall be
required if the information was obtained in the course of a deleted text begin physician-patientdeleted text end new text begin provider-patientnew text end
relationship if the patient is a physician assistant, and the treating deleted text begin physiciandeleted text end new text begin providernew text end
successfully counsels the person to limit or withdraw from practice to the extent required
by the impairment.
Sec. 15.
Minnesota Statutes 2018, section 147A.16, is amended to read:
147A.16 FORMS OF DISCIPLINARY ACTION.
When the board finds that a licensed physician assistant has violated a provision of this
chapter, it may do one or more of the following:
(1) revoke the license;
(2) suspend the license;
(3) impose limitations or conditions on the physician assistant's practice, including
limiting the scope of practice to designated field specialties; deleted text begin imposedeleted text end new text begin imposingnew text end retraining or
rehabilitation requirements; deleted text begin require practice under additional supervision;deleted text end or deleted text begin condition
continueddeleted text end new text begin limitingnew text end practice deleted text begin ondeleted text end new text begin untilnew text end demonstration of knowledge or skills by appropriate
examination or other review of skill and competence;
(4) impose a civil penalty not exceeding $10,000 for each separate violation, the amount
of the civil penalty to be fixed so as to deprive the physician assistant of any economic
advantage gained by reason of the violation charged or to reimburse the board for the cost
of the investigation and proceeding;new text begin or
new text end
deleted text begin
(5) order the physician assistant to provide unremunerated professional service under
supervision at a designated public hospital, clinic, or other health care institution; or
deleted text end
deleted text begin (6)deleted text end new text begin (5)new text end censure or reprimand the licensed physician assistant.
Upon judicial review of any board disciplinary action taken under this chapter, the
reviewing court shall seal the administrative record, except for the board's final decision,
and shall not make the administrative record available to the public.
Sec. 16.
new text begin
[147A.185] PRESCRIBING DRUGS AND THERAPEUTIC DEVICES.
new text end
new text begin Subd. 1. new text end
new text begin Diagnosis, prescribing, and ordering. new text end
new text begin
A physician assistant is authorized to:
new text end
new text begin
(1) diagnose, prescribe, and institute therapy or referrals of patients to health care agencies
and providers;
new text end
new text begin
(2) prescribe, procure, sign for, record, administer, and dispense over-the-counter drugs,
legend drugs, and controlled substances, including sample drugs; and
new text end
new text begin
(3) plan and initiate a therapeutic regimen that includes ordering and prescribing durable
medical devices and equipment, nutrition, diagnostic services, and supportive services
including but not limited to home health care, hospice, physical therapy, and occupational
therapy.
new text end
new text begin Subd. 2. new text end
new text begin Drug Enforcement Administration requirements. new text end
new text begin
(a) A physician assistant
must:
new text end
new text begin
(1) comply with federal Drug Enforcement Administration (DEA) requirements related
to controlled substances; and
new text end
new text begin
(2) file any and all of the physician assistant's DEA registrations and numbers with the
board.
new text end
new text begin
(b) The board shall maintain current records of all physician assistants with DEA
registration and numbers.
new text end
new text begin Subd. 3. new text end
new text begin Other requirements and restrictions. new text end
new text begin
(a) Each prescription initiated by a
physician assistant shall indicate the following:
new text end
new text begin
(1) the date of issue;
new text end
new text begin
(2) the name and address of the patient;
new text end
new text begin
(3) the name and quantity of the drug prescribed;
new text end
new text begin
(4) directions for use; and
new text end
new text begin
(5) the name and address of the prescribing physician assistant.
new text end
new text begin
(b) In prescribing, dispensing, and administering legend drugs, controlled substances,
and medical devices, a physician assistant must comply with this chapter and chapters 151
and 152.
new text end
Sec. 17.
Minnesota Statutes 2018, section 147A.23, is amended to read:
147A.23 RESPONDING TO DISASTER SITUATIONS.
deleted text begin (a)deleted text end A physician assistant duly licensed or credentialed in a United States jurisdiction or
by a federal employer who is responding to a need for medical care created by an emergency
according to section 604A.01, or a state or local disaster may render such care as the
physician assistant is trained to provide, under the physician assistant's license or credentialdeleted text begin ,
without the need of a physician-physician assistant delegation agreement or a notice of
intent to practice as required under section 147A.20. A physician assistant may provide
emergency care without physician supervision or under the supervision that is availabledeleted text end .
deleted text begin
(b) The physician who provides supervision to a physician assistant while the physician
assistant is rendering care in accordance with this section may do so without meeting the
requirements of section 147A.20.
deleted text end
deleted text begin
(c) The supervising physician who otherwise provides supervision to a physician assistant
under a physician-physician assistant delegation agreement described in section 147A.20
shall not be held medically responsible for the care rendered by a physician assistant pursuant
to paragraph (a). Services provided by a physician assistant under paragraph (a) shall be
considered outside the scope of the relationship between the supervising physician and the
physician assistant.
deleted text end
Sec. 18.
Minnesota Statutes 2018, section 147D.03, subdivision 2, is amended to read:
Subd. 2.
Scope of practice.
The practice of traditional midwifery includesdeleted text begin ,deleted text end but is not
limited to:
(1) initial and ongoing assessment for suitability of traditional midwifery care;
(2) providing prenatal education and coordinating with a licensed health care provider
as necessary to provide comprehensive prenatal care, including the routine monitoring of
vital signs, indicators of fetal developments, and new text begin ordering standard prenatal new text end laboratory testsnew text begin
and imagingnew text end , as needed, with attention to the physical, nutritional, and emotional needs of
the woman and her family;
(3) attending and supporting the natural process of labor and birth;
(4) postpartum care of the mother and an initial assessment of the newborn; deleted text begin and
deleted text end
(5) providing information and referrals to community resources on childbirth preparation,
breastfeeding, exercise, nutrition, parenting, and care of the newborndeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(6) ordering ultrasounds, providing point-of-care testing, and ordering laboratory tests
that conform to the standard prenatal protocol of the licensed traditional midwife's standard
of care.
new text end
Sec. 19.
Minnesota Statutes 2019 Supplement, section 151.01, subdivision 23, is amended
to read:
Subd. 23.
Practitioner.
"Practitioner" means a licensed doctor of medicine, licensed
doctor of osteopathic medicine duly licensed to practice medicine, licensed doctor of
dentistry, licensed doctor of optometry, licensed podiatrist, licensed veterinarian, deleted text begin ordeleted text end licensed
advanced practice registered nursedeleted text begin . For purposes of sections 151.15, subdivision 4; 151.211,
subdivision 3; 151.252, subdivision 3; 151.37, subdivision 2, paragraphs (b), (e), and (f);
and 151.461, "practitioner" also means adeleted text end new text begin , or licensednew text end physician assistant deleted text begin authorized to
prescribe, dispense, and administer under chapter 147Adeleted text end . For purposes of sections 151.15,
subdivision 4; 151.211, subdivision 3; 151.252, subdivision 3; 151.37, subdivision 2,
paragraph (b); and 151.461, "practitioner" also means a dental therapist authorized to dispense
and administer under chapter 150A.new text begin For purposes of sections 151.252, subdivision 3, and
151.461, "practitioner" also means a pharmacist authorized to prescribe self-administered
hormonal contraceptives, nicotine replacement medications, or opiate antagonists under
section 151.37, subdivision 14, 15, or 16.
new text end
Sec. 20.
Minnesota Statutes 2019 Supplement, section 151.01, subdivision 27, is amended
to read:
Subd. 27.
Practice of pharmacy.
"Practice of pharmacy" means:
(1) interpretation and evaluation of prescription drug orders;
(2) compounding, labeling, and dispensing drugs and devices (except labeling by a
manufacturer or packager of nonprescription drugs or commercially packaged legend drugs
and devices);
(3) participation in clinical interpretations and monitoring of drug therapy for assurance
of safe and effective use of drugs, including the performance of laboratory tests that are
waived under the federal Clinical Laboratory Improvement Act of 1988, United States Code,
title 42, section 263a et seq., provided that a pharmacist may interpret the results of laboratory
tests but may modify drug therapy only pursuant to a protocol or collaborative practice
agreement;
(4) participation in drug and therapeutic device selection; drug administration for first
dosage and medical emergencies; intramuscular and subcutaneous administration used for
the treatment of alcohol or opioid dependence; drug regimen reviews; and drug or
drug-related research;
(5) drug administration, through intramuscular and subcutaneous administration used
to treat mental illnesses as permitted under the following conditions:
(i) upon the order of a prescriber and the prescriber is notified after administration is
complete; or
(ii) pursuant to a protocol or collaborative practice agreement as defined by section
151.01, subdivisions 27b and 27c, and participation in the initiation, management,
modification, administration, and discontinuation of drug therapy is according to the protocol
or collaborative practice agreement between the pharmacist and a dentist, optometrist,
physician, podiatrist, or veterinarian, or an advanced practice registered nurse authorized
to prescribe, dispense, and administer under section 148.235. Any changes in drug therapy
or medication administration made pursuant to a protocol or collaborative practice agreement
must be documented by the pharmacist in the patient's medical record or reported by the
pharmacist to a practitioner responsible for the patient's care;
(6) participation in administration of influenza vaccinesnew text begin and vaccines approved by the
United States Food and Drug Administration related to COVID-19 or SARS-CoV-2new text end to all
eligible individuals six years of age and older and all other vaccines to patients 13 years of
age and older by written protocol with a physician licensed under chapter 147, a physician
assistant authorized to prescribe drugs under chapter 147A, or an advanced practice registered
nurse authorized to prescribe drugs under section 148.235, provided that:
(i) the protocol includes, at a minimum:
(A) the name, dose, and route of each vaccine that may be given;
(B) the patient population for whom the vaccine may be given;
(C) contraindications and precautions to the vaccine;
(D) the procedure for handling an adverse reaction;
(E) the name, signature, and address of the physician, physician assistant, or advanced
practice registered nurse;
(F) a telephone number at which the physician, physician assistant, or advanced practice
registered nurse can be contacted; and
(G) the date and time period for which the protocol is valid;
(ii) the pharmacist has successfully completed a program approved by the Accreditation
Council for Pharmacy Education specifically for the administration of immunizations or a
program approved by the board;
(iii) the pharmacist utilizes the Minnesota Immunization Information Connection to
assess the immunization status of individuals prior to the administration of vaccines, except
when administering influenza vaccines to individuals age nine and older;
(iv) the pharmacist reports the administration of the immunization to the Minnesota
Immunization Information Connection; and
(v) the pharmacist complies with guidelines for vaccines and immunizations established
by the federal Advisory Committee on Immunization Practices, except that a pharmacist
does not need to comply with those portions of the guidelines that establish immunization
schedules when administering a vaccine pursuant to a valid, patient-specific order issued
by a physician licensed under chapter 147, a physician assistant authorized to prescribe
drugs under chapter 147A, or an advanced practice new text begin registered new text end nurse authorized to prescribe
drugs under section 148.235, provided that the order is consistent with the United States
Food and Drug Administration approved labeling of the vaccine;
(7) participation in the initiation, management, modification, and discontinuation of
drug therapy according to a written protocol or collaborative practice agreement between:
(i) one or more pharmacists and one or more dentists, optometrists, physicians, podiatrists,
or veterinarians; or (ii) one or more pharmacists and one or more physician assistants
authorized to prescribe, dispense, and administer under chapter 147A, or advanced practice
new text begin registered new text end nurses authorized to prescribe, dispense, and administer under section 148.235.
Any changes in drug therapy made pursuant to a protocol or collaborative practice agreement
must be documented by the pharmacist in the patient's medical record or reported by the
pharmacist to a practitioner responsible for the patient's care;
(8) participation in the storage of drugs and the maintenance of records;
(9) patient counseling on therapeutic values, content, hazards, and uses of drugs and
devices;
(10) offering or performing those acts, services, operations, or transactions necessary
in the conduct, operation, management, and control of a pharmacy; deleted text begin and
deleted text end
(11) participation in the initiation, management, modification, and discontinuation of
therapy with opiate antagonists, as defined in section 604A.04, subdivision 1, pursuant to:
(i) a written protocol as allowed under clause (6); or
(ii) a written protocol with a community health board medical consultant or a practitioner
designated by the commissioner of health, as allowed under section 151.37, subdivision 13new text begin ;
and
new text end
new text begin (12) prescribing self-administered hormonal contraceptives; nicotine replacement
medications; and opiate antagonists for the treatment of an acute opiate overdose pursuant
to section 151.37, subdivision 14, 15, or 16new text end .
Sec. 21.
Minnesota Statutes 2018, section 151.01, is amended by adding a subdivision to
read:
new text begin Subd. 42. new text end
new text begin Self-administered hormonal contraceptive. new text end
new text begin
"Self-administered hormonal
contraceptive" means a drug composed of a combination of hormones that is approved by
the United States Food and Drug Administration to prevent pregnancy and is administered
by the user.
new text end
Sec. 22.
Minnesota Statutes 2018, section 151.37, subdivision 2, is amended to read:
Subd. 2.
Prescribing and filing.
(a) A licensed practitioner in the course of professional
practice only, may prescribe, administer, and dispense a legend drug, and may cause the
same to be administered by a nurse, a physician assistant, or medical student or resident
under the practitioner's direction and supervision, and may cause a person who is an
appropriately certified, registered, or licensed health care professional to prescribe, dispense,
and administer the same within the expressed legal scope of the person's practice as defined
in Minnesota Statutes. A licensed practitioner may prescribe a legend drug, without reference
to a specific patient, by directing a licensed dietitian or licensed nutritionist, pursuant to
section 148.634; a nurse, pursuant to section 148.235, subdivisions 8 and 9; physician
assistant; medical student or resident; or pharmacist according to section 151.01, subdivision
27, to adhere to a particular practice guideline or protocol when treating patients whose
condition falls within such guideline or protocol, and when such guideline or protocol
specifies the circumstances under which the legend drug is to be prescribed and administered.
An individual who verbally, electronically, or otherwise transmits a written, oral, or electronic
order, as an agent of a prescriber, shall not be deemed to have prescribed the legend drug.
This paragraph applies to a physician assistant only if the physician assistant meets the
requirements of section 147A.18.
(b) The commissioner of health, if a licensed practitioner, or a person designated by the
commissioner who is a licensed practitioner, may prescribe a legend drug to an individual
or by protocol for mass dispensing purposes where the commissioner finds that the conditions
triggering section 144.4197 or 144.4198, subdivision 2, paragraph (b), exist. The
commissioner, if a licensed practitioner, or a designated licensed practitioner, may prescribe,
dispense, or administer a legend drug or other substance listed in subdivision 10 to control
tuberculosis and other communicable diseases. The commissioner may modify state drug
labeling requirements, and medical screening criteria and documentation, where time is
critical and limited labeling and screening are most likely to ensure legend drugs reach the
maximum number of persons in a timely fashion so as to reduce morbidity and mortality.
(c) A licensed practitioner that dispenses for profit a legend drug that is to be administered
orally, is ordinarily dispensed by a pharmacist, and is not a vaccine, must file with the
practitioner's licensing board a statement indicating that the practitioner dispenses legend
drugs for profit, the general circumstances under which the practitioner dispenses for profit,
and the types of legend drugs generally dispensed. It is unlawful to dispense legend drugs
for profit after July 31, 1990, unless the statement has been filed with the appropriate
licensing board. For purposes of this paragraph, "profit" means (1) any amount received by
the practitioner in excess of the acquisition cost of a legend drug for legend drugs that are
purchased in prepackaged form, or (2) any amount received by the practitioner in excess
of the acquisition cost of a legend drug plus the cost of making the drug available if the
legend drug requires compounding, packaging, or other treatment. The statement filed under
this paragraph is public data under section 13.03. This paragraph does not apply to a licensed
doctor of veterinary medicine or a registered pharmacist. Any person other than a licensed
practitioner with the authority to prescribe, dispense, and administer a legend drug under
paragraph (a) shall not dispense for profit. To dispense for profit does not include dispensing
by a community health clinic when the profit from dispensing is used to meet operating
expenses.
(d) A prescription drug order for the following drugs is not valid, unless it can be
established that the prescription drug order was based on a documented patient evaluation,
including an examination, adequate to establish a diagnosis and identify underlying conditions
and contraindications to treatment:
(1) controlled substance drugs listed in section 152.02, subdivisions 3 to 5;
(2) drugs defined by the Board of Pharmacy as controlled substances under section
152.02, subdivisions 7, 8, and 12;
(3) muscle relaxants;
(4) centrally acting analgesics with opioid activity;
(5) drugs containing butalbital; or
(6) phosphodiesterase type 5 inhibitors when used to treat erectile dysfunction.
new text begin
For purposes of prescribing drugs listed in clause (6), the requirement for a documented
patient evaluation, including an examination, may be met through the use of telemedicine,
as defined in section 147.033, subdivision 1.
new text end
(e) For the purposes of paragraph (d), the requirement for an examination shall be met
if an in-person examination has been completed in any of the following circumstances:
(1) the prescribing practitioner examines the patient at the time the prescription or drug
order is issued;
(2) the prescribing practitioner has performed a prior examination of the patient;
(3) another prescribing practitioner practicing within the same group or clinic as the
prescribing practitioner has examined the patient;
(4) a consulting practitioner to whom the prescribing practitioner has referred the patient
has examined the patient; or
(5) the referring practitioner has performed an examination in the case of a consultant
practitioner issuing a prescription or drug order when providing services by means of
telemedicine.
(f) Nothing in paragraph (d) or (e) prohibits a licensed practitioner from prescribing a
drug through the use of a guideline or protocol pursuant to paragraph (a).
(g) Nothing in this chapter prohibits a licensed practitioner from issuing a prescription
or dispensing a legend drug in accordance with the Expedited Partner Therapy in the
Management of Sexually Transmitted Diseases guidance document issued by the United
States Centers for Disease Control.
(h) Nothing in paragraph (d) or (e) limits prescription, administration, or dispensing of
legend drugs through a public health clinic or other distribution mechanism approved by
the commissioner of health or a community health board in order to prevent, mitigate, or
treat a pandemic illness, infectious disease outbreak, or intentional or accidental release of
a biological, chemical, or radiological agent.
(i) No pharmacist employed by, under contract to, or working for a pharmacy located
within the state and licensed under section 151.19, subdivision 1, may dispense a legend
drug based on a prescription that the pharmacist knows, or would reasonably be expected
to know, is not valid under paragraph (d).
(j) No pharmacist employed by, under contract to, or working for a pharmacy located
outside the state and licensed under section 151.19, subdivision 1, may dispense a legend
drug to a resident of this state based on a prescription that the pharmacist knows, or would
reasonably be expected to know, is not valid under paragraph (d).
(k) Nothing in this chapter prohibits the commissioner of health, if a licensed practitioner,
or, if not a licensed practitioner, a designee of the commissioner who is a licensed
practitioner, from prescribing legend drugs for field-delivered therapy in the treatment of
a communicable disease according to the Centers For Disease Control and Prevention Partner
Services Guidelines.
Sec. 23.
Minnesota Statutes 2018, section 151.37, is amended by adding a subdivision to
read:
new text begin Subd. 14. new text end
new text begin Self-administered hormonal contraceptives. new text end
new text begin
(a) A pharmacist is authorized
to prescribe self-administered hormonal contraceptives if the intended use is contraception
in accordance with this subdivision. By January 1, 2021, the board shall develop a
standardized protocol for the pharmacist to follow in prescribing self-administrated hormonal
contraceptives. In developing the protocol, the board shall consult with the Minnesota Board
of Medical Practice; the Minnesota Board of Nursing; the commissioner of health; the
Minnesota section of the American Congress of Obstetricians and Gynecologists; professional
pharmacy associations; and professional associations of physicians, physician assistants,
and advanced practice registered nurses. The protocol must, at a minimum, include:
new text end
new text begin
(1) requiring the patient to complete a self-screening tool to identify patient risk factors
for the use of self-administered hormonal contraceptives, based on the current United States
Medical Eligibility Criteria for Contraceptive Use developed by the federal Centers for
Disease Control and Prevention;
new text end
new text begin
(2) requiring the pharmacist to review the screening tool with the patient;
new text end
new text begin
(3) other assessments the pharmacist should make before prescribing self-administered
hormonal contraceptives;
new text end
new text begin
(4) situations when the prescribing of self-administered hormonal contraceptives by a
pharmacist is contraindicated;
new text end
new text begin
(5) situations when the pharmacist must refer a patient to the patient's primary care
provider or, if the patient does not have a primary care provider, to a nearby clinic or hospital;
and
new text end
new text begin
(6) any additional information concerning the requirements and prohibitions in this
subdivision that the board considers necessary.
new text end
new text begin
(b) Before a pharmacist is authorized to prescribe a self-administered hormonal
contraceptive to a patient under this subdivision, the pharmacist shall successfully complete
a training program on prescribing self-administered hormonal contraceptives that is offered
by a college of pharmacy or by a continuing education provider that is accredited by the
Accreditation Council for Pharmacy Education, or a program approved by the board. To
maintain authorization to prescribe, the pharmacist shall complete continuing education
requirements as specified by the board.
new text end
new text begin
(c) Before prescribing a self-administered hormonal contraceptive, the pharmacist shall
follow the standardized protocol developed under paragraph (a), and if appropriate, may
prescribe a self-administered hormonal contraceptive to a patient, if the patient is:
new text end
new text begin
(1) 18 years of age or older; or
new text end
new text begin
(2) under the age of 18 if the patient has previously been prescribed a self-administered
hormonal contraceptive by a licensed physician, physician assistant, or advanced practice
registered nurse.
new text end
new text begin
(d) The pharmacist shall provide counseling to the patient on the use of self-administered
hormonal contraceptives and provide the patient with a fact sheet that includes but is not
limited to the contraindications for use of the drug, the appropriate method for using the
drug, the need for medical follow-up, and any additional information listed in Minnesota
Rules, part 6800.0910, subpart 2, that is required to be given to a patient during the counseling
process. The pharmacist shall also provide the patient with a written record of the
self-administered hormonal contraceptive prescribed by the pharmacist.
new text end
new text begin
(e) If a pharmacist prescribes and dispenses a self-administered hormonal contraceptive
under this subdivision, the pharmacist shall not prescribe a refill to the patient unless the
patient has evidence of a clinical visit with a physician, physician assistant, or advanced
practice registered nurse within the preceding three years.
new text end
new text begin
(f) A pharmacist who is authorized to prescribe a self-administered hormonal
contraceptive is prohibited from delegating the prescribing to any other person. A pharmacist
intern registered pursuant to section 151.101 may prepare a prescription for a
self-administered hormonal contraceptive, but before the prescription is processed or
dispensed, a pharmacist authorized to prescribe under this subdivision must review, approve,
and sign the prescription.
new text end
new text begin
(g) Nothing in this subdivision prohibits a pharmacist from participating in the initiation,
management, modification, and discontinuation of drug therapy according to a protocol or
collaborative agreement as authorized in this section and in section 151.01, subdivision 27.
new text end
Sec. 24.
Minnesota Statutes 2018, section 151.37, is amended by adding a subdivision to
read:
new text begin Subd. 15. new text end
new text begin Nicotine replacement medications. new text end
new text begin
(a) A pharmacist is authorized to prescribe
nicotine replacement medications approved by the United States Food and Drug
Administration in accordance with this subdivision. By January 1, 2021, the board shall
develop a standardized protocol for the pharmacist to follow in prescribing nicotine
replacement medications. In developing the protocol, the board shall consult with the
Minnesota Board of Medical Practice; the Minnesota Board of Nursing; the commissioner
of health; professional pharmacy associations; and professional associations of physicians,
physician assistants, and advanced practice registered nurses.
new text end
new text begin
(b) Before a pharmacist is authorized to prescribe nicotine replacement medications
under this subdivision, the pharmacist shall successfully complete a training program
specifically developed for prescribing nicotine replacement medications that is offered by
a college of pharmacy or by a continuing education provider that is accredited by the
Accreditation Council for Pharmacy Education, or a program approved by the board. To
maintain authorization to prescribe, the pharmacist shall complete continuing education
requirements as specified by the board.
new text end
new text begin
(c) Before prescribing a nicotine replacement medication, the pharmacist shall follow
the appropriate standardized protocol developed under paragraph (a), and if appropriate,
may dispense to a patient a nicotine replacement medication.
new text end
new text begin
(d) The pharmacist shall provide counseling to the patient on the use of the nicotine
replacement medication and provide the patient with a fact sheet that includes but is not
limited to the indications and contraindications for use of a nicotine replacement medication,
the appropriate method for using the medication or product, the need for medical follow-up,
and any additional information listed in Minnesota Rules, part 6800.0910, subpart 2, that
is required to be given to a patient during the counseling process. The pharmacist shall also
provide the patient with a written record of the medication prescribed by the pharmacist.
new text end
new text begin
(e) A pharmacist who is authorized to prescribe a nicotine replacement medication under
this subdivision is prohibited from delegating the prescribing of the medication to any other
person. A pharmacist intern registered pursuant to section 151.101 may prepare a prescription
for the medication, but before the prescription is processed or dispensed, a pharmacist
authorized to prescribe under this subdivision must review, approve, and sign the prescription.
new text end
new text begin
(f) Nothing in this subdivision prohibits a pharmacist from participating in the initiation,
management, modification, and discontinuation of drug therapy according to a protocol or
collaborative agreement as authorized in this section and in section 151.01, subdivision 27.
new text end
Sec. 25.
Minnesota Statutes 2018, section 151.37, is amended by adding a subdivision to
read:
new text begin Subd. 16. new text end
new text begin Opiate antagonists for the treatment of an acute opiate overdose. new text end
new text begin
(a) A
pharmacist is authorized to prescribe opiate antagonists for the treatment of an acute opiate
overdose. By January 1, 2021, the board shall develop a standardized protocol for the
pharmacist to follow in prescribing an opiate antagonist. In developing the protocol, the
board shall consult with the Minnesota Board of Medical Practice; the Minnesota Board of
Nursing; the commissioner of health; professional pharmacy associations; and professional
associations of physicians, physician assistants, and advanced practice registered nurses.
new text end
new text begin
(b) Before a pharmacist is authorized to prescribe an opiate antagonist under this
subdivision, the pharmacist shall successfully complete a training program specifically
developed for prescribing opiate antagonists for the treatment of an acute opiate overdose
that is offered by a college of pharmacy or by a continuing education provider that is
accredited by the Accreditation Council for Pharmacy Education, or a program approved
by the board. To maintain authorization to prescribe, the pharmacist shall complete continuing
education requirements as specified by the board.
new text end
new text begin
(c) Before prescribing an opiate antagonist under this subdivision, the pharmacist shall
follow the appropriate standardized protocol developed under paragraph (a), and if
appropriate, may dispense to a patient an opiate antagonist.
new text end
new text begin
(d) The pharmacist shall provide counseling to the patient on the use of the opiate
antagonist and provide the patient with a fact sheet that includes but is not limited to the
indications and contraindications for use of the opiate antagonist, the appropriate method
for using the opiate antagonist, the need for medical follow-up, and any additional
information listed in Minnesota Rules, part 6800.0910, subpart 2, that is required to be given
to a patient during the counseling process. The pharmacist shall also provide the patient
with a written record of the opiate antagonist prescribed by the pharmacist.
new text end
new text begin
(e) A pharmacist who prescribes an opiate antagonist under this subdivision is prohibited
from delegating the prescribing of the medication to any other person. A pharmacist intern
registered pursuant to section 151.101 may prepare the prescription for the opiate antagonist,
but before the prescription is processed or dispensed, a pharmacist authorized to prescribe
under this subdivision must review, approve, and sign the prescription.
new text end
new text begin
(f) Nothing in this subdivision prohibits a pharmacist from participating in the initiation,
management, modification, and discontinuation of drug therapy according to a protocol as
authorized in this section and in section 151.01, subdivision 27.
new text end
Sec. 26.
Minnesota Statutes 2019 Supplement, section 151.555, subdivision 3, is amended
to read:
Subd. 3.
Central repository requirements.
(a) The board deleted text begin shalldeleted text end new text begin maynew text end publish a request
for proposal for participants who meet the requirements of this subdivision and are interested
in acting as the central repository for the drug repository program. deleted text begin The boarddeleted text end new text begin If the board
publishes a request for proposal, itnew text end shall follow all applicable state procurement procedures
in the selection process.new text begin The board may also work directly with the University of Minnesota
to establish a central repository.
new text end
(b) To be eligible to act as the central repository, the participant must be a wholesale
drug distributor located in Minnesota, licensed pursuant to section 151.47, and in compliance
with all applicable federal and state statutes, rules, and regulations.
(c) The central repository shall be subject to inspection by the board pursuant to section
151.06, subdivision 1.
(d) The central repository shall comply with all applicable federal and state laws, rules,
and regulations pertaining to the drug repository program, drug storage, and dispensing.
The facility must maintain in good standing any state license or registration that applies to
the facility.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 27.
Minnesota Statutes 2018, section 152.12, subdivision 1, is amended to read:
Subdivision 1.
Prescribing, dispensing, administering controlled substances in
Schedules II through V.
A licensed doctor of medicine, a doctor of osteopathic medicine,
duly licensed to practice medicine, a doctor of dental surgery, a doctor of dental medicine,
a licensed doctor of podiatry, a licensed advanced practice registered nurse,new text begin a licensed
physician assistant,new text end or a licensed doctor of optometry limited to Schedules IV and V, and
in the course of professional practice only, may prescribe, administer, and dispense a
controlled substance included in Schedules II through V of section 152.02, may cause the
same to be administered by a nurse, an intern or an assistant under the direction and
supervision of the doctor, and may cause a person who is an appropriately certified and
licensed health care professional to prescribe and administer the same within the expressed
legal scope of the person's practice as defined in Minnesota Statutes.
Sec. 28.
Minnesota Statutes 2019 Supplement, section 256B.0625, subdivision 13, is
amended to read:
Subd. 13.
Drugs.
(a) Medical assistance covers drugs, except for fertility drugs when
specifically used to enhance fertility, if prescribed by a licensed practitioner and dispensed
by a licensed pharmacist, by a physician enrolled in the medical assistance program as a
dispensing physician, or by a physician, physician assistant, or a nurse practitioner employed
by or under contract with a community health board as defined in section 145A.02,
subdivision 5, for the purposes of communicable disease control.
(b) The dispensed quantity of a prescription drug must not exceed a 34-day supply,
unless authorized by the commissioner.
(c) For the purpose of this subdivision and subdivision 13d, an "active pharmaceutical
ingredient" is defined as a substance that is represented for use in a drug and when used in
the manufacturing, processing, or packaging of a drug becomes an active ingredient of the
drug product. An "excipient" is defined as an inert substance used as a diluent or vehicle
for a drug. The commissioner shall establish a list of active pharmaceutical ingredients and
excipients which are included in the medical assistance formulary. Medical assistance covers
selected active pharmaceutical ingredients and excipients used in compounded prescriptions
when the compounded combination is specifically approved by the commissioner or when
a commercially available product:
(1) is not a therapeutic option for the patient;
(2) does not exist in the same combination of active ingredients in the same strengths
as the compounded prescription; and
(3) cannot be used in place of the active pharmaceutical ingredient in the compounded
prescription.
(d) Medical assistance covers the following over-the-counter drugs when prescribed by
a licensed practitioner or by a licensed pharmacist who meets standards established by the
commissioner, in consultation with the board of pharmacy: antacids, acetaminophen, family
planning products, aspirin, insulin, products for the treatment of lice, vitamins for adults
with documented vitamin deficiencies, vitamins for children under the age of seven and
pregnant or nursing women, and any other over-the-counter drug identified by the
commissioner, in consultation with the Formulary Committee, as necessary, appropriate,
and cost-effective for the treatment of certain specified chronic diseases, conditions, or
disorders, and this determination shall not be subject to the requirements of chapter 14. A
pharmacist may prescribe over-the-counter medications as provided under this paragraph
for purposes of receiving reimbursement under Medicaid. When prescribing over-the-counter
drugs under this paragraph, licensed pharmacists must consult with the recipient to determine
necessity, provide drug counseling, review drug therapy for potential adverse interactions,
and make referrals as needed to other health care professionals.
(e) Effective January 1, 2006, medical assistance shall not cover drugs that are coverable
under Medicare Part D as defined in the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003, Public Law 108-173, section 1860D-2(e), for individuals eligible
for drug coverage as defined in the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003, Public Law 108-173, section 1860D-1(a)(3)(A). For these
individuals, medical assistance may cover drugs from the drug classes listed in United States
Code, title 42, section 1396r-8(d)(2), subject to this subdivision and subdivisions 13a to
13g, except that drugs listed in United States Code, title 42, section 1396r-8(d)(2)(E), shall
not be covered.
(f) Medical assistance covers drugs acquired through the federal 340B Drug Pricing
Program and dispensed by 340B covered entities and ambulatory pharmacies under common
ownership of the 340B covered entity. Medical assistance does not cover drugs acquired
through the federal 340B Drug Pricing Program and dispensed by 340B contract pharmacies.
new text begin
(g) Notwithstanding paragraph (a), medical assistance covers self-administered hormonal
contraceptives prescribed and dispensed by a licensed pharmacist in accordance with section
151.37, subdivision 14; nicotine replacement medications prescribed and dispensed by a
licensed pharmacist in accordance with section 151.37, subdivision 15; and opiate antagonists
used for the treatment of an acute opiate overdose prescribed and dispensed by a licensed
pharmacist in accordance with section 151.37, subdivision 16.
new text end
Sec. 29.
Minnesota Statutes 2018, section 256B.0625, subdivision 13h, is amended to
read:
Subd. 13h.
Medication therapy management services.
(a) Medical assistance covers
medication therapy management services for a recipient taking prescriptions to treat or
prevent one or more chronic medical conditions. For purposes of this subdivision,
"medication therapy management" means the provision of the following pharmaceutical
care services by a licensed pharmacist to optimize the therapeutic outcomes of the patient's
medications:
(1) performing or obtaining necessary assessments of the patient's health status;
(2) formulating a medication treatment plannew text begin , which may include prescribing medications
or products in accordance with section 151.37, subdivision 14, 15, or 16new text end ;
(3) monitoring and evaluating the patient's response to therapy, including safety and
effectiveness;
(4) performing a comprehensive medication review to identify, resolve, and prevent
medication-related problems, including adverse drug events;
(5) documenting the care delivered and communicating essential information to the
patient's other primary care providers;
(6) providing verbal education and training designed to enhance patient understanding
and appropriate use of the patient's medications;
(7) providing information, support services, and resources designed to enhance patient
adherence with the patient's therapeutic regimens; and
(8) coordinating and integrating medication therapy management services within the
broader health care management services being provided to the patient.
Nothing in this subdivision shall be construed to expand or modify the scope of practice of
the pharmacist as defined in section 151.01, subdivision 27.
(b) To be eligible for reimbursement for services under this subdivision, a pharmacist
must meet the following requirements:
(1) have a valid license issued by the Board of Pharmacy of the state in which the
medication therapy management service is being performed;
(2) have graduated from an accredited college of pharmacy on or after May 1996, or
completed a structured and comprehensive education program approved by the Board of
Pharmacy and the American Council of Pharmaceutical Education for the provision and
documentation of pharmaceutical care management services that has both clinical and
didactic elements;
(3) be practicing in an ambulatory care setting as part of a multidisciplinary team or
have developed a structured patient care process that is offered in a private or semiprivate
patient care area that is separate from the commercial business that also occurs in the setting,
or in home settings, including long-term care settings, group homes, and facilities providing
assisted living services, but excluding skilled nursing facilities; and
(4) make use of an electronic patient record system that meets state standards.
(c) For purposes of reimbursement for medication therapy management services, the
commissioner may enroll individual pharmacists as medical assistance providers. The
commissioner may also establish contact requirements between the pharmacist and recipient,
including limiting the number of reimbursable consultations per recipient.
(d) If there are no pharmacists who meet the requirements of paragraph (b) practicing
within a reasonable geographic distance of the patient, a pharmacist who meets the
requirements may provide the services via two-way interactive video. Reimbursement shall
be at the same rates and under the same conditions that would otherwise apply to the services
provided. To qualify for reimbursement under this paragraph, the pharmacist providing the
services must meet the requirements of paragraph (b), and must be located within an
ambulatory care setting that meets the requirements of paragraph (b), clause (3). The patient
must also be located within an ambulatory care setting that meets the requirements of
paragraph (b), clause (3). Services provided under this paragraph may not be transmitted
into the patient's residence.
(e) Medication therapy management services may be delivered into a patient's residence
via secure interactive video if the medication therapy management services are performed
electronically during a covered home care visit by an enrolled provider. Reimbursement
shall be at the same rates and under the same conditions that would otherwise apply to the
services provided. To qualify for reimbursement under this paragraph, the pharmacist
providing the services must meet the requirements of paragraph (b) and must be located
within an ambulatory care setting that meets the requirements of paragraph (b), clause (3).
Sec. 30. new text begin ISSUANCE OF PRESCRIPTIONS TO TREAT SUBSTANCE USE
DISORDERS.
new text end
new text begin Subdivision 1. new text end
new text begin Applicability during a peacetime emergency. new text end
new text begin
This section applies
during a peacetime emergency declared by the governor under Minnesota Statutes, section
12.31, subdivision 2, for an outbreak of COVID-19.
new text end
new text begin Subd. 2. new text end
new text begin Use of telemedicine allowed. new text end
new text begin
For purposes of Minnesota Statutes, section
151.37, subdivision 2, paragraph (d), the requirement for an examination shall be met if the
prescribing practitioner has performed a telemedicine examination of the patient before
issuing a prescription drug order for the treatment of a substance use disorder.
new text end
new text begin Subd. 3. new text end
new text begin Expiration. new text end
new text begin
This section expires 60 days after the peacetime emergency specified
in subdivision 1 is terminated or rescinded by proper authority.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 31. new text begin LICENSE RENEWAL FOR PODIATRISTS; CONTINUING EDUCATION.
new text end
new text begin
(a) Notwithstanding Minnesota Statutes, section 153.16, subdivision 5, for purposes of
obtaining the required hours of continuing education for licensure renewal, any continuing
education hours obtained by a licensed podiatrist through participation in an internet live
online continuing educational activity as defined by the Council on Podiatric Medical
Education from March 13, 2020, to the expiration date of this section, shall be classified
by the board of podiatric medicine in the same manner as if the credits were obtained through
in-person participation.
new text end
new text begin
(b) This section expires December 31, 2020, or the day after the peacetime emergency
declared by the governor under Minnesota Statutes, section 12.31, subdivision 2, for an
outbreak of COVID-19 is terminated or rescinded by proper authority, whichever is later.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 32. new text begin OBSERVATION OF PHYSICAL THERAPIST ASSISTANTS.
new text end
new text begin Subdivision 1. new text end
new text begin Applicability during a peacetime emergency. new text end
new text begin
This section applies
during a peacetime emergency by the governor under Minnesota Statutes, section 12.31,
subdivision 2, for an outbreak of COVID-19.
new text end
new text begin Subd. 2. new text end
new text begin On-site requirements. new text end
new text begin
For purposes of Minnesota Statutes, section 148.706,
subdivision 3, the on-site observation requirement of treatment components delegated to a
physical therapist assistant by a physical therapist may be met through observation via
telemedicine.
new text end
new text begin Subd. 3. new text end
new text begin Expiration. new text end
new text begin
This section expires 60 days after the peacetime emergency specified
in subdivision 1 is terminated or rescinded by the proper authority.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 33. new text begin THERAPEUTIC INTERCHANGE.
new text end
new text begin Subdivision 1. new text end
new text begin Applicability during a peacetime emergency. new text end
new text begin
This section applies
during a peacetime emergency declared by the governor under Minnesota Statutes, section
12.31, subdivision 2, for an outbreak of COVID-19.
new text end
new text begin Subd. 2. new text end
new text begin Therapeutic interchange. new text end
new text begin
Notwithstanding Minnesota Statutes, section 151.21,
subdivision 7a, paragraph (a), a pharmacist may dispense a therapeutically equivalent and
interchangeable prescribed drug or biological product, without having a protocol in place,
provided:
new text end
new text begin
(1) the drug prescribed is in short supply and the pharmacist is unable to obtain it from
the manufacturer, drug wholesalers, or other local pharmacies;
new text end
new text begin
(2) the pharmacist is unable to contact the prescriber within a reasonable period of time
to get authorization to dispense a drug that is available;
new text end
new text begin
(3) the pharmacist determines a therapeutically equivalent drug to the one prescribed is
available and is in the same American Hospital Formulary Service pharmacologic-therapeutic
classification;
new text end
new text begin
(4) the pharmacist informs the patient as required in Minnesota Statutes, section 151.21,
subdivision 7a, paragraph (b), and provides counseling to the patient, as required by the
Board of Pharmacy rules, about the substituted drug;
new text end
new text begin
(5) the pharmacist informs the prescriber as soon as possible that the therapeutic
interchange has been made; and
new text end
new text begin
(6) the therapeutic interchange pursuant to this section is allowed only until the expiration
date under subdivision 3.
new text end
new text begin Subd. 3. new text end
new text begin Expiration. new text end
new text begin
This section expires 60 days after the peacetime emergency specified
in subdivision 1 is terminated or rescinded by proper authority.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 34. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2018, sections 147A.01, subdivisions 4, 11, 16a, 17a, 24, and 25;
147A.04; 147A.10; 147A.11; 147A.18, subdivisions 1, 2, and 3; and 147A.20,
new text end
new text begin
are repealed.
new text end
ARTICLE 3
HEALTH CARE
Section 1.
Minnesota Statutes 2019 Supplement, section 16A.151, subdivision 2, is
amended to read:
Subd. 2.
Exceptions.
(a) If a state official litigates or settles a matter on behalf of specific
injured persons or entities, this section does not prohibit distribution of money to the specific
injured persons or entities on whose behalf the litigation or settlement efforts were initiated.
If money recovered on behalf of injured persons or entities cannot reasonably be distributed
to those persons or entities because they cannot readily be located or identified or because
the cost of distributing the money would outweigh the benefit to the persons or entities, the
money must be paid into the general fund.
(b) Money recovered on behalf of a fund in the state treasury other than the general fund
may be deposited in that fund.
(c) This section does not prohibit a state official from distributing money to a person or
entity other than the state in litigation or potential litigation in which the state is a defendant
or potential defendant.
(d) State agencies may accept funds as directed by a federal court for any restitution or
monetary penalty under United States Code, title 18, section 3663(a)(3)new text begin ,new text end or United States
Code, title 18, section 3663A(a)(3). Funds received must be deposited in a special revenue
account and are appropriated to the commissioner of the agency for the purpose as directed
by the federal court.
(e) Tobacco settlement revenues as defined in section 16A.98, subdivision 1, paragraph
(t), may be deposited as provided in section 16A.98, subdivision 12.
(f) Any money received by the state resulting from a settlement agreement or an assurance
of discontinuance entered into by the attorney general of the state, or a court order in litigation
brought by the attorney general of the state, on behalf of the state or a state agency, against
one or more opioid manufacturers or opioid wholesale drug distributors related to alleged
violations of consumer fraud laws in the marketing, sale, or distribution of opioids in this
state or other alleged illegal actions that contributed to the excessive use of opioids, must
be deposited in a separate account in the state treasury and the commissioner shall notify
the chairs and ranking minority members of the Finance Committee in the senate and the
Ways and Means Committee in the house of representatives that an account has been created.
This paragraph does not apply to attorney fees and costs awarded to the state or the Attorney
General's Office, to contract attorneys hired by the state or Attorney General's Office, or to
other state agency attorneys. If the licensing fees under section 151.065, subdivision 1,
clause (16), and subdivision 3, clause (14), are reduced and the registration fee under section
151.066, subdivision 3, is repealed in accordance with section 256.043, subdivision 4, then
the commissioner shall transfer from the separate account created in this paragraph to the
opiate epidemic response deleted text begin accountdeleted text end new text begin fundnew text end under section 256.043 an amount that ensures that
$20,940,000 each fiscal year is available for distribution in accordance with section 256.043,
subdivisions 2 and 3.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 2.
Minnesota Statutes 2018, section 62U.03, is amended to read:
62U.03 PAYMENT RESTRUCTURING; CARE COORDINATION PAYMENTS.
(a) By January 1, 2010, health plan companies shall include health care homes in their
provider networks and by July 1, 2010, shall pay a care coordination fee for their members
who choose to enroll in health care homes certified by the deleted text begin commissioners of health and
human servicesdeleted text end new text begin commissionernew text end under section 256B.0751. Health plan companies shall develop
payment conditions and terms for the care coordination fee for health care homes participating
in their network in a manner that is consistent with the system developed under section
256B.0753. Nothing in this section shall restrict the ability of health plan companies to
selectively contract with health care providers, including health care homes. Health plan
companies may reduce or reallocate payments to other providers to ensure that
implementation of care coordination payments is cost neutral.
(b) By July 1, 2010, the commissioner of management and budget shall implement the
care coordination payments for participants in the state employee group insurance program.
The commissioner of management and budget may reallocate payments within the health
care system in order to ensure that the implementation of this section is cost neutral.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 3.
Minnesota Statutes 2018, section 62U.04, subdivision 11, is amended to read:
Subd. 11.
Restricted uses of the all-payer claims data.
(a) Notwithstanding subdivision
4, paragraph (b), and subdivision 5, paragraph (b), the commissioner or the commissioner's
designee shall only use the data submitted under subdivisions 4 and 5 for the following
purposes:
(1) to evaluate the performance of the health care home program as authorized under
deleted text begin sectionsdeleted text end new text begin sectionnew text end 256B.0751, subdivision 6deleted text begin , and 256B.0752, subdivision 2deleted text end ;
(2) to study, in collaboration with the reducing avoidable readmissions effectively
(RARE) campaign, hospital readmission trends and rates;
(3) to analyze variations in health care costs, quality, utilization, and illness burden based
on geographical areas or populations;
(4) to evaluate the state innovation model (SIM) testing grant received by the Departments
of Health and Human Services, including the analysis of health care cost, quality, and
utilization baseline and trend information for targeted populations and communities; and
(5) to compile one or more public use files of summary data or tables that must:
(i) be available to the public for no or minimal cost by March 1, 2016, and available by
web-based electronic data download by June 30, 2019;
(ii) not identify individual patients, payers, or providers;
(iii) be updated by the commissioner, at least annually, with the most current data
available;
(iv) contain clear and conspicuous explanations of the characteristics of the data, such
as the dates of the data contained in the files, the absence of costs of care for uninsured
patients or nonresidents, and other disclaimers that provide appropriate context; and
(v) not lead to the collection of additional data elements beyond what is authorized under
this section as of June 30, 2015.
(b) The commissioner may publish the results of the authorized uses identified in
paragraph (a) so long as the data released publicly do not contain information or descriptions
in which the identity of individual hospitals, clinics, or other providers may be discerned.
(c) Nothing in this subdivision shall be construed to prohibit the commissioner from
using the data collected under subdivision 4 to complete the state-based risk adjustment
system assessment due to the legislature on October 1, 2015.
(d) The commissioner or the commissioner's designee may use the data submitted under
subdivisions 4 and 5 for the purpose described in paragraph (a), clause (3), until July 1,
2023.
(e) The commissioner shall consult with the all-payer claims database work group
established under subdivision 12 regarding the technical considerations necessary to create
the public use files of summary data described in paragraph (a), clause (5).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 4.
Minnesota Statutes 2019 Supplement, section 151.065, subdivision 1, as amended
by Laws 2020, chapter 71, article 2, section 5, is amended to read:
Subdivision 1.
Application fees.
Application fees for licensure and registration are as
follows:
(1) pharmacist licensed by examination, $175;
(2) pharmacist licensed by reciprocity, $275;
(3) pharmacy intern, $50;
(4) pharmacy technician, $50;
(5) pharmacy, $260;
(6) drug wholesaler, legend drugs only, $5,260;
(7) drug wholesaler, legend and nonlegend drugs, $5,260;
(8) drug wholesaler, nonlegend drugs, veterinary legend drugs, or both, $5,260;
(9) drug wholesaler, medical gases, $5,260 for the first facility and $260 for each
additional facility;
(10) third-party logistics provider, $260;
(11) drug manufacturer, nonopiate legend drugs only, $5,260;
(12) drug manufacturer, nonopiate legend and nonlegend drugs, $5,260;
(13) drug manufacturer, nonlegend or veterinary legend drugs, $5,260;
(14) drug manufacturer, medical gases, $5,260 for the first facility and $260 for each
additional facility;
(15) drug manufacturer, also licensed as a pharmacy in Minnesota, $5,260;
(16) drug manufacturer of opiate-containing controlled substances listed in section
152.02, subdivisions 3 to 5, deleted text begin $55,000deleted text end new text begin $55,260new text end ;
(17) medical gas deleted text begin distributordeleted text end new text begin dispensernew text end , $260;
(18) controlled substance researcher, $75; and
(19) pharmacy professional corporation, $150.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 5.
Minnesota Statutes 2019 Supplement, section 151.065, subdivision 3, as amended
by Laws 2020, chapter 71, article 2, section 6, is amended to read:
Subd. 3.
Annual renewal fees.
Annual licensure and registration renewal fees are as
follows:
(1) pharmacist, $175;
(2) pharmacy technician, $50;
(3) pharmacy, $260;
(4) drug wholesaler, legend drugs only, $5,260;
(5) drug wholesaler, legend and nonlegend drugs, $5,260;
(6) drug wholesaler, nonlegend drugs, veterinary legend drugs, or both, $5,260;
(7) drug wholesaler, medical gases, $5,260 for the first facility and $260 for each
additional facility;
(8) third-party logistics provider, $260;
(9) drug manufacturer, nonopiate legend drugs only, $5,260;
(10) drug manufacturer, nonopiate legend and nonlegend drugs, $5,260;
(11) drug manufacturer, nonlegend, veterinary legend drugs, or both, $5,260;
(12) drug manufacturer, medical gases, $5,260 for the first facility and $260 for each
additional facility;
(13) drug manufacturer, also licensed as a pharmacy in Minnesota, $5,260;
(14) drug manufacturer of opiate-containing controlled substances listed in section
152.02, subdivisions 3 to 5, deleted text begin $55,000deleted text end new text begin $55,260new text end ;
(15) medical gas deleted text begin distributordeleted text end new text begin dispensernew text end , $260;
(16) controlled substance researcher, $75; and
(17) pharmacy professional corporation, $100.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 6.
Minnesota Statutes 2019 Supplement, section 151.065, subdivision 6, is amended
to read:
Subd. 6.
Reinstatement fees.
(a) A pharmacist who has allowed the pharmacist's license
to lapse may reinstate the license with board approval and upon payment of any fees and
late fees in arrears, up to a maximum of $1,000.
(b) A pharmacy technician who has allowed the technician's registration to lapse may
reinstate the registration with board approval and upon payment of any fees and late fees
in arrears, up to a maximum of $90.
(c) An owner of a pharmacy, a drug wholesaler, a drug manufacturer, third-party logistics
provider, or a medical gas deleted text begin distributordeleted text end new text begin dispensernew text end who has allowed the license of the
establishment to lapse may reinstate the license with board approval and upon payment of
any fees and late fees in arrears.
(d) A controlled substance researcher who has allowed the researcher's registration to
lapse may reinstate the registration with board approval and upon payment of any fees and
late fees in arrears.
(e) A pharmacist owner of a professional corporation who has allowed the corporation's
registration to lapse may reinstate the registration with board approval and upon payment
of any fees and late fees in arrears.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 7.
Minnesota Statutes 2019 Supplement, section 151.065, subdivision 7, as amended
by Laws 2020, chapter 71, article 2, section 7, is amended to read:
Subd. 7.
Deposit of fees.
(a) The license fees collected under this section, with the
exception of the fees identified in paragraphs (b) and (c), shall be deposited in the state
government special revenue fund.
(b) $5,000 of each fee collected under subdivision 1, clauses (6) to (9), and (11) to (15),
and subdivision 3, clauses (4) to (7), and (9) to (13), and deleted text begin the feesdeleted text end new text begin $55,000 of each feenew text end
collected under subdivision 1, clause (16), and subdivision 3, clause (14), shall be deposited
in the opiate epidemic response deleted text begin accountdeleted text end new text begin fundnew text end established in section 256.043.
(c) If the fees collected under subdivision 1, clause (16), or subdivision 3, clause (14),
are reducednew text begin under section 256.043new text end , $5,000 of the reduced fee shall be deposited in the opiate
epidemic response deleted text begin accountdeleted text end new text begin fundnew text end in section 256.043.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 8.
Minnesota Statutes 2019 Supplement, section 151.071, subdivision 2, is amended
to read:
Subd. 2.
Grounds for disciplinary action.
The following conduct is prohibited and is
grounds for disciplinary action:
(1) failure to demonstrate the qualifications or satisfy the requirements for a license or
registration contained in this chapter or the rules of the board. The burden of proof is on
the applicant to demonstrate such qualifications or satisfaction of such requirements;
(2) obtaining a license by fraud or by misleading the board in any way during the
application process or obtaining a license by cheating, or attempting to subvert the licensing
examination process. Conduct that subverts or attempts to subvert the licensing examination
process includes, but is not limited to: (i) conduct that violates the security of the examination
materials, such as removing examination materials from the examination room or having
unauthorized possession of any portion of a future, current, or previously administered
licensing examination; (ii) conduct that violates the standard of test administration, such as
communicating with another examinee during administration of the examination, copying
another examinee's answers, permitting another examinee to copy one's answers, or
possessing unauthorized materials; or (iii) impersonating an examinee or permitting an
impersonator to take the examination on one's own behalf;
(3) for a pharmacist, pharmacy technician, pharmacist intern, applicant for a pharmacist
or pharmacy license, or applicant for a pharmacy technician or pharmacist intern registration,
conviction of a felony reasonably related to the practice of pharmacy. Conviction as used
in this subdivision includes a conviction of an offense that if committed in this state would
be deemed a felony without regard to its designation elsewhere, or a criminal proceeding
where a finding or verdict of guilt is made or returned but the adjudication of guilt is either
withheld or not entered thereon. The board may delay the issuance of a new license or
registration if the applicant has been charged with a felony until the matter has been
adjudicated;
(4) for a facility, other than a pharmacy, licensed or registered by the board, if an owner
or applicant is convicted of a felony reasonably related to the operation of the facility. The
board may delay the issuance of a new license or registration if the owner or applicant has
been charged with a felony until the matter has been adjudicated;
(5) for a controlled substance researcher, conviction of a felony reasonably related to
controlled substances or to the practice of the researcher's profession. The board may delay
the issuance of a registration if the applicant has been charged with a felony until the matter
has been adjudicated;
(6) disciplinary action taken by another state or by one of this state's health licensing
agencies:
(i) revocation, suspension, restriction, limitation, or other disciplinary action against a
license or registration in another state or jurisdiction, failure to report to the board that
charges or allegations regarding the person's license or registration have been brought in
another state or jurisdiction, or having been refused a license or registration by any other
state or jurisdiction. The board may delay the issuance of a new license or registration if an
investigation or disciplinary action is pending in another state or jurisdiction until the
investigation or action has been dismissed or otherwise resolved; and
(ii) revocation, suspension, restriction, limitation, or other disciplinary action against a
license or registration issued by another of this state's health licensing agencies, failure to
report to the board that charges regarding the person's license or registration have been
brought by another of this state's health licensing agencies, or having been refused a license
or registration by another of this state's health licensing agencies. The board may delay the
issuance of a new license or registration if a disciplinary action is pending before another
of this state's health licensing agencies until the action has been dismissed or otherwise
resolved;
(7) for a pharmacist, pharmacy, pharmacy technician, or pharmacist intern, violation of
any order of the board, of any of the provisions of this chapter or any rules of the board or
violation of any federal, state, or local law or rule reasonably pertaining to the practice of
pharmacy;
(8) for a facility, other than a pharmacy, licensed by the board, violations of any order
of the board, of any of the provisions of this chapter or the rules of the board or violation
of any federal, state, or local law relating to the operation of the facility;
(9) engaging in any unethical conduct; conduct likely to deceive, defraud, or harm the
public, or demonstrating a willful or careless disregard for the health, welfare, or safety of
a patient; or pharmacy practice that is professionally incompetent, in that it may create
unnecessary danger to any patient's life, health, or safety, in any of which cases, proof of
actual injury need not be established;
(10) aiding or abetting an unlicensed person in the practice of pharmacy, except that it
is not a violation of this clause for a pharmacist to supervise a properly registered pharmacy
technician or pharmacist intern if that person is performing duties allowed by this chapter
or the rules of the board;
(11) for an individual licensed or registered by the board, adjudication as mentally ill
or developmentally disabled, or as a chemically dependent person, a person dangerous to
the public, a sexually dangerous person, or a person who has a sexual psychopathic
personality, by a court of competent jurisdiction, within or without this state. Such
adjudication shall automatically suspend a license for the duration thereof unless the board
orders otherwise;
(12) for a pharmacist or pharmacy intern, engaging in unprofessional conduct as specified
in the board's rules. In the case of a pharmacy technician, engaging in conduct specified in
board rules that would be unprofessional if it were engaged in by a pharmacist or pharmacist
intern or performing duties specifically reserved for pharmacists under this chapter or the
rules of the board;
(13) for a pharmacy, operation of the pharmacy without a pharmacist present and on
duty except as allowed by a variance approved by the board;
(14) for a pharmacist, the inability to practice pharmacy with reasonable skill and safety
to patients by reason of illness, use of alcohol, drugs, narcotics, chemicals, or any other type
of material or as a result of any mental or physical condition, including deterioration through
the aging process or loss of motor skills. In the case of registered pharmacy technicians,
pharmacist interns, or controlled substance researchers, the inability to carry out duties
allowed under this chapter or the rules of the board with reasonable skill and safety to
patients by reason of illness, use of alcohol, drugs, narcotics, chemicals, or any other type
of material or as a result of any mental or physical condition, including deterioration through
the aging process or loss of motor skills;
(15) for a pharmacist, pharmacy, pharmacist intern, pharmacy technician, medical gas
deleted text begin distributordeleted text end new text begin dispensernew text end , or controlled substance researcher, revealing a privileged
communication from or relating to a patient except when otherwise required or permitted
by law;
(16) for a pharmacist or pharmacy, improper management of patient records, including
failure to maintain adequate patient records, to comply with a patient's request made pursuant
to sections 144.291 to 144.298, or to furnish a patient record or report required by law;
(17) fee splitting, including without limitation:
(i) paying, offering to pay, receiving, or agreeing to receive, a commission, rebate,
kickback, or other form of remuneration, directly or indirectly, for the referral of patients;
(ii) referring a patient to any health care provider as defined in sections 144.291 to
144.298 in which the licensee or registrant has a financial or economic interest as defined
in section 144.6521, subdivision 3, unless the licensee or registrant has disclosed the
licensee's or registrant's financial or economic interest in accordance with section 144.6521;
and
(iii) any arrangement through which a pharmacy, in which the prescribing practitioner
does not have a significant ownership interest, fills a prescription drug order and the
prescribing practitioner is involved in any manner, directly or indirectly, in setting the price
for the filled prescription that is charged to the patient, the patient's insurer or pharmacy
benefit manager, or other person paying for the prescription or, in the case of veterinary
patients, the price for the filled prescription that is charged to the client or other person
paying for the prescription, except that a veterinarian and a pharmacy may enter into such
an arrangement provided that the client or other person paying for the prescription is notified,
in writing and with each prescription dispensed, about the arrangement, unless such
arrangement involves pharmacy services provided for livestock, poultry, and agricultural
production systems, in which case client notification would not be required;
(18) engaging in abusive or fraudulent billing practices, including violations of the
federal Medicare and Medicaid laws or state medical assistance laws or rules;
(19) engaging in conduct with a patient that is sexual or may reasonably be interpreted
by the patient as sexual, or in any verbal behavior that is seductive or sexually demeaning
to a patient;
(20) failure to make reports as required by section 151.072 or to cooperate with an
investigation of the board as required by section 151.074;
(21) knowingly providing false or misleading information that is directly related to the
care of a patient unless done for an accepted therapeutic purpose such as the dispensing and
administration of a placebo;
(22) aiding suicide or aiding attempted suicide in violation of section 609.215 as
established by any of the following:
(i) a copy of the record of criminal conviction or plea of guilty for a felony in violation
of section 609.215, subdivision 1 or 2;
(ii) a copy of the record of a judgment of contempt of court for violating an injunction
issued under section 609.215, subdivision 4;
(iii) a copy of the record of a judgment assessing damages under section 609.215,
subdivision 5; or
(iv) a finding by the board that the person violated section 609.215, subdivision 1 or 2.
The board deleted text begin shalldeleted text end new text begin mustnew text end investigate any complaint of a violation of section 609.215, subdivision
1 or 2;
(23) for a pharmacist, practice of pharmacy under a lapsed or nonrenewed license. For
a pharmacist intern, pharmacy technician, or controlled substance researcher, performing
duties permitted to such individuals by this chapter or the rules of the board under a lapsed
or nonrenewed registration. For a facility required to be licensed under this chapter, operation
of the facility under a lapsed or nonrenewed license or registration; and
(24) for a pharmacist, pharmacist intern, or pharmacy technician, termination or discharge
from the health professionals services program for reasons other than the satisfactory
completion of the program.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 9.
Minnesota Statutes 2018, section 151.071, subdivision 8, is amended to read:
Subd. 8.
Temporary suspension of license for pharmacies, drug wholesalers, drug
manufacturers, medical gas manufacturers, and medical gas deleted text begin distributorsdeleted text end new text begin dispensersnew text end .
In
addition to any other remedy provided by law, the board may, without a hearing, temporarily
suspend the license or registration of a pharmacy, drug wholesaler, drug manufacturer,
medical gas manufacturer, or medical gas deleted text begin distributordeleted text end new text begin dispensernew text end if the board finds that the
licensee or registrant has violated a statute or rule that the board is empowered to enforce
and continued operation of the licensed facility would create a serious risk of harm to the
public. The suspension deleted text begin shalldeleted text end new text begin mustnew text end take effect upon written notice to the licensee or registrant,
specifying the statute or rule violated. The suspension deleted text begin shalldeleted text end new text begin mustnew text end remain in effect until the
board issues a final order in the matter after a hearing. At the time it issues the suspension
notice, the board deleted text begin shalldeleted text end new text begin mustnew text end schedule a disciplinary hearing to be held pursuant to the
Administrative Procedure Act. The licensee or registrant deleted text begin shalldeleted text end new text begin mustnew text end be provided with at
least 20 days' notice of any hearing held pursuant to this subdivision. The hearing deleted text begin shalldeleted text end new text begin mustnew text end
be scheduled to begin no later than 30 days after the issuance of the suspension order.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 10.
Minnesota Statutes 2019 Supplement, section 151.19, subdivision 3, is amended
to read:
Subd. 3.
Sale of federally restricted medical gases.
(a) A person or establishment not
licensed as a pharmacy or a practitioner deleted text begin shalldeleted text end new text begin mustnew text end not engage in the retail sale or deleted text begin distributiondeleted text end new text begin
dispensingnew text end of federally restricted medical gases without first obtaining a registration from
the board and paying the applicable fee specified in section 151.065. The registration deleted text begin shalldeleted text end new text begin
mustnew text end be displayed in a conspicuous place in the business for which it is issued and expires
on the date set by the board. It is unlawful for a person to sell or deleted text begin distributedeleted text end new text begin dispensenew text end federally
restricted medical gases unless a certificate has been issued to that person by the board.
(b) Application for a medical gas deleted text begin distributordeleted text end new text begin dispensernew text end registration under this section
deleted text begin shalldeleted text end new text begin mustnew text end be made in a manner specified by the board.
(c) deleted text begin Nodeleted text end new text begin Anew text end registration deleted text begin shalldeleted text end new text begin must notnew text end be issued or renewed for a medical gas deleted text begin distributordeleted text end new text begin
dispensernew text end located within the state unless the applicant agrees to operate in a manner prescribed
by federal and state law and according to the rules adopted by the board. deleted text begin Nodeleted text end new text begin Anew text end license deleted text begin shalldeleted text end new text begin
must notnew text end be issued for a medical gas deleted text begin distributordeleted text end new text begin dispensernew text end located outside of the state unless
the applicant agrees to operate in a manner prescribed by federal law and, when deleted text begin distributingdeleted text end new text begin
dispensingnew text end medical gases for residents of this state, the laws of this state and Minnesota
Rules.
(d) deleted text begin Nodeleted text end new text begin Anew text end registration deleted text begin shalldeleted text end new text begin must notnew text end be issued or renewed for a medical gas deleted text begin distributordeleted text end new text begin
dispensernew text end that is required to be licensed or registered by the state in which it is physically
located unless the applicant supplies the board with proof of the licensure or registration.
The board may, by rule, establish standards for the registration of a medical gas deleted text begin distributordeleted text end new text begin
dispensernew text end that is not required to be licensed or registered by the state in which it is physically
located.
(e) The board deleted text begin shalldeleted text end new text begin mustnew text end require a separate registration for each medical gas deleted text begin distributordeleted text end new text begin
dispensernew text end located within the state and for each facility located outside of the state from
which medical gases are deleted text begin distributeddeleted text end new text begin dispensednew text end to residents of this state.
(f) Prior to the issuance of an initial or renewed registration for a medical gas deleted text begin distributordeleted text end new text begin
dispensernew text end , the board may require the medical gas deleted text begin distributordeleted text end new text begin dispensernew text end to pass an inspection
conducted by an authorized representative of the board. In the case of a medical gas
deleted text begin distributordeleted text end new text begin dispensernew text end located outside of the state, the board may require the applicant to pay
the cost of the inspection, in addition to the license fee in section 151.065, unless the applicant
furnishes the board with a report, issued by the appropriate regulatory agency of the state
in which the facility is located, of an inspection that has occurred within the 24 months
immediately preceding receipt of the license application by the board. The board may deny
licensure unless the applicant submits documentation satisfactory to the board that any
deficiencies noted in an inspection report have been corrected.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 11.
Minnesota Statutes 2019 Supplement, section 151.252, subdivision 1, is amended
to read:
Subdivision 1.
Requirements.
(a) No person shall act as a drug manufacturer without
first obtaining a license from the board and paying any applicable fee specified in section
151.065.
(b) In addition to the license required under paragraph (a), each manufacturer required
to pay the registration fee under section 151.066 must pay the fee by June 1 of each year,
beginning June 1, 2020. In the event of a change of ownership of the manufacturer, the new
owner must pay the registration fee specified under section 151.066, subdivision 3, that the
original owner would have been assessed had the original owner retained ownership. The
registration fee collected under this paragraph shall be deposited in the opiate epidemic
response deleted text begin accountdeleted text end new text begin fundnew text end established under section 256.043.
(c) Application for a drug manufacturer license under this section shall be made in a
manner specified by the board.
(d) No license shall be issued or renewed for a drug manufacturer unless the applicant
agrees to operate in a manner prescribed by federal and state law and according to Minnesota
Rules.
(e) No license shall be issued or renewed for a drug manufacturer that is required to be
registered pursuant to United States Code, title 21, section 360, unless the applicant supplies
the board with proof of registration. The board may establish by rule the standards for
licensure of drug manufacturers that are not required to be registered under United States
Code, title 21, section 360.
(f) No license shall be issued or renewed for a drug manufacturer that is required to be
licensed or registered by the state in which it is physically located unless the applicant
supplies the board with proof of licensure or registration. The board may establish, by rule,
standards for the licensure of a drug manufacturer that is not required to be licensed or
registered by the state in which it is physically located.
(g) The board shall require a separate license for each facility located within the state at
which drug manufacturing occurs and for each facility located outside of the state at which
drugs that are shipped into the state are manufactured, except a manufacturer of
opiate-containing controlled substances shall not be required to pay the fee under section
151.065, subdivision 1, clause (16), or subdivision 3, clause (14), for more than one facility.
(h) Prior to the issuance of an initial or renewed license for a drug manufacturing facility,
the board may require the facility to pass a current good manufacturing practices inspection
conducted by an authorized representative of the board. In the case of a drug manufacturing
facility located outside of the state, the board may require the applicant to pay the cost of
the inspection, in addition to the license fee in section 151.065, unless the applicant furnishes
the board with a report, issued by the appropriate regulatory agency of the state in which
the facility is located or by the United States Food and Drug Administration, of an inspection
that has occurred within the 24 months immediately preceding receipt of the license
application by the board. The board may deny licensure unless the applicant submits
documentation satisfactory to the board that any deficiencies noted in an inspection report
have been corrected.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 12.
Minnesota Statutes 2018, section 256.01, subdivision 29, is amended to read:
Subd. 29.
State medical review team.
(a) To ensure the timely processing of
determinations of disability by the commissioner's state medical review team under sections
256B.055, deleted text begin subdivisiondeleted text end new text begin subdivisions new text end 7, paragraph (b), new text begin and 12, and new text end 256B.057, subdivision 9,
deleted text begin and 256B.055, subdivision 12,deleted text end the commissioner shall review all medical evidence deleted text begin submitted
by county agencies with a referraldeleted text end and seek deleted text begin additionaldeleted text end information from providers, applicants,
and enrollees to support the determination of disability where necessary. Disability shall
be determined according to the rules of title XVI and title XIX of the Social Security Act
and pertinent rules and policies of the Social Security Administration.
(b) Prior to a denial or withdrawal of a requested determination of disability due to
insufficient evidence, the commissioner shall (1) ensure that the missing evidence is necessary
and appropriate to a determination of disability, and (2) assist applicants and enrollees to
obtain the evidence, including, but not limited to, medical examinations and electronic
medical records.
(c) The commissioner shall provide the chairs of the legislative committees with
jurisdiction over health and human services finance and budget the following information
on the activities of the state medical review team by February 1 of each year:
(1) the number of applications to the state medical review team that were denied,
approved, or withdrawn;
(2) the average length of time from receipt of the application to a decision;
(3) the number of appeals, appeal results, and the length of time taken from the date the
person involved requested an appeal for a written decision to be made on each appeal;
(4) for applicants, their age, health coverage at the time of application, hospitalization
history within three months of application, and whether an application for Social Security
or Supplemental Security Income benefits is pending; and
(5) specific information on the medical certification, licensure, or other credentials of
the person or persons performing the medical review determinations and length of time in
that position.
(d) Any appeal made under section 256.045, subdivision 3, of a disability determination
made by the state medical review team must be decided according to the timelines under
section 256.0451, subdivision 22, paragraph (a). If a written decision is not issued within
the timelines under section 256.0451, subdivision 22, paragraph (a), the appeal must be
immediately reviewed by the chief human services judge.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 13.
Minnesota Statutes 2019 Supplement, section 256.042, subdivision 2, is amended
to read:
Subd. 2.
Membership.
(a) The council shall consist of the following 19 voting members,
appointed by the commissioner of human services except as otherwise specified, and three
nonvoting members:
(1) two members of the house of representatives, appointed in the following sequence:
the first from the majority party appointed by the speaker of the house and the second from
the minority party appointed by the minority leader. Of these two members, one member
must represent a district outside of the seven-county metropolitan area, and one member
must represent a district that includes the seven-county metropolitan area. The appointment
by the minority leader must ensure that this requirement for geographic diversity in
appointments is met;
(2) two members of the senate, appointed in the following sequence: the first from the
majority party appointed by the senate majority leader and the second from the minority
party appointed by the senate minority leader. Of these two members, one member must
represent a district outside of the seven-county metropolitan area and one member must
represent a district that includes the seven-county metropolitan area. The appointment by
the minority leader must ensure that this requirement for geographic diversity in appointments
is met;
(3) one member appointed by the Board of Pharmacy;
(4) one member who is a physician appointed by the Minnesota Medical Association;
(5) one member representing opioid treatment programs, sober living programs, or
substance use disorder programs licensed under chapter 245G;
(6) one member appointed by the Minnesota Society of Addiction Medicine who is an
addiction psychiatrist;
(7) one member representing professionals providing alternative pain management
therapies, including, but not limited to, acupuncture, chiropractic, or massage therapy;
(8) one member representing nonprofit organizations conducting initiatives to address
the opioid epidemic, with the commissioner's initial appointment being a member
representing the Steve Rummler Hope Network, and subsequent appointments representing
this or other organizations;
(9) one member appointed by the Minnesota Ambulance Association who is serving
with an ambulance service as an emergency medical technician, advanced emergency
medical technician, or paramedic;
(10) one member representing the Minnesota courts who is a judge or law enforcement
officer;
(11) one public member who is a Minnesota resident and who is in opioid addiction
recovery;
(12) two members representing Indian tribes, one representing the Ojibwe tribes and
one representing the Dakota tribes;
(13) one public member who is a Minnesota resident and who is suffering from chronic
pain, intractable pain, or a rare disease or condition;
(14) one mental health advocate representing persons with mental illness;
(15) one member deleted text begin representingdeleted text end new text begin appointed bynew text end the Minnesota Hospital Association;
(16) one member representing a local health department; and
(17) the commissioners of human services, health, and corrections, or their designees,
who shall be ex officio nonvoting members of the council.
(b) The commissioner of human services shall coordinate the commissioner's
appointments to provide geographic, racial, and gender diversity, and shall ensure that at
least one-half of council members appointed by the commissioner reside outside of the
seven-county metropolitan area. Of the members appointed by the commissioner, to the
extent practicable, at least one member must represent a community of color
disproportionately affected by the opioid epidemic.
(c) The council is governed by section 15.059, except that members of the council new text begin shall
serve three-year terms and new text end shall receive no compensation other than reimbursement for
expenses. Notwithstanding section 15.059, subdivision 6, the council shall not expire.
(d) The chair shall convene the council at least quarterly, and may convene other meetings
as necessary. The chair shall convene meetings at different locations in the state to provide
geographic access, and shall ensure that at least one-half of the meetings are held at locations
outside of the seven-county metropolitan area.
(e) The commissioner of human services shall provide staff and administrative services
for the advisory council.
(f) The council is subject to chapter 13D.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 14.
Minnesota Statutes 2019 Supplement, section 256.042, subdivision 4, is amended
to read:
Subd. 4.
Grants.
(a) The commissioner of human services shall submit a report of the
grants proposed by the advisory council to be awarded for the upcoming fiscal year to the
chairs and ranking minority members of the legislative committees with jurisdiction over
health and human services policy and finance, by March 1 of each year, beginning March
1, 2020.
(b) The commissioner of human services shall award grants from the opiate epidemic
response deleted text begin accountdeleted text end new text begin fundnew text end under section 256.043. The grants shall be awarded to proposals
selected by the advisory council that address the priorities in subdivision 1, paragraph (a),
clauses (1) to (4), unless otherwise appropriated by the legislature. No more than three
percent of the grant amount may be used by a grantee for administration.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 15.
Minnesota Statutes 2019 Supplement, section 256.043, is amended to read:
256.043 OPIATE EPIDEMIC RESPONSE deleted text begin ACCOUNTdeleted text end new text begin FUNDnew text end .
Subdivision 1.
Establishment.
The opiate epidemic response deleted text begin accountdeleted text end new text begin fundnew text end is established
in the deleted text begin special revenue fund in thedeleted text end state treasury. The registration fees assessed by the Board
of Pharmacy under section 151.066 and the license fees identified in section 151.065,
subdivision 7, paragraphs (b) and (c), shall be deposited into the deleted text begin accountdeleted text end new text begin fundnew text end . Beginning
in fiscal year 2021, for each fiscal year, the deleted text begin funds in the accountdeleted text end new text begin fundnew text end shall be administered
according to this section.
deleted text begin Subd. 2. deleted text end
deleted text begin Transfers from account to state agencies. deleted text end
deleted text begin
(a) The commissioner shall transfer
the following amounts to the agencies specified in this subdivision.
deleted text end
deleted text begin
(b) $126,000 to the Board of Pharmacy for the collection of the registration fees under
section 151.066.
deleted text end
deleted text begin
(c) $672,000 to the commissioner of public safety for the Bureau of Criminal
Apprehension. Of this amount, $384,000 is for drug scientists and lab supplies and $288,000
is for special agent positions focused on drug interdiction and drug trafficking.
deleted text end
Subd. 3.
Appropriations from deleted text begin accountdeleted text end new text begin fundnew text end .
(a) After the deleted text begin transfers described in
subdivision 2, and thedeleted text end appropriations in new text begin Laws 2019, chapter 63, new text end article 3, section 1,
paragraphs (e), (f), (g), and (h) are made, $249,000 is appropriated new text begin to the commissioner of
human services new text end for the provision of administrative services to the Opiate Epidemic Response
Advisory Council and for the administration of the grants awarded under paragraph deleted text begin (c)deleted text end new text begin (e)new text end .
new text begin
(b) $126,000 is appropriated to the Board of Pharmacy for the collection of the registration
fees under section 151.066.
new text end
new text begin
(c) $672,000 is appropriated to the commissioner of public safety for the Bureau of
Criminal Apprehension. Of this amount, $384,000 is for drug scientists and lab supplies
and $288,000 is for special agent positions focused on drug interdiction and drug trafficking.
new text end
deleted text begin (b)deleted text end new text begin (d)new text end After the deleted text begin transfers in subdivision 2 and thedeleted text end appropriations in deleted text begin paragraphdeleted text end new text begin paragraphsnew text end
(a)new text begin to (c)new text end are made, 50 percent of the remaining amount is appropriated to the commissioner
new text begin of human services new text end for distribution to county social service and tribal social service agencies
to provide child protection services to children and families who are affected by addiction.
The commissioner shall distribute this money proportionally to counties and tribal social
service agencies based on out-of-home placement episodes where parental drug abuse is
the primary reason for the out-of-home placement using data from the previous calendar
year. County and tribal social service agencies receiving funds from the opiate epidemic
response deleted text begin accountdeleted text end new text begin fundnew text end must annually report to the commissioner on how the funds were
used to provide child protection services, including measurable outcomes, as determined
by the commissioner. County social service agencies and tribal social service agencies must
not use funds received under this paragraph to supplant current state or local funding received
for child protection services for children and families who are affected by addiction.
deleted text begin (c)deleted text end new text begin (e)new text end After making the deleted text begin transfers in subdivision 2 and thedeleted text end appropriations in paragraphs
(a) deleted text begin and (b)deleted text end new text begin to (d)new text end , the remaining deleted text begin funds in the account aredeleted text end new text begin amount in the fund isnew text end appropriated
to the commissioner to award grants as specified by the Opiate Epidemic Response Advisory
Council in accordance with section 256.042, unless otherwise appropriated by the legislature.
Subd. 4.
Settlement; sunset.
(a) If the state receives a total sum of $250,000,000 either
as a result of a settlement agreement or an assurance of discontinuance entered into by the
attorney general of the state, or resulting from a court order in litigation brought by the
attorney general of the state on behalf of the state or a state agency, against one or more
opioid manufacturers or opioid wholesale drug distributors related to alleged violations of
consumer fraud laws in the marketing, sale, or distribution of opioids in this state, or other
alleged illegal actions that contributed to the excessive use of opioids, or from the fees
collected under sections 151.065, subdivisions 1 and 3, and 151.066, that are deposited into
the opiate epidemic response deleted text begin accountdeleted text end new text begin fundnew text end established in new text begin this new text end section deleted text begin 256.043deleted text end , or from a
combination of both, the fees specified in section 151.065, subdivisions 1, clause (16), and
3, clause (14), shall be reduced to $5,260, and the opiate registration fee in section 151.066,
subdivision 3, shall be repealed.
(b) The commissioner of management and budget shall inform the board of pharmacy,
the governor, and the legislature when the amount specified in paragraph (a) has been
reached. The board shall apply the reduced license fee for the next licensure period.
(c) Notwithstanding paragraph (a), the reduction of the license fee in section 151.065,
subdivisions 1 and 3, and the repeal of the registration fee in section 151.066 shall not occur
before July 1, 2024.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 16.
Minnesota Statutes 2018, section 256B.056, subdivision 1a, is amended to read:
Subd. 1a.
Income and assets generally.
(a)(1) Unless specifically required by state law
or rule or federal law or regulation, the methodologies used in counting income and assets
to determine eligibility for medical assistance for persons whose eligibility category is based
on blindness, disability, or age of 65 or more years, the methodologies for the Supplemental
Security Income program shall be used, except as provided under subdivision 3, paragraph
(a), clause (6).
(2) Increases in benefits under title II of the Social Security Act shall not be counted as
income for purposes of this subdivision until July 1 of each year. Effective upon federal
approval, for children eligible under section 256B.055, subdivision 12, or for home and
community-based waiver services whose eligibility for medical assistance is determined
without regard to parental income, child support payments, including any payments made
by an obligor in satisfaction of or in addition to a temporary or permanent order for child
support, and Social Security payments are not counted as income.
(b)(1) The modified adjusted gross income methodology as defined in deleted text begin the Affordable
Care Actdeleted text end new text begin United States Code, title 42, section 1396a(e)(14),new text end shall be used for eligibility
categories based on:
(i) children under age 19 and their parents and relative caretakers as defined in section
256B.055, subdivision 3a;
(ii) children ages 19 to 20 as defined in section 256B.055, subdivision 16;
(iii) pregnant women as defined in section 256B.055, subdivision 6;
(iv) infants as defined in sections 256B.055, subdivision 10, and 256B.057, subdivision
deleted text begin 8deleted text end new text begin 1new text end ; and
(v) adults without children as defined in section 256B.055, subdivision 15.
For these purposes, a "methodology" does not include an asset or income standard, or
accounting method, or method of determining effective dates.
(2) For individuals whose income eligibility is determined using the modified adjusted
gross income methodology in clause (1)deleted text begin ,deleted text end new text begin :
new text end
new text begin (i) new text end the commissioner shall subtract from the individual's modified adjusted gross income
an amount equivalent to five percent of the federal poverty guidelinesdeleted text begin .deleted text end new text begin ; and
new text end
new text begin
(ii) the individual's current monthly income and household size is used to determine
eligibility for the 12-month eligibility period. If an individual's income is expected to vary
month to month, eligibility is determined based on the income predicted for the 12-month
eligibility period.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 17.
Minnesota Statutes 2018, section 256B.056, subdivision 4, is amended to read:
Subd. 4.
Income.
(a) To be eligible for medical assistance, a person eligible under section
256B.055, subdivisions 7, 7a, and 12, may have income up to 100 percent of the federal
poverty guidelines. Effective January 1, 2000, and each successive January, recipients of
Supplemental Security Income may have an income up to the Supplemental Security Income
standard in effect on that date.
(b) deleted text begin Effective January 1, 2014,deleted text end To be eligible for medical assistancedeleted text begin ,deleted text end under section
256B.055, subdivision 3a, a parent or caretaker relative may have an income up to 133
percent of the federal poverty guidelines for the household size.
(c) To be eligible for medical assistance under section 256B.055, subdivision 15, a
person may have an income up to 133 percent of federal poverty guidelines for the household
size.
(d) To be eligible for medical assistance under section 256B.055, subdivision 16, a child
age 19 to 20 may have an income up to 133 percent of the federal poverty guidelines for
the household size.
(e) To be eligible for medical assistance under section 256B.055, subdivision 3a, a child
under age 19 may have income up to 275 percent of the federal poverty guidelines for the
household size deleted text begin or an equivalent standard when converted using modified adjusted gross
income methodology as required under the Affordable Care Act. Children who are enrolled
in medical assistance as of December 31, 2013, and are determined ineligible for medical
assistance because of the elimination of income disregards under modified adjusted gross
income methodology as defined in subdivision 1a remain eligible for medical assistance
under the Children's Health Insurance Program Reauthorization Act of 2009, Public Law
111-3, until the date of their next regularly scheduled eligibility redetermination as required
in subdivision 7adeleted text end .
(f) In computing income to determine eligibility of persons under paragraphs (a) to (e)
who are not residents of long-term care facilities, the commissioner shall disregard increases
in income as required by Public Laws 94-566, section 503; 99-272; and 99-509. For persons
eligible under paragraph (a), veteran aid and attendance benefits and Veterans Administration
unusual medical expense payments are considered income to the recipient.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 18.
Minnesota Statutes 2018, section 256B.056, subdivision 7, is amended to read:
Subd. 7.
Period of eligibility.
new text begin (a) new text end Eligibility is available for the month of application
and for three months prior to application if the person was eligible in those prior months.
A redetermination of eligibility must occur every 12 months.
new text begin
(b) For a person eligible for an insurance affordability program as defined in section
256B.02, subdivision 19, who reports a change that makes the person eligible for medical
assistance, eligibility is available for the month the change was reported and for three months
prior to the month the change was reported, if the person was eligible in those prior months.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 19.
Minnesota Statutes 2019 Supplement, section 256B.056, subdivision 7a, is
amended to read:
Subd. 7a.
Periodic renewal of eligibility.
(a) The commissioner shall make an annual
redetermination of eligibility based on information contained in the enrollee's case file and
other information available to the agency, including but not limited to information accessed
through an electronic database, without requiring the enrollee to submit any information
when sufficient data is available for the agency to renew eligibility.
(b) If the commissioner cannot renew eligibility in accordance with paragraph (a), the
commissioner must provide the enrollee with a prepopulated renewal form containing
eligibility information available to the agency and permit the enrollee to submit the form
with any corrections or additional information to the agency and sign the renewal form via
any of the modes of submission specified in section 256B.04, subdivision 18.
(c) An enrollee who is terminated for failure to complete the renewal process may
subsequently submit the renewal form and required information within four months after
the date of termination and have coverage reinstated without a lapse, if otherwise eligible
under this chapter. The local agency may close the enrollee's case file if the required
information is not submitted within four months of termination.
(d) Notwithstanding paragraph (a), deleted text begin individualsdeleted text end new text begin a person who isnew text end eligible under subdivision
5 shall be deleted text begin required to renew eligibilitydeleted text end new text begin subject to a review of the person's incomenew text end every six
months.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 20.
Minnesota Statutes 2018, section 256B.056, subdivision 10, is amended to read:
Subd. 10.
Eligibility verification.
(a) The commissioner shall require women who are
applying for the continuation of medical assistance coverage following the end of the 60-day
postpartum period to update their income and asset information and to submit any required
income or asset verification.
(b) The commissioner shall determine the eligibility of private-sector health care coverage
for infants less than one year of age eligible under section 256B.055, subdivision 10, or
256B.057, subdivision 1, paragraph deleted text begin (b)deleted text end new text begin (c)new text end , and shall pay for private-sector coverage if this
is determined to be cost-effective.
(c) The commissioner shall verify assets and income for all applicants, and for all
recipients upon renewal.
(d) The commissioner shall utilize information obtained through the electronic service
established by the secretary of the United States Department of Health and Human Services
and other available electronic data sources in Code of Federal Regulations, title 42, sections
435.940 to 435.956, to verify eligibility requirements. The commissioner shall establish
standards to define when information obtained electronically is reasonably compatible with
information provided by applicants and enrollees, including use of self-attestation, to
accomplish real-time eligibility determinations and maintain program integrity.
new text begin
(e) Each person applying for or receiving medical assistance under section 256B.055,
subdivision 7, and any other person whose resources are required by law to be disclosed to
determine the applicant's or recipient's eligibility must authorize the commissioner to obtain
information from financial institutions to identify unreported accounts as required in section
256.01, subdivision 18f. If a person refuses or revokes the authorization, the commissioner
may determine that the applicant or recipient is ineligible for medical assistance. For purposes
of this paragraph, an authorization to identify unreported accounts meets the requirements
of the Right to Financial Privacy Act, United States Code, title 12, chapter 35, and need not
be furnished to the financial institution.
new text end
new text begin
(f) County and tribal agencies shall comply with the standards established by the
commissioner for appropriate use of the asset verification system specified in section 256.01,
subdivision 18f.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 21.
Minnesota Statutes 2018, section 256B.0561, subdivision 2, is amended to read:
Subd. 2.
Periodic data matching.
(a) deleted text begin Beginning April 1, 2018,deleted text end The commissioner shall
conduct periodic data matching to identify recipients who, based on available electronic
data, may not meet eligibility criteria for the public health care program in which the recipient
is enrolled. The commissioner shall conduct data matching for medical assistance or
MinnesotaCare recipients at least once during a recipient's 12-month period of eligibility.
(b) If data matching indicates a recipient may no longer qualify for medical assistance
or MinnesotaCare, the commissioner must notify the recipient and allow the recipient no
more than 30 days to confirm the information obtained through the periodic data matching
or provide a reasonable explanation for the discrepancy to the state or county agency directly
responsible for the recipient's case. If a recipient does not respond within the advance notice
period or does not respond with information that demonstrates eligibility or provides a
reasonable explanation for the discrepancy within the 30-day time period, the commissioner
shall terminate the recipient's eligibility in the manner provided for by the laws and
regulations governing the health care program for which the recipient has been identified
as being ineligible.
(c) The commissioner shall not terminate eligibility for a recipient who is cooperating
with the requirements of paragraph (b) and needs additional time to provide information in
response to the notification.
new text begin
(d) A recipient whose eligibility was terminated according to paragraph (b) may be
eligible for medical assistance no earlier than the first day of the month in which the recipient
provides information that demonstrates the recipient's eligibility.
new text end
deleted text begin (d)deleted text end new text begin (e)new text end Any termination of eligibility for benefits under this section may be appealed as
provided for in sections 256.045 to 256.0451, and the laws governing the health care
programs for which eligibility is terminated.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 22.
Minnesota Statutes 2018, section 256B.057, subdivision 1, is amended to read:
Subdivision 1.
Infants and pregnant women.
(a) An infant less than two years of age
deleted text begin or a pregnant womandeleted text end is eligible for medical assistance if the deleted text begin individual'sdeleted text end new text begin infant'snew text end countable
household income is equal to or less than deleted text begin 275deleted text end new text begin 283new text end percent of the federal poverty guideline
for the same household size deleted text begin or an equivalent standard when converted using modified
adjusted gross income methodology as required under the Affordable Care Actdeleted text end .new text begin Medical
assistance for an uninsured infant younger than two years of age may be paid with federal
funds available under title XXI of the Social Security Act and the state children's health
insurance program, for an infant with countable income above 275 percent and equal to or
less than 283 percent of the federal poverty guideline for the household size.
new text end
new text begin
(b) A pregnant woman is eligible for medical assistance if the woman's countable income
is equal to or less than 278 percent of the federal poverty guideline for the applicable
household size.
new text end
deleted text begin (b)deleted text end new text begin (c)new text end An infant born to a woman who was eligible for and receiving medical assistance
on the date of the child's birth shall continue to be eligible for medical assistance without
redetermination until the child's first birthday.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 23.
Minnesota Statutes 2018, section 256B.057, subdivision 10, is amended to read:
Subd. 10.
Certain persons needing treatment for breast or cervical cancer.
(a)
Medical assistance may be paid for a person who:
(1) has been screened for breast or cervical cancer by deleted text begin the Minnesotadeleted text end new text begin any Centers for
Disease Control and Prevention (CDC) National Breast and Cervical Cancer Early Detection
Program (NBCCEDP)-fundednew text end breast and cervical cancer control program, and program
funds have been used to pay for the person's screening;
(2) according to the person's treating health professional, needs treatment, including
diagnostic services necessary to determine the extent and proper course of treatment, for
breast or cervical cancer, including precancerous conditions and early stage cancer;
(3) meets the income eligibility guidelines for deleted text begin the Minnesotadeleted text end new text begin any CDC NBCCEDP-fundednew text end
breast and cervical cancer control program;
(4) is under age 65;
(5) is not otherwise eligible for medical assistance under United States Code, title 42,
section 1396a(a)(10)(A)(i); and
(6) is not otherwise covered under creditable coverage, as defined under United States
Code, title 42, section 1396a(aa).
(b) Medical assistance provided for an eligible person under this subdivision shall be
limited to services provided during the period that the person receives treatment for breast
or cervical cancer.
(c) A person meeting the criteria in paragraph (a) is eligible for medical assistance
without meeting the eligibility criteria relating to income and assets in section 256B.056,
subdivisions 1a to 5a.
Sec. 24.
Minnesota Statutes 2018, section 256B.0575, subdivision 1, is amended to read:
Subdivision 1.
Income deductions.
When an institutionalized person is determined
eligible for medical assistance, the income that exceeds the deductions in paragraphs (a)
and (b) must be applied to the cost of institutional care.
(a) The following amounts must be deducted from the institutionalized person's income
in the following order:
(1) the personal needs allowance under section 256B.35 or, for a veteran who does not
have a spouse or child, or a surviving spouse of a veteran having no child, the amount of
an improved pension received from the veteran's administration deleted text begin not exceeding $90 per
monthdeleted text end new text begin , whichever amount is greaternew text end ;
(2) the personal allowance for disabled individuals under section 256B.36;
(3) if the institutionalized person has a legally appointed guardian or conservator, five
percent of the recipient's gross monthly income up to $100 as reimbursement for guardianship
or conservatorship services;
(4) a monthly income allowance determined under section 256B.058, subdivision 2, but
only to the extent income of the institutionalized spouse is made available to the community
spouse;
(5) a monthly allowance for children under age 18 which, together with the net income
of the children, would provide income equal to the medical assistance standard for families
and children according to section 256B.056, subdivision 4, for a family size that includes
only the minor children. This deduction applies only if the children do not live with the
community spouse and only to the extent that the deduction is not included in the personal
needs allowance under section 256B.35, subdivision 1, as child support garnished under a
court order;
(6) a monthly family allowance for other family members, equal to one-third of the
difference between 122 percent of the federal poverty guidelines and the monthly income
for that family member;
(7) reparations payments made by the Federal Republic of Germany and reparations
payments made by the Netherlands for victims of Nazi persecution between 1940 and 1945;
(8) all other exclusions from income for institutionalized persons as mandated by federal
law; and
(9) amounts for reasonable expenses, as specified in subdivision 2, incurred for necessary
medical or remedial care for the institutionalized person that are recognized under state law,
not medical assistance covered expenses, and not subject to payment by a third party.
For purposes of clause (6), "other family member" means a person who resides with the
community spouse and who is a minor or dependent child, dependent parent, or dependent
sibling of either spouse. "Dependent" means a person who could be claimed as a dependent
for federal income tax purposes under the Internal Revenue Code.
(b) Income shall be allocated to an institutionalized person for a period of up to three
calendar months, in an amount equal to the medical assistance standard for a family size of
one if:
(1) a physician or advanced practice registered nurse certifies that the person is expected
to reside in the long-term care facility for three calendar months or less;
(2) if the person has expenses of maintaining a residence in the community; and
(3) if one of the following circumstances apply:
(i) the person was not living together with a spouse or a family member as defined in
paragraph (a) when the person entered a long-term care facility; or
(ii) the person and the person's spouse become institutionalized on the same date, in
which case the allocation shall be applied to the income of one of the spouses.
For purposes of this paragraph, a person is determined to be residing in a licensed nursing
home, regional treatment center, or medical institution if the person is expected to remain
for a period of one full calendar month or more.
Sec. 25.
Minnesota Statutes 2018, section 256B.0575, subdivision 2, is amended to read:
Subd. 2.
Reasonable expenses.
For the purposes of subdivision 1, paragraph (a), clause
(9), reasonable expenses are limited to expenses that have not been previously used as a
deduction from income and were not:
(1) for long-term care expenses incurred during a period of ineligibility as defined in
section 256B.0595, subdivision 2;
(2) incurred more than three months before the month of application associated with the
current period of eligibility;
(3) for expenses incurred by a recipient that are duplicative of services that are covered
under chapter 256B; deleted text begin or
deleted text end
(4) nursing facility expenses incurred without a timely assessment as required under
section 256B.0911deleted text begin .deleted text end new text begin ; or
new text end
new text begin
(5) for private room fees incurred by an assisted living client as defined in section
144G.01, subdivision 3.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 26.
Minnesota Statutes 2018, section 256B.0625, subdivision 1, is amended to read:
Subdivision 1.
Inpatient hospital services.
(a) Medical assistance covers inpatient
hospital servicesnew text begin performed by hospitals holding Medicare certifications for the services
performednew text end . deleted text begin A second medical opinion is required prior to reimbursement for elective surgeries
requiring a second opinion. The commissioner shall publish in the State Register a list of
elective surgeries that require a second medical opinion prior to reimbursement, and the
criteria and standards for deciding whether an elective surgery should require a second
medical opinion. The list and the criteria and standards are not subject to the requirements
of sections 14.001 to 14.69. The commissioner's decision whether a second medical opinion
is required, made in accordance with rules governing that decision, is not subject to
administrative appeal.
deleted text end
(b) When determining medical necessity for inpatient hospital services, the medical
review agent shall follow industry standard medical necessity criteria in determining the
following:
(1) whether a recipient's admission is medically necessary;
(2) whether the inpatient hospital services provided to the recipient were medically
necessary;
(3) whether the recipient's continued stay was or will be medically necessary; and
(4) whether all medically necessary inpatient hospital services were provided to the
recipient.
The medical review agent will determine medical necessity of inpatient hospital services,
including inpatient psychiatric treatment, based on a review of the patient's medical condition
and records, in conjunction with industry standard evidence-based criteria to ensure consistent
and optimal application of medical appropriateness criteria.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 27.
Minnesota Statutes 2018, section 256B.0625, subdivision 27, is amended to read:
Subd. 27.
Organ and tissue transplants.
deleted text begin All organ transplants must be performed at
transplant centers meeting united network for organ sharing criteria or at Medicare-approved
organ transplant centers.deleted text end new text begin Organ and tissue transplants are a covered service. new text end Stem cell or
bone marrow transplant centers must meet the standards established by the Foundation for
the Accreditation of Hematopoietic Cell Therapy.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 28.
Minnesota Statutes 2018, section 256B.0625, subdivision 64, is amended to read:
Subd. 64.
Investigational drugs, biological products, deleted text begin anddeleted text end devicesnew text begin , and clinical
trialsnew text end .
deleted text begin (a)deleted text end Medical assistance and the early periodic screening, diagnosis, and treatment
(EPSDT) program do not cover new text begin the new text end costs new text begin of any services that are new text end incidental to, associated
with, or resulting from the use of investigational drugs, biological products, or devices as
defined in section 151.375new text begin or any other treatment that is part of an approved clinical trial
as defined in section 62Q.526. Participation of an enrollee in an approved clinical trial does
not preclude coverage of medically necessary services covered under this chapter that are
not related to the approved clinical trialnew text end .
deleted text begin
(b) Notwithstanding paragraph (a), stiripentol may be covered by the EPSDT program
if all the following conditions are met:
deleted text end
deleted text begin
(1) the use of stiripentol is determined to be medically necessary;
deleted text end
deleted text begin
(2) the enrollee has a documented diagnosis of Dravet syndrome, regardless of whether
an SCN1A genetic mutation is found, or the enrollee is a child with malignant migrating
partial epilepsy in infancy due to an SCN2A genetic mutation;
deleted text end
deleted text begin
(3) all other available covered prescription medications that are medically necessary for
the enrollee have been tried without successful outcomes; and
deleted text end
deleted text begin
(4) the United States Food and Drug Administration has approved the treating physician's
individual patient investigational new drug application (IND) for the use of stiripentol for
treatment.
deleted text end
deleted text begin
This paragraph does not apply to MinnesotaCare coverage under chapter 256L.
deleted text end
Sec. 29.
Minnesota Statutes 2018, section 256B.0751, is amended to read:
256B.0751 HEALTH CARE HOMES.
Subdivision 1.
Definitions.
(a) For purposes of deleted text begin sectionsdeleted text end new text begin sectionnew text end 256B.0751 deleted text begin to 256B.0753deleted text end ,
the following definitions apply.
(b) "Commissioner" means the commissioner of deleted text begin human servicesdeleted text end new text begin healthnew text end .
deleted text begin
(c) "Commissioners" means the commissioner of human services and the commissioner
of health, acting jointly.
deleted text end
deleted text begin (d)deleted text end new text begin (c)new text end "Health plan company" has the meaning provided in section 62Q.01, subdivision
4.
deleted text begin (e)deleted text end new text begin (d)new text end "Personal clinician" means a physician licensed under chapter 147, a physician
assistant licensed and practicing under chapter 147A, or an advanced practice nurse licensed
and registered to practice under chapter 148.
deleted text begin
(f) "State health care program" means the medical assistance and MinnesotaCare
programs.
deleted text end
Subd. 2.
Development and implementation of standards.
(a) deleted text begin By July 1, 2009,deleted text end The
deleted text begin commissionersdeleted text end new text begin commissionernew text end of health deleted text begin and human servicesdeleted text end shall develop and implement
standards of certification for health care homes deleted text begin for state health care programsdeleted text end . In developing
these standards, the deleted text begin commissionersdeleted text end new text begin commissionernew text end shall consider existing standards developed
by national independent accrediting and medical home organizations. The standards
developed by the deleted text begin commissionersdeleted text end new text begin commissionernew text end must meet the following criteria:
(1) emphasize, enhance, and encourage the use of primary care, and include the use of
primary care physicians, advanced practice nurses, and physician assistants as personal
clinicians;
(2) focus on delivering high-quality, efficient, and effective health care services;
(3) encourage patient-centered care, including active participation by the patient and
family or a legal guardian, or a health care agent as defined in chapter 145C, as appropriate
in decision making and care plan development, and providing care that is appropriate to the
patient's race, ethnicity, and language;
(4) provide patients with a consistent, ongoing contact with a personal clinician or team
of clinical professionals to ensure continuous and appropriate care for the patient's condition;
(5) ensure that health care homes develop and maintain appropriate comprehensive care
plans for their patients with complex or chronic conditions, including an assessment of
health risks and chronic conditions;
(6) enable and encourage utilization of a range of qualified health care professionals,
including dedicated care coordinators, in a manner that enables providers to practice to the
fullest extent of their license;
(7) focus initially on patients who have or are at risk of developing chronic health
conditions;
(8) incorporate measures of quality, resource use, cost of care, and patient experience;
(9) ensure the use of health information technology and systematic follow-up, including
the use of patient registries; and
(10) encourage the use of scientifically based health care, patient decision-making aids
that provide patients with information about treatment options and their associated benefits,
risks, costs, and comparative outcomes, and other clinical decision support tools.
(b) In developing these standards, the deleted text begin commissionersdeleted text end new text begin commissionernew text end shall consult with
national and local organizations working on health care home models, physicians, relevant
state agencies, health plan companies, hospitals, other providers, patients, and patient
advocates. deleted text begin The commissioners may satisfy this requirement by continuing the provider
directed care coordination advisory committee.
deleted text end
(c) For the purposes of developing and implementing these standards, the deleted text begin commissionersdeleted text end new text begin
commissionernew text end may use the expedited rulemaking process under section 14.389.
Subd. 3.
Requirements for clinicians certified as health care homes.
(a) A personal
clinician or a primary care clinic may be certified as a health care home. If a primary care
clinic is certified, all of the primary care clinic's clinicians must meet the criteria of a health
care home. deleted text begin In orderdeleted text end To be certified as a health care home, a clinician or clinic must meet
the standards set by the deleted text begin commissionersdeleted text end new text begin commissionernew text end in accordance with this section.
Certification as a health care home is voluntary. deleted text begin In orderdeleted text end To maintain their status as health
care homes, clinicians or clinics must renew their certification every three years.
(b) Clinicians or clinics certified as health care homes must offer their health care home
services to all their patients with complex or chronic health conditions who are interested
in participation.
(c) Health care homes must participate in the health care home collaborative established
under subdivision 5.
Subd. 4.
Alternative models and waivers of requirements.
(a) Nothing in this section
deleted text begin shall precludedeleted text end new text begin precludesnew text end the continued development of existing medical or health care home
projects currently operating or under development by the commissioner of human services
or deleted text begin precludedeleted text end new text begin precludesnew text end the commissioner new text begin of human services new text end from establishing alternative
models and payment mechanisms for persons who are enrolled in integrated Medicare and
Medicaid programs under section 256B.69, subdivisions 23 and 28, are enrolled in managed
care long-term care programs under section 256B.69, subdivision 6b, are dually eligible for
Medicare and medical assistance, are in the waiting period for Medicare, or who have other
primary coverage.
(b) The commissioner deleted text begin of healthdeleted text end shall waive health care home certification requirements
if an applicant demonstrates that compliance with a certification requirement will create a
major financial hardship or is not feasible, and the applicant establishes an alternative way
to accomplish the objectives of the certification requirement.
Subd. 5.
Health care home collaborative.
deleted text begin By July 1, 2009,deleted text end The deleted text begin commissionersdeleted text end new text begin
commissionernew text end shall establish a health care home collaborative to provide an opportunity for
health care homes and state agencies to exchange information related to quality improvement
and best practices.
Subd. 6.
Evaluation and continued development.
(a) For continued certification under
this section, health care homes must meet process, outcome, and quality standards as
developed and specified by the deleted text begin commissionersdeleted text end new text begin commissionernew text end . The deleted text begin commissionersdeleted text end new text begin
commissionernew text end shall collect data from health care homes necessary for monitoring compliance
with certification standards and for evaluating the impact of health care homes on health
care quality, cost, and outcomes.
(b) The deleted text begin commissionersdeleted text end new text begin commissionernew text end may contract with a private entity to perform an
evaluation of the effectiveness of health care homes. Data collected under this subdivision
is classified as nonpublic data under chapter 13.
Subd. 7.
Outreach.
deleted text begin Beginning July 1, 2009,deleted text end The commissioner new text begin of human services new text end shall
encourage state health care program enrollees who have a complex or chronic condition to
select a primary care clinic with clinicians who have been certified as health care homes.
Subd. 8.
Coordination with local services.
The health care home and the county shall
coordinate care and services provided to patients enrolled with a health care home who have
complex medical needs or a disability, and who need and are eligible for additional local
services administered by counties, including but not limited to waivered services, mental
health services, social services, public health services, transportation, and housing. The
coordination of care and services must be as provided in the plan established by the patient
and new text begin the new text end health care home.
Subd. 9.
Pediatric care coordination.
The commissioner new text begin of human services new text end shall
implement a pediatric care coordination service for children with high-cost medical or
high-cost psychiatric conditions who are at risk of recurrent hospitalization or emergency
room use for acute, chronic, or psychiatric illness, who receive medical assistance services.
Care coordination services must be targeted to children not already receiving care
coordination through another service and may include but are not limited to the provision
of health care home services to children admitted to hospitals that do not currently provide
care coordination. Care coordination services must be provided by care coordinators who
are directly linked to provider teams in the care delivery setting, but who may be part of a
community care team shared by multiple primary care providers or practices. For purposes
of this subdivision, the commissioner new text begin of human services new text end shall, to the extent possible, use
the existing health care home certification and payment structure established under this
section and section 256B.0753.
Subd. 10.
Health care homes advisory committee.
(a) The deleted text begin commissioners of health
and human servicesdeleted text end new text begin commissionernew text end shall establish a health care homes advisory committee
to advise the deleted text begin commissionersdeleted text end new text begin commissionernew text end on the ongoing statewide implementation of the
health care homes program authorized in this section.
(b) The deleted text begin commissionersdeleted text end new text begin commissionernew text end shall establish an advisory committee that includes
representatives of the health care professions such as primary care providersdeleted text begin ;deleted text end new text begin ,new text end mental health
providersdeleted text begin ;deleted text end new text begin ,new text end nursing and care coordinatorsdeleted text begin ;deleted text end new text begin ,new text end certified health care home clinics with statewide
representationdeleted text begin ;deleted text end new text begin ,new text end health plan companiesdeleted text begin ;deleted text end new text begin ,new text end state agenciesdeleted text begin ;deleted text end new text begin ,new text end employersdeleted text begin ;deleted text end new text begin ,new text end academic researchersdeleted text begin ;deleted text end new text begin ,new text end
consumersdeleted text begin ;deleted text end new text begin ,new text end and organizations that work to improve health care quality in Minnesota. At
least 25 percent of the committee members must be consumers or patients in health care
homes. The deleted text begin commissionersdeleted text end new text begin commissionernew text end , in making appointments to the committee, shall
ensure geographic representation of all regions of the state.
(c) The advisory committee shall advise the deleted text begin commissionersdeleted text end new text begin commissionernew text end on ongoing
implementation of the health care homes program, including, but not limited to, the following
activities:
(1) implementation of certified health care homes across the state on performance
management and implementation of benchmarking;
(2) implementation of modifications to the health care homes program based on results
of the legislatively mandated health care homes evaluation;
(3) statewide solutions for engagement of employers and commercial payers;
(4) potential modifications of the health care homes rules or statutes;
(5) consumer engagement, including patient and family-centered care, patient activation
in health care, and shared decision making;
(6) oversight for health care homes subject matter task forces or workgroups; and
(7) other related issues as requested by the deleted text begin commissionersdeleted text end new text begin commissionernew text end .
(d) The advisory committee shall have the ability to establish subcommittees on specific
topics. The advisory committee is governed by section 15.059. Notwithstanding section
15.059, the advisory committee does not expire.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 30.
Minnesota Statutes 2018, section 256B.0753, subdivision 1, is amended to read:
Subdivision 1.
Development.
The commissioner of human services, in coordination
with the commissioner of health, shall develop a payment system that provides per-person
care coordination payments to health care homes certified under section 256B.0751 for
providing care coordination services and directly managing on-site or employing care
coordinators. The care coordination payments under this section are in addition to the quality
incentive payments in section 256B.0754, subdivision 1. The care coordination payment
system must vary the fees paid by thresholds of care complexity, with the highest fees being
paid for care provided to individuals requiring the most intensive care coordination. In
developing the criteria for care coordination payments, the commissioner shall consider the
feasibility of including the additional time and resources needed by patients with limited
English-language skills, cultural differences, or other barriers to health care. The
commissioner may determine a schedule for phasing in care coordination fees such that the
fees will be applied first to individuals who have, or are at risk of developing, complex or
chronic health conditions. deleted text begin Development of the payment system must be completed by
January 1, 2010.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 31.
Minnesota Statutes 2018, section 256B.69, is amended by adding a subdivision
to read:
new text begin Subd. 6e. new text end
new text begin Dental services. new text end
new text begin
(a) If a dental provider is providing services to an enrollee
of a managed care plan or county-based purchasing plan based on a treatment plan that
requires more than one visit, the managed care plan or county-based purchasing plan or the
plan's subcontractor, if the plan subcontracts with a third party to administer dental services
to the plan's enrollees, must not require the completion of the treatment plan as a condition
of payment to the dental provider for services performed as part of the treatment plan. The
health plan or subcontractor must reimburse the dental provider for all services performed
by the provider regardless of whether the treatment plan is completed, as long as the enrollee
was covered under the plan at the time the service was performed.
new text end
new text begin
(b) Nothing in paragraph (a) prevents a health plan or its subcontractor from paying for
services using a bundled payment method. If a bundled payment method is used and the
treatment plan covered by the payment is not completed for any reason, the health plan or
its subcontractor must reimburse the dental provider for the services performed, as long as
the enrollee was covered under the plan at the time the service was performed.
new text end
Sec. 32.
Minnesota Statutes 2018, section 256B.75, is amended to read:
256B.75 HOSPITAL OUTPATIENT REIMBURSEMENT.
(a) For outpatient hospital facility fee payments for services rendered on or after October
1, 1992, the commissioner of human services shall pay the lower of (1) submitted charge,
or (2) 32 percent above the rate in effect on June 30, 1992, except for those services for
which there is a federal maximum allowable payment. Effective for services rendered on
or after January 1, 2000, payment rates for nonsurgical outpatient hospital facility fees and
emergency room facility fees shall be increased by eight percent over the rates in effect on
December 31, 1999, except for those services for which there is a federal maximum allowable
payment. Services for which there is a federal maximum allowable payment shall be paid
at the lower of (1) submitted charge, or (2) the federal maximum allowable payment. Total
aggregate payment for outpatient hospital facility fee services shall not exceed the Medicare
upper limit. If it is determined that a provision of this section conflicts with existing or
future requirements of the United States government with respect to federal financial
participation in medical assistance, the federal requirements prevail. The commissioner
may, in the aggregate, prospectively reduce payment rates to avoid reduced federal financial
participation resulting from rates that are in excess of the Medicare upper limitations.
(b) Notwithstanding paragraph (a), payment for outpatient, emergency, and ambulatory
surgery hospital facility fee services for critical access hospitals designated under section
144.1483, clause (9), shall be paid on a cost-based payment system that is based on the
cost-finding methods and allowable costs of the Medicare program. Effective for services
provided on or after July 1, 2015, rates established for critical access hospitals under this
paragraph for the applicable payment year shall be the final payment and shall not be settled
to actual costs. Effective for services delivered on or after the first day of the hospital's fiscal
year ending in deleted text begin 2016deleted text end new text begin 2017new text end , the rate for outpatient hospital services shall be computed using
information from each hospital's Medicare cost report as filed with Medicare for the year
that is two years before the year that the rate is being computed. Rates shall be computed
using information from Worksheet C series until the department finalizes the medical
assistance cost reporting process for critical access hospitals. After the cost reporting process
is finalized, rates shall be computed using information from Title XIX Worksheet D series.
The outpatient rate shall be equal to ancillary cost plus outpatient cost, excluding costs
related to rural health clinics and federally qualified health clinics, divided by ancillary
charges plus outpatient charges, excluding charges related to rural health clinics and federally
qualified health clinics.
(c) Effective for services provided on or after July 1, 2003, rates that are based on the
Medicare outpatient prospective payment system shall be replaced by a budget neutral
prospective payment system that is derived using medical assistance data. The commissioner
shall provide a proposal to the 2003 legislature to define and implement this provision.
(d) For fee-for-service services provided on or after July 1, 2002, the total payment,
before third-party liability and spenddown, made to hospitals for outpatient hospital facility
services is reduced by .5 percent from the current statutory rate.
(e) In addition to the reduction in paragraph (d), the total payment for fee-for-service
services provided on or after July 1, 2003, made to hospitals for outpatient hospital facility
services before third-party liability and spenddown, is reduced five percent from the current
statutory rates. Facilities defined under section 256.969, subdivision 16, are excluded from
this paragraph.
(f) In addition to the reductions in paragraphs (d) and (e), the total payment for
fee-for-service services provided on or after July 1, 2008, made to hospitals for outpatient
hospital facility services before third-party liability and spenddown, is reduced three percent
from the current statutory rates. Mental health services and facilities defined under section
256.969, subdivision 16, are excluded from this paragraph.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 33.
Minnesota Statutes 2018, section 256L.03, subdivision 1, is amended to read:
Subdivision 1.
Covered health services.
(a) "Covered health services" means the health
services reimbursed under chapter 256B, with the exception of special education services,
home care nursing services, adult dental care services other than services covered under
section 256B.0625, subdivision 9, orthodontic services, nonemergency medical transportation
services, personal care assistance and case management services, new text begin behavioral health home
services under section 256B.0757, new text end and nursing home or intermediate care facilities services.
(b) No public funds shall be used for coverage of abortion under MinnesotaCare except
where the life of the female would be endangered or substantial and irreversible impairment
of a major bodily function would result if the fetus were carried to term; or where the
pregnancy is the result of rape or incest.
(c) Covered health services shall be expanded as provided in this section.
(d) For the purposes of covered health services under this section, "child" means an
individual younger than 19 years of age.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 34.
Minnesota Statutes 2018, section 256L.15, subdivision 1, is amended to read:
Subdivision 1.
Premium determination for MinnesotaCare.
(a) Families with children
and individuals shall pay a premium determined according to subdivision 2.
(b) Members of the military and their families who meet the eligibility criteria for
MinnesotaCare upon eligibility approval made within 24 months following the end of the
member's tour of active duty shall have their premiums paid by the commissioner. The
effective date of coverage for an individual or family who meets the criteria of this paragraph
shall be the first day of the month following the month in which eligibility is approved. This
exemption applies for 12 months.
(c) Beginning July 1, 2009, American Indians enrolled in MinnesotaCare and their
families shall have their premiums waived by the commissioner in accordance with section
5006 of the American Recovery and Reinvestment Act of 2009, Public Law 111-5. An
individual must indicate status as an American Indian, as defined under Code of Federal
Regulations, title 42, section 447.50, to qualify for the waiver of premiums. The
commissioner shall accept attestation of an individual's status as an American Indian as
verification until the United States Department of Health and Human Services approves an
electronic data source for this purpose.
deleted text begin
(d) For premiums effective August 1, 2015, and after, the commissioner, after consulting
with the chairs and ranking minority members of the legislative committees with jurisdiction
over human services, shall increase premiums under subdivision 2 for recipients based on
June 2015 program enrollment. Premium increases shall be sufficient to increase projected
revenue to the fund described in section 16A.724 by at least $27,800,000 for the biennium
ending June 30, 2017. The commissioner shall publish the revised premium scale on the
Department of Human Services website and in the State Register no later than June 15,
2015. The revised premium scale applies to all premiums on or after August 1, 2015, in
place of the scale under subdivision 2.
deleted text end
deleted text begin
(e) By July 1, 2015, the commissioner shall provide the chairs and ranking minority
members of the legislative committees with jurisdiction over human services the revised
premium scale effective August 1, 2015, and statutory language to codify the revised
premium schedule.
deleted text end
deleted text begin
(f) Premium changes authorized under paragraph (d) must only apply to enrollees not
otherwise excluded from paying premiums under state or federal law. Premium changes
authorized under paragraph (d) must satisfy the requirements for premiums for the Basic
Health Program under title 42 of Code of Federal Regulations, section 600.505.
deleted text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 35.
Laws 2019, chapter 63, article 3, section 1, is amended to read:
Section 1. APPROPRIATIONS.
(a) Board of Pharmacy; administration. $244,000 in fiscal year 2020 is appropriated
from the general fund to the Board of Pharmacy for onetime information technology and
operating costs for administration of licensing activities under Minnesota Statutes, section
151.066. This is a onetime appropriation.
(b) Commissioner of human services; administration. $309,000 in fiscal year 2020
is appropriated from the general fund and $60,000 in fiscal year 2021 is appropriated from
the opiate epidemic response deleted text begin accountdeleted text end new text begin fundnew text end to the commissioner of human services for the
provision of administrative services to the Opiate Epidemic Response Advisory Council
and for the administration of the grants awarded under paragraphs (f), (g), and (h). The
opiate epidemic response deleted text begin accountdeleted text end new text begin fundnew text end base for this appropriation is $60,000 in fiscal year
2022, $60,000 in fiscal year 2023, $60,000 in fiscal year 2024, and $0 in fiscal year 2025.
(c) Board of Pharmacy; administration. $126,000 in fiscal year 2020 is appropriated
from the general fund to the Board of Pharmacy for the collection of the registration fees
under section 151.066.
(d) Commissioner of public safety; enforcement activities. $672,000 in fiscal year
2020 is appropriated from the general fund to the commissioner of public safety for the
Bureau of Criminal Apprehension. Of this amount, $384,000 is for drug scientists and lab
supplies and $288,000 is for special agent positions focused on drug interdiction and drug
trafficking.
(e) Commissioner of management and budget; evaluation activities. $300,000 in
fiscal year 2020 is appropriated from the general fund and $300,000 in fiscal year 2021 is
appropriated from the opiate epidemic response deleted text begin accountdeleted text end new text begin fundnew text end to the commissioner of
management and budget for evaluation activities under Minnesota Statutes, section 256.042,
subdivision 1, paragraph (c). The opiate epidemic response deleted text begin accountdeleted text end new text begin fundnew text end base for this
appropriation is $300,000 in fiscal year 2022, $300,000 in fiscal year 2023, $300,000 in
fiscal year 2024, and $0 in fiscal year 2025.
(f) Commissioner of human services; grants for Project ECHO. $400,000 in fiscal
year 2020 is appropriated from the general fund and $400,000 in fiscal year 2021 is
appropriated from the opiate epidemic response deleted text begin accountdeleted text end new text begin fundnew text end to the commissioner of human
services for grants of $200,000 to CHI St. Gabriel's Health Family Medical Center for the
opioid-focused Project ECHO program and $200,000 to Hennepin Health Care for the
opioid-focused Project ECHO program. The opiate epidemic response deleted text begin accountdeleted text end new text begin fundnew text end base
for this appropriation is $400,000 in fiscal year 2022, $400,000 in fiscal year 2023, $400,000
in fiscal year 2024, and $0 in fiscal year 2025.
(g) Commissioner of human services; opioid overdose prevention grant. $100,000
in fiscal year 2020 is appropriated from the general fund and $100,000 in fiscal year 2021
is appropriated from the opiate epidemic response deleted text begin accountdeleted text end new text begin fundnew text end to the commissioner of
human services for a grant to a nonprofit organization that has provided overdose prevention
programs to the public in at least 60 counties within the state, for at least three years, has
received federal funding before January 1, 2019, and is dedicated to addressing the opioid
epidemic. The grant must be used for opioid overdose prevention, community asset mapping,
education, and overdose antagonist distribution. The opiate epidemic response deleted text begin accountdeleted text end new text begin fundnew text end
base for this appropriation is $100,000 in fiscal year 2022, $100,000 in fiscal year 2023,
$100,000 in fiscal year 2024, and $0 in fiscal year 2025.
(h) Commissioner of human services; traditional healing. $2,000,000 in fiscal year
2020 is appropriated from the general fund and $2,000,000 in fiscal year 2021 is appropriated
from the opiate epidemic response deleted text begin accountdeleted text end new text begin fundnew text end to the commissioner of human services to
award grants to tribal nations and five urban Indian communities for traditional healing
practices to American Indians and to increase the capacity of culturally specific providers
in the behavioral health workforce. The opiate epidemic response deleted text begin accountdeleted text end new text begin fundnew text end base for
this appropriation is $2,000,000 in fiscal year 2022, $2,000,000 in fiscal year 2023,
$2,000,000 in fiscal year 2024, and $0 in fiscal year 2025.
(i) Board of Dentistry; continuing education. $11,000 in fiscal year 2020 is
appropriated from the state government special revenue fund to the Board of Dentistry to
implement the continuing education requirements under Minnesota Statutes, section 214.12,
subdivision 6.
(j) Board of Medical Practice; continuing education. $17,000 in fiscal year 2020 is
appropriated from the state government special revenue fund to the Board of Medical Practice
to implement the continuing education requirements under Minnesota Statutes, section
214.12, subdivision 6.
(k) Board of Nursing; continuing education. $17,000 in fiscal year 2020 is appropriated
from the state government special revenue fund to the Board of Nursing to implement the
continuing education requirements under Minnesota Statutes, section 214.12, subdivision
6.
(l) Board of Optometry; continuing education. $5,000 in fiscal year 2020 is
appropriated from the state government special revenue fund to the Board of Optometry to
implement the continuing education requirements under Minnesota Statutes, section 214.12,
subdivision 6.
(m) Board of Podiatric Medicine; continuing education. $5,000 in fiscal year 2020
is appropriated from the state government special revenue fund to the Board of Podiatric
Medicine to implement the continuing education requirements under Minnesota Statutes,
section 214.12, subdivision 6.
(n) Commissioner of health; nonnarcotic pain management and wellness. $1,250,000
is appropriated in fiscal year 2020 from the general fund to the commissioner of health, to
provide funding for:
(1) statewide mapping and assessment of community-based nonnarcotic pain management
and wellness resources; and
(2) up to five demonstration projects in different geographic areas of the state to provide
community-based nonnarcotic pain management and wellness resources to patients and
consumers.
The demonstration projects must include an evaluation component and scalability analysis.
The commissioner shall award the grant for the statewide mapping and assessment, and the
demonstration project grants, through a competitive request for proposal process. Grants
for statewide mapping and assessment and demonstration projects may be awarded
simultaneously. In awarding demonstration project grants, the commissioner shall give
preference to proposals that incorporate innovative community partnerships, are informed
and led by people in the community where the project is taking place, and are culturally
relevant and delivered by culturally competent providers. This is a onetime appropriation.
(o) Commissioner of health; administration. $38,000 in fiscal year 2020 is appropriated
from the general fund to the commissioner of health for the administration of the grants
awarded in paragraph (n).
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 36.
Laws 2019, chapter 63, article 3, section 2, is amended to read:
Sec. 2. TRANSFER.
By June 30, 2021, the commissioner of human services shall transfer $5,439,000 from
the opiate epidemic response deleted text begin accountdeleted text end new text begin fundnew text end to the general fund. This is a onetime transfer.
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 37.
Laws 2020, chapter 73, section 4, subdivision 3, is amended to read:
Subd. 3.
Access to urgent-need insulin.
(a) MNsure shall develop an application form
to be used by an individual who is in urgent need of insulin. The application must ask the
individual to attest to the eligibility requirements described in subdivision 2. The form shall
be accessible through MNsure's website. MNsure shall also make the form available to
pharmacies and health care providers who prescribe or dispense insulin, hospital emergency
departments, urgent care clinics, and community health clinics. By submitting a completed,
signed, and dated application to a pharmacy, the individual attests that the information
contained in the application is correct.
(b) If the individual is in urgent need of insulin, the individual may present a completed,
signed, and dated application form to a pharmacy. The individual must also:
(1) have a valid insulin prescription; and
(2) present the pharmacist with identification indicating Minnesota residency in the form
of a valid Minnesota identification card, driver's licensedeleted text begin ,deleted text end or permitnew text begin , or tribal identification
card as defined in section 171.072, paragraph (b)new text end . If the individual in urgent need of insulin
is under the age of 18, the individual's parent or legal guardian must provide the pharmacist
with proof of residency.
(c) Upon receipt of a completed and signed application, the pharmacist shall dispense
the prescribed insulin in an amount that will provide the individual with a 30-day supply.
The pharmacy must notify the health care practitioner who issued the prescription order no
later than 72 hours after the insulin is dispensed.
(d) The pharmacy may submit to the manufacturer of the dispensed insulin product or
to the manufacturer's vendor a claim for payment that is in accordance with the National
Council for Prescription Drug Program standards for electronic claims processing, unless
the manufacturer agrees to send to the pharmacy a replacement supply of the same insulin
as dispensed in the amount dispensed. If the pharmacy submits an electronic claim to the
manufacturer or the manufacturer's vendor, the manufacturer or vendor shall reimburse the
pharmacy in an amount that covers the pharmacy's acquisition cost.
(e) The pharmacy may collect an insulin co-payment from the individual to cover the
pharmacy's costs of processing and dispensing in an amount not to exceed $35 for the 30-day
supply of insulin dispensed.
(f) The pharmacy shall also provide each eligible individual with the information sheet
described in subdivision 7 and a list of trained navigators provided by the Board of Pharmacy
for the individual to contact if the individual is in need of accessing ongoing insulin coverage
options, including assistance in:
(1) applying for medical assistance or MinnesotaCare;
(2) applying for a qualified health plan offered through MNsure, subject to open and
special enrollment periods;
(3) accessing information on providers who participate in prescription drug discount
programs, including providers who are authorized to participate in the 340B program under
section 340b of the federal Public Health Services Act, United States Code, title 42, section
256b; and
(4) accessing insulin manufacturers' patient assistance programs, co-payment assistance
programs, and other foundation-based programs.
(g) The pharmacist shall retain a copy of the application form submitted by the individual
to the pharmacy for reporting and auditing purposes.
Sec. 38.
Laws 2020, chapter 73, section 4, subdivision 4, is amended to read:
Subd. 4.
Continuing safety net program; general.
(a) Each manufacturer shall make
a patient assistance program available to any individual who meets the requirements of this
subdivision. Each manufacturer's patient assistance programs must meet the requirements
of this section. Each manufacturer shall provide the Board of Pharmacy with information
regarding the manufacturer's patient assistance program, including contact information for
individuals to call for assistance in accessing their patient assistance program.
(b) To be eligible to participate in a manufacturer's patient assistance program, the
individual must:
(1) be a Minnesota resident with a valid Minnesota identification card that indicates
Minnesota residency in the form of a Minnesota identification card deleted text begin ordeleted text end new text begin ,new text end driver's license or
permitnew text begin , or tribal identification card as defined in section 171.072, paragraph (b)new text end . If the
individual is under the age of 18, the individual's parent or legal guardian must provide
proof of residency;
(2) have a family income that is equal to or less than 400 percent of the federal poverty
guidelines;
(3) not be enrolled in medical assistance or MinnesotaCare;
(4) not be eligible to receive health care through a federally funded program or receive
prescription drug benefits through the Department of Veterans Affairs; and
(5) not be enrolled in prescription drug coverage through an individual or group health
plan that limits the total amount of cost-sharing that an enrollee is required to pay for a
30-day supply of insulin, including co-payments, deductibles, or coinsurance to $75 or less,
regardless of the type or amount of insulin needed.
(c) Notwithstanding the requirement in paragraph (b), clause (4), an individual who is
enrolled in Medicare Part D is eligible for a manufacturer's patient assistance program if
the individual has spent $1,000 on prescription drugs in the current calendar year and meets
the eligibility requirements in paragraph (b), clauses (1) to (3).
(d) An individual who is interested in participating in a manufacturer's patient assistance
program may apply directly to the manufacturer; apply through the individual's health care
practitioner, if the practitioner participates; or contact a trained navigator for assistance in
finding a long-term insulin supply solution, including assistance in applying to a
manufacturer's patient assistance program.
Sec. 39. new text begin REVISOR INSTRUCTION.
new text end
new text begin
(a) The revisor of statutes shall number the existing language in Minnesota Statutes,
section 62U.03, as subdivision 1 and renumber the provisions of Minnesota Statutes listed
in column A to the references listed in column B.
new text end
|
new text begin
Column A new text end |
new text begin
Column B new text end |
|
new text begin
256B.0751, subdivision 1 new text end |
new text begin
62U.03, subdivision 2 new text end |
|
new text begin
256B.0751, subdivision 2 new text end |
new text begin
62U.03, subdivision 3 new text end |
|
new text begin
256B.0751, subdivision 3 new text end |
new text begin
62U.03, subdivision 4 new text end |
|
new text begin
256B.0751, subdivision 4 new text end |
new text begin
62U.03, subdivision 5 new text end |
|
new text begin
256B.0751, subdivision 5 new text end |
new text begin
62U.03, subdivision 6 new text end |
|
new text begin
256B.0751, subdivision 6 new text end |
new text begin
62U.03, subdivision 7 new text end |
|
new text begin
256B.0751, subdivision 7 new text end |
new text begin
62U.03, subdivision 8 new text end |
|
new text begin
256B.0751, subdivision 8 new text end |
new text begin
62U.03, subdivision 9 new text end |
|
new text begin
256B.0751, subdivision 9 new text end |
new text begin
62U.03, subdivision 10 new text end |
|
new text begin
256B.0751, subdivision 10 new text end |
new text begin
62U.03, subdivision 11 new text end |
new text begin
(b) The revisor of statutes shall change the applicable references to Minnesota Statutes,
section 256B.0751, to section 62U.03. The revisor shall make necessary cross-reference
changes in Minnesota Statutes consistent with the renumbering. The revisor shall also make
technical and other necessary changes to sentence structure to preserve the meaning of the
text.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
Sec. 40. new text begin REPEALER.
new text end
new text begin
Minnesota Statutes 2018, sections 62U.15, subdivision 2; 256B.057, subdivision 8;
256B.0752; and 256L.04, subdivision 13,
new text end
new text begin
are repealed.
new text end
new text begin EFFECTIVE DATE. new text end
new text begin
This section is effective the day following final enactment.
new text end
ARTICLE 4
ADVANCED PRACTICE REGISTERED NURSE PROVISIONS
Section 1.
Minnesota Statutes 2018, section 62D.09, subdivision 1, is amended to read:
Subdivision 1.
Marketing requirements.
(a) Any written marketing materials which
may be directed toward potential enrollees and which include a detailed description of
benefits provided by the health maintenance organization shall include a statement of enrollee
information and rights as described in section 62D.07, subdivision 3, clauses (2) and (3).
Prior to any oral marketing presentation, the agent marketing the plan must inform the
potential enrollees that any complaints concerning the material presented should be directed
to the health maintenance organization, the commissioner of health, or, if applicable, the
employer.
(b) Detailed marketing materials must affirmatively disclose all exclusions and limitations
in the organization's services or kinds of services offered to the contracting party, including
but not limited to the following types of exclusions and limitations:
(1) health care services not provided;
(2) health care services requiring co-payments or deductibles paid by enrollees;
(3) the fact that access to health care services does not guarantee access to a particular
provider type; and
(4) health care services that are or may be provided only by referral of a physiciannew text begin or
advanced practice registered nursenew text end .
(c) No marketing materials may lead consumers to believe that all health care needs will
be covered. All marketing materials must alert consumers to possible uncovered expenses
with the following language in bold print: "THIS HEALTH CARE PLAN MAY NOT
COVER ALL YOUR HEALTH CARE EXPENSES; READ YOUR CONTRACT
CAREFULLY TO DETERMINE WHICH EXPENSES ARE COVERED." Immediately
following the disclosure required under paragraph (b), clause (3), consumers must be given
a telephone number to use to contact the health maintenance organization for specific
information about access to provider types.
(d) The disclosures required in paragraphs (b) and (c) are not required on billboards or
image, and name identification advertisement.
Sec. 2.
Minnesota Statutes 2018, section 62E.06, subdivision 1, is amended to read:
Subdivision 1.
Number three plan.
A plan of health coverage shall be certified as a
number three qualified plan if it otherwise meets the requirements established by chapters
62A, 62C, and 62Q, and the other laws of this state, whether or not the policy is issued in
Minnesota, and meets or exceeds the following minimum standards:
(a) The minimum benefits for a covered individual shall, subject to the other provisions
of this subdivision, be equal to at least 80 percent of the cost of covered services in excess
of an annual deductible which does not exceed $150 per person. The coverage shall include
a limitation of $3,000 per person on total annual out-of-pocket expenses for services covered
under this subdivision. The coverage shall not be subject to a lifetime maximum on essential
health benefits.
The prohibition on lifetime maximums for essential health benefits and $3,000 limitation
on total annual out-of-pocket expenses shall not be subject to change or substitution by use
of an actuarially equivalent benefit.
(b) Covered expenses shall be the usual and customary charges for the following services
and articles when prescribed by a physiciannew text begin or advanced practice registered nursenew text end :
(1) hospital services;
(2) professional services for the diagnosis or treatment of injuries, illnesses, or conditions,
other than dental, which are rendered by a physiciannew text begin or advanced practice registered nursenew text end
or at the physician'snew text begin or advanced practice registered nurse'snew text end direction;
(3) drugs requiring a physician'snew text begin or advanced practice registered nurse'snew text end prescription;
(4) services of a nursing home for not more than 120 days in a year if the services would
qualify as reimbursable services under Medicare;
(5) services of a home health agency if the services would qualify as reimbursable
services under Medicare;
(6) use of radium or other radioactive materials;
(7) oxygen;
(8) anesthetics;
(9) prostheses other than dental but including scalp hair prostheses worn for hair loss
suffered as a result of alopecia areata;
(10) rental or purchase, as appropriate, of durable medical equipment other than
eyeglasses and hearing aids, unless coverage is required under section 62Q.675;
(11) diagnostic x-rays and laboratory tests;
(12) oral surgery for partially or completely unerupted impacted teeth, a tooth root
without the extraction of the entire tooth, or the gums and tissues of the mouth when not
performed in connection with the extraction or repair of teeth;
(13) services of a physical therapist;
(14) transportation provided by licensed ambulance service to the nearest facility qualified
to treat the condition; or a reasonable mileage rate for transportation to a kidney dialysis
center for treatment; and
(15) services of an occupational therapist.
(c) Covered expenses for the services and articles specified in this subdivision do not
include the following:
(1) any charge for care for injury or disease either (i) arising out of an injury in the course
of employment and subject to a workers' compensation or similar law, (ii) for which benefits
are payable without regard to fault under coverage statutorily required to be contained in
any motor vehicle, or other liability insurance policy or equivalent self-insurance, or (iii)
for which benefits are payable under another policy of accident and health insurance,
Medicare, or any other governmental program except as otherwise provided by section
62A.04, subdivision 3, clause (4);
(2) any charge for treatment for cosmetic purposes other than for reconstructive surgery
when such service is incidental to or follows surgery resulting from injury, sickness, or
other diseases of the involved part or when such service is performed on a covered dependent
child because of congenital disease or anomaly which has resulted in a functional defect as
determined by the attending physiciannew text begin or advanced practice registered nursenew text end ;
(3) care which is primarily for custodial or domiciliary purposes which would not qualify
as eligible services under Medicare;
(4) any charge for confinement in a private room to the extent it is in excess of the
institution's charge for its most common semiprivate room, unless a private room is prescribed
as medically necessary by a physiciannew text begin or advanced practice registered nursenew text end , provided,
however, that if the institution does not have semiprivate rooms, its most common semiprivate
room charge shall be considered to be 90 percent of its lowest private room charge;
(5) that part of any charge for services or articles rendered or prescribed by a physician,new text begin
advanced practice registered nurse,new text end dentist, or other health care personnel which exceeds
the prevailing charge in the locality where the service is provided; and
(6) any charge for services or articles the provision of which is not within the scope of
authorized practice of the institution or individual rendering the services or articles.
(d) The minimum benefits for a qualified plan shall include, in addition to those benefits
specified in clauses (a) and (e), benefits for well baby care, effective July 1, 1980, subject
to applicable deductibles, coinsurance provisions, and maximum lifetime benefit limitations.
(e) Effective July 1, 1979, the minimum benefits of a qualified plan shall include, in
addition to those benefits specified in clause (a), a second opinion from a physician on all
surgical procedures expected to cost a total of $500 or more in physician, laboratory, and
hospital fees, provided that the coverage need not include the repetition of any diagnostic
tests.
(f) Effective August 1, 1985, the minimum benefits of a qualified plan must include, in
addition to the benefits specified in clauses (a), (d), and (e), coverage for special dietary
treatment for phenylketonuria when recommended by a physiciannew text begin or advanced practice
registered nursenew text end .
(g) Outpatient mental health coverage is subject to section 62A.152, subdivision 2.
Sec. 3.
Minnesota Statutes 2018, section 62J.17, subdivision 4a, is amended to read:
Subd. 4a.
Expenditure reporting.
Each hospital, outpatient surgical center, diagnostic
imaging center, and physiciannew text begin or advanced practice registered nursenew text end clinic shall report
annually to the commissioner on all major spending commitments, in the form and manner
specified by the commissioner. The report shall include the following information:
(1) a description of major spending commitments made during the previous year,
including the total dollar amount of major spending commitments and purpose of the
expenditures;
(2) the cost of land acquisition, construction of new facilities, and renovation of existing
facilities;
(3) the cost of purchased or leased medical equipment, by type of equipment;
(4) expenditures by type for specialty care and new specialized services;
(5) information on the amount and types of added capacity for diagnostic imaging
services, outpatient surgical services, and new specialized services; and
(6) information on investments in electronic medical records systems.
For hospitals and outpatient surgical centers, this information shall be included in reports
to the commissioner that are required under section 144.698. For diagnostic imaging centers,
this information shall be included in reports to the commissioner that are required under
section 144.565. For all other health care providers that are subject to this reporting
requirement, reports must be submitted to the commissioner by March 1 each year for the
preceding calendar year.
Sec. 4.
Minnesota Statutes 2019 Supplement, section 62J.23, subdivision 2, is amended
to read:
Subd. 2.
Restrictions.
(a) From July 1, 1992, until rules are adopted by the commissioner
under this section, the restrictions in the federal Medicare antikickback statutes in section
1128B(b) of the Social Security Act, United States Code, title 42, section 1320a-7b(b), and
rules adopted under the federal statutes, apply to all persons in the state, regardless of whether
the person participates in any state health care program.
(b) Nothing in paragraph (a) shall be construed to prohibit an individual from receiving
a discount or other reduction in price or a limited-time free supply or samples of a prescription
drug, medical supply, or medical equipment offered by a pharmaceutical manufacturer,
medical supply or device manufacturer, health plan company, or pharmacy benefit manager,
so long as:
(1) the discount or reduction in price is provided to the individual in connection with
the purchase of a prescription drug, medical supply, or medical equipment prescribed for
that individual;
(2) it otherwise complies with the requirements of state and federal law applicable to
enrollees of state and federal public health care programs;
(3) the discount or reduction in price does not exceed the amount paid directly by the
individual for the prescription drug, medical supply, or medical equipment; and
(4) the limited-time free supply or samples are provided by a physiciannew text begin , advanced practice
registered nurse,new text end or pharmacist, as provided by the federal Prescription Drug Marketing
Act.
For purposes of this paragraph, "prescription drug" includes prescription drugs that are
administered through infusion, and related services and supplies.
(c) No benefit, reward, remuneration, or incentive for continued product use may be
provided to an individual or an individual's family by a pharmaceutical manufacturer,
medical supply or device manufacturer, or pharmacy benefit manager, except that this
prohibition does not apply to:
(1) activities permitted under paragraph (b);
(2) a pharmaceutical manufacturer, medical supply or device manufacturer, health plan
company, or pharmacy benefit manager providing to a patient, at a discount or reduced
price or free of charge, ancillary products necessary for treatment of the medical condition
for which the prescription drug, medical supply, or medical equipment was prescribed or
provided; and
(3) a pharmaceutical manufacturer, medical supply or device manufacturer, health plan
company, or pharmacy benefit manager providing to a patient a trinket or memento of
insignificant value.
(d) Nothing in this subdivision shall be construed to prohibit a health plan company
from offering a tiered formulary with different co-payment or cost-sharing amounts for
different drugs.
Sec. 5.
Minnesota Statutes 2018, section 62J.495, subdivision 1a, is amended to read:
Subd. 1a.
Definitions.
(a) "Certified electronic health record technology" means an
electronic health record that is certified pursuant to section 3001(c)(5) of the HITECH Act
to meet the standards and implementation specifications adopted under section 3004 as
applicable.
(b) "Commissioner" means the commissioner of health.
(c) "Pharmaceutical electronic data intermediary" means any entity that provides the
infrastructure to connect computer systems or other electronic devices utilized by prescribing
practitioners with those used by pharmacies, health plans, third-party administrators, and
pharmacy benefit managers in order to facilitate the secure transmission of electronic
prescriptions, refill authorization requests, communications, and other prescription-related
information between such entities.
(d) "HITECH Act" means the Health Information Technology for Economic and Clinical
Health Act in division A, title XIII and division B, title IV of the American Recovery and
Reinvestment Act of 2009, including federal regulations adopted under that act.
(e) "Interoperable electronic health record" means an electronic health record that securely
exchanges health information with another electronic health record system that meets
requirements specified in subdivision 3, and national requirements for certification under
the HITECH Act.
(f) "Qualified electronic health record" means an electronic record of health-related
information on an individual that includes patient demographic and clinical health information
and has the capacity to:
(1) provide clinical decision support;
(2) support deleted text begin physiciandeleted text end new text begin providernew text end order entry;
(3) capture and query information relevant to health care quality; and
(4) exchange electronic health information with, and integrate such information from,
other sources.
Sec. 6.
Minnesota Statutes 2018, section 62J.52, subdivision 2, is amended to read:
Subd. 2.
Uniform billing form CMS 1500.
(a) On and after January 1, 1996, all
noninstitutional health care services rendered by providers in Minnesota except dental or
pharmacy providers, that are not currently being billed using an equivalent electronic billing
format, must be billed using the most current version of the health insurance claim form
CMS 1500.
(b) The instructions and definitions for the use of the uniform billing form CMS 1500
shall be in accordance with the manual developed by the Administrative Uniformity
Committee entitled standards for the use of the CMS 1500 form, dated February 1994, as
further defined by the commissioner.
(c) Services to be billed using the uniform billing form CMS 1500 include physician
services and supplies, durable medical equipment, noninstitutional ambulance services,
independent ancillary services including occupational therapy, physical therapy, speech
therapy and audiology, home infusion therapy, podiatry services, optometry services, mental
health licensed professional services, substance abuse licensed professional services, deleted text begin nursing
practitioner professional services, certified registered nurse anesthetistsdeleted text end new text begin advanced practice
registered nurse servicesnew text end , chiropractors, physician assistants, laboratories, medical suppliers,
waivered services, personal care attendants, and other health care providers such as day
activity centers and freestanding ambulatory surgical centers.
(d) Services provided by Medicare Critical Access Hospitals electing Method II billing
will be allowed an exception to this provision to allow the inclusion of the professional fees
on the CMS 1450.
Sec. 7.
Minnesota Statutes 2018, section 62J.823, subdivision 3, is amended to read:
Subd. 3.
Applicability and scope.
Any hospital, as defined in section 144.696,
subdivision 3, and outpatient surgical center, as defined in section 144.696, subdivision 4,
shall provide a written estimate of the cost of a specific service or stay upon the request of
a patient, doctor,new text begin advanced practice registered nurse,new text end or the patient's representative. The
request must include:
(1) the health coverage status of the patient, including the specific health plan or other
health coverage under which the patient is enrolled, if any; and
(2) at least one of the following:
(i) the specific diagnostic-related group code;
(ii) the name of the procedure or procedures to be performed;
(iii) the type of treatment to be received; or
(iv) any other information that will allow the hospital or outpatient surgical center to
determine the specific diagnostic-related group or procedure code or codes.
Sec. 8.
Minnesota Statutes 2019 Supplement, section 62Q.184, subdivision 1, is amended
to read:
Subdivision 1.
Definitions.
(a) For the purposes of this section, the terms in this
subdivision have the meanings given them.
(b) "Clinical practice guideline" means a systematically developed statement to assist
health care providers and enrollees in making decisions about appropriate health care services
for specific clinical circumstances and conditions developed independently of a health plan
company, pharmaceutical manufacturer, or any entity with a conflict of interest. A clinical
practice guideline also includes a preferred drug list developed in accordance with section
256B.0625.
(c) "Clinical review criteria" means the written screening procedures, decision abstracts,
clinical protocols, and clinical practice guidelines used by a health plan company to determine
the medical necessity and appropriateness of health care services.
(d) "Health plan company" has the meaning given in section 62Q.01, subdivision 4, but
also includes a county-based purchasing plan participating in a public program under chapter
256B or 256L and an integrated health partnership under section 256B.0755.
(e) "Step therapy protocol" means a protocol or program that establishes the specific
sequence in which prescription drugs for a specified medical condition, including
self-administered deleted text begin and physician-administereddeleted text end drugsnew text begin and drugs that are administered by a
physician or advanced practice nurse practitionernew text end , are medically appropriate for a particular
enrollee and are covered under a health plan.
(f) "Step therapy override" means that the step therapy protocol is overridden in favor
of coverage of the selected prescription drug of the prescribing health care provider because
at least one of the conditions of subdivision 3, paragraph (a), exists.
Sec. 9.
Minnesota Statutes 2018, section 62Q.43, subdivision 1, is amended to read:
Subdivision 1.
Closed-panel health plan.
For purposes of this section, "closed-panel
health plan" means a health plan as defined in section 62Q.01 that requires an enrollee to
receive all or a majority of primary care services from a specific clinic or deleted text begin physiciandeleted text end new text begin primary
care providernew text end designated by the enrollee that is within the health plan company's clinic or
deleted text begin physiciandeleted text end new text begin providernew text end network.
Sec. 10.
Minnesota Statutes 2018, section 62Q.43, subdivision 2, is amended to read:
Subd. 2.
Access requirement.
Every closed-panel health plan must allow enrollees
under the age of 26 years to change their designated clinic or deleted text begin physiciandeleted text end new text begin primary care providernew text end
at least once per month, as long as the clinic or deleted text begin physiciandeleted text end new text begin providernew text end is part of the health plan
company's statewide clinic or deleted text begin physiciandeleted text end new text begin providernew text end network. A health plan company shall not
charge enrollees who choose this option higher premiums or cost sharing than would
otherwise apply to enrollees who do not choose this option. A health plan company may
require enrollees to provide 15 days' written notice of intent to change their designated clinic
or deleted text begin physiciandeleted text end new text begin primary care providernew text end .
Sec. 11.
Minnesota Statutes 2018, section 62Q.54, is amended to read:
62Q.54 REFERRALS FOR RESIDENTS OF HEALTH CARE FACILITIES.
If an enrollee is a resident of a health care facility licensed under chapter 144A or a
housing with services establishment registered under chapter 144D, the enrollee's primary
care deleted text begin physiciandeleted text end new text begin providernew text end must refer the enrollee to that facility's skilled nursing unit or that
facility's appropriate care setting, provided that the health plan company and the provider
can best meet the patient's needs in that setting, if the following conditions are met:
(1) the facility agrees to be reimbursed at that health plan company's contract rate
negotiated with similar providers for the same services and supplies; and
(2) the facility meets all guidelines established by the health plan company related to
quality of care, utilization, referral authorization, risk assumption, use of health plan company
network, and other criteria applicable to providers under contract for the same services and
supplies.
Sec. 12.
Minnesota Statutes 2018, section 62Q.57, subdivision 1, is amended to read:
Subdivision 1.
Choice of primary care provider.
(a) If a health plan company offering
a group health plan, or an individual health plan that is not a grandfathered plan, requires
or provides for the designation by an enrollee of a participating primary care provider, the
health plan company shall permit each enrollee to:
(1) designate any participating primary care provider available to accept the enrollee;
and
(2) for a child, designate any participating physiciannew text begin or advanced practice registered
nursenew text end who specializes in pediatrics as the child's primary care provider and is available to
accept the child.
(b) This section does not waive any exclusions of coverage under the terms and conditions
of the health plan with respect to coverage of pediatric care.
Sec. 13.
Minnesota Statutes 2018, section 62Q.73, subdivision 7, is amended to read:
Subd. 7.
Standards of review.
(a) For an external review of any issue in an adverse
determination that does not require a medical necessity determination, the external review
must be based on whether the adverse determination was in compliance with the enrollee's
health benefit plan.
(b) For an external review of any issue in an adverse determination by a health plan
company licensed under chapter 62D that requires a medical necessity determination, the
external review must determine whether the adverse determination was consistent with the
definition of medically necessary care in Minnesota Rules, part 4685.0100, subpart 9b.
(c) For an external review of any issue in an adverse determination by a health plan
company, other than a health plan company licensed under chapter 62D, that requires a
medical necessity determination, the external review must determine whether the adverse
determination was consistent with the definition of medically necessary care in section
62Q.53, subdivision 2.
(d) For an external review of an adverse determination involving experimental or
investigational treatment, the external review entity must base its decision on all documents
submitted by the health plan company and enrollee, including medical records, the attending
physiciannew text begin , advanced practice registered nurse,new text end or health care professional's recommendation,
consulting reports from health care professionals, the terms of coverage, federal Food and
Drug Administration approval, and medical or scientific evidence or evidence-based
standards.
Sec. 14.
Minnesota Statutes 2018, section 62Q.733, subdivision 3, is amended to read:
Subd. 3.
Health care provider or provider.
"Health care provider" or "provider" means
a physician, new text begin advanced practice registered nurse, new text end chiropractor, dentist, podiatrist, or other
provider as defined under section 62J.03, other than hospitals, ambulatory surgical centers,
or freestanding emergency rooms.
Sec. 15.
Minnesota Statutes 2018, section 62Q.74, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
(a) For purposes of this section, "category of coverage"
means one of the following types of health-related coverage:
(1) health;
(2) no-fault automobile medical benefits; or
(3) workers' compensation medical benefits.
(b) "Health care provider" or "provider" means a physician, new text begin advanced practice registered
nurse, new text end chiropractor, dentist, podiatrist, hospital, ambulatory surgical center, freestanding
emergency room, or other provider, as defined in section 62J.03.
Sec. 16.
Minnesota Statutes 2018, section 62S.08, subdivision 3, is amended to read:
Subd. 3.
Mandatory format.
The following standard format outline of coverage must
be used, unless otherwise specifically indicated:
COMPANY NAME
ADDRESS - CITY AND STATE
TELEPHONE NUMBER
LONG-TERM CARE INSURANCE
OUTLINE OF COVERAGE
Policy Number or Group Master Policy and Certificate Number
(Except for policies or certificates which are guaranteed issue, the following caution
statement, or language substantially similar, must appear as follows in the outline of
coverage.)
CAUTION: The issuance of this long-term care insurance (policy) (certificate) is based
upon your responses to the questions on your application. A copy of your (application)
(enrollment form) (is enclosed) (was retained by you when you applied). If your answers
are incorrect or untrue, the company has the right to deny benefits or rescind your policy.
The best time to clear up any questions is now, before a claim arises. If, for any reason, any
of your answers are incorrect, contact the company at this address: (insert address).
(1) This policy is (an individual policy of insurance) (a group policy) which was issued
in the (indicate jurisdiction in which group policy was issued).
(2) PURPOSE OF OUTLINE OF COVERAGE. This outline of coverage provides a
very brief description of the important features of the policy. You should compare this
outline of coverage to outlines of coverage for other policies available to you. This is not
an insurance contract, but only a summary of coverage. Only the individual or group policy
contains governing contractual provisions. This means that the policy or group policy sets
forth in detail the rights and obligations of both you and the insurance company. Therefore,
if you purchase this coverage, or any other coverage, it is important that you READ YOUR
POLICY (OR CERTIFICATE) CAREFULLY.
(3) THIS PLAN IS INTENDED TO BE A QUALIFIED LONG-TERM CARE
INSURANCE CONTRACT AS DEFINED UNDER SECTION 7702(B)(b) OF THE
INTERNAL REVENUE CODE OF 1986.
(4) TERMS UNDER WHICH THE POLICY OR CERTIFICATE MAY BE
CONTINUED IN FORCE OR DISCONTINUED.
(a) (For long-term care health insurance policies or certificates describe one of the
following permissible policy renewability provisions:)
(1) (Policies and certificates that are guaranteed renewable shall contain the following
statement:) RENEWABILITY: THIS POLICY (CERTIFICATE) IS GUARANTEED
RENEWABLE. This means you have the right, subject to the terms of your policy,
(certificate) to continue this policy as long as you pay your premiums on time. (Company
name) cannot change any of the terms of your policy on its own, except that, in the future,
IT MAY INCREASE THE PREMIUM YOU PAY.
(2) (Policies and certificates that are noncancelable shall contain the following statement:)
RENEWABILITY: THIS POLICY (CERTIFICATE) IS NONCANCELABLE. This means
that you have the right, subject to the terms of your policy, to continue this policy as long
as you pay your premiums on time. (Company name) cannot change any of the terms of
your policy on its own and cannot change the premium you currently pay. However, if your
policy contains an inflation protection feature where you choose to increase your benefits,
(company name) may increase your premium at that time for those additional benefits.
(b) (For group coverage, specifically describe continuation/conversion provisions
applicable to the certificate and group policy.)
(c) (Describe waiver of premium provisions or state that there are not such provisions.)
(5) TERMS UNDER WHICH THE COMPANY MAY CHANGE PREMIUMS.
(In bold type larger than the maximum type required to be used for the other provisions
of the outline of coverage, state whether or not the company has a right to change the
premium and, if a right exists, describe clearly and concisely each circumstance under which
the premium may change.)
(6) TERMS UNDER WHICH THE POLICY OR CERTIFICATE MAY BE RETURNED
AND PREMIUM REFUNDED.
(a) (Provide a brief description of the right to return -- "free look" provision of the policy.)
(b) (Include a statement that the policy either does or does not contain provisions
providing for a refund or partial refund of premium upon the death of an insured or surrender
of the policy or certificate. If the policy contains such provisions, include a description of
them.)
(7) THIS IS NOT MEDICARE SUPPLEMENT COVERAGE. If you are eligible for
Medicare, review the Medicare Supplement Buyer's Guide available from the insurance
company.
(a) (For agents) neither (insert company name) nor its agents represent Medicare, the
federal government, or any state government.
(b) (For direct response) (insert company name) is not representing Medicare, the federal
government, or any state government.
(8) LONG-TERM CARE COVERAGE. Policies of this category are designed to provide
coverage for one or more necessary or medically necessary diagnostic, preventive,
therapeutic, rehabilitative, maintenance, or personal care services, provided in a setting
other than an acute care unit of a hospital, such as in a nursing home, in the community, or
in the home.
This policy provides coverage in the form of a fixed dollar indemnity benefit for covered
long-term care expenses, subject to policy (limitations), (waiting periods), and (coinsurance)
requirements. (Modify this paragraph if the policy is not an indemnity policy.)
(9) BENEFITS PROVIDED BY THIS POLICY.
(a) (Covered services, related deductible(s), waiting periods, elimination periods, and
benefit maximums.)
(b) (Institutional benefits, by skill level.)
(c) (Noninstitutional benefits, by skill level.)
(d) (Eligibility for payment of benefits.)
(Activities of daily living and cognitive impairment shall be used to measure an insured's
need for long-term care and must be defined and described as part of the outline of coverage.)
(Any benefit screens must be explained in this section. If these screens differ for different
benefits, explanation of the screen should accompany each benefit description. If an attending
physiciannew text begin , advanced practice registered nurse,new text end or other specified person must certify a certain
level of functional dependency in order to be eligible for benefits, this too must be specified.
If activities of daily living (ADLs) are used to measure an insured's need for long-term care,
then these qualifying criteria or screens must be explained.)
(10) LIMITATIONS AND EXCLUSIONS:
Describe:
(a) preexisting conditions;
(b) noneligible facilities/provider;
(c) noneligible levels of care (e.g., unlicensed providers, care or treatment provided by
a family member, etc.);
(d) exclusions/exceptions; and
(e) limitations.
(This section should provide a brief specific description of any policy provisions which
limit, exclude, restrict, reduce, delay, or in any other manner operate to qualify payment of
the benefits described in paragraph (8).)
THIS POLICY MAY NOT COVER ALL THE EXPENSES ASSOCIATED WITH
YOUR LONG-TERM CARE NEEDS.
(11) RELATIONSHIP OF COST OF CARE AND BENEFITS. Because the costs of
long-term care services will likely increase over time, you should consider whether and
how the benefits of this plan may be adjusted. As applicable, indicate the following:
(a) that the benefit level will not increase over time;
(b) any automatic benefit adjustment provisions;
(c) whether the insured will be guaranteed the option to buy additional benefits and the
basis upon which benefits will be increased over time if not by a specified amount or
percentage;
(d) if there is such a guarantee, include whether additional underwriting or health
screening will be required, the frequency and amounts of the upgrade options, and any
significant restrictions or limitations; and
(e) whether there will be any additional premium charge imposed and how that is to be
calculated.
(12) ALZHEIMER'S DISEASE AND OTHER ORGANIC BRAIN DISORDERS. (State
that the policy provides coverage for insureds clinically diagnosed as having Alzheimer's
disease or related degenerative and dementing illnesses. Specifically, describe each benefit
screen or other policy provision which provides preconditions to the availability of policy
benefits for such an insured.)
(13) PREMIUM.
(a) State the total annual premium for the policy.
(b) If the premium varies with an applicant's choice among benefit options, indicate the
portion of annual premium which corresponds to each benefit option.
(14) ADDITIONAL FEATURES.
(a) Indicate if medical underwriting is used.
(b) Describe other important features.
(15) CONTACT THE STATE DEPARTMENT OF COMMERCE OR SENIOR
LINKAGE LINE IF YOU HAVE GENERAL QUESTIONS REGARDING LONG-TERM
CARE INSURANCE. CONTACT THE INSURANCE COMPANY IF YOU HAVE
SPECIFIC QUESTIONS REGARDING YOUR LONG-TERM CARE INSURANCE
POLICY OR CERTIFICATE.
Sec. 17.
Minnesota Statutes 2018, section 62S.20, subdivision 5b, is amended to read:
Subd. 5b.
Benefit triggers.
Activities of daily living and cognitive impairment must be
used to measure an insured's need for long-term care and must be described in the policy
or certificate in a separate paragraph and must be labeled "Eligibility for the Payment of
Benefits." Any additional benefit triggers must also be explained in this section. If these
triggers differ for different benefits, explanation of the trigger must accompany each benefit
description. If an attending physiciannew text begin , advanced practice registered nurse,new text end or other specified
person must certify a certain level of functional dependency in order to be eligible for
benefits, this too shall be specified.
Sec. 18.
Minnesota Statutes 2018, section 62S.21, subdivision 2, is amended to read:
Subd. 2.
Medication information required.
If an application for long-term care
insurance contains a question which asks whether the applicant has had medication prescribed
by a physiciannew text begin or advanced practice registered nursenew text end , it must also ask the applicant to list
the medication that has been prescribed. If the medications listed in the application were
known by the insurer, or should have been known at the time of application, to be directly
related to a medical condition for which coverage would otherwise be denied, then the
policy or certificate shall not be rescinded for that condition.
Sec. 19.
Minnesota Statutes 2018, section 62S.268, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
For purposes of this section, the following terms have the
meanings given them:
(a) "Qualified long-term care services" means services that meet the requirements of
section 7702(c)(1) of the Internal Revenue Code of 1986, as amended, as follows: necessary
diagnostic, preventive, therapeutic, curative, treatment, mitigation, and rehabilitative services,
and maintenance or personal care services which are required by a chronically ill individual,
and are provided pursuant to a plan of care prescribed by a licensed health care practitioner.
(b) "Chronically ill individual" has the meaning prescribed for this term by section
7702B(c)(2) of the Internal Revenue Code of 1986, as amended. Under this provision, a
chronically ill individual means any individual who has been certified by a licensed health
care practitioner as being unable to perform, without substantial assistance from another
individual, at least two activities of daily living for a period of at least 90 days due to a loss
of functional capacity, or requiring substantial supervision to protect the individual from
threats to health and safety due to severe cognitive impairment.
The term "chronically ill individual" does not include an individual otherwise meeting
these requirements unless within the preceding 12-month period a licensed health care
practitioner has certified that the individual meets these requirements.
(c) "Licensed health care practitioner" means a physician, as defined in section 1861(r)(1)
of the Social Security Act,new text begin an advanced practice registered nurse,new text end a registered professional
nurse, licensed social worker, or other individual who meets requirements prescribed by
the Secretary of the Treasury.
(d) "Maintenance or personal care services" means any care the primary purpose of
which is the provision of needed assistance with any of the disabilities as a result of which
the individual is a chronically ill individual, including the protection from threats to health
and safety due to severe cognitive impairment.
Sec. 20.
Minnesota Statutes 2018, section 144.3345, subdivision 1, is amended to read:
Subdivision 1.
Definitions.
(a) The following definitions are used for the purposes of
this section.
(b) "Eligible community e-health collaborative" means an existing or newly established
collaborative to support the adoption and use of interoperable electronic health records. A
collaborative must consist of at least two or more eligible health care entities in at least two
of the categories listed in paragraph (c) and have a focus on interconnecting the members
of the collaborative for secure and interoperable exchange of health care information.
(c) "Eligible health care entity" means one of the following:
(1) community clinics, as defined under section 145.9268;
(2) hospitals eligible for rural hospital capital improvement grants, as defined in section
144.148;
(3) physiciannew text begin or advanced practice registered nursenew text end clinics located in a community with
a population of less than 50,000 according to United States Census Bureau statistics and
outside the seven-county metropolitan area;
(4) nursing facilities licensed under sections 144A.01 to 144A.27;
(5) community health boards as established under chapter 145A;
(6) nonprofit entities with a purpose to provide health information exchange coordination
governed by a representative, multi-stakeholder board of directors; and
(7) other providers of health or health care services approved by the commissioner for
which interoperable electronic health record capability would improve quality of care,
patient safety, or community health.
Sec. 21.
Minnesota Statutes 2018, section 144.3352, is amended to read:
144.3352 HEPATITIS B MATERNAL CARRIER DATA; INFANT
IMMUNIZATION.
The commissioner of health or a community health board may inform the physiciannew text begin or
advanced practice registered nursenew text end attending a newborn of the hepatitis B infection status
of the biological mother.
Sec. 22.
Minnesota Statutes 2018, section 144.34, is amended to read:
144.34 INVESTIGATION AND CONTROL OF OCCUPATIONAL DISEASES.
Any physiciannew text begin or advanced practice registered nursenew text end having under professional care any
person whom the physiciannew text begin or advanced practice registered nursenew text end believes to be suffering
from poisoning from lead, phosphorus, arsenic, brass, silica dust, carbon monoxide gas,
wood alcohol, or mercury, or their compounds, or from anthrax or from compressed-air
illness or any other disease contracted as a result of the nature of the employment of such
person shall within five days mail to the Department of Health a report stating the name,
address, and occupation of such patient, the name, address, and business of the patient's
employer, the nature of the disease, and such other information as may reasonably be required
by the department. The department shall prepare and furnish the physiciansnew text begin and advanced
practice registered nursesnew text end of this state suitable blanks for the reports herein required. No
report made pursuant to the provisions of this section shall be admissible as evidence of the
facts therein stated in any action at law or in any action under the Workers' Compensation
Act against any employer of such diseased person. The Department of Health is authorized
to investigate and to make recommendations for the elimination or prevention of occupational
diseases which have been reported to it, or which shall be reported to it, in accordance with
the provisions of this section. The department is also authorized to study and provide advice
in regard to conditions that may be suspected of causing occupational diseases. Information
obtained upon investigations made in accordance with the provisions of this section shall
not be admissible as evidence in any action at law to recover damages for personal injury
or in any action under the Workers' Compensation Act. Nothing herein contained shall be
construed to interfere with or limit the powers of the Department of Labor and Industry to
make inspections of places of employment or issue orders for the protection of the health
of the persons therein employed. When upon investigation the commissioner of health
reaches a conclusion that a condition exists which is dangerous to the life and health of the
workers in any industry or factory or other industrial institutions the commissioner shall
file a report thereon with the Department of Labor and Industry.
Sec. 23.
Minnesota Statutes 2018, section 144.441, subdivision 4, is amended to read:
Subd. 4.
Screening of employees.
As determined by the commissioner under subdivision
2, a person employed by the designated school or school district shall submit to the
administrator or other person having general control and supervision of the school one of
the following:
(1) a statement from a physiciannew text begin , advanced practice registered nurse,new text end or public clinic
stating that the person has had a negative Mantoux test reaction within the past year, provided
that the person has no symptoms suggestive of tuberculosis or evidence of a new exposure
to active tuberculosis;
(2) a statement from a physiciannew text begin , advanced practice registered nurse,new text end or public clinic
stating that a person who has a positive Mantoux test reaction has had a negative chest
roentgenogram (X-ray) for tuberculosis within the past year, provided that the person has
no symptoms suggestive of tuberculosis or evidence of a new exposure to active tuberculosis;
(3) a statement from a physiciannew text begin , advanced practice registered nurse,new text end or public health
clinic stating that the person (i) has a history of adequately treated active tuberculosis; (ii)
is currently receiving tuberculosis preventive therapy; (iii) is currently undergoing therapy
for active tuberculosis and the person's presence in a school building will not endanger the
health of other people; or (iv) has completed a course of preventive therapy or was intolerant
to preventive therapy, provided the person has no symptoms suggestive of tuberculosis or
evidence of a new exposure to active tuberculosis; or
(4) a notarized statement signed by the person stating that the person has not submitted
the proof of tuberculosis screening as required by this subdivision because of conscientiously
held beliefs. This statement must be forwarded to the commissioner of health.
Sec. 24.
Minnesota Statutes 2018, section 144.441, subdivision 5, is amended to read:
Subd. 5.
Exceptions.
Subdivisions 3 and 4 do not apply to:
(1) a person with a history of either a past positive Mantoux test reaction or active
tuberculosis who has a documented history of completing a course of tuberculosis therapy
or preventive therapy when the school or school district holds a statement from a physiciannew text begin ,
advanced practice registered nurse,new text end or public health clinic indicating that such therapy was
provided to the person and that the person has no symptoms suggestive of tuberculosis or
evidence of a new exposure to active tuberculosis; and
(2) a person with a history of a past positive Mantoux test reaction who has not completed
a course of preventive therapy. This determination shall be made by the commissioner based
on currently accepted public health standards and the person's health status.
Sec. 25.
Minnesota Statutes 2018, section 144.442, subdivision 1, is amended to read:
Subdivision 1.
Administration; notification.
In the event that the commissioner
designates a school or school district under section 144.441, subdivision 2, the school or
school district or community health board may administer Mantoux screening tests to some
or all persons enrolled in or employed by the designated school or school district. Any
Mantoux screening provided under this section shall be under the direction of a licensed
physiciannew text begin or advanced practice registered nursenew text end .
Prior to administering the Mantoux test to such persons, the school or school district or
community health board shall inform in writing such persons and parents or guardians of
minor children to whom the test may be administered, of the following:
(1) that there has been an occurrence of active tuberculosis or evidence of a higher than
expected prevalence of tuberculosis infection in that school or school district;
(2) that screening is necessary to avoid the spread of tuberculosis;
(3) the manner by which tuberculosis is transmitted;
(4) the risks and possible side effects of the Mantoux test;
(5) the risks from untreated tuberculosis to the infected person and others;
(6) the ordinary course of further diagnosis and treatment if the Mantoux test is positive;
(7) that screening has been scheduled; and
(8) that no person will be required to submit to the screening if the person submits a
statement of objection due to the conscientiously held beliefs of the person employed or of
the parent or guardian of a minor child.
Sec. 26.
Minnesota Statutes 2018, section 144.4803, subdivision 1, is amended to read:
Subdivision 1.
Active tuberculosis.
"Active tuberculosis" includes infectious and
noninfectious tuberculosis and means:
(1) a condition evidenced by a positive culture for mycobacterium tuberculosis taken
from a pulmonary or laryngeal source;
(2) a condition evidenced by a positive culture for mycobacterium tuberculosis taken
from an extrapulmonary source when there is clinical evidence such as a positive skin test
for tuberculosis infection, coughing, sputum production, fever, or other symptoms compatible
with pulmonary tuberculosis; or
(3) a condition in which clinical specimens are not available for culture, but there is
radiographic evidence of tuberculosis such as an abnormal chest x-ray, and clinical evidence
such as a positive skin test for tuberculosis infection, coughing, sputum production, fever,
or other symptoms compatible with pulmonary tuberculosis, that lead a physiciannew text begin or advanced
practice registered nursenew text end to reasonably diagnose active tuberculosis according to currently
accepted standards of medical practice and to initiate treatment for tuberculosis.
Sec. 27.
Minnesota Statutes 2018, section 144.4803, is amended by adding a subdivision
to read:
new text begin Subd. 1a. new text end
new text begin Advanced practice registered nurse. new text end
new text begin
"Advanced practice registered nurse"
means a person who is licensed by the Board of Nursing under chapter 148 to practice as
an advanced practice registered nurse.
new text end
Sec. 28.
Minnesota Statutes 2018, section 144.4803, subdivision 4, is amended to read:
Subd. 4.
Clinically suspected of having active tuberculosis.
"Clinically suspected of
having active tuberculosis" means presenting a reasonable possibility of having active
tuberculosis based upon epidemiologic, clinical, or radiographic evidence, laboratory test
results, or other reliable evidence as determined by a physiciannew text begin or advanced practice
registered nursenew text end using currently accepted standards of medical practice.
Sec. 29.
Minnesota Statutes 2018, section 144.4803, subdivision 10, is amended to read:
Subd. 10.
Endangerment to the public health.
"Endangerment to the public health"
means a carrier who may transmit tuberculosis to another person or persons because the
carrier has engaged or is engaging in any of the following conduct:
(1) refuses or fails to submit to a diagnostic tuberculosis examination that is ordered by
a physiciannew text begin or advanced practice registered nursenew text end and is reasonable according to currently
accepted standards of medical practice;
(2) refuses or fails to initiate or complete treatment for tuberculosis that is prescribed
by a physiciannew text begin or advanced practice registered nursenew text end and is reasonable according to currently
accepted standards of medical practice;
(3) refuses or fails to keep appointments for treatment of tuberculosis;
(4) refuses or fails to provide the commissioner, upon request, with evidence showing
the completion of a course of treatment for tuberculosis that is prescribed by a physiciannew text begin or
advanced practice registered nursenew text end and is reasonable according to currently accepted standards
of medical practice;
(5) refuses or fails to initiate or complete a course of directly observed therapy that is
prescribed by a physiciannew text begin or advanced practice registered nursenew text end and is reasonable according
to currently accepted standards of medical practice;
(6) misses at least 20 percent of scheduled appointments for directly observed therapy,
or misses at least two consecutive appointments for directly observed therapy;
(7) refuses or fails to follow contagion precautions for tuberculosis after being instructed
on the precautions by a licensed health professional or by the commissioner;
(8) based on evidence of the carrier's past or present behavior, may not complete a course
of treatment for tuberculosis that is reasonable according to currently accepted standards
of medical practice; or
(9) may expose other persons to tuberculosis based on epidemiological, medical, or other
reliable evidence.
Sec. 30.
Minnesota Statutes 2018, section 144.4806, is amended to read:
144.4806 PREVENTIVE MEASURES UNDER HEALTH ORDER.
A health order may include, but need not be limited to, an order:
(1) requiring the carrier's attending physiciannew text begin , advanced practice registered nurse,new text end or
treatment facility to isolate and detain the carrier for treatment or for a diagnostic examination
for tuberculosis, pursuant to section 144.4807, subdivision 1, if the carrier is an endangerment
to the public health and is in a treatment facility;
(2) requiring a carrier who is an endangerment to the public health to submit to diagnostic
examination for tuberculosis and to remain in the treatment facility until the commissioner
receives the results of the examination;
(3) requiring a carrier who is an endangerment to the public health to remain in or present
at a treatment facility until the carrier has completed a course of treatment for tuberculosis
that is prescribed by a physiciannew text begin or advanced practice registered nursenew text end and is reasonable
according to currently accepted standards of medical practice;
(4) requiring a carrier who is an endangerment to the public health to complete a course
of treatment for tuberculosis that is prescribed by a physiciannew text begin or advanced practice registered
nursenew text end and is reasonable according to currently accepted standards of medical practice and,
if necessary, to follow contagion precautions for tuberculosis;
(5) requiring a carrier who is an endangerment to the public health to follow a course
of directly observed therapy that is prescribed by a physiciannew text begin or advanced practice registered
nursenew text end and is reasonable according to currently accepted standards of medical practice;
(6) excluding a carrier who is an endangerment to the public health from the carrier's
place of work or school, or from other premises if the commissioner determines that exclusion
is necessary because contagion precautions for tuberculosis cannot be maintained in a
manner adequate to protect others from being exposed to tuberculosis;
(7) requiring a licensed health professional or treatment facility to provide to the
commissioner certified copies of all medical and epidemiological data relevant to the carrier's
tuberculosis and status as an endangerment to the public health;
(8) requiring the diagnostic examination for tuberculosis of other persons in the carrier's
household, workplace, or school, or other persons in close contact with the carrier if the
commissioner has probable cause to believe that the persons may have active tuberculosis
or may have been exposed to tuberculosis based on epidemiological, medical, or other
reliable evidence; or
(9) requiring a carrier or other persons to follow contagion precautions for tuberculosis.
Sec. 31.
Minnesota Statutes 2018, section 144.4807, subdivision 1, is amended to read:
Subdivision 1.
Obligation to isolate.
If the carrier is in a treatment facility, the
commissioner or a carrier's attending physiciannew text begin or advanced practice registered nursenew text end , after
obtaining approval from the commissioner, may issue a notice of obligation to isolate to a
treatment facility if the commissioner or attending physiciannew text begin or advanced practice registered
nursenew text end has probable cause to believe that a carrier is an endangerment to the public health.
Sec. 32.
Minnesota Statutes 2018, section 144.4807, subdivision 2, is amended to read:
Subd. 2.
Obligation to examine.
If the carrier is clinically suspected of having active
tuberculosis, the commissioner may issue a notice of obligation to examine to the carrier's
attending physiciannew text begin or advanced practice registered nursenew text end to conduct a diagnostic examination
for tuberculosis on the carrier.
Sec. 33.
Minnesota Statutes 2018, section 144.4807, subdivision 4, is amended to read:
Subd. 4.
Service of health order on carrier.
When issuing a notice of obligation to
isolate or examine to the carrier's physiciannew text begin or advanced practice registered nursenew text end or a
treatment facility, the commissioner shall simultaneously serve a health order on the carrier
ordering the carrier to remain in the treatment facility for treatment or examination.
Sec. 34.
Minnesota Statutes 2018, section 144.50, subdivision 2, is amended to read:
Subd. 2.
Hospital, sanitarium, other institution; definition.
Hospital, sanitarium or
other institution for the hospitalization or care of human beings, within the meaning of
sections 144.50 to 144.56 shall mean any institution, place, building, or agency, in which
any accommodation is maintained, furnished, or offered for five or more persons for: the
hospitalization of the sick or injured; the provision of care in a swing bed authorized under
section 144.562; elective outpatient surgery for preexamined, prediagnosed low risk patients;
emergency medical services offered 24 hours a day, seven days a week, in an ambulatory
or outpatient setting in a facility not a part of a licensed hospital; or the institutional care of
human beings. Nothing in sections 144.50 to 144.56 shall apply to a clinic, a physician'snew text begin or
advanced practice registered nurse'snew text end office or to hotels or other similar places that furnish
only board and room, or either, to their guests.
Sec. 35.
Minnesota Statutes 2019 Supplement, section 144.55, subdivision 2, is amended
to read:
Subd. 2.
Definitions.
(a) For the purposes of this section, the terms in this subdivision
have the meanings given them.
(b) "Outpatient surgical center" or "center" means a facility organized for the specific
purpose of providing elective outpatient surgery for preexamined, prediagnosed, low-risk
patients. An outpatient surgical center is not organized to provide regular emergency medical
services and does not include a physician'snew text begin , advanced practice nurse's, new text end or dentist's office
or clinic for the practice of medicine, the practice of dentistry, or the delivery of primary
care.
(c) "Approved accrediting organization" means any organization recognized as an
accreditation organization by the Centers for Medicare and Medicaid Services.
Sec. 36.
Minnesota Statutes 2018, section 144.55, subdivision 6, is amended to read:
Subd. 6.
Suspension, revocation, and refusal to renew.
(a) The commissioner may
refuse to grant or renew, or may suspend or revoke, a license on any of the following grounds:
(1) violation of any of the provisions of sections 144.50 to 144.56 or the rules or standards
issued pursuant thereto, or Minnesota Rules, chapters 4650 and 4675;
(2) permitting, aiding, or abetting the commission of any illegal act in the institution;
(3) conduct or practices detrimental to the welfare of the patient; or
(4) obtaining or attempting to obtain a license by fraud or misrepresentation; or
(5) with respect to hospitals and outpatient surgical centers, if the commissioner
determines that there is a pattern of conduct that one or more physiciansnew text begin or advanced practice
registered nursesnew text end who have a "financial or economic interest," as defined in section 144.6521,
subdivision 3, in the hospital or outpatient surgical center, have not provided the notice and
disclosure of the financial or economic interest required by section 144.6521.
(b) The commissioner shall not renew a license for a boarding care bed in a resident
room with more than four beds.
Sec. 37.
Minnesota Statutes 2018, section 144.6501, subdivision 7, is amended to read:
Subd. 7.
Consent to treatment.
An admission contract must not include a clause
requiring a resident to sign a consent to all treatment ordered by any physiciannew text begin or advanced
practice registered nursenew text end . An admission contract may require consent only for routine nursing
care or emergency care. An admission contract must contain a clause that informs the
resident of the right to refuse treatment.
Sec. 38.
Minnesota Statutes 2018, section 144.651, subdivision 7, is amended to read:
Subd. 7.
Physician'snew text begin or advanced practice registered nurse'snew text end identity.
Patients and
residents shall have or be given, in writing, the name, business address, telephone number,
and specialty, if any, of the physiciannew text begin or advanced practice registered nursenew text end responsible for
coordination of their care. In cases where it is medically inadvisable, as documented by the
attending physiciannew text begin or advanced practice registered nursenew text end in a patient's or resident's care
record, the information shall be given to the patient's or resident's guardian or other person
designated by the patient or resident as a representative.
Sec. 39.
Minnesota Statutes 2018, section 144.651, subdivision 8, is amended to read:
Subd. 8.
Relationship with other health services.
Patients and residents who receive
services from an outside provider are entitled, upon request, to be told the identity of the
provider. Residents shall be informed, in writing, of any health care services which are
provided to those residents by individuals, corporations, or organizations other than their
facility. Information shall include the name of the outside provider, the address, and a
description of the service which may be rendered. In cases where it is medically inadvisable,
as documented by the attending physiciannew text begin or advanced practice registered nursenew text end in a patient's
or resident's care record, the information shall be given to the patient's or resident's guardian
or other person designated by the patient or resident as a representative.
Sec. 40.
Minnesota Statutes 2018, section 144.651, subdivision 9, is amended to read:
Subd. 9.
Information about treatment.
Patients and residents shall be given by their
physiciansnew text begin or advanced practice registered nursesnew text end complete and current information
concerning their diagnosis, treatment, alternatives, risks, and prognosis as required by the
physician'snew text begin or advanced practice registered nurse'snew text end legal duty to disclose. This information
shall be in terms and language the patients or residents can reasonably be expected to
understand. Patients and residents may be accompanied by a family member or other chosen
representative, or both. This information shall include the likely medical or major
psychological results of the treatment and its alternatives. In cases where it is medically
inadvisable, as documented by the attending physiciannew text begin or advanced practice registered nursenew text end
in a patient's or resident's medical record, the information shall be given to the patient's or
resident's guardian or other person designated by the patient or resident as a representative.
Individuals have the right to refuse this information.
Every patient or resident suffering from any form of breast cancer shall be fully informed,
prior to or at the time of admission and during her stay, of all alternative effective methods
of treatment of which the treating physiciannew text begin or advanced practice registered nursenew text end is
knowledgeable, including surgical, radiological, or chemotherapeutic treatments or
combinations of treatments and the risks associated with each of those methods.
Sec. 41.
Minnesota Statutes 2018, section 144.651, subdivision 10, is amended to read:
Subd. 10.
Participation in planning treatment; notification of family members.
(a)
Patients and residents shall have the right to participate in the planning of their health care.
This right includes the opportunity to discuss treatment and alternatives with individual
caregivers, the opportunity to request and participate in formal care conferences, and the
right to include a family member or other chosen representative, or both. In the event that
the patient or resident cannot be present, a family member or other representative chosen
by the patient or resident may be included in such conferences. A chosen representative
may include a doula of the patient's choice.
(b) If a patient or resident who enters a facility is unconscious or comatose or is unable
to communicate, the facility shall make reasonable efforts as required under paragraph (c)
to notify either a family member or a person designated in writing by the patient as the
person to contact in an emergency that the patient or resident has been admitted to the
facility. The facility shall allow the family member to participate in treatment planning,
unless the facility knows or has reason to believe the patient or resident has an effective
advance directive to the contrary or knows the patient or resident has specified in writing
that they do not want a family member included in treatment planning. After notifying a
family member but prior to allowing a family member to participate in treatment planning,
the facility must make reasonable efforts, consistent with reasonable medical practice, to
determine if the patient or resident has executed an advance directive relative to the patient
or resident's health care decisions. For purposes of this paragraph, "reasonable efforts"
include:
(1) examining the personal effects of the patient or resident;
(2) examining the medical records of the patient or resident in the possession of the
facility;
(3) inquiring of any emergency contact or family member contacted under this section
whether the patient or resident has executed an advance directive and whether the patient
or resident has a physiciannew text begin or advanced practice registered nursenew text end to whom the patient or
resident normally goes for care; and
(4) inquiring of the physiciannew text begin or advanced practice registered nursenew text end to whom the patient
or resident normally goes for care, if known, whether the patient or resident has executed
an advance directive. If a facility notifies a family member or designated emergency contact
or allows a family member to participate in treatment planning in accordance with this
paragraph, the facility is not liable to the patient or resident for damages on the grounds
that the notification of the family member or emergency contact or the participation of the
family member was improper or violated the patient's privacy rights.
(c) In making reasonable efforts to notify a family member or designated emergency
contact, the facility shall attempt to identify family members or a designated emergency
contact by examining the personal effects of the patient or resident and the medical records
of the patient or resident in the possession of the facility. If the facility is unable to notify
a family member or designated emergency contact within 24 hours after the admission, the
facility shall notify the county social service agency or local law enforcement agency that
the patient or resident has been admitted and the facility has been unable to notify a family
member or designated emergency contact. The county social service agency and local law
enforcement agency shall assist the facility in identifying and notifying a family member
or designated emergency contact. A county social service agency or local law enforcement
agency that assists a facility in implementing this subdivision is not liable to the patient or
resident for damages on the grounds that the notification of the family member or emergency
contact or the participation of the family member was improper or violated the patient's
privacy rights.
Sec. 42.
Minnesota Statutes 2018, section 144.651, subdivision 12, is amended to read:
Subd. 12.
Right to refuse care.
Competent patients and residents shall have the right
to refuse treatment based on the information required in subdivision 9. Residents who refuse
treatment, medication, or dietary restrictions shall be informed of the likely medical or major
psychological results of the refusal, with documentation in the individual medical record.
In cases where a patient or resident is incapable of understanding the circumstances but has
not been adjudicated incompetent, or when legal requirements limit the right to refuse
treatment, the conditions and circumstances shall be fully documented by the attending
physiciannew text begin or advanced practice registered nursenew text end in the patient's or resident's medical record.
Sec. 43.
Minnesota Statutes 2018, section 144.651, subdivision 14, is amended to read:
Subd. 14.
Freedom from maltreatment.
Patients and residents shall be free from
maltreatment as defined in the Vulnerable Adults Protection Act. "Maltreatment" means
conduct described in section 626.5572, subdivision 15, or the intentional and nontherapeutic
infliction of physical pain or injury, or any persistent course of conduct intended to produce
mental or emotional distress. Every patient and resident shall also be free from nontherapeutic
chemical and physical restraints, except in fully documented emergencies, or as authorized
in writing after examination by a patient's or resident's physiciannew text begin or advanced practice
registered nursenew text end for a specified and limited period of time, and only when necessary to
protect the resident from self-injury or injury to others.
Sec. 44.
Minnesota Statutes 2018, section 144.651, subdivision 31, is amended to read:
Subd. 31.
Isolation and restraints.
A minor patient who has been admitted to a
residential program as defined in section 253C.01 has the right to be free from physical
restraint and isolation except in emergency situations involving a likelihood that the patient
will physically harm the patient's self or others. These procedures may not be used for
disciplinary purposes, to enforce program rules, or for the convenience of staff. Isolation
or restraint may be used only upon the prior authorization of a physician,new text begin advanced practice
registered nurse,new text end psychiatrist, or licensed psychologist, only when less restrictive measures
are ineffective or not feasible and only for the shortest time necessary.
Sec. 45.
Minnesota Statutes 2018, section 144.651, subdivision 33, is amended to read:
Subd. 33.
Restraints.
(a) Competent nursing home residents, family members of residents
who are not competent, and legally appointed conservators, guardians, and health care agents
as defined under section 145C.01, have the right to request and consent to the use of a
physical restraint in order to treat the medical symptoms of the resident.
(b) Upon receiving a request for a physical restraint, a nursing home shall inform the
resident, family member, or legal representative of alternatives to and the risks involved
with physical restraint use. The nursing home shall provide a physical restraint to a resident
only upon receipt of a signed consent form authorizing restraint use and a written order
from the attending physiciannew text begin or advanced practice registered nursenew text end that contains statements
and determinations regarding medical symptoms and specifies the circumstances under
which restraints are to be used.
(c) A nursing home providing a restraint under paragraph (b) must:
(1) document that the procedures outlined in that paragraph have been followed;
(2) monitor the use of the restraint by the resident; and
(3) periodically, in consultation with the resident, the family, and the attending physiciannew text begin
or advanced practice registered nursenew text end , reevaluate the resident's need for the restraint.
(d) A nursing home shall not be subject to fines, civil money penalties, or other state or
federal survey enforcement remedies solely as the result of allowing the use of a physical
restraint as authorized in this subdivision. Nothing in this subdivision shall preclude the
commissioner from taking action to protect the health and safety of a resident if:
(1) the use of the restraint has jeopardized the health and safety of the resident; and
(2) the nursing home failed to take reasonable measures to protect the health and safety
of the resident.
(e) For purposes of this subdivision, "medical symptoms" include:
(1) a concern for the physical safety of the resident; and
(2) physical or psychological needs expressed by a resident. A resident's fear of falling
may be the basis of a medical symptom.
A written order from the attending physiciannew text begin or advanced practice registered nursenew text end that
contains statements and determinations regarding medical symptoms is sufficient evidence
of the medical necessity of the physical restraint.
(f) When determining nursing facility compliance with state and federal standards for
the use of physical restraints, the commissioner of health is bound by the statements and
determinations contained in the attending physician'snew text begin or advanced practice registered nurse'snew text end
order regarding medical symptoms. For purposes of this order, "medical symptoms" include
the request by a competent resident, family member of a resident who is not competent, or
legally appointed conservator, guardian, or health care agent as defined under section
145C.01, that the facility provide a physical restraint in order