Minnesota Legislature
SF 4
1st Engrossment - 82nd Legislature, 2001 1st Special Session (2001 - 2002) Posted on 12/15/2009 12:00am
KEY: stricken = removed, old language.
underscored = added, new language.
Current Version - 1st Engrossment
1.1 A bill for an act 1.2 relating to the operation of state government; 1.3 modifying provisions relating to health; health 1.4 department; health care; human services; human 1.5 services department; continuing care; consumer 1.6 information; long-term care; mental health and civil 1.7 commitment; assistance programs; nursing services 1.8 agencies; workforce and recruitment; child welfare and 1.9 foster care; child support licensing and licensing 1.10 background studies; vital statistics; patient 1.11 protection; criminal justice; driving while impaired; 1.12 appropriating money for health and human services and 1.13 criminal justice; amending Minnesota Statutes 2000, 1.14 sections 13.46, subdivision 4; 13.461, subdivision 17; 1.15 13B.06, subdivision 7; 15A.083, subdivision 4; 45.027, 1.16 subdivision 6; 62A.095, subdivision 1; 62A.48, 1.17 subdivision 4, by adding subdivisions; 62D.17, 1.18 subdivision 1; 62J.152, subdivision 8; 62J.38; 1.19 62J.451, subdivision 5; 62J.692, subdivision 7, by 1.20 adding a subdivision; 62M.02, subdivision 21; 62Q.56; 1.21 62Q.58; 62S.01, by adding subdivisions; 62S.26; 1.22 103I.101, subdivision 6; 103I.112; 103I.208, 1.23 subdivisions 1, 2; 103I.235, subdivision 1; 103I.525, 1.24 subdivisions 2, 6, 8, 9; 103I.531, subdivisions 2, 6, 1.25 8, 9; 103I.535, subdivisions 2, 6, 8, 9; 103I.541, 1.26 subdivisions 2b, 4, 5; 103I.545; 116L.11, subdivision 1.27 4; 116L.12, subdivisions 4, 5; 116L.13, subdivision 1; 1.28 121A.15, by adding subdivisions; 135A.14, by adding a 1.29 subdivision; 137.38, subdivision 1; 144.057; 144.0721, 1.30 subdivision 1; 144.1202, subdivision 4; 144.122; 1.31 144.1464; 144.148, subdivision 2; 144.1491, 1.32 subdivision 1; 144.212, subdivisions 2a, 3, 5, 7, 8, 1.33 9, 11; 144.214, subdivisions 1, 3, 4; 144.215, 1.34 subdivisions 1, 3, 4, 6, 7; 144.217; 144.218; 144.221, 1.35 subdivisions 1, 3; 144.222, subdivision 2; 144.223; 1.36 144.225, subdivisions 1, 2, 2a, 3, 7, as amended; 1.37 144.226, subdivisions 1, 3, 4; 144.227; 144.395, 1.38 subdivision 2; 144.551, subdivision 1; 144.98, 1.39 subdivision 3; 144A.071, subdivisions 1, 1a, 2, 4a; 1.40 144A.073, subdivisions 2, as amended, 4; 144A.44, 1.41 subdivision 1; 144A.4605, subdivision 4; 144D.03, 1.42 subdivision 2; 144D.04, subdivisions 2, 3; 144D.06; 1.43 145.881, subdivision 2; 145A.15, subdivision 1, by 1.44 adding a subdivision; 145A.16, subdivision 1, by 1.45 adding a subdivision; 148.212; 148.284; 148B.21, 1.46 subdivision 6a; 148B.22, subdivision 3; 150A.10, by 2.1 adding a subdivision; 157.16, subdivision 3; 157.22, 2.2 as amended; 169A.07; 169A.20, subdivision 3; 169A.25; 2.3 169A.26; 169A.27; 169A.275; 169A.283, subdivision 1; 2.4 169A.40, subdivision 3; 169A.63, subdivision 1; 2.5 171.29, subdivision 2; 214.104; 241.272, subdivision 2.6 6; 241.32, by adding a subdivision; 241.45; 242.192; 2.7 243.51, subdivisions 1, 3; 245.462, subdivisions 8, 2.8 18, by adding subdivisions; 245.474, by adding a 2.9 subdivision; 245.4871, subdivisions 10, 27, by adding 2.10 a subdivision; 245.4875, subdivision 2; 245.4876, 2.11 subdivision 1, by adding a subdivision; 245.488, by 2.12 adding a subdivision; 245.4885, subdivision 1; 2.13 245.4886, subdivision 1; 245.814, subdivision 1; 2.14 245.99, subdivision 4; 245A.02, subdivisions 1, 9, by 2.15 adding a subdivision; 245A.03, subdivisions 2, 2b, by 2.16 adding a subdivision; 245A.035, subdivision 1; 2.17 245A.04, subdivisions 3, 3a, 3b, 3c, 3d, 6, 11, by 2.18 adding a subdivision; 245A.05; 245A.06; 245A.07; 2.19 245A.08; 245A.13, subdivisions 7, 8; 245A.16, 2.20 subdivision 1; 245B.08, subdivision 3; 252.275, 2.21 subdivision 4b; 252A.02, subdivisions 12, 13, by 2.22 adding a subdivision; 252A.111, subdivision 6; 2.23 252A.16, subdivision 1; 252A.19, subdivision 2; 2.24 252A.20, subdivision 1; 253B.02, subdivisions 10, 13; 2.25 253B.03, subdivisions 5, 10, by adding a subdivision; 2.26 253B.04, subdivisions 1, 1a, by adding a subdivision; 2.27 253B.045, subdivision 6; 253B.05, subdivision 1; 2.28 253B.065, subdivision 5; 253B.066, subdivision 1; 2.29 253B.07, subdivisions 1, 2, 7; 253B.09, subdivision 1; 2.30 253B.10, subdivision 4; 254B.02, subdivision 3; 2.31 254B.03, subdivision 1; 254B.04, subdivision 1; 2.32 254B.09, by adding a subdivision; 256.01, subdivisions 2.33 2, as amended, 18, by adding a subdivision; 256.045, 2.34 subdivisions 3, 3b, 4; 256.476, subdivisions 1, 2, 3, 2.35 4, 5, 8, by adding a subdivision; 256.741, 2.36 subdivisions 1, 5, 8; 256.955, subdivisions 2a, 2b; 2.37 256.9657, subdivision 2; 256.969, subdivision 3a, by 2.38 adding a subdivision; 256.975, by adding subdivisions; 2.39 256.979, subdivisions 5, 6; 256.98, subdivision 8; 2.40 256B.04, by adding a subdivision; 256B.055, 2.41 subdivision 3a; 256B.056, subdivisions 1a, 3, 4, 4b, 2.42 5, by adding subdivisions; 256B.057, subdivisions 2, 2.43 3, 7, 9, by adding a subdivision; 256B.0625, 2.44 subdivisions 3b, 7, 13, 13a, 17, 17a, 18a, 19a, 19c, 2.45 20, 30, 34, by adding subdivisions; 256B.0627, 2.46 subdivisions 1, 2, 4, 5, 7, 8, 10, 11, by adding 2.47 subdivisions; 256B.0635, subdivisions 1, 2; 256B.0644; 2.48 256B.0911, subdivisions 1, 3, 5, 6, 7, by adding 2.49 subdivisions; 256B.0913, subdivisions 1, 2, 4, 5, 6, 2.50 7, 8, 9, 10, 11, 12, 13, 14; 256B.0915, subdivisions 2.51 1d, 3, 5; 256B.0916, subdivisions 7, 9, by adding a 2.52 subdivision; 256B.0917, subdivision 7, by adding a 2.53 subdivision; 256B.092, subdivision 5; 256B.093, 2.54 subdivision 3; 256B.095; 256B.0951, subdivisions 1, 3, 2.55 4, 5, 7, by adding subdivisions; 256B.0952, 2.56 subdivisions 1, 4; 256B.19, subdivision 1c; 256B.431, 2.57 subdivisions 2e, 17, by adding subdivisions; 256B.433, 2.58 subdivision 3a; 256B.434, subdivision 4, by adding 2.59 subdivisions; 256B.49, by adding subdivisions; 2.60 256B.5012, by adding a subdivision; 256B.69, 2.61 subdivisions 4, 5c, 23, by adding a subdivision; 2.62 256B.75; 256B.76; 256D.03, subdivision 3; 256D.053, 2.63 subdivision 1; 256D.35, by adding subdivisions; 2.64 256D.425, subdivision 1; 256D.44, subdivision 5; 2.65 256I.05, subdivisions 1d, 1e, by adding a subdivision; 2.66 256J.08, subdivision 55a, by adding a subdivision; 2.67 256J.09, subdivisions 1, 2, 3, by adding subdivisions; 2.68 256J.21, subdivision 2; 256J.24, subdivisions 2, 9, 2.69 10; 256J.26, subdivision 1; 256J.31, subdivisions 4, 2.70 12; 256J.32, subdivisions 4, 7a; 256J.37, subdivision 2.71 9; 256J.39, subdivision 2; 256J.42, subdivisions 1, 3, 3.1 4, by adding a subdivision; 256J.45, subdivisions 1, 3.2 2; 256J.46, subdivisions 1, 2a; 256J.48, by adding a 3.3 subdivision; 256J.49, subdivisions 2, 13, by adding a 3.4 subdivision; 256J.50, subdivisions 1, 7, 10, by adding 3.5 a subdivision; 256J.515; 256J.52, subdivisions 2, 6; 3.6 256J.53, subdivision 1; 256J.56; 256J.57, subdivision 3.7 2; 256J.62, subdivisions 2a, 9; 256J.625, subdivisions 3.8 1, 2, 4; 256J.645; 256J.751; 256K.03, subdivision 1; 3.9 256K.07; 256K.25, subdivisions 1, 3, 4, 5, 6; 256L.03, 3.10 by adding a subdivision; 256L.05, subdivision 2; 3.11 256L.06, subdivision 3; 256L.07, subdivision 2; 3.12 256L.12, by adding a subdivision; 256L.15, subdivision 3.13 1; 256L.16; 256L.17, subdivision 2; 257.0725; 3.14 260C.201, subdivision 1, as amended; 260C.301, 3.15 subdivision 3, as amended; 260C.317, subdivision 4; 3.16 261.062; 268.0122, subdivision 2; 326.38; 357.021, 3.17 subdivisions 6, 7; 393.07, by adding a subdivision; 3.18 518.5513, subdivision 5; 518.575, subdivision 1; 3.19 518.5851, by adding a subdivision; 518.5853, by adding 3.20 a subdivision; 518.6111, subdivision 5; 518.6195; 3.21 518.64, subdivision 2, as amended; 518.641, 3.22 subdivisions 1, 2, 3, by adding a subdivision; 3.23 548.091, subdivision 1a; 611.23; 626.556, subdivisions 3.24 10, as amended, 10b, 10d, as amended, 10e, 10f, 10i, 3.25 as amended, 11, 12; 626.557, subdivisions 3, 9d, 12b; 3.26 626.5572, subdivision 17; 626.559, subdivision 2; Laws 3.27 1995, chapter 178, article 2, section 36; Laws 1995, 3.28 chapter 207, article 3, section 21, as amended; Laws 3.29 1997, chapter 203, article 9, section 21, as amended; 3.30 Laws 1999, chapter 152, section 1; Laws 1999, chapter 3.31 152, section 4; Laws 1999, chapter 245, article 3, 3.32 section 45, as amended; Laws 1999, chapter 245, 3.33 article 4, section 110; Laws 1999, chapter 245, 3.34 article 10, section 10, as amended; Laws 2000, chapter 3.35 364, section 2; Laws 2001, chapter 154, section 1, 3.36 subdivision 1; Laws 2001, chapter 161, section 45; 3.37 proposing coding for new law in Minnesota Statutes, 3.38 chapters 62D; 62Q; 62S; 116L; 144; 144A; 145; 145A; 3.39 169A; 214; 244; 245A; 246; 256; 256B; 256I; 256J; 3.40 299A; 325F; repealing Minnesota Statutes 2000, 3.41 sections 116L.12, subdivisions 2, 7; 121A.15, 3.42 subdivision 6; 144.148, subdivision 8; 144.1761; 3.43 144.217, subdivision 4; 144.219; 144A.16; 145.9245; 3.44 145.927; 252A.111, subdivision 3; 256.476, subdivision 3.45 7; 256B.0635, subdivision 3; 256B.0911, subdivisions 3.46 2, 2a, 4, 9; 256B.0912; 256B.0913, subdivisions 3, 3.47 15a, 15b, 15c, 16; 256B.0915, subdivisions 3a, 3b, 3c; 3.48 256B.0951, subdivision 6; 256B.19, subdivision 1b; 3.49 256B.434, subdivision 5; 256B.49, subdivisions 1, 2, 3.50 3, 4, 5, 6, 7, 8, 9, 10; 256D.066; 256J.08, 3.51 subdivision 50a; 256J.12, subdivision 3; 256J.43; 3.52 256J.44; 256J.46, subdivision 1a; 256J.49, subdivision 3.53 11; 256J.53, subdivision 4; 256L.02, subdivision 4; 3.54 518.641, subdivisions 4, 5; Laws 1995, chapter 178, 3.55 article 2, section 48, subdivision 6; Minnesota Rules, 3.56 parts 4655.6810; 4655.6820; 4655.6830; 4658.1600; 3.57 4658.1605; 4658.1610; 4658.1690; 9505.2390; 9505.2395; 3.58 9505.2396; 9505.2400; 9505.2405; 9505.2410; 9505.2413; 3.59 9505.2415; 9505.2420; 9505.2425; 9505.2426; 9505.2430; 3.60 9505.2435; 9505.2440; 9505.2445; 9505.2450; 9505.2455; 3.61 9505.2458; 9505.2460; 9505.2465; 9505.2470; 9505.2473; 3.62 9505.2475; 9505.2480; 9505.2485; 9505.2486; 9505.2490; 3.63 9505.2495; 9505.2496; 9505.2500; 9505.3010; 9505.3015; 3.64 9505.3020; 9505.3025; 9505.3030; 9505.3035; 9505.3040; 3.65 9505.3065; 9505.3085; 9505.3135; 9505.3500; 9505.3510; 3.66 9505.3520; 9505.3530; 9505.3535; 9505.3540; 9505.3545; 3.67 9505.3550; 9505.3560; 9505.3570; 9505.3575; 9505.3580; 3.68 9505.3585; 9505.3600; 9505.3610; 9505.3620; 9505.3622; 3.69 9505.3624; 9505.3626; 9505.3630; 9505.3635; 9505.3640; 3.70 9505.3645; 9505.3650; 9505.3660; 9505.3670; 9543.3000; 3.71 9543.3010; 9543.3020; 9543.3030; 9543.3040; 9543.3050; 4.1 9543.3060; 9543.3080; 9543.3090; 9546.0010; 9546.0020; 4.2 9546.0030; 9546.0040; 9546.0050; 9546.0060. 4.3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MINNESOTA: 4.4 ARTICLE 1 4.5 DEPARTMENT OF HEALTH 4.6 Section 1. Minnesota Statutes 2000, section 62J.152, 4.7 subdivision 8, is amended to read: 4.8 Subd. 8. [REPEALER.] This section and sections 62J.15 and 4.9 62J.156 are repealed effective July 1,20012005. 4.10 Sec. 2. Minnesota Statutes 2000, section 62J.451, 4.11 subdivision 5, is amended to read: 4.12 Subd. 5. [HEALTH CARE ELECTRONIC DATA INTERCHANGE 4.13 SYSTEM.](a)The health data institute shall establish an 4.14 electronic data interchange system that electronically 4.15 transmits, collects, archives, and provides users of data with 4.16 the data necessary for their specific interests, in order to 4.17 promote a high quality, cost-effective, consumer-responsive 4.18 health care system. This public-private information system 4.19 shall be developed to make health care claims processing and 4.20 financial settlement transactions more efficient and to provide 4.21 an efficient, unobtrusive method for meeting the shared 4.22 electronic data interchange needs of consumers, group 4.23 purchasers, providers, and the state. 4.24(b) The health data institute shall operate the Minnesota4.25center for health care electronic data interchange established4.26in section 62J.57, and shall integrate the goals, objectives,4.27and activities of the center with those of the health data4.28institute's electronic data interchange system.4.29 Sec. 3. Minnesota Statutes 2000, section 103I.101, 4.30 subdivision 6, is amended to read: 4.31 Subd. 6. [FEES FOR VARIANCES.] The commissioner shall 4.32 charge a nonrefundable application fee of$120$150 to cover the 4.33 administrative cost of processing a request for a variance or 4.34 modification of rules adopted by the commissioner under this 4.35 chapter. 4.36 [EFFECTIVE DATE.] This section is effective July 1, 2002. 5.1 Sec. 4. Minnesota Statutes 2000, section 103I.112, is 5.2 amended to read: 5.3 103I.112 [FEE EXEMPTIONS FOR STATE AND LOCAL GOVERNMENT.] 5.4 (a) The commissioner of health may not charge fees required 5.5 under this chapter to a federal agency, state agency, or a local 5.6 unit of government or to a subcontractor performing work for the 5.7 state agency or local unit of government. 5.8 (b) "Local unit of government" means a statutory or home 5.9 rule charter city, town, county, or soil and water conservation 5.10 district, watershed district, an organization formed for the 5.11 joint exercise of powers under section 471.59, a board of health 5.12 or community health board, or other special purpose district or 5.13 authority with local jurisdiction in water and related land 5.14 resources management. 5.15 [EFFECTIVE DATE.] This section is effective July 1, 2002. 5.16 Sec. 5. Minnesota Statutes 2000, section 103I.208, 5.17 subdivision 1, is amended to read: 5.18 Subdivision 1. [WELL NOTIFICATION FEE.] The well 5.19 notification fee to be paid by a property owner is: 5.20 (1) for a new well,$120$150, which includes the state 5.21 core function fee; 5.22 (2) for a well sealing,$20$30 for each well, which 5.23 includes the state core function fee, except that for monitoring 5.24 wells constructed on a single property, having depths within a 5.25 25 foot range, and sealed within 48 hours of start of 5.26 construction, a single fee of$20$30; and 5.27 (3) for construction of a dewatering well,$120$150, which 5.28 includes the state core function fee, for each well except a 5.29 dewatering project comprising five or more wells shall be 5.30 assessed a single fee of$600$750 for the wells recorded on the 5.31 notification. 5.32 [EFFECTIVE DATE.] This section is effective July 1, 2002. 5.33 Sec. 6. Minnesota Statutes 2000, section 103I.208, 5.34 subdivision 2, is amended to read: 5.35 Subd. 2. [PERMIT FEE.] The permit fee to be paid by a 5.36 property owner is: 6.1 (1) for a well that is not in use under a maintenance 6.2 permit,$100$125 annually; 6.3 (2) for construction of a monitoring well,$120$150, which 6.4 includes the state core function fee; 6.5 (3) for a monitoring well that is unsealed under a 6.6 maintenance permit,$100$125 annually; 6.7 (4) for monitoring wells used as a leak detection device at 6.8 a single motor fuel retail outlet, a single petroleum bulk 6.9 storage site excluding tank farms, or a single agricultural 6.10 chemical facility site, the construction permit fee 6.11 is$120$150, which includes the state core function fee, per 6.12 site regardless of the number of wells constructed on the site, 6.13 and the annual fee for a maintenance permit for unsealed 6.14 monitoring wells is$100$125 per site regardless of the number 6.15 of monitoring wells located on site; 6.16 (5) for a groundwater thermal exchange device, in addition 6.17 to the notification fee for wells,$120$150, which includes the 6.18 state core function fee; 6.19 (6) for a vertical heat exchanger,$120$150; 6.20 (7) for a dewatering well that is unsealed under a 6.21 maintenance permit,$100$125 annually for each well, except a 6.22 dewatering project comprising more than five wells shall be 6.23 issued a single permit for$500$625 annually for wells recorded 6.24 on the permit; and 6.25 (8) for excavating holes for the purpose of installing 6.26 elevator shafts,$120$150 for each hole. 6.27 [EFFECTIVE DATE.] This section is effective July 1, 2002. 6.28 Sec. 7. Minnesota Statutes 2000, section 103I.235, 6.29 subdivision 1, is amended to read: 6.30 Subdivision 1. [DISCLOSURE OF WELLS TO BUYER.] (a) Before 6.31 signing an agreement to sell or transfer real property, the 6.32 seller must disclose in writing to the buyer information about 6.33 the status and location of all known wells on the property, by 6.34 delivering to the buyer either a statement by the seller that 6.35 the seller does not know of any wells on the property, or a 6.36 disclosure statement indicating the legal description and 7.1 county, and a map drawn from available information showing the 7.2 location of each well to the extent practicable. In the 7.3 disclosure statement, the seller must indicate, for each well, 7.4 whether the well is in use, not in use, or sealed. 7.5 (b) At the time of closing of the sale, the disclosure 7.6 statement information, name and mailing address of the buyer, 7.7 and the quartile, section, township, and range in which each 7.8 well is located must be provided on a well disclosure 7.9 certificate signed by the seller or a person authorized to act 7.10 on behalf of the seller. 7.11 (c) A well disclosure certificate need not be provided if 7.12 the seller does not know of any wells on the property and the 7.13 deed or other instrument of conveyance contains the statement: 7.14 "The Seller certifies that the Seller does not know of any wells 7.15 on the described real property." 7.16 (d) If a deed is given pursuant to a contract for deed, the 7.17 well disclosure certificate required by this subdivision shall 7.18 be signed by the buyer or a person authorized to act on behalf 7.19 of the buyer. If the buyer knows of no wells on the property, a 7.20 well disclosure certificate is not required if the following 7.21 statement appears on the deed followed by the signature of the 7.22 grantee or, if there is more than one grantee, the signature of 7.23 at least one of the grantees: "The Grantee certifies that the 7.24 Grantee does not know of any wells on the described real 7.25 property." The statement and signature of the grantee may be on 7.26 the front or back of the deed or on an attached sheet and an 7.27 acknowledgment of the statement by the grantee is not required 7.28 for the deed to be recordable. 7.29 (e) This subdivision does not apply to the sale, exchange, 7.30 or transfer of real property: 7.31 (1) that consists solely of a sale or transfer of severed 7.32 mineral interests; or 7.33 (2) that consists of an individual condominium unit as 7.34 described in chapters 515 and 515B. 7.35 (f) For an area owned in common under chapter 515 or 515B 7.36 the association or other responsible person must report to the 8.1 commissioner by July 1, 1992, the location and status of all 8.2 wells in the common area. The association or other responsible 8.3 person must notify the commissioner within 30 days of any change 8.4 in the reported status of wells. 8.5 (g) For real property sold by the state under section 8.6 92.67, the lessee at the time of the sale is responsible for 8.7 compliance with this subdivision. 8.8 (h) If the seller fails to provide a required well 8.9 disclosure certificate, the buyer, or a person authorized to act 8.10 on behalf of the buyer, may sign a well disclosure certificate 8.11 based on the information provided on the disclosure statement 8.12 required by this section or based on other available information. 8.13 (i) A county recorder or registrar of titles may not record 8.14 a deed or other instrument of conveyance dated after October 31, 8.15 1990, for which a certificate of value is required under section 8.16 272.115, or any deed or other instrument of conveyance dated 8.17 after October 31, 1990, from a governmental body exempt from the 8.18 payment of state deed tax, unless the deed or other instrument 8.19 of conveyance contains the statement made in accordance with 8.20 paragraph (c) or (d) or is accompanied by the well disclosure 8.21 certificate containing all the information required by paragraph 8.22 (b) or (d). The county recorder or registrar of titles must not 8.23 accept a certificate unless it contains all the required 8.24 information. The county recorder or registrar of titles shall 8.25 note on each deed or other instrument of conveyance accompanied 8.26 by a well disclosure certificate that the well disclosure 8.27 certificate was received. The notation must include the 8.28 statement "No wells on property" if the disclosure certificate 8.29 states there are no wells on the property. The well disclosure 8.30 certificate shall not be filed or recorded in the records 8.31 maintained by the county recorder or registrar of titles. After 8.32 noting "No wells on property" on the deed or other instrument of 8.33 conveyance, the county recorder or registrar of titles shall 8.34 destroy or return to the buyer the well disclosure certificate. 8.35 The county recorder or registrar of titles shall collect from 8.36 the buyer or the person seeking to record a deed or other 9.1 instrument of conveyance, a fee of$20$30 for receipt of a 9.2 completed well disclosure certificate. By the tenth day of each 9.3 month, the county recorder or registrar of titles shall transmit 9.4 the well disclosure certificates to the commissioner of health. 9.5 By the tenth day after the end of each calendar quarter, the 9.6 county recorder or registrar of titles shall transmit to the 9.7 commissioner of health$17.50$27.50 of the fee for each well 9.8 disclosure certificate received during the quarter. The 9.9 commissioner shall maintain the well disclosure certificate for 9.10 at least six years. The commissioner may store the certificate 9.11 as an electronic image. A copy of that image shall be as valid 9.12 as the original. 9.13 (j) No new well disclosure certificate is required under 9.14 this subdivision if the buyer or seller, or a person authorized 9.15 to act on behalf of the buyer or seller, certifies on the deed 9.16 or other instrument of conveyance that the status and number of 9.17 wells on the property have not changed since the last previously 9.18 filed well disclosure certificate. The following statement, if 9.19 followed by the signature of the person making the statement, is 9.20 sufficient to comply with the certification requirement of this 9.21 paragraph: "I am familiar with the property described in this 9.22 instrument and I certify that the status and number of wells on 9.23 the described real property have not changed since the last 9.24 previously filed well disclosure certificate." The 9.25 certification and signature may be on the front or back of the 9.26 deed or on an attached sheet and an acknowledgment of the 9.27 statement is not required for the deed or other instrument of 9.28 conveyance to be recordable. 9.29 (k) The commissioner in consultation with county recorders 9.30 shall prescribe the form for a well disclosure certificate and 9.31 provide well disclosure certificate forms to county recorders 9.32 and registrars of titles and other interested persons. 9.33 (l) Failure to comply with a requirement of this 9.34 subdivision does not impair: 9.35 (1) the validity of a deed or other instrument of 9.36 conveyance as between the parties to the deed or instrument or 10.1 as to any other person who otherwise would be bound by the deed 10.2 or instrument; or 10.3 (2) the record, as notice, of any deed or other instrument 10.4 of conveyance accepted for filing or recording contrary to the 10.5 provisions of this subdivision. 10.6 [EFFECTIVE DATE.] This section is effective July 1, 2002. 10.7 Sec. 8. Minnesota Statutes 2000, section 103I.525, 10.8 subdivision 2, is amended to read: 10.9 Subd. 2. [APPLICATION FEE.] The application fee for a well 10.10 contractor's license is$50$75. The commissioner may not act 10.11 on an application until the application fee is paid. 10.12 [EFFECTIVE DATE.] This section is effective July 1, 2002. 10.13 Sec. 9. Minnesota Statutes 2000, section 103I.525, 10.14 subdivision 6, is amended to read: 10.15 Subd. 6. [LICENSE FEE.] The fee for a well contractor's 10.16 license is $250, except the fee for an individual well 10.17 contractor's license is$50$75. 10.18 [EFFECTIVE DATE.] This section is effective July 1, 2002. 10.19 Sec. 10. Minnesota Statutes 2000, section 103I.525, 10.20 subdivision 8, is amended to read: 10.21 Subd. 8. [RENEWAL.] (a) A licensee must file an 10.22 application and a renewal application fee to renew the license 10.23 by the date stated in the license. 10.24 (b) The renewal application feeshall be set by the10.25commissioner under section 16A.1285for a well contractor's 10.26 license is $250. 10.27 (c) The renewal application must include information that 10.28 the applicant has met continuing education requirements 10.29 established by the commissioner by rule. 10.30 (d) At the time of the renewal, the commissioner must have 10.31 on file all properly completed well reports, well sealing 10.32 reports, reports of excavations to construct elevator shafts, 10.33 well permits, and well notifications for work conducted by the 10.34 licensee since the last license renewal. 10.35 [EFFECTIVE DATE.] This section is effective July 1, 2002. 10.36 Sec. 11. Minnesota Statutes 2000, section 103I.525, 11.1 subdivision 9, is amended to read: 11.2 Subd. 9. [INCOMPLETE OR LATE RENEWAL.] If a licensee fails 11.3 to submit all information required for renewal in subdivision 8 11.4 or submits the application and information after the required 11.5 renewal date: 11.6 (1) the licensee must includean additionala late feeset11.7by the commissionerof $75; and 11.8 (2) the licensee may not conduct activities authorized by 11.9 the well contractor's license until the renewal application, 11.10 renewal application fee, late fee, and all other information 11.11 required in subdivision 8 are submitted. 11.12 [EFFECTIVE DATE.] This section is effective July 1, 2002. 11.13 Sec. 12. Minnesota Statutes 2000, section 103I.531, 11.14 subdivision 2, is amended to read: 11.15 Subd. 2. [APPLICATION FEE.] The application fee for a 11.16 limited well/boring contractor's license is$50$75. The 11.17 commissioner may not act on an application until the application 11.18 fee is paid. 11.19 [EFFECTIVE DATE.] This section is effective July 1, 2002. 11.20 Sec. 13. Minnesota Statutes 2000, section 103I.531, 11.21 subdivision 6, is amended to read: 11.22 Subd. 6. [LICENSE FEE.] The fee for a limited well/boring 11.23 contractor's license is$50$75. 11.24 [EFFECTIVE DATE.] This section is effective July 1, 2002. 11.25 Sec. 14. Minnesota Statutes 2000, section 103I.531, 11.26 subdivision 8, is amended to read: 11.27 Subd. 8. [RENEWAL.] (a) A person must file an application 11.28 and a renewal application fee to renew the limited well/boring 11.29 contractor's license by the date stated in the license. 11.30 (b) The renewal application feeshall be set by the11.31commissioner under section 16A.1285for a limited well/boring 11.32 contractor's license is $75. 11.33 (c) The renewal application must include information that 11.34 the applicant has met continuing education requirements 11.35 established by the commissioner by rule. 11.36 (d) At the time of the renewal, the commissioner must have 12.1 on file all properly completed well sealing reports, well 12.2 permits, vertical heat exchanger permits, and well notifications 12.3 for work conducted by the licensee since the last license 12.4 renewal. 12.5 [EFFECTIVE DATE.] This section is effective July 1, 2002. 12.6 Sec. 15. Minnesota Statutes 2000, section 103I.531, 12.7 subdivision 9, is amended to read: 12.8 Subd. 9. [INCOMPLETE OR LATE RENEWAL.] If a licensee fails 12.9 to submit all information required for renewal in subdivision 8 12.10 or submits the application and information after the required 12.11 renewal date: 12.12 (1) the licensee must includean additionala late feeset12.13by the commissionerof $75; and 12.14 (2) the licensee may not conduct activities authorized by 12.15 the limited well/boring contractor's license until the renewal 12.16 application, renewal application fee, and late fee, and all 12.17 other information required in subdivision 8 are submitted. 12.18 [EFFECTIVE DATE.] This section is effective July 1, 2002. 12.19 Sec. 16. Minnesota Statutes 2000, section 103I.535, 12.20 subdivision 2, is amended to read: 12.21 Subd. 2. [APPLICATION FEE.] The application fee for an 12.22 elevator shaft contractor's license is$50$75. The 12.23 commissioner may not act on an application until the application 12.24 fee is paid. 12.25 [EFFECTIVE DATE.] This section is effective July 1, 2002. 12.26 Sec. 17. Minnesota Statutes 2000, section 103I.535, 12.27 subdivision 6, is amended to read: 12.28 Subd. 6. [LICENSE FEE.] The fee for an elevator shaft 12.29 contractor's license is$50$75. 12.30 [EFFECTIVE DATE.] This section is effective July 1, 2002. 12.31 Sec. 18. Minnesota Statutes 2000, section 103I.535, 12.32 subdivision 8, is amended to read: 12.33 Subd. 8. [RENEWAL.] (a) A person must file an application 12.34 and a renewal application fee to renew the license by the date 12.35 stated in the license. 12.36 (b) The renewal application feeshall be set by the13.1commissioner under section 16A.1285for an elevator shaft 13.2 contractor's license is $75. 13.3 (c) The renewal application must include information that 13.4 the applicant has met continuing education requirements 13.5 established by the commissioner by rule. 13.6 (d) At the time of renewal, the commissioner must have on 13.7 file all reports and permits for elevator shaft work conducted 13.8 by the licensee since the last license renewal. 13.9 [EFFECTIVE DATE.] This section is effective July 1, 2002. 13.10 Sec. 19. Minnesota Statutes 2000, section 103I.535, 13.11 subdivision 9, is amended to read: 13.12 Subd. 9. [INCOMPLETE OR LATE RENEWAL.] If a licensee fails 13.13 to submit all information required for renewal in subdivision 8 13.14 or submits the application and information after the required 13.15 renewal date: 13.16 (1) the licensee must includean additionala late feeset13.17by the commissionerof $75; and 13.18 (2) the licensee may not conduct activities authorized by 13.19 the elevator shaft contractor's license until the renewal 13.20 application, renewal application fee, and late fee, and all 13.21 other information required in subdivision 8 are submitted. 13.22 [EFFECTIVE DATE.] This section is effective July 1, 2002. 13.23 Sec. 20. Minnesota Statutes 2000, section 103I.541, 13.24 subdivision 2b, is amended to read: 13.25 Subd. 2b. [APPLICATION FEE.] The application fee for a 13.26 monitoring well contractor registration is$50$75. The 13.27 commissioner may not act on an application until the application 13.28 fee is paid. 13.29 [EFFECTIVE DATE.] This section is effective July 1, 2002. 13.30 Sec. 21. Minnesota Statutes 2000, section 103I.541, 13.31 subdivision 4, is amended to read: 13.32 Subd. 4. [RENEWAL.] (a) A person must file an application 13.33 and a renewal application fee to renew the registration by the 13.34 date stated in the registration. 13.35 (b) The renewal application feeshall be set by the13.36commissioner under section 16A.1285for a monitoring well 14.1 contractor's registration is $75. 14.2 (c) The renewal application must include information that 14.3 the applicant has met continuing education requirements 14.4 established by the commissioner by rule. 14.5 (d) At the time of the renewal, the commissioner must have 14.6 on file all well reports, well sealing reports, well permits, 14.7 and notifications for work conducted by the registered person 14.8 since the last registration renewal. 14.9 [EFFECTIVE DATE.] This section is effective July 1, 2002. 14.10 Sec. 22. Minnesota Statutes 2000, section 103I.541, 14.11 subdivision 5, is amended to read: 14.12 Subd. 5. [INCOMPLETE OR LATE RENEWAL.] If a registered 14.13 person submits a renewal application after the required renewal 14.14 date: 14.15 (1) the registered person must includean additionala late 14.16 feeset by the commissionerof $75; and 14.17 (2) the registered person may not conduct activities 14.18 authorized by the monitoring well contractor's registration 14.19 until the renewal application, renewal application fee, late 14.20 fee, and all other information required in subdivision 4 are 14.21 submitted. 14.22 [EFFECTIVE DATE.] This section is effective July 1, 2002. 14.23 Sec. 23. Minnesota Statutes 2000, section 103I.545, is 14.24 amended to read: 14.25 103I.545 [REGISTRATION OF DRILLING MACHINES REQUIRED.] 14.26 Subdivision 1. [DRILLING MACHINE.] (a) A person may not 14.27 use a drilling machine such as a cable tool, rotary tool, hollow 14.28 rod tool, or auger for a drilling activity requiring a license 14.29 or registration under this chapter unless the drilling machine 14.30 is registered with the commissioner. 14.31 (b) A person must apply for the registration on forms 14.32 prescribed by the commissioner and submit a$50$75 registration 14.33 fee. 14.34 (c) A registration is valid for one year. 14.35 Subd. 2. [PUMP HOIST.] (a) A person may not use a machine 14.36 such as a pump hoist for an activity requiring a license or 15.1 registration under this chapter to repair wells or borings, seal 15.2 wells or borings, or install pumps unless the machine is 15.3 registered with the commissioner. 15.4 (b) A person must apply for the registration on forms 15.5 prescribed by the commissioner and submit a$50$75 registration 15.6 fee. 15.7 (c) A registration is valid for one year. 15.8 [EFFECTIVE DATE.] This section is effective July 1, 2002. 15.9 Sec. 24. Minnesota Statutes 2000, section 121A.15, is 15.10 amended by adding a subdivision to read: 15.11 Subd. 3a. [DISCLOSURES REQUIRED.] (a) This paragraph 15.12 applies to any written information about immunization 15.13 requirements for enrollment in a school or child care facility 15.14 that: 15.15 (1) is provided to a person to be immunized or enrolling or 15.16 enrolled in a school or child care facility, or to the person's 15.17 parent or guardian if the person is under 18 years of age and 15.18 not emancipated; and 15.19 (2) is provided by the department of health; the department 15.20 of children, families, and learning; the department of human 15.21 services; an immunization provider; or a school or child care 15.22 facility. 15.23 Such written information must describe the exemptions from 15.24 immunizations permitted under subdivision 3, paragraphs (c) and 15.25 (d). The information on exemptions from immunizations provided 15.26 according to this paragraph must be in a font size at least 15.27 equal to the font size of the immunization requirements, in the 15.28 same font style as the immunization requirements, and on the 15.29 same page of the written document as the immunization 15.30 requirements. 15.31 (b) Before immunizing a person, an immunization provider 15.32 must provide the person, or the person's parent or guardian if 15.33 the person is under 18 years of age and not emancipated, with 15.34 the following information in writing: 15.35 (1) a list of the immunizations required for enrollment in 15.36 a school or child care facility; 16.1 (2) a description of the exemptions from immunizations 16.2 permitted under subdivision 3, paragraphs (c) and (d); 16.3 (3) a list of additional immunizations currently 16.4 recommended by the commissioner; and 16.5 (4) in accordance with federal law, a copy of the vaccine 16.6 information sheet from the federal Department of Health and 16.7 Human Services that lists possible adverse reactions to the 16.8 immunization to be provided. 16.9 Sec. 25. Minnesota Statutes 2000, section 121A.15, is 16.10 amended by adding a subdivision to read: 16.11 Subd. 12. [MODIFICATIONS TO SCHEDULE.] (a) The 16.12 commissioner of health may adopt modifications to the 16.13 immunization requirements of this section. A proposed 16.14 modification made under this subdivision must be part of the 16.15 current immunization recommendations of each of the following 16.16 organizations: the United States Public Health Service's 16.17 Advisory Committee on Immunization Practices, the American 16.18 Academy of Family Physicians, and the American Academy of 16.19 Pediatrics. In proposing a modification to the immunization 16.20 schedule, the commissioner must: 16.21 (1) consult with the commissioner of children, families, 16.22 and learning; the commissioner of human services; the chancellor 16.23 of the Minnesota state colleges and universities; and the 16.24 president of the University of Minnesota; and 16.25 (2) consider the following criteria: the epidemiology of 16.26 the disease, the morbidity and mortality rates for the disease, 16.27 the safety and efficacy of the vaccine, the cost of a 16.28 vaccination program, the cost of enforcing vaccination 16.29 requirements, and a cost-benefit analysis of the vaccination. 16.30 (b) Before a proposed modification may be adopted, the 16.31 commissioner must notify the chairs of the house and senate 16.32 committees with jurisdiction over health policy issues. If the 16.33 chairs of the relevant standing committees determine a public 16.34 hearing regarding the proposed modifications is in order, the 16.35 hearing must be scheduled within 60 days of receiving notice 16.36 from the commissioner. If a hearing is scheduled, the 17.1 commissioner may not adopt any proposed modifications until 17.2 after the hearing is held. 17.3 (c) The commissioner shall comply with the requirements of 17.4 chapter 14 regarding the adoption of any proposed modifications 17.5 to the immunization schedule. 17.6 (d) In addition to the publication requirements of chapter 17.7 14, the commissioner of health must inform all immunization 17.8 providers of any adopted modifications to the immunization 17.9 schedule in a timely manner. 17.10 Sec. 26. Minnesota Statutes 2000, section 135A.14, is 17.11 amended by adding a subdivision to read: 17.12 Subd. 7. [MODIFICATIONS TO SCHEDULE.] (a) The commissioner 17.13 of health may adopt modifications to the immunization 17.14 requirements of this section. A proposed modification made 17.15 under this subdivision must be part of the current immunization 17.16 recommendations of each of the following organizations: the 17.17 United States Public Health Service's Advisory Committee on 17.18 Immunization Practices, the American Academy of Family 17.19 Physicians, and the American Academy of Pediatrics. In 17.20 proposing a modification to the immunization schedule, the 17.21 commissioner must: 17.22 (1) consult with the commissioner of children, families, 17.23 and learning; the commissioner of human services; the chancellor 17.24 of the Minnesota state colleges and universities; and the 17.25 president of the University of Minnesota; and 17.26 (2) consider the following criteria: the epidemiology of 17.27 the disease, the morbidity and mortality rates for the disease, 17.28 the safety and efficacy of the vaccine, the cost of a 17.29 vaccination program, the cost of enforcing vaccination 17.30 requirements, and a cost-benefit analysis of the vaccination. 17.31 (b) Before a proposed modification may be adopted, the 17.32 commissioner must notify the chairs of the house and senate 17.33 committees with jurisdiction over health policy issues. If the 17.34 chairs of the relevant standing committees determine a public 17.35 hearing regarding the proposed modifications is in order, the 17.36 hearing must be scheduled within 60 days of receiving notice 18.1 from the commissioner. If a hearing is scheduled, the 18.2 commissioner may not adopt any proposed modifications until 18.3 after the hearing is held. 18.4 (c) The commissioner shall comply with the requirements of 18.5 chapter 14 regarding the adoption of any proposed modifications 18.6 to the immunization schedule. 18.7 (d) In addition to the publication requirements of chapter 18.8 14, the commissioner of health must inform all immunization 18.9 providers of any adopted modifications to the immunization 18.10 schedule in a timely manner. 18.11 Sec. 27. [144.0751] [HEALTH STANDARDS.] 18.12 (a) Safe drinking water or air quality standards 18.13 established or revised by the commissioner of health must: 18.14 (1) be based on scientifically acceptable, peer-reviewed 18.15 information; and 18.16 (2) include a reasonable margin of safety to adequately 18.17 protect the health of infants, children, and adults by taking 18.18 into consideration risks to each of the following health 18.19 outcomes: reproductive development and function, respiratory 18.20 function, immunologic suppression or hypersensitization, 18.21 development of the brain and nervous system, endocrine 18.22 (hormonal) function, cancer, general infant and child 18.23 development, and any other important health outcomes identified 18.24 by the commissioner. 18.25 (b) For purposes of this section, "peer-reviewed" means a 18.26 scientifically based review conducted by individuals with 18.27 substantial knowledge and experience in toxicology, health risk 18.28 assessment, or other related fields as determined by the 18.29 commissioner. 18.30 Sec. 28. Minnesota Statutes 2000, section 144.1202, 18.31 subdivision 4, is amended to read: 18.32 Subd. 4. [AGREEMENT; CONDITIONS OF IMPLEMENTATION.] (a) An 18.33 agreement entered into before August 2,20022003, must remain 18.34 in effect until terminated under the Atomic Energy Act of 1954, 18.35 United States Code, title 42, section 2021, paragraph (j). The 18.36 governor may not enter into an initial agreement with the 19.1 Nuclear Regulatory Commission after August 1,20022003. If an 19.2 agreement is not entered into by August 1,20022003, any rules 19.3 adopted under this section are repealed effective August 1,200219.4 2003. 19.5 (b) An agreement authorized under subdivision 1 must be 19.6 approved by law before it may be implemented. 19.7 Sec. 29. [144.1205] [RADIOACTIVE MATERIAL; SOURCE AND 19.8 SPECIAL NUCLEAR MATERIAL; FEES; INSPECTION.] 19.9 Subdivision 1. [APPLICATION AND LICENSE RENEWAL FEE.] When 19.10 a license is required for radioactive material or source or 19.11 special nuclear material by a rule adopted under section 19.12 144.1202, subdivision 2, an application fee according to 19.13 subdivision 4 must be paid upon initial application for a 19.14 license. The licensee must renew the license 60 days before the 19.15 expiration date of the license by paying a license renewal fee 19.16 equal to the application fee under subdivision 4. The 19.17 expiration date of a license is the date set by the United 19.18 States Nuclear Regulatory Commission before transfer of the 19.19 licensing program under section 144.1202 and thereafter as 19.20 specified by rule of the commissioner of health. 19.21 Subd. 2. [ANNUAL FEE.] A licensee must pay an annual fee 19.22 at least 60 days before the anniversary date of the issuance of 19.23 the license. The annual fee is an amount equal to 80 percent of 19.24 the application fee under subdivision 4, rounded to the nearest 19.25 whole dollar. 19.26 Subd. 3. [FEE CATEGORIES; INCORPORATION OF FEDERAL 19.27 LICENSING CATEGORIES.] (a) Fee categories under this section are 19.28 equivalent to the licensing categories used by the United States 19.29 Nuclear Regulatory Commission under Code of Federal Regulations, 19.30 title 10, parts 30 to 36, 39, 40, 70, 71, and 150, except as 19.31 provided in paragraph (b). 19.32 (b) The category of "Academic, small" is the type of 19.33 license required for the use of radioactive materials in a 19.34 teaching institution. Radioactive materials are limited to ten 19.35 radionuclides not to exceed a total activity amount of one curie. 19.36 Subd. 4. [APPLICATION FEE.] A licensee must pay an 20.1 application fee as follows: 20.2 Radioactive material, Application U.S. Nuclear Regulatory 20.3 source and fee Commission licensing 20.4 special material category as reference 20.6 Type A broadscope $20,000 Medical institution type A 20.7 Type B broadscope $15,000 Research and development 20.8 type B 20.9 Type C broadscope $10,000 Academic type C 20.10 Medical use $4,000 Medical 20.11 Medical institution 20.12 Medical private practice 20.13 Mobile nuclear 20.14 medical laboratory $4,000 Mobile medical laboratory 20.15 Medical special use 20.16 sealed sources $6,000 Teletherapy 20.17 High dose rate remote 20.18 afterloaders 20.19 Stereotactic 20.20 radiosurgery devices 20.21 In vitro testing $2,300 In vitro testing 20.22 laboratories 20.23 Measuring gauge, 20.24 sealed sources $2,000 Fixed gauges 20.25 Portable gauges 20.26 Analytical instruments 20.27 Measuring systems - other 20.28 Gas chromatographs $1,200 Gas chromatographs 20.29 Manufacturing and 20.30 distribution $14,700 Manufacturing and 20.31 distribution - other 20.32 Distribution only $8,800 Distribution of 20.33 radioactive material 20.34 for commercial use only 20.35 Other services $1,500 Other services 20.36 Nuclear medicine 21.1 pharmacy $4,100 Nuclear pharmacy 21.2 Waste disposal $9,400 Waste disposal service 21.3 prepackage 21.4 Waste disposal service 21.5 processing/repackage 21.6 Waste storage only $7,000 To receive and store 21.7 radioactive material waste 21.8 Industrial 21.9 radiography $8,400 Industrial radiography 21.10 fixed location 21.11 Industrial radiography 21.12 portable/temporary sites 21.13 Irradiator - 21.14 self-shielded $4,100 Irradiators self-shielded 21.15 less than 10,000 curies 21.16 Irradiator - 21.17 less than 10,000 Ci $7,500 Irradiators less than 21.18 10,000 curies 21.19 Irradiator - 21.20 more than 10,000 Ci $11,500 Irradiators greater than 21.21 10,000 curies 21.22 Research and 21.23 development, 21.24 no distribution $4,100 Research and development 21.25 Radioactive material 21.26 possession only $1,000 Byproduct possession only 21.27 Source material $1,000 Source material shielding 21.28 Special nuclear 21.29 material, less than 21.30 200 grams $1,000 Special nuclear material 21.31 plutonium-neutron sources 21.32 less than 200 grams 21.33 Pacemaker 21.34 manufacturing $1,000 Pacemaker byproduct 21.35 and/or special nuclear 21.36 material - medical 22.1 institution 22.2 General license 22.3 distribution $2,100 General license 22.4 distribution 22.5 General license 22.6 distribution, exempt $1,500 General license 22.7 distribution - 22.8 certain exempt items 22.9 Academic, small $1,000 Possession limit of ten 22.10 radionuclides, not to 22.11 exceed a total of one curie 22.12 of activity 22.13 Veterinary $2,000 Veterinary use 22.14 Well logging $5,000 Well logging 22.15 Subd. 5. [PENALTY FOR LATE PAYMENT.] An annual fee or a 22.16 license renewal fee submitted to the commissioner after the due 22.17 date specified by rule must be accompanied by an additional 22.18 amount equal to 25 percent of the fee due. 22.19 Subd. 6. [INSPECTIONS.] The commissioner of health shall 22.20 make periodic safety inspections of the radioactive material and 22.21 source and special nuclear material of a licensee. The 22.22 commissioner shall prescribe the frequency of safety inspections 22.23 by rule. 22.24 Subd. 7. [RECOVERY OF REINSPECTION COST.] If the 22.25 commissioner finds serious violations of public health standards 22.26 during an inspection under subdivision 6, the licensee must pay 22.27 all costs associated with subsequent reinspection of the 22.28 source. The costs shall be the actual costs incurred by the 22.29 commissioner and include, but are not limited to, labor, 22.30 transportation, per diem, materials, legal fees, testing, and 22.31 monitoring costs. 22.32 Subd. 8. [RECIPROCITY FEE.] A licensee submitting an 22.33 application for reciprocal recognition of a materials license 22.34 issued by another agreement state or the United States Nuclear 22.35 Regulatory Commission for a period of 180 days or less during a 22.36 calendar year must pay one-half of the application fee specified 23.1 under subdivision 4. For a period of 181 days or more, the 23.2 licensee must pay the entire application fee under subdivision 4. 23.3 Subd. 9. [FEES FOR LICENSE AMENDMENTS.] A licensee must 23.4 pay a fee to amend a license as follows: 23.5 (1) to amend a license requiring no license review 23.6 including, but not limited to, facility name change or removal 23.7 of a previously authorized user, no fee; 23.8 (2) to amend a license requiring review including, but not 23.9 limited to, addition of isotopes, procedure changes, new 23.10 authorized users, or a new radiation safety officer, $200; and 23.11 (3) to amend a license requiring review and a site visit 23.12 including, but not limited to, facility move or addition of 23.13 processes, $400. 23.14 [EFFECTIVE DATE.] This section is effective July 1, 2002. 23.15 Sec. 30. Minnesota Statutes 2000, section 144.122, is 23.16 amended to read: 23.17 144.122 [LICENSE, PERMIT, AND SURVEY FEES.] 23.18 (a) The state commissioner of health, by rule, may 23.19 prescribe reasonable procedures and fees for filing with the 23.20 commissioner as prescribed by statute and for the issuance of 23.21 original and renewal permits, licenses, registrations, and 23.22 certifications issued under authority of the commissioner. The 23.23 expiration dates of the various licenses, permits, 23.24 registrations, and certifications as prescribed by the rules 23.25 shall be plainly marked thereon. Fees may include application 23.26 and examination fees and a penalty fee for renewal applications 23.27 submitted after the expiration date of the previously issued 23.28 permit, license, registration, and certification. The 23.29 commissioner may also prescribe, by rule, reduced fees for 23.30 permits, licenses, registrations, and certifications when the 23.31 application therefor is submitted during the last three months 23.32 of the permit, license, registration, or certification period. 23.33 Fees proposed to be prescribed in the rules shall be first 23.34 approved by the department of finance. All fees proposed to be 23.35 prescribed in rules shall be reasonable. The fees shall be in 23.36 an amount so that the total fees collected by the commissioner 24.1 will, where practical, approximate the cost to the commissioner 24.2 in administering the program. All fees collected shall be 24.3 deposited in the state treasury and credited to the state 24.4 government special revenue fund unless otherwise specifically 24.5 appropriated by law for specific purposes. 24.6 (b) The commissioner may charge a fee for voluntary 24.7 certification of medical laboratories and environmental 24.8 laboratories, and for environmental and medical laboratory 24.9 services provided by the department, without complying with 24.10 paragraph (a) or chapter 14. Fees charged for environment and 24.11 medical laboratory services provided by the department must be 24.12 approximately equal to the costs of providing the services. 24.13 (c) The commissioner may develop a schedule of fees for 24.14 diagnostic evaluations conducted at clinics held by the services 24.15 for children with handicaps program. All receipts generated by 24.16 the program are annually appropriated to the commissioner for 24.17 use in the maternal and child health program. 24.18 (d) The commissioner, for fiscal years 1996 and beyond,24.19 shall set license fees for hospitals and nursing homes that are 24.20 not boarding care homes at the following levels: 24.21 Joint Commission on Accreditation of Healthcare 24.22 Organizations (JCAHO hospitals)$1,01724.23 $7,055 24.24 Non-JCAHO hospitals$762 plus $34 per bed24.25 $4,680 plus $234 per bed 24.26 Nursing home$78 plus $19 per bed24.27 $183 plus $91 per bed 24.28For fiscal years 1996 and beyond,The commissioner shall 24.29 set license fees for outpatient surgical centers, boarding care 24.30 homes, and supervised living facilities at the following levels: 24.31 Outpatient surgical centers$51724.32 $1,512 24.33 Boarding care homes$78 plus $19 per bed24.34 $183 plus $91 per bed 24.35 Supervised living facilities$78 plus $19 per bed24.36 $183 plus $91 per bed. 25.1 (e) Unless prohibited by federal law, the commissioner of 25.2 health shall charge applicants the following fees to cover the 25.3 cost of any initial certification surveys required to determine 25.4 a provider's eligibility to participate in the Medicare or 25.5 Medicaid program: 25.6 Prospective payment surveys for $ 900 25.7 hospitals 25.9 Swing bed surveys for nursing homes $1,200 25.11 Psychiatric hospitals $1,400 25.13 Rural health facilities $1,100 25.15 Portable X-ray providers $ 500 25.17 Home health agencies $1,800 25.19 Outpatient therapy agencies $ 800 25.21 End stage renal dialysis providers $2,100 25.23 Independent therapists $ 800 25.25 Comprehensive rehabilitation $1,200 25.26 outpatient facilities 25.28 Hospice providers $1,700 25.30 Ambulatory surgical providers $1,800 25.32 Hospitals $4,200 25.34 Other provider categories or Actual surveyor costs: 25.35 additional resurveys required average surveyor cost x 25.36 to complete initial certification number of hours for the 25.37 survey process. 25.38 These fees shall be submitted at the time of the 25.39 application for federal certification and shall not be 25.40 refunded. All fees collected after the date that the imposition 25.41 of fees is not prohibited by federal law shall be deposited in 25.42 the state treasury and credited to the state government special 25.43 revenue fund. 25.44 Sec. 31. Minnesota Statutes 2000, section 144.1464, is 25.45 amended to read: 25.46 144.1464 [SUMMER HEALTH CARE INTERNS.] 25.47 Subdivision 1. [SUMMER INTERNSHIPS.] The commissioner of 25.48 health, through a contract with a nonprofit organization as 25.49 required by subdivision 4, shall award grants to hospitalsand, 25.50 clinics, nursing facilities, and home care providers to 25.51 establish a secondary and post-secondary summer health care 26.1 intern program. The purpose of the program is to expose 26.2 interested secondary and post-secondary pupils to various 26.3 careers within the health care profession. 26.4 Subd. 2. [CRITERIA.] (a) The commissioner, through the 26.5 organization under contract, shall award grants to 26.6 hospitalsand, clinics, nursing facilities, and home care 26.7 providers that agree to: 26.8 (1) provide secondary and post-secondary summer health care 26.9 interns with formal exposure to the health care profession; 26.10 (2) provide an orientation for the secondary and 26.11 post-secondary summer health care interns; 26.12 (3) pay one-half the costs of employing the secondary and 26.13 post-secondary summer health care intern, based on an overall26.14hourly wage that is at least the minimum wage but does not26.15exceed $6 an hour; 26.16 (4) interview and hire secondary and post-secondary pupils 26.17 for a minimum of six weeks and a maximum of 12 weeks; and 26.18 (5) employ at least one secondary student for each 26.19 post-secondary student employed, to the extent that there are 26.20 sufficient qualifying secondary student applicants. 26.21 (b) In order to be eligible to be hired as a secondary 26.22 summer health intern by a hospitalor, clinic, nursing facility, 26.23 or home care provider, a pupil must: 26.24 (1) intend to complete high school graduation requirements 26.25 and be between the junior and senior year of high school; and 26.26 (2) be from a school district in proximity to the facility;26.27and26.28(3) provide the facility with a letter of recommendation26.29from a health occupations or science educator. 26.30 (c) In order to be eligible to be hired as a post-secondary 26.31 summer health care intern by a hospital or clinic, a pupil must: 26.32 (1) intend to complete a health care training program or a 26.33 two-year or four-year degree program and be planning on 26.34 enrolling in or be enrolled in that training program or degree 26.35 program; and 26.36 (2) be enrolled in a Minnesota educational institution or 27.1 be a resident of the state of Minnesota; priority must be given 27.2 to applicants from a school district or an educational 27.3 institution in proximity to the facility; and27.4(3) provide the facility with a letter of recommendation27.5from a health occupations or science educator. 27.6 (d) Hospitalsand, clinics, nursing facilities, and home 27.7 care providers awarded grants may employ pupils as secondary and 27.8 post-secondary summer health care interns beginning on or after 27.9 June 15, 1993, if they agree to pay the intern, during the 27.10 period before disbursement of state grant money, with money 27.11 designated as the facility's 50 percent contribution towards 27.12 internship costs. 27.13 Subd. 3. [GRANTS.] The commissioner, through the 27.14 organization under contract, shall award separate grants to 27.15 hospitalsand, clinics, nursing facilities, and home care 27.16 providers meeting the requirements of subdivision 2. The grants 27.17 must be used to pay one-half of the costs of employing secondary 27.18 and post-secondary pupils in a hospitalor, clinic, nursing 27.19 facility, or home care setting during the course of the 27.20 program. No more than 50 percent of the participants may be 27.21 post-secondary students, unless the program does not receive 27.22 enough qualified secondary applicants per fiscal year. No more 27.23 than five pupils may be selected from any secondary or 27.24 post-secondary institution to participate in the program and no 27.25 more than one-half of the number of pupils selected may be from 27.26 the seven-county metropolitan area. 27.27 Subd. 4. [CONTRACT.] The commissioner shall contract with 27.28 a statewide, nonprofit organization representing facilities at 27.29 which secondary and post-secondary summer health care interns 27.30 will serve, to administer the grant program established by this 27.31 section. Grant funds that are not used in one fiscal year may 27.32 be carried over to the next fiscal year. The organization 27.33 awarded the grant shall provide the commissioner with any 27.34 information needed by the commissioner to evaluate the program, 27.35 in the form and at the times specified by the commissioner. 27.36 Sec. 32. Minnesota Statutes 2000, section 144.148, 28.1 subdivision 2, is amended to read: 28.2 Subd. 2. [PROGRAM.] (a) The commissioner of health shall 28.3 award rural hospital capital improvement grants to eligible 28.4 rural hospitals. Except as provided in paragraph (b), a grant 28.5 shall not exceed$300,000$500,000 per hospital. Prior to the 28.6 receipt of any grant, the hospital must certify to the 28.7 commissioner that at least one-quarter of the grant amount, 28.8 which may include in-kind services, is available for the same 28.9 purposes from nonstate resources. 28.10 (b) A grant shall not exceed $1,500,000 per eligible rural 28.11 hospital that also satisfies the following criteria: 28.12 (1) is the only hospital in a county; 28.13 (2) has 25 or fewer licensed hospital beds with a net 28.14 hospital operating margin not greater than an average of two 28.15 percent over the three fiscal years prior to application; 28.16 (3) is located in a medically underserved community (MUC) 28.17 or a health professional shortage area (HPSA); 28.18 (4) is located near a migrant worker employment site and 28.19 regularly treats significant numbers of migrant workers and 28.20 their families; and 28.21 (5) has not previously received a grant under this section 28.22 prior to July 1, 1999. 28.23 Sec. 33. [144.1499] [PROMOTION OF HEALTH CARE AND 28.24 LONG-TERM CARE CAREERS.] 28.25 The commissioner of health, in consultation with an 28.26 organization representing health care employers, long-term care 28.27 employers, and educational institutions, may make grants to 28.28 qualifying consortia as defined in section 116L.11, subdivision 28.29 4, for intergenerational programs to encourage middle and high 28.30 school students to work and volunteer in health care and 28.31 long-term care settings. To qualify for a grant under this 28.32 section, a consortium shall: 28.33 (1) develop a health and long-term care careers curriculum 28.34 that provides career exploration and training in national skill 28.35 standards for health care and long-term care and that is 28.36 consistent with Minnesota graduation standards and other related 29.1 requirements; 29.2 (2) offer programs for high school students that provide 29.3 training in health and long-term care careers with credits that 29.4 articulate into post-secondary programs; and 29.5 (3) provide technical support to the participating health 29.6 care and long-term care employer to enable the use of the 29.7 employer's facilities and programs for kindergarten to grade 12 29.8 health and long-term care careers education. 29.9 Sec. 34. [144.1502] [DENTISTS LOAN FORGIVENESS.] 29.10 Subdivision 1. [DEFINITION.] For purposes of this section, 29.11 "qualifying educational loans" means government, commercial, and 29.12 foundation loans for actual costs paid for tuition, reasonable 29.13 education expenses, and reasonable living expenses related to 29.14 the graduate or undergraduate education of a dentist. 29.15 Subd. 2. [CREATION OF ACCOUNT; LOAN FORGIVENESS 29.16 PROGRAM.] A dentist education account is established in the 29.17 general fund. The commissioner of health shall use money from 29.18 the account to establish a loan forgiveness program for dentists 29.19 who agree to care for substantial numbers of state public 29.20 program participants and other low- to moderate-income uninsured 29.21 patients. 29.22 Subd. 3. [ELIGIBILITY.] To be eligible to participate in 29.23 the loan forgiveness program, a dental student must submit an 29.24 application to the commissioner of health while attending a 29.25 program of study designed to prepare the individual to become a 29.26 licensed dentist. For fiscal year 2002, applicants may have 29.27 graduated from a dentistry program in calendar year 2001. A 29.28 dental student who is accepted into the loan forgiveness program 29.29 must sign a contract to agree to serve a minimum three-year 29.30 service obligation during which at least 25 percent of the 29.31 dentist's yearly patient encounters are delivered to state 29.32 public program enrollees or patients receiving sliding fee 29.33 schedule discounts through a formal sliding fee schedule meeting 29.34 the standards established by the United States Department of 29.35 Health and Human Services under Code of Federal Regulations, 29.36 title 42, section 51, chapter 303. The service obligation shall 30.1 begin no later than March 31 of the first year following 30.2 completion of training. If fewer applications are submitted by 30.3 dental students than there are participant slots available, the 30.4 commissioner may consider applications submitted by dental 30.5 program graduates who are licensed dentists. Dentists selected 30.6 for loan forgiveness must comply with all terms and conditions 30.7 of this section. 30.8 Subd. 4. [LOAN FORGIVENESS.] The commissioner of health 30.9 may accept up to 14 applicants per year for participation in the 30.10 loan forgiveness program. Applicants are responsible for 30.11 securing their own loans. The commissioner shall select 30.12 participants based on their suitability for practice serving 30.13 public program patients, as indicated by experience or 30.14 training. The commissioner shall give preference to applicants 30.15 who have attended a Minnesota dentistry educational institution 30.16 and to applicants closest to completing their training. For 30.17 each year that a participant meets the service obligation 30.18 required under subdivision 3, up to a maximum of four years, the 30.19 commissioner shall make annual disbursements directly to the 30.20 participant equivalent to $10,000 per year of service, not to 30.21 exceed $40,000 or the balance of the qualifying educational 30.22 loans, whichever is less. Before receiving loan repayment 30.23 disbursements and as requested, the participant must complete 30.24 and return to the commissioner an affidavit of practice form 30.25 provided by the commissioner verifying that the participant is 30.26 practicing as required under subdivision 3. The participant 30.27 must provide the commissioner with verification that the full 30.28 amount of loan repayment disbursement received by the 30.29 participant has been applied toward the designated loans. After 30.30 each disbursement, verification must be received by the 30.31 commissioner and approved before the next loan repayment 30.32 disbursement is made. Participants who move their practice 30.33 remain eligible for loan repayment as long as they practice as 30.34 required under subdivision 3. 30.35 Subd. 5. [PENALTY FOR NONFULFILLMENT.] If a participant 30.36 does not fulfill the service commitment under subdivision 3, the 31.1 commissioner of health shall collect from the participant 100 31.2 percent of any payments made for qualified educational loans and 31.3 interest at a rate established according to section 270.75. The 31.4 commissioner shall deposit the money collected in the dentist 31.5 education account established under subdivision 2. 31.6 Subd. 6. [SUSPENSION OR WAIVER OF OBLIGATION.] Payment or 31.7 service obligations cancel in the event of a participant's 31.8 death. The commissioner of health may waive or suspend payment 31.9 or service obligations in cases of total and permanent 31.10 disability or long-term temporary disability lasting for more 31.11 than two years. The commissioner shall evaluate all other 31.12 requests for suspension or waivers on a case-by-case basis and 31.13 may grant a waiver of all or part of the money owed as a result 31.14 of a nonfulfillment penalty if emergency circumstances prevented 31.15 fulfillment of the required service commitment. 31.16 Sec. 35. Minnesota Statutes 2000, section 144.226, 31.17 subdivision 4, is amended to read: 31.18 Subd. 4. [VITAL RECORDS SURCHARGE.] In addition to any fee 31.19 prescribed under subdivision 1, there is a nonrefundable 31.20 surcharge of$3$2 for each certified and noncertified birth or 31.21 death record, and for a certification that the record cannot be 31.22 found. The local or state registrar shall forward this amount 31.23 to the state treasurer to be deposited into the state government 31.24 special revenue fund. This surcharge shall not be charged under 31.25 those circumstances in which no fee for a birth or death record 31.26 is permitted under subdivision 1, paragraph (a).This surcharge31.27requirement expires June 30, 2002.31.28 Sec. 36. Minnesota Statutes 2000, section 144.395, 31.29 subdivision 2, is amended to read: 31.30 Subd. 2. [EXPENDITURES.] (a) Up to five percent of the 31.31 fair market value of the fund on the preceding July 1, must be 31.32 spent to reduce the human and economic consequences of tobacco 31.33 use among the youth of this state through state and local 31.34 tobacco prevention measures and efforts, and for other public 31.35 health initiatives. 31.36 (b) Notwithstanding paragraph (a), on January 1, 2000, up 32.1 to five percent of the fair market value of the fund is 32.2 appropriated to the commissioner of health to distribute as 32.3 grants under section 144.396, subdivisions 5 and 6, in 32.4 accordance with allocations in paragraph (c), clauses (1) and 32.5 (2). Up to $200,000 of this appropriation is available to the 32.6 commissioner to conduct the statewide assessments described in 32.7 section 144.396, subdivision 3. 32.8 (c) Beginning July 1, 2000, and on July 1 of each year 32.9 thereafter, the money in paragraph (a) is appropriated as 32.10 follows, except as provided in paragraphs (d) and (e): 32.11 (1) 67 percent to the commissioner of health to distribute 32.12 as grants under section 144.396, subdivision 5, to fund 32.13 statewide tobacco use prevention initiatives aimed at youth; 32.14 (2) 16.5 percent to the commissioner of health to 32.15 distribute as grants under section 144.396, subdivision 6, to 32.16 fund local public health initiatives aimed at tobacco use 32.17 prevention in coordination with other local health-related 32.18 efforts to achieve measurable improvements in health among 32.19 youth; and 32.20 (3) 16.5 percent to the commissioner of health to 32.21 distribute in accordance with section 144.396, subdivision 7. 32.22 (d) A maximum of $150,000 of each annual appropriation to 32.23 the commissioner of health in paragraphs (b) and (c) may be used 32.24 by the commissioner for administrative expenses associated with 32.25 implementing this section. 32.26 (e) Beginning July 1, 2001,$1,100,000$1,250,000 of each 32.27 annual appropriation to the commissioner under paragraph (c), 32.28 clause (1), may be used to provide base level funding for the 32.29 commissioner's tobacco prevention and control programs and 32.30 activities. This appropriation must occur before any other 32.31 appropriation under this subdivision. 32.32 Sec. 37. Minnesota Statutes 2000, section 144.551, 32.33 subdivision 1, is amended to read: 32.34 Subdivision 1. [RESTRICTED CONSTRUCTION OR MODIFICATION.] 32.35 (a) The following construction or modification may not be 32.36 commenced: 33.1 (1) any erection, building, alteration, reconstruction, 33.2 modernization, improvement, extension, lease, or other 33.3 acquisition by or on behalf of a hospital that increases the bed 33.4 capacity of a hospital, relocates hospital beds from one 33.5 physical facility, complex, or site to another, or otherwise 33.6 results in an increase or redistribution of hospital beds within 33.7 the state; and 33.8 (2) the establishment of a new hospital. 33.9 (b) This section does not apply to: 33.10 (1) construction or relocation within a county by a 33.11 hospital, clinic, or other health care facility that is a 33.12 national referral center engaged in substantial programs of 33.13 patient care, medical research, and medical education meeting 33.14 state and national needs that receives more than 40 percent of 33.15 its patients from outside the state of Minnesota; 33.16 (2) a project for construction or modification for which a 33.17 health care facility held an approved certificate of need on May 33.18 1, 1984, regardless of the date of expiration of the 33.19 certificate; 33.20 (3) a project for which a certificate of need was denied 33.21 before July 1, 1990, if a timely appeal results in an order 33.22 reversing the denial; 33.23 (4) a project exempted from certificate of need 33.24 requirements by Laws 1981, chapter 200, section 2; 33.25 (5) a project involving consolidation of pediatric 33.26 specialty hospital services within the Minneapolis-St. Paul 33.27 metropolitan area that would not result in a net increase in the 33.28 number of pediatric specialty hospital beds among the hospitals 33.29 being consolidated; 33.30 (6) a project involving the temporary relocation of 33.31 pediatric-orthopedic hospital beds to an existing licensed 33.32 hospital that will allow for the reconstruction of a new 33.33 philanthropic, pediatric-orthopedic hospital on an existing site 33.34 and that will not result in a net increase in the number of 33.35 hospital beds. Upon completion of the reconstruction, the 33.36 licenses of both hospitals must be reinstated at the capacity 34.1 that existed on each site before the relocation; 34.2 (7) the relocation or redistribution of hospital beds 34.3 within a hospital building or identifiable complex of buildings 34.4 provided the relocation or redistribution does not result in: 34.5 (i) an increase in the overall bed capacity at that site; (ii) 34.6 relocation of hospital beds from one physical site or complex to 34.7 another; or (iii) redistribution of hospital beds within the 34.8 state or a region of the state; 34.9 (8) relocation or redistribution of hospital beds within a 34.10 hospital corporate system that involves the transfer of beds 34.11 from a closed facility site or complex to an existing site or 34.12 complex provided that: (i) no more than 50 percent of the 34.13 capacity of the closed facility is transferred; (ii) the 34.14 capacity of the site or complex to which the beds are 34.15 transferred does not increase by more than 50 percent; (iii) the 34.16 beds are not transferred outside of a federal health systems 34.17 agency boundary in place on July 1, 1983; and (iv) the 34.18 relocation or redistribution does not involve the construction 34.19 of a new hospital building; 34.20 (9) a construction project involving up to 35 new beds in a 34.21 psychiatric hospital in Rice county that primarily serves 34.22 adolescents and that receives more than 70 percent of its 34.23 patients from outside the state of Minnesota; 34.24 (10) a project to replace a hospital or hospitals with a 34.25 combined licensed capacity of 130 beds or less if: (i) the new 34.26 hospital site is located within five miles of the current site; 34.27 and (ii) the total licensed capacity of the replacement 34.28 hospital, either at the time of construction of the initial 34.29 building or as the result of future expansion, will not exceed 34.30 70 licensed hospital beds, or the combined licensed capacity of 34.31 the hospitals, whichever is less; 34.32 (11) the relocation of licensed hospital beds from an 34.33 existing state facility operated by the commissioner of human 34.34 services to a new or existing facility, building, or complex 34.35 operated by the commissioner of human services; from one 34.36 regional treatment center site to another; or from one building 35.1 or site to a new or existing building or site on the same 35.2 campus; 35.3 (12) the construction or relocation of hospital beds 35.4 operated by a hospital having a statutory obligation to provide 35.5 hospital and medical services for the indigent that does not 35.6 result in a net increase in the number of hospital beds;or35.7 (13) a construction project involving the addition of up to 35.8 31 new beds in an existing nonfederal hospital in Beltrami 35.9 county; or 35.10 (14) a construction project involving the addition of up to 35.11 eight new beds in an existing nonfederal hospital in Otter Tail 35.12 county with 100 licensed acute care beds. 35.13 Sec. 38. Minnesota Statutes 2000, section 144.98, 35.14 subdivision 3, is amended to read: 35.15 Subd. 3. [FEES.] (a) An application for certification 35.16 under subdivision 1 must be accompanied by the biennial fee 35.17 specified in this subdivision. The fees are for: 35.18 (1) nonrefundable base certification fee,$500$1,200; and 35.19 (2) test category certification fees: 35.20 Test Category Certification Fee 35.21 Clean water program bacteriology$200$600 35.22 Safe drinking water program bacteriology $600 35.23 Clean water program inorganic chemistry,35.24fewer than four constituents$100$600 35.25 Safe drinking water program inorganic chemistry,35.26four or more constituents$300$600 35.27 Clean water program chemistry metals,35.28fewer than four constituents$200$800 35.29 Safe drinking water program chemistry metals,35.30four or more constituents$500$800 35.31 Resource conservation and recovery program 35.32 chemistry metals $800 35.33 Clean water program volatile organic compounds$600$1,200 35.34 Safe drinking water program 35.35 volatile organic compounds $1,200 35.36 Resource conservation and recovery program 36.1 volatile organic compounds $1,200 36.2 Underground storage tank program 36.3 volatile organic compounds $1,200 36.4 Clean water program other organic compounds$600$1,200 36.5 Safe drinking water program other organic compounds $1,200 36.6 Resource conservation and recovery program 36.7 other organic compounds $1,200 36.8 (b) The total biennial certification fee is the base fee 36.9 plus the applicable test category fees.The biennial36.10certification fee for a contract laboratory is 1.5 times the36.11total certification fee.36.12 (c) Laboratories located outside of this state that require 36.13 an on-site survey will be assessed an additional$1,200$2,500 36.14 fee. 36.15 (d) Fees must be set so that the total fees support the 36.16 laboratory certification program. Direct costs of the 36.17 certification service include program administration, 36.18 inspections, the agency's general support costs, and attorney 36.19 general costs attributable to the fee function. 36.20 (e) A change fee shall be assessed if a laboratory requests 36.21 additional analytes or methods at any time other than when 36.22 applying for or renewing its certification. The change fee is 36.23 equal to the test category certification fee for the analyte. 36.24 (f) A variance fee shall be assessed if a laboratory 36.25 requests and is granted a variance from a rule adopted under 36.26 this section. The variance fee is $500 per variance. 36.27 (g) Refunds or credits shall not be made for analytes or 36.28 methods requested but not approved. 36.29 (h) Certification of a laboratory shall not be awarded 36.30 until all fees are paid. 36.31 Sec. 39. Minnesota Statutes 2000, section 144A.44, 36.32 subdivision 1, is amended to read: 36.33 Subdivision 1. [STATEMENT OF RIGHTS.] A person who 36.34 receives home care services has these rights: 36.35 (1) the right to receive written information about rights 36.36 in advance of receiving care or during the initial evaluation 37.1 visit before the initiation of treatment, including what to do 37.2 if rights are violated; 37.3 (2) the right to receive care and services according to a 37.4 suitable and up-to-date plan, and subject to accepted medical or 37.5 nursing standards, to take an active part in creating and 37.6 changing the plan and evaluating care and services; 37.7 (3) the right to be told in advance of receiving care about 37.8 the services that will be provided, the disciplines that will 37.9 furnish care, the frequency of visits proposed to be furnished, 37.10 other choices that are available, and the consequences of these 37.11 choices including the consequences of refusing these services; 37.12 (4) the right to be told in advance of any change in the 37.13 plan of care and to take an active part in any change; 37.14 (5) the right to refuse services or treatment; 37.15 (6) the right to know, in advance, any limits to the 37.16 services available from a provider, and the provider's grounds 37.17 for a termination of services; 37.18 (7) the right to know in advance of receiving care whether 37.19 the services are covered by health insurance, medical 37.20 assistance, or other health programs, the charges for services 37.21 that will not be covered by Medicare, and the charges that the 37.22 individual may have to pay; 37.23 (8) the right to know what the charges are for services, no 37.24 matter who will be paying the bill; 37.25 (9) the right to know that there may be other services 37.26 available in the community, including other home care services 37.27 and providers, and to know where to go for information about 37.28 these services; 37.29 (10) the right to choose freely among available providers 37.30 and to change providers after services have begun, within the 37.31 limits of health insurance, medical assistance, or other health 37.32 programs; 37.33 (11) the right to have personal, financial, and medical 37.34 information kept private, and to be advised of the provider's 37.35 policies and procedures regarding disclosure of such 37.36 information; 38.1 (12) the right to be allowed access to records and written 38.2 information from records in accordance with section 144.335; 38.3 (13) the right to be served by people who are properly 38.4 trained and competent to perform their duties; 38.5 (14) the right to be treated with courtesy and respect, and 38.6 to have the patient's property treated with respect; 38.7 (15) the right to be free from physical and verbal abuse; 38.8 (16) the right to reasonable, advance notice of changes in 38.9 services or charges, including at least ten days' advance notice 38.10 of the termination of a service by a provider, except in cases 38.11 where: 38.12 (i) the recipient of services engages in conduct that 38.13 alters the conditions of employment as specified in the 38.14 employment contract between the home care provider and the 38.15 individual providing home care services, or creates an abusive 38.16 or unsafe work environment for the individual providing home 38.17 care services; or 38.18 (ii) an emergency for the informal caregiver or a 38.19 significant change in the recipient's condition has resulted in 38.20 service needs that exceed the current service provider agreement 38.21 and that cannot be safely met by the home care provider; 38.22 (17) the right to a coordinated transfer when there will be 38.23 a change in the provider of services; 38.24 (18) the right to voice grievances regarding treatment or 38.25 care that is, or fails to be, furnished, or regarding the lack 38.26 of courtesy or respect to the patient or the patient's property; 38.27 (19) the right to know how to contact an individual 38.28 associated with the provider who is responsible for handling 38.29 problems and to have the provider investigate and attempt to 38.30 resolve the grievance or complaint; 38.31 (20) the right to know the name and address of the state or 38.32 county agency to contact for additional information or 38.33 assistance; and 38.34 (21) the right to assert these rights personally, or have 38.35 them asserted by the patient's family or guardian when the 38.36 patient has been judged incompetent, without retaliation. 39.1 Sec. 40. Minnesota Statutes 2000, section 144A.4605, 39.2 subdivision 4, is amended to read: 39.3 Subd. 4. [LICENSE REQUIRED.] (a) A housing with services 39.4 establishment registered under chapter 144D that is required to 39.5 obtain a home care license must obtain an assisted living home 39.6 care license according to this section or a class A or class E 39.7 license according to rule. A housing with services 39.8 establishment that obtains a class E license under this 39.9 subdivision remains subject to the payment limitations in 39.10 sections 256B.0913, subdivision 5, paragraph (h), and 256B.0915, 39.11 subdivision 3, paragraph (g). 39.12 (b) A board and lodging establishment registered for 39.13 special services as of December 31, 1996, and also registered as 39.14 a housing with services establishment under chapter 144D, must 39.15 deliver home care services according to sections 144A.43 to 39.16 144A.48, and may apply for a waiver from requirements under 39.17 Minnesota Rules, parts 4668.0002 to 4668.0240, to operate a 39.18 licensed agency under the standards of section 157.17. Such 39.19 waivers as may be granted by the department will expire upon 39.20 promulgation of home care rules implementing section 144A.4605. 39.21 (c) An adult foster care provider licensed by the 39.22 department of human services and registered under chapter 144D 39.23 may continue to provide health-related services under its foster 39.24 care license until the promulgation of home care rules 39.25 implementing this section. 39.26 (d) An assisted living home care provider licensed under 39.27 this section must comply with the disclosure provisions of 39.28 section 325F.691 to the extent they are applicable. 39.29 [EFFECTIVE DATE.] This section is effective October 1, 2001. 39.30 Sec. 41. Minnesota Statutes 2000, section 144D.03, 39.31 subdivision 2, is amended to read: 39.32 Subd. 2. [REGISTRATION INFORMATION.] The establishment 39.33 shall provide the following information to the commissioner in 39.34 order to be registered: 39.35 (1) the business name, street address, and mailing address 39.36 of the establishment; 40.1 (2) the name and mailing address of the owner or owners of 40.2 the establishment and, if the owner or owners are not natural 40.3 persons, identification of the type of business entity of the 40.4 owner or owners, and the names and addresses of the officers and 40.5 members of the governing body, or comparable persons for 40.6 partnerships, limited liability corporations, or other types of 40.7 business organizations of the owner or owners; 40.8 (3) the name and mailing address of the managing agent, 40.9 whether through management agreement or lease agreement, of the 40.10 establishment, if different from the owner or owners, and the 40.11 name of the on-site manager, if any; 40.12 (4) verification that the establishment has entered into an 40.13 elderly housing with services contract, as required in section 40.14 144D.04, with each resident or resident's representative; 40.15 (5) verification that the establishment is complying with 40.16 the requirements of section 325F.691, if applicable; 40.17(5)(6) the name and address of at least one natural person 40.18 who shall be responsible for dealing with the commissioner on 40.19 all matters provided for in sections 144D.01 to 144D.06, and on 40.20 whom personal service of all notices and orders shall be made, 40.21 and who shall be authorized to accept service on behalf of the 40.22 owner or owners and the managing agent, if any; and 40.23(6)(7) the signature of the authorized representative of 40.24 the owner or owners or, if the owner or owners are not natural 40.25 persons, signatures of at least two authorized representatives 40.26 of each owner, one of which shall be an officer of the owner. 40.27 Personal service on the person identified under clause(5)40.28 (6) by the owner or owners in the registration shall be 40.29 considered service on the owner or owners, and it shall not be a 40.30 defense to any action that personal service was not made on each 40.31 individual or entity. The designation of one or more 40.32 individuals under this subdivision shall not affect the legal 40.33 responsibility of the owner or owners under sections 144D.01 to 40.34 144D.06. 40.35 [EFFECTIVE DATE.] This section is effective October 1, 2001. 40.36 Sec. 42. Minnesota Statutes 2000, section 144D.04, 41.1 subdivision 2, is amended to read: 41.2 Subd. 2. [CONTENTS OF CONTRACT.] An elderly housing with 41.3 services contract, which need not be entitled as such to comply 41.4 with this section, shall include at least the following elements 41.5 in itself or through supporting documents or attachments: 41.6 (1) name, street address, and mailing address of the 41.7 establishment; 41.8 (2) the name and mailing address of the owner or owners of 41.9 the establishment and, if the owner or owners is not a natural 41.10 person, identification of the type of business entity of the 41.11 owner or owners; 41.12 (3) the name and mailing address of the managing agent, 41.13 through management agreement or lease agreement, of the 41.14 establishment, if different from the owner or owners; 41.15 (4) the name and address of at least one natural person who 41.16 is authorized to accept service on behalf of the owner or owners 41.17 and managing agent; 41.18 (5) statement describing the registration and licensure 41.19 status of the establishment and any provider providing 41.20 health-related or supportive services under an arrangement with 41.21 the establishment; 41.22 (6) term of the contract; 41.23 (7) description of the services to be provided to the 41.24 resident in the base rate to be paid by resident; 41.25 (8) description of any additional services available for an 41.26 additional fee from the establishment directly or through 41.27 arrangements with the establishment; 41.28 (9) fee schedules outlining the cost of any additional 41.29 services; 41.30 (10) description of the process through which the contract 41.31 may be modified, amended, or terminated; 41.32 (11) description of the establishment's complaint 41.33 resolution process available to residents including the 41.34 toll-free complaint line for the office of ombudsman for older 41.35 Minnesotans; 41.36 (12) the resident's designated representative, if any; 42.1 (13) the establishment's referral procedures if the 42.2 contract is terminated; 42.3 (14) criteria used by the establishment to determine who 42.4 may continue to reside in the elderly housing with services 42.5 establishment; 42.6 (15) billing and payment procedures and requirements; 42.7 (16) statement regarding the ability of residents to 42.8 receive services from service providers with whom the 42.9 establishment does not have an arrangement; and 42.10 (17) statement regarding the availability of public funds 42.11 for payment for residence or services in the establishment. 42.12 [EFFECTIVE DATE.] This section is effective October 1, 2001. 42.13 Sec. 43. Minnesota Statutes 2000, section 144D.04, 42.14 subdivision 3, is amended to read: 42.15 Subd. 3. [CONTRACTS IN PERMANENT FILES.] Elderly housing 42.16 with services contracts and related documents executed by each 42.17 resident or resident's representative shall be maintained by the 42.18 establishment in files from the date of execution until three 42.19 years after the contract is terminated. The contracts and the 42.20 written disclosures required under section 325F.691, if 42.21 applicable, shall be made available for on-site inspection by 42.22 the commissioner upon request at any time. 42.23 [EFFECTIVE DATE.] This section is effective October 1, 2001. 42.24 Sec. 44. Minnesota Statutes 2000, section 144D.06, is 42.25 amended to read: 42.26 144D.06 [OTHER LAWS.] 42.27 A housing with services establishment shall obtain and 42.28 maintain all other licenses, permits, registrations, or other 42.29 governmental approvals required of it in addition to 42.30 registration under this chapter. A housing with services 42.31 establishment is subject to the provisions of section 325F.691 42.32 and chapter 504B. 42.33 [EFFECTIVE DATE.] This section is effective October 1, 2001. 42.34 Sec. 45. [145.56] [SUICIDE PREVENTION.] 42.35 Subdivision 1. [SUICIDE PREVENTION PLAN.] The commissioner 42.36 of health shall refine, coordinate, and implement the state's 43.1 suicide prevention plan using an evidence-based, public health 43.2 approach focused on prevention, in collaboration with the 43.3 commissioner of human services; the commissioner of public 43.4 safety; the commissioner of children, families, and learning; 43.5 and appropriate agencies, organizations, and institutions in the 43.6 community. 43.7 Subd. 2. [COMMUNITY-BASED PROGRAMS.] (a) The commissioner 43.8 shall establish a grant program to fund: 43.9 (1) community-based programs to provide education, 43.10 outreach, and advocacy services to populations who may be at 43.11 risk for suicide; 43.12 (2) community-based programs that educate community helpers 43.13 and gatekeepers, such as family members, spiritual leaders, 43.14 coaches, and business owners, employers, and coworkers on how to 43.15 prevent suicide by encouraging help-seeking behaviors; 43.16 (3) community-based programs that educate populations at 43.17 risk for suicide and community helpers and gatekeepers that must 43.18 include information on the symptoms of depression and other 43.19 psychiatric illnesses, the warning signs of suicide, skills for 43.20 preventing suicides, and making or seeking effective referrals 43.21 to intervention and community resources; and 43.22 (4) community-based programs to provide evidence-based 43.23 suicide prevention and intervention education to school staff, 43.24 parents, and students in grades kindergarten through 12. 43.25 Subd. 3. [WORKPLACE AND PROFESSIONAL EDUCATION.] (a) The 43.26 commissioner shall promote the use of employee assistance and 43.27 workplace programs to support employees with depression and 43.28 other psychiatric illnesses and substance abuse disorders, and 43.29 refer them to services. In promoting these programs, the 43.30 commissioner shall collaborate with employer and professional 43.31 associations, unions, and safety councils. 43.32 (b) The commissioner shall provide training and technical 43.33 assistance to local public health and other community-based 43.34 professionals to provide for integrated implementation of best 43.35 practices for preventing suicides. 43.36 Subd. 4. [COLLECTION AND REPORTING SUICIDE DATA.] The 44.1 commissioner shall coordinate with federal, regional, local, and 44.2 other state agencies to collect, analyze, and annually issue a 44.3 public report on Minnesota-specific data on suicide and suicidal 44.4 behaviors. 44.5 Subd. 5. [PERIODIC EVALUATIONS; BIENNIAL REPORTS.] The 44.6 commissioner shall conduct periodic evaluations of the impact of 44.7 and outcomes from implementation of the state's suicide 44.8 prevention plan and each of the activities specified in this 44.9 section. By July 1, 2002, and July 1 of each even-numbered year 44.10 thereafter, the commissioner shall report the results of these 44.11 evaluations to the chairs of the policy and finance committees 44.12 in the house and senate with jurisdiction over health and human 44.13 services issues. 44.14 Sec. 46. Minnesota Statutes 2000, section 145.881, 44.15 subdivision 2, is amended to read: 44.16 Subd. 2. [DUTIES.] The advisory task force shall meet on a 44.17 regular basis to perform the following duties: 44.18 (a) review and report on the health care needs of mothers 44.19 and children throughout the state of Minnesota; 44.20 (b) review and report on the type, frequency and impact of 44.21 maternal and child health care services provided to mothers and 44.22 children under existing maternal and child health care programs, 44.23 including programs administered by the commissioner of health; 44.24 (c) establish, review, and report to the commissioner a 44.25 list of program guidelines and criteria which the advisory task 44.26 force considers essential to providing an effective maternal and 44.27 child health care program to low income populations and high 44.28 risk persons and fulfilling the purposes defined in section 44.29 145.88; 44.30 (d) review staff recommendations of the department of 44.31 health regarding maternal and child health grant awards before 44.32 the awards are made; 44.33 (e) make recommendations to the commissioner for the use of 44.34 other federal and state funds available to meet maternal and 44.35 child health needs; 44.36 (f) make recommendations to the commissioner of health on 45.1 priorities for funding the following maternal and child health 45.2 services: (1) prenatal, delivery and postpartum care, (2) 45.3 comprehensive health care for children, especially from birth 45.4 through five years of age, (3) adolescent health services, (4) 45.5 family planning services, (5) preventive dental care, (6) 45.6 special services for chronically ill and handicapped children 45.7 and (7) any other services which promote the health of mothers 45.8 and children;and45.9 (g) make recommendations to the commissioner of health on 45.10 the process to distribute, award and administer the maternal and 45.11 child health block grant funds; and 45.12 (h) review the measures that are used to define the 45.13 variables of the funding distribution formula in section 45.14 145.882, subdivision 4, every two years and make recommendations 45.15 to the commissioner of health for changes based upon principles 45.16 established by the advisory task force for this purpose. 45.17 Sec. 47. [145.9268] [COMMUNITY CLINIC GRANTS.] 45.18 Subdivision 1. [DEFINITION.] For purposes of this section, 45.19 "eligible community clinic" means: 45.20 (1) a clinic that provides services under conditions as 45.21 defined in Minnesota Rules, part 9505.0255, and utilizes a 45.22 sliding fee scale to determine eligibility for charity care; 45.23 (2) an Indian tribal government or Indian health service 45.24 unit; or 45.25 (3) a consortium of clinics comprised of entities under 45.26 clause (1) or (2). 45.27 Subd. 2. [GRANTS AUTHORIZED.] The commissioner of health 45.28 shall award grants to eligible community clinics to improve the 45.29 ongoing viability of Minnesota's clinic-based safety net 45.30 providers. Grants shall be awarded to support the capacity of 45.31 eligible community clinics to serve low-income populations, 45.32 reduce current or future uncompensated care burdens, or provide 45.33 for improved care delivery infrastructure. The commissioner 45.34 shall award grants to community clinics in metropolitan and 45.35 rural areas of the state, and shall ensure geographic 45.36 representation in grant awards among all regions of the state. 46.1 Subd. 3. [ALLOCATION OF GRANTS.] (a) To receive a grant 46.2 under this section, an eligible community clinic must submit an 46.3 application to the commissioner of health by the deadline 46.4 established by the commissioner. A grant may be awarded upon 46.5 the signing of a grant contract. Community clinics may apply 46.6 for and the commissioner may award grants for one-year or 46.7 two-year periods. 46.8 (b) An application must be on a form and contain 46.9 information as specified by the commissioner but at a minimum 46.10 must contain: 46.11 (1) a description of the purpose or project for which grant 46.12 funds will be used; 46.13 (2) a description of the problem or problems the grant 46.14 funds will be used to address; and 46.15 (3) a description of achievable objectives, a workplan, and 46.16 a timeline for implementation and completion of processes or 46.17 projects enabled by the grant. 46.18 (c) The commissioner shall review each application to 46.19 determine whether the application is complete and whether the 46.20 applicant and the project are eligible for a grant. In 46.21 evaluating applications according to paragraph (d), the 46.22 commissioner shall establish criteria including, but not limited 46.23 to: the priority level of the project; the applicant's 46.24 thoroughness and clarity in describing the problem grant funds 46.25 are intended to address; a description of the applicant's 46.26 proposed project; the manner in which the applicant will 46.27 demonstrate the effectiveness of any projects undertaken; and 46.28 evidence of efficiencies and effectiveness gained through 46.29 collaborative efforts. The commissioner may also take into 46.30 account other relevant factors, including, but not limited to, 46.31 the percentage for which uninsured patients represent the 46.32 applicant's patient base and the degree to which grant funds 46.33 will be used to support services increasing access to health 46.34 care services. During application review, the commissioner may 46.35 request additional information about a proposed project, 46.36 including information on project cost. Failure to provide the 47.1 information requested disqualifies an applicant. The 47.2 commissioner has discretion over the number of grants awarded. 47.3 (d) In determining which eligible community clinics will 47.4 receive grants under this section, the commissioner shall give 47.5 preference to those grant applications that show evidence of 47.6 collaboration with other eligible community clinics, hospitals, 47.7 health care providers, or community organizations. In addition, 47.8 the commissioner shall give priority, in declining order, to 47.9 grant applications for projects that: 47.10 (1) provide a direct offset to expenses incurred for 47.11 services provided to the clinic's target population; 47.12 (2) establish, update, or improve information, data 47.13 collection, or billing systems; 47.14 (3) procure, modernize, remodel, or replace equipment used 47.15 an the delivery of direct patient care at a clinic; 47.16 (4) provide improvements for care delivery, such as 47.17 increased translation and interpretation services; or 47.18 (5) other projects determined by the commissioner to 47.19 improve the ability of applicants to provide care to the 47.20 vulnerable populations they serve. 47.21 (e) A grant awarded to an eligible community clinic may not 47.22 exceed $300,000 per eligible community clinic. For an applicant 47.23 applying as a consortium of clinics, a grant may not exceed 47.24 $300,000 per clinic included in the consortium. The 47.25 commissioner has discretion over the number of grants awarded. 47.26 Subd. 4. [EVALUATION AND REPORT.] The commissioner of 47.27 health shall evaluate the overall effectiveness of the grant 47.28 program. The commissioner shall collect progress reports to 47.29 evaluate the grant program from the eligible community clinics 47.30 receiving grants. Every two years, as part of this evaluation, 47.31 the commissioner shall report to the legislature on priority 47.32 areas for grants set under subdivision 3 and provide any 47.33 recommendations for adding or changing priority areas. 47.34 Sec. 48. [145.928] [ELIMINATING HEALTH DISPARITIES.] 47.35 Subdivision 1. [GOAL; ESTABLISHMENT.] It is the goal of 47.36 the state, by 2010, to decrease by 50 percent the disparities in 48.1 infant mortality rates and adult and child immunization rates 48.2 for American Indians and populations of color, as compared with 48.3 rates for whites. To do so and to achieve other measurable 48.4 outcomes, the commissioner of health shall establish a program 48.5 to close the gap in the health status of American Indians and 48.6 populations of color as compared with whites in the following 48.7 priority areas: infant mortality, breast and cervical cancer 48.8 screening, HIV/AIDS and sexually transmitted infections, adult 48.9 and child immunizations, cardiovascular disease, diabetes, and 48.10 accidental injuries and violence. 48.11 Subd. 2. [STATE-COMMUNITY PARTNERSHIPS; PLAN.] The 48.12 commissioner, in partnership with culturally-based community 48.13 organizations; the Indian affairs council under section 3.922; 48.14 the council on affairs of Chicano/Latino people under section 48.15 3.9223; the council on Black Minnesotans under section 3.9225; 48.16 the council on Asian-Pacific Minnesotans under section 3.9226; 48.17 community health boards as defined in section 145A.02; and 48.18 tribal governments, shall develop and implement a comprehensive, 48.19 coordinated plan to reduce health disparities in the health 48.20 disparity priority areas identified in subdivision 1. 48.21 Subd. 3. [MEASURABLE OUTCOMES.] The commissioner, in 48.22 consultation with the community partners listed in subdivision 48.23 2, shall establish measurable outcomes to achieve the goal 48.24 specified in subdivision 1 and to determine the effectiveness of 48.25 the grants and other activities funded under this section in 48.26 reducing health disparities in the priority areas identified in 48.27 subdivision 1. The development of measurable outcomes must be 48.28 completed before any funds are distributed under this section. 48.29 Subd. 4. [STATEWIDE ASSESSMENT.] The commissioner shall 48.30 enhance current data tools to ensure a statewide assessment of 48.31 the risk behaviors associated with the health disparity priority 48.32 areas identified in subdivision 1. The statewide assessment 48.33 must be used to establish a baseline to measure the effect of 48.34 activities funded under this section. To the extent feasible, 48.35 the commissioner shall conduct the assessment so that the 48.36 results may be compared to national data. 49.1 Subd. 5. [TECHNICAL ASSISTANCE.] The commissioner shall 49.2 provide the necessary expertise to grant applicants to ensure 49.3 that submitted proposals are likely to be successful in reducing 49.4 the health disparities identified in subdivision 1. The 49.5 commissioner shall provide grant recipients with guidance and 49.6 training on best or most promising strategies to use to reduce 49.7 the health disparities identified in subdivision 1. The 49.8 commissioner shall also assist grant recipients in the 49.9 development of materials and procedures to evaluate local 49.10 community activities. 49.11 Subd. 6. [PROCESS.] (a) The commissioner, in consultation 49.12 with the community partners listed in subdivision 2, shall 49.13 develop the criteria and procedures used to allocate grants 49.14 under this section. In developing the criteria, the 49.15 commissioner shall establish an administrative cost limit for 49.16 grant recipients. At the time a grant is awarded, the 49.17 commissioner must provide a grant recipient with information on 49.18 the outcomes established according to subdivision 3. 49.19 (b) A grant recipient must coordinate its activities to 49.20 reduce health disparities with other entities receiving funds 49.21 under this section that are in the grant recipient's service 49.22 area. 49.23 Subd. 7. [COMMUNITY GRANT PROGRAM; IMMUNIZATION RATES AND 49.24 INFANT MORTALITY RATES.] (a) The commissioner shall award grants 49.25 to eligible applicants for local or regional projects and 49.26 initiatives directed at reducing health disparities in one or 49.27 both of the following priority areas: 49.28 (1) decreasing racial and ethnic disparities in infant 49.29 mortality rates; or 49.30 (2) increasing adult and child immunization rates in 49.31 nonwhite racial and ethnic populations. 49.32 (b) The commissioner may award up to 20 percent of the 49.33 funds available as planning grants. Planning grants must be 49.34 used to address such areas as community assessment, coordination 49.35 activities, and development of community supported strategies. 49.36 (c) Eligible applicants may include, but are not limited 50.1 to, faith-based organizations, social service organizations, 50.2 community nonprofit organizations, community health boards, 50.3 tribal governments, and community clinics. Applicants must 50.4 submit proposals to the commissioner. A proposal must specify 50.5 the strategies to be implemented to address one or both of the 50.6 priority areas listed in paragraph (a) and must be targeted to 50.7 achieve the outcomes established according to subdivision 3. 50.8 (d) The commissioner shall give priority to applicants who 50.9 demonstrate that their proposed project or initiative: 50.10 (1) is supported by the community the applicant will serve; 50.11 (2) is research-based or based on promising strategies; 50.12 (3) is designed to complement other related community 50.13 activities; 50.14 (4) utilizes strategies that positively impact both 50.15 priority areas; 50.16 (5) reflects racially and ethnically appropriate 50.17 approaches; and 50.18 (6) will be implemented through or with community-based 50.19 organizations that reflect the race or ethnicity of the 50.20 population to be reached. 50.21 Subd. 8. [COMMUNITY GRANT PROGRAM; OTHER HEALTH 50.22 DISPARITIES.] (a) The commissioner shall award grants to 50.23 eligible applicants for local or regional projects and 50.24 initiatives directed at reducing health disparities in one or 50.25 more of the following priority areas: 50.26 (1) decreasing racial and ethnic disparities in morbidity 50.27 and mortality rates from breast and cervical cancer; 50.28 (2) decreasing racial and ethnic disparities in morbidity 50.29 and mortality rates from HIV/AIDS and sexually transmitted 50.30 infections; 50.31 (3) decreasing racial and ethnic disparities in morbidity 50.32 and mortality rates from cardiovascular disease; 50.33 (4) decreasing racial and ethnic disparities in morbidity 50.34 and mortality rates from diabetes; or 50.35 (5) decreasing racial and ethnic disparities in morbidity 50.36 and mortality rates from accidental injuries or violence. 51.1 (b) The commissioner may award up to 20 percent of the 51.2 funds available as planning grants. Planning grants must be 51.3 used to address such areas as community assessment, determining 51.4 community priority areas, coordination activities, and 51.5 development of community supported strategies. 51.6 (c) Eligible applicants may include, but are not limited 51.7 to, faith-based organizations, social service organizations, 51.8 community nonprofit organizations, community health boards, and 51.9 community clinics. Applicants shall submit proposals to the 51.10 commissioner. A proposal must specify the strategies to be 51.11 implemented to address one or more of the priority areas listed 51.12 in paragraph (a) and must be targeted to achieve the outcomes 51.13 established according to subdivision 3. 51.14 (d) The commissioner shall give priority to applicants who 51.15 demonstrate that their proposed project or initiative: 51.16 (1) is supported by the community the applicant will serve; 51.17 (2) is research-based or based on promising strategies; 51.18 (3) is designed to complement other related community 51.19 activities; 51.20 (4) utilizes strategies that positively impact more than 51.21 one priority area; 51.22 (5) reflects racially and ethnically appropriate 51.23 approaches; and 51.24 (6) will be implemented through or with community-based 51.25 organizations that reflect the race or ethnicity of the 51.26 population to be reached. 51.27 Subd. 9. [HEALTH OF FOREIGN-BORN PERSONS.] (a) The 51.28 commissioner shall distribute funds to community health boards 51.29 for health screening and follow-up services for tuberculosis for 51.30 foreign-born persons. Funds shall be distributed based on the 51.31 following formula: 51.32 (1) $1,500 per foreign-born person with pulmonary 51.33 tuberculosis in the community health board's service area; 51.34 (2) $500 per foreign-born person with extrapulmonary 51.35 tuberculosis in the community health board's service area; 51.36 (3) $500 per month of directly observed therapy provided by 52.1 the community health board for each uninsured foreign-born 52.2 person with pulmonary or extrapulmonary tuberculosis; and 52.3 (4) $50 per foreign-born person in the community health 52.4 board's service area. 52.5 (b) Payments must be made at the end of each state fiscal 52.6 year. The amount paid per tuberculosis case, per month of 52.7 directly observed therapy, and per foreign-born person must be 52.8 proportionately increased or decreased to fit the actual amount 52.9 appropriated for that fiscal year. 52.10 Subd. 10. [TRIBAL GOVERNMENTS.] The commissioner shall 52.11 award grants to American Indian tribal governments for 52.12 implementation of community interventions to reduce health 52.13 disparities for the priority areas listed in subdivisions 7 and 52.14 8. A community intervention must be targeted to achieve the 52.15 outcomes established according to subdivision 3. Tribal 52.16 governments must submit proposals to the commissioner and must 52.17 demonstrate partnerships with local public health entities. The 52.18 distribution formula shall be determined by the commissioner, in 52.19 consultation with the tribal governments. 52.20 Subd. 11. [COORDINATION.] The commissioner shall 52.21 coordinate the projects and initiatives funded under this 52.22 section with other efforts at the local, state, or national 52.23 level to avoid duplication and promote complementary efforts. 52.24 Subd. 12. [EVALUATION.] Using the outcomes established 52.25 according to subdivision 3, the commissioner shall conduct a 52.26 biennial evaluation of the community grant programs, community 52.27 health board activities, and tribal government activities funded 52.28 under this section. Grant recipients, tribal governments, and 52.29 community health boards shall cooperate with the commissioner in 52.30 the evaluation and shall provide the commissioner with the 52.31 information needed to conduct the evaluation. 52.32 Subd. 13. [REPORT.] The commissioner shall submit a 52.33 biennial report to the legislature on the local community 52.34 projects, tribal government, and community health board 52.35 prevention activities funded under this section. These reports 52.36 must include information on grant recipients, activities that 53.1 were conducted using grant funds, evaluation data, and outcome 53.2 measures, if available. These reports are due by January 15 of 53.3 every other year, beginning in the year 2003. 53.4 Subd. 14. [SUPPLANTATION OF EXISTING FUNDS.] Funds 53.5 received under this section must be used to develop new programs 53.6 or expand current programs that reduce health disparities. 53.7 Funds must not be used to supplant current county or tribal 53.8 expenditures. 53.9 Sec. 49. Minnesota Statutes 2000, section 145A.15, 53.10 subdivision 1, is amended to read: 53.11 Subdivision 1. [ESTABLISHMENT.] (a) The commissioner of 53.12 health shall expand the current grant program to fund additional 53.13 projects designed to prevent child abuse and neglect and reduce 53.14 juvenile delinquency by promoting positive parenting, resiliency 53.15 in children, and a healthy beginning for children by providing 53.16 early intervention services for families in need. Grant dollars 53.17 shall be available to train paraprofessionals to provide in-home 53.18 intervention services and to allow public health nurses to do 53.19 case management of services. The grant program shall provide 53.20 early intervention services for families in need and will 53.21 include: 53.22 (1) expansion of current public health nurse and family 53.23 aide home visiting programs and public health home visiting 53.24 projects which prevent child abuse and neglect, prevent juvenile 53.25 delinquency, and build resiliency in children; 53.26 (2) early intervention to promote a healthy and nurturing 53.27 beginning; 53.28 (3) distribution of educational and public information 53.29 programs and materials in hospital maternity divisions, 53.30 well-baby clinics, obstetrical clinics, and community clinics; 53.31 and 53.32 (4) training of home visitors in skills necessary for 53.33 comprehensive home visiting which promotes a healthy and 53.34 nurturing beginning for the child. 53.35 (b) No new grants shall be awarded under this section after 53.36 June 30, 2001. Grant contracts awarded and in effect under this 54.1 section as of July 1, 2001, shall continue until their 54.2 expiration date. 54.3 Sec. 50. Minnesota Statutes 2000, section 145A.15, is 54.4 amended by adding a subdivision to read: 54.5 Subd. 5. [EXPIRATION.] This section expires June 30, 2003. 54.6 Sec. 51. Minnesota Statutes 2000, section 145A.16, 54.7 subdivision 1, is amended to read: 54.8 Subdivision 1. [ESTABLISHMENT.] The commissioner shall 54.9 establish a grant program to fund universally offered home 54.10 visiting programs designed to serve all live births in 54.11 designated geographic areas. The commissioner shall designate 54.12 the geographic area to be served by each program. At least one 54.13 program must provide home visiting services to families within 54.14 the seven-county metropolitan area, and at least one program 54.15 must provide home visiting services to families outside the 54.16 metropolitan area. The purpose of the program is to strengthen 54.17 families and to promote positive parenting and healthy child 54.18 development. No new grants shall be awarded under this section 54.19 after June 30, 2001. Competitive grant contracts awarded and in 54.20 effect under this section as of July 1, 2001, shall expire 54.21 December 31, 2003. 54.22 Sec. 52. Minnesota Statutes 2000, section 145A.16, is 54.23 amended by adding a subdivision to read: 54.24 Subd. 10. [EXPIRATION.] This section expires December 31, 54.25 2003. 54.26 Sec. 53. [145A.17] [FAMILY HOME VISITING PROGRAMS.] 54.27 Subdivision 1. [ESTABLISHMENT; GOALS.] The commissioner 54.28 shall establish a program to fund family home visiting programs 54.29 designed to foster a healthy beginning for children in families 54.30 at or below 200 percent of the federal poverty guidelines, 54.31 prevent child abuse and neglect, reduce juvenile delinquency, 54.32 promote positive parenting and resiliency in children, and 54.33 promote family health and economic self-sufficiency. A program 54.34 funded under this section must serve families at or below 200 54.35 percent of the federal poverty guidelines, and other families 54.36 determined to be at risk, including but not limited to being at 55.1 risk for child abuse, child neglect, or juvenile delinquency. 55.2 Programs must give priority for services to families considered 55.3 to be in need of services, including but not limited to families 55.4 with: 55.5 (1) adolescent parents; 55.6 (2) a history of alcohol or other drug abuse; 55.7 (3) a history of child abuse, domestic abuse, or other 55.8 types of violence; 55.9 (4) a history of domestic abuse, rape, or other forms of 55.10 victimization; 55.11 (5) reduced cognitive functioning; 55.12 (6) a lack of knowledge of child growth and development 55.13 stages; 55.14 (7) low resiliency to adversities and environmental 55.15 stresses; or 55.16 (8) insufficient financial resources to meet family needs. 55.17 Subd. 2. [ALLOCATION OF FUNDS.] The commissioner shall 55.18 distribute funds available under this section to community 55.19 health boards, as defined in section 145A.02, and to tribal 55.20 governments. Funds shall be distributed to community health 55.21 boards as follows: (1) each community health board shall 55.22 receive an allocation of $25,000 per year; and (2) remaining 55.23 funds available to community health boards shall be distributed 55.24 according to the formula in section 256J.625, subdivision 3. 55.25 The commissioner, in consultation with tribal governments, shall 55.26 establish a formula for distributing funds to tribal governments. 55.27 Subd. 3. [REQUIREMENTS FOR PROGRAMS; PROCESS.] (a) Before 55.28 a community health board or tribal government may receive an 55.29 allocation under subdivision 2, a community health board or 55.30 tribal government must submit a proposal to the commissioner 55.31 that includes identification, based on a community assessment, 55.32 of the populations at or below 200 percent of the federal 55.33 poverty guidelines that will be served and the other populations 55.34 that will be served. Each program that receives funds must: 55.35 (1) use either a broad community-based or selective 55.36 community-based strategy to provide preventive and early 56.1 intervention home visiting services; 56.2 (2) offer a home visit by a trained home visitor. If a 56.3 home visit is accepted, the first home visit must occur 56.4 prenatally or as soon after birth as possible and must include a 56.5 public health nursing assessment by a public health nurse; 56.6 (3) offer, at a minimum, information on infant care, child 56.7 growth and development, positive parenting, preventing diseases, 56.8 preventing exposure to environmental hazards, and support 56.9 services available in the community; 56.10 (4) provide information on and referrals to health care 56.11 services, if needed, including information on health care 56.12 coverage for which the child or family may be eligible; and 56.13 provide information on preventive services, developmental 56.14 assessments, and the availability of public assistance programs 56.15 as appropriate; 56.16 (5) provide youth development programs; 56.17 (6) recruit home visitors who will represent, to the extent 56.18 possible, the races, cultures, and languages spoken by families 56.19 that may be served; 56.20 (7) train and supervise home visitors in accordance with 56.21 the requirements established under subdivision 4; 56.22 (8) maximize resources and minimize duplication by 56.23 coordinating activities with local social and human services 56.24 organizations, education organizations, and other appropriate 56.25 governmental entities and community-based organizations and 56.26 agencies; and 56.27 (9) utilize appropriate racial and ethnic approaches to 56.28 providing home visiting services. 56.29 (b) Funds available under this section shall not be used 56.30 for medical services. The commissioner shall establish an 56.31 administrative cost limit for recipients of funds. The outcome 56.32 measures established under subdivision 6 must be specified to 56.33 recipients of funds at the time the funds are distributed. 56.34 (c) Data collected on individuals served by the home 56.35 visiting programs must remain confidential and must not be 56.36 disclosed by providers of home visiting services without a 57.1 specific informed written consent that identifies disclosures to 57.2 be made. Upon request, agencies providing home visiting 57.3 services must provide recipients with information on 57.4 disclosures, including the names of entities and individuals 57.5 receiving the information and the general purpose of the 57.6 disclosure. Prospective and current recipients of home visiting 57.7 services must be told and informed in writing that written 57.8 consent for disclosure of data is not required for access to 57.9 home visiting services. 57.10 Subd. 4. [TRAINING.] The commissioner shall establish 57.11 training requirements for home visitors and minimum requirements 57.12 for supervision by a public health nurse. The requirements for 57.13 nurses must be consistent with chapter 148. Training must 57.14 include child development, positive parenting techniques, 57.15 screening and referrals for child abuse and neglect, and diverse 57.16 cultural practices in child rearing and family systems. 57.17 Subd. 5. [TECHNICAL ASSISTANCE.] The commissioner shall 57.18 provide administrative and technical assistance to each program, 57.19 including assistance in data collection and other activities 57.20 related to conducting short- and long-term evaluations of the 57.21 programs as required under subdivision 7. The commissioner may 57.22 request research and evaluation support from the University of 57.23 Minnesota. 57.24 Subd. 6. [OUTCOME MEASURES.] The commissioner shall 57.25 establish outcomes to determine the impact of family home 57.26 visiting programs funded under this section on the following 57.27 areas: 57.28 (1) appropriate utilization of preventive health care; 57.29 (2) rates of substantiated child abuse and neglect; 57.30 (3) rates of unintentional child injuries; 57.31 (4) rates of children who are screened and who pass early 57.32 childhood screening; and 57.33 (5) any additional qualitative goals and quantitative 57.34 measures established by the commissioner. 57.35 Subd. 7. [EVALUATION.] Using the qualitative goals and 57.36 quantitative outcome measures established under subdivisions 1 58.1 and 6, the commissioner shall conduct ongoing evaluations of the 58.2 programs funded under this section. Community health boards and 58.3 tribal governments shall cooperate with the commissioner in the 58.4 evaluations and shall provide the commissioner with the 58.5 information necessary to conduct the evaluations. As part of 58.6 the ongoing evaluations, the commissioner shall rate the impact 58.7 of the programs on the outcome measures listed in subdivision 6, 58.8 and shall periodically determine whether home visiting programs 58.9 are the best way to achieve the qualitative goals established 58.10 under subdivisions 1 and 6. If the commissioner determines that 58.11 home visiting programs are not the best way to achieve these 58.12 goals, the commissioner shall provide the legislature with 58.13 alternative methods for achieving them. 58.14 Subd. 8. [REPORT.] By January 15, 2002, and January 15 of 58.15 each even-numbered year thereafter, the commissioner shall 58.16 submit a report to the legislature on the family home visiting 58.17 programs funded under this section and on the results of the 58.18 evaluations conducted under subdivision 7. 58.19 Subd. 9. [NO SUPPLANTING OF EXISTING FUNDS.] Funding 58.20 available under this section may be used only to supplement, not 58.21 to replace, nonstate funds being used for home visiting services 58.22 as of July 1, 2001. 58.23 Sec. 54. Minnesota Statutes 2000, section 157.16, 58.24 subdivision 3, is amended to read: 58.25 Subd. 3. [ESTABLISHMENT FEES; DEFINITIONS.] (a) The 58.26 following fees are required for food and beverage service 58.27 establishments, hotels, motels, lodging establishments, and 58.28 resorts licensed under this chapter. Food and beverage service 58.29 establishments must pay the highest applicable fee under 58.30 paragraph (e), clause (1), (2), (3), or (4), and establishments 58.31 serving alcohol must pay the highest applicable fee under 58.32 paragraph (e), clause (6) or (7). The license fee for new 58.33 operators previously licensed under this chapter for the same 58.34 calendar year is one-half of the appropriate annual license fee, 58.35 plus any penalty that may be required. The license fee for 58.36 operators opening on or after October 1 is one-half of the 59.1 appropriate annual license fee, plus any penalty that may be 59.2 required. 59.3 (b) All food and beverage service establishments, except 59.4 special event food stands, and all hotels, motels, lodging 59.5 establishments, and resorts shall pay an annual base fee of 59.6$100$145. 59.7 (c) A special event food stand shall pay a flat fee 59.8 of$30$35 annually. "Special event food stand" means a fee 59.9 category where food is prepared or served in conjunction with 59.10 celebrations, county fairs, or special events from a special 59.11 event food stand as defined in section 157.15. 59.12 (d) In addition to the base fee in paragraph (b), each food 59.13 and beverage service establishment, other than a special event 59.14 food stand, and each hotel, motel, lodging establishment, and 59.15 resort shall pay an additional annual fee for each fee category 59.16 as specified in this paragraph: 59.17 (1) Limited food menu selection,$30$40. "Limited food 59.18 menu selection" means a fee category that provides one or more 59.19 of the following: 59.20 (i) prepackaged food that receives heat treatment and is 59.21 served in the package; 59.22 (ii) frozen pizza that is heated and served; 59.23 (iii) a continental breakfast such as rolls, coffee, juice, 59.24 milk, and cold cereal; 59.25 (iv) soft drinks, coffee, or nonalcoholic beverages; or 59.26 (v) cleaning for eating, drinking, or cooking utensils, 59.27 when the only food served is prepared off site. 59.28 (2) Small establishment, including boarding establishments, 59.29$55$75. "Small establishment" means a fee category that has no 59.30 salad bar and meets one or more of the following: 59.31 (i) possesses food service equipment that consists of no 59.32 more than a deep fat fryer, a grill, two hot holding containers, 59.33 and one or more microwave ovens; 59.34 (ii) serves dipped ice cream or soft serve frozen desserts; 59.35 (iii) serves breakfast in an owner-occupied bed and 59.36 breakfast establishment; 60.1 (iv) is a boarding establishment; or 60.2 (v) meets the equipment criteria in clause (3), item (i) or 60.3 (ii), and has a maximum patron seating capacity of not more than 60.4 50. 60.5 (3) Medium establishment,$150$210. "Medium establishment" 60.6 means a fee category that meets one or more of the following: 60.7 (i) possesses food service equipment that includes a range, 60.8 oven, steam table, salad bar, or salad preparation area; 60.9 (ii) possesses food service equipment that includes more 60.10 than one deep fat fryer, one grill, or two hot holding 60.11 containers; or 60.12 (iii) is an establishment where food is prepared at one 60.13 location and served at one or more separate locations. 60.14 Establishments meeting criteria in clause (2), item (v), 60.15 are not included in this fee category. 60.16 (4) Large establishment,$250$350. "Large establishment" 60.17 means either: 60.18 (i) a fee category that (A) meets the criteria in clause 60.19 (3), items (i) or (ii), for a medium establishment, (B) seats 60.20 more than 175 people, and (C) offers the full menu selection an 60.21 average of five or more days a week during the weeks of 60.22 operation; or 60.23 (ii) a fee category that (A) meets the criteria in clause 60.24 (3), item (iii), for a medium establishment, and (B) prepares 60.25 and serves 500 or more meals per day. 60.26 (5) Other food and beverage service, including food carts, 60.27 mobile food units, seasonal temporary food stands, and seasonal 60.28 permanent food stands,$30$40. 60.29 (6) Beer or wine table service,$30$40. "Beer or wine 60.30 table service" means a fee category where the only alcoholic 60.31 beverage service is beer or wine, served to customers seated at 60.32 tables. 60.33 (7) Alcoholic beverage service, other than beer or wine 60.34 table service,$75$105. 60.35 "Alcohol beverage service, other than beer or wine table 60.36 service" means a fee category where alcoholic mixed drinks are 61.1 served or where beer or wine are served from a bar. 61.2 (8) Lodging per sleeping accommodation unit,$4$6, 61.3 including hotels, motels, lodging establishments, and resorts, 61.4 up to a maximum of$400$600. "Lodging per sleeping 61.5 accommodation unit" means a fee category including the number of 61.6 guest rooms, cottages, or other rental units of a hotel, motel, 61.7 lodging establishment, or resort; or the number of beds in a 61.8 dormitory. 61.9 (9) First public swimming pool,$100$140; each additional 61.10 public swimming pool,$50$80. "Public swimming pool" means a 61.11 fee category that has the meaning given in Minnesota Rules, part 61.12 4717.0250, subpart 8. 61.13 (10) First spa,$50$80; each additional spa,$25$40. 61.14 "Spa pool" means a fee category that has the meaning given in 61.15 Minnesota Rules, part 4717.0250, subpart 9. 61.16 (11) Private sewer or water,$30$40. "Individual private 61.17 water" means a fee category with a water supply other than a 61.18 community public water supply as defined in Minnesota Rules, 61.19 chapter 4720. "Individual private sewer" means a fee category 61.20 with an individual sewage treatment system which uses subsurface 61.21 treatment and disposal. 61.22 (e)A fee is not required for a food and beverage service61.23establishment operated by a school as defined in sections61.24120A.05, subdivisions 9, 11, 13, and 17 and 120A.22.61.25(f)A fee of $150 for review of the construction plans must 61.26 accompany the initial license application for food and beverage 61.27 service establishments, hotels, motels, lodging establishments, 61.28 or resorts. 61.29(g)(f) When existing food and beverage service 61.30 establishments, hotels, motels, lodging establishments, or 61.31 resorts are extensively remodeled, a fee of $150 must be 61.32 submitted with the remodeling plans. 61.33(h)(g) Seasonal temporary food stands and special event 61.34 food stands are not required to submit construction or 61.35 remodeling plans for review. 61.36 [EFFECTIVE DATE.] This section is effective January 1, 2002. 62.1 Sec. 55. Minnesota Statutes 2000, section 157.22, as 62.2 amended by Laws 2001, chapter 65, section 1, is amended to read: 62.3 157.22 [EXEMPTIONS.] 62.4 This chapter shall not be construed to apply to: 62.5 (1) interstate carriers under the supervision of the United 62.6 States Department of Health and Human Services; 62.7 (2) any building constructed and primarily used for 62.8 religious worship; 62.9 (3) any building owned, operated, and used by a college or 62.10 university in accordance with health regulations promulgated by 62.11 the college or university under chapter 14; 62.12 (4) any person, firm, or corporation whose principal mode 62.13 of business is licensed under sections 28A.04 and 28A.05, is 62.14 exempt at that premises from licensure as a food or beverage 62.15 establishment; provided that the holding of any license pursuant 62.16 to sections 28A.04 and 28A.05 shall not exempt any person, firm, 62.17 or corporation from the applicable provisions of this chapter or 62.18 the rules of the state commissioner of health relating to food 62.19 and beverage service establishments; 62.20 (5) family day care homes and group family day care homes 62.21 governed by sections 245A.01 to 245A.16; 62.22 (6) nonprofit senior citizen centers for the sale of 62.23 home-baked goods; 62.24 (7) fraternal or patriotic organizations that are tax 62.25 exempt under section 501(c)(3), 501(c)(4), 501(c)(6), 501(c)(7), 62.26 501(c)(10), or 501(c)(19) of the Internal Revenue Code of 1986, 62.27 or organizations related to or affiliated with such fraternal or 62.28 patriotic organizations. Such organizations may organize events 62.29 at which home-prepared food is donated by organization members 62.30 for sale at the events, provided: 62.31 (i) the event is not a circus, carnival, or fair; 62.32 (ii) the organization controls the admission of persons to 62.33 the event, the event agenda, or both; and 62.34 (iii) the organization's licensed kitchen is not used in 62.35 any manner for the event;and62.36 (8) food not prepared at an establishment and brought in by 63.1 individuals attending a potluck event for consumption at the 63.2 potluck event. An organization sponsoring a potluck event under 63.3 this clause may advertise the potluck event to the public 63.4 through any means. Individuals who are not members of an 63.5 organization sponsoring a potluck event under this clause may 63.6 attend the potluck event and consume the food at the event. 63.7 Licensed food establishments other than schools cannot be 63.8 sponsors of potluck events. A school may sponsor and hold 63.9 potluck events in areas of the school other than the school's 63.10 kitchen, provided that the school's kitchen is not used in any 63.11 manner for the potluck event. For purposes of this clause, 63.12 "school" means a public school as defined in section 120A.05, 63.13 subdivisions 9, 11, 13, and 17, or a nonpublic school, church, 63.14 or religious organization at which a child is provided with 63.15 instruction in compliance with sections 120A.22 and 120A.24. 63.16 Potluck event food shall not be brought into a licensed food 63.17 establishment kitchen; and 63.18 (9) a home school in which a child is provided instruction 63.19 at home. 63.20 Sec. 56. Minnesota Statutes 2000, section 326.38, is 63.21 amended to read: 63.22 326.38 [LOCAL REGULATIONS.] 63.23 Any city having a system of waterworks or sewerage, or any 63.24 town in which reside over 5,000 people exclusive of any 63.25 statutory cities located therein, or the metropolitan airports 63.26 commission, may, by ordinance, adopt local regulations providing 63.27 for plumbing permits, bonds, approval of plans, and inspections 63.28 of plumbing, which regulations are not in conflict with the 63.29 plumbing standards on the same subject prescribed by the state 63.30 commissioner of health. No city or such town shall prohibit 63.31 plumbers licensed by the state commissioner of health from 63.32 engaging in or working at the business, except cities and 63.33 statutory cities which, prior to April 21, 1933, by ordinance 63.34 required the licensing of plumbers. Any city by ordinance may 63.35 prescribe regulations, reasonable standards, and inspections and 63.36 grant permits to any person, firm, or corporation engaged in the 64.1 business of installing water softeners, who is not licensed as a 64.2 master plumber or journeyman plumber by the state commissioner 64.3 of health, to connect water softening and water filtering 64.4 equipment to private residence water distribution systems, where 64.5 provision has been previously made therefor and openings left 64.6 for that purpose or by use of cold water connections to a 64.7 domestic water heater; where it is not necessary to rearrange, 64.8 make any extension or alteration of, or addition to any pipe, 64.9 fixture or plumbing connected with the water system except to 64.10 connect the water softener, and provided the connections so made 64.11 comply with minimum standards prescribed by the state 64.12 commissioner of health. 64.13 Sec. 57. [325F.691] [DISCLOSURE OF SPECIAL CARE STATUS 64.14 REQUIRED.] 64.15 Subdivision 1. [PERSONS TO WHOM DISCLOSURE IS 64.16 REQUIRED.] Housing with services establishments, as defined in 64.17 sections 144D.01 to 144D.07, that secure, segregate, or provide 64.18 a special program or special unit for residents with a diagnosis 64.19 of probable Alzheimer's disease or a related disorder or that 64.20 advertise, market, or otherwise promote the establishment as 64.21 providing specialized care for Alzheimer's disease or a related 64.22 disorder are considered a "special care unit." All special care 64.23 units shall provide a written disclosure to the following: 64.24 (1) the commissioner of health, if requested; 64.25 (2) the office of ombudsman for older Minnesotans; and 64.26 (3) each person seeking placement within a residence, or 64.27 the person's authorized representative, before an agreement to 64.28 provide the care is entered into. 64.29 Subd. 2. [CONTENT.] Written disclosure shall include, but 64.30 is not limited to, the following: 64.31 (1) a statement of the overall philosophy and how it 64.32 reflects the special needs of residents with Alzheimer's disease 64.33 or other dementias; 64.34 (2) the criteria for determining who may reside in the 64.35 special care unit; 64.36 (3) the process used for assessment and establishment of 65.1 the service plan or agreement, including how the plan is 65.2 responsive to changes in the resident's condition; 65.3 (4) staffing credentials, job descriptions, and staff 65.4 duties and availability, including any training specific to 65.5 dementia; 65.6 (5) physical environment as well as design and security 65.7 features that specifically address the needs of residents with 65.8 Alzheimer's disease or other dementias; 65.9 (6) frequency and type of programs and activities for 65.10 residents of the special care unit; 65.11 (7) involvement of families in resident care and 65.12 availability of family support programs; 65.13 (8) fee schedules for additional services to the residents 65.14 of the special care unit; and 65.15 (9) a statement that residents will be given a written 65.16 notice 30 days prior to changes in the fee schedule. 65.17 Subd. 3. [DUTY TO UPDATE.] Substantial changes to 65.18 disclosures must be reported to the parties listed in 65.19 subdivision 1 at the time the change is made. 65.20 Subd. 4. [REMEDY.] The attorney general may seek the 65.21 remedies set forth in section 8.31 for repeated and intentional 65.22 violations of this section. However, no private right of action 65.23 may be maintained as provided under section 8.31, subdivision 3a. 65.24 [EFFECTIVE DATE.] This section is effective October 1, 2001. 65.25 Sec. 58. [RECOMMENDATIONS; INCENTIVES FOR MAGNET 65.26 HOSPITALS.] 65.27 The commissioner of health shall develop recommendations 65.28 for incentives that may be implemented to increase the number of 65.29 magnet hospitals in Minnesota. These recommendations must be 65.30 reported by December 1, 2001 to the chairs of the house and 65.31 senate committees with jurisdiction over health and human 65.32 services policy and finance issues. 65.33 Sec. 59. [STUDY; FACTORS INFLUENCING PATIENT CARE AND 65.34 PATIENT SAFETY.] 65.35 The commissioner of health, in consultation with relevant 65.36 stakeholders, shall review available research and literature and 66.1 identify the major factors influencing patient care and patient 66.2 safety, including but not limited to staffing levels for nurses 66.3 and other health care professionals in health care facilities. 66.4 This report must be coordinated, to the extent possible, with 66.5 other studies relating to health quality and patient safety 66.6 authorized by the 2001 legislature. The commissioner shall 66.7 report findings from the study, including recommendations on 66.8 ongoing analysis and measurement of these factors for the 66.9 Minnesota health care system, to the chairs of the policy and 66.10 finance committees in the house and senate with jurisdiction 66.11 over health and human services issues by February 15, 2002. 66.12 Sec. 60. [STUDY; IMPACT OF WORKFORCE SHORTAGE ON HEALTH 66.13 CARE COSTS.] 66.14 The commissioner of health shall review available data, 66.15 research, and literature and assess the effects of health care 66.16 labor availability and its impact on health care costs. The 66.17 commissioner shall report findings and recommendations to the 66.18 chairs of the policy and finance committees in the house and 66.19 senate with jurisdiction over health and human services issues 66.20 by February 15, 2002. 66.21 Sec. 61. [MEDICATIONS DISPENSED IN SCHOOLS STUDY.] 66.22 (a) The commissioner of health, in consultation with the 66.23 board of nursing, shall study the relationship between the Nurse 66.24 Practice Act, Minnesota Statutes, sections 148.171 to 148.285; 66.25 and 121A.22, which specifies the administration of medications 66.26 in schools and the activities authorized under these sections, 66.27 including the administration of prescription and nonprescription 66.28 medications and medications needed by students to manage a 66.29 chronic illness. The commissioner shall also make 66.30 recommendations on necessary statutory changes needed to promote 66.31 student health and safety in relation to administering 66.32 medications in schools and addressing the changing health needs 66.33 of students. 66.34 (b) The commissioner shall convene a work group to assist 66.35 in the study and recommendations. The work group shall consist 66.36 of representatives of the commissioner of human services; the 67.1 commissioner of children, families, and learning; the board of 67.2 nursing; the board of teaching; school nurses; parents; school 67.3 administrators; school board associations; the American Academy 67.4 of Pediatrics; and the Minnesota Nurse's Association. 67.5 (c) The commissioner shall submit these recommendations and 67.6 any recommended statutory changes to the legislature by January 67.7 15, 2002. 67.8 Sec. 62. [REPEALER.] 67.9 (a) Minnesota Statutes 2000, section 144.148, subdivision 67.10 8, is repealed. 67.11 (b) Minnesota Statutes 2000, sections 121A.15, subdivision 67.12 6; and 145.927, are repealed. 67.13 [EFFECTIVE DATE.] Paragraph (a) of this section is 67.14 effective the day following final enactment. 67.15 ARTICLE 2 67.16 HEALTH CARE 67.17 Section 1. Minnesota Statutes 2000, section 62A.095, 67.18 subdivision 1, is amended to read: 67.19 Subdivision 1. [APPLICABILITY.] (a) No health plan shall 67.20 be offered, sold, or issued to a resident of this state, or to 67.21 cover a resident of this state, unless the health plan complies 67.22 with subdivision 2. 67.23 (b) Health plans providing benefits under health care 67.24 programs administered by the commissioner of human services are 67.25 not subject to the limits described in subdivision 2 but are 67.26 subject to the right of subrogation provisions under section 67.27 256B.37 and the lien provisions under section 256.015; 256B.042; 67.28 256D.03, subdivision 8; or 256L.03, subdivision 6. 67.29 Sec. 2. Minnesota Statutes 2000, section 62J.692, 67.30 subdivision 7, is amended to read: 67.31 Subd. 7. [TRANSFERS FROM THE COMMISSIONER OF HUMAN 67.32 SERVICES.] (a) The amount transferred according to section 67.33 256B.69, subdivision 5c, paragraph (a), clause (1), shall be 67.34 distributed by the commissioner to clinical medical education 67.35 programs that meet the qualifications of subdivision 3 based on 67.36 a distribution formula that reflects a summation of two factors: 68.1 (1) an education factor, which is determined by the total 68.2 number of eligible trainee FTEs and the total statewide average 68.3 costs per trainee, by type of trainee, in each clinical medical 68.4 education program; and 68.5 (2) a public program volume factor, which is determined by 68.6 the total volume of public program revenue received by each 68.7 training site as a percentage of all public program revenue 68.8 received by all training sites in the fund pool created under 68.9 this subdivision. 68.10 In this formula, the education factor shall be weighted at 68.11 50 percent and the public program volume factor shall be 68.12 weighted at 50 percent. 68.13(b)Public program revenue for the distribution formulain68.14paragraph (a)shall include revenue from medical assistance, 68.15 prepaid medical assistance, general assistance medical care, and 68.16 prepaid general assistance medical care. 68.17(c)Training sites that receive no public program revenue 68.18 shall be ineligible for funds available under this 68.19subdivisionparagraph. 68.20 (b) Fifty percent of the amount transferred according to 68.21 section 256B.69, subdivision 5c, paragraph (a), clause (2), 68.22 shall be distributed by the commissioner to the University of 68.23 Minnesota board of regents for the purposes described in 68.24 sections 137.38 to 137.40. Of the remaining amount transferred 68.25 according to section 256B.69, subdivision 5c, paragraph (a), 68.26 clause (2), 24 percent of the amount shall be distributed by the 68.27 commissioner to the Hennepin County Medical Center for clinical 68.28 medical education. The remaining 26 percent of the amount 68.29 transferred shall be distributed by the commissioner in 68.30 accordance with subdivision 7a. If the federal approval is not 68.31 obtained for the matching funds under section 256B.69, 68.32 subdivision 5c, paragraph (a), clause (2), 100 percent of the 68.33 amount transferred under this paragraph shall be distributed by 68.34 the commissioner to the University of Minnesota board of regents 68.35 for the purposes described in sections 137.38 to 137.40. 68.36 Sec. 3. Minnesota Statutes 2000, section 62J.692, is 69.1 amended by adding a subdivision to read: 69.2 Subd. 7a. [CLINICAL MEDICAL EDUCATION INNOVATIONS 69.3 GRANTS.] (a) The commissioner shall award grants to teaching 69.4 institutions and clinical training sites for projects that 69.5 increase dental access for underserved populations and promote 69.6 innovative clinical training of dental professionals. In 69.7 awarding the grants, the commissioner, in consultation with the 69.8 commissioner of human services, shall consider the following: 69.9 (1) potential to successfully increase access to an 69.10 underserved population; 69.11 (2) the long-term viability of the project to improve 69.12 access beyond the period of initial funding; 69.13 (3) evidence of collaboration between the applicant and 69.14 local communities; 69.15 (4) the efficiency in the use of the funding; and 69.16 (5) the priority level of the project in relation to state 69.17 clinical education, access, and workforce goals. 69.18 (b) The commissioner shall periodically evaluate the 69.19 priorities in awarding the innovations grants in order to ensure 69.20 that the priorities meet the changing workforce needs of the 69.21 state. 69.22 Sec. 4. Minnesota Statutes 2000, section 137.38, 69.23 subdivision 1, is amended to read: 69.24 Subdivision 1. [CONDITION.] If the board of regents 69.25 accepts thefunding appropriated foramount transferred under 69.26 section 62J.692, subdivision 7, paragraph (b), to be used for 69.27 the purposes described in sections 137.38 to 137.40, it shall 69.28 comply with the duties for which theappropriations aretransfer 69.29 is made. 69.30 Sec. 5. Minnesota Statutes 2000, section 150A.10, is 69.31 amended by adding a subdivision to read: 69.32 Subd. 1a. [LIMITED AUTHORIZATION FOR DENTAL 69.33 HYGIENISTS.] (a) Notwithstanding subdivision 1, a dental 69.34 hygienist licensed under this chapter may be employed or 69.35 retained by a health care facility to perform dental hygiene 69.36 services described under paragraph (b) without the patient first 70.1 being examined by a licensed dentist if the dental hygienist: 70.2 (1) has two years practical clinical experience with a 70.3 licensed dentist within the preceding five years; and 70.4 (2) has entered into a collaborative agreement with a 70.5 licensed dentist that designates authorization for the services 70.6 provided by the dental hygienist. 70.7 (b) The dental hygiene services authorized to be performed 70.8 by a dental hygienist under this subdivision are limited to 70.9 removal of deposits and stains from the surfaces of the teeth, 70.10 application of topical preventive or prophylactic agents, 70.11 polishing and smoothing restorations, removal of marginal 70.12 overhangs, performance of preliminary charting, taking of 70.13 radiographs, and performance of root planing and soft-tissue 70.14 curettage. The dental hygienist shall not place pit and fissure 70.15 sealants, unless the patient has been recently examined and the 70.16 treatment planned by a licensed dentist. The dental hygienist 70.17 shall not perform injections of anesthetic agents or the 70.18 administration of nitrous oxide unless under the indirect 70.19 supervision of a licensed dentist. The performance of dental 70.20 hygiene services in a health care facility is limited to 70.21 patients, students, and residents of the facility. 70.22 (c) A collaborating dentist must be licensed under this 70.23 chapter and may enter into a collaborative agreement with no 70.24 more than four dental hygienists. The collaborative agreement 70.25 must include: 70.26 (1) consideration for medically compromised patients and 70.27 medical conditions for which a dental evaluation and treatment 70.28 plan must occur prior to the provision of dental hygiene 70.29 services; and 70.30 (2) a period of time in which an examination by a dentist 70.31 should occur. 70.32 The collaborative agreement must be maintained by the dentist 70.33 and the dental hygienist and must be made available to the board 70.34 upon request. 70.35 (d) For the purposes of this subdivision, a "health care 70.36 facility" is limited to a hospital; nursing home; home health 71.1 agency; group home serving the elderly, disabled, or juveniles; 71.2 state-operated facility licensed by the commissioner of human 71.3 services or the commissioner of corrections; and federal, state, 71.4 or local public health facility, community clinic, or tribal 71.5 clinic. 71.6 (e) For purposes of this subdivision, a "collaborative 71.7 agreement" means a written agreement with a licensed dentist who 71.8 authorizes and accepts responsibility for the services performed 71.9 by the dental hygienist. The services authorized under this 71.10 subdivision and the collaborative agreement may be performed 71.11 without the presence of a licensed dentist and may be performed 71.12 at a location other than the usual place of practice of the 71.13 dentist or dental hygienist and without a dentist's diagnosis 71.14 and treatment plan, unless specified in the collaborative 71.15 agreement. 71.16 Sec. 6. Minnesota Statutes 2000, section 256.01, 71.17 subdivision 2, as amended by Laws 2001, chapter 178, article 1, 71.18 section 2, is amended to read: 71.19 Subd. 2. [SPECIFIC POWERS.] Subject to the provisions of 71.20 section 241.021, subdivision 2, the commissioner of human 71.21 services shall: 71.22 (1) Administer and supervise all forms of public assistance 71.23 provided for by state law and other welfare activities or 71.24 services as are vested in the commissioner. Administration and 71.25 supervision of human services activities or services includes, 71.26 but is not limited to, assuring timely and accurate distribution 71.27 of benefits, completeness of service, and quality program 71.28 management. In addition to administering and supervising human 71.29 services activities vested by law in the department, the 71.30 commissioner shall have the authority to: 71.31 (a) require county agency participation in training and 71.32 technical assistance programs to promote compliance with 71.33 statutes, rules, federal laws, regulations, and policies 71.34 governing human services; 71.35 (b) monitor, on an ongoing basis, the performance of county 71.36 agencies in the operation and administration of human services, 72.1 enforce compliance with statutes, rules, federal laws, 72.2 regulations, and policies governing welfare services and promote 72.3 excellence of administration and program operation; 72.4 (c) develop a quality control program or other monitoring 72.5 program to review county performance and accuracy of benefit 72.6 determinations; 72.7 (d) require county agencies to make an adjustment to the 72.8 public assistance benefits issued to any individual consistent 72.9 with federal law and regulation and state law and rule and to 72.10 issue or recover benefits as appropriate; 72.11 (e) delay or deny payment of all or part of the state and 72.12 federal share of benefits and administrative reimbursement 72.13 according to the procedures set forth in section 256.017; 72.14 (f) make contracts with and grants to public and private 72.15 agencies and organizations, both profit and nonprofit, and 72.16 individuals, using appropriated funds; and 72.17 (g) enter into contractual agreements with federally 72.18 recognized Indian tribes with a reservation in Minnesota to the 72.19 extent necessary for the tribe to operate a federally approved 72.20 family assistance program or any other program under the 72.21 supervision of the commissioner. The commissioner shall consult 72.22 with the affected county or counties in the contractual 72.23 agreement negotiations, if the county or counties wish to be 72.24 included, in order to avoid the duplication of county and tribal 72.25 assistance program services. The commissioner may establish 72.26 necessary accounts for the purposes of receiving and disbursing 72.27 funds as necessary for the operation of the programs. 72.28 (2) Inform county agencies, on a timely basis, of changes 72.29 in statute, rule, federal law, regulation, and policy necessary 72.30 to county agency administration of the programs. 72.31 (3) Administer and supervise all child welfare activities; 72.32 promote the enforcement of laws protecting handicapped, 72.33 dependent, neglected and delinquent children, and children born 72.34 to mothers who were not married to the children's fathers at the 72.35 times of the conception nor at the births of the children; 72.36 license and supervise child-caring and child-placing agencies 73.1 and institutions; supervise the care of children in boarding and 73.2 foster homes or in private institutions; and generally perform 73.3 all functions relating to the field of child welfare now vested 73.4 in the state board of control. 73.5 (4) Administer and supervise all noninstitutional service 73.6 to handicapped persons, including those who are visually 73.7 impaired, hearing impaired, or physically impaired or otherwise 73.8 handicapped. The commissioner may provide and contract for the 73.9 care and treatment of qualified indigent children in facilities 73.10 other than those located and available at state hospitals when 73.11 it is not feasible to provide the service in state hospitals. 73.12 (5) Assist and actively cooperate with other departments, 73.13 agencies and institutions, local, state, and federal, by 73.14 performing services in conformity with the purposes of Laws 73.15 1939, chapter 431. 73.16 (6) Act as the agent of and cooperate with the federal 73.17 government in matters of mutual concern relative to and in 73.18 conformity with the provisions of Laws 1939, chapter 431, 73.19 including the administration of any federal funds granted to the 73.20 state to aid in the performance of any functions of the 73.21 commissioner as specified in Laws 1939, chapter 431, and 73.22 including the promulgation of rules making uniformly available 73.23 medical care benefits to all recipients of public assistance, at 73.24 such times as the federal government increases its participation 73.25 in assistance expenditures for medical care to recipients of 73.26 public assistance, the cost thereof to be borne in the same 73.27 proportion as are grants of aid to said recipients. 73.28 (7) Establish and maintain any administrative units 73.29 reasonably necessary for the performance of administrative 73.30 functions common to all divisions of the department. 73.31 (8) Act as designated guardian of both the estate and the 73.32 person of all the wards of the state of Minnesota, whether by 73.33 operation of law or by an order of court, without any further 73.34 act or proceeding whatever, except as to persons committed as 73.35 mentally retarded. For children under the guardianship of the 73.36 commissioner whose interests would be best served by adoptive 74.1 placement, the commissioner may contract with a licensed 74.2 child-placing agency or a tribal social services agency to 74.3 provide adoption services. A contract with a licensed 74.4 child-placing agency must be designed to supplement existing 74.5 county efforts and may not replace existing county programs, 74.6 unless the replacement is agreed to by the county board and the 74.7 appropriate exclusive bargaining representative or the 74.8 commissioner has evidence that child placements of the county 74.9 continue to be substantially below that of other counties. 74.10 Funds encumbered and obligated under an agreement for a specific 74.11 child shall remain available until the terms of the agreement 74.12 are fulfilled or the agreement is terminated. 74.13 (9) Act as coordinating referral and informational center 74.14 on requests for service for newly arrived immigrants coming to 74.15 Minnesota. 74.16 (10) The specific enumeration of powers and duties as 74.17 hereinabove set forth shall in no way be construed to be a 74.18 limitation upon the general transfer of powers herein contained. 74.19 (11) Establish county, regional, or statewide schedules of 74.20 maximum fees and charges which may be paid by county agencies 74.21 for medical, dental, surgical, hospital, nursing and nursing 74.22 home care and medicine and medical supplies under all programs 74.23 of medical care provided by the state and for congregate living 74.24 care under the income maintenance programs. 74.25 (12) Have the authority to conduct and administer 74.26 experimental projects to test methods and procedures of 74.27 administering assistance and services to recipients or potential 74.28 recipients of public welfare. To carry out such experimental 74.29 projects, it is further provided that the commissioner of human 74.30 services is authorized to waive the enforcement of existing 74.31 specific statutory program requirements, rules, and standards in 74.32 one or more counties. The order establishing the waiver shall 74.33 provide alternative methods and procedures of administration, 74.34 shall not be in conflict with the basic purposes, coverage, or 74.35 benefits provided by law, and in no event shall the duration of 74.36 a project exceed four years. It is further provided that no 75.1 order establishing an experimental project as authorized by the 75.2 provisions of this section shall become effective until the 75.3 following conditions have been met: 75.4 (a) The secretary of health and human services of the 75.5 United States has agreed, for the same project, to waive state 75.6 plan requirements relative to statewide uniformity. 75.7 (b) A comprehensive plan, including estimated project 75.8 costs, shall be approved by the legislative advisory commission 75.9 and filed with the commissioner of administration. 75.10 (13) According to federal requirements, establish 75.11 procedures to be followed by local welfare boards in creating 75.12 citizen advisory committees, including procedures for selection 75.13 of committee members. 75.14 (14) Allocate federal fiscal disallowances or sanctions 75.15 which are based on quality control error rates for the aid to 75.16 families with dependent children program formerly codified in 75.17 sections 256.72 to 256.87, medical assistance, or food stamp 75.18 program in the following manner: 75.19 (a) One-half of the total amount of the disallowance shall 75.20 be borne by the county boards responsible for administering the 75.21 programs. For the medical assistance and the AFDC program 75.22 formerly codified in sections 256.72 to 256.87, disallowances 75.23 shall be shared by each county board in the same proportion as 75.24 that county's expenditures for the sanctioned program are to the 75.25 total of all counties' expenditures for the AFDC program 75.26 formerly codified in sections 256.72 to 256.87, and medical 75.27 assistance programs. For the food stamp program, sanctions 75.28 shall be shared by each county board, with 50 percent of the 75.29 sanction being distributed to each county in the same proportion 75.30 as that county's administrative costs for food stamps are to the 75.31 total of all food stamp administrative costs for all counties, 75.32 and 50 percent of the sanctions being distributed to each county 75.33 in the same proportion as that county's value of food stamp 75.34 benefits issued are to the total of all benefits issued for all 75.35 counties. Each county shall pay its share of the disallowance 75.36 to the state of Minnesota. When a county fails to pay the 76.1 amount due hereunder, the commissioner may deduct the amount 76.2 from reimbursement otherwise due the county, or the attorney 76.3 general, upon the request of the commissioner, may institute 76.4 civil action to recover the amount due. 76.5 (b) Notwithstanding the provisions of paragraph (a), if the 76.6 disallowance results from knowing noncompliance by one or more 76.7 counties with a specific program instruction, and that knowing 76.8 noncompliance is a matter of official county board record, the 76.9 commissioner may require payment or recover from the county or 76.10 counties, in the manner prescribed in paragraph (a), an amount 76.11 equal to the portion of the total disallowance which resulted 76.12 from the noncompliance, and may distribute the balance of the 76.13 disallowance according to paragraph (a). 76.14 (15) Develop and implement special projects that maximize 76.15 reimbursements and result in the recovery of money to the 76.16 state. For the purpose of recovering state money, the 76.17 commissioner may enter into contracts with third parties. Any 76.18 recoveries that result from projects or contracts entered into 76.19 under this paragraph shall be deposited in the state treasury 76.20 and credited to a special account until the balance in the 76.21 account reaches $1,000,000. When the balance in the account 76.22 exceeds $1,000,000, the excess shall be transferred and credited 76.23 to the general fund. All money in the account is appropriated 76.24 to the commissioner for the purposes of this paragraph. 76.25 (16) Have the authority to make direct payments to 76.26 facilities providing shelter to women and their children 76.27 according to section 256D.05, subdivision 3. Upon the written 76.28 request of a shelter facility that has been denied payments 76.29 under section 256D.05, subdivision 3, the commissioner shall 76.30 review all relevant evidence and make a determination within 30 76.31 days of the request for review regarding issuance of direct 76.32 payments to the shelter facility. Failure to act within 30 days 76.33 shall be considered a determination not to issue direct payments. 76.34 (17) Have the authority to establish and enforce the 76.35 following county reporting requirements: 76.36 (a) The commissioner shall establish fiscal and statistical 77.1 reporting requirements necessary to account for the expenditure 77.2 of funds allocated to counties for human services programs. 77.3 When establishing financial and statistical reporting 77.4 requirements, the commissioner shall evaluate all reports, in 77.5 consultation with the counties, to determine if the reports can 77.6 be simplified or the number of reports can be reduced. 77.7 (b) The county board shall submit monthly or quarterly 77.8 reports to the department as required by the commissioner. 77.9 Monthly reports are due no later than 15 working days after the 77.10 end of the month. Quarterly reports are due no later than 30 77.11 calendar days after the end of the quarter, unless the 77.12 commissioner determines that the deadline must be shortened to 77.13 20 calendar days to avoid jeopardizing compliance with federal 77.14 deadlines or risking a loss of federal funding. Only reports 77.15 that are complete, legible, and in the required format shall be 77.16 accepted by the commissioner. 77.17 (c) If the required reports are not received by the 77.18 deadlines established in clause (b), the commissioner may delay 77.19 payments and withhold funds from the county board until the next 77.20 reporting period. When the report is needed to account for the 77.21 use of federal funds and the late report results in a reduction 77.22 in federal funding, the commissioner shall withhold from the 77.23 county boards with late reports an amount equal to the reduction 77.24 in federal funding until full federal funding is received. 77.25 (d) A county board that submits reports that are late, 77.26 illegible, incomplete, or not in the required format for two out 77.27 of three consecutive reporting periods is considered 77.28 noncompliant. When a county board is found to be noncompliant, 77.29 the commissioner shall notify the county board of the reason the 77.30 county board is considered noncompliant and request that the 77.31 county board develop a corrective action plan stating how the 77.32 county board plans to correct the problem. The corrective 77.33 action plan must be submitted to the commissioner within 45 days 77.34 after the date the county board received notice of noncompliance. 77.35 (e) The final deadline for fiscal reports or amendments to 77.36 fiscal reports is one year after the date the report was 78.1 originally due. If the commissioner does not receive a report 78.2 by the final deadline, the county board forfeits the funding 78.3 associated with the report for that reporting period and the 78.4 county board must repay any funds associated with the report 78.5 received for that reporting period. 78.6 (f) The commissioner may not delay payments, withhold 78.7 funds, or require repayment under paragraph (c) or (e) if the 78.8 county demonstrates that the commissioner failed to provide 78.9 appropriate forms, guidelines, and technical assistance to 78.10 enable the county to comply with the requirements. If the 78.11 county board disagrees with an action taken by the commissioner 78.12 under paragraph (c) or (e), the county board may appeal the 78.13 action according to sections 14.57 to 14.69. 78.14 (g) Counties subject to withholding of funds under 78.15 paragraph (c) or forfeiture or repayment of funds under 78.16 paragraph (e) shall not reduce or withhold benefits or services 78.17 to clients to cover costs incurred due to actions taken by the 78.18 commissioner under paragraph (c) or (e). 78.19 (18) Allocate federal fiscal disallowances or sanctions for 78.20 audit exceptions when federal fiscal disallowances or sanctions 78.21 are based on a statewide random sample for the foster care 78.22 program under title IV-E of the Social Security Act, United 78.23 States Code, title 42, in direct proportion to each county's 78.24 title IV-E foster care maintenance claim for that period. 78.25 (19) Be responsible for ensuring the detection, prevention, 78.26 investigation, and resolution of fraudulent activities or 78.27 behavior by applicants, recipients, and other participants in 78.28 the human services programs administered by the department. 78.29 (20) Require county agencies to identify overpayments, 78.30 establish claims, and utilize all available and cost-beneficial 78.31 methodologies to collect and recover these overpayments in the 78.32 human services programs administered by the department. 78.33 (21) Have the authority to administer a drug rebate program 78.34 for drugs purchased pursuant to the prescription drug program 78.35 established under section 256.955 after the beneficiary's 78.36 satisfaction of any deductible established in the program. The 79.1 commissioner shall require a rebate agreement from all 79.2 manufacturers of covered drugs as defined in section 256B.0625, 79.3 subdivision 13. Rebate agreements for prescription drugs 79.4 delivered on or after July 1, 2002, must include rebates for 79.5 individuals covered under the prescription drug program who are 79.6 under 65 years of age. For each drug, the amount of the rebate 79.7 shall be equal to the basic rebate as defined for purposes of 79.8 the federal rebate program in United States Code, title 42, 79.9 section 1396r-8(c)(1). This basic rebate shall be applied to 79.10 single-source and multiple-source drugs. The manufacturers must 79.11 provide full payment within 30 days of receipt of the state 79.12 invoice for the rebate within the terms and conditions used for 79.13 the federal rebate program established pursuant to section 1927 79.14 of title XIX of the Social Security Act. The manufacturers must 79.15 provide the commissioner with any information necessary to 79.16 verify the rebate determined per drug. The rebate program shall 79.17 utilize the terms and conditions used for the federal rebate 79.18 program established pursuant to section 1927 of title XIX of the 79.19 Social Security Act. 79.20 (22) Have the authority to administer the federal drug 79.21 rebate program for drugs purchased under the medical assistance 79.22 program as allowed by section 1927 of title XIX of the Social 79.23 Security Act and according to the terms and conditions of 79.24 section 1927. Rebates shall be collected for all drugs that 79.25 have been dispensed or administered in an outpatient setting and 79.26 that are from manufacturers who have signed a rebate agreement 79.27 with the United States Department of Health and Human Services. 79.28(22)(23) Operate the department's communication systems 79.29 account established in Laws 1993, First Special Session chapter 79.30 1, article 1, section 2, subdivision 2, to manage shared 79.31 communication costs necessary for the operation of the programs 79.32 the commissioner supervises. A communications account may also 79.33 be established for each regional treatment center which operates 79.34 communications systems. Each account must be used to manage 79.35 shared communication costs necessary for the operations of the 79.36 programs the commissioner supervises. The commissioner may 80.1 distribute the costs of operating and maintaining communication 80.2 systems to participants in a manner that reflects actual usage. 80.3 Costs may include acquisition, licensing, insurance, 80.4 maintenance, repair, staff time and other costs as determined by 80.5 the commissioner. Nonprofit organizations and state, county, 80.6 and local government agencies involved in the operation of 80.7 programs the commissioner supervises may participate in the use 80.8 of the department's communications technology and share in the 80.9 cost of operation. The commissioner may accept on behalf of the 80.10 state any gift, bequest, devise or personal property of any 80.11 kind, or money tendered to the state for any lawful purpose 80.12 pertaining to the communication activities of the department. 80.13 Any money received for this purpose must be deposited in the 80.14 department's communication systems accounts. Money collected by 80.15 the commissioner for the use of communication systems must be 80.16 deposited in the state communication systems account and is 80.17 appropriated to the commissioner for purposes of this section. 80.18(23)(24) Receive any federal matching money that is made 80.19 available through the medical assistance program for the 80.20 consumer satisfaction survey. Any federal money received for 80.21 the survey is appropriated to the commissioner for this 80.22 purpose. The commissioner may expend the federal money received 80.23 for the consumer satisfaction survey in either year of the 80.24 biennium. 80.25(24)(25) Incorporate cost reimbursement claims from First 80.26 Call Minnesota and Greater Twin Cities United Way into the 80.27 federal cost reimbursement claiming processes of the department 80.28 according to federal law, rule, and regulations. Any 80.29 reimbursement received is appropriated to the commissioner and 80.30 shall be disbursed to First Call Minnesota and Greater Twin 80.31 Cities United Way according to normal department payment 80.32 schedules. 80.33(25)(26) Develop recommended standards for foster care 80.34 homes that address the components of specialized therapeutic 80.35 services to be provided by foster care homes with those services. 80.36 [EFFECTIVE DATE.] This section is effective 30 days 81.1 following final enactment. 81.2 Sec. 7. Minnesota Statutes 2000, section 256.955, 81.3 subdivision 2a, is amended to read: 81.4 Subd. 2a. [ELIGIBILITY.] An individual satisfying the 81.5 following requirements and the requirements described in 81.6 subdivision 2, paragraph (d), is eligible for the prescription 81.7 drug program: 81.8 (1) is at least 65 years of age or older; and 81.9 (2) is eligible as a qualified Medicare beneficiary 81.10 according to section 256B.057, subdivision 3or, 3a, or, 3b, 81.11 clause (1), or is eligible under section 256B.057, subdivision 3 81.12or, 3a, or 3b, clause (1), and is also eligible for medical 81.13 assistance or general assistance medical care with a spenddown 81.14 as defined in section 256B.056, subdivision 5. 81.15 [EFFECTIVE DATE.] This section is effective January 1, 2002. 81.16 Sec. 8. Minnesota Statutes 2000, section 256.955, 81.17 subdivision 2b, is amended to read: 81.18 Subd. 2b. [ELIGIBILITY.] Effective July 1, 2002, an 81.19 individual satisfying the following requirements and the 81.20 requirements described in subdivision 2, paragraph (d), is 81.21 eligible for the prescription drug program: 81.22 (1) is under 65 years of age; and 81.23 (2) is eligible as a qualified Medicare beneficiary 81.24 according to section 256B.057, subdivision 3,or 3a or is 81.25 eligible under section 256B.057, subdivision 3,or 3a and is 81.26 also eligible for medical assistance or general assistance 81.27 medical care with a spenddown as defined in section 256B.056, 81.28 subdivision 5. 81.29 [EFFECTIVE DATE.] This section is effective July 1, 2002. 81.30 Sec. 9. [256.956] [PURCHASING ALLIANCE STOP-LOSS FUND.] 81.31 Subdivision 1. [DEFINITIONS.] For purposes of this 81.32 section, the following definitions apply: 81.33 (a) "Commissioner" means the commissioner of human services. 81.34 (b) "Health plan" means a policy, contract, or certificate 81.35 issued by a health plan company to a qualifying purchasing 81.36 alliance. Any health plan issued to the members of a qualifying 82.1 purchasing alliance must meet the requirements of chapter 62L. 82.2 (c) "Health plan company" means: 82.3 (1) a health carrier as defined under section 62A.011, 82.4 subdivision 2; 82.5 (2) a community integrated service network operating under 82.6 chapter 62N; or 82.7 (3) an accountable provider network operating under chapter 82.8 62T. 82.9 (d) "Qualifying employer" means an employer who: 82.10 (1) is a member of a qualifying purchasing alliance; 82.11 (2) has at least one employee but no more than ten 82.12 employees or is a sole proprietor or farmer; 82.13 (3) did not offer employer-subsidized health care coverage 82.14 to its employees for at least 12 months prior to joining the 82.15 purchasing alliance; and 82.16 (4) is offering health coverage through the purchasing 82.17 alliance to all employees who work at least 20 hours per week 82.18 unless the employee is eligible for Medicare. 82.19 For purposes of this subdivision, "employer-subsidized health 82.20 coverage" means health coverage for which the employer pays at 82.21 least 50 percent of the cost of coverage for the employee. 82.22 (e) "Qualifying enrollee" means an employee of a qualifying 82.23 employer or the employee's dependent covered by a health plan. 82.24 (f) "Qualifying purchasing alliance" means a purchasing 82.25 alliance as defined in section 62T.01, subdivision 2, that: 82.26 (1) meets the requirements of chapter 62T; 82.27 (2) services a geographic area located in outstate 82.28 Minnesota, excluding the city of Duluth; and 82.29 (3) is organized and operating before May 1, 2001. 82.30 The criteria used by the qualifying purchasing alliance for 82.31 membership must be approved by the commissioner of health. A 82.32 qualifying purchasing alliance may begin enrolling qualifying 82.33 employers after July 1, 2001, with enrollment ending by December 82.34 31, 2003. 82.35 Subd. 2. [CREATION OF ACCOUNT.] A purchasing alliance 82.36 stop-loss fund account is established in the general fund. The 83.1 commissioner shall use the money to establish a stop-loss fund 83.2 from which a health plan company may receive reimbursement for 83.3 claims paid for qualifying enrollees. The account consists of 83.4 money appropriated by the legislature. Money from the account 83.5 must be used for the stop-loss fund. 83.6 Subd. 3. [REIMBURSEMENT.] (a) A health plan company may 83.7 receive reimbursement from the fund for 90 percent of the 83.8 portion of the claim that exceeds $30,000 but not of the portion 83.9 that exceeds $100,000 in a calendar year for a qualifying 83.10 enrollee. 83.11 (b) Claims shall be reported and funds shall be distributed 83.12 on a calendar-year basis. Claims shall be eligible for 83.13 reimbursement only for the calendar year in which the claims 83.14 were paid. 83.15 (c) Once claims paid on behalf of a qualifying enrollee 83.16 reach $100,000 in a given calendar year, no further claims may 83.17 be submitted for reimbursement on behalf of that enrollee in 83.18 that calendar year. 83.19 Subd. 4. [REQUEST PROCESS.] (a) Each health plan company 83.20 must submit a request for reimbursement from the fund on a form 83.21 prescribed by the commissioner. Requests for payment must be 83.22 submitted no later than April 1 following the end of the 83.23 calendar year for which the reimbursement request is being made, 83.24 beginning April 1, 2002. 83.25 (b) The commissioner may require a health plan company to 83.26 submit claims data as needed in connection with the 83.27 reimbursement request. 83.28 Subd. 5. [DISTRIBUTION.] (a) The commissioner shall 83.29 calculate the total claims reimbursement amount for all 83.30 qualifying health plan companies for the calendar year for which 83.31 claims are being reported and shall distribute the stop-loss 83.32 funds on an annual basis. 83.33 (b) In the event that the total amount requested for 83.34 reimbursement by the health plan companies for a calendar year 83.35 exceeds the funds available for distribution for claims paid by 83.36 all health plan companies during the same calendar year, the 84.1 commissioner shall provide for the pro rata distribution of the 84.2 available funds. Each health plan company shall be eligible to 84.3 receive only a proportionate amount of the available funds as 84.4 the health plan company's total eligible claims paid compares to 84.5 the total eligible claims paid by all health plan companies. 84.6 (c) In the event that funds available for distribution for 84.7 claims paid by all health plan companies during a calendar year 84.8 exceed the total amount requested for reimbursement by all 84.9 health plan companies during the same calendar year, any excess 84.10 funds shall be reallocated for distribution in the next calendar 84.11 year. 84.12 Subd. 6. [DATA.] Upon the request of the commissioner, 84.13 each health plan company shall furnish such data as the 84.14 commissioner deems necessary to administer the fund. The 84.15 commissioner may require that such data be submitted on a per 84.16 enrollee, aggregate, or categorical basis. Any data submitted 84.17 under this section shall be classified as private data or 84.18 nonpublic data as defined in section 13.02. 84.19 Subd. 7. [DELEGATION.] The commissioner may delegate any 84.20 or all of the commissioner's administrative duties to another 84.21 state agency or to a private contractor. 84.22 Subd. 8. [REPORT.] The commissioner of commerce, in 84.23 consultation with the office of rural health and the qualifying 84.24 purchasing alliances, shall evaluate the extent to which the 84.25 purchasing alliance stop-loss fund increases the availability of 84.26 employer-subsidized health care coverage for residents residing 84.27 in the geographic areas served by the qualifying purchasing 84.28 alliances. A preliminary report must be submitted to the 84.29 legislature by February 15, 2003, and a final report must be 84.30 submitted by February 15, 2004. 84.31 Subd. 9. [SUNSET.] This section shall expire January 1, 84.32 2005. 84.33 Sec. 10. [256.958] [RETIRED DENTIST PROGRAM.] 84.34 Subdivision 1. [PROGRAM.] The commissioner of human 84.35 services shall establish a program to reimburse a retired 84.36 dentist for the dentist's license fee and for the reasonable 85.1 cost of malpractice insurance compared to other dentists in the 85.2 community in exchange for the dentist providing 100 hours of 85.3 dental services on a volunteer basis within a 12-month period at 85.4 a community dental clinic or a dental training clinic located at 85.5 a Minnesota state college or university. 85.6 Subd. 2. [DOCUMENTATION.] Upon completion of the required 85.7 hours, the retired dentist shall submit to the commissioner the 85.8 following: 85.9 (1) documentation of the service provided; 85.10 (2) the cost of malpractice insurance for the 12-month 85.11 period; and 85.12 (3) the cost of the license. 85.13 Subd. 3. [REIMBURSEMENT.] Upon receipt of the information 85.14 described in subdivision 2, the commissioner shall provide 85.15 reimbursement to the retired dentist for the cost of malpractice 85.16 insurance for the previous 12-month period and the cost of the 85.17 license. 85.18 Sec. 11. [256.959] [DENTAL PRACTICE DONATION PROGRAM.] 85.19 Subdivision 1. [ESTABLISHMENT.] The commissioner of human 85.20 services shall establish a dental practice donation program that 85.21 coordinates the donation of a qualifying dental practice to a 85.22 qualified charitable organization and assists in locating a 85.23 dentist licensed under chapter 150A who wishes to maintain the 85.24 dental practice. 85.25 Subd. 2. [QUALIFYING DENTAL PRACTICE.] To qualify for the 85.26 dental practice donation program, a dental practice must meet 85.27 the following requirements: 85.28 (1) the dental practice must be owned by the donating 85.29 dentist; 85.30 (2) the dental practice must be located in a designated 85.31 underserved area of the state as defined by the commissioner; 85.32 and 85.33 (3) the practice must be equipped with the basic dental 85.34 equipment necessary to maintain a dental practice as determined 85.35 by the commissioner. 85.36 Subd. 3. [COORDINATION.] The commissioner shall establish 86.1 a procedure for dentists to donate their dental practices to a 86.2 qualified charitable organization. The commissioner shall 86.3 authorize a practice for donation only if it meets the 86.4 requirements of subdivision 2 and there is a licensed dentist 86.5 who is interested in entering into an agreement as described in 86.6 subdivision 4. Upon donation of the practice, the commissioner 86.7 shall provide the donating dentist with a statement verifying 86.8 that a donation of the practice was made to a qualifying 86.9 charitable organization for purposes of state and federal income 86.10 tax returns. 86.11 Subd. 4. [DONATED DENTAL PRACTICE AGREEMENT.] (a) A 86.12 dentist accepting the donated practice must enter into an 86.13 agreement with the qualified charitable organization to maintain 86.14 the dental practice for a minimum of five years at the donated 86.15 practice site and to provide services to underserved populations 86.16 up to a preagreed percentage of patients served. 86.17 (b) The agreement must include the terms for the recovery 86.18 of the donated dental practice if the dentist accepting the 86.19 practice does not fulfill the service commitment required under 86.20 this subdivision. 86.21 (c) Any costs associated with operating the dental practice 86.22 during the service commitment time period are the financial 86.23 responsibility of the dentist accepting the practice. 86.24 Sec. 12. Minnesota Statutes 2000, section 256.9657, 86.25 subdivision 2, is amended to read: 86.26 Subd. 2. [HOSPITAL SURCHARGE.] (a) Effective October 1, 86.27 1992, each Minnesota hospital except facilities of the federal 86.28 Indian Health Service and regional treatment centers shall pay 86.29 to the medical assistance account a surcharge equal to 1.4 86.30 percent of net patient revenues excluding net Medicare revenues 86.31 reported by that provider to the health care cost information 86.32 system according to the schedule in subdivision 4. 86.33 (b) Effective July 1, 1994, the surcharge under paragraph 86.34 (a) is increased to 1.56 percent. 86.35 (c) Notwithstanding the Medicare cost finding and allowable 86.36 cost principles, the hospital surcharge is not an allowable cost 87.1 for purposes of rate setting under sections 256.9685 to 256.9695. 87.2 Sec. 13. Minnesota Statutes 2000, section 256.969, is 87.3 amended by adding a subdivision to read: 87.4 Subd. 26. [GREATER MINNESOTA PAYMENT ADJUSTMENT AFTER JUNE 87.5 30, 2001.] (a) For admissions occurring after June 30, 2001, the 87.6 commissioner shall pay fee-for-service inpatient admissions for 87.7 the diagnosis-related groups specified in paragraph (b) at 87.8 hospitals located outside of the seven-county metropolitan area 87.9 at the higher of: 87.10 (1) the hospital's current payment rate for the diagnostic 87.11 category to which the diagnosis-related group belongs, exclusive 87.12 of disproportionate population adjustments received under 87.13 subdivision 9 and hospital payment adjustments received under 87.14 subdivision 23; or 87.15 (2) 90 percent of the average payment rate for that 87.16 diagnostic category for hospitals located within the 87.17 seven-county metropolitan area, exclusive of disproportionate 87.18 population adjustments received under subdivision 9 and hospital 87.19 payment adjustments received under subdivisions 20 and 23. The 87.20 commissioner may adjust this percentage each year so that the 87.21 estimated payment increases under this paragraph are equal to 87.22 the funding provided under section 256B.195 for this purpose. 87.23 (b) The payment increases provided in paragraph (a) apply 87.24 to the following diagnosis-related groups, as they fall within 87.25 the diagnostic categories: 87.26 (1) 370 cesarean section with complicating diagnosis; 87.27 (2) 371 cesarean section without complicating diagnosis; 87.28 (3) 372 vaginal delivery with complicating diagnosis; 87.29 (4) 373 vaginal delivery without complicating diagnosis; 87.30 (5) 386 extreme immaturity and respiratory distress 87.31 syndrome, neonate; 87.32 (6) 388 full-term neonates with other problems; 87.33 (7) 390 prematurity without major problems; 87.34 (8) 391 normal newborn; 87.35 (9) 385 neonate, died or transferred to another acute care 87.36 facility; 88.1 (10) 425 acute adjustment reaction and psychosocial 88.2 dysfunction; 88.3 (11) 430 psychoses; 88.4 (12) 431 childhood mental disorders; and 88.5 (13) 164-167 appendectomy. 88.6 Sec. 14. Minnesota Statutes 2000, section 256B.04, is 88.7 amended by adding a subdivision to read: 88.8 Subd. 1b. [CONTRACT FOR ADMINISTRATIVE SERVICES FOR 88.9 AMERICAN INDIAN CHILDREN.] Notwithstanding subdivision 1, the 88.10 commissioner may contract with federally recognized Indian 88.11 tribes with a reservation in Minnesota for the provision of 88.12 early and periodic screening, diagnosis, and treatment 88.13 administrative services for American Indian children, according 88.14 to Code of Federal Regulations, title 42, section 441, subpart 88.15 B, and Minnesota Rules, part 9505.1693 et seq., when the tribe 88.16 chooses to provide such services. For purposes of this 88.17 subdivision, "American Indian" has the meaning given to persons 88.18 to whom services will be provided for in Code of Federal 88.19 Regulations, title 42, section 36.12. Notwithstanding Minnesota 88.20 Rules, part 9505.1748, subpart 1, the commissioner, the local 88.21 agency, and the tribe may contract with any entity for the 88.22 provision of early and periodic screening, diagnosis, and 88.23 treatment administrative services. 88.24 [EFFECTIVE DATE.] This section is effective the day 88.25 following final enactment. 88.26 Sec. 15. Minnesota Statutes 2000, section 256B.055, 88.27 subdivision 3a, is amended to read: 88.28 Subd. 3a. [MFIP-S FAMILIES;FAMILIESELIGIBLE UNDER PRIOR88.29AFDC RULESWITH CHILDREN.](a) Beginning January 1, 1998, or on88.30the date that MFIP-S is implemented in counties, medical88.31assistance may be paid for a person receiving public assistance88.32under the MFIP-S program.Beginning July 1, 2002, medical 88.33 assistance may be paid for a person who is a child under the age 88.34 of 18, or age 18 if a full-time student in a secondary school, 88.35 or in the equivalent level of vocational or technical training, 88.36 and reasonably expected to complete the program before reaching 89.1 age 19; the parent of a dependent child, including a pregnant 89.2 woman; or a caretaker relative of a dependent child. 89.3(b) Beginning January 1, 1998, medical assistance may be89.4paid for a person who would have been eligible for public89.5assistance under the income and resource standards, or who would89.6have been eligible but for excess income or assets, under the89.7state's AFDC plan in effect as of July 16, 1996, as required by89.8the Personal Responsibility and Work Opportunity Reconciliation89.9Act of 1996 (PRWORA), Public Law Number 104-193.89.10 [EFFECTIVE DATE.] This section is effective July 1, 2002. 89.11 Sec. 16. Minnesota Statutes 2000, section 256B.056, 89.12 subdivision 1a, is amended to read: 89.13 Subd. 1a. [INCOME AND ASSETS GENERALLY.] Unless 89.14 specifically required by state law or rule or federal law or 89.15 regulation, the methodologies used in counting income and assets 89.16 to determine eligibility for medical assistance for persons 89.17 whose eligibility category is based on blindness, disability, or 89.18 age of 65 or more years, the methodologies for the supplemental 89.19 security income program shall be used. Increases in benefits 89.20 under title II of the Social Security Act shall not be counted 89.21 as income for purposes of this subdivision until July 1 of each 89.22 year. Effective upon federal approval, for children eligible 89.23 under section 256B.055, subdivision 12, or for home and 89.24 community-based waiver services whose eligibility for medical 89.25 assistance is determined without regard to parental income, 89.26 child support payments, including any payments made by an 89.27 obligor in satisfaction of or in addition to a temporary or 89.28 permanent order for child support, and social security payments 89.29 are not counted as income. For families and children, which 89.30 includes all other eligibility categories, the methodologies 89.31 under the state's AFDC plan in effect as of July 16, 1996, as 89.32 required by the Personal Responsibility and Work Opportunity 89.33 Reconciliation Act of 1996 (PRWORA), Public Law Number 104-193, 89.34 shall be used, except that effective July 1, 2002, the $90 and 89.35 $30 and one-third earned income disregards shall not apply and 89.36 the disregard specified in subdivision 1c shall apply. 90.1 Effective upon federal approval, in-kind contributions to, and 90.2 payments made on behalf of, a recipient, by an obligor, in 90.3 satisfaction of or in addition to a temporary or permanent order 90.4 for child support or maintenance, shall be considered income to 90.5 the recipient. For these purposes, a "methodology" does not 90.6 include an asset or income standard, or accounting method, or 90.7 method of determining effective dates. 90.8 [EFFECTIVE DATE.] This section is effective July 1, 2001. 90.9 Sec. 17. Minnesota Statutes 2000, section 256B.056, is 90.10 amended by adding a subdivision to read: 90.11 Subd. 1b. [AGED, BLIND, AND DISABLED INCOME 90.12 METHODOLOGY.] The $20 general income disregard allowed under the 90.13 supplemental security income program is included in the standard 90.14 and shall not be allowed as a deduction from income for a person 90.15 eligible under section 256B.055, subdivisions 7, 7a, and 12. 90.16 [EFFECTIVE DATE.] This section is effective July 1, 2001. 90.17 Sec. 18. Minnesota Statutes 2000, section 256B.056, is 90.18 amended by adding a subdivision to read: 90.19 Subd. 1c. [FAMILIES WITH CHILDREN INCOME METHODOLOGY.] (a) 90.20 For children ages one to five whose eligibility is determined 90.21 under section 256B.057, subdivision 2, 21 percent of countable 90.22 earned income shall be disregarded for up to four months. 90.23 (b) For families with children whose eligibility is 90.24 determined using the standard specified in section 256B.056, 90.25 subdivision 4, paragraph (c), 17 percent of countable earned 90.26 income shall be disregarded for up to four months. 90.27 (c) If the disregard has been applied to the wage earner's 90.28 income for four months, the disregard shall not be applied again 90.29 until the wage earner's income has not been considered in 90.30 determining medical assistance eligibility for 12 consecutive 90.31 months. 90.32 [EFFECTIVE DATE.] This section is effective July 1, 2002. 90.33 Sec. 19. Minnesota Statutes 2000, section 256B.056, 90.34 subdivision 3, is amended to read: 90.35 Subd. 3. [ASSET LIMITATIONS FOR ELDERLY AND DISABLED 90.36 INDIVIDUALS.] To be eligible for medical assistance, a person 91.1 must not individually own more than $3,000 in assets, or if a 91.2 member of a household with two family members, husband and wife, 91.3 or parent and child, the household must not own more than $6,000 91.4 in assets, plus $200 for each additional legal dependent. In 91.5 addition to these maximum amounts, an eligible individual or 91.6 family may accrue interest on these amounts, but they must be 91.7 reduced to the maximum at the time of an eligibility 91.8 redetermination. The accumulation of the clothing and personal 91.9 needs allowance according to section 256B.35 must also be 91.10 reduced to the maximum at the time of the eligibility 91.11 redetermination. The value of assets that are not considered in 91.12 determining eligibility for medical assistance is the value of 91.13 those assets excluded underthe AFDC state plan as of July 16,91.141996, as required by the Personal Responsibility and Work91.15Opportunity Reconciliation Act of 1996 (PRWORA), Public Law91.16Number 104-193, for families and children, andthe supplemental 91.17 security income program for aged, blind, and disabled persons, 91.18 with the following exceptions: 91.19 (a) Household goods and personal effects are not considered. 91.20 (b) Capital and operating assets of a trade or business 91.21 that the local agency determines are necessary to the person's 91.22 ability to earn an income are not considered. 91.23 (c) Motor vehicles are excluded to the same extent excluded 91.24 by the supplemental security income program. 91.25 (d) Assets designated as burial expenses are excluded to 91.26 the same extent excluded by the supplemental security income 91.27 program. 91.28 (e) Effective upon federal approval, for a person who no 91.29 longer qualifies as an employed person with a disability due to 91.30 loss of earnings, assets allowed while eligible for medical 91.31 assistance under section 256B.057, subdivision 9, are not 91.32 considered for 12 months, beginning with the first month of 91.33 ineligibility as an employed person with a disability, to the 91.34 extent that the person's total assets remain within the allowed 91.35 limits of section 256B.057, subdivision 9, paragraph (b). 91.36 Sec. 20. Minnesota Statutes 2000, section 256B.056, is 92.1 amended by adding a subdivision to read: 92.2 Subd. 3a. [ASSET LIMITATIONS FOR FAMILIES AND CHILDREN.] A 92.3 household of two or more persons must not own more than $30,000 92.4 in total net assets, and a household of one person must not own 92.5 more than $15,000 in total net assets. In addition to these 92.6 maximum amounts, an eligible individual or family may accrue 92.7 interest on these amounts, but they must be reduced to the 92.8 maximum at the time of an eligibility redetermination. The 92.9 value of assets that are not considered in determining 92.10 eligibility for medical assistance for families and children is 92.11 the value of those assets excluded under the AFDC state plan as 92.12 of July 16, 1996, as required by the Personal Responsibility and 92.13 Work Opportunity Reconciliation Act of 1996 (PRWORA), Public Law 92.14 Number 104-193, with the following exceptions: 92.15 (1) household goods and personal effects are not 92.16 considered; 92.17 (2) capital and operating assets of a trade or business up 92.18 to $200,000 are not considered; 92.19 (3) one motor vehicle is excluded for each person of legal 92.20 driving age who is employed or seeking employment; 92.21 (4) one burial plot and all other burial expenses equal to 92.22 the supplemental security income program asset limit are not 92.23 considered for each individual; 92.24 (5) court-ordered settlements up to $10,000 are not 92.25 considered; 92.26 (6) individual retirement accounts and funds are not 92.27 considered; and 92.28 (7) assets owned by children are not considered. 92.29 [EFFECTIVE DATE.] This section is effective July 1, 2002. 92.30 Sec. 21. Minnesota Statutes 2000, section 256B.056, 92.31 subdivision 4, is amended to read: 92.32 Subd. 4. [INCOME.] (a) To be eligible for medical 92.33 assistance, a person eligible under section 256B.055, 92.34subdivisionsubdivisions 7,not receiving supplemental security92.35income program payments, and7a, and 12, may have income up to 92.36 100 percent of the federal poverty guidelines. Effective 93.1 January 1, 2000, and each successive January, recipients of 93.2 supplemental security income may have an income up to the 93.3 supplemental security income standard in effect on that date. 93.4 (b) To be eligible for medical assistance, families and 93.5 children may have an income up to 133-1/3 percent of the AFDC 93.6 income standard in effect under the July 16, 1996, AFDC state 93.7 plan. Effective July 1, 2000, the base AFDC standard in effect 93.8 on July 16, 1996, shall be increased by three 93.9 percent.Effective January 1, 2000, and each successive93.10January, recipients of supplemental security income may have an93.11income up to the supplemental security income standard in effect93.12on that date.93.13 (c) Effective July 1, 2002, to be eligible for medical 93.14 assistance, families and children may have an income up to 100 93.15 percent of the federal poverty guidelines for the family size. 93.16 (d) In computing income to determine eligibility of persons 93.17 under paragraphs (a) to (c) who are not residents of long-term 93.18 care facilities, the commissioner shall disregard increases in 93.19 income as required by Public Law Numbers 94-566, section 503; 93.20 99-272; and 99-509. Veterans aid and attendance benefits and 93.21 Veterans Administration unusual medical expense payments are 93.22 considered income to the recipient. 93.23 [EFFECTIVE DATE.] This section is effective July 1, 2001. 93.24 Sec. 22. Minnesota Statutes 2000, section 256B.056, 93.25 subdivision 4b, is amended to read: 93.26 Subd. 4b. [INCOME VERIFICATION.] The local agency shall 93.27 not require a monthly income verification form for a recipient 93.28 who is a resident of a long-term care facility and who has 93.29 monthly earned income of $80 or less. The commissioner or 93.30 county agency shall use electronic verification as the primary 93.31 method of income verification. If there is a discrepancy 93.32 between reported income and electronically verified income, an 93.33 individual may be required to submit additional verification. 93.34 Sec. 23. Minnesota Statutes 2000, section 256B.056, 93.35 subdivision 5, is amended to read: 93.36 Subd. 5. [EXCESS INCOME.] A person who has excess income 94.1 is eligible for medical assistance if the person has expenses 94.2 for medical care that are more than the amount of the person's 94.3 excess income, computed by deducting incurred medical expenses 94.4 from the excess income to reduce the excess to the income 94.5 standard specified in subdivision45c. The person shall elect 94.6 to have the medical expenses deducted at the beginning of a 94.7 one-month budget period or at the beginning of a six-month 94.8 budget period. The commissioner shall allow persons eligible 94.9 for assistance on a one-month spenddown basis under this 94.10 subdivision to elect to pay the monthly spenddown amount in 94.11 advance of the month of eligibility to the state agency in order 94.12 to maintain eligibility on a continuous basis. If the recipient 94.13 does not pay the spenddown amount on or before the 20th of the 94.14 month, the recipient is ineligible for this option for the 94.15 following month. The local agency shall code the Medicaid 94.16 Management Information System (MMIS) to indicate that the 94.17 recipient has elected this option. The state agency shall 94.18 convey recipient eligibility information relative to the 94.19 collection of the spenddown to providers through the Electronic 94.20 Verification System (EVS). A recipient electing advance payment 94.21 must pay the state agency the monthly spenddown amount on or 94.22 before the 20th of the month in order to be eligible for this 94.23 option in the following month. 94.24 [EFFECTIVE DATE.] This section is effective July 1, 2001. 94.25 Sec. 24. Minnesota Statutes 2000, section 256B.056, is 94.26 amended by adding a subdivision to read: 94.27 Subd. 5c. [EXCESS INCOME STANDARD.] (a) The excess income 94.28 standard for families with children is the standard specified in 94.29 subdivision 4. 94.30 (b) The excess income standard for a person whose 94.31 eligibility is based on blindness, disability, or age of 65 or 94.32 more years is 70 percent of the federal poverty guidelines for 94.33 the family size. Effective July 1, 2002, the excess income 94.34 standard for this paragraph shall equal 75 percent of the 94.35 federal poverty guidelines. 94.36 [EFFECTIVE DATE.] This section is effective July 1, 2001. 95.1 Sec. 25. Minnesota Statutes 2000, section 256B.057, 95.2 subdivision 2, is amended to read: 95.3 Subd. 2. [CHILDREN.] Except as specified in subdivision 95.4 1b, effective July 1, 2002, a child one throughfive18 years of 95.5 age in a family whose countable income islessno greater than 95.6133170 percent of the federal poverty guidelines for the same 95.7 family size, is eligible for medical assistance.A child six95.8through 18 years of age, who was born after September 30, 1983,95.9in a family whose countable income is less than 100 percent of95.10the federal poverty guidelines for the same family size is95.11eligible for medical assistance.95.12 [EFFECTIVE DATE.] This section is effective July 1, 2002. 95.13 Sec. 26. Minnesota Statutes 2000, section 256B.057, 95.14 subdivision 3, is amended to read: 95.15 Subd. 3. [QUALIFIED MEDICARE BENEFICIARIES.] A person who 95.16 is entitled to Part A Medicare benefits, whose income is equal 95.17 to or less than 100 percent of the federal poverty guidelines, 95.18 and whose assets are no more than $10,000 for a single 95.19 individual and $18,000 for a married couple or family of two or 95.20 more, is eligible for medical assistance reimbursement of Part A 95.21 and Part B premiums, Part A and Part B coinsurance and 95.22 deductibles, and cost-effective premiums for enrollment with a 95.23 health maintenance organization or a competitive medical plan 95.24 under section 1876 of the Social Security Act. Reimbursement of 95.25 the Medicare coinsurance and deductibles, when added to the 95.26 amount paid by Medicare, must not exceed the total rate the 95.27 provider would have received for the same service or services if 95.28 the person were a medical assistance recipient with Medicare 95.29 coverage. Increases in benefits under Title II of the Social 95.30 Security Act shall not be counted as income for purposes of this 95.31 subdivision untilthe first day of the second full month95.32following publication of the change in the federal poverty95.33guidelinesJuly 1 of each year. 95.34 [EFFECTIVE DATE.] This section is effective July 1, 2001. 95.35 Sec. 27. Minnesota Statutes 2000, section 256B.057, 95.36 subdivision 7, is amended to read: 96.1 Subd. 7. [WAIVER OF MAINTENANCE OF EFFORT REQUIREMENT.] 96.2 Unless a federal waiver of the maintenance of effort requirement 96.3 of section 2105(d) of title XXI of the Balanced Budget Act of 96.4 1997, Public Law Number 105-33, Statutes at Large, volume 111, 96.5 page 251, is granted by the federal Department of Health and 96.6 Human Services by September 30, 1998, eligibility for children 96.7 under age 21 must be determined without regard to asset 96.8 standards established in section 256B.056, subdivision33a. 96.9 The commissioner of human services shall publish a notice in the 96.10 State Register upon receipt of a federal waiver. 96.11 Sec. 28. Minnesota Statutes 2000, section 256B.057, 96.12 subdivision 9, is amended to read: 96.13 Subd. 9. [EMPLOYED PERSONS WITH DISABILITIES.] (a) Medical 96.14 assistance may be paid for a person who is employed and who: 96.15 (1) meets the definition of disabled under the supplemental 96.16 security income program; 96.17 (2) is at least 16 but less than 65 years of age; 96.18 (3) meets the asset limits in paragraph (b); and 96.19 (4) pays a premium, if required, under paragraph (c). 96.20 Any spousal income or assets shall be disregarded for purposes 96.21 of eligibility and premium determinations. 96.22 After the month of enrollment, a person enrolled in medical 96.23 assistance under this subdivision who is temporarily unable to 96.24 work and without receipt of earned income due to a medical 96.25 condition, as verified by a physician, may retain eligibility 96.26 for up to four calendar months. 96.27 (b) For purposes of determining eligibility under this 96.28 subdivision, a person's assets must not exceed $20,000, 96.29 excluding: 96.30 (1) all assets excluded under section 256B.056; 96.31 (2) retirement accounts, including individual accounts, 96.32 401(k) plans, 403(b) plans, Keogh plans, and pension plans; and 96.33 (3) medical expense accounts set up through the person's 96.34 employer. 96.35 (c) A person whose earned and unearned income is equal to 96.36 or greaterthan 200than 100 percent of federal poverty 97.1 guidelines for the applicable family size must pay a premium to 97.2 be eligible for medical assistance under this subdivision. The 97.3 premium shall beequal to ten percent of the person's gross97.4earned and unearned income above 200 percent of federal poverty97.5guidelines for the applicable family size up to the cost of97.6coveragebased on the person's gross earned and unearned income 97.7 and the applicable family size using a sliding fee scale 97.8 established by the commissioner, which begins at one percent of 97.9 income at 100 percent of the federal poverty guidelines and 97.10 increases to 7.5 percent of income for those with incomes at or 97.11 above 300 percent of the federal poverty guidelines. Annual 97.12 adjustments in the premium schedule based upon changes in the 97.13 federal poverty guidelines shall be effective for premiums due 97.14 in July of each year. 97.15 (d) A person's eligibility and premium shall be determined 97.16 by the local county agency. Premiums must be paid to the 97.17 commissioner. All premiums are dedicated to the commissioner. 97.18 (e) Any required premium shall be determined at application 97.19 and redetermined annually at recertification or when a change in 97.20 income or family size occurs. 97.21 (f) Premium payment is due upon notification from the 97.22 commissioner of the premium amount required. Premiums may be 97.23 paid in installments at the discretion of the commissioner. 97.24 (g) Nonpayment of the premium shall result in denial or 97.25 termination of medical assistance unless the person demonstrates 97.26 good cause for nonpayment. Good cause exists if the 97.27 requirements specified in Minnesota Rules, part 9506.0040, 97.28 subpart 7, items B to D, are met. Nonpayment shall include 97.29 payment with a returned, refused, or dishonored instrument. The 97.30 commissioner may require a guaranteed form of payment as the 97.31 only means to replace a returned, refused, or dishonored 97.32 instrument. 97.33 [EFFECTIVE DATE.] This section is effective November 1, 97.34 2001. 97.35 Sec. 29. Minnesota Statutes 2000, section 256B.057, is 97.36 amended by adding a subdivision to read: 98.1 Subd. 10. [CERTAIN PERSONS NEEDING TREATMENT FOR BREAST OR 98.2 CERVICAL CANCER.] (a) Medical assistance may be paid for a 98.3 person who: 98.4 (1) has been screened for breast or cervical cancer by the 98.5 Minnesota breast and cervical cancer control program, and 98.6 program funds have been used to pay for the person's screening; 98.7 (2) according to the person's treating health professional, 98.8 needs treatment, including diagnostic services necessary to 98.9 determine the extent and proper course of treatment, for breast 98.10 or cervical cancer, including precancerous conditions and early 98.11 stage cancer; 98.12 (3) meets the income eligibility guidelines for the 98.13 Minnesota breast and cervical cancer control program; 98.14 (4) is under age 65; 98.15 (5) is not otherwise eligible for medical assistance under 98.16 United States Code, title 42, section 1396(a)(10)(A)(i); and 98.17 (6) is not otherwise covered under creditable coverage, as 98.18 defined under United States Code, title 42, section 300gg(c). 98.19 (b) Medical assistance provided for an eligible person 98.20 under this subdivision shall be limited to services provided 98.21 during the period that the person receives treatment for breast 98.22 or cervical cancer. 98.23 (c) A person meeting the criteria in paragraph (a) is 98.24 eligible for medical assistance without meeting the eligibility 98.25 criteria relating to income and assets in section 256B.056, 98.26 subdivisions 1a to 5b. 98.27 [EFFECTIVE DATE.] This section is effective July 1, 2002. 98.28 Sec. 30. Minnesota Statutes 2000, section 256B.0625, 98.29 subdivision 3b, is amended to read: 98.30 Subd. 3b. [TELEMEDICINE CONSULTATIONS.](a)Medical 98.31 assistance covers telemedicine consultations. Telemedicine 98.32 consultations must be made via two-way, interactive video or 98.33 store-and-forward technology. Store-and-forward technology 98.34 includes telemedicine consultations that do not occur in real 98.35 time via synchronous transmissions, and that do not require a 98.36 face-to-face encounter with the patient for all or any part of 99.1 any such telemedicine consultation. The patient record must 99.2 include a written opinion from the consulting physician 99.3 providing the telemedicine consultation. A communication 99.4 between two physicians that consists solely of a telephone 99.5 conversation is not a telemedicine consultation. Coverage is 99.6 limited to three telemedicine consultations per recipient per 99.7 calendar week. Telemedicine consultations shall be paid at the 99.8 full allowable rate. 99.9(b) This subdivision expires July 1, 2001.99.10 Sec. 31. Minnesota Statutes 2000, section 256B.0625, is 99.11 amended by adding a subdivision to read: 99.12 Subd. 5a. [INTENSIVE EARLY INTERVENTION BEHAVIOR THERAPY 99.13 SERVICES FOR CHILDREN WITH AUTISM SPECTRUM DISORDERS.] (a) 99.14 [COVERAGE.] Medical assistance covers home-based intensive early 99.15 intervention behavior therapy for children with autism spectrum 99.16 disorders. Children with autism spectrum disorder, and their 99.17 custodial parents or foster parents, may access other covered 99.18 services to treat autism spectrum disorder, and are not required 99.19 to receive intensive early intervention behavior therapy 99.20 services under this subdivision. Intensive early intervention 99.21 behavior therapy does not include coverage for services to treat 99.22 developmental disorders of language, early onset psychosis, 99.23 Rett's disorder, selective mutism, social anxiety disorder, 99.24 stereotypic movement disorder, dementia, obsessive compulsive 99.25 disorder, schizoid personality disorder, avoidant personality 99.26 disorder, or reactive attachment disorder. If a child with 99.27 autism spectrum disorder is diagnosed to have one or more of 99.28 these conditions, intensive early intervention behavior therapy 99.29 includes coverage only for services necessary to treat the 99.30 autism spectrum disorder. 99.31 (b) [PURPOSE OF INTENSIVE EARLY INTERVENTION BEHAVIOR 99.32 THERAPY SERVICES (IEIBTS).] The purpose of IEIBTS is to improve 99.33 the child's behavioral functioning, to prevent development of 99.34 challenging behaviors, to eliminate autistic behaviors, to 99.35 reduce the risk of out-of-home placement, and to establish 99.36 independent typical functioning in language and social 100.1 behavior. The procedures used to accomplish these goals are 100.2 based upon research in applied behavior analysis. 100.3 (c) [ELIGIBLE CHILDREN.] A child is eligible to initiate 100.4 IEIBTS if, the child meets the additional eligibility criteria 100.5 in paragraph (d) and in a diagnostic assessment by a mental 100.6 health professional who is not under the employ of the service 100.7 provider, the child: 100.8 (1) is found to have an autism spectrum disorder; 100.9 (2) has a current IQ of either untestable, or at least 30; 100.10 (3) if nonverbal, initiated behavior therapy by 42 months 100.11 of age; 100.12 (4) if verbal, initiated behavior therapy by 48 months of 100.13 age; or 100.14 (5) if having an IQ of at least 50, initiated behavior 100.15 therapy by 84 months of age. 100.16 To continue after six-month individualized treatment plan (ITP) 100.17 reviews, at least one of the child's custodial parents or foster 100.18 parents must participate in an average of at least five hours of 100.19 documented behavior therapy per week for six months, and 100.20 consistently implement behavior therapy recommendations 24 hours 100.21 a day. To continue after six-month individualized treatment 100.22 plan (ITP) reviews, the child must show documented progress 100.23 toward mastery of six-month benchmark behavior objectives. The 100.24 maximum number of months during which services may be billed is 100.25 54, or up to the month of August in the first year in which the 100.26 child completes first grade, whichever comes last. If 100.27 significant progress towards treatment goals has not been 100.28 achieved after 24 months of treatment, treatment must be 100.29 discontinued. 100.30 (d) [ADDITIONAL ELIGIBILITY CRITERIA.] A child is eligible 100.31 to initiate IEIBTS if: 100.32 (1) in medical and diagnostic assessments by medical and 100.33 mental health professionals, it is determined that the child 100.34 does not have severe or profound mental retardation; 100.35 (2) an accurate assessment of the child's hearing has been 100.36 performed, including audiometry if the brain stem auditory 101.1 evokes response; 101.2 (3) a blood lead test has been performed prior to 101.3 initiation of treatment; and 101.4 (4) an EEG or neurologic evaluation is done, prior to 101.5 initiation of treatment, if the child has a history of staring 101.6 spells or developmental regression. 101.7 (e) [COVERED SERVICES.] The focus of IEIBTS must be to 101.8 treat the principal diagnostic features of the autism spectrum 101.9 disorder. All IEIBTS must be delivered by a team of 101.10 practitioners under the consistent supervision of a single 101.11 clinical supervisor. A mental health professional must develop 101.12 the ITP for IEIBTS. The ITP must include six-month benchmark 101.13 behavior objectives. All behavior therapy must be based upon 101.14 research in applied behavior analysis, with an emphasis upon 101.15 positive reinforcement of carefully task-analyzed skills for 101.16 optimum rates of progress. All behavior therapy must be 101.17 consistently applied and generalized throughout the 24-hour day 101.18 and seven-day week by all of the child's regular care 101.19 providers. When placing the child in school activities, a 101.20 majority of the peers must have no mental health diagnosis, and 101.21 the child must have sufficient social skills to succeed with 80 101.22 percent of the school activities. Reactive consequences, such 101.23 as redirection, correction, positive practice, or time-out, must 101.24 be used only when necessary to improve the child's success when 101.25 proactive procedures alone have not been effective. IEIBTS must 101.26 be delivered by a team of behavior therapy practitioners who are 101.27 employed under the direction of the same agency. The team may 101.28 deliver up to 200 billable hours per year of direct clinical 101.29 supervisor services, up to 700 billable hours per year of senior 101.30 behavior therapist services, and up to 1,800 billable hours per 101.31 year of direct behavior therapist services. A one-hour clinical 101.32 review meeting for the child, parents, and staff must be 101.33 scheduled 50 weeks a year, at which behavior therapy is reviewed 101.34 and planned. At least one-quarter of the annual clinical 101.35 supervisor billable hours shall consist of on-site clinical 101.36 meeting time. At least one-half of the annual senior behavior 102.1 therapist billable hours shall consist of direct services to the 102.2 child or parents. All of the behavioral therapist billable 102.3 hours shall consist of direct on-site services to the child or 102.4 parents. None of the senior behavior therapist billable hours 102.5 or behavior therapist billable hours shall consist of clinical 102.6 meeting time. If there is any regression of the autistic 102.7 spectrum disorder after 12 months of therapy, a neurologic 102.8 consultation must be performed. 102.9 (f) [PROVIDER QUALIFICATIONS.] The provider agency must be 102.10 capable of delivering consistent applied behavior analysis 102.11 (ABA)-based behavior therapy in the home. The site director of 102.12 the agency must be a mental health professional and a board 102.13 certified behavior analyst certified by the behavior analyst 102.14 certification board. Each clinical supervisor must be a 102.15 certified associate behavior analyst certified by the behavior 102.16 analyst certification board or have equivalent experience in 102.17 applied behavior analysis. 102.18 (g) [SUPERVISION REQUIREMENTS.] (1) Each behavior therapist 102.19 practitioner must be continuously supervised while in the home 102.20 until the practitioner has mastered competencies for independent 102.21 practice. Each behavior therapist must have mastered three 102.22 credits of academic content and practice in an applied behavior 102.23 analysis sequence at an accredited university before providing 102.24 more than 12 months of therapy. A college degree or minimum 102.25 hours of experience are not required. Each behavior therapist 102.26 must continue training through weekly direct observation by the 102.27 senior behavior therapist, through demonstrated performance in 102.28 clinical meetings with the clinical supervisor, and annual 102.29 training in applied behavior analysis. 102.30 (2) Each senior behavior therapist practitioner must have 102.31 mastered the senior behavior therapy competencies, completed one 102.32 year of practice as a behavior therapist, and six months of 102.33 co-therapy training with another senior behavior therapist or 102.34 have an equivalent amount of experience in applied behavior 102.35 analysis. Each senior behavior therapist must have mastered 12 102.36 credits of academic content and practice in an applied behavior 103.1 analysis sequence at an accredited university before providing 103.2 more than 12 months of senior behavior therapy. Each senior 103.3 behavior therapist must continue training through demonstrated 103.4 performance in clinical meetings with the clinical supervisor, 103.5 and annual training in applied behavior analysis. 103.6 (3) Each clinical supervisor practitioner must have 103.7 mastered the clinical supervisor and family consultation 103.8 competencies, completed two years of practice as a senior 103.9 behavior therapist and one year of co-therapy training with 103.10 another clinical supervisor, or equivalent experience in applied 103.11 behavior analysis. Each clinical supervisor must continue 103.12 training through annual training in applied behavior analysis. 103.13 (h) [PLACE OF SERVICE.] IEIBTS are provided primarily in 103.14 the child's home and community. Services may be provided in the 103.15 child's natural school or preschool classroom, home of a 103.16 relative, natural recreational setting, or day care. 103.17 (i) [PRIOR AUTHORIZATION REQUIREMENTS.] Prior authorization 103.18 shall be required for services provided after 200 hours of 103.19 clinical supervisor, 700 hours of senior behavior therapist, or 103.20 1,800 hours of behavior therapist services per year. 103.21 (j) [PAYMENT RATES.] The following payment rates apply: 103.22 (1) for an IEIBTS clinical supervisor practitioner under 103.23 supervision of a mental health professional, the lower of the 103.24 submitted charge or $67 per hour unit; 103.25 (2) for an IEIBTS senior behavior therapist practitioner 103.26 under supervision of a mental health professional, the lower of 103.27 the submitted charge or $37 per hour unit; or 103.28 (3) for an IEIBTS behavior therapist practitioner under 103.29 supervision of a mental health professional, the lower of the 103.30 submitted charge or $27 per hour unit. 103.31 An IEIBTS practitioner may receive payment for travel time which 103.32 exceeds 50 minutes one-way. The maximum payment allowed will be 103.33 $0.51 per minute for up to a maximum of 300 hours per year. 103.34 For any week during which the above charges are made to 103.35 medical assistance, payments for the following services are 103.36 excluded: supervising mental health professional hours and 104.1 personal care attendant, home-based mental health, 104.2 family-community support, or mental health behavioral aide hours. 104.3 (k) [REPORT.] The commissioner shall collect evidence of 104.4 the effectiveness of intensive early intervention behavior 104.5 therapy services and present a report to the legislature by July 104.6 1, 2006. 104.7 [EFFECTIVE DATE.] This section is effective January 1, 2003. 104.8 Sec. 32. Minnesota Statutes 2000, section 256B.0625, 104.9 subdivision 13, is amended to read: 104.10 Subd. 13. [DRUGS.] (a) Medical assistance covers drugs, 104.11 except for fertility drugs when specifically used to enhance 104.12 fertility, if prescribed by a licensed practitioner and 104.13 dispensed by a licensed pharmacist, by a physician enrolled in 104.14 the medical assistance program as a dispensing physician, or by 104.15 a physician or a nurse practitioner employed by or under 104.16 contract with a community health board as defined in section 104.17 145A.02, subdivision 5, for the purposes of communicable disease 104.18 control. The commissioner, after receiving recommendations from 104.19 professional medical associations and professional pharmacist 104.20 associations, shall designate a formulary committee to advise 104.21 the commissioner on the names of drugs for which payment is 104.22 made, recommend a system for reimbursing providers on a set fee 104.23 or charge basis rather than the present system, and develop 104.24 methods encouraging use of generic drugs when they are less 104.25 expensive and equally effective as trademark drugs. The 104.26 formulary committee shall consist of nine members, four of whom 104.27 shall be physicians who are not employed by the department of 104.28 human services, and a majority of whose practice is for persons 104.29 paying privately or through health insurance, three of whom 104.30 shall be pharmacists who are not employed by the department of 104.31 human services, and a majority of whose practice is for persons 104.32 paying privately or through health insurance, a consumer 104.33 representative, and a nursing home representative. Committee 104.34 members shall serve three-year terms and shall serve without 104.35 compensation. Members may be reappointed once. 104.36 (b) The commissioner shall establish a drug formulary. Its 105.1 establishment and publication shall not be subject to the 105.2 requirements of the Administrative Procedure Act, but the 105.3 formulary committee shall review and comment on the formulary 105.4 contents. The formulary committee shall review and recommend 105.5 drugs which require prior authorization. The formulary 105.6 committee may recommend drugs for prior authorization directly 105.7 to the commissioner, as long as opportunity for public input is 105.8 provided. Prior authorization may be requested by the 105.9 commissioner based on medical and clinical criteria before 105.10 certain drugs are eligible for payment. Before a drug may be 105.11 considered for prior authorization at the request of the 105.12 commissioner: 105.13 (1) the drug formulary committee must develop criteria to 105.14 be used for identifying drugs; the development of these criteria 105.15 is not subject to the requirements of chapter 14, but the 105.16 formulary committee shall provide opportunity for public input 105.17 in developing criteria; 105.18 (2) the drug formulary committee must hold a public forum 105.19 and receive public comment for an additional 15 days; and 105.20 (3) the commissioner must provide information to the 105.21 formulary committee on the impact that placing the drug on prior 105.22 authorization will have on the quality of patient care and 105.23 information regarding whether the drug is subject to clinical 105.24 abuse or misuse. Prior authorization may be required by the 105.25 commissioner before certain formulary drugs are eligible for 105.26 payment. The formulary shall not include: 105.27 (i) drugs or products for which there is no federal 105.28 funding; 105.29 (ii) over-the-counter drugs, except for antacids, 105.30 acetaminophen, family planning products, aspirin, insulin, 105.31 products for the treatment of lice, vitamins for adults with 105.32 documented vitamin deficiencies, vitamins for children under the 105.33 age of seven and pregnant or nursing women, and any other 105.34 over-the-counter drug identified by the commissioner, in 105.35 consultation with the drug formulary committee, as necessary, 105.36 appropriate, and cost-effective for the treatment of certain 106.1 specified chronic diseases, conditions or disorders, and this 106.2 determination shall not be subject to the requirements of 106.3 chapter 14; 106.4 (iii) anorectics, except that medically necessary 106.5 anorectics shall be covered for a recipient previously diagnosed 106.6 as having pickwickian syndrome and currently diagnosed as having 106.7 diabetes and being morbidly obese; 106.8 (iv) drugs for which medical value has not been 106.9 established; and 106.10 (v) drugs from manufacturers who have not signed a rebate 106.11 agreement with the Department of Health and Human Services 106.12 pursuant to section 1927 of title XIX of the Social Security Act. 106.13 The commissioner shall publish conditions for prohibiting 106.14 payment for specific drugs after considering the formulary 106.15 committee's recommendations. An honorarium of $100 per meeting 106.16 and reimbursement for mileage shall be paid to each committee 106.17 member in attendance. 106.18 (c) The basis for determining the amount of payment shall 106.19 be the lower of the actual acquisition costs of the drugs plus a 106.20 fixed dispensing fee; the maximum allowable cost set by the 106.21 federal government or by the commissioner plus the fixed 106.22 dispensing fee; or the usual and customary price charged to the 106.23 public. The pharmacy dispensing fee shall be $3.65, except that 106.24 the dispensing fee for intravenous solutions which must be 106.25 compounded by the pharmacist shall be $8 per bag, $14 per bag 106.26 for cancer chemotherapy products, and $30 per bag for total 106.27 parenteral nutritional products dispensed in one liter 106.28 quantities, or $44 per bag for total parenteral nutritional 106.29 products dispensed in quantities greater than one liter. Actual 106.30 acquisition cost includes quantity and other special discounts 106.31 except time and cash discounts. The actual acquisition cost of 106.32 a drug shall be estimated by the commissioner, at average 106.33 wholesale price minus nine percent, except that where a drug has 106.34 had its wholesale price reduced as a result of the actions of 106.35 the National Association of Medicaid Fraud Control Units, the 106.36 estimated actual acquisition cost shall be the reduced average 107.1 wholesale price, without the nine percent deduction. The 107.2 maximum allowable cost of a multisource drug may be set by the 107.3 commissioner and it shall be comparable to, but no higher than, 107.4 the maximum amount paid by other third-party payors in this 107.5 state who have maximum allowable cost programs. The 107.6 commissioner shall set maximum allowable costs for multisource 107.7 drugs that are not on the federal upper limit list as described 107.8 in United States Code, title 42, chapter 7, section 1396r-8(e), 107.9 the Social Security Act, and Code of Federal Regulations, title 107.10 42, part 447, section 447.332. Establishment of the amount of 107.11 payment for drugs shall not be subject to the requirements of 107.12 the Administrative Procedure Act. An additional dispensing fee 107.13 of $.30 may be added to the dispensing fee paid to pharmacists 107.14 for legend drug prescriptions dispensed to residents of 107.15 long-term care facilities when a unit dose blister card system, 107.16 approved by the department, is used. Under this type of 107.17 dispensing system, the pharmacist must dispense a 30-day supply 107.18 of drug. The National Drug Code (NDC) from the drug container 107.19 used to fill the blister card must be identified on the claim to 107.20 the department. The unit dose blister card containing the drug 107.21 must meet the packaging standards set forth in Minnesota Rules, 107.22 part 6800.2700, that govern the return of unused drugs to the 107.23 pharmacy for reuse. The pharmacy provider will be required to 107.24 credit the department for the actual acquisition cost of all 107.25 unused drugs that are eligible for reuse. Over-the-counter 107.26 medications must be dispensed in the manufacturer's unopened 107.27 package. The commissioner may permit the drug clozapine to be 107.28 dispensed in a quantity that is less than a 30-day supply. 107.29 Whenever a generically equivalent product is available, payment 107.30 shall be on the basis of the actual acquisition cost of the 107.31 generic drug, unless the prescriber specifically indicates 107.32 "dispense as written - brand necessary" on the prescription as 107.33 required by section 151.21, subdivision 2. 107.34 (d) For purposes of this subdivision, "multisource drugs" 107.35 means covered outpatient drugs, excluding innovator multisource 107.36 drugs for which there are two or more drug products, which: 108.1 (1) are related as therapeutically equivalent under the 108.2 Food and Drug Administration's most recent publication of 108.3 "Approved Drug Products with Therapeutic Equivalence 108.4 Evaluations"; 108.5 (2) are pharmaceutically equivalent and bioequivalent as 108.6 determined by the Food and Drug Administration; and 108.7 (3) are sold or marketed in Minnesota. 108.8 "Innovator multisource drug" means a multisource drug that was 108.9 originally marketed under an original new drug application 108.10 approved by the Food and Drug Administration. 108.11 (e) The basis for determining the amount of payment for 108.12 drugs administered in an outpatient setting shall be the lower 108.13 of the usual and customary cost submitted by the provider; the 108.14 average wholesale price minus five percent; or the maximum 108.15 allowable cost set by the federal government under United States 108.16 Code, title 42, chapter 7, section 1396r-8(e) and Code of 108.17 Federal Regulations, title 42, section 447.332, or by the 108.18 commissioner under paragraph (c). 108.19 [EFFECTIVE DATE.] This section is effective 30 days 108.20 following final enactment. 108.21 Sec. 33. Minnesota Statutes 2000, section 256B.0625, 108.22 subdivision 13a, is amended to read: 108.23 Subd. 13a. [DRUG UTILIZATION REVIEW BOARD.] A nine-member 108.24 drug utilization review board is established. The board is 108.25 comprised of at least three but no more than four licensed 108.26 physicians actively engaged in the practice of medicine in 108.27 Minnesota; at least three licensed pharmacists actively engaged 108.28 in the practice of pharmacy in Minnesota; and one consumer 108.29 representative; the remainder to be made up of health care 108.30 professionals who are licensed in their field and have 108.31 recognized knowledge in the clinically appropriate prescribing, 108.32 dispensing, and monitoring of covered outpatient drugs. The 108.33 board shall be staffed by an employee of the department who 108.34 shall serve as an ex officio nonvoting member of the board. The 108.35 members of the board shall be appointed by the commissioner and 108.36 shall serve three-year terms. The members shall be selected 109.1 from lists submitted by professional associations. The 109.2 commissioner shall appoint the initial members of the board for 109.3 terms expiring as follows: three members for terms expiring 109.4 June 30, 1996; three members for terms expiring June 30, 1997; 109.5 and three members for terms expiring June 30, 1998. Members may 109.6 be reappointed once. The board shall annually elect a chair 109.7 from among the members. 109.8 The commissioner shall, with the advice of the board: 109.9 (1) implement a medical assistance retrospective and 109.10 prospective drug utilization review program as required by 109.11 United States Code, title 42, section 1396r-8(g)(3); 109.12 (2) develop and implement the predetermined criteria and 109.13 practice parameters for appropriate prescribing to be used in 109.14 retrospective and prospective drug utilization review; 109.15 (3) develop, select, implement, and assess interventions 109.16 for physicians, pharmacists, and patients that are educational 109.17 and not punitive in nature; 109.18 (4) establish a grievance and appeals process for 109.19 physicians and pharmacists under this section; 109.20 (5) publish and disseminate educational information to 109.21 physicians and pharmacists regarding the board and the review 109.22 program; 109.23 (6) adopt and implement procedures designed to ensure the 109.24 confidentiality of any information collected, stored, retrieved, 109.25 assessed, or analyzed by the board, staff to the board, or 109.26 contractors to the review program that identifies individual 109.27 physicians, pharmacists, or recipients; 109.28 (7) establish and implement an ongoing process to (i) 109.29 receive public comment regarding drug utilization review 109.30 criteria and standards, and (ii) consider the comments along 109.31 with other scientific and clinical information in order to 109.32 revise criteria and standards on a timely basis; and 109.33 (8) adopt any rules necessary to carry out this section. 109.34 The board may establish advisory committees. The 109.35 commissioner may contract with appropriate organizations to 109.36 assist the board in carrying out the board's duties. The 110.1 commissioner may enter into contracts for services to develop 110.2 and implement a retrospective and prospective review program. 110.3 The board shall report to the commissioner annually on the 110.4 date the Drug Utilization Review Annual Report is due to the 110.5 Health Care Financing Administration. This report is to cover 110.6 the preceding federal fiscal year. The commissioner shall make 110.7 the report available to the public upon request. The report 110.8 must include information on the activities of the board and the 110.9 program; the effectiveness of implemented interventions; 110.10 administrative costs; and any fiscal impact resulting from the 110.11 program. An honorarium of$50$100 per meeting and 110.12 reimbursement for mileage shall be paid to each board member in 110.13 attendance. 110.14 Sec. 34. Minnesota Statutes 2000, section 256B.0625, 110.15 subdivision 17, is amended to read: 110.16 Subd. 17. [TRANSPORTATION COSTS.] (a) Medical assistance 110.17 covers transportation costs incurred solely for obtaining 110.18 emergency medical care or transportation costs incurred by 110.19 nonambulatory persons in obtaining emergency or nonemergency 110.20 medical care when paid directly to an ambulance company, common 110.21 carrier, or other recognized providers of transportation 110.22 services. For the purpose of this subdivision, a person who is 110.23 incapable of transport by taxicab or bus shall be considered to 110.24 be nonambulatory. 110.25 (b) Medical assistance covers special transportation, as 110.26 defined in Minnesota Rules, part 9505.0315, subpart 1, item F, 110.27 if the provider receives and maintains a current physician's 110.28 order by the recipient's attending physician certifying that the 110.29 recipient has a physical or mental impairment that would 110.30 prohibit the recipient from safely accessing and using a bus, 110.31 taxi, other commercial transportation, or private automobile. 110.32 Special transportation includes driver-assisted service to 110.33 eligible individuals. Driver-assisted service includes 110.34 passenger pickup at and return to the individual's residence or 110.35 place of business, assistance with admittance of the individual 110.36 to the medical facility, and assistance in passenger securement 111.1 or in securing of wheelchairs or stretchers in the vehicle. The 111.2 commissioner shall establish maximum medical assistance 111.3 reimbursement rates for special transportation services for 111.4 persons who need a wheelchairliftaccessible van or 111.5stretcher-equippedstretcher-accessible vehicle and for those 111.6 who do not need a wheelchairliftaccessible van or 111.7stretcher-equippedstretcher-accessible vehicle. The average of 111.8 these two rates per trip must not exceed $15 for the base rate 111.9 and$1.20$1.40 per mile. Special transportation provided to 111.10 nonambulatory persons who do not need a wheelchairlift111.11 accessible van orstretcher-equippedstretcher-accessible 111.12 vehicle, may be reimbursed at a lower rate than special 111.13 transportation provided to persons who need a wheelchairlift111.14 accessible van orstretcher-equippedstretcher-accessible 111.15 vehicle. 111.16 [EFFECTIVE DATE.] This section is effective July 1, 2001. 111.17 Sec. 35. Minnesota Statutes 2000, section 256B.0625, 111.18 subdivision 17a, is amended to read: 111.19 Subd. 17a. [PAYMENT FOR AMBULANCE SERVICES.] Effective for 111.20 services rendered on or after July 1,19992001, medical 111.21 assistance payments for ambulance services shall beincreased by111.22five percentpaid at the Medicare reimbursement rate or at the 111.23 medical assistance payment rate in effect on July 1, 2000, 111.24 whichever is greater. 111.25 Sec. 36. Minnesota Statutes 2000, section 256B.0625, 111.26 subdivision 18a, is amended to read: 111.27 Subd. 18a. [PAYMENT FOR MEALS AND LODGINGACCESS TO 111.28 MEDICAL SERVICES.] (a) Medical assistance reimbursement for 111.29 meals for persons traveling to receive medical care may not 111.30 exceed $5.50 for breakfast, $6.50 for lunch, or $8 for dinner. 111.31 (b) Medical assistance reimbursement for lodging for 111.32 persons traveling to receive medical care may not exceed $50 per 111.33 day unless prior authorized by the local agency. 111.34 (c) Medical assistance direct mileage reimbursement to the 111.35 eligible person or the eligible person's driver may not exceed 111.36 20 cents per mile. 112.1 (d) Medical assistance covers oral language interpreter 112.2 services when provided by an enrolled health care provider 112.3 during the course of providing a direct, person-to-person 112.4 covered health care service to an enrolled recipient with 112.5 limited English proficiency. 112.6 Sec. 37. Minnesota Statutes 2000, section 256B.0625, 112.7 subdivision 30, is amended to read: 112.8 Subd. 30. [OTHER CLINIC SERVICES.] (a) Medical assistance 112.9 covers rural health clinic services, federally qualified health 112.10 center services, nonprofit community health clinic services, 112.11 public health clinic services, and the services of a clinic 112.12 meeting the criteria established in rule by the commissioner. 112.13 Rural health clinic services and federally qualified health 112.14 center services mean services defined in United States Code, 112.15 title 42, section 1396d(a)(2)(B) and (C). Payment for rural 112.16 health clinic and federally qualified health center services 112.17 shall be made according to applicable federal law and regulation. 112.18 (b) A federally qualified health center that is beginning 112.19 initial operation shall submit an estimate of budgeted costs and 112.20 visits for the initial reporting period in the form and detail 112.21 required by the commissioner. A federally qualified health 112.22 center that is already in operation shall submit an initial 112.23 report using actual costs and visits for the initial reporting 112.24 period. Within 90 days of the end of its reporting period, a 112.25 federally qualified health center shall submit, in the form and 112.26 detail required by the commissioner, a report of its operations, 112.27 including allowable costs actually incurred for the period and 112.28 the actual number of visits for services furnished during the 112.29 period, and other information required by the commissioner. 112.30 Federally qualified health centers that file Medicare cost 112.31 reports shall provide the commissioner with a copy of the most 112.32 recent Medicare cost report filed with the Medicare program 112.33 intermediary for the reporting year which support the costs 112.34 claimed on their cost report to the state. 112.35 (c) In order to continue cost-based payment under the 112.36 medical assistance program according to paragraphs (a) and (b), 113.1 a federally qualified health center or rural health clinic must 113.2 apply for designation as an essential community provider within 113.3 six months of final adoption of rules by the department of 113.4 health according to section 62Q.19, subdivision 7. For those 113.5 federally qualified health centers and rural health clinics that 113.6 have applied for essential community provider status within the 113.7 six-month time prescribed, medical assistance payments will 113.8 continue to be made according to paragraphs (a) and (b) for the 113.9 first three years after application. For federally qualified 113.10 health centers and rural health clinics that either do not apply 113.11 within the time specified above or who have had essential 113.12 community provider status for three years, medical assistance 113.13 payments for health services provided by these entities shall be 113.14 according to the same rates and conditions applicable to the 113.15 same service provided by health care providers that are not 113.16 federally qualified health centers or rural health clinics. 113.17 (d) Effective July 1, 1999, the provisions of paragraph (c) 113.18 requiring a federally qualified health center or a rural health 113.19 clinic to make application for an essential community provider 113.20 designation in order to have cost-based payments made according 113.21 to paragraphs (a) and (b) no longer apply. 113.22 (e) Effective January 1, 2000, payments made according to 113.23 paragraphs (a) and (b) shall be limited to the cost phase-out 113.24 schedule of the Balanced Budget Act of 1997. 113.25 (f) Effective January 1, 2001, each federally qualified 113.26 health center and rural health clinic may elect to be paid 113.27 either under the prospective payment system established in 113.28 United States Code, title 42, section 1396a(aa) or under an 113.29 alternative payment methodology consistent with the requirements 113.30 of United States Code, title 42, section 1396a(aa) and approved 113.31 by the Health Care Financing Administration. The alternative 113.32 payment methodology shall be 100 percent of cost as determined 113.33 according to Medicare cost principles. 113.34 Sec. 38. Minnesota Statutes 2000, section 256B.0625, 113.35 subdivision 34, is amended to read: 113.36 Subd. 34. [INDIAN HEALTH SERVICES FACILITIES.] Medical 114.1 assistance payments and MinnesotaCare payments to facilities of 114.2 the Indian health service and facilities operated by a tribe or 114.3 tribal organization under funding authorized by United States 114.4 Code, title 25, sections 450f to 450n, or title III of the 114.5 Indian Self-Determination and Education Assistance Act, Public 114.6 Law Number 93-638, for enrollees who are eligible for federal 114.7 financial participation, shall be at the option of the facility 114.8 in accordance with the rate published by the United States 114.9 Assistant Secretary for Health under the authority of United 114.10 States Code, title 42, sections 248(a) and 249(b). General 114.11 assistance medical care payments to facilities of the Indian 114.12 health services and facilities operated by a tribe or tribal 114.13 organization for the provision of outpatient medical care 114.14 services billed after June 30, 1990, must be in accordance with 114.15 the general assistance medical care rates paid for the same 114.16 services when provided in a facility other than a facility of 114.17 the Indian health service or a facility operated by a tribe or 114.18 tribal organization. MinnesotaCare payments for enrollees who 114.19 are not eligible for federal financial participation at 114.20 facilities of the Indian Health Service and facilities operated 114.21 by a tribe or tribal organization for the provision of 114.22 outpatient medical services must be in accordance with the 114.23 medical assistance rates paid for the same services when 114.24 provided in a facility other than a facility of the Indian 114.25 Health Service or a facility operated by a tribe or tribal 114.26 organization. 114.27 [EFFECTIVE DATE.] This section is effective the day 114.28 following final enactment. 114.29 Sec. 39. Minnesota Statutes 2000, section 256B.0625, is 114.30 amended by adding a subdivision to read: 114.31 Subd. 43. [TARGETED CASE MANAGEMENT SERVICES.] Medical 114.32 assistance covers case management services for vulnerable adults 114.33 and persons with developmental disabilities not receiving home 114.34 and community-based waiver services. 114.35 Sec. 40. Minnesota Statutes 2000, section 256B.0635, 114.36 subdivision 1, is amended to read: 115.1 Subdivision 1. [INCREASED EMPLOYMENT.]Beginning January115.21, 1998(a) Until June 30, 2002, medical assistance may be paid 115.3 for persons who received MFIP-S or medical assistance for 115.4 families and children in at least three of six months preceding 115.5 the month in which the person became ineligible for MFIP-S or 115.6 medical assistance, if the ineligibility was due to an increase 115.7 in hours of employment or employment income or due to the loss 115.8 of an earned income disregard. In addition, to receive 115.9 continued assistance under this section, persons who received 115.10 medical assistance for families and children but did not receive 115.11 MFIP-S must have had income less than or equal to the assistance 115.12 standard for their family size under the state's AFDC plan in 115.13 effect as of July 16, 1996,as required by the Personal115.14Responsibility and Work Opportunity Reconciliation Act of 1996115.15(PRWORA), Public Law Number 104-193,increased by three percent 115.16 effective July 1, 2000, at the time medical assistance 115.17 eligibility began. A person who is eligible for extended 115.18 medical assistance is entitled to six months of assistance 115.19 without reapplication, unless the assistance unit ceases to 115.20 include a dependent child. For a person under 21 years of age, 115.21 medical assistance may not be discontinued within the six-month 115.22 period of extended eligibility until it has been determined that 115.23 the person is not otherwise eligible for medical assistance. 115.24 Medical assistance may be continued for an additional six months 115.25 if the person meets all requirements for the additional six 115.26 months, according to title XIX of the Social Security Act, as 115.27 amended by section 303 of the Family Support Act of 1988, Public 115.28 Law Number 100-485. 115.29 (b) Beginning July 1, 2002, medical assistance for families 115.30 and children may be paid for persons who were eligible under 115.31 section 256B.055, subdivision 3a, in at least three of six 115.32 months preceding the month in which the person became ineligible 115.33 under that section if the ineligibility was due to an increase 115.34 in hours of employment or employment income or due to the loss 115.35 of an earned income disregard. A person who is eligible for 115.36 extended medical assistance is entitled to six months of 116.1 assistance without reapplication, unless the assistance unit 116.2 ceases to include a dependent child, except medical assistance 116.3 may not be discontinued for that dependent child under 21 years 116.4 of age within the six-month period of extended eligibility until 116.5 it has been determined that the person is not otherwise eligible 116.6 for medical assistance. Medical assistance may be continued for 116.7 an additional six months if the person meets all requirements 116.8 for the additional six months, according to title XIX of the 116.9 Social Security Act, as amended by section 303 of the Family 116.10 Support Act of 1988, Public Law Number 100-485. 116.11 [EFFECTIVE DATE.] This section is effective July 1, 2001. 116.12 Sec. 41. Minnesota Statutes 2000, section 256B.0635, 116.13 subdivision 2, is amended to read: 116.14 Subd. 2. [INCREASED CHILD OR SPOUSAL SUPPORT.]Beginning116.15January 1, 1998(a) Until June 30, 2002, medical assistance may 116.16 be paid for persons who received MFIP-S or medical assistance 116.17 for families and children in at least three of the six months 116.18 preceding the month in which the person became ineligible for 116.19 MFIP-S or medical assistance, if the ineligibility was the 116.20 result of the collection of child or spousal support under part 116.21 D of title IV of the Social Security Act. In addition, to 116.22 receive continued assistance under this section, persons who 116.23 received medical assistance for families and children but did 116.24 not receive MFIP-S must have had income less than or equal to 116.25 the assistance standard for their family size under the state's 116.26 AFDC plan in effect as of July 16, 1996,as required by the116.27Personal Responsibility and Work Opportunity Reconciliation Act116.28of 1996 (PRWORA), Public Law Number 104-193increased by three 116.29 percent effective July 1, 2000, at the time medical assistance 116.30 eligibility began. A person who is eligible for extended 116.31 medical assistance under this subdivision is entitled to four 116.32 months of assistance without reapplication, unless the 116.33 assistance unit ceases to include a dependent child. For a116.34person under 21 years of age, except medical assistance may not 116.35 be discontinued for that dependent child under 21 years of age 116.36 within the four-month period of extended eligibility until it 117.1 has been determined that the person is not otherwise eligible 117.2 for medical assistance. 117.3 (b) Beginning July 1, 2002, medical assistance for families 117.4 and children may be paid for persons who were eligible under 117.5 section 256B.055, subdivision 3a, in at least three of the six 117.6 months preceding the month in which the person became ineligible 117.7 under that section if the ineligibility was the result of the 117.8 collection of child or spousal support under part D of title IV 117.9 of the Social Security Act. A person who is eligible for 117.10 extended medical assistance under this subdivision is entitled 117.11 to four months of assistance without reapplication, unless the 117.12 assistance unit ceases to include a dependent child, except 117.13 medical assistance may not be discontinued for that dependent 117.14 child under 21 years of age within the four-month period of 117.15 extended eligibility until it has been determined that the 117.16 person is not otherwise eligible for medical assistance. 117.17 [EFFECTIVE DATE.] This section is effective July 1, 2001. 117.18 Sec. 42. [256B.0637] [PRESUMPTIVE ELIGIBILITY FOR CERTAIN 117.19 PERSONS NEEDING TREATMENT FOR BREAST OR CERVICAL CANCER.] 117.20 Medical assistance is available during a presumptive 117.21 eligibility period for persons who meet the criteria in section 117.22 256B.057, subdivision 10. For purposes of this section, the 117.23 presumptive eligibility period begins on the date on which an 117.24 entity designated by the commissioner determines, based on 117.25 preliminary information, that the person meets the criteria in 117.26 section 256B.057, subdivision 10. The presumptive eligibility 117.27 period ends on the day on which a determination is made as to 117.28 the person's eligibility, except that if an application is not 117.29 submitted by the last day of the month following the month 117.30 during which the determination based on preliminary information 117.31 is made, the presumptive eligibility period ends on that last 117.32 day of the month. 117.33 [EFFECTIVE DATE.] This section is effective July 1, 2002. 117.34 Sec. 43. Minnesota Statutes 2000, section 256B.0644, is 117.35 amended to read: 117.36 256B.0644 [PARTICIPATION REQUIRED FOR REIMBURSEMENT UNDER 118.1 OTHER STATE HEALTH CARE PROGRAMS.] 118.2 A vendor of medical care, as defined in section 256B.02, 118.3 subdivision 7, and a health maintenance organization, as defined 118.4 in chapter 62D, must participate as a provider or contractor in 118.5 the medical assistance program, general assistance medical care 118.6 program, and MinnesotaCare as a condition of participating as a 118.7 provider in health insurance plans and programs or contractor 118.8 for state employees established under section 43A.18, the public 118.9 employees insurance program under section 43A.316, for health 118.10 insurance plans offered to local statutory or home rule charter 118.11 city, county, and school district employees, the workers' 118.12 compensation system under section 176.135, and insurance plans 118.13 provided through the Minnesota comprehensive health association 118.14 under sections 62E.01 to 62E.19. The limitations on insurance 118.15 plans offered to local government employees shall not be 118.16 applicable in geographic areas where provider participation is 118.17 limited by managed care contracts with the department of human 118.18 services. For providers other than health maintenance 118.19 organizations, participation in the medical assistance program 118.20 means that (1) the provider accepts new medical assistance, 118.21 general assistance medical care, and MinnesotaCare patients or 118.22 (2) at least 20 percent of the provider's patients are covered 118.23 by medical assistance, general assistance medical care, and 118.24 MinnesotaCare as their primary source of coverage. Patients 118.25 seen on a volunteer basis by the provider at a location other 118.26 than the provider's usual place of practice may be considered in 118.27 meeting this participation requirement. The commissioner shall 118.28 establish participation requirements for health maintenance 118.29 organizations. The commissioner shall provide lists of 118.30 participating medical assistance providers on a quarterly basis 118.31 to the commissioner of employee relations, the commissioner of 118.32 labor and industry, and the commissioner of commerce. Each of 118.33 the commissioners shall develop and implement procedures to 118.34 exclude as participating providers in the program or programs 118.35 under their jurisdiction those providers who do not participate 118.36 in the medical assistance program. The commissioner of employee 119.1 relations shall implement this section through contracts with 119.2 participating health and dental carriers. 119.3 Sec. 44. [256B.0924] [TARGETED CASE MANAGEMENT SERVICES 119.4 FOR VULNERABLE ADULTS AND PERSONS WITH DEVELOPMENTAL 119.5 DISABILITIES.] 119.6 Subdivision 1. [PURPOSE.] The state recognizes that 119.7 targeted case management services can decrease the need for more 119.8 costly services such as multiple emergency room visits or 119.9 hospitalizations by linking eligible individuals with less 119.10 costly services available in the community. 119.11 Subd. 2. [DEFINITIONS.] For purposes of this section, the 119.12 following terms have the meanings given: 119.13 (a) "Targeted case management" means services which will 119.14 assist medical assistance eligible persons to gain access to 119.15 needed medical, social, educational, and other services. 119.16 Targeted case management does not include therapy, treatment, 119.17 legal, or outreach services. 119.18 (b) "Targeted case management for adults" means activities 119.19 that coordinate and link social and other services designed to 119.20 help eligible persons gain access to needed protective services, 119.21 social, health care, mental health, habilitative, educational, 119.22 vocational, recreational, advocacy, legal, chemical, health, and 119.23 other related services. 119.24 Subd. 3. [ELIGIBILITY.] Persons are eligible to receive 119.25 targeted case management services under this section if the 119.26 requirements in paragraphs (a) and (b) are met. 119.27 (a) The person must be assessed and determined by the local 119.28 county agency to: 119.29 (1) be age 18 or older; 119.30 (2) be receiving medical assistance; 119.31 (3) have significant functional limitations; and 119.32 (4) be in need of service coordination to attain or 119.33 maintain living in an integrated community setting. 119.34 (b) The person must be a vulnerable adult in need of adult 119.35 protection as defined in section 626.5572, or is an adult with 119.36 mental retardation as defined in section 252A.02, subdivision 2, 120.1 or a related condition as defined in section 252.27, subdivision 120.2 1a, and is not receiving home and community-based waiver 120.3 services. 120.4 Subd. 4. [TARGETED CASE MANAGEMENT SERVICE 120.5 ACTIVITIES.] (a) For persons with mental retardation or a 120.6 related condition, targeted case management services must meet 120.7 the provisions of section 256B.092. 120.8 (b) For persons not eligible as a person with mental 120.9 retardation or a related condition, targeted case management 120.10 service activities include: 120.11 (1) an assessment of the person's need for targeted case 120.12 management services; 120.13 (2) the development of a written personal service plan; 120.14 (3) a regular review and revision of the written personal 120.15 service plan with the recipient and the recipient's legal 120.16 representative, and others as identified by the recipient, to 120.17 ensure access to necessary services and supports identified in 120.18 the plan; 120.19 (4) effective communication with the recipient and the 120.20 recipient's legal representative and others identified by the 120.21 recipient; 120.22 (5) coordination of referrals for needed services with 120.23 qualified providers; 120.24 (6) coordination and monitoring of the overall service 120.25 delivery to ensure the quality and effectiveness of services; 120.26 (7) assistance to the recipient and the recipient's legal 120.27 representative to help make an informed choice of services; 120.28 (8) advocating on behalf of the recipient when service 120.29 barriers are encountered or referring the recipient and the 120.30 recipient's legal representative to an independent advocate; 120.31 (9) monitoring and evaluating services identified in the 120.32 personal service plan to ensure personal outcomes are met and to 120.33 ensure satisfaction with services and service delivery; 120.34 (10) conducting face-to-face monitoring with the recipient 120.35 at least twice a year; 120.36 (11) completing and maintain necessary documentation that 121.1 supports verifies the activities in this section; 121.2 (12) coordinating with the medical assistance facility 121.3 discharge planner in the 180-day period prior to the recipient's 121.4 discharge into the community; and 121.5 (13) a personal service plan developed and reviewed at 121.6 least annually with the recipient and the recipient's legal 121.7 representative. The personal service plan must be revised when 121.8 there is a change in the recipient's status. The personal 121.9 service plan must identify: 121.10 (i) the desired personal short and long-term outcomes; 121.11 (ii) the recipient's preferences for services and supports, 121.12 including development of a person-centered plan if requested; 121.13 and 121.14 (iii) formal and informal services and supports based on 121.15 areas of assessment, such as: social, health, mental health, 121.16 residence, family, educational and vocational, safety, legal, 121.17 self-determination, financial, and chemical health as determined 121.18 by the recipient and the recipient's legal representative and 121.19 the recipient's support network. 121.20 Subd. 5. [PROVIDER STANDARDS.] County boards or providers 121.21 who contract with the county are eligible to receive medical 121.22 assistance reimbursement for adult targeted case management 121.23 services. To qualify as a provider of targeted case management 121.24 services the vendor must: 121.25 (1) have demonstrated the capacity and experience to 121.26 provide the activities of case management services defined in 121.27 subdivision 4; 121.28 (2) be able to coordinate and link community resources 121.29 needed by the recipient; 121.30 (3) have the administrative capacity and experience to 121.31 serve the eligible population in providing services and to 121.32 ensure quality of services under state and federal requirements; 121.33 (4) have a financial management system that provides 121.34 accurate documentation of services and costs under state and 121.35 federal requirements; 121.36 (5) have the capacity to document and maintain individual 122.1 case records complying with state and federal requirements; 122.2 (6) coordinate with county social service agencies 122.3 responsible for planning for community social services under 122.4 chapters 256E and 256F; conducting adult protective 122.5 investigations under section 626.557, and conducting prepetition 122.6 screenings for commitments under section 253B.07; 122.7 (7) coordinate with health care providers to ensure access 122.8 to necessary health care services; 122.9 (8) have a procedure in place that notifies the recipient 122.10 and the recipient's legal representative of any conflict of 122.11 interest if the contracted targeted case management service 122.12 provider also provides the recipient's services and supports and 122.13 provides information on all potential conflicts of interest and 122.14 obtains the recipient's informed consent and provides the 122.15 recipient with alternatives; and 122.16 (9) have demonstrated the capacity to achieve the following 122.17 performance outcomes: access, quality, and consumer 122.18 satisfaction. 122.19 Subd. 6. [PAYMENT FOR TARGETED CASE MANAGEMENT.] (a) 122.20 Medical assistance and MinnesotaCare payment for targeted case 122.21 management shall be made on a monthly basis. In order to 122.22 receive payment for an eligible adult, the provider must 122.23 document at least one contact per month and not more than two 122.24 consecutive months without a face-to-face contact with the adult 122.25 or the adult's legal representative. 122.26 (b) Payment for targeted case management provided by county 122.27 staff under this subdivision shall be based on the monthly rate 122.28 methodology under section 256B.094, subdivision 6, paragraph 122.29 (b), calculated as one combined average rate together with adult 122.30 mental health case management under section 256B.0625, 122.31 subdivision 20, except for calendar year 2002. In calendar year 122.32 2002, the rate for case management under this section shall be 122.33 the same as the rate for adult mental health case management in 122.34 effect as of December 31, 2001. Billing and payment must 122.35 identify the recipient's primary population group to allow 122.36 tracking of revenues. 123.1 (c) Payment for targeted case management provided by 123.2 county-contracted vendors shall be based on a monthly rate 123.3 negotiated by the host county. The negotiated rate must not 123.4 exceed the rate charged by the vendor for the same service to 123.5 other payers. If the service is provided by a team of 123.6 contracted vendors, the county may negotiate a team rate with a 123.7 vendor who is a member of the team. The team shall determine 123.8 how to distribute the rate among its members. No reimbursement 123.9 received by contracted vendors shall be returned to the county, 123.10 except to reimburse the county for advance funding provided by 123.11 the county to the vendor. 123.12 (d) If the service is provided by a team that includes 123.13 contracted vendors and county staff, the costs for county staff 123.14 participation on the team shall be included in the rate for 123.15 county-provided services. In this case, the contracted vendor 123.16 and the county may each receive separate payment for services 123.17 provided by each entity in the same month. In order to prevent 123.18 duplication of services, the county must document, in the 123.19 recipient's file, the need for team targeted case management and 123.20 a description of the different roles of the team members. 123.21 (e) Notwithstanding section 256B.19, subdivision 1, the 123.22 nonfederal share of costs for targeted case management shall be 123.23 provided by the recipient's county of responsibility, as defined 123.24 in sections 256G.01 to 256G.12, from sources other than federal 123.25 funds or funds used to match other federal funds. 123.26 (f) The commissioner may suspend, reduce, or terminate 123.27 reimbursement to a provider that does not meet the reporting or 123.28 other requirements of this section. The county of 123.29 responsibility, as defined in sections 256G.01 to 256G.12, is 123.30 responsible for any federal disallowances. The county may share 123.31 this responsibility with its contracted vendors. 123.32 (g) The commissioner shall set aside five percent of the 123.33 federal funds received under this section for use in reimbursing 123.34 the state for costs of developing and implementing this section. 123.35 (h) Notwithstanding section 256.025, subdivision 2, 123.36 payments to counties for targeted case management expenditures 124.1 under this section shall only be made from federal earnings from 124.2 services provided under this section. Payments to contracted 124.3 vendors shall include both the federal earnings and the county 124.4 share. 124.5 (i) Notwithstanding section 256B.041, county payments for 124.6 the cost of case management services provided by county staff 124.7 shall not be made to the state treasurer. For the purposes of 124.8 targeted case management services provided by county staff under 124.9 this section, the centralized disbursement of payments to 124.10 counties under section 256B.041 consists only of federal 124.11 earnings from services provided under this section. 124.12 (j) If the recipient is a resident of a nursing facility, 124.13 intermediate care facility, or hospital, and the recipient's 124.14 institutional care is paid by medical assistance, payment for 124.15 targeted case management services under this subdivision is 124.16 limited to the last 180 days of the recipient's residency in 124.17 that facility and may not exceed more than six months in a 124.18 calendar year. 124.19 (k) Payment for targeted case management services under 124.20 this subdivision shall not duplicate payments made under other 124.21 program authorities for the same purpose. 124.22 (l) Any growth in targeted case management services and 124.23 cost increases under this section shall be the responsibility of 124.24 the counties. 124.25 Subd. 7. [IMPLEMENTATION AND EVALUATION.] The commissioner 124.26 of human services in consultation with county boards shall 124.27 establish a program to accomplish the provisions of subdivisions 124.28 1 to 6. The commissioner in consultation with county boards 124.29 shall establish performance measures to evaluate the 124.30 effectiveness of the targeted case management services. If a 124.31 county fails to meet agreed upon performance measures, the 124.32 commissioner may authorize contracted providers other than the 124.33 county. Providers contracted by the commissioner shall also be 124.34 subject to the standards in subdivision 6. 124.35 [EFFECTIVE DATE.] This section is effective January 1, 2002. 124.36 Sec. 45. Minnesota Statutes 2000, section 256B.19, 125.1 subdivision 1c, is amended to read: 125.2 Subd. 1c. [ADDITIONAL PORTION OF NONFEDERAL SHARE.]In125.3addition to any payment required under subdivision 1b,(a) 125.4 Hennepin county shall be responsible for a monthly transfer 125.5 payment of $1,500,000, due before noon on the 15th of each month 125.6 and the University of Minnesota shall be responsible for a 125.7 monthly transfer payment of $500,000 due before noon on the 15th 125.8 of each month, beginning July 15, 1995. These sums shall be 125.9 part of the designated governmental unit's portion of the 125.10 nonfederal share of medical assistance costs, but shall not be 125.11 subject to payback provisions of section 256.025. 125.12 (b) Beginning July 1, 2001, Hennepin county's payment under 125.13 paragraph (a) shall be $2,066,000 each month. 125.14 (c) Beginning July 1, 2001, the commissioner shall increase 125.15 annual capitation payments to metropolitan health plan under 125.16 section 256B.69 for the prepaid medical assistance program by 125.17 approximately $3,400,000, plus any available federal matching 125.18 funds, to recognize higher than average medical education costs. 125.19 Sec. 46. [256B.195] [ADDITIONAL INTERGOVERNMENTAL 125.20 TRANSFERS; HOSPITAL PAYMENTS.] 125.21 Subdivision 1. [FEDERAL APPROVAL REQUIRED.] Sections 125.22 145.9268, 256.969, subdivision 26, and this section are 125.23 contingent on federal approval of the intergovernmental 125.24 transfers and payments to safety net hospitals and community 125.25 clinics authorized under this section. These sections are also 125.26 contingent on current payment, by the government entities, of 125.27 intergovernmental transfers under section 256B.19 and this 125.28 section. 125.29 Subd. 2. [PAYMENTS FROM GOVERNMENTAL ENTITIES.] (a) In 125.30 addition to any payment required under section 256B.19, 125.31 effective July 15, 2001, the following government entities shall 125.32 make the payments indicated before noon on the 15th of each 125.33 month: 125.34 (1) Hennepin county, $2,000,000; and 125.35 (2) Ramsey county, $1,000,000. 125.36 (b) These sums shall be part of the designated governmental 126.1 unit's portion of the nonfederal share of medical assistance 126.2 costs. Of these payments, Hennepin county shall pay 71 percent 126.3 directly to Hennepin County Medical Center, and Ramsey county 126.4 shall pay 71 percent directly to Regions hospital. The counties 126.5 must provide certification to the commissioner of payments to 126.6 hospitals under this subdivision. 126.7 Subd. 3. [PAYMENTS TO CERTAIN SAFETY NET PROVIDERS.] (a) 126.8 Effective July 15, 2001, the commissioner shall make the 126.9 following payments to the hospitals indicated after noon on the 126.10 15th of each month: 126.11 (1) to Hennepin County Medical Center, any federal matching 126.12 funds available to match the payments received by the medical 126.13 center under subdivision 2, to increase payments for medical 126.14 assistance admissions and to recognize higher medical assistance 126.15 costs in institutions that provide high levels of charity care; 126.16 and 126.17 (2) to Regions hospital, any federal matching funds 126.18 available to match the payments received by the hospital under 126.19 subdivision 2, to increase payments for medical assistance 126.20 admissions and to recognize higher medical assistance costs in 126.21 institutions that provide high levels of charity care. 126.22 (b) Effective July 15, 2001, the following percentages of 126.23 the transfers under subdivision 2 shall be retained by the 126.24 commissioner for deposit each month into the general fund: 126.25 (1) 18 percent, plus any federal matching funds, shall be 126.26 allocated for the following purposes: 126.27 (i) during the fiscal year beginning July 1, 2001, of the 126.28 amount available under this clause, 39.7 percent shall be 126.29 allocated to make increased hospital payments under section 126.30 256.969, subdivision 26; 34.2 percent shall be allocated to fund 126.31 the amounts due from small rural hospitals, as defined in 126.32 section 144.148, for overpayments under section 256.969, 126.33 subdivision 5a, resulting from a determination that medical 126.34 assistance and general assistance payments exceeded the charge 126.35 limit during the period from 1994 to 1997; and 26.1 percent 126.36 shall be allocated to the commissioner of health for rural 127.1 hospital capital improvement grants under section 144.148; and 127.2 (ii) during fiscal years beginning on or after July 1, 127.3 2002, of the amount available under this clause, 55 percent 127.4 shall be allocated to make increased hospital payments under 127.5 section 256.969, subdivision 26, and 45 percent shall be 127.6 allocated to the commissioner of health for rural hospital 127.7 capital improvement grants under section 144.148; and 127.8 (2) 11 percent shall be allocated to the commissioner of 127.9 health to fund community clinic grants under section 145.9268. 127.10 (c) This subdivision shall apply to fee-for-service 127.11 payments only and shall not increase capitation payments or 127.12 payments made based on average rates. 127.13 (d) Medical assistance rate or payment changes, including 127.14 those required to obtain federal financial participation under 127.15 section 62J.692, subdivision 8, shall precede the determination 127.16 of intergovernmental transfer amounts determined in this 127.17 subdivision. Participation in the intergovernmental transfer 127.18 program shall not result in the offset of any health care 127.19 provider's receipt of medical assistance payment increases other 127.20 than limits resulting from hospital-specific charge limits and 127.21 limits on disproportionate share hospital payments. 127.22 Subd. 4. [ADJUSTMENTS PERMITTED.] (a) The commissioner may 127.23 adjust the intergovernmental transfers under subdivision 2 and 127.24 the payments under subdivision 3, and payments and transfers 127.25 under subdivision 5, based on the commissioner's determination 127.26 of Medicare upper payment limits, hospital-specific charge 127.27 limits, and hospital-specific limitations on disproportionate 127.28 share payments. Any adjustments must be made on a proportional 127.29 basis. If participation by a particular hospital under this 127.30 section is limited, the commissioner shall adjust the payments 127.31 that relate to that hospital under subdivisions 2, 3, and 5 on a 127.32 proportional basis in order to allow the hospital to participate 127.33 under this section to the fullest extent possible and shall 127.34 increase other payments under subdivisions 2, 3, and 5 to the 127.35 extent allowable to maintain the overall level of payments under 127.36 this section. The commissioner may make adjustments under this 128.1 subdivision only after consultation with the counties and 128.2 hospitals identified in subdivisions 2 and 3, and, if 128.3 subdivision 5 receives federal approval, with the hospital and 128.4 educational institution identified in subdivision 5. 128.5 (b) The ratio of medical assistance payments specified in 128.6 subdivision 3 to the intergovernmental transfers specified in 128.7 subdivision 2 shall not be reduced except as provided under 128.8 paragraph (a). 128.9 Subd. 5. [INCLUSION OF FAIRVIEW UNIVERSITY MEDICAL 128.10 CENTER.] (a) Upon federal approval of the inclusion of Fairview 128.11 university medical center in the nonstate government category, 128.12 the commissioner shall establish an intergovernmental transfer 128.13 with the University of Minnesota in an amount determined by the 128.14 commissioner based on the increase in the Medicare upper payment 128.15 limit due solely to the inclusion of Fairview university medical 128.16 center as a nonstate government hospital and limited by 128.17 hospital-specific charge limits and the amount available under 128.18 the hospital-specific disproportionate share limit. 128.19 (b) The commissioner shall increase payments for medical 128.20 assistance admissions at Fairview University Medical Center by 128.21 71 percent of the transfer plus any federal matching payments on 128.22 that amount, to increase payments for medical assistance 128.23 admissions and to recognize higher medical assistance costs in 128.24 institutions that provide high levels of charity care. From 128.25 this payment, Fairview University Medical Center shall pay to 128.26 the University of Minnesota the cost of the transfer, on the 128.27 same day the payment is received. Eighteen percent of the 128.28 transfer plus any federal matching payments shall be used as 128.29 specified in subdivision 3, paragraph (b), clause (1). Payments 128.30 under section 256.969, subdivision 26, may be increased above 128.31 the 90 percent level specified in that subdivision within the 128.32 limits of additional funding available under this subdivision. 128.33 Eleven percent of the transfer shall be used to increase the 128.34 grants under section 145.9268. 128.35 Sec. 47. [256B.53] [DENTAL ACCESS GRANTS.] 128.36 (a) The commissioner shall award grants to community 129.1 clinics or other nonprofit community organizations, political 129.2 subdivisions, professional associations, or other organizations 129.3 that demonstrate the ability to provide dental services 129.4 effectively to public program recipients. Grants may be used to 129.5 fund the costs related to coordinating access for recipients, 129.6 developing and implementing patient care criteria, upgrading or 129.7 establishing new facilities, acquiring furnishings or equipment, 129.8 recruiting new providers, or other development costs that will 129.9 improve access to dental care in a region. 129.10 (b) In awarding grants, the commissioner shall give 129.11 priority to applicants that plan to serve areas of the state in 129.12 which the number of dental providers is not currently sufficient 129.13 to meet the needs of recipients of public programs or uninsured 129.14 individuals. The commissioner shall consider the following in 129.15 awarding the grants: 129.16 (1) potential to successfully increase access to an 129.17 underserved population; 129.18 (2) the long-term viability of the project to improve 129.19 access beyond the period of initial funding; 129.20 (3) the efficiency in the use of the funding; and 129.21 (4) the experience of the applicants in providing services 129.22 to the target population. 129.23 (c) The commissioner shall consider grants for the 129.24 following: 129.25 (1) implementation of new programs or continued expansion 129.26 of current access programs that have demonstrated success in 129.27 providing dental services in underserved areas; 129.28 (2) a program for mobile or other types of outreach dental 129.29 clinics in underserved geographic areas; 129.30 (3) a program for school-based dental clinics in schools 129.31 with high numbers of children receiving medical assistance; 129.32 (4) a program testing new models of care that are sensitive 129.33 to the cultural needs of the recipients; 129.34 (5) a program creating new educational campaigns that 129.35 inform individuals of the importance of good oral health and the 129.36 link between dental disease and overall health status; 130.1 (6) a program that organizes a network of volunteer 130.2 dentists to provide dental services to public program recipients 130.3 or uninsured individuals; and 130.4 (7) a program that tests new delivery models by creating 130.5 partnerships between local providers and county public health 130.6 agencies. 130.7 (d) The commissioner shall evaluate the effects of the 130.8 dental access initiatives funded through the dental access 130.9 grants and submit a report to the legislature by January 15, 130.10 2003. 130.11 Sec. 48. [256B.55] [DENTAL ACCESS ADVISORY COMMITTEE.] 130.12 Subdivision 1. [ESTABLISHMENT.] The commissioner shall 130.13 establish a dental access advisory committee to monitor the 130.14 purchasing, administration, and coverage of dental care services 130.15 for the public health care programs to ensure dental care access 130.16 and quality for public program recipients. 130.17 Subd. 2. [MEMBERSHIP.] (a) The membership of the advisory 130.18 committee shall include, but is not limited to, representatives 130.19 of dentists, including a dentist practicing in the seven-county 130.20 metropolitan area and a dentist practicing outside the 130.21 seven-county metropolitan area; oral surgeons; pediatric 130.22 dentists; dental hygienists; community clinics; client advocacy 130.23 groups; public health; health service plans; the University of 130.24 Minnesota school of dentistry and the department of pediatrics; 130.25 and the commissioner of health. 130.26 (b) The advisory committee is governed by section 15.059 130.27 for membership terms and removal of members. Members shall not 130.28 receive per diem compensation or reimbursement for expenses. 130.29 Subd. 3. [DUTIES.] The advisory committee shall provide 130.30 recommendations on the following: 130.31 (1) how to reduce the administrative burden governing 130.32 dental care coverage policies in order to promote administrative 130.33 simplification, including prior authorization, coverage limits, 130.34 and co-payment collections; 130.35 (2) developing and implementing an action plan to improve 130.36 the oral health of children and persons with special needs in 131.1 the state; 131.2 (3) exploring alternative ways of purchasing and improving 131.3 access to dental services; 131.4 (4) developing ways to foster greater responsibility among 131.5 health care program recipients in seeking and obtaining dental 131.6 care, including initiatives to keep dental appointments and 131.7 comply with dental care plans; 131.8 (5) exploring innovative ways for dental providers to 131.9 schedule public program patients in order to reduce or minimize 131.10 the effect of appointment no shows; 131.11 (6) exploring ways to meet the barriers that may be present 131.12 in providing dental services to health care program recipients 131.13 such as language, culture, disability, and lack of 131.14 transportation; and 131.15 (7) exploring the possibility of pediatricians, family 131.16 physicians, and nurse practitioners providing basic oral health 131.17 screenings and basic preventive dental services. 131.18 Subd. 4. [REPORT.] The commissioner shall submit a report 131.19 by February 1, 2002, and by February 1, 2003, summarizing the 131.20 activities and recommendations of the advisory committee. 131.21 Subd. 5. [SUNSET.] Notwithstanding section 15.059, 131.22 subdivision 5, this section expires June 30, 2003. 131.23 Sec. 49. Minnesota Statutes 2000, section 256B.69, 131.24 subdivision 4, is amended to read: 131.25 Subd. 4. [LIMITATION OF CHOICE.] (a) The commissioner 131.26 shall develop criteria to determine when limitation of choice 131.27 may be implemented in the experimental counties. The criteria 131.28 shall ensure that all eligible individuals in the county have 131.29 continuing access to the full range of medical assistance 131.30 services as specified in subdivision 6. 131.31 (b) The commissioner shall exempt the following persons 131.32 from participation in the project, in addition to those who do 131.33 not meet the criteria for limitation of choice: 131.34 (1) persons eligible for medical assistance according to 131.35 section 256B.055, subdivision 1; 131.36 (2) persons eligible for medical assistance due to 132.1 blindness or disability as determined by the social security 132.2 administration or the state medical review team, unless: 132.3 (i) they are 65 years of age or older,; or 132.4 (ii) they reside in Itasca county or they reside in a 132.5 county in which the commissioner conducts a pilot project under 132.6 a waiver granted pursuant to section 1115 of the Social Security 132.7 Act; 132.8 (3) recipients who currently have private coverage through 132.9 a health maintenance organization; 132.10 (4) recipients who are eligible for medical assistance by 132.11 spending down excess income for medical expenses other than the 132.12 nursing facility per diem expense; 132.13 (5) recipients who receive benefits under the Refugee 132.14 Assistance Program, established under United States Code, title 132.15 8, section 1522(e); 132.16 (6) children who are both determined to be severely 132.17 emotionally disturbed and receiving case management services 132.18 according to section 256B.0625, subdivision 20;and132.19 (7) adults who are both determined to be seriously and 132.20 persistently mentally ill and received case management services 132.21 according to section 256B.0625, subdivision 20; and 132.22 (8) persons eligible for medical assistance according to 132.23 section 256B.057, subdivision 10. 132.24 Children under age 21 who are in foster placement may enroll in 132.25 the project on an elective basis. Individuals excluded under 132.26 clauses (6) and (7) may choose to enroll on an elective basis. 132.27 (c) The commissioner may allow persons with a one-month 132.28 spenddown who are otherwise eligible to enroll to voluntarily 132.29 enroll or remain enrolled, if they elect to prepay their monthly 132.30 spenddown to the state. 132.31 (d)Beginning on or after July 1, 1997,The commissioner 132.32 may require those individuals to enroll in the prepaid medical 132.33 assistance program who otherwise would have been excluded 132.34 under paragraph (b), clauses (1)and, (3), and (8), and under 132.35 Minnesota Rules, part 9500.1452, subpart 2, items H, K, and L. 132.36 (e) Before limitation of choice is implemented, eligible 133.1 individuals shall be notified and after notification, shall be 133.2 allowed to choose only among demonstration providers. The 133.3 commissioner may assign an individual with private coverage 133.4 through a health maintenance organization, to the same health 133.5 maintenance organization for medical assistance coverage, if the 133.6 health maintenance organization is under contract for medical 133.7 assistance in the individual's county of residence. After 133.8 initially choosing a provider, the recipient is allowed to 133.9 change that choice only at specified times as allowed by the 133.10 commissioner. If a demonstration provider ends participation in 133.11 the project for any reason, a recipient enrolled with that 133.12 provider must select a new provider but may change providers 133.13 without cause once more within the first 60 days after 133.14 enrollment with the second provider. 133.15 [EFFECTIVE DATE.] This section is effective July 1, 2002. 133.16 Sec. 50. Minnesota Statutes 2000, section 256B.69, 133.17 subdivision 5c, is amended to read: 133.18 Subd. 5c. [MEDICAL EDUCATION AND RESEARCH FUND.] (a) 133.19Beginning in January 1999 and each year thereafter:133.20(1)The commissioner of human services shall transferan133.21amount equal to the reduction in the prepaid medical assistance133.22and prepaid general assistance medical care payments resulting133.23from clause (2), excluding nursing facility and elderly waiver133.24payments and demonstration projects operating under subdivision133.2523, to the medical education and research fund established under133.26section 62J.692;each year to the medical education and research 133.27 fund established under section 62J.692, the following: 133.28(2)(1) an amount equal to the reduction in the prepaid 133.29 medical assistance and prepaid general assistance medical care 133.30 payments as specified in this clause. Until January 1, 2002, 133.31 the county medical assistance and general assistance medical 133.32 care capitation base rate prior to plan specific adjustments and 133.33 after the regional rate adjustments under section 256B.69, 133.34 subdivision 5b,shall beis reduced 6.3 percent for Hennepin 133.35 county, two percent for the remaining metropolitan counties, and 133.36 no reduction for nonmetropolitan Minnesota counties; and after 134.1 January 1, 2002, the county medical assistance and general 134.2 assistance medical care capitation base rate prior to plan 134.3 specific adjustmentsshall beis reduced 6.3 percent for 134.4 Hennepin county, two percent for the remaining metropolitan 134.5 counties, and 1.6 percent for nonmetropolitan Minnesota 134.6 counties. Nursing facility and elderly waiver payments and 134.7 demonstration project payments operating under subdivision 23 134.8 are excluded from this reduction. The amount calculated under 134.9 this clause shall not be adjusted for periods already paid due 134.10 to subsequent changes to the capitation payments; and 134.11 (2) beginning July 1, 2001, $2,537,000 from the capitation 134.12 rates paid under this section plus any federal matching funds on 134.13 this amount. 134.14(3) the amount calculated under clause (1) shall not be134.15adjusted for subsequent changes to the capitation payments for134.16periods already paid.134.17 (b) This subdivision shall be effective upon approval of a 134.18 federal waiver which allows federal financial participation in 134.19 the medical education and research fund. 134.20 Sec. 51. Minnesota Statutes 2000, section 256B.69, is 134.21 amended by adding a subdivision to read: 134.22 Subd. 6c. [DENTAL SERVICES DEMONSTRATION PROJECT.] The 134.23 commissioner shall establish a dental services demonstration 134.24 project in Crow Wing, Todd, Morrison, Wadena, and Cass counties 134.25 for provision of dental services to medical assistance, general 134.26 assistance medical care, and MinnesotaCare recipients. The 134.27 commissioner may contract on a prospective per capita payment 134.28 basis for these dental services with an organization licensed 134.29 under chapter 62C, 62D, or 62N in accordance with section 134.30 256B.037 or may establish and administer a fee-for-service 134.31 system for the reimbursement of dental services. 134.32 Sec. 52. Minnesota Statutes 2000, section 256B.69, 134.33 subdivision 23, is amended to read: 134.34 Subd. 23. [ALTERNATIVE INTEGRATED LONG-TERM CARE SERVICES; 134.35 ELDERLY AND DISABLED PERSONS.] (a) The commissioner may 134.36 implement demonstration projects to create alternative 135.1 integrated delivery systems for acute and long-term care 135.2 services to elderly persons and persons with disabilities as 135.3 defined in section 256B.77, subdivision 7a, that provide 135.4 increased coordination, improve access to quality services, and 135.5 mitigate future cost increases. The commissioner may seek 135.6 federal authority to combine Medicare and Medicaid capitation 135.7 payments for the purpose of such demonstrations. Medicare funds 135.8 and services shall be administered according to the terms and 135.9 conditions of the federal waiver and demonstration provisions. 135.10 For the purpose of administering medical assistance funds, 135.11 demonstrations under this subdivision are subject to 135.12 subdivisions 1 to 22. The provisions of Minnesota Rules, parts 135.13 9500.1450 to 9500.1464, apply to these demonstrations, with the 135.14 exceptions of parts 9500.1452, subpart 2, item B; and 9500.1457, 135.15 subpart 1, items B and C, which do not apply to persons 135.16 enrolling in demonstrations under this section. An initial open 135.17 enrollment period may be provided. Persons who disenroll from 135.18 demonstrations under this subdivision remain subject to 135.19 Minnesota Rules, parts 9500.1450 to 9500.1464. When a person is 135.20 enrolled in a health plan under these demonstrations and the 135.21 health plan's participation is subsequently terminated for any 135.22 reason, the person shall be provided an opportunity to select a 135.23 new health plan and shall have the right to change health plans 135.24 within the first 60 days of enrollment in the second health 135.25 plan. Persons required to participate in health plans under 135.26 this section who fail to make a choice of health plan shall not 135.27 be randomly assigned to health plans under these demonstrations. 135.28 Notwithstanding section 256L.12, subdivision 5, and Minnesota 135.29 Rules, part 9505.5220, subpart 1, item A, if adopted, for the 135.30 purpose of demonstrations under this subdivision, the 135.31 commissioner may contract with managed care organizations, 135.32 including counties, to serve only elderly persons eligible for 135.33 medical assistance, elderly and disabled persons, or disabled 135.34 persons only. For persons with primary diagnoses of mental 135.35 retardation or a related condition, serious and persistent 135.36 mental illness, or serious emotional disturbance, the 136.1 commissioner must ensure that the county authority has approved 136.2 the demonstration and contracting design. Enrollment in these 136.3 projects for persons with disabilities shall be voluntaryuntil136.4July 1, 2001. The commissioner shall not implement any 136.5 demonstration project under this subdivision for persons with 136.6 primary diagnoses of mental retardation or a related condition, 136.7 serious and persistent mental illness, or serious emotional 136.8 disturbance, without approval of the county board of the county 136.9 in which the demonstration is being implemented. 136.10 Before implementation of a demonstration project for 136.11 disabled persons, the commissioner must provide information to 136.12 appropriate committees of the house of representatives and 136.13 senate and must involve representatives of affected disability 136.14 groups in the design of the demonstration projects. 136.15 (b) A nursing facility reimbursed under the alternative 136.16 reimbursement methodology in section 256B.434 may, in 136.17 collaboration with a hospital, clinic, or other health care 136.18 entity provide services under paragraph (a). The commissioner 136.19 shall amend the state plan and seek any federal waivers 136.20 necessary to implement this paragraph. 136.21 Sec. 53. Minnesota Statutes 2000, section 256B.75, is 136.22 amended to read: 136.23 256B.75 [HOSPITAL OUTPATIENT REIMBURSEMENT.] 136.24 (a) For outpatient hospital facility fee payments for 136.25 services rendered on or after October 1, 1992, the commissioner 136.26 of human services shall pay the lower of (1) submitted charge, 136.27 or (2) 32 percent above the rate in effect on June 30, 1992, 136.28 except for those services for which there is a federal maximum 136.29 allowable payment. Effective for services rendered on or after 136.30 January 1, 2000, payment rates for nonsurgical outpatient 136.31 hospital facility fees and emergency room facility fees shall be 136.32 increased by eight percent over the rates in effect on December 136.33 31, 1999, except for those services for which there is a federal 136.34 maximum allowable payment. Services for which there is a 136.35 federal maximum allowable payment shall be paid at the lower of 136.36 (1) submitted charge, or (2) the federal maximum allowable 137.1 payment. Total aggregate payment for outpatient hospital 137.2 facility fee services shall not exceed the Medicare upper 137.3 limit. If it is determined that a provision of this section 137.4 conflicts with existing or future requirements of the United 137.5 States government with respect to federal financial 137.6 participation in medical assistance, the federal requirements 137.7 prevail. The commissioner may, in the aggregate, prospectively 137.8 reduce payment rates to avoid reduced federal financial 137.9 participation resulting from rates that are in excess of the 137.10 Medicare upper limitations. 137.11 (b) Notwithstanding paragraph (a), payment for outpatient, 137.12 emergency, and ambulatory surgery hospital facility fee services 137.13 for critical access hospitals designated under section 144.1483, 137.14 clause (11), shall be paid on a cost-based payment system that 137.15 is based on the cost-finding methods and allowable costs of the 137.16 Medicare program. 137.17 (c) Effective for services provided on or after July 1, 137.18 2002, rates that are based on the Medicare outpatient 137.19 prospective payment system shall be replaced by a budget neutral 137.20 prospective payment system that is derived using medical 137.21 assistance data. The commissioner shall provide a proposal to 137.22 the 2002 legislature to define and implement this provision. 137.23 Sec. 54. Minnesota Statutes 2000, section 256B.76, is 137.24 amended to read: 137.25 256B.76 [PHYSICIAN AND DENTAL REIMBURSEMENT.] 137.26 (a) Effective for services rendered on or after October 1, 137.27 1992, the commissioner shall make payments for physician 137.28 services as follows: 137.29 (1) payment for level one Health Care Finance 137.30 Administration's common procedural coding system (HCPCS) codes 137.31 titled "office and other outpatient services," "preventive 137.32 medicine new and established patient," "delivery, antepartum, 137.33 and postpartum care," "critical care,"Caesareancesarean 137.34 delivery and pharmacologic management provided to psychiatric 137.35 patients, and HCPCS level three codes for enhanced services for 137.36 prenatal high risk, shall be paid at the lower of (i) submitted 138.1 charges, or (ii) 25 percent above the rate in effect on June 30, 138.2 1992. If the rate on any procedure code within these categories 138.3 is different than the rate that would have been paid under the 138.4 methodology in section 256B.74, subdivision 2, then the larger 138.5 rate shall be paid; 138.6 (2) payments for all other services shall be paid at the 138.7 lower of (i) submitted charges, or (ii) 15.4 percent above the 138.8 rate in effect on June 30, 1992; 138.9 (3) all physician rates shall be converted from the 50th 138.10 percentile of 1982 to the 50th percentile of 1989, less the 138.11 percent in aggregate necessary to equal the above increases 138.12 except that payment rates for home health agency services shall 138.13 be the rates in effect on September 30, 1992; 138.14 (4) effective for services rendered on or after January 1, 138.15 2000, payment rates for physician and professional services 138.16 shall be increased by three percent over the rates in effect on 138.17 December 31, 1999, except for home health agency and family 138.18 planning agency services; and 138.19 (5) the increases in clause (4) shall be implemented 138.20 January 1, 2000, for managed care. 138.21 (b) Effective for services rendered on or after October 1, 138.22 1992, the commissioner shall make payments for dental services 138.23 as follows: 138.24 (1) dental services shall be paid at the lower of (i) 138.25 submitted charges, or (ii) 25 percent above the rate in effect 138.26 on June 30, 1992; 138.27 (2) dental rates shall be converted from the 50th 138.28 percentile of 1982 to the 50th percentile of 1989, less the 138.29 percent in aggregate necessary to equal the above increases; 138.30 (3) effective for services rendered on or after January 1, 138.31 2000, payment rates for dental services shall be increased by 138.32 three percent over the rates in effect on December 31, 1999; 138.33 (4) the commissioner shall award grants to community 138.34 clinics or other nonprofit community organizations, political 138.35 subdivisions, professional associations, or other organizations 138.36 that demonstrate the ability to provide dental services 139.1 effectively to public program recipients. Grants may be used to 139.2 fund the costs related to coordinating access for recipients, 139.3 developing and implementing patient care criteria, upgrading or 139.4 establishing new facilities, acquiring furnishings or equipment, 139.5 recruiting new providers, or other development costs that will 139.6 improve access to dental care in a region. In awarding grants, 139.7 the commissioner shall give priority to applicants that plan to 139.8 serve areas of the state in which the number of dental providers 139.9 is not currently sufficient to meet the needs of recipients of 139.10 public programs or uninsured individuals. The commissioner 139.11 shall consider the following in awarding the grants: (i) 139.12 potential to successfully increase access to an underserved 139.13 population; (ii) the ability to raise matching funds; (iii) the 139.14 long-term viability of the project to improve access beyond the 139.15 period of initial funding; (iv) the efficiency in the use of the 139.16 funding; and (v) the experience of the proposers in providing 139.17 services to the target population. 139.18 The commissioner shall monitor the grants and may terminate 139.19 a grant if the grantee does not increase dental access for 139.20 public program recipients. The commissioner shall consider 139.21 grants for the following: 139.22 (i) implementation of new programs or continued expansion 139.23 of current access programs that have demonstrated success in 139.24 providing dental services in underserved areas; 139.25 (ii) a pilot program for utilizing hygienists outside of a 139.26 traditional dental office to provide dental hygiene services; 139.27 and 139.28 (iii) a program that organizes a network of volunteer 139.29 dentists, establishes a system to refer eligible individuals to 139.30 volunteer dentists, and through that network provides donated 139.31 dental care services to public program recipients or uninsured 139.32 individuals. 139.33 (5) beginning October 1, 1999, the payment for tooth 139.34 sealants and fluoride treatments shall be the lower of (i) 139.35 submitted charge, or (ii) 80 percent of median 1997 charges;and139.36 (6) the increases listed in clauses (3) and (5) shall be 140.1 implemented January 1, 2000, for managed care; and 140.2 (7) effective for services provided on or after January 1, 140.3 2002, payment for diagnostic examinations and dental x-rays 140.4 provided to children under age 21 shall be the lower of (i) the 140.5 submitted charge, or (ii) 85 percent of median 1999 charges. 140.6 (c) Effective for dental services rendered on or after 140.7 January 1, 2002, the commissioner may, within the limits of 140.8 available appropriation, increase reimbursements to dentists and 140.9 dental clinics deemed by the commissioner to be critical access 140.10 dental providers. Reimbursement to a critical access dental 140.11 provider may be increased by not more than 50 percent above the 140.12 reimbursement rate that would otherwise be paid to the 140.13 provider. Payments to health plan companies shall be adjusted 140.14 to reflect increased reimbursements to critical access dental 140.15 providers as approved by the commissioner. In determining which 140.16 dentists and dental clinics shall be deemed critical access 140.17 dental providers, the commissioner shall review: 140.18 (1) the utilization rate in the service area in which the 140.19 dentist or dental clinic operates for dental services to 140.20 patients covered by medical assistance, general assistance 140.21 medical care, or MinnesotaCare as their primary source of 140.22 coverage; 140.23 (2) the level of services provided by the dentist or dental 140.24 clinic to patients covered by medical assistance, general 140.25 assistance medical care, or MinnesotaCare as their primary 140.26 source of coverage; and 140.27 (3) whether the level of services provided by the dentist 140.28 or dental clinic is critical to maintaining adequate levels of 140.29 patient access within the service area. 140.30 In the absence of a critical access dental provider in a service 140.31 area, the commissioner may designate a dentist or dental clinic 140.32 as a critical access dental provider if the dentist or dental 140.33 clinic is willing to provide care to patients covered by medical 140.34 assistance, general assistance medical care, or MinnesotaCare at 140.35 a level which significantly increases access to dental care in 140.36 the service area. 141.1 (d) An entity that operates both a Medicare certified 141.2 comprehensive outpatient rehabilitation facility and a facility 141.3 which was certified prior to January 1, 1993, that is licensed 141.4 under Minnesota Rules, parts 9570.2000 to 9570.3600, and for 141.5 whom at least 33 percent of the clients receiving rehabilitation 141.6 services in the most recent calendar year are medical assistance 141.7 recipients, shall be reimbursed by the commissioner for 141.8 rehabilitation services at rates that are 38 percent greater 141.9 than the maximum reimbursement rate allowed under paragraph (a), 141.10 clause (2), when those services are (1) provided within the 141.11 comprehensive outpatient rehabilitation facility and (2) 141.12 provided to residents of nursing facilities owned by the entity. 141.13 Sec. 55. [256B.78] [MEDICAL ASSISTANCE DEMONSTRATION 141.14 PROJECT FOR FAMILY PLANNING SERVICES.] 141.15 (a) The commissioner of human services shall establish a 141.16 medical assistance demonstration project to determine whether 141.17 improved access to coverage of prepregnancy family planning 141.18 services reduces medical assistance and MFIP costs. 141.19 (b) This section is effective upon federal approval of the 141.20 demonstration project. 141.21 Sec. 56. Minnesota Statutes 2000, section 256D.03, 141.22 subdivision 3, is amended to read: 141.23 Subd. 3. [GENERAL ASSISTANCE MEDICAL CARE; ELIGIBILITY.] 141.24 (a) General assistance medical care may be paid for any person 141.25 who is not eligible for medical assistance under chapter 256B, 141.26 including eligibility for medical assistance based on a 141.27 spenddown of excess income according to section 256B.056, 141.28 subdivision 5, or MinnesotaCare as defined in paragraph (b), 141.29 except as provided in paragraph (c); and: 141.30 (1) who is receiving assistance under section 256D.05, 141.31 except for families with children who are eligible under 141.32 Minnesota family investment program-statewide (MFIP-S), who is 141.33 having a payment made on the person's behalf under sections 141.34 256I.01 to 256I.06, or who resides in group residential housing 141.35 as defined in chapter 256I and can meet a spenddown using the 141.36 cost of remedial services received through group residential 142.1 housing; or 142.2 (2)(i) who is a resident of Minnesota; and whose equity in 142.3 assets is not in excess of $1,000 per assistance unit. Exempt 142.4 assets, the reduction of excess assets, and the waiver of excess 142.5 assets must conform to the medical assistance program in chapter 142.6 256B, with the following exception: the maximum amount of 142.7 undistributed funds in a trust that could be distributed to or 142.8 on behalf of the beneficiary by the trustee, assuming the full 142.9 exercise of the trustee's discretion under the terms of the 142.10 trust, must be applied toward the asset maximum; and 142.11 (ii) who has countable income not in excess of the 142.12 assistance standards established in section 256B.056, 142.13 subdivision45c, paragraph (b), or whose excess income is spent 142.14 downaccording to section 256B.056, subdivision 5,to that 142.15 standard using a six-month budget period. The method for 142.16 calculating earned income disregards and deductions for a person 142.17 who resides with a dependent child under age 21 shall 142.18 followsection 256B.056, subdivision 1a. However, if a142.19disregard of $30 and one-third of the remainder has been applied142.20to the wage earner's income, the disregard shall not be applied142.21again until the wage earner's income has not been considered in142.22an eligibility determination for general assistance, general142.23assistance medical care, medical assistance, or MFIP-S for 12142.24consecutive monthsthe AFDC income disregard and deductions in 142.25 effect under the July 16, 1996, AFDC state plan. The earned 142.26 income and work expense deductions for a person who does not 142.27 reside with a dependent child under age 21 shall be the same as 142.28 the method used to determine eligibility for a person under 142.29 section 256D.06, subdivision 1, except the disregard of the 142.30 first $50 of earned income is not allowed; 142.31 (3) who would be eligible for medical assistance except 142.32 that the person resides in a facility that is determined by the 142.33 commissioner or the federal Health Care Financing Administration 142.34 to be an institution for mental diseases; or 142.35 (4) who is ineligible for medical assistance under chapter 142.36 256B or general assistance medical care under any other 143.1 provision of this section, and is receiving care and 143.2 rehabilitation services from a nonprofit center established to 143.3 serve victims of torture. These individuals are eligible for 143.4 general assistance medical care only for the period during which 143.5 they are receiving services from the center. During this period 143.6 of eligibility, individuals eligible under this clause shall not 143.7 be required to participate in prepaid general assistance medical 143.8 care. 143.9 (b) Beginning January 1, 2000, applicants or recipients who 143.10 meet all eligibility requirements of MinnesotaCare as defined in 143.11 sections 256L.01 to 256L.16, and are: 143.12 (i) adults with dependent children under 21 whose gross 143.13 family income is equal to or less than 275 percent of the 143.14 federal poverty guidelines; or 143.15 (ii) adults without children with earned income and whose 143.16 family gross income is between 75 percent of the federal poverty 143.17 guidelines and the amount set by section 256L.04, subdivision 7, 143.18 shall be terminated from general assistance medical care upon 143.19 enrollment in MinnesotaCare. 143.20 (c) For services rendered on or after July 1, 1997, 143.21 eligibility is limited to one month prior to application if the 143.22 person is determined eligible in the prior month. A 143.23 redetermination of eligibility must occur every 12 months. 143.24 Beginning January 1, 2000, Minnesota health care program 143.25 applications completed by recipients and applicants who are 143.26 persons described in paragraph (b), may be returned to the 143.27 county agency to be forwarded to the department of human 143.28 services or sent directly to the department of human services 143.29 for enrollment in MinnesotaCare. If all other eligibility 143.30 requirements of this subdivision are met, eligibility for 143.31 general assistance medical care shall be available in any month 143.32 during which a MinnesotaCare eligibility determination and 143.33 enrollment are pending. Upon notification of eligibility for 143.34 MinnesotaCare, notice of termination for eligibility for general 143.35 assistance medical care shall be sent to an applicant or 143.36 recipient. If all other eligibility requirements of this 144.1 subdivision are met, eligibility for general assistance medical 144.2 care shall be available until enrollment in MinnesotaCare 144.3 subject to the provisions of paragraph (e). 144.4 (d) The date of an initial Minnesota health care program 144.5 application necessary to begin a determination of eligibility 144.6 shall be the date the applicant has provided a name, address, 144.7 and social security number, signed and dated, to the county 144.8 agency or the department of human services. If the applicant is 144.9 unable to provide an initial application when health care is 144.10 delivered due to a medical condition or disability, a health 144.11 care provider may act on the person's behalf to complete the 144.12 initial application. The applicant must complete the remainder 144.13 of the application and provide necessary verification before 144.14 eligibility can be determined. The county agency must assist 144.15 the applicant in obtaining verification if necessary. On the 144.16 basis of information provided on the completed application, an 144.17 applicant who meets the following criteria shall be determined 144.18 eligible beginning in the month of application: 144.19 (1) has gross income less than 90 percent of the applicable 144.20 income standard; 144.21 (2) has liquid assets that total within $300 of the asset 144.22 standard; 144.23 (3) does not reside in a long-term care facility; and 144.24 (4) meets all other eligibility requirements. 144.25 The applicant must provide all required verifications within 30 144.26 days' notice of the eligibility determination or eligibility 144.27 shall be terminated. 144.28 (e) County agencies are authorized to use all automated 144.29 databases containing information regarding recipients' or 144.30 applicants' income in order to determine eligibility for general 144.31 assistance medical care or MinnesotaCare. Such use shall be 144.32 considered sufficient in order to determine eligibility and 144.33 premium payments by the county agency. 144.34 (f) General assistance medical care is not available for a 144.35 person in a correctional facility unless the person is detained 144.36 by law for less than one year in a county correctional or 145.1 detention facility as a person accused or convicted of a crime, 145.2 or admitted as an inpatient to a hospital on a criminal hold 145.3 order, and the person is a recipient of general assistance 145.4 medical care at the time the person is detained by law or 145.5 admitted on a criminal hold order and as long as the person 145.6 continues to meet other eligibility requirements of this 145.7 subdivision. 145.8 (g) General assistance medical care is not available for 145.9 applicants or recipients who do not cooperate with the county 145.10 agency to meet the requirements of medical assistance. General 145.11 assistance medical care is limited to payment of emergency 145.12 services only for applicants or recipients as described in 145.13 paragraph (b), whose MinnesotaCare coverage is denied or 145.14 terminated for nonpayment of premiums as required by sections 145.15 256L.06 and 256L.07. 145.16 (h) In determining the amount of assets of an individual, 145.17 there shall be included any asset or interest in an asset, 145.18 including an asset excluded under paragraph (a), that was given 145.19 away, sold, or disposed of for less than fair market value 145.20 within the 60 months preceding application for general 145.21 assistance medical care or during the period of eligibility. 145.22 Any transfer described in this paragraph shall be presumed to 145.23 have been for the purpose of establishing eligibility for 145.24 general assistance medical care, unless the individual furnishes 145.25 convincing evidence to establish that the transaction was 145.26 exclusively for another purpose. For purposes of this 145.27 paragraph, the value of the asset or interest shall be the fair 145.28 market value at the time it was given away, sold, or disposed 145.29 of, less the amount of compensation received. For any 145.30 uncompensated transfer, the number of months of ineligibility, 145.31 including partial months, shall be calculated by dividing the 145.32 uncompensated transfer amount by the average monthly per person 145.33 payment made by the medical assistance program to skilled 145.34 nursing facilities for the previous calendar year. The 145.35 individual shall remain ineligible until this fixed period has 145.36 expired. The period of ineligibility may exceed 30 months, and 146.1 a reapplication for benefits after 30 months from the date of 146.2 the transfer shall not result in eligibility unless and until 146.3 the period of ineligibility has expired. The period of 146.4 ineligibility begins in the month the transfer was reported to 146.5 the county agency, or if the transfer was not reported, the 146.6 month in which the county agency discovered the transfer, 146.7 whichever comes first. For applicants, the period of 146.8 ineligibility begins on the date of the first approved 146.9 application. 146.10 (i) When determining eligibility for any state benefits 146.11 under this subdivision, the income and resources of all 146.12 noncitizens shall be deemed to include their sponsor's income 146.13 and resources as defined in the Personal Responsibility and Work 146.14 Opportunity Reconciliation Act of 1996, title IV, Public Law 146.15 Number 104-193, sections 421 and 422, and subsequently set out 146.16 in federal rules. 146.17 (j)(1) An undocumented noncitizen or a nonimmigrant is 146.18 ineligible for general assistance medical care other than 146.19 emergency services. For purposes of this subdivision, a 146.20 nonimmigrant is an individual in one or more of the classes 146.21 listed in United States Code, title 8, section 1101(a)(15), and 146.22 an undocumented noncitizen is an individual who resides in the 146.23 United States without the approval or acquiescence of the 146.24 Immigration and Naturalization Service. 146.25 (2) This paragraph does not apply to a child under age 18, 146.26 to a Cuban or Haitian entrant as defined in Public Law Number 146.27 96-422, section 501(e)(1) or (2)(a), or to a noncitizen who is 146.28 aged, blind, or disabled as defined in Code of Federal 146.29 Regulations, title 42, sections 435.520, 435.530, 435.531, 146.30 435.540, and 435.541, or effective October 1, 1998, to an 146.31 individual eligible for general assistance medical care under 146.32 paragraph (a), clause (4), who cooperates with the Immigration 146.33 and Naturalization Service to pursue any applicable immigration 146.34 status, including citizenship, that would qualify the individual 146.35 for medical assistance with federal financial participation. 146.36 (k) For purposes of paragraphs (g) and (j), "emergency 147.1 services" has the meaning given in Code of Federal Regulations, 147.2 title 42, section 440.255(b)(1), except that it also means 147.3 services rendered because of suspected or actual pesticide 147.4 poisoning. 147.5 (l) Notwithstanding any other provision of law, a 147.6 noncitizen who is ineligible for medical assistance due to the 147.7 deeming of a sponsor's income and resources, is ineligible for 147.8 general assistance medical care. 147.9 [EFFECTIVE DATE.] This section is effective July 1, 2001. 147.10 Sec. 57. Minnesota Statutes 2000, section 256J.31, 147.11 subdivision 12, is amended to read: 147.12 Subd. 12. [RIGHT TO DISCONTINUE CASH ASSISTANCE.] A 147.13 participant who is not in vendor payment status may discontinue 147.14 receipt of the cash assistance portion of the MFIP assistance 147.15 grant and retain eligibility for child care assistance under 147.16 section 119B.05and for medical assistance under sections147.17256B.055, subdivision 3a, and 256B.0635. For the months a 147.18 participant chooses to discontinue the receipt of the cash 147.19 portion of the MFIP grant, the assistance unit accrues months of 147.20 eligibility to be applied toward eligibility for child care 147.21 under section 119B.05and for medical assistance under sections147.22256B.055, subdivision 3a, and 256B.0635. 147.23 [EFFECTIVE DATE.] This section is effective July 1, 2002. 147.24 Sec. 58. Minnesota Statutes 2000, section 256K.03, 147.25 subdivision 1, is amended to read: 147.26 Subdivision 1. [NOTIFICATION OF PROGRAM.] Except for the 147.27 provisions in this section, the provisions for the MFIP 147.28 application process shall be followed. Within two days after 147.29 receipt of a completed combined application form, the county 147.30 agency must refer to the provider the applicant who meets the 147.31 conditions under section 256K.02, and notify the applicant in 147.32 writing of the program including the following provisions: 147.33 (1) notification that, as part of the application process, 147.34 applicants are required to attend orientation, to be followed 147.35 immediately by a job search; 147.36 (2) the program provider, the date, time, and location of 148.1 the scheduled program orientation; 148.2 (3) the procedures for qualifying for and receiving 148.3 benefits under the program; 148.4 (4) the immediate availability of supportive services, 148.5 including, but not limited to, child care, transportation, 148.6medical assistance,and other work-related aid; and 148.7 (5) the rights, responsibilities, and obligations of 148.8 participants in the program, including, but not limited to, the 148.9 grounds for exemptions and deferrals, the consequences for 148.10 refusing or failing to participate fully, and the appeal process. 148.11 [EFFECTIVE DATE.] This section is effective July 1, 2002. 148.12 Sec. 59. Minnesota Statutes 2000, section 256K.07, is 148.13 amended to read: 148.14 256K.07 [ELIGIBILITY FOR FOOD STAMPS, MEDICAL ASSISTANCE,148.15 AND CHILD CARE.] 148.16 The participant shall be treated as an MFIP recipient for 148.17 food stamps, medical assistance,and child care eligibility 148.18 purposes. The participant who leaves the program as a result of 148.19 increased earnings from employment shall be eligible for 148.20transitional medical assistance andchild care without regard to 148.21 MFIP receipt in three of the six months preceding ineligibility. 148.22 [EFFECTIVE DATE.] This section is effective July 1, 2002. 148.23 Sec. 60. Minnesota Statutes 2000, section 256L.03, is 148.24 amended by adding a subdivision to read: 148.25 Subd. 5a. [CO-PAYMENTS FOR CERTAIN CHILDREN.] Effective 148.26 July 1, 2002, through June 30, 2006, the MinnesotaCare benefit 148.27 plan for children enrolled in MinnesotaCare who, in accordance 148.28 with section 256L.15, subdivision 1, paragraph (c), opt not to 148.29 pay a premium shall include a $5 co-payment for nonpreventive 148.30 physician services, chiropractic services, and hospital 148.31 outpatient services as determined by the commissioner. 148.32 [EFFECTIVE DATE.] This section is effective July 1, 2002. 148.33 Sec. 61. Minnesota Statutes 2000, section 256L.05, 148.34 subdivision 2, is amended to read: 148.35 Subd. 2. [COMMISSIONER'S DUTIES.] The commissionershall148.36use individuals' social security numbers as identifiers for149.1purposes of administering the plan and conduct data matches to149.2verify income. Applicants shall submit evidence of individual149.3and family income, earned and unearned, such as the most recent149.4income tax return, wage slips, or other documentation that is149.5determined by the commissioner as necessary to verify income149.6eligibilityor county agency shall use electronic verification 149.7 as the primary method of income verification. If there is a 149.8 discrepancy between reported income and electronically verified 149.9 income, an individual may be required to submit additional 149.10 verification. In addition, the commissioner shall perform 149.11 random audits to verify reported income and eligibility. The 149.12 commissioner may execute data sharing arrangements with the 149.13 department of revenue and any other governmental agency in order 149.14 to perform income verification related to eligibility and 149.15 premium payment under the MinnesotaCare program. 149.16 Sec. 62. Minnesota Statutes 2000, section 256L.06, 149.17 subdivision 3, is amended to read: 149.18 Subd. 3. [ADMINISTRATION AND COMMISSIONER'S DUTIES.] (a) 149.19 Premiums are dedicated to the commissioner for MinnesotaCare. 149.20 (b) The commissioner shall develop and implement procedures 149.21 to: (1) require enrollees to report changes in income; (2) 149.22 adjust sliding scale premium payments, based upon changes in 149.23 enrollee income; and (3) disenroll enrollees from MinnesotaCare 149.24 for failure to pay required premiums. Failure to pay includes 149.25 payment with a dishonored check, a returned automatic bank 149.26 withdrawal, or a refused credit card or debit card payment. The 149.27 commissioner may demand a guaranteed form of payment, including 149.28 a cashier's check or a money order, as the only means to replace 149.29 a dishonored, returned, or refused payment. 149.30 (c) Premiums are calculated on a calendar month basis and 149.31 may be paid on a monthly, quarterly, or annual basis, with the 149.32 first payment due upon notice from the commissioner of the 149.33 premium amount required. The commissioner shall inform 149.34 applicants and enrollees of these premium payment options. 149.35 Premium payment is required before enrollment is complete and to 149.36 maintain eligibility in MinnesotaCare. 150.1 (d) Nonpayment of the premium will result in disenrollment 150.2 from the planwithin one calendar month after the due date150.3 effective for the calendar month for which the premium was due. 150.4 Persons disenrolled for nonpayment or who voluntarily terminate 150.5 coverage from the program may not reenroll until four calendar 150.6 months have elapsed. Persons disenrolled for nonpayment who pay 150.7 all past due premiums as well as current premiums due, including 150.8 premiums due for the period of disenrollment, within 20 days of 150.9 disenrollment, shall be reenrolled retroactively to the first 150.10 day of disenrollment. Persons disenrolled for nonpayment or who 150.11 voluntarily terminate coverage from the program may not reenroll 150.12 for four calendar months unless the person demonstrates good 150.13 cause for nonpayment. Good cause does not exist if a person 150.14 chooses to pay other family expenses instead of the premium. 150.15 The commissioner shall define good cause in rule. 150.16 [EFFECTIVE DATE.] This section is effective July 1, 2002. 150.17 Sec. 63. Minnesota Statutes 2000, section 256L.07, 150.18 subdivision 2, is amended to read: 150.19 Subd. 2. [MUST NOT HAVE ACCESS TO EMPLOYER-SUBSIDIZED 150.20 COVERAGE.] (a) To be eligible, a family or individual must not 150.21 have access to subsidized health coverage through an employer 150.22 and must not have had access to employer-subsidized coverage 150.23 through a current employer for 18 months prior to application or 150.24 reapplication. A family or individual whose employer-subsidized 150.25 coverage is lost due to an employer terminating health care 150.26 coverage as an employee benefit during the previous 18 months is 150.27 not eligible. 150.28 (b) This subdivision does not apply to a family or 150.29 individual who was enrolled in MinnesotaCare within six months 150.30 or less of reapplication and who no longer has 150.31 employer-subsidized coverage due to the employer terminating 150.32 health care coverage as an employee benefit. 150.33 (c) For purposes of this requirement, subsidized health 150.34 coverage means health coverage for which the employer pays at 150.35 least 50 percent of the cost of coverage for the employee or 150.36 dependent, or a higher percentage as specified by the 151.1 commissioner. Children are eligible for employer-subsidized 151.2 coverage through either parent, including the noncustodial 151.3 parent. The commissioner must treat employer contributions to 151.4 Internal Revenue Code Section 125 plans and any other employer 151.5 benefits intended to pay health care costs as qualified employer 151.6 subsidies toward the cost of health coverage for employees for 151.7 purposes of this subdivision. 151.8 [EFFECTIVE DATE.] This section is effective July 1, 2001, 151.9 or upon receipt of federal approval, whichever is later. 151.10 Sec. 64. Minnesota Statutes 2000, section 256L.12, is 151.11 amended by adding a subdivision to read: 151.12 Subd. 11. [COVERAGE AT INDIAN HEALTH SERVICE 151.13 FACILITIES.] For American Indian enrollees of MinnesotaCare, 151.14 MinnesotaCare shall cover health care services provided at 151.15 Indian Health Service facilities and facilities operated by a 151.16 tribe or tribal organization under funding authorized by United 151.17 States Code, title 25, sections 450f to 450n, or title III of 151.18 the Indian Self-Determination and Education Act, Public Law 151.19 Number 93-638, if those services would otherwise be covered 151.20 under section 256L.03. Payments for services provided under 151.21 this subdivision shall be made on a fee-for-service basis, and 151.22 may, at the option of the tribe or organization, be made at the 151.23 rates authorized under sections 256.969, subdivision 16, and 151.24 256B.0625, subdivision 34, for those MinnesotaCare enrollees 151.25 eligible for coverage at medical assistance rates. For purposes 151.26 of this subdivision, "American Indian" has the meaning given to 151.27 persons to whom services will be provided for in the Code of 151.28 Federal Regulations, title 42, section 36.12. 151.29 [EFFECTIVE DATE.] This section is effective the day 151.30 following final enactment. 151.31 Sec. 65. Minnesota Statutes 2000, section 256L.15, 151.32 subdivision 1, is amended to read: 151.33 Subdivision 1. [PREMIUM DETERMINATION.] (a) Families with 151.34 children and individuals shall pay a premium determined 151.35 according to a sliding fee based on a percentage of the family's 151.36 gross family income. 152.1 (b) Pregnant women and children under age two are exempt 152.2 from the provisions of section 256L.06, subdivision 3, paragraph 152.3 (b), clause (3), requiring disenrollment for failure to pay 152.4 premiums. For pregnant women, this exemption continues until 152.5 the first day of the month following the 60th day postpartum. 152.6 Women who remain enrolled during pregnancy or the postpartum 152.7 period, despite nonpayment of premiums, shall be disenrolled on 152.8 the first of the month following the 60th day postpartum for the 152.9 penalty period that otherwise applies under section 256L.06, 152.10 unless they begin paying premiums. 152.11 (c) Effective July 1, 2002, through June 30, 2006, at their 152.12 option, children with gross family income at or below 217 152.13 percent of the federal poverty guidelines who are eligible for 152.14 MinnesotaCare in the first month following termination from 152.15 medical assistance shall not pay a premium for 12 months. 152.16 [EFFECTIVE DATE.] This section is effective July 1, 2002. 152.17 Sec. 66. Minnesota Statutes 2000, section 256L.16, is 152.18 amended to read: 152.19 256L.16 [PAYMENT RATES; SERVICES FOR FAMILIES AND CHILDREN 152.20 UNDER THE MINNESOTACARE HEALTH CARE REFORM WAIVER.] 152.21 Section 256L.11, subdivision 2, shall not apply to services 152.22 provided tochildrenfamilies with children who are eligibleto152.23receive expanded servicesaccording to section256L.03,152.24subdivision 1a256L.04, subdivision 1, paragraph (a). 152.25 Sec. 67. Minnesota Statutes 2000, section 256L.17, 152.26 subdivision 2, is amended to read: 152.27 Subd. 2. [LIMIT ON TOTAL ASSETS.] (a) EffectiveApril 1,152.281997July 1, 2002, or upon federal approval, whichever is later, 152.29 in order to be eligible for the MinnesotaCare program, a 152.30 household of two or more persons must not own more than $30,000 152.31 in total net assets, and a household of one person must not own 152.32 more than $15,000 in total net assets. 152.33 (b) For purposes of this subdivision,total net assets152.34include all assets, with the following exceptions:152.35(1) a homestead is not considered;152.36(2) household goods and personal effects are not153.1considered;153.2(3) any assets owned by children;153.3(4) vehicles used for employment;153.4(5) court-ordered settlements up to $10,000;153.5(6) individual retirement accounts; and153.6(7) capital and operating assets of a trade or business up153.7to $200,000 in net assets are not considered.153.8(c) If an asset excluded under paragraph (b) has a negative153.9value, the negative value shall be subtracted from the total net153.10assets under paragraph (a)assets are determined according to 153.11 section 256B.056, subdivision 3a. 153.12 [EFFECTIVE DATE.] This section is effective July 1, 2001. 153.13 Sec. 68. Laws 1995, chapter 178, article 2, section 36, is 153.14 amended to read: 153.15 Sec. 36. [EMPOWERMENT ZONES; ADMINISTRATIVE SIMPLIFICATION 153.16 OF WELFARE LAWS.] 153.17 (a) The commissioner of human services shall make 153.18 recommendations to effectuate the changes in federal laws and 153.19 regulations, state laws and rules, and the state plan to improve 153.20 the administrative efficiency of the aid to families with 153.21 dependent children, general assistance, work readiness, family 153.22 general assistance, medical assistance, general assistance 153.23 medical care, and food stamp programs. At a minimum, the 153.24 following administrative standards and procedures must be 153.25 changed. 153.26 The commissioner shall: 153.27 (1) require income or eligibility reviews no more 153.28 frequently than annually for cases in which income is normally 153.29 invariant, as in aid to families with dependent children cases 153.30 where the only source of household income is Supplemental Social 153.31 Security Income; 153.32 (2) permit households to report income annually when the 153.33 source of income is excluded, such as a minor's earnings; 153.34 (3)require income or eligibility reviews no more153.35frequently than annually for extended medical assistance cases;153.36(4)require income or eligibility reviews no more 154.1 frequently than annually for a medical assistance postpartum 154.2 client, where the client previously had eligibility under a 154.3 different basis prior to pregnancy or if other household members 154.4 have eligibility with the same income/basis that applies to the 154.5 client; 154.6(5)(4) permit all income or eligibility reviews for foster 154.7 care medical assistance cases to use the short application form; 154.8 and 154.9(6)(5) make dependent care expenses declaratory for 154.10 medical assistance; and154.11(7) permit households to only report gifts worth $100 or154.12more per month. 154.13 (b) The county's administrative savings resulting from 154.14 these changes may be allocated to fund any lawful purpose. 154.15 (c) The recommendations must be provided in a report to the 154.16 chairs of the appropriate legislative committees by August 1, 154.17 1995. The recommendations must include a list of the 154.18 administrative standards and procedures that require approval by 154.19 the federal government before implementation, and also which 154.20 administrative simplification standards and procedures may be 154.21 implemented by a county prior to receiving a federal waiver. 154.22 (d) The commissioner shall seek the necessary waivers from 154.23 the federal government as soon as possible to implement the 154.24 administrative simplification standards and procedures. 154.25 Sec. 69. Laws 1999, chapter 245, article 4, section 110, 154.26 is amended to read: 154.27 Sec. 110. [PROGRAMS FOR SENIOR CITIZENS.] 154.28 The commissioner of human services shall study the 154.29 eligibility criteria of and benefits provided to persons age 65 154.30 and over through the array of cash assistance and health care 154.31 programs administered by the department, and the extent to which 154.32 these programs can be combined, simplified, or coordinated to 154.33 reduce administrative costs and improve access. The 154.34 commissioner shall also study potential barriers to enrollment 154.35 for low-income seniors who would otherwise deplete resources 154.36 necessary to maintain independent community living. At a 155.1 minimum, the study must include an evaluation of asset 155.2 requirements and enrollment sites. The commissioner shall 155.3 report study findings and recommendations to the legislature by 155.4June 30, 2001January 15, 2002. 155.5 Sec. 70. [REGULATORY SIMPLIFICATION FOR STATE HEALTH CARE 155.6 PROGRAM PROVIDERS.] 155.7 The commissioner of human services, in consultation with 155.8 providers participating in state health care programs, shall 155.9 identify nonfinancial barriers to increased provider enrollment 155.10 and provider retention in state health care programs, and shall 155.11 implement procedures to address these barriers. Areas to be 155.12 examined by the commissioner shall include, but are not limited 155.13 to, regulatory complexity and inconsistencies between state 155.14 health care programs, provider requirements, provision of 155.15 technical assistance to providers, responsiveness to provider 155.16 inquiries and complaints, claims processing turnaround times, 155.17 and policies for rejecting provider claims. The commissioner 155.18 shall report to the legislature by February 15, 2002, on any 155.19 changes to the administration of state health care programs that 155.20 will be implemented as a result of the study, and present 155.21 recommendations for any necessary changes in state law. 155.22 Sec. 71. [EXPAND DENTAL AUXILIARY PERSONNEL; 155.23 FOREIGN-TRAINED DENTISTS; DENTAL CLINICS.] 155.24 Subdivision 1. [DEVELOPMENT.] (a) The board of dentistry, 155.25 in consultation with the University of Minnesota school of 155.26 dentistry, the Minnesota state colleges and universities that 155.27 offer a dental auxiliary training program, the commissioner of 155.28 health, and licensed dentists and dental auxiliaries practicing 155.29 in private practice and at community clinics, shall develop new 155.30 expanded duties for registered dental assistants and dental 155.31 hygienists. The new duties must be performed under direct or 155.32 indirect supervision of a licensed dentist. These expanded 155.33 duties must be limited to reversible procedures, including, but 155.34 not limited to, placement, contouring, and adjustment of amalgam 155.35 restorations, temporary restorations, the alignment and 155.36 cementing of stainless steel crowns to primary teeth, and 156.1 application of pit and fissure sealants. These expanded duties 156.2 shall not include or imply a diagnosis or treatment plan, nor 156.3 include prescribing medications, cutting hard or soft tissue, or 156.4 any direct patient care in which formal training has not been 156.5 completed. The board shall establish the necessary educational 156.6 qualifications to perform the new duties. 156.7 (b) The board shall make recommendations to amend Minnesota 156.8 Statutes, chapter 150A, to permit a foreign-trained dentist to 156.9 practice as a dental hygienist or as a registered dental 156.10 assistant. 156.11 (c) The board shall submit the proposed changes to 156.12 Minnesota Statutes, chapter 150A, to the legislature by January 156.13 15, 2002. 156.14 Subd. 2. [DENTAL CLINICS.] The commissioner of health, in 156.15 consultation with the Minnesota state colleges and universities, 156.16 shall determine the capital improvements needed to establish 156.17 community-based dental clinics at state colleges and 156.18 universities to be used as training sites and as public 156.19 community-based dental clinics for public program recipients 156.20 during times when the school is not in session and the clinic is 156.21 not in use. The commissioner shall submit the necessary capital 156.22 improvement costs for start-up equipment and necessary 156.23 infrastructure as part of the 2002 legislative capital budget 156.24 requests. 156.25 Sec. 72. [NOTICE OF PREMIUM CHANGES IN THE EMPLOYED 156.26 PERSONS WITH DISABILITIES PROGRAM.] 156.27 The commissioner of human services shall provide notice to 156.28 all medical assistance recipients receiving coverage through the 156.29 employed persons with disabilities program under Minnesota 156.30 Statutes, section 256B.057, subdivision 9, of the first new 156.31 premium schedule in effect on November 1, 2001, at least two 156.32 months before the month in which the first new premium is due. 156.33 Sec. 73. [ADDITIONAL TRAINING REQUIREMENTS.] 156.34 The board of dentistry may make recommendations to the 2002 156.35 legislature on additional training requirements for dental 156.36 hygienists practicing under the limited authorization provided 157.1 in Minnesota Statutes, section 150A.10, subdivision 1a. 157.2 Sec. 74. [ELIGIBILITY EXCEPTION TO THE PRESCRIPTION DRUG 157.3 PROGRAM.] 157.4 Notwithstanding the requirements of Minnesota Statutes, 157.5 section 256.955, subdivision 2, paragraph (d), from March 1, 157.6 2001, to June 30, 2002, the definition of a "qualified 157.7 individual" in the prescription drug program established under 157.8 Minnesota Statutes, section 256.955, shall include an individual 157.9 who: 157.10 (1) was enrolled in the prescription drug program prior to 157.11 March 1, 2001; 157.12 (2) was enrolled in a Medicare risk plan prior to March 1, 157.13 2001, to which an annual prescription drug benefit of $400 was 157.14 added on March 1, 2001; and 157.15 (3) meets the requirements described in Minnesota Statutes, 157.16 section 256.955, subdivision 2, paragraph (d), clauses (1) and 157.17 (5), and subdivision 2a. 157.18 The prescription benefit offered by the Medicare risk plan shall 157.19 be primary to benefits provided under the prescription drug 157.20 program. 157.21 Sec. 75. [MINNESOTACARE ELIGIBILITY FOR SELF-EMPLOYED 157.22 FARMERS.] 157.23 (a) The commissioner of human services shall seek federal 157.24 approval to redefine in the MinnesotaCare program the definition 157.25 of "gross individual or gross family income" for farm 157.26 self-employed to mean income calculated using as a baseline the 157.27 adjusted gross income reported on the applicant's federal income 157.28 tax form for the previous year and adding back in reported 157.29 depreciation amounts that apply to the business in which the 157.30 family is currently engaged. 157.31 (b) Upon receipt of federal approval, the commissioner 157.32 shall notify the legislature. No change to the definition shall 157.33 be implemented without further action by the legislature. 157.34 Sec. 76. [REPEALER.] 157.35 (a) Minnesota Statutes 2000, section 256B.0635, subdivision 157.36 3, and 256B.19, subdivision 1b, are repealed effective July 1, 158.1 2001. 158.2 (b) Minnesota Statutes 2000, section 256L.02, subdivision 158.3 4, is repealed effective January 1, 2003. 158.4 ARTICLE 3 158.5 CONTINUING CARE 158.6 Section 1. Minnesota Statutes 2000, section 245A.13, 158.7 subdivision 7, is amended to read: 158.8 Subd. 7. [RATE RECOMMENDATION.] The commissioner of human 158.9 services may review rates of a residential program participating 158.10 in the medical assistance program which is in receivership and 158.11 that has needs or deficiencies documented by the department of 158.12 health or the department of human services. If the commissioner 158.13 of human services determines that a review of the rate 158.14 established undersection 256B.501sections 256B.5012 and 158.15 256B.5013 is needed, the commissioner shall: 158.16 (1) review the order or determination that cites the 158.17 deficiencies or needs; and 158.18 (2) determine the need for additional staff, additional 158.19 annual hours by type of employee, and additional consultants, 158.20 services, supplies, equipment, repairs, or capital assets 158.21 necessary to satisfy the needs or deficiencies. 158.22 Sec. 2. Minnesota Statutes 2000, section 245A.13, 158.23 subdivision 8, is amended to read: 158.24 Subd. 8. [ADJUSTMENT TO THE RATE.] Upon review of rates 158.25 under subdivision 7, the commissioner may adjust the residential 158.26 program's payment rate. The commissioner shall review the 158.27 circumstances, together with the residentialprogram cost report158.28 program's most recent income and expense report, to determine 158.29 whether or not the deficiencies or needs can be corrected or met 158.30 by reallocating residential program staff, costs, revenues, 158.31 or any other resources includinganyinvestments, efficiency158.32incentives, or allowances. If the commissioner determines that 158.33 any deficiency cannot be corrected or the need cannot be met 158.34 with the payment rate currently being paid, the commissioner 158.35 shall determine the payment rate adjustment by dividing the 158.36 additional annual costs established during the commissioner's 159.1 review by the residential program's actual resident days from 159.2 the most recentdesk-audited costincome and expense report or 159.3 the estimated resident days in the projected receivership 159.4 period. The payment rate adjustmentmust meet the conditions in159.5Minnesota Rules, parts 9553.0010 to 9553.0080, andremains in 159.6 effect during the period of the receivership or until another 159.7 date set by the commissioner. Upon the subsequent sale, 159.8 closure, or transfer of the residential program, the 159.9 commissioner may recover amounts that were paid as payment rate 159.10 adjustments under this subdivision. This recovery shall be 159.11 determined through a review of actual costs and resident days in 159.12 the receivership period. The costs the commissioner finds to be 159.13 allowable shall be divided by the actual resident days for the 159.14 receivership period. This rate shall be compared to the rate 159.15 paid throughout the receivership period, with the difference 159.16 multiplied by resident days, being the amount to be repaid to 159.17 the commissioner. Allowable costs shall be determined by the 159.18 commissioner as those ordinary, necessary, and related to 159.19 resident care by prudent and cost-conscious management. The 159.20 buyer or transferee shall repay this amount to the commissioner 159.21 within 60 days after the commissioner notifies the buyer or 159.22 transferee of the obligation to repay. This provision does not 159.23 limit the liability of the seller to the commissioner pursuant 159.24 to section 256B.0641. 159.25 Sec. 3. Minnesota Statutes 2000, section 252.275, 159.26 subdivision 4b, is amended to read: 159.27 Subd. 4b. [GUARANTEED FLOOR.] Each countywith an original159.28allocation for the preceding year that is equal to or less than159.29the guaranteed floor minimum index shall have a guaranteed floor159.30equal to its original allocation for the preceding year. Each159.31county with an original allocation for the preceding year that159.32is greater than the guaranteed floor minimum indexshall have a 159.33 guaranteed floor equal to the lesser of clause (1) or (2): 159.34 (1) the county's original allocation for the preceding 159.35 year; or 159.36 (2) 70 percent of the county's reported expenditures 160.1 eligible for reimbursement during the 12 months ending on June 160.2 30 of the preceding calendar year. 160.3For calendar year 1993, the guaranteed floor minimum index160.4shall be $20,000. For each subsequent year, the index shall be160.5adjusted by the projected change in the average value in the160.6United States Department of Labor Bureau of Labor Statistics160.7consumer price index (all urban) for that year.160.8 Notwithstanding this subdivision, no county shall be 160.9 allocated a guaranteed floor of less than $1,000. 160.10 When the amount of funds available for allocation is less 160.11 than the amount available in the previous year, each county's 160.12 previous year allocation shall be reduced in proportion to the 160.13 reduction in the statewide funding, to establish each county's 160.14 guaranteed floor. 160.15 Sec. 4. Minnesota Statutes 2000, section 254B.02, 160.16 subdivision 3, is amended to read: 160.17 Subd. 3. [RESERVE ACCOUNT.] The commissioner shall 160.18 allocate money from the reserve account to counties that, during 160.19 the current fiscal year, have met or exceeded the base level of 160.20 expenditures for eligible chemical dependency services from 160.21 local money. The commissioner shall establish the base level 160.22 for fiscal year 1988 as the amount of local money used for 160.23 eligible services in calendar year 1986. In later years, the 160.24 base level must be increased in the same proportion as state 160.25 appropriations to implement Laws 1986, chapter 394, sections 8 160.26 to 20, are increased. The base level must be decreased if the 160.27 fund balance from which allocations are made under section 160.28 254B.02, subdivision 1, is decreased in later years. The local 160.29 match rate for the reserve account is the same rate as applied 160.30 to the initial allocation. Reserve account payments must not be 160.31 included when calculating the county adjustments made according 160.32 to subdivision 2. For counties providing medical assistance or 160.33 general assistance medical care through managed care plans on 160.34 January 1, 1996, the base year is fiscal year 1995. For 160.35 counties beginning provision of managed care after January 1, 160.36 1996, the base year is the most recent fiscal year before 161.1 enrollment in managed care begins. For counties providing 161.2 managed care, the base level will be increased or decreased in 161.3 proportion to changes in the fund balance from which allocations 161.4 are made under subdivision 2, but will be additionally increased 161.5 or decreased in proportion to the change in county adjusted 161.6 population made in subdivision 1, paragraphs (b) and 161.7 (c). Effective July 1, 2001, at the end of each biennium, any 161.8 funds deposited in the reserve account funds in excess of those 161.9 needed to meet obligations incurred under this section and 161.10 sections 254B.06 and 254B.09 shall cancel to the general fund. 161.11 Sec. 5. Minnesota Statutes 2000, section 254B.03, 161.12 subdivision 1, is amended to read: 161.13 Subdivision 1. [LOCAL AGENCY DUTIES.] (a) Every local 161.14 agency shall provide chemical dependency services to persons 161.15 residing within its jurisdiction who meet criteria established 161.16 by the commissioner for placement in a chemical dependency 161.17 residential or nonresidential treatment service. Chemical 161.18 dependency money must be administered by the local agencies 161.19 according to law and rules adopted by the commissioner under 161.20 sections 14.001 to 14.69. 161.21 (b) In order to contain costs, the county board shall, with 161.22 the approval of the commissioner of human services, select 161.23 eligible vendors of chemical dependency services who can provide 161.24 economical and appropriate treatment. Unless the local agency 161.25 is a social services department directly administered by a 161.26 county or human services board, the local agency shall not be an 161.27 eligible vendor under section 254B.05. The commissioner may 161.28 approve proposals from county boards to provide services in an 161.29 economical manner or to control utilization, with safeguards to 161.30 ensure that necessary services are provided. If a county 161.31 implements a demonstration or experimental medical services 161.32 funding plan, the commissioner shall transfer the money as 161.33 appropriate. If a county selects a vendor located in another 161.34 state, the county shall ensure that the vendor is in compliance 161.35 with the rules governing licensure of programs located in the 161.36 state. 162.1 (c) The calendar year19982002 rate for vendors may not 162.2 increase more than three percent above the rate approved in 162.3 effect on January 1,19972001. The calendar year19992003 162.4 rate for vendors may not increase more than three percent above 162.5 the rate in effect on January 1,19982002. The calendar years 162.6 2004 and 2005 rates may not exceed the rate in effect on January 162.7 1, 2003. 162.8 (d) A culturally specific vendor that provides assessments 162.9 under a variance under Minnesota Rules, part 9530.6610, shall be 162.10 allowed to provide assessment services to persons not covered by 162.11 the variance. 162.12 Sec. 6. Minnesota Statutes 2000, section 254B.04, 162.13 subdivision 1, is amended to read: 162.14 Subdivision 1. [ELIGIBILITY.] (a) Persons eligible for 162.15 benefits under Code of Federal Regulations, title 25, part 20, 162.16 persons eligible for medical assistance benefits under sections 162.17 256B.055, 256B.056, and 256B.057, subdivisions 1, 2, 5, and 6, 162.18 or who meet the income standards of section 256B.056, 162.19 subdivision 4, and persons eligible for general assistance 162.20 medical care under section 256D.03, subdivision 3, are entitled 162.21 to chemical dependency fund services. State money appropriated 162.22 for this paragraph must be placed in a separate account 162.23 established for this purpose. 162.24 Persons with dependent children who are determined to be in 162.25 need of chemical dependency treatment pursuant to an assessment 162.26 under section 626.556, subdivision 10, or a case plan under 162.27 section 260C.201, subdivision 6, or 260C.212, shall be assisted 162.28 by the local agency to access needed treatment services. 162.29 Treatment services must be appropriate for the individual or 162.30 family, which may include long-term care treatment or treatment 162.31 in a facility that allows the dependent children to stay in the 162.32 treatment facility. The county shall pay for out-of-home 162.33 placement costs, if applicable. 162.34 (b) A person not entitled to services under paragraph (a), 162.35 but with family income that is less than60 percent of the state162.36median income for a family of like size and composition215 163.1 percent of the federal poverty guidelines for the applicable 163.2 family size, shall be eligible to receive chemical dependency 163.3 fund services within the limit of fundsavailable after persons163.4entitled to services under paragraph (a) have been163.5servedappropriated for this group for the fiscal year. If 163.6 notified by the state agency of limited funds, a county must 163.7 give preferential treatment to persons with dependent children 163.8 who are in need of chemical dependency treatment pursuant to an 163.9 assessment under section 626.556, subdivision 10, or a case plan 163.10 under section 260C.201, subdivision 6, or 260C.212. A county 163.11 may spend money from its own sources to serve persons under this 163.12 paragraph. State money appropriated for this paragraph must be 163.13 placed in a separate account established for this purpose. 163.14 (c) Persons whose income is between60215 percent and115163.15 412 percent of thestate median incomefederal poverty 163.16 guidelines for the applicable family size shall be eligible for 163.17 chemical dependency services on a sliding fee basis, within the 163.18 limit of fundsavailable, after persons entitled to services163.19under paragraph (a) and persons eligible for services under163.20paragraph (b) have been servedappropriated for this group for 163.21 the fiscal year. Persons eligible under this paragraph must 163.22 contribute to the cost of services according to the sliding fee 163.23 scale established under subdivision 3. A county may spend money 163.24 from its own sources to provide services to persons under this 163.25 paragraph. State money appropriated for this paragraph must be 163.26 placed in a separate account established for this purpose. 163.27 Sec. 7. Minnesota Statutes 2000, section 254B.09, is 163.28 amended by adding a subdivision to read: 163.29 Subd. 8. [PAYMENTS TO IMPROVE SERVICES TO AMERICAN 163.30 INDIANS.] The commissioner may set rates for chemical dependency 163.31 services according to the American Indian Health Improvement 163.32 Act, Public Law Number 94-437, for eligible vendors. These 163.33 rates shall supersede rates set in county purchase of service 163.34 agreements when payments are made on behalf of clients eligible 163.35 according to Public Law Number 94-437. 163.36 Sec. 8. Minnesota Statutes 2000, section 256.01, is 164.1 amended by adding a subdivision to read: 164.2 Subd. 19. [GRANTS FOR CASE MANAGEMENT SERVICES TO PERSONS 164.3 WITH HIV OR AIDS.] The commissioner may award grants to eligible 164.4 vendors for the development, implementation, and evaluation of 164.5 case management services for individuals infected with the human 164.6 immunodeficiency virus. HIV/AIDs case management services will 164.7 be provided to increase access to cost effective health care 164.8 services, to reduce the risk of HIV transmission, to ensure that 164.9 basic client needs are met, and to increase client access to 164.10 needed community supports or services. 164.11 Sec. 9. Minnesota Statutes 2000, section 256.476, 164.12 subdivision 1, is amended to read: 164.13 Subdivision 1. [PURPOSE AND GOALS.] The commissioner of 164.14 human services shall establish a consumer support grant 164.15 programto assistfor individuals with functional limitations 164.16 and their familiesin purchasing and securing supports which the164.17individuals need to live as independently and productively in164.18the community as possiblewho wish to purchase and secure their 164.19 own supports. The commissioner and local agencies shall jointly 164.20 develop an implementation plan which must include a way to 164.21 resolve the issues related to county liability. The program 164.22 shall: 164.23 (1) make support grants or exception grants described in 164.24 subdivision 11 available to individuals or families as an 164.25 effective alternative to existing programs and services, such as 164.26 the developmental disability family support program,the164.27alternative care program,personal care attendant services, home 164.28 health aide services, and private duty nursingfacility164.29 services; 164.30 (2) provide consumers more control, flexibility, and 164.31 responsibility overthe needed supportstheir services and 164.32 supports; 164.33 (3) promote local program management and decision making; 164.34 and 164.35 (4) encourage the use of informal and typical community 164.36 supports. 165.1 Sec. 10. Minnesota Statutes 2000, section 256.476, 165.2 subdivision 2, is amended to read: 165.3 Subd. 2. [DEFINITIONS.] For purposes of this section, the 165.4 following terms have the meanings given them: 165.5 (a) "County board" means the county board of commissioners 165.6 for the county of financial responsibility as defined in section 165.7 256G.02, subdivision 4, or its designated representative. When 165.8 a human services board has been established under sections 165.9 402.01 to 402.10, it shall be considered the county board for 165.10 the purposes of this section. 165.11 (b) "Family" means the person's birth parents, adoptive 165.12 parents or stepparents, siblings or stepsiblings, children or 165.13 stepchildren, grandparents, grandchildren, niece, nephew, aunt, 165.14 uncle, or spouse. For the purposes of this section, a family 165.15 member is at least 18 years of age. 165.16 (c) "Functional limitations" means the long-term inability 165.17 to perform an activity or task in one or more areas of major 165.18 life activity, including self-care, understanding and use of 165.19 language, learning, mobility, self-direction, and capacity for 165.20 independent living. For the purpose of this section, the 165.21 inability to perform an activity or task results from a mental, 165.22 emotional, psychological, sensory, or physical disability, 165.23 condition, or illness. 165.24 (d) "Informed choice" means a voluntary decision made by 165.25 the person or the person's legal representative, after becoming 165.26 familiarized with the alternatives to: 165.27 (1) select a preferred alternative from a number of 165.28 feasible alternatives; 165.29 (2) select an alternative which may be developed in the 165.30 future; and 165.31 (3) refuse any or all alternatives. 165.32 (e) "Local agency" means the local agency authorized by the 165.33 county board or, for counties not participating in the consumer 165.34 grant program by July 1, 2002, the commissioner, to carry out 165.35 the provisions of this section. 165.36 (f) "Person" or "persons" means a person or persons meeting 166.1 the eligibility criteria in subdivision 3. 166.2 (g) "Authorized representative" means an individual 166.3 designated by the person or their legal representative to act on 166.4 their behalf. This individual may be a family member, guardian, 166.5 representative payee, or other individual designated by the 166.6 person or their legal representative, if any, to assist in 166.7 purchasing and arranging for supports. For the purposes of this 166.8 section, an authorized representative is at least 18 years of 166.9 age. 166.10 (h) "Screening" means the screening of a person's service 166.11 needs under sections 256B.0911 and 256B.092. 166.12 (i) "Supports" means services, care, aids,home166.13 environmental modifications, or assistance purchased by the 166.14 person or the person's family. Examples of supports include 166.15 respite care, assistance with daily living, andadaptive aids166.16 assistive technology. For the purpose of this section, 166.17 notwithstanding the provisions of section 144A.43, supports 166.18 purchased under the consumer support program are not considered 166.19 home care services. 166.20 (j) "Program of origination" means the program the 166.21 individual transferred from when approved for the consumer 166.22 support grant program. 166.23 Sec. 11. Minnesota Statutes 2000, section 256.476, 166.24 subdivision 3, is amended to read: 166.25 Subd. 3. [ELIGIBILITY TO APPLY FOR GRANTS.] (a) A person 166.26 is eligible to apply for a consumer support grant if the person 166.27 meets all of the following criteria: 166.28 (1) the person is eligible for and has been approved to 166.29 receive services under medical assistance as determined under 166.30 sections 256B.055 and 256B.056or the person is eligible for and166.31has been approved to receive services under alternative care166.32services as determined under section 256B.0913or the person has 166.33 been approved to receive a grant under the developmental 166.34 disability family support program under section 252.32; 166.35 (2) the person is able to direct and purchase the person's 166.36 own care and supports, or the person has a family member, legal 167.1 representative, or other authorized representative who can 167.2 purchase and arrange supports on the person's behalf; 167.3 (3) the person has functional limitations, requires ongoing 167.4 supports to live in the community, and is at risk of or would 167.5 continue institutionalization without such supports; and 167.6 (4) the person will live in a home. For the purpose of 167.7 this section, "home" means the person's own home or home of a 167.8 person's family member. These homes are natural home settings 167.9 and are not licensed by the department of health or human 167.10 services. 167.11 (b) Persons may not concurrently receive a consumer support 167.12 grant if they are: 167.13 (1) receiving home and community-based services under 167.14 United States Code, title 42, section 1396h(c); personal care 167.15 attendant and home health aide services under section 256B.0625; 167.16 a developmental disability family support grant; or alternative 167.17 care services under section 256B.0913; or 167.18 (2) residing in an institutional or congregate care setting. 167.19 (c) A person or person's family receiving a consumer 167.20 support grant shall not be charged a fee or premium by a local 167.21 agency for participating in the program. 167.22 (d) The commissioner may limit the participation ofnursing167.23facility residents, residents of intermediate care facilities167.24for persons with mental retardation, and therecipients of 167.25 services from federal waiver programs in the consumer support 167.26 grant program if the participation of these individuals will 167.27 result in an increase in the cost to the state. 167.28 (e) The commissioner shall establish a budgeted 167.29 appropriation each fiscal year for the consumer support grant 167.30 program. The number of individuals participating in the program 167.31 will be adjusted so the total amount allocated to counties does 167.32 not exceed the amount of the budgeted appropriation. The 167.33 budgeted appropriation will be adjusted annually to accommodate 167.34 changes in demand for the consumer support grants. 167.35 Sec. 12. Minnesota Statutes 2000, section 256.476, 167.36 subdivision 4, is amended to read: 168.1 Subd. 4. [SUPPORT GRANTS; CRITERIA AND LIMITATIONS.] (a) A 168.2 county board may choose to participate in the consumer support 168.3 grant program. If a countyboard chooses to participate in the168.4program,has not chosen to participate by July 1, 2002, the 168.5 commissioner shall contract with another county or other entity 168.6 to provide access to residents of the nonparticipating county 168.7 who choose the consumer support grant option. The commissioner 168.8 shall notify the county board in a county that has declined to 168.9 participate of the commissioner's intent to enter into a 168.10 contract with another county or other entity at least 30 days in 168.11 advance of entering into the contract. The local agency shall 168.12 establish written procedures and criteria to determine the 168.13 amount and use of support grants. These procedures must 168.14 include, at least, the availability of respite care, assistance 168.15 with daily living, and adaptive aids. The local agency may 168.16 establish monthly or annual maximum amounts for grants and 168.17 procedures where exceptional resources may be required to meet 168.18 the health and safety needs of the person on a time-limited 168.19 basis, however, the total amount awarded to each individual may 168.20 not exceed the limits established insubdivision 5, paragraph168.21(f)subdivision 11. 168.22 (b) Support grants to a person or a person's family will be 168.23 provided through a monthly subsidy payment and be in the form of 168.24 cash, voucher, or direct county payment to vendor. Support 168.25 grant amounts must be determined by the local agency. Each 168.26 service and item purchased with a support grant must meet all of 168.27 the following criteria: 168.28 (1) it must be over and above the normal cost of caring for 168.29 the person if the person did not have functional limitations; 168.30 (2) it must be directly attributable to the person's 168.31 functional limitations; 168.32 (3) it must enable the person or the person's family to 168.33 delay or prevent out-of-home placement of the person; and 168.34 (4) it must be consistent with the needs identified in the 168.35 service plan, when applicable. 168.36 (c) Items and services purchased with support grants must 169.1 be those for which there are no other public or private funds 169.2 available to the person or the person's family. Fees assessed 169.3 to the person or the person's family for health and human 169.4 services are not reimbursable through the grant. 169.5 (d) In approving or denying applications, the local agency 169.6 shall consider the following factors: 169.7 (1) the extent and areas of the person's functional 169.8 limitations; 169.9 (2) the degree of need in the home environment for 169.10 additional support; and 169.11 (3) the potential effectiveness of the grant to maintain 169.12 and support the person in the family environment or the person's 169.13 own home. 169.14 (e) At the time of application to the program or screening 169.15 for other services, the person or the person's family shall be 169.16 provided sufficient information to ensure an informed choice of 169.17 alternatives by the person, the person's legal representative, 169.18 if any, or the person's family. The application shall be made 169.19 to the local agency and shall specify the needs of the person 169.20 and family, the form and amount of grant requested, the items 169.21 and services to be reimbursed, and evidence of eligibility for 169.22 medical assistanceor alternative care program. 169.23 (f) Upon approval of an application by the local agency and 169.24 agreement on a support plan for the person or person's family, 169.25 the local agency shall make grants to the person or the person's 169.26 family. The grant shall be in an amount for the direct costs of 169.27 the services or supports outlined in the service agreement. 169.28 (g) Reimbursable costs shall not include costs for 169.29 resources already available, such as special education classes, 169.30 day training and habilitation, case management, other services 169.31 to which the person is entitled, medical costs covered by 169.32 insurance or other health programs, or other resources usually 169.33 available at no cost to the person or the person's family. 169.34 (h) The state of Minnesota, the county boards participating 169.35 in the consumer support grant program, or the agencies acting on 169.36 behalf of the county boards in the implementation and 170.1 administration of the consumer support grant program shall not 170.2 be liable for damages, injuries, or liabilities sustained 170.3 through the purchase of support by the individual, the 170.4 individual's family, or the authorized representative under this 170.5 section with funds received through the consumer support grant 170.6 program. Liabilities include but are not limited to: workers' 170.7 compensation liability, the Federal Insurance Contributions Act 170.8 (FICA), or the Federal Unemployment Tax Act (FUTA). For 170.9 purposes of this section, participating county boards and 170.10 agencies acting on behalf of county boards are exempt from the 170.11 provisions of section 268.04. 170.12 Sec. 13. Minnesota Statutes 2000, section 256.476, 170.13 subdivision 5, is amended to read: 170.14 Subd. 5. [REIMBURSEMENT, ALLOCATIONS, AND REPORTING.] (a) 170.15 For the purpose of transferring persons to the consumer support 170.16 grant program from specific programs or services, such as the 170.17 developmental disability family support program andalternative170.18care program,personal careattendantassistant services, home 170.19 health aide services, ornursing facilityprivate duty nursing 170.20 services, the amount of funds transferred by the commissioner 170.21 between the developmental disability family support program 170.22 account,the alternative care account,the medical assistance 170.23 account, or the consumer support grant account shall be based on 170.24 each county's participation in transferring persons to the 170.25 consumer support grant program from those programs and services. 170.26 (b) At the beginning of each fiscal year, county 170.27 allocations for consumer support grants shall be based on: 170.28 (1) the number of persons to whom the county board expects 170.29 to provide consumer supports grants; 170.30 (2) their eligibility for current program and services; 170.31 (3) the amount of nonfederal dollarsexpended on those170.32individuals for those programs and services or, in situations170.33where an individual is unable to obtain the support needed from170.34the program of origination due to the unavailability of service170.35providers at the time or the location where the supports are170.36needed, the allocation will be based on the county's best171.1estimate of the nonfederal dollars that would have been expended171.2if the services had been availableallowed under subdivision 11; 171.3 and 171.4 (4) projected dates when persons will start receiving 171.5 grants. County allocations shall be adjusted periodically by 171.6 the commissioner based on the actual transfer of persons or 171.7 service openings, and the nonfederal dollars associated with 171.8 those persons or service openings, to the consumer support grant 171.9 program. 171.10 (c) The amount of funds transferred by the commissioner 171.11 fromthe alternative care account andthe medical assistance 171.12 account for an individual may be changed if it is determined by 171.13 the county or its agent that the individual's need for support 171.14 has changed. 171.15 (d) The authority to utilize funds transferred to the 171.16 consumer support grant account for the purposes of implementing 171.17 and administering the consumer support grant program will not be 171.18 limited or constrained by the spending authority provided to the 171.19 program of origination. 171.20 (e) The commissionershallmay use up to five percent of 171.21 each county's allocation, as adjusted, for paymentsto that171.22countyfor administrative expenses, to be paid as a 171.23 proportionate addition to reported direct service expenditures. 171.24 (f)Except as provided in this paragraph,The county 171.25 allocation for each individual or individual's family cannot 171.26 exceed80 percent of the total nonfederal dollars expended on171.27the individual by the program of origination except for the171.28developmental disabilities family support grant program which171.29can be approved up to 100 percent of the nonfederal dollars and171.30in situations as described in paragraph (b), clause (3). In171.31situations where exceptional need exists or the individual's171.32need for support increases, up to 100 percent of the nonfederal171.33dollars expended may be allocated to the county. Allocations171.34that exceed 80 percent of the nonfederal dollars expended on the171.35individual by the program of origination must be approved by the171.36commissioner. The remainder of the amount expended on the172.1individual by the program of origination will be used in the172.2following proportions: half will be made available to the172.3consumer support grant program and participating counties for172.4consumer training, resource development, and other costs, and172.5half will be returned to the state general fundthe amount 172.6 allowed under subdivision 11. 172.7 (g) The commissioner may recover, suspend, or withhold 172.8 payments if the county board, local agency, or grantee does not 172.9 comply with the requirements of this section. 172.10 (h) Grant funds unexpended by consumers shall return to the 172.11 state once a year. The annual return of unexpended grant funds 172.12 shall occur in the quarter following the end of the state fiscal 172.13 year. 172.14 Sec. 14. Minnesota Statutes 2000, section 256.476, 172.15 subdivision 8, is amended to read: 172.16 Subd. 8. [COMMISSIONER RESPONSIBILITIES.] The commissioner 172.17 shall: 172.18 (1) transfer and allocate funds pursuant tothis172.19sectionsubdivision 11; 172.20 (2) determine allocations based on projected and actual 172.21 local agency use; 172.22 (3) monitor and oversee overall program spending; 172.23 (4) evaluate the effectiveness of the program; 172.24 (5) provide training and technical assistance for local 172.25 agencies and consumers to help identify potential applicants to 172.26 the program; and 172.27 (6) develop guidelines for local agency program 172.28 administration and consumer information; and172.29(7) apply for a federal waiver or take any other action172.30necessary to maximize federal funding for the program by172.31September 1, 1999. 172.32 Sec. 15. Minnesota Statutes 2000, section 256.476, is 172.33 amended by adding a subdivision to read: 172.34 Subd. 11. [CONSUMER SUPPORT GRANT PROGRAM AFTER JULY 1, 172.35 2001.] (a) Effective July 1, 2001, the commissioner shall 172.36 allocate consumer support grant resources to serve additional 173.1 individuals based on a review of Medicaid authorization and 173.2 payment information of persons eligible for a consumer support 173.3 grant from the most recent fiscal year. The commissioner shall 173.4 use the following methodology to calculate maximum allowable 173.5 monthly consumer support grant levels: 173.6 (1) for individuals whose program of origination is medical 173.7 assistance home care under section 256B.0627, the maximum 173.8 allowable monthly grant levels are calculated by: 173.9 (i) determining the nonfederal share of the average service 173.10 authorization for each home care rating; 173.11 (ii) calculating the overall ratio of actual payments to 173.12 service authorizations by program; 173.13 (iii) applying the overall ratio to the average service 173.14 authorization level of each home care rating; 173.15 (iv) adjusting the result for any authorized rate increases 173.16 provided by the legislature; and 173.17 (v) adjusting the result for the average monthly 173.18 utilization per recipient; and 173.19 (2) for persons with programs of origination other than the 173.20 program described in clause (1), the maximum grant level for an 173.21 individual shall not exceed the total of the nonfederal dollars 173.22 expended on the individual by the program of origination. 173.23 (b) Persons receiving consumer support grants prior to July 173.24 1, 2001, may continue to receive the grant amount established 173.25 prior to July 1, 2001. 173.26 (c) The commissioner may provide up to 200 exception 173.27 grants, including grants in use under paragraph (b). Eligible 173.28 persons shall be provided an exception grant in priority order 173.29 based upon the date of the commissioner's receipt of the county 173.30 request. The maximum allowable grant level for an exception 173.31 grant shall be based upon the nonfederal share of the average 173.32 service authorization from the most recent fiscal year for each 173.33 home care rating category. The amount of each exception grant 173.34 shall be based upon the commissioner's determination of the 173.35 nonfederal dollars that would have been expended if services had 173.36 been available for an individual who is unable to obtain the 174.1 support needed from the program of origination due to the 174.2 unavailability of qualified service providers at the time or the 174.3 location where the supports are needed. 174.4 Sec. 16. Minnesota Statutes 2000, section 256B.0625, 174.5 subdivision 7, is amended to read: 174.6 Subd. 7. [PRIVATE DUTY NURSING.] Medical assistance covers 174.7 private duty nursing services in a recipient's home. Recipients 174.8 who are authorized to receive private duty nursing services in 174.9 their home may use approved hours outside of the home during 174.10 hours when normal life activities take them outside of their 174.11 homeand when, without the provision of private duty nursing,174.12their health and safety would be jeopardized. To use private 174.13 duty nursing services at school, the recipient or responsible 174.14 party must provide written authorization in the care plan 174.15 identifying the chosen provider and the daily amount of services 174.16 to be used at school. Medical assistance does not cover private 174.17 duty nursing services for residents of a hospital, nursing 174.18 facility, intermediate care facility, or a health care facility 174.19 licensed by the commissioner of health, except as authorized in 174.20 section 256B.64 for ventilator-dependent recipients in hospitals 174.21 or unless a resident who is otherwise eligible is on leave from 174.22 the facility and the facility either pays for the private duty 174.23 nursing services or forgoes the facility per diem for the leave 174.24 days that private duty nursing services are used. Total hours 174.25 of service and payment allowed for services outside the home 174.26 cannot exceed that which is otherwise allowed in an in-home 174.27 setting according to section 256B.0627. All private duty 174.28 nursing services must be provided according to the limits 174.29 established under section 256B.0627. Private duty nursing 174.30 services may not be reimbursed if the nurse is thespouse of the174.31recipient or the parent orfoster care provider of a recipient 174.32 who is under age 18, or the recipient's legal guardian. 174.33 Sec. 17. Minnesota Statutes 2000, section 256B.0625, 174.34 subdivision 19a, is amended to read: 174.35 Subd. 19a. [PERSONAL CARE ASSISTANT SERVICES.] Medical 174.36 assistance covers personal care assistant services in a 175.1 recipient's home. To qualify for personal care assistant 175.2 services, recipients or responsible parties must be able to 175.3 identify the recipient's needs, direct and evaluate task 175.4 accomplishment, and provide for health and safety. Approved 175.5 hours may be used outside the home when normal life activities 175.6 take them outside the homeand when, without the provision of175.7personal care, their health and safety would be jeopardized. To 175.8 use personal care assistant services at school, the recipient or 175.9 responsible party must provide written authorization in the care 175.10 plan identifying the chosen provider and the daily amount of 175.11 services to be used at school. Total hours for services, 175.12 whether actually performed inside or outside the recipient's 175.13 home, cannot exceed that which is otherwise allowed for personal 175.14 care assistant services in an in-home setting according to 175.15 section 256B.0627. Medical assistance does not cover personal 175.16 care assistant services for residents of a hospital, nursing 175.17 facility, intermediate care facility, health care facility 175.18 licensed by the commissioner of health, or unless a resident who 175.19 is otherwise eligible is on leave from the facility and the 175.20 facility either pays for the personal care assistant services or 175.21 forgoes the facility per diem for the leave days that personal 175.22 care assistant services are used. All personal care assistant 175.23 services must be provided according to section 256B.0627. 175.24 Personal care assistant services may not be reimbursed if the 175.25 personal care assistant is the spouse or legal guardian of the 175.26 recipient or the parent of a recipient under age 18, or the 175.27 responsible party or the foster care provider of a recipient who 175.28 cannot direct the recipient's own care unless, in the case of a 175.29 foster care provider, a county or state case manager visits the 175.30 recipient as needed, but not less than every six months, to 175.31 monitor the health and safety of the recipient and to ensure the 175.32 goals of the care plan are met. Parents of adult recipients, 175.33 adult children of the recipient or adult siblings of the 175.34 recipient may be reimbursed for personal care assistant services 175.35if they are not the recipient's legal guardian and, if they are 175.36 granted a waiver under section 256B.0627.Until July 1, 2001,176.1andNotwithstanding the provisions of section 256B.0627, 176.2 subdivision 4, paragraph (b), clause (4), the noncorporate legal 176.3 guardian or conservator of an adult, who is not the responsible 176.4 party and not the personal care provider organization, may be 176.5 granted a hardship waiver under section 256B.0627, to be 176.6 reimbursed to provide personal care assistant services to the 176.7 recipient, and shall not be considered to have a service 176.8 provider interest for purposes of participation on the screening 176.9 team under section 256B.092, subdivision 7. 176.10 Sec. 18. Minnesota Statutes 2000, section 256B.0625, 176.11 subdivision 19c, is amended to read: 176.12 Subd. 19c. [PERSONAL CARE.] Medical assistance covers 176.13 personal care assistant services provided by an individual who 176.14 is qualified to provide the services according to subdivision 176.15 19a and section 256B.0627, where the services are prescribed by 176.16 a physician in accordance with a plan of treatment and are 176.17 supervised by the recipientunder the fiscal agent option176.18according to section 256B.0627, subdivision 10,or a qualified 176.19 professional. "Qualified professional" means a mental health 176.20 professional as defined in section 245.462, subdivision 18, or 176.21 245.4871, subdivision 27; or a registered nurse as defined in 176.22 sections 148.171 to 148.285. As part of the assessment, the 176.23 county public health nurse willconsult withassist the 176.24 recipient or responsible partyandto identify the most 176.25 appropriate person to provide supervision of the personal care 176.26 assistant. The qualified professional shall perform the duties 176.27 described in Minnesota Rules, part 9505.0335, subpart 4. 176.28 Sec. 19. Minnesota Statutes 2000, section 256B.0625, 176.29 subdivision 20, is amended to read: 176.30 Subd. 20. [MENTAL HEALTH CASE MANAGEMENT.] (a) To the 176.31 extent authorized by rule of the state agency, medical 176.32 assistance covers case management services to persons with 176.33 serious and persistent mental illness and children with severe 176.34 emotional disturbance. Services provided under this section 176.35 must meet the relevant standards in sections 245.461 to 176.36 245.4888, the Comprehensive Adult and Children's Mental Health 177.1 Acts, Minnesota Rules, parts 9520.0900 to 9520.0926, and 177.2 9505.0322, excluding subpart 10. 177.3 (b) Entities meeting program standards set out in rules 177.4 governing family community support services as defined in 177.5 section 245.4871, subdivision 17, are eligible for medical 177.6 assistance reimbursement for case management services for 177.7 children with severe emotional disturbance when these services 177.8 meet the program standards in Minnesota Rules, parts 9520.0900 177.9 to 9520.0926 and 9505.0322, excluding subparts 6 and 10. 177.10 (c) Medical assistance and MinnesotaCare payment for mental 177.11 health case management shall be made on a monthly basis. In 177.12 order to receive payment for an eligible child, the provider 177.13 must document at least a face-to-face contact with the child, 177.14 the child's parents, or the child's legal representative. To 177.15 receive payment for an eligible adult, the provider must 177.16 document: 177.17 (1) at least a face-to-face contact with the adult or the 177.18 adult's legal representative; or 177.19 (2) at least a telephone contact with the adult or the 177.20 adult's legal representative and document a face-to-face contact 177.21 with the adult or the adult's legal representative within the 177.22 preceding two months. 177.23 (d) Payment for mental health case management provided by 177.24 county or state staff shall be based on the monthly rate 177.25 methodology under section 256B.094, subdivision 6, paragraph 177.26 (b), with separate rates calculated for child welfare and mental 177.27 health, and within mental health, separate rates for children 177.28 and adults. 177.29 (e) Payment for mental health case management provided by 177.30 county-contracted vendors shall be based on a monthly rate 177.31 negotiated by the host county. The negotiated rate must not 177.32 exceed the rate charged by the vendor for the same service to 177.33 other payers. If the service is provided by a team of 177.34 contracted vendors, the county may negotiate a team rate with a 177.35 vendor who is a member of the team. The team shall determine 177.36 how to distribute the rate among its members. No reimbursement 178.1 received by contracted vendors shall be returned to the county, 178.2 except to reimburse the county for advance funding provided by 178.3 the county to the vendor. 178.4 (f) If the service is provided by a team which includes 178.5 contracted vendors and county or state staff, the costs for 178.6 county or state staff participation in the team shall be 178.7 included in the rate for county-provided services. In this 178.8 case, the contracted vendor and the county may each receive 178.9 separate payment for services provided by each entity in the 178.10 same month. In order to prevent duplication of services, the 178.11 county must document, in the recipient's file, the need for team 178.12 case management and a description of the roles of the team 178.13 members. 178.14 (g) The commissioner shall calculate the nonfederal share 178.15 of actual medical assistance and general assistance medical care 178.16 payments for each county, based on the higher of calendar year 178.17 1995 or 1996, by service date, project that amount forward to 178.18 1999, and transfer one-half of the result from medical 178.19 assistance and general assistance medical care to each county's 178.20 mental health grants under sections 245.4886 and 256E.12 for 178.21 calendar year 1999. The annualized minimum amount added to each 178.22 county's mental health grant shall be $3,000 per year for 178.23 children and $5,000 per year for adults. The commissioner may 178.24 reduce the statewide growth factor in order to fund these 178.25 minimums. The annualized total amount transferred shall become 178.26 part of the base for future mental health grants for each county. 178.27 (h) Any net increase in revenue to the county as a result 178.28 of the change in this section must be used to provide expanded 178.29 mental health services as defined in sections 245.461 to 178.30 245.4888, the Comprehensive Adult and Children's Mental Health 178.31 Acts, excluding inpatient and residential treatment. For 178.32 adults, increased revenue may also be used for services and 178.33 consumer supports which are part of adult mental health projects 178.34 approved under Laws 1997, chapter 203, article 7, section 25. 178.35 For children, increased revenue may also be used for respite 178.36 care and nonresidential individualized rehabilitation services 179.1 as defined in section 245.492, subdivisions 17 and 23. 179.2 "Increased revenue" has the meaning given in Minnesota Rules, 179.3 part 9520.0903, subpart 3. 179.4 (i) Notwithstanding section 256B.19, subdivision 1, the 179.5 nonfederal share of costs for mental health case management 179.6 shall be provided by the recipient's county of responsibility, 179.7 as defined in sections 256G.01 to 256G.12, from sources other 179.8 than federal funds or funds used to match other federal funds. 179.9 (j) The commissioner may suspend, reduce, or terminate the 179.10 reimbursement to a provider that does not meet the reporting or 179.11 other requirements of this section. The county of 179.12 responsibility, as defined in sections 256G.01 to 256G.12, is 179.13 responsible for any federal disallowances. The county may share 179.14 this responsibility with its contracted vendors. 179.15 (k) The commissioner shall set aside a portion of the 179.16 federal funds earned under this section to repay the special 179.17 revenue maximization account under section 256.01, subdivision 179.18 2, clause (15). The repayment is limited to: 179.19 (1) the costs of developing and implementing this section; 179.20 and 179.21 (2) programming the information systems. 179.22 (l) Notwithstanding section 256.025, subdivision 2, 179.23 payments to counties for case management expenditures under this 179.24 section shall only be made from federal earnings from services 179.25 provided under this section. Payments to contracted vendors 179.26 shall include both the federal earnings and the county share. 179.27 (m) Notwithstanding section 256B.041, county payments for 179.28 the cost of mental health case management services provided by 179.29 county or state staff shall not be made to the state treasurer. 179.30 For the purposes of mental health case management services 179.31 provided by county or state staff under this section, the 179.32 centralized disbursement of payments to counties under section 179.33 256B.041 consists only of federal earnings from services 179.34 provided under this section. 179.35 (n) Case management services under this subdivision do not 179.36 include therapy, treatment, legal, or outreach services. 180.1 (o) If the recipient is a resident of a nursing facility, 180.2 intermediate care facility, or hospital, and the recipient's 180.3 institutional care is paid by medical assistance, payment for 180.4 case management services under this subdivision is limited to 180.5 the last30180 days of the recipient's residency in that 180.6 facility and may not exceed more thantwosix months in a 180.7 calendar year. 180.8 (p) Payment for case management services under this 180.9 subdivision shall not duplicate payments made under other 180.10 program authorities for the same purpose. 180.11 (q) By July 1, 2000, the commissioner shall evaluate the 180.12 effectiveness of the changes required by this section, including 180.13 changes in number of persons receiving mental health case 180.14 management, changes in hours of service per person, and changes 180.15 in caseload size. 180.16 (r) For each calendar year beginning with the calendar year 180.17 2001, the annualized amount of state funds for each county 180.18 determined under paragraph (g) shall be adjusted by the county's 180.19 percentage change in the average number of clients per month who 180.20 received case management under this section during the fiscal 180.21 year that ended six months prior to the calendar year in 180.22 question, in comparison to the prior fiscal year. 180.23 (s) For counties receiving the minimum allocation of $3,000 180.24 or $5,000 described in paragraph (g), the adjustment in 180.25 paragraph (r) shall be determined so that the county receives 180.26 the higher of the following amounts: 180.27 (1) a continuation of the minimum allocation in paragraph 180.28 (g); or 180.29 (2) an amount based on that county's average number of 180.30 clients per month who received case management under this 180.31 section during the fiscal year that ended six months prior to 180.32 the calendar year in question, in comparison to the prior fiscal 180.33 year, times the average statewide grant per person per month for 180.34 counties not receiving the minimum allocation. 180.35 (t) The adjustments in paragraphs (r) and (s) shall be 180.36 calculated separately for children and adults. 181.1 Sec. 20. Minnesota Statutes 2000, section 256B.0625, is 181.2 amended by adding a subdivision to read: 181.3 Subd. 43. [TARGETED CASE MANAGEMENT.] For purposes of 181.4 subdivisions 43a to 43h, the following terms have the meanings 181.5 given them: 181.6 (1) "home care service recipients" means those individuals 181.7 receiving the following services under section 256B.0627: 181.8 skilled nursing visits, home health aide visits, private duty 181.9 nursing, personal care assistants, or therapies provided through 181.10 a home health agency; 181.11 (2) "home care targeted case management" means the 181.12 provision of targeted case management services for the purpose 181.13 of assisting home care service recipients to gain access to 181.14 needed services and supports so that they may remain in the 181.15 community; 181.16 (3) "institutions" means hospitals, consistent with Code of 181.17 Federal Regulations, title 42, section 440.10; regional 181.18 treatment center inpatient services, consistent with section 181.19 245.474; nursing facilities; and intermediate care facilities 181.20 for persons with mental retardation; 181.21 (4) "relocation targeted case management" means the 181.22 provision of targeted case management services for the purpose 181.23 of assisting recipients to gain access to needed services and 181.24 supports if they choose to move from an institution to the 181.25 community. Relocation targeted case management may be provided 181.26 during the last 180 consecutive days of an eligible recipient's 181.27 institutional stay; and 181.28 (5) "targeted case management" means case management 181.29 services provided to help recipients gain access to needed 181.30 medical, social, educational, and other services and supports. 181.31 Sec. 21. Minnesota Statutes 2000, section 256B.0625, is 181.32 amended by adding a subdivision to read: 181.33 Subd. 43a. [ELIGIBILITY.] The following persons are 181.34 eligible for relocation targeted case management or home 181.35 care-targeted case management: 181.36 (1) medical assistance eligible persons residing in 182.1 institutions who choose to move into the community are eligible 182.2 for relocation targeted case management services; and 182.3 (2) medical assistance eligible persons receiving home care 182.4 services, who are not eligible for any other medical assistance 182.5 reimbursable case management service, are eligible for home 182.6 care-targeted case management services beginning January 1, 2003. 182.7 Sec. 22. Minnesota Statutes 2000, section 256B.0625, is 182.8 amended by adding a subdivision to read: 182.9 Subd. 43b. [RELOCATION TARGETED CASE MANAGEMENT PROVIDER 182.10 QUALIFICATIONS.] The following qualifications and certification 182.11 standards must be met by providers of relocation targeted case 182.12 management: 182.13 (a) The commissioner must certify each provider of 182.14 relocation targeted case management before enrollment. The 182.15 certification process shall examine the provider's ability to 182.16 meet the requirements in this subdivision and other federal and 182.17 state requirements of this service. A certified relocation 182.18 targeted case management provider may subcontract with another 182.19 provider to deliver relocation targeted case management 182.20 services. Subcontracted providers must demonstrate the ability 182.21 to provide the services outlined in subdivision 43d. 182.22 (b) A relocation targeted case management provider is an 182.23 enrolled medical assistance provider who is determined by the 182.24 commissioner to have all of the following characteristics: 182.25 (1) the legal authority to provide public welfare under 182.26 sections 393.01, subdivision 7; and 393.07; or a federally 182.27 recognized Indian tribe; 182.28 (2) the demonstrated capacity and experience to provide the 182.29 components of case management to coordinate and link community 182.30 resources needed by the eligible population; 182.31 (3) the administrative capacity and experience to serve the 182.32 target population for whom it will provide services and ensure 182.33 quality of services under state and federal requirements; 182.34 (4) the legal authority to provide complete investigative 182.35 and protective services under section 626.556, subdivision 10; 182.36 and child welfare and foster care services under section 393.07, 183.1 subdivisions 1 and 2; or a federally recognized Indian tribe; 183.2 (5) a financial management system that provides accurate 183.3 documentation of services and costs under state and federal 183.4 requirements; and 183.5 (6) the capacity to document and maintain individual case 183.6 records under state and federal requirements. 183.7 A provider of targeted case management under subdivision 20 may 183.8 be deemed a certified provider of relocation targeted case 183.9 management. 183.10 Sec. 23. Minnesota Statutes 2000, section 256B.0625, is 183.11 amended by adding a subdivision to read: 183.12 Subd. 43c. [HOME CARE TARGETED CASE MANAGEMENT PROVIDER 183.13 QUALIFICATIONS.] The following qualifications and certification 183.14 standards must be met by providers of home care targeted case 183.15 management. 183.16 (a) The commissioner must certify each provider of home 183.17 care targeted case management before enrollment. The 183.18 certification process shall examine the provider's ability to 183.19 meet the requirements in this subdivision and other state and 183.20 federal requirements of this service. 183.21 (b) A home care targeted case management provider is an 183.22 enrolled medical assistance provider who has a minimum of a 183.23 bachelor's degree or a license in a health or human services 183.24 field, and is determined by the commissioner to have all of the 183.25 following characteristics: 183.26 (1) the demonstrated capacity and experience to provide the 183.27 components of case management to coordinate and link community 183.28 resources needed by the eligible population; 183.29 (2) the administrative capacity and experience to serve the 183.30 target population for whom it will provide services and ensure 183.31 quality of services under state and federal requirements; 183.32 (3) a financial management system that provides accurate 183.33 documentation of services and costs under state and federal 183.34 requirements; 183.35 (4) the capacity to document and maintain individual case 183.36 records under state and federal requirements; and 184.1 (5) the capacity to coordinate with county administrative 184.2 functions. 184.3 Sec. 24. Minnesota Statutes 2000, section 256B.0625, is 184.4 amended by adding a subdivision to read: 184.5 Subd. 43d. [ELIGIBLE SERVICES.] Services eligible for 184.6 medical assistance reimbursement as targeted case management 184.7 include: 184.8 (1) assessment of the recipient's need for targeted case 184.9 management services; 184.10 (2) development, completion, and regular review of a 184.11 written individual service plan, which is based upon the 184.12 assessment of the recipient's needs and choices, and which will 184.13 ensure access to medical, social, educational, and other related 184.14 services and supports; 184.15 (3) routine contact or communication with the recipient, 184.16 recipient's family, primary caregiver, legal representative, 184.17 substitute care provider, service providers, or other relevant 184.18 persons identified as necessary to the development or 184.19 implementation of the goals of the individual service plan; 184.20 (4) coordinating referrals for, and the provision of, case 184.21 management services for the recipient with appropriate service 184.22 providers, consistent with section 1902(a)(23) of the Social 184.23 Security Act; 184.24 (5) coordinating and monitoring the overall service 184.25 delivery to ensure quality of services, appropriateness, and 184.26 continued need; 184.27 (6) completing and maintaining necessary documentation that 184.28 supports and verifies the activities in this subdivision; 184.29 (7) traveling to conduct a visit with the recipient or 184.30 other relevant person necessary to develop or implement the 184.31 goals of the individual service plan; and 184.32 (8) coordinating with the institution discharge planner in 184.33 the 180-day period before the recipient's discharge. 184.34 Sec. 25. Minnesota Statutes 2000, section 256B.0625, is 184.35 amended by adding a subdivision to read: 184.36 Subd. 43e. [TIME LINES.] The following time lines must be 185.1 met for assigning a case manager: 185.2 (1) for relocation targeted case management, an eligible 185.3 recipient must be assigned a case manager who visits the person 185.4 within 20 working days of requesting a case manager from their 185.5 county of financial responsibility as determined under chapter 185.6 256G. If a county agency does not provide case management 185.7 services as required, the recipient may, after written notice to 185.8 the county agency, obtain targeted relocation case management 185.9 services from a home care targeted case management provider, as 185.10 defined in subdivision 43c; and 185.11 (2) for home care targeted case management, an eligible 185.12 recipient must be assigned a case manager within 20 working days 185.13 of requesting a case manager from a home care targeted case 185.14 management provider, as defined in subdivision 43c. 185.15 Sec. 26. Minnesota Statutes 2000, section 256B.0625, is 185.16 amended by adding a subdivision to read: 185.17 Subd. 43f. [EVALUATION.] The commissioner shall evaluate 185.18 the delivery of targeted case management, including, but not 185.19 limited to, access to case management services, consumer 185.20 satisfaction with case management services, and quality of case 185.21 management services. 185.22 Sec. 27. Minnesota Statutes 2000, section 256B.0625, is 185.23 amended by adding a subdivision to read: 185.24 Subd. 43g. [CONTACT DOCUMENTATION.] The case manager must 185.25 document each face-to-face and telephone contact with the 185.26 recipient and others involved in the recipient's individual 185.27 service plan. 185.28 Sec. 28. Minnesota Statutes 2000, section 256B.0625, is 185.29 amended by adding a subdivision to read: 185.30 Subd. 43h. [PAYMENT RATES.] The commissioner shall set 185.31 payment rates for targeted case management under this 185.32 subdivision. Case managers may bill according to the following 185.33 criteria: 185.34 (1) for relocation targeted case management, case managers 185.35 may bill for direct case management activities, including 185.36 face-to-face and telephone contacts, in the 180 days preceding 186.1 an eligible recipient's discharge from an institution; 186.2 (2) for home care targeted case management, case managers 186.3 may bill for direct case management activities, including 186.4 face-to-face and telephone contacts; and 186.5 (3) billings for targeted case management services under 186.6 this subdivision shall not duplicate payments made under other 186.7 program authorities for the same purpose. 186.8 Sec. 29. Minnesota Statutes 2000, section 256B.0627, 186.9 subdivision 1, is amended to read: 186.10 Subdivision 1. [DEFINITION.] (a) "Activities of daily 186.11 living" includes eating, toileting, grooming, dressing, bathing, 186.12 transferring, mobility, and positioning. 186.13 (b) "Assessment" means a review and evaluation of a 186.14 recipient's need for home care services conducted in person. 186.15 Assessments for private duty nursing shall be conducted by a 186.16 registered private duty nurse. Assessments for home health 186.17 agency services shall be conducted by a home health agency 186.18 nurse. Assessments for personal care assistant services shall 186.19 be conducted by the county public health nurse or a certified 186.20 public health nurse under contract with the county. A 186.21 face-to-face assessment must include: documentation of health 186.22 status, determination of need, evaluation of service 186.23 effectiveness, identification of appropriate services, service 186.24 plan development or modification, coordination of services, 186.25 referrals and follow-up to appropriate payers and community 186.26 resources, completion of required reports, recommendation of 186.27 service authorization, and consumer education. Once the need 186.28 for personal care assistant services is determined under this 186.29 section, the county public health nurse or certified public 186.30 health nurse under contract with the county is responsible for 186.31 communicating this recommendation to the commissioner and the 186.32 recipient. A face-to-face assessment for personal 186.33 care assistant services is conducted on those recipients who 186.34 have never had a county public health nurse assessment. A 186.35 face-to-face assessment must occur at least annually or when 186.36 there is a significant change in the recipient's condition or 187.1 when there is a change in the need for personal care assistant 187.2 services. A service update may substitute for the annual 187.3 face-to-face assessment when there is not a significant change 187.4 in recipient condition or a change in the need for personal care 187.5 assistant service. A service update or review for temporary 187.6 increase includes a review of initial baseline data, evaluation 187.7 of service effectiveness, redetermination of service need, 187.8 modification of service plan and appropriate referrals, update 187.9 of initial forms, obtaining service authorization, and on going 187.10 consumer education. Assessments for medical assistance home 187.11 care services for mental retardation or related conditions and 187.12 alternative care services for developmentally disabled home and 187.13 community-based waivered recipients may be conducted by the 187.14 county public health nurse to ensure coordination and avoid 187.15 duplication. Assessments must be completed on forms provided by 187.16 the commissioner within 30 days of a request for home care 187.17 services by a recipient or responsible party. 187.18(b)(c) "Care plan" means a written description of personal 187.19 care assistant services developed by the qualified 187.20 professional or the recipient's physician with the recipient or 187.21 responsible party to be used by the personal care assistant with 187.22 a copy provided to the recipient or responsible party. 187.23 (d) "Complex and regular private duty nursing care" means: 187.24 (1) complex care is private duty nursing provided to 187.25 recipients who are ventilator dependent or for whom a physician 187.26 has certified that were it not for private duty nursing the 187.27 recipient would meet the criteria for inpatient hospital 187.28 intensive care unit (ICU) level of care; and 187.29 (2) regular care is private duty nursing provided to all 187.30 other recipients. 187.31 (e) "Health-related functions" means functions that can be 187.32 delegated or assigned by a licensed health care professional 187.33 under state law to be performed by a personal care attendant. 187.34(c)(f) "Home care services" means a health service, 187.35 determined by the commissioner as medically necessary, that is 187.36 ordered by a physician and documented in a service plan that is 188.1 reviewed by the physician at least once every6260 days for the 188.2 provision of home health services, or private duty nursing, or 188.3 at least once every 365 days for personal care. Home care 188.4 services are provided to the recipient at the recipient's 188.5 residence that is a place other than a hospital or long-term 188.6 care facility or as specified in section 256B.0625. 188.7 (g) "Instrumental activities of daily living" includes meal 188.8 planning and preparation, managing finances, shopping for food, 188.9 clothing, and other essential items, performing essential 188.10 household chores, communication by telephone and other media, 188.11 and getting around and participating in the community. 188.12(d)(h) "Medically necessary" has the meaning given in 188.13 Minnesota Rules, parts 9505.0170 to 9505.0475. 188.14(e)(i) "Personal care assistant" means a person who: 188.15 (1) is at least 18 years old, except for persons 16 to 18 188.16 years of age who participated in a related school-based job 188.17 training program or have completed a certified home health aide 188.18 competency evaluation; 188.19 (2) is able to effectively communicate with the recipient 188.20 and personal care provider organization; 188.21 (3) effective July 1, 1996, has completed one of the 188.22 training requirements as specified in Minnesota Rules, part 188.23 9505.0335, subpart 3, items A to D; 188.24 (4) has the ability to, and provides covered personal 188.25 care assistant services according to the recipient's care plan, 188.26 responds appropriately to recipient needs, and reports changes 188.27 in the recipient's condition to the supervising qualified 188.28 professional or physician; 188.29 (5) is not a consumer of personal care assistant services; 188.30 and 188.31 (6) is subject to criminal background checks and procedures 188.32 specified in section 245A.04. 188.33(f)(j) "Personal care provider organization" means an 188.34 organization enrolled to provide personal care assistant 188.35 services under the medical assistance program that complies with 188.36 the following: (1) owners who have a five percent interest or 189.1 more, and managerial officials are subject to a background study 189.2 as provided in section 245A.04. This applies to currently 189.3 enrolled personal care provider organizations and those agencies 189.4 seeking enrollment as a personal care provider organization. An 189.5 organization will be barred from enrollment if an owner or 189.6 managerial official of the organization has been convicted of a 189.7 crime specified in section 245A.04, or a comparable crime in 189.8 another jurisdiction, unless the owner or managerial official 189.9 meets the reconsideration criteria specified in section 245A.04; 189.10 (2) the organization must maintain a surety bond and liability 189.11 insurance throughout the duration of enrollment and provides 189.12 proof thereof. The insurer must notify the department of human 189.13 services of the cancellation or lapse of policy; and (3) the 189.14 organization must maintain documentation of services as 189.15 specified in Minnesota Rules, part 9505.2175, subpart 7, as well 189.16 as evidence of compliance with personal care assistant training 189.17 requirements. 189.18(g)(k) "Responsible party" means an individual residing 189.19 with a recipient of personal care assistant services who is 189.20 capable of providing the supportive care necessary to assist the 189.21 recipient to live in the community, is at least 18 years old, 189.22 and is not a personal care assistant. Responsible parties who 189.23 are parents of minors or guardians of minors or incapacitated 189.24 persons may delegate the responsibility to another adult during 189.25 a temporary absence of at least 24 hours but not more than six 189.26 months. The person delegated as a responsible party must be 189.27 able to meet the definition of responsible party, except that 189.28 the delegated responsible party is required to reside with the 189.29 recipient only while serving as the responsible party. Foster 189.30 care license holders may be designated the responsible party for 189.31 residents of the foster care home if case management is provided 189.32 as required in section 256B.0625, subdivision 19a. For persons 189.33 who, as of April 1, 1992, are sharing personal care assistant 189.34 services in order to obtain the availability of 24-hour 189.35 coverage, an employee of the personal care provider organization 189.36 may be designated as the responsible party if case management is 190.1 provided as required in section 256B.0625, subdivision 19a. 190.2(h)(l) "Service plan" means a written description of the 190.3 services needed based on the assessment developed by the nurse 190.4 who conducts the assessment together with the recipient or 190.5 responsible party. The service plan shall include a description 190.6 of the covered home care services, frequency and duration of 190.7 services, and expected outcomes and goals. The recipient and 190.8 the provider chosen by the recipient or responsible party must 190.9 be given a copy of the completed service plan within 30 calendar 190.10 days of the request for home care services by the recipient or 190.11 responsible party. 190.12(i)(m) "Skilled nurse visits" are provided in a 190.13 recipient's residence under a plan of care or service plan that 190.14 specifies a level of care which the nurse is qualified to 190.15 provide. These services are: 190.16 (1) nursing services according to the written plan of care 190.17 or service plan and accepted standards of medical and nursing 190.18 practice in accordance with chapter 148; 190.19 (2) services which due to the recipient's medical condition 190.20 may only be safely and effectively provided by a registered 190.21 nurse or a licensed practical nurse; 190.22 (3) assessments performed only by a registered nurse; and 190.23 (4) teaching and training the recipient, the recipient's 190.24 family, or other caregivers requiring the skills of a registered 190.25 nurse or licensed practical nurse. 190.26 (n) "Telehomecare" means the use of telecommunications 190.27 technology by a home health care professional to deliver home 190.28 health care services, within the professional's scope of 190.29 practice, to a patient located at a site other than the site 190.30 where the practitioner is located. 190.31 Sec. 30. Minnesota Statutes 2000, section 256B.0627, 190.32 subdivision 2, is amended to read: 190.33 Subd. 2. [SERVICES COVERED.] Home care services covered 190.34 under this section include: 190.35 (1) nursing services under section 256B.0625, subdivision 190.36 6a; 191.1 (2) private duty nursing services under section 256B.0625, 191.2 subdivision 7; 191.3 (3) home healthaideservices under section 256B.0625, 191.4 subdivision 6a; 191.5 (4) personal care assistant services under section 191.6 256B.0625, subdivision 19a; 191.7 (5) supervision of personal care assistant services 191.8 provided by a qualified professional under section 256B.0625, 191.9 subdivision 19a; 191.10 (6)consultingqualified professional of personal care 191.11 assistant services under the fiscalagentintermediary option as 191.12 specified in subdivision 10; 191.13 (7) face-to-face assessments by county public health nurses 191.14 for services under section 256B.0625, subdivision 19a; and 191.15 (8) service updates and review of temporary increases for 191.16 personal care assistant services by the county public health 191.17 nurse for services under section 256B.0625, subdivision 19a. 191.18 Sec. 31. Minnesota Statutes 2000, section 256B.0627, 191.19 subdivision 4, is amended to read: 191.20 Subd. 4. [PERSONAL CARE ASSISTANT SERVICES.] (a) The 191.21 personal care assistant services that are eligible for payment 191.22 arethe following:services and supports furnished to an 191.23 individual, as needed, to assist in accomplishing activities of 191.24 daily living; instrumental activities of daily living; 191.25 health-related functions through hands-on assistance, 191.26 supervision, and cuing; and redirection and intervention for 191.27 behavior including observation and monitoring. 191.28 (b) Payment for services will be made within the limits 191.29 approved using the prior authorized process established in 191.30 subdivision 5. 191.31 (c) The amount and type of services authorized shall be 191.32 based on an assessment of the recipient's needs in these areas: 191.33 (1) bowel and bladder care; 191.34 (2) skin care to maintain the health of the skin; 191.35 (3) repetitive maintenance range of motion, muscle 191.36 strengthening exercises, and other tasks specific to maintaining 192.1 a recipient's optimal level of function; 192.2 (4) respiratory assistance; 192.3 (5) transfers and ambulation; 192.4 (6) bathing, grooming, and hairwashing necessary for 192.5 personal hygiene; 192.6 (7) turning and positioning; 192.7 (8) assistance with furnishing medication that is 192.8 self-administered; 192.9 (9) application and maintenance of prosthetics and 192.10 orthotics; 192.11 (10) cleaning medical equipment; 192.12 (11) dressing or undressing; 192.13 (12) assistance with eating and meal preparation and 192.14 necessary grocery shopping; 192.15 (13) accompanying a recipient to obtain medical diagnosis 192.16 or treatment; 192.17 (14) assisting, monitoring, or prompting the recipient to 192.18 complete the services in clauses (1) to (13); 192.19 (15) redirection, monitoring, and observation that are 192.20 medically necessary and an integral part of completing the 192.21 personal care assistant services described in clauses (1) to 192.22 (14); 192.23 (16) redirection and intervention for behavior, including 192.24 observation and monitoring; 192.25 (17) interventions for seizure disorders, including 192.26 monitoring and observation if the recipient has had a seizure 192.27 that requires intervention within the past three months; 192.28 (18) tracheostomy suctioning using a clean procedure if the 192.29 procedure is properly delegated by a registered nurse. Before 192.30 this procedure can be delegated to a personal care assistant, a 192.31 registered nurse must determine that the tracheostomy suctioning 192.32 can be accomplished utilizing a clean rather than a sterile 192.33 procedure and must ensure that the personal care assistant has 192.34 been taught the proper procedure; and 192.35 (19) incidental household services that are an integral 192.36 part of a personal care service described in clauses (1) to (18). 193.1 For purposes of this subdivision, monitoring and observation 193.2 means watching for outward visible signs that are likely to 193.3 occur and for which there is a covered personal care service or 193.4 an appropriate personal care intervention. For purposes of this 193.5 subdivision, a clean procedure refers to a procedure that 193.6 reduces the numbers of microorganisms or prevents or reduces the 193.7 transmission of microorganisms from one person or place to 193.8 another. A clean procedure may be used beginning 14 days after 193.9 insertion. 193.10(b)(d) The personal care assistant services that are not 193.11 eligible for payment are the following: 193.12 (1) services not ordered by the physician; 193.13 (2) assessments by personal care assistant provider 193.14 organizations or by independently enrolled registered nurses; 193.15 (3) services that are not in the service plan; 193.16 (4) services provided by the recipient's spouse, legal 193.17 guardian for an adult or child recipient, or parent of a 193.18 recipient under age 18; 193.19 (5) services provided by a foster care provider of a 193.20 recipient who cannot direct the recipient's own care, unless 193.21 monitored by a county or state case manager under section 193.22 256B.0625, subdivision 19a; 193.23 (6) services provided by the residential or program license 193.24 holder in a residence for more than four persons; 193.25 (7) services that are the responsibility of a residential 193.26 or program license holder under the terms of a service agreement 193.27 and administrative rules; 193.28 (8) sterile procedures; 193.29 (9) injections of fluids into veins, muscles, or skin; 193.30 (10) services provided by parents of adult recipients, 193.31 adult children, or siblings of the recipient, unless these 193.32 relatives meet one of the following hardship criteria and the 193.33 commissioner waives this requirement: 193.34 (i) the relative resigns from a part-time or full-time job 193.35 to provide personal care for the recipient; 193.36 (ii) the relative goes from a full-time to a part-time job 194.1 with less compensation to provide personal care for the 194.2 recipient; 194.3 (iii) the relative takes a leave of absence without pay to 194.4 provide personal care for the recipient; 194.5 (iv) the relative incurs substantial expenses by providing 194.6 personal care for the recipient; or 194.7 (v) because of labor conditions, special language needs, or 194.8 intermittent hours of care needed, the relative is needed in 194.9 order to provide an adequate number of qualified personal care 194.10 assistants to meet the medical needs of the recipient; 194.11 (11) homemaker services that are not an integral part of a 194.12 personal care assistant services; 194.13 (12) home maintenance, or chore services; 194.14 (13) services not specified under paragraph (a); and 194.15 (14) services not authorized by the commissioner or the 194.16 commissioner's designee. 194.17 (e) The recipient or responsible party may choose to 194.18 supervise the personal care assistant or to have a qualified 194.19 professional, as defined in section 256B.0625, subdivision 19c, 194.20 provide the supervision. As required under section 256B.0625, 194.21 subdivision 19c, the county public health nurse, as a part of 194.22 the assessment, will assist the recipient or responsible party 194.23 to identify the most appropriate person to provide supervision 194.24 of the personal care assistant. Health-related delegated tasks 194.25 performed by the personal care assistant will be under the 194.26 supervision of a qualified professional or the direction of the 194.27 recipient's physician. If the recipient has a qualified 194.28 professional, Minnesota Rules, part 9505.0335, subpart 4, 194.29 applies. 194.30 Sec. 32. Minnesota Statutes 2000, section 256B.0627, 194.31 subdivision 5, is amended to read: 194.32 Subd. 5. [LIMITATION ON PAYMENTS.] Medical assistance 194.33 payments for home care services shall be limited according to 194.34 this subdivision. 194.35 (a) [LIMITS ON SERVICES WITHOUT PRIOR AUTHORIZATION.] A 194.36 recipient may receive the following home care services during a 195.1 calendar year: 195.2 (1) up to two face-to-face assessments to determine a 195.3 recipient's need for personal care assistant services; 195.4 (2) one service update done to determine a recipient's need 195.5 for personal care assistant services; and 195.6 (3) up tofivenine skilled nurse visits. 195.7 (b) [PRIOR AUTHORIZATION; EXCEPTIONS.] All home care 195.8 services above the limits in paragraph (a) must receive the 195.9 commissioner's prior authorization, except when: 195.10 (1) the home care services were required to treat an 195.11 emergency medical condition that if not immediately treated 195.12 could cause a recipient serious physical or mental disability, 195.13 continuation of severe pain, or death. The provider must 195.14 request retroactive authorization no later than five working 195.15 days after giving the initial service. The provider must be 195.16 able to substantiate the emergency by documentation such as 195.17 reports, notes, and admission or discharge histories; 195.18 (2) the home care services were provided on or after the 195.19 date on which the recipient's eligibility began, but before the 195.20 date on which the recipient was notified that the case was 195.21 opened. Authorization will be considered if the request is 195.22 submitted by the provider within 20 working days of the date the 195.23 recipient was notified that the case was opened; 195.24 (3) a third-party payor for home care services has denied 195.25 or adjusted a payment. Authorization requests must be submitted 195.26 by the provider within 20 working days of the notice of denial 195.27 or adjustment. A copy of the notice must be included with the 195.28 request; 195.29 (4) the commissioner has determined that a county or state 195.30 human services agency has made an error; or 195.31 (5) the professional nurse determines an immediate need for 195.32 up to 40 skilled nursing or home health aide visits per calendar 195.33 year and submits a request for authorization within 20 working 195.34 days of the initial service date, and medical assistance is 195.35 determined to be the appropriate payer. 195.36 (c) [RETROACTIVE AUTHORIZATION.] A request for retroactive 196.1 authorization will be evaluated according to the same criteria 196.2 applied to prior authorization requests. 196.3 (d) [ASSESSMENT AND SERVICE PLAN.] Assessments under 196.4 section 256B.0627, subdivision 1, paragraph (a), shall be 196.5 conducted initially, and at least annually thereafter, in person 196.6 with the recipient and result in a completed service plan using 196.7 forms specified by the commissioner. Within 30 days of 196.8 recipient or responsible party request for home care services, 196.9 the assessment, the service plan, and other information 196.10 necessary to determine medical necessity such as diagnostic or 196.11 testing information, social or medical histories, and hospital 196.12 or facility discharge summaries shall be submitted to the 196.13 commissioner. Notwithstanding the provisions of section 196.14 256B.0627, subdivision 12, the commissioner shall maximize 196.15 federal financial participation to pay for public health nurse 196.16 assessments for personal care services. For personal care 196.17 assistant services: 196.18 (1) The amount and type of service authorized based upon 196.19 the assessment and service plan will follow the recipient if the 196.20 recipient chooses to change providers. 196.21 (2) If the recipient's medical need changes, the 196.22 recipient's provider may assess the need for a change in service 196.23 authorization and request the change from the county public 196.24 health nurse. Within 30 days of the request, the public health 196.25 nurse will determine whether to request the change in services 196.26 based upon the provider assessment, or conduct a home visit to 196.27 assess the need and determine whether the change is appropriate. 196.28 (3) To continue to receive personal care assistant services 196.29 after the first year, the recipient or the responsible party, in 196.30 conjunction with the public health nurse, may complete a service 196.31 update on forms developed by the commissioner according to 196.32 criteria and procedures in subdivision 1. 196.33 (e) [PRIOR AUTHORIZATION.] The commissioner, or the 196.34 commissioner's designee, shall review the assessment, service 196.35 update, request for temporary services, service plan, and any 196.36 additional information that is submitted. The commissioner 197.1 shall, within 30 days after receiving a complete request, 197.2 assessment, and service plan, authorize home care services as 197.3 follows: 197.4 (1) [HOME HEALTH SERVICES.] All home health services 197.5 provided by alicensed nurse or ahome health aide must be prior 197.6 authorized by the commissioner or the commissioner's designee. 197.7 Prior authorization must be based on medical necessity and 197.8 cost-effectiveness when compared with other care options. When 197.9 home health services are used in combination with personal care 197.10 and private duty nursing, the cost of all home care services 197.11 shall be considered for cost-effectiveness. The commissioner 197.12 shall limitnurse andhome health aide visits to no more than 197.13 one visit each per day. The commissioner, or the commissioner's 197.14 designee, may authorize up to two skilled nurse visits per day. 197.15 (2) [PERSONAL CARE ASSISTANT SERVICES.] (i) All personal 197.16 care assistant services and supervision by a qualified 197.17 professional, if requested by the recipient, must be prior 197.18 authorized by the commissioner or the commissioner's designee 197.19 except for the assessments established in paragraph (a). The 197.20 amount of personal care assistant services authorized must be 197.21 based on the recipient's home care rating. A child may not be 197.22 found to be dependent in an activity of daily living if because 197.23 of the child's age an adult would either perform the activity 197.24 for the child or assist the child with the activity and the 197.25 amount of assistance needed is similar to the assistance 197.26 appropriate for a typical child of the same age. Based on 197.27 medical necessity, the commissioner may authorize: 197.28 (A) up to two times the average number of direct care hours 197.29 provided in nursing facilities for the recipient's comparable 197.30 case mix level; or 197.31 (B) up to three times the average number of direct care 197.32 hours provided in nursing facilities for recipients who have 197.33 complex medical needs or are dependent in at least seven 197.34 activities of daily living and need physical assistance with 197.35 eating or have a neurological diagnosis; or 197.36 (C) up to 60 percent of the average reimbursement rate, as 198.1 of July 1, 1991, for care provided in a regional treatment 198.2 center for recipients who have Level I behavior, plus any 198.3 inflation adjustment as provided by the legislature for personal 198.4 care service; or 198.5 (D) up to the amount the commissioner would pay, as of July 198.6 1, 1991, plus any inflation adjustment provided for home care 198.7 services, for care provided in a regional treatment center for 198.8 recipients referred to the commissioner by a regional treatment 198.9 center preadmission evaluation team. For purposes of this 198.10 clause, home care services means all services provided in the 198.11 home or community that would be included in the payment to a 198.12 regional treatment center; or 198.13 (E) up to the amount medical assistance would reimburse for 198.14 facility care for recipients referred to the commissioner by a 198.15 preadmission screening team established under section 256B.0911 198.16 or 256B.092; and 198.17 (F) a reasonable amount of time for the provision of 198.18 supervision by a qualified professional of personal 198.19 care assistant services, if a qualified professional is 198.20 requested by the recipient or responsible party. 198.21 (ii) The number of direct care hours shall be determined 198.22 according to the annual cost report submitted to the department 198.23 by nursing facilities. The average number of direct care hours, 198.24 as established by May 1, 1992, shall be calculated and 198.25 incorporated into the home care limits on July 1, 1992. These 198.26 limits shall be calculated to the nearest quarter hour. 198.27 (iii) The home care rating shall be determined by the 198.28 commissioner or the commissioner's designee based on information 198.29 submitted to the commissioner by the county public health nurse 198.30 on forms specified by the commissioner. The home care rating 198.31 shall be a combination of current assessment tools developed 198.32 under sections 256B.0911 and 256B.501 with an addition for 198.33 seizure activity that will assess the frequency and severity of 198.34 seizure activity and with adjustments, additions, and 198.35 clarifications that are necessary to reflect the needs and 198.36 conditions of recipients who need home care including children 199.1 and adults under 65 years of age. The commissioner shall 199.2 establish these forms and protocols under this section and shall 199.3 use an advisory group, including representatives of recipients, 199.4 providers, and counties, for consultation in establishing and 199.5 revising the forms and protocols. 199.6 (iv) A recipient shall qualify as having complex medical 199.7 needs if the care required is difficult to perform and because 199.8 of recipient's medical condition requires more time than 199.9 community-based standards allow or requires more skill than 199.10 would ordinarily be required and the recipient needs or has one 199.11 or more of the following: 199.12 (A) daily tube feedings; 199.13 (B) daily parenteral therapy; 199.14 (C) wound or decubiti care; 199.15 (D) postural drainage, percussion, nebulizer treatments, 199.16 suctioning, tracheotomy care, oxygen, mechanical ventilation; 199.17 (E) catheterization; 199.18 (F) ostomy care; 199.19 (G) quadriplegia; or 199.20 (H) other comparable medical conditions or treatments the 199.21 commissioner determines would otherwise require institutional 199.22 care. 199.23 (v) A recipient shall qualify as having Level I behavior if 199.24 there is reasonable supporting evidence that the recipient 199.25 exhibits, or that without supervision, observation, or 199.26 redirection would exhibit, one or more of the following 199.27 behaviors that cause, or have the potential to cause: 199.28 (A) injury to the recipient's own body; 199.29 (B) physical injury to other people; or 199.30 (C) destruction of property. 199.31 (vi) Time authorized for personal care relating to Level I 199.32 behavior in subclause (v), items (A) to (C), shall be based on 199.33 the predictability, frequency, and amount of intervention 199.34 required. 199.35 (vii) A recipient shall qualify as having Level II behavior 199.36 if the recipient exhibits on a daily basis one or more of the 200.1 following behaviors that interfere with the completion of 200.2 personal care assistant services under subdivision 4, paragraph 200.3 (a): 200.4 (A) unusual or repetitive habits; 200.5 (B) withdrawn behavior; or 200.6 (C) offensive behavior. 200.7 (viii) A recipient with a home care rating of Level II 200.8 behavior in subclause (vii), items (A) to (C), shall be rated as 200.9 comparable to a recipient with complex medical needs under 200.10 subclause (iv). If a recipient has both complex medical needs 200.11 and Level II behavior, the home care rating shall be the next 200.12 complex category up to the maximum rating under subclause (i), 200.13 item (B). 200.14 (3) [PRIVATE DUTY NURSING SERVICES.] All private duty 200.15 nursing services shall be prior authorized by the commissioner 200.16 or the commissioner's designee. Prior authorization for private 200.17 duty nursing services shall be based on medical necessity and 200.18 cost-effectiveness when compared with alternative care options. 200.19 The commissioner may authorize medically necessary private duty 200.20 nursing services in quarter-hour units when: 200.21 (i) the recipient requires more individual and continuous 200.22 care than can be provided during a nurse visit; or 200.23 (ii) the cares are outside of the scope of services that 200.24 can be provided by a home health aide or personal care assistant. 200.25 The commissioner may authorize: 200.26 (A) up to two times the average amount of direct care hours 200.27 provided in nursing facilities statewide for case mix 200.28 classification "K" as established by the annual cost report 200.29 submitted to the department by nursing facilities in May 1992; 200.30 (B) private duty nursing in combination with other home 200.31 care services up to the total cost allowed under clause (2); 200.32 (C) up to 16 hours per day if the recipient requires more 200.33 nursing than the maximum number of direct care hours as 200.34 established in item (A) and the recipient meets the hospital 200.35 admission criteria established under Minnesota Rules, parts 200.369505.05009505.0501 to 9505.0540. 201.1 The commissioner may authorize up to 16 hours per day of 201.2 medically necessary private duty nursing services or up to 24 201.3 hours per day of medically necessary private duty nursing 201.4 services until such time as the commissioner is able to make a 201.5 determination of eligibility for recipients who are 201.6 cooperatively applying for home care services under the 201.7 community alternative care program developed under section 201.8 256B.49, or until it is determined by the appropriate regulatory 201.9 agency that a health benefit plan is or is not required to pay 201.10 for appropriate medically necessary health care services. 201.11 Recipients or their representatives must cooperatively assist 201.12 the commissioner in obtaining this determination. Recipients 201.13 who are eligible for the community alternative care program may 201.14 not receive more hours of nursing under this section than would 201.15 otherwise be authorized under section 256B.49. 201.16 (4) [VENTILATOR-DEPENDENT RECIPIENTS.] If the recipient is 201.17 ventilator-dependent, the monthly medical assistance 201.18 authorization for home care services shall not exceed what the 201.19 commissioner would pay for care at the highest cost hospital 201.20 designated as a long-term hospital under the Medicare program. 201.21 For purposes of this clause, home care services means all 201.22 services provided in the home that would be included in the 201.23 payment for care at the long-term hospital. 201.24 "Ventilator-dependent" means an individual who receives 201.25 mechanical ventilation for life support at least six hours per 201.26 day and is expected to be or has been dependent for at least 30 201.27 consecutive days. 201.28 (f) [PRIOR AUTHORIZATION; TIME LIMITS.] The commissioner 201.29 or the commissioner's designee shall determine the time period 201.30 for which a prior authorization shall be effective. If the 201.31 recipient continues to require home care services beyond the 201.32 duration of the prior authorization, the home care provider must 201.33 request a new prior authorization. Under no circumstances, 201.34 other than the exceptions in paragraph (b), shall a prior 201.35 authorization be valid prior to the date the commissioner 201.36 receives the request or for more than 12 months. A recipient 202.1 who appeals a reduction in previously authorized home care 202.2 services may continue previously authorized services, other than 202.3 temporary services under paragraph (h), pending an appeal under 202.4 section 256.045. The commissioner must provide a detailed 202.5 explanation of why the authorized services are reduced in amount 202.6 from those requested by the home care provider. 202.7 (g) [APPROVAL OF HOME CARE SERVICES.] The commissioner or 202.8 the commissioner's designee shall determine the medical 202.9 necessity of home care services, the level of caregiver 202.10 according to subdivision 2, and the institutional comparison 202.11 according to this subdivision, the cost-effectiveness of 202.12 services, and the amount, scope, and duration of home care 202.13 services reimbursable by medical assistance, based on the 202.14 assessment, primary payer coverage determination information as 202.15 required, the service plan, the recipient's age, the cost of 202.16 services, the recipient's medical condition, and diagnosis or 202.17 disability. The commissioner may publish additional criteria 202.18 for determining medical necessity according to section 256B.04. 202.19 (h) [PRIOR AUTHORIZATION REQUESTS; TEMPORARY SERVICES.] 202.20 The agency nurse, the independently enrolled private duty nurse, 202.21 or county public health nurse may request a temporary 202.22 authorization for home care services by telephone. The 202.23 commissioner may approve a temporary level of home care services 202.24 based on the assessment, and service or care plan information, 202.25 and primary payer coverage determination information as required. 202.26 Authorization for a temporary level of home care services 202.27 including nurse supervision is limited to the time specified by 202.28 the commissioner, but shall not exceed 45 days, unless extended 202.29 because the county public health nurse has not completed the 202.30 required assessment and service plan, or the commissioner's 202.31 determination has not been made. The level of services 202.32 authorized under this provision shall have no bearing on a 202.33 future prior authorization. 202.34 (i) [PRIOR AUTHORIZATION REQUIRED IN FOSTER CARE SETTING.] 202.35 Home care services provided in an adult or child foster care 202.36 setting must receive prior authorization by the department 203.1 according to the limits established in paragraph (a). 203.2 The commissioner may not authorize: 203.3 (1) home care services that are the responsibility of the 203.4 foster care provider under the terms of the foster care 203.5 placement agreement and administrative rules; 203.6 (2) personal care assistant services when the foster care 203.7 license holder is also the personal care provider or personal 203.8 care assistant unless the recipient can direct the recipient's 203.9 own care, or case management is provided as required in section 203.10 256B.0625, subdivision 19a; 203.11 (3) personal care assistant services when the responsible 203.12 party is an employee of, or under contract with, or has any 203.13 direct or indirect financial relationship with the personal care 203.14 provider or personal care assistant, unless case management is 203.15 provided as required in section 256B.0625, subdivision 19a; or 203.16 (4) personal care assistant and private duty nursing 203.17 services when the number of foster care residents is greater 203.18 than four unless the county responsible for the recipient's 203.19 foster placement made the placement prior to April 1, 1992, 203.20 requests that personal care assistant and private duty nursing 203.21 services be provided, and case management is provided as 203.22 required in section 256B.0625, subdivision 19a. 203.23 Sec. 33. Minnesota Statutes 2000, section 256B.0627, 203.24 subdivision 7, is amended to read: 203.25 Subd. 7. [NONCOVERED HOME CARE SERVICES.] The following 203.26 home care services are not eligible for payment under medical 203.27 assistance: 203.28 (1) skilled nurse visits for the sole purpose of 203.29 supervision of the home health aide; 203.30 (2) a skilled nursing visit: 203.31 (i) only for the purpose of monitoring medication 203.32 compliance with an established medication program for a 203.33 recipient; or 203.34 (ii) to administer or assist with medication 203.35 administration, including injections, prefilling syringes for 203.36 injections, or oral medication set-up of an adult recipient, 204.1 when as determined and documented by the registered nurse, the 204.2 need can be met by an available pharmacy or the recipient is 204.3 physically and mentally able to self-administer or prefill a 204.4 medication; 204.5 (3) home care services to a recipient who is eligible for 204.6 covered servicesincluding hospice, if elected by the recipient,204.7 under the Medicare program or any other insurance held by the 204.8 recipient; 204.9 (4) services to other members of the recipient's household; 204.10 (5) a visit made by a skilled nurse solely to train other 204.11 home health agency workers; 204.12 (6) any home care service included in the daily rate of the 204.13 community-based residential facility where the recipient is 204.14 residing; 204.15 (7) nursing and rehabilitation therapy services that are 204.16 reasonably accessible to a recipient outside the recipient's 204.17 place of residence, excluding the assessment, counseling and 204.18 education, and personal assistant care; 204.19 (8) any home health agency service, excluding personal care 204.20 assistant services and private duty nursing services, which are 204.21 performed in a place other than the recipient's residence; and 204.22 (9) Medicare evaluation or administrative nursing visits on 204.23 dual-eligible recipients that do not qualify for Medicare visit 204.24 billing. 204.25 Sec. 34. Minnesota Statutes 2000, section 256B.0627, 204.26 subdivision 8, is amended to read: 204.27 Subd. 8. [SHARED PERSONAL CARE ASSISTANT SERVICES.] (a) 204.28 Medical assistance payments for shared personal care assistance 204.29 services shall be limited according to this subdivision. 204.30 (b) Recipients of personal care assistant services may 204.31 share staff and the commissioner shall provide a rate system for 204.32 shared personal care assistant services. For two persons 204.33 sharing services, the rate paid to a provider shall not exceed 204.34 1-1/2 times the rate paid for serving a single individual, and 204.35 for three persons sharing services, the rate paid to a provider 204.36 shall not exceed twice the rate paid for serving a single 205.1 individual. These rates apply only to situations in which all 205.2 recipients were present and received shared services on the date 205.3 for which the service is billed. No more than three persons may 205.4 receive shared services from a personal care assistant in a 205.5 single setting. 205.6 (c) Shared service is the provision of personal 205.7 care assistant services by a personal care assistant to two or 205.8 three recipients at the same time and in the same setting. For 205.9 the purposes of this subdivision, "setting" means: 205.10 (1) the home or foster care home of one of the individual 205.11 recipients; or 205.12 (2) a child care program in which all recipients served by 205.13 one personal care assistant are participating, which is licensed 205.14 under chapter 245A or operated by a local school district or 205.15 private school; or 205.16 (3) outside the home or foster care home of one of the 205.17 recipients when normal life activities take the recipients 205.18 outside the home. 205.19 The provisions of this subdivision do not apply when a 205.20 personal care assistant is caring for multiple recipients in 205.21 more than one setting. 205.22 (d) The recipient or the recipient's responsible party, in 205.23 conjunction with the county public health nurse, shall determine: 205.24 (1) whether shared personal care assistant services is an 205.25 appropriate option based on the individual needs and preferences 205.26 of the recipient; and 205.27 (2) the amount of shared services allocated as part of the 205.28 overall authorization of personal care assistant services. 205.29 The recipient or the responsible party, in conjunction with 205.30 the supervising qualified professional, if a qualified 205.31 professional is requested by any one of the recipients or 205.32 responsible parties, shall arrange the setting and grouping of 205.33 shared services based on the individual needs and preferences of 205.34 the recipients. Decisions on the selection of recipients to 205.35 share services must be based on the ages of the recipients, 205.36 compatibility, and coordination of their care needs. 206.1 (e) The following items must be considered by the recipient 206.2 or the responsible party and the supervising qualified 206.3 professional, if a qualified professional has been requested by 206.4 any one of the recipients or responsible parties, and documented 206.5 in the recipient's health service record: 206.6 (1) the additional qualifications needed by the personal 206.7 care assistant to provide care to several recipients in the same 206.8 setting; 206.9 (2) the additional training and supervision needed by the 206.10 personal care assistant to ensure that the needs of the 206.11 recipient are met appropriately and safely. The provider must 206.12 provide on-site supervision by a qualified professional within 206.13 the first 14 days of shared services, and monthly thereafter, if 206.14 supervision by a qualified provider has been requested by any 206.15 one of the recipients or responsible parties; 206.16 (3) the setting in which the shared services will be 206.17 provided; 206.18 (4) the ongoing monitoring and evaluation of the 206.19 effectiveness and appropriateness of the service and process 206.20 used to make changes in service or setting; and 206.21 (5) a contingency plan which accounts for absence of the 206.22 recipient in a shared services setting due to illness or other 206.23 circumstances and staffing contingencies. 206.24 (f) The provider must offer the recipient or the 206.25 responsible party the option of shared or one-on-one personal 206.26 care assistant services. The recipient or the responsible party 206.27 can withdraw from participating in a shared services arrangement 206.28 at any time. 206.29 (g) In addition to documentation requirements under 206.30 Minnesota Rules, part 9505.2175, a personal care provider must 206.31 meet documentation requirements for shared personal care 206.32 assistant services and must document the following in the health 206.33 service record for each individual recipient sharing services: 206.34 (1) permission by the recipient or the recipient's 206.35 responsible party, if any, for the maximum number of shared 206.36 services hours per week chosen by the recipient; 207.1 (2) permission by the recipient or the recipient's 207.2 responsible party, if any, for personal care assistant services 207.3 provided outside the recipient's residence; 207.4 (3) permission by the recipient or the recipient's 207.5 responsible party, if any, for others to receive shared services 207.6 in the recipient's residence; 207.7 (4) revocation by the recipient or the recipient's 207.8 responsible party, if any, of the shared service authorization, 207.9 or the shared service to be provided to others in the 207.10 recipient's residence, or the shared service to be provided 207.11 outside the recipient's residence; 207.12 (5) supervision of the shared personal care assistant 207.13 services by the qualified professional, if a qualified 207.14 professional is requested by one of the recipients or 207.15 responsible parties, including the date, time of day, number of 207.16 hours spent supervising the provision of shared services, 207.17 whether the supervision was face-to-face or another method of 207.18 supervision, changes in the recipient's condition, shared 207.19 services scheduling issues and recommendations; 207.20 (6) documentation by the qualified professional, if a 207.21 qualified professional is requested by one of the recipients or 207.22 responsible parties, of telephone calls or other discussions 207.23 with the personal care assistant regarding services being 207.24 provided to the recipient who has requested the supervision; and 207.25 (7) daily documentation of the shared services provided by 207.26 each identified personal care assistant including: 207.27 (i) the names of each recipient receiving shared services 207.28 together; 207.29 (ii) the setting for the shared services, including the 207.30 starting and ending times that the recipient received shared 207.31 services; and 207.32 (iii) notes by the personal care assistant regarding 207.33 changes in the recipient's condition, problems that may arise 207.34 from the sharing of services, scheduling issues, care issues, 207.35 and other notes as required by the qualified professional, if a 207.36 qualified professional is requested by one of the recipients or 208.1 responsible parties. 208.2 (h) Unless otherwise provided in this subdivision, all 208.3 other statutory and regulatory provisions relating to personal 208.4 care assistant services apply to shared services. 208.5 (i) In the event that supervision by a qualified 208.6 professional has been requested by one or more recipients, but 208.7 not by all of the recipients, the supervision duties of the 208.8 qualified professional shall be limited to only those recipients 208.9 who have requested the supervision. 208.10 Nothing in this subdivision shall be construed to reduce 208.11 the total number of hours authorized for an individual recipient. 208.12 Sec. 35. Minnesota Statutes 2000, section 256B.0627, 208.13 subdivision 10, is amended to read: 208.14 Subd. 10. [FISCALAGENTINTERMEDIARY OPTION AVAILABLE FOR 208.15 PERSONAL CARE ASSISTANT SERVICES.] (a)"Fiscal agent option" is208.16an option that allows the recipient to:208.17(1) use a fiscal agent instead of a personal care provider208.18organization;208.19(2) supervise the personal care assistant; and208.20(3) use a consulting professional.208.21 The commissioner may allow a recipient of personal care 208.22 assistant services to use a fiscalagentintermediary to assist 208.23 the recipient in paying and accounting for medically necessary 208.24 covered personal care assistant services authorized in 208.25 subdivision 4 and within the payment parameters of subdivision 208.26 5. Unless otherwise provided in this subdivision, all other 208.27 statutory and regulatory provisions relating to personal care 208.28 assistant services apply to a recipient using the fiscalagent208.29 intermediary option. 208.30 (b) The recipient or responsible party shall: 208.31 (1)hire, and terminate the personal care assistant and208.32consulting professional, with the fiscal agentrecruit, hire, 208.33 and terminate a qualified professional, if a qualified 208.34 professional is requested by the recipient or responsible party; 208.35 (2)recruit the personal care assistant and consulting208.36professional and orient and train the personal care assistant in209.1areas that do not require professional delegation as determined209.2by the county public health nurseverify and document the 209.3 credentials of the qualified professional, if a qualified 209.4 professional is requested by the recipient or responsible party; 209.5 (3)supervise and evaluate the personal care assistant in209.6areas that do not require professional delegation as determined209.7in the assessment;209.8(4) cooperate with a consultingdevelop a service plan 209.9 based on physician orders and public health nurse assessment 209.10 with the assistance of a qualified professionaland implement209.11recommendations pertaining to the health and safety of the209.12recipient, if a qualified professional is requested by the 209.13 recipient or responsible party, that addresses the health and 209.14 safety of the recipient; 209.15(5) hire a qualified professional to train and supervise209.16the performance of delegated tasks done by(4) recruit, hire, 209.17 and terminate the personal care assistant; 209.18(6) monitor services and verify in writing the hours worked209.19by the personal care assistant and the consulting(5) orient and 209.20 train the personal care assistant with assistance as needed from 209.21 the qualified professional; 209.22(7) develop and revise a care plan with assistance from a209.23consulting(6) supervise and evaluate the personal care 209.24 assistant with assistance as needed from the recipient's 209.25 physician or the qualified professional; 209.26(8) verify and document the credentials of the consulting209.27 (7) monitor and verify in writing and report to the fiscal 209.28 intermediary the number of hours worked by the personal care 209.29 assistant and the qualified professional; and 209.30(9)(8) enter into a written agreement, as specified in 209.31 paragraph (f). 209.32 (c) The duties of the fiscalagentintermediary shall be to: 209.33 (1) bill the medical assistance program for personal care 209.34 assistant andconsultingqualified professional services; 209.35 (2) request and secure background checks on personal care 209.36 assistants andconsultingqualified professionals according to 210.1 section 245A.04; 210.2 (3) pay the personal care assistant andconsulting210.3 qualified professional based on actual hours of services 210.4 provided; 210.5 (4) withhold and pay all applicable federal and state 210.6 taxes; 210.7 (5) verify anddocumentkeep records of hours worked by the 210.8 personal care assistant andconsultingqualified professional; 210.9 (6) make the arrangements and pay unemployment insurance, 210.10 taxes, workers' compensation, liability insurance, and other 210.11 benefits, if any; 210.12 (7) enroll in the medical assistance program as a fiscal 210.13agentintermediary; and 210.14 (8) enter into a written agreement as specified in 210.15 paragraph (f) before services are provided. 210.16 (d) The fiscalagentintermediary: 210.17 (1) may not be related to the recipient,consulting210.18 qualified professional, or the personal care assistant; 210.19 (2) must ensure arm's length transactions with the 210.20 recipient and personal care assistant; and 210.21 (3) shall be considered a joint employer of the personal 210.22 care assistant andconsultingqualified professional to the 210.23 extent specified in this section. 210.24 The fiscalagentintermediary or owners of the entity that 210.25 provides fiscalagentintermediary services under this 210.26 subdivision must pass a criminal background check as required in 210.27 section 256B.0627, subdivision 1, paragraph (e). 210.28 (e) If the recipient or responsible party requests a 210.29 qualified professional, theconsultingqualified professional 210.30 providing assistance to the recipient shall meet the 210.31 qualifications specified in section 256B.0625, subdivision 19c. 210.32 Theconsultingqualified professional shall assist the recipient 210.33 in developing and revising a plan to meet the 210.34 recipient'sassessedneeds,and supervise the performance of210.35delegated tasks, as determined by the public health nurseas 210.36 assessed by the public health nurse. In performing this 211.1 function, theconsultingqualified professional must visit the 211.2 recipient in the recipient's home at least once annually. 211.3 Theconsultingqualified professional must reportto the local211.4county public health nurse concerns relating to the health and211.5safety of the recipient, andany suspected abuse, neglect, or 211.6 financial exploitation of the recipient to the appropriate 211.7 authorities. 211.8 (f) The fiscalagentintermediary, recipient or responsible 211.9 party, personal care assistant, andconsultingqualified 211.10 professional shall enter into a written agreement before 211.11 services are started. The agreement shall include: 211.12 (1) the duties of the recipient, qualified professional, 211.13 personal care assistant, and fiscal agent based on paragraphs 211.14 (a) to (e); 211.15 (2) the salary and benefits for the personal care assistant 211.16 andthose providing professional consultationthe qualified 211.17 professional; 211.18 (3) the administrative fee of the fiscalagentintermediary 211.19 and services paid for with that fee, including background check 211.20 fees; 211.21 (4) procedures to respond to billing or payment complaints; 211.22 and 211.23 (5) procedures for hiring and terminating the personal care 211.24 assistant andthose providing professional consultationthe 211.25 qualified professional. 211.26 (g) The rates paid for personal care assistant services, 211.27 qualified professionalassistanceservices, and fiscalagency211.28 intermediary services under this subdivision shall be the same 211.29 rates paid for personal care assistant services and qualified 211.30 professional services under subdivision 2 respectively. Except 211.31 for the administrative fee of the fiscalagentintermediary 211.32 specified in paragraph (f), the remainder of the rates paid to 211.33 the fiscalagentintermediary must be used to pay for the salary 211.34 and benefits for the personal care assistant orthose providing211.35professional consultationthe qualified professional. 211.36 (h) As part of the assessment defined in subdivision 1, the 212.1 following conditions must be met to use or continue use of a 212.2 fiscalagentintermediary: 212.3 (1) the recipient must be able to direct the recipient's 212.4 own care, or the responsible party for the recipient must be 212.5 readily available to direct the care of the personal care 212.6 assistant; 212.7 (2) the recipient or responsible party must be 212.8 knowledgeable of the health care needs of the recipient and be 212.9 able to effectively communicate those needs; 212.10 (3) a face-to-face assessment must be conducted by the 212.11 local county public health nurse at least annually, or when 212.12 there is a significant change in the recipient's condition or 212.13 change in the need for personal care assistant services. The212.14county public health nurse shall determine the services that212.15require professional delegation, if any, and the amount and212.16frequency of related supervision; 212.17 (4) the recipient cannot select the shared services option 212.18 as specified in subdivision 8; and 212.19 (5) parties must be in compliance with the written 212.20 agreement specified in paragraph (f). 212.21 (i) The commissioner shall deny, revoke, or suspend the 212.22 authorization to use the fiscalagentintermediary option if: 212.23 (1) it has been determined by theconsultingqualified 212.24 professional or local county public health nurse that the use of 212.25 this option jeopardizes the recipient's health and safety; 212.26 (2) the parties have failed to comply with the written 212.27 agreement specified in paragraph (f); or 212.28 (3) the use of the option has led to abusive or fraudulent 212.29 billing for personal care assistant services. 212.30 The recipient or responsible party may appeal the 212.31 commissioner's action according to section 256.045. The denial, 212.32 revocation, or suspension to use the fiscalagentintermediary 212.33 option shall not affect the recipient's authorized level of 212.34 personal care assistant services as determined in subdivision 5. 212.35 Sec. 36. Minnesota Statutes 2000, section 256B.0627, 212.36 subdivision 11, is amended to read: 213.1 Subd. 11. [SHARED PRIVATE DUTY NURSING CARE OPTION.] (a) 213.2 Medical assistance payments for shared private duty nursing 213.3 services by a private duty nurse shall be limited according to 213.4 this subdivision. For the purposes of this section, "private 213.5 duty nursing agency" means an agency licensed under chapter 144A 213.6 to provide private duty nursing services. 213.7 (b) Recipients of private duty nursing services may share 213.8 nursing staff and the commissioner shall provide a rate 213.9 methodology for shared private duty nursing. For two persons 213.10 sharing nursing care, the rate paid to a provider shall not 213.11 exceed 1.5 times thenonwaiveredregular private duty nursing 213.12 rates paid for serving a single individualwho is not ventilator213.13dependent,by a registered nurse or licensed practical nurse. 213.14 These rates apply only to situations in which both recipients 213.15 are present and receive shared private duty nursing care on the 213.16 date for which the service is billed. No more than two persons 213.17 may receive shared private duty nursing services from a private 213.18 duty nurse in a single setting. 213.19 (c) Shared private duty nursing care is the provision of 213.20 nursing services by a private duty nurse to two recipients at 213.21 the same time and in the same setting. For the purposes of this 213.22 subdivision, "setting" means: 213.23 (1) the home or foster care home of one of the individual 213.24 recipients; or 213.25 (2) a child care program licensed under chapter 245A or 213.26 operated by a local school district or private school; or 213.27 (3) an adult day care service licensed under chapter 245A; 213.28 or 213.29 (4) outside the home or foster care home of one of the 213.30 recipients when normal life activities take the recipients 213.31 outside the home. 213.32 This subdivision does not apply when a private duty nurse 213.33 is caring for multiple recipients in more than one setting. 213.34 (d) The recipient or the recipient's legal representative, 213.35 and the recipient's physician, in conjunction with the home 213.36 health care agency, shall determine: 214.1 (1) whether shared private duty nursing care is an 214.2 appropriate option based on the individual needs and preferences 214.3 of the recipient; and 214.4 (2) the amount of shared private duty nursing services 214.5 authorized as part of the overall authorization of nursing 214.6 services. 214.7 (e) The recipient or the recipient's legal representative, 214.8 in conjunction with the private duty nursing agency, shall 214.9 approve the setting, grouping, and arrangement of shared private 214.10 duty nursing care based on the individual needs and preferences 214.11 of the recipients. Decisions on the selection of recipients to 214.12 share services must be based on the ages of the recipients, 214.13 compatibility, and coordination of their care needs. 214.14 (f) The following items must be considered by the recipient 214.15 or the recipient's legal representative and the private duty 214.16 nursing agency, and documented in the recipient's health service 214.17 record: 214.18 (1) the additional training needed by the private duty 214.19 nurse to provide care to two recipients in the same setting and 214.20 to ensure that the needs of the recipients are met appropriately 214.21 and safely; 214.22 (2) the setting in which the shared private duty nursing 214.23 care will be provided; 214.24 (3) the ongoing monitoring and evaluation of the 214.25 effectiveness and appropriateness of the service and process 214.26 used to make changes in service or setting; 214.27 (4) a contingency plan which accounts for absence of the 214.28 recipient in a shared private duty nursing setting due to 214.29 illness or other circumstances; 214.30 (5) staffing backup contingencies in the event of employee 214.31 illness or absence; and 214.32 (6) arrangements for additional assistance to respond to 214.33 urgent or emergency care needs of the recipients. 214.34 (g) The provider must offer the recipient or responsible 214.35 party the option of shared or one-on-one private duty nursing 214.36 services. The recipient or responsible party can withdraw from 215.1 participating in a shared service arrangement at any time. 215.2 (h) The private duty nursing agency must document the 215.3 following in the health service record for each individual 215.4 recipient sharing private duty nursing care: 215.5 (1) permission by the recipient or the recipient's legal 215.6 representative for the maximum number of shared nursing care 215.7 hours per week chosen by the recipient; 215.8 (2) permission by the recipient or the recipient's legal 215.9 representative for shared private duty nursing services provided 215.10 outside the recipient's residence; 215.11 (3) permission by the recipient or the recipient's legal 215.12 representative for others to receive shared private duty nursing 215.13 services in the recipient's residence; 215.14 (4) revocation by the recipient or the recipient's legal 215.15 representative of the shared private duty nursing care 215.16 authorization, or the shared care to be provided to others in 215.17 the recipient's residence, or the shared private duty nursing 215.18 services to be provided outside the recipient's residence; and 215.19 (5) daily documentation of the shared private duty nursing 215.20 services provided by each identified private duty nurse, 215.21 including: 215.22 (i) the names of each recipient receiving shared private 215.23 duty nursing services together; 215.24 (ii) the setting for the shared services, including the 215.25 starting and ending times that the recipient received shared 215.26 private duty nursing care; and 215.27 (iii) notes by the private duty nurse regarding changes in 215.28 the recipient's condition, problems that may arise from the 215.29 sharing of private duty nursing services, and scheduling and 215.30 care issues. 215.31 (i) Unless otherwise provided in this subdivision, all 215.32 other statutory and regulatory provisions relating to private 215.33 duty nursing services apply to shared private duty nursing 215.34 services. 215.35 Nothing in this subdivision shall be construed to reduce 215.36 the total number of private duty nursing hours authorized for an 216.1 individual recipient under subdivision 5. 216.2 Sec. 37. Minnesota Statutes 2000, section 256B.0627, is 216.3 amended by adding a subdivision to read: 216.4 Subd. 13. [CONSUMER-DIRECTED HOME CARE DEMONSTRATION 216.5 PROJECT.] (a) Upon the receipt of federal waiver authority, the 216.6 commissioner shall implement a consumer-directed home care 216.7 demonstration project. The consumer-directed home care 216.8 demonstration project must demonstrate and evaluate the outcomes 216.9 of a consumer-directed service delivery alternative to improve 216.10 access, increase consumer control and accountability over 216.11 available resources, and enable the use of supports that are 216.12 more individualized and cost-effective for eligible medical 216.13 assistance recipients receiving certain medical assistance home 216.14 care services. The consumer-directed home care demonstration 216.15 project will be administered locally by county agencies, tribal 216.16 governments, or administrative entities under contract with the 216.17 state in regions where counties choose not to provide this 216.18 service. 216.19 (b) Grant awards for persons who have been receiving 216.20 medical assistance covered personal care, home health aide, or 216.21 private duty nursing services for a period of 12 consecutive 216.22 months or more prior to enrollment in the consumer-directed home 216.23 care demonstration project will be established on a case-by-case 216.24 basis using historical service expenditure data. An average 216.25 monthly expenditure for each continuing enrollee will be 216.26 calculated based on historical expenditures made on behalf of 216.27 the enrollee for personal care, home health aide, or private 216.28 duty nursing services during the 12 month period directly prior 216.29 to enrollment in the project. The grant award will equal 90 216.30 percent of the average monthly expenditure. 216.31 (c) Grant awards for project enrollees who have been 216.32 receiving medical assistance covered personal care, home health 216.33 aide, or private duty nursing services for a period of less than 216.34 12 consecutive months prior to project enrollment will be 216.35 calculated on a case-by-case basis using the service 216.36 authorization in place at the time of enrollment. The total 217.1 number of units of personal care, home health aide, or private 217.2 duty nursing services the enrollee has been authorized to 217.3 receive will be converted to the total cost of the authorized 217.4 services in a given month using the statewide average service 217.5 payment rates. To determine an estimated monthly expenditure, 217.6 the total authorized monthly personal care, home health aide or 217.7 private duty nursing service costs will be reduced by a 217.8 percentage rate equivalent to the difference between the 217.9 statewide average service authorization and the statewide 217.10 average utilization rate for each of the services by medical 217.11 assistance eligibles during the most recent fiscal year for 217.12 which 12 months of data is available. The grant award will 217.13 equal 90 percent of the estimated monthly expenditure. 217.14 (d) The state of Minnesota, county agencies, tribal 217.15 governments, or administrative entities under contract with the 217.16 state that participate in the implementation and administration 217.17 of the consumer-directed home care demonstration project, shall 217.18 not be liable for damages, injuries, or liabilities sustained 217.19 through the purchase of support by the individual, the 217.20 individual's family, legal representative, or the authorized 217.21 representative under this section with funds received through 217.22 the consumer-directed home care demonstration project. 217.23 Liabilities include but are not limited to: workers' 217.24 compensation liability, the Federal Insurance Contributions Act 217.25 (FICA), or the Federal Unemployment Tax Act (FUTA). 217.26 (e) With federal approval, the commissioner may adjust 217.27 methodologies in paragraphs (b) and (c) to simplify program 217.28 administration, improve consistency between state and federal 217.29 programs, and maximize federal financial participation. 217.30 Sec. 38. Minnesota Statutes 2000, section 256B.0627, is 217.31 amended by adding a subdivision to read: 217.32 Subd. 14. [TELEHOMECARE; SKILLED NURSE VISITS.] Medical 217.33 assistance covers skilled nurse visits according to section 217.34 256B.0625, subdivision 6a, provided via telehomecare, for 217.35 services which do not require hands-on care between the home 217.36 care nurse and recipient. The provision of telehomecare must be 218.1 made via live, two-way interactive audiovisual technology and 218.2 may be augmented by utilizing store-and-forward technologies. 218.3 Store-and-forward technology includes telehomecare services that 218.4 do not occur in real time via synchronous transmissions, and 218.5 that do not require a face-to-face encounter with the recipient 218.6 for all or any part of any such telehomecare visit. 218.7 Individually identifiable patient data obtained through 218.8 real-time or store-and-forward technology must be maintained as 218.9 health records according to section 144.335. If the video is 218.10 used for research, training, or other purposes unrelated to the 218.11 care of the patient, the identity of the patient must be 218.12 concealed. A communication between the home care nurse and 218.13 recipient that consists solely of a telephone conversation, 218.14 facsimile, electronic mail, or a consultation between two health 218.15 care practitioners, is not to be considered a telehomecare visit. 218.16 Multiple daily skilled nurse visits provided via telehomecare 218.17 are allowed. Coverage of telehomecare is limited to two visits 218.18 per day. All skilled nurse visits provided via telehomecare 218.19 must be prior authorized by the commissioner or the 218.20 commissioner's designee and will be covered at the same 218.21 allowable rate as skilled nurse visits provided in-person. 218.22 Sec. 39. Minnesota Statutes 2000, section 256B.0627, is 218.23 amended by adding a subdivision to read: 218.24 Subd. 15. [THERAPIES THROUGH HOME HEALTH AGENCIES.] (a) 218.25 [PHYSICAL THERAPY.] Medical assistance covers physical therapy 218.26 and related services, including specialized maintenance 218.27 therapy. Services provided by a physical therapy assistant 218.28 shall be reimbursed at the same rate as services performed by a 218.29 physical therapist when the services of the physical therapy 218.30 assistant are provided under the direction of a physical 218.31 therapist who is on the premises. Services provided by a 218.32 physical therapy assistant that are provided under the direction 218.33 of a physical therapist who is not on the premises shall be 218.34 reimbursed at 65 percent of the physical therapist rate. 218.35 Direction of the physical therapy assistant must be provided by 218.36 the physical therapist as described in Minnesota Rules, part 219.1 9505.0390, subpart 1, item B. The physical therapist and 219.2 physical therapist assistant may not both bill for services 219.3 provided to a recipient on the same day. 219.4 (b) [OCCUPATIONAL THERAPY.] Medical assistance covers 219.5 occupational therapy and related services, including specialized 219.6 maintenance therapy. Services provided by an occupational 219.7 therapy assistant shall be reimbursed at the same rate as 219.8 services performed by an occupational therapist when the 219.9 services of the occupational therapy assistant are provided 219.10 under the direction of the occupational therapist who is on the 219.11 premises. Services provided by an occupational therapy 219.12 assistant under the direction of an occupational therapist who 219.13 is not on the premises shall be reimbursed at 65 percent of the 219.14 occupational therapist rate. Direction of the occupational 219.15 therapy assistant must be provided by the occupational therapist 219.16 as described in Minnesota Rules, part 9505.0390, subpart 1, item 219.17 B. The occupational therapist and occupational therapist 219.18 assistant may not both bill for services provided to a recipient 219.19 on the same day. 219.20 Sec. 40. Minnesota Statutes 2000, section 256B.0627, is 219.21 amended by adding a subdivision to read: 219.22 Subd. 16. [HARDSHIP CRITERIA; PRIVATE DUTY NURSING.] (a) 219.23 Payment is allowed for extraordinary services that require 219.24 specialized nursing skills and are provided by parents of minor 219.25 children, spouses, and legal guardians who are providing private 219.26 duty nursing care under the following conditions: 219.27 (1) the provision of these services is not legally required 219.28 of the parents, spouses, or legal guardians; 219.29 (2) the services are necessary to prevent hospitalization 219.30 of the recipient; and 219.31 (3) the recipient is eligible for state plan home care or a 219.32 home and community-based waiver and one of the following 219.33 hardship criteria are met: 219.34 (i) the parent, spouse, or legal guardian resigns from a 219.35 part-time or full-time job to provide nursing care for the 219.36 recipient; or 220.1 (ii) the parent, spouse, or legal guardian goes from a 220.2 full-time to a part-time job with less compensation to provide 220.3 nursing care for the recipient; or 220.4 (iii) the parent, spouse, or legal guardian takes a leave 220.5 of absence without pay to provide nursing care for the 220.6 recipient; or 220.7 (iv) because of labor conditions, special language needs, 220.8 or intermittent hours of care needed, the parent, spouse, or 220.9 legal guardian is needed in order to provide adequate private 220.10 duty nursing services to meet the medical needs of the recipient. 220.11 (b) Private duty nursing may be provided by a parent, 220.12 spouse, or legal guardian who is a nurse licensed in Minnesota. 220.13 Private duty nursing services provided by a parent, spouse, or 220.14 legal guardian cannot be used in lieu of nursing services 220.15 covered and available under liable third-party payors, including 220.16 Medicare. The private duty nursing provided by a parent, 220.17 spouse, or legal guardian must be included in the service plan. 220.18 Authorized skilled nursing services provided by the parent, 220.19 spouse, or legal guardian may not exceed 50 percent of the total 220.20 approved nursing hours, or eight hours per day, whichever is 220.21 less, up to a maximum of 40 hours per week. Nothing in this 220.22 subdivision precludes the parent's, spouse's, or legal 220.23 guardian's obligation of assuming the nonreimbursed family 220.24 responsibilities of emergency backup caregiver and primary 220.25 caregiver. 220.26 (c) A parent or a spouse may not be paid to provide private 220.27 duty nursing care if the parent or spouse fails to pass a 220.28 criminal background check according to section 245A.04, or if it 220.29 has been determined by the home health agency, the case manager, 220.30 or the physician that the private duty nursing care provided by 220.31 the parent, spouse, or legal guardian is unsafe. 220.32 Sec. 41. Minnesota Statutes 2000, section 256B.0627, is 220.33 amended by adding a subdivision to read: 220.34 Subd. 17. [QUALITY ASSURANCE PLAN FOR PERSONAL CARE 220.35 ASSISTANT SERVICES.] The commissioner shall establish a quality 220.36 assurance plan for personal care assistant services that 221.1 includes: 221.2 (1) performance-based provider agreements; 221.3 (2) meaningful consumer input, which may include consumer 221.4 surveys, that measure the extent to which participants receive 221.5 the services and supports described in the individual plan and 221.6 participant satisfaction with such services and supports; 221.7 (3) ongoing monitoring of the health and well-being of 221.8 consumers; and 221.9 (4) an ongoing public process for development, 221.10 implementation, and review of the quality assurance plan. 221.11 Sec. 42. Minnesota Statutes 2000, section 256B.0911, is 221.12 amended by adding a subdivision to read: 221.13 Subd. 4d. [PREADMISSION SCREENING OF INDIVIDUALS UNDER 65 221.14 YEARS OF AGE.] (a) It is the policy of the state of Minnesota to 221.15 ensure that individuals with disabilities or chronic illness are 221.16 served in the most integrated setting appropriate to their needs 221.17 and have the necessary information to make informed choices 221.18 about home and community-based service options. 221.19 (b) Individuals under 65 years of age who are admitted to a 221.20 nursing facility from a hospital must be screened prior to 221.21 admission as outlined in subdivisions 4a through 4c. 221.22 (c) Individuals under 65 years of age who are admitted to 221.23 nursing facilities with only a telephone screening must receive 221.24 a face-to-face assessment from the long-term care consultation 221.25 team member of the county in which the facility is located or 221.26 from the recipient's county case manager within 20 working days 221.27 of admission. 221.28 (d) At the face-to-face assessment, the long-term care 221.29 consultation team member or county case manager must perform the 221.30 activities required under subdivision 3b. 221.31 (e) For individuals under 21 years of age, a screening 221.32 interview which recommends nursing facility admission must be 221.33 face-to-face and approved by the commissioner before the 221.34 individual is admitted to the nursing facility. 221.35 (f) In the event that an individual under 65 years of age 221.36 is admitted to a nursing facility on an emergency basis, the 222.1 county must be notified of the admission on the next working 222.2 day, and a face-to-face assessment as described in paragraph (c) 222.3 must be conducted within 20 working days of admission. 222.4 (g) At the face-to-face assessment, the long-term care 222.5 consultation team member or the case manager must present 222.6 information about home and community-based options so the 222.7 individual can make informed choices. If the individual chooses 222.8 home and community-based services, the long-term care 222.9 consultation team member or case manager must complete a written 222.10 relocation plan within 20 working days of the visit. The plan 222.11 shall describe the services needed to move out of the facility 222.12 and a time line for the move which is designed to ensure a 222.13 smooth transition to the individual's home and community. 222.14 (h) An individual under 65 years of age residing in a 222.15 nursing facility shall receive a face-to-face assessment at 222.16 least every 12 months to review the person's service choices and 222.17 available alternatives unless the individual indicates, in 222.18 writing, that annual visits are not desired. In this case, the 222.19 individual must receive a face-to-face assessment at least once 222.20 every 36 months for the same purposes. 222.21 (i) Notwithstanding the provisions of subdivision 6, the 222.22 commissioner may pay county agencies directly for face-to-face 222.23 assessments for individuals under 65 years of age who are being 222.24 considered for placement or residing in a nursing facility. 222.25 Sec. 43. Minnesota Statutes 2000, section 256B.0916, is 222.26 amended by adding a subdivision to read: 222.27 Subd. 6a. [STATEWIDE AVAILABILITY OF CONSUMER-DIRECTED 222.28 COMMUNITY SUPPORT SERVICES.] (a) The commissioner shall submit 222.29 to the federal Health Care Financing Administration by August 1, 222.30 2001, an amendment to the home and community-based waiver for 222.31 persons with mental retardation or related conditions to make 222.32 consumer-directed community support services available in every 222.33 county of the state by January 1, 2002. 222.34 (b) If a county declines to meet the requirements for 222.35 provision of consumer-directed community supports, the 222.36 commissioner shall contract with another county, a group of 223.1 counties, or a private agency to plan for and administer 223.2 consumer-directed community supports in that county. 223.3 (c) The state of Minnesota, county agencies, tribal 223.4 governments, or administrative entities under contract to 223.5 participate in the implementation and administration of the home 223.6 and community-based waiver for persons with mental retardation 223.7 or a related condition, shall not be liable for damages, 223.8 injuries, or liabilities sustained through the purchase of 223.9 support by the individual, the individual's family, legal 223.10 representative, or the authorized representative with funds 223.11 received through the consumer-directed community support service 223.12 under this section. Liabilities include but are not limited 223.13 to: workers' compensation liability, the Federal Insurance 223.14 Contributions Act (FICA), or the Federal Unemployment Tax Act 223.15 (FUTA). 223.16 Sec. 44. Minnesota Statutes 2000, section 256B.0916, 223.17 subdivision 7, is amended to read: 223.18 Subd. 7. [ANNUAL REPORT BY COMMISSIONER.] Beginning 223.19October 1, 1999, and each October 1November 1, 2001, and each 223.20 November 1 thereafter, the commissioner shall issue an annual 223.21 report on county and state use of available resources for the 223.22 home and community-based waiver for persons with mental 223.23 retardation or related conditions. For each county or county 223.24 partnership, the report shall include: 223.25 (1) the amount of funds allocated but not used; 223.26 (2) the county specific allowed reserve amount approved and 223.27 used; 223.28 (3) the number, ages, and living situations of individuals 223.29 screened and waiting for services; 223.30 (4) the urgency of need for services to begin within one, 223.31 two, or more than two years for each individual; 223.32 (5) the services needed; 223.33 (6) the number of additional persons served by approval of 223.34 increased capacity within existing allocations; 223.35 (7) results of action by the commissioner to streamline 223.36 administrative requirements and improve county resource 224.1 management; and 224.2 (8) additional action that would decrease the number of 224.3 those eligible and waiting for waivered services. 224.4 The commissioner shall specify intended outcomes for the program 224.5 and the degree to which these specified outcomes are attained. 224.6 Sec. 45. Minnesota Statutes 2000, section 256B.0916, 224.7 subdivision 9, is amended to read: 224.8 Subd. 9. [LEGAL REPRESENTATIVE PARTICIPATION EXCEPTION.] 224.9 The commissioner, in cooperation with representatives of 224.10 counties, service providers, service recipients, family members, 224.11 legal representatives and advocates, shall develop criteria to 224.12 allow legal representatives to be reimbursed for providing 224.13 specific support services to meet the person's needs when a plan 224.14 which assures health and safety has been agreed upon and carried 224.15 out by the legal representative, the person, and the county. 224.16 Legal representatives providing support underconsumer-directed224.17community support services pursuant to section 256B.092,224.18subdivision 4,the home and community-based waiver for persons 224.19 with mental retardation or related conditions or the consumer 224.20 support grant program pursuant to section256B.092, subdivision224.217256.476, shall not be considered to have a direct or indirect 224.22 service provider interest under section 256B.092, subdivision 7, 224.23 if a health and safety plan which meets the criteria established 224.24 has been agreed upon and implemented. ByOctober 1, 1999August 224.25 1, 2001, the commissioner shall submit, for federal approval, 224.26 amendments to allow legal representatives to provide support and 224.27 receive reimbursement under theconsumer-directed community224.28support services section of thehome and community-based waiver 224.29 plan. 224.30 Sec. 46. Minnesota Statutes 2000, section 256B.092, 224.31 subdivision 5, is amended to read: 224.32 Subd. 5. [FEDERAL WAIVERS.] (a) The commissioner shall 224.33 apply for any federal waivers necessary to secure, to the extent 224.34 allowed by law, federal financial participation under United 224.35 States Code, title 42, sections 1396 et seq., as amended, for 224.36 the provision of services to persons who, in the absence of the 225.1 services, would need the level of care provided in a regional 225.2 treatment center or a community intermediate care facility for 225.3 persons with mental retardation or related conditions. The 225.4 commissioner may seek amendments to the waivers or apply for 225.5 additional waivers under United States Code, title 42, sections 225.6 1396 et seq., as amended, to contain costs. The commissioner 225.7 shall ensure that payment for the cost of providing home and 225.8 community-based alternative services under the federal waiver 225.9 plan shall not exceed the cost of intermediate care services 225.10 including day training and habilitation services that would have 225.11 been provided without the waivered services. 225.12 (b) The commissioner, in administering home and 225.13 community-based waivers for persons with mental retardation and 225.14 related conditions, shall ensure that day services for eligible 225.15 persons are not provided by the person's residential service 225.16 provider, unless the person or the person's legal representative 225.17 is offered a choice of providers and agrees in writing to 225.18 provision of day services by the residential service provider. 225.19 The individual service plan for individuals who choose to have 225.20 their residential service provider provide their day services 225.21 must describe how health, safety, and protection needs will be 225.22 met by frequent and regular contact with persons other than the 225.23 residential service provider. 225.24 Sec. 47. Minnesota Statutes 2000, section 256B.093, 225.25 subdivision 3, is amended to read: 225.26 Subd. 3. [TRAUMATIC BRAIN INJURY PROGRAM DUTIES.] The 225.27 department shall fund administrative case management under this 225.28 subdivision using medical assistance administrative funds. The 225.29 traumatic brain injury program duties include: 225.30 (1) recommending to the commissioner in consultation with 225.31 the medical review agent according to Minnesota Rules, parts 225.32 9505.0500 to 9505.0540, the approval or denial of medical 225.33 assistance funds to pay for out-of-state placements for 225.34 traumatic brain injury services and in-state traumatic brain 225.35 injury services provided by designated Medicare long-term care 225.36 hospitals; 226.1 (2) coordinating the traumatic brain injury home and 226.2 community-based waiver; 226.3 (3)approving traumatic brain injury waiver eligibility or226.4care plans or both;226.5(4)providing ongoing technical assistance and consultation 226.6 to county and facility case managers to facilitate care plan 226.7 development for appropriate, accessible, and cost-effective 226.8 medical assistance services; 226.9(5)(4) providing technical assistance to promote statewide 226.10 development of appropriate, accessible, and cost-effective 226.11 medical assistance services and related policy; 226.12(6)(5) providing training and outreach to facilitate 226.13 access to appropriate home and community-based services to 226.14 prevent institutionalization; 226.15(7)(6) facilitating appropriate admissions, continued stay 226.16 review, discharges, and utilization review for neurobehavioral 226.17 hospitals and other specialized institutions; 226.18(8)(7) providing technical assistance on the use of prior 226.19 authorization of home care services and coordination of these 226.20 services with other medical assistance services; 226.21(9)(8) developing a system for identification of nursing 226.22 facility and hospital residents with traumatic brain injury to 226.23 assist in long-term planning for medical assistance services. 226.24 Factors will include, but are not limited to, number of 226.25 individuals served, length of stay, services received, and 226.26 barriers to community placement; and 226.27(10)(9) providing information, referral, and case 226.28 consultation to access medical assistance services for 226.29 recipients without a county or facility case manager. Direct 226.30 access to this assistance may be limited due to the structure of 226.31 the program. 226.32 Sec. 48. Minnesota Statutes 2000, section 256B.095, is 226.33 amended to read: 226.34 256B.095 [THREE-YEARQUALITY ASSURANCEPILOTPROJECT 226.35 ESTABLISHED.] 226.36 Effective July 1, 1998, an alternative quality assurance 227.1 licensing systempilotproject for programs for persons with 227.2 developmental disabilities is established in Dodge, Fillmore, 227.3 Freeborn, Goodhue, Houston, Mower, Olmsted, Rice, Steele, 227.4 Wabasha, and Winona counties for the purpose of improving the 227.5 quality of services provided to persons with developmental 227.6 disabilities. A county, at its option, may choose to have all 227.7 programs for persons with developmental disabilities located 227.8 within the county licensed under chapter 245A using standards 227.9 determined under the alternative quality assurance licensing 227.10 systempilotproject or may continue regulation of these 227.11 programs under the licensing system operated by the 227.12 commissioner. Thepilotproject expires on June 30,20012005. 227.13 Sec. 49. Minnesota Statutes 2000, section 256B.0951, 227.14 subdivision 1, is amended to read: 227.15 Subdivision 1. [MEMBERSHIP.] The region 10 quality 227.16 assurance commission is established. The commission consists of 227.17 at least 14 but not more than 21 members as follows: at least 227.18 three but not more than five members representing advocacy 227.19 organizations; at least three but not more than five members 227.20 representing consumers, families, and their legal 227.21 representatives; at least three but not more than five members 227.22 representing service providers; at least three but not more than 227.23 five members representing counties; and the commissioner of 227.24 human services or the commissioner's designee. Initial 227.25 membership of the commission shall be recruited and approved by 227.26 the region 10 stakeholders group. Prior to approving the 227.27 commission's membership, the stakeholders group shall provide to 227.28 the commissioner a list of the membership in the stakeholders 227.29 group, as of February 1, 1997, a brief summary of meetings held 227.30 by the group since July 1, 1996, and copies of any materials 227.31 prepared by the group for public distribution. The first 227.32 commission shall establish membership guidelines for the 227.33 transition and recruitment of membership for the commission's 227.34 ongoing existence. Members of the commission who do not receive 227.35 a salary or wages from an employer for time spent on commission 227.36 duties may receive a per diem payment when performing commission 228.1 duties and functions. All members may be reimbursed for 228.2 expenses related to commission activities. Notwithstanding the 228.3 provisions of section 15.059, subdivision 5, the commission 228.4 expires on June 30,20012005. 228.5 Sec. 50. Minnesota Statutes 2000, section 256B.0951, 228.6 subdivision 3, is amended to read: 228.7 Subd. 3. [COMMISSION DUTIES.] (a) By October 1, 1997, the 228.8 commission, in cooperation with the commissioners of human 228.9 services and health, shall do the following: (1) approve an 228.10 alternative quality assurance licensing system based on the 228.11 evaluation of outcomes; (2) approve measurable outcomes in the 228.12 areas of health and safety, consumer evaluation, education and 228.13 training, providers, and systems that shall be evaluated during 228.14 the alternative licensing process; and (3) establish variable 228.15 licensure periods not to exceed three years based on outcomes 228.16 achieved. For purposes of this subdivision, "outcome" means the 228.17 behavior, action, or status of a person that can be observed or 228.18 measured and can be reliably and validly determined. 228.19 (b) By January 15, 1998, the commission shall approve, in 228.20 cooperation with the commissioner of human services, a training 228.21 program for members of the quality assurance teams established 228.22 under section 256B.0952, subdivision 4. 228.23 (c) The commission and the commissioner shall establish an 228.24 ongoing review process for the alternative quality assurance 228.25 licensing system. The review shall take into account the 228.26 comprehensive nature of the alternative system, which is 228.27 designed to evaluate the broad spectrum of licensed and 228.28 unlicensed entities that provide services to clients, as 228.29 compared to the current licensing system. 228.30 (d) The commission shall contract with an independent 228.31 entity to conduct a financial review of the alternative quality 228.32 assurancepilotproject. The review shall take into account the 228.33 comprehensive nature of the alternative system, which is 228.34 designed to evaluate the broad spectrum of licensed and 228.35 unlicensed entities that provide services to clients, as 228.36 compared to the current licensing system. The review shall 229.1 include an evaluation of possible budgetary savings within the 229.2 department of human services as a result of implementation of 229.3 the alternative quality assurancepilotproject. If a federal 229.4 waiver is approved under subdivision 7, the financial review 229.5 shall also evaluate possible savings within the department of 229.6 health. This review must be completed by December 15, 2000. 229.7 (e) The commission shall submit a report to the legislature 229.8 by January 15, 2001, on the results of the review process for 229.9 the alternative quality assurancepilotproject, a summary of 229.10 the results of the independent financial review, and a 229.11 recommendation on whether thepilotproject should be extended 229.12 beyond June 30, 2001. 229.13 (f) The commissioner, in consultation with the commission, 229.14 shall examine the feasibility of expanding the project to other 229.15 populations or geographic areas and identify barriers to 229.16 expansion. The commissioner shall report findings and 229.17 recommendations to the legislature by December 15, 2004. 229.18 Sec. 51. Minnesota Statutes 2000, section 256B.0951, 229.19 subdivision 4, is amended to read: 229.20 Subd. 4. [COMMISSION'S AUTHORITY TO RECOMMEND VARIANCES OF 229.21 LICENSING STANDARDS.] The commission may recommend to the 229.22 commissioners of human services and health variances from the 229.23 standards governing licensure of programs for persons with 229.24 developmental disabilities in order to improve the quality of 229.25 services by implementing an alternative developmental 229.26 disabilities licensing system if the commission determines that 229.27 the alternative licensing system does not adversely affect the 229.28 health or safety of persons being served by the licensed program 229.29 nor compromise the qualifications of staff to provide services. 229.30 Sec. 52. Minnesota Statutes 2000, section 256B.0951, 229.31 subdivision 5, is amended to read: 229.32 Subd. 5. [VARIANCE OF CERTAIN STANDARDS PROHIBITED.] The 229.33 safety standards, rights, or procedural protections under 229.34 sections 245.825; 245.91 to 245.97; 245A.04, subdivisions 3, 3a, 229.35 3b, and 3c; 245A.09, subdivision 2, paragraph (c), clauses (2) 229.36 and (5); 245A.12; 245A.13; 252.41, subdivision 9; 256B.092, 230.1 subdivisions 1b, clause (7), and 10; 626.556; 626.557, and 230.2 procedures for the monitoring of psychotropic medications shall 230.3 not be varied under the alternative licensing systempilot230.4 project. The commission may make recommendations to the 230.5 commissioners of human services and health or to the legislature 230.6 regarding alternatives to or modifications of the rules and 230.7 procedures referenced in this subdivision. 230.8 Sec. 53. Minnesota Statutes 2000, section 256B.0951, 230.9 subdivision 7, is amended to read: 230.10 Subd. 7. [WAIVER OF RULES.] The commissioner of health may 230.11 exempt residents of intermediate care facilities for persons 230.12 with mental retardation (ICFs/MR) who participate in the 230.13 three-year quality assurance pilot project established in 230.14 section 256B.095 from the requirements of Minnesota Rules, 230.15 chapter 4665, upon approval by the federal government of a 230.16 waiver of federal certification requirements for ICFs/MR.The230.17commissioners of health and human services shall apply for any230.18necessary waivers as soon as practicable and shall submit the230.19concept paper to the federal government by June 1, 1998.230.20 Sec. 54. Minnesota Statutes 2000, section 256B.0951, is 230.21 amended by adding a subdivision to read: 230.22 Subd. 8. [FEDERAL WAIVER.] The commissioner of human 230.23 services shall seek federal authority to waive provisions of 230.24 intermediate care facilities for persons with mental retardation 230.25 (ICFs/MR) regulations to enable the demonstration and evaluation 230.26 of the alternative quality assurance system for ICFs/MR under 230.27 the project. The commissioner of human services shall apply for 230.28 any necessary waivers as soon as practicable. 230.29 Sec. 55. Minnesota Statutes 2000, section 256B.0951, is 230.30 amended by adding a subdivision to read: 230.31 Subd. 9. [EVALUATION.] The commission, in consultation 230.32 with the commissioner of human services, shall conduct an 230.33 evaluation of the alternative quality assurance system, and 230.34 present a report to the commissioner by June 30, 2004. 230.35 Sec. 56. Minnesota Statutes 2000, section 256B.0952, 230.36 subdivision 1, is amended to read: 231.1 Subdivision 1. [NOTIFICATION.]By January 15, 1998, each231.2affected county shall notify the commission and the231.3commissioners of human services and health as to whether it231.4chooses to implement on July 1, 1998, the alternative licensing231.5system for the pilot project. A county that does not implement231.6the alternative licensing system on July 1, 1998, may give231.7notice to the commission and the commissioners by January 15,231.81999, or January 15, 2000, that it will implement the231.9alternative licensing system on the following July 1. A county231.10that implements the alternative licensing system commits to231.11participate until June 30, 2001.For each year of the project, 231.12 region 10 counties shall give notice to the commission and 231.13 commissioners of human services and health by March 15 of intent 231.14 to join the quality assurance alternative licensing system, 231.15 effective July 1 of that year. A county choosing to participate 231.16 in the alternative licensing system commits to participate until 231.17 June 30, 2005. Counties participating in the quality assurance 231.18 alternative licensing system as of January 1, 2001, shall notify 231.19 the commission and the commissioners of human services and 231.20 health by March 15, 2001, of intent to continue participation. 231.21 Counties that elect to continue participation must participate 231.22 in the alternative licensing system until June 30, 2005. 231.23 Sec. 57. Minnesota Statutes 2000, section 256B.0952, 231.24 subdivision 4, is amended to read: 231.25 Subd. 4. [APPOINTMENT OF QUALITY ASSURANCE MANAGER.] (a) A 231.26 county or group of counties that chooses to participate in the 231.27 alternative licensing system shall designate a quality assurance 231.28 manager and shall establish quality assurance teams in 231.29 accordance with subdivision 5. The manager shall recruit, 231.30 train, and assign duties to the quality assurance team members. 231.31 In assigning team members to conduct the quality assurance 231.32 process at a facility, program, or service, the manager shall 231.33 take into account the size of the service provider, the number 231.34 of services to be reviewed, the skills necessary for team 231.35 members to complete the process, and other relevant factors. 231.36 The manager shall ensure that no team member has a financial, 232.1 personal, or family relationship with the facility, program, or 232.2 service being reviewed or with any clients of the facility, 232.3 program, or service. 232.4 (b) Quality assurance teams shall report the findings of 232.5 their quality assurance reviews to the quality assurance manager. 232.6 The quality assurance manager shall provide the report from the 232.7 quality assurance team to the county and, upon request, to the 232.8 commissioners of human services and health, and shall provide a 232.9 summary of the report to the quality assurance review council. 232.10 Sec. 58. Minnesota Statutes 2000, section 256B.49, is 232.11 amended by adding a subdivision to read: 232.12 Subd. 11. [AUTHORITY.] (a) The commissioner is authorized 232.13 to apply for home and community-based service waivers, as 232.14 authorized under section 1915(c) of the Social Security Act to 232.15 serve persons under the age of 65 who are determined to require 232.16 the level of care provided in a nursing home and persons who 232.17 require the level of care provided in a hospital. The 232.18 commissioner shall apply for the home and community-based 232.19 waivers in order to: (i) promote the support of persons with 232.20 disabilities in the most integrated settings; (ii) expand the 232.21 availability of services for persons who are eligible for 232.22 medical assistance; (iii) promote cost-effective options to 232.23 institutional care; and (iv) obtain federal financial 232.24 participation. 232.25 (b) The provision of waivered services to medical 232.26 assistance recipients with disabilities shall comply with the 232.27 requirements outlined in the federally approved applications for 232.28 home and community-based services and subsequent amendments, 232.29 including provision of services according to a service plan 232.30 designed to meet the needs of the individual. For purposes of 232.31 this section, the approved home and community-based application 232.32 is considered the necessary federal requirement. 232.33 (c) The commissioner shall provide interested persons 232.34 serving on agency advisory committees and task forces, and 232.35 others upon request, with notice of, and an opportunity to 232.36 comment on, any changes or amendments to the federally approved 233.1 applications for home and community-based waivers, prior to 233.2 their submission to the federal health care financing 233.3 administration. 233.4 (d) The commissioner shall seek approval, as authorized 233.5 under section 1915(c) of the Social Security Act, to allow 233.6 medical assistance eligibility under this section for children 233.7 under age 21 without deeming of parental income or assets. 233.8 (e) The commissioner shall seek approval, as authorized 233.9 under section 1915(c) of the Social Act, to allow medical 233.10 assistance eligibility under this section for individuals under 233.11 age 65 without deeming the spouse's income or assets. 233.12 Sec. 59. Minnesota Statutes 2000, section 256B.49, is 233.13 amended by adding a subdivision to read: 233.14 Subd. 12. [INFORMED CHOICE.] Persons who are determined 233.15 likely to require the level of care provided in a nursing 233.16 facility or hospital shall be informed of the home and 233.17 community-based support alternatives to the provision of 233.18 inpatient hospital services or nursing facility services. Each 233.19 person must be given the choice of either institutional or home 233.20 and community-based services using the provisions described in 233.21 section 256B.77, subdivision 2, paragraph (p). 233.22 Sec. 60. Minnesota Statutes 2000, section 256B.49, is 233.23 amended by adding a subdivision to read: 233.24 Subd. 13. [CASE MANAGEMENT.] (a) Each recipient of a home 233.25 and community-based waiver shall be provided case management 233.26 services by qualified vendors as described in the federally 233.27 approved waiver application. The case management service 233.28 activities provided will include: 233.29 (1) assessing the needs of the individual within 20 working 233.30 days of a recipient's request; 233.31 (2) developing the written individual service plan within 233.32 ten working days after the assessment is completed; 233.33 (3) informing the recipient or the recipient's legal 233.34 guardian or conservator of service options; 233.35 (4) assisting the recipient in the identification of 233.36 potential service providers; 234.1 (5) assisting the recipient to access services; 234.2 (6) coordinating, evaluating, and monitoring of the 234.3 services identified in the service plan; 234.4 (7) completing the annual reviews of the service plan; and 234.5 (8) informing the recipient or legal representative of the 234.6 right to have assessments completed and service plans developed 234.7 within specified time periods, and to appeal county action or 234.8 inaction under section 256.045, subdivision 3. 234.9 (b) The case manager may delegate certain aspects of the 234.10 case management service activities to another individual 234.11 provided there is oversight by the case manager. The case 234.12 manager may not delegate those aspects which require 234.13 professional judgment including assessments, reassessments, and 234.14 care plan development. 234.15 Sec. 61. Minnesota Statutes 2000, section 256B.49, is 234.16 amended by adding a subdivision to read: 234.17 Subd. 14. [ASSESSMENT AND REASSESSMENT.] (a) Assessments 234.18 of each recipient's strengths, informal support systems, and 234.19 need for services shall be completed within 20 working days of 234.20 the recipient's request. Reassessment of each recipient's 234.21 strengths, support systems, and need for services shall be 234.22 conducted at least every 12 months and at other times when there 234.23 has been a significant change in the recipient's functioning. 234.24 (b) Persons with mental retardation or a related condition 234.25 who apply for services under the nursing facility level waiver 234.26 programs shall be screened for the appropriate level of care 234.27 according to section 256B.092. 234.28 (c) Recipients who are found eligible for home and 234.29 community-based services under this section before their 65th 234.30 birthday may remain eligible for these services after their 65th 234.31 birthday if they continue to meet all other eligibility factors. 234.32 Sec. 62. Minnesota Statutes 2000, section 256B.49, is 234.33 amended by adding a subdivision to read: 234.34 Subd. 15. [INDIVIDUALIZED SERVICE PLAN.] Each recipient of 234.35 home and community-based waivered services shall be provided a 234.36 copy of the written service plan which: 235.1 (1) is developed and signed by the recipient within ten 235.2 working days of the completion of the assessment; 235.3 (2) meets the assessed needs of the recipient; 235.4 (3) reasonably ensures the health and safety of the 235.5 recipient; 235.6 (4) promotes independence; 235.7 (5) allows for services to be provided in the most 235.8 integrated settings; and 235.9 (6) provides for an informed choice, as defined in section 235.10 256B.77, subdivision 2, paragraph (p), of service and support 235.11 providers. 235.12 Sec. 63. Minnesota Statutes 2000, section 256B.49, is 235.13 amended by adding a subdivision to read: 235.14 Subd. 16. [SERVICES AND SUPPORTS.] (a) Services and 235.15 supports included in the home and community-based waivers for 235.16 persons with disabilities shall meet the requirements set out in 235.17 United States Code, title 42, section 1396n. The services and 235.18 supports, which are offered as alternatives to institutional 235.19 care, shall promote consumer choice, community inclusion, 235.20 self-sufficiency, and self-determination. 235.21 (b) Beginning January 1, 2003, the commissioner shall 235.22 simplify and improve access to home and community-based waivered 235.23 services, to the extent possible, through the establishment of a 235.24 common service menu that is available to eligible recipients 235.25 regardless of age, disability type, or waiver program. 235.26 (c) Consumer directed community support services shall be 235.27 offered as an option to all persons eligible for services under 235.28 subdivision 11, by January 1, 2002. 235.29 (d) Services and supports shall be arranged and provided 235.30 consistent with individualized written plans of care for 235.31 eligible waiver recipients. 235.32 (e) The state of Minnesota and county agencies that 235.33 administer home and community-based waivered services for 235.34 persons with disabilities, shall not be liable for damages, 235.35 injuries, or liabilities sustained through the purchase of 235.36 supports by the individual, the individual's family, legal 236.1 representative, or the authorized representative with funds 236.2 received through the consumer-directed community support service 236.3 under this section. Liabilities include but are not limited 236.4 to: workers' compensation liability, the Federal Insurance 236.5 Contributions Act (FICA), or the Federal Unemployment Tax Act 236.6 (FUTA). 236.7 Sec. 64. Minnesota Statutes 2000, section 256B.49, is 236.8 amended by adding a subdivision to read: 236.9 Subd. 17. [COST OF SERVICES AND SUPPORTS.] (a) The 236.10 commissioner shall ensure that the average per capita 236.11 expenditures estimated in any fiscal year for home and 236.12 community-based waiver recipients does not exceed the average 236.13 per capita expenditures that would have been made to provide 236.14 institutional services for recipients in the absence of the 236.15 waiver. 236.16 (b) The commissioner shall implement on January 1, 2002, 236.17 one or more aggregate, need-based methods for allocating to 236.18 local agencies the home and community-based waivered service 236.19 resources available to support recipients with disabilities in 236.20 need of the level of care provided in a nursing facility or a 236.21 hospital. The commissioner shall allocate resources to single 236.22 counties and county partnerships in a manner that reflects 236.23 consideration of: 236.24 (1) an incentive-based payment process for achieving 236.25 outcomes; 236.26 (2) the need for a state-level risk pool; 236.27 (3) the need for retention of management responsibility at 236.28 the state agency level; and 236.29 (4) a phase-in strategy as appropriate. 236.30 (c) Until the allocation methods described in paragraph (b) 236.31 are implemented, the annual allowable reimbursement level of 236.32 home and community-based waiver services shall be the greater of: 236.33 (1) the statewide average payment amount which the 236.34 recipient is assigned under the waiver reimbursement system in 236.35 place on June 30, 2001, modified by the percentage of any 236.36 provider rate increase appropriated for home and community-based 237.1 services; or 237.2 (2) an amount approved by the commissioner based on the 237.3 recipient's extraordinary needs that cannot be met within the 237.4 current allowable reimbursement level. The increased 237.5 reimbursement level must be necessary to allow the recipient to 237.6 be discharged from an institution or to prevent imminent 237.7 placement in an institution. The additional reimbursement may 237.8 be used to secure environmental modifications; assistive 237.9 technology and equipment; and increased costs for supervision, 237.10 training, and support services necessary to address the 237.11 recipient's extraordinary needs. The commissioner may approve 237.12 an increased reimbursement level for up to one year of the 237.13 recipient's relocation from an institution or up to six months 237.14 of a determination that a current waiver recipient is at 237.15 imminent risk of being placed in an institution. 237.16 (d) Beginning July 1, 2001, medically necessary private 237.17 duty nursing services will be authorized under this section as 237.18 complex and regular care according to section 256B.0627. The 237.19 rate established by the commissioner for registered nurse or 237.20 licensed practical nurse services under any home and 237.21 community-based waiver as of January 1, 2001, shall not be 237.22 reduced. 237.23 Sec. 65. Minnesota Statutes 2000, section 256B.49, is 237.24 amended by adding a subdivision to read: 237.25 Subd. 18. [PAYMENTS.] The commissioner shall reimburse 237.26 approved vendors from the medical assistance account for the 237.27 costs of providing home and community-based services to eligible 237.28 recipients using the invoice processing procedures of the 237.29 Medicaid management information system (MMIS). Recipients will 237.30 be screened and authorized for services according to the 237.31 federally approved waiver application and its subsequent 237.32 amendments. 237.33 Sec. 66. Minnesota Statutes 2000, section 256B.49, is 237.34 amended by adding a subdivision to read: 237.35 Subd. 19. [HEALTH AND WELFARE.] The commissioner of human 237.36 services shall take the necessary safeguards to protect the 238.1 health and welfare of individuals provided services under the 238.2 waiver. 238.3 Sec. 67. Minnesota Statutes 2000, section 256B.49, is 238.4 amended by adding a subdivision to read: 238.5 Subd. 20. [TRAUMATIC BRAIN INJURY AND RELATED CONDITIONS.] 238.6 The commissioner shall seek to amend the traumatic brain injury 238.7 waiver to include, as eligible persons, individuals with an 238.8 acquired or degenerative disease diagnosis where cognitive 238.9 impairment is present, such as multiple sclerosis. 238.10 Sec. 68. Minnesota Statutes 2000, section 256D.35, is 238.11 amended by adding a subdivision to read: 238.12 Subd. 11a. [INSTITUTION.] "Institution" means a hospital, 238.13 consistent with Code of Federal Regulations, title 42, section 238.14 440.10; regional treatment center inpatient services, consistent 238.15 with section 245.474; a nursing facility; and an intermediate 238.16 care facility for persons with mental retardation. 238.17 Sec. 69. Minnesota Statutes 2000, section 256D.35, is 238.18 amended by adding a subdivision to read: 238.19 Subd. 18a. [SHELTER COSTS.] "Shelter costs" means rent, 238.20 manufactured home lot rentals; monthly principal, interest, 238.21 insurance premiums, and property taxes due for mortgages or 238.22 contract for deed costs; costs for utilities, including heating, 238.23 cooling, electricity, water, and sewerage; garbage collection 238.24 fees; and the basic service fee for one telephone. 238.25 Sec. 70. Minnesota Statutes 2000, section 256D.44, 238.26 subdivision 5, is amended to read: 238.27 Subd. 5. [SPECIAL NEEDS.] In addition to the state 238.28 standards of assistance established in subdivisions 1 to 4, 238.29 payments are allowed for the following special needs of 238.30 recipients of Minnesota supplemental aid who are not residents 238.31 of a nursing home, a regional treatment center, or a group 238.32 residential housing facility. 238.33 (a) The county agency shall pay a monthly allowance for 238.34 medically prescribed diets payable under the Minnesota family 238.35 investment program if the cost of those additional dietary needs 238.36 cannot be met through some other maintenance benefit. 239.1 (b) Payment for nonrecurring special needs must be allowed 239.2 for necessary home repairs or necessary repairs or replacement 239.3 of household furniture and appliances using the payment standard 239.4 of the AFDC program in effect on July 16, 1996, for these 239.5 expenses, as long as other funding sources are not available. 239.6 (c) A fee for guardian or conservator service is allowed at 239.7 a reasonable rate negotiated by the county or approved by the 239.8 court. This rate shall not exceed five percent of the 239.9 assistance unit's gross monthly income up to a maximum of $100 239.10 per month. If the guardian or conservator is a member of the 239.11 county agency staff, no fee is allowed. 239.12 (d) The county agency shall continue to pay a monthly 239.13 allowance of $68 for restaurant meals for a person who was 239.14 receiving a restaurant meal allowance on June 1, 1990, and who 239.15 eats two or more meals in a restaurant daily. The allowance 239.16 must continue until the person has not received Minnesota 239.17 supplemental aid for one full calendar month or until the 239.18 person's living arrangement changes and the person no longer 239.19 meets the criteria for the restaurant meal allowance, whichever 239.20 occurs first. 239.21 (e) A fee of ten percent of the recipient's gross income or 239.22 $25, whichever is less, is allowed for representative payee 239.23 services provided by an agency that meets the requirements under 239.24 SSI regulations to charge a fee for representative payee 239.25 services. This special need is available to all recipients of 239.26 Minnesota supplemental aid regardless of their living 239.27 arrangement. 239.28 (f) Notwithstanding the language in this subdivision, an 239.29 amount equal to the maximum allotment authorized by the federal 239.30 Food Stamp Program for a single individual which is in effect on 239.31 the first day of January of the previous year will be added to 239.32 the standards of assistance established in subdivisions 1 to 4 239.33 for individuals under the age of 65 who are relocating from an 239.34 institution and who are shelter needy. An eligible individual 239.35 who receives this benefit prior to age 65 may continue to 239.36 receive the benefit after the age of 65. 240.1 "Shelter needy" means that the assistance unit incurs 240.2 monthly shelter costs that exceed 40 percent of the assistance 240.3 unit's gross income before the application of this special needs 240.4 standard. "Gross income" for the purposes of this section is 240.5 the applicant's or recipient's income as defined in section 240.6 256D.35, subdivision 10, or the standard specified in 240.7 subdivision 3, whichever is greater. A recipient of a federal 240.8 or state housing subsidy, that limits shelter costs to a 240.9 percentage of gross income, shall not be considered shelter 240.10 needy for purposes of this paragraph. 240.11 Sec. 71. [256I.07] [RESPITE CARE PILOT PROJECT FOR FAMILY 240.12 ADULT FOSTER CARE PROVIDERS.] 240.13 Subdivision 1. [PROGRAM ESTABLISHED.] The state recognizes 240.14 the importance of developing and maintaining quality family 240.15 foster care resources. In order to accomplish that goal, the 240.16 commissioner shall establish a two-year respite care pilot 240.17 project for family adult foster care providers in three 240.18 counties. This pilot project is intended to provide support to 240.19 caregivers of family adult foster care residents. The 240.20 commissioner shall establish a state-funded pilot project to 240.21 accomplish the provisions in subdivisions 2 to 4. 240.22 Subd. 2. [ELIGIBILITY.] A family adult foster care home 240.23 provider as defined under section 144D.01, subdivision 7, who 240.24 has been licensed for six months is eligible for up to 30 days 240.25 of respite care per calendar year. In cases of emergency, a 240.26 county social services agency may waive the six-month licensing 240.27 requirement. In order to be eligible to receive respite 240.28 payment, a provider must take time off away from their foster 240.29 care residents. 240.30 Subd. 3. [PAYMENT STRUCTURE.] (a) The rate of payment for 240.31 respite care for an adult foster care resident eligible for only 240.32 group residential housing shall be based on the current monthly 240.33 group residential housing base room and board rate and the 240.34 current maximum monthly group residential housing difficulty of 240.35 care rate. 240.36 (b) The rate of payment for respite care for an adult 241.1 foster care resident eligible for alternative care funds shall 241.2 be based on the resident's alternative care foster care rate. 241.3 (c) The rate of payment for respite care for an adult 241.4 foster care resident eligible for Medicaid home and 241.5 community-based services waiver funds shall be based on the 241.6 group residential housing base room and board rate. 241.7 (d) The total amount available to pay for respite care for 241.8 a family adult foster care provider shall be based on the number 241.9 of residents currently served in the foster care home. Respite 241.10 care must be paid for on a per diem basis and for a full day. 241.11 Subd. 4. [PRIVATE PAY RESIDENTS.] Payment for respite care 241.12 for private pay foster care residents must be arranged between 241.13 the provider and the resident or the resident's family. 241.14 Sec. 72. Laws 1999, chapter 152, section 1, is amended to 241.15 read: 241.16 Section 1. [TASK FORCE.] 241.17 A day training and habilitation task force is established. 241.18 Task force membership shall consist of representatives of the 241.19 commissioner of human services, counties, service consumers, and 241.20 vendors of day training and habilitation as defined in Minnesota 241.21 Statutes, section 252.41, subdivision 9, including at least one 241.22 representative from each association representing day training 241.23 and habilitation vendors. Appointments to the task force shall 241.24 be made by the commissioner of human services and technical 241.25 assistance shall be provided by the department of human services. 241.26 Sec. 73. [SEMI-INDEPENDENT LIVING SERVICES (SILS) STUDY.] 241.27 The commissioner of human services, in consultation with 241.28 county representatives and other interested persons, shall 241.29 develop recommendations revising the funding methodology for 241.30 SILS as defined in Minnesota Statutes, section 252.275, 241.31 subdivisions 3, 4, 4b, and 4c, and report by January 15, 2002, 241.32 to the chair of the house of representatives health and human 241.33 services finance committee and the chair of the senate health, 241.34 human services and corrections budget division. 241.35 Sec. 74. [WAIVER REQUEST REGARDING SPOUSAL INCOME.] 241.36 By September 1, 2001, the commissioner of human services 242.1 shall seek federal approval to allow recipients of home and 242.2 community-based waivers authorized under Minnesota Statutes, 242.3 section 256B.49, to choose either a waiver of deeming of spousal 242.4 income or the spousal impoverishment protections authorized 242.5 under United States Code, title 42, section 1396r-5, with the 242.6 addition of a recipient's maintenance needs in an amount equal 242.7 to the Minnesota supplemental aid equivalent rate as defined in 242.8 Minnesota Statutes, section 256I.03, subdivision 5, plus the 242.9 personal needs allowance as defined in Minnesota Statutes, 242.10 section 256B.35, subdivision 1, paragraph (a). Recipient 242.11 maintenance needs shall be adjusted under this provision each 242.12 July 1. 242.13 Sec. 75. [FEDERAL WAIVER REQUESTS.] 242.14 The commissioner of human services shall submit to the 242.15 federal Health Care Financing Administration by September 1, 242.16 2001, a request for a home and community-based services waiver 242.17 for day services, including: community inclusion, supported 242.18 employment, and day training and habilitation services defined 242.19 in Minnesota Statutes, section 252.41, subdivision 3, clause 242.20 (1), for persons eligible for the waiver under Minnesota 242.21 Statutes, section 256B.092. 242.22 Sec. 76. [REPEALER.] 242.23 (a) Minnesota Statutes 2000, section 256B.0951, subdivision 242.24 6, is repealed. 242.25 (b) Minnesota Statutes 2000, sections 145.9245; 256.476, 242.26 subdivision 7; 256B.0912; 256B.0915, subdivisions 3a, 3b, and 242.27 3c; and 256B.49, subdivisions 1, 2, 3, 4, 5, 6, 7, 8, 9, and 10, 242.28 are repealed. 242.29 (c) Laws 1995, chapter 178, article 2, section 48, 242.30 subdivision 6, is repealed. 242.31 (d) Minnesota Rules, parts 9505.2455; 9505.2458; 9505.2460; 242.32 9505.2465; 9505.2470; 9505.2473; 9505.2475; 9505.2480; 242.33 9505.2485; 9505.2486; 9505.2490; 9505.2495; 9505.2496; 242.34 9505.2500; 9505.3010; 9505.3015; 9505.3020; 9505.3025; 242.35 9505.3030; 9505.3035; 9505.3040; 9505.3065; 9505.3085; 242.36 9505.3135; 9505.3500; 9505.3510; 9505.3520; 9505.3530; 243.1 9505.3535; 9505.3540; 9505.3545; 9505.3550; 9505.3560; 243.2 9505.3570; 9505.3575; 9505.3580; 9505.3585; 9505.3600; 243.3 9505.3610; 9505.3620; 9505.3622; 9505.3624; 9505.3626; 243.4 9505.3630; 9505.3635; 9505.3640; 9505.3645; 9505.3650; 243.5 9505.3660; and 9505.3670, are repealed. 243.6 Sec. 77. [EFFECTIVE DATE.] 243.7 Section 23 is effective January 1, 2003. 243.8 ARTICLE 4 243.9 CONSUMER INFORMATION 243.10 Section 1. [144A.35] [EXPANSION OF BED DISTRIBUTION 243.11 STUDY.] 243.12 The commissioner of human services, shall monitor and 243.13 analyze the distribution of older adult services, including, but 243.14 not limited to, nursing home beds, senior housing, housing with 243.15 services units, and home and community-based services in the 243.16 different geographic areas of the state. The study shall 243.17 include an analysis of the impact of amendments to the nursing 243.18 home moratorium law which would allow for transfers of nursing 243.19 home beds within the state. The commissioner of human services 243.20 shall submit to the legislature, beginning June 1, 2002, and 243.21 each January 15 thereafter, an assessment of the distribution of 243.22 long-term health care services by geographic area, with 243.23 particular attention to service deficits or problems, and 243.24 corrective action plans. 243.25 Sec. 2. Minnesota Statutes 2000, section 256.975, is 243.26 amended by adding a subdivision to read: 243.27 Subd. 7. [CONSUMER INFORMATION AND ASSISTANCE; SENIOR 243.28 LINKAGE.] (a) The Minnesota board on aging shall operate a 243.29 statewide information and assistance service to aid older 243.30 Minnesotans and their families in making informed choices about 243.31 long-term care options and health care benefits. Language 243.32 services to persons with limited English language skills may be 243.33 made available. The service, known as Senior LinkAge Line, must 243.34 be available during business hours through a statewide toll-free 243.35 number and must also be available through the Internet. 243.36 (b) The service must assist older adults, caregivers, and 244.1 providers in accessing information about choices in long-term 244.2 care services that are purchased through private providers or 244.3 available through public options. The service must: 244.4 (1) develop a comprehensive database that includes detailed 244.5 listings in both consumer- and provider-oriented formats; 244.6 (2) make the database accessible on the Internet and 244.7 through other telecommunication and media-related tools; 244.8 (3) link callers to interactive long-term care screening 244.9 tools and make these tools available through the Internet by 244.10 integrating the tools with the database; 244.11 (4) develop community education materials with a focus on 244.12 planning for long-term care and evaluating independent living, 244.13 housing, and service options; 244.14 (5) conduct an outreach campaign to assist older adults and 244.15 their caregivers in finding information on the Internet and 244.16 through other means of communication; 244.17 (6) implement a messaging system for overflow callers and 244.18 respond to these callers by the next business day; 244.19 (7) link callers with county human services and other 244.20 providers to receive more in-depth assistance and consultation 244.21 related to long-term care options; and 244.22 (8) link callers with quality profiles for nursing 244.23 facilities and other providers developed by the commissioner of 244.24 health. 244.25 (c) The Minnesota board on aging shall conduct an 244.26 evaluation of the effectiveness of the statewide information and 244.27 assistance, and submit this evaluation to the legislature by 244.28 December 1, 2002. The evaluation must include an analysis of 244.29 funding adequacy, gaps in service delivery, continuity in 244.30 information between the service and identified linkages, and 244.31 potential use of private funding to enhance the service. 244.32 Sec. 3. [256.9754] [COMMUNITY SERVICES DEVELOPMENT GRANTS 244.33 PROGRAM.] 244.34 Subdivision 1. [DEFINITIONS.] For purposes of this 244.35 section, the following terms have the meanings given. 244.36 (a) "Community" means a town, township, city, or targeted 245.1 neighborhood within a city, or a consortium of towns, townships, 245.2 cities, or targeted neighborhoods within cities. 245.3 (b) "Older adult services" means any services available 245.4 under the elderly waiver program or alternative care grant 245.5 programs; nursing facility services; transportation services; 245.6 respite services; and other community-based services identified 245.7 as necessary either to maintain lifestyle choices for older 245.8 Minnesotans, or to promote independence. 245.9 (c) "Older adult" refers to individuals 65 years of age and 245.10 older. 245.11 Subd. 2. [CREATION.] The community services development 245.12 grants program is created under the administration of the 245.13 commissioner of human services. 245.14 Subd. 3. [PROVISION OF GRANTS.] The commissioner shall 245.15 make grants available to communities, providers of older adult 245.16 services identified in subdivision 1, or to a consortium of 245.17 providers of older adult services, to establish older adult 245.18 services. Grants may be provided for capital and other costs 245.19 including, but not limited to, start-up and training costs, 245.20 equipment, and supplies related to older adult services or other 245.21 residential or service alternatives to nursing facility care. 245.22 Grants may also be made to renovate current buildings, provide 245.23 transportation services, fund programs that would allow older 245.24 adults or disabled individuals to stay in their own homes by 245.25 sharing a home, fund programs that coordinate and manage formal 245.26 and informal services to older adults in their homes to enable 245.27 them to live as independently as possible in their own homes as 245.28 an alternative to nursing home care, or expand state-funded 245.29 programs in the area. 245.30 Subd. 4. [ELIGIBILITY.] Grants may be awarded only to 245.31 communities and providers or to a consortium of providers that 245.32 have a local match of 50 percent of the costs for the project in 245.33 the form of donations, local tax dollars, in-kind donations, 245.34 fundraising, or other local matches. 245.35 Subd. 5. [GRANT PREFERENCE.] The commissioner of human 245.36 services shall give preference when awarding grants under this 246.1 section to areas where nursing facility closures have occurred 246.2 or are occurring. The commissioner may award grants to the 246.3 extent grant funds are available and to the extent applications 246.4 are approved by the commissioner. Denial of approval of an 246.5 application in one year does not preclude submission of an 246.6 application in a subsequent year. The maximum grant amount is 246.7 limited to $750,000. 246.8 Sec. 4. Minnesota Statutes 2000, section 256B.0911, 246.9 subdivision 1, is amended to read: 246.10 Subdivision 1. [PURPOSE AND GOAL.] (a) The purpose ofthe246.11preadmission screening programlong-term care consultation 246.12 services is to assist persons with long-term or chronic care 246.13 needs in making long-term care decisions and selecting options 246.14 that meet their needs and reflect their preferences. The 246.15 availability of, and access to, information and other types of 246.16 assistance is also intended to prevent or delay certified 246.17 nursing facility placementsby assessing applicants and246.18residents and offering cost-effective alternatives appropriate246.19for the person's needsand to provide transition assistance 246.20 after admission. Further, the goal ofthe programthese 246.21 services is to contain costs associated with unnecessary 246.22 certified nursing facility admissions. The commissioners of 246.23 human services and health shall seek to maximize use of 246.24 available federal and state funds and establish the broadest 246.25 program possible within the funding available. 246.26 (b) These services must be coordinated with services 246.27 provided under sections 256.975, subdivision 7, and 256.9772, 246.28 and with services provided by other public and private agencies 246.29 in the community to offer a variety of cost-effective 246.30 alternatives to persons with disabilities and elderly persons. 246.31 The county agency providing long-term care consultation services 246.32 shall encourage the use of volunteers from families, religious 246.33 organizations, social clubs, and similar civic and service 246.34 organizations to provide community-based services. 246.35 Sec. 5. Minnesota Statutes 2000, section 256B.0911, is 246.36 amended by adding a subdivision to read: 247.1 Subd. 1a. [DEFINITIONS.] For purposes of this section, the 247.2 following definitions apply: 247.3 (a) "Long-term care consultation services" means: 247.4 (1) providing information and education to the general 247.5 public regarding availability of the services authorized under 247.6 this section; 247.7 (2) an intake process that provides access to the services 247.8 described in this section; 247.9 (3) assessment of the health, psychological, and social 247.10 needs of referred individuals; 247.11 (4) assistance in identifying services needed to maintain 247.12 an individual in the least restrictive environment; 247.13 (5) providing recommendations on cost-effective community 247.14 services that are available to the individual; 247.15 (6) development of an individual's community support plan; 247.16 (7) providing information regarding eligibility for 247.17 Minnesota health care programs; 247.18 (8) preadmission screening to determine the need for a 247.19 nursing facility level of care; 247.20 (9) preliminary determination of Minnesota health care 247.21 programs eligibility for individuals who need a nursing facility 247.22 level of care, with appropriate referrals for final 247.23 determination; 247.24 (10) providing recommendations for nursing facility 247.25 placement when there are no cost-effective community services 247.26 available; and 247.27 (11) assistance to transition people back to community 247.28 settings after facility admission. 247.29 (b) "Minnesota health care programs" means the medical 247.30 assistance program under chapter 256B, the alternative care 247.31 program under section 256B.0913, and the prescription drug 247.32 program under section 256.955. 247.33 Sec. 6. Minnesota Statutes 2000, section 256B.0911, 247.34 subdivision 3, is amended to read: 247.35 Subd. 3. [PERSONS RESPONSIBLE FOR CONDUCTING THE247.36PREADMISSION SCREENINGLONG-TERM CARE CONSULTATION TEAM.] (a) A 248.1local screeninglong-term care consultation team shall be 248.2 established by the county board of commissioners. Each local 248.3screeningconsultation team shall consist ofscreeners who are a248.4 at least one social worker andaat least one public health 248.5 nurse from their respective county agencies. The board may 248.6 designate public health or social services as the lead agency 248.7 for long-term care consultation services. If a county does not 248.8 have a public health nurse available, it may request approval 248.9 from the commissioner to assign a county registered nurse with 248.10 at least one year experience in home care to participate on the 248.11 team.The screening team members must confer regarding the most248.12appropriate care for each individual screened.Two or more 248.13 counties may collaborate to establish a joint localscreening248.14 consultation team or teams. 248.15 (b)In assessing a person's needs, screeners shall have a248.16physician available for consultation and shall consider the248.17assessment of the individual's attending physician, if any. The248.18individual's physician shall be included if the physician248.19chooses to participate. Other personnel may be included on the248.20team as deemed appropriate by the county agencies.The team is 248.21 responsible for providing long-term care consultation services 248.22 to all persons located in the county who request the services, 248.23 regardless of eligibility for Minnesota health care programs. 248.24 Sec. 7. Minnesota Statutes 2000, section 256B.0911, is 248.25 amended by adding a subdivision to read: 248.26 Subd. 3a. [ASSESSMENT AND SUPPORT PLANNING.] (a) Persons 248.27 requesting assessment, services planning, or other assistance 248.28 intended to support community-based living must be visited by a 248.29 long-term care consultation team within ten working days after 248.30 the date on which an assessment was requested or recommended. 248.31 Assessments must be conducted according to paragraphs (b) to (g). 248.32 (b) The county may utilize a team of either the social 248.33 worker or public health nurse, or both, to conduct the 248.34 assessment in a face-to-face interview. The consultation team 248.35 members must confer regarding the most appropriate care for each 248.36 individual screened or assessed. 249.1 (c) The long-term care consultation team must assess the 249.2 health and social needs of the person, using an assessment form 249.3 provided by the commissioner. 249.4 (d) The team must conduct the assessment in a face-to-face 249.5 interview with the person being assessed and the person's legal 249.6 representative, if applicable. 249.7 (e) The team must provide the person, or the person's legal 249.8 representative, with written recommendations for facility- or 249.9 community-based services. The team must document that the most 249.10 cost-effective alternatives available were offered to the 249.11 individual. For purposes of this requirement, "cost-effective 249.12 alternatives" means community services and living arrangements 249.13 that cost the same as or less than nursing facility care. 249.14 (f) If the person chooses to use community-based services, 249.15 the team must provide the person or the person's legal 249.16 representative with a written community support plan, regardless 249.17 of whether the individual is eligible for Minnesota health care 249.18 programs. The person may request assistance in developing a 249.19 community support plan without participating in a complete 249.20 assessment. 249.21 (g) The team must give the person receiving assessment or 249.22 support planning, or the person's legal representative, 249.23 materials supplied by the commissioner containing the following 249.24 information: 249.25 (1) the purpose of preadmission screening and assessment; 249.26 (2) information about Minnesota health care programs; 249.27 (3) the person's freedom to accept or reject the 249.28 recommendations of the team; 249.29 (4) the person's right to confidentiality under the 249.30 Minnesota Government Data Practices Act, chapter 13; and 249.31 (5) the person's right to appeal the decision regarding the 249.32 need for nursing facility level of care or the county's final 249.33 decisions regarding public programs eligibility according to 249.34 section 256.045, subdivision 3. 249.35 Sec. 8. Minnesota Statutes 2000, section 256B.0911, is 249.36 amended by adding a subdivision to read: 250.1 Subd. 3b. [TRANSITION ASSISTANCE.] (a) A long-term care 250.2 consultation team shall provide assistance to persons residing 250.3 in a nursing facility, hospital, regional treatment center, or 250.4 intermediate care facility for persons with mental retardation 250.5 who request or are referred for assistance. Transition 250.6 assistance must include assessment, community support plan 250.7 development, referrals to Minnesota health care programs, and 250.8 referrals to programs that provide assistance with housing. 250.9 (b) The county shall develop transition processes with 250.10 institutional social workers and discharge planners to ensure 250.11 that: 250.12 (1) persons admitted to facilities receive information 250.13 about transition assistance that is available; 250.14 (2) the assessment is completed for persons within ten 250.15 working days of the date of request or recommendation for 250.16 assessment; and 250.17 (3) there is a plan for transition and follow-up for the 250.18 individual's return to the community. The plan must require 250.19 notification of other local agencies when a person who may 250.20 require assistance is screened by one county for admission to a 250.21 facility located in another county. 250.22 (c) If a person who is eligible for a Minnesota health care 250.23 program is admitted to a nursing facility, the nursing facility 250.24 must include a consultation team member or the case manager in 250.25 the discharge planning process. 250.26 Sec. 9. Minnesota Statutes 2000, section 256B.0911, is 250.27 amended by adding a subdivision to read: 250.28 Subd. 4a. [PREADMISSION SCREENING ACTIVITIES RELATED TO 250.29 NURSING FACILITY ADMISSIONS.] (a) All applicants to Medicaid 250.30 certified nursing facilities, including certified boarding care 250.31 facilities, must be screened prior to admission regardless of 250.32 income, assets, or funding sources for nursing facility care, 250.33 except as described in subdivision 4b. The purpose of the 250.34 screening is to determine the need for nursing facility level of 250.35 care as described in paragraph (d) and to complete activities 250.36 required under federal law related to mental illness and mental 251.1 retardation as outlined in paragraph (b). 251.2 (b) A person who has a diagnosis or possible diagnosis of 251.3 mental illness, mental retardation, or a related condition must 251.4 receive a preadmission screening before admission regardless of 251.5 the exemptions outlined in subdivision 4b, paragraph (b), to 251.6 identify the need for further evaluation and specialized 251.7 services, unless the admission prior to screening is authorized 251.8 by the local mental health authority or the local developmental 251.9 disabilities case manager, or unless authorized by the county 251.10 agency according to Public Law Number 100-508. 251.11 The following criteria apply to the preadmission screening: 251.12 (1) the county must use forms and criteria developed by the 251.13 commissioner to identify persons who require referral for 251.14 further evaluation and determination of the need for specialized 251.15 services; and 251.16 (2) the evaluation and determination of the need for 251.17 specialized services must be done by: 251.18 (i) a qualified independent mental health professional, for 251.19 persons with a primary or secondary diagnosis of a serious 251.20 mental illness; or 251.21 (ii) a qualified mental retardation professional, for 251.22 persons with a primary or secondary diagnosis of mental 251.23 retardation or related conditions. For purposes of this 251.24 requirement, a qualified mental retardation professional must 251.25 meet the standards for a qualified mental retardation 251.26 professional under Code of Federal Regulations, title 42, 251.27 section 483.430. 251.28 (c) The local county mental health authority or the state 251.29 mental retardation authority under Public Law Numbers 100-203 251.30 and 101-508 may prohibit admission to a nursing facility if the 251.31 individual does not meet the nursing facility level of care 251.32 criteria or needs specialized services as defined in Public Law 251.33 Numbers 100-203 and 101-508. For purposes of this section, 251.34 "specialized services" for a person with mental retardation or a 251.35 related condition means active treatment as that term is defined 251.36 under Code of Federal Regulations, title 42, section 483.440 252.1 (a)(1). 252.2 (d) The determination of the need for nursing facility 252.3 level of care must be made according to criteria developed by 252.4 the commissioner. In assessing a person's needs, consultation 252.5 team members shall have a physician available for consultation 252.6 and shall consider the assessment of the individual's attending 252.7 physician, if any. The individual's physician must be included 252.8 if the physician chooses to participate. Other personnel may be 252.9 included on the team as deemed appropriate by the county. 252.10 Sec. 10. Minnesota Statutes 2000, section 256B.0911, is 252.11 amended by adding a subdivision to read: 252.12 Subd. 4b. [EXEMPTIONS AND EMERGENCY ADMISSIONS.] (a) 252.13 Exemptions from the federal screening requirements outlined in 252.14 subdivision 4a, paragraphs (b) and (c), are limited to: 252.15 (1) a person who, having entered an acute care facility 252.16 from a certified nursing facility, is returning to a certified 252.17 nursing facility; and 252.18 (2) a person transferring from one certified nursing 252.19 facility in Minnesota to another certified nursing facility in 252.20 Minnesota. 252.21 (b) Persons who are exempt from preadmission screening for 252.22 purposes of level of care determination include: 252.23 (1) persons described in paragraph (a); 252.24 (2) an individual who has a contractual right to have 252.25 nursing facility care paid for indefinitely by the veterans' 252.26 administration; 252.27 (3) an individual enrolled in a demonstration project under 252.28 section 256B.69, subdivision 8, at the time of application to a 252.29 nursing facility; 252.30 (4) an individual currently being served under the 252.31 alternative care program or under a home and community-based 252.32 services waiver authorized under section 1915(c) of the federal 252.33 Social Security Act; and 252.34 (5) individuals admitted to a certified nursing facility 252.35 for a short-term stay, which is expected to be 14 days or less 252.36 in duration based upon a physician's certification, and who have 253.1 been assessed and approved for nursing facility admission within 253.2 the previous six months. This exemption applies only if the 253.3 consultation team member determines at the time of the initial 253.4 assessment of the six-month period that it is appropriate to use 253.5 the nursing facility for short-term stays and that there is an 253.6 adequate plan of care for return to the home or community-based 253.7 setting. If a stay exceeds 14 days, the individual must be 253.8 referred no later than the first county working day following 253.9 the 14th resident day for a screening, which must be completed 253.10 within five working days of the referral. The payment 253.11 limitations in subdivision 7 apply to an individual found at 253.12 screening to not meet the level of care criteria for admission 253.13 to a certified nursing facility. 253.14 (c) Persons admitted to a Medicaid-certified nursing 253.15 facility from the community on an emergency basis as described 253.16 in paragraph (d) or from an acute care facility on a nonworking 253.17 day must be screened the first working day after admission. 253.18 (d) Emergency admission to a nursing facility prior to 253.19 screening is permitted when all of the following conditions are 253.20 met: 253.21 (1) a person is admitted from the community to a certified 253.22 nursing or certified boarding care facility during county 253.23 nonworking hours; 253.24 (2) a physician has determined that delaying admission 253.25 until preadmission screening is completed would adversely affect 253.26 the person's health and safety; 253.27 (3) there is a recent precipitating event that precludes 253.28 the client from living safely in the community, such as 253.29 sustaining an injury, sudden onset of acute illness, or a 253.30 caregiver's inability to continue to provide care; 253.31 (4) the attending physician has authorized the emergency 253.32 placement and has documented the reason that the emergency 253.33 placement is recommended; and 253.34 (5) the county is contacted on the first working day 253.35 following the emergency admission. 253.36 Transfer of a patient from an acute care hospital to a nursing 254.1 facility is not considered an emergency except for a person who 254.2 has received hospital services in the following situations: 254.3 hospital admission for observation, care in an emergency room 254.4 without hospital admission, or following hospital 24-hour bed 254.5 care. 254.6 Sec. 11. Minnesota Statutes 2000, section 256B.0911, is 254.7 amended by adding a subdivision to read: 254.8 Subd. 4c. [SCREENING REQUIREMENTS.] (a) A person may be 254.9 screened for nursing facility admission by telephone or in a 254.10 face-to-face screening interview. Consultation team members 254.11 shall identify each individual's needs using the following 254.12 categories: 254.13 (1) the person needs no face-to-face screening interview to 254.14 determine the need for nursing facility level of care based on 254.15 information obtained from other health care professionals; 254.16 (2) the person needs an immediate face-to-face screening 254.17 interview to determine the need for nursing facility level of 254.18 care and complete activities required under subdivision 4a; or 254.19 (3) the person may be exempt from screening requirements as 254.20 outlined in subdivision 4b, but will need transitional 254.21 assistance after admission or in-person follow-along after a 254.22 return home. 254.23 (b) Persons admitted on a nonemergency basis to a 254.24 Medicaid-certified nursing facility must be screened prior to 254.25 admission. 254.26 (c) The long-term care consultation team shall recommend a 254.27 case mix classification for persons admitted to a certified 254.28 nursing facility when sufficient information is received to make 254.29 that classification. The nursing facility is authorized to 254.30 conduct all case mix assessments for persons who have been 254.31 screened prior to admission for whom the county did not 254.32 recommend a case mix classification. The nursing facility is 254.33 authorized to conduct all case mix assessments for persons 254.34 admitted to the facility prior to a preadmission screening. The 254.35 county retains the responsibility of distributing appropriate 254.36 case mix forms to the nursing facility. 255.1 (d) The county screening or intake activity must include 255.2 processes to identify persons who may require transition 255.3 assistance as described in subdivision 3b. 255.4 Sec. 12. Minnesota Statutes 2000, section 256B.0911, 255.5 subdivision 5, is amended to read: 255.6 Subd. 5. [SIMPLIFICATION OF FORMSADMINISTRATIVE 255.7 ACTIVITY.] The commissioner shall minimize the number of forms 255.8 required in thepreadmission screening processprovision of 255.9 long-term care consultation services and shall limit the 255.10 screening document to items necessary forcarecommunity support 255.11 plan approval, reimbursement, program planning, evaluation, and 255.12 policy development. 255.13 Sec. 13. Minnesota Statutes 2000, section 256B.0911, 255.14 subdivision 6, is amended to read: 255.15 Subd. 6. [PAYMENT FORPREADMISSION SCREENINGLONG-TERM 255.16 CARE CONSULTATION SERVICES.] (a) The totalscreeningpayment for 255.17 each county must be paid monthly by certified nursing facilities 255.18 in the county. The monthly amount to be paid by each nursing 255.19 facility for each fiscal year must be determined by dividing the 255.20 county's annual allocation forscreeningslong-term care 255.21 consultation services by 12 to determine the monthly payment and 255.22 allocating the monthly payment to each nursing facility based on 255.23 the number of licensed beds in the nursing facility. Payments 255.24 to counties in which there is no certified nursing facility must 255.25 be made by increasing the payment rate of the two facilities 255.26 located nearest to the county seat. 255.27 (b) The commissioner shall include the total annual payment 255.28for screeningdetermined under paragraph (a) for each nursing 255.29 facility reimbursed under section 256B.431 or 256B.434 according 255.30 to section 256B.431, subdivision 2b, paragraph (g), or 256B.435. 255.31 (c) In the event of the layaway, delicensure and 255.32 decertification, or removal from layaway of 25 percent or more 255.33 of the beds in a facility, the commissioner may adjust the per 255.34 diem payment amount in paragraph (b) and may adjust the monthly 255.35 payment amount in paragraph (a). The effective date of an 255.36 adjustment made under this paragraph shall be on or after the 256.1 first day of the month following the effective date of the 256.2 layaway, delicensure and decertification, or removal from 256.3 layaway. 256.4 (d) Payments forscreening activitieslong-term care 256.5 consultation services are available to the county or counties to 256.6 cover staff salaries and expenses to provide thescreening256.7functionservices described in subdivision 1a. Thelead agency256.8 county shall employ, or contract with other agencies to employ, 256.9 within the limits of available funding, sufficient personnel 256.10 toconduct the preadmission screening activityprovide long-term 256.11 care consultation services while meeting the state's long-term 256.12 care outcomes and objectives as defined in section 256B.0917, 256.13 subdivision 1. Thelocal agencycounty shall be accountable for 256.14 meeting local objectives as approved by the commissioner in the 256.15 CSSA biennial plan. 256.16(d)(e) Notwithstanding section 256B.0641, overpayments 256.17 attributable to payment of the screening costs under the medical 256.18 assistance program may not be recovered from a facility. 256.19(e)(f) The commissioner of human services shall amend the 256.20 Minnesota medical assistance plan to include reimbursement for 256.21 the localscreeningconsultation teams. 256.22 (g) The county may bill, as case management services, 256.23 assessments, support planning, and follow-along provided to 256.24 persons determined to be eligible for case management under 256.25 Minnesota health care programs. No individual or family member 256.26 shall be charged for an initial assessment or initial support 256.27 plan development provided under subdivision 3a or 3b. 256.28 Sec. 14. Minnesota Statutes 2000, section 256B.0911, 256.29 subdivision 7, is amended to read: 256.30 Subd. 7. [REIMBURSEMENT FOR CERTIFIED NURSING FACILITIES.] 256.31 (a) Medical assistance reimbursement for nursing facilities 256.32 shall be authorized for a medical assistance recipient only if a 256.33 preadmission screening has been conducted prior to admission or 256.34 thelocalcountyagencyhas authorized an exemption. Medical 256.35 assistance reimbursement for nursing facilities shall not be 256.36 provided for any recipient who the local screener has determined 257.1 does not meet the level of care criteria for nursing facility 257.2 placement or, if indicated, has not had a level IIPASARROBRA 257.3 evaluation as required under the federal Omnibus Budget 257.4 Reconciliation Act of 1987 completed unless an admission for a 257.5 recipient with mental illness is approved by the local mental 257.6 health authority or an admission for a recipient with mental 257.7 retardation or related condition is approved by the state mental 257.8 retardation authority. 257.9 (b) The nursing facility must not bill a person who is not 257.10 a medical assistance recipient for resident days that preceded 257.11 the date of completion of screening activities as required under 257.12 subdivisions 4a, 4b, and 4c. The nursing facility must include 257.13 unreimbursed resident days in the nursing facility resident day 257.14 totals reported to the commissioner. 257.15 (c) The commissioner shall make a request to the health 257.16 care financing administration for a waiver allowingscreening257.17 team approval of Medicaid payments for certified nursing 257.18 facility care. An individual has a choice and makes the final 257.19 decision between nursing facility placement and community 257.20 placement after the screening team's recommendation, except as 257.21 provided inparagraphs (b) and (c)subdivision 4a, paragraph (c). 257.22(c) The local county mental health authority or the state257.23mental retardation authority under Public Law Numbers 100-203257.24and 101-508 may prohibit admission to a nursing facility, if the257.25individual does not meet the nursing facility level of care257.26criteria or needs specialized services as defined in Public Law257.27Numbers 100-203 and 101-508. For purposes of this section,257.28"specialized services" for a person with mental retardation or a257.29related condition means "active treatment" as that term is257.30defined in Code of Federal Regulations, title 42, section257.31483.440(a)(1).257.32(e) Appeals from the screening team's recommendation or the257.33county agency's final decision shall be made according to257.34section 256.045, subdivision 3.257.35 Sec. 15. Minnesota Statutes 2000, section 256B.0913, 257.36 subdivision 1, is amended to read: 258.1 Subdivision 1. [PURPOSE AND GOALS.] The purpose of the 258.2 alternative care program is to provide funding foror access to258.3 home and community-based services forfrailelderly persons, in 258.4 order to limit nursing facility placements. The program is 258.5 designed to supportfrailelderly persons in their desire to 258.6 remain in the community as independently and as long as possible 258.7 and to support informal caregivers in their efforts to provide 258.8 care forfrailelderly people. Further, the goals of the 258.9 program are: 258.10 (1) to contain medical assistance expenditures byproviding258.11 funding care in the communityat a cost the same or less than258.12nursing facility costs; and 258.13 (2) to maintain the moratorium on new construction of 258.14 nursing home beds. 258.15 Sec. 16. Minnesota Statutes 2000, section 256B.0913, 258.16 subdivision 2, is amended to read: 258.17 Subd. 2. [ELIGIBILITY FOR SERVICES.] Alternative care 258.18 services are available toall frail olderMinnesotans. This258.19includes:258.20(1) persons who are receiving medical assistance and served258.21under the medical assistance program or the Medicaid waiver258.22program;258.23(2) personsage 65 or older who are not eligible for 258.24 medical assistance without a spenddown or waiver obligation but 258.25 who would be eligible for medical assistance within 180 days of 258.26 admission to a nursing facility andserved undersubject to 258.27 subdivisions 4 to 13; and258.28(3) persons who are paying for their services out-of-pocket. 258.29 Sec. 17. Minnesota Statutes 2000, section 256B.0913, 258.30 subdivision 4, is amended to read: 258.31 Subd. 4. [ELIGIBILITY FOR FUNDING FOR SERVICES FOR 258.32 NONMEDICAL ASSISTANCE RECIPIENTS.] (a) Funding for services 258.33 under the alternative care program is available to persons who 258.34 meet the following criteria: 258.35 (1) the person has beenscreened by the county screening258.36team or, if previously screened and served under the alternative259.1care program, assessed by the local county social worker or259.2public health nursedetermined by a community assessment under 259.3 section 256B.0911, to be a person who would require the level of 259.4 care provided in a nursing facility, but for the provision of 259.5 services under the alternative care program; 259.6 (2) the person is age 65 or older; 259.7 (3) the person would befinanciallyeligible for medical 259.8 assistance within 180 days of admission to a nursing facility; 259.9 (4) the personmeets the asset transfer requirements ofis 259.10 not ineligible for the medical assistance program due to an 259.11 asset transfer penalty; 259.12 (5)the screening team would recommend nursing facility259.13admission or continued stay for the person if alternative care259.14services were not available;259.15(6)the person needs services that are notavailable at259.16that time in the countyfunded through othercounty,state,or 259.17 federal fundingsources; and 259.18(7)(6) the monthly cost of the alternative care services 259.19 funded by the program for this person does not exceed 75 percent 259.20 of the statewideaverage monthly medical assistance payment for259.21nursing facility care at the individual's case mix259.22classificationweighted average monthly nursing facility rate of 259.23 the case mix resident class to which the individual alternative 259.24 care client would be assigned under Minnesota Rules, parts 259.25 9549.0050 to 9549.0059, less the recipient's maintenance needs 259.26 allowance as described in section 256B.0915, subdivision 1d, 259.27 paragraph (a), until the first day of the state fiscal year in 259.28 which the resident assessment system, under section 256B.437, 259.29 for nursing home rate determination is implemented. Effective 259.30 on the first day of the state fiscal year in which a resident 259.31 assessment system, under section 256B.437, for nursing home rate 259.32 determination is implemented and the first day of each 259.33 subsequent state fiscal year, the monthly cost of alternative 259.34 care services for this person shall not exceed the alternative 259.35 care monthly cap for the case mix resident class to which the 259.36 alternative care client would be assigned under Minnesota Rules, 260.1 parts 9549.0050 to 9549.0059, which was in effect on the last 260.2 day of the previous state fiscal year, and adjusted by the 260.3 greater of any legislatively adopted home and community-based 260.4 services cost-of-living percentage increase or any legislatively 260.5 adopted statewide percent rate increase for nursing facilities. 260.6 This monthly limit does not prohibit the alternative care client 260.7 from payment for additional services, but in no case may the 260.8 cost of additional services purchased under this section exceed 260.9 the difference between the client's monthly service limit 260.10 defined under section 256B.0915, subdivision 3, and the 260.11 alternative care program monthly service limit defined in this 260.12 paragraph. If medical supplies and equipment oradaptations260.13 environmental modifications are or will be purchased for an 260.14 alternative care services recipient, the costs may be prorated 260.15 on a monthly basisthroughout the year in which they are260.16purchasedfor up to 12 consecutive months beginning with the 260.17 month of purchase. If the monthly cost of a recipient's other 260.18 alternative care services exceeds the monthly limit established 260.19 in this paragraph, the annual cost of the alternative care 260.20 services shall be determined. In this event, the annual cost of 260.21 alternative care services shall not exceed 12 times the monthly 260.22 limitcalculateddescribed in this paragraph. 260.23 (b)Individuals who meet the criteria in paragraph (a) and260.24who have been approved for alternative care funding are called260.25180-day eligible clients.260.26(c) The statewide average payment for nursing facility care260.27is the statewide average monthly nursing facility rate in effect260.28on July 1 of the fiscal year in which the cost is incurred, less260.29the statewide average monthly income of nursing facility260.30residents who are age 65 or older and who are medical assistance260.31recipients in the month of March of the previous fiscal year.260.32This monthly limit does not prohibit the 180-day eligible client260.33from paying for additional services needed or desired.260.34(d) In determining the total costs of alternative care260.35services for one month, the costs of all services funded by the260.36alternative care program, including supplies and equipment, must261.1be included.261.2(e)Alternative care funding under this subdivision is not 261.3 available for a person who is a medical assistance recipient or 261.4 who would be eligible for medical assistance without a 261.5 spenddown, unless authorized by the commissioneror waiver 261.6 obligation. A person whose initial application for medical 261.7 assistance is being processed may be served under the 261.8 alternative care program for a period up to 60 days. If the 261.9 individual is found to be eligible for medical assistance,the261.10county must billmedical assistance must be billed for services 261.11 payable under the federally approved elderly waiver plan and 261.12 delivered from the date the individual was found eligible 261.13 forservices reimbursable underthe federally approved elderly 261.14 waiverprogramplan. Notwithstanding this provision, upon 261.15 federal approval, alternative care funds may not be used to pay 261.16 for any service the cost of which is payable by medical 261.17 assistance or which is used by a recipient to meet a medical 261.18 assistance income spenddown or waiver obligation. 261.19(f)(c) Alternative care funding is not available for a 261.20 person who resides in a licensed nursing homeor, certified 261.21 boarding care home, hospital, or intermediate care facility, 261.22 except for case management services which arebeingprovided in 261.23 support of the discharge planning process to a nursing home 261.24 resident or certified boarding care home resident who is 261.25 ineligible for case management funded by medical assistance. 261.26 Sec. 18. Minnesota Statutes 2000, section 256B.0913, 261.27 subdivision 5, is amended to read: 261.28 Subd. 5. [SERVICES COVERED UNDER ALTERNATIVE CARE.] (a) 261.29 Alternative care funding may be used for payment of costs of: 261.30 (1) adult foster care; 261.31 (2) adult day care; 261.32 (3) home health aide; 261.33 (4) homemaker services; 261.34 (5) personal care; 261.35 (6) case management; 261.36 (7) respite care; 262.1 (8) assisted living; 262.2 (9) residential care services; 262.3 (10) care-related supplies and equipment; 262.4 (11) meals delivered to the home; 262.5 (12) transportation; 262.6 (13) skilled nursing; 262.7 (14) chore services; 262.8 (15) companion services; 262.9 (16) nutrition services; 262.10 (17) training for direct informal caregivers; 262.11 (18) telemedicine devices to monitor recipients in their 262.12 own homes as an alternative to hospital care, nursing home care, 262.13 or home visits;and262.14 (19) other servicesincludingwhich includes discretionary 262.15 funds and direct cash payments to clients,approved by the262.16county agencyfollowing approval by the commissioner, subject to 262.17 the provisions of paragraph(m)(j). Total annual payments for " 262.18 other services" for all clients within a county may not exceed 262.19 either ten percent of that county's annual alternative care 262.20 program base allocation or $5,000, whichever is greater. In no 262.21 case shall this amount exceed the county's total annual 262.22 alternative care program base allocation; and 262.23 (20) environmental modifications. 262.24 (b) The county agency must ensure that the funds are not 262.25 usedonly to supplement and notto supplant services available 262.26 through other public assistance or services programs. 262.27 (c) Unless specified in statute, the service definitions 262.28 and standards for alternative care services shall be the same as 262.29 the service definitions and standardsdefinedspecified in the 262.30 federally approved elderly waiver plan. Except for the county 262.31 agencies' approval of direct cash payments to clients as 262.32 described in paragraph (j) or for a provider of supplies and 262.33 equipment when the monthly cost of the supplies and equipment is 262.34 less than $250, persons or agencies must be employed by or under 262.35 a contract with the county agency or the public health nursing 262.36 agency of the local board of health in order to receive funding 263.1 under the alternative care program. Supplies and equipment may 263.2 be purchased from a vendor not certified to participate in the 263.3 Medicaid program if the cost for the item is less than that of a 263.4 Medicaid vendor. 263.5 (d) The adult foster care rate shall be considered a 263.6 difficulty of care payment and shall not include room and 263.7 board. The adult foster caredailyrate shall be negotiated 263.8 between the county agency and the foster care provider.The263.9rate established under this section shall not exceed 75 percent263.10of the state average monthly nursing home payment for the case263.11mix classification to which the individual receiving foster care263.12is assigned, and it must allow for other alternative care263.13services to be authorized by the case manager.The alternative 263.14 care payment for the foster care service in combination with the 263.15 payment for other alternative care services, including case 263.16 management, must not exceed the limit specified in subdivision 263.17 4, paragraph (a), clause (6). 263.18 (e) Personal care servicesmay be provided by a personal263.19care provider organization.must meet the service standards 263.20 defined in the federally approved elderly waiver plan, except 263.21 that a county agency may contract with a client's relativeof263.22the clientwho meets the relative hardship waiver requirement as 263.23 defined in section 256B.0627, subdivision 4, paragraph (b), 263.24 clause (10), to provide personal care services, but must ensure263.25nursingif the county agency ensures supervision of this service 263.26 by a registered nurse or mental health practitioner.Covered263.27personal care services defined in section 256B.0627, subdivision263.284, must meet applicable standards in Minnesota Rules, part263.299505.0335.263.30 (f)A county may use alternative care funds to purchase263.31medical supplies and equipment without prior approval from the263.32commissioner when: (1) there is no other funding source; (2)263.33the supplies and equipment are specified in the individual's263.34care plan as medically necessary to enable the individual to263.35remain in the community according to the criteria in Minnesota263.36Rules, part 9505.0210, item A; and (3) the supplies and264.1equipment represent an effective and appropriate use of264.2alternative care funds. A county may use alternative care funds264.3to purchase supplies and equipment from a non-Medicaid certified264.4vendor if the cost for the items is less than that of a Medicaid264.5vendor. A county is not required to contract with a provider of264.6supplies and equipment if the monthly cost of the supplies and264.7equipment is less than $250.264.8(g)For purposes of this section, residential care services 264.9 are services which are provided to individuals living in 264.10 residential care homes. Residential care homes are currently 264.11 licensed as board and lodging establishments and are registered 264.12 with the department of health as providing special 264.13 services under section 157.17 and are not subject to 264.14 registration under chapter 144D. Residential care services are 264.15 defined as "supportive services" and "health-related services." 264.16 "Supportive services" means the provision of up to 24-hour 264.17 supervision and oversight. Supportive services includes: (1) 264.18 transportation, when provided by the residential carecenter264.19 home only; (2) socialization, when socialization is part of the 264.20 plan of care, has specific goals and outcomes established, and 264.21 is not diversional or recreational in nature; (3) assisting 264.22 clients in setting up meetings and appointments; (4) assisting 264.23 clients in setting up medical and social services; (5) providing 264.24 assistance with personal laundry, such as carrying the client's 264.25 laundry to the laundry room. Assistance with personal laundry 264.26 does not include any laundry, such as bed linen, that is 264.27 included in the room and board rate. "Health-related services" 264.28 are limited to minimal assistance with dressing, grooming, and 264.29 bathing and providing reminders to residents to take medications 264.30 that are self-administered or providing storage for medications, 264.31 if requested. Individuals receiving residential care services 264.32 cannot receive homemaking services funded under this section. 264.33(h)(g) For the purposes of this section, "assisted living" 264.34 refers to supportive services provided by a single vendor to 264.35 clients who reside in the same apartment building of three or 264.36 more units which are not subject to registration under chapter 265.1 144D and are licensed by the department of health as a class A 265.2 home care provider or a class E home care provider. Assisted 265.3 living services are defined as up to 24-hour supervision, and 265.4 oversight, supportive services as defined in clause (1), 265.5 individualized home care aide tasks as defined in clause (2), 265.6 and individualized home management tasks as defined in clause 265.7 (3) provided to residents of a residential center living in 265.8 their units or apartments with a full kitchen and bathroom. A 265.9 full kitchen includes a stove, oven, refrigerator, food 265.10 preparation counter space, and a kitchen utensil storage 265.11 compartment. Assisted living services must be provided by the 265.12 management of the residential center or by providers under 265.13 contract with the management or with the county. 265.14 (1) Supportive services include: 265.15 (i) socialization, when socialization is part of the plan 265.16 of care, has specific goals and outcomes established, and is not 265.17 diversional or recreational in nature; 265.18 (ii) assisting clients in setting up meetings and 265.19 appointments; and 265.20 (iii) providing transportation, when provided by the 265.21 residential center only. 265.22Individuals receiving assisted living services will not265.23receive both assisted living services and homemaking services.265.24Individualized means services are chosen and designed265.25specifically for each resident's needs, rather than provided or265.26offered to all residents regardless of their illnesses,265.27disabilities, or physical conditions.265.28 (2) Home care aide tasks means: 265.29 (i) preparing modified diets, such as diabetic or low 265.30 sodium diets; 265.31 (ii) reminding residents to take regularly scheduled 265.32 medications or to perform exercises; 265.33 (iii) household chores in the presence of technically 265.34 sophisticated medical equipment or episodes of acute illness or 265.35 infectious disease; 265.36 (iv) household chores when the resident's care requires the 266.1 prevention of exposure to infectious disease or containment of 266.2 infectious disease; and 266.3 (v) assisting with dressing, oral hygiene, hair care, 266.4 grooming, and bathing, if the resident is ambulatory, and if the 266.5 resident has no serious acute illness or infectious disease. 266.6 Oral hygiene means care of teeth, gums, and oral prosthetic 266.7 devices. 266.8 (3) Home management tasks means: 266.9 (i) housekeeping; 266.10 (ii) laundry; 266.11 (iii) preparation of regular snacks and meals; and 266.12 (iv) shopping. 266.13 Individuals receiving assisted living services shall not 266.14 receive both assisted living services and homemaking services. 266.15 Individualized means services are chosen and designed 266.16 specifically for each resident's needs, rather than provided or 266.17 offered to all residents regardless of their illnesses, 266.18 disabilities, or physical conditions. Assisted living services 266.19 as defined in this section shall not be authorized in boarding 266.20 and lodging establishments licensed according to sections 266.21 157.011 and 157.15 to 157.22. 266.22(i)(h) For establishments registered under chapter 144D, 266.23 assisted living services under this section means either the 266.24 services describedand licensedin paragraph (g) and delivered 266.25 by a class E home care provider licensed by the department of 266.26 health or the services described under section 144A.4605 and 266.27 delivered by an assisted living home care provider or a class A 266.28 home care provider licensed by the commissioner of health. 266.29(j) For the purposes of this section, reimbursement(i) 266.30 Payment for assisted living services and residential care 266.31 services shall be a monthly rate negotiated and authorized by 266.32 the county agency based on an individualized service plan for 266.33 each resident and may not cover direct rent or food costs.The266.34rate266.35 (1) The individualized monthly negotiated payment for 266.36 assisted living services as described in paragraph (g) or (h), 267.1 and residential care services as described in paragraph (f), 267.2 shall not exceed the nonfederal share in effect on July 1 of the 267.3 state fiscal year for which the rate limit is being calculated 267.4 of the greater of either the statewide or any of the geographic 267.5 groups' weighted average monthlymedical assistancenursing 267.6 facility payment rate of the case mix resident class to which 267.7 the180-dayalternative care eligible client would be assigned 267.8 under Minnesota Rules, parts 9549.0050 to 9549.0059,unless the267.9 less the maintenance needs allowance as described in section 267.10 256B.0915, subdivision 1d, paragraph (a), until the first day of 267.11 the state fiscal year in which a resident assessment system, 267.12 under section 256B.437, of nursing home rate determination is 267.13 implemented. Effective on the first day of the state fiscal 267.14 year in which a resident assessment system, under section 267.15 256B.437, of nursing home rate determination is implemented and 267.16 the first day of each subsequent state fiscal year, the 267.17 individualized monthly negotiated payment for the services 267.18 described in this clause shall not exceed the limit described in 267.19 this clause which was in effect on the last day of the previous 267.20 state fiscal year and which has been adjusted by the greater of 267.21 any legislatively adopted home and community-based services 267.22 cost-of-living percentage increase or any legislatively adopted 267.23 statewide percent rate increase for nursing facilities. 267.24 (2) The individualized monthly negotiated payment for 267.25 assisted living servicesare provided by a home caredescribed 267.26 under section 144A.4605 and delivered by a provider licensed by 267.27 the department of health as a class A home care provider or an 267.28 assisted living home care provider andareprovided in a 267.29 building that is registered as a housing with services 267.30 establishment under chapter 144D and that provides 24-hour 267.31 supervision in combination with the payment for other 267.32 alternative care services, including case management, must not 267.33 exceed the limit specified in subdivision 4, paragraph (a), 267.34 clause (6). 267.35(k) For purposes of this section, companion services are267.36defined as nonmedical care, supervision and oversight, provided268.1to a functionally impaired adult. Companions may assist the268.2individual with such tasks as meal preparation, laundry and268.3shopping, but do not perform these activities as discrete268.4services. The provision of companion services does not entail268.5hands-on medical care. Providers may also perform light268.6housekeeping tasks which are incidental to the care and268.7supervision of the recipient. This service must be approved by268.8the case manager as part of the care plan. Companion services268.9must be provided by individuals or organizations who are under268.10contract with the local agency to provide the service. Any268.11person related to the waiver recipient by blood, marriage or268.12adoption cannot be reimbursed under this service. Persons268.13providing companion services will be monitored by the case268.14manager.268.15(l) For purposes of this section, training for direct268.16informal caregivers is defined as a classroom or home course of268.17instruction which may include: transfer and lifting skills,268.18nutrition, personal and physical cares, home safety in a home268.19environment, stress reduction and management, behavioral268.20management, long-term care decision making, care coordination268.21and family dynamics. The training is provided to an informal268.22unpaid caregiver of a 180-day eligible client which enables the268.23caregiver to deliver care in a home setting with high levels of268.24quality. The training must be approved by the case manager as268.25part of the individual care plan. Individuals, agencies, and268.26educational facilities which provide caregiver training and268.27education will be monitored by the case manager.268.28(m)(j) A county agency may make payment from their 268.29 alternative care program allocation for "other services" 268.30provided to an alternative care program recipient if those268.31services prevent, shorten, or delay institutionalization. These268.32services maywhich include use of "discretionary funds" for 268.33 services that are not otherwise defined in this section and 268.34 direct cash payments to therecipientclient for the purpose of 268.35 purchasing therecipient'sservices. The following provisions 268.36 apply to payments under this paragraph: 269.1 (1) a cash payment to a client under this provision cannot 269.2 exceed 80 percent of the monthly payment limit for that client 269.3 as specified in subdivision 4, paragraph (a), clause(7)(6); 269.4 (2) a county may not approve any cash payment for a client 269.5 who meets either of the following: 269.6 (i) has been assessed as having a dependency in 269.7 orientation, unless the client has an authorized 269.8 representativeunder section 256.476, subdivision 2, paragraph269.9(g), or for a client who. An "authorized representative" means 269.10 an individual who is at least 18 years of age and is designated 269.11 by the person or the person's legal representative to act on the 269.12 person's behalf. This individual may be a family member, 269.13 guardian, representative payee, or other individual designated 269.14 by the person or the person's legal representative, if any, to 269.15 assist in purchasing and arranging for supports; or 269.16 (ii) is concurrently receiving adult foster care, 269.17 residential care, or assisted living services; 269.18 (3)any service approved under this section must be a269.19service which meets the purpose and goals of the program as269.20listed in subdivision 1;269.21(4) cash payments must also meet the criteria of and are269.22governed by the procedures and liability protection established269.23in section 256.476, subdivision 4, paragraphs (b) through (h),269.24and recipients of cash grants must meet the requirements in269.25section 256.476, subdivision 10; andcash payments to a person 269.26 or a person's family will be provided through a monthly payment 269.27 and be in the form of cash, voucher, or direct county payment to 269.28 a vendor. Fees or premiums assessed to the person for 269.29 eligibility for health and human services are not reimbursable 269.30 through this service option. Services and goods purchased 269.31 through cash payments must be identified in the person's 269.32 individualized care plan and must meet all of the following 269.33 criteria: 269.34 (i) they must be over and above the normal cost of caring 269.35 for the person if the person did not have functional 269.36 limitations; 270.1 (ii) they must be directly attributable to the person's 270.2 functional limitations; 270.3 (iii) they must have the potential to be effective at 270.4 meeting the goals of the program; 270.5 (iv) they must be consistent with the needs identified in 270.6 the individualized service plan. The service plan shall specify 270.7 the needs of the person and family, the form and amount of 270.8 payment, the items and services to be reimbursed, and the 270.9 arrangements for management of the individual grant; and 270.10 (v) the person, the person's family, or the legal 270.11 representative shall be provided sufficient information to 270.12 ensure an informed choice of alternatives. The local agency 270.13 shall document this information in the person's care plan, 270.14 including the type and level of expenditures to be reimbursed; 270.15 (4) the county, lead agency under contract, or tribal 270.16 government under contract to administer the alternative care 270.17 program shall not be liable for damages, injuries, or 270.18 liabilities sustained through the purchase of direct supports or 270.19 goods by the person, the person's family, or the authorized 270.20 representative with funds received through the cash payments 270.21 under this section. Liabilities include, but are not limited 270.22 to, workers' compensation, the Federal Insurance Contributions 270.23 Act (FICA), or the Federal Unemployment Tax Act (FUTA); 270.24 (5) persons receiving grants under this section shall have 270.25 the following responsibilities: 270.26 (i) spend the grant money in a manner consistent with their 270.27 individualized service plan with the local agency; 270.28 (ii) notify the local agency of any necessary changes in 270.29 the grant-expenditures; 270.30 (iii) arrange and pay for supports; and 270.31 (iv) inform the local agency of areas where they have 270.32 experienced difficulty securing or maintaining supports; and 270.33(5)(6) the county shall report client outcomes, services, 270.34 and costs under this paragraph in a manner prescribed by the 270.35 commissioner. 270.36 (k) Upon implementation of direct cash payments to clients 271.1 under this section, any person determined eligible for the 271.2 alternative care program who chooses a cash payment approved by 271.3 the county agency shall receive the cash payment under this 271.4 section and not under section 256.476 unless the person was 271.5 receiving a consumer support grant under section 256.476 before 271.6 implementation of direct cash payments under this section. 271.7 Sec. 19. Minnesota Statutes 2000, section 256B.0913, 271.8 subdivision 6, is amended to read: 271.9 Subd. 6. [ALTERNATIVE CARE PROGRAM ADMINISTRATION.] The 271.10 alternative care program is administered by the county agency. 271.11 This agency is the lead agency responsible for the local 271.12 administration of the alternative care program as described in 271.13 this section. However, it may contract with the public health 271.14 nursing service to be the lead agency. The commissioner may 271.15 contract with federally recognized Indian tribes with a 271.16 reservation in Minnesota to serve as the lead agency responsible 271.17 for the local administration of the alternative care program as 271.18 described in the contract. 271.19 Sec. 20. Minnesota Statutes 2000, section 256B.0913, 271.20 subdivision 7, is amended to read: 271.21 Subd. 7. [CASE MANAGEMENT.] Providers of case management 271.22 services for persons receiving services funded by the 271.23 alternative care program must meet the qualification 271.24 requirements and standards specified in section 256B.0915, 271.25 subdivision 1b. The case manager mustensure the health and271.26safety of the individual client andnot approve alternative care 271.27 funding for a client in any setting in which the case manager 271.28 cannot reasonably ensure the client's health and safety. The 271.29 case manager is responsible for the cost-effectiveness of the 271.30 alternative care individual care plan and must not approve any 271.31 care plan in which the cost of services funded by alternative 271.32 care and client contributions exceeds the limit specified in 271.33 section 256B.0915, subdivision 3, paragraph (b). The county may 271.34 allow a case manager employed by the county to delegate certain 271.35 aspects of the case management activity to another individual 271.36 employed by the county provided there is oversight of the 272.1 individual by the case manager. The case manager may not 272.2 delegate those aspects which require professional judgment 272.3 including assessments, reassessments, and care plan development. 272.4 Sec. 21. Minnesota Statutes 2000, section 256B.0913, 272.5 subdivision 8, is amended to read: 272.6 Subd. 8. [REQUIREMENTS FOR INDIVIDUAL CARE PLAN.] (a) The 272.7 case manager shall implement the plan of care for each180-day272.8eligiblealternative care client and ensure that a client's 272.9 service needs and eligibility are reassessed at least every 12 272.10 months. The plan shall include any services prescribed by the 272.11 individual's attending physician as necessary to allow the 272.12 individual to remain in a community setting. In developing the 272.13 individual's care plan, the case manager should include the use 272.14 of volunteers from families and neighbors, religious 272.15 organizations, social clubs, and civic and service organizations 272.16 to support the formal home care services. The county shall be 272.17 held harmless for damages or injuries sustained through the use 272.18 of volunteers under this subdivision including workers' 272.19 compensation liability.The lead agency shall provide272.20documentation to the commissioner verifying that the272.21individual's alternative care is not available at that time272.22through any other public assistance or service program.The 272.23 lead agency shall provide documentation in each individual's 272.24 plan of care and, if requested, to the commissioner that the 272.25 most cost-effective alternatives available have been offered to 272.26 the individual and that the individual was free to choose among 272.27 available qualified providers, both public and private. The 272.28 case manager must give the individual a ten-day written notice 272.29 of any decrease in or termination of alternative care services. 272.30 (b) If the county administering alternative care services 272.31 is different than the county of financial responsibility, the 272.32 care plan may be implemented without the approval of the county 272.33 of financial responsibility. 272.34 Sec. 22. Minnesota Statutes 2000, section 256B.0913, 272.35 subdivision 9, is amended to read: 272.36 Subd. 9. [CONTRACTING PROVISIONS FOR PROVIDERS.]The lead273.1agency shall document to the commissioner that the agency made273.2reasonable efforts to inform potential providers of the273.3anticipated need for services under the alternative care program273.4or waiver programs under sections 256B.0915 and 256B.49,273.5including a minimum of 14 days' written advance notice of the273.6opportunity to be selected as a service provider and an annual273.7public meeting with providers to explain and review the criteria273.8for selection. The lead agency shall also document to the273.9commissioner that the agency allowed potential providers an273.10opportunity to be selected to contract with the county agency.273.11Funds reimbursed to counties under this subdivisionAlternative 273.12 care funds paid to service providers are subject to audit by the 273.13 commissioner for fiscal and utilization control. 273.14 The lead agency must select providers for contracts or 273.15 agreements using the following criteria and other criteria 273.16 established by the county: 273.17 (1) the need for the particular services offered by the 273.18 provider; 273.19 (2) the population to be served, including the number of 273.20 clients, the length of time services will be provided, and the 273.21 medical condition of clients; 273.22 (3) the geographic area to be served; 273.23 (4) quality assurance methods, including appropriate 273.24 licensure, certification, or standards, and supervision of 273.25 employees when needed; 273.26 (5) rates for each service and unit of service exclusive of 273.27 county administrative costs; 273.28 (6) evaluation of services previously delivered by the 273.29 provider; and 273.30 (7) contract or agreement conditions, including billing 273.31 requirements, cancellation, and indemnification. 273.32 The county must evaluate its own agency services under the 273.33 criteria established for other providers.The county shall273.34provide a written statement of the reasons for not selecting273.35providers.273.36 Sec. 23. Minnesota Statutes 2000, section 256B.0913, 274.1 subdivision 10, is amended to read: 274.2 Subd. 10. [ALLOCATION FORMULA.] (a) The alternative care 274.3 appropriation for fiscal years 1992 and beyond shall cover 274.4 only180-dayalternative care eligible clients. Prior to July 1 274.5 of each year, the commissioner shall allocate to county agencies 274.6 the state funds available for alternative care for persons 274.7 eligible under subdivision 2. 274.8 (b)Prior to July 1 of each year, the commissioner shall274.9allocate to county agencies the state funds available for274.10alternative care for persons eligible under subdivision 2. The274.11allocation for fiscal year 1992 shall be calculated using a base274.12that is adjusted to exclude the medical assistance share of274.13alternative care expenditures. The adjusted base is calculated274.14by multiplying each county's allocation for fiscal year 1991 by274.15the percentage of county alternative care expenditures for274.16180-day eligible clients. The percentage is determined based on274.17expenditures for services rendered in fiscal year 1989 or274.18calendar year 1989, whichever is greater.The adjusted base for 274.19 each county is the county's current fiscal year base allocation 274.20 plus any targeted funds approved during the current fiscal 274.21 year. Calculations for paragraphs (c) and (d) are to be made as 274.22 follows: for each county, the determination of alternative care 274.23 program expenditures shall be based on payments for services 274.24 rendered from April 1 through March 31 in the base year, to the 274.25 extent that claims have been submitted and paid by June 1 of 274.26 that year. 274.27 (c) If thecountyalternative care program expendituresfor274.28180-day eligible clientsas defined in paragraph (b) are 95 274.29 percent or more ofitsthe county's adjusted base allocation, 274.30 the allocation for the next fiscal year is 100 percent of the 274.31 adjusted base, plus inflation to the extent that inflation is 274.32 included in the state budget. 274.33 (d) If thecountyalternative care program expendituresfor274.34180-day eligible clientsas defined in paragraph (b) are less 274.35 than 95 percent ofitsthe county's adjusted base allocation, 274.36 the allocation for the next fiscal year is the adjusted base 275.1 allocation less the amount of unspent funds below the 95 percent 275.2 level. 275.3 (e)For fiscal year 1992 only, a county may receive an275.4increased allocation if annualized service costs for the month275.5of May 1991 for 180-day eligible clients are greater than the275.6allocation otherwise determined. A county may apply for this275.7increase by reporting projected expenditures for May to the275.8commissioner by June 1, 1991. The amount of the allocation may275.9exceed the amount calculated in paragraph (b). The projected275.10expenditures for May must be based on actual 180-day eligible275.11client caseload and the individual cost of clients' care plans.275.12If a county does not report its expenditures for May, the amount275.13in paragraph (c) or (d) shall be used.275.14(f) Calculations for paragraphs (c) and (d) are to be made275.15as follows: for each county, the determination of expenditures275.16shall be based on payments for services rendered from April 1275.17through March 31 in the base year, to the extent that claims275.18have been submitted by June 1 of that year. Calculations for275.19paragraphs (c) and (d) must also include the funds transferred275.20to the consumer support grant program for clients who have275.21transferred to that program from April 1 through March 31 in the275.22base year.275.23(g) For the biennium ending June 30, 2001, the allocation275.24of state funds to county agencies shall be calculated as275.25described in paragraphs (c) and (d).If the annual legislative 275.26 appropriation for the alternative care program is inadequate to 275.27 fund the combined county allocations forfiscal year 2000 or275.282001a biennium, the commissioner shall distribute to each 275.29 county the entire annual appropriation as that county's 275.30 percentage of the computed base as calculated inparagraph275.31(f)paragraphs (c) and (d). 275.32 Sec. 24. Minnesota Statutes 2000, section 256B.0913, 275.33 subdivision 11, is amended to read: 275.34 Subd. 11. [TARGETED FUNDING.] (a) The purpose of targeted 275.35 funding is to make additional money available to counties with 275.36 the greatest need. Targeted funds are not intended to be 276.1 distributed equitably among all counties, but rather, allocated 276.2 to those with long-term care strategies that meet state goals. 276.3 (b) The funds available for targeted funding shall be the 276.4 total appropriation for each fiscal year minus county 276.5 allocations determined under subdivision 10 as adjusted for any 276.6 inflation increases provided in appropriations for the biennium. 276.7 (c) The commissioner shall allocate targeted funds to 276.8 counties that demonstrate to the satisfaction of the 276.9 commissioner that they have developed feasible plans to increase 276.10 alternative care spending. In making targeted funding 276.11 allocations, the commissioner shall use the following priorities: 276.12 (1) counties that received a lower allocation in fiscal 276.13 year 1991 than in fiscal year 1990. Counties remain in this 276.14 priority until they have been restored to their fiscal year 1990 276.15 level plus inflation; 276.16 (2) counties that sustain a base allocation reduction for 276.17 failure to spend 95 percent of the allocation if they 276.18 demonstrate that the base reduction should be restored; 276.19 (3) counties that propose projects to divert community 276.20 residents from nursing home placement or convert nursing home 276.21 residents to community living; and 276.22 (4) counties that can otherwise justify program growth by 276.23 demonstrating the existence of waiting lists, demographically 276.24 justified needs, or other unmet needs. 276.25 (d) Counties that would receive targeted funds according to 276.26 paragraph (c) must demonstrate to the commissioner's 276.27 satisfaction that the funds would be appropriately spent by 276.28 showing how the funds would be used to further the state's 276.29 alternative care goals as described in subdivision 1, and that 276.30 the county has the administrative and service delivery 276.31 capability to use them. 276.32 (e) The commissioner shall request applicationsby June 1276.33each year, for county agencies to applyfor targeted funds by 276.34 November 1 of each year. The counties selected for targeted 276.35 funds shall be notified of the amount of their additional 276.36 fundingby August 1 of each year. Targeted funds allocated to a 277.1 county agency in one year shall be treated as part of the 277.2 county's base allocation for that year in determining 277.3 allocations for subsequent years. No reallocations between 277.4 counties shall be made. 277.5(f) The allocation for each year after fiscal year 1992277.6shall be determined using the previous fiscal year's allocation,277.7including any targeted funds, as the base and then applying the277.8criteria under subdivision 10, paragraphs (c), (d), and (f), to277.9the current year's expenditures.277.10 Sec. 25. Minnesota Statutes 2000, section 256B.0913, 277.11 subdivision 12, is amended to read: 277.12 Subd. 12. [CLIENT PREMIUMS.] (a) A premium is required for 277.13 all180-dayalternative care eligible clients to help pay for 277.14 the cost of participating in the program. The amount of the 277.15 premium for the alternative care client shall be determined as 277.16 follows: 277.17 (1) when the alternative care client's income less 277.18 recurring and predictable medical expenses is greater than the 277.19medical assistance income standardrecipient's maintenance needs 277.20 allowance as defined in section 256B.0915, subdivision 1d, 277.21 paragraph (a), but less than 150 percent of the federal poverty 277.22 guideline effective on July 1 of the state fiscal year in which 277.23 the premium is being computed, and total assets are less than 277.24 $10,000, the fee is zero; 277.25 (2) when the alternative care client's income less 277.26 recurring and predictable medical expenses is greater than 150 277.27 percent of the federal poverty guideline effective on July 1 of 277.28 the state fiscal year in which the premium is being computed, 277.29 and total assets are less than $10,000, the fee is 25 percent of 277.30 the cost of alternative care services or the difference between 277.31 150 percent of the federal poverty guideline effective on July 1 277.32 of the state fiscal year in which the premium is being computed 277.33 and the client's income less recurring and predictable medical 277.34 expenses, whichever is less; and 277.35 (3) when the alternative care client's total assets are 277.36 greater than $10,000, the fee is 25 percent of the cost of 278.1 alternative care services. 278.2 For married persons, total assets are defined as the total 278.3 marital assets less the estimated community spouse asset 278.4 allowance, under section 256B.059, if applicable. For married 278.5 persons, total income is defined as the client's income less the 278.6 monthly spousal allotment, under section 256B.058. 278.7 All alternative care services except case management shall 278.8 be included in the estimated costs for the purpose of 278.9 determining 25 percent of the costs. 278.10 The monthly premium shall be calculated based on the cost 278.11 of the first full month of alternative care services and shall 278.12 continue unaltered until the next reassessment is completed or 278.13 at the end of 12 months, whichever comes first. Premiums are 278.14 due and payable each month alternative care services are 278.15 received unless the actual cost of the services is less than the 278.16 premium. 278.17 (b) The fee shall be waived by the commissioner when: 278.18 (1) a person who is residing in a nursing facility is 278.19 receiving case management only; 278.20 (2) a person is applying for medical assistance; 278.21 (3) a married couple is requesting an asset assessment 278.22 under the spousal impoverishment provisions; 278.23 (4)a person is a medical assistance recipient, but has278.24been approved for alternative care-funded assisted living278.25services;278.26(5)a person is found eligible for alternative care, but is 278.27 not yet receiving alternative care services; or 278.28(6)(5) a person's fee under paragraph (a) is less than $25. 278.29 (c) The county agency must record in the state's receivable 278.30 system the client's assessed premium amount or the reason the 278.31 premium has been waived. The commissioner will bill and collect 278.32 the premium from the clientand forward the amounts collected to278.33the commissioner in the manner and at the times prescribed by278.34the commissioner. Money collected must be deposited in the 278.35 general fund and is appropriated to the commissioner for the 278.36 alternative care program. The client must supply the county 279.1 with the client's social security number at the time of 279.2 application.If a client fails or refuses to pay the premium279.3due,The county shall supply the commissioner with the client's 279.4 social security number and other information the commissioner 279.5 requires to collect the premium from the client. The 279.6 commissioner shall collect unpaid premiums using the Revenue 279.7 Recapture Act in chapter 270A and other methods available to the 279.8 commissioner. The commissioner may require counties to inform 279.9 clients of the collection procedures that may be used by the 279.10 state if a premium is not paid. This paragraph does not apply 279.11 to alternative care pilot projects authorized in Laws 1993, 279.12 First Special Session chapter 1, article 5, section 133, if a 279.13 county operating under the pilot project reports the following 279.14 dollar amounts to the commissioner quarterly: 279.15 (1) total premiums billed to clients; 279.16 (2) total collections of premiums billed; and 279.17 (3) balance of premiums owed by clients. 279.18 If a county does not adhere to these reporting requirements, the 279.19 commissioner may terminate the billing, collecting, and 279.20 remitting portions of the pilot project and require the county 279.21 involved to operate under the procedures set forth in this 279.22 paragraph. 279.23 (d) The commissioner shall begin to adopt emergency or 279.24 permanent rules governing client premiums within 30 days after 279.25 July 1, 1991, including criteria for determining when services 279.26 to a client must be terminated due to failure to pay a premium. 279.27 Sec. 26. Minnesota Statutes 2000, section 256B.0913, 279.28 subdivision 13, is amended to read: 279.29 Subd. 13. [COUNTY BIENNIAL PLAN.] The county biennial plan 279.30 forthe preadmission screening programlong-term care 279.31 consultation services under section 256B.0911, the alternative 279.32 care program under this section, and waivers for the elderly 279.33 under section 256B.0915,and waivers for the disabled under279.34section 256B.49,shall be incorporated into the biennial 279.35 Community Social Services Act plan and shall meet the 279.36 regulations and timelines of that plan.This county biennial280.1plan shall include:280.2(1) information on the administration of the preadmission280.3screening program;280.4(2) information on the administration of the home and280.5community-based services waivers for the elderly under section280.6256B.0915, and for the disabled under section 256B.49; and280.7(3) information on the administration of the alternative280.8care program.280.9 Sec. 27. Minnesota Statutes 2000, section 256B.0913, 280.10 subdivision 14, is amended to read: 280.11 Subd. 14. [REIMBURSEMENTPAYMENT AND RATE ADJUSTMENTS.] (a) 280.12ReimbursementPayment forexpenditures for theprovided 280.13 alternative care services as approved by the client's case 280.14 manager shall be through the invoice processing procedures of 280.15 the department's Medicaid Management Information System (MMIS). 280.16 To receivereimbursementpayment, the county or vendor must 280.17 submit invoices within 12 months following the date of service. 280.18 The county agency and its vendors under contract shall not be 280.19 reimbursed for services which exceed the county allocation. 280.20 (b)If a county collects less than 50 percent of the client280.21premiums due under subdivision 12, the commissioner may withhold280.22up to three percent of the county's final alternative care280.23program allocation determined under subdivisions 10 and 11.280.24(c)The county shall negotiate individual rates with 280.25 vendors and maybe reimbursedauthorize service payment for 280.26 actual costs up tothe greater ofthe county's current approved 280.27 rateor 60 percent of the maximum rate in fiscal year 1994 and280.2865 percent of the maximum rate in fiscal year 1995 for each280.29alternative care service. Notwithstanding any other rule or 280.30 statutory provision to the contrary, the commissioner shall not 280.31 be authorized to increase rates by an annual inflation factor, 280.32 unless so authorized by the legislature. 280.33(d) On July 1, 1993, the commissioner shall increase the280.34maximum rate for home delivered meals to $4.50 per meal.To 280.35 improve access to community services and eliminate payment 280.36 disparities between the alternative care program and the elderly 281.1 waiver program, the commissioner shall establish statewide 281.2 maximum service rate limits and eliminate county-specific 281.3 service rate limits. 281.4 (1) Effective July 1, 2001, for service rate limits, except 281.5 those in subdivision 5, paragraphs (d) and (i), the rate limit 281.6 for each service shall be the greater of the alternative care 281.7 statewide maximum rate or the elderly waiver statewide maximum 281.8 rate. 281.9 (2) Counties may negotiate individual service rates with 281.10 vendors for actual costs up to the statewide maximum service 281.11 rate limit. 281.12 Sec. 28. Minnesota Statutes 2000, section 256B.0915, 281.13 subdivision 1d, is amended to read: 281.14 Subd. 1d. [POSTELIGIBILITY TREATMENT OF INCOME AND 281.15 RESOURCES FOR ELDERLY WAIVER.](a)Notwithstanding the 281.16 provisions of section 256B.056, the commissioner shall make the 281.17 following amendment to the medical assistance elderly waiver 281.18 program effective July 1, 1999, or upon federal approval, 281.19 whichever is later. 281.20 A recipient's maintenance needs will be an amount equal to 281.21 the Minnesota supplemental aid equivalent rate as defined in 281.22 section 256I.03, subdivision 5, plus the medical assistance 281.23 personal needs allowance as defined in section 256B.35, 281.24 subdivision 1, paragraph (a), when applying posteligibility 281.25 treatment of income rules to the gross income of elderly waiver 281.26 recipients, except for individuals whose income is in excess of 281.27 the special income standard according to Code of Federal 281.28 Regulations, title 42, section 435.236. Recipient maintenance 281.29 needs shall be adjusted under this provision each July 1. 281.30(b) The commissioner of human services shall secure281.31approval of additional elderly waiver slots sufficient to serve281.32persons who will qualify under the revised income standard281.33described in paragraph (a) before implementing section281.34256B.0913, subdivision 16.281.35(c) In implementing this subdivision, the commissioner281.36shall consider allowing persons who would otherwise be eligible282.1for the alternative care program but would qualify for the282.2elderly waiver with a spenddown to remain on the alternative282.3care program.282.4 Sec. 29. Minnesota Statutes 2000, section 256B.0915, 282.5 subdivision 3, is amended to read: 282.6 Subd. 3. [LIMITS OF CASES, RATES,REIMBURSEMENTPAYMENTS, 282.7 AND FORECASTING.] (a) The number of medical assistance waiver 282.8 recipients that a county may serve must be allocated according 282.9 to the number of medical assistance waiver cases open on July 1 282.10 of each fiscal year. Additional recipients may be served with 282.11 the approval of the commissioner. 282.12 (b) The monthly limit for the cost of waivered services to 282.13 an individual elderly waiver client shall be thestatewide282.14average paymentweighted average monthly nursing facility rate 282.15 of the case mix resident class to which the elderly waiver 282.16 client would be assigned underthe medical assistance case mix282.17reimbursement system.Minnesota Rules, parts 9549.0050 to 282.18 9549.0059, less the recipient's maintenance needs allowance as 282.19 described in subdivision 1d, paragraph (a), until the first day 282.20 of the state fiscal year in which the resident assessment system 282.21 as described in section 256B.437 for nursing home rate 282.22 determination is implemented. Effective on the first day of the 282.23 state fiscal year in which the resident assessment system as 282.24 described in section 256B.437 for nursing home rate 282.25 determination is implemented and the first day of each 282.26 subsequent state fiscal year, the monthly limit for the cost of 282.27 waivered services to an individual elderly waiver client shall 282.28 be the rate of the case mix resident class to which the waiver 282.29 client would be assigned under Minnesota Rules, parts 9549.0050 282.30 to 9549.0059, in effect on the last day of the previous state 282.31 fiscal year, adjusted by the greater of any legislatively 282.32 adopted home and community-based services cost-of-living 282.33 percentage increase or any legislatively adopted statewide 282.34 percent rate increase for nursing facilities. 282.35 (c) If extended medical supplies and equipment or 282.36adaptationsenvironmental modifications are or will be purchased 283.1 for an elderly waiverservices recipientclient, the costs may 283.2 be proratedon a monthly basis throughout the year in which they283.3are purchasedfor up to 12 consecutive months beginning with the 283.4 month of purchase. If the monthly cost of a recipient'sother283.5 waivered services exceeds the monthly limit established inthis283.6 paragraph (b), the annual cost oftheall waivered services 283.7 shall be determined. In this event, the annual cost of all 283.8 waivered services shall not exceed 12 times the monthly 283.9 limitcalculated in this paragraph. The statewide average283.10payment rate is calculated by determining the statewide average283.11monthly nursing home rate, effective July 1 of the fiscal year283.12in which the cost is incurred, less the statewide average283.13monthly income of nursing home residents who are age 65 or283.14older, and who are medical assistance recipients in the month of283.15March of the previous state fiscal year. The annual cost283.16divided by 12 of elderly or disabled waivered servicesof 283.17 waivered services as described in paragraph (b). 283.18 (d) For a person who is a nursing facility resident at the 283.19 time of requesting a determination of eligibility for elderlyor283.20disabledwaivered servicesshall be the greater of the monthly283.21payment for: (i), a monthly conversion limit for the cost of 283.22 elderly waivered services may be requested. The monthly 283.23 conversion limit for the cost of elderly waiver services shall 283.24 be the resident class assigned under Minnesota Rules, parts 283.25 9549.0050 to 9549.0059, for that resident in the nursing 283.26 facility where the resident currently resides; or (ii) the283.27statewide average payment of the case mix resident class to283.28which the resident would be assigned under the medical283.29assistance case mix reimbursement system, provided thatuntil 283.30 July 1 of the state fiscal year in which the resident assessment 283.31 system as described in section 256B.437 for nursing home rate 283.32 determination is implemented. Effective on July 1 of the state 283.33 fiscal year in which the resident assessment system as described 283.34 in section 256B.437 for nursing home rate determination is 283.35 implemented, the monthly conversion limit for the cost of 283.36 elderly waiver services shall be the per diem nursing facility 284.1 rate as determined by the resident assessment system as 284.2 described in section 256B.437 for that resident in the nursing 284.3 facility where the resident currently resides multiplied by 365 284.4 and divided by 12, less the recipient's maintenance needs 284.5 allowance as described in subdivision 1d. The limit under this 284.6 clause only applies to persons discharged from a nursing 284.7 facility after a minimum 30-day stay and found eligible for 284.8 waivered services on or after July 1, 1997. The following costs 284.9 must be included in determining the total monthly costs for the 284.10 waiver client: 284.11 (1) cost of all waivered services, including extended 284.12 medical supplies and equipment and environmental modifications; 284.13 and 284.14 (2) cost of skilled nursing, home health aide, and personal 284.15 care services reimbursable by medical assistance. 284.16(c)(e) Medical assistance funding for skilled nursing 284.17 services, private duty nursing, home health aide, and personal 284.18 care services for waiver recipients must be approved by the case 284.19 manager and included in the individual care plan. 284.20(d) For both the elderly waiver and the nursing facility284.21disabled waiver, a county may purchase extended supplies and284.22equipment without prior approval from the commissioner when284.23there is no other funding source and the supplies and equipment284.24are specified in the individual's care plan as medically284.25necessary to enable the individual to remain in the community284.26according to the criteria in Minnesota Rules, part 9505.0210,284.27items A and B.(f) A county is not required to contract with a 284.28 provider of supplies and equipment if the monthly cost of the 284.29 supplies and equipment is less than $250. 284.30(e)(g) The adult foster caredailyratefor the elderly284.31and disabled waiversshall be considered a difficulty of care 284.32 payment and shall not include room and board. The adult foster 284.33 care service rate shall be negotiated between the county agency 284.34 and the foster care provider.The rate established under this284.35section shall not exceed the state average monthly nursing home284.36payment for the case mix classification to which the individual285.1receiving foster care is assigned; the rate must allow for other285.2waiver and medical assistance home care services to be285.3authorized by the case manager.The elderly waiver payment for 285.4 the foster care service in combination with the payment for all 285.5 other elderly waiver services, including case management, must 285.6 not exceed the limit specified in paragraph (b). 285.7(f) The assisted living and residential care service rates285.8for elderly and community alternatives for disabled individuals285.9(CADI) waivers shall be made to the vendor as a monthly rate285.10negotiated with the county agency based on an individualized285.11service plan for each resident. The rate shall not exceed the285.12nonfederal share of the greater of either the statewide or any285.13of the geographic groups' weighted average monthly medical285.14assistance nursing facility payment rate of the case mix285.15resident class to which the elderly or disabled client would be285.16assigned under Minnesota Rules, parts 9549.0050 to 9549.0059,285.17unless the services are provided by a home care provider285.18licensed by the department of health and are provided in a285.19building that is registered as a housing with services285.20establishment under chapter 144D and that provides 24-hour285.21supervision. For alternative care assisted living projects285.22established under Laws 1988, chapter 689, article 2, section285.23256, monthly rates may not exceed 65 percent of the greater of285.24either the statewide or any of the geographic groups' weighted285.25average monthly medical assistance nursing facility payment rate285.26for the case mix resident class to which the elderly or disabled285.27client would be assigned under Minnesota Rules, parts 9549.0050285.28to 9549.0059. The rate may not cover direct rent or food costs.285.29 (h) Payment for assisted living service shall be a monthly 285.30 rate negotiated and authorized by the county agency based on an 285.31 individualized service plan for each resident and may not cover 285.32 direct rent or food costs. 285.33 (1) The individualized monthly negotiated payment for 285.34 assisted living services as described in section 256B.0913, 285.35 subdivision 5, paragraph (g) or (h), and residential care 285.36 services as described in section 256B.0913, subdivision 5, 286.1 paragraph (f), shall not exceed the nonfederal share, in effect 286.2 on July 1 of the state fiscal year for which the rate limit is 286.3 being calculated, of the greater of either the statewide or any 286.4 of the geographic groups' weighted average monthly nursing 286.5 facility rate of the case mix resident class to which the 286.6 elderly waiver eligible client would be assigned under Minnesota 286.7 Rules, parts 9549.0050 to 9549.0059, less the maintenance needs 286.8 allowance as described in subdivision 1d, paragraph (a), until 286.9 the July 1 of the state fiscal year in which the resident 286.10 assessment system as described in section 256B.437 for nursing 286.11 home rate determination is implemented. Effective on July 1 of 286.12 the state fiscal year in which the resident assessment system as 286.13 described in section 256B.437 for nursing home rate 286.14 determination is implemented and July 1 of each subsequent state 286.15 fiscal year, the individualized monthly negotiated payment for 286.16 the services described in this clause shall not exceed the limit 286.17 described in this clause which was in effect on June 30 of the 286.18 previous state fiscal year and which has been adjusted by the 286.19 greater of any legislatively adopted home and community-based 286.20 services cost-of-living percentage increase or any legislatively 286.21 adopted statewide percent rate increase for nursing facilities. 286.22 (2) The individualized monthly negotiated payment for 286.23 assisted living services described in section 144A.4605 and 286.24 delivered by a provider licensed by the department of health as 286.25 a class A home care provider or an assisted living home care 286.26 provider and provided in a building that is registered as a 286.27 housing with services establishment under chapter 144D and that 286.28 provides 24-hour supervision in combination with the payment for 286.29 other elderly waiver services, including case management, must 286.30 not exceed the limit specified in paragraph (b). 286.31(g)(i) The county shall negotiate individual service rates 286.32 with vendors and maybe reimbursedauthorize payment for actual 286.33 costs up to thegreater of thecounty's current approved rateor286.3460 percent of the maximum rate in fiscal year 1994 and 65286.35percent of the maximum rate in fiscal year 1995 for each service286.36within each program. Persons or agencies must be employed by or 287.1 under a contract with the county agency or the public health 287.2 nursing agency of the local board of health in order to receive 287.3 funding under the elderly waiver program, except as a provider 287.4 of supplies and equipment when the monthly cost of the supplies 287.5 and equipment is less than $250. 287.6(h) On July 1, 1993, the commissioner shall increase the287.7maximum rate for home-delivered meals to $4.50 per meal.287.8(i)(j) Reimbursement for the medical assistance recipients 287.9 under the approved waiver shall be made from the medical 287.10 assistance account through the invoice processing procedures of 287.11 the department's Medicaid Management Information System (MMIS), 287.12 only with the approval of the client's case manager. The budget 287.13 for the state share of the Medicaid expenditures shall be 287.14 forecasted with the medical assistance budget, and shall be 287.15 consistent with the approved waiver. 287.16 (k) To improve access to community services and eliminate 287.17 payment disparities between the alternative care program and the 287.18 elderly waiver, the commissioner shall establish statewide 287.19 maximum service rate limits and eliminate county-specific 287.20 service rate limits. 287.21 (1) Effective July 1, 2001, for service rate limits, except 287.22 those described or defined in paragraphs (g) and (h), the rate 287.23 limit for each service shall be the greater of the alternative 287.24 care statewide maximum rate or the elderly waiver statewide 287.25 maximum rate. 287.26 (2) Counties may negotiate individual service rates with 287.27 vendors for actual costs up to the statewide maximum service 287.28 rate limit. 287.29(j)(l) Beginning July 1, 1991, the state shall reimburse 287.30 counties according to the payment schedule in section 256.025 287.31 for the county share of costs incurred under this subdivision on 287.32 or after January 1, 1991, for individuals who are receiving 287.33 medical assistance. 287.34(k) For the community alternatives for disabled individuals287.35waiver, and nursing facility disabled waivers, county may use287.36waiver funds for the cost of minor adaptations to a client's288.1residence or vehicle without prior approval from the288.2commissioner if there is no other source of funding and the288.3adaptation:288.4(1) is necessary to avoid institutionalization;288.5(2) has no utility apart from the needs of the client; and288.6(3) meets the criteria in Minnesota Rules, part 9505.0210,288.7items A and B.288.8For purposes of this subdivision, "residence" means the client's288.9own home, the client's family residence, or a family foster288.10home. For purposes of this subdivision, "vehicle" means the288.11client's vehicle, the client's family vehicle, or the client's288.12family foster home vehicle.288.13(l) The commissioner shall establish a maximum rate unit288.14for baths provided by an adult day care provider that are not288.15included in the provider's contractual daily or hourly rate.288.16This maximum rate must equal the home health aide extended rate288.17and shall be paid for baths provided to clients served under the288.18elderly and disabled waivers.288.19 Sec. 30. Minnesota Statutes 2000, section 256B.0915, 288.20 subdivision 5, is amended to read: 288.21 Subd. 5. [REASSESSMENTS FOR WAIVER CLIENTS.] A 288.22 reassessment of a client served under the elderlyor disabled288.23 waiver must be conducted at least every 12 months and at other 288.24 times when the case manager determines that there has been 288.25 significant change in the client's functioning. This may 288.26 include instances where the client is discharged from the 288.27 hospital. 288.28 Sec. 31. Minnesota Statutes 2000, section 256B.0917, 288.29 subdivision 7, is amended to read: 288.30 Subd. 7. [CONTRACT.] (a) The commissioner of human 288.31 services shall execute a contract with Living at Home/Block 288.32 Nurse Program, Inc. (LAH/BN, Inc.). The contract shall require 288.33 LAH/BN, Inc. to: 288.34 (1) develop criteria for and award grants to establish 288.35 community-based organizations that will implement 288.36 living-at-home/block nurse programs throughout the state; 289.1 (2) award grants to enablecurrentliving-at-home/block 289.2 nurse programs to continue to implement the combined 289.3 living-at-home/block nurse program model; 289.4 (3) serve as a state technical assistance center to assist 289.5 and coordinate the living-at-home/block nurse programs 289.6 established; and 289.7 (4) manage contracts with individual living-at-home/block 289.8 nurse programs. 289.9 (b) The contract shall be effective July 1, 1997, and 289.10 section 16B.17 shall not apply. 289.11 Sec. 32. Minnesota Statutes 2000, section 256B.0917, is 289.12 amended by adding a subdivision to read: 289.13 Subd. 13. [COMMUNITY SERVICE GRANTS.] The commissioner 289.14 shall award contracts for grants to public and private nonprofit 289.15 agencies to establish services that strengthen a community's 289.16 ability to provide a system of home and community-based services 289.17 for elderly persons. The commissioner shall use a request for 289.18 proposal process. The commissioner shall give preference when 289.19 awarding grants under this section to areas where nursing 289.20 facility closures have occurred or are occurring. The 289.21 commissioner shall consider grants for: 289.22 (1) caregiver support and respite care projects under 289.23 subdivision 6; 289.24 (2) on-site coordination under section 256.9731; 289.25 (3) the living-at-home/block nurse grant under subdivisions 289.26 7 to 10; and 289.27 (4) services identified as needed for community transition. 289.28 Sec. 33. [RESPITE CARE.] 289.29 The Minnesota board on aging shall report to the 289.30 legislature by February 1, 2002, on the provision of in-home and 289.31 out-of-home respite care services on a sliding scale basis under 289.32 the federal Older Americans Act. 289.33 Sec. 34. [REPEALER.] 289.34 (a) Minnesota Statutes 2000, sections 256B.0911, 289.35 subdivisions 2, 2a, 4, and 9; 256B.0913, subdivisions 3, 15a, 289.36 15b, 15c, and 16; and 256B.0915, subdivisions 3a, 3b, and 3c, 290.1 are repealed. 290.2 (b) Minnesota Rules, parts 9505.2390; 9505.2395; 9505.2396; 290.3 9505.2400; 9505.2405; 9505.2410; 9505.2413; 9505.2415; 290.4 9505.2420; 9505.2425; 9505.2426; 9505.2430; 9505.2435; 290.5 9505.2440; 9505.2445; 9505.2450; 9505.2455; 9505.2458; 290.6 9505.2460; 9505.2465; 9505.2470; 9505.2473; 9505.2475; 290.7 9505.2480; 9505.2485; 9505.2486; 9505.2490; 9505.2495; 290.8 9505.2496; and 9505.2500, are repealed. 290.9 ARTICLE 5 290.10 LONG-TERM CARE SYSTEM REFORM AND REIMBURSEMENT 290.11 Section 1. Minnesota Statutes 2000, section 144.0721, 290.12 subdivision 1, is amended to read: 290.13 Subdivision 1. [APPROPRIATENESS AND QUALITY.] Until the 290.14 date of implementation of the revised case mix system based on 290.15 the minimum data set, the commissioner of health shall assess 290.16 the appropriateness and quality of care and services furnished 290.17 to private paying residents in nursing homes and boarding care 290.18 homes that are certified for participation in the medical 290.19 assistance program under United States Code, title 42, sections 290.20 1396-1396p. These assessments shall be conducted until the date 290.21 of implementation of the revised case mix system based on the 290.22 minimum data set, in accordance with section 144.072, with the 290.23 exception of provisions requiring recommendations for changes in 290.24 the level of care provided to the private paying residents. 290.25 Sec. 2. [144.0724] [RESIDENT REIMBURSEMENT 290.26 CLASSIFICATION.] 290.27 Subdivision 1. [RESIDENT REIMBURSEMENT 290.28 CLASSIFICATIONS.] The commissioner of health shall establish 290.29 resident reimbursement classifications based upon the 290.30 assessments of residents of nursing homes and boarding care 290.31 homes conducted under this section and according to section 290.32 256B.438. The reimbursement classifications established under 290.33 this section shall be implemented after June 30, 2002, but no 290.34 later than January 1, 2003. 290.35 Subd. 2. [DEFINITIONS.] For purposes of this section, the 290.36 following terms have the meanings given. 291.1 (a) [ASSESSMENT REFERENCE DATE.] "Assessment reference 291.2 date" means the last day of the minimum data set observation 291.3 period. The date sets the designated endpoint of the common 291.4 observation period, and all minimum data set items refer back in 291.5 time from that point. 291.6 (b) [CASE MIX INDEX.] "Case mix index" means the weighting 291.7 factors assigned to the RUG-III classifications. 291.8 (c) [INDEX MAXIMIZATION.] "Index maximization" means 291.9 classifying a resident who could be assigned to more than one 291.10 category, to the category with the highest case mix index. 291.11 (d) [MINIMUM DATA SET.] "Minimum data set" means the 291.12 assessment instrument specified by the Health Care Financing 291.13 Administration and designated by the Minnesota department of 291.14 health. 291.15 (e) [REPRESENTATIVE.] "Representative" means a person who 291.16 is the resident's guardian or conservator, the person authorized 291.17 to pay the nursing home expenses of the resident, a 291.18 representative of the nursing home ombudsman's office whose 291.19 assistance has been requested, or any other individual 291.20 designated by the resident. 291.21 (f) [RESOURCE UTILIZATION GROUPS OR RUG.] "Resource 291.22 utilization groups" or "RUG" means the system for grouping a 291.23 nursing facility's residents according to their clinical and 291.24 functional status identified in data supplied by the facility's 291.25 minimum data set. 291.26 Subd. 3. [RESIDENT REIMBURSEMENT CLASSIFICATIONS.] (a) 291.27 Resident reimbursement classifications shall be based on the 291.28 minimum data set, version 2.0 assessment instrument, or its 291.29 successor version mandated by the Health Care Financing 291.30 Administration that nursing facilities are required to complete 291.31 for all residents. The commissioner of health shall establish 291.32 resident classes according to the 34 group, resource utilization 291.33 groups, version III or RUG-III model. Resident classes must be 291.34 established based on the individual items on the minimum data 291.35 set and must be completed according to the facility manual for 291.36 case mix classification issued by the Minnesota department of 292.1 health. The facility manual for case mix classification shall 292.2 be drafted by the Minnesota department of health and presented 292.3 to the chairs of health and human services legislative 292.4 committees by December 31, 2001. 292.5 (b) Each resident must be classified based on the 292.6 information from the minimum data set according to general 292.7 domains in clauses (1) to (7): 292.8 (1) extensive services where a resident requires 292.9 intravenous feeding or medications, suctioning, tracheostomy 292.10 care, or is on a ventilator or respirator; 292.11 (2) rehabilitation where a resident requires physical, 292.12 occupational, or speech therapy; 292.13 (3) special care where a resident has cerebral palsy; 292.14 quadriplegia; multiple sclerosis; pressure ulcers; fever with 292.15 vomiting, weight loss, or dehydration; tube feeding and aphasia; 292.16 or is receiving radiation therapy; 292.17 (4) clinically complex status where a resident has burns, 292.18 coma, septicemia, pneumonia, internal bleeding, chemotherapy, 292.19 wounds, kidney failure, urinary tract infections, oxygen, or 292.20 transfusions; 292.21 (5) impaired cognition where a resident has poor cognitive 292.22 performance; 292.23 (6) behavior problems where a resident exhibits wandering, 292.24 has hallucinations, or is physically or verbally abusive toward 292.25 others, unless the resident's other condition would place the 292.26 resident in other categories; and 292.27 (7) reduced physical functioning where a resident has no 292.28 special clinical conditions. 292.29 (c) The commissioner of health shall establish resident 292.30 classification according to a 34 group model based on the 292.31 information on the minimum data set and within the general 292.32 domains listed in paragraph (b), clauses (1) to (7). Detailed 292.33 descriptions of each resource utilization group shall be defined 292.34 in the facility manual for case mix classification issued by the 292.35 Minnesota department of health. The 34 groups are described as 292.36 follows: 293.1 (1) SE3: requires four or five extensive services; 293.2 (2) SE2: requires two or three extensive services; 293.3 (3) SE1: requires one extensive service; 293.4 (4) RAD: requires rehabilitation services and is dependent 293.5 in activity of daily living (ADL) at a count of 17 or 18; 293.6 (5) RAC: requires rehabilitation services and ADL count is 293.7 14 to 16; 293.8 (6) RAB: requires rehabilitation services and ADL count is 293.9 ten to 13; 293.10 (7) RAA: requires rehabilitation services and ADL count is 293.11 four to nine; 293.12 (8) SSC: requires special care and ADL count is 17 or 18; 293.13 (9) SSB: requires special care and ADL count is 15 or 16; 293.14 (10) SSA: requires special care and ADL count is seven to 293.15 14; 293.16 (11) CC2: clinically complex with depression and ADL count 293.17 is 17 or 18; 293.18 (12) CC1: clinically complex with no depression and ADL 293.19 count is 17 or 18; 293.20 (13) CB2: clinically complex with depression and ADL count 293.21 is 12 to 16; 293.22 (14) CB1: clinically complex with no depression and ADL 293.23 count is 12 to 16; 293.24 (15) CA2: clinically complex with depression and ADL count 293.25 is four to 11; 293.26 (16) CA1: clinically complex with no depression and ADL 293.27 count is four to 11; 293.28 (17) IB2: impaired cognition with nursing rehabilitation 293.29 and ADL count is six to ten; 293.30 (18) IB1: impaired cognition with no nursing 293.31 rehabilitation and ADL count is six to ten; 293.32 (19) IA2: impaired cognition with nursing rehabilitation 293.33 and ADL count is four or five; 293.34 (20) IA1: impaired cognition with no nursing 293.35 rehabilitation and ADL count is four or five; 293.36 (21) BB2: behavior problems with nursing rehabilitation 294.1 and ADL count is six to ten; 294.2 (22) BB1: behavior problems with no nursing rehabilitation 294.3 and ADL count is six to ten; 294.4 (23) BA2: behavior problems with nursing rehabilitation 294.5 and ADL count is four to five; 294.6 (24) BA1: behavior problems with no nursing rehabilitation 294.7 and ADL count is four to five; 294.8 (25) PE2: reduced physical functioning with nursing 294.9 rehabilitation and ADL count is 16 to 18; 294.10 (26) PE1: reduced physical functioning with no nursing 294.11 rehabilitation and ADL count is 16 to 18; 294.12 (27) PD2: reduced physical functioning with nursing 294.13 rehabilitation and ADL count is 11 to 15; 294.14 (28) PD1: reduced physical functioning with no nursing 294.15 rehabilitation and ADL count is 11 to 15; 294.16 (29) PC2: reduced physical functioning with nursing 294.17 rehabilitation and ADL count is nine or ten; 294.18 (30) PC1: reduced physical functioning with no nursing 294.19 rehabilitation and ADL count is nine or ten; 294.20 (31) PB2: reduced physical functioning with nursing 294.21 rehabilitation and ADL count is six to eight; 294.22 (32) PB1: reduced physical functioning with no nursing 294.23 rehabilitation and ADL count is six to eight; 294.24 (33) PA2: reduced physical functioning with nursing 294.25 rehabilitation and ADL count is four or five; and 294.26 (34) PA1: reduced physical functioning with no nursing 294.27 rehabilitation and ADL count is four or five. 294.28 Subd. 4. [RESIDENT ASSESSMENT SCHEDULE.] (a) A facility 294.29 must conduct and electronically submit to the commissioner of 294.30 health case mix assessments that conform with the assessment 294.31 schedule defined by the Code of Federal Regulations, title 42, 294.32 section 483.20, and published by the United States Department of 294.33 Health and Human Services, Health Care Financing Administration, 294.34 in the Long Term Care Assessment Instrument User's Manual, 294.35 version 2.0, October 1995, and subsequent clarifications made in 294.36 the Long-Term Care Assessment Instrument Questions and Answers, 295.1 version 2.0, August 1996. The commissioner of health may 295.2 substitute successor manuals or question and answer documents 295.3 published by the United States Department of Health and Human 295.4 Services, Health Care Financing Administration, to replace or 295.5 supplement the current version of the manual or document. 295.6 (b) The assessments used to determine a case mix 295.7 classification for reimbursement include the following: 295.8 (1) a new admission assessment must be completed by day 14 295.9 following admission; 295.10 (2) an annual assessment must be completed within 366 days 295.11 of the last comprehensive assessment; 295.12 (3) a significant change assessment must be completed 295.13 within 14 days of the identification of a significant change; 295.14 and 295.15 (4) the second quarterly assessment following either a new 295.16 admission assessment, an annual assessment, or a significant 295.17 change assessment. Each quarterly assessment must be completed 295.18 within 92 days of the previous assessment. 295.19 Subd. 5. [SHORT STAYS.] (a) A facility must submit to the 295.20 commissioner of health an initial admission assessment for all 295.21 residents who stay in the facility less than 14 days. 295.22 (b) Notwithstanding the admission assessment requirements 295.23 of paragraph (a), a facility may elect to accept a default rate 295.24 with a case mix index of 1.0 for all facility residents who stay 295.25 less than 14 days in lieu of submitting an initial assessment. 295.26 Facilities may make this election to be effective on the day of 295.27 implementation of the revised case mix system. 295.28 (c) After implementation of the revised case mix system, 295.29 nursing facilities must elect one of the options described in 295.30 paragraphs (a) and (b) on the annual report to the commissioner 295.31 of human services filed for each report year ending September 295.32 30. The election shall be effective on the following July 1. 295.33 (d) For residents who are admitted or readmitted and leave 295.34 the facility on a frequent basis and for whom readmission is 295.35 expected, the resident may be discharged on an extended leave 295.36 status. This status does not require reassessment each time the 296.1 resident returns to the facility unless a significant change in 296.2 the resident's status has occurred since the last assessment. 296.3 The case mix classification for these residents is determined by 296.4 the facility election made in paragraphs (a) and (b). 296.5 Subd. 6. [PENALTIES FOR LATE OR NONSUBMISSION.] A facility 296.6 that fails to complete or submit an assessment for a RUG-III 296.7 classification within seven days of the time requirements in 296.8 subdivisions 4 and 5 is subject to a reduced rate for that 296.9 resident. The reduced rate shall be the lowest rate for that 296.10 facility. The reduced rate is effective on the day of admission 296.11 for new admission assessments or on the day that the assessment 296.12 was due for all other assessments and continues in effect until 296.13 the first day of the month following the date of submission of 296.14 the resident's assessment. 296.15 Subd. 7. [NOTICE OF RESIDENT REIMBURSEMENT 296.16 CLASSIFICATION.] (a) A facility must elect between the options 296.17 in clauses (1) and (2) to provide notice to a resident of the 296.18 resident's case mix classification. 296.19 (1) The commissioner of health shall provide to a nursing 296.20 facility a notice for each resident of the reimbursement 296.21 classification established under subdivision 1. The notice must 296.22 inform the resident of the classification that was assigned, the 296.23 opportunity to review the documentation supporting the 296.24 classification, the opportunity to obtain clarification from the 296.25 commissioner, and the opportunity to request a reconsideration 296.26 of the classification. The commissioner must send notice of 296.27 resident classification by first class mail. A nursing facility 296.28 is responsible for the distribution of the notice to each 296.29 resident, to the person responsible for the payment of the 296.30 resident's nursing home expenses, or to another person 296.31 designated by the resident. This notice must be distributed 296.32 within three working days after the facility's receipt of the 296.33 notice from the commissioner of health. 296.34 (2) A facility may choose to provide a classification 296.35 notice, as prescribed by the commissioner of health, to a 296.36 resident upon receipt of the confirmation of the case mix 297.1 classification calculated by a facility or a corrected case mix 297.2 classification as indicated on the final validation report from 297.3 the commissioner. A nursing facility is responsible for the 297.4 distribution of the notice to each resident, to the person 297.5 responsible for the payment of the resident's nursing home 297.6 expenses, or to another person designated by the resident. This 297.7 notice must be distributed within three working days after the 297.8 facility's receipt of the validation report from the 297.9 commissioner. If a facility elects this option, the 297.10 commissioner of health shall provide the facility with a list of 297.11 residents and their case mix classifications as determined by 297.12 the commissioner. A nursing facility may make this election to 297.13 be effective on the day of implementation of the revised case 297.14 mix system. 297.15 (3) After implementation of the revised case mix system, a 297.16 nursing facility shall elect a notice of resident reimbursement 297.17 classification procedure as described in clause (1) or (2) on 297.18 the annual report to the commissioner of human services filed 297.19 for each report year ending September 30. The election will be 297.20 effective the following July 1. 297.21 (b) If a facility submits a correction to an assessment 297.22 conducted under subdivision 3 that results in a change in case 297.23 mix classification, the facility shall give written notice to 297.24 the resident or the resident's representative about the item 297.25 that was corrected and the reason for the correction. The 297.26 notice of corrected assessment may be provided at the same time 297.27 that the resident or resident's representative is provided the 297.28 resident's corrected notice of classification. 297.29 Subd. 8. [REQUEST FOR RECONSIDERATION OF RESIDENT 297.30 CLASSIFICATIONS.] (a) The resident, or resident's 297.31 representative, or the nursing facility or boarding care home 297.32 may request that the commissioner of health reconsider the 297.33 assigned reimbursement classification. The request for 297.34 reconsideration must be submitted in writing to the commissioner 297.35 within 30 days of the day the resident or the resident's 297.36 representative receives the resident classification notice. The 298.1 request for reconsideration must include the name of the 298.2 resident, the name and address of the facility in which the 298.3 resident resides, the reasons for the reconsideration, the 298.4 requested classification changes, and documentation supporting 298.5 the requested classification. The documentation accompanying 298.6 the reconsideration request is limited to documentation which 298.7 establishes that the needs of the resident at the time of the 298.8 assessment justify a classification which is different than the 298.9 classification established by the commissioner of health. 298.10 (b) Upon request, the nursing facility must give the 298.11 resident or the resident's representative a copy of the 298.12 assessment form and the other documentation that was given to 298.13 the commissioner of health to support the assessment findings. 298.14 The nursing facility shall also provide access to and a copy of 298.15 other information from the resident's record that has been 298.16 requested by or on behalf of the resident to support a 298.17 resident's reconsideration request. A copy of any requested 298.18 material must be provided within three working days of receipt 298.19 of a written request for the information. If a facility fails 298.20 to provide the material within this time, it is subject to the 298.21 issuance of a correction order and penalty assessment under 298.22 sections 144.653 and 144A.10. Notwithstanding those sections, 298.23 any correction order issued under this subdivision must require 298.24 that the nursing facility immediately comply with the request 298.25 for information and that as of the date of the issuance of the 298.26 correction order, the facility shall forfeit to the state a $100 298.27 fine for the first day of noncompliance, and an increase in the 298.28 $100 fine by $50 increments for each day the noncompliance 298.29 continues. 298.30 (c) In addition to the information required under 298.31 paragraphs (a) and (b), a reconsideration request from a nursing 298.32 facility must contain the following information: (i) the date 298.33 the reimbursement classification notices were received by the 298.34 facility; (ii) the date the classification notices were 298.35 distributed to the resident or the resident's representative; 298.36 and (iii) a copy of a notice sent to the resident or to the 299.1 resident's representative. This notice must inform the resident 299.2 or the resident's representative that a reconsideration of the 299.3 resident's classification is being requested, the reason for the 299.4 request, that the resident's rate will change if the request is 299.5 approved by the commissioner, the extent of the change, that 299.6 copies of the facility's request and supporting documentation 299.7 are available for review, and that the resident also has the 299.8 right to request a reconsideration. If the facility fails to 299.9 provide the required information with the reconsideration 299.10 request, the request must be denied, and the facility may not 299.11 make further reconsideration requests on that specific 299.12 reimbursement classification. 299.13 (d) Reconsideration by the commissioner must be made by 299.14 individuals not involved in reviewing the assessment, audit, or 299.15 reconsideration that established the disputed classification. 299.16 The reconsideration must be based upon the initial assessment 299.17 and upon the information provided to the commissioner under 299.18 paragraphs (a) and (b). If necessary for evaluating the 299.19 reconsideration request, the commissioner may conduct on-site 299.20 reviews. Within 15 working days of receiving the request for 299.21 reconsideration, the commissioner shall affirm or modify the 299.22 original resident classification. The original classification 299.23 must be modified if the commissioner determines that the 299.24 assessment resulting in the classification did not accurately 299.25 reflect the needs or assessment characteristics of the resident 299.26 at the time of the assessment. The resident and the nursing 299.27 facility or boarding care home shall be notified within five 299.28 working days after the decision is made. A decision by the 299.29 commissioner under this subdivision is the final administrative 299.30 decision of the agency for the party requesting reconsideration. 299.31 (e) The resident classification established by the 299.32 commissioner shall be the classification that applies to the 299.33 resident while the request for reconsideration is pending. 299.34 (f) The commissioner may request additional documentation 299.35 regarding a reconsideration necessary to make an accurate 299.36 reconsideration determination. 300.1 Subd. 9. [AUDIT AUTHORITY.] (a) The commissioner shall 300.2 audit the accuracy of resident assessments performed under 300.3 section 256B.438 through desk audits, on-site review of 300.4 residents and their records, and interviews with staff and 300.5 families. The commissioner shall reclassify a resident if the 300.6 commissioner determines that the resident was incorrectly 300.7 classified. 300.8 (b) The commissioner is authorized to conduct on-site 300.9 audits on an unannounced basis. 300.10 (c) A facility must grant the commissioner access to 300.11 examine the medical records relating to the resident assessments 300.12 selected for audit under this subdivision. The commissioner may 300.13 also observe and speak to facility staff and residents. 300.14 (d) The commissioner shall consider documentation under the 300.15 time frames for coding items on the minimum data set as set out 300.16 in the Resident Assessment Instrument Manual published by the 300.17 Health Care Financing Administration. 300.18 (e) The commissioner shall develop an audit selection 300.19 procedure that includes the following factors: 300.20 (1) The commissioner may target facilities that demonstrate 300.21 an atypical pattern of scoring minimum data set items, 300.22 nonsubmission of assessments, late submission of assessments, or 300.23 a previous history of audit changes of greater than 35 percent. 300.24 The commissioner shall select at least 20 percent of the most 300.25 current assessments submitted to the state for audit. Audits of 300.26 assessments selected in the targeted facilities must focus on 300.27 the factors leading to the audit. If the number of targeted 300.28 assessments selected does not meet the threshold of 20 percent 300.29 of the facility residents, then a stratified sample of the 300.30 remainder of assessments shall be drawn to meet the quota. If 300.31 the total change exceeds 35 percent, the commissioner may 300.32 conduct an expanded audit up to 100 percent of the remaining 300.33 current assessments. 300.34 (2) Facilities that are not a part of the targeted group 300.35 shall be placed in a general pool from which facilities will be 300.36 selected on a random basis for audit. Every facility shall be 301.1 audited annually. If a facility has two successive audits in 301.2 which the percentage of change is five percent or less and the 301.3 facility has not been the subject of a targeted audit in the 301.4 past 36 months, the facility may be audited biannually. A 301.5 stratified sample of 15 percent of the most current assessments 301.6 shall be selected for audit. If more than 20 percent of the 301.7 RUGS-III classifications after the audit are changed, the audit 301.8 shall be expanded to a second 15 percent sample. If the total 301.9 change between the first and second samples exceed 35 percent, 301.10 the commissioner may expand the audit to all of the remaining 301.11 assessments. 301.12 (3) If a facility qualifies for an expanded audit, the 301.13 commissioner may audit the facility again within six months. If 301.14 a facility has two expanded audits within a 24-month period, 301.15 that facility will be audited at least every six months for the 301.16 next 18 months. 301.17 (4) The commissioner may conduct special audits if the 301.18 commissioner determines that circumstances exist that could 301.19 alter or affect the validity of case mix classifications of 301.20 residents. These circumstances include, but are not limited to, 301.21 the following: 301.22 (i) frequent changes in the administration or management of 301.23 the facility; 301.24 (ii) an unusually high percentage of residents in a 301.25 specific case mix classification; 301.26 (iii) a high frequency in the number of reconsideration 301.27 requests received from a facility; 301.28 (iv) frequent adjustments of case mix classifications as 301.29 the result of reconsiderations or audits; 301.30 (v) a criminal indictment alleging provider fraud; or 301.31 (vi) other similar factors that relate to a facility's 301.32 ability to conduct accurate assessments. 301.33 (f) Within 15 working days of completing the audit process, 301.34 the commissioner shall mail the written results of the audit to 301.35 the facility, along with a written notice for each resident 301.36 affected to be forwarded by the facility. The notice must 302.1 contain the resident's classification and a statement informing 302.2 the resident, the resident's authorized representative, and the 302.3 facility of their right to review the commissioner's documents 302.4 supporting the classification and to request a reconsideration 302.5 of the classification. This notice must also include the 302.6 address and telephone number of the area nursing home ombudsman. 302.7 Subd. 10. [TRANSITION.] After implementation of this 302.8 section, reconsiderations requested for classifications made 302.9 under section 144.0722, subdivision 1, shall be determined under 302.10 section 144.0722, subdivision 3. 302.11 Sec. 3. Minnesota Statutes 2000, section 144A.071, 302.12 subdivision 1, is amended to read: 302.13 Subdivision 1. [FINDINGS.] The legislature declares that a 302.14 moratorium on the licensure and medical assistance certification 302.15 of new nursing home beds and construction projects that 302.16 exceed$750,000$1,000,000 is necessary to control nursing home 302.17 expenditure growth and enable the state to meet the needs of its 302.18 elderly by providing high quality services in the most 302.19 appropriate manner along a continuum of care. 302.20 Sec. 4. Minnesota Statutes 2000, section 144A.071, 302.21 subdivision 1a, is amended to read: 302.22 Subd. 1a. [DEFINITIONS.] For purposes of sections 144A.071 302.23 to 144A.073, the following terms have the meanings given them: 302.24 (a) "attached fixtures" has the meaning given in Minnesota 302.25 Rules, part 9549.0020, subpart 6. 302.26 (b) "buildings" has the meaning given in Minnesota Rules, 302.27 part 9549.0020, subpart 7. 302.28 (c) "capital assets" has the meaning given in section 302.29 256B.421, subdivision 16. 302.30 (d) "commenced construction" means that all of the 302.31 following conditions were met: the final working drawings and 302.32 specifications were approved by the commissioner of health; the 302.33 construction contracts were let; a timely construction schedule 302.34 was developed, stipulating dates for beginning, achieving 302.35 various stages, and completing construction; and all zoning and 302.36 building permits were applied for. 303.1 (e) "completion date" means the date on which a certificate 303.2 of occupancy is issued for a construction project, or if a 303.3 certificate of occupancy is not required, the date on which the 303.4 construction project is available for facility use. 303.5 (f) "construction" means any erection, building, 303.6 alteration, reconstruction, modernization, or improvement 303.7 necessary to comply with the nursing home licensure rules. 303.8 (g) "construction project" means: 303.9 (1) a capital asset addition to, or replacement of a 303.10 nursing home or certified boarding care home that results in new 303.11 space or the remodeling of or renovations to existing facility 303.12 space; 303.13 (2) the remodeling or renovation of existing facility space 303.14 the use of which is modified as a result of the project 303.15 described in clause (1). This existing space and the project 303.16 described in clause (1) must be used for the functions as 303.17 designated on the construction plans on completion of the 303.18 project described in clause (1) for a period of not less than 24 303.19 months; or 303.20 (3) capital asset additions or replacements that are 303.21 completed within 12 months before or after the completion date 303.22 of the project described in clause (1). 303.23 (h) "new licensed" or "new certified beds" means: 303.24 (1) newly constructed beds in a facility or the 303.25 construction of a new facility that would increase the total 303.26 number of licensed nursing home beds or certified boarding care 303.27 or nursing home beds in the state; or 303.28 (2) newly licensed nursing home beds or newly certified 303.29 boarding care or nursing home beds that result from remodeling 303.30 of the facility that involves relocation of beds but does not 303.31 result in an increase in the total number of beds, except when 303.32 the project involves the upgrade of boarding care beds to 303.33 nursing home beds, as defined in section 144A.073, subdivision 303.34 1. "Remodeling" includes any of the type of conversion, 303.35 renovation, replacement, or upgrading projects as defined in 303.36 section 144A.073, subdivision 1. 304.1 (i) "project construction costs" means the cost of the 304.2 facility capital asset additions, replacements, renovations, or 304.3 remodeling projects, construction site preparation costs, and 304.4 related soft costs. Project construction costsalsoinclude the 304.5 cost of any remodeling or renovation of existing facility space 304.6 which is modified as a result of the construction 304.7 project. Project construction costs also includes the cost of 304.8 new technology implemented as part of the construction project. 304.9 (j) "technology" means information systems or devices that 304.10 make documentation, charting, and staff time more efficient or 304.11 encourage and allow for care through alternative settings 304.12 including, but not limited to, touch screens, monitors, 304.13 hand-helds, swipe cards, motion detectors, pagers, telemedicine, 304.14 medication dispensers, and equipment to monitor vital signs and 304.15 self-injections, and to observe skin and other conditions. 304.16 Sec. 5. Minnesota Statutes 2000, section 144A.071, 304.17 subdivision 2, is amended to read: 304.18 Subd. 2. [MORATORIUM.] The commissioner of health, in 304.19 coordination with the commissioner of human services, shall deny 304.20 each request for new licensed or certified nursing home or 304.21 certified boarding care beds except as provided in subdivision 3 304.22 or 4a, or section 144A.073. "Certified bed" means a nursing 304.23 home bed or a boarding care bed certified by the commissioner of 304.24 health for the purposes of the medical assistance program, under 304.25 United States Code, title 42, sections 1396 et seq. 304.26 The commissioner of human services, in coordination with 304.27 the commissioner of health, shall deny any request to issue a 304.28 license under section 252.28 and chapter 245A to a nursing home 304.29 or boarding care home, if that license would result in an 304.30 increase in the medical assistance reimbursement amount. 304.31 In addition, the commissioner of health must not approve 304.32 any construction project whose cost exceeds$750,000$1,000,000, 304.33 unless: 304.34 (a) any construction costs exceeding$750,000$1,000,000 304.35 are not added to the facility's appraised value and are not 304.36 included in the facility's payment rate for reimbursement under 305.1 the medical assistance program; or 305.2 (b) the project: 305.3 (1) has been approved through the process described in 305.4 section 144A.073; 305.5 (2) meets an exception in subdivision 3 or 4a; 305.6 (3) is necessary to correct violations of state or federal 305.7 law issued by the commissioner of health; 305.8 (4) is necessary to repair or replace a portion of the 305.9 facility that was damaged by fire, lightning, groundshifts, or 305.10 other such hazards, including environmental hazards, provided 305.11 that the provisions of subdivision 4a, clause (a), are met; 305.12 (5) as of May 1, 1992, the facility has submitted to the 305.13 commissioner of health written documentation evidencing that the 305.14 facility meets the "commenced construction" definition as 305.15 specified in subdivision 1a, clause (d), or that substantial 305.16 steps have been taken prior to April 1, 1992, relating to the 305.17 construction project. "Substantial steps" require that the 305.18 facility has made arrangements with outside parties relating to 305.19 the construction project and include the hiring of an architect 305.20 or construction firm, submission of preliminary plans to the 305.21 department of health or documentation from a financial 305.22 institution that financing arrangements for the construction 305.23 project have been made; or 305.24 (6) is being proposed by a licensed nursing facility that 305.25 is not certified to participate in the medical assistance 305.26 program and will not result in new licensed or certified beds. 305.27 Prior to the final plan approval of any construction 305.28 project, the commissioner of health shall be provided with an 305.29 itemized cost estimate for the project construction costs. If a 305.30 construction project is anticipated to be completed in phases, 305.31 the total estimated cost of all phases of the project shall be 305.32 submitted to the commissioner and shall be considered as one 305.33 construction project. Once the construction project is 305.34 completed and prior to the final clearance by the commissioner, 305.35 the total project construction costs for the construction 305.36 project shall be submitted to the commissioner. If the final 306.1 project construction cost exceeds the dollar threshold in this 306.2 subdivision, the commissioner of human services shall not 306.3 recognize any of the project construction costs or the related 306.4 financing costs in excess of this threshold in establishing the 306.5 facility's property-related payment rate. 306.6 The dollar thresholds for construction projects are as 306.7 follows: for construction projects other than those authorized 306.8 in clauses (1) to (6), the dollar threshold 306.9 is$750,000$1,000,000. For projects authorized after July 1, 306.10 1993, under clause (1), the dollar threshold is the cost 306.11 estimate submitted with a proposal for an exception under 306.12 section 144A.073, plus inflation as calculated according to 306.13 section 256B.431, subdivision 3f, paragraph (a). For projects 306.14 authorized under clauses (2) to (4), the dollar threshold is the 306.15 itemized estimate project construction costs submitted to the 306.16 commissioner of health at the time of final plan approval, plus 306.17 inflation as calculated according to section 256B.431, 306.18 subdivision 3f, paragraph (a). 306.19 The commissioner of health shall adopt rules to implement 306.20 this section or to amend the emergency rules for granting 306.21 exceptions to the moratorium on nursing homes under section 306.22 144A.073. 306.23 Sec. 6. Minnesota Statutes 2000, section 144A.071, 306.24 subdivision 4a, is amended to read: 306.25 Subd. 4a. [EXCEPTIONS FOR REPLACEMENT BEDS.] It is in the 306.26 best interest of the state to ensure that nursing homes and 306.27 boarding care homes continue to meet the physical plant 306.28 licensing and certification requirements by permitting certain 306.29 construction projects. Facilities should be maintained in 306.30 condition to satisfy the physical and emotional needs of 306.31 residents while allowing the state to maintain control over 306.32 nursing home expenditure growth. 306.33 The commissioner of health in coordination with the 306.34 commissioner of human services, may approve the renovation, 306.35 replacement, upgrading, or relocation of a nursing home or 306.36 boarding care home, under the following conditions: 307.1 (a) to license or certify beds in a new facility 307.2 constructed to replace a facility or to make repairs in an 307.3 existing facility that was destroyed or damaged after June 30, 307.4 1987, by fire, lightning, or other hazard provided: 307.5 (i) destruction was not caused by the intentional act of or 307.6 at the direction of a controlling person of the facility; 307.7 (ii) at the time the facility was destroyed or damaged the 307.8 controlling persons of the facility maintained insurance 307.9 coverage for the type of hazard that occurred in an amount that 307.10 a reasonable person would conclude was adequate; 307.11 (iii) the net proceeds from an insurance settlement for the 307.12 damages caused by the hazard are applied to the cost of the new 307.13 facility or repairs; 307.14 (iv) the new facility is constructed on the same site as 307.15 the destroyed facility or on another site subject to the 307.16 restrictions in section 144A.073, subdivision 5; 307.17 (v) the number of licensed and certified beds in the new 307.18 facility does not exceed the number of licensed and certified 307.19 beds in the destroyed facility; and 307.20 (vi) the commissioner determines that the replacement beds 307.21 are needed to prevent an inadequate supply of beds. 307.22 Project construction costs incurred for repairs authorized under 307.23 this clause shall not be considered in the dollar threshold 307.24 amount defined in subdivision 2; 307.25 (b) to license or certify beds that are moved from one 307.26 location to another within a nursing home facility, provided the 307.27 total costs of remodeling performed in conjunction with the 307.28 relocation of beds does not exceed$750,000$1,000,000; 307.29 (c) to license or certify beds in a project recommended for 307.30 approval under section 144A.073; 307.31 (d) to license or certify beds that are moved from an 307.32 existing state nursing home to a different state facility, 307.33 provided there is no net increase in the number of state nursing 307.34 home beds; 307.35 (e) to certify and license as nursing home beds boarding 307.36 care beds in a certified boarding care facility if the beds meet 308.1 the standards for nursing home licensure, or in a facility that 308.2 was granted an exception to the moratorium under section 308.3 144A.073, and if the cost of any remodeling of the facility does 308.4 not exceed$750,000$1,000,000. If boarding care beds are 308.5 licensed as nursing home beds, the number of boarding care beds 308.6 in the facility must not increase beyond the number remaining at 308.7 the time of the upgrade in licensure. The provisions contained 308.8 in section 144A.073 regarding the upgrading of the facilities do 308.9 not apply to facilities that satisfy these requirements; 308.10 (f) to license and certify up to 40 beds transferred from 308.11 an existing facility owned and operated by the Amherst H. Wilder 308.12 Foundation in the city of St. Paul to a new unit at the same 308.13 location as the existing facility that will serve persons with 308.14 Alzheimer's disease and other related disorders. The transfer 308.15 of beds may occur gradually or in stages, provided the total 308.16 number of beds transferred does not exceed 40. At the time of 308.17 licensure and certification of a bed or beds in the new unit, 308.18 the commissioner of health shall delicense and decertify the 308.19 same number of beds in the existing facility. As a condition of 308.20 receiving a license or certification under this clause, the 308.21 facility must make a written commitment to the commissioner of 308.22 human services that it will not seek to receive an increase in 308.23 its property-related payment rate as a result of the transfers 308.24 allowed under this paragraph; 308.25 (g) to license and certify nursing home beds to replace 308.26 currently licensed and certified boarding care beds which may be 308.27 located either in a remodeled or renovated boarding care or 308.28 nursing home facility or in a remodeled, renovated, newly 308.29 constructed, or replacement nursing home facility within the 308.30 identifiable complex of health care facilities in which the 308.31 currently licensed boarding care beds are presently located, 308.32 provided that the number of boarding care beds in the facility 308.33 or complex are decreased by the number to be licensed as nursing 308.34 home beds and further provided that, if the total costs of new 308.35 construction, replacement, remodeling, or renovation exceed ten 308.36 percent of the appraised value of the facility or $200,000, 309.1 whichever is less, the facility makes a written commitment to 309.2 the commissioner of human services that it will not seek to 309.3 receive an increase in its property-related payment rate by 309.4 reason of the new construction, replacement, remodeling, or 309.5 renovation. The provisions contained in section 144A.073 309.6 regarding the upgrading of facilities do not apply to facilities 309.7 that satisfy these requirements; 309.8 (h) to license as a nursing home and certify as a nursing 309.9 facility a facility that is licensed as a boarding care facility 309.10 but not certified under the medical assistance program, but only 309.11 if the commissioner of human services certifies to the 309.12 commissioner of health that licensing the facility as a nursing 309.13 home and certifying the facility as a nursing facility will 309.14 result in a net annual savings to the state general fund of 309.15 $200,000 or more; 309.16 (i) to certify, after September 30, 1992, and prior to July 309.17 1, 1993, existing nursing home beds in a facility that was 309.18 licensed and in operation prior to January 1, 1992; 309.19 (j) to license and certify new nursing home beds to replace 309.20 beds in a facility acquired by the Minneapolis community 309.21 development agency as part of redevelopment activities in a city 309.22 of the first class, provided the new facility is located within 309.23 three miles of the site of the old facility. Operating and 309.24 property costs for the new facility must be determined and 309.25 allowed under section 256B.431 or 256B.434; 309.26 (k) to license and certify up to 20 new nursing home beds 309.27 in a community-operated hospital and attached convalescent and 309.28 nursing care facility with 40 beds on April 21, 1991, that 309.29 suspended operation of the hospital in April 1986. The 309.30 commissioner of human services shall provide the facility with 309.31 the same per diem property-related payment rate for each 309.32 additional licensed and certified bed as it will receive for its 309.33 existing 40 beds; 309.34 (l) to license or certify beds in renovation, replacement, 309.35 or upgrading projects as defined in section 144A.073, 309.36 subdivision 1, so long as the cumulative total costs of the 310.1 facility's remodeling projects do not 310.2 exceed$750,000$1,000,000; 310.3 (m) to license and certify beds that are moved from one 310.4 location to another for the purposes of converting up to five 310.5 four-bed wards to single or double occupancy rooms in a nursing 310.6 home that, as of January 1, 1993, was county-owned and had a 310.7 licensed capacity of 115 beds; 310.8 (n) to allow a facility that on April 16, 1993, was a 310.9 106-bed licensed and certified nursing facility located in 310.10 Minneapolis to layaway all of its licensed and certified nursing 310.11 home beds. These beds may be relicensed and recertified in a 310.12 newly-constructed teaching nursing home facility affiliated with 310.13 a teaching hospital upon approval by the legislature. The 310.14 proposal must be developed in consultation with the interagency 310.15 committee on long-term care planning. The beds on layaway 310.16 status shall have the same status as voluntarily delicensed and 310.17 decertified beds, except that beds on layaway status remain 310.18 subject to the surcharge in section 256.9657. This layaway 310.19 provision expires July 1, 1998; 310.20 (o) to allow a project which will be completed in 310.21 conjunction with an approved moratorium exception project for a 310.22 nursing home in southern Cass county and which is directly 310.23 related to that portion of the facility that must be repaired, 310.24 renovated, or replaced, to correct an emergency plumbing problem 310.25 for which a state correction order has been issued and which 310.26 must be corrected by August 31, 1993; 310.27 (p) to allow a facility that on April 16, 1993, was a 310.28 368-bed licensed and certified nursing facility located in 310.29 Minneapolis to layaway, upon 30 days prior written notice to the 310.30 commissioner, up to 30 of the facility's licensed and certified 310.31 beds by converting three-bed wards to single or double 310.32 occupancy. Beds on layaway status shall have the same status as 310.33 voluntarily delicensed and decertified beds except that beds on 310.34 layaway status remain subject to the surcharge in section 310.35 256.9657, remain subject to the license application and renewal 310.36 fees under section 144A.07 and shall be subject to a $100 per 311.1 bed reactivation fee. In addition, at any time within three 311.2 years of the effective date of the layaway, the beds on layaway 311.3 status may be: 311.4 (1) relicensed and recertified upon relocation and 311.5 reactivation of some or all of the beds to an existing licensed 311.6 and certified facility or facilities located in Pine River, 311.7 Brainerd, or International Falls; provided that the total 311.8 project construction costs related to the relocation of beds 311.9 from layaway status for any facility receiving relocated beds 311.10 may not exceed the dollar threshold provided in subdivision 2 311.11 unless the construction project has been approved through the 311.12 moratorium exception process under section 144A.073; 311.13 (2) relicensed and recertified, upon reactivation of some 311.14 or all of the beds within the facility which placed the beds in 311.15 layaway status, if the commissioner has determined a need for 311.16 the reactivation of the beds on layaway status. 311.17 The property-related payment rate of a facility placing 311.18 beds on layaway status must be adjusted by the incremental 311.19 change in its rental per diem after recalculating the rental per 311.20 diem as provided in section 256B.431, subdivision 3a, paragraph 311.21 (c). The property-related payment rate for a facility 311.22 relicensing and recertifying beds from layaway status must be 311.23 adjusted by the incremental change in its rental per diem after 311.24 recalculating its rental per diem using the number of beds after 311.25 the relicensing to establish the facility's capacity day 311.26 divisor, which shall be effective the first day of the month 311.27 following the month in which the relicensing and recertification 311.28 became effective. Any beds remaining on layaway status more 311.29 than three years after the date the layaway status became 311.30 effective must be removed from layaway status and immediately 311.31 delicensed and decertified; 311.32 (q) to license and certify beds in a renovation and 311.33 remodeling project to convert 12 four-bed wards into 24 two-bed 311.34 rooms, expand space, and add improvements in a nursing home 311.35 that, as of January 1, 1994, met the following conditions: the 311.36 nursing home was located in Ramsey county; had a licensed 312.1 capacity of 154 beds; and had been ranked among the top 15 312.2 applicants by the 1993 moratorium exceptions advisory review 312.3 panel. The total project construction cost estimate for this 312.4 project must not exceed the cost estimate submitted in 312.5 connection with the 1993 moratorium exception process; 312.6 (r) to license and certify up to 117 beds that are 312.7 relocated from a licensed and certified 138-bed nursing facility 312.8 located in St. Paul to a hospital with 130 licensed hospital 312.9 beds located in South St. Paul, provided that the nursing 312.10 facility and hospital are owned by the same or a related 312.11 organization and that prior to the date the relocation is 312.12 completed the hospital ceases operation of its inpatient 312.13 hospital services at that hospital. After relocation, the 312.14 nursing facility's status under section 256B.431, subdivision 312.15 2j, shall be the same as it was prior to relocation. The 312.16 nursing facility's property-related payment rate resulting from 312.17 the project authorized in this paragraph shall become effective 312.18 no earlier than April 1, 1996. For purposes of calculating the 312.19 incremental change in the facility's rental per diem resulting 312.20 from this project, the allowable appraised value of the nursing 312.21 facility portion of the existing health care facility physical 312.22 plant prior to the renovation and relocation may not exceed 312.23 $2,490,000; 312.24 (s) to license and certify two beds in a facility to 312.25 replace beds that were voluntarily delicensed and decertified on 312.26 June 28, 1991; 312.27 (t) to allow 16 licensed and certified beds located on July 312.28 1, 1994, in a 142-bed nursing home and 21-bed boarding care home 312.29 facility in Minneapolis, notwithstanding the licensure and 312.30 certification after July 1, 1995, of the Minneapolis facility as 312.31 a 147-bed nursing home facility after completion of a 312.32 construction project approved in 1993 under section 144A.073, to 312.33 be laid away upon 30 days' prior written notice to the 312.34 commissioner. Beds on layaway status shall have the same status 312.35 as voluntarily delicensed or decertified beds except that they 312.36 shall remain subject to the surcharge in section 256.9657. The 313.1 16 beds on layaway status may be relicensed as nursing home beds 313.2 and recertified at any time within five years of the effective 313.3 date of the layaway upon relocation of some or all of the beds 313.4 to a licensed and certified facility located in Watertown, 313.5 provided that the total project construction costs related to 313.6 the relocation of beds from layaway status for the Watertown 313.7 facility may not exceed the dollar threshold provided in 313.8 subdivision 2 unless the construction project has been approved 313.9 through the moratorium exception process under section 144A.073. 313.10 The property-related payment rate of the facility placing 313.11 beds on layaway status must be adjusted by the incremental 313.12 change in its rental per diem after recalculating the rental per 313.13 diem as provided in section 256B.431, subdivision 3a, paragraph 313.14 (c). The property-related payment rate for the facility 313.15 relicensing and recertifying beds from layaway status must be 313.16 adjusted by the incremental change in its rental per diem after 313.17 recalculating its rental per diem using the number of beds after 313.18 the relicensing to establish the facility's capacity day 313.19 divisor, which shall be effective the first day of the month 313.20 following the month in which the relicensing and recertification 313.21 became effective. Any beds remaining on layaway status more 313.22 than five years after the date the layaway status became 313.23 effective must be removed from layaway status and immediately 313.24 delicensed and decertified; 313.25 (u) to license and certify beds that are moved within an 313.26 existing area of a facility or to a newly constructed addition 313.27 which is built for the purpose of eliminating three- and 313.28 four-bed rooms and adding space for dining, lounge areas, 313.29 bathing rooms, and ancillary service areas in a nursing home 313.30 that, as of January 1, 1995, was located in Fridley and had a 313.31 licensed capacity of 129 beds; 313.32 (v) to relocate 36 beds in Crow Wing county and four beds 313.33 from Hennepin county to a 160-bed facility in Crow Wing county, 313.34 provided all the affected beds are under common ownership; 313.35 (w) to license and certify a total replacement project of 313.36 up to 49 beds located in Norman county that are relocated from a 314.1 nursing home destroyed by flood and whose residents were 314.2 relocated to other nursing homes. The operating cost payment 314.3 rates for the new nursing facility shall be determined based on 314.4 the interim and settle-up payment provisions of Minnesota Rules, 314.5 part 9549.0057, and the reimbursement provisions of section 314.6 256B.431, except that subdivision 26, paragraphs (a) and (b), 314.7 shall not apply until the second rate year after the settle-up 314.8 cost report is filed. Property-related reimbursement rates 314.9 shall be determined under section 256B.431, taking into account 314.10 any federal or state flood-related loans or grants provided to 314.11 the facility; 314.12 (x) to license and certify a total replacement project of 314.13 up to 129 beds located in Polk county that are relocated from a 314.14 nursing home destroyed by flood and whose residents were 314.15 relocated to other nursing homes. The operating cost payment 314.16 rates for the new nursing facility shall be determined based on 314.17 the interim and settle-up payment provisions of Minnesota Rules, 314.18 part 9549.0057, and the reimbursement provisions of section 314.19 256B.431, except that subdivision 26, paragraphs (a) and (b), 314.20 shall not apply until the second rate year after the settle-up 314.21 cost report is filed. Property-related reimbursement rates 314.22 shall be determined under section 256B.431, taking into account 314.23 any federal or state flood-related loans or grants provided to 314.24 the facility; 314.25 (y) to license and certify beds in a renovation and 314.26 remodeling project to convert 13 three-bed wards into 13 two-bed 314.27 rooms and 13 single-bed rooms, expand space, and add 314.28 improvements in a nursing home that, as of January 1, 1994, met 314.29 the following conditions: the nursing home was located in 314.30 Ramsey county, was not owned by a hospital corporation, had a 314.31 licensed capacity of 64 beds, and had been ranked among the top 314.32 15 applicants by the 1993 moratorium exceptions advisory review 314.33 panel. The total project construction cost estimate for this 314.34 project must not exceed the cost estimate submitted in 314.35 connection with the 1993 moratorium exception process; 314.36 (z) to license and certify up to 150 nursing home beds to 315.1 replace an existing 285 bed nursing facility located in St. 315.2 Paul. The replacement project shall include both the renovation 315.3 of existing buildings and the construction of new facilities at 315.4 the existing site. The reduction in the licensed capacity of 315.5 the existing facility shall occur during the construction 315.6 project as beds are taken out of service due to the construction 315.7 process. Prior to the start of the construction process, the 315.8 facility shall provide written information to the commissioner 315.9 of health describing the process for bed reduction, plans for 315.10 the relocation of residents, and the estimated construction 315.11 schedule. The relocation of residents shall be in accordance 315.12 with the provisions of law and rule; 315.13 (aa) to allow the commissioner of human services to license 315.14 an additional 36 beds to provide residential services for the 315.15 physically handicapped under Minnesota Rules, parts 9570.2000 to 315.16 9570.3400, in a 198-bed nursing home located in Red Wing, 315.17 provided that the total number of licensed and certified beds at 315.18 the facility does not increase; 315.19 (bb) to license and certify a new facility in St. Louis 315.20 county with 44 beds constructed to replace an existing facility 315.21 in St. Louis county with 31 beds, which has resident rooms on 315.22 two separate floors and an antiquated elevator that creates 315.23 safety concerns for residents and prevents nonambulatory 315.24 residents from residing on the second floor. The project shall 315.25 include the elimination of three- and four-bed rooms; 315.26 (cc) to license and certify four beds in a 16-bed certified 315.27 boarding care home in Minneapolis to replace beds that were 315.28 voluntarily delicensed and decertified on or before March 31, 315.29 1992. The licensure and certification is conditional upon the 315.30 facility periodically assessing and adjusting its resident mix 315.31 and other factors which may contribute to a potential 315.32 institution for mental disease declaration. The commissioner of 315.33 human services shall retain the authority to audit the facility 315.34 at any time and shall require the facility to comply with any 315.35 requirements necessary to prevent an institution for mental 315.36 disease declaration, including delicensure and decertification 316.1 of beds, if necessary;or316.2 (dd) to license and certify 72 beds in an existing facility 316.3 in Mille Lacs county with 80 beds as part of a renovation 316.4 project. The renovation must include construction of an 316.5 addition to accommodate ten residents with beginning and 316.6 midstage dementia in a self-contained living unit; creation of 316.7 three resident households where dining, activities, and support 316.8 spaces are located near resident living quarters; designation of 316.9 four beds for rehabilitation in a self-contained area; 316.10 designation of 30 private rooms; and other improvements.; 316.11 (ee) to license and certify beds in a facility that has 316.12 undergone replacement or remodeling as part of a planned closure 316.13 under section 256B.437; 316.14 (ff) to license and certify a total replacement project of 316.15 up to 124 beds located in Wilkin county that are in need of 316.16 relocation from a nursing home significantly damaged by flood. 316.17 The operating cost payment rates for the new nursing facility 316.18 shall be determined based on the interim and settle-up payment 316.19 provisions of Minnesota Rules, part 9549.0057, and the 316.20 reimbursement provisions of section 256B.431, except that 316.21 section 256B.431, subdivision 26, paragraphs (a) and (b), shall 316.22 not apply until the second rate year after the settle-up cost 316.23 report is filed. Property-related reimbursement rates shall be 316.24 determined under section 256B.431, taking into account any 316.25 federal or state flood-related loans or grants provided to the 316.26 facility; 316.27 (gg) to allow the commissioner of human services to license 316.28 an additional nine beds to provide residential services for the 316.29 physically handicapped under Minnesota Rules, parts 9570.2000 to 316.30 9570.3400, in a 240-bed nursing home located in Duluth, provided 316.31 that the total number of licensed and certified beds at the 316.32 facility does not increase; 316.33 (hh) to license and certify up to 120 new nursing facility 316.34 beds to replace beds in a facility in Anoka county, which was 316.35 licensed for 98 beds as of July 1, 2000, provided the new 316.36 facility is located within four miles of the existing facility 317.1 and is in Anoka county. Operating and property rates shall be 317.2 determined and allowed under section 256B.431 and Minnesota 317.3 Rules, parts 9549.0010 to 9549.0080, or section 256B.434 or 317.4 256B.435. The provisions of section 256B.431, subdivision 26, 317.5 paragraphs (a) and (b), do not apply until the second rate year 317.6 following settle-up; or 317.7 (ii) to transfer up to 98 beds of a 129-licensed bed 317.8 facility located in Anoka county that, as of March 25, 2001, is 317.9 in the active process of closing, to a 122-licensed bed 317.10 nonprofit nursing facility located in the city of Columbia 317.11 Heights or its affiliate. The transfer is effective when the 317.12 receiving facility notifies the commissioner in writing of the 317.13 number of beds accepted. The commissioner shall place all 317.14 transferred beds on layaway status held in the name of the 317.15 receiving facility. The layaway adjustment provisions of 317.16 section 256B.431, subdivision 30, do not apply to this layaway. 317.17 The receiving facility may only remove the beds from layaway for 317.18 recertification and relicensure at the receiving facility's 317.19 current site, or at a newly constructed facility located in 317.20 Anoka county. The receiving facility must receive statutory 317.21 authorization before removing these beds from layaway status. 317.22 Sec. 7. Minnesota Statutes 2000, section 144A.073, 317.23 subdivision 2, as amended by Laws 2001, chapter 161, section 22, 317.24 is amended to read: 317.25 Subd. 2. [REQUEST FOR PROPOSALS.] At the authorization by 317.26 the legislature of additional medical assistance expenditures 317.27 for exceptions to the moratorium on nursing homes, the 317.28 commissioner shall publish in the State Register a request for 317.29 proposals for nursing home projects to be licensed or certified 317.30 under section 144A.071, subdivision 4a, clause (c). The public 317.31 notice of this funding and the request for proposals must 317.32 specify how the approval criteria will be prioritized by the 317.33 commissioner. The notice must describe the information that 317.34 must accompany a request and state that proposals must be 317.35 submitted to the commissioner within 90 days of the date of 317.36 publication. The notice must include the amount of the 318.1 legislative appropriation available for the additional costs to 318.2 the medical assistance program of projects approved under this 318.3 section. If no money is appropriated for a year, the 318.4 commissioner shall publish a notice to that effect, and no 318.5 proposals shall be requested. If money is appropriated, the 318.6 commissioner shall initiate the application and review process 318.7 described in this section at least twice each biennium and up to 318.8 four times each biennium, according to dates established by 318.9 rule. Authorized funds shall be allocated proportionally to the 318.10 number of processes. Funds not encumbered by an earlier process 318.11 within a biennium shall carry forward to subsequent iterations 318.12 of the process. Authorization for expenditures does not carry 318.13 forward into the following biennium. To be considered for 318.14 approval, a proposal must include the following information: 318.15 (1) whether the request is for renovation, replacement, 318.16 upgrading, conversion, or relocation; 318.17 (2) a description of the problem the project is designed to 318.18 address; 318.19 (3) a description of the proposed project; 318.20 (4) an analysis of projected costs of the nursing facility 318.21 proposal, which are not required to exceed the cost threshold 318.22 referred to in section 144A.071, subdivision 1, to be considered 318.23 under this section, including initial construction and 318.24 remodeling costs; site preparation costs; technology costs; 318.25 financing costs, including the current estimated long-term 318.26 financing costs of the proposal, which consists of estimates of 318.27 the amount and sources of money, reserves if required under the 318.28 proposed funding mechanism, annual payments schedule, interest 318.29 rates, length of term, closing costs and fees, insurance costs, 318.30 and any completed marketing study or underwriting review; and 318.31 estimated operating costs during the first two years after 318.32 completion of the project; 318.33 (5) for proposals involving replacement of all or part of a 318.34 facility, the proposed location of the replacement facility and 318.35 an estimate of the cost of addressing the problem through 318.36 renovation; 319.1 (6) for proposals involving renovation, an estimate of the 319.2 cost of addressing the problem through replacement; 319.3 (7) the proposed timetable for commencing construction and 319.4 completing the project; 319.5 (8) a statement of any licensure or certification issues, 319.6 such as certification survey deficiencies; 319.7 (9) the proposed relocation plan for current residents if 319.8 beds are to be closed so that the department of human services 319.9 can estimate the total costs of a proposal; and 319.10 (10) other information required by permanent rule of the 319.11 commissioner of health in accordance with subdivisions 4 and 8. 319.12 Sec. 8. Minnesota Statutes 2000, section 144A.073, 319.13 subdivision 4, is amended to read: 319.14 Subd. 4. [CRITERIA FOR REVIEW.] The following criteria 319.15 shall be used in a consistent manner to compare, evaluate, and 319.16 rank all proposals submitted. Except for the criteria specified 319.17 in clause (3), the application of criteria listed under this 319.18 subdivision shall not reflect any distinction based on the 319.19 geographic location of the proposed project: 319.20 (1) the extent to which the proposal furthers state 319.21 long-term care goals,including the goals stated in section319.22144A.31, andincluding the goal of enhancing the availability 319.23 and use of alternative care services and the goal of reducing 319.24 the number of long-term care resident rooms with more than two 319.25 beds; 319.26 (2) the proposal's long-term effects on state costs 319.27 including the cost estimate of the project according to section 319.28 144A.071, subdivision 5a; 319.29 (3) the extent to which the proposal promotes equitable 319.30 access to long-term care services in nursing homes through 319.31 redistribution of the nursing home bed supply, as measured by 319.32 the number of beds relative to the population 85 or older, 319.33 projected to the year 2000 by the state demographer, and 319.34 according to items (i) to (iv): 319.35 (i) reduce beds in counties where the supply is high, 319.36 relative to the statewide mean, and increase beds in counties 320.1 where the supply is low, relative to the statewide mean; 320.2 (ii) adjust the bed supply so as to create the greatest 320.3 benefits in improving the distribution of beds; 320.4 (iii) adjust the existing bed supply in counties so that 320.5 the bed supply in a county moves toward the statewide mean; and 320.6 (iv) adjust the existing bed supply so that the 320.7 distribution of beds as projected for the year 2020 would be 320.8 consistent with projected need, based on the methodology 320.9 outlined in the interagency long-term care committee's1993320.10 nursing home bed distribution study; 320.11 (4) the extent to which the project improves conditions 320.12 that affect the health or safety of residents, such as narrow 320.13 corridors, narrow door frames, unenclosed fire exits, and wood 320.14 frame construction, and similar provisions contained in fire and 320.15 life safety codes and licensure and certification rules; 320.16 (5) the extent to which the project improves conditions 320.17 that affect the comfort or quality of life of residents in a 320.18 facility or the ability of the facility to provide efficient 320.19 care, such as a relatively high number of residents in a room; 320.20 inadequate lighting or ventilation; poor access to bathing or 320.21 toilet facilities; a lack of available ancillary space for 320.22 dining rooms, day rooms, or rooms used for other activities; 320.23 problems relating to heating, cooling, or energy efficiency; 320.24 inefficient location of nursing stations; narrow corridors; or 320.25 other provisions contained in the licensure and certification 320.26 rules; 320.27 (6) the extent to which the applicant demonstrates the 320.28 delivery of quality care, as defined in state and federal 320.29 statutes and rules, to residents as evidenced by the two most 320.30 recent state agency certification surveys and the applicants' 320.31 response to those surveys; 320.32 (7) the extent to which the project removes the need for 320.33 waivers or variances previously granted by either the licensing 320.34 agency, certifying agency, fire marshal, or local government 320.35 entity;and320.36 (8) the extent to which the project increases the number of 321.1 private or single bed rooms; and 321.2 (9) other factors that may be developed in permanent rule 321.3 by the commissioner of health that evaluate and assess how the 321.4 proposed project will further promote or protect the health, 321.5 safety, comfort, treatment, or well-being of the facility's 321.6 residents. 321.7 Sec. 9. [144A.161] [NURSING FACILITY RESIDENT RELOCATION.] 321.8 Subdivision 1. [DEFINITIONS.] The definitions in this 321.9 subdivision apply to subdivisions 2 to 10. 321.10 (a) "Closure" means the cessation of operations of a 321.11 facility and the delicensure and decertification of all beds 321.12 within the facility. 321.13 (b) "Curtailment," "reduction," or "change" refers to any 321.14 change in operations which would result in or encourage the 321.15 relocation of residents. 321.16 (c) "Facility" means a nursing home licensed pursuant to 321.17 this chapter, or a certified boarding care home licensed 321.18 pursuant to sections 144.50 to 144.56. 321.19 (d) "Licensee" means the owner of the facility or the 321.20 owner's designee or the commissioner of health for a facility in 321.21 receivership. 321.22 (e) "Local agency" means the county or multicounty social 321.23 service agency authorized under sections 393.01 and 393.07, as 321.24 the agency responsible for providing social services for the 321.25 county in which the nursing home is located. 321.26 (f) "Plan" means a process developed under subdivision 3, 321.27 paragraph (b), for the closure, curtailment, reduction, or 321.28 change in operations in a facility and the subsequent relocation 321.29 of residents. 321.30 (g) "Relocation" means the discharge of a resident and 321.31 movement of the resident to another facility or living 321.32 arrangement as a result of the closing, curtailment, reduction, 321.33 or change in operations of a nursing home or boarding care home. 321.34 Subd. 2. [INITIAL NOTICE FROM LICENSEE.] (a) A licensee 321.35 shall notify the following parties in writing when there is an 321.36 intent to close or curtail, reduce, or change operations which 322.1 would result in or encourage the relocation of residents: 322.2 (1) the commissioner of health; 322.3 (2) the commissioner of human services; 322.4 (3) the local agency; 322.5 (4) the office of the ombudsman for older Minnesotans; and 322.6 (5) the office of the ombudsman for mental health and 322.7 mental retardation. 322.8 (b) The written notice shall include the names, telephone 322.9 numbers, facsimile numbers, and e-mail addresses of the persons 322.10 in the facility responsible for coordinating the licensee's 322.11 efforts in the planning process, and the number of residents 322.12 potentially affected by the closure or curtailment, reduction, 322.13 or change in operations. 322.14 Subd. 3. [PLANNING PROCESS.] (a) The local agency shall, 322.15 within five working days of receiving initial notice of the 322.16 licensee's intent to close or curtail, reduce, or change 322.17 operations, provide the licensee and all parties identified in 322.18 subdivision 2, paragraph (a), with the names, telephone numbers, 322.19 facsimile numbers, and e-mail addresses of those persons 322.20 responsible for coordinating local agency efforts in the 322.21 planning process. 322.22 (b) Within ten working days of receipt of the notice under 322.23 paragraph (a), the local agency and licensee shall meet to 322.24 develop the relocation plan. The local agency shall inform the 322.25 departments of health and human services, the office of the 322.26 ombudsman for older Minnesotans, and the office of the ombudsman 322.27 for mental health and mental retardation of the date, time, and 322.28 location of the meeting so that their representatives may 322.29 attend. The relocation plan must be completed within 45 days of 322.30 receipt of the initial notice. However, the plan may be 322.31 finalized on an earlier schedule agreed to by all parties. To 322.32 the extent practicable, consistent with requirements to protect 322.33 the safety and health of residents, the commissioner may 322.34 authorize the planning process under this subdivision to occur 322.35 concurrent with the 60-day notice required under subdivision 322.36 5a. The plan shall: 323.1 (1) identify the expected date of closure, curtailment, 323.2 reduction, or change in operations; 323.3 (2) outline the process for public notification of the 323.4 closure, curtailment, reduction, or change in operations; 323.5 (3) identify efforts that will be made to include other 323.6 stakeholders in the relocation process; 323.7 (4) outline the process to ensure 60-day advance written 323.8 notice to residents, family members, and designated 323.9 representatives; 323.10 (5) present an aggregate description of the resident 323.11 population remaining to be relocated and the population's needs; 323.12 (6) outline the individual resident assessment process to 323.13 be utilized; 323.14 (7) identify an inventory of available relocation options, 323.15 including home and community-based services; 323.16 (8) identify a timeline for submission of the list 323.17 identified in subdivision 5c, paragraph (b); and 323.18 (9) identify a schedule for the timely completion of each 323.19 element of the plan. 323.20 (c) All parties to the plan shall refrain from any public 323.21 notification of the intent to close or curtail, reduce, or 323.22 change operations until a relocation plan has been established. 323.23 If the planning process occurs concurrently with the 60-day 323.24 notice period, this requirement does not apply once 60-day 323.25 notice is given. 323.26 Subd. 4. [RESPONSIBILITIES OF LICENSEE FOR RESIDENT 323.27 RELOCATIONS.] The licensee shall provide for the safe, orderly, 323.28 and appropriate relocation of residents. The licensee and 323.29 facility staff shall cooperate with representatives from the 323.30 local agency, the department of health, the department of human 323.31 services, the office of ombudsman for older Minnesotans, and 323.32 ombudsman for mental health and mental retardation in planning 323.33 for and implementing the relocation of residents. 323.34 Subd. 5. [LICENSEE RESPONSIBILITIES PRIOR TO 323.35 RELOCATION.] (a) The licensee shall establish an 323.36 interdisciplinary team responsible for coordinating and 324.1 implementing the plan. The interdisciplinary team shall include 324.2 representatives from the local agency, the office of ombudsman 324.3 for older Minnesotans, facility staff that provide direct care 324.4 services to the residents, and facility administration. 324.5 (b) The licensee shall provide a list to the local agency 324.6 that includes the following information on each resident to be 324.7 relocated: 324.8 (1) name; 324.9 (2) date of birth; 324.10 (3) social security number; 324.11 (4) medical assistance identification number; 324.12 (5) all diagnoses; and 324.13 (6) the name and contact information for the resident's 324.14 family or other designated representative. 324.15 (c) The licensee shall consult with the local agency on the 324.16 availability and development of available resources and on the 324.17 resident relocation process. 324.18 Subd. 5a. [LICENSEE RESPONSIBILITIES TO PROVIDE 324.19 NOTICE.] At least 60 days before the proposed date of closing, 324.20 curtailment, reduction, or change in operations as agreed to in 324.21 the plan, the licensee shall send a written notice of closure or 324.22 curtailment, reduction, or change in operations to each resident 324.23 being relocated, the resident's family member or designated 324.24 representative, and the resident's attending physician. The 324.25 notice must include the following: 324.26 (1) the date of the proposed closure, curtailment, 324.27 reduction, or change in operations; 324.28 (2) the name, address, telephone number, facsimile number, 324.29 and e-mail address of the individual or individuals in the 324.30 facility responsible for providing assistance and information; 324.31 (3) notification of upcoming meetings for residents, 324.32 families and designated representatives, and resident and family 324.33 councils to discuss the relocation of residents; 324.34 (4) the name, address, and telephone number of the local 324.35 agency contact person; and 324.36 (5) the name, address, and telephone number of the office 325.1 of ombudsman for older Minnesotans and the ombudsman for mental 325.2 health and mental retardation. 325.3 The notice must comply with all applicable state and 325.4 federal requirements for notice of transfer or discharge of 325.5 nursing home residents. 325.6 Subd. 5b. [LICENSEE RESPONSIBILITY REGARDING MEDICAL 325.7 INFORMATION.] The licensee shall request the attending physician 325.8 provide or arrange for the release of medical information needed 325.9 to update resident medical records and prepare all required 325.10 forms and discharge summaries. 325.11 Subd. 5c. [LICENSEE RESPONSIBILITY REGARDING PLACEMENT 325.12 INFORMATION.] (a) The licensee shall provide sufficient 325.13 preparation to residents to ensure safe, orderly, and 325.14 appropriate discharge and relocation. The licensee shall assist 325.15 residents in finding placements that respond to personal 325.16 preferences, such as desired geographic location. 325.17 (b) The licensee shall prepare a resource list with several 325.18 relocation options for each resident. The list must contain the 325.19 following information for each relocation option, when 325.20 applicable: 325.21 (1) the name, address, and telephone and facsimile numbers 325.22 of each facility with appropriate, available beds or services; 325.23 (2) the certification level of the available beds; 325.24 (3) the types of services available; and 325.25 (4) the name, address, and telephone and facsimile numbers 325.26 of appropriate available home and community-based placements, 325.27 services, and settings or other options for individuals with 325.28 special needs. 325.29 The list shall be made available to residents and their families 325.30 or designated representatives, and upon request to the office of 325.31 ombudsman for older Minnesotans, the ombudsman for mental health 325.32 and mental retardation, and the local agency. 325.33 (c) The Senior LinkAge line may make available via a Web 325.34 site the name, address, and telephone and facsimile numbers of 325.35 each facility with available beds, the certification level of 325.36 the available beds, the types of services available, and the 326.1 number of beds that are available as updated daily by the listed 326.2 facilities. The licensee must provide residents, their families 326.3 or designated representatives, the office of the ombudsman for 326.4 older Minnesotans, the office of the ombudsman for mental health 326.5 and mental retardation, and the local agency with the toll-free 326.6 number and Web site address for the Senior LinkAge line. 326.7 Subd. 5d. [LICENSEE RESPONSIBILITY TO MEET WITH RESIDENTS 326.8 AND FAMILIES.] Following the establishment of the plan, the 326.9 licensee shall conduct meetings with residents, families and 326.10 designated representatives, and resident and family councils to 326.11 notify them of the process for resident relocation. 326.12 Representatives from the local county social services agency, 326.13 the office of ombudsman for older Minnesotans, the ombudsman for 326.14 mental health and mental retardation, the commissioner of 326.15 health, and the commissioner of human services shall receive 326.16 advance notice of the meetings. 326.17 Subd. 5e. [LICENSEE RESPONSIBILITY FOR SITE VISITS.] The 326.18 licensee shall assist residents desiring to make site visits to 326.19 facilities with available beds or other appropriate living 326.20 options to which the resident may relocate, unless it is 326.21 medically inadvisable, as documented by the attending physician 326.22 in the resident's care record. The licensee shall provide or 326.23 arrange transportation for site visits to facilities or other 326.24 living options within a 50-mile radius to which the resident may 326.25 relocate, or within a larger radius if no suitable options are 326.26 available within 50 miles. The licensee shall provide available 326.27 written materials to residents on a potential new facility or 326.28 living option. 326.29 Subd. 5f. [LICENSEE RESPONSIBILITY FOR PERSONAL PROPERTY, 326.30 PERSONAL FUNDS, AND TELEPHONE SERVICE.] (a) The licensee shall 326.31 complete an inventory of resident personal possessions and 326.32 provide a copy of the final inventory to the resident and the 326.33 resident's designated representative prior to relocation. The 326.34 licensee shall be responsible for the transfer of the resident's 326.35 possessions for all relocations within a 50-mile radius of the 326.36 facility, or within a larger radius if no suitable options are 327.1 available within 50 miles. The licensee shall complete the 327.2 transfer of resident possessions in a timely manner, but no 327.3 later than the date of the actual physical relocation of the 327.4 resident. 327.5 (b) The licensee shall complete a final accounting of 327.6 personal funds held in trust by the facility and provide a copy 327.7 of this accounting to the resident and the resident's family or 327.8 the resident's designated representative. The licensee shall be 327.9 responsible for the transfer of all personal funds held in trust 327.10 by the facility. The licensee shall complete the transfer of 327.11 all personal funds in a timely manner. 327.12 (c) The licensee shall assist residents with the transfer 327.13 and reconnection of service for telephones or, for residents who 327.14 are deaf or blind, other personal communication devices or 327.15 services. The licensee shall pay the costs associated with 327.16 reestablishing service for telephones or other personal 327.17 communication devices or services, such as connection fees or 327.18 other one-time charges. The transfer or reconnection of 327.19 personal communication devices or services shall be completed in 327.20 a timely manner. 327.21 Subd. 5g. [LICENSEE RESPONSIBILITIES FOR FINAL NOTICE AND 327.22 RECORDS TRANSFER.] (a) The licensee shall provide the resident, 327.23 the resident's family or designated representative, and the 327.24 resident's attending physician final written notice prior to the 327.25 relocation of the resident. The notice must: 327.26 (1) be provided seven days prior to the actual relocation, 327.27 unless the resident agrees to waive the right to advance notice; 327.28 and 327.29 (2) identify the date of the anticipated relocation and the 327.30 destination to which the resident is being relocated. 327.31 (b) The licensee shall provide the receiving facility or 327.32 other health, housing, or care entity with complete and accurate 327.33 resident records including information on family members, 327.34 designated representatives, guardians, social service 327.35 caseworkers, or other contact information. These records must 327.36 also include all information necessary to provide appropriate 328.1 medical care and social services. This includes, but is not 328.2 limited to, information on preadmission screening, Level I and 328.3 Level II screening, minimum data set (MDS), and all other 328.4 assessments, resident diagnoses, social, behavioral, and 328.5 medication information. 328.6 (c) For residents with special care needs, the licensee 328.7 shall consult with the receiving facility or other placement 328.8 entity and provide staff training or other preparation as needed 328.9 to assist in providing for the special needs. 328.10 Subd. 6. [RESPONSIBILITIES OF THE LICENSEE DURING 328.11 RELOCATION.] (a) The licensee shall make arrangements or provide 328.12 for the transportation of residents to the new facility or 328.13 placement within a 50-mile radius, or within a larger radius if 328.14 no suitable options are available within 50 miles. The licensee 328.15 shall provide a staff person to accompany the resident during 328.16 transportation, upon request of the resident, the resident's 328.17 family, or designated representative. The discharge and 328.18 relocation of residents must comply with all applicable state 328.19 and federal requirements and must be conducted in a safe, 328.20 orderly, and appropriate manner. The licensee must ensure that 328.21 there is no disruption in providing meals, medications, or 328.22 treatments of a resident during the relocation process. 328.23 (b) Beginning the week following development of the initial 328.24 relocation plan, the licensee shall submit biweekly status 328.25 reports to the commissioners of health and human services or 328.26 their designees and to the local agency. The initial status 328.27 report must identify: 328.28 (1) the relocation plan developed; 328.29 (2) the interdisciplinary team members; and 328.30 (3) the number of residents to be relocated. 328.31 (c) Subsequent status reports must identify: 328.32 (1) any modifications to the plan; 328.33 (2) any change of interdisciplinary team members; 328.34 (3) the number of residents relocated; 328.35 (4) the destination to which residents have been relocated; 328.36 (5) the number of residents remaining to be relocated; and 329.1 (6) issues or problems encountered during the process and 329.2 resolution of these issues. 329.3 Subd. 7. [RESPONSIBILITIES OF THE LICENSEE FOLLOWING 329.4 RELOCATION.] The licensee shall retain or make arrangements for 329.5 the retention of all remaining resident records for the period 329.6 required by law. The licensee shall provide the department of 329.7 health access to these records. The licensee shall notify the 329.8 department of health of the location of any resident records 329.9 that have not been transferred to the new facility or other 329.10 health care entity. 329.11 Subd. 8. [RESPONSIBILITIES OF THE LOCAL AGENCY.] (a) The 329.12 local agency shall participate in the meeting as outlined in 329.13 subdivision 3, paragraph (b), to develop a relocation plan. 329.14 (b) The local agency shall designate a representative to 329.15 the interdisciplinary team established by the licensee 329.16 responsible for coordinating the relocation efforts. 329.17 (c) The local agency shall serve as a resource in the 329.18 relocation process. 329.19 (d) Concurrent with the notice sent to residents from the 329.20 licensee as provided in subdivision 5a, the local agency shall 329.21 provide written notice to residents, family, or designated 329.22 representatives describing: 329.23 (1) the county's role in the relocation process and in the 329.24 follow-up to relocations; 329.25 (2) a local agency contact name, address, and telephone 329.26 number; and 329.27 (3) the name, address, and telephone number of the office 329.28 of ombudsman for older Minnesotans and the ombudsman for mental 329.29 health and mental retardation. 329.30 (e) The local agency designee shall meet with appropriate 329.31 facility staff to coordinate any assistance in the relocation 329.32 process. This coordination shall include participating in group 329.33 meetings with residents, families, and designated 329.34 representatives to explain the relocation process. 329.35 (f) The local agency shall monitor compliance with all 329.36 components of the plan. If the licensee is not in compliance, 330.1 the local agency shall notify the commissioners of the 330.2 department of health and the department of human services. 330.3 (g) Except as requested by the resident, family member, or 330.4 designated representative and within the parameters of the 330.5 Vulnerable Adults Act, the local agency may halt a relocation 330.6 that it deems inappropriate or dangerous to the health or safety 330.7 of a resident. The local agency shall pursue remedies to 330.8 protect the resident during the relocation process, including, 330.9 but not limited to, assisting the resident with filing an appeal 330.10 of transfer or discharge, notification of all appropriate 330.11 licensing boards and agencies, and other remedies available to 330.12 the county under section 626.557, subdivision 10. 330.13 (h) A member of the local agency staff shall visit 330.14 residents relocated within 100 miles of the county within 30 330.15 days after the relocation. Local agency staff shall interview 330.16 the resident and family or designated representative, observe 330.17 the resident on site, and review and discuss pertinent medical 330.18 or social records with appropriate facility staff to: 330.19 (1) assess the adjustment of the resident to the new 330.20 placement; 330.21 (2) recommend services or methods to meet any special needs 330.22 of the resident; and 330.23 (3) identify residents at risk. 330.24 (i) The local agency may conduct subsequent follow-up 330.25 visits in cases where the adjustment of the resident to the new 330.26 placement is in question. 330.27 (j) Within 60 days of the completion of the follow-up 330.28 visits, the local agency shall submit a written summary of the 330.29 follow-up work to the department of health and the department of 330.30 human services in a manner approved by the commissioners. 330.31 (k) The local agency shall submit to the department of 330.32 health and the department of human services a report of any 330.33 issues that may require further review or monitoring. 330.34 (l) The local agency shall be responsible for the safe and 330.35 orderly relocation of residents in cases where an emergent need 330.36 arises or when the licensee has abrogated its responsibilities 331.1 under the plan. 331.2 Subd. 9. [PENALTIES.] Upon the recommendation of the 331.3 commissioner of health, the commissioner of human services may 331.4 eliminate a closure rate adjustment under subdivision 10 for 331.5 violations of this section. 331.6 Subd. 10. [FACILITY CLOSURE RATE ADJUSTMENT.] Upon the 331.7 request of a closing facility, the commissioner of human 331.8 services must allow the facility a closure rate adjustment equal 331.9 to a 50 percent payment rate increase to reimburse relocation 331.10 costs or other costs related to facility closure. This rate 331.11 increase is effective on the date the facility's occupancy 331.12 decreases to 90 percent of capacity days after the written 331.13 notice of closure is distributed under subdivision 5 and shall 331.14 remain in effect for a period of up to 60 days. The 331.15 commissioner shall delay the implementation of rate adjustments 331.16 under section 256B.437, subdivisions 3, paragraph (b), and 6, 331.17 paragraph (a), to offset the cost of this rate adjustment. 331.18 Subd. 11. [COUNTY COSTS.] The commissioner of human 331.19 services shall allocate up to $450 in total state and federal 331.20 funds per nursing facility bed that is closing, within the 331.21 limits of the appropriation specified for this purpose, to be 331.22 used for relocation costs incurred by counties for resident 331.23 relocation under this section or planned closures under section 331.24 256B.437. To be eligible for this allocation, a county in which 331.25 a nursing facility closes must provide to the commissioner a 331.26 detailed statement in a form provided by the commissioner of 331.27 additional costs, not to exceed $450 in total state and federal 331.28 funds per bed closed, that are directly incurred related to the 331.29 county's role in the relocation process. 331.30 Sec. 10. [144A.162] [TRANSFER OF RESIDENTS WITHIN 331.31 FACILITIES.] 331.32 The licensee shall provide for the safe, orderly, and 331.33 appropriate transfer of residents within the facility. In 331.34 situations where there is a curtailment, reduction, capital 331.35 improvement, or change in operations within a facility, the 331.36 licensee shall minimize the number of intra-facility transfers 332.1 needed to complete the project or change in operations, consider 332.2 individual resident needs and preferences, and provide 332.3 reasonable accommodation for individual resident requests 332.4 regarding their room transfer. The licensee shall provide 332.5 notice to the office of ombudsman for older Minnesotans and, 332.6 when appropriate, the office of ombudsman for mental health and 332.7 mental retardation, in advance of any notice to residents and 332.8 family, when all of the following circumstances apply: 332.9 (1) the transfers of residents within the facility are 332.10 being proposed due to curtailment, reduction, capital 332.11 improvements or change in operations; 332.12 (2) the transfers of residents within the facility are not 332.13 temporary moves to accommodate physical plan upgrades or 332.14 renovation; and 332.15 (3) the transfers involve multiple residents being moved 332.16 simultaneously. 332.17 Sec. 11. [144A.1888] [REUSE OF FACILITIES.] 332.18 Notwithstanding any local ordinance related to development, 332.19 planning, or zoning to the contrary, the conversion or reuse of 332.20 a nursing home that closes or that curtails, reduces, or changes 332.21 operations shall be considered a conforming use permitted under 332.22 local law, provided that the facility is converted to another 332.23 long-term care service approved by a regional planning group 332.24 under section 256B.437 that serves a smaller number of persons 332.25 than the number of persons served before the closure or 332.26 curtailment, reduction, or change in operations. 332.27 Sec. 12. [144A.36] [TRANSITION PLANNING GRANTS.] 332.28 Subdivision 1. [DEFINITIONS.] "Eligible nursing home" 332.29 means any nursing home licensed under sections 144A.01 to 332.30 144A.16 and certified by the appropriate authority under United 332.31 States Code, title 42, sections 1396-1396p, to participate as a 332.32 vendor in the medical assistance program established under 332.33 chapter 256B. 332.34 Subd. 2. [GRANTS AUTHORIZED.] (a) The commissioner shall 332.35 establish a program of transition planning grants to assist 332.36 eligible nursing homes in implementing the provisions in 333.1 paragraphs (b) and (c). 333.2 (b) Transition planning grants may be used by nursing homes 333.3 to develop strategic plans which identify the appropriate 333.4 institutional and noninstitutional settings necessary to meet 333.5 the older adult service needs of the community. 333.6 (c) At a minimum, a strategic plan must consist of: 333.7 (1) a needs assessment to determine what older adult 333.8 services are needed and desired by the community; 333.9 (2) an assessment of the appropriate settings in which to 333.10 provide needed older adult services; 333.11 (3) an assessment identifying currently available services 333.12 and their settings in the community; and 333.13 (4) a transition plan to achieve the needed outcome 333.14 identified by the assessment. 333.15 Subd. 3. [ALLOCATION OF GRANTS.] (a) Eligible nursing 333.16 homes must apply to the commissioner no later than September 1 333.17 of each fiscal year for grants awarded in that fiscal year. A 333.18 grant shall be awarded upon signing of a grant contract. 333.19 (b) The commissioner must make a final decision on the 333.20 funding of each application within 60 days of the deadline for 333.21 receiving applications. 333.22 Subd. 4. [EVALUATION.] The commissioner shall evaluate the 333.23 overall effectiveness of the grant program. The commissioner 333.24 may collect, from the nursing homes receiving grants, the 333.25 information necessary to evaluate the grant program. 333.26 Information related to the financial condition of individual 333.27 nursing homes shall be classified as nonpublic data. 333.28 Sec. 13. [144A.37] [ALTERNATIVE NURSING HOME SURVEY 333.29 PROCESS.] 333.30 Subdivision 1. [ALTERNATIVE NURSING HOME SURVEY 333.31 SCHEDULES.] (a) The commissioner of health shall implement 333.32 alternative procedures for the nursing home survey process as 333.33 authorized under this section. 333.34 (b) These alternative survey process procedures seek to: 333.35 (1) use department resources more effectively and efficiently to 333.36 target problem areas; (2) use other existing or new mechanisms 334.1 to provide objective assessments of quality and to measure 334.2 quality improvement; (3) provide for frequent collaborative 334.3 interaction of facility staff and surveyors rather than a 334.4 punitive approach; and (4) reward a nursing home that has 334.5 performed very well by extending intervals between full surveys. 334.6 (c) The commissioner shall pursue changes in federal law 334.7 necessary to accomplish this process and shall apply for any 334.8 necessary federal waivers or approval. If a federal waiver is 334.9 approved, the commissioner shall promptly submit, to the house 334.10 and senate committees with jurisdiction over health and human 334.11 services policy and finance, fiscal estimates for implementing 334.12 the alternative survey process waiver. The commissioner shall 334.13 also pursue any necessary federal law changes during the 107th 334.14 Congress. 334.15 (d) The alternative nursing home survey schedule and 334.16 related educational activities shall not be implemented until 334.17 funding is appropriated by the legislature. 334.18 Subd. 2. [SURVEY INTERVALS.] The commissioner of health 334.19 must extend the time period between standard surveys up to 30 334.20 months based on the criteria established in subdivision 4. In 334.21 using the alternative survey schedule, the requirement for the 334.22 statewide average to not exceed 12 months does not apply. 334.23 Subd. 3. [COMPLIANCE HISTORY.] The commissioner shall 334.24 develop a process for identifying the survey cycles for skilled 334.25 nursing facilities based upon the compliance history of the 334.26 facility. This process can use a range of months for survey 334.27 intervals. At a minimum, the process must be based on 334.28 information from the last two survey cycles and shall take into 334.29 consideration any deficiencies issued as the result of a survey 334.30 or a complaint investigation during the interval. A skilled 334.31 nursing facility with a finding of substandard quality of care 334.32 or a finding of immediate jeopardy is not entitled to a survey 334.33 interval greater than 12 months. The commissioner shall alter 334.34 the survey cycle for a specific skilled nursing facility based 334.35 on findings identified through the completion of a survey, a 334.36 monitoring visit, or a complaint investigation. The 335.1 commissioner must also take into consideration information other 335.2 than the facility's compliance history. 335.3 Subd. 4. [CRITERIA FOR SURVEY INTERVAL 335.4 CLASSIFICATION.] (a) The commissioner shall provide public 335.5 notice of the classification process and shall identify the 335.6 selected survey cycles for each skilled nursing facility. The 335.7 classification system must be based on an analysis of the 335.8 findings made during the past two standard survey intervals, but 335.9 it only takes one survey or complaint finding to modify the 335.10 interval. 335.11 (b) The commissioner shall also take into consideration 335.12 information obtained from residents and family members in each 335.13 skilled nursing facility and from other sources such as 335.14 employees and ombudsmen in determining the appropriate survey 335.15 intervals for facilities. 335.16 Subd. 5. [REQUIRED MONITORING.] (a) The commissioner shall 335.17 conduct at least one monitoring visit on an annual basis for 335.18 every skilled nursing facility which has been selected for a 335.19 survey cycle greater than 12 months. The commissioner shall 335.20 develop protocols for the monitoring visits which shall be less 335.21 extensive than the requirements for a standard survey. The 335.22 commissioner shall use the criteria in paragraph (b) to 335.23 determine whether additional monitoring visits to a facility 335.24 will be required. 335.25 (b) The criteria shall include, but not be limited to, the 335.26 following: 335.27 (1) changes in ownership, administration of the facility, 335.28 or direction of the facility's nursing service; 335.29 (2) changes in the facility's quality indicators which 335.30 might evidence a decline in the facility's quality of care; 335.31 (3) reductions in staffing or an increase in the 335.32 utilization of temporary nursing personnel; and 335.33 (4) complaint information or other information that 335.34 identifies potential concerns for the quality of the care and 335.35 services provided in the skilled nursing facility. 335.36 Subd. 6. [SURVEY REQUIREMENTS FOR FACILITIES NOT APPROVED 336.1 FOR EXTENDED SURVEY INTERVALS.] The commissioner shall establish 336.2 a process for surveying and monitoring of facilities which 336.3 require a survey interval of less than 15 months. This 336.4 information shall identify the steps that the commissioner must 336.5 take to monitor the facility in addition to the standard survey. 336.6 Subd. 7. [IMPACT ON SURVEY AGENCY'S BUDGET.] The 336.7 implementation of an alternative survey process for the state 336.8 must not result in any reduction of funding that would have been 336.9 provided to the state survey agency for survey and enforcement 336.10 activity based upon the completion of full standard surveys for 336.11 each skilled nursing facility in the state. 336.12 Subd. 8. [EDUCATIONAL ACTIVITIES.] The commissioner shall 336.13 expand the state survey agency's ability to conduct training and 336.14 educational efforts for skilled nursing facilities, residents 336.15 and family members, residents and family councils, long-term 336.16 care ombudsman programs, and the general public. 336.17 Subd. 9. [EVALUATION.] The commissioner shall develop a 336.18 process for the evaluation of the effectiveness of an 336.19 alternative survey process conducted under this section. 336.20 [EFFECTIVE DATE.] This section is effective the day 336.21 following final enactment. 336.22 Sec. 14. [144A.38] [INNOVATIONS IN QUALITY DEMONSTRATION 336.23 GRANTS.] 336.24 Subdivision 1. [PROGRAM ESTABLISHED.] The commissioner of 336.25 health and the commissioner of human services shall establish a 336.26 long-term care grant program that demonstrates best practices 336.27 and innovation for long-term care service delivery and housing. 336.28 The grants must fund demonstrations that create new means and 336.29 models for serving the elderly or demonstrate creativity in 336.30 service provision through the scope of their program or service. 336.31 Subd. 2. [ELIGIBILITY.] Grants may only be made to those 336.32 who provide direct service or housing to the elderly within the 336.33 state. Grants may only be made for projects that show 336.34 innovations and measurable improvement in resident care, quality 336.35 of life, use of technology, or customer satisfaction. 336.36 Subd. 3. [AWARDING OF GRANTS.] (a) Applications for grants 337.1 must be made to the commissioners on forms prescribed by the 337.2 commissioners. 337.3 (b) The commissioners shall review applications and award 337.4 grants based on the following criteria: 337.5 (1) improvement in direct care to residents; 337.6 (2) increase in efficiency through the use of technology; 337.7 (3) increase in quality of care through the use of 337.8 technology; 337.9 (4) increase in the access and delivery of service; 337.10 (5) enhancement of nursing staff training; 337.11 (6) the effectiveness of the project as a demonstration; 337.12 and 337.13 (7) the immediate transferability of the project to scale. 337.14 (c) In reviewing applications and awarding grants, the 337.15 commissioners shall consult with long-term care providers, 337.16 consumers of long-term care, long-term care researchers, and 337.17 staff of other state agencies. 337.18 (d) Grants for eligible projects may not exceed $100,000. 337.19 Sec. 15. Minnesota Statutes 2000, section 256B.431, 337.20 subdivision 2e, is amended to read: 337.21 Subd. 2e. [CONTRACTS FOR SERVICES FOR VENTILATOR-DEPENDENT 337.22 PERSONS.] The commissioner may contract with a nursing facility 337.23 eligible to receive medical assistance payments to provide 337.24 services to a ventilator-dependent person identified by the 337.25 commissioner according to criteria developed by the 337.26 commissioner, including: 337.27 (1) nursing facility care has been recommended for the 337.28 person by a preadmission screening team; 337.29 (2)the person has been assessed at case mix classification337.30K;337.31(3)the person has been hospitalizedfor at least six337.32monthsand no longer requires inpatient acute care hospital 337.33 services; and 337.34(4)(3) the commissioner has determined that necessary 337.35 services for the person cannot be provided under existing 337.36 nursing facility rates. 338.1 The commissioner may issue a request for proposals to 338.2 provide services to a ventilator-dependent person to nursing 338.3 facilities eligible to receive medical assistance payments and 338.4 shall select nursing facilities from among respondents according 338.5 to criteria developed by the commissioner, including: 338.6 (1) the cost-effectiveness and appropriateness of services; 338.7 (2) the nursing facility's compliance with federal and 338.8 state licensing and certification standards; and 338.9 (3) the proximity of the nursing facility to a 338.10 ventilator-dependent person identified by the commissioner who 338.11 requires nursing facility placement. 338.12 The commissioner may negotiate an adjustment to the 338.13 operating cost payment rate for a nursing facility selected by 338.14 the commissioner from among respondents to the request for 338.15 proposals. The negotiated adjustment must reflect only the 338.16 actual additional cost of meeting the specialized care needs of 338.17 a ventilator-dependent person identified by the commissioner for 338.18 whom necessary services cannot be provided under existing 338.19 nursing facility rates and which are not otherwise covered under 338.20 Minnesota Rules, parts 9549.0010 to 9549.0080 or 9505.0170 to 338.21 9505.0475. For persons who are initially admitted to a nursing 338.22 facility before July 1, 2001, and have their payment rate under 338.23 this subdivision negotiated after July 1, 2001, the negotiated 338.24 payment rate must not exceed 200 percent of the highest multiple 338.25 bedroom payment rate fora Minnesota nursingthe facility, as 338.26 initially established by the commissioner for the rate year for 338.27 case mix classification K. For persons initially admitted to a 338.28 nursing facility on or after July 1, 2001, the negotiated 338.29 payment rate must not exceed 300 percent of the facility's 338.30 multiple bedroom payment rate for case mix classification K. 338.31 The negotiated adjustment shall not affect the payment rate 338.32 charged to private paying residents under the provisions of 338.33 section 256B.48, subdivision 1. 338.34 Sec. 16. Minnesota Statutes 2000, section 256B.431, 338.35 subdivision 17, is amended to read: 338.36 Subd. 17. [SPECIAL PROVISIONS FOR MORATORIUM EXCEPTIONS.] 339.1 (a) Notwithstanding Minnesota Rules, part 9549.0060, subpart 3, 339.2 for rate periods beginning on October 1, 1992, and for rate 339.3 years beginning after June 30, 1993, a nursing facility that (1) 339.4 has completed a construction project approved under section 339.5 144A.071, subdivision 4a, clause (m); (2) has completed a 339.6 construction project approved under section 144A.071, 339.7 subdivision 4a, and effective after June 30, 1995; or (3) has 339.8 completed a renovation, replacement, or upgrading project 339.9 approved under the moratorium exception process in section 339.10 144A.073 shall be reimbursed for costs directly identified to 339.11 that project as provided in subdivision 16 and this subdivision. 339.12 (b) Notwithstanding Minnesota Rules, part 9549.0060, 339.13 subparts 5, item A, subitems (1) and (3), and 7, item D, 339.14 allowable interest expense on debt shall include: 339.15 (1) interest expense on debt related to the cost of 339.16 purchasing or replacing depreciable equipment, excluding 339.17 vehicles, not to exceed six percent of the total historical cost 339.18 of the project; and 339.19 (2) interest expense on debt related to financing or 339.20 refinancing costs, including costs related to points, loan 339.21 origination fees, financing charges, legal fees, and title 339.22 searches; and issuance costs including bond discounts, bond 339.23 counsel, underwriter's counsel, corporate counsel, printing, and 339.24 financial forecasts. Allowable debt related to items in this 339.25 clause shall not exceed seven percent of the total historical 339.26 cost of the project. To the extent these costs are financed, 339.27 the straight-line amortization of the costs in this clause is 339.28 not an allowable cost; and 339.29 (3) interest on debt incurred for the establishment of a 339.30 debt reserve fund, net of the interest earned on the debt 339.31 reserve fund. 339.32 (c) Debt incurred for costs under paragraph (b) is not 339.33 subject to Minnesota Rules, part 9549.0060, subpart 5, item A, 339.34 subitem (5) or (6). 339.35 (d) The incremental increase in a nursing facility's rental 339.36 rate, determined under Minnesota Rules, parts 9549.0010 to 340.1 9549.0080, and this section, resulting from the acquisition of 340.2 allowable capital assets, and allowable debt and interest 340.3 expense under this subdivision shall be added to its 340.4 property-related payment rate and shall be effective on the 340.5 first day of the month following the month in which the 340.6 moratorium project was completed. 340.7 (e) Notwithstanding subdivision 3f, paragraph (a), for rate 340.8 periods beginning on October 1, 1992, and for rate years 340.9 beginning after June 30, 1993, the replacement-costs-new per bed 340.10 limit to be used in Minnesota Rules, part 9549.0060, subpart 4, 340.11 item B, for a nursing facility that has completed a renovation, 340.12 replacement, or upgrading project that has been approved under 340.13 the moratorium exception process in section 144A.073, or that 340.14 has completed an addition to or replacement of buildings, 340.15 attached fixtures, or land improvements for which the total 340.16 historical cost exceeds the lesser of $150,000 or ten percent of 340.17 the most recent appraised value, must be $47,500 per licensed 340.18 bed in multiple-bed rooms and $71,250 per licensed bed in a 340.19 single-bed room. These amounts must be adjusted annually as 340.20 specified in subdivision 3f, paragraph (a), beginning January 1, 340.21 1993. 340.22 (f) For purposes of this paragraph, a total replacement 340.23 means the complete replacement of the nursing facility's 340.24 physical plant through the construction of a new physical plant, 340.25 the transfer of the nursing facility's license from one physical 340.26 plant location to another, or a new building addition to 340.27 relocate beds from three- and four-bed wards. For total 340.28 replacement projects completed on or after July 1, 1992, the 340.29 commissioner shall compute the incremental change in the nursing 340.30 facility's rental per diem, for rate years beginning on or after 340.31 July 1, 1995, by replacing its appraised value, including the 340.32 historical capital asset costs, and the capital debt and 340.33 interest costs with the new nursing facility's allowable capital 340.34 asset costs and the related allowable capital debt and interest 340.35 costs. If the new nursing facility has decreased its licensed 340.36 capacity, the aggregate investment per bed limit in subdivision 341.1 3a, paragraph (c), shall apply. If the new nursing facility has 341.2 retained a portion of the original physical plant for nursing 341.3 facility usage, then a portion of the appraised value prior to 341.4 the replacement must be retained and included in the calculation 341.5 of the incremental change in the nursing facility's rental per 341.6 diem. For purposes of this part, the original nursing facility 341.7 means the nursing facility prior to the total replacement 341.8 project. The portion of the appraised value to be retained 341.9 shall be calculated according to clauses (1) to (3): 341.10 (1) The numerator of the allocation ratio shall be the 341.11 square footage of the area in the original physical plant which 341.12 is being retained for nursing facility usage. 341.13 (2) The denominator of the allocation ratio shall be the 341.14 total square footage of the original nursing facility physical 341.15 plant. 341.16 (3) Each component of the nursing facility's allowable 341.17 appraised value prior to the total replacement project shall be 341.18 multiplied by the allocation ratio developed by dividing clause 341.19 (1) by clause (2). 341.20 In the case of either type of total replacement as 341.21 authorized under section 144A.071 or 144A.073, the provisions of 341.22 this subdivision shall also apply. For purposes of the 341.23 moratorium exception authorized under section 144A.071, 341.24 subdivision 4a, paragraph (s), if the total replacement involves 341.25 the renovation and use of an existing health care facility 341.26 physical plant, the new allowable capital asset costs and 341.27 related debt and interest costs shall include first the 341.28 allowable capital asset costs and related debt and interest 341.29 costs of the renovation, to which shall be added the allowable 341.30 capital asset costs of the existing physical plant prior to the 341.31 renovation, and if reported by the facility, the related 341.32 allowable capital debt and interest costs. 341.33 (g) Notwithstanding Minnesota Rules, part 9549.0060, 341.34 subpart 11, item C, subitem (2), for a total replacement, as 341.35 defined in paragraph (f), authorized under section 144A.071 or 341.36 144A.073 after July 1, 1999, or any building project that is a 342.1 relocation, renovation, upgrading, or conversionauthorized342.2under section 144A.073,completed on or after July 1, 2001, the 342.3 replacement-costs-new per bed limit shall be $74,280 per 342.4 licensed bed in multiple-bed rooms, $92,850 per licensed bed in 342.5 semiprivate rooms with a fixed partition separating the resident 342.6 beds, and $111,420 per licensed bed in single rooms. Minnesota 342.7 Rules, part 9549.0060, subpart 11, item C, subitem (2), does not 342.8 apply. These amounts must be adjusted annually as specified in 342.9 subdivision 3f, paragraph (a), beginning January 1, 2000. 342.10 (h) For a total replacement, as defined in paragraph (f), 342.11 authorized under section 144A.073 for a 96-bed nursing home in 342.12 Carlton county, the replacement-costs-new per bed limit shall be 342.13 $74,280 per licensed bed in multiple-bed rooms, $92,850 per 342.14 licensed bed in semiprivate rooms with a fixed partition 342.15 separating the resident's beds, and $111,420 per licensed bed in 342.16 a single room. Minnesota Rules, part 9549.0060, subpart 11, 342.17 item C, subitem (2), does not apply. The resulting maximum 342.18 allowable replacement-costs-new multiplied by 1.25 shall 342.19 constitute the project's dollar threshold for purposes of 342.20 application of the limit set forth in section 144A.071, 342.21 subdivision 2. The commissioner of health may waive the 342.22 requirements of section 144A.073, subdivision 3b, paragraph (b), 342.23 clause (2), on the condition that the other requirements of that 342.24 paragraph are met. 342.25 (i) For a renovation authorized under section 144A.073 for 342.26 a 65-bed nursing home in St. Louis county, the incremental 342.27 increase in rental rate for purposes of paragraph (d) shall be 342.28 $8.16, and the total replacement cost, allowable appraised 342.29 value, allowable debt, and allowable interest shall be increased 342.30 according to the incremental increase. 342.31 (j) For a total replacement, as defined in paragraph (f), 342.32 authorized under section 144A.073 involving a new building 342.33 addition that relocates beds from three-bed wards for an 80-bed 342.34 nursing home in Redwood county, the replacement-costs-new per 342.35 bed limit shall be $74,280 per licensed bed for multiple-bed 342.36 rooms; $92,850 per licensed bed for semiprivate rooms with a 343.1 fixed partition separating the beds; and $111,420 per licensed 343.2 bed for single rooms. These amounts shall be adjusted annually, 343.3 beginning January 1, 2001. Minnesota Rules, part 9549.0060, 343.4 subpart 11, item C, subitem (2), does not apply. The resulting 343.5 maximum allowable replacement-costs-new multiplied by 1.25 shall 343.6 constitute the project's dollar threshold for purposes of 343.7 application of the limit set forth in section 144A.071, 343.8 subdivision 2. The commissioner of health may waive the 343.9 requirements of section 144A.073, subdivision 3b, paragraph (b), 343.10 clause (2), on the condition that the other requirements of that 343.11 paragraph are met. 343.12 Sec. 17. Minnesota Statutes 2000, section 256B.431, is 343.13 amended by adding a subdivision to read: 343.14 Subd. 31. [NURSING FACILITY RATE INCREASES BEGINNING JULY 343.15 1, 2001, AND JULY 1, 2002.] For the rate years beginning July 1, 343.16 2001, and July 1, 2002, the commissioner shall provide to each 343.17 nursing facility reimbursed under this section or section 343.18 256B.434 an adjustment equal to 3.0 percent of the total 343.19 operating payment rate. The operating payment rates in effect 343.20 on June 30, 2001, shall include the adjustment in subdivision 343.21 2i, paragraph (c). 343.22 Sec. 18. Minnesota Statutes 2000, section 256B.431, is 343.23 amended by adding a subdivision to read: 343.24 Subd. 32. [PAYMENT DURING FIRST 90 DAYS.] (a) For rate 343.25 years beginning on or after July 1, 2001, the total payment rate 343.26 for a facility reimbursed under this section, section 256B.434, 343.27 or any other section for the first 90 paid days after admission 343.28 shall be: 343.29 (1) for the first 30 paid days, the rate shall be 120 343.30 percent of the facility's medical assistance rate for each case 343.31 mix class; and 343.32 (2) for the next 60 paid days after the first 30 paid days, 343.33 the rate shall be 110 percent of the facility's medical 343.34 assistance rate for each case mix class. 343.35 (b) Beginning with the 91st paid day after admission, the 343.36 payment rate shall be the rate otherwise determined under this 344.1 section, section 256B.434, or any other section. 344.2 (c) This subdivision applies to admissions occurring on or 344.3 after July 1, 2001. 344.4 Sec. 19. Minnesota Statutes 2000, section 256B.431, is 344.5 amended by adding a subdivision to read: 344.6 Subd. 33. [STAGED REDUCTION IN RATE DISPARITIES.] (a) For 344.7 the rate years beginning July 1, 2001, and July 1, 2002, the 344.8 commissioner shall adjust the operating payment rates for 344.9 low-rate nursing facilities reimbursed under this section or 344.10 section 256B.434. 344.11 (b) For the rate year beginning July 1, 2001, for each case 344.12 mix level, if the amount computed under subdivision 32 is less 344.13 than the amount in clause (1), the commissioner shall make 344.14 available the lesser of the amount in clause (1) or an increase 344.15 of ten percent over the rate in effect on June 30, 2001, as an 344.16 adjustment to the operating payment rate. For the rate year 344.17 beginning July 1, 2002, for each case mix level, if the amount 344.18 computed under subdivision 32 is less than the amount in clause 344.19 (2), the commissioner shall make available the lesser of the 344.20 amount in clause (2) or an increase of ten percent over the rate 344.21 in effect on June 30, 2002, as an adjustment to the operating 344.22 payment rate. For purposes of this subdivision, nursing 344.23 facilities shall be considered to be metro if they are located 344.24 in Anoka, Carver, Dakota, Hennepin, Olmsted, Ramsey, Scott, or 344.25 Washington counties; or in the cities of Moorhead or 344.26 Breckenridge; or in St. Louis county, north of Toivola and south 344.27 of Cook; or in Itasca county, east of a north south line two 344.28 miles west of Grand Rapids: 344.29 (1) Operating Payment Rate Target Level for July 1, 2001: 344.30 Case Mix Classification Metro Nonmetro 344.31 A $ 76.00 $ 68.13 344.32 B $ 83.40 $ 74.46 344.33 C $ 91.67 $ 81.63 344.34 D $ 99.51 $ 88.04 344.35 E $107.46 $ 94.87 344.36 F $107.96 $ 95.29 345.1 G $114.67 $100.98 345.2 H $126.99 $111.31 345.3 I $131.42 $115.06 345.4 J $138.34 $120.85 345.5 K $152.26 $133.10 345.6 (2) Operating Payment Rate Target Level for July 1, 2002: 345.7 Case Mix Classification Metro Nonmetro 345.8 A $ 78.28 $ 70.51 345.9 B $ 85.91 $ 77.16 345.10 C $ 94.42 $ 84.62 345.11 D $102.50 $ 91.42 345.12 E $110.68 $ 98.40 345.13 F $111.20 $ 98.84 345.14 G $118.11 $104.77 345.15 H $130.80 $115.64 345.16 I $135.38 $119.50 345.17 J $142.49 $125.38 345.18 K $156.85 $137.77 345.19 Sec. 20. Minnesota Statutes 2000, section 256B.431, is 345.20 amended by adding a subdivision to read: 345.21 Subd. 34. [NURSING FACILITY RATE INCREASES BEGINNING JULY 345.22 1, 2001, AND JULY 1, 2002.] (a) For the rate years beginning 345.23 July 1, 2001, and July 1, 2002, two-thirds of the money 345.24 resulting from the rate adjustment under subdivision 31 and 345.25 one-half of the money resulting from the rate adjustment under 345.26 subdivisions 32 and 33 must be used to increase the wages and 345.27 benefits and pay associated costs of all employees except 345.28 management fees, the administrator, and central office staff. 345.29 (b) Money received by a facility as a result of the rate 345.30 adjustments provided in subdivisions 31 to 33, which must be 345.31 used as provided in paragraph (a), must be used only for wage 345.32 and benefit increases implemented on or after July 1, 2001, or 345.33 July 1, 2002, respectively, and must not be used for wage 345.34 increases implemented prior to those dates. 345.35 (c) Nursing facilities may apply for the portions of the 345.36 rate adjustments under subdivisions 31 to 33, which must be used 346.1 as provided in paragraph (a). The application must be made to 346.2 the commissioner and contain a plan by which the nursing 346.3 facility will distribute to employees of the nursing facility 346.4 the funds, which must be used as provided in paragraph (a). For 346.5 nursing facilities in which the employees are represented by an 346.6 exclusive bargaining representative, an agreement negotiated and 346.7 agreed to by the employer and the exclusive bargaining 346.8 representative constitutes the plan. A negotiated agreement may 346.9 constitute the plan only if the agreement is finalized after the 346.10 date of enactment of all increases for the rate year. The 346.11 commissioner shall review the plan to ensure that the rate 346.12 adjustments are used as provided in paragraph (a). To be 346.13 eligible, a facility must submit its plan for the wage and 346.14 benefit distribution by December 31 each year. If a facility's 346.15 plan for wage and benefit distribution is effective for its 346.16 employees after July 1 of the year that the funds are available, 346.17 the portion of the rate adjustments, which must be used as 346.18 provided in paragraph (a), are effective the same date as its 346.19 plan. 346.20 (d) A hospital-attached nursing facility may include costs 346.21 in their distribution plan for wages and benefits and associated 346.22 costs of employees in the organization's shared services 346.23 departments, provided that: 346.24 (1) the nursing facility and the hospital share common 346.25 ownership; and 346.26 (2) adjustments for hospital services using the 346.27 diagnostic-related grouping payment rates per admission under 346.28 Medicare are less than three percent during the 12 months prior 346.29 to the effective date of these rate adjustments. 346.30 If a hospital-attached facility meets the qualifications in 346.31 this paragraph, the difference between the rate adjustments 346.32 approved for nursing facility services and the rate increase 346.33 approved for hospital services may be permitted as a 346.34 distribution in the hospital-attached facility's plan regardless 346.35 of whether the use of those funds is shown as being attributable 346.36 to employee hours worked in the nursing facility or employee 347.1 hours worked in the hospital. 347.2 For the purposes of this paragraph, a hospital-attached 347.3 347.4 nursing facility is one that meets the definition under 347.5 subdivision 2j, or, in the case of a facility reimbursed under 347.6 section 256B.434, met this definition at the time their last 347.7 payment rate was established under Minnesota Rules, parts 347.8 9549.0010 to 9549.0080, and this section. 347.9 (e) A copy of the approved distribution plan must be made 347.10 available to all employees by giving each employee a copy or by 347.11 posting it in an area of the nursing facility to which all 347.12 employees have access. If an employee does not receive the wage 347.13 and benefit adjustment described in the facility's approved plan 347.14 and is unable to resolve the problem with the facility's 347.15 management or through the employee's union representative, the 347.16 employee may contact the commissioner at an address or telephone 347.17 number provided by the commissioner and included in the approved 347.18 plan. 347.19 (f) Notwithstanding section 256B.48, subdivision 1, clause 347.20 (a), upon the request of a nursing facility, the commissioner 347.21 may authorize the facility to raise per diem rates for 347.22 private-pay residents on July 1 by the amount anticipated to be 347.23 required upon implementation of the rate adjustments allowable 347.24 under subdivisions 31 to 33. The commissioner shall require any 347.25 amounts collected under this paragraph, which must be used as 347.26 provided in paragraph (a), to be placed in an escrow account 347.27 established for this purpose with a financial institution that 347.28 provides deposit insurance until the medical assistance rate is 347.29 finalized. The commissioner shall conduct audits as necessary 347.30 to ensure that: 347.31 (1) the amounts collected are retained in escrow until 347.32 medical assistance rates are increased to reflect the 347.33 wage-related adjustment; and 347.34 (2) any amounts collected from private-pay residents in 347.35 excess of the final medical assistance rate are repaid to the 347.36 private-pay residents with interest at the rate used by the 347.37 commissioner of revenue for the late payment of taxes and in 348.1 effect on the date the distribution plan is approved by the 348.2 commissioner of human services. 348.3 Sec. 21. Minnesota Statutes 2000, section 256B.431, is 348.4 amended by adding a subdivision to read: 348.5 Subd. 35. [EXCLUSION OF RAW FOOD COST ADJUSTMENT.] For 348.6 rate years beginning on or after July 1, 2001, in calculating a 348.7 nursing facility's operating cost per diem for the purposes of 348.8 constructing an array, determining a median, or otherwise 348.9 performing a statistical measure of nursing facility payment 348.10 rates to be used to determine future rate increases under this 348.11 section, section 256B.434, or any other section, the 348.12 commissioner shall exclude adjustments for raw food costs under 348.13 subdivision 2b, paragraph (h), that are related to providing 348.14 special diets based on religious beliefs. 348.15 Sec. 22. Minnesota Statutes 2000, section 256B.433, 348.16 subdivision 3a, is amended to read: 348.17 Subd. 3a. [EXEMPTION FROM REQUIREMENT FOR SEPARATE THERAPY 348.18 BILLING.] The provisions of subdivision 3 do not apply to 348.19 nursing facilities that are reimbursed according to the 348.20 provisions of section 256B.431and are located in a county348.21participating in the prepaid medical assistance program. 348.22 Nursing facilities that are reimbursed according to the 348.23 provisions of section 256B.434 and are located in a county 348.24 participating in the prepaid medical assistance program are 348.25 exempt from the maximum therapy rent revenue provisions of 348.26 subdivision 3, paragraph (c). 348.27 [EFFECTIVE DATE.] This section is effective the day 348.28 following final enactment. 348.29 Sec. 23. Minnesota Statutes 2000, section 256B.434, 348.30 subdivision 4, is amended to read: 348.31 Subd. 4. [ALTERNATE RATES FOR NURSING FACILITIES.] (a) For 348.32 nursing facilities which have their payment rates determined 348.33 under this section rather than section 256B.431, the 348.34 commissioner shall establish a rate under this subdivision. The 348.35 nursing facility must enter into a written contract with the 348.36 commissioner. 349.1 (b) A nursing facility's case mix payment rate for the 349.2 first rate year of a facility's contract under this section is 349.3 the payment rate the facility would have received under section 349.4 256B.431. 349.5 (c) A nursing facility's case mix payment rates for the 349.6 second and subsequent years of a facility's contract under this 349.7 section are the previous rate year's contract payment rates plus 349.8 an inflation adjustment and, for facilities reimbursed under 349.9 this section or section 256B.431, an adjustment to include the 349.10 cost of any increase in health department licensing fees for the 349.11 facility taking effect on or after July 1, 2001. The index for 349.12 the inflation adjustment must be based on the change in the 349.13 Consumer Price Index-All Items (United States City average) 349.14 (CPI-U) forecasted by Data Resources, Inc., as forecasted in the 349.15 fourth quarter of the calendar year preceding the rate year. 349.16 The inflation adjustment must be based on the 12-month period 349.17 from the midpoint of the previous rate year to the midpoint of 349.18 the rate year for which the rate is being determined. For the 349.19 rate years beginning on July 1, 1999,andJuly 1, 2000, July 1, 349.20 2001, and July 1, 2002, this paragraph shall apply only to the 349.21 property-related payment rate, except that adjustments to 349.22 include the cost of any increase in health department licensing 349.23 fees taking effect on or after July 1, 2001, shall be provided. 349.24 In determining the amount of the property-related payment rate 349.25 adjustment under this paragraph, the commissioner shall 349.26 determine the proportion of the facility's rates that are 349.27 property-related based on the facility's most recent cost report. 349.28 (d) The commissioner shall develop additional 349.29 incentive-based payments of up to five percent above the 349.30 standard contract rate for achieving outcomes specified in each 349.31 contract. The specified facility-specific outcomes must be 349.32 measurable and approved by the commissioner. The commissioner 349.33 may establish, for each contract, various levels of achievement 349.34 within an outcome. After the outcomes have been specified the 349.35 commissioner shall assign various levels of payment associated 349.36 with achieving the outcome. Any incentive-based payment cancels 350.1 if there is a termination of the contract. In establishing the 350.2 specified outcomes and related criteria the commissioner shall 350.3 consider the following state policy objectives: 350.4 (1) improved cost effectiveness and quality of life as 350.5 measured by improved clinical outcomes; 350.6 (2) successful diversion or discharge to community 350.7 alternatives; 350.8 (3) decreased acute care costs; 350.9 (4) improved consumer satisfaction; 350.10 (5) the achievement of quality; or 350.11 (6) any additional outcomes proposed by a nursing facility 350.12 that the commissioner finds desirable. 350.13 Sec. 24. Minnesota Statutes 2000, section 256B.434, is 350.14 amended by adding a subdivision to read: 350.15 Subd. 4c. [FACILITY RATE INCREASES EFFECTIVE JANUARY 1, 350.16 2002.] For the rate period beginning January 1, 2002, and for 350.17 the rate year beginning July 1, 2002, a nursing facility in 350.18 Morrison county licensed for 83 beds as of March 1, 2001, shall 350.19 receive an increase of $2.54 in each case mix payment rate to 350.20 offset property tax payments due as a result of the facility's 350.21 conversion from nonprofit to for-profit status. The increase 350.22 under this subdivision shall be added following the 350.23 determination under this chapter of the payment rate for the 350.24 rate year beginning July 1, 2001, and shall be included in the 350.25 facility's total payment rates for the purposes of determining 350.26 future rates under this section or any other section. 350.27 Sec. 25. Minnesota Statutes 2000, section 256B.434, is 350.28 amended by adding a subdivision to read: 350.29 Subd. 4d. [FACILITY RATE INCREASES EFFECTIVE JULY 1, 350.30 2001.] For the rate year beginning July 1, 2001, a nursing 350.31 facility in Hennepin county licensed for 302 beds shall receive 350.32 an increase of 29 cents in each case mix payment rate to correct 350.33 an error in the cost-reporting system that occurred prior to the 350.34 date that the facility entered the alternative payment 350.35 demonstration project. The increase under this subdivision 350.36 shall be added following the determination under this chapter of 351.1 the payment rate for the rate year beginning July 1, 2001, and 351.2 shall be included in the facility's total payment rates for the 351.3 purposes of determining future rates under this section or any 351.4 other section. 351.5 Sec. 26. Minnesota Statutes 2000, section 256B.434, is 351.6 amended by adding a subdivision to read: 351.7 Subd. 4e. [RATE INCREASE EFFECTIVE JULY 1, 2001.] A 351.8 nursing facility in Anoka county licensed for 98 beds as of July 351.9 1, 2000, shall receive a total increase of $10 in each case mix 351.10 rate for the rate year beginning July 1, 2001, as a result of 351.11 increases provided under this subdivision and section 256B.431, 351.12 subdivision 33. The increases under this subdivision shall be 351.13 added prior to the determination under section 256B.431, 351.14 subdivision 33, of the payment rate for the rate year beginning 351.15 July 1, 2001, and shall be included in the facility's total 351.16 payment rate for purposes of determining future rates under this 351.17 section or any other section through June 30, 2004. 351.18 Sec. 27. [256B.437] [NURSING FACILITY VOLUNTARY CLOSURES; 351.19 PLANNING AND DEVELOPMENT OF COMMUNITY-BASED ALTERNATIVES.] 351.20 Subdivision 1. [DEFINITIONS.] (a) The definitions in this 351.21 subdivision apply to subdivisions 2 to 9. 351.22 (b) "Closure" means the cessation of operations of a 351.23 nursing facility and delicensure and decertification of all beds 351.24 within the facility. 351.25 (c) "Closure plan" means a plan to close a nursing facility 351.26 and reallocate a portion of the resulting savings to provide 351.27 planned closure rate adjustments at other facilities. 351.28 (d) "Commencement of closure" means the date on which 351.29 residents and designated representatives are notified of a 351.30 planned closure as provided in section 144A.161, subdivision 5a, 351.31 as part of an approved closure plan. 351.32 (e) "Completion of closure" means the date on which the 351.33 final resident of the nursing facility designated for closure in 351.34 an approved closure plan is discharged from the facility. 351.35 (f) "Partial closure" means the delicensure and 351.36 decertification of a portion of the beds within the facility. 352.1 (g) "Planned closure rate adjustment" means an increase in 352.2 a nursing facility's operating rates resulting from a planned 352.3 closure or a planned partial closure of another facility. 352.4 Subd. 2. [PLANNING AND DEVELOPMENT OF COMMUNITY-BASED 352.5 SERVICES.] (a) The commissioner of human services shall 352.6 establish a process to adjust the capacity and distribution of 352.7 long-term care services to equalize the supply and demand for 352.8 different types of services. This process must include 352.9 community planning, expansion or establishment of needed 352.10 services, and analysis of voluntary nursing facility closures. 352.11 (b) The purpose of this process is to support the planning 352.12 and development of community-based services. This process must 352.13 support early intervention, advocacy, and consumer protection 352.14 while providing resources and incentives for expanded county 352.15 planning and for nursing facilities to transition to meet 352.16 community needs. 352.17 (c) The process shall support and facilitate expansion of 352.18 community-based services under the county-administered 352.19 alternative care program under section 256B.0913 and waivers for 352.20 elderly under section 256B.0915, including, but not limited to, 352.21 the development of supportive services such as housing and 352.22 transportation. The process shall utilize community assessments 352.23 and planning developed for the community health services plan 352.24 and plan update and for the community social services act plan, 352.25 and other relevant information. 352.26 (d) The commissioners of health and human services as 352.27 appropriate shall provide, by July 15, 2001, available data 352.28 necessary for the county, including, but not limited to, data on 352.29 nursing facility bed distribution, housing with services 352.30 options, the closure of nursing facilities that occur outside of 352.31 the planned closure process, and approval of planned closures in 352.32 the county and contiguous counties. 352.33 (e) Each county shall submit to the commissioner of human 352.34 services, by October 15, 2001, a gaps analysis that identifies 352.35 local service needs, pending development of services, and any 352.36 other issues that would contribute to or impede further 353.1 development of community-based services. The gaps analysis must 353.2 also be sent to the local area agency on aging and, if 353.3 applicable, local SAIL projects, for review and comment. The 353.4 review and comment must assess needs across county boundaries. 353.5 The area agencies on aging and SAIL projects must provide the 353.6 commissioner and the counties with their review and analyses by 353.7 November 15, 2001. 353.8 (f) The addendum to the biennial plan shall be submitted 353.9 annually, beginning December 31, 2001, and each December 31 353.10 thereafter, and shall include recommendations for development of 353.11 community-based services. Both planning and implementation 353.12 shall be implemented within the amount of funding made available 353.13 to the county board for these purposes. 353.14 (g) The plan, within the funding allocated, shall: 353.15 (1) include the gaps analysis required by paragraph (e); 353.16 (2) involve providers, consumers, cities, townships, 353.17 businesses, and area agencies on aging in the planning process; 353.18 (3) address the availability of alternative care and 353.19 elderly waiver services for eligible recipients; 353.20 (4) address the development of other supportive services, 353.21 such as transit, housing, and workforce and economic 353.22 development; and 353.23 (5) estimate the cost and timelines for development. 353.24 (h) The biennial plan addendum shall be coordinated with 353.25 the county mental health plan for inclusion in the community 353.26 health services plan and included as an addendum to the 353.27 community social services plan. 353.28 (i) The county board having financial responsibility for 353.29 persons present in another county shall cooperate with that 353.30 county for planning and development of services. 353.31 (j) The county board shall cooperate in planning and 353.32 development of community-based services with other counties, as 353.33 necessary, and coordinate planning for long-term care services 353.34 that involve more than one county, within the funding allocated 353.35 for these purposes. 353.36 (k) The commissioners of health and human services, in 354.1 cooperation with county boards, shall report to the legislature 354.2 by February 1 of each year, beginning February 1, 2002, 354.3 regarding the development of community-based services, 354.4 transition or closure of nursing facilities, and specific gaps 354.5 in services in identified geographic areas that may require 354.6 additional resources or flexibility, as documented by the 354.7 process in this subdivision and reported to the commissioners by 354.8 December 31 of each year. 354.9 Subd. 3. [APPLICATIONS FOR PLANNED CLOSURE OF NURSING 354.10 FACILITIES.] (a) By August 15, 2001, the commissioner of human 354.11 services shall implement and announce a program for closure or 354.12 partial closure of nursing facilities. Names and identifying 354.13 information provided in response to the announcement shall 354.14 remain private unless approved, according to the timelines 354.15 established in the plan. The announcement must specify: 354.16 (1) the criteria in subdivision 4 that will be used by the 354.17 commissioner to approve or reject applications; 354.18 (2) a requirement for the submission of a letter of intent 354.19 before the submission of an application; 354.20 (3) the information that must accompany an application; and 354.21 (4) that applications may combine planned closure rate 354.22 adjustments with moratorium exception funding, in which case a 354.23 single application may serve both purposes. 354.24 Between August 1, 2001, and June 30, 2003, the commissioner may 354.25 approve planned closures of up to 5,140 nursing facility beds, 354.26 less the number of licensed beds in facilities that close during 354.27 the same time period without approved closure plans or that have 354.28 notified the commissioner of health of their intent to close 354.29 without an approved closure plan. 354.30 (b) A facility or facilities reimbursed under section 354.31 256B.431 or 256B.434 with a closure plan approved by the 354.32 commissioner under subdivision 5 may assign a planned closure 354.33 rate adjustment to another facility or facilities that are not 354.34 closing or in the case of a partial closure, to the facility 354.35 undertaking the partial closure. A facility may also elect to 354.36 have a planned closure rate adjustment shared equally by the 355.1 five nursing facilities with the lowest total operating payment 355.2 rates in the state development region designated under section 355.3 462.385, in which the facility that is closing is located. The 355.4 planned closure rate adjustment must be calculated under 355.5 subdivision 6. Facilities that close without a closure plan, or 355.6 whose closure plan is not approved by the commissioner, are not 355.7 eligible to assign a planned closure rate adjustment under 355.8 subdivision 6. The commissioner shall calculate the amount the 355.9 facility would have been eligible to assign under subdivision 6, 355.10 and shall use this amount to provide equal rate adjustments to 355.11 the five nursing facilities with the lowest total operating 355.12 payment rates in the state development region designated under 355.13 section 462.385, in which the facility that closed is located. 355.14 (c) To be considered for approval, an application must 355.15 include: 355.16 (1) a description of the proposed closure plan, which must 355.17 include identification of the facility or facilities to receive 355.18 a planned closure rate adjustment and the amount and timing of a 355.19 planned closure rate adjustment proposed for each facility; 355.20 (2) the proposed timetable for any proposed closure, 355.21 including the proposed dates for announcement to residents, 355.22 commencement of closure, and completion of closure; 355.23 (3) the proposed relocation plan for current residents of 355.24 any facility designated for closure. The proposed relocation 355.25 plan must be designed to comply with all applicable state and 355.26 federal statutes and regulations, including, but not limited to, 355.27 section 144A.161; 355.28 (4) a description of the relationship between the nursing 355.29 facility that is proposed for closure and the nursing facility 355.30 or facilities proposed to receive the planned closure rate 355.31 adjustment. If these facilities are not under common ownership, 355.32 copies of any contracts, purchase agreements, or other documents 355.33 establishing a relationship or proposed relationship must be 355.34 provided; 355.35 (5) documentation, in a format approved by the 355.36 commissioner, that all the nursing facilities receiving a 356.1 planned closure rate adjustment under the plan have accepted 356.2 joint and several liability for recovery of overpayments under 356.3 section 256B.0641, subdivision 2, for the facilities designated 356.4 for closure under the plan; and 356.5 (6) an explanation of how the application coordinates with 356.6 planning efforts under subdivision 2. If the planning group 356.7 does not support a level of nursing facility closures that the 356.8 commissioner considers to be reasonable, the commissioner may 356.9 approve a planned closure proposal without its support. 356.10 (d) The application must address the criteria listed in 356.11 subdivision 4. 356.12 Subd. 4. [CRITERIA FOR REVIEW OF APPLICATION.] In 356.13 reviewing and approving closure proposals, the commissioner 356.14 shall consider, but not be limited to, the following criteria: 356.15 (1) improved quality of care and quality of life for 356.16 consumers; 356.17 (2) closure of a nursing facility that has a poor physical 356.18 plant, which may be evidenced by the conditions referred to in 356.19 section 144A.073, subdivision 4, clauses (4) and (5); 356.20 (3) the existence of excess nursing facility beds, measured 356.21 in terms of beds per thousand persons aged 85 or older. The 356.22 excess must be measured in reference to: 356.23 (i) the county in which the facility is located; 356.24 (ii) the county and all contiguous counties; 356.25 (iii) the region in which the facility is located; or 356.26 (iv) the facility's service area; 356.27 the facility shall indicate in its application the service area 356.28 it believes is appropriate for this measurement. A facility in 356.29 a county that is in the lowest quartile of counties with 356.30 reference to beds per thousand persons aged 85 or older is not 356.31 in an area of excess capacity; 356.32 (4) low-occupancy rates, provided that the unoccupied beds 356.33 are not the result of a personnel shortage. In analyzing 356.34 occupancy rates, the commissioner shall examine waiting lists in 356.35 the applicant facility and at facilities in the surrounding 356.36 area, as determined under clause (3); 357.1 (5) evidence of coordination between the community planning 357.2 process and the facility application. If the planning group 357.3 does not support a level of nursing facility closures that the 357.4 commissioner considers to be reasonable, the commissioner may 357.5 approve a planned closure proposal without its support; 357.6 (6) proposed usage of funds available from a planned 357.7 closure rate adjustment for care-related purposes; 357.8 (7) innovative use planned for the closed facility's 357.9 physical plant; 357.10 (8) evidence that the proposal serves the interests of the 357.11 state; and 357.12 (9) evidence of other factors that affect the viability of 357.13 the facility, including excessive nursing pool costs. 357.14 Subd. 5. [REVIEW AND APPROVAL OF APPLICATIONS.] (a) The 357.15 commissioner of human services, in consultation with the 357.16 commissioner of health, shall approve or disapprove an 357.17 application within 30 days after receiving it. The commissioner 357.18 may appoint an advisory review panel composed of representatives 357.19 of counties, SAIL projects, consumers, and providers to review 357.20 proposals and provide comments and recommendations to the 357.21 committee. The commissioners of human services and health shall 357.22 provide staff and technical assistance to the committee for the 357.23 review and analysis of proposals. 357.24 (b) Approval of a planned closure expires 18 months after 357.25 approval by the commissioner of human services, unless 357.26 commencement of closure has begun. 357.27 (c) The commissioner of human services may change any 357.28 provision of the application to which the applicant, the 357.29 regional planning group, and the commissioner agree. 357.30 Subd. 6. [PLANNED CLOSURE RATE ADJUSTMENT.] (a) The 357.31 commissioner of human services shall calculate the amount of the 357.32 planned closure rate adjustment available under subdivision 3, 357.33 paragraph (b), for up to 5,140 beds according to clauses (1) to 357.34 (4): 357.35 (1) the amount available is the net reduction of nursing 357.36 facility beds multiplied by $2,080; 358.1 (2) the total number of beds in the nursing facility or 358.2 facilities receiving the planned closure rate adjustment must be 358.3 identified; 358.4 (3) capacity days are determined by multiplying the number 358.5 determined under clause (2) by 365; and 358.6 (4) the planned closure rate adjustment is the amount 358.7 available in clause (1), divided by capacity days determined 358.8 under clause (3). 358.9 (b) A planned closure rate adjustment under this section is 358.10 effective on the first day of the month following completion of 358.11 closure of the facility designated for closure in the 358.12 application and becomes part of the nursing facility's total 358.13 operating payment rate. 358.14 (c) Applicants may use the planned closure rate adjustment 358.15 to allow for a property payment for a new nursing facility or an 358.16 addition to an existing nursing facility or as an operating 358.17 payment rate adjustment. Applications approved under this 358.18 subdivision are exempt from other requirements for moratorium 358.19 exceptions under section 144A.073, subdivisions 2 and 3. 358.20 (d) Upon the request of a closing facility, the 358.21 commissioner must allow the facility a closure rate adjustment 358.22 as provided under section 144A.161, subdivision 10. 358.23 Subd. 7. [OTHER RATE ADJUSTMENTS.] Facilities receiving 358.24 planned closure rate adjustments remain eligible for any 358.25 applicable rate adjustments provided under section 256B.431, 358.26 256B.434, or any other section. 358.27 Subd. 8. [COUNTY COSTS.] The commissioner of human 358.28 services shall allocate funds for relocation costs incurred by 358.29 counties for planned closures under this section as provided 358.30 under section 144A.161, subdivision 11. 358.31 Sec. 28. [256B.438] [IMPLEMENTATION OF A CASE MIX SYSTEM 358.32 FOR NURSING FACILITIES BASED ON THE MINIMUM DATA SET.] 358.33 Subdivision 1. [SCOPE.] This section establishes the 358.34 method and criteria used to determine resident reimbursement 358.35 classifications based upon the assessments of residents of 358.36 nursing homes and boarding care homes whose payment rates are 359.1 established under section 256B.431, 256B.434, or 256B.435. 359.2 Resident reimbursement classifications shall be established 359.3 according to the 34 group, resource utilization groups, version 359.4 III or RUG-III model as described in section 144.0724. 359.5 Reimbursement classifications established under this section 359.6 shall be implemented after June 30, 2002, but no later than 359.7 January 1, 2003. 359.8 Subd. 2. [DEFINITIONS.] For purposes of this section, the 359.9 following terms have the meanings given. 359.10 (a) [ASSESSMENT REFERENCE DATE.] "Assessment reference 359.11 date" has the meaning given in section 144.0724, subdivision 2, 359.12 paragraph (a). 359.13 (b) [CASE MIX INDEX.] "Case mix index" has the meaning 359.14 given in section 144.0724, subdivision 2, paragraph (b). 359.15 (c) [INDEX MAXIMIZATION.] "Index maximization" has the 359.16 meaning given in section 144.0724, subdivision 2, paragraph (c). 359.17 (d) [MINIMUM DATA SET.] "Minimum data set" has the meaning 359.18 given in section 144.0724, subdivision 2, paragraph (d). 359.19 (e) [REPRESENTATIVE.] "Representative" has the meaning 359.20 given in section 144.0724, subdivision 2, paragraph (e). 359.21 (f) [RESOURCE UTILIZATION GROUPS OR RUG.] "Resource 359.22 utilization groups" or "RUG" has the meaning given in section 359.23 144.0724, subdivision 2, paragraph (f). 359.24 Subd. 3. [CASE MIX INDICES.] (a) The commissioner of human 359.25 services shall assign a case mix index to each resident class 359.26 based on the Health Care Financing Administration's staff time 359.27 measurement study and adjusted for Minnesota-specific wage 359.28 indices. The case mix indices assigned to each resident class 359.29 shall be published in the Minnesota State Register at least 120 359.30 days prior to the implementation of the 34 group, RUG-III 359.31 resident classification system. 359.32 (b) An index maximization approach shall be used to 359.33 classify residents. 359.34 (c) After implementation of the revised case mix system, 359.35 the commissioner of human services may annually rebase case mix 359.36 indices and base rates using more current data on average wage 360.1 rates and staff time measurement studies. This rebasing shall 360.2 be calculated under subdivision 7, paragraph (b). The 360.3 commissioner shall publish in the Minnesota State Register 360.4 adjusted case mix indices at least 45 days prior to the 360.5 effective date of the adjusted case mix indices. 360.6 Subd. 4. [RESIDENT ASSESSMENT SCHEDULE.] (a) Nursing 360.7 facilities shall conduct and submit case mix assessments 360.8 according to the schedule established by the commissioner of 360.9 health under section 144.0724, subdivisions 4 and 5. 360.10 (b) The resident reimbursement classifications established 360.11 under section 144.0724, subdivision 3, shall be effective the 360.12 day of admission for new admission assessments. The effective 360.13 date for significant change assessments shall be the assessment 360.14 reference date. The effective date for annual and second 360.15 quarterly assessments shall be the first day of the month 360.16 following assessment reference date. 360.17 Subd. 5. [NOTICE OF RESIDENT REIMBURSEMENT 360.18 CLASSIFICATION.] Nursing facilities shall provide notice to a 360.19 resident of the resident's case mix classification according to 360.20 procedures established by the commissioner of health under 360.21 section 144.0724, subdivision 7. 360.22 Subd. 6. [RECONSIDERATION OF RESIDENT CLASSIFICATION.] Any 360.23 request for reconsideration of a resident classification must be 360.24 made under section 144.0724, subdivision 8. 360.25 Subd. 7. [RATE DETERMINATION UPON TRANSITION TO RUG-III 360.26 PAYMENT RATES.] (a) The commissioner of human services shall 360.27 determine payment rates at the time of transition to the RUG 360.28 based payment model in a facility-specific, budget-neutral 360.29 manner. The case mix indices as defined in subdivision 3 shall 360.30 be used to allocate the case mix adjusted component of total 360.31 payment across all case mix groups. To transition from the 360.32 current calculation methodology to the RUG based methodology, 360.33 the commissioner of health shall report to the commissioner of 360.34 human services the resident days classified according to the 360.35 categories defined in subdivision 3 for the 12-month reporting 360.36 period ending September 30, 2001, for each nursing facility. 361.1 The commissioner of human services shall use this data to 361.2 compute the standardized days for the reporting period under the 361.3 RUG system. 361.4 (b) The commissioner of human services shall determine the 361.5 case mix adjusted component of the rate as follows: 361.6 (1) determine the case mix portion of the 11 case mix rates 361.7 in effect on June 30, 2002, or the 34 case mix rates in effect 361.8 on or after June 30, 2003; 361.9 (2) multiply each amount in clause (1) by the number of 361.10 resident days assigned to each group for the reporting period 361.11 ending September 30, 2001, or the most recent year for which 361.12 data is available; 361.13 (3) compute the sum of the amounts in clause (2); 361.14 (4) determine the total RUG standardized days for the 361.15 reporting period ending September 30, 2001, or the most recent 361.16 year for which data is available using the new indices 361.17 calculated under subdivision 3, paragraph (c); 361.18 (5) divide the amount in clause (3) by the amount in clause 361.19 (4) which shall be the average case mix adjusted component of 361.20 the rate under the RUG method; and 361.21 (6) multiply this average rate by the case mix weight in 361.22 subdivision 3 for each RUG group. 361.23 (c) The noncase mix component will be allocated to each RUG 361.24 group as a constant amount to determine the transition payment 361.25 rate. Any other rate adjustments that are effective on or after 361.26 July 1, 2002, shall be applied to the transition rates 361.27 determined under this section. 361.28 Sec. 29. [256B.439] [LONG-TERM CARE QUALITY PROFILES.] 361.29 Subdivision l. [DEVELOPMENT AND IMPLEMENTATION OF QUALITY 361.30 PROFILES.] (a) The commissioner of human services, in 361.31 cooperation with the commissioner of health, shall develop and 361.32 implement a quality profile system for nursing facilities and, 361.33 beginning not later than July 1, 2003, other providers of 361.34 long-term care services, except when the quality profile system 361.35 would duplicate requirements under section 256B.5011, 256B.5012, 361.36 or 256B.5013. The system must be developed and implemented to 362.1 the extent possible without the collection of significant 362.2 amounts of new data. To the extent possible, the system must 362.3 incorporate or be coordinated with information on quality 362.4 maintained by area agencies on aging, long-term care trade 362.5 associations, and other entities. The system must be designed 362.6 to provide information on quality to: 362.7 (1) consumers and their families to facilitate informed 362.8 choices of service providers; 362.9 (2) providers to enable them to measure the results of 362.10 their quality improvement efforts and compare quality 362.11 achievements with other service providers; and 362.12 (3) public and private purchasers of long-term care 362.13 services to enable them to purchase high-quality care. 362.14 (b) The system must be developed in consultation with the 362.15 long-term care task force, area agencies on aging, and 362.16 representatives of consumers, providers, and labor unions. 362.17 Within the limits of available appropriations, the commissioners 362.18 may employ consultants to assist with this project. 362.19 Subd. 2. [QUALITY MEASUREMENT TOOLS.] The commissioners 362.20 shall identify and apply existing quality measurement tools to: 362.21 (1) emphasize quality of care and its relationship to 362.22 quality of life; and 362.23 (2) address the needs of various users of long-term care 362.24 services, including, but not limited to, short-stay residents, 362.25 persons with behavioral problems, persons with dementia, and 362.26 persons who are members of minority groups. 362.27 The tools must be identified and applied, to the extent 362.28 possible, without requiring providers to supply information 362.29 beyond current state and federal requirements. 362.30 Subd. 3. [CONSUMER SURVEYS.] Following identification of 362.31 the quality measurement tool, the commissioners shall conduct 362.32 surveys of long-term care service consumers to develop quality 362.33 profiles of providers. To the extent possible, surveys must be 362.34 conducted face-to-face by state employees or contractors. At 362.35 the discretion of the commissioners, surveys may be conducted by 362.36 telephone or by provider staff. Surveys must be conducted 363.1 periodically to update quality profiles of individual service 363.2 providers. 363.3 Subd. 4. [DISSEMINATION OF QUALITY PROFILES.] By July 1, 363.4 2002, the commissioners shall implement a system to disseminate 363.5 the quality profiles developed from consumer surveys using the 363.6 quality measurement tool. Profiles may be disseminated to the 363.7 Senior LinkAge line and to consumers, providers, and purchasers 363.8 of long-term care services through all feasible printed and 363.9 electronic outlets. The commissioners may conduct a public 363.10 awareness campaign to inform potential users regarding profile 363.11 contents and potential uses. 363.12 Sec. 30. Minnesota Statutes 2000, section 256B.5012, is 363.13 amended by adding a subdivision to read: 363.14 Subd. 4. [ICF/MR RATE INCREASES BEGINNING JULY 1, 2001, 363.15 AND JULY 1, 2002.] (a) For the rate years beginning July 1, 363.16 2001, and July 1, 2002, the commissioner shall make available to 363.17 each facility reimbursed under this section an adjustment to the 363.18 total operating payment rate of 3.5 percent. Of this 363.19 adjustment, two-thirds must be used as provided under paragraph 363.20 (b) and one-third must be used for operating costs. 363.21 (b) The adjustment under this paragraph must be used to 363.22 increase the wages and benefits and pay associated costs of all 363.23 employees except administrative and central office employees, 363.24 provided that this increase must be used only for wage and 363.25 benefit increases implemented on or after the first day of the 363.26 rate year and must not be used for increases implemented prior 363.27 to that date. 363.28 (c) For each facility, the commissioner shall make 363.29 available an adjustment using the percentage specified in 363.30 paragraph (a) multiplied by the total payment rate, excluding 363.31 the property-related payment rate, in effect on the preceding 363.32 June 30. The total payment rate shall include the adjustment 363.33 provided in section 256B.501, subdivision 12. 363.34 (d) A facility whose payment rates are governed by closure 363.35 agreements, receivership agreements, or Minnesota Rules, part 363.36 9553.0075, is not eligible for an adjustment otherwise granted 364.1 under this subdivision. 364.2 (e) A facility may apply for the payment rate adjustment 364.3 provided under paragraph (b). The application must be made to 364.4 the commissioner and contain a plan by which the facility will 364.5 distribute the adjustment in paragraph (b) to employees of the 364.6 facility. For facilities in which the employees are represented 364.7 by an exclusive bargaining representative, an agreement 364.8 negotiated and agreed to by the employer and the exclusive 364.9 bargaining representative constitutes the plan. A negotiated 364.10 agreement may constitute the plan only if the agreement is 364.11 finalized after the date of enactment of all rate increases for 364.12 the rate year. The commissioner shall review the plan to ensure 364.13 that the payment rate adjustment per diem is used as provided in 364.14 this subdivision. To be eligible, a facility must submit its 364.15 plan by March 31, 2002, and March 31, 2003, respectively. If a 364.16 facility's plan is effective for its employees after the first 364.17 day of the applicable rate year that the funds are available, 364.18 the payment rate adjustment per diem is effective the same date 364.19 as its plan. 364.20 (f) A copy of the approved distribution plan must be made 364.21 available to all employees by giving each employee a copy or by 364.22 posting it in an area of the facility to which all employees 364.23 have access. If an employee does not receive the wage and 364.24 benefit adjustment described in the facility's approved plan and 364.25 is unable to resolve the problem with the facility's management 364.26 or through the employee's union representative, the employee may 364.27 contact the commissioner at an address or telephone number 364.28 provided by the commissioner and included in the approved plan. 364.29 Sec. 31. Minnesota Statutes 2000, section 626.557, 364.30 subdivision 12b, is amended to read: 364.31 Subd. 12b. [DATA MANAGEMENT.] (a) [COUNTY DATA.] In 364.32 performing any of the duties of this section as a lead agency, 364.33 the county social service agency shall maintain appropriate 364.34 records. Data collected by the county social service agency 364.35 under this section are welfare data under section 13.46. 364.36 Notwithstanding section 13.46, subdivision 1, paragraph (a), 365.1 data under this paragraph that are inactive investigative data 365.2 on an individual who is a vendor of services are private data on 365.3 individuals, as defined in section 13.02. The identity of the 365.4 reporter may only be disclosed as provided in paragraph (c). 365.5 Data maintained by the common entry point are confidential 365.6 data on individuals or protected nonpublic data as defined in 365.7 section 13.02. Notwithstanding section 138.163, the common 365.8 entry point shall destroy data three calendar years after date 365.9 of receipt. 365.10 (b) [LEAD AGENCY DATA.] The commissioners of health and 365.11 human services shall prepare an investigation memorandum for 365.12 each report alleging maltreatment investigated under this 365.13 section. During an investigation by the commissioner of health 365.14 or the commissioner of human services, data collected under this 365.15 section are confidential data on individuals or protected 365.16 nonpublic data as defined in section 13.02. Upon completion of 365.17 the investigation, the data are classified as provided in 365.18 clauses (1) to (3) and paragraph (c). 365.19 (1) The investigation memorandum must contain the following 365.20 data, which are public: 365.21 (i) the name of the facility investigated; 365.22 (ii) a statement of the nature of the alleged maltreatment; 365.23 (iii) pertinent information obtained from medical or other 365.24 records reviewed; 365.25 (iv) the identity of the investigator; 365.26 (v) a summary of the investigation's findings; 365.27 (vi) statement of whether the report was found to be 365.28 substantiated, inconclusive, false, or that no determination 365.29 will be made; 365.30 (vii) a statement of any action taken by the facility; 365.31 (viii) a statement of any action taken by the lead agency; 365.32 and 365.33 (ix) when a lead agency's determination has substantiated 365.34 maltreatment, a statement of whether an individual, individuals, 365.35 or a facility were responsible for the substantiated 365.36 maltreatment, if known. 366.1 The investigation memorandum must be written in a manner 366.2 which protects the identity of the reporter and of the 366.3 vulnerable adult and may not contain the names or, to the extent 366.4 possible, data on individuals or private data listed in clause 366.5 (2). 366.6 (2) Data on individuals collected and maintained in the 366.7 investigation memorandum are private data, including: 366.8 (i) the name of the vulnerable adult; 366.9 (ii) the identity of the individual alleged to be the 366.10 perpetrator; 366.11 (iii) the identity of the individual substantiated as the 366.12 perpetrator; and 366.13 (iv) the identity of all individuals interviewed as part of 366.14 the investigation. 366.15 (3) Other data on individuals maintained as part of an 366.16 investigation under this section are private data on individuals 366.17 upon completion of the investigation. 366.18 (c) [IDENTITY OF REPORTER.] The subject of the report may 366.19 compel disclosure of the name of the reporter only with the 366.20 consent of the reporter or upon a written finding by a court 366.21 that the report was false and there is evidence that the report 366.22 was made in bad faith. This subdivision does not alter 366.23 disclosure responsibilities or obligations under the rules of 366.24 criminal procedure, except that where the identity of the 366.25 reporter is relevant to a criminal prosecution, the district 366.26 court shall do an in-camera review prior to determining whether 366.27 to order disclosure of the identity of the reporter. 366.28 (d) [DESTRUCTION OF DATA.] Notwithstanding section 366.29 138.163, data maintained under this section by the commissioners 366.30 of health and human services must be destroyed under the 366.31 following schedule: 366.32 (1) data from reports determined to be false, two years 366.33 after the finding was made; 366.34 (2) data from reports determined to be inconclusive, four 366.35 years after the finding was made; 366.36 (3) data from reports determined to be substantiated, seven 367.1 years after the finding was made; and 367.2 (4) data from reports which were not investigated by a lead 367.3 agency and for which there is no final disposition, two years 367.4 from the date of the report. 367.5 (e) [SUMMARY OF REPORTS.] The commissioners of health and 367.6 human services shall each annuallyprepare a summary ofreport 367.7 to the legislature and the governor on the number and type of 367.8 reports of alleged maltreatment involving licensed facilities 367.9 reported under this section, the number of those requiring 367.10 investigation under this section, and the resolution of those 367.11 investigations. The report shall identify: 367.12 (1) whether and where backlogs of cases result in a failure 367.13 to conform with statutory time frames; 367.14 (2) where adequate coverage requires additional 367.15 appropriations and staffing; and 367.16 (3) any other trends that affect the safety of vulnerable 367.17 adults. 367.18 (f) [RECORD RETENTION POLICY.] Each lead agency must have 367.19 a record retention policy. 367.20 (g) [EXCHANGE OF INFORMATION.] Lead agencies, prosecuting 367.21 authorities, and law enforcement agencies may exchange not 367.22 public data, as defined in section 13.02, if the agency or 367.23 authority requesting the data determines that the data are 367.24 pertinent and necessary to the requesting agency in initiating, 367.25 furthering, or completing an investigation under this section. 367.26 Data collected under this section must be made available to 367.27 prosecuting authorities and law enforcement officials, local 367.28 county agencies, and licensing agencies investigating the 367.29 alleged maltreatment under this section. The lead agency shall 367.30 exchange not public data with the vulnerable adult maltreatment 367.31 review panel established in section 256.021 if the data are 367.32 pertinent and necessary for a review requested under that 367.33 section. Upon completion of the review, not public data 367.34 received by the review panel must be returned to the lead agency. 367.35 (h) [COMPLETION TIME.] Each lead agency shall keep records 367.36 of the length of time it takes to complete its investigations. 368.1 (i) [NOTIFICATION OF OTHER AFFECTED PARTIES.] A lead 368.2 agency may notify other affected parties and their authorized 368.3 representative if the agency has reason to believe maltreatment 368.4 has occurred and determines the information will safeguard the 368.5 well-being of the affected parties or dispel widespread rumor or 368.6 unrest in the affected facility. 368.7 (j) [FEDERAL REQUIREMENTS.] Under any notification 368.8 provision of this section, where federal law specifically 368.9 prohibits the disclosure of patient identifying information, a 368.10 lead agency may not provide any notice unless the vulnerable 368.11 adult has consented to disclosure in a manner which conforms to 368.12 federal requirements. 368.13 Sec. 32. Laws 1995, chapter 207, article 3, section 21, as 368.14 amended by Laws 1999, chapter 245, article 3, section 43, is 368.15 amended to read: 368.16 Sec. 21. [FACILITY CERTIFICATION.] 368.17 (a) Notwithstanding Minnesota Statutes, section 252.291, 368.18 subdivisions 1 and 2, the commissioner of health shall inspect 368.19 to certify a large community-based facility currently licensed 368.20 under Minnesota Rules, parts 9525.0215 to 9525.0355, for more 368.21 than 16 beds and located in Northfield. The facility may be 368.22 certified for up to 44 beds. The commissioner of health must 368.23 inspect to certify the facility as soon as possible after the 368.24 effective date of this section. The commissioner of human 368.25 services shall work with the facility and affected counties to 368.26 relocate any current residents of the facility who do not meet 368.27 the admission criteria for an ICF/MR. Until January 1, 1999, in 368.28 order to fund the ICF/MR services and relocations of current 368.29 residents authorized, the commissioner of human services may 368.30 transfer on a quarterly basis to the medical assistance account 368.31 from each affected county's community social service allocation, 368.32 an amount equal to the state share of medical assistance 368.33 reimbursement for the residential and day habilitation services 368.34 funded by medical assistance and provided to clients for whom 368.35 the county is financially responsible. 368.36 (b) After January 1, 1999, the commissioner of human 369.1 services shall fund the services under the state medical 369.2 assistance program and may transfer on a quarterly basis to the 369.3 medical assistance account from each affected county's community 369.4 social service allocation, an amount equal to one-half of the 369.5 state share of medical assistance reimbursement for the 369.6 residential and day habilitation services funded by medical 369.7 assistance and provided to clients for whom the county is 369.8 financially responsible. 369.9 (c) Effective July 1, 2001, the commissioner of human 369.10 services shall fund the entire state share of medical assistance 369.11 reimbursement for the residential and day habilitation services 369.12 funded by medical assistance and provided to clients for whom 369.13 counties are financially responsible from the medical assistance 369.14 account, and shall not make any transfer from the community 369.15 social service allocations of affected counties. 369.16 (d) For nonresidents of Minnesota seeking admission to the 369.17 facility, Rice county shall be notified in order to assure that 369.18 appropriate funding is guaranteed from their state or country of 369.19 residence. 369.20 Sec. 33. Laws 1999, chapter 245, article 3, section 45, as 369.21 amended by Laws 2000, chapter 312, section 3, is amended to read: 369.22 Sec. 45. [STATE LICENSURE CONFLICTS WITH FEDERAL 369.23 REGULATIONS.] 369.24 (a) Notwithstanding the provisions of Minnesota Rules, part 369.25 4658.0520, an incontinent resident must be checked according to 369.26 a specific time interval written in the resident's care plan. 369.27 The resident's attending physician must authorize in writing any 369.28 interval longer than two hours unless the resident, if 369.29 competent, or a family member or legally appointed conservator, 369.30 guardian, or health care agent of a resident who is not 369.31 competent, agrees in writing to waive physician involvement in 369.32 determining this interval. 369.33 (b) This section expires July 1,20012003. 369.34 Sec. 34. Laws 2000, chapter 364, section 2, is amended to 369.35 read: 369.36 Sec. 2. [MORATORIUM EXCEPTION PROCESS.] 370.1 Forfiscal yearthe biennium beginning July 1,20002001, 370.2 when approving nursing home moratorium exception projects under 370.3 Minnesota Statutes, section 144A.073, the commissioner of health 370.4 shall give priority toproposalsa proposal to build a 370.5 replacementfacilitiesfacility in the city of Anoka or within 370.6 ten miles of the city of Anoka. 370.7 Sec. 35. [DEVELOPMENT OF NEW NURSING FACILITY 370.8 REIMBURSEMENT SYSTEM.] 370.9 (a) The commissioner of human services shall develop and 370.10 report to the legislature by January 15, 2003, a system to 370.11 replace the current nursing facility reimbursement system 370.12 established under Minnesota Statutes, sections 256B.431, 370.13 256B.434, and 256B.435. 370.14 (b) The system must be developed in consultation with the 370.15 long-term care task force and with representatives of consumers, 370.16 providers, and labor unions. Within the limits of available 370.17 appropriations, the commissioner may employ consultants to 370.18 assist with this project. 370.19 (c) The new reimbursement system must: 370.20 (1) provide incentives to enhance quality of life and 370.21 quality of care; 370.22 (2) recognize cost differences in the care of different 370.23 types of populations, including subacute care and dementia care; 370.24 (3) establish rates that are sufficient without being 370.25 excessive; 370.26 (4) be affordable for the state and for private-pay 370.27 residents; 370.28 (5) be sensitive to changing conditions in the long-term 370.29 care environment; 370.30 (6) avoid creating access problems related to insufficient 370.31 funding; 370.32 (7) allow providers maximum flexibility in their business 370.33 operations; 370.34 (8) recognize the need for capital investment to improve 370.35 physical plants; and 370.36 (9) provide incentives for the development and use of 371.1 private rooms. 371.2 (d) Notwithstanding Minnesota Statutes, section 256B.435, 371.3 the commissioner must not implement a performance-based 371.4 contracting system for nursing facilities prior to July 1, 2003. 371.5 The commissioner shall continue to reimburse nursing facilities 371.6 under Minnesota Statutes, section 256B.431 or 256B.434, until 371.7 otherwise directed by law. 371.8 (e) The commissioner of human services, in consultation 371.9 with the commissioner of health, shall conduct or contract for a 371.10 time study to determine staff time being spent on various case 371.11 mix categories; recommend adjustments to the case mix weights 371.12 based on the time study data; and determine whether current 371.13 staffing standards are adequate for providing quality care based 371.14 on professional best practice and consumer experience. If the 371.15 commissioner determines the current standards are inadequate, 371.16 the commissioner shall determine an appropriate staffing 371.17 standard for the various case mix categories and the financial 371.18 implications of phasing into this standard over the next four 371.19 years. 371.20 Sec. 36. [MINIMUM STAFFING STANDARDS REPORT.] 371.21 By January 15, 2002, the commissioner of health and the 371.22 commissioner of human services shall report to the legislature 371.23 on whether they should translate the minimum nurse staffing 371.24 requirement in Minnesota Statutes, section 144A.04, subdivision 371.25 7, paragraph (a), upon the transition to the RUG-III 371.26 classification system, or whether they should establish 371.27 different time-based standards, and how to accomplish either. 371.28 Sec. 37. [PROVIDER RATE INCREASES.] 371.29 (a) The commissioner of human services shall increase 371.30 reimbursement rates by three percent each year of the biennium 371.31 for the providers listed in paragraph (b) and 3.5 percent for 371.32 the providers listed in paragraph (c). The increases are 371.33 effective for services rendered on or after July 1 of each year. 371.34 (b) The three percent rate increases described in this 371.35 section must be provided to: 371.36 (1) home and community-based waivered services for persons 372.1 with mental retardation or related conditions under Minnesota 372.2 Statutes, section 256B.501; 372.3 (2) home and community-based waivered services for the 372.4 elderly under Minnesota Statutes, section 256B.0915; 372.5 (3) waivered services under community alternatives for 372.6 disabled individuals under Minnesota Statutes, section 256B.49; 372.7 (4) community alternative care waivered services under 372.8 Minnesota Statutes, section 256B.49; 372.9 (5) traumatic brain injury waivered services under 372.10 Minnesota Statutes, section 256B.49; 372.11 (6) nursing services and home health services under 372.12 Minnesota Statutes, section 256B.0625, subdivision 6a; 372.13 (7) personal care services and nursing supervision of 372.14 personal care services under Minnesota Statutes, section 372.15 256B.0625, subdivision 19a; 372.16 (8) private duty nursing services under Minnesota Statutes, 372.17 section 256B.0625, subdivision 7; 372.18 (9) day training and habilitation services for adults with 372.19 mental retardation or related conditions under Minnesota 372.20 Statutes, sections 252.40 to 252.46; 372.21 (10) alternative care services under Minnesota Statutes, 372.22 section 256B.0913; 372.23 (11) adult residential program grants under Minnesota 372.24 Rules, parts 9535.2000 to 9535.3000; 372.25 (12) adult and family community support grants under 372.26 Minnesota Rules, parts 9535.1700 to 9535.1760; 372.27 (13) the group residential housing supplementary service 372.28 rate under Minnesota Statutes, section 256I.05, subdivision 1a; 372.29 (14) adult mental health integrated fund grants under 372.30 Minnesota Statutes, section 245.4661; 372.31 (15) semi-independent living services under Minnesota 372.32 Statutes, section 252.275, including SILS funding under county 372.33 social services grants formerly funded under Minnesota Statutes, 372.34 chapter 256I; 372.35 (16) community support services for deaf and 372.36 hard-of-hearing adults with mental illness who use or wish to 373.1 use sign language as their primary means of communication; and 373.2 (17) living skills training programs for persons with 373.3 intractable epilepsy who need assistance in the transition to 373.4 independent living. 373.5 (c) The 3.5 percent rate increases described in this 373.6 section must be provided to day training and habilitation 373.7 services under Minnesota Statutes, chapter 256B. 373.8 (d) Providers that receive a rate increase under this 373.9 section shall use one-third of the additional revenue for 373.10 operating cost increases and two-thirds of the additional 373.11 revenue to increase wages and benefits and pay associated costs 373.12 for all employees other than the administrator and central 373.13 office staff. For public employees, the portion of this 373.14 increase reserved to increase wages and benefits for certain 373.15 staff is available and pay rates shall be increased only to the 373.16 extent that they comply with laws governing public employees 373.17 collective bargaining. Money received by a provider for pay 373.18 increases under this section must be used only for increases 373.19 implemented on or after the first day of the state fiscal year 373.20 in which the increase is available and must not be used for 373.21 increases implemented prior to that date. 373.22 (e) A copy of the provider's plan for complying with 373.23 paragraph (d) must be made available to all employees by giving 373.24 each employee a copy or by posting it in an area of the 373.25 provider's operation to which all employees have access. If an 373.26 employee does not receive the adjustment described in the plan 373.27 and is unable to resolve the problem with the provider, the 373.28 employee may contact the employee's union representative. If 373.29 the employee is not covered by a collective bargaining 373.30 agreement, the employee may contact the commissioner at a phone 373.31 number provided by the commissioner and included in the 373.32 provider's plan. 373.33 Sec. 38. [REGULATORY FLEXIBILITY.] 373.34 (a) By September 1, 2001, the commissioners of health and 373.35 human services shall: 373.36 (1) develop a summary of federal nursing facility and 374.1 community long-term care regulations that hamper state 374.2 flexibility and place burdens on the goal of achieving 374.3 high-quality care and optimum outcomes for consumers of 374.4 services; and 374.5 (2) share this summary with the legislature, other states, 374.6 national groups that advocate for state interests with Congress, 374.7 and the Minnesota congressional delegation. 374.8 (b) The commissioners shall conduct ongoing follow-up with 374.9 the entities to which this summary is provided and with the 374.10 health care financing administration to achieve maximum 374.11 regulatory flexibility, including the possibility of pilot 374.12 projects to demonstrate regulatory flexibility on less than a 374.13 statewide basis. 374.14 Sec. 39. [REPORT.] 374.15 By January 15, 2003, the commissioner of health and the 374.16 commissioner of human services shall report to the senate health 374.17 and family security committee and the house health and human 374.18 services policy committee on the number of closures that have 374.19 taken place under Minnesota Statutes, section 256B.437, and any 374.20 other nursing facility closures that may have taken place, 374.21 alternatives to nursing facility care that have been developed, 374.22 any problems with access to long-term care services that have 374.23 resulted, and any recommendations for continuation of the 374.24 regional long-term care planning process and the closure process 374.25 after June 30, 2003. 374.26 Sec. 40. [INSTRUCTION TO REVISOR.] 374.27 The revisor of statutes shall delete any reference to 374.28 Minnesota Statutes, section 144A.16, in Minnesota Statutes and 374.29 Minnesota Rules. 374.30 Sec. 41. [REPEALER.] 374.31 (a) Minnesota Statutes 2000, sections 144A.16; and 374.32 256B.434, subdivision 5, are repealed. 374.33 (b) Minnesota Rules, parts 4655.6810; 4655.6820; 4655.6830; 374.34 4658.1600; 4658.1605; 4658.1610; 4658.1690; 9546.0010; 374.35 9546.0020; 9546.0030; 9546.0040; 9546.0050; and 9546.0060, are 374.36 repealed. 375.1 ARTICLE 6 375.2 WORKFORCE RECRUITMENT AND RETENTION 375.3 Section 1. Minnesota Statutes 2000, section 116L.11, 375.4 subdivision 4, is amended to read: 375.5 Subd. 4. [QUALIFYING CONSORTIUM.] "Qualifying consortium" 375.6 means an entity thatmay includeincludes a public or private 375.7 institution of higher education, work force center, county,and 375.8 oneor moreeligibleemployers, but must include a public or375.9private institution of higher education and one or more eligible375.10employersemployer. 375.11 Sec. 2. Minnesota Statutes 2000, section 116L.12, 375.12 subdivision 4, is amended to read: 375.13 Subd. 4. [GRANTS.] Within the limits of available 375.14 appropriations, the board shall make grants not to exceed 375.15 $400,000 each to qualifying consortia to operate local, 375.16 regional, or statewide training and retention programs. Grants 375.17 may be made from TANF funds, general fund appropriations, and 375.18 any other funding sources available to the board, provided the 375.19 requirements of those funding sources are satisfied. Grant 375.20 awards must establish specific, measurable outcomes and 375.21 timelines for achieving those outcomes. 375.22 Sec. 3. Minnesota Statutes 2000, section 116L.12, 375.23 subdivision 5, is amended to read: 375.24 Subd. 5. [LOCAL MATCH REQUIREMENTS.] A consortium must 375.25provide at least a 50 percent match from local resources for375.26money appropriated under this section. The local match375.27requirement must be satisfied on an overall program basis but375.28need not be satisfied for each particular client. The local375.29match requirement may be reduced for consortia that include a375.30relatively large number of small employers whose financial375.31contribution has been reduced in accordance with section 116L.15.375.32In-kind services and expenditures under section 116L.13,375.33subdivision 2, may be used to meet this local match375.34requirement. The grant application must specify the financial375.35contribution from each member of the consortiumsatisfy the 375.36 match requirements established in section 116L.02, paragraph (a). 376.1 Sec. 4. Minnesota Statutes 2000, section 116L.13, 376.2 subdivision 1, is amended to read: 376.3 Subdivision 1. [MARKETING AND RECRUITMENT.] A qualifying 376.4 consortium must implement a marketing and outreach strategy to 376.5 recruit into the health care and human services fields persons 376.6 from one or more of the potential employee target groups. 376.7 Recruitment strategies must include: 376.8 (1) a screening process to evaluate whether potential 376.9 employees may be disqualified as the result of a required 376.10 background check or are otherwise unlikely to succeed in the 376.11 position for which they are being recruited; and 376.12 (2) a process for modifying course work to meet the 376.13 training needs of non-English-speaking persons, when appropriate. 376.14 Sec. 5. [116L.146] [EXPEDITED GRANT PROCESS.] 376.15 (a) The board may authorize grants not to exceed $50,000 376.16 each through an expedited grant approval process to: 376.17 (1) eligible employers to provide training programs for up 376.18 to 50 workers; or 376.19 (2) a public or private institution of higher education to: 376.20 (i) do predevelopment or curriculum development for 376.21 training programs prior to submission for program funding under 376.22 section 116L.12; 376.23 (ii) convert an existing curriculum for distance learning 376.24 through interactive television or other communication methods; 376.25 or 376.26 (iii) enable a training program to be offered when it would 376.27 otherwise be canceled due to an enrollment shortfall of one or 376.28 two students when the program is offered in a health-related 376.29 field with a documented worker shortage and is part of a 376.30 training program not exceeding two years in length. 376.31 (b) The board shall develop application procedures and 376.32 evaluation policies for grants made under this section. 376.33 Sec. 6. Minnesota Statutes 2000, section 256B.431, is 376.34 amended by adding a subdivision to read: 376.35 Subd. 35. [EMPLOYEE SCHOLARSHIP COSTS AND TRAINING IN 376.36 ENGLISH AS A SECOND LANGUAGE.] (a) For the period between July 377.1 1, 2001, and June 30, 2003, the commissioner shall provide to 377.2 each nursing facility reimbursed under this section, section 377.3 256B.434, or any other section, a scholarship per diem of 25 377.4 cents to the total operating payment rate to be used: 377.5 (1) for employee scholarships that satisfy the following 377.6 requirements: 377.7 (i) scholarships are available to all employees who work an 377.8 average of at least 20 hours per week at the facility except the 377.9 administrator, department supervisors, and registered nurses; 377.10 and 377.11 (ii) the course of study is expected to lead to career 377.12 advancement with the facility or in long-term care, including 377.13 medical care interpreter services and social work; and 377.14 (2) to provide job-related training in English as a second 377.15 language. 377.16 (b) A facility receiving a rate adjustment under this 377.17 subdivision may submit to the commissioner on a schedule 377.18 determined by the commissioner and on a form supplied by the 377.19 commissioner a calculation of the scholarship per diem, 377.20 including: the amount received from this rate adjustment; the 377.21 amount used for training in English as a second language; the 377.22 number of persons receiving the training; the name of the person 377.23 or entity providing the training; and for each scholarship 377.24 recipient, the name of the recipient, the amount awarded, the 377.25 educational institution attended, the nature of the educational 377.26 program, the program completion date, and a determination of the 377.27 per diem amount of these costs based on actual resident days. 377.28 (c) On July 1, 2003, the commissioner shall remove the 25 377.29 cent scholarship per diem from the total operating payment rate 377.30 of each facility. 377.31 (d) For rate years beginning after June 30, 2003, the 377.32 commissioner shall provide to each facility the scholarship per 377.33 diem determined in paragraph (b). 377.34 Sec. 7. [CHIP WAIVER.] 377.35 The commissioner of human services shall seek all waivers 377.36 necessary to obtain enhanced matching funds under the state 378.1 children's health insurance program established as title XXI of 378.2 the Social Security Act, United States Code, title 42, section 378.3 1397aa et seq. for a program to develop a long-term care 378.4 employee health insurance program. Upon receipt of federal 378.5 approval, the commissioner, in consultation with the long-term 378.6 care task force, shall report to the legislature with 378.7 recommendations on implementing the program. 378.8 [EFFECTIVE DATE.] This section is effective the day 378.9 following final enactment. 378.10 Sec. 8. [REPEALER.] 378.11 Minnesota Statutes 2000, section 116L.12, subdivisions 2 378.12 and 7, are repealed. 378.13 ARTICLE 7 378.14 REGULATION OF SUPPLEMENTAL 378.15 NURSING SERVICES AGENCIES 378.16 Section 1. Minnesota Statutes 2000, section 144.057, is 378.17 amended to read: 378.18 144.057 [BACKGROUND STUDIES ON LICENSEES AND SUPPLEMENTAL 378.19 NURSING SERVICES AGENCY PERSONNEL.] 378.20 Subdivision 1. [BACKGROUND STUDIES REQUIRED.] The 378.21 commissioner of health shall contract with the commissioner of 378.22 human services to conduct background studies of: 378.23 (1) individuals providing services which have direct 378.24 contact, as defined under section 245A.04, subdivision 3, with 378.25 patients and residents in hospitals, boarding care homes, 378.26 outpatient surgical centers licensed under sections 144.50 to 378.27 144.58; nursing homes and home care agencies licensed under 378.28 chapter 144A; residential care homes licensed under chapter 378.29 144B, and board and lodging establishments that are registered 378.30 to provide supportive or health supervision services under 378.31 section 157.17;and378.32 (2) beginning July 1, 1999, all other employees in nursing 378.33 homes licensed under chapter 144A, and boarding care homes 378.34 licensed under sections 144.50 to 144.58. A disqualification of 378.35 an individual in this section shall disqualify the individual 378.36 from positions allowing direct contact or access to patients or 379.1 residents receiving services; 379.2 (3) individuals employed by a supplemental nursing services 379.3 agency, as defined under section 144A.70, who are providing 379.4 services in health care facilities; and 379.5 (4) controlling persons of a supplemental nursing services 379.6 agency, as defined under section 144A.70. 379.7 If a facility or program is licensed by the department of 379.8 human services and subject to the background study provisions of 379.9 chapter 245A and is also licensed by the department of health, 379.10 the department of human services is solely responsible for the 379.11 background studies of individuals in the jointly licensed 379.12 programs. 379.13 Subd. 2. [RESPONSIBILITIES OF DEPARTMENT OF HUMAN 379.14 SERVICES.] The department of human services shall conduct the 379.15 background studies required by subdivision 1 in compliance with 379.16 the provisions of chapter 245A and Minnesota Rules, parts 379.17 9543.3000 to 9543.3090. For the purpose of this section, the 379.18 term "residential program" shall include all facilities 379.19 described in subdivision 1. The department of human services 379.20 shall provide necessary forms and instructions, shall conduct 379.21 the necessary background studies of individuals, and shall 379.22 provide notification of the results of the studies to the 379.23 facilities, supplemental nursing services agencies, individuals, 379.24 and the commissioner of health. Individuals shall be 379.25 disqualified under the provisions of chapter 245A and Minnesota 379.26 Rules, parts 9543.3000 to 9543.3090. If an individual is 379.27 disqualified, the department of human services shall notify the 379.28 facility, the supplemental nursing services agency, and the 379.29 individual and shall inform the individual of the right to 379.30 request a reconsideration of the disqualification by submitting 379.31 the request to the department of health. 379.32 Subd. 3. [RECONSIDERATIONS.] The commissioner of health 379.33 shall review and decide reconsideration requests, including the 379.34 granting of variances, in accordance with the procedures and 379.35 criteria contained in chapter 245A and Minnesota Rules, parts 379.36 9543.3000 to 9543.3090. The commissioner's decision shall be 380.1 provided to the individual and to the department of human 380.2 services. The commissioner's decision to grant or deny a 380.3 reconsideration of disqualification is the final administrative 380.4 agency action, except for the provisions under section 245A.04, 380.5 subdivisions 3b, paragraphs (e) and (f); and 3c, paragraph (a). 380.6 [EFFECTIVE DATE.] This subdivision is effective January 1, 380.7 2002. 380.8 Subd. 4. [RESPONSIBILITIES OF FACILITIES AND AGENCIES.] 380.9 Facilities and agencies described in subdivision 1 shall be 380.10 responsible for cooperating with the departments in implementing 380.11 the provisions of this section. The responsibilities imposed on 380.12 applicants and licensees under chapter 245A and Minnesota Rules, 380.13 parts 9543.3000 to 9543.3090, shall apply to these 380.14 facilities and supplemental nursing services agencies. The 380.15 provision of section 245A.04, subdivision 3, paragraph (e), 380.16 shall apply to applicants, licensees, registrants, or an 380.17 individual's refusal to cooperate with the completion of the 380.18 background studies. Supplemental nursing services agencies 380.19 subject to the registration requirements in section 144A.71 must 380.20 maintain records verifying compliance with the background study 380.21 requirements under this section. 380.22 Sec. 2. [144A.70] [REGISTRATION OF SUPPLEMENTAL NURSING 380.23 SERVICES AGENCIES; DEFINITIONS.] 380.24 Subdivision 1. [SCOPE.] As used in sections 144A.70 to 380.25 144A.74, the terms defined in this section have the meanings 380.26 given them. 380.27 Subd. 2. [COMMISSIONER.] "Commissioner" means the 380.28 commissioner of health. 380.29 Subd. 3. [CONTROLLING PERSON.] "Controlling person" means 380.30 a business entity, officer, program administrator, or director 380.31 whose responsibilities include the direction of the management 380.32 or policies of a supplemental nursing services agency. 380.33 Controlling person also means an individual who, directly or 380.34 indirectly, beneficially owns an interest in a corporation, 380.35 partnership, or other business association that is a controlling 380.36 person. 381.1 Subd. 4. [HEALTH CARE FACILITY.] "Health care facility" 381.2 means a hospital, boarding care home, or outpatient surgical 381.3 center licensed under sections 144.50 to 144.58; a nursing home 381.4 or home care agency licensed under this chapter; a housing with 381.5 services establishment registered under chapter 144D; or a board 381.6 and lodging establishment that is registered to provide 381.7 supportive or health supervision services under section 157.17. 381.8 Subd. 5. [PERSON.] "Person" includes an individual, firm, 381.9 corporation, partnership, or association. 381.10 Subd. 6. [SUPPLEMENTAL NURSING SERVICES 381.11 AGENCY.] "Supplemental nursing services agency" means a person, 381.12 firm, corporation, partnership, or association engaged for hire 381.13 in the business of providing or procuring temporary employment 381.14 in health care facilities for nurses, nursing assistants, nurse 381.15 aides, and orderlies. Supplemental nursing services agency does 381.16 not include an individual who only engages in providing the 381.17 individual's services on a temporary basis to health care 381.18 facilities. Supplemental nursing services agency also does not 381.19 include any nursing service agency that is limited to providing 381.20 temporary nursing personnel solely to one or more health care 381.21 facilities owned or operated by the same person, firm, 381.22 corporation, or partnership. 381.23 Sec. 3. [144A.71] [SUPPLEMENTAL NURSING SERVICES AGENCY 381.24 REGISTRATION.] 381.25 Subdivision 1. [DUTY TO REGISTER.] A person who operates a 381.26 supplemental nursing services agency shall register the agency 381.27 with the commissioner. Each separate location of the business 381.28 of a supplemental nursing services agency shall register the 381.29 agency with the commissioner. Each separate location of the 381.30 business of a supplemental nursing services agency shall have a 381.31 separate registration. 381.32 Subd. 2. [APPLICATION INFORMATION AND FEE.] The 381.33 commissioner shall establish forms and procedures for processing 381.34 each supplemental nursing services agency registration 381.35 application. An application for a supplemental nursing services 381.36 agency registration must include at least the following: 382.1 (1) the names and addresses of the owner or owners of the 382.2 supplemental nursing services agency; 382.3 (2) if the owner is a corporation, copies of its articles 382.4 of incorporation and current bylaws, together with the names and 382.5 addresses of its officers and directors; 382.6 (3) any other relevant information that the commissioner 382.7 determines is necessary to properly evaluate an application for 382.8 registration; and 382.9 (4) the annual registration fee for a supplemental nursing 382.10 services agency, which is $891. 382.11 Subd. 3. [REGISTRATION NOT TRANSFERABLE.] A registration 382.12 issued by the commissioner according to this section is 382.13 effective for a period of one year from the date of its issuance 382.14 unless the registration is revoked or suspended under section 382.15 144A.72, subdivision 2, or unless the supplemental nursing 382.16 services agency is sold or ownership or management is 382.17 transferred. When a supplemental nursing services agency is 382.18 sold or ownership or management is transferred, the registration 382.19 of the agency must be voided and the new owner or operator may 382.20 apply for a new registration. 382.21 Sec. 4. [144A.72] [REGISTRATION REQUIREMENTS; PENALTIES.] 382.22 Subdivision 1. [MINIMUM CRITERIA.] The commissioner shall 382.23 require that, as a condition of registration: 382.24 (1) the supplemental nursing services agency shall document 382.25 that each temporary employee provided to health care facilities 382.26 currently meets the minimum licensing, training, and continuing 382.27 education standards for the position in which the employee will 382.28 be working; 382.29 (2) the supplemental nursing services agency shall comply 382.30 with all pertinent requirements relating to the health and other 382.31 qualifications of personnel employed in health care facilities; 382.32 (3) the supplemental nursing services agency must not 382.33 restrict in any manner the employment opportunities of its 382.34 employees; 382.35 (4) the supplemental nursing services agency, when 382.36 supplying temporary employees to a health care facility, and 383.1 when requested by the facility to do so, shall agree that at 383.2 least 30 percent of the total personnel hours supplied are 383.3 during night, holiday, or weekend shifts; 383.4 (5) the supplemental nursing services agency shall carry 383.5 medical malpractice insurance to insure against the loss, 383.6 damage, or expense incident to a claim arising out of the death 383.7 or injury of any person as the result of negligence or 383.8 malpractice in the provision of health care services by the 383.9 supplemental nursing services agency or by any employee of the 383.10 agency; and 383.11 (6) the supplemental nursing services agency must not, in 383.12 any contract with any employee or health care facility, require 383.13 the payment of liquidated damages, employment fees, or other 383.14 compensation should the employee be hired as a permanent 383.15 employee of a health care facility. 383.16 Subd. 2. [PENALTIES.] A pattern of failure to comply with 383.17 this section shall subject the supplemental nursing services 383.18 agency to revocation or nonrenewal of its registration. 383.19 Violations of section 144A.74 are subject to a fine equal to 200 383.20 percent of the amount billed or received in excess of the 383.21 maximum permitted under that section. 383.22 Sec. 5. [144A.73] [COMPLAINT SYSTEM.] 383.23 The commissioner shall establish a system for reporting 383.24 complaints against a supplemental nursing services agency or its 383.25 employees. Complaints may be made by any member of the public. 383.26 Written complaints must be forwarded to the employer of each 383.27 person against whom a complaint is made. The employer shall 383.28 promptly report to the commissioner any corrective action taken. 383.29 Sec. 6. [144A.74] [MAXIMUM CHARGES.] 383.30 A supplemental nursing services agency must not bill or 383.31 receive payments from a nursing home licensed under this chapter 383.32 at a rate higher than 150 percent of the weighted average wage 383.33 rate for the applicable employee classification for the 383.34 geographic group to which the nursing home is assigned under 383.35 Minnesota Rules, part 9549.0052. The weighted average wage 383.36 rates must be determined by the commissioner of human services 384.1 and reported to the commissioner of health on an annual basis. 384.2 Facilities shall provide information necessary to determine 384.3 weighted average wage rates to the commissioner of human 384.4 services in a format requested by the commissioner. The maximum 384.5 rate must include all charges for administrative fees, contract 384.6 fees, or other special charges in addition to the hourly rates 384.7 for the temporary nursing pool personnel supplied to a nursing 384.8 home. 384.9 [EFFECTIVE DATE.] This section is effective August 31, 2001. 384.10 Sec. 7. [256B.039] [REPORTING OF SUPPLEMENTAL NURSING 384.11 SERVICES AGENCY USE.] 384.12 Beginning March 1, 2002, the commissioner shall to report 384.13 to the legislature annually on the use of supplemental nursing 384.14 services, including the number of hours worked by supplemental 384.15 nursing services agency personnel and payments to supplemental 384.16 nursing services agencies. 384.17 ARTICLE 8 384.18 LONG-TERM CARE INSURANCE 384.19 Section 1. Minnesota Statutes 2000, section 62A.48, 384.20 subdivision 4, is amended to read: 384.21 Subd. 4. [LOSS RATIO.] The anticipated loss ratio for 384.22 long-term care policies must not be less than 65 percent for 384.23 policies issued on a group basis or 60 percent for policies 384.24 issued on an individual or mass-market basis. This subdivision 384.25 does not apply to policies issued on or after January 1, 2002, 384.26 that comply with sections 62S.021 and 62S.081. 384.27 [EFFECTIVE DATE.] This section is effective the day 384.28 following final enactment. 384.29 Sec. 2. Minnesota Statutes 2000, section 62A.48, is 384.30 amended by adding a subdivision to read: 384.31 Subd. 10. [REGULATION OF PREMIUMS AND PREMIUM 384.32 INCREASES.] Policies issued under sections 62A.46 to 62A.56 on 384.33 or after January 1, 2002, must comply with sections 62S.021, 384.34 62S.081, 62S.265, and 62S.266 to the same extent as policies 384.35 issued under chapter 62S. 384.36 [EFFECTIVE DATE.] This section is effective the day 385.1 following final enactment. 385.2 Sec. 3. Minnesota Statutes 2000, section 62A.48, is 385.3 amended by adding a subdivision to read: 385.4 Subd. 11. [NONFORFEITURE BENEFITS.] Policies issued under 385.5 sections 62A.46 to 62A.56 on or after January 1, 2002, must 385.6 comply with section 62S.02, subdivision 2, to the same extent as 385.7 policies issued under chapter 62S. 385.8 [EFFECTIVE DATE.] This section is effective the day 385.9 following final enactment. 385.10 Sec. 4. Minnesota Statutes 2000, section 62S.01, is 385.11 amended by adding a subdivision to read: 385.12 Subd. 13a. [EXCEPTIONAL INCREASE.] (a) "Exceptional 385.13 increase" means only those premium rate increases filed by an 385.14 insurer as exceptional for which the commissioner determines 385.15 that the need for the premium rate increase is justified due to 385.16 changes in laws or rules applicable to long-term care coverage 385.17 in this state, or due to increased and unexpected utilization 385.18 that affects the majority of insurers of similar products. 385.19 (b) Except as provided in section 62S.265, exceptional 385.20 increases are subject to the same requirements as other premium 385.21 rate schedule increases. The commissioner may request a review 385.22 by an independent actuary or a professional actuarial body of 385.23 the basis for a request that an increase be considered an 385.24 exceptional increase. The commissioner, in determining that the 385.25 necessary basis for an exceptional increase exists, shall also 385.26 determine any potential offsets to higher claims costs. 385.27 [EFFECTIVE DATE.] This section is effective the day 385.28 following final enactment. 385.29 Sec. 5. Minnesota Statutes 2000, section 62S.01, is 385.30 amended by adding a subdivision to read: 385.31 Subd. 17a. [INCIDENTAL.] "Incidental," as used in section 385.32 62S.265, subdivision 10, means that the value of the long-term 385.33 care benefits provided is less than ten percent of the total 385.34 value of the benefits provided over the life of the policy. 385.35 These values must be measured as of the date of issue. 385.36 [EFFECTIVE DATE.] This section is effective the day 386.1 following final enactment. 386.2 Sec. 6. Minnesota Statutes 2000, section 62S.01, is 386.3 amended by adding a subdivision to read: 386.4 Subd. 23a. [QUALIFIED ACTUARY.] "Qualified actuary" means 386.5 a member in good standing of the American Academy of Actuaries. 386.6 [EFFECTIVE DATE.] This section is effective the day 386.7 following final enactment. 386.8 Sec. 7. Minnesota Statutes 2000, section 62S.01, is 386.9 amended by adding a subdivision to read: 386.10 Subd. 25a. [SIMILAR POLICY FORMS.] "Similar policy forms" 386.11 means all of the long-term care insurance policies and 386.12 certificates issued by an insurer in the same long-term care 386.13 benefit classification as the policy form being considered. 386.14 Certificates of groups that meet the definition in section 386.15 62S.01, subdivision 15, clause (1), are not considered similar 386.16 to certificates or policies otherwise issued as long-term care 386.17 insurance, but are similar to other comparable certificates with 386.18 the same long-term care benefit classifications. For purposes 386.19 of determining similar policy forms, long-term care benefit 386.20 classifications are defined as follows: institutional long-term 386.21 care benefits only, noninstitutional long-term care benefits 386.22 only, or comprehensive long-term care benefits. 386.23 [EFFECTIVE DATE.] This section is effective the day 386.24 following final enactment. 386.25 Sec. 8. [62S.021] [LONG-TERM CARE INSURANCE; INITIAL 386.26 FILING.] 386.27 Subdivision 1. [APPLICABILITY.] This section applies to 386.28 any long-term care policy issued in this state on or after 386.29 January 1, 2002, under this chapter or sections 62A.46 to 62A.56. 386.30 Subd. 2. [REQUIRED SUBMISSION TO COMMISSIONER.] An insurer 386.31 shall provide the following information to the commissioner 30 386.32 days prior to making a long-term care insurance form available 386.33 for sale: 386.34 (1) a copy of the disclosure documents required in section 386.35 62S.081; and 386.36 (2) an actuarial certification consisting of at least the 387.1 following: 387.2 (i) a statement that the initial premium rate schedule is 387.3 sufficient to cover anticipated costs under moderately adverse 387.4 experience and that the premium rate schedule is reasonably 387.5 expected to be sustainable over the life of the form with no 387.6 future premium increases anticipated; 387.7 (ii) a statement that the policy design and coverage 387.8 provided have been reviewed and taken into consideration; 387.9 (iii) a statement that the underwriting and claims 387.10 adjudication processes have been reviewed and taken into 387.11 consideration; and 387.12 (iv) a complete description of the basis for contract 387.13 reserves that are anticipated to be held under the form, to 387.14 include: 387.15 (A) sufficient detail or sample calculations provided so as 387.16 to have a complete depiction of the reserve amounts to be held; 387.17 (B) a statement that the assumptions used for reserves 387.18 contain reasonable margins for adverse experience; 387.19 (C) a statement that the net valuation premium for renewal 387.20 years does not increase, except for attained age rating where 387.21 permitted; 387.22 (D) a statement that the difference between the gross 387.23 premium and the net valuation premium for renewal years is 387.24 sufficient to cover expected renewal expenses, or if such a 387.25 statement cannot be made, a complete description of the 387.26 situations in which this does not occur. An aggregate 387.27 distribution of anticipated issues may be used as long as the 387.28 underlying gross premiums maintain a reasonably consistent 387.29 relationship. If the gross premiums for certain age groups 387.30 appear to be inconsistent with this requirement, the 387.31 commissioner may request a demonstration under item (i) based on 387.32 a standard age distribution; and 387.33 (E) either a statement that the premium rate schedule is 387.34 not less than the premium rate schedule for existing similar 387.35 policy forms also available from the insurer except for 387.36 reasonable differences attributable to benefits, or a comparison 388.1 of the premium schedules for similar policy forms that are 388.2 currently available from the insurer with an explanation of the 388.3 differences. 388.4 Subd. 3. [ACTUARIAL DEMONSTRATION.] The commissioner may 388.5 request an actuarial demonstration that benefits are reasonable 388.6 in relation to premiums. The actuarial demonstration must 388.7 include either premium and claim experience on similar policy 388.8 forms, adjusted for any premium or benefit differences, relevant 388.9 and credible data from other studies, or both. If the 388.10 commissioner asks for additional information under this 388.11 subdivision, the 30-day time limit in subdivision 2 does not 388.12 include the time during which the insurer is preparing the 388.13 requested information. 388.14 [EFFECTIVE DATE.] This section is effective the day 388.15 following final enactment. 388.16 Sec. 9. [62S.081] [REQUIRED DISCLOSURE OF RATING PRACTICES 388.17 TO CONSUMERS.] 388.18 Subdivision 1. [APPLICATION.] This section applies as 388.19 follows: 388.20 (a) Except as provided in paragraph (b), this section 388.21 applies to any long-term care policy or certificate issued in 388.22 this state on or after January 1, 2002. 388.23 (b) For certificates issued on or after the effective date 388.24 of this section under a policy of group long-term care insurance 388.25 as defined in section 62S.01, subdivision 15, that was in force 388.26 on the effective date of this section, this section applies on 388.27 the policy anniversary following June 30, 2002. 388.28 Subd. 2. [REQUIRED DISCLOSURES.] Other than policies for 388.29 which no applicable premium rate or rate schedule increases can 388.30 be made, insurers shall provide all of the information listed in 388.31 this subdivision to the applicant at the time of application or 388.32 enrollment, unless the method of application does not allow for 388.33 delivery at that time; in this case, an insurer shall provide 388.34 all of the information listed in this subdivision to the 388.35 applicant no later than at the time of delivery of the policy or 388.36 certificate: 389.1 (1) a statement that the policy may be subject to rate 389.2 increases in the future; 389.3 (2) an explanation of potential future premium rate 389.4 revisions and the policyholder's or certificate holder's option 389.5 in the event of a premium rate revision; 389.6 (3) the premium rate or rate schedules applicable to the 389.7 applicant that will be in effect until a request is made for an 389.8 increase; 389.9 (4) a general explanation of applying premium rate or rate 389.10 schedule adjustments that must include: 389.11 (i) a description of when premium rate or rate schedule 389.12 adjustments will be effective, for example the next anniversary 389.13 date or the next billing date; and 389.14 (ii) the right to a revised premium rate or rate schedule 389.15 as provided in clause (3) if the premium rate or rate schedule 389.16 is changed; and 389.17 (5)(i) information regarding each premium rate increase on 389.18 this policy form or similar policy forms over the past ten years 389.19 for this state or any other state that, at a minimum, identifies: 389.20 (A) the policy forms for which premium rates have been 389.21 increased; 389.22 (B) the calendar years when the form was available for 389.23 purchase; and 389.24 (C) the amount or percent of each increase. The percentage 389.25 may be expressed as a percentage of the premium rate prior to 389.26 the increase and may also be expressed as minimum and maximum 389.27 percentages if the rate increase is variable by rating 389.28 characteristics; 389.29 (ii) the insurer may, in a fair manner, provide additional 389.30 explanatory information related to the rate increases; 389.31 (iii) an insurer has the right to exclude from the 389.32 disclosure premium rate increases that apply only to blocks of 389.33 business acquired from other nonaffiliated insurers or the 389.34 long-term care policies acquired from other nonaffiliated 389.35 insurers when those increases occurred prior to the acquisition; 389.36 (iv) if an acquiring insurer files for a rate increase on a 390.1 long-term care policy form acquired from nonaffiliated insurers 390.2 or a block of policy forms acquired from nonaffiliated insurers 390.3 on or before the later of the effective date of this section, or 390.4 the end of a 24-month period following the acquisition of the 390.5 block of policies, the acquiring insurer may exclude that rate 390.6 increase from the disclosure. However, the nonaffiliated 390.7 selling company must include the disclosure of that rate 390.8 increase according to item (i); and 390.9 (v) if the acquiring insurer in item (iv) files for a 390.10 subsequent rate increase, even within the 24-month period, on 390.11 the same policy form acquired from nonaffiliated insurers or 390.12 block of policy forms acquired from nonaffiliated insurers 390.13 referenced in item (iv), the acquiring insurer shall make all 390.14 disclosures required by this subdivision, including disclosure 390.15 of the earlier rate increase referenced in item (iv). 390.16 Subd. 3. [ACKNOWLEDGMENT.] An applicant shall sign an 390.17 acknowledgment at the time of application, unless the method of 390.18 application does not allow for signature at that time, that the 390.19 insurer made the disclosure required under subdivision 2. If, 390.20 due to the method of application, the applicant cannot sign an 390.21 acknowledgment at the time of application, the applicant shall 390.22 sign no later than at the time of delivery of the policy or 390.23 certificate. 390.24 Subd. 4. [FORMS.] An insurer shall use the forms in 390.25 Appendices B and F of the Long-term Care Insurance Model 390.26 Regulation adopted by the National Association of Insurance 390.27 Commissioners to comply with the requirements of subdivisions 1 390.28 and 2. 390.29 Subd. 5. [NOTICE OF INCREASE.] An insurer shall provide 390.30 notice of an upcoming premium rate schedule increase, after the 390.31 increase has been approved by the commissioner, to all 390.32 policyholders or certificate holders, if applicable, at least 45 390.33 days prior to the implementation of the premium rate schedule 390.34 increase by the insurer. The notice must include the 390.35 information required by subdivision 2 when the rate increase is 390.36 implemented. 391.1 [EFFECTIVE DATE.] This section is effective the day 391.2 following final enactment. 391.3 Sec. 10. Minnesota Statutes 2000, section 62S.26, is 391.4 amended to read: 391.5 62S.26 [LOSS RATIO.] 391.6 (a) The minimum loss ratio must be at least 60 percent, 391.7 calculated in a manner which provides for adequate reserving of 391.8 the long-term care insurance risk. In evaluating the expected 391.9 loss ratio, the commissioner shall give consideration to all 391.10 relevant factors, including: 391.11 (1) statistical credibility of incurred claims experience 391.12 and earned premiums; 391.13 (2) the period for which rates are computed to provide 391.14 coverage; 391.15 (3) experienced and projected trends; 391.16 (4) concentration of experience within early policy 391.17 duration; 391.18 (5) expected claim fluctuation; 391.19 (6) experience refunds, adjustments, or dividends; 391.20 (7) renewability features; 391.21 (8) all appropriate expense factors; 391.22 (9) interest; 391.23 (10) experimental nature of the coverage; 391.24 (11) policy reserves; 391.25 (12) mix of business by risk classification; and 391.26 (13) product features such as long elimination periods, 391.27 high deductibles, and high maximum limits. 391.28 (b) This section does not apply to policies or certificates 391.29 that are subject to sections 62S.021, 62S.081, and 62S.265, and 391.30 that comply with those sections. 391.31 [EFFECTIVE DATE.] This section is effective the day 391.32 following final enactment. 391.33 Sec. 11. [62S.265] [PREMIUM RATE SCHEDULE INCREASES.] 391.34 Subdivision 1. [APPLICABILITY.] (a) Except as provided in 391.35 paragraph (b), this section applies to any long-term care policy 391.36 or certificate issued in this state on or after January 1, 2002, 392.1 under this chapter or sections 62A.46 to 62A.56. 392.2 (b) For certificates issued on or after the effective date 392.3 of this section under a group long-term care insurance policy as 392.4 defined in section 62S.01, subdivision 15, issued under this 392.5 chapter, that was in force on the effective date of this 392.6 section, this section applies on the policy anniversary 392.7 following June 30, 2002. 392.8 Subd. 2. [NOTICE.] An insurer shall file a requested 392.9 premium rate schedule increase, including an exceptional 392.10 increase, to the commissioner for prior approval at least 60 392.11 days prior to the notice to the policyholders and shall include: 392.12 (1) all information required by section 62S.081; 392.13 (2) certification by a qualified actuary that: 392.14 (i) if the requested premium rate schedule increase is 392.15 implemented and the underlying assumptions, which reflect 392.16 moderately adverse conditions, are realized, no further premium 392.17 rate schedule increases are anticipated; and 392.18 (ii) the premium rate filing complies with this section; 392.19 (3) an actuarial memorandum justifying the rate schedule 392.20 change request that includes: 392.21 (i) lifetime projections of earned premiums and incurred 392.22 claims based on the filed premium rate schedule increase and the 392.23 method and assumptions used in determining the projected values, 392.24 including reflection of any assumptions that deviate from those 392.25 used for pricing other forms currently available for sale; 392.26 (A) annual values for the five years preceding and the 392.27 three years following the valuation date must be provided 392.28 separately; 392.29 (B) the projections must include the development of the 392.30 lifetime loss ratio, unless the rate increase is an exceptional 392.31 increase; 392.32 (C) the projections must demonstrate compliance with 392.33 subdivision 3; and 392.34 (D) for exceptional increases, the projected experience 392.35 must be limited to the increases in claims expenses attributable 392.36 to the approved reasons for the exceptional increase and, if the 393.1 commissioner determines that offsets to higher claim costs may 393.2 exist, the insurer shall use appropriate net projected 393.3 experience; 393.4 (ii) disclosure of how reserves have been incorporated in 393.5 this rate increase whenever the rate increase will trigger 393.6 contingent benefit upon lapse; 393.7 (iii) disclosure of the analysis performed to determine why 393.8 a rate adjustment is necessary, which pricing assumptions were 393.9 not realized and why, and what other actions taken by the 393.10 company have been relied upon by the actuary; 393.11 (iv) a statement that policy design, underwriting, and 393.12 claims adjudication practices have been taken into 393.13 consideration; and 393.14 (v) if it is necessary to maintain consistent premium rates 393.15 for new certificates and certificates receiving a rate increase, 393.16 the insurer shall file composite rates reflecting projections of 393.17 new certificates; 393.18 (4) a statement that renewal premium rate schedules are not 393.19 greater than new business premium rate schedules except for 393.20 differences attributable to benefits, unless sufficient 393.21 justification is provided to the commissioner; and 393.22 (5) sufficient information for review and approval of the 393.23 premium rate schedule increase by the commissioner. 393.24 Subd. 3. [REQUIREMENTS PERTAINING TO RATE INCREASES.] All 393.25 premium rate schedule increases must be determined according to 393.26 the following requirements: 393.27 (1) exceptional increases must provide that 70 percent of 393.28 the present value of projected additional premiums from the 393.29 exceptional increase will be returned to policyholders in 393.30 benefits; 393.31 (2) premium rate schedule increases must be calculated so 393.32 that the sum of the accumulated value of incurred claims, 393.33 without the inclusion of active life reserves, and the present 393.34 value of future projected incurred claims, without the inclusion 393.35 of active life reserves, will not be less than the sum of the 393.36 following: 394.1 (i) the accumulated value of the initial earned premium 394.2 times 58 percent; 394.3 (ii) 85 percent of the accumulated value of prior premium 394.4 rate schedule increases on an earned basis; 394.5 (iii) the present value of future projected initial earned 394.6 premiums times 58 percent; and 394.7 (iv) 85 percent of the present value of future projected 394.8 premiums not in item (iii) on an earned basis; 394.9 (3) if a policy form has both exceptional and other 394.10 increases, the values in clause (2), items (ii) and (iv), must 394.11 also include 70 percent for exceptional rate increase amounts; 394.12 and 394.13 (4) all present and accumulated values used to determine 394.14 rate increases must use the maximum valuation interest rate for 394.15 contract reserves permitted for valuation of whole life 394.16 insurance policies issued in this state on the same date. The 394.17 actuary shall disclose as part of the actuarial memorandum the 394.18 use of any appropriate averages. 394.19 Subd. 4. [PROJECTIONS.] For each rate increase that is 394.20 implemented, the insurer shall file for approval by the 394.21 commissioner updated projections, as described in subdivision 2, 394.22 clause (3), item (i), annually for the next three years and 394.23 include a comparison of actual results to projected values. The 394.24 commissioner may extend the period to greater than three years 394.25 if actual results are not consistent with projected values from 394.26 prior projections. For group insurance policies that meet the 394.27 conditions in subdivision 11, the projections required by this 394.28 subdivision must be provided to the policyholder in lieu of 394.29 filing with the commissioner. 394.30 Subd. 5. [LIFETIME PROJECTIONS.] If any premium rate in 394.31 the revised premium rate schedule is greater than 200 percent of 394.32 the comparable rate in the initial premium schedule, lifetime 394.33 projections, as described in subdivision 2, clause (3), item 394.34 (i), must be filed for approval by the commissioner every five 394.35 years following the end of the required period in subdivision 394.36 4. For group insurance policies that meet the conditions in 395.1 subdivision 11, the projections required by this subdivision 395.2 must be provided to the policyholder in lieu of filing with the 395.3 commissioner. 395.4 Subd. 6. [EFFECT OF ACTUAL EXPERIENCE.] (a) If the 395.5 commissioner has determined that the actual experience following 395.6 a rate increase does not adequately match the projected 395.7 experience and that the current projections under moderately 395.8 adverse conditions demonstrate that incurred claims will not 395.9 exceed proportions of premiums specified in subdivision 3, the 395.10 commissioner may require the insurer to implement any of the 395.11 following: 395.12 (1) premium rate schedule adjustments; or 395.13 (2) other measures to reduce the difference between the 395.14 projected and actual experience. 395.15 (b) In determining whether the actual experience adequately 395.16 matches the projected experience, consideration must be given to 395.17 subdivision 2, clause (3), item (v), if applicable. 395.18 Subd. 7. [CONTINGENT BENEFIT UPON LAPSE.] If the majority 395.19 of the policies or certificates to which the increase is 395.20 applicable are eligible for the contingent benefit upon lapse, 395.21 the insurer shall file: 395.22 (1) a plan, subject to commissioner approval, for improved 395.23 administration or claims processing designed to eliminate the 395.24 potential for further deterioration of the policy form requiring 395.25 further premium rate schedule increases, or both, or a 395.26 demonstration that appropriate administration and claims 395.27 processing have been implemented or are in effect; otherwise, 395.28 the commissioner may impose the condition in subdivision 8, 395.29 paragraph (b); and 395.30 (2) the original anticipated lifetime loss ratio, and the 395.31 premium rate schedule increase that would have been calculated 395.32 according to subdivision 3 had the greater of the original 395.33 anticipated lifetime loss ratio or 58 percent been used in the 395.34 calculations described in subdivision 3, clause (2), items (i) 395.35 and (iii). 395.36 Subd. 8. [PROJECTED LAPSE RATES.] (a) For a rate increase 396.1 filing that meets the following criteria, the commissioner shall 396.2 review, for all policies included in the filing, the projected 396.3 lapse rates and past lapse rates during the 12 months following 396.4 each increase to determine if significant adverse lapsation has 396.5 occurred or is anticipated: 396.6 (1) the rate increase is not the first rate increase 396.7 requested for the specific policy form or forms; 396.8 (2) the rate increase is not an exceptional increase; and 396.9 (3) the majority of the policies or certificates to which 396.10 the increase is applicable are eligible for the contingent 396.11 benefit upon lapse. 396.12 (b) If significant adverse lapsation has occurred, is 396.13 anticipated in the filing, or is evidenced in the actual results 396.14 as presented in the updated projections provided by the insurer 396.15 following the requested rate increase, the commissioner may 396.16 determine that a rate spiral exists. Following the 396.17 determination that a rate spiral exists, the commissioner may 396.18 require the insurer to offer, without underwriting, to all 396.19 in-force insureds subject to the rate increase, the option to 396.20 replace existing coverage with one or more reasonably comparable 396.21 products being offered by the insurer or its affiliates. The 396.22 offer must: 396.23 (1) be subject to the approval of the commissioner; 396.24 (2) be based upon actuarially sound principles, but not be 396.25 based upon attained age; and 396.26 (3) provide that maximum benefits under any new policy 396.27 accepted by an insured are reduced by comparable benefits 396.28 already paid under the existing policy. 396.29 (c) The insurer shall maintain the experience of all the 396.30 replacement insureds separate from the experience of insureds 396.31 originally issued the policy forms. In the event of a request 396.32 for a rate increase on the policy form, the rate increase must 396.33 be limited to the lesser of the maximum rate increase determined 396.34 based on the combined experience and the maximum rate increase 396.35 determined based only upon the experience of the insureds 396.36 originally issued the form plus ten percent. 397.1 Subd. 9. [PERSISTENT PRACTICE OF INADEQUATE INITIAL 397.2 RATES.] If the commissioner determines that the insurer has 397.3 exhibited a persistent practice of filing inadequate initial 397.4 premium rates for long-term care insurance, the commissioner 397.5 may, in addition to the provisions of subdivision 8, prohibit 397.6 the insurer from either of the following: 397.7 (1) filing and marketing comparable coverage for a period 397.8 of up to five years; or 397.9 (2) offering all other similar coverages and limiting 397.10 marketing of new applications to the products subject to recent 397.11 premium rate schedule increases. 397.12 Subd. 10. [INCIDENTAL LONG-TERM CARE 397.13 BENEFITS.] Subdivisions 1 to 9 do not apply to policies for 397.14 which the long-term care benefits provided by the policy are 397.15 incidental, as defined in section 62S.01, subdivision 17a, if 397.16 the policy complies with all of the following provisions: 397.17 (1) the interest credited internally to determine cash 397.18 value accumulations, including long-term care, if any, are 397.19 guaranteed not to be less than the minimum guaranteed interest 397.20 rate for cash value accumulations without long-term care set 397.21 forth in the policy; 397.22 (2) the portion of the policy that provides insurance 397.23 benefits other than long-term care coverage meets the 397.24 nonforfeiture requirements as applicable in any of the following: 397.25 (i) for life insurance, section 61A.25; 397.26 (ii) for individual deferred annuities, section 61A.245; 397.27 and 397.28 (iii) for variable annuities, section 61A.21; 397.29 (3) the policy meets the disclosure requirements of 397.30 sections 62S.10 and 62S.11 if the policy is governed by chapter 397.31 62S and of section 62A.50 if the policy is governed by sections 397.32 62A.46 to 62A.56; 397.33 (4) the portion of the policy that provides insurance 397.34 benefits other than long-term care coverage meets the 397.35 requirements as applicable in the following: 397.36 (i) policy illustrations to the extent required by state 398.1 law applicable to life insurance; 398.2 (ii) disclosure requirements in state law applicable to 398.3 annuities; and 398.4 (iii) disclosure requirements applicable to variable 398.5 annuities; and 398.6 (5) an actuarial memorandum is filed with the commissioner 398.7 that includes: 398.8 (i) a description of the basis on which the long-term care 398.9 rates were determined; 398.10 (ii) a description of the basis for the reserves; 398.11 (iii) a summary of the type of policy, benefits, 398.12 renewability, general marketing method, and limits on ages of 398.13 issuance; 398.14 (iv) a description and a table of each actuarial assumption 398.15 used. For expenses, an insurer must include percent of premium 398.16 dollars per policy and dollars per unit of benefits, if any; 398.17 (v) a description and a table of the anticipated policy 398.18 reserves and additional reserves to be held in each future year 398.19 for active lives; 398.20 (vi) the estimated average annual premium per policy and 398.21 the average issue age; 398.22 (vii) a statement as to whether underwriting is performed 398.23 at the time of application. The statement must indicate whether 398.24 underwriting is used and, if used, the statement shall include a 398.25 description of the type or types of underwriting used, such as 398.26 medical underwriting or functional assessment underwriting. 398.27 Concerning a group policy, the statement must indicate whether 398.28 the enrollee or any dependent will be underwritten and when 398.29 underwriting occurs; and 398.30 (viii) a description of the effect of the long-term care 398.31 policy provision on the required premiums, nonforfeiture values, 398.32 and reserves on the underlying insurance policy, both for active 398.33 lives and those in long-ter